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Funnel usefulness in direct-to-implant breast reconstruction using periareolar incision with prepectoral implant placement and complete coverage with acellular dermal matrix

Title
Funnel usefulness in direct-to-implant breast reconstruction using periareolar incision with prepectoral implant placement and complete coverage with acellular dermal matrix
Authors
Woo J.Seung I.H.Hong S.E.
Ewha Authors
홍승은우주현
SCOPUS Author ID
홍승은scopus; 우주현scopusscopus
Issue Date
2020
Journal Title
Journal of Plastic, Reconstructive and Aesthetic Surgery
ISSN
1748-6815JCR Link
Citation
Journal of Plastic, Reconstructive and Aesthetic Surgery vol. 73, no. 11, pp. 2016 - 2024
Keywords
Acellular dermal matrixBreast reconstructionFunnelPeriareolar incisionPrepectoral reconstructionSilicone implant
Publisher
Churchill Livingstone
Indexed
SCIE; SCOPUS WOS scopus
Document Type
Article
Abstract
Background: The funnel has been used in esthetic breast surgery that requires a small incision. Recent advances in minimally invasive surgical techniques have led to more cases of nipple-sparing mastectomy (NSM) through periareolar incision. However, prepectoral implant placement and complete coverage with acellular dermal matrix (ADM) is almost impossible with the periareolar approach. Funnels can also be useful for direct-to-implant breast reconstruction. Methods: NSM with periareolar incision and direct-to-implant breast reconstruction were performed with prepectoral implant placement between January 2017 and July 2019. The ADM full-wrapped anatomic textured implant was inserted using a funnel without additional incisions during surgery. Results: A total of 21 patients were enrolled, including 2 who received bilateral breast reconstruction. All operations were successfully performed using funnels with minimal periareolar incisions. Anatomic textured implants (mean: 251.7 cc, range: 90–450 cc) wrapped in ADM can be effectively inserted in the prepectoral plane using a funnel. Two patients experienced delayed wound healing of the areola that was treated by conservative wound management. Patients also experienced less pain overall, and the cosmetic result was very good. Patient satisfaction scores were also very high. Conclusions: While the periareolar incision is esthetically pleasing, additional resection is often necessary. However, the use of funnels ensured that no additional incision was needed even in large implants. This subsequently led to better results in terms of pain and scarring. Prepectoral breast reconstruction involving complete implant coverage with ADM using a funnel through the periareolar approach represents a good alternative to the traditional dual plane subpectoral method. This method provides good patient satisfaction without adverse outcomes. © 2020 British Association of Plastic, Reconstructive and Aesthetic Surgeons
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DOI
10.1016/j.bjps.2020.08.078
Appears in Collections:
의과대학 > 의학과 > Journal papers
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