Contralateral Augmentation with a Transmidline Scarless Technique During Unilateral Breast Reconstruction Using Implants

Abstract

Background: Unilateral breast reconstruction can be a challenge when attempting to achieve an aesthetically pleasing and symmetrical breast mound on the contralateral side. This study investigates the outcomes of using a contralateral augmentation transmidline scarless (CATS) technique to simultaneously augment the contralateral breast using implants.

Methods: Between January 2004 and July 2016, patients undergoing unilateral implant-based breast reconstruction and simultaneous contralateral implant augmentation using a transmidline access were studied. Characteristics and complications using this technique were assessed.

Results: Sixty-five (91.5%) of 71 patients used the CATS technique for unilateral breast reconstruction using implants with contralateral breast implant augmentation. The remaining 6 cases used a preexisting chest scar. In the assessment of complication rates between the reconstructed and augmented sides, the reconstructed side had a statistically significant higher rate of implant exposure (P = 0.04) and total complications (P = 0.02). In comparing the revision rates between these 2 groups, the need for implant change (P = 0.04) and the total revision rates (P = 0.01) were higher in the reconstructive side. Use of saline implants had a higher rate of chest wall and breast skin necrosis (P = 0.03) in comparison with silicone implants. There was not a statistically significant difference in complications when comparing timing of reconstructions (immediate versus delayed).

Conclusions: The CATS technique can be performed safely, with a desirable aesthetic outcome, and also symmetry with minimal risk of symmastia during unilateral breast reconstruction using implant-based reconstruction.

Fig. 1.

Preoperative markings for breast exchange of the tissue expander on the right side with a permanent implant while simultaneously augmenting the left breast with an implant using the CATS technique.

Fig. 2.

Development of a 3-cm opening through the transmidline approach and placement of a saline implant (in this patient) in the submuscular plane for contralateral augmentation with a transmidline scarless approach.

Fig. 3.

Placement of 2 sizers into the contralateral and ipsilateral breasts, assessment of symmetry with the patient in an upright sitting position, and decision making for implant size selection.

Fig. 4.

Surface landmarks for the third and fifth rib (black arrows). Location of midline dissection of the contralateral pectoralis major to create the 3 cm (saline implant) or 5 cm (silicone implant) tunnel at the midline (green arrow). Placement of 2 horizontal mattress sutures at the transmidline incision to fixate the midline area between the breasts (red arrows).

Fig. 5.

Preoperative and 1 month postoperative photographs of a patient with 360 cc saline implant for left reconstruction and 185 cc saline implant for contralateral augmentation using this CATS technique.

Fig. 6.

Preoperative (A) and 20 months’ postoperative (B-C) photographs of a patient with silicone implants using a 2-stage implant reconstruction with the CATS technique: right breast skin-sparing mastectomy and immediate tissue expander insertion with subsequent exchange of a tissue expander for a permanent 320 cc silicone implant and simultaneous contralateral augmentation with a 220 cc silicone implant.