Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul 18:9:935410.
doi: 10.3389/fsurg.2022.935410. eCollection 2022.

Immediate direct-to-implant breast reconstruction: A single center comparison between different procedures

Francesco Klinger  1 , Andrea Lisa  1 , Alberto Testori  2 , Stefano Vaccari  1 , Valeria Bandi  1 , Valerio Lorenzano  1 , Marco Klinger  1 , Corrado Tinterri  3 , Valeriano Vinci  4   5
Affiliations

Immediate direct-to-implant breast reconstruction: A single center comparison between different procedures

Francesco Klinger et al. Front Surg. .

Abstract

Background: The increased incidence of conservative mastectomy operations (nipple- and skin- sparing) has increased the frequency of immediate breast reconstructions (IBR). In order to guarantee patients the best possible aesthetic outcome, the least chance of complications and moreover, the least postoperative pain, the technique with prepectoral prosthetic pocket was recently reconsidered with the use of ADM. This is the first study using Fortiva® in prepectoral breast reconstruction, and it compares the outcomes of three different patient populations (undergoing retromuscular, prepectoral and prepectoral reconstruction with ADM). The authors suggest that prepectoral breast reconstruction with ADM may bring benefits compared to the current standard technique (retromuscular) as well as compared to the prepectoral reconstruction without ADM.

Methods: Retrospective data analysis of patients who underwent mastectomy followed by immediate breast reconstruction with silicone implants (DTI), performed by a team of breast surgeons and plastic surgeons. Logistic factor regressions were performed in order to investigate the effects of the three different intervention techniques on the incidence of complications. Fisher's exact test was used to analyze the differences in the occurrence of each complication. Mann Whitney test was used to compare the averages of referred pain. A p value <0.05 was considered significant.

Results: A total of 67 patients underwent DTI reconstruction, of which 43 with retromuscular prosthesis, 13 prepectoral and 11 prepectoral with ADM. We found a significantly lower incidence of surgical complications with ADM, exclusively in comparison with retromuscular reconstruction (p = 0.028). It emerges prepectoral reconstruction with ADM involves significantly less visibility of the implant than both the prepectoral surgery without ADM (p = 0.013) and the retromuscular technique (p = 0.029). Finally, postoperative pain referred at twelfth month is significantly less relevant in the group with prepectoral prosthesis and ADM, both in the group with retromuscular (p < 0.001) and prepectoral without ADM (p = 0.001).

Conclusions: This study demonstrates that immediate prepectoral breast reconstruction with ADM is a safe and reliable technique, able to exceed some type of limits imposed by prepectoral reconstruction. Moreover, it provides benefits if compared to the current standard technique. In the future, this technique could also be added to it, after a proper selection of patients in pre- and intraoperative time.

Keywords: acellular dermal matrix; breast implants; breast reconstruction; direct to implant (DTI); prepectoral breast reconstruction; subcutaneous breast reconstruction.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
IBR with retromuscular implantation, preceded by monolateral nipple-sparing mastectomy. Pre- (left) and post-operative photos (right).
Figure 2
Figure 2
IBR with prepectoral implantation, preceded bilateral nipple-sparing mastectomy. Pre- (left) and post- operative photos (right).
Figure 3
Figure 3
IBR with prepectoral implantation and ADM Fortiva®, preceded by bilateral nipple-sparing mastectomy. Pre- (left) and post-operative photos (right).
Figure 4
Figure 4
ADM cut to better adapt to the prosthesis and its fixation with stitches.
Figure 5
Figure 5
Prosthesis wrapped in ADM ready for implantation.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Bertozzi N, Pesce M, Santi P, Raposio E. One-stage immediate breast reconstruction: a concise review. Biomed Res Int. (2017) 2017:6486859. 10.1155/2017/6486859 - DOI - PMC - PubMed
    1. Apfelberg DB, Maser MR, Lash H, Lee RH, Kieraldo J. Breast reconstruction for malignant or premalignant disease. West J Med. (1976) 125(5):350–3. - PMC - PubMed
    1. Rolph R, Farhadi J. The use of meshes and matrices in breast reconstruction. Br J Hosp Med. (2018) 79(8):454–9. 10.12968/hmed.2018.79.8.454 - DOI - PubMed
    1. Rosato RE, Fink PJ, Horton CE, Payne RL, Jr. Immediate postmastectomy reconstruction. J Surg Oncol. (1976) 8(4):277–80. 10.1002/jso.2930080403 - DOI - PubMed
    1. Snyderman RK, Guthrie RH. Reconstruction of the female breast following radical mastectomy. Plast Reconstr Surg. (1971) 47(6):565–7. 10.1097/00006534-197106000-00008 - DOI - PubMed