Archives of Plastic Surgery

  • 제46권6호
  • /
  • Pages.550-557
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  • 2019
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  • 2234-6163(pISSN)
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  • 2234-6171(eISSN)
대한성형외과학회 (Korean Society of Plastic and Reconstructive Surgeons)
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Considerations for patient selection: Prepectoral versus subpectoral implant-based breast reconstruction

  • Yang, Jun Young (Department of Plastic and Reconstructive Surgery, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Kim, Chan Woo (Department of Plastic and Reconstructive Surgery, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Lee, Jang Won (Department of Plastic and Reconstructive Surgery, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Kim, Seung Ki (Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Lee, Seung Ah (Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine) ;
  • Hwang, Euna (Department of Plastic and Reconstructive Surgery, CHA Bundang Medical Center, CHA University School of Medicine)
  • 투고 : 2019.03.29
  • 심사 : 2019.10.22
  • 발행 : 2019.11.15
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초록

Background In recent years, breast implants have been frequently placed in the subcutaneous pocket, in the so-called prepectoral approach. We report our technique of prepectoral implant-based breast reconstruction (IBR), as well as its surgical and aesthetic outcomes, in comparison with subpectoral IBR. We also discuss relevant considerations and pitfalls in prepectoral IBR and suggest an algorithm for the selection of patients for IBR based on our experiences. Methods We performed 79 immediate breast reconstructions with a breast implant and an acellular dermal matrix (ADM) sling, of which 47 were subpectoral IBRs and 32 were prepectoral IBRs. Two-stage IBR was performed in 36 cases (20 subpectoral, 16 prepectoral), and direct-to-implant IBR in 43 cases (27 prepectoral, 16 subpectoral). The ADM sling supplemented the inferolateral side of the breast prosthesis in the subpectoral group and covered the entire anterior surface of the breast prosthesis in the prepectoral group. Results The postoperative pain score was much lower in the prepectoral group than in the subpectoral group (1.78 vs. 7.17). The incidence of seroma was higher in the prepectoral group (31.3% vs. 6.4%). Other postoperative complications, such as surgical site infection, flap necrosis, implant failure, and wound dehiscence, occurred at similar rates in both groups. Animation deformities developed in 8.5% of patients in the subpectoral group and rippling deformities were more common in the prepectoral group (21.9% vs. 12.8%). Conclusions The indications for prepectoral IBR include moderately-sized breasts with a thick well-vascularized mastectomy flap and concomitant bilateral breast reconstruction with prophylactic mastectomy.

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참고문헌

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피인용 문헌

  1. Outcome Assessment According to the Thickness and Direction of the Acellular Dermal Matrix after Implant-Based Breast Reconstruction vol.2021, 2019, https://doi.org/10.1155/2021/8101009
  2. Current status of breast implant-associated anaplastic large cell lymphoma in South Korea vol.64, pp.1, 2019, https://doi.org/10.5124/jkma.2021.64.1.5
  3. A Sustainable Approach to Prepectoral Breast Reconstruction Using Meshed Acellular Dermal Matrix vol.9, pp.1, 2019, https://doi.org/10.1097/gox.0000000000003392
  4. Immediate Prosthetic Breast Reconstruction after Nipple-Sparing Mastectomy: Traditional Subpectoral Technique versus Direct-to-Implant Prepectoral Reconstruction without Acellular Dermal Matrix vol.11, pp.2, 2019, https://doi.org/10.3390/jpm11020153