Abstract
This chapter will put forward the case for controlled coverage and support of a definitive implant or tissue expander, for improved, long-term outcomes, in immediate implant-based breast reconstruction. Tissue support is provided mostly with an acellular dermal matrix (ADM) or less frequently with de-epithelialised lower pole dermal sling (LPS). We will discuss the surgical considerations for an optimal skin-sparing mastectomy (SSM), nipple-sparing mastectomy (NSM) or skin-reducing mastectomy (SRM) for both risk-reducing mastectomy and therapeutic mastectomy for breast cancer, and the correct selection of the most appropriate lower pole support and implant to acchieve a good result. Specific techniques of pocket dissection will be discussed for both ADM-based and LPS-based pockets, with emphasis on how to define the infra-mammary fold (IMF) and the lateral mammary fold (LMF) and offload the weight of the implabt off the lower pole soft tissue envelope of the breast. The chapter will outline the early and delayed complications and experience with the techniques described as well as suggested strategies (including optimising radiotherapy planning, delayed fat grafting) for successful management.
| Original language | English |
|---|---|
| Title of host publication | Oncoplastic and Reconstructive Breast Surgery, Second Edition |
| Publisher | Springer International Publishing |
| Pages | 501-529 |
| Number of pages | 29 |
| ISBN (Electronic) | 9783319629278 |
| ISBN (Print) | 9783319629254 |
| DOIs | |
| State | Published - 1 Jan 2019 |
| Externally published | Yes |
Bibliographical note
Publisher Copyright:© Springer International Publishing AG, part of Springer Nature 2013, 2019
Keywords
- Acellular dermal matrix (ADM)
- Implant reconstruction
- Infra-mammary fold (IMF)
- Lateral mammary fold (LMF)
- Lower pole sling (LPS)
- Nipple-sparing mastectomy (NSM)
- Skin-reducing mastectomy (SRM)
- Skin-sparing mastectomy (SSM)
