Immediate Prosthetic Breast Reconstruction after Nipple-Sparing Mastectomy: Traditional Subpectoral Technique versus Direct-to-Implant Prepectoral Reconstruction without Acellular Dermal Matrix.

Gianluca Franceschini,Sabatino D’Archi,Marzia Salgarello,Lorenzo Scardina,Beatrice Carnassale,Elena Jane Mason,Stefano Magno,Antonio Franco,Federica Murando,Giuseppe Visconti,Alejandro Martin Sanchez,Riccardo Masetti,Alba Di Leone,Liliana Barone Adesi,Armando Orlandi,Daniela Andreina Terribile

doi:10.3390/jpm11020153

Abstract

Background: The aim of this study was to compare outcomes of immediate prosthetic breast reconstruction (IPBR) using traditional submuscular (SM) positioning of implants versus prepectoral (PP) positioning of micropolyurethane-foam-coated implants (microthane) without further coverage. Methods: We retrospectively reviewed the medical records of breast cancer patients treated by nipple-sparing mastectomy (NSM) and IPBR in our institution during the two-year period from January 2018 to December 2019. Patients were divided into two groups based on the plane of implant placement: SM versus PP. Results: 177 patients who received IPBR after NSM were included in the study; implants were positioned in a SM plane in 95 patients and in a PP plane in 82 patients. The two cohorts were similar for mean age (44 years and 47 years in the SM and PP groups, respectively) and follow-up (20 months and 16 months, respectively). The mean operative time was 70 min shorter in the PP group. No significant differences were observed in length of hospital stay or overall major complication rates. Statistically significant advantages were observed in the PP group in terms of aesthetic results, chronic pain, shoulder dysfunction, and skin sensibility (p < 0.05), as well as a trend of better outcomes for sports activity and sexual/relationship life. Cost analysis revealed that PP-IPBR was also economically advantageous over SM-IPBR. Conclusions: Our preliminary experience seems to confirm that PP positioning of a polyurethane-coated implant is a safe, reliable and effective method to perform IPBR after NSM.

Highlights

Immediate prosthetic breast reconstruction (IPBR) is considered as an integral part of the surgical treatment of patients undergoing nipple-sparing mastectomy (NSM) for breast cancer, as it positively affects psychological health, sexuality, body image, and self-esteem.Traditionally, immediate prosthetic breast reconstruction (IPBR) has been performed by placement of the prosthetic implant in a submuscular (SM) pocket created beneath the pectoralis major muscle, in order to protect the integrity of the implant and reduce its visibility and palpability [1,2]
Patients treated before January 2018 were not enrolled because before that date, PP-IPBR in our institution was routinely performed with acellular dermal matrix (ADM), which would have added heterogeneity to our population
Patients were divided into two cohorts based on the site of implant placement: in SM-IPBR, anatomical textured implants were positioned in the subpectoral pocket according to a previously described standardized technique, while in PP-IPBR, a definitive

Summary

Introduction

Immediate prosthetic breast reconstruction (IPBR) is considered as an integral part of the surgical treatment of patients undergoing nipple-sparing mastectomy (NSM) for breast cancer, as it positively affects psychological health, sexuality, body image, and self-esteem.Traditionally, IPBR has been performed by placement of the prosthetic implant in a submuscular (SM) pocket created beneath the pectoralis major muscle, in order to protect the integrity of the implant and reduce its visibility and palpability [1,2]. Placement of the implant in a prepectoral (PP) plane has been increasingly employed When this technique is performed, the implant is usually covered with an acellular dermal matrix (ADM) to shield it in the subcutaneous space underneath the skin flaps; the use of ADM has been reported to increase risks of seroma, infection, and skin/nipple-areola complex (NAC) necrosis, and associated with higher medical costs [1]. To limit these inconveniences, the use of implants with a special micropolyurethane-foamcoated shell surface (microthane) that does not require ADM coverage has recently been proposed [2,5].

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