Cancer of the Right Breast - Before No Pec Touch Breast Reconstruction

A 36-year- old female presented with a 1.5- cm lump in the upper outer quadrant of the right breast. There was no lymphadenopathy. The tumor was visible on an ultrasound scan and mammography. Core biopsy showed an invasive ductal carcinoma NST no special type, ER 80%, PR 60%, HER2- negative, G2, Ki67-28%, no BRCA1 mutation. She opted for nipple- sparing mastectomy with immediate implant based breast reconstruction and sentinel node biopsy. The patient had requested reconstruction without elevation of her pectoralis major muscle because she was a sportsperson. Therefore we used a novel Braxon® wrap-around porcine acellular dermal matrix (ADM) breast implant, sutured onto the pectoralis major muscle ( “no-pec touch”, muscle-sparing implant- based breast reconstruction), after written informed consent from the patient and local Ethics Committee approval. Inclusion criteria for the wrap-around ADM are mastectomy and immediate breast reconstruction as a single stage operation in women having small or medium sized breasts ( 1cm) and body mass index BMI < 30. Surgical techniques: The standard approach for the new Braxon wrap-around ADM breast reconstruction involves skin or nipple-sparing mastectomy performed with scalpel , in order to maintain a well perfused skin envelope and a good subcutaneous layer, and avoiding the use of excessive mono-polar electrocautery. The choice of the wrap-around Braxon ADM size is made using a breast sizer and with the patient in a semi-upright position. The anatomically-shaped breast implant is then wrapped in the ADM and the ADM edges sutured together, tightly wrapping the breast implant. The ADM containing implant is placed into the breast pocket and secured with apical, medial and lateral transfixion stitches directly above the pectoralis major muscle and with the subcutaneous layer before the closure of the skin. The manufacturer recommends not to use betadine for the breast pocket irrigation or for implant wash as it may potentially be cytotoxic to fibroblasts and cells of the immune system involved in matrix remodeling.