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Gunnarsson GL, Salzberg CA. Current status of pre- and retropectoral breast reconstructions worldwide: a narrative review. Gland Surg 2024; 13:1305-1314. [PMID: 39175699 PMCID: PMC11336793 DOI: 10.21037/gs-24-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 06/21/2024] [Indexed: 08/24/2024]
Abstract
Background and Objective Advances in breast cancer research and technology contribute to conservative ablative surgical approach with emphasis on reconstruction. The introduction of biologic membranes in breast surgery facilitates a one-stage implant reconstruction while the importance of the pectoralis major muscle involvement in the procedure becomes debatable. A subsequent increase in prepectoral implant placement procedures seems to close a cycle of innovations in implant-based breast reconstructions. This sparks a debate that calls for a critical review of existing literature considering that new challenges tend to arise along with new perspectives. The authors seek to scope the present status of prepectoral and subpectoral implant reconstruction worldwide, and answer recurring questions, including the novelty of presented innovations in the context of existing literature. Methods The article is based on a literature search in PubMed with the keywords "prepectoral" or "subpectoral" and "breast reconstruction", in addition to the authors' experience with a large number of patients. Key Content and Findings Recent studies focus on the comparative safety of prepectoral vs. subpectoral placement debating the use of biologic vs. non-biologic sheets and implant texture. There seems to be more emphasis on early post-operative safety of the procedures, rather than any long-term prospects of their comparison, up to this point. Skin and nipple sparing mastectomy (SSM/NSM) together with biological membranes have played a key role in current practice and cannot be overlooked. Conclusions After reading this paper, the reader should have a firm understanding of the key elements of implant-based breast reconstruction in historical context with emphasis on muscle planes and their pros and cons.
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Duet M, Pestana IA. Outcomes of Nipple-Sparing Mastectomy in the Ptotic and Non-Ptotic Breast with Staged-Immediate Reconstruction Timing and Pre-Pectoral, Direct-to-Implant Technique. Cureus 2023; 15:e42363. [PMID: 37621816 PMCID: PMC10445411 DOI: 10.7759/cureus.42363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
Background and objectives Proven to be oncologically safe, nipple-sparing mastectomy (NSM) preserves the entire breast skin envelope and is associated with higher patient satisfaction. However, breast ptosis is a relative contraindication to NSM, limiting who it is offered to. Direct-to-implant (DTI) breast reconstruction eliminates tissue expansion and shortens the reconstructive process but may be associated with mastectomy skin flap compromise after the placement of full-volume implants. Staged-immediate (SI) reconstruction initiates reconstruction two to three weeks after mastectomy. This timing and its use in DTI pre-pectoral (PP) breast reconstruction have not been reported. We aim to describe the outcomes of SI DTI PP reconstruction following NSM of ptotic and non-ptotic breasts. Methods Retrospective analysis utilizing descriptive statistics was completed evaluating patients who underwent nipple-sparing mastectomy with staged-immediate, pre-pectoral, direct-to-implant reconstruction by the senior author over a three-year period. Results and conclusions With SI timing, the majority of mastectomy-related problems occurred prior to implant placement, likely mitigating their effects on reconstruction following NSM, regardless of ptosis grade. Although a second procedure is needed for this reconstructive timing variation, over 50% of women achieved reconstruction completion at implant placement without further revision. These findings support the utility of SI timing in PP DTI reconstruction following NSM.
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Affiliation(s)
- Mary Duet
- Plastic and Reconstructive Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, USA
| | - Ivo A Pestana
- Plastic and Reconstructive Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, USA
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Sub-Muscular Direct-to-Implant Immediate Breast Reconstruction in Previously Irradiated Patients Avoiding the Use of ADM: A Preliminary Study. J Clin Med 2022; 11:jcm11195856. [PMID: 36233723 PMCID: PMC9573151 DOI: 10.3390/jcm11195856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The aim of this paper is to present a preliminary experience of sub-muscular primary direct-to-implant (DTI) breast reconstruction without acellular dermal matrix (ADM), after salvage mastectomy for local recurrence following prior irradiation. METHODS A retrospective investigation was performed on a prospectively maintained database of breast reconstruction cases at our institution between January 2015 and December 2020. We considered only immediate DTI breast reconstructions without ADM following radiotherapy and salvage mastectomy for local recurrence, with at least a 12-month follow-up. RESULTS The study considered 18 female patients with an average of 68 years. According to the BREAST-Q questionnaire, all patients reported high levels of "satisfaction with outcome" with good "psychosocial wellness" and "physical impact" related to the reconstruction. The aesthetic evaluation showed a significant difference between the VAS score gave by the patient (mean 6.9) and the surgeon (mean 5.4). No implant exposure occurred in this series. In terms of complications, four patients (22%) suffered from wound dehiscence and were managed conservatively. Three patients (17%) required primary closure in day surgery following superficial mastectomy flap necrosis. Late capsular contracture was seen in seven patients (four Baker stage II and three Baker stage III, totally 39%); however, no patient was willing to undergo implant exchange. CONCLUSIONS DTI breast reconstruction following prior irradiation can be considered as an option in patients who are not good candidates for autologous breast reconstruction. Our general outcomes compared favorably with literature data regarding the use of staged procedures, with acceptable complication rates and levels of patient satisfaction.
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Tondu T, Thiessen F, Hubens G, Tjalma W, Blondeel P, Verhoeven V. Delayed two-stage nipple sparing mastectomy and simultaneous expander-to-implant reconstruction of the large and ptotic breast. Gland Surg 2022; 11:524-534. [PMID: 35402205 PMCID: PMC8984988 DOI: 10.21037/gs-21-734] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/28/2022] [Indexed: 08/10/2023]
Abstract
BACKGROUND Large and ptotic breasts are considered an anatomical contraindication for nipple sparing mastectomy (NSM). Necrosis rates can be as high as 76%. The authors examined whether targeted preshaping mastopexy/reduction combined with simultaneous two-stage preshaping of the implant pocket prepares for an uneventful implant reconstruction. METHODS Macromastia and ptosis patients opting for risk-reducing NSM or having a peripherally localized carcinoma in situ, were offered a two-stage mastopexy/reduction simultaneously with preshaping of the implant pocket by subpectoral expansion. Only the inferior pedicle bearing the nipple-areola complex (NAC), remained. A delayed secondary NSM and tissue expander-to-implant reconstruction was scheduled 3 months later. The use of an acellular dermal matrix (ADM) was not necessary because the capsule around the expander created a hammock supporting the definite prosthesis. Follow up was at 2 weeks, 3 months, and 6 months. RESULTS Forty-one procedures were performed in 24 patients. The mean age was 45±12.08 years (range, 22 to 72 years). Patients' mean body mass index (BMI) was 26.79 kg/m2 (range, 19 to 35 kg/m2). One patient had diabetes and two smoked. One transient epidermolysis of the NAC occurred in each stage. No NAC or skin necrosis occurred; no implant had to be removed. CONCLUSIONS A two-stage mastopexy/reduction, simultaneously with preshaping of the implant pocket by tissue expansion and followed by a 3-month delayed secondary NSM with tissue expander-to-implant reconstruction is a safe technique in large ptotic breasts.
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Affiliation(s)
- Thierry Tondu
- Department of Abdominal, Pediatric and Reconstructive Surgery, Plastic Surgery Unit, Antwerp University Hospital, Antwerp, Belgium
- Multidisciplinary Breast Clinic, Unit of Gynecologic Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Filip Thiessen
- Department of Abdominal, Pediatric and Reconstructive Surgery, Plastic Surgery Unit, Antwerp University Hospital, Antwerp, Belgium
- Multidisciplinary Breast Clinic, Unit of Gynecologic Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Guy Hubens
- Department of Abdominal, Pediatric and Reconstructive Surgery, Plastic Surgery Unit, Antwerp University Hospital, Antwerp, Belgium
| | - Wiebren Tjalma
- Multidisciplinary Breast Clinic, Unit of Gynecologic Oncology, Antwerp University Hospital, Antwerp, Belgium
- Department of Obstetrics and Gynecology, Antwerp University Hospital, Antwerp, Belgium
| | - Phillip Blondeel
- Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Veronique Verhoeven
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Breast Splint for Prevention of Nipple-areolar Complex Malposition after Direct-to-implant Breast Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e3965. [PMID: 34987948 PMCID: PMC8721646 DOI: 10.1097/gox.0000000000003965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/06/2021] [Indexed: 12/02/2022]
Abstract
Breast reconstruction with immediate placement of breast implants (direct-to-implant methods) following nipple-sparing mastectomy has increased because of the low burden on the patient and good aesthetic results. However, nipple–areolar complex (NAC) malposition after this surgery remains a common complication that has yet to be entirely resolved. Here, we introduce an approach using Duoactive CGF to prevent postoperative NAC malposition. Immediate postoperative fixation of Duoactive CGF cranially to the NAC of the operated breast was applied for 2–4 weeks. This is referred to as a breast splint. In the study, nine patients who received breast splints and 15 patients who did not were enrolled. The NAC position on the splint-treated breast was compared with that on the healthy side within 6 months after surgery. A case with little visual malposition was defined as having a good outcome, based on the deviation in the cranial direction not exceeding the position of the contralateral NAC. Our preliminary data demonstrated that the rate of good outcomes was significantly higher (P = 0.028) in cases in which a breast splint was used, compared with those that were not treated with a breast splint (7/9, 78.8% versus 4/15, 26.7%). Postoperative application of a breast splint using Duoactive CGF is a simple and useful method to prevent NAC malposition after breast reconstruction, using a direct-to-implant method.
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Invited Discussion on: "Sub-Muscular Reconstruction After NAC Sparing Mastectomy: Direct to Implant Based Reconstruction with Human ADM Versus Tissue Expander". Aesthetic Plast Surg 2021; 45:421-422. [PMID: 33205221 DOI: 10.1007/s00266-020-02044-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 11/02/2020] [Indexed: 10/23/2022]
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Li Y, Wang X, Thomsen JB, Nahabedian MY, Ishii N, Rozen WM, Long X, Ho YS. Research trends and performances of breast reconstruction: a bibliometric analysis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1529. [PMID: 33313274 PMCID: PMC7729324 DOI: 10.21037/atm-20-3476] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background The need for postmastectomy breast reconstruction surgery has increased dramatically, and significant progress has been made both in implant and autologous based breast reconstruction in recent decades. In this paper, we performed a bibliometric analysis with the aim of providing an overview of the developments in breast reconstruction research and insight into the research trends. Methods We searched the Science Citation Index Expanded database and the Web of Science Core Collection for articles published between 1991 to 2018 in the topic domain, using title, abstract, author keywords, and KeyWords Plus. Four citation indicators TCyear, Cyear, C0 and CPPyear were employed to help analyse the identified articles. Results The number of scientific articles in breast reconstruction in this period steadily increased. It took most articles nearly a decade to hit a plateau in terms of citation counts. Plastic and Reconstructive Surgery, Annals of Plastic Surgery, and Journal of Plastic Reconstructive and Aesthetic Surgery published the largest number of articles on breast reconstruction. Nine of the top ten most prolific publications were based in the USA. The research highlights related to breast reconstruction were implant-based breast reconstruction, deep inferior epigastric perforator (DIEP) flap breast reconstruction, and superficial inferior epigastric artery (SIEA) flap breast reconstruction. Conclusions This bibliometric analysis yielded data on citation number, publication outputs, categories, journals, institutions, countries, research highlights and tendencies. It helps to picture the panorama of breast reconstruction research, and guide the future research work.
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Affiliation(s)
- Yunzhu Li
- Department of Plastic Surgery, Peking Union Medical College (PUMC) Hospital, PUMC and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaojun Wang
- Department of Plastic Surgery, Peking Union Medical College (PUMC) Hospital, PUMC and Chinese Academy of Medical Sciences, Beijing, China
| | - Jørn Bo Thomsen
- Department of Plastic Surgery, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Denmark
| | - Maurice Y Nahabedian
- Department of Plastic Surgery, Virginia Commonwealth University, Inova Branch, Falls Church, Virginia, USA
| | - Naohiro Ishii
- Department of Plastic and Reconstructive Surgery, International University of Health and Welfare Hospital, Japan
| | - Warren M Rozen
- Department of Plastic and Reconstructive Surgery, Frankston Hospital, Australia
| | - Xiao Long
- Department of Plastic Surgery, Peking Union Medical College (PUMC) Hospital, PUMC and Chinese Academy of Medical Sciences, Beijing, China
| | - Yuh-Shan Ho
- Trend Research Centre, Asia University, Taichung, Taiwan
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Quinn EM, Barry M, Kell M. Immediate implant reconstruction using absorbable TIGR mesh after nipple-sparing mastectomy. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-019-01603-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tondu T, Hubens G, Tjalma WA, Thiessen FE, Vrints I, Van Thielen J, Verhoeven V. Breast reconstruction after nipple-sparing mastectomy in the large and/or ptotic breast: A systematic review of indications, techniques, and outcomes. J Plast Reconstr Aesthet Surg 2020; 73:469-485. [PMID: 31987776 DOI: 10.1016/j.bjps.2019.11.047] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 11/22/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Surgeons remain reluctant to perform nipple-sparing mastectomy (NSM) in large breasts due to a higher risk of necrosis. We performed a systematic review of the literature to evaluate indications, techniques, and outcomes in immediate or delayed breast reconstructions in large and/or ptotic breasts. METHODS The following search terms were used for both titles and key words: [NSM AND ("breast ptosis" OR "ptotic breast" OR "large breast" OR "breast hypertrophy" OR "gigantomastia")]. All forms of breast reconstruction in large and/or ptotic breasts from 1990 through September 1st 2018 reporting indications, techniques, and outcomes were included. RESULTS Thirty-one studies met the inclusion criteria, yielding 1128 NSMs (709 immediate and 419 delayed) in 629 patients for analysis. The overall complication rate was 29.08%. The mastectomy flap necrosis rate was 12%, the partial nipple-areola complex (NAC) necrosis 11%, and the complete NAC rate 11%. The overall complication rate in one-stage versus delayed reconstructions was 37.52% versus 14.8%. The incidence of necrosis in one-stage versus delayed reconstructions was 5.36% versus 2.15% for partial, 5.08% versus 0.48% for complete NAC necrosis, and 4.8% versus 1.43% for skin flap necrosis. CONCLUSIONS The majority of studies being small and retrospective as well as the large variation in outcomes indicates that we lack consensus on the timing of reconstruction or ideal technique. A noticeable difference in skin flap and NAC necrosis, however, is seen in the favor of NAC-delayed procedures. Randomized controlled trials are mandatory to prove this difference significantly.
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Affiliation(s)
- Thierry Tondu
- Department of Abdominal, Pediatric and Reconstructive Surgery, Plastic Surgery Unit, Antwerp University Hospital, Antwerp, Belgium; Multidisciplinary Breast Clinic, Unit of Gynecologic Oncology, Antwerp University Hospital, Antwerp, Belgium; Clinic 12B, Plastic Surgery Private Clinic, Antwerp, Belgium.
| | - Guy Hubens
- Department of Abdominal, Pediatric and Reconstructive Surgery, Plastic Surgery Unit, Antwerp University Hospital, Antwerp, Belgium
| | - Wiebren Aa Tjalma
- Clinic 12B, Plastic Surgery Private Clinic, Antwerp, Belgium; Department of Obstetrics and Gynecology, Antwerp University Hospital, Antwerp, Belgium
| | - Filip Ef Thiessen
- Department of Abdominal, Pediatric and Reconstructive Surgery, Plastic Surgery Unit, Antwerp University Hospital, Antwerp, Belgium; Multidisciplinary Breast Clinic, Unit of Gynecologic Oncology, Antwerp University Hospital, Antwerp, Belgium; Clinic 12B, Plastic Surgery Private Clinic, Antwerp, Belgium
| | - Ina Vrints
- Department of Abdominal, Pediatric and Reconstructive Surgery, Plastic Surgery Unit, Antwerp University Hospital, Antwerp, Belgium; Multidisciplinary Breast Clinic, Unit of Gynecologic Oncology, Antwerp University Hospital, Antwerp, Belgium; Clinic 12B, Plastic Surgery Private Clinic, Antwerp, Belgium
| | | | - Veronique Verhoeven
- Department of Primary and Interdisciplinary Care (ELIZA), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Tasoulis MK, Teoh V, Khan A, Montgomery C, Mohammed K, Gui G. Acellular dermal matrices as an adjunct to implant breast reconstruction: Analysis of outcomes and complications. Eur J Surg Oncol 2019; 46:511-515. [PMID: 31706716 DOI: 10.1016/j.ejso.2019.10.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/20/2019] [Accepted: 10/31/2019] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Acellular dermal matrices (ADM) are increasingly used in implant-based breast reconstruction (IBR). Uncertainty remains with regard to their efficacy and complications. The aim of this study was to evaluate the outcomes and complication rates associated with the use of ADMs in IBR. METHODS Retrospective cohort study of patients undergoing ADM-assisted IBR between 2008 and 2013. Cases were identified from a prospectively collected database. Simple descriptive statistics and logistic regression analysis were performed. RESULTS A total of 110 patients (175 mastectomies) were included in the analysis. The median age was 46 (19-75) years and the median BMI was 22.2 (16.2-41.5). Seventy nine mastectomies were performed for therapeutic purposes. The median mastectomy weight was 244 (185-335) gr. The majority of reconstructions were performed with fixed volume (n = 115, 66%) or permanent expandable implants (n = 53, 30%) as one-stage procedures. Forty mastectomies were associated with at least one complication. The infection rate was 2.3% (n = 4). Post-operative haematoma developed in 5 cases (2.9%), but only 2 required surgical interventions. Three mastectomies were complicated by nipple necrosis (3.6%), 3 with skin necrosis (1.7%) and 9 with wound dehiscence (5.1%). The capsule formation rate was 2.3% (n = 4). Reconstruction failure with implant loss occurred in 3 cases (1.7%). CONCLUSIONS The complication rates following ADM-assisted IBR can be very low with appropriate patient selection and meticulous surgical technique. This supports the safety of using ADM in carefully selected patients. Further research is warranted to assess the health economics of ADM use in IBR.
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Affiliation(s)
| | - Victoria Teoh
- Breast Surgery Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Ayesha Khan
- Breast Surgery Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Catherine Montgomery
- Breast Surgery Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Kabir Mohammed
- Research and Development Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, UK
| | - Gerald Gui
- Breast Surgery Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
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Bille C, Dalaei F, Thomsen JB. Identifying the dissection plane for mastectomy-description and visualization of our technique. Gland Surg 2019; 8:S276-S280. [PMID: 31709167 PMCID: PMC6819889 DOI: 10.21037/gs.2019.05.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/06/2019] [Indexed: 11/06/2022]
Abstract
In this visualized surgery paper, we present our experience identifying the optimal dissection plane in nipple-sparing mastectomy using hydrodissection through an inframammary incision. The surgical technique comprises of preoperative magnetic resonance imaging (MRI) aiming to assess the thickness and expected quality of the mastectomy flaps, an inframammary incision, and hydrodissection to assist the surgeon in identifying the optimal dissection plane. This surgical method results in an adequate resection of breast parenchyma to obtain the best oncological outcome, while retaining the maximum amount of subcutaneous adipose tissue on the skin flaps to achieve a superior aesthetic result resembling the natural breast. The mastectomy flap thickness and quality can then be assessed prior to an immediate reconstruction.
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Affiliation(s)
- Camilla Bille
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Farima Dalaei
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Jørn Bo Thomsen
- Department of Plastic Surgery, Odense University Hospital and Lillebaelt Hospital, Vejle, Denmark
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Dyrberg DL, Bille C, Gunnarsson GL, Sørensen JA, Thomsen JB. Visualized pre- and subpectoral implant placement for immediate breast reconstruction. Gland Surg 2019; 8:S251-S254. [PMID: 31709163 PMCID: PMC6819886 DOI: 10.21037/gs.2019.05.09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/27/2019] [Indexed: 11/06/2022]
Abstract
The use of mesh for immediate breast reconstruction was introduced almost two decades ago. Lately, the number of prepectoral direct to implant breast reconstructions has increased as this technique seems to leave an unimpaired muscle function and may lead to less or no breast animation deformity (BAD) and quicker recovery. However, challenges still remain as there is a risk of thin tissue coverage, visible implant edges and secondary ptosis. In this visualized surgery paper, we visualize the technical disparities between the sub- and prepectoral direct to implant breast reconstruction.
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Affiliation(s)
- Diana L Dyrberg
- Department of Plastic Surgery, Odense University Hospital, Odense/Lillebaelt Hospital, Vejle, Denmark
| | - Camilla Bille
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | | | - Jens A Sørensen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Jørn B Thomsen
- Department of Plastic Surgery, Odense University Hospital, Odense/Lillebaelt Hospital, Vejle, Denmark
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