title: An Alternative Technique for Immediate Direct-to-Implant Breast Reconstruction-A Case Series.
abstract: BACKGROUND
  The practice of breast reconstruction continues to evolve with the introduction of new technologies. The authors describe a unique approach allowing immediate direct-to-implant reconstruction that can be performed on an outpatient basis.
  
  
  METHODS
  After a nipple-sparing mastectomy, acellular dermal matrix (ADM)-covered implants are placed in a prepectoral position in an immediate reconstruction. Assessment of results was performed via a retrospective review of demographic and procedural data.
  
  
  RESULTS
  Forty-five patients (79 breasts), mean age 46.8 years, were treated with direct-to-implant reconstruction using ADM-wrapped implants placed above the muscle with mean follow-up of 23.1 months (median 22 mo). Mean body mass index was 24.3, and 15 patients (33.3%) were current or former smokers. Twenty-seven patients (60%) had prior breast surgery with 22 (49%) exposed to chemotherapy and 34 (76%) radiation. Procedure time averaged 155 minutes and hospital length of stay averaged 0.6 days. Complications included flap necrosis in 22 cases (28%), seroma in 12 (15%), infection in 8 (10%), rippling in 28 (35%), and contracture in 8 (10%). In 14 breasts (18%), postoperative wound complications (flap necrosis or infection) led to implant loss.
  
  
  CONCLUSIONS
  The availability of ADM and cohesive gel implants has allowed us to perform above-the-muscle implant breast reconstruction in reduced time and often on an outpatient basis. Complication rates were comparable to expected results of standard expander-to-implant, staged breast reconstruction. This technique is a viable option delivering clinically and aesthetically acceptable results in select patients.
authors.affiliation: Department of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Ind.; Department of Image Recovery, St. Joseph Regional Medical Center, Mishawaka, Ind.; and The Centre, P.C. Comprehensive Plastic Surgery, The Centre PC, Mishawaka, Ind.
authors.forename: Ronald K
authors.initials: RK
authors.lastname: Downs
authors.affiliation: Department of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Ind.; Department of Image Recovery, St. Joseph Regional Medical Center, Mishawaka, Ind.; and The Centre, P.C. Comprehensive Plastic Surgery, The Centre PC, Mishawaka, Ind.
authors.forename: Kellee
authors.initials: K
authors.lastname: Hedges