by Casella, Donato; Kaciulyte, Juste; Lo Torto, Federico;
Mori, Francesco L. R.; Barellini, Leonardo; Fausto, Alfonso; Fanelli,
Benedetta; Greco, Manfredi; Ribuffo, Diego; Marcasciano, Marco
Plastic and Reconstructive Surgery: June 2021 -
Volume 147 - Issue 6 - p 1278-1286
Background: Implant-based reconstruction is the most
performed breast reconstruction, and both subpectoral and prepectoral
approaches can lead to excellent results. Choosing the best procedure requires
a thorough understanding of every single technique, and proper patient selection
is critical to achieve surgical success, in particular when dealing with
prepectoral breast reconstruction.
Methods: Between January of 2014 and December of 2018,
patients undergoing mastectomy and eligible for immediate prepectoral breast
reconstruction with tissue expander or definitive implant, were selected. The
Prepectoral Breast Reconstruction Assessment score was applied to evaluate
patient-related preoperative and intraoperative risk factors that could
influence the success of prepectoral breast reconstruction. All patients were
scored retrospectively, and the results obtained through this assessment tool
were compared to the records of the surgical procedures actually performed.
Results: Three hundred fifty-two patients were included; 112
of them underwent direct-to-implant immediate reconstruction, and 240 underwent
the two-stage procedure with temporary tissue expander. According to the
Prepectoral Breast Reconstruction Assessment score, direct-to-implant
reconstruction should have been performed 6.2 percent times less, leading to an
increase of 1.4 percent in two-stage reconstruction and 4.8 percent in
submuscular implant placement.
Conclusions: To date, there is no validated system to guide
surgeons in identifying the ideal patient for subcutaneous or retropectoral
breast reconstruction and eventually whether she is a good candidate for
direct-to-implant or two-stage reconstruction. The authors processed a simple
risk-assessment score to objectively evaluate the patient’s risk factors, to
standardize the decision-making process, and to identify the safest and most
reliable breast reconstructive procedure. CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
