Dual-Plane Retro-pectoral Versus Pre-pectoral DTI Breast Reconstruction: An Italian Multicenter Experience

Diego Ribuffo,Ugo Redi,Luigi Losco,Manfredi Greco,Giovanni Di Benedetto,Francesco Luca Rocco Mori,Juste Kaciulyte,Marco Marcasciano,Emanuele Cigna,Maria Giuseppina Onesti,Luigi Valdatta,Roy De Vita,Vittorio Quercia,Mario Cherubino,Giorgio Berna,Alessandro Scalise,Federico Lo Torto

doi:10.1007/s00266-020-01892-y

Abstract

BackgroundThe use of conservative mastectomies has risen significantly during the last few years. The reconstructive choice of direct-to-implant reconstruction has become more practicable with modern mastectomy techniques. The initial trend in Italian centers was to use dual-plane hybrid reconstruction. However, a high level of complications has been registered. From 2015 onward, in our centers, a pre-pectoral approach has been adopted. The authors sought to describe the Italian trend to gradually discard the sub-pectoral technique with lower lateral pole coverage of the prosthesis using ADMs comparing it with the pre-pectoral approach with ADMs, without any muscle dissection, in terms of complication rates.Materials and MethodsA multicenter retrospective clinical study was performed from January 2010 to June 2018. The enrolled patients were divided into two groups: Cases with an ADM-only coverage pre-pectoral reconstruction made up the first group (Group 1). Those with the retro-pectoral muscular position + ADM implant coverage comprised the second one (Group 2). Complications such as seroma, hematoma, wound dehiscence, surgical site infection, reconstruction failure, animation deformity and capsular contracture were recorded.ResultsWe performed 716 direct-to-implant reconstructions: 509 were partially sub-pectoral and 207 were pre-pectoral. Minimum follow-up was 1 year. Incidence of complications was higher in dual-plane reconstructions. There were statistical significant differences in the rates of seroma and hematoma.ConclusionUsing the pre-pectoral approach, the authors have experienced favorable aesthetics and superior clinical and functional outcomes. Retro-pectoral muscular ADM implant coverage has to be considered only in specific complicated second-stage surgeries.Level of Evidence VThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Highlights

When correctly indicated, conservative mastectomies and implant-based breast reconstruction (IBR) are safe procedures from an oncological viewpoint with satisfying aesthetic outcomes that have changed perspectives and possibilities of breast reconstruction [1]
The reconstructive choice of direct-to-implant reconstruction has become more practicable with modern mastectomy techniques
The authors sought to describe the Italian trend to gradually discard the sub-pectoral technique with lower lateral pole coverage of the prosthesis using acellular dermal matrices (ADM) comparing it with the pre-pectoral approach with ADMs, without any muscle dissection, in terms of complication rates

Summary

Introduction

Conservative mastectomies (nipple sparing or skin sparing) and implant-based breast reconstruction (IBR) are safe procedures from an oncological viewpoint with satisfying aesthetic outcomes that have changed perspectives and possibilities of breast reconstruction [1]. Introduction of ADMs for lower pole coverage led surgeons to perform reconstructive procedures with permanent implant without the need of expansion, the so-called directto-implant breast reconstruction (DTI) [3, 4]. The psychological impact of mastectomy, psychosocial distress, body image disruptions and unfavorable effects on sexual well-being are reduced to a minimum by one-stage procedures, as the breast mound is restored during the same operative episode, which preserves good aesthetic results from total implant coverage [5]. The initial trend in Italian centers was to use dualplane hybrid reconstruction. The authors sought to describe the Italian trend to gradually discard the sub-pectoral technique with lower lateral pole coverage of the prosthesis using ADMs comparing it with the pre-pectoral approach with ADMs, without any muscle dissection, in terms of complication rates.

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