Inmediate Breast

Reconstruction with direct

implants

Introduction

Oncologic radicality vs Cosmetic

outcomes
Female breast identify*:
Footprint
Conus (Contents)
Skin envelope (Container)
NAC

*Blondeel et al. Shaping the breast in aesthetic and reconstructive breast surgery.PRS 2009

Introduction

Inmediate vs Delayed
Implants vs Autologus
Conservative vs Radical matectomies
SSM vs NSM
ADM
Inferior dermal flap (Boztwick
technique)
Autoderm (Dermal autograft)

Inmediate vs Delayed

Inmediate
Improved

Delayed
Psichological effects

Altered body image

psychological
wellWomen
who undergo Diminished
delayedself-worth
being
reconstruction stated that, in
retrospect
Loss
of sense of feminity
Less anesthesia
Anxiety
given their current knowledge,
they would
Work with virgin
Depression
have
chosen
to
undergo
inmediate
tissue
reconstruction
Reconstructive time
*Al-Ghazal
Decrease
etcosts
al. The psychological effect of inmediate rather
Avoid skinthan
contracture
delayed breast reconstruction
Dont require as
much lipofilling

Conservative mastectomies

Skin-sparing mastectomie

SSM incisions:

Skin-sparing mastectomies

SSM (I, II and III):

Skin-reducing mastectomies

SRM (IV and V):

Mastectomies review

NSM
Periareolar incision
Hemiperiareolar incision
Related to higher rate of NAC complications*.

Radial incisions:
Lateral 3h / 9h incision
Vertical 6h incision
Breast cup >C
Ptotic breast
*Salgarello et al. One-stage inmediate breast reconstruction with implants in
conservative mastectomies

Mastectomies indications

SSM

Extensive DCIS
Multicentric tumors
No infiltrate skin
Early breast
cancer (Stage I
II)
Unfavorable breast
to tumor radio
No response to QT

NSM

Oncologic risk
< 3cm
Peripheral
(-) axillary node
(-) IQ AP tissue
beneath nipple

*Salgarello et al. One-stage inmediate breast reconstruction with implants in

conservative mastectomies

ADM

Concept:
Biotechnological tissue
Scaffold for normal tissue in-growth and

cellular repopulation
Cellular components that cause rejection
have been removed

Origin:
Human (Alloderm, Dermamatrix)
Porcine (Strattice)
Bovine (Surgimend)

ADM

Brueing et al (2005)
Sling to cover the infero-lateral pole in

inmediate permanent implant

reconstruction

ADM

Advantages
Coverage
Aesthetic

outcomes
Lower pole
projection
IMF

No need recruiting

muscles
No donor site
morbidity

ADM

Disadvantages
Increased

postoperative
complications*
Infectious
Seroma
Explantation

*Liu AS et al. Postoperative complications in prosthesis-based breast reconstruction

using acellular dermal matrix.

ADM

Technique

ADM + direct implants

Indications
Small-medium

breast size
No or minimal
ptosis
Adequate skin flaps

Contraindications

RT
Breast cup D
Ptosis grade 2
Obesity*
Smoking*

*Liu AS et al. Postoperative complications in prosthesis-based breast reconstruction

using acellular dermal matrix.

ADM + direct implants

A higher complication rate ocurred in the
combined first year performing singlesurgeons
Complications
stage
implantetreconstruction
(21.4%) compared
Colwell
al.
with subsequent
yearsrate
(10.9%)*
Overall complication
14.8%
Early:

*Colwell et al. Retrospective review of 331 consecutive inmediate single stage implant
reconstructions with ADM PRS 2011

Skin flap necrosis 9.1%

Explantation 1.5%
Hematoma, Seroma, Infection

Late:

Asymetry
Implant wrinkling
Malposition
Capsular contracture

Seroma incidence of 14.1% ADM

vs 2.7 % NO ADM*
*Chun et al. Implant breast reconstruction
using ADM and the risk of postoperative
complications PRS

Dermal autograft

Biological mesh
Creation of a lower pole sling to support
a breast implant
Abdominal donor site closure like an
abdominoplasty
Preserving the ability to perform a

free flap

Advantages*:
Low complication rates
Reducing cost comparing with ADM
*Selber et al. Autoderm: An alternative bioprosthetic for breast
reconstruction

Dermal autograft*

Technique:

*Selber et al. Autoderm: An alternative bioprosthetic for breast reconstruction

Autoderm + direct implants

Indications
Same as ADM
Small non ptotic
breasts

Pre-existing

abdominal scars
Patient wishes not
to have allograft

Contraindications
Same as ADM
Large ptotic breasts

Inferior dermal flap

Bostwich(1990):
Excess skin in the ptotic breast provides a

deepithelialized inferiorly based dermal flap

Allows total device coverage with two layers of
vascularized tissue, improved breast contour and
scar pattern, and potential single-stage
reconstruction*
*Ladizinsky et al. Breast Reconstruction with the Boztwick Autoderm Technique PRS 2013

Inferior dermal flap*

(Wise pattern)

Technique

*Ladizinsky et al. Breast Reconstruction with the Boztwick Autoderm Technique PRS 2013

Inferior dermal flap*

*Ladizinsky et al. Breast Reconstruction with the Boztwick Autoderm Technique PRS 2013

Inferior dermal flap

*Ladizinsky et al. Breast Reconstruction with the Boztwick Autoderm Technique PRS 2013

Inferior dermal flap

(Vertical pattern)

Inferior dermal flap + direct

implants

Indications

Breast large size

Ptotic
Oncologic risk ptes
Early cancer stage

Contraindications

RT
Smoke
Obesity
Small breast size
No ptosis

Summary

IBR with direct implants is becoming an

useful tecnique in selected ptes
Coverage of implant is one of the
most important issues to a succesful
surgery
Our own tissues are better than
alloplastics

Summary

Getting expertise in a procedure

results in less complications,
reflecting better the real result of a new
technique
ADM and dermal autograft for small
non-ptotic breasts.
SRM + Inferior dermal flap for large
ptotic breasts.

Bibliography

Blondeel et al. Shaping the breast in aesthetic and reconstructive breast

surgery.PRS 2009
Al-Ghazal et al. The psychological effect of inmediate rather than delayed
breast reconstruction
Salgarello et al. One-stage inmediate breast reconstruction with implants
in conservative mastectomies
Liu AS et al. Postoperative complications in prosthesis-based breast
reconstruction using acellular dermal matrix.
Colwell et al. Retrospective review of 331 consecutive inmediate single
stage implant reconstructions with ADM PRS 2011
Selber et al. Autoderm: An alternative bioprosthetic for breast
reconstruction
Ladizinsky et al. Breast Reconstruction with the Boztwick Autoderm
Technique PRS 2013

Thank you!