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Review
. 2017:2017:6486859.
doi: 10.1155/2017/6486859. Epub 2017 Oct 2.

One-Stage Immediate Breast Reconstruction: A Concise Review

Nicolò Bertozzi  1   2 , Marianna Pesce  3   4 , Pierluigi Santi  3   4 , Edoardo Raposio  1   2
Affiliations
Review

One-Stage Immediate Breast Reconstruction: A Concise Review

Nicolò Bertozzi et al. Biomed Res Int. 2017.

Abstract

Background: One-stage direct-to-implant immediate breast reconstruction (IBR) is performed simultaneously with breast cancer resection. We explored indications, techniques, and outcomes of IBR to determine its feasibility, safety, and effectiveness.

Material and methods: We reviewed the available literature on one-stage direct-to-implant IBR, with or without acellular dermal matrix (ADM), synthetic mesh, or autologous fat grafting. We analyzed the indications, preoperative work-up, surgical technique, postoperative care, outcomes, and complications.

Results: IBR is indicated for small-to-medium nonptotic breasts and contraindicated in patients who require or have undergone radiotherapy, due to unacceptably high complications rates. Only patients with thick, well-vascularized mastectomy flaps are IBR candidates. Expandable implants should be used for ptotic breasts, while anatomical shaped implants should be used to reconstruct small-to-medium nonptotic breasts. ADMs can be used to cover the implant during IBR and avoid muscle elevation, thereby minimizing postoperative pain. Flap necrosis, reoperation, and implant loss are more common with IBR than conventional two-staged reconstruction, but IBR has advantages such as lack of secondary surgery, faster recovery, and better quality of life.

Conclusions: IBR has good outcomes and patient-satisfaction rates. With ADM use, a shift from conventional reconstruction to IBR has occurred. Drawbacks of IBR can be overcome by careful patient selection.

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Figures

Figure 1
Figure 1
Preoperative view (a) and postoperative result (b) after right breast skin-sparing mastectomy with radial lateral incision and one-stage implant-based reconstruction after. Nipple-areola complex was reconstructed with local flap and tattooing. Matching surgery of the left breast was not required.
Figure 2
Figure 2
Preoperative view (a) and postoperative result (b) after right breast nipple-sparing mastectomy with radial lateral incision and one-stage implant-based reconstruction. Left breast augmentation with periareolar incision and vertical extension was also performed.
See this image and copyright information in PMC

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