Autologous breast reconstruction is an appealing choice for breast cancer undergoing mastectomy. Evaluating for adequate donor tissue volume is a highly subjective process with potentials for miscommunication. It is not uncommon for patients to desire significant augmentation of their autologous breast reconstruction with delayed insertion of an implant. However, flap elevation in the pre-pectoral plane can be treacherous. Our novel technique combines autologous abdominal free flaps with immediate pre-pectoral adjustable saline implants to provide a customizable, single-stage strategy. A retrospective review of patients undergoing breast reconstruction with abdominal free tissue transfer and either immediate placement of adjustable saline implants or delayed placement of implants for augmentation was performed. Patient characteristics, operative details and complications were recorded. Complications, patient satisfaction and ability to achieve goal breast size was compared between the immediate adjustable saline implant group and delayed implant placement group. Twenty-four patients (41 breasts) were identified and met inclusion criteria. Sixteen patients received implants in a delayed manner (28 breasts), while 8 received adjustable saline implants immediately with flap reconstruction (13 breasts). High patient satisfaction with breast size and shape was noted across both cohorts. Nearly all patients across both cohorts believed that it was beneficial to be able to adjust breast volumes post-reconstruction. Immediate saline implant placement was demonstrated to increased odds of patient-reported satisfaction by multivariable analysis. A single-stage hybrid approach breast reconstruction with a pre-pectoral adjustable saline implant and abdominal free flap is feasible. This novel technique reduces the rate of major revision surgery and optimizes patient satisfaction in autologous breast reconstruction.
| Published in | Journal of Surgery (Volume 9, Issue 6) |
| DOI | 10.11648/j.js.20210906.12 |
| Page(s) | 256-263 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2024. Published by Science Publishing Group |
Autologous Breast Reconstruction, Adjustable Implant, Hybrid Reconstruction, Revision Breast Surgery
| [1] | Pusic AL, Matros E, Fine N, et al. Patient-reported outcomes 1 year after immediate breast reconstruction: Results of the Mastectomy Reconstruction Outcomes Consortium study. J Clin Oncol. 2017; 35 (22): 2499-2506. |
| [2] | Santosa KB, Qi J, Kim HM, et al. Long-term Patient-Reported Outcomes in Postmastectomy Breast Reconstruction. JAMA Surg. 2018; 153 (10): 891-899. |
| [3] | Kanchwala S, Momeni A. Hybrid breast reconstruction-the best of both worlds. Gland Surg. 2019; 8 (1): 82–89. |
| [4] | Momeni A, Kanchwala S. Hybrid prepectoral breast reconstruction: A surgical approach that combines the benefits of autologous and implant-based reconstruction. Plast Reconstr Surg. 2018; 142 (5): 1109-1115. |
| [5] | Chu MW, Samra F, Kanchwala SK, et al. Treatment Options for Bilateral Autologous Breast Reconstruction in Patients with Inadequate Donor-Site Volume. J Reconstr Microsurg. 2017; 33 (5): 305-311. |
| [6] | Hsieh F, Shah A, Malata CM. Experience with the Mentor Contour Profile Becker-35 expandable implants in reconstructive breast surgery. J Plast Reconstr Aesthetic Surg. 2010; 63 (7): 1124-30. |
| [7] | Scuderi N, Alfano C, Campus GV, et al. Multicenter study on breast reconstruction outcome using becker implants. Aesthetic Plast Surg. 2011; 35 (1): 66-72. |
| [8] | Choo AMH, Forouhi P, Malata CM. Innovative combination of therapeutic mammoplasty and expandable-implant breast augmentation for immediate partial breast reconstruction. Int J Surg Case Rep. 2016; 23: 146–150. |
| [9] | Spear SL, Seruya M, Clemens MW, et al. Acellular dermal matrix for the treatment and prevention of implant-associated breast deformities. Plastic Surgical Nursing. 2011; 127 (3): 1047-1058. |
| [10] | Lardi AM, Ho-Asjoe M, Junge K, et al. Capsular contracture in implant based breast reconstruction-the effect of porcine acellular dermal matrix. Gland Surg. 2017; 6 (1): 49–56. |
| [11] | Mowlds DS, Salibian AA, Scholz T, et al. Capsular Contracture in Implant-Based Breast Reconstruction. Plast Reconstr Surg. 2015; 136 (4): 629-635. |
| [12] | Vardanian AJ, Clayton JL, Roostaeian J, et al. Comparison of implant-based immediate breast reconstruction with and without acellular dermal matrix. Plast Reconstr Surg. 2011; 128 (5): 403e-410e. |
| [13] | Bach AD, Morgenstern IH, Horch RE. Secondary “hybrid Reconstruction” concept with silicone implants after autologous breast reconstruction - Is it safe and reasonable? Med Sci Monit. 2020; 26: e921329. |
| [14] | Roehl KR, Baumann DP, Chevray PM, et al. Evaluation of outcomes in breast reconstructions combining lower abdominal free flaps and permanent implants. Plast Reconstr Surg. 2010; 126 (2): 349-357. |
| [15] | Miller MJ, Rock CS, Robb GL. Aesthetic breast reconstruction using a combination of free transverse rectus abdominis musculocutaneous flaps and breast implants. Ann Plast Surg. 1996; 37 (3): 258-64. |
| [16] | Serletti JM, Moran SL. The combined use of the TRAM and expanders/implants in breast reconstruction. Ann Plast Surg. 1998; 40 (5): 510-4. |
| [17] | Chang KP, Lin SD, Lin TM, et al. The simultaneous combination of implants and tram flaps for an aesthetically pleasing breast. Kaohsiung J Med Sci. 2002; 18 (5): 215-20. |
| [18] | Kronowitz SJ, Robb GL, Youssef A, et al. Optimizing autologous breast reconstruction in thin patients. Plast Reconstr Surg. 2003; 112 (7): 1768-78. |
| [19] | Momeni A, Kanchwala SK. Improved pocket control in immediate microsurgical breast reconstruction with simultaneous implant placement through the use of mesh. Microsurgery. 2018; 38 (5): 450-457. |
| [20] | Spear SL, Wolfe AJ. The coincidence of TRAM flaps and prostheses in the setting of breast reconstruction. Plast Reconstr Surg. 2002; 110 (2): 478-86. |
| [21] | Greenfield S, Kaplan S, Ware JE. Expanding patient involvement in care: Effects on patient outcomes. Ann Intern Med. 1985; 102 (4): 520-8. |
| [22] | Moyer A, Salovey P. Patient participation in treatment decision making and the psychological consequences of breast cancer surgery. Womens Health. 1998; 4 (2): 103-16. |
| [23] | Street RL, Voigt B. Patient participation in deciding breast cancer treatment and subsequent quality of life. Med Decis Mak. 1997; 17 (3): 298-306. |
| [24] | Shell, J. A. & Kirsch S. Psychosocial issues, outcomes, and quality of life. In S. E. Otto (Ed.). Oncology Nurs. 2001: 4th ed., pp. 948-972. |
APA Style
Anna Zhou, Peter Deptula, Pooja Yesantharao, Irene Ma, Dung Nguyen. (2021). One-Stage Hybrid Breast Reconstruction with Inflatable Saline Implants: Minimizing the Need for Major Revision Surgery. Journal of Surgery, 9(6), 256-263. https://doi.org/10.11648/j.js.20210906.12
ACS Style
Anna Zhou; Peter Deptula; Pooja Yesantharao; Irene Ma; Dung Nguyen. One-Stage Hybrid Breast Reconstruction with Inflatable Saline Implants: Minimizing the Need for Major Revision Surgery. J. Surg. 2021, 9(6), 256-263. doi: 10.11648/j.js.20210906.12
AMA Style
Anna Zhou, Peter Deptula, Pooja Yesantharao, Irene Ma, Dung Nguyen. One-Stage Hybrid Breast Reconstruction with Inflatable Saline Implants: Minimizing the Need for Major Revision Surgery. J Surg. 2021;9(6):256-263. doi: 10.11648/j.js.20210906.12
Share This Article
Twitter
Linked In
Facebook
Copy
Download@article{10.11648/j.js.20210906.12,
author = {Anna Zhou and Peter Deptula and Pooja Yesantharao and Irene Ma and Dung Nguyen},
title = {One-Stage Hybrid Breast Reconstruction with Inflatable Saline Implants: Minimizing the Need for Major Revision Surgery},
journal = {Journal of Surgery},
volume = {9},
number = {6},
pages = {256-263},
doi = {10.11648/j.js.20210906.12},
url = {https://doi.org/10.11648/j.js.20210906.12},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20210906.12},
abstract = {Autologous breast reconstruction is an appealing choice for breast cancer undergoing mastectomy. Evaluating for adequate donor tissue volume is a highly subjective process with potentials for miscommunication. It is not uncommon for patients to desire significant augmentation of their autologous breast reconstruction with delayed insertion of an implant. However, flap elevation in the pre-pectoral plane can be treacherous. Our novel technique combines autologous abdominal free flaps with immediate pre-pectoral adjustable saline implants to provide a customizable, single-stage strategy. A retrospective review of patients undergoing breast reconstruction with abdominal free tissue transfer and either immediate placement of adjustable saline implants or delayed placement of implants for augmentation was performed. Patient characteristics, operative details and complications were recorded. Complications, patient satisfaction and ability to achieve goal breast size was compared between the immediate adjustable saline implant group and delayed implant placement group. Twenty-four patients (41 breasts) were identified and met inclusion criteria. Sixteen patients received implants in a delayed manner (28 breasts), while 8 received adjustable saline implants immediately with flap reconstruction (13 breasts). High patient satisfaction with breast size and shape was noted across both cohorts. Nearly all patients across both cohorts believed that it was beneficial to be able to adjust breast volumes post-reconstruction. Immediate saline implant placement was demonstrated to increased odds of patient-reported satisfaction by multivariable analysis. A single-stage hybrid approach breast reconstruction with a pre-pectoral adjustable saline implant and abdominal free flap is feasible. This novel technique reduces the rate of major revision surgery and optimizes patient satisfaction in autologous breast reconstruction.},
year = {2021}
}
TY - JOUR T1 - One-Stage Hybrid Breast Reconstruction with Inflatable Saline Implants: Minimizing the Need for Major Revision Surgery AU - Anna Zhou AU - Peter Deptula AU - Pooja Yesantharao AU - Irene Ma AU - Dung Nguyen Y1 - 2021/11/10 PY - 2021 N1 - https://doi.org/10.11648/j.js.20210906.12 DO - 10.11648/j.js.20210906.12 T2 - Journal of Surgery JF - Journal of Surgery JO - Journal of Surgery SP - 256 EP - 263 PB - Science Publishing Group SN - 2330-0930 UR - https://doi.org/10.11648/j.js.20210906.12 AB - Autologous breast reconstruction is an appealing choice for breast cancer undergoing mastectomy. Evaluating for adequate donor tissue volume is a highly subjective process with potentials for miscommunication. It is not uncommon for patients to desire significant augmentation of their autologous breast reconstruction with delayed insertion of an implant. However, flap elevation in the pre-pectoral plane can be treacherous. Our novel technique combines autologous abdominal free flaps with immediate pre-pectoral adjustable saline implants to provide a customizable, single-stage strategy. A retrospective review of patients undergoing breast reconstruction with abdominal free tissue transfer and either immediate placement of adjustable saline implants or delayed placement of implants for augmentation was performed. Patient characteristics, operative details and complications were recorded. Complications, patient satisfaction and ability to achieve goal breast size was compared between the immediate adjustable saline implant group and delayed implant placement group. Twenty-four patients (41 breasts) were identified and met inclusion criteria. Sixteen patients received implants in a delayed manner (28 breasts), while 8 received adjustable saline implants immediately with flap reconstruction (13 breasts). High patient satisfaction with breast size and shape was noted across both cohorts. Nearly all patients across both cohorts believed that it was beneficial to be able to adjust breast volumes post-reconstruction. Immediate saline implant placement was demonstrated to increased odds of patient-reported satisfaction by multivariable analysis. A single-stage hybrid approach breast reconstruction with a pre-pectoral adjustable saline implant and abdominal free flap is feasible. This novel technique reduces the rate of major revision surgery and optimizes patient satisfaction in autologous breast reconstruction. VL - 9 IS - 6 ER -
Information
Email: