Novel approach for risk-reducing mastectomy - first stage implant placement and subsequent second stage mastectomy.

Background: Risk-reducing mastectomy (RRM) with tissue expander then implant-based breast reconstruction conventionally involved immediate submuscular placement of tissue expanders during mastectomy, then after expansion, replacement of expanders for permanent implants in a second stage operation. Use of acellular dermal matrix (ADM) can achieve a single staged operation but ADMs are costly and may have potential complications. We aim to assess the feasibility of placement of implants as a first stage before RRM as a novel technique of reconstruction which avoids the need for serial outpatient expansion and ADM. Methods: Patients for RRM were offered first stage dual plane placement of fixed volume silicone gel permanent implants via inframammary fold incisions. RRM was undertaken several months later as the second operation, leaving the implants in place protected by the muscle and capsule pocket. Nipples were preserved or reconstructed according to patient's choice. Results: Eight patients with 15 operated breasts were recruited. Anatomically shaped implants were used in all patients and complete coverage of each implant was achieved. Mean implant volume was 433ml (range: 290-545ml). There were no complications and good aesthetic outcomes were achieved. Conclusions: This proof of principle finds that placement of implants before RRM is a novel technique for women at high breast cancer risk that could reduce the use of tissue expanders and ADMs and their associated problems. Two-staged RRM with first stage implant placement and subsequent RRM leaving the implants in place is feasible with no complications and can produce a good cosmetic outcome. Novel reconstruction of risk-reducing mastectomy The authors declare no conflict of interest and do not have any financial disclosure. Corresponding author: Dr Geok-Hoon Lim, Address: KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Republic of Singapore. Tel: (65) 6225 5554, Fax: (65) 6394 5817, Email: ghlimsg@yahoo.com.sg ©2018American Society of Plastic Surgeons

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