Safety Of Breast Reconstruction Using Inferiorly Based Dermal Flap For Ptotic Breast
Thais Calderon1, Trevor Hansen1, Kathryn Skibba1, Ashley Amalfi2, Elaina Chen1
1Division of Plastic Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY; 2Quatela Center for Plastic Surgery, Rochester, NY
Introduction: The utilization of an inferiorly based dermal flap (IBDF) with implant insertion is one technique for reconstruction of a ptotic breast following mastectomy. An IBDF allows for reduction of the skin envelope while also providing implant protection at the inferior pole with a fully vascularized autologous pocket. Previous literature has demonstrated high patient satisfaction when utilizing this surgical technique as measured by the BRECON-31. There is some concern that invaginations in the dermal flap that contain epithelial components may serve as a nidus for infection. There is some data regarding IBDF complication rates, but no study to date has compared the safety of an IBDF technique with other forms of immediate reconstruction. We hypothesize that there is no increase in surgical complications in the IBDF surgical approach versus other common breast reconstruction procedures.
Methods: This is a single-institution retrospective chart review of all patients who underwent implant-based reconstruction from June 2016 through December 2020. Patients who did not have a permanent implant placed by December 2020 or had delayed reconstruction were excluded. Two cohorts were established: those who underwent immediate reconstruction following mastectomy with an IBDF and those who underwent immediate reconstruction without a IBDF. Patient demographics, use of the IBDF technique, reconstructive characteristics, and surgical complications were recorded and compared amongst the two cohorts.
Results: A total of 207 breasts were included: 52 breasts in the IBDF cohort and 155 breasts in the control cohort. There were no statistically significant differences between cohorts, except the IBDF cohort has a significantly higher BMI (Mean=30.9 versus 26.5, p=<0.001). There was no statistically significant difference in the rate of complications between the IBDF and control groups, including seroma (5.8% vs. 3.9%), hematoma (3.8% vs 0.6%), wound dehiscence (0.0% vs. 1.9%), mastectomy flap necrosis (11.5% vs. 6.5%), breast infection (5.8% vs. 7.1%), need for implant salvage (0.0% vs. 5.8%), and implant loss (5.8% vs. 5.8%), respectively.
Conclusions: Utilizing an IBDF to reconstruct a ptotic breast immediately following mastectomy has a similar risk profile compared to other breast reconstruction techniques. Additionally, it has previously demonstrated optimal patient satisfaction scores and allows for a “one-stop reconstruction” of ptotic breasts that otherwise require sequential revisions. We conclude that immediate implant-based reconstruction of a ptotic breast following mastectomy using an IBDF can be performed safely with a high level of patient satisfaction.
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