Prepectoral breast reconstruction with complete implant coverage using double-crossed acellular dermal matrixs

Background: Prepectoral implant-based breast reconstruction involving full implant coverage with an acellular dermal matrix (ADM) is more convenient, provides better aesthetic results, and carries lower risk of complications than does the traditional dual-plane method with an ADM. However, the recently reported technique usually involves full wrapping of the implant using a single, large ADM. We aimed to clarify the usefulness of an implant covering technique using two double-crossed ADMs. Methods: We retrospectively evaluated the records of 23 breast cancer patients who, between February 2017 and March 2018, received skin-sparing or nipple-sparing mastectomy followed by immediate prepectoral implant-breast reconstruction. We assessed preoperative characteristics, cancer treatment parameters, incidence of postoperative complications (necrosis, capsular contracture, infection), and patient satisfaction at 12 months postoperatively. Results: This cohort (mean age, 45.5 years; body mass index, 22.1 kg/m²; preoperative breast volume, 315.7 cc, excised mass weight, 291.4 g; silicone implant size, 252.4 cc) included 11 patients with ductal carcinoma in situ and 12 with invasive ductal carcinoma. Postoperatively, one patient received radiotherapy and nine received chemotherapy. Among postoperative complications, we noted capsular contracture (1/23, 4.3%), wound dehiscence (2/23, 8.7%), and seroma (3/23, 13.0%). Good patient satisfaction (mean score, 4.2-4.8 on the KNUH Breast Reconstruction Satisfaction Questionnaire) was obtained in all categories (breast symmetry, reconstructed breast size, shape, feel, pain, scar, self-confidence, sexual attractiveness, and overall satisfaction).