Reitsamera, R.
Peintingerb, F.
Klaassen-Federspiela, F.
Andreas, S.

September 03, 2019

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Prepectoral implant placement is an innovative option for breast reconstruction, due tomultiple advantages over subpectoral implant placement. The adoption of various ADMs and meshessupports the utilization of the prepectoral technique.

200 breasts were reconstructed with prepectoral implant placement after nipple-sparingmastectomy in a one-stage direct-to-implant procedure. The implants were completely covered andfixed with porcine ADMs (Stratticeor Artia), or with synthetic meshes (TIGR®). The pectoralis majormuscle was not detached at all and kept intact entirely.

Minor complications included minimal nipple necrosis without further intervention and com-plete healing in 14 breasts (7.0%). Major complications comprised implant loss due to skin necrosis andwound infection in 7 breasts (3.5%), and hematoma with revision surgery in 8 breasts (4.0%). At a meanfollow-up of 36 months cosmetic results were excellent and good in 180 breasts (90.0%), sufficient in 13breasts (6.5%) and insufficient in 7 breasts (3.5%). Breast animation deformity and implant displacementcould not be observed, while implant rotation was documented in 5 breasts (2.5%). Capsular contracturesgrade III or IV could not be observed neither in patients with previous radiotherapy nor in patients withradiotherapy to the reconstructed breast.

The single-stage direct-to-implant prepectoral implant placement after NSM with completecoverage of the implant with ADM or synthetic mesh represents a novel and feasible technique for breastreconstruction. This technique provides an alternative to the subpectoral implant placement withexcellent cosmetic results avoiding the disadvantages of the subpectoral implant placement.