Hybrid Pre-pectoral Breast Reconstruction – A Surgical Approach that Combines the Benefits of Autologous and Implant-based Reconstruction

Background: The advantages of hybrid breast reconstruction, i.e. the combination of free tissue transfer with simultaneous implant placement, are well-known. In an attempt to further minimize morbidity and simplify the procedure, the authors have modified their approach in that a pre-pectoral approach is now routinely chosen. Methods: A retrospective analysis of patients who underwent immediate microsurgical breast reconstruction with simultaneous pre-pectoral implant placement was performed. Clinical outcomes and postoperative complications were examined. Results: A total of 23 patients with a mean age of 46.6 years (range, 26 - 72 years) and mean BMI of 25.8 kg/m2 (range, 21.4 to 32.1) underwent reconstruction with 46 free flaps with simultaneous pre-pectoral silicone gel implant placement. The most common implant volume was 210 cc (range, 150 - 255 cc). Postoperative complications included hematoma (N=1 [4.3%]), mastectomy skin necrosis (N=5 [21.7%]), fat necrosis (N=3 [13%]), and delayed wound healing at the flap donor-site (N=4 [17.4%]). No case of implant malposition, implant infection, flap loss, or "red breast" syndrome was encountered during a mean follow-up of 8.4 months (range, 2 - 17 months). Conclusion: Pre-pectoral hybrid breast reconstruction is a safe procedure that combines the benefits of autologous and implant-based reconstruction. While the transfer of well-vascularized soft tissue allows reconstruction of natural breast ptosis, the addition of an implant provides the desired projection, however, without being associated with complications such as rippling or animation deformity. Financial Disclosure: Dr. Momeni is a consultant for Allergan, AxoGen, Inc., and Stryker Corporation. Dr. Kanchwala is a consultant for AxoGen, Inc. No compensation or support was received for this study. Acknowledgement: The authors would like to thank Dr. Sarah Sorice Virk for preparing the medical illustrations. Corresponding author: Arash Momeni, MD, Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, 770 Welch Road, Suite 400, Palo Alto, CA 94304, Phone: 650-723-6189, Email: amomeni@stanford.edu ©2018American Society of Plastic Surgeons

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