Summary
Implant based breast reconstruction after risk reducing mastectomy (RRM) is challenging
as implants are inadequately covered in their lower pole. Also complication rates
with one stage procedures are significant.
We describe a novel method of pre-expansion by inserting subpectoral anatomical expandable
implants to prepare the breast mound before RRM is carried out. Lipomodelling is later
used to enhance the overall result of the reconstruction. Six patients who were BRCA
1 mutation carriers requested bilateral RRM. Median age was 31. All were non-smokers.
Anatomical expandable implants were inserted via an inframammary incision and were
expanded in the next two months. RRM was carried out 6–13 months later and was followed
by lipomodelling seven months afterwards. Four patients had a nipple sparing mastectomy.
In three cases access was via the previous inframammary scar.
In all cases complete implant cover had been achieved. There were no early postoperative
complications but one patient has developed grade III capsular contracture on the
side of previous wide local tumour excision and radiotherapy. Five patients have so
far undergone post-mastectomy lipomodelling to improve breast contour. In conclusion,
we believe that our technique provides better aesthetic results with reduced complication
rates for these patients.
Keywords
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References
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Article info
Publication history
Published online: September 19, 2011
Accepted:
September 6,
2011
Received:
July 7,
2011
Footnotes
☆Paper presented at the BAPRAS Winter Scientific Meeting, London, December 2010.
Identification
Copyright
© 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
