Arash Momeni1, Suhail Kanchwala1. 1. From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center; and the Division of Plastic Surgery, University of Pennsylvania Health Systems.
Abstract
BACKGROUND: The advantages of hybrid breast reconstruction (i.e., the combination of free tissue transfer with simultaneous implant placement) are well known. In an attempt to further minimize morbidity and simplify the procedure, the authors have modified their approach in that a prepectoral approach is now routinely chosen. METHODS: A retrospective analysis of patients who underwent immediate microsurgical breast reconstruction with simultaneous prepectoral implant placement was performed. Clinical outcomes and postoperative complications were examined. RESULTS: A total of 23 patients with a mean age of 46.6 years (range, 26 to 72 years) and mean body mass index of 25.8 kg/m (range, 21.4 to 32.1 kg/m) underwent reconstruction with 46 free flaps with simultaneous prepectoral silicone gel implant placement. The most common implant volume was 210 cc (range, 150 to 255 cc). Postoperative complications included hematoma [n = 1 (4.3 percent)], mastectomy skin flap necrosis [n = 5 (21.7 percent)], fat necrosis [n = 3 (13 percent)], and delayed wound healing at the flap donor site [n = 4 (17.4 percent)]. No case of implant malposition, implant infection, flap loss, or "red breast" syndrome was encountered during a mean follow-up of 8.4 months (range, 2 to 17 months). CONCLUSIONS: Prepectoral hybrid breast reconstruction is a safe procedure that combines the benefits of autologous and implant-based reconstruction. Although the transfer of well-vascularized soft tissue allows reconstruction of natural breast ptosis, the addition of an implant provides the desired projection, but without being associated with complications such as rippling or animation deformity. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
BACKGROUND: The advantages of hybrid breast reconstruction (i.e., the combination of free tissue transfer with simultaneous implant placement) are well known. In an attempt to further minimize morbidity and simplify the procedure, the authors have modified their approach in that a prepectoral approach is now routinely chosen. METHODS: A retrospective analysis of patients who underwent immediate microsurgical breast reconstruction with simultaneous prepectoral implant placement was performed. Clinical outcomes and postoperative complications were examined. RESULTS: A total of 23 patients with a mean age of 46.6 years (range, 26 to 72 years) and mean body mass index of 25.8 kg/m (range, 21.4 to 32.1 kg/m) underwent reconstruction with 46 free flaps with simultaneous prepectoral silicone gel implant placement. The most common implant volume was 210 cc (range, 150 to 255 cc). Postoperative complications included hematoma [n = 1 (4.3 percent)], mastectomy skin flap necrosis [n = 5 (21.7 percent)], fat necrosis [n = 3 (13 percent)], and delayed wound healing at the flap donor site [n = 4 (17.4 percent)]. No case of implant malposition, implant infection, flap loss, or "red breast" syndrome was encountered during a mean follow-up of 8.4 months (range, 2 to 17 months). CONCLUSIONS: Prepectoral hybrid breast reconstruction is a safe procedure that combines the benefits of autologous and implant-based reconstruction. Although the transfer of well-vascularized soft tissue allows reconstruction of natural breast ptosis, the addition of an implant provides the desired projection, but without being associated with complications such as rippling or animation deformity. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Authors: Fares Samra; Nikhil Sobti; Jonas A Nelson; Robert J Allen; Babak Mehrara; Joseph H Dayan Journal: Plast Reconstr Surg Glob Open Date: 2019-06-12