Augmenting the Breast Reconstruction: Core Projection With Hybrid Microsurgical Breast Reconstruction With Flap and Stacked Prepectoral Acellular Dermal Matrix.

Background: Many patients who require breast reconstruction prefer a flap-based approach for various reasons, including the permanence and aesthetic benefit of a breast that looks and feels natural. For patients who desire autologous breast reconstruction following mastectomy but lack adequate donor site volume, the authors utilize the novel hybrid flap, prepectoral acellular dermal matrix (HyPAD) approach. In this technique, the deep inferior epigastric perforator (DIEP) flap is augmented with a stacked acellular dermal matrix (ADM). The purpose of this study is to quantify the soft tissue augmentation and core projection achieved with this technique during autologous flap-based breast reconstruction.

Methods: Consecutive patients who underwent the HyPAD technique during the study period (August 2021 to December 2022) were identified. All patients lacked adequate donor site volume and wished to avoid the placement of implants during their reconstruction. Demographic information and outcomes were assessed. Intraoperatively, the weights (g) of the mastectomy specimen, the flap donor site, and the stacked ADM were recorded.

Results: During the study period, 21 patients (n = 21) were identified. The mean age of patients at the time of surgery was 48.9 ± 7.85 years. The mean body mass index was 24.1 kg/m² ± 3.3 kg/m². The mean mastectomy specimen weight was 436.35 g, and the mean flap weight was 370.73 g, posing an average discrepancy of 15.04% or 65.62 g. The average weight of the ADM used to augment the flap was 81.76 g. This weight accounted for an average of 18.07% of the total reconstructed breast weight.

Conclusions: The use of ADM during autologous breast reconstruction provides patients with an alternative to implants that allows them to obtain their desired breast volume. Given the aesthetic impact that ADM has on the total amount of flap weight and projection, it is recommended that the HyPAD technique be considered for patients who desire a breast that cannot be restored with their own flap weight and wish to avoid implants.