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In SK, Park SW, Myung Y. Effect of Perioperative Prophylactic Intravenous Antibiotic Use in Immediate Implant-Based Breast Reconstruction: A Retrospective Matched Cohort Study. Arch Plast Surg 2024; 51:36-41. [PMID: 38425851 PMCID: PMC10901589 DOI: 10.1055/a-2161-7521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 08/26/2023] [Indexed: 03/02/2024] Open
Abstract
Background Among breast reconstruction methods, implant-based breast reconstruction has become the mainstream. However, periprosthetic infection is still an unresolved problem. Although published articles have revealed that limited use of antibiotics is sufficient to reduce infection rates, the number of surgeons still preferring elongated usage of antibiotics is not less. The aim of our study is to validate the appropriate duration of antibiotic use to reduce infection rate after implant-based breast reconstruction. Methods A retrospective study reviewed medical record of 235 patients (274 implants for reconstruction) who underwent prepectoral direct to implant breast reconstruction using acellular dermal matrix wrapping technique. Infection rates were analyzed for the patients administered postoperative prophylactic antibiotics until drain removal and those who received only perioperative prophylactic antibiotics for 24 hours. Results Of the 274 implants, 98 who were administered prophylactic antibiotics until drain removal had an infection rate of 3.06% (three implants) and 176 who received prophylactic antibiotics no longer than 24 hours postoperatively had an infection rate of 4.49% (eight implants). A total of 11 patients diagnosed with postoperative infection clinically, 8 were salvaged by antibiotic treatment, and 3 had implant removal and replacement with autologous flap. Postoperative antibiotic prophylaxis duration had no statistically significant effects in the risk of infection ( p = 0.549). Conclusion The duration of prophylactic antibiotics after surgery was not related to infection risk. Further study with a large number of patients, randomized control study, and route of antibiotics is needed.
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Affiliation(s)
- Seok Kyung In
- Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Republic of Korea
| | - Seok Won Park
- Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Republic of Korea
| | - Yujin Myung
- Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Republic of Korea
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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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Bassetto F, Pandis L, Facchin F, Azzena G, Vindigni V. Braxon®-assisted prepectoral breast reconstruction: A decade later. Front Surg 2022; 9:1009356. [PMID: 36420412 PMCID: PMC9677958 DOI: 10.3389/fsurg.2022.1009356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/28/2022] [Indexed: 11/09/2022] Open
Abstract
We are sitting on the cusp of the bioengineered breast era, in which implant-based breast reconstruction is seeing a growing trend and biotechnology research progressively empowers clinical practice. As never before, the choice of biomaterials has acquired great importance for achieving reconstructive outcomes, and the increase in the use of acellular dermal matrices (ADMs) in the field of senology tells us a story of profound upheaval and progress. With the advent of prepectoral breast reconstruction (PPBR), plenty of devices have been proposed to wrap the silicone prosthesis, either completely or partially. However, this has caused a great deal of confusion and dissent with regard to the adoption of feasible reconstructive strategies as well as the original scientific rationale underlying the prepectoral approach. Braxon® is the very first device that made prepectoral implant positioning possible, wrapping around the prosthesis and exerting the proven ADM regenerative potential at the implant–tissue interface, taking advantage of the body's physiological healing mechanisms. To date, the Braxon® method is among the most studied and practiced worldwide, and more than 50 publications confirm the superior performance of the device in the most varied clinical scenarios. However, a comprehensive record of the working of this pioneering device is still missing. Therefore, our aim with this review is to lay a structured knowledge of surgery with BRAXON® and to provide a decision-making tool in the field of PPBR through a complete understanding on the very first device for prepectoral, one decade after its introduction.
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Guimier E, Carson L, David B, Lambert JM, Heery E, Malcolm RK. Pharmacological Approaches for the Prevention of Breast Implant Capsular Contracture. J Surg Res 2022; 280:129-150. [PMID: 35969932 DOI: 10.1016/j.jss.2022.06.073] [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: 11/02/2021] [Revised: 06/17/2022] [Accepted: 06/29/2022] [Indexed: 11/15/2022]
Abstract
Capsular contracture is a common complication associated with breast implants following reconstructive or aesthetic surgery in which a tight or constricting scar tissue capsule forms around the implant, often distorting the breast shape and resulting in chronic pain. Capsulectomy (involving full removal of the capsule surrounding the implant) and capsulotomy (where the capsule is released and/or partly removed to create more space for the implant) are the most common surgical procedures used to treat capsular contracture. Various structural modifications of the implant device (including use of textured implants, submuscular placement of the implant, and the use of polyurethane-coated implants) and surgical strategies (including pre-operative skin washing and irrigation of the implant pocket with antibiotics) have been and/or are currently used to help reduce the incidence of capsular contracture. In this article, we review the pharmacological approaches-both commonly practiced in the clinic and experimental-reported in the scientific and clinical literature aimed at either preventing or treating capsular contracture, including (i) pre- and post-operative intravenous administration of drug substances, (ii) systemic (usually oral) administration of drugs before and after surgery, (iii) modification of the implant surface with grafted drug substances, (iv) irrigation of the implant or peri-implant tissue with drugs prior to implantation, and (v) incorporation of drugs into the implant shell or filler prior to surgery followed by drug release in situ after implantation.
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Affiliation(s)
| | - Louise Carson
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Benny David
- NuSil Technology LLC, Carpinteria, California
| | | | | | - R Karl Malcolm
- School of Pharmacy, Queen's University Belfast, Belfast, UK.
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Reducing Capsular Contracture Formation in Breast Augmentation with Silicone Implants: Experimental Study on Rats. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12084056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Silicone implants are frequently used for breast augmentation and reconstruction. However, late complication, such as capsular contracture, remain the most important side effect. In this study we compare different methods for reducing the inflammatory reaction around the silicone implant by introducing one microtextured breast implant in wistar rats. The rats were dividing in 4 groups: the first one was the control group that received untreated implant; in the second we used silicone implants impregnated with rifampin solution, the third one had implant combined with intramuscular dexamethasone injection and the last one had silicone implant associated with autologous centrifuged fat introduced in the implant pocket. The implants and the capsular tissue surrounding were removed after eight weeks. Capsule samples were submitted to histological evaluations. The present study demonstrated that fat grafting may have a role in reducing and preventing capsular contractures after breast augmentation with silicone implants by decreasing the inflammatory process.
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Quintero Sierra LA, Busato A, Zingaretti N, Conti A, Biswas R, Governa M, Vigato E, Parodi PC, Bernardi P, Sbarbati A, Conti G. Tissue-Material Integration and Biostimulation Study of Collagen Acellular Matrices. Tissue Eng Regen Med 2022; 19:477-490. [PMID: 35244884 PMCID: PMC9130448 DOI: 10.1007/s13770-021-00420-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Breast reconstruction after mastectomy using silicone implants is a surgical procedure that occasionally leads to capsular contracture formation. This phenomenon constitutes an important and persistent cause of morbidity, and no successful therapies are available to date. Recently, the use of acellular membranes as a protective material for silicone prostheses has been gaining attention due to their ability to prevent this adverse outcome. For this reason, the evaluation of the tissue-material integration and the induced biostimulation by acellular membranes results crucial. Evaluation of in vivo tissue integration and biostimulation induced by three different natural acellular collagen membranes. Methods: Scanning electron microscopy was performed to analyse the membrane porosity and cells-biomaterial interaction in vitro, both in dry and wet conditions. Adipose-derived stem cells were cultured in the presence of membranes, and the colonisation capacity and differentiation potential of cells were assessed. In vivo tests and ex vivo analyses have been performed to evaluate dermal integration, absorption degree and biostimulation induced by the evaluated membrane. Results: Analysis performed in vitro on the three different acellular dermal matrices evidenced that porosity and the morphological structure of membranes influence the liquid swelling ratio, affecting the cell mobility and the colonisation capacity. Moreover, the evaluated membranes influenced in different manner the adipose derived stem cells differentiation and their survival. In vivo investigation indicated that the absorption degree and the fluid accumulation surrounding the implant were membrane-dependent. Finally, ex vivo analysis confirmed the membrane-dependent behavior revealing different degree of tissue integration and biostimulation, such as adipogenic stimulation. Conclusion: The physico-chemical characteristics of the membranes play a key role in the biostimulation of the cellular environment inducing the development of well-organized adipose tissue.
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Affiliation(s)
| | - Alice Busato
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Strada le Grazie 8, 37134, Verona, Italy
| | - Nicola Zingaretti
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Strada le Grazie 8, 37134, Verona, Italy.,Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy
| | - Anita Conti
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Strada le Grazie 8, 37134, Verona, Italy
| | - Reetuparna Biswas
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Strada le Grazie 8, 37134, Verona, Italy
| | - Maurizio Governa
- Department of Plastic and Reconstructive Surgery, Azienda Ospedaliera Universitaria Integrata, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Enrico Vigato
- Department of Plastic and Reconstructive Surgery, Azienda Ospedaliera Universitaria Integrata, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Pier Camillo Parodi
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy
| | - Paolo Bernardi
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Strada le Grazie 8, 37134, Verona, Italy
| | - Andrea Sbarbati
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Strada le Grazie 8, 37134, Verona, Italy
| | - Giamaica Conti
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Strada le Grazie 8, 37134, Verona, Italy
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Outcome Assessment According to the Thickness and Direction of the Acellular Dermal Matrix after Implant-Based Breast Reconstruction. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8101009. [PMID: 34825003 PMCID: PMC8610697 DOI: 10.1155/2021/8101009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/11/2021] [Accepted: 11/01/2021] [Indexed: 11/21/2022]
Abstract
Purpose The acellular dermal matrix plays an important role in reinforcing thin mastectomy skin and repositioning the implant in prosthetic breast reconstruction. As the concept of prepectoral plane has become widespread, the role of the acellular dermal matrix has become increasingly important. However, evidences and standards for appropriate thickness and direction during placement remain insufficient. This study is aimed at testing the assumption that differences in the acellular dermal matrix thickness and orientation during placement may affect surgical outcomes including the incidence of postoperative complications. Methods This was a retrospective single-centered analysis of 43 patients (50 breasts) who underwent implant-based reconstruction with MegaDerm® (L&C Bio, Seoul, Korea) and 23 patients (23 breasts) who underwent implant-based reconstruction with DermACELL® (LifeNet Health, Virginia Beach, VA, USA), two types of human-derived acellular dermal matrix. All surgeries were performed by a single surgeon. Demographic variables, surgery-related factors, and complications were compared between a thick matrix group (1.5–2.3 mm) and a thin matrix group (1.0–1.5 mm). The same processes were performed in the nonreverse and reverse matrix insertion groups. Results Baseline demographics and surgery-related data were summarized according to matrix thickness and direction. There were no significant intergroup differences in the demographic variables such as history of smoking, radiation, or chemotherapy. The mean drain volume was significantly higher in the thick matrix group than that in the thin matrix group (p = 0.0445). However, there were no significant differences in overall complication rates by matrix thickness (p = 0.3139). Additionally, there were no significant differences in complications between the nonreverse and reverse matrix insertion groups (p = 0.538). Conclusion Our findings suggest that patients with a thick acellular dermal matrix need a prolonged period for engraftment. However, the thickness did not directly affect the surgical outcomes between the thick and thin matrix groups. Likewise, the orientation in which the acellular dermal matrix was inserted did not affect the surgical outcomes including postoperative complications.
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BROWSE: A multicentre comparison of nine year outcomes in acellular dermal matrix based and complete submuscular implant-based immediate breast reconstruction-aesthetics, capsular contracture and patient reported outcomes. Eur J Surg Oncol 2021; 48:73-81. [PMID: 34836730 DOI: 10.1016/j.ejso.2021.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/21/2021] [Accepted: 10/27/2021] [Indexed: 12/14/2022] Open
Abstract
Approximately 60% of implant-based breast reconstructions (IBBR) are performed with an acellular dermal matrix (ADM), for which, reliable, good quality long-term outcome data is limited. In a retrospective multicentre cohort study, we aimed to determine long-term aesthetic and quality of life outcomes of IBBR with ADM (Strattice™) compared to a submuscular technique. METHODS Capsular contracture (Baker III/IV capsule) was determined by clinical examination by an independent researcher. Quality of life was assessed using BREAST-Q and aesthetic outcome by photographic assessment from a breast surgeon, breast care nurse and lay person, blinded to reconstruction type. RESULTS We recruited 117 (51 bilateral) patients with ADM reconstructions, median follow-up 62 months (range 29-113) and 49 patients (16 bilateral) with submuscular reconstructions, median follow-up 76 months (range 38-111). 17 (10.1%) ADM reconstructions were Baker 3/4 compared to six (9.2%) submuscular (p = 0.85). Of the Baker 1/2 reconstructions six (3.6%) ADM and eight (13.6%) submuscular had previously undergone revision surgery to correct capsular contracture (p = 0.01). Combining both findings gave an estimated rate of capsular contracture of 13.6% in the ADM group and 21.2% in the submuscular (p = 0.14). A higher mean score for satisfaction with breasts was demonstrated when comparing ADM to submuscular (62 and 55, respectively; p = 0.01) but no significant difference in other BREAST-Q domains. The mean 'general satisfaction' score was higher in the ADM group for all three photograph assessors. CONCLUSION This study provides evidence of improved aesthetic outcome and reduction in capsular contracture with ADM reconstruction when compared to submuscular, consistent over long-term follow-up.
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Acellular Dermal Matrix-Associated Contracture: A Clinical and Histologic Analysis of Patients Undergoing Prosthetic Breast Reconstruction. Plast Reconstr Surg 2021; 148:968-977. [PMID: 34495907 DOI: 10.1097/prs.0000000000008485] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Capsular contracture is a well-recognized complication following prosthetic breast reconstruction. It has been the authors' observation that some patients undergoing breast reconstruction experience contracture specifically of the acellular dermal matrix placed at the time of their tissue expander insertion. The goal of the authors' study was to identify clinical and histologic findings associated with the development of acellular dermal matrix-associated contracture. METHODS The authors performed a retrospective cohort study of all patients undergoing bilateral implant-based breast reconstruction performed by the senior author (M.S.A.). Patients were excluded if they had radiation therapy to the breast. Patients with suspected acellular dermal matrix-associated contracture were identified by clinical photographs and review of operative notes. Histologic analysis was performed on specimens taken from two patients with acellular dermal matrix contracture. RESULTS The authors included a total of 46 patients (92 breasts), of which 19 breasts had suspected acellular dermal matrix-associated contracture. Acellular dermal matrix contracture was less common in direct-to-implant reconstruction (4.2 percent versus 26.5 percent; p = 0.020) and more common in breasts that had seromas (0 percent versus 15.8 percent; p = 0.001) or complications requiring early expander replacement. Contracted acellular dermal matrix had less vascularity and a lower collagen I-to-collagen III ratio, and was twice as thick as noncontracted acellular dermal matrix. CONCLUSIONS The authors have described a distinct phenomenon of acellular dermal matrix-associated contracture that occurs in a small subset of breasts where acellular dermal matrix is used. This merits further investigation. Future work will be required to better characterize the clinical factors that make acellular dermal matrix-associated contracture more likely to occur. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Comparison of the Incidence of Capsular Formation in Two-Stage, Implant-Based Breast Reconstruction Using an Insertion Funnel and Sizer. BIOMED RESEARCH INTERNATIONAL 2021; 2021:3898585. [PMID: 34337008 PMCID: PMC8286178 DOI: 10.1155/2021/3898585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/30/2021] [Indexed: 11/18/2022]
Abstract
Purpose Capsular formation around breast implants can produce various complications, including erythema, tenderness, discomfort, and breast deformation. Moreover, the capsule is thought to be correlated with breast implant-associated anaplastic large cell lymphoma. The proposed technique of capsule reduction can prevent some of these complications. Thus, the authors suggest a no-touch technique in two-stage, implant-based breast reconstruction. Patients and Methods. This single-center retrospective study evaluated the medical records and digitalized pathological slides of patients who underwent two-stage, implant-based breast reconstruction between February 2018 and May 2019. The selected patients were divided into group A and group B. Group A underwent a no-touch technique that included the following two steps: (1) using a sizer as the frame to create the submuscular and acellular dermal matrix (ADM) pocket for expander insertion and (2) inserting the expander through the funnel. After the second stage of implant insertion, the capsule was harvested for biopsy of the ADM, chest wall, and muscle. Results This study included 33 breasts (31 patients): 18 in group A and 15 in group B. The capsular thicknesses of the ADM, the chest wall, and the muscle of group A were significantly thinner than those in group B. Pearson's correlation coefficient indicated negative correlations between capsular thickness and age; underlying disease; lesion side; interval of two-stage implant insertion; size of the expander; and radiotherapy, chemotherapy, or hormone therapy. Conclusion To reduce the incidence of capsular formation following breast reconstruction using prostheses, a no-touch technique that uses a funnel and sizer to avoid implant contact is both efficient and beneficial.
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Outcome of complete acellular dermal matrix wrap with polyurethane implant in immediate prepectoral breast reconstruction. Arch Plast Surg 2020; 47:567-573. [PMID: 33238344 PMCID: PMC7700864 DOI: 10.5999/aps.2020.01207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/06/2020] [Indexed: 11/12/2022] Open
Abstract
Background Polyurethane implants have been used on and off in breast reconstruction since 1991 while prepectoral breast reconstruction has gained popularity in recent times. In this study, we present our outcomes from the use of acellular dermal matrix (ADM) complete wrap with polyurethane implants in prepectoral breast reconstruction. Methods This is a retrospective review of prospectively maintained database from 41 patients receiving complete ADM wrap with prepectoral polyurethane implants over a 3-year period. Selection criteria were adapted from a previous study (4135 Trust Clinical Audit Database) evaluating prepectoral reconstruction with Braxon matrices. Patient demographics, operative data, surgical complications, and outcomes were collected and analyzed. Results A total of 52 implant reconstructions were performed in 41 patients with a mean follow-up of 14.3 months (range, 6–36 months). The overall reported complication rates including early (less than 6 weeks) and late complications. Early complications included two patients (4.9%) with wound dehiscence. One of which had an implant loss that was salvageable. Another patient (2%) developed red-breast syndrome and two women (4.9%) developed with seroma treated conservatively. Late complications included one patient (2%) with grade II capsular contraction, 12 patients with grade I-II rippling and two patients (4.9%) with grade III rippling. Conclusions We present our experience of prepectoral polyurethane implant using complete ADM wrap. This is one of the few papers to report on the outcome of the prepectoral use of polyurethane in immediate implant-based breast reconstruction. Our early observational series show satisfactory outcome and long-term results are warranted by a large multicenter study.
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Funnel usefulness in direct-to-implant breast reconstruction using periareolar incision with prepectoral implant placement and complete coverage with acellular dermal matrix. J Plast Reconstr Aesthet Surg 2020; 73:2016-2024. [PMID: 32921621 DOI: 10.1016/j.bjps.2020.08.078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/29/2020] [Accepted: 08/01/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND The funnel has been used in esthetic breast surgery that requires a small incision. Recent advances in minimally invasive surgical techniques have led to more cases of nipple-sparing mastectomy (NSM) through periareolar incision. However, prepectoral implant placement and complete coverage with acellular dermal matrix (ADM) is almost impossible with the periareolar approach. Funnels can also be useful for direct-to-implant breast reconstruction. METHODS NSM with periareolar incision and direct-to-implant breast reconstruction were performed with prepectoral implant placement between January 2017 and July 2019. The ADM full-wrapped anatomic textured implant was inserted using a funnel without additional incisions during surgery. RESULTS A total of 21 patients were enrolled, including 2 who received bilateral breast reconstruction. All operations were successfully performed using funnels with minimal periareolar incisions. Anatomic textured implants (mean: 251.7 cc, range: 90-450 cc) wrapped in ADM can be effectively inserted in the prepectoral plane using a funnel. Two patients experienced delayed wound healing of the areola that was treated by conservative wound management. Patients also experienced less pain overall, and the cosmetic result was very good. Patient satisfaction scores were also very high. CONCLUSIONS While the periareolar incision is esthetically pleasing, additional resection is often necessary. However, the use of funnels ensured that no additional incision was needed even in large implants. This subsequently led to better results in terms of pain and scarring. Prepectoral breast reconstruction involving complete implant coverage with ADM using a funnel through the periareolar approach represents a good alternative to the traditional dual plane subpectoral method. This method provides good patient satisfaction without adverse outcomes.
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Masià J. The largest multicentre data collection on prepectoral breast reconstruction: The iBAG study. J Surg Oncol 2020; 122:848-860. [PMID: 32786089 PMCID: PMC7540676 DOI: 10.1002/jso.26073] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/08/2020] [Indexed: 12/11/2022]
Abstract
Background and Objectives In the last years, prepectoral breast reconstruction has increased its popularity, becoming a standard reconstructive technique by preserving pectoralis major anatomy and functionality. Nevertheless, the lack of solid and extensive data negatively impacts on surgeons’ correct information about postoperative complication rates and proper patient selection. This study aims to collect the largest evidence on this procedure. Methods A multicentre retrospective audit, promoted by the Barcelona Hospital, collected the experience of 30 centers on prepectoral breast reconstruction with Braxon ADM. The study had the scientific support of INPECS and IIB societies which provided the online database Clinapsis. Results A total of 1450 procedures were retrospectively collected in a 6‐year period. Mean age 52.4 years, BMI 23.9, follow‐up 22.7 months. Reconstruction was carried out after a tumor in 77.1% of the cases, 20.1% had prophylactic surgery, 2.8% had revisions. Diabetes, smoke, and immunosuppression had an influence on complications occurrence, as well as implant weight. Capsular contracture was associated with postoperative radiotherapy, but the overall rate was low (2.1%). Complications led to implant loss in 6.5% of the cases. Conclusions The international Braxon Audit Group multicentre data collection represents a milestone in the field of breast reconstruction, extensively improving the knowledge on this procedure.
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Affiliation(s)
- Jaume Masià
- Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
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Meta-analysis of prepectoral implant-based breast reconstruction: guide to patient selection and current outcomes. Breast Cancer Res Treat 2020; 182:543-554. [PMID: 32514624 DOI: 10.1007/s10549-020-05722-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This meta-analysis provides a large-scale comparison of prepectoral vs. subpectoral implant-based breast reconstruction, with primary outcomes of patient safety and efficacy. METHODS Literature review was performed via PRISMA criteria, 33 studies met inclusion criteria for prepectoral review and 13 studies met inclusion criteria for meta-analysis. Patient characteristics and per-breast complications were collected. Data were analyzed using Cochrane RevMan and IBM SPSS. RESULTS In 4692 breasts of 3014 patients that underwent prepectoral breast reconstruction, rippling was observed as the most common complication, followed by seroma and skin flap necrosis. Meta-analysis demonstrated statistically significant decrease in odds of skin flap necrosis and capsular contracture in prepectoral groups compared to subpectoral groups. Odds of infection, seroma, and hematoma were equal between the two groups. CONCLUSIONS Prepectoral breast reconstruction has surged in popularity in recent years. This review and large-scale analysis corroborates current literature reporting a favorable safety profile with emphasis on patient selection. Variability in skin flap thickness and vascularity mandates thoughtful selection of patients whose overall health and intra-operative skin flap assessment can tolerate a muscle-sparing reconstruction.
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15
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ADM-assisted prepectoral breast reconstruction and skin reduction mastectomy: Expanding the indications for subcutaneous reconstruction. J Plast Reconstr Aesthet Surg 2020; 73:673-680. [DOI: 10.1016/j.bjps.2019.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 08/07/2019] [Accepted: 11/22/2019] [Indexed: 12/12/2022]
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16
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Chandarana M, Harries S. Multicentre study of prepectoral breast reconstruction using acellular dermal matrix. BJS Open 2019; 4:71-77. [PMID: 32011819 PMCID: PMC6996627 DOI: 10.1002/bjs5.50236] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/03/2019] [Indexed: 11/30/2022] Open
Abstract
Background Single‐stage reconstruction is used widely after mastectomy. Prepectoral implant placement is a relatively new technique. This multicentre audit examined surgical outcomes following prepectoral reconstruction using acellular dermal matrix (ADM). Methods All patients who had a mastectomy with prepectoral breast reconstruction and ADM in the participating centres between January 2015 and December 2017 were included. Demographic and treatment details, and short‐ and long‐term operative outcomes were recorded. Factors affecting complications and implant loss were analysed: age, BMI, smoking status, diabetes, vascular disease, laterality of surgery, previous ipsilateral breast surgery or radiotherapy, indication for surgery (invasive versus in situ carcinoma, or risk reduction), type of mastectomy, axillary clearance, breast volume, implant volume, and neoadjuvant and adjuvant chemotherapy. Results A total of 406 reconstructions were performed across 18 centres. Median follow‐up was 9·65 months. Median hospital stay was 1 day. The 90‐day unplanned readmission rate was 15·7 per cent, and the return‐to‐theatre rate 16·7 per cent. Some 15·3 per cent of patients had a major complication, with a 90‐day implant loss rate of 4·9 per cent. A further six patients had delayed implant loss. In multivariable analysis, no factor was significantly associated with complications or implant loss. Conclusion Prepectoral breast reconstruction with ADM has satisfactory surgical outcomes. The duration of follow‐up needs to be extended to examine outcomes in patients who received adjuvant radiotherapy.
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Affiliation(s)
- M Chandarana
- Department of General Surgery, Forth Valley Royal Hospital, Larbert, UK
| | - S Harries
- Department of Breast Surgery, Warwick Hospital, South Warwickshire NHS Foundation Trust, Warwick, UK
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17
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Reitsamer R, Peintinger F, Klaassen-Federspiel F, Sir A. Prepectoral direct-to-implant breast reconstruction with complete ADM or synthetic mesh coverage – 36-Months follow-up in 200 reconstructed breasts. Breast 2019; 48:32-37. [DOI: 10.1016/j.breast.2019.08.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/21/2019] [Accepted: 08/19/2019] [Indexed: 12/18/2022] Open
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18
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Ludolph I, Gruener J, Kengelbach-Weigand A, Fiessler C, Horch R, Schmitz M. Long-term studies on the integration of acellular porcine dermis as an implant shell and the effect on capsular fibrosis around silicone implants in a rat model. J Plast Reconstr Aesthet Surg 2019; 72:1555-1563. [DOI: 10.1016/j.bjps.2019.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 03/20/2019] [Accepted: 04/23/2019] [Indexed: 01/19/2023]
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19
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Casella D, Di Taranto G, Onesti M, Greco M, Ribuffo D. A retrospective comparative analysis of risk factors and outcomes in direct-to-implant and two-stages prepectoral breast reconstruction: BMI and radiotherapy as new selection criteria of patients. Eur J Surg Oncol 2019; 45:1357-1363. [DOI: 10.1016/j.ejso.2019.02.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/24/2019] [Accepted: 02/06/2019] [Indexed: 11/30/2022] Open
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20
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Bernardini R, Varvaras D, D'Amico F, Bielli A, Scioli MG, Coniglione F, Rossi P, Buonomo OC, Petrella G, Mattei M, Orlandi A. Biological acellular pericardial mesh regulated tissue integration and remodeling in a rat model of breast prosthetic implantation. J Biomed Mater Res B Appl Biomater 2019; 108:577-590. [PMID: 31094057 DOI: 10.1002/jbm.b.34413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/15/2019] [Accepted: 04/25/2019] [Indexed: 12/29/2022]
Abstract
The use of biological meshes has proven beneficial in surgical restriction and periprosthetic capsular contracture following breast prosthetic-reconstruction. Three different types (smooth, texturized, and polyurethane) of silicone round mini prostheses were implanted under rat skin with or without two different bovine acellular pericardial biological meshes (APMs, BioRipar, and Tutomesh). One hundred eighty-six female rats were divided into 12 groups, sacrificed after 3, 6, and 24 weeks and tissue samples investigated by histology and immunohistochemistry. Implantation of both APMs, with or without prostheses, reduced capsular α-SMA expression and CD3+ inflammatory cell infiltration, increasing capillary density and cell proliferation, with some differences. In particular, Tutomesh was associated with higher peri-APM CD3+ inflammation, prosthetic capsular dermal α-SMA expression and less CD31+ vessels and cell proliferation compared with BioRipar. None differences were observed in tissue integration and remodeling following the APM + prostheses implantation; the different prostheses did not influence tissue remodeling. The aim of our study was to investigate if/how the use of different APMs, with peculiar intrinsic characteristics, may influence tissue integration. The structure of APMs critically influenced tissue remodeling after implantation. Further studies are needed to develop new APMs able to optimize tissue integration and neoangiogenesis minimizing periprosthetic inflammation and fibrosis.
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Affiliation(s)
- Roberta Bernardini
- Centro Servizi Interdipartimentale-STA, University of Rome "Tor Vergata", Rome, Italy
| | - Dimitrios Varvaras
- Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy
| | - Federico D'Amico
- Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Alessandra Bielli
- Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Maria Giovanna Scioli
- Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Filadelfo Coniglione
- Department of Clinical Science and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy.,Department of Biomedical Sciences, Catholic University Our Lady of Good Counsel, Tirana, Albania
| | - Piero Rossi
- Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy
| | - Oreste C Buonomo
- Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy
| | - Giuseppe Petrella
- Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy
| | - Maurizio Mattei
- Centro Servizi Interdipartimentale-STA, University of Rome "Tor Vergata", Rome, Italy.,Department of Biology, University of Rome "Tor Vergata", Italy
| | - Augusto Orlandi
- Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.,Department of Biomedical Sciences, Catholic University Our Lady of Good Counsel, Tirana, Albania
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21
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Vidya R, Berna G, Sbitany H, Nahabedian M, Becker H, Reitsamer R, Rancati A, Macmillan D, Cawthorn S. Prepectoral implant-based breast reconstruction: a joint consensus guide from UK, European and USA breast and plastic reconstructive surgeons. Ecancermedicalscience 2019; 13:927. [PMID: 31281424 PMCID: PMC6592711 DOI: 10.3332/ecancer.2019.927] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Indexed: 12/20/2022] Open
Abstract
Advances in implantable biologic and synthetic products over the last decade have enabled surgeons to replace traditional submuscular implant-based breast reconstruction techniques with a prepectoral or muscle-sparing technique. Prepectoral breast reconstruction is becoming increasingly popular among surgeons and patients due to the preservation of normal chest wall anatomy, with the restoration of body image with minimal morbidity. In this article, we have described a guide to prepectoral or muscle-sparing breast reconstruction with a particular emphasis on patient selection, technique and postoperative outcomes. Hence, a joint consensus guide from European and USA breast and plastic reconstructive surgeons has been agreed, and a crowd-writing method has been adopted to produce this guide.
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Affiliation(s)
- Raghavan Vidya
- Royal Wolverhampton Hospital, Wolverhampton WV10 0QP, UK
| | - Giorgio Berna
- Department of Plastic and Reconstructive Surgery, Ulss 9, General Hospital, Treviso, Italy
| | - Hani Sbitany
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Mt Sinai Medical Center, New York, NY 10029 USA
| | - Maurice Nahabedian
- VCU College of Medicine-Inova Branch, National Center for Plastic Surgery, McLean, VA 22102 USA
| | - Hilton Becker
- Voluntary Faculty Cleveland Clinic Florida Department of Plastic Surgery, Florida Atlantic University, Boca Raton, FL 33431 USA
| | - Roland Reitsamer
- University Hospital Salzburg, Breast Centre Salzburg, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Alberto Rancati
- Henry Moore Oncologic Institute, Universidad de Buenos Aires, Buenos Aires C1053, Argentina
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22
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Fredman R, Wu C, Rapolti M, Luckett D, Fine J, McGuire K, Gallagher K, Roughton M. Prepectoral Direct-to-Implant Breast Reconstruction: Early Outcomes and Analysis of Postoperative Pain. Aesthet Surg J Open Forum 2019; 1:ojz006. [PMID: 33791602 PMCID: PMC7984832 DOI: 10.1093/asjof/ojz006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Direct-to-implant (DTI) breast reconstruction provides high-quality aesthetic results in appropriate candidates. Most commonly, implants are placed in the subpectoral space which can lead to pain and breast animation. Surgical and technological advances have allowed for successful prepectoral implant placement which may eliminate these trade-offs. OBJECTIVES Here we present early outcomes from 153 reconstructions in 94 patients who underwent prepectoral DTI. We sought to determine whether these patients have less postoperative pain and narcotic use than subpectoral implant or expander placement. METHODS A retrospective review was performed for all prepectoral DTI reconstructions at our institution from 2015 to 2016. Data were collected on postoperative pain and narcotic use while in hospital. RESULTS The average follow-up time was 8.5 months (range, 3-17 months) and the overall complication rate was 27% (n = 41) with the most common complications being skin necrosis (9%, n = 13) and infection (7%, n = 11). No statistically significant difference in complications was found in patients who underwent postmastectomy radiation therapy. Patients who underwent prepectoral DTI reconstruction did not have a statistically significant difference in postoperative pain and narcotic use while in-hospital compared with other techniques. CONCLUSION Prepectoral DTI reconstruction provides good results with similar complication rates to subpectoral techniques. Prepectoral DTI eliminates the problem of breast animation. Although our series did not reach statistical significance in pain scores or requirement for postoperative narcotics, we believe that it is an important preliminary result and with larger numbers we anticipate a more definitive conclusion. LEVEL OF EVIDENCE 4
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Affiliation(s)
- Rafi Fredman
- Division of Plastic and Reconstructive Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Cindy Wu
- Division of Plastic and Reconstructive Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mihaela Rapolti
- Division of Plastic and Reconstructive Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Daniel Luckett
- Division of Plastic and Reconstructive Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jason Fine
- Division of Plastic and Reconstructive Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kandace McGuire
- Division of Plastic and Reconstructive Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kristalyn Gallagher
- Division of Plastic and Reconstructive Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Michelle Roughton
- Division of Plastic and Reconstructive Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
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23
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Gardani M, Simonacci F, De Sario G, Cattadori F, Raposio E, Palli D. Prepectoral breast reconstruction using the Braxon® porcine acellular dermal matrix: a retrospective study. EUROPEAN JOURNAL OF PLASTIC SURGERY 2018. [DOI: 10.1007/s00238-018-1455-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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24
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Abstract
Breast cancer is the most common cancer diagnosed in the UK ( Cancer Research UK, 2018 ). Breast reconstruction following mastectomy can be performed with prosthetic devices or autologous tissue. In the UK implant-based breast reconstruction following mastectomy is the most common type of breast reconstruction, estimated to account for 70% of the reconstructive caseload in the UK. Since 2001 there has been a considerable increase in the number of prosthetic reconstructions performed with the use of mesh or matrix to augment the reconstructive pocket. This article introduces the main types of mesh and matrix used in implant-based breast reconstruction, reconstructive techniques and reviews the benefits and complications associated with their use.
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Affiliation(s)
- Rachel Rolph
- Honorary Research Fellow, Department of Plastic and Reconstructive Surgery, Guys and St Thomas' NHS Foundation Trust, London SE1 7EH
| | - Jian Farhadi
- Consultant Plastic Surgeon, Department of Plastic and Reconstructive Surgery, Guys and St Thomas' NHS Foundation Trust, London
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25
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Current Approaches Including Novel Nano/Microtechniques to Reduce Silicone Implant-Induced Contracture with Adverse Immune Responses. Int J Mol Sci 2018; 19:ijms19041171. [PMID: 29649133 PMCID: PMC5979366 DOI: 10.3390/ijms19041171] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 03/28/2018] [Accepted: 04/10/2018] [Indexed: 12/29/2022] Open
Abstract
Capsular contracture, which is the pathologic development of fibrous capsules around implants, is a major complication of reconstructive and aesthetic breast surgeries. Capsular contracture can cause implant failure with breast hardening, deformity, and severe pain. The exact mechanisms underlying this complication remain unclear. In addition, anaplastic large cell lymphoma is now widely recognized as a very rare disease associated with breast implants. Foreign body reactions are an inevitable common denominator of capsular contracture. A number of studies have focused on the associated immune responses and their regulation. The present article provides an overview of the currently available techniques, including novel nano/microtechniques, to reduce silicone implant-induced contracture and associated foreign body responses.
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26
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Jafferbhoy S, Chandarana M, Houlihan M, Parmeshwar R, Narayanan S, Soumian S, Harries S, Jones L, Clarke D. Early multicentre experience of pre-pectoral implant based immediate breast reconstruction using Braxon ®. Gland Surg 2017; 6:682-688. [PMID: 29302486 DOI: 10.21037/gs.2017.07.07] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The last two decades have seen significant changes in surgical management of breast cancer. The offer of immediate breast reconstruction (IBR) following mastectomy is currently standard practice. Skin sparing and nipple sparing mastectomy with implant-based IBR have emerged as oncologically safe treatment options. Prepectoral implant placement and complete coverage of implant with acellular dermal matrix (ADM) eliminates the need to detach the muscle from underlying chest wall in contrast to the subpectoral technique. We report short-term outcomes of a multicentre study from the United Kingdom (UK) using Braxon® in women having an IBR. Methods A prospective study was conducted from December 2015 to October 2016 and included all patients from three breast units in the UK who underwent a mastectomy and an implant-based IBR using Braxon®. The demographic details, co-morbidities, operative details, immediate and delayed complications were recorded. Specific complications recorded were infection, seroma, unplanned readmission and loss of implant. A comparison was made with complications reported in the National Mastectomy and Reconstruction Audit. Results Seventy-eight IBRs were included in the analysis with a median follow-up of 9.98 months. Mean age of the cohort was 50 years with a mean body mass index of 25.7 kg/m2. Mean implant volume was 365 cc. The inpatient hospital stay was 1.48 days. About 23% of patients had a seroma, 30% had erythema requiring antibiotics and the explant rate was 10.2 percent. Bilateral reconstructions were significantly associated with implant loss and peri-operative complications on univariate analysis. Conclusions Our early experience with this novel prepectoral technique using Braxon® has shown it to be an effective technique with complication rates comparable to subpectoral IBR. The advantages of prepectoral implant-based IBR are quicker postoperative recovery and short post-operative hospital stay. Long-term studies are required to assess rippling, post-operative animation, capsular contracture and impact of radiotherapy.
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Affiliation(s)
- Sadaf Jafferbhoy
- Department of Breast Surgery, University Hospital of North Midlands, Stoke-on-Trent, UK
| | - Mihir Chandarana
- Department of Breast Surgery, University Hospital of North Midlands, Stoke-on-Trent, UK
| | - Maria Houlihan
- Department of Breast Surgery, University Hospital of North Midlands, Stoke-on-Trent, UK
| | | | - Sankaran Narayanan
- Department of Breast Surgery, University Hospital of North Midlands, Stoke-on-Trent, UK
| | - Soni Soumian
- Department of Breast Surgery, University Hospital of North Midlands, Stoke-on-Trent, UK
| | - Simon Harries
- Department of Breast Surgery, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - Lucie Jones
- Department of Breast Surgery, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - Dayalan Clarke
- Department of Breast Surgery, South Warwickshire NHS Foundation Trust, Warwick, UK
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27
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Prepectoral Implant-Based Breast Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1488. [PMID: 29062655 PMCID: PMC5640360 DOI: 10.1097/gox.0000000000001488] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/19/2017] [Indexed: 12/27/2022]
Abstract
Background: The development of acellular dermal matrices (ADMs) has facilitated single-stage implant breast reconstruction (IBR) following skin-sparing mastectomy. The conventional approach of postpectoral implant placement with lower pole ADM confers a good cosmetic result by improving lower pole projection and control, while minimizing issues of implant visibility, palpability, and rippling. This is balanced with potential disadvantages including pain, disruption of pectoral muscle function, and animation. We report the results of a prospective study of prepectoral IBR with total ADM coverage. Methods: Prepectoral IBR with total ADM coverage was performed in 106 patients (166 breasts) in our institution from 2013 to 2017. The cohort included patients undergoing immediate IBR (113 breasts) and revision of existing submuscular IBR (53 breasts). Patient demographics, surgical complications, and outcomes from a prospective database were analyzed. Results: At a mean follow-up of 485 days, patient satisfaction and cosmetic outcomes have been good, with no significant capsular contractures or animation deformity. Minor complications including delayed healing, red breast, or seroma occurred in 14 breasts (8.4%). Major complications including necrosis and implant loss occurred in 5 breasts (3 patients), with a total explantation rate of 3%. No patients required more than an overnight stay in hospital, and there were no delays to adjuvant treatment in therapeutic cases. Conclusion: Prepectoral implant placement with ADM cover is emerging as an alternative approach for IBR. This method facilitates breast reconstruction with a good cosmetic outcome for patients who want a quick recovery without potential compromise of pectoral muscle function and associated problems.
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Vidya R, Masià J, Cawthorn S, Berna G, Bozza F, Gardetto A, Kolacinska A, Dell'Antonia F, Tiengo C, Bassetto F, Caputo GG, Governa M. Reply to Rana Nadeem's Letter to the Editor. Breast J 2017; 24:225-226. [PMID: 28741889 DOI: 10.1111/tbj.12882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 06/13/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Raghavan Vidya
- Breast Care Center, Royal Wolverhampton Hospital, Wolverhampton, UK
| | - Jaume Masià
- Plastic and Reconstructive Surgery Department, Hospital de la Santa Creu i Sant Pau (Universitat Autònoma de Barcelona), Barcelona, Spain
| | - Simon Cawthorn
- Breast Care Center, North Bristol NHS Trust, Bristol, UK
| | - Giorgio Berna
- Plastic and Reconstructive Surgery Department, Ulss 9 General Hospital, Treviso, Italy
| | - Fernando Bozza
- Breast Care Center, Venetian Oncology Institute, Padova, Italy
| | - Alexander Gardetto
- Plastic and Reconstructive Surgery Department, South Tyrol Healthcare Company, Brixen, Italy
| | - Agnieszka Kolacinska
- Cancer Center Copernicus Memorial Hospital, Medical University of Lodz, Lodz, Poland
| | | | - Cesare Tiengo
- Plastic and Reconstructive Surgery Department, University Hospital of Padua, Padua, Italy
| | - Franco Bassetto
- Plastic and Reconstructive Surgery Department, University Hospital of Padua, Padua, Italy
| | - Glenda G Caputo
- Plastic and Reconstructive Surgery, Surgery and Odontology Department, University Hospital of Verona, Verona, Italy
| | - Maurizio Governa
- Plastic and Reconstructive Surgery, Surgery and Odontology Department, University Hospital of Verona, Verona, Italy
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29
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A Guide to Prepectoral Breast Reconstruction: A New Dimension to Implant-based Breast Reconstruction. Clin Breast Cancer 2017; 17:266-271. [DOI: 10.1016/j.clbc.2016.11.009] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 11/08/2016] [Indexed: 11/24/2022]
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30
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Vidya R, Masià J, Cawthorn S, Berna G, Bozza F, Gardetto A, Kołacińska A, Dell'Antonia F, Tiengo C, Bassetto F, Caputo GG, Governa M. Evaluation of the effectiveness of the prepectoral breast reconstruction with Braxon dermal matrix: First multicenter European report on 100 cases. Breast J 2017; 23:670-676. [DOI: 10.1111/tbj.12810] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/09/2016] [Accepted: 08/17/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Raghavan Vidya
- Breast Care Center; Royal Wolverhampton Hospital; Wolverhampton UK
| | - Jaume Masià
- Plastic and Reconstructive Surgery Department; Hospital de la Santa Creu i Sant Pau (Universitat Autònoma de Barcelona); Barcelona Spain
| | | | - Giorgio Berna
- Plastic and Reconstructive Surgery Department; Ulss 9 General Hospital; Treviso Italy
| | - Fernando Bozza
- Breast Care Center; Venetian Oncology Institute; Padova Italy
| | - Alexander Gardetto
- Plastic and Reconstructive Surgery Department; South Tyrol Healthcare Company; Brixen Italy
| | - Agnieszka Kołacińska
- Department of Surgical Oncology and Head and Neck Cancer Surgery, Medical University of Lodz; Cancer Center Copernicus Memorial Hospital; Medical University of Lodz; Lodz Poland
| | | | - Cesare Tiengo
- Plastic and Reconstructive Surgery Department; University Hospital of Padua; Padua Italy
| | - Franco Bassetto
- Plastic and Reconstructive Surgery Department; University Hospital of Padua; Padua Italy
| | - Glenda G. Caputo
- Plastic and Reconstructive Surgery; Surgery and Odontology Department; University Hospital of Verona; Verona Italy
| | - Maurizio Governa
- Plastic and Reconstructive Surgery; Surgery and Odontology Department; University Hospital of Verona; Verona Italy
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31
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Long term follow-up on prepectoral ADM-assisted breast reconstruction: evidences after 4 years. EUROPEAN JOURNAL OF PLASTIC SURGERY 2017. [DOI: 10.1007/s00238-017-1285-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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32
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Assessment and planning for oncoplastic and reconstructive breast surgery: a review and a proposed chart. EUROPEAN JOURNAL OF PLASTIC SURGERY 2016. [DOI: 10.1007/s00238-016-1221-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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33
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Comparison of Histological Characteristics of Acellular Dermal Matrix Capsules to Surrounding Breast Capsules in Acellular Dermal Matrix–Assisted Breast Reconstruction. Ann Plast Surg 2016; 76:485-8. [DOI: 10.1097/sap.0000000000000368] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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34
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Capsular Contracture after Breast Augmentation: An Update for Clinical Practice. Arch Plast Surg 2015; 42:532-43. [PMID: 26430623 PMCID: PMC4579163 DOI: 10.5999/aps.2015.42.5.532] [Citation(s) in RCA: 199] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 04/09/2015] [Accepted: 04/13/2015] [Indexed: 01/17/2023] Open
Abstract
Capsular contracture is the most common complication following implant based breast surgery and is one of the most common reasons for reoperation. Therefore, it is important to try and understand why this happens, and what can be done to reduce its incidence. A literature search using the MEDLINE database was conducted including search terms 'capsular contracture breast augmentation', 'capsular contracture pathogenesis', 'capsular contracture incidence', and 'capsular contracture management', which yielded 82 results which met inclusion criteria. Capsular contracture is caused by an excessive fibrotic reaction to a foreign body (the implant) and has an overall incidence of 10.6%. Risk factors that were identified included the use of smooth (vs. textured) implants, a subglandular (vs. submuscular) placement, use of a silicone (vs. saline) filled implant and previous radiotherapy to the breast. The standard management of capsular contracture is surgical via a capsulectomy or capsulotomy. Medical treatment using the off-label leukotriene receptor antagonist Zafirlukast has been reported to reduce severity and help prevent capsular contracture from forming, as has the use of acellular dermal matrices, botox and neopocket formation. However, nearly all therapeutic approaches are associated with a significant rate of recurrence. Capsular contracture is a multifactorial fibrotic process the precise cause of which is still unknown. The incidence of contracture developing is lower with the use of textured implants, submuscular placement and the use of polyurethane coated implants. Symptomatic capsular contracture is usually managed surgically, however recent research has focussed on preventing capsular contracture from occurring, or treating it with autologous fat transfer.
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M D, J A, A S, A G, T R, B G, J S. Patient-Report Satisfaction and Health-Related Quality of Life in TiLOOP® Bra-Assisted or Implant-Based Breast Reconstruction Alone. Aesthetic Plast Surg 2015; 39:523-33. [PMID: 26085227 DOI: 10.1007/s00266-015-0520-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 06/10/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Implant-based breast reconstructions (IBBR) using alternatives to acellular dermal matrixes are increasing. Data on complications are limited, and information concerning health-related quality of life (HR-QoL) following the use of these synthetic meshes do not exist. METHODS Between January 2006 and January 2013, patients undergoing immediate or delayed-immediate IBBR with or without titanium covered polypropylene mesh (TiLOOP® Bra) were investigated. HR-QoL was assessed using the validated self-reporting BREAST-Q questionnaire. Patient demographics and complications were evaluated retrospectively. Stepwise regression backward elimination analysis was performed to identify influential factors on each BREAST-Q domain. RESULTS Of the 90 women, 42 had IBBR alone and 48 in combination with TiLOOP® Bra. The mean follow-up was 18 months in the TiLOOP® Bra and 17.5 months in the implant alone group (p = 0.827). The overall complication rate was 21.1 %, with 14.6 % in the TiLOOP® Bra and in 28.6 % in the implant alone group (p = 0.105). Capsular contraction rate was 4.4 % in the TiLOOP® Bra and 16.7 % in the implant alone group (p = 0.052). The analysis of the HR-QoL showed no significant differences between the groups. Surgeries prior to IBBR had a positive influence on HR-QoL. TiLOOP® Bra was associated with a negative effect on "satisfaction with breast" (β = -5.72; p < 0.001), as it was no longer observed for "satisfaction with outcome" and other domains.
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Reitsamer R, Peintinger F. Prepectoral implant placement and complete coverage with porcine acellular dermal matrix: A new technique for direct-to-implant breast reconstruction after nipple-sparing mastectomy. J Plast Reconstr Aesthet Surg 2015; 68:162-7. [DOI: 10.1016/j.bjps.2014.10.012] [Citation(s) in RCA: 147] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 06/30/2014] [Accepted: 10/05/2014] [Indexed: 11/29/2022]
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Berna G, Cawthorn SJ, Papaccio G, Balestrieri N. Evaluation of a novel breast reconstruction technique using the Braxon®
acellular dermal matrix: a new muscle-sparing breast reconstruction. ANZ J Surg 2014; 87:493-498. [DOI: 10.1111/ans.12849] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Giorgio Berna
- Department of Plastic and Reconstructive Surgery; Ulss 9 General Hospital; Treviso Italy
| | | | - Guido Papaccio
- Breast Care Center; Ulss 12 General Hospital; Mestre Italy
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Casella D, Bernini M, Bencini L, Roselli J, Lacaria MT, Martellucci J, Banfi R, Calabrese C, Orzalesi L. TiLoop® Bra mesh used for immediate breast reconstruction: comparison of retropectoral and subcutaneous implant placement in a prospective single-institution series. EUROPEAN JOURNAL OF PLASTIC SURGERY 2014; 37:599-604. [PMID: 25339795 PMCID: PMC4197328 DOI: 10.1007/s00238-014-1001-1] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 07/20/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Immediate implant reconstruction after a conservative mastectomy is an attractive option made easier by prosthetic devices. Titanized polypropylene meshes are used as a hammock to cover the lower lateral implant pole. We conducted a prospective nonrandomized single-institution study of reconstructions using titanium-coated meshes either in a standard muscular mesh pocket or in a complete subcutaneous approach. The complete subcutaneous approach means to wrap an implant with titanized mesh in order to position the implant subcutaneously and spare muscles. METHODS Between November 2011 and January 2014, we performed immediate implant breast reconstructions after conservative mastectomies using TiLoop® Bra, either with the standard retropectoral or with a prepectoral approach. Selection criteria included only women with normal Body Mass Index (BMI), no large and very ptotic breasts, no history of smoking, no diabetes, and no previous radiotherapy. We analyzed short-term outcomes of such procedures and compared the outcomes to evaluate implant losses and surgical complications. RESULTS A total of 73 mastectomies were performed. Group 1 comprised 29 women, 5 bilateral procedures, 34 reconstructions, using the standard muscular mesh pocket. Group 2 comprised 34 women, 5 bilateral procedures, 39 reconstructions with the prepectoral subcutaneous technique. Baseline and oncologic characteristics were homogeneous between the two groups. After a median follow-up period of 13 and 12 months, respectively, no implant losses were recorded in group 1, and one implant loss was recorded in group 2. We registered three surgical complications in group 1 and two surgical complications in group 2. CONCLUSIONS Titanium-coated polypropylene meshes, as a tool for immediate definitive implant breast reconstruction, resulted as safe and effective in a short-term analysis, both for a retropectoral and a totally subcutaneous implant placement. Long-term results are forthcoming. A strict selection is mandatory to achieve optimal results. Level of Evidence: Level II, therapeutic study.
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Affiliation(s)
- Donato Casella
- Breast Unit Surgery, Oncology Department, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy
| | - Marco Bernini
- Breast Unit Surgery, Oncology Department, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy
| | - Lapo Bencini
- Surgical Oncology, Oncology Department, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy
| | - Jenny Roselli
- Breast Unit Surgery, Oncology Department, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy
| | - Maria Teresa Lacaria
- Breast Unit Surgery, Oncology Department, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy
| | - Jacopo Martellucci
- General Surgery, Emergency Department, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy
| | - Roberto Banfi
- Drugs and Devices Service, Pharmacy Department, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy
| | - Claudio Calabrese
- Breast Unit Surgery, Oncology Department, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy
| | - Lorenzo Orzalesi
- Breast Unit Surgery, Oncology Department, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy
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Xiong Q, Lin H, Hua X, Liu L, Sun P, Zhao Z, Shen X, Cui D, Xu M, Chen F, Geng H. A nanomedicine approach to effectively inhibit contracture during bladder acellular matrix allograft-induced bladder regeneration by sustained delivery of vascular endothelial growth factor. Tissue Eng Part A 2014; 21:45-52. [PMID: 24947133 DOI: 10.1089/ten.tea.2013.0671] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Macroscopic evidence of contracture has been identified as a major issue during the regeneration process. We hypothesize that lack of angiogenesis is the primary cause of contracture and explore a nanomedicine approach to achieve sustained release of vascular endothelial growth factor (VEGF) to stimulate angiogenesis. We evaluate the efficacy of poly(lactic-co-glycolic acid) (PLGA) nanoparticles (NPs) for long-term (3 months) sustained release of VEGF in bladder acellular matrix allografts (BAMA) in a swine model. We anticipate that the sustained release of VEGF could stimulate angiogenesis along the regeneration process and thereby inhibit contracture. Bladder was replaced with BAMA (5×5 cm), modified with PLGA NPs encapsulated with VEGF in a pig model. The time points chosen for sampling were 1, 2, 4, and 12 weeks. The regenerated areas were then measured to obtain the contracture rate, and the extent of revascularization was calculated using histological and morphological features. In the control group of animals, the bladder was replaced with only BAMA. The in vivo release of VEGF was evident for ∼3 months, achieving the goal of long-acting sustained release, and successfully promoted the regeneration of blood vessels and smooth muscle fibers. In addition, less collagen deposition was observed in the experimental group compared with control. Most importantly, the inhibition of contracture was highly significant, and the ultimate contracture rate decreased by ∼57% in the experimental group compared with control. In isolated strips analysis, there were no significant differences between BAMA-regenerated (either VEGF added or not) and autogenous bladder. BAMA modified with VEGF-loaded PLGA-NPs can sustainably release VEGF in vivo (>3 months) to stimulate angiogenesis leading to the inhibition of contracture. This is the first study to report a viable nanomedicine-based strategy to overcome contracture during bladder regeneration induced by BAMA. Furthermore, this study also confirms that insufficient angiogenesis plays a crucial role in the onset of contracture.
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Affiliation(s)
- Qianwei Xiong
- 1 Department of Pediatric Urology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, People's Republic of China
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