Prepectoral Direct-to-Implant Breast Reconstruction without Placement of Acellular Dermal Matrix or Mesh after Nipple-Sparing Mastectomy

Abstract

Background: The aim of this study was to report the results of prepectoral direct-to-implant reconstruction in nipple-sparing mastectomy without acellular dermal matrices or mesh. Methods: A multicenter cohort of patients undergoing prophylactic or therapeutic nipple-sparing mastectomy was included from 2013 to 2020. All sizes and types of breasts were included, except those with previously failed reconstruction, previous radiotherapy with severe skin damage, locally advanced breast cancer, gigantomasty, severe degree of ptosis, tumors close to the nipple-areola complex (<1 cm on magnetic resonance imaging), or combined autologous-based reconstruction. Results: A total of 280 immediate breast reconstructions were performed in 195 patients. The mean age was 45 years and 32.8 percent of patients were postmenopausal. The mean follow-up period was 16.5 (±17.43) months. Eighty-five patients (43.6 percent) underwent bilateral mastectomy; 116 mastectomies (41.4 percent) were prophylactic and 164 (58.6 percent) were therapeutic. Sixty-eight reconstructions (24 percent) had at least one acute complication, the most common being implant explantation (9.2 percent), which was more frequent in smokers. Late complications included rippling (grades 3 and 4) in seven cases (3.8 percent) and capsular contracture (Baker II through IV) in 29 cases (15.7 percent) [22 Baker II (11.9 percent), six Baker III (3.3 percent), and one Baker IV (0.5 percent)]. One implant rotation was observed. No deformity animation was observed. Cosmetic results were considered good or excellent in 87.3 percent of patients. Conclusions: Overall complications were similar to those reported in acellular dermal matrices, mesh, or subpectoral series, except for a higher explantation rate. This technique is safe and economically advantageous, as it is a one-stage technique without acellular dermal matrices and mesh. These are preliminary data and larger and comparative studies are needed. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Inframammary versus Periareolar Incision: A Comparison of Early Complications in Nipple-sparing Mastectomy

“…This technique has attracted the interest of many breast reconstruction surgeons for various reasons, including the ease of reconstruction and a reduced need to mobilize tissues; however, no long-term data are yet available, although early reports have shown a complication profile comparable to that found with subpectoral techniques. 31–33 These factors related to immediate breast reconstruction techniques do not seem to have affected complication rates in this study.…”

Early Complications after Prepectoral Tissue Expander Placement in Breast Reconstruction with and without Acellular Dermal Matrix

“…Although literature examining immediate, prepectoral, direct-to-implant reconstruction point to the many benefits of including ADM, 39–42 others have reported acceptable postoperative complications and final reconstructive results in ADM-sparing techniques. 28,43–45 Our findings that prepectoral tissue expander placement at the time of mastectomy can be safely performed with little difference in clinical outcomes could be a potential area of cost savings, if ADM is only omitted during the first stage of reconstruction.…”

The Utility of a Lateral Adipodermal Flap in Prepectoral Direct-to-implant Breast Reconstruction

“…Previous publications better address the issue of whether ADM is necessary in prepectoral reconstructions. [7][8][9][10] This approach may be of special relevance in less-developed countries where ADM cost may be prohibitive. The author presents this as a new, simple approach that may be of benefit in some patients with LBSE and is likely complementary to other strategies (ADM, fat grafting, cohesive implants, preserving of the oncoplastic plane) to improve aesthetic outcomes.…”