Dual Coverage of the Inferior Pole with Conjoined Fascial Flap and Acellular Dermal Matrix for Immediate One-Stage Breast Reconstruction with a Prosthetic Implant

  • Seo H. Lee
  • Yong S. Chun
  • Heung K. Park
  • Yang W. Kim
  • Young W. Cheon
Original Article Breast Surgery
  • 16 Downloads

Abstract

Background

Elevation of a conjoined fascial flap composed of the pectoralis major, serratus anterior, and external oblique fascia is a type of surgical technique using autologous tissue to cover the lower pole after immediate one-stage direct-to-implant (DTI) breast reconstruction. However, volumetric breast implants hinder use of this technique alone. For better structural stability and more aesthetically favorable breast contour in large breasts, we have devised a technique involving dual coverage of the lower pole by a conjoined fascial flap and acellular dermal matrix (ADM).

Methods

Twenty Asian patients underwent DTI breast reconstruction from March 2013 to May 2014. ADM was used to cover the inferomedial quadrant of the breast, and a conjoined fascial flap was elevated to cover the remaining inferolateral quadrant. Both patient- and plastic surgeon-reported outcome measures were assessed using questionnaires.

Result

For every domain of the patient- and plastic surgeon-reported questionnaires, the mean scores were between satisfied and very satisfied. Two patients developed a seroma and one patient developed partial skin flap necrosis. Both seromas resolved after a series of aspirations. The necrotic skin flap was revised under local anesthesia 3 weeks after the reconstructive surgery.

Conclusion

The use of dual coverage of the inferior pole with a conjoined fascial flap and ADM for immediate DTI among patients with large breasts is supported by high scores in both patient- and plastic surgeon-reported outcome measures, as well as low complication rates.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Keywords

Breast reconstruction Breast implant Acellular dermal matrix Outcome measure 

Notes

Acknowledgements

All authors were involved in the study design and the writing of the article and have no financial interest to declare in relation to the content of this article.

Compliance with Ethical Standards

Conflict of interest

The authors have indicated no interest with commercial supporters.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

References

  1. 1.
    Hon HH, Mubang RN, Wernick BD, Freedman SF, Stoltzfus JC, Miele LF, Stawicki SP, Morrissey WM Jr (2017) Acellular dermal matrix versus inferior deepithelialized flap breast reconstruction: equivalent outcomes, with increased cost. Plast Reconstr Surg Glob Open 5(6):e1382CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    DeSantis C, Siegel R, Bandi P, Jemal A (2011) Breast cancer statistics. CA Cancer J Clin 61(6):409–418CrossRefPubMedGoogle Scholar
  3. 3.
    Holle J, Pierini A (1984) Breast reconstruction with an external oblique abdominis muscle turnover flap and a bipedicled abdominal skin flap. Plast Reconstr Surg 73(3):469–473CrossRefPubMedGoogle Scholar
  4. 4.
    Isken T, Onyedi M, Izmirli H, Alagoz S, Katz R (2009) Abdominal fascial flaps for providing total implant coverage in one-stage breast reconstruction: an autologous solution. Aesthetic Plast Surg 33(6):853–858CrossRefPubMedGoogle Scholar
  5. 5.
    Ross GL (2012) One stage breast reconstruction following prophylactic mastectomy for ptotic breasts: the inferior dermal flap and implant. J Plast Reconstr Aesthet Surg 65(9):1204–1208CrossRefPubMedGoogle Scholar
  6. 6.
    Sorkin M, Qi J, Kim HM, Hamill JB, Kozlow JH, Pusic AL, Wilkins EG (2017) Acellular Dermal Matrix in immediate expander/implant breast reconstruction: a multicenter assessment of risks and benefits. Plast Reconstr Surg 140(6):1091–1100CrossRefPubMedGoogle Scholar
  7. 7.
    Breuing KH, Colwell AS (2007) Inferolateral AlloDerm hammock for implant coverage in breast reconstruction. Ann Plast Surg 59(3):250–255CrossRefPubMedGoogle Scholar
  8. 8.
    Kim YW, Kim YJ, Kong JS, Cheon YW (2014) Use of the pectoralis major, serratus anterior, and external oblique fascial flap for immediate one-stage breast reconstruction with implant. Aesthetic Plast Surg 38(4):704–710CrossRefPubMedGoogle Scholar
  9. 9.
    Salgarello M, Visconti G, Barone-Adesi L (2010) Nipple-sparing mastectomy with immediate implant reconstruction: cosmetic outcomes and technical refinements. Plast Reconstr Surg 126(5):1460–1471CrossRefPubMedGoogle Scholar
  10. 10.
    Sbitany H, Sandeen SN, Amalfi AN, Davenport MS, Langstein HN (2009) Acellular dermis-assisted prosthetic breast reconstruction versus complete submuscular coverage: a head-to-head comparison of outcomes. Plast Reconstr Surg 124(6):1735–1740CrossRefPubMedGoogle Scholar
  11. 11.
    Myckatyn TM, Cavallo JA, Sharma K, Gangopadhyay N, Dudas JR, Roma AA, Baalman S, Tenenbaum MM, Matthews BD, Deeken CR (2015) The impact of chemotherapy and radiation therapy on the remodeling of acellular dermal matrices in staged, prosthetic breast reconstruction. Plast Reconstr Surg 135(1):43e–57eCrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Israeli Ben-Noon H, Farber N, Weissman O, Tessone A, Stavrou D, Shabtai M, Maor Y, Haik J, Winkler E (2013) The effect of acellular dermal matrix on drain secretions after immediate prosthetic breast reconstruction. J Plast Surg Hand Surg 47(4):308–312CrossRefPubMedGoogle Scholar
  13. 13.
    Paprottka FJ, Krezdorn N, Sorg H, Könneker S, Bontikous S, Robertson I, Schlett CL, Dohse NK, Hebebrand D (2017) Evaluation of complication rates after breast surgery using acellular Dermal Matrix: median follow-up of 3 years. Plast Surg Int 2017:1283735PubMedPubMedCentralGoogle Scholar
  14. 14.
    Onesti MG, Maruccia M, Di Taranto G, Albano A, Soda G, Ballesio L, Scuderi N (2017) Clinical, historical, and ultrasound follow-up of breast reconstruction with one-stage muscle-sparing “wrap” technique: a single-center experience. J Plast Reconstr Aesthet Surg 70(11):1527–1536CrossRefPubMedGoogle Scholar
  15. 15.
    Leong M, Basu CB, Hicks MJ (2015) Further evidence that human acellular dermal matrix decreases inflammatory markers of capsule formation in implant-based breast reconstruction. Aesthet Surg J 35(1):40–47CrossRefPubMedGoogle Scholar
  16. 16.
    Ooi ASh, Song DH (2016) Reducing infection risk in implant-based breast-reconstruction surgery: challenges and solutions. Breast Cancer 8:161–172PubMedPubMedCentralGoogle Scholar
  17. 17.
    Chun YS, Verma K, Rosen H, Lipsitz S, Morris D, Kenney P, Eriksson E (2010) Implant-based breast reconstruction using acellular dermal matrix and the risk of postoperative complications. Plast Reconstr Surg 125(2):429–436CrossRefPubMedGoogle Scholar
  18. 18.
    Vardanian AJ, Clayton JL, Roostaeian J, Shirvanian V, Da Lio A, Lipa JE, Crisera C, Festekjian JH (2011) Comparison of implant-based immediate breast reconstruction with and without acellular dermal matrix. Plast Reconstr Surg 128(5):403e–410eCrossRefPubMedGoogle Scholar
  19. 19.
    Kim MS, Sbalchiero JC, Reece GP, Miller MJ, Beahm EK, Markey MK (2008) Assessment of breast aesthetics. Plast Reconstr Surg 121(4):186e–194eCrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Hu ES, Pusic AL, Waljee JF, Kuhn L, Hawley ST, Wilkins E, Alderman AK (2009) Patient-reported aesthetic satisfaction with breast reconstruction during the long-term survivorship Period. Plast Reconstr Surg 124(1):1–8CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2018

Authors and Affiliations

  • Seo H. Lee
    • 1
  • Yong S. Chun
    • 2
  • Heung K. Park
    • 2
  • Yang W. Kim
    • 1
  • Young W. Cheon
    • 1
  1. 1.Department of Plastic and Reconstructive SurgeryGachon University Gil Medical CenterIncheonRepublic of Korea
  2. 2.Department of General SurgeryGachon University Gil Medical CenterIncheonRepublic of Korea

Personalised recommendations