Prepectoral Prosthetic Breast Reconstruction Without ADM Using a Subfascial Approach

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Breast Reconstruction

Background:

• Immediate prosthetic breast reconstruction has advanced to prepectoral techniques.
• A novel approach involves raising the pectoral and serratus fascia superiorly.
• Historically, Vicryl mesh was used for fascial defects, but primary closure or pectoralis muscle pocket creation (direct to implant - DTI) is now preferred.

Purpose of the Study:

• To evaluate a mesh-free technique for immediate prepectoral breast reconstruction.
• To assess the outcomes of this technique regarding prosthetic coverage and extrusion rates.
• To determine the applicability of the technique across different grades of breast ptosis.

Main Methods:

• Retrospective analysis of 47 patients (80 breasts) over a 4-year period.
• Data collection included patient demographics, reconstruction type (tissue expander or DTI), and follow-up outcomes.
• Calculation of percentage fascial coverage of the prosthesis.

Main Results:

• Forty-seven patients (mean age 42) underwent reconstruction; 35 (61 breasts) utilized primary closure without mesh.
• Prosthetic extrusion occurred in 8 breasts (6 without mesh).
• Mean fascial coverage was 74%, with a low extrusion rate reported for the mesh-free technique.

Conclusions:

• A mesh-free technique for immediate prepectoral reconstruction provides an additional layer of prosthetic cover.
• This method is applicable for all grades of breast ptosis.
• The technique demonstrates a low rate of prosthetic extrusion.