Pre-Pectoral Implant Based Breast Reconstruction
Association of Breast Surgery ePoster Library. Highton L. 05/15/17; 166297; P040
Ms. Lyndsey Highton
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Abstract
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Introduction
The conventional approach to implant-based breast reconstruction is for the implant to be placed behind the pectoralis major (PM) with or without acellular dermal matrices (ADM). Improved upper pole implant coverage with this technique comes with the disadvantages of post-operative pain, animation and PM functional pain. We report a case series of pre-pectoral implant based reconstruction.
Methods
A cohesive gel anatomical implant is placed in the pre-pectoral plane and completely covered with ADM. We use two sheets, which are sutured together and secured to the fascia of the PM, lateral chest wall and inframammary fold to contain the implant. Patients are discharged with drain(s) for 7 days and prescribed prophylactic antibiotics.
Results
To date, 145 breast reconstructions have been performed in 95 patients since January 2014. The indications were: risk-reducing mastectomy (40%), therapeutic mastectomy (25%), revision of previous sub-pectoral reconstruction (32%) and delayed expander reconstruction (3%). Mean age was 46 years (20-78 years), mastectomy weight 475g (73-1679g) and implant volume 432cc (165-620cc). Post-operative in-patient stay was 0.9 days (0-2) with a follow up of 362 days (10-1260). Implant loss occurred in 3%. Minor complications occurred in 11%. Revisional surgery has been required in 4.5%.
Conclusion
Pre-pectoral implant placement with total ADM coverage represents a novel approach to implant-based breast reconstruction. The technique is reliable in delivering excellent cosmetic results and patient satisfaction. Despite concerns, rippling has not been problematic. Patients are counselled on the potential advantages and disadvantages of pre and post pectoral reconstruction to ensure informed decision-making.
The conventional approach to implant-based breast reconstruction is for the implant to be placed behind the pectoralis major (PM) with or without acellular dermal matrices (ADM). Improved upper pole implant coverage with this technique comes with the disadvantages of post-operative pain, animation and PM functional pain. We report a case series of pre-pectoral implant based reconstruction.
Methods
A cohesive gel anatomical implant is placed in the pre-pectoral plane and completely covered with ADM. We use two sheets, which are sutured together and secured to the fascia of the PM, lateral chest wall and inframammary fold to contain the implant. Patients are discharged with drain(s) for 7 days and prescribed prophylactic antibiotics.
Results
To date, 145 breast reconstructions have been performed in 95 patients since January 2014. The indications were: risk-reducing mastectomy (40%), therapeutic mastectomy (25%), revision of previous sub-pectoral reconstruction (32%) and delayed expander reconstruction (3%). Mean age was 46 years (20-78 years), mastectomy weight 475g (73-1679g) and implant volume 432cc (165-620cc). Post-operative in-patient stay was 0.9 days (0-2) with a follow up of 362 days (10-1260). Implant loss occurred in 3%. Minor complications occurred in 11%. Revisional surgery has been required in 4.5%.
Conclusion
Pre-pectoral implant placement with total ADM coverage represents a novel approach to implant-based breast reconstruction. The technique is reliable in delivering excellent cosmetic results and patient satisfaction. Despite concerns, rippling has not been problematic. Patients are counselled on the potential advantages and disadvantages of pre and post pectoral reconstruction to ensure informed decision-making.
Introduction
The conventional approach to implant-based breast reconstruction is for the implant to be placed behind the pectoralis major (PM) with or without acellular dermal matrices (ADM). Improved upper pole implant coverage with this technique comes with the disadvantages of post-operative pain, animation and PM functional pain. We report a case series of pre-pectoral implant based reconstruction.
Methods
A cohesive gel anatomical implant is placed in the pre-pectoral plane and completely covered with ADM. We use two sheets, which are sutured together and secured to the fascia of the PM, lateral chest wall and inframammary fold to contain the implant. Patients are discharged with drain(s) for 7 days and prescribed prophylactic antibiotics.
Results
To date, 145 breast reconstructions have been performed in 95 patients since January 2014. The indications were: risk-reducing mastectomy (40%), therapeutic mastectomy (25%), revision of previous sub-pectoral reconstruction (32%) and delayed expander reconstruction (3%). Mean age was 46 years (20-78 years), mastectomy weight 475g (73-1679g) and implant volume 432cc (165-620cc). Post-operative in-patient stay was 0.9 days (0-2) with a follow up of 362 days (10-1260). Implant loss occurred in 3%. Minor complications occurred in 11%. Revisional surgery has been required in 4.5%.
Conclusion
Pre-pectoral implant placement with total ADM coverage represents a novel approach to implant-based breast reconstruction. The technique is reliable in delivering excellent cosmetic results and patient satisfaction. Despite concerns, rippling has not been problematic. Patients are counselled on the potential advantages and disadvantages of pre and post pectoral reconstruction to ensure informed decision-making.
The conventional approach to implant-based breast reconstruction is for the implant to be placed behind the pectoralis major (PM) with or without acellular dermal matrices (ADM). Improved upper pole implant coverage with this technique comes with the disadvantages of post-operative pain, animation and PM functional pain. We report a case series of pre-pectoral implant based reconstruction.
Methods
A cohesive gel anatomical implant is placed in the pre-pectoral plane and completely covered with ADM. We use two sheets, which are sutured together and secured to the fascia of the PM, lateral chest wall and inframammary fold to contain the implant. Patients are discharged with drain(s) for 7 days and prescribed prophylactic antibiotics.
Results
To date, 145 breast reconstructions have been performed in 95 patients since January 2014. The indications were: risk-reducing mastectomy (40%), therapeutic mastectomy (25%), revision of previous sub-pectoral reconstruction (32%) and delayed expander reconstruction (3%). Mean age was 46 years (20-78 years), mastectomy weight 475g (73-1679g) and implant volume 432cc (165-620cc). Post-operative in-patient stay was 0.9 days (0-2) with a follow up of 362 days (10-1260). Implant loss occurred in 3%. Minor complications occurred in 11%. Revisional surgery has been required in 4.5%.
Conclusion
Pre-pectoral implant placement with total ADM coverage represents a novel approach to implant-based breast reconstruction. The technique is reliable in delivering excellent cosmetic results and patient satisfaction. Despite concerns, rippling has not been problematic. Patients are counselled on the potential advantages and disadvantages of pre and post pectoral reconstruction to ensure informed decision-making.
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