Single-Stage Immediate Breast Reconstruction Using a Skin-Sparing Incision and Definitive Saline Implants Compared with a Two-Stage Reconstruction Using Tissue Expansion Plus Implants

Abstract

Background Losing a breast to cancer has significant psychological ramifications, and it has been shown that minimizing this loss can have a profound impact. As a result, breast-conserving therapy or mastectomy followed by breast reconstruction have become the preferred surgical treatments for breast cancer. Limited available breast skin following mastectomy has traditionally necessitated the use of autologous tissue or tissue expansion; however, when reconstructing larger breasts, autologous tissue grafts rarely provide enough tissue and tissue expanders can often take several months to achieve the necessary tissue volume. The skin-sparing mastectomy offers a solution to this lack of skin, and as a result many new options for immediate breast reconstruction have presented. The present pilot study looks at a new method of immediate breast reconstruction involving a Wise pattern skin-sparing mastectomy with placement of a definitive, submuscular saline implant as a way to maintain a large breast size without requiring the patient to undergo a long and painful tissue expansion process. Methods A retrospective, case-control study was performed on 12 women who had undergone bilateral mastectomies with immediate reconstruction either with a tissue expander and later placement of definitive saline implant (control group) (n=5) or who had undergone a single-stage reconstruction involving the placement of a definitive submuscular saline implant (experimental group) (n=7). Patients were compared with respect to change in breast size, number of reoperations and operations in total, as well as satisfaction with their reconstruction. Results Patient satisfaction in both groups was relatively high and there was no statistically significant difference found between the two groups. The experimental group decreased in bra size by 1.4 cup sizes on average whereas the control group experienced no change on average; however, one-third of patient data had to be discarded for various reasons, making the change in size measurement inconclusive. Finally, the average number of reoperations was higher in the experimental group than the control (1.57 versus 1.00); however, the total number of operations required was less (2.57 versus 2.80). Conclusions Immediate breast reconstruction using a definitive submuscular saline implant is a viable option for reconstruction in women with larger breasts that deserves further study on a larger scale. Although limited by sample size, the present pilot study showed, with a large effect size, that this new procedure reduces the total number of operations required for reconstruction when compared with a tissue expander followed by an implant while maintaining an equally high level of patient satisfaction.

Skin-reducing mastectomy and immediate breast reconstruction in patients with macromastia

“…In women with macromastia, a type IV SSM is often required to achieve an aesthetically pleasing reconstruction. A periareolar approach does not allow an adequate cutaneous excision, and several Wise pattern excisions have been developed to solve the problem [ 2 , 21 , 24 ]. However, these procedures have resulted in several complications that were associated with cutaneous flap skeletonization and inadequate space for placing an appropriate permanent implant [ 25 ].…”

“…Patient satisfaction was determined using the modified questionnaire from the Michigan Breast Reconstruction Outcome Scale (Table 2 ) [ 2 , 17 ].…”

“…Loosing a breast to cancer has significant negative psychological and sexual consequences [ 1 ], and one aim of patient care is to ameliorate these problems. Therefore, the radical mastectomy has become less common and has been replaced by wide local excision (breast-conserving therapy) or mastectomy followed by reconstruction [ 2 , 3 ].…”

A Systematic Review and Head-to-Head Meta-Analysis of Outcomes following Direct-to-Implant versus Conventional Two-Stage Implant Reconstruction

“…18,21,[27][28][29][30][31][32][33][34][35][36][37] Ten studies were retrospective cohort studies providing Level III evidence; two studies were prospective cohorts offering Level II evidence; and one study was a prospective, randomized, controlled trial offering Level I evidence. All but one study involved only immediate reconstructions, and Plastic and Reconstructive Surgery • December 2015 delayed reconstruction data were excluded for the one study with both delayed and immediate reconstruction.…”

Direct-to-implant Breast Reconstruction with Autoderm

“…A modified direct-to-implant procedure 1–4 wherein the loose skin envelope is aesthetically shaped through an anchor style breast reduction pattern, results in a more desirable mastopexy. This also medializes the redundant tissue that forms at the lateral chest wall, avoiding the standing cone deformity seen in transverse mastectomy incisions.…”