The triple-plane technique: a surgical technique for subpectoral implant-based breast reconstruction

Abstract

Breast reconstruction surgery is an important part of breast cancer treatment. However, implant-based breast reconstruction is associated with a number of complications, such as infection, seroma, prosthesis exposure, and skin erythema. In this study, we propose a novel surgical technique for implant-based breast reconstruction-the triple-plane technique. This technique positions the prosthesis in a complete submuscular plane. Medially, it is subpectoral, and inferolaterally it is covered by a flap of serratus anterior and latissimus dorsi fascia. As such, the prosthesis is not in contact with the skin, thereby reducing postoperative complications. This article reports on the breast reconstruction results of 96 breast cancer patients who underwent unilateral breast reconstruction surgery using the triple-plane technique at Hunan Cancer Hospital. The results show that breast appearance after surgery was rated as excellent by 92 (95.83%) patients, and good by 4 (4.17%) patients. The average operation time, surgical incision, intraoperative blood loss, and hospitalization time of patients were 88.40±12.13 minutes, 12.24±4.01 cm, 46.40±10.73 mL, and 7.23±1.00 days, respectively. Skin necrosis at the edge of the incision was observed in 1 (1.04%) patient, which healed normally after debridement and closure. The scores of BREAST-Q patient-reported outcome measure ranged from 80 to 100 points for all of the patients. These results demonstrate that the triple-plane technique offers a novel and safe technique for breast reconstruction surgery.

Keywords: Breast reconstruction; postoperative complications; prosthesis implantation.

Figure 1

Breast reconstruction surgery using the triple-plane technique (right breast, the three circles indicate three anatomical planes): pectoralis major muscle plane (A-plane); serratus anterior fascia plane lateral to the pectoralis major (B-plane), and deep layer of the superficial fascia beneath the pectoralis major (C-plane) (both the lateral and lower planes are connected to the pectoralis major through the deep layer of the superficial fascia, allowing for an increase in area based on the size of the prosthesis placed as needed).

Figure 2

Images of breast reconstruction operation using the triple-plane technique. (A) Dissection the retromammary space while preserving the deep layer of the superficial fascia along the lateral margin of the pectoralis major muscle surface. (B) Dissection along the deep layer of the superficial fascia. (C) Detachment of the pectoralis major muscle insertion at the inferior pole of the breast. (D) Dissection of C-plane after prosthesis placement.

Figure 3

Comparison of a patient’s breasts before and after triple-plane breast reconstruction. The same patients were compared preoperatively (A,B) and postoperatively (C,D) with standardized positions.

Figure 4

Comparison of reconstructed breasts after radiotherapy with contralateral breasts in two patients (the photographs were used with the patient’s authorization). (A) Patient A: breast appearance of the reconstructed right breast 3 months after radiotherapy and the left breast. (B) Patient B: breast appearance of the reconstructed right breast 3 months after radiotherapy and the left breast.