Experience in dermomyofascial pouch coverage of immediate implants following skin sparing reduction mastectomy

Chang, Lei; Hargreaves, Warren; Segara, Davendra; Moisidis, Elias

doi:10.1111/j.1445-2197.2012.06313.x

Cited by 8 publications

(5 citation statements)

References 4 publications

(4 reference statements)

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“…For DTI, increased operative time may be a marker for increased surgical complexity and the need for further tissue rearrangement or use of ADM to achieve adequate tissue coverage over the implant. Soft tissue coverage is often inadequate at the inferolateral pole and requires the use of ADM [9] or a local tissue rearrangement for implant coverage [26]. This result also emphasises the need for cooperation between the multiple surgical teams that may be involved in this operation.…”

Section: Discussionmentioning

confidence: 98%

Direct-to-implant breast reconstruction: An analysis of 1612 cases from the ACS-NSQIP surgical outcomes database

Wink

Fischer

Nelson

et al. 2014

Journal of Plastic Surgery and Hand Surgery

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There is continued debate about the outcomes of direct-to-implant (DTI) breast reconstruction when compared to a two-stage expander/implant approach. The purpose of this study was to examine outcomes after DTI reconstruction utilising the American College of Surgeons-National Surgical Quality Improvement (ACS-NSQIP) database. This study reviewed the 2005-2010 ACS-NSQIP databases identifying encounters with common procedural terminology codes for DTI (19340) (mastectomy and immediate implant placement). A composite variable of "major surgical complications" (deep infection, return to OR, device loss) was used as the dependent variable in the analysis. Logistic regression analysis was performed to assess for pre- and intraoperative factors associated with the occurrence of "major surgical complications". Overall, 1612 patients underwent one stage, DTI reconstruction with an average age of 50.8 ± 10.7 years with a body mass index (BMI) (kg/m2) of 26.9 ± 6.3 kg/m2. The incidence of major surgical complications was 9%. A multivariate regression analysis revealed obesity (OR = 1.54, p = 0.03), active smoking (OR = 1.60, p = 0.044), and prolonged operative time (>1 SD above average) (OR = 1.88, p = 0.002) were associated with surgical morbidity. The results of the analysis emphasize that DTI-based breast reconstruction can be an excellent option for a specific group of patients. Careful pre-operative patient selection will optimise outcomes, and caution must be used in assessing suitability of DTI in obese patients and active smokers.

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Section: Discussionmentioning

confidence: 98%

Direct-to-implant breast reconstruction: An analysis of 1612 cases from the ACS-NSQIP surgical outcomes database

Wink

Fischer

Nelson

et al. 2014

Journal of Plastic Surgery and Hand Surgery

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“…The primary weakness of the technique is the potential for flap necrosis in the junction of the horizontal and vertical limbs. 10,11,18,20,21,25 Of those studies reporting outcomes in the current literature review, of a total of 954 breast reconstructions using the Wise pattern, there were 38 implant losses (3.98%). Failure was usually blamed on either skin necrosis or infection (Table 1).…”

Section: Discussionmentioning

confidence: 92%

“…Furthermore, the de-epithelialized flap protects the underlying breast implant or dermal matrix from flap necrosis. 10,11,18,20,21,25 Finally, this technique allows for a 1-stage implant breast reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…2,7,16,21,22,24 The presence of the de-epithelialized inferiorly based dermal flap protects the implant quite a bit, allowing some degree of flap loss without subsequent implant exposure. 10,11,18,20,21,25 Depending on the amount of skin loss, the defect can be allowed to heal in secondarily following conservative wound management or be skin grafted.…”

Section: Discussionmentioning

confidence: 99%

“…Most investigators left this portion of the implant in the subcutaneous space without any additional coverage. 5,10,11,13–15,17,20–25,28 Variations have included free nipple-areolar grafting, 25 maintenance of a superiorly based residual disc of skin for future areolar nipple reconstruction, 23 use of a Becker device expander implant, 22 and nipple-sparing mastectomies. 28 Before the use of acellular dermal matrix in breast reconstruction, those groups concerned with the migration of the breast implant included a portion of the de-epithelialized flap placed laterally 12 or use of a portion of the serratus muscle or fascia to inhibit lateral implant migration.…”

Section: Literature Reviewmentioning

confidence: 99%

See 2 more Smart Citations

Wise Pattern Direct Implant Breast Reconstruction: A Review and Improved Outcomes Using Dermal Matrix

Friedman

Talebagha

Gilstrap

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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Background:The inverted T (Wise pattern) mastectomy for patients with macromastia or significant breast ptosis has evolved along with generalized techniques for breast reconstruction. We present a review of Wise pattern breast reconstruction along with our technique for direct to implant reconstruction using dermal matrix.Methods:The literature was reviewed and an analysis of techniques and complications was performed. We present our series of patients incorporating dermal matrix and relatively large implants in direct to implant reconstruction.Results:Of 18 breasts reconstructed only 2 failed. One caused by flap necrosis secondary to smoking and one as a result of preoperative radiation.Conclusion:Wise pattern breast reconstruction using relatively large implants and dermal matrix in direct to implant reconstruction is a safe technique in selected patients with macromastia.

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Biological acellular pericardial mesh regulated tissue integration and remodeling in a rat model of breast prosthetic implantation

et al. 2019

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The use of biological meshes has proven beneficial in surgical restriction and periprosthetic capsular contracture following breast prosthetic‐reconstruction. Three different types (smooth, texturized, and polyurethane) of silicone round mini prostheses were implanted under rat skin with or without two different bovine acellular pericardial biological meshes (APMs, BioRipar, and Tutomesh). One hundred eighty‐six female rats were divided into 12 groups, sacrificed after 3, 6, and 24 weeks and tissue samples investigated by histology and immunohistochemistry. Implantation of both APMs, with or without prostheses, reduced capsular α‐SMA expression and CD3+ inflammatory cell infiltration, increasing capillary density and cell proliferation, with some differences. In particular, Tutomesh was associated with higher peri‐APM CD3+ inflammation, prosthetic capsular dermal α‐SMA expression and less CD31+ vessels and cell proliferation compared with BioRipar. None differences were observed in tissue integration and remodeling following the APM + prostheses implantation; the different prostheses did not influence tissue remodeling. The aim of our study was to investigate if/how the use of different APMs, with peculiar intrinsic characteristics, may influence tissue integration. The structure of APMs critically influenced tissue remodeling after implantation. Further studies are needed to develop new APMs able to optimize tissue integration and neoangiogenesis minimizing periprosthetic inflammation and fibrosis.

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Experience in dermomyofascial pouch coverage of immediate implants following skin sparing reduction mastectomy

Abstract: In our initial experience, SSRM is a safe and effective method of immediate implant-based breast reconstruction.

Cited by 8 publications

References 4 publications

Direct-to-implant breast reconstruction: An analysis of 1612 cases from the ACS-NSQIP surgical outcomes database

Direct-to-implant breast reconstruction: An analysis of 1612 cases from the ACS-NSQIP surgical outcomes database

Wise Pattern Direct Implant Breast Reconstruction: A Review and Improved Outcomes Using Dermal Matrix

Biological acellular pericardial mesh regulated tissue integration and remodeling in a rat model of breast prosthetic implantation

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