A simple clinical assessment of breast animation deformity following direct-to-implant breast reconstruction

Dyrberg, Diana L.; Gunnarsson, Gudjon Leifur; Bille, Camilla; Sørensen, Jens Ahm; Thomsen, Jørn Bo

doi:10.5999/aps.2019.00493

Cited by 7 publications

(21 citation statements)

References 22 publications

(39 reference statements)

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“…The sample size is based on our experience using the two different reconstructive techniques and the results of a recent retrospective study. In this study, a significant difference between the degrees of BAD in patients having a directto-implant breast reconstruction using either subpectoral or prepectoral implant placement was shown [15].…”

Section: Discussionmentioning

confidence: 57%

“…The primary outcome measure is the degree of BAD assessed by the NSE scale [15]. Two plastic surgeons will assess the degree of BAD by viewing videos recorded at 12-month follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…The primary outcome of this randomised controlled trial is the degree of BAD, assessed by the NSE scale [15]. The degree of BAD, will be assessed by two plastic surgeons viewing videos recorded at 12-month follow-up.…”

Section: Study Objectivesmentioning

confidence: 99%

“…However, a retrospective cohort study in women over 18 years of age who had a unilateral or bilateral directto-implant breast reconstruction between November 2011 and December 2017 suggested the above sample size assumptions to be too conservative [15]. Therefore, we will conduct an interim analysis with 60% of the patients included (i.e.…”

Section: Sample Sizementioning

confidence: 99%

“…In this study, we compare the degree of BAD in patients having a direct-to-implant breast reconstruction using either subpectoral or prepectoral implant placement. The primary outcome measure of our study is the degree of BAD, assessed by the NSE scale [15]. There are currently other trials ongoing concerning immediate breast reconstruction and prepectoral placement of the implant.…”

Section: Introductionmentioning

confidence: 99%

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Direct-to-Implant Extracellular Matrix Hammock-based Breast Reconstruction; Prepectoral or Subpectoral?

Dyrberg

Gunnarsson

Bille

et al. 2020

Trials

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Background: Skin-sparing mastectomy followed by immediate implant-based breast reconstruction is a commonly used treatment for breast cancer. However, when placing the implant in a subpectoral pocket, a high incidence of breast animation deformity (BAD) has been reported. Besides the nuisance that BAD can cause, lifting of the pectoralis major muscle (PMM) can result in a more extended postoperative recovery period. When placing the implant solely prepectorally leaving the PMM undisturbed, the incidence and severity of BAD might be mitigated. However, new challenges may occur because of thinner skin cover. Methods/design: A prospective, multi-centre, randomised controlled trial will be carried out with the primary aim of assessing and comparing the incidence and degree of BAD in women having a direct-to-implant breast reconstruction with either a prepectorally or a subpectorally placed implant. The secondary outcomes are shoulder and arm function, quality of life, aesthetic evaluation, length of stay, complications, need for surgical corrections, and development of capsular contracture. A total of 70 included patients will be followed under admittance and at clinical check-ups 3 months and 1 year after surgery.Discussion: To our knowledge, this trial is the first randomised controlled trial evaluating and comparing subpectoral and prepectoral implant placement when performing direct-to-implant breast reconstruction following skin-sparing mastectomy. The results will hopefully provide us with a broader knowledge of the outcomes of immediate breast reconstruction, making better preoperative planning possible in the future by providing our patients with a more objective information. Trial registration: ClinicalTrials.gov, ID: NCT03143335. Prospectively registered on 8 May 2017.

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Section: Discussionmentioning

confidence: 57%

“…The primary outcome measure is the degree of BAD assessed by the NSE scale [15]. Two plastic surgeons will assess the degree of BAD by viewing videos recorded at 12-month follow-up.…”

Section: Discussionmentioning

confidence: 99%

Section: Study Objectivesmentioning

confidence: 99%

Section: Sample Sizementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Direct-to-Implant Extracellular Matrix Hammock-based Breast Reconstruction; Prepectoral or Subpectoral?

Dyrberg

Gunnarsson

Bille

et al. 2020

Trials

Self Cite

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Evaluation of Breast Animation Deformity following Pre- and Subpectoral Direct-to-Implant Breast Reconstruction: A Randomized Controlled Trial

et al. 2022

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Background The incidence of breast animation deformity (BAD) is reported to be substantial after direct-to-implant breast reconstruction with subpectoral implant placement. It has, however, never been examined if BAD can occur following prepectoral implant placement. Our primary aim was to compare the incidence and degree of BAD after direct-to-implant breast reconstruction using either subpectoral or prepectoral implant placement. Secondary aim of this study was to assess and compare the level of pain between sub- and prepectoral reconstructed women. Methods In this randomized controlled trial, patients were allocated to reconstruction by either subpectoral or prepectoral implant placement in accordance with the CONSORT guidelines. The degree of BAD was assessed by the “Nipple, Surrounding skin, Entire breast (NSE)” grading scale 12 months after surgery. The level of postoperative pain was assessed on a numerical pain rating scale. Results We found a significant difference in the degree of BAD favoring patients in the prepectoral group (23.8 vs. 100%, p < 0.0001; mean NSE grading scale score: 0.4 vs. 3.6, p < 0.0001). The subpectoral reconstructed group reported higher levels of pain on the three subsequent days after surgery. No significant difference in pain levels could be found at 3 months postoperatively. Conclusion The incidence and degree of BAD was significantly lower in women reconstructed by prepectoral direct-to-implant breast reconstruction. Unexpectedly, we found mild degrees of BAD in the prepectoral group. When assessing BAD, distortion can be challenging to discern from rippling.

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Animation Deformity: Evaluating the Role of Morphotopologic Features in Suggesting Preventive Surgical Procedures

Onishi

Suzuki

Yamakawa

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Animation deformity is an undesirable complication after subpectoral implant reconstruction and is defined as skin distortion during activation of the pectoralis major muscle. However, detailed anatomical features of deformities have yet to be clarified. This study aimed to elucidate how (morphology) and where (topology) animation deformity occurs in reconstructed breasts, and to assess causes and prevention of animation deformity. Methods: This study included 100 consecutive patients with breast cancer, who underwent unilateral subpectoral implant reconstruction. Animation deformity was evaluated, and the patients were grouped according to both morphologic and topologic features. Univariate and multivariate analyses were performed to identify independent factors associated with deformities. Results: The patients were divided into three groups based on skin distortions with or without implant movement: group I, 60 patients with upper-medial dimpling; group II, 41 patients with upper-lateral folding; and group III, 52 patients with mid-lower lines. Overall, 86 patients (86 percent) showed one or more types of deformity. Among the patients with animation deformity, 24 (28 percent) had implant movement. The authors’ study identified axillary dissection as an independent factor for the upper-lateral folding group (OR, 0.30), implant volume for the mid-lower lines group (OR, 1.01), and age for implant movement (OR, 1.06). Conclusions: Animation deformity was commonly observed in the cohort of patients who underwent subpectoral implant reconstruction and exhibited three morphotopologic patterns of deformity. The current study demonstrated that the morphotopologic grouping of animation deformity may assist in suggesting possible causes and preventive surgical procedures for these deformities. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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A simple clinical assessment of breast animation deformity following direct-to-implant breast reconstruction

Cited by 7 publications

References 22 publications

Direct-to-Implant Extracellular Matrix Hammock-based Breast Reconstruction; Prepectoral or Subpectoral?

Direct-to-Implant Extracellular Matrix Hammock-based Breast Reconstruction; Prepectoral or Subpectoral?

Evaluation of Breast Animation Deformity following Pre- and Subpectoral Direct-to-Implant Breast Reconstruction: A Randomized Controlled Trial

Animation Deformity: Evaluating the Role of Morphotopologic Features in Suggesting Preventive Surgical Procedures

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