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A case of important weight loss after a prepectoral breast reconstruction

  • Marzia Salgarello
  • Liliana Barone Adesi
  • Maria Lucia Mangialardi
Case Report
  • 37 Downloads

Abstract

The submuscular implant-based breast reconstruction is the most common reconstructive technique following mastectomy. Recently, subcutaneous implant positioning, together with acellular dermal matrix, has become a promising technique in selected patients. We present the case of a 42-year-old woman who underwent left nipple-sparing mastectomy with prepectoral acellular dermal matrix (ADM) assisted direct-to-implant (DTI) breast reconstruction and contralateral mastopexy. The implant was completely wrapped around by Braxon®, a preshaped porcine ADM. A few months after surgery, she experienced a severe weight loss resulting in the aesthetic deterioration of both breasts. The patient showed a migration of the left implant inferiorly and laterally, and deflation of the contralateral breast. In order to improve the left breast, a lateral capsulectomy was performed to reduce the prepectoral pocket size and lift the implant. Subsequently, a modified donut mastopexy was performed to obtain an upward migration of the nipple-areolar complex. One of the limiting factors of prosthetic reconstruction, as compared to autologous reconstruction, is the aesthetic deterioration determined by any weight change. Differently from submuscular implant reconstruction, the prepectoral implant reconstruction follows body changes after weight changes and ageing. In fact, Braxon’s integration determines the formation of a capsule adhering to the mastectomy flap which makes the implant more sensible to dermatochalasis. The greater thickness of the mastectomy flap due to the larger representation of the subcutaneous tissue makes the reconstruction more sensitive to weight changes. A tailored partial capsulectomy combined with a donut mastopexy can be a solution in these patients after an important weight loss.

Level of Evidence: Level V, therapeutic study.

Keywords

Prepectoral breast reconstruction Subcutaneous breast reconstruction Weight loss Capsulectomy Braxon ADM 

Notes

Compliance with ethical standards

Patient consent

Written informed consent was obtained from the patient.

Ethical approval

For this type of study formal consent from a local ethics committee is not required.

Conflict of interest

Marzia Salgarello, Liliana Barone Adesi and Maria Lucia Mangialardi declare that they have no conflict of interest.

Funding

None.

References

  1. 1.
    American Society of Plastic Surgeons. 2014 Plastic Surgery Statistics Report. Available at: http://www.plasticsurgery.org/Documents/ news-resources/statistics/2014-statistics/plastic-surgery-statsitics- full-report.pdf. Accessed 25 Apr 2016
  2. 2.
    Sigalove S, Maxwell GP, Sigalove N, Storm-Dickerson TL, Pope N, Rice J, Gabriel A (2017) Prepectoral implant-based breast reconstruction: rationale, indications, and preliminary results. Plast Reconstr Surg 139(2):287–294CrossRefPubMedGoogle Scholar
  3. 3.
    Snyderman RK, Guthrie RH (1971) Reconstruction of the female breast following radical mastectomy. Plast Reconstr Surg 47:565–567CrossRefPubMedGoogle Scholar
  4. 4.
    Gruber RP, Kahn RA, Lash H, Maser MR, Apfelberg DB, Laub DR (1981) Breast reconstruction following mastectomy: a comparison of submuscular and subcutaneous techniques. Plast Reconstr Surg 67:312–317CrossRefPubMedGoogle Scholar
  5. 5.
    Spear SL, Schwartz J, Dayan JH, Clemens MW (2009) Outcome assessment of breast distortion following submuscular breast augmentation. Aesthetic Plast Surg 33:44–48CrossRefPubMedGoogle Scholar
  6. 6.
    Haynes DF, Kreithen JC (2014) Vicryl mesh in expander/implant breast reconstruction: long-term follow-up in 38 patients. Plast Reconstr Surg 134:892–899CrossRefPubMedGoogle Scholar
  7. 7.
    Martin JB, Moore R, Paydar KZ, Wirth GA (2014) Use of fenestrations in acellular dermal allograft in two-stage tissue expander/implant breast reconstruction. Plast Reconstr Surg 134:901–904CrossRefPubMedGoogle Scholar
  8. 8.
    Dieterich M, Angres J, Stubert J, Stachs A, Reimer T, Gerber B (2015) Patient-reported outcomes in implant-based breast reconstruction alone or in combination with a titanium-coated polypropylene mesh - a detailed analysis of the BREAST-Q and overview of the literature. Geburtshilfe Frauenheilkd 75:692–701CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    McCarthy CM, Lee CN, Halvorson EG, Riedel E, Pusic AL, Mehrara BJ et al (2012) The use of acellular dermal matrices in two-stage expander/implant reconstruction: a multicenter, blinded, randomized controlled trial. Plast Reconstr Surg 130(5 Suppl 2):57S–66SCrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Bernini M, Calabrese C, Cecconi L, Santi C, Gjondedaj U, Roselli J, Nori J, Fausto A, Orzalesi L, Casella D (2015) Subcutaneous direct-to- implant breast reconstruction: surgical, functional, and aesthetic results after long-term follow-up. Plast Reconstr Surg Glob Open 3:e574CrossRefPubMedGoogle Scholar
  11. 11.
    Salibian AA, Frey JD, Choi M, Karp NS (2016) Subcutaneous implant-based breast reconstruction with acellular dermal matrix/mesh: a systematic review. Plast Reconstr Surg Glob Open 4(11):e1139CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Zhu L, Mohan A, Abdelsattar JM, Wang Z, Vijayasekaran A, Michelle Hwang NV, Tran MD et al (2016) Comparison of subcutaneous versus submuscular expander placement in the first stage of immediate breast reconstruction. J Plast Reconstr Aesthet Surg 69(4):e77–e86CrossRefPubMedGoogle Scholar
  13. 13.
    Casella D, Calabrese C, Bianchi S, eattini I, Bernini M (2015) Subcutaneous tissue expander placement with synthetic titanium-coated mesh in breast reconstruction: long-term results. Plast Reconstr Surg Glob Open 3:e577CrossRefPubMedGoogle Scholar
  14. 14.
    Berna G, Cawthorn SJ, Papaccio G, Balestrieri N (2014) Evaluation of a novel breast reconstruction technique using the Braxon® acellular dermal matrix: a new muscle-sparing breast reconstruction. ANZ J Surg 87:493–498CrossRefPubMedGoogle Scholar
  15. 15.
    Woods JE (1983) Subcutaneous mastectomy: current state of the art. Ann Plast Surg 11:541–550CrossRefPubMedGoogle Scholar
  16. 16.
    Goodnight JE Jr, Quagliana JM, Morton DL (1984) Failure of subcutaneous mastectomy to prevent the development of breast cancer. J Surg Oncol 26:198–201CrossRefPubMedGoogle Scholar
  17. 17.
    Reitsamer R, Peintinger F (2015) Prepectoral implant placement and complete coverage with porcine acellular dermal matrix: a new technique for direct-to-implant breast reconstruction after nipple-sparing mastectomy. J Plast Reconstr Aesthet Surg 68:162–167CrossRefPubMedGoogle Scholar
  18. 18.
    Wallace MS, Wallace AM, Lee J (1996) Pain after breast surgery: a survey of 282 women. Pain 66:195–205CrossRefPubMedGoogle Scholar
  19. 19.
    Tomita K, Yano K, Nishibayashi A, Hosokawa K (2015) Effects of subcutaneous versus submuscular tissue expander placement on breast capsule formation. Plast Reconstr Surg Glob Open 3(6):e432CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Becker H, Lind JG 2nd, Hopkins EG (2015) Immediate implant-based prepectoral breast reconstruction using a vertical incision. Plast Reconstr Surg Glob Open 3:e412CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Arquero PS, Zanata FC, Ferreira LM, Nahas FX (2015) Capsular weakness around breast implant: a non-recognized complication. World J Plast Surg 4:168–74.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Plastic and Reconstructive SurgeryPoliclinico Universitario Agostino GemelliRomeItaly

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