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Pre-pectoral conversion for unsatisfactory sub-muscular implant-based breast reconstruction: A single surgeon experience
Alexander Shikhman, DO
Logal Erz, MD
Douglas Wagner, MD
Summa Health Plastic Surgery
2020-01-30
Presenter: Alexander Shikhman, DO
Affidavit:
All of the work in this project was original work by presenting resident.
Director Name: Douglas Wagner, MD
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction
Implant-based breast reconstruction in postmastectomy patients was commonly performed in a submuscular plane. After this type of reconstruction, animation deformity is one of the most displeasing aesthetic results for the patient. In addition, patients may experience more post-operative pain with a submuscular reconstruction. Prepectoral conversion of submuscular implant position is an option for addressing these concerns.
Methods
A retrospective review was conducted of all prepectoral conversions performed by the senior author (D.S.W) from 2017 to 2019. All patients presented with animation deformity and another symptom such as asymmetry, pain and/or capsular contracture. Patients underwent prepectoral conversion with smooth silicone gel implants. Demographic data, outcomes and patient satisfaction were reviewed.
Results
Retrospective review resulted in 33 consecutive patients who underwent prepectoral conversion. All patients had animation deformity. In addition, 12 patients had capsular contracture, seven complained of pain, and five had ruptured implants. Post-operative complications were two infections requiring implant removal, one implant exposure and hematoma requiring implant removal and replacement, five seromas requiring aspiration, and one capsular contracture. Seven patients had contour abnormalities addressed with autologous fat grafting at a second stage. Ultimately, all patients were very satisfied with the results of the conversion.
Conclusion
Displeasing aesthetic results due to animation deformity and chronic pain have led the reconstructive surgeon to consider various techniques to address these issues. The conversion to a prepectoral plane will effectively eliminate animation deformity, resolve pain, and yield satisfactory results in these patients.
