Breast Reconstruction Utilizing Subcutaneous Tissue Expansion Followed by Polyurethane-Covered Silicone Implants

Artz, J. Sheldon; Dinner, Melvyn I.; Foglietti, Mark A.; Sampliner, James E.

doi:10.1097/00006534-199110000-00013

Cited by 8 publications

(7 citation statements)

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“…Postoperative pain scores were reported for the question: "What is the severity of your pain at its worst?" Patients could respond with none (0), mild (1), moderate (2), severe (3), or very severe (4). Complication data for each patient were recorded for the 90-day postoperative period and included mastectomy skin flap necrosis, nipple necrosis, breast hematoma, breast seroma, breast cellulitis (superficial), deep tissue expander infection, exposed tissue expander, leaking/ruptured tissue expander, tissue expander removal, and readmission within 90 days.…”

Section: Outcomes Of Interestmentioning

confidence: 99%

Prepectoral and Subpectoral Tissue Expander–Based Breast Reconstruction: A Propensity-Matched Analysis of 90-Day Clinical and Health-Related Quality-of-Life Outcomes

Nelson

Shamsunder

Vorstenbosch

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Prepectoral placement of tissue expanders for two-stage implant-based breast reconstruction potentially minimizes chest wall morbidity and postoperative pain. The authors explored 90-day clinical and health-related quality-of-life outcomes for prepectoral versus subpectoral tissue expander breast reconstruction. Methods: The authors conducted a propensity score-matching analysis (nearest neighbor, 1:1 matching without replacement) of patients who underwent immediate prepectoral or subpectoral tissue expander breast reconstruction between December of 2017 and January of 2019. Matched covariates included age, body mass index, race/ethnicity, smoking status, chemotherapy, radiotherapy, nipple-sparing mastectomy, and laterality of reconstruction. Outcomes of interest were perioperative analgesia use, 90-day postoperative patient-reported pain, complication rates, and BREAST-Q physical well-being of the chest scores. Results: Of the initial cohort of 921 patients, 238 were propensity-matched and included in the final analysis. The matched cohort had no differences in baseline characteristics. Postoperative ketorolac (p = 0.048) use was higher in the subpectoral group; there were no other significant differences in intraoperative and postoperative analgesia use. Prepectoral patients had lower pain on postoperative days 1 to 2 but no differences on days 3 to 10. BREAST-Q physical well-being of the chest scores did not differ. Prepectoral patients had higher rates of seroma than subpectoral patients (p < 0.001). Rates of tissue expander loss did not differ. Conclusions: This matched analysis of 90-day complications found lower early postoperative pain in prepectoral tissue expander patients but no longer-term patient-reported differences. Although prepectoral reconstruction patients experienced a higher rate of seroma, this did not translate to a difference in tissue expander loss. Long-term analysis of clinical and patient-reported outcomes is needed to understand the full profile of the prepectoral technique. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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Section: Outcomes Of Interestmentioning

confidence: 99%

Prepectoral and Subpectoral Tissue Expander–Based Breast Reconstruction: A Propensity-Matched Analysis of 90-Day Clinical and Health-Related Quality-of-Life Outcomes

Nelson

Shamsunder

Vorstenbosch

et al. 2022

Plastic &Amp; Reconstructive Surgery

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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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“…In the early years following the advent of prosthetic-based breast reconstruction in the 1960s, implants were most commonly placed in the prepectoral or “subcutaneous” plane. 1–3 At a time when pectoralis muscle sacrifice in radical mastectomy was more common and the tissue expander had yet to be invented, this technique became the widely accepted standard. 4,5 Over time, understanding of the possible complications associated with prepectoral breast reconstruction evolved, as high rates of capsular contracture and implant exposure necessitating explantation were observed in early cohort studies.…”

mentioning

confidence: 99%

“…4,5 Over time, understanding of the possible complications associated with prepectoral breast reconstruction evolved, as high rates of capsular contracture and implant exposure necessitating explantation were observed in early cohort studies. 2,3,6 This led to a practice shift in which total submuscular coverage with pectoralis major muscle and serratus anterior fascia grew in popularity and gained favor as the safer, more reliable reconstructive technique. 2,7 Although lauded for providing enhanced soft-tissue coverage of the breast prosthesis, the submuscular plane proved to have its own drawbacks.…”

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confidence: 99%

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Picking the Right Plane: A Comparison of Total Submuscular, Dual-Plane, and Prepectoral Implant-based Breast Reconstruction

Bekisz

Salibian

Frey

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Implant-based breast reconstruction has evolved, with a recent resurgence of prepectoral techniques. Comparative reconstructive outcomes and complications have not been elucidated fully among the total submuscular, dual-plane, and prepectoral planes of implant placement. Methods: All immediate implant-based breast reconstructions from March of 2017 through August of 2019 were reviewed retrospectively. Cases were divided into total submuscular, dual-plane, and prepectoral cohorts. Demographics, operative techniques, and reconstructive outcomes and complications were compared among groups. Results: A total of 826 cases (510 patients) were identified and divided into total submuscular (n = 392), dual-plane (n = 358), and prepectoral (n = 76) cohorts. Average follow-up for all patients was 27 months. The prepectoral cohort had a higher average body mass index and rate of previous reduction or mastopexy. Overall complications were lowest in the total submuscular group, although this difference was not statistically significant. Major infection occurred more frequently in the dual-plane group compared with the total submuscular cohort. The prepectoral cohort had a significantly increased incidence of wound dehiscence than the total submuscular group; both the dual-plane and prepectoral groups had higher rates of seroma formation and explantation compared with the total submuscular group. Conclusions: Overall reconstructive complication rates were comparable among the cohorts. Compared with those undergoing total submuscular reconstruction, the dual-plane cohort was more likely to develop a major infection or require explantation, whereas the prepectoral group had significantly higher rates of isolated dehiscence, seroma formation, and explantation. This suggests that the absence of overlying vascularized muscle may lead to an inherent inability to tolerate wound-healing complications, although further research is needed to clarify these observations. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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Breast Reconstruction Utilizing Subcutaneous Tissue Expansion Followed by Polyurethane-Covered Silicone Implants

Cited by 8 publications

References 0 publications

Prepectoral and Subpectoral Tissue Expander–Based Breast Reconstruction: A Propensity-Matched Analysis of 90-Day Clinical and Health-Related Quality-of-Life Outcomes

Prepectoral and Subpectoral Tissue Expander–Based Breast Reconstruction: A Propensity-Matched Analysis of 90-Day Clinical and Health-Related Quality-of-Life Outcomes

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

Picking the Right Plane: A Comparison of Total Submuscular, Dual-Plane, and Prepectoral Implant-based Breast Reconstruction

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