Clinical Outcomes of Lipodermal Flaps in One-Stage Pre-pectoral Implant-Based Breast Reconstruction with Wise-Pattern Mastectomy: A Single-Center Experience.
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BACKGROUND AND OBJECTIVES: Our findings indicate that the use of a lipodermal flap in one-stage pre-pectoral implant-based breast reconstruction was associated with relatively complication and revision rates in this cohort. However, complications such as skin flap necrosis, capsular contracture, and implant exposure remain concerns. The lipodermal flap technique has been proposed to enhance soft tissue coverage and has been explored as a possible means of reducing these complications. This study aimed to evaluate the impact of lipodermal flaps on reducing postoperative complications and the need for secondary surgical interventions. METHODS: A retrospective study was conducted on 147 women (294 breasts) aged 18 to 65 years who underwent bilateral one-stage pre-pectoral implant-based reconstruction either with a lipodermal flap or without a lipodermal flap (control group) following mastectomy. The surgical technique involved elevating a well-vascularized lipodermal flap, repositioning it over the implant, and performing closure using an inverted-T scar pattern. Demographic characteristics, tumor features, surgical details, and postoperative complications were analyzed. The primary endpoint was the incidence of complications, and the secondary endpoint was the rate of secondary procedures. RESULTS: The mean age of the patient group was 45.60 ± 10.10 years, whereas that of the control group was 42.39 ± 11.09 years. Skin-sparing mastectomy was performed in 54.5% of the patients and nipple-sparing mastectomy in 45.5%, whereas in the control group the proportions were 45.7% and 54.3%, respectively. Of the 147 implants, 14 (18.2%) were associated with complications in the patient group, whereas 21 patients (30.0%) in the control group were affected with seroma, infection and wound dehiscence being the most common. Revisional surgical interventions were required in 16 patients (20.7%) in the patient cohort and in 12 patients (17.1%) in the control cohort. In both groups, lipodermal flap revision represented the most frequent indication for reoperation (n = 3 in each group). Other procedures included capsulotomy combined with autologous fat injection, nipple-areola complex reconstruction, and implant explantation. CONCLUSION: The findings of this study suggest that one-stage pre-pectoral implant-based breast reconstruction with a lipodermal flap may contribute to a reduction in complication rates and the frequency of revisional surgery. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .