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De Vita R, Mangialardi ML, Pozzi M, Vietti Michelina V, Nanni J, Zingaretti N, Parodi PC, Zoccali G. A Pericardium Bovine Matrix Pocket in DTI Prepectoral Breast Reconstruction. Clin Breast Cancer 2024:S1526-8209(24)00162-9. [PMID: 39003171 DOI: 10.1016/j.clbc.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 05/30/2024] [Accepted: 06/08/2024] [Indexed: 07/15/2024]
Abstract
Breast reconstructive surgery has evolved significantly over the years. One of the recent advancements is the use of prepectoral implants in combination with synthetic and biological material as a natural and effective coverage. To date, there is little published data on breast reconstruction using acellular bovine pericardium matrix and most concern submuscular breast reconstruction. This study aimed to describe the multicentric-multisurgeon experience in performing direct to implant (DTI) prepectoral breast reconstructions using acellular bovine pericardium matrix (ABPM) pocket. A retrospective multicentric data collection of the all the immediate prepectoral breast reconstructions using acellular bovine pericardium was carried out by the authors. Surgical data including type of mastectomy, axillary surgery, type and size of implant, size of ABPM, duration of surgery were collected for each patient. Postoperative data including adjuvant treatments, complications, necessity to perform other interventions, patient's satisfaction were collected. Cosmetic results were also evaluated by 7 different observers at minimum 1 year follow-up. A total of 65 breast reconstruction were included in the study. Mean follow up was 21.3 months. Average surgical time was 1,42 hours. Minor complications occurred in 4 breasts; major complications occurred in 2 breasts. After 6 months follow-up, 7 patients underwent fat grafting to correct any rippling and /or wrinkling. Breast aesthetic and patients reported outcomes were satisfactory. Not significant capsular contracture was noted at the follow up control. To date, this is the largest study about prepectoral breast reconstruction with ABPM. On the basis of our results, prepectoral breast reconstruction ABPM assisted is a reliable, safe and suitable option providing good patient satisfaction outcomes.
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Affiliation(s)
- Roy De Vita
- Plastic and Reconstructive Surgery department, I.R.C.C.S. "Regina Elena" National Cancer Institute, Rome, RM, Italy
| | - Maria Lucia Mangialardi
- Plastic and Reconstructive Surgery department, I.R.C.C.S. "Regina Elena" National Cancer Institute, Rome, RM, Italy.
| | - Marcello Pozzi
- Plastic and Reconstructive Surgery department, I.R.C.C.S. "Regina Elena" National Cancer Institute, Rome, RM, Italy
| | - Veronica Vietti Michelina
- Plastic and Reconstructive Surgery department, I.R.C.C.S. "Regina Elena" National Cancer Institute, Rome, RM, Italy
| | - Jacopo Nanni
- Plastic and Reconstructive Surgery department, I.R.C.C.S. "Regina Elena" National Cancer Institute, Rome, RM, Italy
| | - Nicola Zingaretti
- Department of Medical Area (DAME), Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, University of Udine, Udine, Italy
| | - Pier Camillo Parodi
- Department of Medical Area (DAME), Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, University of Udine, Udine, Italy
| | - Giovanni Zoccali
- Plastic and Reconstructive Surgery department, I.R.C.C.S. "Regina Elena" National Cancer Institute, Rome, RM, Italy
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Eyuboglu AA, Akdemir O, Aydogan F, Isken MT. Implant-Based Breast Reconstruction with Bovine Pericardium: Our Approach Using Tutopatch ® and Review of Literature. Aesthetic Plast Surg 2024; 48:285-296. [PMID: 37973674 DOI: 10.1007/s00266-023-03732-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/17/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES To describe the usage and advantages of bovine pericardium mesh (Tutopatch®) in breast reconstruction and to compare different mesh materials used in immediate breast reconstruction. METHODS Our study involved a single-center, retrospective analysis of 103 patients (comprising 114 breasts) who underwent immediate implant-based breast reconstruction using bovine pericardium bovine matrix. The procedures were performed by the same surgical team between April 2018 and May 2023. RESULTS The rates of early and late complications were examined after a median follow-up period of 30.2 ± 5.5 months. The results revealed that the rates of early complications stood at 9.7%, while late complications were observed in 14.5% of the cases. The most common late complication was seroma formation (7.7%) which six were resolved without any surgical intervention. CONCLUSION Tutopatch® can be used as an extension of the muscle to cover the prosthesis. It forms an extra layer over the silicone implant that helps to decrease the complications as capsular contracture and implant exposure. It also represents a significant 85 % reduction in cost when compared to a similar-sized mesh materials. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Atilla Adnan Eyuboglu
- Department of Plastic and Reconstructive Surgery, Arel University Faculty of Medicine, Bahcelievler Memorial Hospital, Bahcelievler Mah. Adnan Kahveci Bulvari no: 227, 34180, Bahcelievler, Istanbul, Turkey.
| | - Ovunc Akdemir
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Aydın University, Istanbul, Turkey
| | - Fatih Aydogan
- Department of Breast Surgery, General Surgery, Bahcelievler Memorial Hospital, Istanbul, Turkey
| | - Mustafa Tonguc Isken
- Department of Plastic and Reconstructive Surgery, Bahcesehir University Faculty of Medicine, Bahcelievler Memorial Hospital, Istanbul, Turkey
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Silva CF, Felzemburgh VA, Vasconcelos LQ, Nunes VLC, Barbosa Júnior AA, Giglioti AF, Araújo RPC, Miguel FB, Meneses JVL, Rosa FP. Histomorphological evaluation of acellularized bovine pericardium in breast implant coverage. BRAZ J BIOL 2023; 83:e276220. [PMID: 38126640 DOI: 10.1590/1519-6984.276220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/17/2023] [Indexed: 12/23/2023] Open
Abstract
Bovine pericardium (BP) has been used as a biomaterial for several decades in many medical applications particularly due to its mechanical properties and the high collagen content. In the acellular form it favors faster tissue repair, providing a three-dimensional support for cellular and vascular events observed during tissue repair and due, to a low elastin content, may favor its use as a breast implant cover, resulting in a low possibility of contracture of the biomaterial, preventing the appearance of irregularities during the reconstruction process. Thus, the aim of this study was to evaluate, histomorphologically, the behavior of acellularized bovine pericardium (ABP) as a mammary implant cover in rats. For this purpose, 16 animals were divided into two groups, with eight animals at each biological point: 7 and 15 days after surgery. Of the 16 animals, 32 specimens were obtained: 16 in the experimental group (EG) and 16 in the control group (CG). Throughout this study, none of the studied groups had postoperative complications. Results: The histomorphological results showed, in the two biological points, both in the EG and in the CG, chronic inflammatory infiltrate, leukocyte fibrin exudate, formation of granulation tissue and deposition of collagen fibers, more evident in the EG, regressive along the biological points. At 15 days, the implanted ABP showed initial biointegration with the fibrous capsule and surrounding tissues of the recipient bed. Conclusion: These results indicate that the due to the observed favorable tissue response ABP may be of potential use as a breast implant cover.
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Affiliation(s)
- C Frutuoso Silva
- Universidade Federal da Bahia - UFBA, Instituto de Ciências da Saúde - ICS, Laboratório de Bioengenharia Tecidual e Biomateriais - LBTB, Salvador, BA, Brasil
| | - V A Felzemburgh
- Universidade Federal da Bahia - UFBA, Instituto de Ciências da Saúde - ICS, Laboratório de Bioengenharia Tecidual e Biomateriais - LBTB, Salvador, BA, Brasil
| | - L Q Vasconcelos
- Universidade Federal da Bahia - UFBA, Instituto de Ciências da Saúde - ICS, Laboratório de Bioengenharia Tecidual e Biomateriais - LBTB, Salvador, BA, Brasil
| | - V L C Nunes
- Universidade Federal da Bahia - UFBA, Faculdade de Medicina da Bahia - FMB, Salvador, BA, Brasil
| | | | - A F Giglioti
- Braile Biomédica, São José do Rio Preto, SP, Brasil
| | - R P C Araújo
- Universidade Federal da Bahia - UFBA, Instituto de Ciências da Saúde - ICS, Laboratório de Bioengenharia Tecidual e Biomateriais - LBTB, Salvador, BA, Brasil
| | - F B Miguel
- Universidade Federal da Bahia - UFBA, Instituto de Ciências da Saúde - ICS, Laboratório de Bioengenharia Tecidual e Biomateriais - LBTB, Salvador, BA, Brasil
| | - J V L Meneses
- Sociedade Brasileira de Cirurgia Plástica - SBCP, São Paulo, SP, Brasil
| | - F P Rosa
- Universidade Federal da Bahia - UFBA, Instituto de Ciências da Saúde - ICS, Laboratório de Bioengenharia Tecidual e Biomateriais - LBTB, Salvador, BA, Brasil
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Pisano C, D'Amico F, Balistreri CR, Vacirca SR, Nardi P, Altieri C, Scioli MG, Bertoldo F, Santo L, Bellisario D, Talice M, Verzicco R, Ruvolo G, Orlandi A. Biomechanical properties and histomorphometric features of aortic tissue in patients with or without bicuspid aortic valve. J Thorac Dis 2020; 12:2304-2316. [PMID: 32642135 PMCID: PMC7330388 DOI: 10.21037/jtd.2020.03.122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background We sought to investigate and compare biomechanical properties and histomorphometric findings of thoracic ascending aorta aneurysm (TAA) tissue from patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) in order to clarify mechanisms underlying differences in the clinical course. Methods Circumferential sections of TAA tissue in patients with BAV (BAV-TAA) and TAV (TAV-TAA) were obtained during surgery and used for biomechanical tests and histomorphometrical analysis. Results In BAV-TAA, we observed biomechanical higher peak stress and lower Young modulus values compared with TAV-TAA wall. The right lateral longitudinal region seemed to be the most fragile zone of the TAA wall. Mechanical stress-induced rupture of BAV-TAA tissue was sudden and uniform in all aortic wall layers, whereas a gradual and progressive aortic wall breakage was described in TAV-TAA. Histomorphometric analysis revealed higher amount of collagen but not elastin in BAV-TAA tunica media. Conclusions The higher deformability of BAV-TAA tissue supports the hypothesis that increased wall shear stress doesn’t explain the increased risk of sudden onset of rupture and dissection; other mechanisms, likely related to alteration of specific genetic pathways and epigenetic signals, could be investigated to explain differences in aortic dissection and rupture in BAV patients.
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Affiliation(s)
- Calogera Pisano
- Department of Cardiac Surgery, Tor Vergata University Hospital, Rome, Italy
| | - Federico D'Amico
- Anatomic Pathology, Department of Biomedicine and Prevention Tor Vergata University, Rome, Italy
| | - Carmela Rita Balistreri
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, Palermo, Italy
| | - Sara Rita Vacirca
- Department of Cardiac Surgery, Tor Vergata University Hospital, Rome, Italy
| | - Paolo Nardi
- Department of Cardiac Surgery, Tor Vergata University Hospital, Rome, Italy
| | - Claudia Altieri
- Department of Cardiac Surgery, Tor Vergata University Hospital, Rome, Italy
| | - Maria Giovanna Scioli
- Anatomic Pathology, Department of Biomedicine and Prevention Tor Vergata University, Rome, Italy
| | - Fabio Bertoldo
- Department of Cardiac Surgery, Tor Vergata University Hospital, Rome, Italy
| | - Loredana Santo
- Department of Industrial Engineering, Tor Vergata University, Rome, Italy
| | - Denise Bellisario
- Department of Industrial Engineering, Tor Vergata University, Rome, Italy
| | | | - Roberto Verzicco
- Department of Industrial Engineering, Tor Vergata University, Rome, Italy
| | - Giovanni Ruvolo
- Department of Cardiac Surgery, Tor Vergata University Hospital, Rome, Italy
| | - Augusto Orlandi
- Anatomic Pathology, Department of Biomedicine and Prevention Tor Vergata University, Rome, Italy.,Department of Biomedical Sciences, Catholic University Our Lady of Good Counsel, Tirana, Albania
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Comparison of round smooth and shaped micro-textured implants in terms of quality of life and aesthetic outcomes in women undergoing breast reconstruction: a single-centre prospective study. Updates Surg 2020; 72:537-546. [PMID: 32062785 DOI: 10.1007/s13304-020-00721-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 02/05/2020] [Indexed: 02/06/2023]
Abstract
Breast cancer (BC) is the most frequent cancer among women, impacting 2.1 million women each year and having caused 627,000 deaths in 2018. In Italy, BC represents the first cancer diagnosis with 53,000 new cases in 2019 and the first cause of mortality for cancer among the female population. Breast implants represent the first reconstructive choice after mastectomy: in Italy, 411,000 prostheses have been implanted since 2010 and more than 95% of them are macro-texturized. The attempt to reduce complications such as capsular contracture, rotation and rupture of the prosthesis and the most recent BIA-ALCL association with macro-texturized implants have led to the development of new materials and the refinement of implants' coating techniques. We carried out a 1-year prospective single-centre study to evaluate patient-reported quality of life (QoL) and aesthetic outcomes after breast reconstructive surgery using two different prostheses: shaped micro-textured implants and round smooth implants. We treated 62 patients with radical or conservative mastectomy followed by reconstructive surgery performed with 44 shaped implants and 48 round implants. Quality of life evaluated through the Breast-Q®-questionnaire showed high scores of psycho-social well being in both groups, as well as pre- and post-operative aesthetic satisfaction and physical well being. Round smooth implants appear to be better in terms of softness, volume and less association with rippling, whereas shaped micro-textured implants prove to be better in the profile delineation. This study confirms the potentialities of both shaped micro-textured and round smooth implants in reconstructive surgery.
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