Skin-Reducing Mastectomy and Direct-to-Implant Breast Reconstruction With Submuscular-Dermal-Mesh Pocket

Abstract

Background Despite skin-sparing mastectomy techniques have significantly improved reconstructive options and aesthetic outcomes, patients with large and ptotic breasts remain a challenging group to treat satisfactorily. The Wise-pattern skin-reducing mastectomy (SRM) has been designed for this kind of patients but is not without morbidity. To improve safety, the authors reviewed their experience with a modified SRM and immediate 1-stage implant-based breast reconstruction, using a synthetic absorbable mesh combined with a dermal flap. Methods A retrospective review was undertaken to identify women with medium to large ptotic breast and medium minimally ptotic breast who had undergone SRM and direct-to-implant breast reconstruction using definitive anatomical gel implant, de-epithelialized dermal flap, and absorbable synthetic mesh, between October 2014 and December 2016. Patient demographics were queried, and complication rates, aesthetic outcomes, and patients satisfaction were assessed. Results Sixty-two procedures of SRM were performed in 56 patients. Forty-five women received contralateral symmetrization. Twenty-one overall complications occurred in 16 patients. Statistical correlation between risk factors and complications onset was assessed. Body mass index resulted the most substantial risk factor (P = 0.0028) for developing complications, whereas preoperative chemotherapy (P = 0.0050) and comorbidities (P = 0.0117) played a decent role. Smoking attitude (P = 0.1122), age (P = 0.9990), and implant weight (P = 0.1583) did not result as significant risk factors. The reconstructive outcomes were good to excellent in 92.8%, with patient satisfaction ranking very to highly satisfied in 84%. Conclusions The authors' series suggests that SRM with direct-to-implant breast reconstruction can be easily performed when an appropriate SRM pattern is designed, providing complete implant coverage with submuscular-dermal-mesh pocket.

Modified Bidirectional Adipodermal Mastopexy, Nipple-sparing Mastectomy, and Direct-to-implant Reconstruction in Patients with Significant Ptosis

“…The literature review identified 25 articles (Table 3), which fell into several reconstructive patterns. Most studies described a discrete, unidirectional, or bidirectional adipodermal flap through which the NAC was supported and repositioned 6,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] and used a Wise or vertical mastopexy pattern for skin retailoring. Other studies did not commit to a unidirectional adipodermal pedicle and kept most attachments intact, [32][33][34][35] which limited the extent of nipple repositioning possible.…”

“…Previous reports described completely incising the medial and lateral vertical limbs with additional extension along both sides of the areola. 23,[26][27][28][29][30][31] Although this facilitates NAC mobility, it results in significant rates of NAC and WPMF necrosis as seen in previous publications. Tissue necrosis at the T junction and along the distal portions of WPMF is a known complication of Wise-pattern mastectomy surgery.…”

Histological evaluation of capsules formed by texturized silicone implants with and without polyester mesh coverage (Parietex®). A study on female rats

“…The reason why the authors chose to use a synthetic mesh in this study is that several papers already reported successful use of this material when associated to silicone implants in human beings [11][12][13][14][15][16][17][18][19][20][21][22][23][24] .…”

“…According to some authors, a capsular contracture with clinical symptoms is related to local inflammatory activity [8][9][10] . Several studies have successfully evaluated the use of meshes during breast reconstruction with implants [11][12][13][14][15][16][17][18][19][20][21][22][23][24] . However, the histological behavior of Parietex Composite® (Covidien, Boulder, United States) associated with silicone implants is not known.…”

Wise-Pattern versus Transverse Pattern Mastectomy in Two-Stage Implant-Based Breast Reconstruction: A Propensity Score-Matched Analysis

“…23 Likewise, in terms of breast shape, size, projection, upper pole fullness, symmetry, and appearance of the scars, satisfaction rates of 84% and 92.6% were reported following reconstruction with the Wise pattern mastectomy from a patient and observer standpoint, respectively, with 95% of patients recommending this incision pattern and indicating they would undergo the procedure again if necessary. 24 Finally, some plastic surgeons may argue that surgical oncologists who feel comfortable with a Wise pattern closure, or even plastic surgeons themselves, can perform this type of mastectomy with minimal complication. In this report, we determined that some surgical oncologists performed a higher proportion of Wise pattern mastectomies during the study period, and some had higher rates of wound-related TE removal.…”