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Combining Autoderm with Single-Stage Implant Breast Reconstruction in Obese Patients
Rachel Danforth, Julia Cook, Tahereh Soleimani, Michael Chu, Rajiv Sood, Brett Hartman
Indiana University School of Medicine, Plastic Surgery
2016-02-01
Presenter: Rachel Danforth MD
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. This abstract is the original work of the resident.The resident was responsible for study design, interpretation of data, drafting abstract.
Director Name: Rajiv Sood
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Abstract
Background: Single-stage implant reconstruction following mastectomy has gained undeniable popularity over recent years as new techniques and products have allowed for lower complication rates. The overwhelming caveat to this has been patient selection. Direct-to-implant reconstruction is reported as troublesome in obese patients with large, ptotic breasts. The purpose of this study was to evaluate the hypothesis that successful cosmetic and clinical outcomes can be achieved in obese patients by combining single-stage implant placement with a skin-reduction, autologous inferior dermal pedicle technique (autoderm).
Methods: In this series, patient characteristics and outcomes from all patients who underwent single-stage implant reconstruction with autoderm technique at our institution from December 2013 through July 2015 are reviewed.
Results: Nine patients (15 breasts) underwent single-stage implant reconstruction using autoderm at the time of mastectomy. The operations were performed by one of three surgeons. The mean follow-up was 7.3 months. The mean body mass index (BMI) in the series was 37.3 kg/m2(range, 27.9 to 46.1). Two patients developed mild epidermolysis treated with topical ointments. No patients developed severe mastectomy flap necrosis, implant exposure, surgical site infection, hematoma, or seroma. There were no unplanned re-operations.
Conclusions: While the literature suggests that obese patients are poor candidates for single-stage implant reconstruction, this experience demonstrates excellent outcomes in a population with very high mean BMI. We believe using the patient's own skin envelope as a mean to achieve complete implant coverage and lower pole support can be an optimal approach to immediate breast reconstruction in obese patients.
