Immediate Implant-Based Breast Reconstruction with an Acellular Dermal Matrix (ADM): Reconstruction Failure Due to Postoperative Hematoma Causing Skin Necrosis and Implant Extrusion

Fig. 43.1

Preoperative view. The tumor was located in the upper quadrant of the left breast. Neoadjuvant chemotherapy led to a complete clinical and radiological remission. A nipple-sparing mastectomy and immediate implant-based reconstruction was planned. The breast was of medium size and moderate ptosis

43.2 Surgery

A nipple-sparing mastectomy was performed 3 weeks after chemotherapy using an incision in the inframammary fold. The weight of the specimen was 270 g. Intraoperative frozen section examination of the retro-areolar tissue found no cancer. The insertions of the pectoralis major muscle were dissected off the thoracic wall in the inferior breast pole and medially up to the third rib. A 295 cc anatomical implant was placed underneath the muscle and covered with an acellular dermal matrix (ADM, Protexa^®) in the inferior pole. Two drains were placed (in the submuscular space and subcutaneously) and a three-layer wound closure was done.

43.3 Clinical and Cosmetic Outcome

The final pathological examination of the mastectomy specimen found a pathological complete remission. The early postoperative course was uneventful and the drains were removed on the 6th postoperative day and the patient was discharged. Two weeks later the patient returned to the outpatient clinic with a large subcutaneous hematoma (Fig. 43.2

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