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Prepectoral immediate breast reconstruction with polyurethane foam-coated implants: Feasibility and early results in risk-reducing and therapeutic mastectomies

  • Maude Coyette
    Correspondence
    Corresponding author at : Department of Plastic and Reconstructive Surgery, Cliniques Universitaires Saint-Luc, UCLouvain, Avenue Hippocrate 10, 1200 Brussels, Belgium.
    Affiliations
    Department of Plastic and Reconstructive Surgery, Cliniques Universitaires Saint-Luc, UCLouvain, Avenue Hippocrate 10, B-1200 Brussels, Belgium
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  • Julien Coulie
    Affiliations
    Department of Plastic and Reconstructive Surgery, Cliniques Universitaires Saint-Luc, UCLouvain, Avenue Hippocrate 10, B-1200 Brussels, Belgium
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  • Audrey Lentini
    Affiliations
    Department of Plastic and Reconstructive Surgery, Cliniques Universitaires Saint-Luc, UCLouvain, Avenue Hippocrate 10, B-1200 Brussels, Belgium
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  • Alexander Gerdom
    Affiliations
    Department of Plastic and Reconstructive Surgery, Cliniques Universitaires Saint-Luc, UCLouvain, Avenue Hippocrate 10, B-1200 Brussels, Belgium
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  • Benoît Lengelé
    Affiliations
    Department of Plastic and Reconstructive Surgery, Cliniques Universitaires Saint-Luc, UCLouvain, Avenue Hippocrate 10, B-1200 Brussels, Belgium
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Published:April 19, 2021DOI:https://doi.org/10.1016/j.bjps.2021.03.077

      Summary

      Background

      There is a renewed interest for prepectoral reconstruction. We aimed to describe the feasibility and the early complications associated with immediate one-stage direct-to-implant (DTI) reconstruction using prepectoral anatomical polyurethane (PU) foam-coated implants alone, for women with breast cancer or mutation carriers undergoing risk-reducing surgery.

      Methods

      We performed a single-center, retrospective review of 50 patients (mean age of 49 years), who underwent skin-sparing mastectomy (SSM) or nipple-sparing mastectomy (NSM) and immediate prepectoral PU implant-based reconstruction. All procedures were performed by the same senior operator, from July 2018 to March 2020.

      Results

      A total of 64 mastectomies (25 SSMs and 39 NSMs) with one-stage prepectoral PU foam-coated implant reconstruction were performed. Out of 50 patients, 6 required surgical revision within 30 days, because of hematoma (2), wound dehiscence (2) infection (1), and full thickness nipple-areolar complex (NAC) necrosis (1). Four patients developed a cutaneous rash with spontaneous resolution. Statistical analysis showed a significant influence of hypothyroidism and previous radiotherapy on the risk of complications. The association with prior radiotherapy (pRT) was not significant using binary logistic regression. When excluding oncological reasons and patient's wish for NAC excision, our decision to perform an NSM was influenced by breast cup size, preoperative measurements, and breast weight.

      Conclusions

      Early experience with immediate prepectoral DTI reconstruction with PU-covered implants alone suggests that it is a reliable procedure. Prior breast irradiation does not increase postoperative complication rates in our series. NAC preservation was decided according to preoperative lower breast measurements.

      Keywords

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