I Ozgur1, S Kurul2, S Bademler3, H Karanlik3. 1. Department of General Surgery, Fatih, Istanbul Medical Faculty, Istanbul University, 34093 Istanbul, Turkey. Electronic address: dr.ilkerozgur@gmail.com. 2. Division of Plastic and Reconstructive Surgery, Surgical Oncology Unit, Institute of Oncology, Istanbul University, Istanbul, Turkey. 3. Division of Breast Surgery, Surgical Oncology Unit, Institute of Oncology, Istanbul University, Istanbul, Turkey.
Abstract
BACKGROUND: Selection of implant pocket and size is a dilemma for surgeons especially if radiation therapy is envisaged after implant based immediate breast reconstruction (IBR). The aim of this study is to compare complication rates between subpectoral and the dual plane polyglactin mesh supported IBR after nipple-areola sparing mastectomy. PATIENTS AND METHOD: Reconstructive analysis of 208 breasts of 190 patients with breast cancer undergoing implant based IBR at a single university hospital were evaluated. The patients were reconstructed with either dual-plane polyglactin mesh supported (n=91) or subpectoral (n=117) implant based IBR after nipple-areola sparing mastectomy. Demographic data, and postoperative complications were compared. RESULTS: The mean age was 43.3 years. Early complications encountered in 12% (n=25) and late complications occurred in 18% (n=37) of breasts. Both early (13,7% vs 9.9%, P=0.406) and late complications (24.8% vs 8.8%, P=0.003) were more common in subpectoral group, but only late complication occurrence rate was statistically significant. Capsular contracture (P=0.000), inframammary fold problems (P=0.010), bottoming-out (P=0.370), mechanical shift (P=0.036) and animation deformity (P=0.007) were all more common in subpectoral group. Only rippling deformity (P=0.011) was more common in dual plane group. CONCLUSIONS: Dual plane IBR has acceptable complication rates compared to subpectoral IBR. It is associated with less capsular contracture, fewer animation and bottoming-out deformity and better inframammary fold appearance.
BACKGROUND: Selection of implant pocket and size is a dilemma for surgeons especially if radiation therapy is envisaged after implant based immediate breast reconstruction (IBR). The aim of this study is to compare complication rates between subpectoral and the dual plane polyglactin mesh supported IBR after nipple-areola sparing mastectomy. PATIENTS AND METHOD: Reconstructive analysis of 208 breasts of 190 patients with breast cancer undergoing implant based IBR at a single university hospital were evaluated. The patients were reconstructed with either dual-plane polyglactin mesh supported (n=91) or subpectoral (n=117) implant based IBR after nipple-areola sparing mastectomy. Demographic data, and postoperative complications were compared. RESULTS: The mean age was 43.3 years. Early complications encountered in 12% (n=25) and late complications occurred in 18% (n=37) of breasts. Both early (13,7% vs 9.9%, P=0.406) and late complications (24.8% vs 8.8%, P=0.003) were more common in subpectoral group, but only late complication occurrence rate was statistically significant. Capsular contracture (P=0.000), inframammary fold problems (P=0.010), bottoming-out (P=0.370), mechanical shift (P=0.036) and animation deformity (P=0.007) were all more common in subpectoral group. Only rippling deformity (P=0.011) was more common in dual plane group. CONCLUSIONS: Dual plane IBR has acceptable complication rates compared to subpectoral IBR. It is associated with less capsular contracture, fewer animation and bottoming-out deformity and better inframammary fold appearance.
Authors: Ian J Saldanha; Justin M Broyles; Gaelen P Adam; Wangnan Cao; Monika Reddy Bhuma; Shivani Mehta; Andrea L Pusic; Laura S Dominici; Ethan M Balk Journal: Plast Reconstr Surg Glob Open Date: 2022-03-18