Ali, R., Mahboub, T., Elsharkawy, O. (2023). Local Autologous Tissues for Expander Coverage in 1st Stage of Delayed-Immediate Breast Reconstruction: Economy-Directed Protocol Modification. The Egyptian Journal of Plastic and Reconstructive Surgery, 47(1), 59-66. doi: 10.21608/ejprs.2023.284363
Rama A Ali; Tarek Mahboub; Omar Elsharkawy. "Local Autologous Tissues for Expander Coverage in 1st Stage of Delayed-Immediate Breast Reconstruction: Economy-Directed Protocol Modification". The Egyptian Journal of Plastic and Reconstructive Surgery, 47, 1, 2023, 59-66. doi: 10.21608/ejprs.2023.284363
Ali, R., Mahboub, T., Elsharkawy, O. (2023). 'Local Autologous Tissues for Expander Coverage in 1st Stage of Delayed-Immediate Breast Reconstruction: Economy-Directed Protocol Modification', The Egyptian Journal of Plastic and Reconstructive Surgery, 47(1), pp. 59-66. doi: 10.21608/ejprs.2023.284363
Ali, R., Mahboub, T., Elsharkawy, O. Local Autologous Tissues for Expander Coverage in 1st Stage of Delayed-Immediate Breast Reconstruction: Economy-Directed Protocol Modification. The Egyptian Journal of Plastic and Reconstructive Surgery, 2023; 47(1): 59-66. doi: 10.21608/ejprs.2023.284363
Local Autologous Tissues for Expander Coverage in 1st Stage of Delayed-Immediate Breast Reconstruction: Economy-Directed Protocol Modification
The Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Cairo University
Abstract
Background: Increasing awareness of post- mastectomy reconstruction raises the demand of searching of many alternatives that can be applied to every patient who came for reconstruction. Completion of expander pocket in first-stage of delayed-immediate breast reconstruction was performed by many techniques. Aim: We propose an algorithm for this step that can be applied in our low-income country. Methods: Thirty-four patients fulfilling skin-sparing mastectomy criteria were enrolled in this study. Definite decision regarding postoperative radiotherapy was questionable. First stage of delayed-immediate reconstruction performed with insertion of expander at time of mastectomy. Regarding choice of completion of sub-muscular pocket of expander, the patients were divided into two groups according to the degree of ptosis: Group I (large ptotic breasts where in dermal flap was indicated), group II (small non ptotic breasts wherein total submuscular pocket indicated). Results: Dermal flap was performed on patients with large ptotic breasts, whereas subpectoral pocket completion was performed on patients with small non-ptotic breasts using the serratus fascia. Two algorithms were proposed to guide the surgeon during the selection of timing and the second one in choosing the most suitable technique. Early post-operative complications where minor and managed conservatively. Conclusion: Decisions regarding postmastectomy breast reconstruction are multifactorial. The factors not only include staging and perioperative adjuvant management but also include considerations regarding cost and availability of resources. Authors proposed an economically directed algorithm in the first stage of delayed-immediate reconstruction for selection of expander coverage.
Colwell A.S. and Taylor E.M.: "Recent Advances in Implant-Based Breast Reconstruction," Plast. and Reconstr. Surg., Vol. 145, p. 421e, 2020. 2- Momoh A.O., Griffith K.A., Hawley S.T., Morrow M., Ward K.C., Hamilton A.S., Shumway D., Katz S.J. and Jagsi R.: "Postmastectomy Breast Reconstruction: Exploring Plastic Surgeon Practice Patterns and Perspectives," Plast. and Reconstr. Surg., Vol. 145, p. 865, 2020. 3- Weichman K.E., Wilson S.C., Weinstein A.L., Hazen A., Levine J.P., Choi M. and Karp N.S.: "The use of acellular dermal matrix in immediate two-stage tissue expander breast reconstruction," Plast. and Reconstr. Surg., Vol. 129, pp. 1049-1058, 2012. 4- Bindingnavele V., Gaon M., Ota K.S., Kulber D.A. and Lee D.J.: "Use of acellular cadaveric dermis and tissue expansion in postmastectomy breast reduction," J. Plast. Reconstr. Aesthet. Surg., Vol. 60, pp. 1214-1218, 2007. 5- Nealon K.P., Weitzman R.E., Sobti N., Gadd M., Specht M., Jimenez R.B., Ehrlichman R., Faulkner H.R., Austen W.G., Jr. and Liao E.C.: "Prepectoral Direct-to-Implant Breast Reconstruction: Safety Outcome Endpoints and Delineation of Risk Factors," Plast. Reconstr. Surg., Vol. 145: p. 898e, 2020. 6- Chai L. and Zhang X.: "Application of serratus anterior muscle flap combined with breast implants for breast reconstruction after modified radical mastectomy," Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi, Vol. 31: pp. 1098- 1101, 2017. 7- Bordoni D., Cadenelli P., Rocco N., Tessone A., Falco G. and Magalotti C.: "Serratus anterior fascia flap versus muscular flap for expander coverage in two-stage breast reconstruction following mastectomy: Early post-operative outcome," Aesthetic Plast. Surg., Vol. 41: pp. 26-30, 2017. 8- Davis C., Boyd C., Mateo de Acosta Andino D.A., Kumbla P.A., Sanchez R.J., Kurapati S., King T.W. and de la Torre J.I.: "Dermal Autografts in Breast Reconstruction A Review of Past and Current Trends," Ann. Plast. Surg., Vol. 84, pp. 618-622, 2020. 9- Lynch M.P., Chung T.M. and Rinker T.B.: "Dermal autografts as a substitute for acellular dermal matrices (ADM) in tissue expander breast reconstruction: A prospective comparative study," J. Plast. Reconstr. Aesthet. Surg., Vol. 66, pp. 1534-1542, 2013. 10- North W.D., Kubajak C.S., St. Martin B. and Rinker B.: "Dermal Autograft Using Donor Breast as Alternative to Acellular Dermal Matrices in Tissue Expander Breast Reconstruction a comparative review," Ann. Plast. Surg., Vol. 78: pp. S282-S285, 2017. 11- Danker S., Schmitt M., Smith N., Chong J.H., Sandholm P.H., Murphy J.A. and Ladizinsky D.A.: "Bostwick Autoderm and Implant Technique - Improved Outcomes for Obese Patients in Immediate Breast Reconstruction," Plast. Reconstr. Surg., Vol. 147: pp. 187e-197e, 2021. 12- Rivet J.J., Day M.K., Rau F.J., Waldrop L.J. and Brzezienski A.M.: "Passot-Type Immediate Breast Reconstruction Obviates the Use of Aceullular Dermal Matrix in Grades 2 and 3 Ptosis," Ann. Plast. Surg., Vol. 82, pp. S394-S398, 2019. 13- Kronowitz S.J., Hunt K.K., Kuerer H.M., Babiera G., McNeese M.D., Buchholz T.A., Strom E.A. and Robb G.L.: "Delayed-Immediate Breast Reconstruction," Plast. Reconstr. Surg., Vol. 113: pp. 1617-1628, 2004. 14- Kronowitz S.J.: "Delayed-immediate breast reconstruction: Technical and timing considerations," Plast. Reconstr. Surg., Vol. 125, No. 2, pp. 463-474, 2010. 15- Breuing K.H. and Warren S.M.: "Immediate Bilateral Breast Reconstruction with Implants and Inferolateral AlloDerm Slings," Ann. Plast. Surg., Vol. 55, pp. 232- 239, 2005. 16- Carstenson L.: "Visualized immediate breast reconstruction with dermal flap and implant," Gland Surg., Vol. 8 (Suppl 4), pp. S255-S261, 2019. 17- Saint-Cyr M., Dauwe P., Wong C., Thakar H., Nagarkar P. and Rohrich R.J.: "Use of the serratus anterior fascia flap for expander coverage in breast reconstruction," Plast. Reconstr. Surg., Vol. 125, No. 4, pp. 1057-1064, 2010.