| Summary: | Background: Pre-pectoral implant-based breast reconstructions using biological meshes have recently gained popularity. There is limited data on the safety of performing a skin-reducing mastectomy with an immediate pre-pectoral implant reconstruction in women with large and ptotic breasts. We present an institutional experience in performing this procedure and using an acellular dermal matrix (ADM) in conjunction with the de-epithelialized inferior dermal flap to achieve complete implant coverage in this challenging cohort of patients. We adopted the term “hybrid” reconstruction to describe this technique. Methods: Data including age, body mass index (BMI), mastectomy weight, and risk factors for postoperative complications were collected retrospectively for patients undergoing a skin-reducing mastectomy and an immediate hybrid reconstruction. The data was collected from October 2016 to September 2019 at an academic tertiary breast cancer center. Early complications, including infection, tissue necrosis, seroma, hematoma, and implant loss, were analyzed. Results: A total of 25 patients (34 breasts) underwent a skin-reducing mastectomy with immediate hybrid breast reconstruction over the study period. The average mastectomy specimen weight was 1,107 g. The average patient age was 49. The BMI was greater than 30 kg/m2 in 40% of patients. Major infection was observed in four patients, three of whom were obese. Two patients experienced implant loss. Both were active smokers. Conclusions: Skin-reducing mastectomy and hybrid breast reconstruction can be safely performed in patients with large and/or ptotic breasts. A high BMI (>30) alone does not exclude patients from being offered immediate implant-based reconstruction. However, a combination of high BMI and active smoking poses a greater risk for complications, and patients should be appropriately counseled. © Annals of Breast Surgery. All rights reserved.
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