Autoderm in Direct-to-implant Prepectoral Breast Reconstruction Decreases Perioperative Complication Rates and Improves Reconstructive Outcomes

Abstract

Background: Wise pattern skin incision in breast reconstruction following mastectomy facilitates removal of skin excess in patients with large and ptotic breasts. The trifurcation of the inverted-T incision poses increased risk of infection and reconstructive failure in implant reconstruction. Autoderm has been described in subpectoral implant-based reconstruction. In this case series, it is described in prepectoral implant-based reconstruction. Methods: A retrospective review of breast cancer patients who underwent either unilateral or bilateral skin-reducing mastectomy via immediate prepectoral implant-based breast reconstruction in conjunction with an inferiorly based autoderm flap for implant coverage between February 2022 to April 2024 was performed and compared with previously published Wise pattern outcomes. Results: Ten patients (15 breasts) underwent immediate prepectoral implant-based breast reconstruction with an inferiorly-based autoderm flap. Implant sizes ranged from 300 to 800 mL. Autoderm was able to cover the implant under the inverted-T incision in 13 breasts, whereas 1 breast required extension of the dermal flap using acellular dermal matrix. No major complications were observed in this study. One patient developed delayed wound healing in 1 breast that was managed nonoperatively. The test of 2 proportions was used to compare complications to published rates. Rate of delay wound healing showed no significant difference (P = 0.38), whereas the overall complication rate was lower (P < 0.05). Conclusions: The inferiorly based autoderm flap in immediate prepectoral implant-based breast reconstruction is a safe and effective option in managing patients with large and ptotic breasts that reduces the rate of infection and reconstructive failure.