The Use of Serratus Anterior Fascial Flap in Integrated Mastectomy and Implant Reconstruction

Abstract

Background Tissue reinforcement with acellular dermal matrix (ADM) in implant-based breast reconstruction contributes to the coverage of the implant and avoids its direct exposure to skin incision, yet not without risk of infection. Our integrated technique makes use of the in situ serratus anterior fascia as a support of the implant following mastectomy, which serves the same purpose of ADM in terms of aesthetic outcomes, but minimizes the hazard of infective complications. Methods We retrospectively reviewed all the nipple-sparing mastectomies with direct-to-implant immediate reconstruction in Hong Kong Sanatorium and Hospital from 2012 to 2016. The authors made use of the serratus anterior fascial flap as inferolateral coverage for the subpectoral implant. Consequently, the implant would be completely covered by autologous tissues. Results Among the 51 women included, primary breast cancers account for 91.8% of our indications for these 61 procedures of integrated mastectomy and implant reconstruction. The remaining five (8.2%) were performed as contralateral prophylactic mastectomy. Almost three quarters of the patients had a bra cup size of B or below. After a mean follow-up of 28.9 months, there was no reported post-operative complication of skin flap or nipple-areolar complex necrosis, or infection or extrusion of the implant. Conclusions Our series support that the serratus anterior fascial flap could provide autologous coverage in integrated mastectomy and implant breast reconstruction, especially in small-and medium-sized breasts. Appropriate patient selection, as well as meticulous surgical technique, is critical for its success.

Immediate surgical mesh-free implant-based breast reconstruction with fascial flap in breast cancer patients after mastectomy

“…As showed in our study, the mean initial volume of prostheses was signi cantly smaller in the fascial group as compared with that of the control group. Indeed, most of the studies regarding the fascia-based IBBR technique that had large enough sample size to date were published by researchers from Eastern Asia [7,18,19,21]. Nevertheless, we have found in our practice that patients with proportional breast size to their body size and habitus generally had su cient fascial aps as supplementary prosthetic coverage after mastectomy.…”

Acellular dermal matrix in reconstructive surgery: Applications, benefits, and cost

“…Chest wall defects are frequently caused by tumor herniation and resection (1,2,21,29,30,(81)(82)(83)(84)(85)(86)(87)(88)(89)(90)(91). Defects in the chest wall impair the strong framework that supports breathing and safeguards the viscera (92).…”

Minimally invasive approach to diseases of the breast and contemporary factors affecting breast cancer surgery

“…Pooled specificity was 69% for ultrasound but much was higher, at 93%, for mammogram. Most causes of PND (around 95%), such as papillomas and ductal ectasia, are benign, 6,7 for which ultrasound 5,8,12,63,68 and mammography 5,12,51,60,68 indeed have a high sensitivity and specificity. Therefore, ultrasound and mammography are likely to remain the initial approach in patients with PND.…”

“…6,8,9 These surgical procedures are performed under general anesthesia, are expensive, and are associated with scarring, which may result in breastfeeding difficulties. 68 Additionally, heterogeneity was high within the groups and between different groups. We cannot explain the high heterogeneity because we consider the methodology and patient population of the studies to be very similar, especially in the subgroup analysis.…”

“…In the Netherlands, similar policies were implemented regarding oncologic care. 68 If possible, elective surgical procedures were postponed, and the national screening programs for breast and colorectal cancer were temporarily halted since March 16, 2020 until half August 2020. 69 This is unfavorable since with approximately 40% of new onset breast cancers are detected through the national screening program.…”