Subcutaneous Breast Reconstruction with Form Stable Implants and ADM wrap
There are many studies that show the advantages of the subcutaneous breast reconstruction versus the submuscular. This makes perfect sense because the breast mount was not created to be under the chest wall muscles.
So why did we feel obligated to use the sub-muscular plane for implant breast reconstruction? The answer is that we needed coverage over the implants to make them less visible and also to avoid capsular contraction. Capsular contraction would give the breast a very unnatural appearance. The breast can turn spherical and hard when the capsule around the implant tightens. The muscle provided some soft tissue coverage over the implant and improved the result to some extent. The submuscular plane requires that the muscle be detaches from it’s lower insertions and dissected off the chest wall. The implant is placed directly over the ribs making this operation more traumatic and painful. There are often animation (motion) deformity when the chest muscle contracted. The introduction of ADMs (acellular dermal matrix) offered a major advance because it provided more room under the muscle. In skin sparing mastectomy reconstructions, the expander could be inflated to its fullest and provide the patient a true immediate reconstruction. In many cases we could go directly to the implant and save the patient from having another operation.
The main question is: Do we still need the muscle if we have the ADMs to provide us with implant coverage and reduce the capsular contraction risk? And here the answer is: Probably not. Now we can place the implant in the subcutaneous mastectomy pocket with a good coverage of ADM and get excellent results. I have to say that as always we need good mastectomy flaps to be able to have good results with the subcutaneous breast reconstruction. It is important that the plastic surgeon develops the mastectomy flaps or he educates the general or oncologic surgeon on how to develop even flaps with the appropriate thickness to satisfy both, the oncologic and the reconstructive requirements. I am fortunate to work with an excellent oncologic surgeon who is very cooperative and understands these requirements well.
As a demonstration, I would like to present this state of the art case of immediate bilateral breast reconstruction after bilateral skin and nipple sparing mastectomies. Here I used a style 410, form stable implants completely wrapped with Alloderm ADM, for this direct to implant immediate reconstruction.
The patient had a nipple sparing mastectomy done through a short vertical infra areolar incision. We were able to match her preoperative breast shape and volume in one operation. This state of the art technique will open the door to patients who desire prophylactic mastectomy because they are at high risk of developing breast cancer.
For further information about this innovative technique and to find out if you are a candidate for this operation, please call my office at 973 2670928.