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CC BY-NC-ND 4.0 · Arch Plast Surg 2022; 49(05): 587-595
DOI: 10.1055/s-0042-1756337
Breast/Trunk: Original Article

Evaluation of Breast Animation Deformity following Pre- and Subpectoral Direct-to-Implant Breast Reconstruction: A Randomized Controlled Trial

Authors

  • Diana L. Dyrberg 

    1   Department of Plastic Surgery, Odense University Hospital, Odense/Lillebaelt Hospital, Vejle, Denmark

  • Camilla Bille 

    2   Department of Plastic Surgery, Odense University Hospital, Odense, Denmark

  • Vibeke Koudahl 

    1   Department of Plastic Surgery, Odense University Hospital, Odense/Lillebaelt Hospital, Vejle, Denmark

  • Oke Gerke 

    3   Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark

  • Jens A. Sørensen 

    2   Department of Plastic Surgery, Odense University Hospital, Odense, Denmark

  • Jørn B. Thomsen 

    2   Department of Plastic Surgery, Odense University Hospital, Odense, Denmark

Funding None.
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Abstract

Background The incidence of breast animation deformity (BAD) is reported to be substantial after direct-to-implant breast reconstruction with subpectoral implant placement. It has, however, never been examined if BAD can occur following prepectoral implant placement. Our primary aim was to compare the incidence and degree of BAD after direct-to-implant breast reconstruction using either subpectoral or prepectoral implant placement. Secondary aim of this study was to assess and compare the level of pain between sub- and prepectoral reconstructed women.

Methods In this randomized controlled trial, patients were allocated to reconstruction by either subpectoral or prepectoral implant placement in accordance with the CONSORT guidelines. The degree of BAD was assessed by the “Nipple, Surrounding skin, Entire breast (NSE)” grading scale 12 months after surgery. The level of postoperative pain was assessed on a numerical pain rating scale.

Results We found a significant difference in the degree of BAD favoring patients in the prepectoral group (23.8 vs. 100%, p < 0.0001; mean NSE grading scale score: 0.4 vs. 3.6, p < 0.0001). The subpectoral reconstructed group reported higher levels of pain on the three subsequent days after surgery. No significant difference in pain levels could be found at 3 months postoperatively.

Conclusion The incidence and degree of BAD was significantly lower in women reconstructed by prepectoral direct-to-implant breast reconstruction. Unexpectedly, we found mild degrees of BAD in the prepectoral group. When assessing BAD, distortion can be challenging to discern from rippling.

Keywords

breast reconstruction - breast deformity - breast implant - treatment outcome - incidence

Ethical Approval

The study was approved by the Regional Committees on Health Research Ethics for Southern Denmark (approval no.: S-20160160) and performed in accordance with the principles of the Declaration of Helsinki. Written informed consent was obtained from the included participants. The study has been prospectively registered at clinicaltrials.gov (identifier: NCT03143335) and the protocol has been published in trials (Direct-to-Implant Extracellular Matrix Hammock-based Breast Reconstruction; Prepectoral or Subpectoral? Doi:10.1186/s13063-020-4125-6).


Authors' Contributions

Conceptualization: D.L.D., J.B.T., and C.B.; data curation: D.L.D.; formal analysis: O.G. and D.L.D.; investigation: D.L.D.; methodology: J.B.T. and C.B.; project administration: D.L.D., J.B.T., and J.A.S.; supervision: J.B.T., C.B., J.A.S., and V.K.; writing the original draft: D.L.D. and J.B.T.; and writing and review and editing: all authors.




Publication History

Received: 11 November 2021

Accepted: 29 March 2022

Article published online:
23 September 2022

© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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Comment to this article:

Commentary: Evaluation of Breast Animation Deformity following Pre- and Subpectoral Direct-to-Implant Breast Reconstruction: A Randomized Controlled TrialArch Plast Surg 2022; 49(05): V1-V1
DOI: 10.1055/s-0043-1777254