Direct to implant reconstruction with adjustable permanent Becker implant expanders with ADM following de-epithelised skin reducing mastectomy in high-risk overweight and obese patients with severe ptosis

Overweight and obese patients with severe ptosis undergoing mastectomy and reconstruction present a challenge to the oncoplastic breast surgeon. This paper investigates early-to medium-term outcome of high-risk overweight and obese women with severe ptosis undergoing de-epithelised skin reducing mastectomy and direct to implant reconstruction with Becker implant expanders. From Nov 2016 and April 2021, 20 Wise pattern skin reducing mastectomies (SRM) were performed, 18 with Adjustable Permanent Becker Implant expanders (APBI) and 2 with fixed volume implants. Median age was 48 years (27-73), and median FU was 21 months (4-49). There were 8 smokers and 7 patients needed radiation treatment. In the ABPI group, there was one infection, 3 patients had threatened wounds which needed revision, and one patient lost her implant. There was no locoregional recurrence or distant metastasis. There was 1 week delay in adjuvant chemotherapy for a patient with wound issues following reconstruction. One patient is awaiting autologous reconstruction following deformity subsequent to radiation treatment. In conclusion the use of APBI following de-epithelised skin reduction surgery in this high-risk group is an option with acceptable early-to medium-term outcome.