Direct-to-implant Breast Reconstruction with Autoderm

McFadden, Eoin; Lopez-Obregon, Beatriz; Stone, Jill P.; Webb, Carmen; Temple‐Oberle, Claire

doi:10.1097/gox.0000000000002027

Cited by 7 publications

(7 citation statements)

References 17 publications

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“…The elliptical excision resulting in a transverse scar has been criticized for poor aesthetic outcome involving flattening of the breast apex, and residual medial and lateral dogears, particularly in larger breasted patients. 12 , 23 Subjectively, the bell pattern creates a more rounded breast shape. This is thought to be due to the curvature allowing for continuously changing tension vectors rather than a single tension vector, akin to Z-plasty.…”

Section: Discussionmentioning

confidence: 99%

“…17–25 When compared to an ellipse, the Wise pattern produces a more projecting breast shape and allows management of horizontal skin excess. 23 However, as is widely reported, 6 , 21 , 22 , 26 this technique is particularly susceptible to flap ischemia, skin necrosis, and implant failure ( Figure 1 ). Although not often discussed, the pattern is difficult to adjust to preoperative breast scars and intraoperative flap ischemia.…”

mentioning

confidence: 89%

“…When utilizing a dermal flap, extensive de-epithelialization requires additional operative time and increases risk for epidermal inclusion cysts. 23 …”

mentioning

confidence: 99%

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The Bell Pattern: A Novel Breast Incision Approach to Skin-Reducing Mastectomies

Albright¹,

Hawkes²

2019

Aesthetic Surgery Journal Open Forum

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Background As immediate direct to permanent implant-based breast reconstruction (IBBR) continues to gain in popularity, surgeons seek to apply these techniques to patients with large or ptotic breasts. A new bell pattern skin excision is described and limits major complications in this high-risk population. Objective The authors describe a novel skin excision pattern for patients with large or ptotic breasts who desire IBBR and assess its safety. The authors also evaluated the ability of the pattern to account for intraoperative developments. Methods This retrospective analysis of a single surgeon’s experience included 17 consecutive patients (31 breasts) with large or ptotic breasts undergoing skin-reducing mastectomy with attempted utilization of the bell pattern approach and IBBR with acellular dermal matrix. Results Mean age was 50 years, mean body mass index was 27.4 kg/m2, and mean breast specimen weight was 683g. A bell pattern excision was planned for all breasts preoperatively. Three breasts (10%) required an alternative closure pattern due to intraoperative ischemia (n=1), or additional oncologic resection (n=2). The pattern successfully accommodated flap ischemia in 8 (26%) other breasts. After a median follow up of 5.1 months, the number of bell pattern breasts with major and minor complications was 0 (0%) and 9 (32%), respectively. The most common minor complication was seroma (n=5, 18%), and minor incision wound (n=3, 11%). There were no reconstruction failures utilizing the bell pattern. Conclusion The bell pattern approach is a safe and adaptable alternative to traditional skin-reducing mastectomy in patients with large or ptotic breasts.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 89%

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The Bell Pattern: A Novel Breast Incision Approach to Skin-Reducing Mastectomies

Albright¹,

Hawkes²

2019

Aesthetic Surgery Journal Open Forum

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“…Differences between groups were determined using a t test for continuous variables and chi-square test or Fisher exact test for categorical variables. Statistical analysis was performed using online software (available at http://www.socscistatistics.com) as described by McFadden et al 28 A value of P < 0.05 was considered significant.…”

Section: Methodsmentioning

confidence: 99%

“Surgical Timing and Neurocognitive Development Among Patients with Craniosynostosis: Analysis of Confounding Variables and Selection Bias.”

Lynn

Buchman

Breuler

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Background: In 1988, Renier and Marchac asserted that children with craniosynostosis who undergo cranial vault remodeling (CVR) after 12 months of age experience delayed neurocognitive development compared to children who undergo CVR before 12 months of age. The purpose of this study was to identify factors potentially confounding this cause-and-effect relationship. The authors hypothesize that children with socioeconomic disadvantages or comorbid conditions are more likely to undergo CVR after 12 months and may represent a selection bias toward delayed neurocognitive development. Methods: Patients with nonsyndromic single-suture craniosynostosis who underwent CVR between 2009 and 2020 at Michigan Medicine were included (n = 227). Sociodemographic and clinical variables were documented. The sample was dichotomized to compare patients who underwent CVR before (early) and after (late) 12 months of age. Statistical analysis was performed at P < 0.05 significance. Results: The early and late groups contained 157 patients and 70 patients, respectively. Compared to the early group, the late group contained a larger proportion of patients who identified as non-White (P = 0.03), qualified for need-based financial assistance (P = 0.03), were born preterm (P < 0.01), or had a comorbid condition (P < 0.01). Based on preoperative testing, the late group contained a larger proportion of patients with baseline cognitive (P < 0.001) and language (P = 0.008) delays relative to the early group. Conclusions: This study demonstrates that socioeconomic disadvantages and comorbid conditions are prevalent among patients who undergo delayed CVR and may represent a selection bias toward delayed neurocognitive development. Future studies evaluating the relationship between surgical timing and neurocognitive development must control for these factors. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

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“…Patient-reported outcomes literature suggests that the dermal flap technique provides superior outcomes 10 . Literature on the rates of complications associated with this method deems it favorable overall 7 .…”

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confidence: 99%

Safety of Breast Reconstruction Using Inferiorly Based Dermal Flap for the Ptotic Breast

et al. 2022

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Introduction The use of an inferiorly based dermal flap (IBDF) with implant insertion allows for 1-step reconstruction of a ptotic breast after mastectomy. An IBDF allows for secondary protection of the inferior pole and provides a vascularized pocket for implant insertion. Previous literature has demonstrated the use of this surgical approach for optimal patient satisfaction and higher patient-reported outcomes. For this approach, the dermal flap epidermis is removed before insetting; however, invaginations containing epithelial components may serve as a nidus for infection. There is no study that has compared the safety of an IBDF technique to standard reconstruction. We hypothesize that there is no increase in surgical complications in the IBDF approach versus standard reconstruction. Methods This is a single-institution retrospective chart review of all patients who underwent implant-based reconstruction from June 2016 through December 2020. Patients who did not have a permanent implant placed by December 2020 or had delayed reconstruction were excluded. Two cohorts were established: those who underwent immediate reconstruction after mastectomy via IBDF and reconstruction without an IBDF. Patient demographics, use of the IBDF technique, and surgical complications were recorded and compared. Results A total of 208 breasts were included: 52 breasts in the IBDF cohort and 156 breasts in the control cohort. There were no statistically significant differences between cohorts, except that the IBDF cohort has a significantly higher body mass index (mean = 30.9 vs 26.5, P ≤ .001). There was no statistically significant difference in the rate of complications between the IBDF and control groups, including seroma (5.8% vs 3.8%), hematoma (3.8% vs 0.6%), wound dehiscence (0.0% vs. 1.9%), mastectomy flap necrosis (11.5% vs 6.4%), breast infection (5.8% vs 7.1%), implant salvage (0.0% vs 5.8%), and implant loss (5.8% vs. 5.8%), respectively. Conclusions Using an IBDF to reconstruct a ptotic breast immediately after mastectomy has a similar risk profile to an immediate standard breast reconstruction. This technique has resulted in optimal patient satisfaction scores and allows for a “one-stop reconstruction” of ptotic breasts that normally would undergo sequential revisions. In conclusion, immediate implant-based reconstruction of a ptotic breast after mastectomy using a IBDF can be performed safely.

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Direct-to-implant Breast Reconstruction with Autoderm

Cited by 7 publications

References 17 publications

The Bell Pattern: A Novel Breast Incision Approach to Skin-Reducing Mastectomies

The Bell Pattern: A Novel Breast Incision Approach to Skin-Reducing Mastectomies

“Surgical Timing and Neurocognitive Development Among Patients with Craniosynostosis: Analysis of Confounding Variables and Selection Bias.”

Safety of Breast Reconstruction Using Inferiorly Based Dermal Flap for the Ptotic Breast

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