Pectoral Sparing Immediate Implant Breast Reconstruction

Introduction: Traditionally the pectoralis major muscle (PMM) is used for superomedial implant cover during implant based reconstruction. The release of PMM can cause postoperative pain. Long term problems include animation of the reconstruction and lateral displacement.

We present our experience of pectoral sparing implant reconstruction using full implant coverage using an acellular dermal matrix (ADM) and ADM in conjunction with a dermal sling (DS).

Methods: Technique used depended on breast shape and ptosis, two sheets of ADM sutured together or one sutured to a DS. The ADM is fixed supero-medially. Control of the lateral border is achieved with interrupted sutures following implant placement, allowing good medial projection and implant positioning without PMM disruption.

Results: This technique has been performed on 24 patients (30 breasts). Indications: malignancy (n=9), risk reduction (n=14), revision (n=5)  delayed reconstruction (n=2). Nine had synchronous nipple reconstruction, six were nipple-sparing mastectomies. Mean mastectomy weight: 450g (164-1057), median implant volume: 390cc (265-545). Length of stay was one night. Four patients experienced delayed wound healing, two required explantation.

Conclusions: This technique is suited to women seeking single stage implant based reconstruction who are athletic and don’t want disruption of their PMM. Recovery time is quick and postoperative pain reduced. Cosmetic outcomes from this single stage implant reconstruction are excellent.