Skin-Reducing Mastectomy and Pre-pectoral Breast Reconstruction in Large Ptotic Breasts

Maruccia, Michele; Gurrado, Angela; Moschetta, Marco; Nacchiero, Eleonora; Bolletta, Alberto; Testini, Mario; Giudice, Giuseppe

doi:10.1007/s00266-020-01616-2

Cited by 41 publications

(39 citation statements)

References 33 publications

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“…For example, core temperature of patients and environment temperature were not measured when performing ICG angiography, but these temperatures could affect peripheral circulation and measurements of ICG angiography. Breast measurements such as sternal notch to nipple distance and degree of ptosis could also be associated with NAC necrosis because NAC perfusion after NSM is dependent only on the skin flap perfusion and a greater distance from the chest wall to the nipple could increase NAC necrosis (28)(29)(30). According to the result of this study, sternal notch to nipple distance was not a significant predictor for NAC necrosis.…”

Section: Discussionmentioning

confidence: 67%

Pure hemi-periareolar incision versus conventional lateral radial incision mastectomy and direct-to-implant breast reconstructions: comparison of indocyanine green angiographic perfusion and necrosis of the nipple

et al. 2020

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Background: This study evaluated the feasibility of direct-to-implant breast reconstruction after nipplesparing mastectomy using pure hemi-periareolar incision without extension and with the aid of indocyanine green angiographic evaluation on the mastectomy skin flap.Methods: Patients who underwent immediate direct-to-implant breast reconstruction from December 2018 to February 2020 were included. After nipple-sparing mastectomy, indocyanine green angiographic evaluation of perfusion to nipple-areola complex was performed by video recording with a near infrared camera, and nipple perfusion time and perfusion pattern were analyzed. Patients were divided into a pure hemi-periareolar incision group and conventional lateral radial incision groups to compare nipple perfusion and surgical outcomes.Results: A total of 61 breasts in 56 patients were included. Pure hemi-periareolar incision was used in 41 breasts, and conventional lateral radial incisions were used in 20 breasts. Nipple perfusion time was significantly increased in the pure hemi-periareolar incision group (79.6±65.8 vs. 43.2±49.8 seconds, P=0.031). While minor nipple-areola complex necrosis was significantly increased in the pure hemiperiareolar incision group (19.5% versus 0%; P=0.044), major nipple-areola complex necrosis (2.4% versus 5.0%; P>0.999) was not significantly different between the two groups. The rates of nipple-areola complex necrosis were 0%, 16.7%, and 63.6% in rapid, delayed, and no perfusion groups, respectively (P<0.001). No nipple perfusion pattern was a significant predictor for nipple-areola complex necrosis in univariable and multivariable analyses (P<0.001). There was no case of reconstruction failure.Conclusions: Immediate direct-to-implant breast reconstruction after nipple-sparing mastectomy using pure hemi-periareolar incision can be safely performed using indocyanine green angiographic evaluation on the mastectomy skin flap.

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Section: Discussionmentioning

confidence: 67%

Pure hemi-periareolar incision versus conventional lateral radial incision mastectomy and direct-to-implant breast reconstructions: comparison of indocyanine green angiographic perfusion and necrosis of the nipple

et al. 2020

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“… 61 , 66 Hereby, a stable position of the fully covered implant is achieved, and additionally pressure is taken off of the skin flaps. 67 , 68 …”

Section: Discussionmentioning

confidence: 99%

Quality of Life After Bilateral Risk-Reducing Mastectomy and Simultaneous Reconstruction Using Pre-Pectoral Silicone Implants

Spindler¹,

Ebel²,

Briest³

et al. 2021

PPA

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Purpose Bilateral risk-reducing mastectomy (BRRM) can reduce the risk of developing breast cancer by up to 95% in women with increased exposure. Although survival is increased, mastectomies can adversely affect a patient physically, psychologically, and psychosexually. High health-related quality of life (HRQoL) is often achieved after simultaneous breast reconstruction (BR) following BRRM; however, data on the pre- and postoperative results of HRQoL are lacking. Therefore, we investigated the quality of life, esthetic outcome, and patient well-being after BRRM and simultaneous implant-based BR. Patients and Methods Of the 35 patients who underwent skin-sparing or nipple-sparing mastectomy between May 2012 and December 2017 at a university hospital, only 22 completed the evaluation. Baseline data and data on previous operations and operation techniques were retrieved from the patient’s charts. BREAST-Q and short form-36 health survey (SF-36) questionnaires were used to evaluate patient satisfaction and HRQoL. Results SF-36 analysis showed a significantly higher score for pain (p=0.043) in our population than in the general female population. Comparing the pre- and postoperative BREAST-Q results, a significant decrease in the physical well-being of the chest (p=0.0179) and a slight improvement in breast satisfaction were observed (p=0.3266). All patients were well-satisfied with the postoperative outcome, reconstruction, and perioperative surgeon care. Conclusion Bilateral mastectomy with simultaneous BR using pre-pectoral implants is associated with an HRQoL similar to that of the healthy population. Although bilateral mastectomy may have an immense effect on the psychological, physical, and social aspects, immediate BR preserves the outer appearance and improves self-esteem.

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“…A Wise pattern nipple-sparing skin reducing mastectomy with deepithelialisation of an inferior adipo-dermal flap was the chosen technique for Group B patients (Figure 2). PPBR was then performed covering the implant with the ADM and the inferior dermal sling, as previously described by the authors (16,17).…”

Section: Operative Techniquementioning

confidence: 99%

“…In both groups an intraoperative frozen examination of the retroareolar tissue was performed before completing the procedure. Further, intraoperative evaluation of flaps perfusion was assessed using indocyanine green dye laser-induced fluorescence imaging as an adjunctive tool (16). If perfusion of the mastectomy skin flaps was inadequate, an under-filled expander was inserted in a submuscular pocket and patients were excluded from this study.…”

Section: Operative Techniquementioning

confidence: 99%

“…In this group of patients, we have combined nipple-sparing mastectomy with prepectoral implantation and full ADM coverage with inferior adipo-dermal flap. The de-epithelialized dermal flap presumably obviates wound complications by protecting the underlying implant-ADM and improving the reliability of the reconstruction (16). Patients with longer hospitalization belong to this group, as they may require mastectomy flaps' and NAC monitoring.…”

Section: Breast Cancer Represents the Most Common Tumour Amongmentioning

confidence: 99%

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Prepectoral breast reconstruction: an ideal approach to bilateral risk-reducing mastectomy

Maruccia¹,

Tedeschi²,

Gurrado³

et al. 2021

Gland Surg

Self Cite

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Background: Bilateral risk-reducing mastectomy (BRRM) has increased its popularity in the last years because of its aim to minimise the chances of developing breast cancer in high-risk patients. Women undergoing this procedure must be considered highly demanding patients given the need to combine aesthetical, functional and preventive desires. This study aims to present the authors' experience in performing BRRM followed by single-stage prepectoral reconstruction (PPBR) with implant completely covered by acellular dermal matrix (ADM) and to report indications, surgical techniques, functional and aesthetic results.Methods: A single-centre prospective data collection was carried out from January 2017 to January 2021 of patients at high risk of developing breast cancer undergoing BRRM and immediate PPBR with ADM. Patients were subdivided into two groups according to the breast shape: Group A had small and medium size breasts and Group B had large and ptotic breasts. Oncological and surgical outcomes were collected. Satisfaction with reconstruction and related quality of life were evaluated through the BREAST-Q questionnaire.Results: A total of twenty-three patients met the inclusion criteria. Seventeen patients were included in group A and six patients in group B. Average follow-up was 18.4 months. Minor complications occurred in four breasts: one seroma, one hematoma and two cases of wound dehiscence. Capsular contracture was not observed. All patients were satisfied with the final result according to the post-operative BREAST-Q questionnaire.Conclusions: Immediate prepectoral breast reconstruction could represent the ideal reconstruction option after BRRM and should be offered to all women that fulfil the inclusion criteria.

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Skin-Reducing Mastectomy and Pre-pectoral Breast Reconstruction in Large Ptotic Breasts

Cited by 41 publications

References 33 publications

Pure hemi-periareolar incision versus conventional lateral radial incision mastectomy and direct-to-implant breast reconstructions: comparison of indocyanine green angiographic perfusion and necrosis of the nipple

Pure hemi-periareolar incision versus conventional lateral radial incision mastectomy and direct-to-implant breast reconstructions: comparison of indocyanine green angiographic perfusion and necrosis of the nipple

Quality of Life After Bilateral Risk-Reducing Mastectomy and Simultaneous Reconstruction Using Pre-Pectoral Silicone Implants

Prepectoral breast reconstruction: an ideal approach to bilateral risk-reducing mastectomy

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