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01-06-2020 | Wound Dehiscence | Original Article

Skin-Reducing Mastectomy and Pre-pectoral Breast Reconstruction in Large Ptotic Breasts

Authors: Michele Maruccia, Rossella Elia, Angela Gurrado, Marco Moschetta, Eleonora Nacchiero, Alberto Bolletta, Mario Testini, Giuseppe Giudice

Published in: Aesthetic Plastic Surgery | Issue 3/2020

Abstract

Objectives

Pre-pectoral breast reconstruction is increasingly offered to breast cancer patients, as the one-stage technique has proved surgical and oncological safety and aesthetic effectiveness. Nevertheless, there are limited data on outcomes after pre-pectoral breast reconstruction in large and ptotic breasts. The aim of the paper is to present the authors’ experience in performing Wise pattern mastectomy with pre-pectoral implant and complete acellular dermal matrix (ADM) coverage as a single-stage procedure in patients with large ptotic breasts.

Materials and Methods

A retrospective review of protective collected data from January 2017 to June 2019 of patients who presented with large and ptotic breasts undergoing skin-reducing mastectomy and immediate pre-pectoral breast reconstruction with complete ADM coverage and inferior dermal sling was performed. Oncological and surgical outcomes were collected. Satisfaction with reconstruction and related quality of life were evaluated through BREAST-Q questionnaire.

Results

Nineteen patients met the inclusion criteria. The average patient age was 55.6 years, and the mean body mass index was 31.2. Mean follow-up was 23.2 months from the initial reconstruction. One patient experienced seroma, and two cases of wound dehiscence at the T junction were observed and treated conservatively with no implant loss. All patients were satisfied with the final reconstruction.

Conclusion

The Wise pattern skin-reducing mastectomy and pre-pectoral breast reconstruction could be offered to patients presenting with large and ptotic breasts. Future studies should better define long-term outcomes.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Jones G, Antony AK (2019) Single stage, direct to implant pre-pectoral breast reconstruction. Gland Surg 8(1):53–60. https://doi.org/10.21037/gs.2018.10.08 CrossRefPubMedPubMedCentral

Hammond DC, Schmitt WP, O’Connor EA (2015) Treatment of breast animation deformity in implant-based reconstruction with pocket change to the subcutaneous position. Plast Reconstr Surg 135(6):1540–1544. https://doi.org/10.1097/PRS.0000000000001277 CrossRefPubMed

Gabriel A, Sigalove S, Sigalove NM et al (2018) Prepectoral revision breast reconstruction for treatment of implant-associated animation deformity: a review of 102 reconstructions. Aesthet Surg J 38(5):519–526. https://doi.org/10.1093/asj/sjx261 CrossRefPubMed

Ter Louw RP, Nahabedian MY (2017) Prepectoral breast reconstruction. Plast Reconstr Surg 140(5S):51S. https://doi.org/10.1097/PRS.0000000000003942 CrossRefPubMed

Berna G, Cawthorn SJ, Papaccio G, Balestrieri N (2017) Evaluation of a novel breast reconstruction technique using the Braxon^® acellular dermal matrix: a new muscle-sparing breast reconstruction. ANZ J Surg 87(6):493–498. https://doi.org/10.1111/ans.12849 CrossRefPubMed

Vidya R, Masià J, Cawthorn S et al (2017) Evaluation of the effectiveness of the prepectoral breast reconstruction with Braxon dermal matrix: first multicenter European report on 100 cases. Breast J 23(6):670–676. https://doi.org/10.1111/tbj.12810 CrossRefPubMed

Cattelani L, Polotto S, Arcuri MF, Pedrazzi G, Linguadoca C, Bonati E (2018) One-step prepectoral breast reconstruction with dermal matrix-covered implant compared to submuscular implantation: functional and cost evaluation. Clin Breast Cancer 18(4):e703–e711. https://doi.org/10.1016/j.clbc.2017.11.015 CrossRefPubMed

Salibian AA, Frey JD, Karp NS (2019) Strategies and considerations in selecting between subpectoral and prepectoral breast reconstruction. Gland Surg 8(1):11–18. https://doi.org/10.21037/gs.2018.08.01 CrossRefPubMedPubMedCentral

Giudice G, Maruccia M, Nacchiero E, Elia R, Annoscia P, Vestita M (2018) Dual plane breast implant reconstruction in large sized breasts: how to maximise the result following first stage total submuscular expansion. JPRAS Open 15:74–80. https://doi.org/10.1016/j.jpra.2017.11.003 CrossRefPubMedPubMedCentral

10.

Nava MB, Cortinovis U, Ottolenghi J et al (2006) Skin-reducing mastectomy. Plast Reconstr Surg 118(3):603–610. https://doi.org/10.1097/01.prs.0000233024.08392.14(discussion 611-613) CrossRefPubMed

11.

Caputo GG, Marchetti A, Dalla Pozza E et al (2016) Skin-reduction breast reconstructions with prepectoral implant. Plast Reconstr Surg 137(6):1702–1705. https://doi.org/10.1097/PRS.0000000000002227 CrossRefPubMed

12.

Thuman J, Freitas AM, Schaeffer C, Campbell CA (2019) Prepectoral wise-pattern staged implant-based breast reconstruction for obese or ptotic patients. Ann Plast Surg 82(6S Suppl 5):S404–S409. https://doi.org/10.1097/sap.0000000000001791 CrossRefPubMed

13.

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 4(10):e296. https://doi.org/10.1371/journal.pmed.0040296 CrossRef

14.

Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral

15.

Surgical Site Infection (SSI) Event (2016) Centers for disease control and prevention. https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. Accessed 1 Nov 2019

16.

Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ (2009) Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg 124(2):345–353. https://doi.org/10.1097/PRS.0b013e3181aee807 CrossRefPubMed

17.

Giudice G, Maruccia M, Vestita M et al (2019) The medial-central septum based mammaplasty: a reliable technique to preserve nipple-areola complex sensitivity in post bariatric patients. Breast J 25(4):590–596. https://doi.org/10.1111/tbj.13291 CrossRefPubMed

18.

Bucaria V, Elia R, Maruccia M, Vestita M, Boccuzzi A, Giudice G (2018) Methylene blue: a color test for a quality de-epithelialization. Aesthetic Plast Surg 42:1434–1435. https://doi.org/10.1007/s00266-018-1126-x CrossRefPubMed

19.

Inbal A, Gur E, Lemelman BT et al (2017) Optimizing patient selection for direct-to-implant immediate breast reconstruction using wise-pattern skin-reducing mastectomy in large and ptotic breasts. Aesthetic Plast Surg 41(5):1058–1067. https://doi.org/10.1007/s00266-017-0899-7 CrossRefPubMed

20.

Hammond DC, Capraro PA, Ozolins EB, Arnold JF (2002) Use of a skin-sparing reduction pattern to create a combination skin-muscle flap pocket in immediate breast reconstruction. Plast Reconstr Surg 110(1):206–211. https://doi.org/10.1097/00006534-200207000-00035 CrossRefPubMed

21.

Salgarello M, Visconti G, Barone-Adesi L et al (2012) Inverted-T skin-reducing mastectomy with immediate implant reconstruction using the submuscular-subfascial pocket. Plast Reconstr Surg 130(1):31–41. https://doi.org/10.1097/PRS.0b013e3182547d42 CrossRefPubMed

22.

Carlson GW, Bostwick J, Styblo TM et al (1997) Skin-sparing mastectomy. Oncologic and reconstructive considerations. Ann Surg 225(5):570–575. https://doi.org/10.1097/00000658-199705000-00013(discussion 575–578) CrossRefPubMedPubMedCentral

23.

Antony AK, Robinson EC (2019) An algorithmic approach to prepectoral direct-to-implant breast reconstruction: version 2.0. Plast Reconstr Surg 143(5):1311–1319. https://doi.org/10.1097/prs.0000000000005519 CrossRefPubMed

24.

Baker BG, Irri R, MacCallum V, Chattopadhyay R, Murphy J, Harvey JR (2018) A prospective comparison of short-term outcomes of subpectoral and prepectoral strattice-based immediate breast reconstruction. Plast Reconstr Surg 141(5):1077–1084. https://doi.org/10.1097/PRS.0000000000004270 CrossRefPubMed

25.

Vidya R, Green M (2019) Minimal pain with prepectoral implant-based breast reconstruction. Plast Reconstr Surg 143(1):236e. https://doi.org/10.1097/PRS.0000000000005135 CrossRefPubMed

26.

Maruccia M, Mazzocchi M, Dessy LA, Onesti MG (2016) One-stage breast reconstruction techniques in elderly patients to preserve quality of life. Eur Rev Med Pharmacol Sci 20(24):5058–5066PubMed

27.

Maruccia M, Di Taranto G, Onesti MG (2018) One-stage muscle-sparing breast reconstruction in elderly patients: a new tool for retaining excellent quality of life. Breast J 24(2):180–183. https://doi.org/10.1111/tbj.12860 CrossRefPubMed

28.

Onesti MG, Maruccia M, Di Taranto G et al (2017) Clinical, histological, and ultrasound follow-up of breast reconstruction with one-stage muscle-sparing “wrap” technique: a single-center experience. J Plast Reconstr Aesthetic Surg JPRAS 70(11):1527–1536. https://doi.org/10.1016/j.bjps.2017.06.023 CrossRef

29.

Marcasciano M, Frattaroli J, Mori FLR et al (2019) The new trend of pre-pectoral breast reconstruction: an objective evaluation of the quality of online information for patients undergoing breast reconstruction. Aesthetic Plast Surg 43(3):593–599. https://doi.org/10.1007/s00266-019-01311-x CrossRefPubMed

30.

Casella D, Di Taranto G, Marcasciano M et al (2018) Subcutaneous expanders and synthetic mesh for breast reconstruction: long-term and patient-reported BREAST-Q outcomes of a single-center prospective study. J Plast Reconstr Aesthetic Surg JPRAS. https://doi.org/10.1016/j.bjps.2018.12.018 CrossRef

31.

Elswick SM, Harless CA, Bishop SN et al (2018) Prepectoral implant-based breast reconstruction with postmastectomy radiation therapy. Plast Reconstr Surg 142(1):1–12. https://doi.org/10.1097/PRS.0000000000004453 CrossRefPubMed

32.

Sbitany H, Gomez-Sanchez C, Piper M, Lentz R (2019) Prepectoral breast reconstruction in the setting of postmastectomy radiation therapy: an assessment of clinical outcomes and benefits. Plast Reconstr Surg 143(1):10–20. https://doi.org/10.1097/PRS.0000000000005140 CrossRefPubMed

33.

Ellis HL, Asaolu O, Nebo V, Kasem A (2016) Biological and synthetic mesh use in breast reconstructive surgery: a literature review. World J Surg Oncol 14:121. https://doi.org/10.1186/s12957-016-0874-9 CrossRef

34.

Moyer HR, Losken A (2012) Predicting mastectomy skin flap necrosis with indocyanine green angiography: the gray area defined. Plast Reconstr Surg 129(5):1043–1048. https://doi.org/10.1097/PRS.0b013e31824a2b02 CrossRefPubMed

35.

Komorowska-Timek E, Gurtner GC (2010) Intraoperative perfusion mapping with laser-assisted indocyanine green imaging can predict and prevent complications in immediate breast reconstruction. Plast Reconstr Surg 125(4):1065–1073. https://doi.org/10.1097/PRS.0b013e3181d17f80 CrossRefPubMed

Title: Skin-Reducing Mastectomy and Pre-pectoral Breast Reconstruction in Large Ptotic Breasts
Authors: Michele Maruccia
Rossella Elia
Angela Gurrado
Marco Moschetta
Eleonora Nacchiero
Alberto Bolletta
Mario Testini
Giuseppe Giudice
Publication date: 01-06-2020
Publisher: Springer US
Keywords: Wound Dehiscence
Mastectomy
Breast Cancer
Breast Cancer
Published in: Aesthetic Plastic Surgery / Issue 3/2020
Print ISSN: 0364-216X
Electronic ISSN: 1432-5241
DOI: https://doi.org/10.1007/s00266-020-01616-2

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Skin-Reducing Mastectomy and Pre-pectoral Breast Reconstruction in Large Ptotic Breasts

Abstract

Objectives

Materials and Methods

Results

Conclusion

Level of Evidence IV

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objectives

Materials and Methods

Results

Conclusion

Level of Evidence IV

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