Outcomes of Negative Pressure Wound Therapy on Immediate Breast Reconstruction After Mastectomy

Haris M. Akhter, BS; Collin Macdonald, MD; Philip McCarthy, DO, MPH; Ye Huang, BA; Bria R. Meyer, MD; Valerie K. Shostrum, MS; Kerry J. Cromer, DNP, APRN; Perry J. Johnson, MD, FACS; Shannon L. Wong, MD, FACS; Heidi H. Hon, MD

Disclosures

Plast Reconstr Surg Glob Open. 2023;11(8):e5130 

In This Article

Abstract and Introduction

Abstract

Background: Immediate expander/implant-based breast reconstruction after mastectomy has become more sought after by patients. Although many patients choose this technique due to good aesthetic outcomes, lack of donor site morbidity, and shorter procedure times, it is not without complications. The most reported complications include seroma, infection, hematoma, mastectomy flap necrosis, wound dehiscence, and implant exposure, with an overall complication rate as high as 45%. Closed incision negative pressure therapy (ciNPT) has shown value in wound healing and reducing complications; however, the current literature is inconclusive. We aimed to examine if ciNPT improves outcomes for patients receiving this implant-based reconstruction.

Methods: This is a retrospective single-institution study evaluating the ciNPT device, 3M Prevena Restor BellaForm, on breast reconstruction patients. The study was performed between July 1, 2019 and October 30, 2020, with 125 patients (232 breasts). Seventy-seven patients (142 breasts) did not receive the ciNPT dressing, and 48 patients (90 breasts) received the ciNPT dressing. Primary outcomes were categorized by major or minor complications. Age, BMI, and final drain removal were summarized using medians and quartiles, and were compared with nonparametric Mann-Whitney test. Categorical variables were compared using chi-square or Fisher exact test.

Results: There was a statistically significant reduction in major complications in the ciNPT group versus the standard dressing group (P = 0.0247). Drain removal time was higher in the ciNPT group.

Conclusion: Our study shows that ciNPT may help reduce major complication rates in implant-based breast reconstruction patients.

Introduction

The popularity among women requesting immediate breast reconstruction surgery after mastectomy has slowly risen annually over the past decade. In 2020, 137,808 women underwent breast reconstruction surgery in the United States.[1] This was a 1% increase from 2019, but an overall 75% increase from 2000.[1] Although other options are available to women pursuing breast reconstruction after mastectomy, the most selected technique remains expander/implant-based reconstruction, with more than 70% of mastectomy patients undergoing this type of reconstruction worldwide.[2–4] With expander/implant-based reconstruction, the use of acellular dermal matrices (ADM) has revolutionized breast reconstructions since being introduced over two decades ago by providing more precise control of implant placement, allowing larger volume expansions, and decreasing the risk of capsular contracture.[5,6] In addition, ADM provides additional soft tissue coverage of an existing implant or tissue expander, which has been attributed to its good cosmetic outcome and comparable complications.[7–9] Therefore, it can be understood why so many choose implant-based reconstruction after mastectomy due to the satisfactory aesthetic outcomes, lack of donor site morbidity, increase in bilateral mastectomies versus unilateral mastectomies, and shorter procedure times.[10,11]

Despite being the most common procedure for this demographic, it is not without complications. The most commonly reported early complications related to tissue expander/implant-based reconstructions are seroma, infection, hematoma, mastectomy skin flap necrosis, wound dehiscence, implant exposure, and implant deflation.[12,13] Complication incidence rates upward of 45% have been reported.[13] As a result, these complication rates can lead to medical and oncologic management delays and often lead to poor aesthetic outcomes. Many patient and provider-specific variables must be considered as key risk factors when evaluating complication rates, including body-mass-index (BMI), tobacco use, comorbidities, neoadjuvant/adjuvant therapies, and surgical technique.[5,12,14]

Postoperative incision and wound management are vital components in the overall success and healing of postmastectomy expander/implant-based reconstruction. Closed-incision negative pressure therapy (ciNPT) is a technique that creates favorable biomechanical forces to promote healing in surgical and nonsurgical wounds.[15] However, inconsistencies remain in the literature regarding the efficacy of ciNPT in wound management. Some studies demonstrate that ciNPT devices aid in healing while also diminishing complications.[3,4,16] However, other studies do not demonstrate a difference in complications with ciNPT.[17,18] There are also different types of ciNPT on the market. At our institution, we recently implemented the use of 3M Prevena Restor BellaForm, which was specifically designed for breast patients. Our aim was to compare the complication rates for patients undergoing immediate expander or implant-based reconstruction using standard-of-care dressings versus ciNPT. We hypothesize that the use of ciNPT will decrease complication rates.

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