Abstract
BackgroundImplant-based immediate breast reconstruction after skin-sparing mastectomy has shown a significant improvement in patients’ quality of life, making the procedure steadily more popular year after year. However, this technique has a high morbidity rate, including skin necrosis and implant exposure.MethodsA retrospective review of a prospectively held database for autologous breast reconstruction in our institution of the last 5 years found eight cases with exposed implants after nipple-sparing mastectomy and immediate reconstruction. A single-stage procedure consisting on implant removal and immediate replacement with a deepithelialized DIEP flap was performed in all cases (10 DIEP flaps).ResultsAll flaps were successful. Patients’ mean age was 45 years old. Three patients developed seroma (5, 7, and 14 days after surgery, respectively). No infections were detected in up to 24 months of follow-up.ConclusionsNipple-sparing mastectomy with immediate implant-based reconstruction is considered oncologically safe. However, it has a high rate of complications that could require implant removal. Immediate free flap reconstruction is a feasible and safe option to replace the missing volume with low risk of complications that result in a soft and natural-shaped breast.
Highlights
Implant-based immediate breast reconstruction after skin-sparing mastectomy has shown a significant improvement in patients’ quality of life, making the procedure steadily more popular year after year
Immediate breast reconstruction with implants requires a two-stage procedure including subpectoral placement of a tissue expander at the time of mastectomy followed by replacement of the tissue expander with the definitive breast implant as a second stage once breast expansion has been achieved
From June 2012 through May 2017, 140 deep inferior epigastric artery perforator flap (DIEP) flaps were performed for breast reconstruction in the Department of Microsurgery in our institution
Summary
Implant-based immediate breast reconstruction after skin-sparing mastectomy has shown a significant improvement in patients’ quality of life, making the procedure steadily more popular year after year. This technique has a high morbidity rate, including skin necrosis and implant exposure. Proven improvement in most patients’ quality of life has made the frequency of immediate breast reconstruction after skin-sparing mastectomy to steadily rise in the last years. Breast infection or implant exposure increases the rate of failure by 30%, and implant loss has been
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