April 2020 #PRSJournalClub Wrap-Up: Direct-to-Implant, Prepectoral Breast Reconstruction

by Joseph M. Firriolo, MD
University of California, Davis


The April 2020 edition of #PRSJournalClub featured an insightful discussion of an important and timely article entitled “Direct-to-Implant, Prepectoral Breast Reconstruction: A Single-Surgeon Experience with 201 Consecutive Patients” by Drs. Tyler Safran, Becher Al-Halabi, Alex Viezel-Mathieu, Jean-François Boileau, and Tassos Dionisopoulos. The paper can be read here.

This paper was discussed on the #PRSJournalClub podcast earlier this month, with special guest Dr. Maurice Nahabedian. You can listen to the podcast here.

We then had the great opportunity to host a global discussion of this article with the authors themselves on the #PRSJournal Facebook page.

Historically, prepectoral breast reconstruction had been plagued by many complications, largely a consequence of poor mastectomy skin flap viability. However, oncologic and reconstructive techniques have evolved, and prepectoral breast reconstruction has become more popular as a result. Notably, there has been improvement in the technology to assess flap viability, as well as a shift to “anatomic” mastectomy technique, which respects the superficial fascial system of the breast and provides thicker skin flaps.

In this original retrospective study, authors present their experience with the largest single-surgeon, direct-to-implant prepectoral breast reconstruction cohort in the literature. They demonstrated no relationship between surgical complications and acellular dermal matrix use, incision selection, and adjuvant radiation therapy. Their data suggests that there may be an association between acellular dermal matrix use and major complications and radiotherapy with minor complications.

We hope you enjoy the top highlights from the discussion and look forward to seeing you at the next #PRSJournalClub on Facebook!

Congratulations on a great study!
Joseph


This April #PRSJournalClub article (as well as other Journal Club selections from April), selected classic pairings and videos, and the entire Facebook Q&A are archived on PRSJournal.com here.

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