Discussion: A new method of salvaging breast reconstruction after breast implant using negative-pressure wound therapy and instillation

We read with great interest the article entitled ‘‘A New Method of Salvaging Breast Reconstruction After Breast Implant Using Negative Pressure Wound Therapy and Instillation’’ Ju Yong Cheong et al. [1]. Negative-pressure wound therapy (NPWT) is increasingly being used in breast reconstruction, in critical conditions that are difficult to resolve. Furthermore, the use indicated by the authors allows, in our view, a more secure secondary reconstruction with implants. Despite the use of negative pressure, they have failed in any of the cases to save implants previously positioned. The subject our discussion is the possibility of saving the prosthesis/expander with the use of negative pressure before wound dehiscence results in exposure of the implant. In fact in the literature, the use of negative pressure on skin sutures to prevent wound dehiscence has been reported. In the Department of Plastic, Reconstructive and Aesthetic Surgery of the University of Foggia, we do not use negative pressure after surgery for breast reconstruction to avoid wound dehiscence [2, 3], but we used this technique in cases of initial wound dehiscence or a compromised nipple areola complex. The timely use of vacuum therapy has enabled us to prevent possible exposure of the implants; also in the treatment of venous congestion of the NAC, we obtained a recovery of about 80% [4]. We find it interesting and worthy mentioning the use of negative pressure after removal of the implant. In fact, this allows remediation of the pocket, especially with intermittent instillation of saline solution. In traditional practice, many surgeons resort to continuous pocket washes, both during the removal of the implant in the operating room, and after through drainage. The repositioning of a prosthesis after a previous infection and exposure is always a difficult choice. The article indicated a lag treatment with NPWT to a reintegration of safer implants. In our experience, we used NPWT earlier and in some selected cases, we saved the implant/expander. In fact, we think that the authors of the paper discussed could use NPWT before wound dehiscence, when they suspect, if possible, compromised skin or an early stage of dehiscence without exposure as in Figure 1 and Figure 2 [1]. We believe that the key to our communication can be an earlier management, when a problem with the skin or sutures is suspected, through the use of negative-pressure therapy. In fact, early use allows drainage of secretions and The original version of this article was revised: The first author’s given name and family name were inverted. prevents tissue maceration, which provides better preservation of the affected area. Negative-pressure therapy has been shown to reduce the infectious load (always present in prosthesis exposures) and to increase the perfusion of the microcirculation (the basis of the wound healing processes). In our opinion, it can increase the survival percentage of the implants and reduce exposure.