|LETTER TO EDITOR
|Year : 2017 | Volume
| Issue : 1 | Page : 33-34
Implant-based breast reconstruction in resource-constrained settings
Olayinka A Olawoye
Department of Surgery, College of Medicine, Ibadan, Nigeria
|Date of Web Publication||16-Aug-2017|
Olayinka A Olawoye
Department of Surgery, College of Medicine, Ibadan
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Olawoye OA. Implant-based breast reconstruction in resource-constrained settings. Nigerian J Plast Surg 2017;13:33-4
In their recent article titled “Initial experience in breast reconstruction with implants by General surgeons: A report of five cases,” Afuwape et al. reported their experience with reconstructive breast surgery using implants. Though their cases were limited in number, their study significantly contributed to breast reconstruction surgery in a developing economy with limited access to breast implants and sizers. The limited access was because of their prohibitive prices and restrictive access to dermal matrices, which have become necessary adjuncts to implant-based breast reconstructions worldwide.
The author’s estimation of implant size by comparing the breast size to 500-ml infusion bags was innovative. However, significant discrepancies are bound to arise in this method because of the obvious disparity in the shape of the breast and infusion bags. Preoperative estimation of implant size is best done with the use of nomograms, which combine the base diameter of the breast with the breast projection; however, intraoperatively, at least three different breast sizers should be available, namely, the breast sizer corresponding to the estimated breast volume in addition to the sizers of immediate lower and higher volumes. The base diameter is a critical aspect of implant selection. Evidently, in a developing country, procuring a breast implant in the price range of $1000 to $2000 in addition to implant sizers of three different volumes for a single breast reconstruction would be prohibitive for a patient with average wealth but without health insurance.
The subcutaneous placement of implants for breast reconstruction though simple is fraught with a number of challenges, which include a higher incidence of implant migration and capsular contracture, which a number of the patients in the study had. The gold standard for implant placement during breast reconstruction is in the submuscular pocket with increasing use of acellular dermal matrix, (ADM) to cover the deficient inferior pole of the implant. The only patient who had submuscular implant placement in their study had axillary migration with flap necrosis, which necessitated debridement. ADM was not used for any of the patients. Currently, ADMs cost between $3000 and $4000 per piece, which is highly prohibitive for many patients making out-of-pocket payment in our clime. In addition, there is currently no industry proprietary for the distribution and sale of ADM in Nigeria. The consequence of this shortage is obvious: there may be less satisfactory outcome with implant-based breast reconstructions, making autologous reconstruction an option to be considered for patients who fulfill the requirements. This obviously requires advanced technical skills and expertise than implant-based reconstructions.
It is also desirable to have industry representatives with licenses for marketing useful tissue products such as ADMs in the subregion. As health insurance policy in many developing countries gets refined with wider coverage and as the economy of such countries improve, many more patients would be able to benefit from a wider range of breast reconstructive surgery options with expected better outcomes.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Afuwape OO, Ayandipo OO, Abdurrazzaaq AI. Initial experience in breast reconstruction with implants by general surgeons: A report of five cases. Niger J Plast Surg 2016;12:43-6.
Baxter RA. Indications and applications for high profile saline breast implants. Aesthet Surg J 2004;24:24-7.
Ayeni OA, Ibrahim AM, Lin SJ, Slavin SA. Acellular dermal matrices in breast surgery: Tips and pearls. Clin Plast Surg 2012;39:177-86.
Baxter RA. Acellular dermal matrices in breast implant surgery: Defining the problem and proof of concept. Clin Plast Surg 2012;39:103-12.