Revisiting an Old Place: Single Surgeon Experience on Post Mastectomy Subcutaneous Implant Based Breast Reconstruction

Background:

Implant based reconstruction is rapidly evolving with routine use of acellular dermal matrices (ADM), fat grafting, anatomic silicone breast implants, and indocyanine green (ICG) angiography. These new tools have changed what reconstructive results can achieve, and opened new possibilities to the plastic surgeon. The safety and efficacy of prepectoral space implant based breast reconstruction is reevaluated. We present our first 79 cases.

Methods:

We performed a retrospective review of all skin sparing and nipple sparing mastectomy between April 2012 and September 2014. We included all consecutive patients with implant-based reconstruction in the subcutaneous space who did not require radiation therapy. All mastectomy flaps were evaluated clinically and with indocyanine green angiography. All devices were completely covered with ADM and placed in the subcutaneous space. Both tissue expander-to-implant and direct-to-implant reconstructions were included.

Results:

A total of 79 patients with 135 breasts were reconstructed in a single or two staged procedures. At time of abstract submission 74 patients (93.7%) completed implant based reconstruction and 4 patients (5.1%) received or have planned autologous reconstruction. Three patients (3.8%) were treated for postoperative infection and were all explanted as a result. Three patients (3.8%) had post-op bleeding and 2 (2.6%) of those required operative evacuation. Three patients (3.8%) were treated for seroma. There were no patients with implant extrusion or skin necrosis requiring operative intervention.

Conclusion:

We believe that postmastectomy subcutaneous space reconstruction is a safe and effective method of reconstruction with comparable complication rates and equal or superior aesthetic outcomes.  Long term studies are needed to evaluate capsular contracture and malposition of devices over time.