Immediate Prepectoral Breast Reconstruction in Suboptimal Patients Using an Air-filled Spacer

Abstract

Introduction: Immediate prepectoral breast reconstruction offers excellent aesthetic results with less pain and elimination of animation deformity due to avoidance of pectoralis dissection and subpectoral implant placement. Concerns about the effects of prostheses on flap perfusion have limited use of the technique to highly selected patients. We present a series of "suboptimal" patients that have undergone immediate prepectoral breast reconstruction utilizing an air-filled "spacer" implant.

Methods: A single surgeon's experience with immediate, single-stage prepectoral breast reconstruction using a Spectrum implant was retrospectively reviewed. Patient demographics, adjuvant therapies, risk factors for threatened flaps, and complications, including those that required subsequent intervention, were evaluated.

Results: Twenty-five patients (39 breasts) underwent immediate prepectoral reconstruction with a Spectrum implant. Ten patients had minor complications, 6 of whom required intervention with successful correction. There was a single case of implant loss in the series; this patient had prior radiation.

Conclusions: Utilizing the spacer concept, immediate single-stage prepectoral breast reconstruction is a viable alternative to subpectoral implant placement or delay procedures. The technique delivers aesthetic results with less postoperative pain, quicker operative times, and avoidance of animation deformity. It can be considered for any patient, including high-risk patients such as those with radiation exposure, thin/threatened skin flaps, significant ptosis, and obesity.

Fig. 1.

Empty Spectrum implant, which functions as a prepectoral spacer.

Fig. 2.

(A) An empty Spectrum implant is placed in the prepectoral position. (B) Once skin flap circulation is deemed appropriate, further air is injected through the subcutaneous fill port. (C) Serial injections of air are performed until the final desired size is achieved. (D) Air is replaced with saline and the injection port removed, leaving the patient with a permanent saline implant.

Fig. 3.

(A) 56-year-old woman with markedly ptotic breast and right breast carcinoma. (B) Early postoperative result. Flaps noted to be compromised. (C) Necrosis of flap. (D) Implant emptied, flap debrided and closed. (E) air removed and replaced with saline for final result.

Fig. 4.

(A) 50-year-old woman with invasive ductal carcinoma of the right breast. (B) Skin closure after implant placement, circulation compromised. (C) Immediate postoperative result. (D) Final result following fat grafting.

Fig. 5.

(A) 50-year-old patient with left breast carcinoma. (B) Circulation to skin flaps noted to be compromised intraoperatively so air was removed from the implant to relieve pressure. (C) Once circulation improved, air was added to the implant. (D) Once final size and shape was achieved, air was replaced with saline. (E) Implant was replaced with silicone gel implant.