Hybrid Prepectoral Direct-to-Implant and Autologous Fat Graft Simultaneously in Immediate Breast Reconstruction: A Single Surgeon's Experience with 25 Breasts in 15 Consecutive Cases.
Journal
Plastic and reconstructive surgery
ISSN: 1529-4242
Titre abrégé: Plast Reconstr Surg
Pays: United States
ID NLM: 1306050
Informations de publication
Date de publication:
01 Mar 2022
01 Mar 2022
Historique:
entrez:
23
2
2022
pubmed:
24
2
2022
medline:
19
3
2022
Statut:
ppublish
Résumé
The direct-to-implant method depends on the quality of the mastectomy flaps and can be used only when the flaps are adequately perfused. Even though the method was designed to be a definitive reconstruction procedure, it has been associated with an increased likelihood that additional operative revision will be required in order to achieve the expected final cosmetic outcome. The authors describe a hybrid prepectoral direct-to-implant method that combines autologous fat grafting in the superior medial pole with immediate reconstruction. In this prospective study, 15 patients (25 reconstructed breasts) underwent simultaneous hybrid prepectoral direct-to-implant reconstruction together with autologous fat grafting performed by a single senior plastic surgeon (Y.G). The mean quantity of autologous fat grafted in the superior medial aspect of the breast was 59.4 ± 12.8 cc. The mean total volume of the hybrid reconstructed breast, including implant and autologous fat graft, was 497.2 ± 89.1 cc. Satisfying final outcomes were achieved in all cases. There were no major complications, although minor complications were observed. The authors' hybrid approach allows the surgeon to achieve a more satisfying outcome with regard to the cleavage area. It results in a better natural appearance, an improved contour, and reduced upper pole rippling and deflation, with a lower likelihood that an additional operative revision will be required to achieve the desired final aesthetic outcome. The authors believe that their hybrid approach should be implemented as an integral part of the direct-to-implant prepectoral reconstruction procedure. Therapeutic, IV.
Sections du résumé
BACKGROUND
BACKGROUND
The direct-to-implant method depends on the quality of the mastectomy flaps and can be used only when the flaps are adequately perfused. Even though the method was designed to be a definitive reconstruction procedure, it has been associated with an increased likelihood that additional operative revision will be required in order to achieve the expected final cosmetic outcome. The authors describe a hybrid prepectoral direct-to-implant method that combines autologous fat grafting in the superior medial pole with immediate reconstruction.
METHODS
METHODS
In this prospective study, 15 patients (25 reconstructed breasts) underwent simultaneous hybrid prepectoral direct-to-implant reconstruction together with autologous fat grafting performed by a single senior plastic surgeon (Y.G).
RESULTS
RESULTS
The mean quantity of autologous fat grafted in the superior medial aspect of the breast was 59.4 ± 12.8 cc. The mean total volume of the hybrid reconstructed breast, including implant and autologous fat graft, was 497.2 ± 89.1 cc. Satisfying final outcomes were achieved in all cases. There were no major complications, although minor complications were observed.
CONCLUSIONS
CONCLUSIONS
The authors' hybrid approach allows the surgeon to achieve a more satisfying outcome with regard to the cleavage area. It results in a better natural appearance, an improved contour, and reduced upper pole rippling and deflation, with a lower likelihood that an additional operative revision will be required to achieve the desired final aesthetic outcome. The authors believe that their hybrid approach should be implemented as an integral part of the direct-to-implant prepectoral reconstruction procedure.
CLINICAL QUESTION/LEVEL OF EVIDENCE
METHODS
Therapeutic, IV.
Identifiants
pubmed: 35196670
doi: 10.1097/PRS.0000000000008879
pii: 00006534-202203000-00007
doi:
Types de publication
Clinical Trial
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
386e-391eInformations de copyright
Copyright © 2022 by the American Society of Plastic Surgeons.
Références
Radovan C. Breast reconstruction after mastectomy using the temporary expander. Plast Reconstr Surg. 1982;69:195–208.
Emily MCP, Alex ML, Catherine H, et al. Revisions in implant-based breast reconstruction: How does direct-to-implant measure up? Plast Reconstr Surg. 2016;137:1690–1699.
Susarla SM, Ganske I, Helliwell L, Morris D, Eriksson E, Chun YS. Comparison of clinical outcomes and patient satisfaction in immediate single-stage versus two-stage implant-based breast reconstruction. Plast Reconstr Surg. 2015;135:1e–8e.
Srinivasa DR, Garvey PB, Qi J, et al. Direct-to-implant versus two-stage tissue expander/implant reconstruction: 2-Year risks and patient-reported outcomes from a prospective, multicenter study. Plast Reconstr Surg. 2017;140:869–877.
Katzel EB, Bucky LP. Fat grafting to the breast: Clinical applications and outcomes for reconstructive surgery. Plast Reconstr Surg. 2017;140(5S Advances in Breast Reconstruction):69S–76S.
Khouri RK Jr, Khouri RE, Lujan-Hernandez JR, Khouri KR, Lancerotto L, Orgill DP. Diffusion and perfusion: The keys to fat grafting. Plast Reconstr Surg Glob Open. 2014;2:e220.
Khouri RK Jr, Khouri RK. Current clinical applications of fat grafting. Plast Reconstr Surg. 2017;140:466e–486e.
Eto H, Kato H, Suga H, et al. The fate of adipocytes after nonvascularized fat grafting: Evidence of early death and replacement of adipocytes. Plast Reconstr Surg. 2012;129:1081–1092.
Krastev T, van Turnhout A, Vriens E, Smits L, van der Hulst R. Long-term follow-up of autologous fat transfer vs conventional breast reconstruction and association with cancer relapse in patients with breast cancer. JAMA Surg. 2019;154:56–63.
Spear SL, Schwartz J, Dayan JH, Clemens MW. Outcome assessment of breast distortion following submuscular breast augmentation. Aesthetic Plast Surg. 2009;33:44–48.
Ter Louw RP, Nahabedian MY. Prepectoral breast reconstruction. Plast Reconstr Surg. 2017;140(5S Advances in Breast Reconstruction):51S–59S.
Chatterjee A, Nahabedian MY, Gabriel A, et al. Early assessment of post-surgical outcomes with pre-pectoral breast reconstruction: A literature review and meta-analysis. J Surg Oncol. 2018;117:1119–1130.
Nahabedian MY. Current approaches to prepectoral breast reconstruction. Plast Reconstr Surg. 2018;142:871–880.
Storm-Dickerson T, Sigalove N. Prepectoral breast reconstruction: The breast surgeon’s perspective. Plast Reconstr Surg. 2017;140(6S Prepectoral Breast Reconstruction):43S–48S.
Pittman TA, Abbate OA, Economides JM. The P1 method: Prepectoral breast reconstruction to minimize the palpable implant edge and upper pole rippling. Ann Plast Surg. 2018;80:487–492.
Glyn J, Antony AK. Single stage, direct to implant pre-pectoral breast reconstruction. Gland Surg. 2019;8:53–60.
Chatterjee A, Nahabedian MY, Gabriel A, et al. Early assessment of post-surgical outcomes with pre-pectoral breast reconstruction: A literature review and meta-analysis. J Surg Oncol. 2018;117:1119–1130.
Qureshi AA, Odom EB, Parikh RP, Myckatyn TM, Tenenbaum MM. Patient-reported outcomes of aesthetics and satisfaction in immediate breast reconstruction after nipple-sparing mastectomy with implants and fat grafting. Aesthet Surg J. 2017;37:999–1008.