Roy de Vita1, Ernesto Maria Buccheri1, Amedeo Villanucci2, Marcello Pozzi1. 1. Department of Plastic and Reconstructive Surgery, Instituti Fisioterapici Ospitalieri, Regina Elena National Cancer Institute, Rome, Italy. 2. Department of Plastic and Reconstructive Surgery, Instituti Fisioterapici Ospitalieri, Regina Elena National Cancer Institute, Rome, Italy; Department of Biotechnological and Applied Clinical Sciences, General Surgery Section, L'Aquila University, L'Aquila, Italy. Electronic address: amedeo.villanucci@gmail.com.
Abstract
BACKGROUND: Implant-based breast reconstruction after nipple-sparing mastectomy has been the most common breast reconstruction procedure performed, for both breast cancer treatment and prophylactically. Subpectoral implant placement with partial detachment of the pectoralis major muscle has been the procedure of choice for staged reconstruction and direct-to-implantation. Prepectoral implant placement has recently increased in popularity among plastic surgeons owing to the high rates of animation deformity, loss of muscle function, and chronic pain observed with submuscular implant placement. Acellular dermal matrices or synthetic meshes have been used for implant coverage and support to avoid capsular contracture and implant visibility. In the present study, we have introduced breast reconstruction actualized in nipple-sparing mastectomy and direct-to-implant with prepectoral polyurethane positioning (BRAND4P). PATIENTS AND METHODS: A total of 34 nipple-sparing mastectomies and immediate direct-to-implant breast reconstructions with prepectoral polyurethane-coated implant placement were performed in 21 patients (13 bilateral and 8 unilateral). The implant was placed subcutaneously in the exact place of the excised breast parenchyma with no further coverage. RESULTS: After a mean follow-up of 4 months, no major complications had been observed. No patient presented with animation deformity or grade III-IV capsular contracture. Patient satisfaction, assessed using the BREAST-Q, was excellent. CONCLUSIONS: The BRAND4P method represents a novel prepectoral approach and a feasible alternative to subpectoral implant placement among the available implant-based breast reconstruction techniques.
BACKGROUND: Implant-based breast reconstruction after nipple-sparing mastectomy has been the most common breast reconstruction procedure performed, for both breast cancer treatment and prophylactically. Subpectoral implant placement with partial detachment of the pectoralis major muscle has been the procedure of choice for staged reconstruction and direct-to-implantation. Prepectoral implant placement has recently increased in popularity among plastic surgeons owing to the high rates of animation deformity, loss of muscle function, and chronic pain observed with submuscular implant placement. Acellular dermal matrices or synthetic meshes have been used for implant coverage and support to avoid capsular contracture and implant visibility. In the present study, we have introduced breast reconstruction actualized in nipple-sparing mastectomy and direct-to-implant with prepectoral polyurethane positioning (BRAND4P). PATIENTS AND METHODS: A total of 34 nipple-sparing mastectomies and immediate direct-to-implant breast reconstructions with prepectoral polyurethane-coated implant placement were performed in 21 patients (13 bilateral and 8 unilateral). The implant was placed subcutaneously in the exact place of the excised breast parenchyma with no further coverage. RESULTS: After a mean follow-up of 4 months, no major complications had been observed. No patient presented with animation deformity or grade III-IV capsular contracture. Patient satisfaction, assessed using the BREAST-Q, was excellent. CONCLUSIONS: The BRAND4P method represents a novel prepectoral approach and a feasible alternative to subpectoral implant placement among the available implant-based breast reconstruction techniques.
Authors: Fabio Pelle; Sonia Cappelli; Franco Graziano; Loredana Piarulli; Flavia Cavicchi; Domenico Magagnano; Assunta De Luca; Roy De Vita; Marcello Pozzi; Maurizio Costantini; Antonio Varanese; Massimo Panimolle; Pietro Paolo Gullo; Maddalena Barba; Patrizia Vici; Enrico Vizza; Francesco Cognetti; Giuseppe Sanguineti; Elena Saracca; Gennaro Ciliberto; Claudio Botti Journal: J Exp Clin Cancer Res Date: 2020-08-27
Authors: Diego Ribuffo; Giorgio Berna; Roy De Vita; Giovanni Di Benedetto; Emanuele Cigna; Manfredi Greco; Luigi Valdatta; Maria Giuseppina Onesti; Federico Lo Torto; Marco Marcasciano; Ugo Redi; Vittorio Quercia; Juste Kaciulyte; Mario Cherubino; Luigi Losco; Francesco Luca Rocco Mori; Alessandro Scalise Journal: Aesthetic Plast Surg Date: 2020-08-28 Impact factor: 2.326