Utilization of Serratus Muscle-Fascia Flap to Ensure Implant Stability in Prepectoral Direct-to-Implant Reconstruction.

backgroundIn prosthetic breast reconstruction, the thought on the placement of the implant has changed over the years. The aim of this study was to use the serratus muscle-fascia flap for prepectoral breast reconstruction with a permanent implant, performed simultaneously with mastectomy, in cases where mesh was not used. Essentially, the serratus muscle-fascia flap was used in prepectoral repairs to ensuring the implant is positioned where it should be. The goal here is to keep the prosthesis stable in the mastectomy pocket until the capsule forms.

methodsThis retrospective study included all patients who underwent prepectoral reconstruction using the serratus muscle-fascia flap between January 2023 and September 2024. This study consists only of patients who underwent surgery at the Acıbadem University Senology Institute. Two-stage reconstruction, delayed reconstruction, and breast reconstruction with autologous tissue were excluded from the study. The surgery was performed by Güven E and Sağır M from the plastic surgery team, and the mastectomy was performed by Uras C from the general surgery team. In the mastectomy pouch, the prosthesis was supported from the lateral and superolateral regions with serratus muscle-fascia flaps. The patients were evaluated for implant position at the end of the eighth week. They were also evaluated for early and late complications.

resultsThis study includes 57 patients and 70 breasts. Early complications were observed in 3 breasts, while late complications were observed in 9 breasts. At the 8-week postoperative follow-up, no lateral displacement of the implant was observed in any of the breasts, and all breast quadrants were formed. No full-thickness necrosis of the areola or skin flaps was observed in any of the breasts. In the late period, two breasts developed seroma. The most common complication was rippling with fat injection.

conclusionPrepectoral permanent implant reconstruction was performed without the use of mesh, reducing costs. In lateral incisions, in prepectoral reconstruction, the entire or part of the incision line is supported by vascularized tissue. The indication for prepectoral breast reconstruction has been expanded. LEVEL OF EVIDENCE IV: 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 .