The Novel Strategy for Covering Implant-Based Breast Reconstruction: Pectoralis Major Fascia, Serratus Anterior Fascia, and Superficial Pectoral Fascia

Abstract

The increasing number of patients have been electing to undergo breast-conserving surgery via immediate, one-stage direct-to-implant breast reconstruction. Conventionally, this implant-based breast reconstruction is conducted utilizing a surgical methodology in which the pectoralis major muscle is incised to create two distinct planes. However, achieving satisfactory implant coverage remains a significant challenge, primarily due to the supplementary financial implications associated with the use of an acellular dermal matrix patch. There is a pressing necessity to discover an innovative surgical technique to address this limitation. The primary objective of this research is to investigate the potential advantages of employing a flap comprising the pectoralis major and serratus anterior muscle fascia for implant coverage during the process of breast reconstruction. The implant was encapsulated within a lateral tissue pocket, crafted from the fascia of the pectoralis major and serratus anterior muscles. This novel surgical technique maintained the original boundaries of the pectoralis major and serratus anterior muscles and substituted the high-cost acellular dermal matrix with an autologous fascial flap. After the operation, all patients exhibited a diminished rate of complications, with no occurrences of severe post-operative issues. Patient satisfaction surveys were administered to evaluate the esthetic effects of the reconstructed breast shape. All patients successfully underwent the surgical procedure. The aggregate complication rate, specifically for seroma and hematoma, was observed to be a minimal 5.41%, with no instances of capsular contracture recorded. Feedback obtained from the administered BREAST-Q questionnaires indicated good satisfaction and aesthetic outcomes among all the patients with reconstructed breasts. The utilization of a flap composed of the pectoralis major and serratus anterior muscle fascia to craft a lateral tissue pocket encapsulating the implant represents a reliable, secure, and economically efficient surgical methodology. Moreover, this technique can yield aesthetically pleasing outcomes.