Breast reconstruction using hand-meshed free dermal autograft: a case series

Abstract 

Background: Breast reconstruction with implants immediately after mastectomy has attracted great attention in recent years. Acellular dermal matrices (ADM) are commonly used for breast reconstruction. However, it has drawbacks such as high cost, infection, and seroma formation. Herein, we present a method for implant-based breast reconstruction using hand-meshed free dermal autograft in pre-pectoral (harvested corium-covered implant (HACCIM)) and partial subpectoral implant-based breast reconstruction procedures.

Methods: A total of 22 patients, including 17 patients with unilateral and 5 patients with bilateral breast reconstruction were included in this study. Twenty—seven breasts underwent one-stage pre-pectoral (n = 11) and partial subpectoral (n = 16) implant-based breast reconstructive surgery using patients-derived hand-meshed free dermal autograft. Patients’ characteristics, clinical and operative data, and outcomes of interest were examined and recorded.

Results: The median age and BMI of patients who underwent breast reconstruction were 44.5 years (ranging from 34 to 65 years) and 24.97 kg/m² (ranging from 20.57 to 32.87 kg/m²) respectively. The follow-up duration ranged from 2 to 13 months (Median: 8 months). The mean time of free dermal autograft harvest and preparation was 30.26 ± 6.22 min. Superficial skin flap necrosis was observed in 8 breasts (29.63%) with 4 breasts in the partial subpectoral group and 4 in the pre-pectoral group. All minor skin flap necroses were managed successfully by outpatient care. Implant failure occurred in 4 breasts (14.81%), comprising 3 breasts in the partial subpectoral group and one in the pre-pectoral group. Three of the patients who showed implant failure had a history of radiation therapy, and the last one had full-thickness skin flap necrosis related to skin-sparing mastectomy.

Conclusion: Our study indicated that free dermal autograft can be utilized safely in one-stage pre-pectoral and subpectoral implant-based breast reconstruction. Further interventional studies are required to affirm our findings.