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. 2021 Feb 22;11(2):153.
doi: 10.3390/jpm11020153.

Immediate Prosthetic Breast Reconstruction after Nipple-Sparing Mastectomy: Traditional Subpectoral Technique versus Direct-to-Implant Prepectoral Reconstruction without Acellular Dermal Matrix

Gianluca Franceschini  1 , Lorenzo Scardina  1 , Alba Di Leone  1 , Daniela Andreina Terribile  1 , Alejandro Martin Sanchez  1 , Stefano Magno  1 , Sabatino D'Archi  1 , Antonio Franco  1 , Elena Jane Mason  1 , Beatrice Carnassale  1 , Federica Murando  1 , Armando Orlandi  2 , Liliana Barone Adesi  3 , Giuseppe Visconti  3 , Marzia Salgarello  3 , Riccardo Masetti  1
Affiliations

Immediate Prosthetic Breast Reconstruction after Nipple-Sparing Mastectomy: Traditional Subpectoral Technique versus Direct-to-Implant Prepectoral Reconstruction without Acellular Dermal Matrix

Gianluca Franceschini et al. J Pers Med. .

Abstract

Background: The aim of this study was to compare outcomes of immediate prosthetic breast reconstruction (IPBR) using traditional submuscular (SM) positioning of implants versus prepectoral (PP) positioning of micropolyurethane-foam-coated implants (microthane) without further coverage.

Methods: We retrospectively reviewed the medical records of breast cancer patients treated by nipple-sparing mastectomy (NSM) and IPBR in our institution during the two-year period from January 2018 to December 2019. Patients were divided into two groups based on the plane of implant placement: SM versus PP.

Results: 177 patients who received IPBR after NSM were included in the study; implants were positioned in a SM plane in 95 patients and in a PP plane in 82 patients. The two cohorts were similar for mean age (44 years and 47 years in the SM and PP groups, respectively) and follow-up (20 months and 16 months, respectively). The mean operative time was 70 min shorter in the PP group. No significant differences were observed in length of hospital stay or overall major complication rates. Statistically significant advantages were observed in the PP group in terms of aesthetic results, chronic pain, shoulder dysfunction, and skin sensibility (p < 0.05), as well as a trend of better outcomes for sports activity and sexual/relationship life. Cost analysis revealed that PP-IPBR was also economically advantageous over SM-IPBR.

Conclusions: Our preliminary experience seems to confirm that PP positioning of a polyurethane-coated implant is a safe, reliable and effective method to perform IPBR after NSM.

Keywords: acellular dermal matrix (ADM); aesthetic and oncological outcomes; breast cancer; immediate breast reconstruction; nipple-sparing mastectomy; quality of life.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A case of nipple-sparing mastectomy and direct-to-implant prepectoral reconstruction without acellular dermal matrix. (a,b) Preoperative pictures of a 43-year-old right-breast cancer patient for whom right nipple-sparing mastectomy and direct-to-implant prepectoral reconstruction without acellular dermal matrix were planned. (c,d) Six-month postoperative pictures after right nipple-sparing mastectomy through a radial lateral incision (mastectomy specimen 190 g) and prepectoral reconstruction using a definitive anatomical implant (Polytech 30746, 295cc) with a micropolyurethane-foam-coated shell surface, placed in the subcutaneous plane.
Figure 2
Figure 2
A case of nipple-sparing mastectomy and direct-to-implant submuscular reconstruction. (a,b) Preoperative pictures of a 47-year-old bilateral-breast cancer patient for whom bilateral nipple-sparing mastectomy and direct-to-implant submuscular reconstruction without acellular dermal matrix were planned. (c,d) Six-month postoperative pictures after bilateral nipple-sparing mastectomy through a radial lateral incision.
See this image and copyright information in PMC

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