Breast Reconstruction Following Mastectomy

Gruber, Ronald P.; Kahn, Richard; Lash, Harvey; Maser, Morton R.; Apfelberg, David B.; Laub, Donald R.

doi:10.1097/00006534-198103000-00007

Cited by 169 publications

(45 citation statements)

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“…These led to a submuscular approach where the implants were completely covered by the pectoralis major and serratus anterior muscles using a prepectoral approach. Gruber et al reported a comparison of submuscular and subcutaneous techniques for breast reconstruc-tion following mastectomy [3] and concluded that submuscular implants are clearly superior to subcutaneous ones and that the subserratus techniques provided the lowest incidence of capsular contracture. Augmentation case studies have also concluded that the subpectoral approach is superior, especially in regard to capsular contracture [4,5].…”

Section: Historymentioning

confidence: 99%

Prepectoral breast reconstruction

Kim

2019

Yeungnam Univ J Med

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Implant-based breast reconstruction is the most commonly used reconstruction technique after mastectomy. This is because skin-sparing mastectomy has become possible with advancements in oncology. In addition, the development of breast implants and the advent of acellular dermal matrices have reduced postoperative complications and resulted in superior cosmetic results. The most frequently performed surgical breast reconstruction procedure for the past 20 years was the insertion of an implant under the pectoralis major muscle by means of the dual plane approach. However, some patients suffered from pain and animation deformity caused by muscle manipulation. Recently, a prepectoral approach has been used to solve the above problems in select patients, and the results are similar to subpectoral results. However, this technique is not always chosen due to the number of considerations for successful surgery. In this article, we will discuss the emergence of prepectoral breast reconstruction, indications and contraindications, surgical procedures, and outcomes.

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Section: Historymentioning

confidence: 99%

Prepectoral breast reconstruction

Kim

2019

Yeungnam Univ J Med

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“…Prepectoral breast reconstruction has become increasingly described in the literature over the last several years. This represents a near full-circle journey from prosthesis placement in the “subcutaneous” plane, 1 , 2 to total submuscular coverage, 2 dual-plane approaches, 3 , 4 and now muscle-sparing techniques. 5 , 6 Critical differences in today’s procedures include refined mastectomy techniques to minimize any residual breast tissue while preserving the subcutaneous tissue and superficial perfusion, 7 as well as newer-generation prosthetic devices and adjunctive tools such as acellular dermal matrix (ADM).…”

Section: Introductionmentioning

confidence: 99%

Do We Need Support in Prepectoral Breast Reconstruction? Comparing Outcomes with and without ADM

Salibian

Bekisz

Kussie

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Background: The majority of two-stage prepectoral breast reconstruction has been described utilizing acellular dermal matrix (ADM). Although reports of prepectoral breast reconstruction without ADM exist, there is a paucity of comparative studies. Methods: A single-institution retrospective review was performed of consecutive patients undergoing immediate prepectoral two-stage breast reconstruction with tissue expanders from 2017 to 2019. Short-term reconstructive and aesthetic complications were compared between cases that utilized ADM for support and those that did not. Results: In total, 76 cases (51 patients) were identified, of which 35 cases utilized ADM and 41 did not. Risk factors and demographics were similar between the two cohorts with the exception of body mass index, which was higher in the ADM cohort (29.3 versus 25.4, P = 0.011). Average follow-up length was also longer in patients who received ADM (20.3 versus 12.3 months, P < 0.001). Intraoperative expander fill was higher in patients who did not receive ADM (296.8 cm3 versus 151.4 cm3, P < 0.001) though final implant size was comparable in both cohorts (P = 0.584). There was no significant difference in the rate of any complication between the ADM and no ADM cohorts (25.7% versus 17.1%, respectively P = 0.357), including major mastectomy flap necrosis (P = 0.245), major infection (P = 1.000), seroma (P = 0.620), expander explantation (P = 1.000), capsular contracture (P = 1.000), implant dystopia (P = 1.000), and rippling (P = 0.362). Conclusions: Immediate two-stage prepectoral breast reconstruction with tissue expanders has comparable rates of short-term complications with or without ADM support. Safety of prepectoral expander placement without ADM may warrant more selective ADM use in these cases.

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“…When correctly indicated, conservative mastectomies (nipple sparing or skin sparing) and implant-based breast reconstruction (IBR) are safe procedures from an oncological viewpoint with satisfying aesthetic outcomes that have changed perspectives and possibilities of breast reconstruction [1]. For decades, plastic surgery writing has been dominated by the so-called two-stage reconstruction, which consists in the placement of a tissue expander in the sub-muscular space and the following replacement with a definitive implant [2].…”

Section: Introductionmentioning

confidence: 99%

Dual-Plane Retro-pectoral Versus Pre-pectoral DTI Breast Reconstruction: An Italian Multicenter Experience

et al. 2020

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Background The use of conservative mastectomies has risen significantly during the last few years. The reconstructive choice of direct-to-implant reconstruction has become more practicable with modern mastectomy techniques. The initial trend in Italian centers was to use dualplane hybrid reconstruction. However, a high level of complications has been registered. From 2015 onward, in our centers, a pre-pectoral approach has been adopted. The authors sought to describe the Italian trend to gradually discard the sub-pectoral technique with lower lateral pole coverage of the prosthesis using ADMs comparing it with the pre-pectoral approach with ADMs, without any muscle dissection, in terms of complication rates. Materials and Methods A multicenter retrospective clinical study was performed from January 2010 to June 2018. The enrolled patients were divided into two groups: Cases with an ADM-only coverage pre-pectoral reconstruction made up the first group (Group 1). Those with the retropectoral muscular position ? ADM implant coverage comprised the second one (Group 2). Complications such as seroma, hematoma, wound dehiscence, surgical site infection, reconstruction failure, animation deformity and capsular contracture were recorded. Results We performed 716 direct-to-implant reconstructions: 509 were partially sub-pectoral and 207 were prepectoral. Minimum follow-up was 1 year. Incidence of complications was higher in dual-plane reconstructions. There were statistical significant differences in the rates of seroma and hematoma. Conclusion Using the pre-pectoral approach, the authors have experienced favorable aesthetics and superior clinical and functional outcomes. Retro-pectoral muscular ADM implant coverage has to be considered only in specific complicated second-stage surgeries.

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Breast Reconstruction Following Mastectomy

Cited by 169 publications

References 0 publications

Prepectoral breast reconstruction

Prepectoral breast reconstruction

Do We Need Support in Prepectoral Breast Reconstruction? Comparing Outcomes with and without ADM

Dual-Plane Retro-pectoral Versus Pre-pectoral DTI Breast Reconstruction: An Italian Multicenter Experience

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