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Immediate Implant-Based Breast Reconstruction In The Previously Augmented Patient
Andrew Kochuba, MD
Kenneth Shestak, MD
University of Pittsburgh Medical Center
2019-02-14
Presenter: Andrew Kochuba, MD
Affidavit:
Agree with the above statement.
Director Name: Dr. Vu Nguyen
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
PURPOSE: Breast augmentation is a common plastic surgery. A portion of augmented patients will develop breast cancer and pursue alloplastic reconstruction. Little data exists on these patients. The purpose is to review the outcomes and develop a surgical algorithm for previously augmented patients with breast cancer who undergo prosthetic breast reconstruction.
METHOD: Retrospective study of single surgeon's practice. Inclusion criteria were patients with previous breast augmentation, breast cancer, oncologic resection, and alloplastic reconstruction. An outcomes assessment based on the reconstructive techniques was performed. The primary endpoints were the incidence and type of complications.
RESULTS: Group 1: Submuscular capsule, proper position, and supports larger implant. Group 2: Submuscular capsule not ideally positioned requiring capsulorraphy. Group 3: Submuscular capsule unable to support larger implant requiring ADM. Group 4: Subglandular capsule, new submuscular pocket created with ADM. Group 5: Subglandular capsule, new submuscular pocket created. 4 patients in Group 1 (late complication of capsular contracture), 3 patients in Group 2 (late complication of capsular contracture), 5 patients in Group 3 (early complication of wound dehiscence, 4 late complications of capsular contracture and contour abnormality), 3 patients in Group 4 (early complication of flap necrosis and 2 late complications of contour abnormality), and 1 patient in Group 5.
CONCLUSION: Breast augmentation is common amongst women. Given the lifetime risk of breast cancer, a portion of those patients will develop cancer. The mainstay of reconstruction continues to be prosthetic. Despite previous breast augmentation, women undergoing mastectomy can still have implant-based reconstruction in the right situation.
