Application of Closed Incision Negative Pressure Therapy with Full-Coverage Dressings After Mastectomy and Immediate Breast Reconstruction

Abstract

Incision healing after mastectomy and immediate reconstruction can be supported with closed incision negative pressure therapy (ciNPT), which removes exudate, helps to hold the incision edges together, and creates a closed incisional environment. Studies have shown that patients receiving postoperative care with ciNPT after breast surgery have exhibited lower rates of dehiscence, infection, necrosis, and seroma, compared to standard dressings.1-3 A recent approach to ciNPT involves the application of negative pressure to the incision and a wider area of surrounding tissue. In this case series, we investigated the outcomes of ciNPT using full-coverage dressings over the entire breast following mastectomy and reconstruction. This was a retrospective study of 54 patients (N=105 incisions) who underwent mastectomies with immediate prepectoral breast reconstruction. Informed consent was obtained for the collection of patient data. All patients were female, with an average age of 53.5 years and 29.1 kg/m2 body mass index. Common comorbidities included prior chemotherapy (31.3%) or radiation (21.6%), hypertension (14.8%), and diabetes (5.6%). The incisions resulted from skin reducing (34.3%), skin sparing (7.6%), and nipple sparing mastectomies (58.1%). Lymph nodes were removed in 38 (36.2%) incisions. After surgery, patients received oral antibiotics and ciNPT with full-coverage dressings at -125 mmHg. All patients were discharged home with ciNPT on postoperative Day (POD) 1. On POD 5-7, patients returned for ciNPT dressing removal. Upon follow-up on POD 30, there were no incidents of dehiscence or tissue necrosis. Three patients developed seromas, requiring revision. Of these, one required removal of the left tissue expander. The remaining 102 incisions (97.1%) healed without complication. Among this cohort, the use of ciNPT with full coverage of the breast incisions and surrounding soft tissue was effective in supporting incisional healing after mastectomy and immediate reconstruction.

*PREVENA RESTOR BELLA•FORM™ Incision Management System; 3M, San Antonio, TX, USA

References

  1. Ferrando PM, Ala A, Bussone R, Beramasco L, Actis Perinetti F, Malan F. Closed Incision Negative Pressure Therapy in Oncological Breast Surgery: Comparison with Standard Care Dressings. Plast Reconstr Surg Glob Open 2018;6(6):e1732.
  2. Gabriel A, Sigalove S, Sigalove N et al. The Impact of Closed Incision Negative Pressure Therapy on Postoperative Breast Reconstruction Outcomes. Plast Reconstr Surg Glob Open 2018;6(8):e1880.
  3. Muller-Sloof E, de Laat HE, Hummelink SL, Peters JW, Ulrich DJ. The effect of postoperative closed incision negative pressure therapy on the incidence of donor site wound dehiscence in breast reconstruction patients: DEhiscence PREvention Study (DEPRES), pilot randomized controlled trial. Journal of Tissue Viability 2018;27(4):262-266. doi:10.1016/j.jtv.2018.08.005.

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