Tissue Contraction—A New Paradigm in Breast Reconstruction

Hilton Becker, MD, FACS; Olga Zhadan, MD, MS


Plast Reconstr Surg Glob Open. 2018;6(7):e1865 

In This Article

Patients and Methods

A prospective analysis of the outcome results of 20 consecutive prepectoral adjustable Spectrum implant-based breast reconstructions following skin-sparing or nipple-sparing mastectomies was performed. Patients were closely followed from May 2016 to September 2017 (mean time of follow-up was 12 months).

Patients included in the study ranged in age from 27 to 76 (mean, 53 years) with skin excess following skin-sparing or nipple-sparing mastectomy. Patients who exhibited any degree of breast ptosis preoperatively and were thought to possibly benefit from skin contraction were included in the series. Patients who underwent sentinel lymph node biopsy or axillary lymph node dissection were not excluded from the study, and their management was not different. All the cases were performed by 1 plastic surgeon in a single institution. The analyzed data included patient's age, diagnosis, amount of air inflated to the implant initially and subsequently, timeline of additional air inflation during the office visits, postoperative complications, and additional interventions. Cosmetic outcome and patient satisfaction were documented. The ethical principles stated in the 1964 Declaration of Helsinki were strictly followed.

The nipple-sparing mastectomy was performed by a general surgeon. The axilla and lateral mastectomy pocket were closed using a running No. 1 STRATAFIX suture. The smooth Spectrum adjustable saline implant was used in all cases. The implants were placed prepectorally and initially underfilled with varying volumes of air to prevent collapse of the implant (Figure 2B). The amount of air ranged from 10% to 70% (mean 40%) of the implant capacity. No ADM or mesh support was utilized, and skin flaps were allowed to contract over an underfilled implant.

Figure 2.

Schematic diagrams of the reconstructive technique. A, Expander/implant filled with saline places pressure on the lower pole. B, Prepectoral placement of the adjustable implant underfilled with air. C, Skin contracts and thickens. D, Air is replaced with saline to achieve the desired size. E, Injection port removed.

Where skin contraction was desired, the implant was filled with the lowest volume of air that would support the implant and prevent folding of the skin flap. Close clinical follow-up was performed postoperatively in all cases. Patients were seen every day for the first 3–4 days after surgery, then once or twice a week for the following 4 weeks, and biweekly after that. Depending on the needed degree of contraction, implants were left underfilled for up to 10 weeks (average 4 weeks) (Figure 2C). When further air was added, the air syringe filters (Cole-Parmer, Vernon Hills, Ill.) were used as a precautionary measure through the remote injection port.[7]

When the desired healing and cosmetic results were achieved, the air was replaced with saline (Figure 2D). Rippling of the saline-filled implant was seen in 4 patients (20%). It was successfully corrected with fat injections. The injection port was removed, and the saline implant retained as the definitive implant (Figure 2E, Supplemental Digital Content Figure 1).

If rippling was present or at the patient's request, the saline-filled implant was replaced with a silicone gel implant. At this stage, further fat injections were performed. In patients who had the adjustable Spectrum implants exchanged for gel implants, a small degree of skin adjustment was performed when necessary.