Focus on technique: one-stage implant-based breast reconstruction

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Breast Surgery

Background:

• Direct-to-implant breast reconstruction with acellular dermal matrix (ADM) offers a single-stage option post-mastectomy.
• This technique avoids tissue expansion and multiple surgeries, potentially improving patient body image sooner.

Purpose of the Study:

• To evaluate the long-term safety and aesthetic outcomes of direct-to-implant breast reconstruction using ADM.
• To assess complication rates associated with this one-stage reconstructive approach.

Main Methods:

• A subpectoral pocket is created after mastectomy, with the pectoralis major muscle elevated for implant placement.
• ADM is secured to the pectoralis muscle and mammary fold, followed by implant insertion and drain placement.
• Skin closure is performed after drain insertion, completing the one-stage reconstruction.

Main Results:

• Over 10 years, 439 patients (790 breasts) underwent this procedure.
• Consistently low complication rates were achieved, with major complications below 2%.
• Specific complications included implant loss (1.6%), skin necrosis (1.3%), and infection (1.1%).

Conclusions:

• ADM in direct-to-implant breast reconstruction is effective, safe, and provides aesthetic benefits over 10 years.
• Successful outcomes depend on careful patient selection and adherence to specific surgical techniques.
• The procedure demonstrates long-term efficacy for patients undergoing immediate breast reconstruction.