Immediate Hybrid Breast Reconstruction: Dual-Plane Approach Using Prepectoral Implants and Retropectoral Fat Grafting.

Abstract

Implant-based breast reconstruction (BR) is to date the most popular reconstructive modality. The aim of the study was to evaluate the immediate hybrid 1-stage BR technique, with a dual-plane approach, using prepectoral implants and retropectoral autologous fat transfer (AFT). The autthors prospectively enrolled patients scheduled for immediate BR using a hybrid approach, which included retropectoral AFT and prepectoral breast implants (group A). This cohort was compared with a retrospective control group of patients who underwent immediate direct-to-implant BR without AFT (group B). Complications, hospitalization days, number of AFT procedures for a complete BR, aesthetic outcomes, and patient satisfaction were analyzed. Fat suuvival rate was assessed through comparison of preoperative and 6-month postoperative MRI scans. Thirty immediate BRs were included in each group. The average amount of AFT in the retropectoral plane was 106.30 cc (SD, 16.54), and the mean breast implant size was statistically higher in group B (P = 0.00026). MRI assessment confirmed an average of 47.90% (SD, 0.14%) retropectoral fat survival at 6 months postoperatively. No statistically significant differences in terms of complications and hospitalization days were observed (P > 0.05), whereas a significant difference was observed regarding additional AFT sessions (P = 0.00062). After a propensity score-weighted analysis, assessment by surgeons and patients showed a significantly higher overall satisfaction in the active group. The immediate hybrid approach for 1-stage BR enabled the use of smaller breast implants, allowed a decrease in AFT procedures with costs reduction, and yielded optimal breast shape and contour by reducing stepoff deformity and rippling alterations, without adding complications. Therapeutic, III.