One-Stage Immediate Breast Reconstruction: A Concise Review.

Nicolò Bertozzi,Edoardo Raposio,Pierluigi Santi,Marianna Pesce

doi:10.1155/2017/6486859

Nicolò Bertozzi, Edoardo Raposio + Show 2 more

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https://doi.org/10.1155/2017/6486859

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Abstract

Background One-stage direct-to-implant immediate breast reconstruction (IBR) is performed simultaneously with breast cancer resection. We explored indications, techniques, and outcomes of IBR to determine its feasibility, safety, and effectiveness. Material and Methods We reviewed the available literature on one-stage direct-to-implant IBR, with or without acellular dermal matrix (ADM), synthetic mesh, or autologous fat grafting. We analyzed the indications, preoperative work-up, surgical technique, postoperative care, outcomes, and complications. Results IBR is indicated for small-to-medium nonptotic breasts and contraindicated in patients who require or have undergone radiotherapy, due to unacceptably high complications rates. Only patients with thick, well-vascularized mastectomy flaps are IBR candidates. Expandable implants should be used for ptotic breasts, while anatomical shaped implants should be used to reconstruct small-to-medium nonptotic breasts. ADMs can be used to cover the implant during IBR and avoid muscle elevation, thereby minimizing postoperative pain. Flap necrosis, reoperation, and implant loss are more common with IBR than conventional two-staged reconstruction, but IBR has advantages such as lack of secondary surgery, faster recovery, and better quality of life. Conclusions IBR has good outcomes and patient-satisfaction rates. With ADM use, a shift from conventional reconstruction to IBR has occurred. Drawbacks of IBR can be overcome by careful patient selection.

Highlights

One-stage direct-to-implant immediate breast reconstruction (IBR) is performed simultaneously with breast cancer resection
Given the fewer hospital accesses required, IBR may be convenient for both patients and the healthcare system [10], and this partially explains the increasing number of IBRs performed [11, 12]
The recent introduction of acellular dermal matrices (ADMs) and synthetic meshes has widened the indications for IBR [13,14,15]

Summary

Introduction

One-stage direct-to-implant immediate breast reconstruction (IBR) is performed simultaneously with breast cancer resection. IBR is indicated for small-to-medium nonptotic breasts and contraindicated in patients who require or have undergone radiotherapy, due to unacceptably high complications rates. Since skin- and nipple-sparing mastectomies have proven to be oncologically safe, an increasing number of patients with invasive breast cancer undergo breast reconstruction [1, 2]. One-stage immediate breast reconstruction (IBR) is a method to reconstruct a definitive breast mound at the time of oncologic resection without the need for tissue expansion or tissue expander/implant exchange. The likelihood of requiring secondary procedure (e.g., scar revision, autologous fat grafting, nipple-areola complex (NAC) reconstruction, and matching surgery to the contralateral breast) is not lower after one-stage IBR than after two-stage implant-based IBR [10]. The recent introduction of acellular dermal matrices (ADMs) and synthetic meshes has widened the indications for IBR [13,14,15]

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