The Breast Implant Size Selection System for Direct To Implant Breast Reconstruction. A Retrospective and Prospective analysis

Background: Direct alloplastic breast reconstruction following prophylactic or therapeutic mastectomy (DTI), is a common operative procedure. Implant selection is a key step for a successful reconstructive result. Nowadays, there is no widely accepted implant size selection system for reconstructive breast surgery. Objective: Describe the senior author implant size selection process in direct-to-implant breast reconstruction. Patients and Methods: The clinical trial was composed of a two-phase study: phase 1: Retrospective review of patients with small to medium size breasts undergoing primary DTI breast reconstruction procedures between Jan 2022 and June 2023. Phase 2. Prospective analysis of patients undergoing primary DTI breast reconstruction procedures from August 2023 to August 2024. Results: In the first retrospective phase, 20 consecutive patients underwent DTI reconstructive procedure, utilizing the implant size selection technique. With a 90% success rate. In the second prospective phase of this study, 22 consecutive patients were analyzed, with 91% success rate. Discussion: The technique described is a size selection system, for DTI breast reconstruction, after skin sparing or nipple sparing mastectomy, in medium and small size breast. While most surgeons simply rely on breast width and height, our technique also considers the anterior skin envelope, which is a crucial measurement in predicting breast size in breast reconstruction. The breast implant selection system facilitates a precise prediction of the final implant used. There is hardly ever a deviation of more than 25ml from our original estimate. Being able to predict implant size pre-operatively gives a certain reassurance regarding the outcome for the patient and the surgeon alike, as well as “visualizing” the reconstructive outcome in reality and not on 3D simulations.