PRIMARY STUDY ON IMPLANT COVERAGE WITH LOCAL SOFT TISSUE IN IMMEDIATE IMPLANT-BASED BREAST RECONSTRUCTION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIGuangxue , MULan , LIUYan ,  YANGKai , PENGZhe , BIYe

Department of Aesthetic Surgery, Peking University People's Hospital, Beijing, 100044, P.R.China;

Corresponding author：

YANGKai, Email: mulan666@aliyun.com

Keywords：

Immediate breast reconstruction; Mastectomy; Pectoralis muscle; Serratus anterior muscle; Rectus sheath

DOI：

10.7507/1002-1892.20160076

Video：

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Objective To explore the method of implant coverage with local soft tissue in immediate implant-based breast reconstruction and to evaluate the early effectiveness. Methods Between April 2014 and August 2015, 11 patients with breast cancer underwent immediate breast reconstruction with implants after mastectomy, and the clinical data were reviewed retrospectively. The age ranged 29-48 years (mean, 36 years). The disease duration was from 7 days to 12 months (median, 3 months). According to tumor staging, 3 cases were rated as T_isN₀M₀, 4 cases as T₁N₀M₀, and 4 cases as T₂N₀M₀. The implants were covered with local soft tissue according to the volume of mastectomy and contralateral breast size, including pectoralis major myocutaneous flaps with inframammary adipofasical flaps (3 cases), with serratus anterior fascial flap (5 cases), with rectus sheath fascial flap (1 case), and with serratus anterior fascial flap and rectus sheath fascial flap (2 cases). The size of pectoralis major myocutaneous flaps ranged from 15 cm×9 cm to 20 cm×15 cm, and the serratus anterior fascial flaps from 10 cm×8 cm to 15 cm×10 cm, and the rectus sheath fascial flap from 8 cm×6 cm to 10 cm×8 cm. Results One patient had partial nipple necrosis postoperatively and was cured, and no other postoperative complications of hematoma, infection, or implant exposure was found. The patients were followed up 4-13 months (median, 8 months). The reconstructive outcomes were excellent in 10 cases and good in 1 case, with an excellent and good rate of 100%. During follow-up, no rupture or exposure of the implant was observed; capsular contracture (Baker grade II) occurred in 1 case. Conclusion Adequate coverage of implants with different local soft tissue flaps can achieve satisfactory early effectiveness in immediate implant-based breast reconstruction after mastectomy.

Citation： LIGuangxue, MULan, LIUYan, YANGKai, PENGZhe, BIYe. PRIMARY STUDY ON IMPLANT COVERAGE WITH LOCAL SOFT TISSUE IN IMMEDIATE IMPLANT-BASED BREAST RECONSTRUCTION. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(3): 385-388. doi: 10.7507/1002-1892.20160076 Copy

1.	Mowlds DS, Salibian AA, Scholz T, et al. Capsular contracture in implant-based breast reconstruction: examining the role of acellular dermal matrix fenestrations. Plast Reconstr Surg, 2015, 136(4): 629-635.
2.	Scheflan M, Colwell AS. Tissue reinforcement in implant-based breast reconstruction. Plast Reconstr Surg Glob Open, 2014, 2(8): e192.
3.	Zhao X, Wu X, Dong J, et al. A meta-analysis of postoperative complications of tissue expander/implant breast reconstruction using acellular dermal matrix. Aesthetic Plast Surg, 2015, 39(6): 892-901.
4.	董洁, 吴小蔚, 田方兴.脱细胞真皮基质对扩张器/假体乳房再造并发症影响的Meta分析.中华整形外科杂志, 2013, 29(5): 356-361.
5.	Munhoz AM, Aldrighi C, Montag E, et al. Optimizing the nipple-areola sparing mastectomy with double concentric periareolar incision and biodimensional expander-implant reconstruction: aesthetic and technical refinements. Breast, 2009, 18(6): 356-367.
6.	Salgarello M, Visconti G, Barone-Adesi L. Nipple-sparing mastectomy with immediate implant reconstruction: cosmetic outcomes and technical refinements. Plast Reconstr Surg, 2010, 126(5): 1460-1471.
7.	Moyer HR, Ghazi B, Daniel JR, et al. Nipple-sparing mastectomy: technical aspects and aesthetic outcomes. Ann Plast Surg, 2012, 68(5): 446-450.
8.	Mosahebi A, Ramakrishnan V, Gittos M, et al. Aesthetic outcome of different techniques of reconstruction following nipple-areola-preserving envelope mastectomy with immediate reconstruction. Plast Reconstr Surg, 2007, 119(3): 796-803.
9.	Rodriguez-Unda N, Leiva S, Cheng HT, et al. Low incidence of complications using polyglactin 910 (Vicryl) mesh in breast reconstruction: A systematic review. J Plast Reconstr Aesthet Surg, 2015, 68(11): 1543-1549.
10.	Haynes DF, Kreithen JC. Vicryl mesh in expander/implant breast reconstruction: long-term follow-up in 38 patients. Plast Reconstr Surg, 2014, 134(5): 892-899.
11.	Dikmans RE, El Morabit F, Ottenhof MJ, et al. Single-stage breast reconstruction using Strattice TM: A retrospective study. J Plast Reconstr Aesthet Surg, 2015. [Epub ahead of print].
12.	Saint-Cyr M, Dauwe P, Wong C, et al. Use of the serratus anterior fascia flap for expander coverage in breast reconstruction. Plast Reconstr Surg, 2010, 125(4): 1057-1064.
13.	Isken T, Onyedi M, Izmirli H, et al. Abdominal fascial flaps for providing total implant coverage in one-stage breast reconstruction: an autologous solution. Aesthetic Plast Surg, 2009, 33(6): 853-858.
14.	Kim YW, Kim YJ, Kong JS, et al. Use of the pectoralis major, serratus anterior, and external oblique fascial flap for immediate one-stage breast reconstruction with implant. Aesthetic Plast Surg, 2014, 38(4): 704-710.
15.	D'Alessio R, Razzano S, D'Alessio M, et al. The rectus sheath and serratus fascia "reverse" fashion flap for the coverage of the lower pole in immediate implant-based breast reconstruction. J Plast Reconstr Aesthet Surg, 2015, 68(6): 868-870.
16.	Uda H, Tomioka YK, Sugawara Y, et al. Shaping of the unaffected breast with brava-assisted autologous fat grafting to obtain symmetry after breast reconstruction. Aesthet Surg J, 2015, 35(5): 565-573.
17.	Wang T, He J, Xu H, et al. Achieving symmetry in unilateral DIEP flap breast reconstruction: an analysis of 126 cases over 3 years. Aesthetic Plast Surg, 2015, 39(1): 63-68.
18.	Salgarello M, Visconti G, Barone-Adesi L, et al. Contralateral breast symmetrisation in immediate prosthetic breast reconstruction after unilateral nipple-sparing mastectomy: the tailored reduction/augmentation mammaplasty. Arch Plast Surg, 2015, 42(3): 302-308.

1. Mowlds DS, Salibian AA, Scholz T, et al. Capsular contracture in implant-based breast reconstruction: examining the role of acellular dermal matrix fenestrations. Plast Reconstr Surg, 2015, 136(4): 629-635.
2. Scheflan M, Colwell AS. Tissue reinforcement in implant-based breast reconstruction. Plast Reconstr Surg Glob Open, 2014, 2(8): e192.
3. Zhao X, Wu X, Dong J, et al. A meta-analysis of postoperative complications of tissue expander/implant breast reconstruction using acellular dermal matrix. Aesthetic Plast Surg, 2015, 39(6): 892-901.
4. 董洁, 吴小蔚, 田方兴.脱细胞真皮基质对扩张器/假体乳房再造并发症影响的Meta分析.中华整形外科杂志, 2013, 29(5): 356-361.
5. Munhoz AM, Aldrighi C, Montag E, et al. Optimizing the nipple-areola sparing mastectomy with double concentric periareolar incision and biodimensional expander-implant reconstruction: aesthetic and technical refinements. Breast, 2009, 18(6): 356-367.
6. Salgarello M, Visconti G, Barone-Adesi L. Nipple-sparing mastectomy with immediate implant reconstruction: cosmetic outcomes and technical refinements. Plast Reconstr Surg, 2010, 126(5): 1460-1471.
7. Moyer HR, Ghazi B, Daniel JR, et al. Nipple-sparing mastectomy: technical aspects and aesthetic outcomes. Ann Plast Surg, 2012, 68(5): 446-450.
8. Mosahebi A, Ramakrishnan V, Gittos M, et al. Aesthetic outcome of different techniques of reconstruction following nipple-areola-preserving envelope mastectomy with immediate reconstruction. Plast Reconstr Surg, 2007, 119(3): 796-803.
9. Rodriguez-Unda N, Leiva S, Cheng HT, et al. Low incidence of complications using polyglactin 910 (Vicryl) mesh in breast reconstruction: A systematic review. J Plast Reconstr Aesthet Surg, 2015, 68(11): 1543-1549.
10. Haynes DF, Kreithen JC. Vicryl mesh in expander/implant breast reconstruction: long-term follow-up in 38 patients. Plast Reconstr Surg, 2014, 134(5): 892-899.
11. Dikmans RE, El Morabit F, Ottenhof MJ, et al. Single-stage breast reconstruction using Strattice TM: A retrospective study. J Plast Reconstr Aesthet Surg, 2015. [Epub ahead of print].
12. Saint-Cyr M, Dauwe P, Wong C, et al. Use of the serratus anterior fascia flap for expander coverage in breast reconstruction. Plast Reconstr Surg, 2010, 125(4): 1057-1064.
13. Isken T, Onyedi M, Izmirli H, et al. Abdominal fascial flaps for providing total implant coverage in one-stage breast reconstruction: an autologous solution. Aesthetic Plast Surg, 2009, 33(6): 853-858.
14. Kim YW, Kim YJ, Kong JS, et al. Use of the pectoralis major, serratus anterior, and external oblique fascial flap for immediate one-stage breast reconstruction with implant. Aesthetic Plast Surg, 2014, 38(4): 704-710.
15. D'Alessio R, Razzano S, D'Alessio M, et al. The rectus sheath and serratus fascia "reverse" fashion flap for the coverage of the lower pole in immediate implant-based breast reconstruction. J Plast Reconstr Aesthet Surg, 2015, 68(6): 868-870.
16. Uda H, Tomioka YK, Sugawara Y, et al. Shaping of the unaffected breast with brava-assisted autologous fat grafting to obtain symmetry after breast reconstruction. Aesthet Surg J, 2015, 35(5): 565-573.
17. Wang T, He J, Xu H, et al. Achieving symmetry in unilateral DIEP flap breast reconstruction: an analysis of 126 cases over 3 years. Aesthetic Plast Surg, 2015, 39(1): 63-68.
18. Salgarello M, Visconti G, Barone-Adesi L, et al. Contralateral breast symmetrisation in immediate prosthetic breast reconstruction after unilateral nipple-sparing mastectomy: the tailored reduction/augmentation mammaplasty. Arch Plast Surg, 2015, 42(3): 302-308.

Chinese Journal of Reparative and Reconstructive Surgery

PRIMARY STUDY ON IMPLANT COVERAGE WITH LOCAL SOFT TISSUE IN IMMEDIATE IMPLANT-BASED BREAST RECONSTRUCTION

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