Breast animation deformity

Three and twelve-month analysis of the PROM-Q study: comparison of patient-reported outcome measures using the BREAST-Q questionnaire in pre- vs. sub-pectoral implant-based immediate breast reconstruction

PURPOSE

Implant-based breast reconstruction (IBR) is being increasingly performed with implant placed above the pectoral muscle (pre-pectoral), instead of below the pectoral muscle (sub-pectoral). Currently, there is a lack of comparative data on clinical and patient-perceived outcomes between pre- vs. sub-pectoral IBR. We investigated whether this difference in surgical approach influenced clinical or patient-perceived outcomes.

METHODS

This prospective non-randomised longitudinal cohort study (ClinicalTrials.gov identifier: NCT04842240) recruited patients undergoing immediate IBR at the Leeds Breast Unit (Sep 2019-Sep 2021). Data collection included patient characteristics and post-operative complications. Patient-Reported Outcome Measures were collected using the BREAST-Q questionnaire at baseline, 2 weeks, 3- and 12-months post-surgery.

RESULTS

Seventy-eight patients underwent IBR (46 patients pre-pectoral; 59% vs. 32 patients sub-pectoral; 41%). Similar complication rates were observed (15.2% pre-pectoral vs. 9.4% sub-pectoral; p = 0.44). Overall implant loss rate was 3.8% (6.5% pre-pectoral vs. 0% sub-pectoral; p = 0.13). Respective median Breast-Q scores for pre- and sub-pectoral IBR at 3 months were: breast satisfaction (58 vs. 48; p = 0.01), psychosocial well-being (60 vs. 57; p = 0.9), physical well-being (68 vs. 76; p = 0.53), and Animation Q scores (73 vs. 76; p = 0.45). Respective Breast-Q scores at 12 months were: breast satisfaction (58 vs. 53; p = 0.3), psychosocial well-being (59 vs. 60; p = 0.9), physical well-being (68 vs. 78; p = 0.18), and Animation Q scores (69 vs. 73; p = 0.4).

CONCLUSIONS

This study demonstrates equivalent clinical and patient-perceived outcomes between pre- and sub-pectoral IBR. The study findings can be utilised to aid informed decision making regarding either surgical option.

Early Experience of Direct-to-Implant Breast Reconstruction Using Acellular Dermal Matrix after Robot-Assisted Nipple-Sparing Mastectomy

BACKGROUND

The authors performed a retrospective review to analyze operative outcomes of breast mound reconstruction after robot-assisted mastectomy.

METHODS

Patients who underwent nipple-sparing mastectomy (NSM) with a robotic device (Da Vinci Xi) and immediate prepectoral prosthetic reconstruction by lateral incision from June of 2018 to July of 2019 were enrolled. Patient characteristics, complications, and satisfaction rates as assessed by BREAST-Q were analyzed. The surgical technique was described in detail.

RESULTS

Thirty-nine cases, including 7 bilateral cases (total 46 breasts), underwent robot-assisted NSM followed by immediate prepectoral prosthetic implant reconstruction. The median patient age was 46.63 years (range, 21 to 63 years). The mean operation time for each prepectoral breast mound reconstruction using the direct-to-implant technique was 126.55 minutes. Robot-assisted reconstruction resulted in superior BREAST-Q scores compared with the conventional reconstruction method. Major infection occurred in 7 cases (15.2%), and complete nipple loss occurred in 3 cases (6.6%). Severe complications requiring breast implant removal occurred in 4 breasts (8.7%). Two cases were due to the coexistence of infection and skin necrosis; in 1 case, the skin flap became congested on postoperative day 3 and required additional surgery to change the expander. Other complications were resolved with conservative care or minor revision.

CONCLUSIONS

This report is the first concerning robot-assisted NSM followed by prepectoral acellular dermal matrix-wrapped prosthetic reconstruction. This procedure was not inferior to other methods. Further prospective research to evaluate oncologic outcomes is warranted.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Prepectoral Breast Reconstruction with Prosthesis and Acellular Dermal Matrix: A New Technique of ADM Implantation and Fixation

Background

Direct-to-implant (DTI) immediate breast reconstruction has proven to be an oncologically safe technique and linked to better overall results. The introduction of new surgical techniques has prompted us to develop an acellular dermal matrix fixation technique that reduces the rate of complications and implant loss.

Methods

We retrospectively analyzed data from patients who underwent DTI prepectoral breast reconstruction with two different techniques of acellular dermal matrix fixation to the chest wall. Descriptive statistics were reported using frequencies and percentages for categorical variables, and means and SDs for continuous variables. Pearson chi-square test was used to compare differences in categorical variables. Univariable and multivariable logistic regression models were fitted to investigate the predictors of complications.

Results

From October 2019 to March 2023, 90 DTI breast reconstructions were performed, 43 using the standard technique and 47 using the new technique. The new technique demonstrated a significant reduction of major complications (P = 0.010), namely seroma (13.9% versus 2.3%), skin necrosis (9.3% versus 2.3%), implant loss (7% versus 0%), wound dehiscence (9.3% versus 0%), and infection (4.7% versus 0%). Compared with the standard technique, the new one reduced the risk of complications by 76% (OR 0.24; 95% confidence interval 0.09-0.68; P = 0.007) and 73% (aOR 0.27; 95% confidence interval 0.08-0.92; P = 0.037), at univariable and multivariable regression models. No other significant predictor of complications was identified.

Conclusions

The procedure performed with the proposed modality proved to be advantageous. Careful fixation of the prosthetic implant and the placement of two drains, were the keys to a drastic reduction in complications.

Local Flaps to Cover Skin Necrosis after Skin-sparing Mastectomy and Prepectoral Reconstruction from PreQ-20 Trial

Background

In recent years, mastectomy has increasingly been indicated for women at high risk and those with breast cancer. Prepectoral reconstruction with polyurethane implant is an option for these patients. Nevertheless, this procedure can become complicated with exposure of the implant. The aim of this article is to describe the feasibility of local flaps to treat skin necrosis and dehiscence after prepectoral reconstruction and its impact on implant loss.

Methods

This study includes the women who met the inclusion/exclusion criteria of the PreQ-20 protocol (12), which assessed patients with exposed implant who required a local flap for its coverage. Three types of flaps were used: thoracoepigastric, lateral thoracic, and batwing.

Results

The study included 226 skin-sparing mastectomies and immediate reconstruction using prepectoral implants (52.7% bilateral mastectomies). Some 20.9% of the patients showed complications, with wound dehiscence the most frequent. Thirteen local flaps to cover the implant were performed. All flaps presented appropriate perfusion; however, the implant cover failed in six patients (46.2%).

Conclusions

The use of local flaps can be a low-morbidity option for preventing implant loss when skin dehiscence or necrosis occurs and delays in oncology treatments.

Recurrent Breast Animation after Conversion from Dual Plane to Prepectoral Breast Implant Placement

Conversion to a prepectoral implant pocket is considered the definitive treatment for breast animation after implant-based breast reconstruction. Although subtle movement of implants placed in the prepectoral plane may be noted on clinical examination by experienced surgeons, current data demonstrate complete resolution of animation deformity with prepectoral implant placement. We present the case of a middle-aged women who underwent breast implant pocket conversion from dual-plane to prepectoral plane for treatment of animation deformity. Although her postoperative recovery was unremarkable with initial resolution of animation, recurrent implant animation was evident on 3-month follow-up. Recurrent breast animation after conversion from dual-plane to prepectoral implant pocket is highly unusual and unreported in the current literature. Although revision surgery may identify potential causes, larger-scale research on contributing factors will be valuable in developing strategies to prevent recurrent animation after conversion to a prepectoral implant pocket.

Literature review and guide for optimal position in implant-based breast reconstruction

Background and Objective

Identification of ideal candidates for prepectoral versus retropectoral implant-based breast reconstruction relies on careful preoperative risk assessment and intraoperative flap evaluation. Few guidelines exist to guide the surgeon's decision-making process when evaluating the preferred plane for implant placement.

Methods

A literature review was performed to develop clinical decision-making algorithms for direct-to-implant (DTI) reconstruction with acellular dermal matrix (ADM) for patients undergoing prophylactic or therapeutic nipple-sparing mastectomy (NSM) based on patient characteristics, surgical techniques, and outcomes.

Key Content and Findings

Prepectoral reconstruction is most suitable for patients with small breasts or macromastia with desire for breast reduction, low-grade ptosis, smaller implant sizes, those undergoing PMRT, and for those who aim to mitigate animation deformity and capsular contracture. Retropectoral reconstruction may be recommended for patients with larger breasts with no desire for size change requiring additional prosthesis support, and in patients who aim to reduce likelihood of rippling and need for subsequent fat grafting procedures to address contour abnormalities.

Conclusions

Careful preoperative and intraoperative assessment of reconstruction options for patients undergoing implant-based breast reconstruction is necessary to mitigate complications and produce superior aesthetic outcomes. Decision algorithms may be used to determine ideal surgical techniques based on patient factors, like radiation history and planning, breast size and ptosis, and patient preferences.

ADM-assisted prepectoral breast reconstruction is not associated with high complication rate as before: a Meta-analysis

Implant-related breast reconstruction can be divided into subpectoral breast reconstruction (SPBR) and prepectoral breast reconstruction (PPBR) according to the different anatomical planes. The previous stereotype was that PPBR had a high complication rate and was not suitable for clinical use. However, with the emergence of acellular dermal matrix (ADM), the clinical effect of PPBR has been improved. To compare the outcomes difference between SPBR and PPBR, We conducted this meta-analysis. Articles on SPBR versus PPBR were searched in PubMed, Web of Sciences, Embase, and Cochrane databases, strictly following the PRISMA guidelines. According to the set criteria, we included the literature that met the requirements. Extracted data were the incidence of adverse events and the duration of drainage. Results show that SPBR has a higher incidence rate in capsular contracture, animation deformity, infection, hematoma and delayed healing wound than PPBR. There are no significant differences in skin flap necrosis, seroma, implant loss, reoperation and duration of drainage between the two groups. Hence, PPBR is no longer a high complication surgical method and can be used in the clinical practice. However, there are few large sample studies at present, so it is necessary to carry out further studies on PPBR.

Advances in Prepectoral Breast Reconstruction

Breast reconstruction can be divided into prepectoral breast reconstruction (PPBR) and subpectoral breast reconstruction (SPBR) according to the implant plane. The original prepectoral breast reconstruction was abandoned for a long time due to the frequent and severe complications. Now, advances in materials technology and improved methods of mastectomy have made safe prepectoral breast reconstruction possible. Moreover, a number of studies have gradually demonstrated the advantages of prepectoral breast reconstruction. As prepectoral breast reconstruction becomes more and more attractive, it is time to review the current advances in prepectoral breast reconstruction.

Prepectoral Versus Subpectoral Implant-Based Breast Reconstruction: A Systemic Review and Meta-analysis

BACKGROUND

Implant-based breast reconstruction (IBBR) remains the standard and most popular option for women undergoing breast reconstruction after mastectomy worldwide. Recently, prepectoral IBBR has resurged in popularity, despite limited data comparing prepectoral with subpectoral IBBR.

METHODS

A systematic search of PubMed and Cochrane Library from January 1, 2011 to December 31, 2021, was performed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) reporting guidelines, data were extracted by independent reviewers. Studies that compared prepectoral with subpectoral IBBR for breast cancer were included.

RESULTS

Overall, 15 studies with 3,101 patients were included in this meta-analysis. Our results showed that patients receiving prepectoral IBBR experienced fewer capsular contractures (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.32-0.92; P = 0.02), animation deformity (OR, 0.02; 95% CI, 0.00-0.25; P = 0.002), and prosthesis failure (OR, 0.58; 95% CI, 0.42-0.80; P = 0.001). There was no significant difference between prepectoral and subpectoral IBBR in overall complications (OR, 0.83; 95% CI, 0.64-1.09; P = 0.19), seroma (OR, 1.21; 95% CI, 0.59-2.51; P = 0.60), hematoma (OR, 0.76; 95% CI, 0.49-1.18; P = 0.22), infection (OR, 0.87; 95% CI, 0.63-1.20; P = 0.39), skin flap necrosis (OR, 0.70; 95% CI, 0.45-1.08; P = 0.11), and recurrence (OR, 1.31; 95% CI, 0.52-3.39; P = 0.55). Similarly, no significant difference was found in Breast-Q scores between the prepectoral and subpectoral IBBR groups.

CONCLUSIONS

The results of our systematic review and meta-analysis demonstrated that prepectoral, implant-based, breast reconstruction is a safe modality and has similar outcomes with significantly lower rates of capsular contracture, prosthesis failure, and animation deformity compared with subpectoral, implant-based, breast reconstruction.

Single-stage Layered versus Nonlayered Mastopexy with Augmentation in Muscle Splitting Biplane: A Comparative Analysis

Single-stage layered mastopexy with augmentation is a modification of muscle-splitting pocket that reduces risk of complications and revision rate.

Evaluation of Breast Animation Deformity following Pre- and Subpectoral Direct-to-Implant Breast Reconstruction: A Randomized Controlled Trial

Background  The incidence of breast animation deformity (BAD) is reported to be substantial after direct-to-implant breast reconstruction with subpectoral implant placement. It has, however, never been examined if BAD can occur following prepectoral implant placement. Our primary aim was to compare the incidence and degree of BAD after direct-to-implant breast reconstruction using either subpectoral or prepectoral implant placement. Secondary aim of this study was to assess and compare the level of pain between sub- and prepectoral reconstructed women. Methods  In this randomized controlled trial, patients were allocated to reconstruction by either subpectoral or prepectoral implant placement in accordance with the CONSORT guidelines. The degree of BAD was assessed by the "Nipple, Surrounding skin, Entire breast (NSE)" grading scale 12 months after surgery. The level of postoperative pain was assessed on a numerical pain rating scale. Results  We found a significant difference in the degree of BAD favoring patients in the prepectoral group (23.8 vs. 100%, p  < 0.0001; mean NSE grading scale score: 0.4 vs. 3.6, p  < 0.0001). The subpectoral reconstructed group reported higher levels of pain on the three subsequent days after surgery. No significant difference in pain levels could be found at 3 months postoperatively. Conclusion  The incidence and degree of BAD was significantly lower in women reconstructed by prepectoral direct-to-implant breast reconstruction. Unexpectedly, we found mild degrees of BAD in the prepectoral group. When assessing BAD, distortion can be challenging to discern from rippling.

Pectoral Muscle Re-Attachment with Breast Implant Removal

Breast implant removal is an increasingly requested procedure. An uncommon but important reason for this is breast animation deformity (BAD). Although methods such as the split muscle have been used for prevention and correction of animation deformity successfully for many years, [1, 2] we occasionally see patients who have undergone explantation and present with unresolved animation. These patients have had prior unsuccessful attempts at correction by further muscle release, and explantation was done as a final attempt at resolution. We regard muscle re-attachment as key to correction of animation. Herein we present illustrative cases and discuss technical points.

Breast Animation Deformity: A Retrospective Study on Long-Term and Patient-Reported Breast-Q Outcomes

BACKGROUND

We evaluated the aesthetic outcomes and quality of life of patients who underwent neurotomy of the lateral and medial branch of the pectoralis nerve for animation deformity after breast reconstruction.

MATERIAL AND METHODS

Health-related quality of life questionnaire and cosmetic outcome evaluation were conducted using the preoperative and the postoperative BREAST-Q modules for reconstructive surgery. An external author also assessed the general aesthetic outcome before and after surgery.

RESULTS

Sixty-two patients with animation deformity after breast reconstruction were enrolled: 43 in group 1 (second-stage breast reconstruction), 10 in group 2 (permanent breast prosthesis), and 9 in group 3 (Baker III-IV capsular contraction). Patients scored high level of satisfaction with outcome concerning all aspects of the survey. Overall satisfaction with breast was significantly increased after surgery in all the 3 groups, whereas physical well-being was improved in group 1 and group 3 and psychosocial well-being was improved in group 1. General outcome evaluation by an external author, compared with the preoperative condition, also showed significant improvement.

CONCLUSIONS

Section of the lateral and medial branches of the pectoralis nerve represents an easy and reproducible technique, associated with low morbidity and very good results in terms of patient satisfaction, comfort, and hospitalization.

Revisionary Surgery Following Primary Augmentation Mammoplasty in Muscle Splitting Biplane Pocket: An Appraisal of 93 Revisionary Surgeries

BACKGROUND

Muscle splitting augmentation mammoplasty is the creation of a submuscular pocket which is gaining attention and acceptance by plastic surgeons worldwide. First introduced in 2007, muscle splitting augmentation mammoplasty has since been used for primary and secondary augmentation mammoplasty and augmentation mastopexy procedures. A personal experience of revision surgeries following muscle splitting augmentation mammoplasty is presented.

METHODS

A retrospective data analysis for revision surgeries, following muscle splitting primary augmentation mammoplasties, performed between October 2005 and October 2018 was carried out.

RESULTS

A total of 1511 primary augmentation mammoplasties were performed. Of these 1511 patients, 93 (6.1%) patients had revisionary or secondary surgery. The mean age of the patients was 33.8 + 9 years (range 20-60). Of the 93 patients, 78 patients had same size implants, mean 337 cc + 53.5 (range 230-495), and 14 had different size implants. Of these 14 patients, mean implant size on right and left was 331 cc + 59.4 (range 225-425) and 351 cc + 61.7 (range 260-450), respectively. Of the recorded texturing in 1495 patients, only 3.1% had smooth implants. Leading causes for revision were implant exchange for various reasons, in 33 (35.4%); 25 (26.8%) wanted larger implants, revisionary surgery for capsular contracture in 18 (19.3%), implant rupture was seen in 9 (9.6%), 4 (4.3%) patients had surgery for recurrent back-to-front flipping, 2 (2.1%) patients wanted a smaller size, 1 (1.07%) patient had fold flaw failure, and in 1 (1.07%) the cause was not recorded. There were no haematoma and breast implant-associated anaplastic large cell lymphoma (BIA ALCL) recorded in the series.

CONCLUSION

The incidence of revisionary surgery following muscle splitting primary augmentation mammoplasty is acceptable and can be corrected using the described techniques.

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 .

Hot Topics in Breast Surgery

Since the first implant-based breast surgeries were performed nearly 70 years ago, breast augmentation it has changed drastically. As understanding of breast augmentation has advanced, so too have the technologies and techniques used to improve results and minimize the risk of complications in breast implant surgery. This article reviews some of the novel techniques and technologies used today in breast augmentation surgery. How these tools and techniques will withstand the test of time remains to be seen, but they no doubt will add to the fascinating and ever-evolving history of breast augmentation.

Prepectoral implant pocket conversion in breast reconstruction

Introduction

While many authors have reported their experience in immediate prepectoral breast reconstruction (BR), implant pocket conversion from a submuscular to a prepectoral plane is less well described. The aim of this study is to provide a comprehensive review on plane conversion in implant-based BR, including the indications, surgical techniques, functional, and esthetic results.

Materials and Methods

A literature search via PubMed, Medline, Google Scholar, and Cochrane databases was performed using the following MeSH terms: “prepectoral pocket conversion”, “subcutaneous pocket conversion”, “prepectoral plane conversion”, “subcutaneous plane conversion”, and “prepectoral breast reconstruction”.

Results

Ten articles in which 504 breasts were studied were deemed eligible for inclusion. The indications to perform plane conversion were animation deformity (AD), chronic pain, and implant malposition. Seven studies described complete or partial capsulectomy. The use of acellular dermal matrices (ADM) was reported in all cases except for three studies. The mean follow-up was 10.64 months. There was resolution of AD in 100% of cases. Three studies reported complete resolution of chronic pain. The overall complication rate was 12.102% and capsular contracture (CC) was the most frequent complication. Cosmetic revisions were reported in six studies (9.52%). The use of ADMs and fat grafting appeared to decrease the rate of subsequent CC formation and cosmetic revisions.

Conclusions

The current article represents the first review about implant pocket conversion from a submuscular to a prepectoral plane, delineating its indications, surgical technique, postoperative complications, and functional and esthetic outcomes.

Does Implant Surface Texture Affect the Risk of Capsular Contracture in Subglandular Breast Augmentation and Breast Augmentation-Mastopexy?

BACKGROUND

Previous studies have reported decreased rates of capsular contracture associated with the use of textured surface breast implants placed in the subglandular plane during breast augmentation. However, since the publication of these studies, our understanding of the pathophysiology of capsular contracture, as well as the surgical techniques utilized to minimize bacterial contamination of the implant, have advanced considerably.

OBJECTIVES

The purpose of this study was to re-evaluate the relation between implant surface texturization and capsular contracture rates for breast implants placed in the subglandular plane during primary breast augmentation.

METHODS

Retrospective chart review was performed of all primary subglandular breast augmentation procedures involving the use of either smooth or textured round silicone gel implants, with or without simultaneous mastopexy. The primary outcome measures included clinically significant capsular contracture (Baker grade III/IV) and revision surgery for capsular contracture.

RESULTS

Between 2010 and 2017, 526 patients underwent primary subglandular breast augmentation with either smooth (n = 212) or textured (n = 314) round silicone gel implants; 248 patients underwent breast augmentation, whereas 278 underwent breast augmentation-mastopexy. Average follow-up was 756 days in the textured group and 461 days in the smooth group. Five cases of capsular contracture were observed in the textured group, and 7 cases of capsular contracture were observed in the smooth group (P = 0.20).

CONCLUSIONS

Smooth surface implants placed in the subglandular plane were not at a significantly increased risk of capsular contracture compared with textured surface implants. We suggest that adherence to a surgical technique focused on minimizing bacterial contamination of the implant is of greater clinical significance than implant surface characteristics when discussing capsular contracture.

LEVEL OF EVIDENCE: 4

Muscle Splitting Augmentation Mammoplasty: A 13-Year Outcome Analysis of 1511 Primary Augmentation Mammoplasties

BACKGROUND

Augmentation mammoplasty is a commonly performed procedure by plastic surgeons with a high satisfaction outcome. Muscle splitting augmentation mammoplasty was first described in 2007 and has been since used for primary and secondary augmentation mammoplasty as well as for primary and secondary augmentation mastopexy procedures.

METHODS

A retrospective analysis of data for muscle splitting primary augmentation mammoplasties performed between October 2005 and October 2018 was carried out.

RESULTS

A total of 1511 patients had their primary augmentation mammoplasty consecutively performed in muscle splitting pocket. Mean age of the patient was 29.4 ± 8.56 years (range 18-67). Of the 1502 patients with documented implant sizes, 1272 patients had same-size implants, mean 340 cc ± 58.3 (range 170-700), and 230 patients had two different-size implants for correction of asymmetry. Of these 230 patients, mean implant size on right and left was 341 cc ± 61.5 (range 200-655) and 345 cc ± 67.4 (range 200-605), respectively. Of the 1495 known texturing, only 3.1% patients had smooth implants. Periprosthetic infection was seen in 10 patients, 38 patients had wound-healing issues and 5 patients had late seroma. Capsular contracture (CC) was recorded at three monthly, six monthly, one yearly and two yearly or longer period. Secondary procedures were performed for various reasons in 93 (6.15%) of the patients. Leading causes for revision were implant exchange in 33 (2.2%), to go for bigger size in 25 (1.65%), CC in 18 (1.2%) and implant rupture in 9 (0.6%). There was no ALCL recorded in the series.

CONCLUSION

Muscle splitting pocket for primary augmentation mammoplasty is a reliable, reproducible procedure with acceptable revision rate.

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 Authorswww.springer.com/00266.

A simple clinical assessment of breast animation deformity following direct-to-implant breast reconstruction

BACKGROUND

A high incidence of breast animation deformity (BAD) has been reported following immediate breast reconstruction with subpectorally placed implants. The aim of this study was to assess and compare the incidence of BAD in women who underwent either subpectoral or prepectoral immediate breast reconstruction. Therefore, we developed a grading tool and tested its reproducibility in a clinical setting.

METHODS

Video recordings of 37 women who had undergone unilateral or bilateral immediate breast reconstruction were evaluated by two consultant plastic surgeons. The degree of BAD was assessed by our grading tool, named the Nipple, Surrounding Skin, Entire Breast (NSE) grading scale, which evaluates the degree of tissue distortion in three areas of the breast. Blinded assessments were performed twice by each observer.

RESULTS

Eighteen patients were reconstructed with subpectoral implant placement and 19 with prepectoral implant placement. Using the NSE grading scale, we found a significant difference in the degree of BAD between the groups, in favor of patients who underwent prepectoral immediate breast reconstruction (0.2 vs. 4, P=0.000). Inter- and intraobserver agreement was moderate (74%) to strong (88%).

CONCLUSIONS

The incidence and severity of BAD was significantly lower in women reconstructed with a prepectorally placed implant than in those who underwent subpectoral immediate breast reconstruction. All patients reconstructed using the subpectoral technique had some degree of BAD. The inter- and intraobserver agreements were high when using the NSE grading scale, suggesting it is an easy-to-use, reproducible scale for assessing BAD in women who undergo immediate breast reconstruction.

Visualized pre- and subpectoral implant placement for immediate breast reconstruction

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.