Kazuyuki Kubo1,1, Hiroyuki Takei2, Atsumori Hamahata3, Hiroshi Matsumoto4, Hiroyuki Sakurai5. 1. Division of Breast Surgery, Saitama Cancer Center, 780 Komuro, Ina, Kita-Adachi, Saitama, 362-0806, Japan. kazu-k@cancer-c.pref.saitama.jp. 2. Department of Breast Oncology, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan. 3. Division of Plastic and Reconstructive Surgery, Saitama Cancer Center, 818 Komuro, Ina, Kita-Adachi, Saitama, 362-0806, Japan. 4. Division of Breast Surgery, Saitama Cancer Center, 780 Komuro, Ina, Kita-Adachi, Saitama, 362-0806, Japan. 5. Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Abstract
PURPOSE: To prevent tissue expander (TE) exposure following mastectomy flap necrosis in immediate breast reconstruction, the TE is usually covered completely or partially with a musculofascial (MF) flap. This study compares the complications of the two coverage methods. METHODS: We reviewed, retrospectively, 106 cases of immediate TE-based breast reconstruction. The patients were divided into two groups according to whether complete or partial TE coverage was done. In the complete coverage group, the serratus anterior MF flap was dissected and sutured to the pectoralis major muscle to cover the TE completely. In the partial coverage group, the serratus anterior MF flap was not dissected, and the lateral border of the pectoralis major muscle was sutured to the mastectomy skin flaps. RESULTS: The TEs were covered completely in 60 breasts and partially in 46 breasts. The mastectomy flap necrosis rate was significantly higher in the complete coverage group (p < 0.01), but there was no incidence of TE exposure in either groups. The lateral migration rate was significantly higher in the partial coverage group (p = 0.033). There were no significant differences in the cranial migration rate (p = 0.133). CONCLUSIONS: The complete coverage method is a better option if there is a high risk of mastectomy flap necrosis; however, surgeons should monitor carefully for cranial migration.
PURPOSE: To prevent tissue expander (TE) exposure following mastectomy flap necrosis in immediate breast reconstruction, the TE is usually covered completely or partially with a musculofascial (MF) flap. This study compares the complications of the two coverage methods. METHODS: We reviewed, retrospectively, 106 cases of immediate TE-based breast reconstruction. The patients were divided into two groups according to whether complete or partial TE coverage was done. In the complete coverage group, the serratus anterior MF flap was dissected and sutured to the pectoralis major muscle to cover the TE completely. In the partial coverage group, the serratus anterior MF flap was not dissected, and the lateral border of the pectoralis major muscle was sutured to the mastectomy skin flaps. RESULTS: The TEs were covered completely in 60 breasts and partially in 46 breasts. The mastectomy flap necrosis rate was significantly higher in the complete coverage group (p < 0.01), but there was no incidence of TE exposure in either groups. The lateral migration rate was significantly higher in the partial coverage group (p = 0.033). There were no significant differences in the cranial migration rate (p = 0.133). CONCLUSIONS: The complete coverage method is a better option if there is a high risk of mastectomy flap necrosis; however, surgeons should monitor carefully for cranial migration.
Entities:
Keywords:
Breast cancer; Breast reconstruction; Postoperative complications; Tissue expander
Authors: Anuja K Antony; Colleen M McCarthy; Peter G Cordeiro; Babak J Mehrara; Andrea L Pusic; Esther H Teo; Alexander F Arriaga; Joseph J Disa Journal: Plast Reconstr Surg Date: 2010-06 Impact factor: 4.730
Authors: Armando A Davila; Akhil K Seth; Edward Wang; Philip Hanwright; Karl Bilimoria; Neil Fine; John Ys Kim Journal: Arch Plast Surg Date: 2013-01-14