Abstract
Background Despite its many advantages, prepectoral breast reconstruction also carries the risk
of implant rippling. The recent introduction of partial superior implant coverage
using a pectoralis muscle slip in prepectoral direct-to-implant (DTI) breast reconstruction
has shown the potential to minimize upper pole rippling. The purpose of this study
was to identify factors associated with rippling and the effectiveness of our surgical
technique.
Methods In total, 156 patients (186 breasts) who underwent prepectoral DTI breast reconstruction
between August 2019 and March 2021 were identified retrospectively. Patient data were
analyzed from medical records. Univariable and multivariable logistic analyses were
performed to contextualize the risks associated with rippling deformity relative to
demographic characteristics and other clinical factors. Retrospective propensity-matched
analysis was performed to identify the relationship between rippling deformity and
the reconstruction method.
Results Patients with body mass index (BMI; odds ratio [OR], 0.736; p < 0.001), those with a postoperative chemotherapy history (OR, 0.324; p = 0.027) and those who received breast reconstruction via the superior coverage technique
(OR, 0.2; p = 0.004), were less likely to develop rippling deformity. The median follow-up period
was 64.9 weeks, and there were no significant differences between patients in types
of mastectomy, implant, or acellular dermal matrix. Patients who underwent superior
coverage technique-based reconstruction showed significantly reduced rippling (OR,
0.083; p = 0.017)
Conclusion Patients with higher BMI and prior postoperative chemotherapy were less likely to
develop rippling deformity. The superior coverage technique can be effective in minimizing
upper pole rippling.
Keywords
breast reconstruction - prepectoral breast reconstruction - implant rippling - rippling
