BACKGROUND: The advantages of hybrid breast reconstruction, i.e. the combination of free tissue transfer with simultaneous implant placement, are well-known. In an attempt to further minimize morbidity and simplify the procedure, the authors have modified their approach in that a pre-pectoral approach is now routinely chosen.METHODS: A retrospective analysis of patients who underwent immediate microsurgical breast reconstruction with simultaneous pre-pectoral implant placement was performed. Clinical outcomes and postoperative complications were examined.RESULTS: A total of 23 patients with a mean age of 46.6 years (range, 26 - 72 years) and mean BMI of 25.8 kg/m2 (range, 21.4 to 32.1) underwent reconstruction with 46 free flaps with simultaneous pre-pectoral silicone gel implant placement. The most common implant volume was 210 cc (range, 150 - 255 cc). Postoperative complications included hematoma (N=1 [4.3%]), mastectomy skin necrosis (N=5 [21.7%]), fat necrosis (N=3 [13%]), and delayed wound healing at the flap donor-site (N=4 [17.4%]). No case of implant malposition, implant infection, flap loss, or 'red breast' syndrome was encountered during a mean follow-up of 8.4 months (range, 2 - 17 months).CONCLUSION: Pre-pectoral hybrid breast reconstruction is a safe procedure that combines the benefits of autologous and implant-based reconstruction. While the transfer of well-vascularized soft tissue allows reconstruction of natural breast ptosis, the addition of an implant provides the desired projection, however, without being associated with complications such as rippling or animation deformity.
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