Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Considerations for patient selection: Prepectoral versus subpectoral implant-based breast reconstruction

  • Yang, Jun Young (Department of Plastic and Reconstructive Surgery, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Kim, Chan Woo (Department of Plastic and Reconstructive Surgery, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Lee, Jang Won (Department of Plastic and Reconstructive Surgery, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Kim, Seung Ki (Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Lee, Seung Ah (Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Hwang, Euna (Department of Plastic and Reconstructive Surgery, CHA Bundang Medical Center, CHA University School of Medicine)
  • Received : 2019.03.29
  • Accepted : 2019.10.22
  • Published : 2019.11.15
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Abstract

Background In recent years, breast implants have been frequently placed in the subcutaneous pocket, in the so-called prepectoral approach. We report our technique of prepectoral implant-based breast reconstruction (IBR), as well as its surgical and aesthetic outcomes, in comparison with subpectoral IBR. We also discuss relevant considerations and pitfalls in prepectoral IBR and suggest an algorithm for the selection of patients for IBR based on our experiences. Methods We performed 79 immediate breast reconstructions with a breast implant and an acellular dermal matrix (ADM) sling, of which 47 were subpectoral IBRs and 32 were prepectoral IBRs. Two-stage IBR was performed in 36 cases (20 subpectoral, 16 prepectoral), and direct-to-implant IBR in 43 cases (27 prepectoral, 16 subpectoral). The ADM sling supplemented the inferolateral side of the breast prosthesis in the subpectoral group and covered the entire anterior surface of the breast prosthesis in the prepectoral group. Results The postoperative pain score was much lower in the prepectoral group than in the subpectoral group (1.78 vs. 7.17). The incidence of seroma was higher in the prepectoral group (31.3% vs. 6.4%). Other postoperative complications, such as surgical site infection, flap necrosis, implant failure, and wound dehiscence, occurred at similar rates in both groups. Animation deformities developed in 8.5% of patients in the subpectoral group and rippling deformities were more common in the prepectoral group (21.9% vs. 12.8%). Conclusions The indications for prepectoral IBR include moderately-sized breasts with a thick well-vascularized mastectomy flap and concomitant bilateral breast reconstruction with prophylactic mastectomy.

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References

  1. Gruber RP, Kahn RA, Lash H, et al. Breast reconstruction following mastectomy: a comparison of submuscular and subcutaneous techniques. Plast Reconstr Surg 1981;67:312-7. https://doi.org/10.1097/00006534-198103000-00007
  2. Schlenker JD, Bueno RA, Ricketson G, et al. Loss of silicone implants after subcutaneous mastectomy and reconstruction. Plast Reconstr Surg 1978;62:853-61. https://doi.org/10.1097/00006534-197812000-00004
  3. Snyderman RK, Guthrie RH. Reconstruction of the female breast following radical mastectomy. Plast Reconstr Surg 1971;47:565-7. https://doi.org/10.1097/00006534-197106000-00008
  4. Apfelberg DB, Laub DR, Maser MR, et al. Submuscular breast reconstruction: indications and techniques. Ann Plast Surg 1981;7:213-21. https://doi.org/10.1097/00000637-198109000-00006
  5. Duncan DI. Correction of implant rippling using allograft dermis. Aesthet Surg J 2001;21:81-4. https://doi.org/10.1067/maj.2001.113438
  6. Breuing KH, Warren SM. Immediate bilateral breast reconstruction with implants and inferolateral AlloDerm slings. Ann Plast Surg 2005;55:232-9. https://doi.org/10.1097/01.sap.0000168527.52472.3c
  7. Spear SL, Parikh PM, Reisin E, et al. Acellular dermis-assisted breast reconstruction. Aesthetic Plast Surg 2008;32:418-25. https://doi.org/10.1007/s00266-008-9128-8
  8. Woo A, Harless C, Jacobson SR. Revisiting an old place: single-surgeon experience on post-mastectomy subcutaneous implant-based breast reconstruction. Breast J 2017;23:545-53. https://doi.org/10.1111/tbj.12790
  9. Jones G, Yoo A, King V, et al. Prepectoral immediate direct-to-implant breast reconstruction with anterior AlloDerm coverage. Plast Reconstr Surg 2017;140(6S):31S-38S. https://doi.org/10.1097/PRS.0000000000004048
  10. Sbitany H, Piper M, Lentz R. Prepectoral breast reconstruction: a safe alternative to submuscular prosthetic reconstruction following nipple-sparing mastectomy. Plast Reconstr Surg 2017;140:432-43. https://doi.org/10.1097/PRS.0000000000003627
  11. Pantelides NM, Srinivasan JR. Rippling following breast augmentation or reconstruction: aetiology, emerging treatment options and a novel classification of severity. Aesthetic Plast Surg 2018;42:980-5. https://doi.org/10.1007/s00266-018-1117-y
  12. Ganske I, Verma K, Rosen H, et al. Minimizing complications with the use of acellular dermal matrix for immediate implant-based breast reconstruction. Ann Plast Surg 2013; 71:464-70. https://doi.org/10.1097/SAP.0b013e3182a7cc9b
  13. Salzberg CA, Ashikari AY, Berry C, et al. Acellular dermal matrix-assisted direct-to-implant breast reconstruction and capsular contracture: a 13-year experience. Plast Reconstr Surg 2016;138:329-37. https://doi.org/10.1097/PRS.0000000000002331
  14. Sbitany H, Serletti JM. Acellular dermis-assisted prosthetic breast reconstruction: a systematic and critical review of efficacy and associated morbidity. Plast Reconstr Surg 2011; 128:1162-9. https://doi.org/10.1097/PRS.0b013e318230c29e
  15. Lohmander F, Lagergren J, Roy PG, et al. Implant based breast reconstruction with acellular dermal matrix: safety data from an open-label, multicenter, randomized, controlled trial in the setting of breast cancer treatment. Ann Surg 2019;269:836-41. https://doi.org/10.1097/SLA.0000000000003054
  16. Nahabedian MY, Cocilovo C. Two-stage prosthetic breast reconstruction: a comparison between prepectoral and partial subpectoral techniques. Plast Reconstr Surg 2017;140(6S): 22S-30S. https://doi.org/10.1097/PRS.0000000000004047
  17. Chandarana MN, Jafferbhoy S, Marla S, et al. Acellular dermal matrix in implant-based immediate breast reconstructions: a comparison of prepectoral and subpectoral approach. Gland Surg 2018;7(Suppl 1):S64-9. https://doi.org/10.21037/gs.2018.03.05
  18. Baker BG, Irri R, MacCallum V, et al. A prospective comparison of short-term outcomes of subpectoral and prepectoral Strattice-based immediate breast reconstruction. Plast Reconstr Surg 2018;141:1077-84. https://doi.org/10.1097/PRS.0000000000004270
  19. Offersen BV, Boersma LJ, Kirkove C, et al. ESTRO consensus guideline on target volume delineation for elective radiation therapy of early stage breast cancer. Radiother Oncol 2015;114:3-10. https://doi.org/10.1016/j.radonc.2014.11.030
  20. Kaidar-Person O, Vrou Offersen B, Hol S, et al. ESTRO ACROP consensus guideline for target volume delineation in the setting of postmastectomy radiation therapy after implant-based immediate reconstruction for early stage breast cancer. Radiother Oncol 2019;137:159-66. https://doi.org/10.1016/j.radonc.2019.04.010

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