Abstract P4-13-12: Immediate one-stage implant-based breast reconstruction without an acellular dermal matrix in Japanese breast cancer patients
Authors: Okumura S , Tatibana S , Narita C , Hyodo I , Sawaki M , Hattori M , Yoshimura A , Ishiguro J , Kotani H , Gondo N , Adati Y , Iwata H , Kamei Y 
Published: February 2018

Background. In immediate one-stage implant-based breast reconstruction, acellular dermal matrix (ADM) has been usually used due to cover the outside part of the pectoralis major muscle in the world. Unfortunately, ADM is not approved in Japan yet. Therefore we have performed safety one-stage implant-based breast reconstruction without ADM according to several unique technics in our institution and obtain the excellent results. We report single institution experience using the retrospective medical data.

Methods. We chose the surgical method of immediate breast reconstruction (autologous and prosthetic) according to patient's preference, breast volume and cancer condition in early breast cancer patients (pts). Two hundred fifty four early breast cancer pts underwent immediate artificial breast reconstruction from January 2014 to March 2017 in our institution. Thirty seven pts were excluded in this analysis because of preplanned the expander insertion. ALLERGAN Natrelle 410 series were used as the silicon breast implant (SBI). We performed three unique steps to determine the one-stage SBI cases as follow. ICG fluorescence imaging to confirm the blood flow state of the chest skin after mastectomy is used as standard method. If there is a defective contrast region, we remove these area. And then, serratus anterior muscle/fascial and external oblique fascial flap is elevated to completely cover the SBI together with the pectoralis major muscle so that the between mastectomy field and the SBI insertion section are isolated. We used sizer to confirm the skin tension and form of breast. After confirming these steps, we adopted cases whether SBI insertion can be safety done.

We evaluated the total cosmetic finding based on three categories of inframammary fold position, balance of both breast size and form at half year after operation. If the difference between both inframammary fold positions was under 1cm, if compensatory pad is not necessary with underwear, if the protrusion of the lower pole is sufficient compared with the contralateral side, we gain the point one on each categories in each cases. The total cosmetic evaluation was classified as three categories. Good, fair and poor were defined as gained 3 points, 2 points and 0/1 points, respectively.

Results. Among 217 planned immediate prosthetic breast reconstruction pts, 186 pts (85.7%) were succeed one-stage implant-based breast reconstruction. Among 186 pts, the median age was 47 years old (23-75), median body weight was 53kg (35-84), median body mass index was 21.08 kg/m2(16.20-29.41), removed breast volume was 240g (56-522) and implant volume was 220cc (90-425). Implant removed in one case because of complications and infection was occurred in five cases. The revision surgery was performed in one cases because of malposition. Among all pts, the good, fair and poor of total cosmetic evaluation is 84.3%, 13.5% and 2.2%, respectively.

Conclusions. Immediate one-stage implant-based breast reconstruction without ADM may be useful and safe procedure according to our unique technics in early breast cancer patients who hope the immediate prosthetic breast reconstruction in Japan.

Citation Format: Okumura S, Tatibana S, Narita C, Hyodo I, Sawaki M, Hattori M, Yoshimura A, Ishiguro J, Kotani H, Gondo N, Adati Y, Iwata H, Kamei Y. Immediate one-stage implant-based breast reconstruction without an acellular dermal matrix in Japanese breast cancer patients [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-13-12.