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CC BY 4.0 · Arch Plast Surg 2023; 50(06): 541-549
DOI: 10.1055/a-2125-7322
Breast/Trunk
Original Article

Associated Factors and Prevention of Upper Pole Rippling in Prepectoral Direct-to-Implant Breast Reconstruction

Da Hye Ryu 
1   Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
,
Oh Young Joo 
1   Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
,
Yun Ho Roh 
2   Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
,
Eun Jung Yang 
1   Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
,
Seung Yong Song 
1   Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
,
Dong Won Lee 
1   Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
› Author Affiliations Funding This work was supported by a National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT; grant no.: 2022R1F1A1076491).
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Abstract

Background Despite its many advantages, prepectoral breast reconstruction also carries the risk of implant rippling. The recent introduction of partial superior implant coverage using a pectoralis muscle slip in prepectoral direct-to-implant (DTI) breast reconstruction has shown the potential to minimize upper pole rippling. The purpose of this study was to identify factors associated with rippling and the effectiveness of our surgical technique.

Methods In total, 156 patients (186 breasts) who underwent prepectoral DTI breast reconstruction between August 2019 and March 2021 were identified retrospectively. Patient data were analyzed from medical records. Univariable and multivariable logistic analyses were performed to contextualize the risks associated with rippling deformity relative to demographic characteristics and other clinical factors. Retrospective propensity-matched analysis was performed to identify the relationship between rippling deformity and the reconstruction method.

Results Patients with body mass index (BMI; odds ratio [OR], 0.736; p < 0.001), those with a postoperative chemotherapy history (OR, 0.324; p = 0.027) and those who received breast reconstruction via the superior coverage technique (OR, 0.2; p = 0.004), were less likely to develop rippling deformity. The median follow-up period was 64.9 weeks, and there were no significant differences between patients in types of mastectomy, implant, or acellular dermal matrix. Patients who underwent superior coverage technique-based reconstruction showed significantly reduced rippling (OR, 0.083; p = 0.017)

Conclusion Patients with higher BMI and prior postoperative chemotherapy were less likely to develop rippling deformity. The superior coverage technique can be effective in minimizing upper pole rippling.

Keywords

breast reconstruction - prepectoral breast reconstruction - implant rippling - rippling

Authors' Contributions

D.H.R. and D.W.L. conceived the presented idea. D.H.R. wrote the manuscript with support from O.Y.J., E.J.Y., S.Y.S., and D.W.L. Y.H.R conducted and verified the statistical analysis. All authors contributed to the interpretation of the results and provided critical feedback to shape the research, analysis and manuscript.


Ethical Approval

The study was approved by the Severance Hospital IRB which is organized and operates according to ICH_GCP (IRB approval no.: 4-2022-0946; date: September 12, 2022).


Patient Consent

The patient provided written informed consent for the publication and use of the images.




Publication History

Received: 22 November 2022

Accepted: 21 June 2023

Accepted Manuscript online:
10 July 2023

Article published online:
30 November 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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