Immediate breast reconstruction with direct, anatomic, gel-cohesive, extra-projection prosthesis: 400 cases

Breast cancer treatments involve tumorectomy or mastectomy. Over the past few decades, the authors have been offering direct breast reconstruction with anatomical, gel-cohesive, extra-projection prostheses. This study aimed to demonstrate that breast reconstruction directly with prostheses in a subpectoral pocket is feasible and safe.

From 2002 through 2008, 400 prostheses reconstructions were performed at a single center. The prosthesis was covered by the muscle in its upper two-thirds and by using the skin from the mastectomy in its lower third. A prospectively maintained database was reviewed. The primary endpoint was the development of a complication.

In all patients, surgery was well tolerated. No systemic or medically unfavorable events occurred in the immediate or late postoperative period. Morbidities, which included infection, required implant removal in four patients. Five patients had marginal ischemia of the skin envelope, and implant removal was required in two cases. Eight cases of implant extrusion required implant removal; two of nine patients with hematoma required implant removal; significant capsule formation requiring capsulectomy occurred in 45 patients. The overall number of cases in which complications resulted from capsule formation was 71 (17.75 percent).

This preliminary study demonstrates that immediate breast reconstruction with a direct, extra-projection, anatomical prosthesis is a good alternative. Because of the low rate of complications elucidated, a prostheses-based technique of breast reconstruction should be made available to the public.