Advertisement

The Use of Serratus Anterior Fascial Flap in Integrated Mastectomy and Implant Reconstruction

  • Yolanda Ho-Yan Chan
  • Ivan Kai-Hong Yue
  • Chiu-Ming Ho
  • Polly Suk-Yee CheungEmail author
Original Scientific Report
  • 32 Downloads

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.

Notes

Funding

None.

Compliance with ethical standards

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.

References

  1. 1.
    Bertozzi N, Pesce M, Santi P, Raposio E (2017) Tissue expansion for breast reconstruction: methods and techniques. Ann Med Surg 21:34–44CrossRefGoogle Scholar
  2. 2.
    Scheflan M, Colwell AS (2014) Tissue reinforcement in implant-based breast reconstruction. Plast Reconstr Surg Glob Open 2(8):e192CrossRefGoogle Scholar
  3. 3.
    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 CrossRefPubMedGoogle Scholar
  4. 4.
    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):641–645CrossRefGoogle Scholar
  5. 5.
    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):703–708CrossRefGoogle Scholar
  6. 6.
    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 235–252CrossRefGoogle Scholar
  7. 7.
    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):1057–1064CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Yolanda Ho-Yan Chan
    • 1
  • Ivan Kai-Hong Yue
    • 1
  • Chiu-Ming Ho
    • 2
  • Polly Suk-Yee Cheung
    • 3
    Email author
  1. 1.Department of SurgeryKwong Wah HospitalKowloonHong Kong SAR
  2. 2.Plastic and Reconstructive Surgery CentreHong Kong Sanatorium and HospitalHappy ValleyHong Kong SAR
  3. 3.Breast Care CentreHong Kong Sanatorium and HospitalHappy ValleyHong Kong SAR

Personalised recommendations