Background/Objectives: Immediate implant-based breast reconstruction is an established option for selected patients undergoing mastectomy. However, patients with large and ptotic breasts present specific reconstructive challenges, often requiring tailored approaches to minimize complications and optimize aesthetics. This pilot study aimed to evaluate the clinical feasibility and effectiveness of a mobile application developed to support intraoperative decision-making based on an institutional algorithm for breast reconstruction. It is also important to underline that this pilot study was exploratory in nature and primarily aimed at assessing feasibility and adherence to an app-based decision pathway, rather than comparative efficacy. Methods: We conducted a prospective observational study from October 2023 to December 2024 at the University Hospital of Sassari. Female patients with large and ptotic breasts undergoing immediate implant-based reconstruction were included. A mobile app, developed using MIT App Inventor 2, implemented our institution’s algorithm and guided surgeons through both preoperative and intraoperative decision-making. Surgical options included subpectoral, prepectoral with autologous fascial flaps, or prepectoral with acellular dermal matrix (ADM) reconstruction, depending on flap thickness and fascia integrity. Results: Sixteen patients (21 reconstructed breasts) were included. Surgical planning and execution followed app-generated recommendations in all cases, with no intraoperative deviations. Subpectoral reconstruction was performed in six patients, prepectoral with ADM in eight, and prepectoral with fascial flaps in two. The app was rated positively by all surgeons and facilitated consistent decision-making. Conclusions: The proposed mobile application, described in this pilot study, proved to be a feasible and effective decision-support tool for implant-based breast reconstruction in patients with challenging anatomy. It standardized surgical choices, supported training, and has the potential to enhance reproducibility and safety in complex reconstructive procedures.
背景/目的：对于符合条件的乳房切除术患者，即刻植入物乳房重建是一种成熟的选择。然而，乳房肥大且下垂的患者面临特定的重建挑战，通常需要定制化方案以降低并发症风险并优化美学效果。本项初步研究旨在评估一款移动应用程序的临床可行性和有效性，该程序基于本机构的乳房重建算法开发，旨在支持术中决策。需要强调的是，本研究为探索性研究，主要目的是评估基于应用程序的决策路径的可行性和依从性，而非进行疗效比较。方法：我们于2023年10月至2024年12月在萨萨里大学医院进行了一项前瞻性观察研究。研究对象为接受即刻植入物重建的乳房肥大且下垂的女性患者。我们使用MIT App Inventor 2开发了一款移动应用程序，该程序实现了本机构的算法，并在术前和术中指导外科医生进行决策。根据皮瓣厚度和筋膜完整性，手术方案包括胸肌下重建、带自体筋膜瓣的胸肌前重建或带脱细胞真皮基质（ADM）的胸肌前重建。结果：研究共纳入16名患者（21例重建乳房）。所有病例的手术规划与执行均遵循应用程序生成的建议，术中未出现偏离。其中6名患者接受了胸肌下重建，8名患者接受了带ADM的胸肌前重建，2名患者接受了带筋膜瓣的胸肌前重建。所有外科医生均对该应用程序给予积极评价，认为其有助于实现一致的决策。结论：本初步研究表明，所提出的移动应用程序对于解剖结构复杂的患者进行植入物乳房重建是一种可行且有效的决策支持工具。它标准化了手术选择，支持了培训，并有望提高复杂重建手术的可重复性和安全性。
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