A case of important weight loss after a prepectoral breast reconstruction

The submuscular implant-based breast reconstruction is the most common reconstructive technique following mastectomy. Recently, subcutaneous implant positioning, together with acellular dermal matrix, has become a promising technique in selected patients. We present the case of a 42-year-old woman who underwent left nipple-sparing mastectomy with prepectoral acellular dermal matrix (ADM) assisted direct-to-implant (DTI) breast reconstruction and contralateral mastopexy. The implant was completely wrapped around by Braxon®, a preshaped porcine ADM. A few months after surgery, she experienced a severe weight loss resulting in the aesthetic deterioration of both breasts. The patient showed a migration of the left implant inferiorly and laterally, and deflation of the contralateral breast. In order to improve the left breast, a lateral capsulectomy was performed to reduce the prepectoral pocket size and lift the implant. Subsequently, a modified donut mastopexy was performed to obtain an upward migration of the nipple-areolar complex. One of the limiting factors of prosthetic reconstruction, as compared to autologous reconstruction, is the aesthetic deterioration determined by any weight change. Differently from submuscular implant reconstruction, the prepectoral implant reconstruction follows body changes after weight changes and ageing. In fact, Braxon’s integration determines the formation of a capsule adhering to the mastectomy flap which makes the implant more sensible to dermatochalasis. The greater thickness of the mastectomy flap due to the larger representation of the subcutaneous tissue makes the reconstruction more sensitive to weight changes. A tailored partial capsulectomy combined with a donut mastopexy can be a solution in these patients after an important weight loss.

Level of Evidence: Level V, therapeutic study.