NSMs replace conventional mastectomies in most patients. Immediate breast reconstruction
is an integral part of this procedure. For the implant-based breast reconstruction
generally the subpectoral implant placement is recommended. The theoretic advantage
of a better cosmetic result has to be outweighed with the disadvantages (partial detachment
of the pectoralis major muscle (PMM) with subsequent muscular deficit, breast animation
and postoperative pain). Prepectoral implant placement and complete coverage with
an ADM may provide an alternative with an excellent cosmetic result avoiding the disadvantages
of the subpectoral implant placement.
In a total of 121 breasts in 84 patients NSM and DTI-breast reconstruction with prepectoral
implant placement was performed. The implant was completely covered by a porcine ADM,
which was sutured to the fascia of the PMM and the superficial thoracic fascia thoracica
superficialis and to the inframmary fold to keep the implant in place.
Cosmetic results were excellent at a median follow-up of 24 months. Breast animation
and implant dislocation could not be observed. Implant rims were visible and palpable
in the upper poles of 5 very skinny patients and visible rippling could be observed
in 6 patients. Major complications comprised skin necrosis with implant loss in one
breast and hemorrhage with evacuation in 7 breasts, minor complications comprised
minimal nipple necrosis without further intervention in 5 breasts.
Prepectoral implant placement and complete coverage with porcine ADM after NSM represents
a novel approach and a feasible alternative to subpectoral implant placement for patients
preferring their pectoralis major muscle to be left intact.
