From Sub-Pectoral to Pre-Pectoral Implant Reconstruction: A Decisional Algorithm to Optimise Outcomes of Breast Replacement Surgery
Background: Innovations and advancements with implant-based breast reconstruction, such as the use of ADMs, fat grafting, NSMs, and better implants, have enabled surgeons to now place breast implants in the pre-pectoral space rather than under the pectoralis major muscle. Breast implant replacement...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-02-01
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| Series: | Healthcare |
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| Online Access: | https://www.mdpi.com/2227-9032/11/5/671 |
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| author | Glenda Giorgia Caputo Sebastiano Mura Filippo Contessi Negrini Roberta Albanese Pier Camillo Parodi |
| author_facet | Glenda Giorgia Caputo Sebastiano Mura Filippo Contessi Negrini Roberta Albanese Pier Camillo Parodi |
| author_sort | Glenda Giorgia Caputo |
| collection | DOAJ |
| description | Background: Innovations and advancements with implant-based breast reconstruction, such as the use of ADMs, fat grafting, NSMs, and better implants, have enabled surgeons to now place breast implants in the pre-pectoral space rather than under the pectoralis major muscle. Breast implant replacement surgery in post-mastectomy patients, with pocket conversion from retro-pectoral to pre-pectoral, is becoming increasingly common, in order to solve the drawbacks of retro-pectoral implant positioning (animation deformity, chronic pain, and poor implant positioning). Materials and Methods: A multicentric retrospective study was conducted, considering all patients previously submitted to implant-based post-mastectomy breast reconstruction who underwent a breast implant replacement with pocket conversion procedure at the University Hospital of Udine—Plastic and Reconstructive Surgery Department—and “Centro di Riferimento Oncologico” (C.R.O.) of Aviano, from January 2020 to September 2021. Patients were candidates for a breast implant replacement with pocket conversion procedure if they met the following inclusion criteria: they underwent a previous implant-based post-mastectomy breast reconstruction and developed animation deformity, chronic pain, severe capsular contracture, or implant malposition. Patient data included age, body mass index (BMI), comorbidities, smoking status, pre- or post-mastectomy radiotherapy (RT), tumour classification, type of mastectomy, previous or ancillary procedures (lipofilling), type and volume of implant used, type of ADM, and post-operative complications (breast infection, implant exposure and malposition, haematoma, or seroma). Results: A total of 31 breasts (30 patients) were included in this analysis. Just three months after surgery, we recorded 100% resolution of the problems for which pocket conversion was indicated, which was confirmed at 6, 9, and 12 months post-operative. We also developed an algorithm describing the correct steps for successful breast-implant pocket conversion. Conclusion: Our results, although only early experience, are very encouraging. We realized that, besides gentle surgical handling, one of the most important factors in proper pocket conversion selection is an accurate pre-operative and intra-operative clinical evaluation of the tissue thickness in all breast quadrants. |
| first_indexed | 2024-03-11T07:24:18Z |
| format | Article |
| id | doaj.art-34d49776fa3d47f1b6152c2917fb4f50 |
| institution | Directory Open Access Journal |
| issn | 2227-9032 |
| language | English |
| last_indexed | 2024-03-11T07:24:18Z |
| publishDate | 2023-02-01 |
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| series | Healthcare |
| spelling | doaj.art-34d49776fa3d47f1b6152c2917fb4f502023-11-17T07:42:59ZengMDPI AGHealthcare2227-90322023-02-0111567110.3390/healthcare11050671From Sub-Pectoral to Pre-Pectoral Implant Reconstruction: A Decisional Algorithm to Optimise Outcomes of Breast Replacement SurgeryGlenda Giorgia Caputo0Sebastiano Mura1Filippo Contessi Negrini2Roberta Albanese3Pier Camillo Parodi4Plastic and Reconstructive Surgery, DAME—Department of Medical Area, University Hospital of Udine, 33100 Udine, ItalyPlastic and Reconstructive Surgery, DAME—Department of Medical Area, University Hospital of Udine, 33100 Udine, ItalyPlastic and Reconstructive Surgery, DAME—Department of Medical Area, University Hospital of Udine, 33100 Udine, ItalyPlastic and Reconstructive Surgery, DAME—Department of Medical Area, University Hospital of Udine, 33100 Udine, ItalyPlastic and Reconstructive Surgery, DAME—Department of Medical Area, University Hospital of Udine, 33100 Udine, ItalyBackground: Innovations and advancements with implant-based breast reconstruction, such as the use of ADMs, fat grafting, NSMs, and better implants, have enabled surgeons to now place breast implants in the pre-pectoral space rather than under the pectoralis major muscle. Breast implant replacement surgery in post-mastectomy patients, with pocket conversion from retro-pectoral to pre-pectoral, is becoming increasingly common, in order to solve the drawbacks of retro-pectoral implant positioning (animation deformity, chronic pain, and poor implant positioning). Materials and Methods: A multicentric retrospective study was conducted, considering all patients previously submitted to implant-based post-mastectomy breast reconstruction who underwent a breast implant replacement with pocket conversion procedure at the University Hospital of Udine—Plastic and Reconstructive Surgery Department—and “Centro di Riferimento Oncologico” (C.R.O.) of Aviano, from January 2020 to September 2021. Patients were candidates for a breast implant replacement with pocket conversion procedure if they met the following inclusion criteria: they underwent a previous implant-based post-mastectomy breast reconstruction and developed animation deformity, chronic pain, severe capsular contracture, or implant malposition. Patient data included age, body mass index (BMI), comorbidities, smoking status, pre- or post-mastectomy radiotherapy (RT), tumour classification, type of mastectomy, previous or ancillary procedures (lipofilling), type and volume of implant used, type of ADM, and post-operative complications (breast infection, implant exposure and malposition, haematoma, or seroma). Results: A total of 31 breasts (30 patients) were included in this analysis. Just three months after surgery, we recorded 100% resolution of the problems for which pocket conversion was indicated, which was confirmed at 6, 9, and 12 months post-operative. We also developed an algorithm describing the correct steps for successful breast-implant pocket conversion. Conclusion: Our results, although only early experience, are very encouraging. We realized that, besides gentle surgical handling, one of the most important factors in proper pocket conversion selection is an accurate pre-operative and intra-operative clinical evaluation of the tissue thickness in all breast quadrants.https://www.mdpi.com/2227-9032/11/5/671breast implant replacement surgerysecondary breast implant surgerypocket exchangepre-pectoral breast implantanimation deformity |
| spellingShingle | Glenda Giorgia Caputo Sebastiano Mura Filippo Contessi Negrini Roberta Albanese Pier Camillo Parodi From Sub-Pectoral to Pre-Pectoral Implant Reconstruction: A Decisional Algorithm to Optimise Outcomes of Breast Replacement Surgery Healthcare breast implant replacement surgery secondary breast implant surgery pocket exchange pre-pectoral breast implant animation deformity |
| title | From Sub-Pectoral to Pre-Pectoral Implant Reconstruction: A Decisional Algorithm to Optimise Outcomes of Breast Replacement Surgery |
| title_full | From Sub-Pectoral to Pre-Pectoral Implant Reconstruction: A Decisional Algorithm to Optimise Outcomes of Breast Replacement Surgery |
| title_fullStr | From Sub-Pectoral to Pre-Pectoral Implant Reconstruction: A Decisional Algorithm to Optimise Outcomes of Breast Replacement Surgery |
| title_full_unstemmed | From Sub-Pectoral to Pre-Pectoral Implant Reconstruction: A Decisional Algorithm to Optimise Outcomes of Breast Replacement Surgery |
| title_short | From Sub-Pectoral to Pre-Pectoral Implant Reconstruction: A Decisional Algorithm to Optimise Outcomes of Breast Replacement Surgery |
| title_sort | from sub pectoral to pre pectoral implant reconstruction a decisional algorithm to optimise outcomes of breast replacement surgery |
| topic | breast implant replacement surgery secondary breast implant surgery pocket exchange pre-pectoral breast implant animation deformity |
| url | https://www.mdpi.com/2227-9032/11/5/671 |
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