Abstract
We report our experience in direct-to-implant breast reconstruction with prepectoral
polyurethane implants, with a focus on intraoperative mastectomy flap thickness compared
to preoperative data (flap thickness ratio) as a reliable predictive variable of ischemic
complications and reconstructive outcomes (satisfaction with breast).
Background
The optimization of nipple sparing mastectomy and implant-based reconstruction techniques
led to an increase in the popularity of prepectoral reconstruction. The aim of this
study is to explore the ratio between the intraoperative and preoperative breast tissue
coverage assessment as reliable tool in order to predict the risk of ischemic complications
in prepectoral reconstruction.
Methods
We analyzed 124 preoperative digital mammograms of 100 patients who underwent prepectoral
implant-based reconstruction. We applied a Rancati modified score for breast tissue
coverage classification, adding 4 measurements on the craniocaudal view. The intraoperative
mastectomy flap thickness was measured using an intraoperative ultrasound assessment.
We investigated the differences between the groups with and without ischemic complications
related to the preoperative, intraoperative, and flap thickness ratio data.
Results
The flap thickness ratio was lower in ischemic complication group compared to no ischemic
complication group (0.4 vs. 0.8) with statistically significant differences for all
ischemic complication subgroups: major mastectomy flap necrosis (P = .000), minor mastectomy flap necrosis (P = .005), partial nipple areola complex necrosis (P = .007), and implant exposure (P = .001).
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical Breast CancerAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Implant-based breast reconstruction: hot topics, controversies, and new directions.Plast Reconstr Surg. 2019; 143: 404e-416e
- Reconstruction of the female breast following radical mastectomy.Plast Reconstr Surg. 1971; 47: 565-567
- The evolution from subcutaneous to prepectoral prosthetic breast reconstruction.Plast Reconstr Surg Glob Open. 2018; 6: e1797
- Direct to implant reconstruction in nipple sparing mastectomy: patient selection by preoperative digital mammogram.Plast Reconstr Surg Glob Open. 2017; 5 (PMID:28740781; PMCID: PMC5505842): e1369https://doi.org/10.1097/GOX.0000000000001369
- Preoperative digital mammography imaging in conservative mastectomy and immediate reconstruction.Gland Surg. 2016; 5 (PMID:26855903; PMCID: PMC4716857): 9-14https://doi.org/10.3978/j.issn.2227-684X.2015.08.01
- Intraoperative perfusion techniques can accurately predict mastectomy skin flap necrosis in breast reconstruction: results of a prospective trial.Plast Reconstr Surg. 2012; 129: 778e-788e
- Direct to Implant Breast Reconstruction With Prepectoral Micropolyurethane Foam-Coated Implant: Analysis of Patient Satisfaction.Clin Breast Cancer. 2021; 21: e454-e461
- Considerations for performing immediate breast reconstruction during the COVID-19 pandemic.Breast J. 2020; 26: 1485-1487
- Low versus high vacuum suction drainage of the submuscular pocket in primary breast reconstruction: a retrospective study.Ann Plast Surg. 2018; 80: 339-343
- The role of fat grafting on contracted breast implant capsules: A retrospective comparative histological and immunohistochemical study.J Plast Reconstr Aesthet Surg. 2022; 75: 1083-1093
- Developmentof a new patient-reported outcome measure for breast surgery: the BREAST-Q.Plast Reconstr Surg. 2009; 124: 345-353
- Patient-reported outcome measures in plastic surgery: use and interpretation in evidence-based medicine.Plast Reconstr Surg. 2011; 127: 1361-1367
- Important considerations for performing prepectoral breast reconstruction.Plast Reconstr Surg. 2017; 140: 7S-13S
- Evaluation of the effectiveness of the prepectoral breast reconstruction with Braxon dermal matrix: First multicenter European report on 100 cases.Breast J. 2017; 23: 670-676
- Is oncologic safety compatible with a predictably viable mastectomy skin flap?.Plast Reconstr Surg. 2011; 127: 27-33
- Determinants of optimal mastectomy skin flap thickness.Br J Surg. 2014; 101: 899-911
- Mastectomy Flap Thickness and Complications in Nipple-Sparing Mastectomy: Objective Evaluation using Magnetic Resonance Imaging.Plast Reconstr Surg Glob Open. 2017; 5: e1439
- Association between breast implant- associated anaplastic large celllymphoma (BIA-ALCL) risk and polyurethane breast implants: clinical evidenceand European PERSPECTIVE.Aesthet Surg J. 2019; 39: S49-S54
- Prepectoral implant-based breastreconstruction and postmastectomy radiotherapy: short-term outcomes.PRSGO. 2017; 5: e1631
- Polyurethane-coated breast implantsrevisited: a 30-year follow-up.Arch Plast Surg. 2015; 42: 186-193
- The functional influence of breast implantouter shell morphology on bacterial attachmentand growth.Plast Reconstr Surg. 2018; 142: 837-849
Article info
Publication history
Published online: November 25, 2022
Accepted:
November 23,
2022
Received:
November 13,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
