scholarly journals Modified Lower Pole Autologous Dermal Sling for Implant Reconstruction in Women Undergoing Immediate Breast Reconstruction after Mastectomy

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Pankaj G. Roy
Keyword(s):  
Risk Reduction ◽  
Cost Effective ◽  
Immediate Breast Reconstruction ◽  
Lower Pole ◽  
One Stage ◽  
Ptotic Breasts ◽  
Nipple Sparing ◽  
Implant Reconstruction ◽  
Wise Pattern ◽  
Dermal Sling

Background. Autologous dermal sling with wise pattern skin reducing mastectomy allows one-stage implant reconstruction in women with large and ptotic breasts needing mastectomy for cancer or risk reduction. However, this technique is not suitable for women who lack ptosis and also carries risk of T-junction breakdown.Method. We have performed one-stage nipple sparing mastectomies with implant reconstruction in 5 women (8 breasts) by modifying the autologous dermal sling approach. All these women had small to moderate breasts with no ptosis or pseudoptosis.Results. Three women had bilateral procedures, two underwent bilateral mastectomies simultaneously, and one had contralateral risk reduction surgery a year after the cancer side operation. All women underwent direct to implant reconstruction with implant volumes varying from 320 to 375 cc. There were no implant losses and only one required further surgery to excise the nipple for positive nipple shaves. A low complication rate was encountered in this series with good aesthetic outcome.Conclusion. The modified lower pole dermal sling allows direct to implant reconstruction in selected women with small to moderate sized breasts with minimal ptosis. The approach is safe and cost-effective and results in more natural reconstruction with preservation of nipple.

scholarly journals ADVANCED AUTOLOGOUS LOWER DERMAL SLING TECHNIQUE FOR IMMEDIATE BREAST RECONSTRUCTION SURGERY IN SMALL AND NON-PTOTIC BREASTS

2021 ◽  
Author(s):  
Chaitanyanand Koppiker ◽  
Aijaz Ul Noor ◽  
Santosh Dixit ◽  
Laleh Busheri ◽  
Gautam Sharan ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Cost Effective ◽  
Well Being ◽  
Immediate Breast Reconstruction ◽  
Immediate Reconstruction ◽  
Reconstruction Surgery ◽  
One Stage ◽  
Patient Reported ◽  
Ptotic Breasts ◽  
Dermal Sling

Background: Breast reconstruction with an autologous lower dermal sling (ALDS) is an established one-stage procedure in patients with moderate to large ptotic breasts. However, this technique is difficult to perform in small and non/minimally ptotic breasts. We describe our experiences from a single institution about a novel Advanced Autologous Lower Dermal Sling (A-ALDS) technique for reconstruction in small breasts. Methods: We performed one stage nipple/skin sparing mastectomies in 61 patients with immediate reconstruction either by conventional immediate breast reconstruction surgery or A-ALDS technique. Results: Mean age of study patients was 46.9 years. We observed significantly better cosmetic score and lower immediate complication rate vis-a-vis skin necrosis, implant loss with the A-ALDS technique (i.e., nil versus 3 in Conventional Immediate Breast Reconstruction Surgery -IBRS). 40 patients completed 12 months follow-up. The PROMs- Patient Reported Outcomes Measures (Breast-Q) revealed good to excellent scores for satisfaction with breast, cosmetic outcome and psychosocial well-being in patients operated with both these techniques. However, sexual well-being was significantly better in the A-ALDS group. Conclusion: The A-ALDS is a novel, cost-effective and safe technique for immediate one stage implant-based reconstruction for small breasts. It provides a dermal barrier flap and hence, ensures less complications, excellent cosmetic results and patient satisfaction.

scholarly journals Delivering Breast Reconstruction Information to Patients—Part 2: Women Report on Preferred Information Content

2020 ◽  
Vol 28 (4) ◽  
pp. 196-203
Author(s):  
Natalie Jacox ◽  
Carmen Webb ◽  
Vishal Sharma ◽  
Claire Temple-Oberle
Keyword(s):  
Breast Reconstruction ◽  
Mixed Methods Research ◽  
Structured Interview ◽  
Immediate Breast Reconstruction ◽  
Reconstruction Surgery ◽  
Purposeful Sampling ◽  
Pros And Cons ◽  
Nipple Sparing ◽  
Interview Transcript ◽  
Implant Reconstruction

Purpose: To determine the type of information women want to be provided in order to make an informed decision as to whether, when, and using what technique to proceed with breast reconstruction. Method: Using purposeful sampling, 19 patients who had recently undergone various breast reconstruction procedures were recruited to each participate in a 30- to 45-minute semi-structured interview. Participants shared their insights and beliefs regarding the type of breast reconstruction information they most valued prior to undergoing breast reconstruction surgery. Participants were also queried as to perceived information gaps. In some cases, the participants’ partners or support persons were also interviewed. Grounded theory and thematic analysis assisted in interview transcript analysis. Results: Eight topics were identified relating to women’s informational needs around breast reconstruction. Examples include how to weigh the pros and cons of various breast reconstruction options to decide between flap or implant reconstruction, whether there are safety concerns with immediate breast reconstruction or nipple-sparing reconstruction, and expectations and advice on how to manage possibly unexpected intimacy issues after breast reconstruction. Conclusions: Using mixed methods research methodology, 19 women reported on preoperative informational gaps relating to their recent breast reconstruction experiences. Patients report that adequate breast reconstruction information prior to breast reconstruction surgery helps them to manage their expectations, prepare for surgery and recovery, and improve postoperative satisfaction.

scholarly journals One-Stage Immediate Breast Reconstruction: A Concise Review

2017 ◽  
Vol 2017 ◽  
pp. 1-12 ◽  
Author(s):  
Nicolò Bertozzi ◽  
Marianna Pesce ◽  
Pierluigi Santi ◽  
Edoardo Raposio
Keyword(s):  
Breast Reconstruction ◽  
Acellular Dermal Matrix ◽  
Synthetic Mesh ◽  
Immediate Breast Reconstruction ◽  
Fat Grafting ◽  
Dermal Matrix ◽  
One Stage ◽  
Care Outcomes ◽  
Ptotic Breasts ◽  
Staged Reconstruction

Background. One-stage direct-to-implant immediate breast reconstruction (IBR) is performed simultaneously with breast cancer resection. We explored indications, techniques, and outcomes of IBR to determine its feasibility, safety, and effectiveness.Material and Methods. We reviewed the available literature on one-stage direct-to-implant IBR, with or without acellular dermal matrix (ADM), synthetic mesh, or autologous fat grafting. We analyzed the indications, preoperative work-up, surgical technique, postoperative care, outcomes, and complications.Results. IBR is indicated for small-to-medium nonptotic breasts and contraindicated in patients who require or have undergone radiotherapy, due to unacceptably high complications rates. Only patients with thick, well-vascularized mastectomy flaps are IBR candidates. Expandable implants should be used for ptotic breasts, while anatomical shaped implants should be used to reconstruct small-to-medium nonptotic breasts. ADMs can be used to cover the implant during IBR and avoid muscle elevation, thereby minimizing postoperative pain. Flap necrosis, reoperation, and implant loss are more common with IBR than conventional two-staged reconstruction, but IBR has advantages such as lack of secondary surgery, faster recovery, and better quality of life.Conclusions. IBR has good outcomes and patient-satisfaction rates. With ADM use, a shift from conventional reconstruction to IBR has occurred. Drawbacks of IBR can be overcome by careful patient selection.

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