Management of Breast Cancer by Skin-Reducing Mastectomy and Immediate Breast Reconstruction by Prepectoral Implant Approach with Polypropylene Mesh for Patients with Large Breasts

ObjectiveTo assess the feasibility and outcomes of immediate breast reconstruction using a dermal sling and polypropylene mesh for fixation after skin-reducing mastectomy with prepectoral prosthesis placement in patients with large breasts who were diagnosed with cancer.MethodsThis retrospective study included demographic and clinical data from female patients with breast cancer and large breasts, who were candidates for skin-reducing mastectomy and immediate reconstruction. Data regarding operative technique, implant size, operative duration, and intraoperative complications were retrieved. Early and late postoperative complications were recorded. Routine assessment of postoperative patient satisfaction was performed using the Breast Reconstruction Satisfaction Questionnaire.ResultsThe study included data from 49 female patients with a mean (+/- SD) age of 40.88 +/- 8.03 years; the mean follow-up was 31.5 +/- 8.1 months. The operation was successful in 47 (95.9%) patients, whereas reconstruction failed in 2. Capsule contracture occurred in 9 (18.4%) patients, 4 of whom required capsulectomy. Severe wound infections occurred in 2 (4.1%) patients, 1 of whom was treated conservatively. Implant exposure occurred in 2 (4.1%) patients, 1 of which was managed using a skin rotational flap. Five (10.2%) patients experienced mildly impaired range of motion. Forty-four (90.0%) patients reported postoperative satisfaction, with 3 expressing satisfaction only when postoperative complications were treated.ConclusionsThe prepectoral approach using a combined synthetic mesh and dermal sling yielded a good solution for patients with large breasts. The technique was associated with minimal complications, yielded good postoperative patient satisfaction, and is affordable. The results of using a synthetic mesh appeared to be equivalent to those of ADM.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.