Immediate Breast Reconstruction Using Saline Implant: Extension of Pectoralis Major Muscle Coverage with AlloDerm(R)

PURPOSE: Using the implant for the breast reconstruction still remains the options, despite the breast reconstruction using autologous tissue is an ideal method. In this study, we used AlloDerm(R) to extend subpectoral pocket for covering implants to reduce implant related complications. METHODS: From January 2005 to June 2007, 18 breasts in 16 patients were reconstructed using implant and AlloDerm(R) immediately after mastectomy. Hospital records, database files, and clinical photographs were reviewed. A ten-point scale was used to evaluate the patient's satisfaction, with a range from 2(poor) to 10 (excellent). RESULTS: Mean age of the patients was 38.7 years at the time of operation. Mean weight of removed breast tissue was 287g. AlloDerm(R) was used to extend subpectoral coverage. Any systemic complication was not reported. Breast complication was developed in 4 cases. Implant removal or change was not experienced. CONCLUSION: Immediate breast reconstruction using Implant is useful methods for certain conditions, when donor tissue is insufficient and breast is non ptotic with round shape. In those cases, extension of muscle coverage using AlloDerm(R) could reduce complications and lead more acceptable results.

Secondary Contouring of Reconstructed Breast with Fat Graft

Sometimes, TRAM flap only is not enough to accomplish symmetric breast reconstruction. Although many secondary procedures have been used to obtain symmetry, only a few studies have been performed to validate the result of fat grafting after TRAM flap breast reconstruction. From January 2004 to July 2008, 96 patients who underwent fat grafting after TRAM breast reconstruction were reviewed. The fat grafting was performed after 6 months following breast reconstruction. Assessments were retrospectively carried out according to the breast reconstruction type, injection volume, injected area, donor site, and complications. Immediate breast reconstruction cases were 92 out of 96 cases, and rest of them was cases of delayed reconstruction. Mean injected volume was 31.7 cc(3-113.5cc). Recipient sites were upper medial and lateral quadrants(85.4%) in 82 cases, upper medial quadrant in 5 cases, all four quadrants in 3 cases and lateral upper quadrant in 2 cases. Any specific complication such as fat embolism, infection, fat necrosis and skin necrosis was not noticed. We obtained a satisfying result in every case without any specific complication. Therefore, fat grafting can be one of the useful options to match the contour of reconstructed breast after TRAM flap reconstruction