Abstract
Background
Tissue reinforcement with acellular dermal matrix (ADM) in implant-based breast reconstruction contributes to the coverage of the implant and avoids its direct exposure to skin incision, yet not without risk of infection. Our integrated technique makes use of the in situ serratus anterior fascia as a support of the implant following mastectomy, which serves the same purpose of ADM in terms of aesthetic outcomes, but minimizes the hazard of infective complications.
Methods
We retrospectively reviewed all the nipple-sparing mastectomies with direct-to-implant immediate reconstruction in Hong Kong Sanatorium and Hospital from 2012 to 2016. The authors made use of the serratus anterior fascial flap as inferolateral coverage for the subpectoral implant. Consequently, the implant would be completely covered by autologous tissues.
Results
Among the 51 women included, primary breast cancers account for 91.8% of our indications for these 61 procedures of integrated mastectomy and implant reconstruction. The remaining five (8.2%) were performed as contralateral prophylactic mastectomy. Almost three quarters of the patients had a bra cup size of B or below. After a mean follow-up of 28.9 months, there was no reported post-operative complication of skin flap or nipple–areolar complex necrosis, or infection or extrusion of the implant.
Conclusions
Our series support that the serratus anterior fascial flap could provide autologous coverage in integrated mastectomy and implant breast reconstruction, especially in small- and medium-sized breasts. Appropriate patient selection, as well as meticulous surgical technique, is critical for its success.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bertozzi N, Pesce M, Santi P, Raposio E (2017) Tissue expansion for breast reconstruction: methods and techniques. Ann Med Surg 21:34–44
Scheflan M, Colwell AS (2014) Tissue reinforcement in implant-based breast reconstruction. Plast Reconstr Surg Glob Open 2(8):e192
Chan YHY, Yau WM, Cheung PSY (2018) Oncological safety and technical feasibility of nipple-sparing mastectomy for breast cancer: the Hong Kong experience. World J Surg 42:1375–1383. https://doi.org/10.1007/s00268-017-4197-y
Seth AK, Hirsch EM, Kim JYS, Fine NA (2017) Outcomes after elevation of serratus anterior fascia during prosthetic breast reconstruction. Ann Plast Surg 78(6):641–645
Kubo K, Takei H, Hamahata A, Matsumoto H, Sakurai H (2018) Complication analysis of complete versus partial coverage of tissue expanders using serratus anterior musculofascial flaps in immediate breast reconstruction. Surg Today 48(7):703–708
Sheflan M, Brown I (2013) Immediate implant-based breast reconstruction using variable lower pole support. In: Urban C, Rietjens M (eds) Oncoplastic and reconstructive breast surgery. Milano, Springer, pp 235–252
Saint-Cyr M, Dauwe P, Wong C, Thakar H, Nagarkar P, Rohrich RJ (2010) Use of the serratus anterior fascia flap for expander coverage in breast reconstruction. Plast Reconstr Surg 125(4):1057–1064
Funding
None.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Chan, Y.HY., Yue, I.KH., Ho, CM. et al. The Use of Serratus Anterior Fascial Flap in Integrated Mastectomy and Implant Reconstruction. World J Surg 44, 825–830 (2020). https://doi.org/10.1007/s00268-019-05275-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-019-05275-6