Size Does Matter: Mastectomy Flap Thickness as an Independent Decisional Factor for the Peri-Prosthetic Device Choice in Prepectoral Breast Reconstruction.

Autor: Kaciulyte, Juste, Sordi, Silvia, Luridiana, Gianluigi, Marcasciano, Marco, Lo Torto, Federico, Cavalieri, Enrico, Codolini, Luca, Cuomo, Roberto, Rozen, Warren Matthew, Seth, Ishith, Ribuffo, Diego, Casella, Donato
Zdroj: Journal of Clinical Medicine; Dec2024, Vol. 13 Issue 23, p7459, 17p
Abstrakt: Background. In alloplastic breast reconstruction, the choice of implant positioning and the selection of periprosthetic devices is a critical and challenging decision. Surgeons must navigate between various biologic and synthetic meshes, including acellular dermal matrices (ADM). This study aimed to propose a simple selection tool for periprosthetic devices in prepectoral breast reconstruction. Methods. Patients scheduled for mastectomy followed by implant-based breast reconstruction between September 2019 and December 2023 were included. Preoperative risk assessments were performed using the Pre-Bra Score, and only those deemed suitable for prepectoral implant placement were selected. Mastectomy flap thickness was used as an independent criterion, and only cases with flap thicknesses less than 1 cm were included. Results. A total of 70 cases with an average flap thickness of 0.7 cm (range, 0.4–0.9 cm), as measured by preoperative contrast-enhanced spectral mammography (CESM), underwent prepectoral reconstruction with ADM covering the implant. Of these, 25 patients (35%) received direct-to-implant reconstruction, while 45 (65%) underwent two-stage reconstruction with a temporary tissue expander. Postoperative complications were recorded during a minimum follow-up period of 6 months. Over an average follow-up duration of 17.5 months (range 6–36 months), no major complications were observed. Minor complications occurred in seven patients: infection (1.28%), seroma (3.85%), and superficial skin necrosis (1.28%). Additionally, 21 patients (30%) experienced rippling, and secondary lipofilling was scheduled. Conclusions. The incidence of rippling was reduced by 40% through ADM in this patient subgroup, reducing the need for secondary aesthetic refinements. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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