Skin-Reducing Mastectomy with Immediate Prepectoral Reconstruction: Surgical, Aesthetic, and Patient-Reported Outcomes with and without Dermal Matrices
Bibliographic record
Abstract
BACKGROUND: Prepectoral breast reconstruction is being increasingly popularized, largely because of technical advances. Patients with ptotic breasts and active cancer require mastectomies through a mastopexy excision pattern to achieve proper pocket control in a prepectoral single-stage operation. This article presents a single-surgeon experience with direct-to-implant, prepectoral reconstruction following skin-reducing mastectomies. METHODS: A retrospective chart review identified all patients undergoing prepectoral, direct-to-implant breast reconstruction following Wise-pattern mastopexy from June of 2016 to June of 2018. Surgical and aesthetic outcomes, including capsular contracture and revision surgery, were measured. The BREAST-Q was administered preoperatively, 6 months postoperatively, and 1 year postoperatively. RESULTS: Eighty-four patients (121 breasts) were included. A widely based inframammary fold adipodermal flap was used in all cases, with acellular dermal matrix used in 77 breasts (63.3 percent), free nipple grafts in 42 breasts (34.7 percent), and postmastectomy radiation therapy in 31 breasts (26.5 percent). Operative complications included nipple-areola complex necrosis in six (5.1 percent), hematoma in four (3.4 percent), seroma in four (3.4 percent), implant exposure in three (2.6 percent), and infection in one (0.9 percent). Minor complications included cellulitis in five (6.0 percent) and minor wound issues in five (4.3 percent). In aesthetic outcomes, only two nonirradiated breasts experienced a grade 3 to 4 or grade 4 capsular contracture requiring capsulectomy. Rippling was visible in four breasts (3.4 percent). The BREAST-Q showed good satisfaction with the technique, with no significant differences between nipple-areola complex techniques. CONCLUSIONS: This cohort represents the largest single-surgeon, Wise-pattern, direct-to-implant prepectoral database in the literature. This report showed that surgical and aesthetic complications did not differ in terms of acellular dermal matrix use. This technique has shown, through patient-reported outcomes, to yield good patient satisfaction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".