Background/Objectives: The rising incidence of breast cancer has led to more mastectomies and increased demand for reconstruction. While retropectoral reconstruction with expanders is common, it has complications like postoperative pain and animation deformity. Prepectoral reconstruction, aided by advancements in biological and synthetic meshes, offers a promising alternative. Methods: This study prospectively evaluated the “Prepectoral Breast Reconstruction Assessment Score” on 20 patients undergoing mastectomy at Policlinico Umberto I, Rome, from July 2022 to February 2024. Patients with scores between 5 and 8 were included. The procedure involved the use of ADM (Acellular Dermal Matrix) or titanium-coated polypropylene mesh, followed by postoperative expansions and final implant placement after six months. Results: The mean age of patients was 51.85 years, with a mean BMI of 24.145 kg/m². ADM was used in 15 cases and synthetic mesh in 5. Complications were one exposure of the expander, one superficial skin necrosis and one seroma. Statistical analysis showed a trend toward fewer complications with higher scores, though this was not statistically significant (p-value = 0.139). Conclusions: Prepectoral reconstruction with expanders is a viable option, offering benefits such as reduced operating time, better volume control, and a more natural breast contour compared to the retropectoral approach. Although the trend suggests fewer complications with higher assessment scores, further studies with larger samples are needed for confirmation.

It has been brought to the Publisher's attention that the first author's family name was not tagged correctly in the above-mentioned article, published on eFirst on April 19, 2019. DOI of the original article is DOI: 10.1055/s-0039-1685543. The name should be listed with “Federico” as first name and “Lo Torto” as family name.

Editor's Note We read with great interest the article titled “Vacuum-Assisted Closure Therapy for the Treatment of Poststernotomy Wound Dehiscence in Neonates and Infants” by Padalino et al.[1] We think the article is very interesting, because the use of vacuum-assisted closure (VAC) therapy in the pediatric population is less frequent than the many existing studies for the adult patients and because there are no univocal standardized protocols, even if it is not clear how the author performed the reconstructive part for each patient specifically: maybe they used muscle flaps. VAC therapy is effective because it removes exudates and debrides, increases blood perfusion by neovascularization, leads to the formation of granulation tissue, and increases the local circulation of antibiotics into the wound bed.[2] For many years, we have used a similar approach in adult patients. The first step corresponds to the surgical debridement of the wound dehiscence, followed by placement of the VAC system; then wound cultures and, consequently, targeted antibiotic therapy are performed. The second step is the reconstructive one, which is achieved only after two consecutive negative wound cultures. At the beginning of our experience, we used to perform a bilateral pectoralis major muscle advancement flap,[3] but then we started to resort to less invasive procedures, such as the unilateral pectoralis major muscle flap[4] or the split pectoralis flap. Because deep sternal infection is a very severe disease with a mortality rate between 1 and 36%, our challenge for the future is to prevent the onset of wound dehiscence.[3] It would be possible by identifying patient risk categories as women, patients with chronic diseases, and smokers and treating them with the Negative Pressure Incision Management System (PREVENA™), immediately after the surgical reconstruction. This negative pressure therapy is a prevention system that protects the incision from external contamination, helps hold incision edges together, and removes any fluid and infection materials, when surgical incisions continue to drain following sutured or stapled closure.