Commentary on: Trans-Vertical Mastectomy With Immediate Implant-Based Reconstruction: A Retrospective, Observational Study
| Autor: | Evan Matros, Joseph J. Disa |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Adult
medicine.medical_specialty Breast implantation Esthetics medicine.medical_treatment Breast Implants Mammaplasty Mastectomy Subcutaneous MEDLINE Breast Neoplasms Surgical Flaps Necrosis Postoperative Complications Breast Surgery medicine Humans Acellular Dermis Breast Breast Implantation Mastectomy Aged Retrospective Studies business.industry Extramural General surgery Retrospective cohort study General Medicine Middle Aged Immediate implant Prophylactic Mastectomy Treatment Outcome Patient Satisfaction Surgery Original Article Female business Follow-Up Studies |
| Zdroj: | Aesthet Surg J Aesthetic Surgery Journal |
| Popis: | Background In women with large and ptotic breasts who require a mastectomy and immediate, implant-based reconstruction, long flaps pose a high risk for flap ischemia and necrosis. A new trans-vertical incision for skin-reducing mastectomy is described, which reduces the skin envelope and lifts the breast. Objectives The authors sought to describe the new mastectomy access incision and assess its efficacy and safety when followed by immediate implant-based reconstruction. Methods This retrospective analysis included 70 consecutive patients (101 breasts) with large and ptotic breasts who underwent a unilateral (n = 39; 55.7%) or bilateral (n = 31; 44.3%), skin-reducing mastectomy utilizing the trans-vertical approach for either breast cancer or risk reduction. All received immediate one- (n = 86; 85.5%) or two-stage (n = 15; 14.5%), implant-based reconstruction utilizing acellular dermal matrix. Results Mean age was 50.1 years and mean body mass index was 25.6 kg/m2. After a median follow-up of 4.9 years, the number of breasts with minor and major complications was 21 (20.8%) and 26 (25.7%), respectively. The most common major complications were skin-flap necrosis (n = 12; 11.9%) and infection (n = 8; 7.9%). All occurred within 3 months postsurgically. There were 7 cases of capsular contracture (6.9%) and 5 reconstruction failures (5.0%). Higher body mass index (P < 0.01) and breast weight (P < 0.05) were associated with increased complication rates. According to BREAST-Q, 55/64 patients (85.9%) were somewhat or very satisfied with the aesthetic outcome. Conclusions The trans-vertical approach is an effective, reproducible, and safe alternative to conventional skin-reducing mastectomy, with favorable aesthetic outcomes, in patients with large and ptotic breasts. Level of Evidence: 4 |
| Databáze: | OpenAIRE |
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