Subcutaneous Prosthetic Breast Reconstructions following Skin Reduction Mastectomy

Abstract

Background: Prepectoral prosthetic breast reconstruction is gaining popularity, offering muscle preservation and outcomes similar to subpectoral implant placement in small or moderate size breasts. This study compares the complications of prepectoral and subpectoral immediate prosthetic breast reconstructions following skin reduction mastectomy in large and ptotic breasts. Methods: All consecutive patients who underwent immediate tissue expander-based reconstruction following Wise pattern skin reduction mastectomy from November 2011 through August 2017 by a single surgeon were reviewed. The collected data included patient demographics and complications (eg, skin necrosis, hematoma, infection, seroma, implant loss, capsular contracture). Results: A total of 54 patients underwent 87 immediate breast reconstructions including 45 subpectoral and 42 prepectoral tissue expander placements. The subpectoral patients had greater body mass indexes (32.5 ± 6.6 versus 29.9 ± 5.4, P = 0.026), higher initial (518 ± 168 ml versus 288 ± 140 ml, P < 0.001) and final (694 ± 123 ml versus 585 ± 122 ml, P = 0.014) implant volumes, more skin flap necrosis (40.0% versus 16.7%, P = 0.044) and infections (37.8% versus 11.9%, P = 0.01) than their prepectoral counterparts, whereas seromas were more common in the prepectoral group (4.4% versus 26.2%, P = 0.015). The overall complication rate, although higher in the subpectoral group compared with the prepectoral group, was not significantly different (62.2% versus 40.5%, P = 0.072). Conclusions: Prepectoral tissue expander placement after skin reduction mastectomy is an appealing reconstructive option in patients with large and ptotic breasts. Prosthetic reconstruction following Wise-pattern skin reduction mastectomy is invariably associated with high complication rates irrespective of the plane of implant placement. Greater emphasis should be placed on patient counseling and complication prevention in this challenging patient population.

Complication Profile of Total Submuscular Versus Prepectoral Tissue Expander Placement

“…To date, numerous studies evaluating prepectoral breast reconstruction have been published. Many of these studies were evaluating prepectoral direct-to-implant reconstruction or comparing prepectoral expander placement to partial submuscular expander placement, with both cohorts using ADM 7,9–12 . Our study compares total submuscular tissue expander placement with no ADM to prepectoral placement with ADM.…”

“…To date, numerous studies evaluating prepectoral breast reconstruction have been published. Many of these studies were evaluating prepectoral direct-to-implant reconstruction or comparing prepectoral expander placement to partial submuscular expander placement, with both cohorts using ADM. 7,[9][10][11][12] Our study compares total submuscular tissue expander placement with no ADM to prepectoral placement with ADM. Previously, literature has been mixed regarding the influence of ADM on infection rates in prosthetic-based breast reconstruction, and seroma rates have typically been reported to have increased incidence.…”

The largest multicentre data collection on prepectoral breast reconstruction: The iBAG study

“…Unfortunately, despite the current multiplicity of different devices committed to PPBR, there is still a lack of high‐quality evidence to support the safety of these new materials. In fact, most of the published studies are limited to small single‐center experiences with no homogeneous outcomes 7‐9 . As mentioned above, the first biologic membrane able to completely cover a silicone implant to position it subcutaneously was a 0.6 mm‐thick preshaped porcine ADM (Braxon; DECOmed Srl, Venice, Italy) 3 .…”

“To Pre or Not to Pre”: Introduction of a Prepectoral Breast Reconstruction Assessment Score to Help Surgeons Solving the Decision-Making Dilemma. Retrospective Results of a Multicenter Experience

“…Furthermore, our assessment score considered also cases with breast ptosis, which would need skin-reducing mastectomy; these cases are associated with a substantial risk of implant exposure at the inframammary fold. 42 We assigned 0 points to patients that were scheduled for Wise-pattern skin-reducing mastectomy, in which the nipple-areola complex was either lifted with a flap or grafted over an inferior dermal flap. Diabetes mellitus, especially if poorly controlled with elevated blood glucose levels documented by hemoglobin A1c levels higher than 7 percent, will affect wound healing and compromise vascular supply.…”