Delayed‐immediate hybrid breast reconstruction—Increasing patient input and precision in breast reconstruction

Abstract

The benefits of breast reconstruction via free tissue transfer with simultaneous implant placement, that is, hybrid breast reconstruction, in select patients are well‐known. Challenges exist, however, and are related to proper implant selection as well as postoperative mastectomy skin necrosis. Here, the authors present an approach that increases reconstructive precision while minimizing postoperative mastectomy skin necrosis. A retrospective analysis of patients who underwent immediate prepectoral tissue expander placement (stage 1) followed by delayed‐immediate hybrid breast reconstruction (stage 2) was performed. Parameters of interest included patient demographics, postoperative complications, and revision rates. A total of 31 patients with a mean age of 48.7 years (range, 30‐67 years) and a mean BMI of 26.3 kg/m2 (range, 21.0‐35.3 kg/m2) who underwent bilateral breast reconstruction were included. Of the 62 free abdominal flaps, 45 (72.6%) and 17 (27.4%) were MS‐TRAM and DIEP flaps, respectively. The most common implant volume was 240 cc (range, 140‐445 cc). Following stage 1, minor and major complications were observed in nine (29%) and one (3.2%) patients, respectively. No major complications were noted after stage 2. Of note, no patient developed mastectomy skin necrosis or requested a change in implant size following stage 2. Delayed‐immediate hybrid breast reconstruction improves the ability to more precisely match patient expectations related to breast size and is associated with a reduction in the rate of mastectomy skin necrosis following the critical second stage of reconstruction.

A Comparison of Surgical Complications in Patients Undergoing Delayed versus Staged Tissue-Expander and Free-Flap Breast Reconstruction

“…19 Furthermore, when examining two-stage reconstruction, studies have shown that the majority of complications, such as surgical-site infection, wound healing complications, and reconstructive failure, occurred in the first stage with tissue expander placement. 8,[20][21][22] These findings are thought to be attributable to the placement of the expander or implant in a hypovascular field with a large amount of dead space. 12 In addition, the combination of two separate surgical teams in the first reconstructive stage may contribute to the increased rates of complications seen in the staged cohort.…”

“…The technique used for staged free-flap breast reconstruction was similar to techniques described previously. [6][7][8][9] In patients undergoing prepectoral reconstruction, acellular dermal matrix was used to drape the anterior surface of the expander before securing the device to the chest wall. During partial submuscular placement, a sling of acellular dermal matrix was used to cover the inferior edge of the device.…”

An Assessment of Patient Satisfaction and Decisional Regret in Patients Undergoing Staged Free-Flap Breast Reconstruction

“…At our institution, patients are evaluated for delayed or staged free-flap breast reconstruction if they are expected to undergo postmastectomy radiation therapy, have significant medical comorbidities, are uncertain about their definitive choice for reconstruction, and/or have tenuous skin flaps at the time of mastectomy. The technique used for staged reconstruction is similar to those previously described 3,4,18,19 . In patients undergoing prepectoral reconstruction, acellular dermal matrix (ADM) is draped over the anterior surface of the expander before securing the device to the chest wall.…”

“…The technique used for staged reconstruction is similar to those previously described. 3,4,18,19 In patients undergoing prepectoral reconstruction, acellular dermal matrix (ADM) is draped over the anterior surface of the expander before securing the device to the chest wall. During partial submuscular placement, a sling of ADM is used to cover the inferior edge of the device.…”

Hybridrekonstruktion der Brust nach Mastektomie

“…‚delayed-immediate' Vorgehen. Hierbei wird nach Mastektomie zunächst ein präpektoraler Gewebeexpander eingelegt und erst in einem zweiten Schritt die Hybridrekonstruktion mittels freiem Gewebetransfer vom Abdomen mit gleichzeitiger Implantatplatzierung vorgenommen [39]. Die Einlage eines Gewebeexpanders und Modifizierung der Füllmenge kann eine Reduktion der Rate an Mastektomiehautnekrosen bewirken [40].…”