title: Serratus Anterior Fascia Flap Versus Muscular Flap for Expander Coverage in Two-stage Breast Reconstruction Following Mastectomy: Early Post-operative Outcomes.
abstract: BACKGROUND
  The demand for reconstructive breast surgery after mastectomy is increasing among women and the two-stage option remains the most commonly performed technique. We conducted a self-controlled prospective clinical trial comparing the use of the serratus anterior fascia with the serratus anterior detached fibers to cover the inferolateral aspect of the expander in immediate two-stage breast reconstruction following conservative mastectomies as oncological or risk-reducing procedures.
  
  
  METHODS
  We analyzed the surgical outcome of 29 bilateral mastectomies and immediate reconstruction with the positioning of a tissue expander in a pocket beneath the pectoralis major and serratus anterior muscle on one side and in a pocket beneath the pectoralis major and a serratus anterior fascia flap on the other side. We considered all complications presenting in the first month after surgery and patient-reported early post-operative pain.
  
  
  RESULTS
  Complication rates in the two groups did not significantly differ (p = 0.237). The total amount of drainage and the time of drainage permanence were significantly lower for the subfascial group (p < 0.05). Patient-reported early post-operative pain was significantly different between the two groups both at 24 h (p < 0.05) and at 5 days (p < 0.05) with significantly lower pain scores reported by the patients in the subfascial group.
  
  
  CONCLUSIONS
  Our self-controlled prospective trial demonstrated an advantage in performing an implant-based two-stage breast reconstruction using a serratus anterior fascia flap when compared with the serratus muscle fibers use for inferolateral implant coverage following mastectomy. The use of the anterior serratus fascia flap for inferolateral implant coverage in two-stage breast reconstructions following mastectomy could be considered as a safe and effective technique, presenting lower morbidity for the patient when compared with the serratus muscle fibers use and lower costs when compared with biological and synthetic meshes use, achieving good outcomes in terms of post-operative complications and women's quality of life and satisfaction levels.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Department of Senology, Asur Marche Area Vasta 1, Santa Maria della Misericordia, Via Comandino 70, Urbino, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Bordoni
authors.affiliation: Department of Plastic Surgery, Hand Surgery and Microsurgery, San Gerardo Hospital, Monza, Milano, Italy.
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Cadenelli
authors.affiliation: Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy. nicolarocco2003@gmail.com.
authors.forename: Nicola
authors.identifier: http://orcid.org/0000-0001-6941-7873
authors.initials: N
authors.lastname: Rocco
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Talpiot Medical Leadership Program, Sheba Medical Center, Tel Aviv, Israel.
authors.forename: Ariel
authors.initials: A
authors.lastname: Tessone
authors.affiliation: Breast Surgery Unit, IRCCS-Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42123, Reggio Emilia, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Falco
authors.affiliation: Department of Senology, Asur Marche Area Vasta 1, Santa Maria della Misericordia, Via Comandino 70, Urbino, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Magalotti
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000235:genetics / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D004954:Esthetics; D005205:Fascia / Q000098:blood supply / Q000637:transplantation*; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008408:Mastectomy / Q000379:methods*; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000098:blood supply / Q000637:transplantation*; D010149:Postoperative Pain / Q000503:physiopathology*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011184:Postoperative Period; D011446:Prospective Studies; D018570:Risk Assessment; D015626:Tissue Expansion / Q000379:methods*; D014945:Wound Healing / Q000502:physiology
keywords: Breast reconstruction; Serratus anterior fascia flap; Two-stage reconstruction