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Tellarini A, Bascialla E, Paganini F, Fasoli V, Buttarelli F, Marra EP, Tamborini F, Corno M, Di Giovanna D, Baraziol R, Flocchini M, Curic LM, Tuttolomondo A, Calabrese S, Valdatta L. Breast reconstruction with TiLOOP® Bra: Another arrow in plastic surgeons' quiver? J Plast Reconstr Aesthet Surg 2024; 97:89-114. [PMID: 39151289 DOI: 10.1016/j.bjps.2024.07.060] [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: 12/30/2023] [Revised: 06/25/2024] [Accepted: 07/22/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND The use of lower-pole sling products has made immediate breast reconstruction a feasible option in women undergoing skin-nipple sparing and skin-reducing mastectomies. To date, available data on the comparative efficacy of biological and synthetic meshes regarding postoperative complications are scattered and limited. METHODS A systematic literature search was performed to screen three different databases (PubMed, Web of Sciences, and Embase) using the following keywords: "breast reconstruction" AND "TiLOOP®" OR "Titanium-Coated Polypropylene Mesh" OR "TCPM". The perioperative and demographic characteristics of patients, complications profiles, and patient-reported outcomes were considered. RESULTS We initially identified 234 articles, of which only 41, including 3923 patients and 5042 reconstructed breasts, fully satisfied the inclusion criteria. CONCLUSION TiLOOP® Bra could be considered a safe and aesthetically valid alternative to Acellular Dermal Matrices (ADMs) in non-smokers patients undergoing skin-nipple sparing and skin-reducing mastectomies and immediate reconstruction. In such populations, complications are more likely to develop in patients with extreme body mass index values. The incidence of seroma with TiLOOP® Bra is comparable to that of ADMs as it is the beneficial effect in radiated patients, where TiLOOP® Bra seems superior to implant alone reconstruction. It has a good bio-integration with host tissues and resistance to infections in patients with a weakened immune system as a consequence of oncologic perioperative treatments.
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Affiliation(s)
- Annachiara Tellarini
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
| | - Elisa Bascialla
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Ferruccio Paganini
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Veronica Fasoli
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Francesco Buttarelli
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Eduardo Paolo Marra
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Federico Tamborini
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Microsurgery and Hand Surgery Unit, ASST Settelaghi Varese, Varese, Italy
| | - Martina Corno
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Danilo Di Giovanna
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Roberto Baraziol
- Department of Plastic Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Maria Flocchini
- Department of Plastic Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Laura Maria Curic
- Department of Plastic Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
| | | | - Sarah Calabrese
- Department of Plastic Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Luigi Valdatta
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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Razdan S, Ahmed GA, Vishwakarma G, Baban C, Tenovici A. Surgical and Patient-Reported Outcomes After Mastectomy and Implant-Based Prepectoral Reconstruction Using TIGR® Synthetic Mesh. Cureus 2024; 16:e61052. [PMID: 38915972 PMCID: PMC11195315 DOI: 10.7759/cureus.61052] [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] [Accepted: 05/21/2024] [Indexed: 06/26/2024] Open
Abstract
Background Single-stage direct-to-implant (DTI) breast reconstruction after mastectomy has gained popularity over the last decade, thanks to the wide use of biological matrices and synthetic meshes. Despite their high cost, there is no evidence of superior outcome from the biological matrices compared to the synthetic meshes. In this study, we aimed to evaluate our experience with TIGR, a synthetic, long-term absorbable mesh, in mastectomy and immediate breast reconstruction (MIBR) with a focus on patient-reported outcomes (PROMs). Methods This was a single-trust prospective quality improvement study conducted between 2017 and 2019. The main objectives were complication rates including infection, implant loss, and other surgical complications in patients undergoing TIGR mesh-assisted MIBR in the prepectoral plane for either cancer or risk reduction. PROMs were measured using the validated European Organisation for Research and Treatment of Cancer (EORTC) breast questionnaire module. Clinical evaluations were conducted at one week, three weeks, and 12 months postoperatively. All patients provided written consent, and the audit was registered with the Quality Improvement Department of the organization. Results One hundred and twelve meshes were used in 93 patients with a mean age of 49 (24-75) years and a body mass index (BMI) of 23.4 (19.1-29.6). During the follow-up period, complications occurred in 26 patients (28%), including infection in four (4.3%), complete skin flap necrosis in one (1%), partial flap necrosis in three (3.2%), and implant loss in four (4.3%) patients. PROM data from 41 individuals indicated a moderate overall quality of life (82.7%), with high functional domain scores with relatively lower emotional functioning scores. Symptom domains generally scored poorly except for body image and sexual functioning. Conclusion Mastectomy and immediate prepectoral breast reconstruction using TIGR mesh is safe with low major complication rates. It is associated with high functional and quality of life scores but low scores in symptom domains which could be multifactorial. However, limitations due to study type and follow-up duration suggest caution in generalizing findings.
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Affiliation(s)
- Shiveta Razdan
- Breast Surgery, Amrita Institute of Medical Science and Research, Faridabad, IND
- Breast Surgery, Frimley Health NHS Foundation Trust, Surrey, GBR
| | - Goran A Ahmed
- Breast Surgery, Frimley Health NHS Foundation Trust, Surrey, GBR
| | | | - Chwanrow Baban
- Breast Surgery, University Hospital Limerick, Limerick, IRL
- Breast Surgery, Frimley Health NHS Foundation Trust, Surrey, GBR
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Lin W, Chen J, Tan Q. [Renaissance of prepectoral implant-based breast reconstruction: theoretical basis and research status]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2023; 37:233-239. [PMID: 36796822 DOI: 10.7507/1002-1892.202210100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Objective To overview the theoretical basis and research status of prepectoral implant-based breast reconstruction. Methods The domestic and foreign researches on the application of prepectoral implant-based breast reconstruction in breast reconstruction were retrospectively analyzed. The theoretical basis, clinical advantages, and limitations of this technique were summarized and the future development trend in this field was discussed. Results The recent advances in breast cancer oncology, the development of materials and the concept of oncology reconstruction have provided a theoretical basis for prepectoral implant-based breast reconstruction. The selection of patients and the experience of surgeons are crucial for postoperative outcomes. Ideal thickness and blood flow of flaps are the most important considerations for the selection of prepectoral implant-based breast reconstruction. However, its long-term reconstruction outcomes and clinical benefits and risks in Asian populations still need to be confirmed by more studies. Conclusion Prepectoral implant-based breast reconstruction has a broad application prospect in breast reconstruction following mastectomy. However, the evidence is limited at present. Randomized study with long-term follow-up is urgently in need to provide sufficient evidence to evaluate the safety and reliability of prepectoral implant-based breast reconstruction.
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Affiliation(s)
- Weiyi Lin
- Department of Breast Surgery, Clinical Center for Breast, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China
| | - Jie Chen
- Department of Breast Surgery, Clinical Center for Breast, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China
| | - Qiuwen Tan
- Department of Breast Surgery, Clinical Center for Breast, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China
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Mastopexy: with or without Acellular Dermal Matrix? PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e3952. [PMID: 35506020 PMCID: PMC9049028 DOI: 10.1097/gox.0000000000003952] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 09/28/2021] [Indexed: 11/26/2022]
Abstract
In the years after unilateral breast reconstruction, the reconstructed breast resists ptosis more than natural breast tissue in the native contralateral breast. As acellular dermal matrix (ADM) becomes fully incorporated into the recipient's anatomy, thus reinforcing the inferior pole of the uplifted breast, we combined our mastopexy cases with ADM in an attempt to reduce the rate of recurrent ptosis. Method This was a prospective randomized analysis of a cohort of 24 patients, divided into two groups (A and B); all underwent primary unilateral mastopexy to correct grade III breast ptosis. Our patients had previously undergone contralateral skin sparing mastectomy with immediate breast reconstruction, for invasive breast cancer or ductal carcinoma in situ that originally was symmetrical to their native breast. The symmetrization mastopexy in half of our patients was carried out with the addition of an ADM sling to the inferior pole of the breast, to act as an internal, subcutaneous supportive "bra" (A). The other half of patients received a standard symmetrization mastopexy, without the addition of an ADM support (B). Patients were followed up for 36 months. Results The difference between control arm and study groups revealed a statistical difference (P < 0.05), when comparing the follow-up period. From the sixth postoperative month onward, the measurements for group A revealed a statistically significant difference (P < 0.05) when compared with group B. Conclusion The additional ADM sling acts as an added layer of support, thus delaying reoccurrence of ptosis following mastopexy.
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Beier L, Faridi A, Neumann C, Paepke S, Mau C, Keller M, Strittmatter HJ, Gerber-Schäfer C, Bauer L, Karsten MM, Kümmel S, Blohmer JU. Human Acellular Dermal Matrix (Epiflex®) in Immediate Implant-Based Breast Reconstruction after Skin- and Nipple-Sparing Mastectomy and Treatment of Capsular Fibrosis: Results of a Multicenter, Prospective, Observational NOGGO-AWOGyn Study. Breast Care (Basel) 2021; 16:461-467. [PMID: 34720805 DOI: 10.1159/000512201] [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: 01/06/2020] [Accepted: 09/24/2020] [Indexed: 11/19/2022] Open
Abstract
Background Over the last decades, the number of acellular dermal matrix (ADM)-assisted implant-based breast reconstructions (IBBR) has substantially increased. However, there is still a lack of prospective data on complication rates. Methods We performed a non-interventional, multicenter, prospective cohort study to evaluate complication rates of a human ADM in patients undergoing an IBBR after skin- and nipple-sparing mastectomies. Patients with primary reconstruction (cohort A) and patients undergoing a secondary reconstruction after capsular fibrosis (cohort B) using the human ADM Epiflex® (DIZG gGmbH, Berlin, Germany) were enrolled in this study. Patients were followed-up for 12 months after surgery. Results Eighty-four eligible patients were included in this study of whom 28 women underwent a bilateral breast reconstruction, leading to 112 human ADM-assisted reconstructions in total (cohort A: 73, cohort B: 39). In 33.0% of the reconstructed breasts at least one of the complications of primary interest occurred, including implant loss 7.1%, seroma 15.2%; infection 5.4%, rash 8.0%, and Baker grade III/IV capsular fibrosis 2.7%, with no statistically significant differences between the cohorts. Previous radiation therapy was significantly associated with occurrence of any postoperative complication (OR 20.41; p value 0.027). Conclusion The rates of most complications were comparable to the rates reported for other ADMs with relatively low rates of capsular fibrosis and infections. The rate of seroma was increased in our study. Prior radiation therapy increased the risk of any postoperative complications. Therefore, the use of ADM in these patients should be considered carefully.
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Affiliation(s)
- Lea Beier
- Gynecology and Breast Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V., Berlin, Germany
| | - Andree Faridi
- Senology and Breast Center, University Hospital Bonn, Bonn, Germany
| | - Corina Neumann
- Breast Center, St. Franziskus Hospital, Münster, Germany
| | - Stefan Paepke
- Comprehensive Cancer Center, Brustzentrum der Technischen Universität München Klinikum Rechts der Isar, Munich, Germany
| | - Christine Mau
- Gynecology, Breast Center, HELIOS Hospital Berlin-Buch, Berlin, Germany
| | - Maren Keller
- Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V., Berlin, Germany
| | | | | | - Lelia Bauer
- Gynecology, GRN Hospital Weinheim, Weinheim, Germany
| | | | - Sherko Kümmel
- Breast Unit, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Essen, Germany
| | - Jens-Uwe Blohmer
- Gynecology and Breast Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Blohmer JU, Beier L, Faridi A, Ankel C, Krause-Bergmann B, Paepke S, Mau C, Keller M, Strittmatter HJ, Karsten MM. Patient-Reported Outcomes and Aesthetic Results after Immediate Breast Reconstruction Using Human Acellular Dermal Matrices: Results of a Multicenter, Prospective, Observational NOGGO-AWOGyn Study. Breast Care (Basel) 2021; 16:335-342. [PMID: 34594165 PMCID: PMC8436721 DOI: 10.1159/000509568] [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: 02/18/2020] [Accepted: 06/15/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND With the increased use of acellular dermal matrices (ADMs) in implant-based breast reconstructions (IBBRs), the evaluation of patient-reported outcomes becomes more important. METHODS Patients who underwent an immediate human ADM-assisted, submuscular IBBR were included in this noninterventional, multicenter, prospective cohort study. Patients with primary reconstruction (cohort A) and patients with a revision surgery after capsular fibrosis (cohort B) were followed up for 12 months after surgery. Quality of life (EORTC BR-23) and patient and surgeon satisfaction scores (1 ["very satisfied"] to 6 ["not satisfied"]) with the outcome and the aesthetic result evaluated by 2 independent, external experts were assessed. RESULTS Eighty-four patients were enrolled in the study. The mean patient satisfaction score was 2.1 ± 0.8, with higher satisfaction in cohort B (p = 0.041). The score did not change significantly during the follow-up (p = 0.479). The mean satisfaction score of the surgeons was 2.0 ± 0.7; it was also higher in cohort B (p = 0.016) and showed no changes over time (p = 0.473). The mean aesthetic result was 2.2 ± 0.7. 92.9% of the patients completed at least 1 quality of life questionnaire. Body image and sexual functioning increased during follow-up. One year after surgery, the mean scores were 77.2 ± 22.5 and 44.7 ± 27.3, respectively. CONCLUSION The level of satisfaction among patients and surgeons and the score of the aesthetic result were constantly high among patients after ADM-assisted IBBR. Higher satisfaction scores could be observed after revision surgery caused by capsular fibrosis (cohort B) compared to primary reconstruction (cohort A). Quality of life increased during the first year after surgery.
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Affiliation(s)
- Jens-Uwe Blohmer
- Gynecology and Breast Center, Charité − Universitätsmedizin Berlin, Berlin, Germany
- AWOGyn, Berlin, Germany
- Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V., Berlin, Germany
| | - Lea Beier
- Gynecology and Breast Center, Charité − Universitätsmedizin Berlin, Berlin, Germany
- Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V., Berlin, Germany
| | - Andree Faridi
- AWOGyn, Berlin, Germany
- Senology and Breast Center, University Hospital Bonn, Bonn, Germany
| | | | | | - Stefan Paepke
- AWOGyn, Berlin, Germany
- Brustzentrum der Technischen Universität München Klinikum Rechts der Isar Comprehensive Cancer Center, Munich, Germany
- Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V., Berlin, Germany
| | - Christine Mau
- Breast Center, Department of Gynecology, HELIOS Hospital Berlin-Buch, Berlin, Germany
- Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V., Berlin, Germany
| | - Maren Keller
- Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V., Berlin, Germany
| | - Hans Joachim Strittmatter
- AWOGyn, Berlin, Germany
- Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V., Berlin, Germany
- Department of Gynecology, Rems-Murr-Hospital Winnenden, Winnenden, Germany
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Mlodinow AS, Yerneni K, Hasse ME, Cruikshank T, Kuzycz MJ, Ellis MF. Evaluation of a Novel Absorbable Mesh in a Porcine Model of Abdominal Wall Repair. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3529. [PMID: 34881139 PMCID: PMC8647887 DOI: 10.1097/gox.0000000000003529] [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: 11/09/2020] [Accepted: 02/14/2021] [Indexed: 11/26/2022]
Abstract
Bioabsorbable meshes have seen increasing clinical use to reinforce soft tissue, and exist on a spectrum of strength loss versus absorption: several retain their strength for months, but remain in situ for years. Others lose strength fully by 6 weeks. An intermediate profile, with some strength for 3 -4 months, but consistent absorption in less than a year, may be an optimal balance of near-term support and long-term safety. In this large animal study, we evaluate such a mesh (DuraSorb, SIA), assessing its utility in a porcine model of abdominal wall repair. METHODS Two full-thickness defects were created in the abdominal walls of nine Yucatan swine via midline approach and repaired preperitoneally with either DuraSorb or long-lasting control mesh (TIGR, Novus Scientific). At 30 days, 3 months, and 1 year, the implantations were assessed by clinical pathology, post-necropsy histopathology, and burst strength testing. RESULTS No device-associated complications were found in vivo, at necropsy, or histologically. DuraSorb was well-integrated and vascularized by 30 days. DuraSorb demonstrated minimal/mild inflammation and fibroplasia, and lower inflammatory scores when compared with TIGR at all time points (P < 0.05). Burst strength of the repair sites was higher than adjacent abdominal wall at all time points (P < 0.05). CONCLUSIONS DuraSorb provided durable long-term support, minimal inflammation, and consistent absorption in this porcine model of abdominal wall repair, as compared to a long-term control. Clinical data is needed, but these results suggest that this mesh provides adequate structural support while potentially reducing long-term device reactions.
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Affiliation(s)
- Alexei S. Mlodinow
- From the Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
- Surgical Innovation Associates, Inc., Chicago, Ill
| | - Ketan Yerneni
- From the Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
- Surgical Innovation Associates, Inc., Chicago, Ill
| | | | | | | | - Marco F. Ellis
- From the Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill
- Department of Surgery, University of Illinois Chicago, Chicago, Ill
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Gao P, Wang Z, Kong X, Wang X, Fang Y, Wang J. Comparisons of Therapeutic and Aesthetic Effects of One-Stage Implant-Based Breast Reconstruction with and without Biological Matrix. Cancer Manag Res 2020; 12:13381-13392. [PMID: 33402848 PMCID: PMC7778507 DOI: 10.2147/cmar.s282442] [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] [Received: 09/19/2020] [Accepted: 12/02/2020] [Indexed: 11/24/2022] Open
Abstract
Background Biological matrix can provide coverage of compromised muscle and augment the subpectoral pocket in the one-stage reconstruction. However, few studies compared one stage implant-based breast reconstruction with and without biological matrix. The primary endpoint of our study was to assess the patient-reported outcomes (PROs) based on BREAST-Q version 2.0 and analyze complications between SIS matrix-assisted implant-based breast reconstruction (IBBR) and no-matrix-assisted IBBR. Methods This retrospective single-center study was conducted from May 2015 to April 2019, and we analyzed 155 patients who underwent one-stage IBBR with at least 1 year of follow-up. Seventy-nine patients underwent one-stage IBBR with SIS matrix group and 76 patients underwent one-stage IBBR without SIS matrix group were evaluated of PROs with BREAST-Q version 2.0 (from 3 different domains) and compared with complications. Complications occurred in patients were divided into major complications and minor complications. Results In the satisfaction domain, the mean score for satisfaction with breasts was 60.27 (17.71) in the SIS matrix group and 54.49 (14.76) in the no-matrix group, p=0.045. The multivariate logistic regression for postoperative complications in the whole series pointed out a statistical significance for age>40 years old (odds ratio 3.314, 95% CI 1.012–10.854, p=0.048) and patients with endocrine therapy (odds ratio 0.260, 95% CI 0.092–0.736, p=0.011). Conclusion Patients who underwent SIS matrix-assisted one-stage IBBR yield better results in PROs of satisfaction with breasts. Other domains and complications between the two groups had no significant difference.
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Affiliation(s)
- Peng Gao
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China
| | - Zhongzhao Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China
| | - Xiangyi Kong
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China
| | - Xiangyu Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China
| | - Yi Fang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China
| | - Jing Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, People's Republic of China
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Thill M, Faridi A, Meiré A, Gerber-Schäfer C, Baumann K, Blohmer JU, Mau C, Tofall S, Nolte E, Strittmatter HJ, Ohlinger R, Paepke S. Patient reported outcome and cosmetic evaluation following implant-based breast-reconstruction with a titanized polypropylene mesh (TiLOOP® Bra): A prospective clinical study in 269 patients. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:1484-1490. [PMID: 32336622 DOI: 10.1016/j.ejso.2020.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/27/2020] [Accepted: 04/08/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Implant-based or expander-supported breast reconstruction is an established surgical method after mastectomies due to cancer or to prophylactic reasons. Patient reported outcome (PRO) and cosmetic outcome after breast reconstruction with a synthetic surgical mesh was investigated in a prospective, single-arm, multi-center study. MATERIAL AND METHODS Primary or secondary implant-based breast reconstruction with support of TiLOOP® Bra was performed in 269 patients during the PRO-BRA study. PRO 12 months after breast reconstruction was evaluated using Breast-Q questionnaire. Cosmetic outcome was evaluated by two independent experts by means of pictures taken preoperatively and at the follow-up visits. RESULTS Breast-Q and 12 months FU were completed by 210 women. Patients without adverse event had a significantly higher Breast-Q score for "sexual well-being" (p = 0.001); "psychosocial well-being" was negatively influenced by prior therapies (p < 0.01), and older patients had significantly lower scores at 12 months FU compared to pre-OP for "satisfaction with breasts" (p < 0.01) while the opposite was true for younger patients. Unilateral surgery resulted in reduced "satisfaction with breast" at 12 months FU (p < 0.01). Radiotherapy negatively influenced "satisfaction with breast", "sexual well-being" and "physical well-being chest". The cosmetic evaluation showed a significant difference (p < 0.001) in the evaluation by the patients and experts with the patients' assessment being worse compared to experts' assessment. CONCLUSION Our study showed that two years after implant-based breast reconstruction with support of TiLOOP® Bra PRO is influenced by different factors. This information can be used to improve the decision-making process for women who chose implant-based breast reconstruction.
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Affiliation(s)
- Marc Thill
- Department of Gynecology and Gynecologic Oncology, Agaplesion Markus Hospital, Frankfurt Am Main, Germany.
| | - Andree Faridi
- Center for Breast Diseases, Vivantes Hospital Am Urban, Berlin, Germany
| | | | | | - Kristin Baumann
- Clinic for Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology with Breast Center Charité, Berlin, Germany
| | | | | | | | | | - Ralf Ohlinger
- Clinic for Gynecology and Obstetrics, University Greifswald, Greifswald, Germany
| | - Stefan Paepke
- Department of Obstetrics and Gynecology, Technical University of Munich, Munich, Germany
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Bassetto F, Pandis L. Clinical experience with Surgimend in breast reconstruction: an overview. Br J Hosp Med (Lond) 2020; 81:1-18. [PMID: 32240008 DOI: 10.12968/hmed.2018.0428c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In the field of breast reconstruction, products and techniques are continuing to evolve to ensure good clinical and quality outcomes. This article reviews the published literature regarding the use of fetal bovine-derived acellular dermal matrix (SurgiMend, SurgiMend PRS and SurgiMend PRS meshed), focusing on safety, clinical outcomes and surgical techniques.
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Affiliation(s)
- F Bassetto
- Plastic Surgery Department, Padova University, Italy
| | - L Pandis
- Plastic Surgery Department, Padova University, Italy
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Liao J, Xu B, Zhang R, Fan Y, Xie H, Li X. Applications of decellularized materials in tissue engineering: advantages, drawbacks and current improvements, and future perspectives. J Mater Chem B 2020; 8:10023-10049. [PMID: 33053004 DOI: 10.1039/d0tb01534b] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Decellularized materials (DMs) are attracting more and more attention in tissue engineering because of their many unique advantages, and they could be further improved in some aspects through various means.
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Affiliation(s)
- Jie Liao
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education
- School of Biological Science and Medical Engineering
- Beijing Advanced Innovation Center for Biomedical Engineering
- Beihang University
- Beijing 100083
| | - Bo Xu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education
- School of Biological Science and Medical Engineering
- Beijing Advanced Innovation Center for Biomedical Engineering
- Beihang University
- Beijing 100083
| | - Ruihong Zhang
- Department of Research and Teaching
- the Fourth Central Hospital of Baoding City
- Baoding 072350
- China
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education
- School of Biological Science and Medical Engineering
- Beijing Advanced Innovation Center for Biomedical Engineering
- Beihang University
- Beijing 100083
| | - Huiqi Xie
- Laboratory of Stem Cell and Tissue Engineering
- State Key Laboratory of Biotherapy and Cancer Center
- West China Hospital
- Sichuan University and Collaborative Innovation Center of Biotherapy
- Chengdu 610041
| | - Xiaoming Li
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education
- School of Biological Science and Medical Engineering
- Beijing Advanced Innovation Center for Biomedical Engineering
- Beihang University
- Beijing 100083
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12
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Paepke S, Kiechle M, Ankel C, Weyrich J, Klein E, Schneider A, Johannigmann-Malek N, Dietrich AS, Ohlinger R, Thill M. Surgical Studies of Reconstructive Breast Surgery - An Overview of the Topics at the 2019 Annual Meeting of the Working Group for Reconstructive Surgery in Oncology-Gynecology. Geburtshilfe Frauenheilkd 2019; 79:584-590. [PMID: 31217627 PMCID: PMC6570614 DOI: 10.1055/a-0873-8110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 03/12/2019] [Indexed: 11/22/2022] Open
Abstract
This yearʼs annual AWOgyn meeting focused on studies of reconstructive breast surgery. As the majority of breast reconstructions are implant-based, most studies also focused on implant-based reconstruction. Since 2011, the guidelines have recommended using interposed mesh materials as support. The basic idea behind every type of material is to provide coverage and stabilization for the implant by constructing an “internal bra” which will create the appropriate implant shape and maintain the position, stability and flexibility of the implant. The Working Group for Reconstructive Surgery in Oncology-Gynecology (AWOgyn) has undertaken to analyze different materials with regard to indications, success rates and side effects as documented in registers, clinical assessments and study protocols. This has increased application safety and is expected to improve it even further in future. Prospective studies are being carried out to investigate issues such as the optimal material, optimal implant site and best cosmetic results. The first results for porcine and human acellular matrices and for partially resorbable titanium-coated synthetic polypropylene meshes are now available. In 2019, the AWOgyn working group will be launching further studies to evaluate a perforated acellular dermal matrix (Fortiva
®
), a titanium-coated implant pocket (TiLOOP
®
Bra Pocket) and a fully resorbable synthetic mesh (TIGR
®
mesh).
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Affiliation(s)
- Stefan Paepke
- Klinik und Poliklinik für Frauenheilkunde, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Marion Kiechle
- Klinik und Poliklinik für Frauenheilkunde, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | | | - Joy Weyrich
- Klinik und Poliklinik für Frauenheilkunde, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Evelyn Klein
- Klinik und Poliklinik für Frauenheilkunde, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Anna Schneider
- Klinik und Poliklinik für Frauenheilkunde, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | | | - Anna-Sophia Dietrich
- Klinik und Poliklinik für Frauenheilkunde, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Ralf Ohlinger
- Gynaecology and Obstetrics, Universitatsmedizin Greifswald, Greifswald, Germany
| | - Marc Thill
- Klinik für Gynäkologie und Geburtshilfe, Interdisziplinäres Brustzentrum, Agaplesion Markus Krankenhaus Frankfurt am Main, Frankfurt am Main, Germany
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13
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[Acellular dermal matrix and synthetic mesh in implant-based immediate breast reconstruction: Current concepts]. ACTA ACUST UNITED AC 2019; 47:311-316. [PMID: 30738819 DOI: 10.1016/j.gofs.2019.01.010] [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: 07/23/2018] [Indexed: 11/23/2022]
Abstract
The use of acellular dermal matrices and synthetic meshes is gaining popularity in direct-to-implant breast reconstruction, allowing the complete coverage of the prosthesis with greater pocket control and improved cosmesis. In this concise review, we present the advantages of acellular dermal matrices and resorbable or nonresorbable synthetic meshes in implant-based breast reconstruction, we discuss the risk of postoperative complications, and we raise their contribution in the growing interest of prepectoral breast reconstruction.
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14
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Machleidt A, Schmidt-Feuerheerd N, Blohmer JU, Ohlinger R, Kueper J, von Waldenfels G, Dittmer S, Paepke S, Klein E. Reconstructive breast surgery with partially absorbable bi-component Seragyn® BR soft mesh: an outcome analysis. Arch Gynecol Obstet 2018; 298:755-761. [PMID: 30083777 DOI: 10.1007/s00404-018-4859-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/28/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Synthetic meshes and acellular dermal matrices are increasingly used in implant-based breast reconstruction. The objective of this study was to determine the incidence and severity of complications following the implantation of the partially absorbable bi-component soft mesh SERAGYN® BR and assess risk factors for adverse operative outcomes. METHODS A retrospective clinical study was performed: The SERAGYN® BR soft mesh was utilized in 148 operations (skin-sparing mastectomy, nipple-sparing mastectomy, breast-conserving surgery, and secondary reconstruction after mastectomy) in four different institutions in Germany from June 2012 to February 2014. We analyzed whether the results were affected by tumor morphology (e.g., grading), patient characteristics and comorbidities, previous surgery or therapies, and use of alloplastic materials. RESULTS The SERAGYN® BR soft mesh was successfully implanted in 131 of 148 operations. The rate of reconstructive failure was 11.5%. The most common complication was seroma (25.7%), followed by hematoma and skin infection (each 14.2%). Wound-healing issues were detected in 13.5% cases, secondary wound infections in 10.8%. 83.8% of operations had no severe complications. Independent predictors for reconstructive failure were wound-healing issues, nipple- or skin necrosis, wound- or skin infections, a high volume of excised tissue, hematomas, seromas, and sentinel lymph node excisions. A higher body mass index was correlated with a higher rate of infection. CONCLUSION SERAGYN® BR mesh can be used successfully in breast reconstructive surgery. Rates of major complications or reconstructive failure are comparable to the use of other synthetic or biological meshes.
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Affiliation(s)
- Anna Machleidt
- Breast Center, Charité-Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Germany
| | | | - Jens-Uwe Blohmer
- Breast Center, Charité-Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Germany
| | - Ralf Ohlinger
- Universitätsmedizin Greifswald, Ferdinand-Sauerbruch Straße, 17475, Greifswald, Germany
| | - Janina Kueper
- Breast Center, Charité-Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Germany
| | | | - Sissi Dittmer
- Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany
| | - Stefan Paepke
- Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany
| | - Evelyn Klein
- Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany
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15
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Wu LH, Zhang MX, Chen CY, Fang QQ, Wang XF, Tan WQ. Breast reconstruction with Alloderm Ready to Use: A meta-analysis of nine observational cohorts. Breast 2018; 39:89-96. [PMID: 29631098 DOI: 10.1016/j.breast.2018.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/10/2018] [Accepted: 03/20/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AlloDerm-RTU is a new member of human acellular dermal matrix (HADM) which was launched in 2012. The present meta-analysis aimed to investigate whether AlloDerm-RTU was superior compared with previous HADMs. METHODS All available databases were searched for retrospective or prospective studies regarding breast reconstruction with AlloDerm-RTU compared with other HADMs. The primary outcome was the incidence of complications among different HADMs. RESULTS Two prospective and seven retrospective studies with a total of 1406 patients were enrolled. There was no significant difference in any of the complications, including the incidence of hematoma (RR 0.78, 95%CI 0.19 to 3.19; P = 0.73), seroma (RR 0.98, 95%CI 0.43 to 2.26; P = 0.97), cellulitis (RR 0.82, 95%CI 0.32 to 2.11; P = 0.68), necrosis (RR 0.69, 95%CI 0.44 to 1.10; P = 0.12), infection (RR 0.68, 95%CI 0.37 to 1.25; P = 0.22), explantation (RR 0.61, 95%CI 0.35 to 1.06; P = 0.08), and total complications (RR 0.91, 95%CI 0.55 to 1.52; P = 0.73). Subgroup analysis showed that AlloDerm-RTU demonstrated no superiority compared with FD AlloDerm, AlloMax, or DermACELL. Sensitivity analysis indicated that the outcomes were stabilized. No publication bias existed in the present meta-analysis. CONCLUSION Four HADM products, AlloDerm-RTU, FD AlloDerm, AlloMax, and DermACELL, showed similar risks of complications. However since most of the included studies had a low level of evidence, further random trials with large numbers of patients are needed.
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Affiliation(s)
- Li-Hong Wu
- Department of Plastic Surgery, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu, Zhejiang Province, China
| | - Min-Xia Zhang
- Department of Plastic Surgery, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu, Zhejiang Province, China
| | - Chun-Ye Chen
- Department of Plastic Surgery, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu, Zhejiang Province, China
| | - Qing-Qing Fang
- Department of Plastic Surgery, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu, Zhejiang Province, China
| | - Xiao-Feng Wang
- Department of Plastic Surgery, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu, Zhejiang Province, China
| | - Wei-Qiang Tan
- Department of Plastic Surgery, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu, Zhejiang Province, China.
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16
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Eichler C, Efremova J, Brunnert K, Kurbacher CM, Gluz O, Puppe J, Warm M. A Head to Head Comparison Between SurgiMend® - Fetal Bovine Acellular Dermal Matrix and Tutomesh® - A Bovine Pericardium Collagen Membrane in Breast Reconstruction in 45 Cases. ACTA ACUST UNITED AC 2018; 31:677-682. [PMID: 28652438 DOI: 10.21873/invivo.11112] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/07/2017] [Accepted: 05/08/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The use of acellular dermal matrices (ADM) has become a widely used option in breast reconstruction. A great deal of literature is available, totaling over 3,200 ADM reconstructions. Head-to-head comparisons between SurgiMend® and Tutomesh® are not yet reported. These are the first comparative clinical data reported on the use of Tutomesh® in breast reconstruction. Postoperative complication rates and costs for these devices were evaluated. PATIENTS AND METHODS This is a retrospective analysis of a 2-year experience with both SurgiMend® - fetal bovine acellular dermal matrix and Tutomesh® - a bovine pericardium collagen membrane in breast reconstruction in 45 cases from 2014-2015. RESULTS Forty-five patients received a total of 45 implant-based reconstructions using SurgiMend® (18 cases; 40%) or Tutomesh® (27 cases; 60%). Gross complication rates were 27.8% for SurgiMend® and 37.0% for Tutomesh® including hematoma, postoperative skin irritation, infection, red breast syndrome and revision surgery. The most common complication was postoperative red breast syndrome. Severe complications requiring revision surgery did not differ significantly in patients treated with SurgiMend® (0 cases, 0%) compared to Tutomesh® (1 case, 3.7%). CONCLUSION This retrospective analysis shows similar overall clinical complication rates for Tutomesh® and SurgiMend®. Severe complication rates are comparable to those reported in literature for both products. Although the retrospective nature of this work limits its clinical impact, it is possible to opt for the cheaper alternative (Tutomesh®).
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Affiliation(s)
- Christian Eichler
- Breast Center, Municipal Hospital Holweide, Cologne, Germany .,Department of Gynecology and Obstetrics, Municipal Hospital Holweide, Cologne, Germany
| | - Jeria Efremova
- Breast Center, Municipal Hospital Holweide, Cologne, Germany
| | - Klaus Brunnert
- Department of Senology, Clinic for Senology, Osnabrueck, Germany
| | - Christian M Kurbacher
- Clinic Center Bonn-Friedensplatz, Bonn, Germany.,Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany
| | - Oleg Gluz
- West German Study Group (WSG), Moenchengladbach, Germany.,Breast Center Niederrhein Moenchengladbach, Moenchengladbach, Germany
| | - Julian Puppe
- Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany
| | - Mathias Warm
- Breast Center, Municipal Hospital Holweide, Cologne, Germany.,Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany
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17
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Dieterich M, Dragu A, Stachs A, Stubert J. Clinical Approaches to Breast Reconstruction: What Is the Appropriate Reconstructive Procedure for My Patient? Breast Care (Basel) 2018; 12:368-373. [PMID: 29456467 DOI: 10.1159/000484926] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Breast reconstruction after breast cancer is an emotional subject for women. Consequently, the correct timing and surgical procedure for each individual woman are important. In general, heterologous or autologous reconstructive procedures are available, both having advantages and disadvantages. Breast size, patient habitus, and previous surgeries or radiation therapy need to be considered, independent of the chosen procedure. New surgical techniques, refinement of surgical procedures, and the development of supportive materials have increased the general patient collective eligible for breast reconstruction. This review highlights the different approaches to immediate breast reconstruction using autologous or heterologous techniques.
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Affiliation(s)
- Max Dieterich
- Department of Obstetrics and Gynecology, Klinikum Südstadt Rostock - Interdisciplinary Breast Center - University of Rostock, Rostock, Germany
| | - Adrian Dragu
- Department of Plastic and Hand Surgery, Carl Gustav Carus University of Dresden, Dresden, Germany
| | - Angrit Stachs
- Department of Obstetrics and Gynecology, Klinikum Südstadt Rostock - Interdisciplinary Breast Center - University of Rostock, Rostock, Germany
| | - Johannes Stubert
- Department of Obstetrics and Gynecology, Klinikum Südstadt Rostock - Interdisciplinary Breast Center - University of Rostock, Rostock, Germany
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18
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The Comparison of Strattice and SurgiMend in Acellular Dermal Matrix–Assisted, Implant-Based Immediate Breast Reconstruction. Plast Reconstr Surg 2018; 141:283-293. [DOI: 10.1097/prs.0000000000004018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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The Use of TIGR Matrix in Breast Aesthetic and Reconstructive Surgery: Is a Resorbable Synthetic Mesh a Viable Alternative to Acellular Dermal Matrices? Clin Plast Surg 2017; 45:65-73. [PMID: 29080661 DOI: 10.1016/j.cps.2017.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The authors document their experience in the use of synthetic 100% bioresorbable surgical mesh (TIGR Matrix, Novus Scientific, Uppsala, Sweden) in breast reconstruction as well as in breast aesthetic surgery. They performed a retrospective review on patients who underwent implant-based breast reconstruction as well as patients who underwent breast reduction mammoplasty procedures with the use of TIGR Matrix Surgical Mesh. When compared with other synthetic but nonresorbable meshes, it appears to show a potentially lower seroma and infection rates, but most importantly, a lower rate of revisional and mesh explantation surgeries.
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20
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Qiao Y, Huang N, Wu Y, Chen Y, Wang L. [Research progress of non-biological meshes for breast reconstruction]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:1141-1145. [PMID: 29798576 DOI: 10.7507/1002-1892.201702073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To review the application progress of non-biological meshes for breast reconstruction (BR). Methods The related home and abroad researches in BR were reviewed and summarized. Results Non-biological meshes can be divided into degradable and nondegradable. The former has many types, whether its degradation rate can match with the grow rate of repair tissue will significantly affect the wound healing and tissue intergradation. TiLOOP, on behalf of the latter, has a good postoperative performance due to its nano TiO 2 layer, lightness and flexibility. Non-biological meshes have been gradually used to cover and fix implant in BR. Compared with biological meshes, non-biological meshes are cheaper and have a more positive postoperative performance generally, but definite comparison can't be concluded due to the limited data. Conclusion As non-biological meshes are applied to BR preliminarily, their effectiveness are still needed to be observed further.
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Affiliation(s)
- Yansha Qiao
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, 201600, P.R.China
| | - Naisi Huang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Hospital, Shanghai, 200032, P.R.China
| | - Yaqiong Wu
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, 201600, P.R.China
| | - Yuehan Chen
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, 201600, P.R.China
| | - Lu Wang
- Key Laboratory of Textile Science & Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, 201600,
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21
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Mallikarjuna U, Mujahid M, Pilkington R, Shaheer M, Mujahid P. Acellular bovine pericardium in implant-based breast reconstruction: A systematic review of the literature. EUROPEAN JOURNAL OF PLASTIC SURGERY 2017. [DOI: 10.1007/s00238-017-1284-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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22
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Gerber B, Marx M, Untch M, Faridi A. Breast Reconstruction Following Cancer Treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:286. [PMID: 26377531 DOI: 10.3238/arztebl.2015.0593] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 06/10/2015] [Accepted: 06/10/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND About 8000 breast reconstructions after mastectomy are per - formed in Germany each year. It has become more difficult to advise patients because of the wide variety of heterologous and autologous techniques that are now available and because of changes in the recommendations about radiotherapy. METHODS This article is based on a review of pertinent articles (2005-2014) that were retrieved by a selective search employing the search terms "mastectomy" and "breast reconstruction." RESULTS The goal of reconstruction is to achieve an oncologically safe and aestically satisfactory result for the patient over the long term. Heterologous, i.e., implant-based, breast reconstruction (IBR) and autologous breast reconstruction (ABR) are complementary techniques. Immediate reconstruction preserves the skin of the breast and its natural form and prevents the psychological trauma associated with mastectomy. If post-mastectomy radiotherapy (PMRT) is not indicated, implant-based reconstruction with or without a net/acellular dermal matrix (ADM) is a common option. Complications such as seroma formation, infection, and explantation are significantly more common when an ADM is used (15.3% vs. 5.4% ). If PMRT is performed, then the complication rate of implant-based breast reconstruction is 1 to 48% ; in particular, Baker grade III/IV capsular fibrosis occurs in 7 to 22% of patients, and the prosthesis must be explanted in 9 to 41% . Primary or, preferably, secondary autologous reconstruction is an alternative. The results of ABR are more stable over the long term, but the operation is markedly more complex. Autologous breast reconstruction after PMRT does not increase the risk of serious complications (20.5% vs. 17.9% without radiotherapy). CONCLUSION No randomized controlled trials have yet been conducted to compare the reconstructive techniques with each other. If radiotherapy will not be performed, immediate reconstruction with an implant is recommended. On the other hand, if post-mastectomy radiotherapy is indicated, then secondary autologous breast reconstruction is the procedure of choice. Future studies should address patients' quality of life and the long-term aesthetic results after breast reconstruction.
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Affiliation(s)
- Bernd Gerber
- Department of Obstetrics and Gynecology, University of Rostock, Clinic for Plastic Surgery, Radebeul, Helios Klinikum Berlin Buch, Center for Breast Diseases, Vivantes Hospital am Urban, Berlin
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Adams WP, Toriumi DM, Van Natta BW. Clinical Use of GalaFLEX in Facial and Breast Cosmetic Plastic Surgery. Aesthet Surg J 2016; 36:S23-S32. [PMID: 27697886 DOI: 10.1093/asj/sjw142] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2016] [Indexed: 12/16/2022] Open
Abstract
Resolution of ptosis is a key step to the success of many plastic surgery procedures. Ptosis is a manifestation of tissue stretch. Tissue stretch can occur as a result of the natural aging process or health of the patient, or tissue may stretch under added weight or volume, such as when implants are placed. Surgical rejuvenation of ptotic tissues is very effective and results in marked changes in the patient profile yet the tissue that resulted in the need for the procedure first place has not improved and ptosis can recur. Recent developments in long-term resorbable porous materials have provided surgeons with the opportunity to experiment with tissue reinforcement in plastic surgery procedures. These new materials have a low profile, rapid tissue integration, and a long-term strength retention profile. Long-term resorbable scaffolds such as poly-4-hydroxybutyrate (P4HB) natural scaffold (GalaFLEX scaffold, Galatea Surgical, Inc., Lexington, MA) have shown promise for a host of plastic surgery indications. This article presents clinical experience with GalaFLEX for soft tissue reinforcement in three different clinical applications; including the reinforcement of the superficial muscular aponeurotic system (SMAS) in minimally invasive facelift, reinforcement of the skin envelope in mastopexy, and reinforcement of the breast capsule (pocket) in revisional breast surgery. Soft tissue reinforcement has been shown to provide increased mechanical strength as well as improved maintenance of postoperative results. LEVEL OF EVIDENCE 5 Therapeutic.
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Affiliation(s)
- William P Adams
- Dr Adams is an Associate Clinical Professor, Program Director Aesthetic Fellowship, Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX. Dr Van Natta is a Clinical Associate Professor, Department of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN. Dr Toriumi is Head, Department of Otolaryngology - Head and Neck Surgery, College of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Dean M Toriumi
- Dr Adams is an Associate Clinical Professor, Program Director Aesthetic Fellowship, Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX. Dr Van Natta is a Clinical Associate Professor, Department of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN. Dr Toriumi is Head, Department of Otolaryngology - Head and Neck Surgery, College of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Bruce W Van Natta
- Dr Adams is an Associate Clinical Professor, Program Director Aesthetic Fellowship, Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX. Dr Van Natta is a Clinical Associate Professor, Department of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN. Dr Toriumi is Head, Department of Otolaryngology - Head and Neck Surgery, College of Medicine, University of Illinois at Chicago, Chicago, IL
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Cabalag MS, Rostek M, Miller GS, Chae MP, Quinn T, Rozen WM, Hunter-Smith DJ. Alloplastic adjuncts in breast reconstruction. Gland Surg 2016; 5:158-73. [PMID: 27047784 DOI: 10.3978/j.issn.2227-684x.2015.06.02] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND There has been an increasing role of acellular dermal matrices (ADMs) and synthetic meshes in both single- and two-stage implant/expander breast reconstruction. Numerous alloplastic adjuncts exist, and these vary in material type, processing, storage, surgical preparation, level of sterility, available sizes and cost. However, there is little published data on most, posing a significant challenge to the reconstructive surgeon trying to compare and select the most suitable product. The aims of this systematic review were to identify, summarize and evaluate the outcomes of studies describing the use of alloplastic adjuncts for post-mastectomy breast reconstruction. The secondary aims were to determine their cost-effectiveness and analyze outcomes in patients who also underwent radiotherapy. METHODS Using the PRSIMA 2009 statement, a systematic review was conducted to find articles reporting on the outcomes on the use of alloplastic adjuncts in post-mastectomy breast reconstruction. Multiple databases were searched independently by three authors (Cabalag MS, Miller GS and Chae MP), including: Ovid MEDLINE (1950 to present), Embase (1980 to 2015), PubMed and Cochrane Database of Systematic Reviews. RESULTS Current published literature on available alloplastic adjuncts are predominantly centered on ADMs, both allogeneic and xenogeneic, with few outcome studies available for synthetic meshes. Outcomes on the 89 articles, which met the inclusion criteria, were summarized and analyzed. The reported outcomes on alloplastic adjunct-assisted breast reconstruction were varied, with most data available on the use of ADMs, particularly AlloDerm(®) (LifeCell, Branchburg, New Jersey, USA). The use of ADMs in single-stage direct-to-implant breast reconstruction resulted in lower complication rates (infection, seroma, implant loss and late revision), and was more cost effective when compared to non-ADM, two-stage reconstruction. The majority of studies demonstrated inferior outcomes in ADM assisted, two-stage expander-to-implant reconstruction compared to non-ADM use. Multiple studies suggest that the use of ADMs results in a reduction of capsular contracture rates. Additionally, the reported beneficial effects of ADM use in irradiated tissue were varied. CONCLUSIONS ADM assisted two-stage breast reconstruction was associated with inferior outcomes when compared to non-ADM use. However, alloplastic adjuncts may have a role in single stage, direct-to-implant breast reconstruction. Published evidence comparing the long-term outcomes between the different types of adjuncts is lacking, and further level one studies are required to identify the ideal product.
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Affiliation(s)
- Miguel S Cabalag
- 1 Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, Frankston, Victoria 3199, Australia ; 2 Monash University Plastic and Reconstructive Surgery Unit (Peninsula Clinical School), Peninsula Health, Frankston, Victoria 3199, Australia ; 3 Department of Surgery, Townsville Hospital, School of Medicine and Dentistry, James Cook University Clinical School, Townsville, Queensland 4814, Australia
| | - Marie Rostek
- 1 Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, Frankston, Victoria 3199, Australia ; 2 Monash University Plastic and Reconstructive Surgery Unit (Peninsula Clinical School), Peninsula Health, Frankston, Victoria 3199, Australia ; 3 Department of Surgery, Townsville Hospital, School of Medicine and Dentistry, James Cook University Clinical School, Townsville, Queensland 4814, Australia
| | - George S Miller
- 1 Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, Frankston, Victoria 3199, Australia ; 2 Monash University Plastic and Reconstructive Surgery Unit (Peninsula Clinical School), Peninsula Health, Frankston, Victoria 3199, Australia ; 3 Department of Surgery, Townsville Hospital, School of Medicine and Dentistry, James Cook University Clinical School, Townsville, Queensland 4814, Australia
| | - Michael P Chae
- 1 Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, Frankston, Victoria 3199, Australia ; 2 Monash University Plastic and Reconstructive Surgery Unit (Peninsula Clinical School), Peninsula Health, Frankston, Victoria 3199, Australia ; 3 Department of Surgery, Townsville Hospital, School of Medicine and Dentistry, James Cook University Clinical School, Townsville, Queensland 4814, Australia
| | - Tam Quinn
- 1 Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, Frankston, Victoria 3199, Australia ; 2 Monash University Plastic and Reconstructive Surgery Unit (Peninsula Clinical School), Peninsula Health, Frankston, Victoria 3199, Australia ; 3 Department of Surgery, Townsville Hospital, School of Medicine and Dentistry, James Cook University Clinical School, Townsville, Queensland 4814, Australia
| | - Warren M Rozen
- 1 Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, Frankston, Victoria 3199, Australia ; 2 Monash University Plastic and Reconstructive Surgery Unit (Peninsula Clinical School), Peninsula Health, Frankston, Victoria 3199, Australia ; 3 Department of Surgery, Townsville Hospital, School of Medicine and Dentistry, James Cook University Clinical School, Townsville, Queensland 4814, Australia
| | - David J Hunter-Smith
- 1 Department of Plastic and Reconstructive Surgery, Frankston Hospital, Peninsula Health, Frankston, Victoria 3199, Australia ; 2 Monash University Plastic and Reconstructive Surgery Unit (Peninsula Clinical School), Peninsula Health, Frankston, Victoria 3199, Australia ; 3 Department of Surgery, Townsville Hospital, School of Medicine and Dentistry, James Cook University Clinical School, Townsville, Queensland 4814, Australia
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Parmaksiz M, Dogan A, Odabas S, Elçin AE, Elçin YM. Clinical applications of decellularized extracellular matrices for tissue engineering and regenerative medicine. Biomed Mater 2016; 11:022003. [DOI: 10.1088/1748-6041/11/2/022003] [Citation(s) in RCA: 149] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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26
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Gschwantler-Kaulich D, Schrenk P, Bjelic-Radisic V, Unterrieder K, Leser C, Fink-Retter A, Salama M, Singer C. Mesh versus acellular dermal matrix in immediate implant-based breast reconstruction - A prospective randomized trial. Eur J Surg Oncol 2016; 42:665-71. [PMID: 26947961 DOI: 10.1016/j.ejso.2016.02.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 01/21/2016] [Accepted: 02/02/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Comparative studies on the use of meshes and acellular dermal matrices (ADM) in implant-based breast reconstruction (IBBR) have not yet been performed. METHODS This prospective, randomized, controlled, multicenter pilot study was performed at four Austrian breast cancer centers. Fifty patients with oncologic or prophylactic indication for mastectomy and IBBR were randomized to immediate IBBR with either an ADM (Protexa(®)) or a titanized mesh (TiLOOP(®) Bra). Complications, failed reconstruction, cosmetic outcome, patients' quality of life and the thickness of the overlying tissue were recorded immediately postoperatively and 3 and 6 months after surgery. RESULTS 48 patients participated in the study (Protexa(®) group: 23; TiLOOP(®) Bra group: 25 patients). The overall complication rate was 31.25% with similar rates in both groups (Protexa(®) group: 9 versus TiLOOP(®) Bra group: 6; p = 0.188). There was a higher incidence of severe complications leading to failed reconstructions with implant loss in the Protexa(®) group than in the TiLOOP(®) Bra group (7 versus 2; p < 0.0001). An inverted T-incision technique led to significantly more complications and reconstructive failure with Protexa(®) (p = 0.037, p = 0.012, respectively). There were no significant differences in patients' satisfaction with cosmetic results (p = 0.632), but surgeons and external specialists graded significantly better outcomes with TiLOOP(®) Bra (p = 0.034, p = 0.032). CONCLUSION This pilot study showed use of TiLOOP(®) Bra or Protexa(®) in IBBR is feasible leading to good cosmetic outcomes and high patient satisfaction. To validate the higher failure rates in the Protexa(®) group, data from a larger trial are required. NCT02562170.
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Affiliation(s)
- D Gschwantler-Kaulich
- Medical University of Vienna, Breast Cancer Center, Department of Gynaecological Oncology, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - P Schrenk
- AKH Linz Breast Cancer Center, Krankenhausstrasse 9, 4021 Linz, Austria
| | - V Bjelic-Radisic
- Medical University of Graz, Department of Gynaecology, Auenbruggerplatz 1, 8036 Graz, Austria
| | - K Unterrieder
- Private Hospital Villach, Breast Cancer Center, Department of Gynaecology, Dr.-Walter-Hochsteiner-Straße 4, 9504 Villach, Austria
| | - C Leser
- Medical University of Vienna, Breast Cancer Center, Department of Gynaecological Oncology, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - A Fink-Retter
- Medical University of Vienna, Breast Cancer Center, Department of Gynaecological Oncology, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - M Salama
- Otto Wagner Hospital, Department of Surgery, Baumgartner Hoehe 1, 1140 Vienna, Austria
| | - C Singer
- Medical University of Vienna, Breast Cancer Center, Department of Gynaecological Oncology, Waehringer Guertel 18-20, 1090 Vienna, Austria
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Luo X, Kulig KM, Finkelstein EB, Nicholson MF, Liu XH, Goldman SM, Vacanti JP, Grottkau BE, Pomerantseva I, Sundback CA, Neville CM. In vitro evaluation of decellularized ECM-derived surgical scaffold biomaterials. J Biomed Mater Res B Appl Biomater 2015; 105:585-593. [PMID: 26663848 DOI: 10.1002/jbm.b.33572] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/19/2015] [Accepted: 11/02/2015] [Indexed: 11/10/2022]
Abstract
Decellularized extracellular matrix (ECM) biomaterials are increasingly used in regenerative medicine for abdominal tissue repair. Emerging ECM biomaterials with greater compliance target surgical procedures like breast and craniofacial reconstruction to enhance aesthetic outcome. Clinical studies report improved outcomes with newly designed ECM scaffolds, but their comparative biological characteristics have received less attention. In this study, we investigated scaffolds derived from dermis (AlloDerm Regenerative Tissue Matrix), small intestinal submucosa (Surgisis 4-layer Tissue Graft and OASIS Wound Matrix), and mesothelium (Meso BioMatrix Surgical Mesh and Veritas Collagen Matrix) and evaluated biological properties that modulate cellular responses and recruitment. An assay panel was utilized to assess the ECM scaffold effects upon cells. Results of the material-conditioned media study demonstrated Meso BioMatrix and OASIS best supported cell proliferation. Meso BioMatrix promoted the greatest migration and chemotaxis signaling, followed by Veritas and OASIS; OASIS had superior suppression of cell apoptosis. The direct adhesion assay indicated that AlloDerm, Meso BioMatrix, Surgisis, and Veritas had sidedness that affected cell-material interactions. In the chick chorioallantoic membrane assay, Meso BioMatrix and OASIS best supported cell infiltration. Among tested materials, Meso BioMatrix and OASIS demonstrated characteristics that facilitate scaffold incorporation, making them promising choices for many clinical applications. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 585-593, 2017.
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Affiliation(s)
- Xiao Luo
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, Massachusetts, 02114.,Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, 434300, People's Republic of China
| | - Katherine M Kulig
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, Massachusetts, 02114
| | - Eric B Finkelstein
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, Massachusetts, 02114.,The Department of Biomedical and Chemical Engineering, Syracuse Biomaterials Institute, Syracuse University, Syracuse, New York, 13244
| | - Margaret F Nicholson
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, Massachusetts, 02114
| | | | | | - Joseph P Vacanti
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, 02114.,Harvard Medical School, Boston, Massachusetts, 02115
| | - Brian E Grottkau
- Harvard Medical School, Boston, Massachusetts, 02115.,Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, 02114
| | - Irina Pomerantseva
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, Massachusetts, 02114.,Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, 02114.,Harvard Medical School, Boston, Massachusetts, 02115
| | - Cathryn A Sundback
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, Massachusetts, 02114.,Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, 02114.,Harvard Medical School, Boston, Massachusetts, 02115
| | - Craig M Neville
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, Massachusetts, 02114.,Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, 02114.,Harvard Medical School, Boston, Massachusetts, 02115.,Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, 02114
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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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Dieterich M, Angres J, Stubert J, Stachs A, Reimer T, Gerber B. Patient-Reported Outcomes in Implant-Based Breast Reconstruction Alone or in Combination with a Titanium-Coated Polypropylene Mesh - A Detailed Analysis of the BREAST-Q and Overview of the Literature. Geburtshilfe Frauenheilkd 2015; 75:692-701. [PMID: 26257406 DOI: 10.1055/s-0035-1546218] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 04/21/2015] [Accepted: 05/15/2015] [Indexed: 10/23/2022] Open
Abstract
Background: Complication rates and surgical outcomes are well reported for implant-based breast reconstruction (IBBR) using supportive materials for the inferior pole of the breast. Patient-reported outcomes (PRO) are underrepresented. The aim of this study was to compare PRO in IBBR using implants alone or in combination with a synthetic mesh. Methods and Methods: PRO was measured in patients undergoing IBBR alone or in combination with a titanium-covered polypropylene mesh (TiLOOP® Bra). In this non-randomized observational trial PRO was retrospectively assessed using the validated self-reporting BREAST-Q. The raw responses of all questions applied in each domain and transformed BREAST-Q data using the Q-Score are presented. Results: Of 90 eligible women, 42 received IBBR alone and 48 received IBBR in combination with mesh. No differences in complication rates were observed. The return rate was 67.7 % and was comparable between the groups (p = 0.117). PRO revealed no differences regarding satisfaction with breast shape (p = 0.079), outcome (p = 0.604), nipple sensitivity (p = 0.502), preoperative information (p = 0.195), office staff (p = 0.462), psychosocial well-being (p = 0.370), sexual well-being (p = 0.508) and physical well-being (p = 0.654). Significant differences were noted regarding satisfaction with the surgeon (p = 0.013) and medical staff (p = 0.035) as well as the response behavior of certain questions of the sub-domains, thus helping to further stratify PRO with regards to aesthetic outcome. However, no differences were observed in the main BREAST-Q results. Conclusion: Use of the TiLOOP® Bra in IBBR results in comparable BREAST-Q scores compared with IBBR alone. Evaluating the BREAST-Q sub-domains helps to stratify PRO more profoundly and assists in interpreting the overall results and specific research questions.
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Affiliation(s)
- M Dieterich
- Department of Obstetrics and Gynecology - Breast Unit, Klinikum Südstadt Rostock, University of Rostock, Rostock
| | - J Angres
- Department of Obstetrics and Gynecology - Breast Unit, Klinikum Südstadt Rostock, University of Rostock, Rostock
| | - J Stubert
- Department of Obstetrics and Gynecology - Breast Unit, Klinikum Südstadt Rostock, University of Rostock, Rostock
| | - A Stachs
- Department of Obstetrics and Gynecology - Breast Unit, Klinikum Südstadt Rostock, University of Rostock, Rostock
| | - T Reimer
- Department of Obstetrics and Gynecology - Breast Unit, Klinikum Südstadt Rostock, University of Rostock, Rostock
| | - B Gerber
- Department of Obstetrics and Gynecology - Breast Unit, Klinikum Südstadt Rostock, University of Rostock, Rostock
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A Head-to-head Comparison between SurgiMend and Epiflex in 127 Breast Reconstructions. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e439. [PMID: 26180740 PMCID: PMC4494509 DOI: 10.1097/gox.0000000000000409] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 05/04/2013] [Indexed: 11/23/2022]
Abstract
Background: The use of acellular dermal matrices (ADM) has become a widely used option in breast reconstruction. A great deal of literature is available, totaling over 2400 ADM reconstructions. Nonetheless, head-to-head comparisons between SurgiMend and Epiflex are not yet reported. In fact, this is the first clinical data report on the use of Epiflex. This work will, therefore, compare postoperative complication rates and costs for these ADMs. Methods: This analysis is a retrospective review of a single surgeon’s 6-year experience with both SurgiMend—an acellular bovine dermal collagen matrix for soft-tissue reconstruction and Epiflex—a decellularized human skin tissue from 2008 to 2013. Results: One hundred patients had a total of 127 implant-based reconstructions using SurgiMend (64 cases; 50.4%) or Epiflex (63 cases; 49.6%). Gross complication rates were 11.1% for SurgiMend and 40.6% for Epiflex including hematoma, postoperative skin irritation, infection, necrosis, and revision surgery. The most common complication was postoperative red breast syndrome. Severe complications requiring revision surgery were significantly increased in patients treated with Epiflex (12.5%) compared with SurgiMend (4.8%). Conclusions: This retrospective analysis favors the use of SurgiMend over Epiflex because of significantly lower gross complication rates. Severe complication rates are comparable with those reported in literature for both products. Although results promote the use of SurgiMend, the single surgeon retrospective nature of this work limits its clinical impact.
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