Bioengineered Breast: Hybrid Breast Reconstruction

 
 
 
 
 
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A post shared by Effie Politis, MD, FACS (@dreffiepolitis)

𝘋𝘦𝘷𝘦𝘭𝘰𝘱𝘪𝘯𝘨 𝘢 𝘩𝘺𝘣𝘳𝘪𝘥 𝘤𝘰𝘯𝘤𝘦𝘱𝘵 𝘪𝘯 𝘪𝘮𝘮𝘦𝘥𝘪𝘢𝘵𝘦 𝘴𝘵𝘢𝘨𝘦 𝘣𝘳𝘦𝘢𝘴𝘵 𝘳𝘦𝘤𝘰𝘯𝘴𝘵𝘳𝘶𝘤𝘵𝘪𝘰𝘯. ⁣⁣⁣

I was first introduced to the concept of “bioengineered breast” in 2009 by Dr. Pat Maxwell and colleagues. He originally coined this term to describe an enhanced breast form consisting of a combination of cohesive gel breast implant, regenerative scaffold, and regenerative cells. ⁣⁣⁣

The implant and the soft tissue covering it can both be enhanced to achieve the optimal female breast form.

Enhancing the soft-tissue cover not only supplements volume and shape but also further alters how the recipient’s host tissue responds to the foreign body implant. ⁣⁣⁣

This powerful combination of constructs better allows us to achieve the ultimate goal of breast reconstruction: to recreate a breast that appears and feels like the natural breast. ⁣⁣⁣

This patient had large breasts and underwent bilateral skin-sparing mastectomies. She opted for one-stage reconstruction to minimize downtime. This was achieved using a hybrid concept after the mastectomy flap perfusion was evaluated. ⁣⁣⁣

I was able to pair an anterior acellular dermal matrix sheet with a posterior stable Galaflex base to provide the patient with both softness and stability. ⁣⁣⁣

She plans on having fat grafting during her nipple-areolar reconstruction to further augment her soft tissue envelope and soften her breast borders.⁣⁣⁣
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How to fix a displaced fold (inferior fold displacement after breast reconstruction)?

This lovely lady had the unfortunate diagnosis of breast cancer found on her annual screening mammogram. ⁣

She underwent bilateral nipple-sparing mastectomies through an inframammary approach. She then underwent bilateral immediate breast reconstruction with silicone implants and acellular dermal matrix. ⁣

Because of the elastic properties of the acellular dermal matrix (its ability to stretch over time just like skin), she suffered from an inferior displacement of her fold (descent of her native inframammary fold) resulting in device malposition. This descent of her right inframammary fold created an increased lower pole breast skin out of proportion to her upper pole. ⁣

I always tell my patients that during the mastectomy, the primary role of the breast surgeon performing the mastectomy is to act as an oncologic surgeon and safely remove all of the breast tissue to increase disease-free survival. ⁣

During the mastectomy, all the natural landmarks and ligaments of the breast are removed with the actual breast tissue and this includes obliteration of the inframammary folds as well as the medial and lateral borders of the breast. ⁣

It is our job as plastic surgeons to reconstruct these with suture techniques and also with adjunct materials that inherently have properties to support the missing ligamentous structures. ⁣

The soft tissues are variable in every patient according to their age, weight, and subcutaneous tissues as well as fascial tissues. ⁣

She was brought back to surgery for revision and stabilization of the fold with GalaShape. Again, this material provides a scaffolding and support to counteract increased downward pressure from the implant in a patient with low body weight and minimal subcutaneous fat.⁣

“Breast in a day” direct-to-implant breast reconstruction

Surgical Technique

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Type of Recon: Single Stage Direct to Implant Breast Reconstruction after Mastectomy⁣⁣⁣, Galaflex Ravioli construct⁣⁣⁣⁣⁣
Type of Mastectomy: Nipple Sparing or Nipple Preserving⁣⁣⁣ through inframammary approach⁣⁣⁣⁣⁣
Implants: Natrelle Inspiration Cohesive SCF 295⁣⁣⁣⁣⁣
SPY Elite Imaging⁣⁣⁣⁣
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Breast in a day” direct-to-implant breast reconstruction represents an emerging technique in the field of postmastectomy reconstruction and holds appeal, as it shortens the reconstructive process, eliminates the expansion period, and avoids a second operation.
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This case was performed with bilateral nipple sparing mastectomy and single stage reconstruction with cohesive implant and Galaflex ravioli construct placed in prepectoral position.⁣⁣⁣⁣⁣
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The advantage of this technique is that it is performed at time of mastectomy whereas traditionally, we place tissue expanders partially under the muscle and expand the patient and then perform a second procedure in 3-6 months where we exchange the expanders for permanent implants. ⁣⁣⁣⁣⁣
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Therefore, instead of a staged process, we can achieve stable and long term results with a single stage or direct to implant reconstruction. This requires collaboration with the surgical oncologist, meticulous dissection, scaffold material (Galaflex to stabilize and secure implant in mastectomy pocket ), and cohesive implants, we are able to perform implant based reconstruction in a single stage. ⁣⁣⁣⁣⁣
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Also, the implants are typically placed over the muscle, which decreases pain, animation deformity, preserves shoulder/arm strength, and creates a more natural result. ⁣⁣⁣⁣⁣
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Please note: These are my individual patients who have provided written photo consent. These photos and posts do not constitute medical advice. Results may vary. See a board certified plastic surgeon for evaluation.⁣⁣⁣⁣
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