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Plastic and reconstructive surgery
10, 2018;142 (4): 871-880.

Current Approaches to Prepectoral Breast Reconstruction.

Maurice Y Nahabedian
Author Information
  1. Maurice Y Nahabedian: From Georgetown University Hospital.
PMID: 30252807 DOI: 10.1097/PRS.0000000000004802

Abstract

Prepectoral prosthetic breast reconstruction has become an acceptable option for women following mastectomy. Benefits include no animation deformity, absence of pectoralis major muscle spasm, and less pain and discomfort. Important aspects of prepectoral reconstruction include working with breast surgeons that are adept at performing an optimal mastectomy. Tissue perfusion and reasonable thickness of the mastectomy are critical components of success. Tissue necrosis, infection, and delayed healing can lead to reconstructive failure. Given the risks and benefits of this procedure, questions regarding indications, patient selection, and specific details related to technique remain because there is no consensus. Whether it is safe to perform prepectoral reconstruction in obese or previously irradiated patients is controversial. The use of acellular dermal matrix is common but not universal. The amount of acellular dermal matrix used is variable, with success being demonstrated with the partial and total wrap techniques. Device selection can vary but is critical in the prepectoral setting. Postoperative care and the management of adverse events are important to understand and can impact surgical and aesthetic outcomes. This article provides current approaches, recommendations, and an algorithm for prepectoral breast reconstruction with an emphasis on patient selection, immediate versus delayed prepectoral reconstruction, specific technical details, and postoperative management.

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MeSH Term

Acellular Dermis
Algorithms
Breast Implants
Drainage
Female
Humans
Mammaplasty
Mastectomy
Patient Selection
Postoperative Care
Postoperative Complications
Surgical Flaps
Tissue Expansion Devices
Journal Article
Article has an altmetric score of 3

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