by Lim, Geok Hoon;
Baildam, Andrew D.
Background:
Risk-reducing mastectomy with tissue expander and then implant-based breast
reconstruction conventionally involved immediate submuscular placement of
tissue expanders during mastectomy and then, after expansion, replacement of
expanders for permanent implants in a second-stage operation. Use of acellular
dermal matrix can achieve a single-stage operation; however, acellular dermal
matrices are costly and may have potential complications. The authors aim to
assess the feasibility of placement of implants as a first-stage procedure
before risk-reducing mastectomy as a novel technique of reconstruction that
avoids the need for serial outpatient expansion and acellular dermal matrix.
Methods:
Patients for whom risk-reducing mastectomy was planned were offered first-stage
dual-plane placement of fixed volume silicone gel permanent implants by means
of inframammary fold incisions. Risk-reducing mastectomy was undertaken several
months later as the second operation, leaving the implants in place protected
by the muscle and capsule pocket. Nipples were preserved or reconstructed
according to the patient’s choice.
Results:
Eight patients with 15 operated breasts were recruited. Anatomically shaped
implants were used in all patients, and complete coverage of each implant was
achieved. Mean implant volume was 433 ml (range, 290 to 545 ml). There were no
complications, and good aesthetic outcomes were achieved.
Conclusions: This
proof-of-principle study finds that placement of implants before risk-reducing
mastectomy is a novel technique for women at high breast cancer risk that could
reduce the use of tissue expanders and acellular dermal matrices and their associated
problems. Two-stage risk-reducing mastectomy with first-stage implant placement
and subsequent risk-reducing mastectomy leaving the implants in place is
feasible, with no complications, and can produce a good cosmetic outcome.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
