Improving Decision-making in Prepectoral Direct-to-implant Reconstruction After Nipple Sparing Mastectomy: The Key Role of Flap Thickness Ratio

Pagliara, Domenico; Montella, Rino Aldo; Garganese, Giorgia; Bove, Sonia; Costantini, Melania; Pino, Valentina; Grieco, Federica; Rubino, Corrado; Salgarello, Marzia

doi:10.1016/j.clbc.2022.11.007

Cited by 7 publications

(3 citation statements)

References 19 publications

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“…In these cases, skin viability is reduced with a high risk of skin necrosis; likewise, it is more likely to observe a visible implant rippling, making the subpectoral approach a better option. Mastectomy skin flaps thinner than 0.8 cm are, as a matter of fact, associated with a higher risk of ischemic complication, as recently described in the literature [38][39][40]. Despite this, we prefer to use a cut-off of 1 cm to ensure better implant coverage and to address the risk of visible rippling.…”

Section: Discussionmentioning

confidence: 98%

One-Stage Immediate Alloplastic Breast Reconstruction in Large and Ptotic Breasts: An Institutional Algorithm

Rampazzo

Spissu²,

Pinna³

et al. 2023

JCM

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Immediate implant-based breast reconstruction in patients with large and ptotic breasts may be challenging due to skin redundancy. The use of a reduction mammoplasty pattern for the mastectomy skin excision has proven to be a reliable option for these patients as it allows for a better shape, projection, and symmetrization. This approach has been described in the literature for both one- and two-stage reconstruction with either sub- or pre-pectoral reconstruction with an acellular dermal matrix (ADM) or non-biological mesh. One-stage immediate breast reconstructions have a positive significant impact on patients’ psychosocial well-being and quality of life. The purpose of this paper is to describe an institutional algorithm that allows one to perform one-stage implant-based breast reconstructions in patients with large and ptotic breasts.

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Section: Discussionmentioning

confidence: 98%

One-Stage Immediate Alloplastic Breast Reconstruction in Large and Ptotic Breasts: An Institutional Algorithm

Rampazzo

Spissu²,

Pinna³

et al. 2023

JCM

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“…Absolute contraindications are previous radiotherapy, heavy smoking habit, morbid obesity and uncontrolled diabetes, as they are associated with a higher risk of complications [ 31–33 ]. Mastectomy skin flaps must be thicker than 10 mm to minimize the risk of skin necrosis [ 34–36 ] and visible rippling [ 37 ]. Adjuvant tool to assess tissue perfusion is represented by the intraoperative use of the indocyanine green fluorescence [ 38 ]; unfortunately the device was not available in our institution at the time of the surgeries, and this may explain the high rate of skin and NAC necrosis that occurred in our case series.…”

Section: Discussionmentioning

confidence: 99%

Autologous coverage for direct-to-implant pre-pectoral reconstruction in large and ptotic breasts: a new technique

Rubino,

Trignano,

Rodio

et al. 2024

Case Reports in Plastic Surgery and Hand Surgery

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Direct-to-implant (DTI) breast reconstruction after skin reducing mastectomy in large and ptotic breast is characterized by a high rate of complication. The Dermal Sling is commonly used to give extra coverage to the lower pole of the mammary implant to lower the risk of implant exposure in case of wound dehiscence at the T-junction. The aim of the paper is to detail an original technique that combines an inferior dermal sling with pectoral and serratus fascial flaps, to create a pre-pectoral pouch. We retrospectively review the clinical data of the patients who underwent Type IV/V mastectomy and DTI breast reconstruction with the described technique. Minor and major post operative complications were analyzed. Patient satisfaction and aesthetic outcomes were evaluated at one year of follow-up through Breast-Q and Validated Aesthetic Scale. Ten patients (fourteen breasts) were included in the study. Skin and/or NAC necrosis occurred in three breasts. One patient underwent implant removal due to periprosthetic infection. At one of follow-up no capsular contracture nor migration of the implant were clinically detected in all patients. One patient had a visible rippling at the upper quadrants of the new breast. Good patient satisfaction and aesthetic outcomes were reported. The association of fascial flaps and dermal sling is a viable option for breast reconstruction in patients with large and ptotic breasts. Along with providing an autologous coverage for the implant, it allows to maintain a good projection, maximize symmetrization in case of concomitant contralateral reduction mammoplasty and avoid any implant displacement.

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“…14,15 Mastectomy flap thickness and vascularization were fundamental criteria for prepectoral reconstruction, and after confirmation of good perfusion and flap viability, assessment of internal dimensions determined the final implant size. [16][17][18][19][20][21] Achieving a complete fit between the implant and the periprosthetic space was crucial. 22 Implant size considerations aimed to prevent dead space, seroma formation, and complications like rippling, wrinkling, and skin necrosis.…”

Section: Methodsmentioning

confidence: 99%

Prepectoral Breast Reconstruction with Prosthesis and Acellular Dermal Matrix: A New Technique of ADM Implantation and Fixation

Tettamanzi,

Arrica,

Ziani

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Background: Direct-to-implant (DTI) immediate breast reconstruction has proven to be an oncologically safe technique and linked to better overall results. The introduction of new surgical techniques has prompted us to develop an acellular dermal matrix fixation technique that reduces the rate of complications and implant loss. Methods: We retrospectively analyzed data from patients who underwent DTI prepectoral breast reconstruction with two different techniques of acellular dermal matrix fixation to the chest wall. Descriptive statistics were reported using frequencies and percentages for categorical variables, and means and SDs for continuous variables. Pearson chi-square test was used to compare differences in categorical variables. Univariable and multivariable logistic regression models were fitted to investigate the predictors of complications. Results: From October 2019 to March 2023, 90 DTI breast reconstructions were performed, 43 using the standard technique and 47 using the new technique. The new technique demonstrated a significant reduction of major complications (P = 0.010), namely seroma (13.9% versus 2.3%), skin necrosis (9.3% versus 2.3%), implant loss (7% versus 0%), wound dehiscence (9.3% versus 0%), and infection (4.7% versus 0%). Compared with the standard technique, the new one reduced the risk of complications by 76% (OR 0.24; 95% confidence interval 0.09–0.68; P = 0.007) and 73% (aOR 0.27; 95% confidence interval 0.08–0.92; P = 0.037), at univariable and multivariable regression models. No other significant predictor of complications was identified. Conclusions: The procedure performed with the proposed modality proved to be advantageous. Careful fixation of the prosthetic implant and the placement of two drains, were the keys to a drastic reduction in complications.

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Improving Decision-making in Prepectoral Direct-to-implant Reconstruction After Nipple Sparing Mastectomy: The Key Role of Flap Thickness Ratio

Cited by 7 publications

References 19 publications

One-Stage Immediate Alloplastic Breast Reconstruction in Large and Ptotic Breasts: An Institutional Algorithm

One-Stage Immediate Alloplastic Breast Reconstruction in Large and Ptotic Breasts: An Institutional Algorithm

Autologous coverage for direct-to-implant pre-pectoral reconstruction in large and ptotic breasts: a new technique

Prepectoral Breast Reconstruction with Prosthesis and Acellular Dermal Matrix: A New Technique of ADM Implantation and Fixation

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