Optimization of Prepectoral Breast Reconstruction

Introduction: Acellular dermal matrix (ADM) were introduced in the early 2000s and more recently permitted new protocols for breast reconstruction allowing a short operative time with improved outcomes until the new muscle-sparing breast reconstruction proposed in 2014 using the Braxon (R) ADM. The aim of this research is to propose a technique to improve the aesthetic outcome using Braxon ADM with prepectoral implants. Materials and Methods: The enrolled patients were submitted to a nipple skin-sparing mastectomy leaving 1 additional centimeter of subcutis on the proximal part of the upper pole of the breast (see Surgical Technique). Aesthetic outcomes were compared to those obtained with traditional breast reconstruction with prosthesis and the Braxon ADM placed in the prepectoral space. Mean values of aesthetic outcomes were analyzed using the Student t test, and the kappa test was used to analyze interobserver variability. Results: The overall aesthetic score was improved of 29.6% of the patients; in particular the most improved score was that for contour (+98.01%). Statistical significance was found for contour, upper pole definition, and total score average (p < 0.05).The kappa test showed interobserver variability with a good level of agreement on contour (kappa = 0.832). Conclusions: The proposed technique has allowed attainment of good results in terms of aesthetic outcomes. In a small sample we did not register any particular complications but we verified a better satisfaction on the evaluation of the aesthetic result (level of evidence: 3).

Automated summary

The study proposed a technique using Braxon ADM with prepectoral implants to improve aesthetic outcomes of breast reconstruction. By comparing aesthetic outcomes with traditional breast reconstruction and Braxon ADM placed in the prepectoral space, it was found that the proposed technique achieved good results in improving aesthetic scores.