ABSTRACT
An overall complication rates for implant-based breast reconstruction (IBBR) have been reported from 29 to 46%, particularly in the setting of adjuvant radiotherapy. Although the majority of the literature describes autologous conversion in such scenario, a microsurgical flap is not always feasible. The aim of the paper is to assess surgical and patient-reported outcomes of breast reconstruction using a Latissimus Dorsi muscle Flap (LDMF), harvested without a back scar, in combination with a tissue expander for a two-staged reconstruction in the setting of a previously failed IBBR. All consecutive patients undergoing a two-stages LDMF IBBR between January 2016 and June 2020 were retrospectively identified. A minimal length vertical incision along the posterior axillary line was used for LD flap harvest. Demographic, clinical and surgical data were collected. Aesthetic outcome was evaluated with the Aesthetic Item Scale, and BREAST-Q was used to assess patients' reported outcomes. Twenty-one patients met the inclusion criteria. Mean age was 45.6 years, and the average follow-up was 41.2 months after tissue expander replacement with definitive implant. All patients completed the secondary reconstructive procedure, without major complications both at reconstructive and donor flap site. All women reported to be very satisfied with the final breast reconstruction. Second-attempt implant-based breast reconstruction for patients with a previously failed IBBR is challenging. A conversion from prosthetic to a mixed breast reconstruction with a "no-back scar" LD flap and tissue expander can be considered as a valuable strategy, especially when an abdominal-based autologous breast reconstruction is not feasible or refused by the patients.Level of Evidence IV This 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 .
ABSTRACT
INTRODUCTION: The severe postpregnancy diastasis of recti muscles causes a biomechanical alteration of the statics of the trunk and an unaesthetic bulging of the abdominal wall. This is always combined with cutaneous and subcutaneous excess, which is different on a case-by-case basis. There is not a consensus on the best way to treat it. The anterior sheath plication is the mostly used surgical technique, and many surgeons believe that the use of mesh is necessary in the cases of severe diastasis. The authors here report the outcomes of the use of dermal automesh in the retromuscular layer. MATERIALS AND METHODS: Between January 2015 and December 2019, a retrospective study on 101 patients was conducted. All patients underwent the repairment of the diastasis recti with transversalis sheath plication and dermal automesh reinforcement in the sublay fashion. In addition, all the patients had an abdominal wall ultrasound before the operation and an ultrasound after 1 month, 3 months, 6 months, 1 year and every year afterward. The median follow-up was 32.5 months RESULTS: No major complications, such as infections, extrusions, respiratory diseases or thrombosis, were reported. The follow-up abdominal wall ultrasound reported the absence of muscle recti diastasis in all patients. All patients were completely satisfied with the final result. CONCLUSION: In postpregnancy women, the severe recti muscles diastasis dermal automesh repair is safe and effective. The dermal graft is easy to handle, has demonstrated comparable tensile strength to alloplastic mesh and is available in abdominoplasty or miniabdominoplasty from the excised skin. LEVEL OF EVIDENCE IV: This 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 .
