by Mosharrafa, Ali M.; Mosharrafa, Tamir M.; Zannis, Victor
J.
Plastic and
Reconstructive Surgery: May 2020 -
Volume 145 - Issue 5 - p 1125-1133
Background:
Direct-to-implant breast reconstruction continues to grow in popularity among
reconstructive breast surgeons and patients alike. Women with large breasts and
ptosis are often thought not to be candidates for nipple sparing or
direct-to-implant reconstruction. The authors utilized a single-stage,
nipple-sparing, direct-to-implant reconstruction with simultaneous mastopexy,
while the nipple-areolar complex was kept viable on an inferiorly based
adipodermal flap in a single stage. They report their experience and outcomes
using this approach in women with breast ptosis and/or macromastia.
Methods: The
authors reviewed all direct-to-implant reconstructions with simultaneous
nipple-sparing mastopexies performed from June of 2015 to March of 2019.
Sixty-five patients and 125 breast reconstructions were analyzed.
Results: Among
the 65 patients (125 breast reconstructions), 15 (23 percent) had implants
placed in the prepectoral space, and 50 (77 percent) had them placed
subpectorally. Forty-seven patients (72 percent) had acellular dermal matrix
used. Partial nipple-areolar complex necrosis occurred in six patients (9
percent). Other complications included partial mastectomy flap necrosis (n = 8
patients, 12 percent), implant exposure (n = 3, 4 percent), infection (n = 1, 1
percent), capsular contracture (n = 4, 6 percent), and reoperation (n = 11, 16
percent). Mean follow-up was 17 months (range, 3 to 47 months). There have been
no cancer recurrences reported in any participants to date.
Conclusions:
Nipple-sparing mastectomy with mastopexy and immediate direct-to-implant
reconstruction dramatically improved the authors’ results for implant-based
breast reconstruction patients. The higher than expected explantation rate of 7
percent early in the study has since improved. This approach provides an
opportunity to expand indications for nipple-sparing mastectomy and direct-to-implant
reconstruction to women with breast ptosis and/or macromastia. CLINICAL
QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
