Optimizing Patient Selection for Direct-to-Implant Immediate Breast Reconstruction Using Wise-Pattern Skin-Reducing Mastectomy in Large and Ptotic Breasts

Abstract

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Subcutaneous Prosthetic Breast Reconstructions following Skin Reduction Mastectomy

“…Immediate reconstruction of large breasts following Wise pattern skin reduction has been associated with high complication rates. 6,8,10 As frequently stated in the literature, obesity and smoking are the main factors contributing to high complications rates in this patient population. 11,12 In fact, for every point increase in BMI, the odds of complications increase by 5.9% and reconstructive failure by 7.9%.…”

“…In a study examining 59 immediate prosthetic-based reconstructions following Wise pattern skin reduction, mastectomy specimens with weight exceeding 700 g resulted in complication rates of 53%, which was in distinct contrast to breast specimens below 700 g associated with complication rate of 14.3%. 6 The authors calculated that for every 100 g increase in the weight of mastectomy specimen, the risk of major complications raises by 1.18-fold. 6 The results of our investigation corroborate the previously published outcomes.…”

“…Wise-pattern skin reduction has been employed in immediate implant-based breast reconstruction offering reshaping of the large breast skin envelope. 6 The original technique of immediate breast reconstruction following skin reduction mastectomy was associated with a substantial risk of implant exposure at the inframammary fold. The reason for this complication stemmed from the fact that the inferior portion of the implant was located directly under the inverted “T” incision line, which frequently experiences malperfusion and break down.…”

Update in Direct-to-Implant Breast Reconstruction

“…Patient selection plays a major role when it comes to deciding between DIT and two-stage reconstruction. 40 Patients with small, minimally ptotic breasts are the most ideal candidates for DIT, whereas patients with larger, more ptotic breasts are counseled for a two-stage approach and a contralateral procedure for symmetry. Irradiated patients are considered less than ideal for implant-based breast reconstruction due to higher capsular contracture rates and the risk of implant extrusion from severe radiodermitis.…”

Tissue Contraction—A New Paradigm in Breast Reconstruction

“…The use of an adjustable implant without ADM reduces the postoperative complication rate. 14 Although ADM may reduce capsular contracture, the complications of seroma and infection, and the cost are important considerations. In our study, prepectoral breast reconstruction was performed using the Spectrum-adjustable saline implant partially filled with air.…”