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
. 2023 Feb 1;12(3):1170.
doi: 10.3390/jcm12031170.

One-Stage Immediate Alloplastic Breast Reconstruction in Large and Ptotic Breasts: An Institutional Algorithm

Silvia Rampazzo  1   2 , Noemi Spissu  1 , Michela Pinna  1 , Germana A M Sini  1 , Emilio Trignano  1   3 , Rita Nonnis  1 , Claudia Sanna  1   2 , Manuela Rodio  1   2 , Matilde Tettamanzi  1   2 , Corrado Rubino  1   3
Affiliations

One-Stage Immediate Alloplastic Breast Reconstruction in Large and Ptotic Breasts: An Institutional Algorithm

Silvia Rampazzo et al. J Clin Med. .

Abstract

Immediate implant-based breast reconstruction in patients with large and ptotic breasts may be challenging due to skin redundancy. The use of a reduction mammoplasty pattern for the mastectomy skin excision has proven to be a reliable option for these patients as it allows for a better shape, projection, and symmetrization. This approach has been described in the literature for both one- and two-stage reconstruction with either sub- or pre-pectoral reconstruction with an acellular dermal matrix (ADM) or non-biological mesh. One-stage immediate breast reconstructions have a positive significant impact on patients' psychosocial well-being and quality of life. The purpose of this paper is to describe an institutional algorithm that allows one to perform one-stage implant-based breast reconstructions in patients with large and ptotic breasts.

Keywords: algorithm; breast hypertrophy; breast reconstruction; mammoplasty; mastectomy; post-bariatric; ptosis.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Institutional algorithm for immediate implant-based breast reconstruction in large and ptotic breasts: (a) preoperative evaluation; (b) intraoperative evaluation.
Figure 2
Figure 2
Preoperative markings: (a) Wise skin excision pattern; (b) modified-Wise skin excision pattern; dashed area shows the upper quadrant that has to be removed.
Figure 3
Figure 3
Different types of access for nipple/skin-sparing mastectomy: (a) type IV mastectomy is performed through a full thickness incision performed along the superior border of the inferior dermal flap; (b) type V mastectomy is performed through a full incision performed along the borders of the upper quadrant that has to be removed.
Figure 4
Figure 4
Intraoperative picture (above) and schematic drawing (below) of the three different options of implant coverage: (a,d) submuscular reconstruction; (b,e) pre-pectoral reconstruction and implant autologous coverage with fascial flaps; (c,f) pre-pectoral reconstruction with ADM.
Figure 5
Figure 5
Clinical result at three months of follow-up. The patient was treated with type IV nipple-sparing mastectomy on the right side with submuscular reconstruction (460 cc implants) and concomitant contralateral reduction mammoplasty.
See this image and copyright information in PMC

References

    1. Heneghan H.M., Prichard R.S., Lyons R., Regan P.J., Kelly J.L., Malone C., McLaughlin R., Sweeney K.J., Kerin M.J. Quality of Life after Immediate Breast Reconstruction and Skin-Sparing Mastectomy–A Comparison with Patients Undergoing Breast Conserving Surgery. Eur. J. Surg. Oncol. 2011;37:937–943. doi: 10.1016/j.ejso.2011.08.126. - DOI - PubMed
    1. Elder E.E., Brandberg Y., Björklund T., Rylander R., Lagergren J., Jurell G., Wickman M., Sandelin K. Quality of Life and Patient Satisfaction in Breast Cancer Patients after Immediate Breast Reconstruction: A Prospective Study. Breast. 2005;14:201–208. doi: 10.1016/j.breast.2004.10.008. - DOI - PubMed
    1. Dimovska E.O.F., Chen C., Chou H., Lin Y., Cheng M. Outcomes and Quality of Life in Immediate One-stage versus Two-stage Breast Reconstructions without an Acellular Dermal Matrix: 17- Years of Experience. J. Surg. Oncol. 2021;124:510–520. doi: 10.1002/jso.26568. - DOI - PubMed
    1. Wise R.J. A preliminary report on a method of planning the mammaplasty. Plast. Reconstr. Surg. 1956;17:367–375. doi: 10.1097/00006534-195605000-00004. - DOI - PubMed
    1. Toth B.A., Lappert P. Modified Skin Incisions for Mastectomy: The Need for Plastic Surgical Input in Preoperative Planning. Plast. Reconstr. Surg. 1991;87:1048–1053. doi: 10.1097/00006534-199106000-00006. - DOI - PubMed

LinkOut - more resources