Breast reconstruction plays a vital role in restoring form and self-confidence in
patients who have undergone mastectomy for breast cancer. This can be achieved in
various ways ranging from simple expander only reconstruction to complex microsurgical
free flap reconstructions. Although autologous free tissue transfer is probably the
ideal form of breast reconstruction, not all patients are suitable for this and reconstruction
needs to individually tailored to the patient. Breast reconstruction with implants
and tissue expanders only has been performed with a variety of techniques and in different
tissue planes, with advantages and disadvantages apparent in each. The subcutaneous
pocket in post-mastectomy patients has been associated with a visible edge to the
implant and an apparently higher rate of capsular contracture, whereas the submuscular
plane has been thought to cause implant distortion on contraction of the muscle and
poor definition of the infra mammary crease.
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Acellular dermal matrix (ADM) products are being used increasingly in expander reconstruction
to cover implants that are only partly covered by the pectoral muscle, to accurately
adjust implant position and to define the infra mammary crease. Unfortunately, these
engineered tissue products can be expensive. We have used the pectoralis fascia as
a graft, in place of an acellular dermal matrix product, to allow complete coverage
of an implant in a reconstructed breast. This case is a good example of using autologous
pectoral fascia instead of more expensive ADM materials.To read this article in full you will need to make a payment
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References
- Subfascial breast implant: a new procedure.Plast Reconstr Surg. 2003; 111: 904-908
- Dual plane breast augmentation: optimizing implant-soft-tissue relationships in a wide range of breast types.Plast Reconstr Surg. 2006; 118 (discussion 99S–102S): 81S-98S
- Update on one-stage immediate breast reconstruction with definitive prosthesis after sparing mastectomies.Breast. 2011; 20: 7-14
- Immediate bilateral breast reconstruction with implants and inferolateral AlloDerm slings.Ann Plast Surg. 2005; 55: 232-239
- Acellular dermis-assisted breast reconstruction.Aesthetic Plast Surg. 2008; 32: 418-425
Article info
Publication history
Published online: November 28, 2011
Received:
October 31,
2011
Identification
Copyright
© 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.