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Vanessa T, Sally K, Johanna S, Andreas E, Lukas P, Norbert H. Quality of life in breast reconstruction: a comparison of lightweight and conventional breast implants. Arch Gynecol Obstet 2024; 310:2153-2160. [PMID: 38874778 DOI: 10.1007/s00404-024-07572-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 05/27/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Due to the declining mortality rates of breast carcinoma and the rising incidence of risk-reducing mastectomies, enhancing the quality of life after breast reconstructions has become an increasingly important goal. The advantages of lightweight breast implants (B-Lite®) may significantly contribute to achieving this objective. This study aims to investigate whether lightweight implants are suitable for patients undergoing breast reconstruction and could improve the quality of life in comparison to conventional implants. METHODS In this study, we retrospectively analyzed 48 patients (38 implants in each group) who underwent implant-based breast reconstruction with either B-Lite® or conventional breast implants between 2019 and 2022 at the University Center for Plastic Surgery in Regensburg. As part of the postoperative follow-up, a clinical examination and a survey using the Breast-Q® questionnaire were conducted to evaluate the postoperative quality of life. RESULTS The implants used were similar in weight and shape. On average, the B-Lite® implants had a higher implant volume and patients in this group had a slightly higher BMI. Patients who received B-Lite® implants showed a significantly better result regarding the sensation of sensitivity in the surgical area and the scar formation also appeared to be more favorable. However, patients with B-Lite® implants perceived their implants as more uncomfortable than those with conventional breast implants. In other terms concerning quality of life, both groups appeared similar. CONCLUSION In summary, there are confounding factors that could influence the outcome of some aspects in this study, which could not be avoided due to the retrospective study design and the temporary suspension of B-Lite implants. Nevertheless, as the first of its kind, this study demonstrated that B-Lite implants could also be suitable for usage in breast reconstructions, thus providing an important foundation for further prospective studies to build upon.
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Affiliation(s)
- Tessmann Vanessa
- Center of Plastic, Hand and Reconstructive Surgery, University Hospital, Regensburg, Germany
| | - Kempa Sally
- Center of Plastic, Hand and Reconstructive Surgery, University Hospital, Regensburg, Germany
| | - Stern Johanna
- Center of Plastic, Hand and Reconstructive Surgery, University Hospital, Regensburg, Germany.
| | - Eigenberger Andreas
- Center of Plastic, Hand and Reconstructive Surgery, University Hospital, Regensburg, Germany
| | - Prantl Lukas
- Center of Plastic, Hand and Reconstructive Surgery, University Hospital, Regensburg, Germany
| | - Heine Norbert
- Center of Plastic, Hand and Reconstructive Surgery, University Hospital, Regensburg, Germany
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Gelidan AG, Al Qurashi AA, Dahlawi M, Hafiz BF, Halawani IR, Mandora RM, Tariq S, Hennawi YB, Bukhari RI, Alobaidi HA. A Systematic Review of Questionnaires Assessing Patient Satisfaction in Plastic Surgery: Tools, Topics, and Surgical Types. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6156. [PMID: 39281089 PMCID: PMC11398821 DOI: 10.1097/gox.0000000000006156] [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: 05/27/2023] [Accepted: 07/24/2024] [Indexed: 09/18/2024]
Abstract
Background Patient satisfaction is crucial for evaluating healthcare services, including plastic surgery. This systematic review aims to analyze questionnaires assessing patient satisfaction in plastic surgery, identifying their strengths and weaknesses to improve outcomes and enhance the quality of care. Methods A comprehensive literature search was conducted using electronic databases. Studies were included if they were original research articles, written in English, and focused on patient satisfaction questionnaires in plastic surgery. Data extraction and descriptive statistics were used to summarize the data. Results A total of 105 studies were included. General/overall satisfaction was the most common topic addressed (99.04%). Cosmetic outcomes were the most frequently assessed category (34.3%). Breast reconstruction was the most common procedure (33.3%). Most studies used a combination of generic and procedure-specific questionnaires (45.71%). The most frequently used measurement tools were BREAST-Q and self-developed questionnaires, each accounting for 28.57% and 27.61%. Conclusions This review provides a comprehensive analysis of patient satisfaction questionnaires in plastic surgery, emphasizing the importance of a holistic approach and well-established, validated tools. The findings contribute to improving plastic surgery outcomes and enhancing the quality of care. Future research should refine assessment tools to address patients' needs and promote patient-centered outcomes in plastic surgery.
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Affiliation(s)
- Adnan G Gelidan
- From the Division of Plastic Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah A Al Qurashi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences at the National Guards, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Maryam Dahlawi
- Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Bayan F Hafiz
- Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
| | | | - Roaa M Mandora
- Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Shahad Tariq
- Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Yasser B Hennawi
- Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Rahaf I Bukhari
- Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Hussain Amin Alobaidi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences at the National Guards, Jeddah, Saudi Arabia
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Wu Y, Yu L, Huang M, Huang Y, Li C, Liang Y, Liang W, Qin T. Comparative complications of prepectoral versus subpectoral breast reconstruction in patients with breast cancer: a meta-analysis. Front Oncol 2024; 14:1439293. [PMID: 39257552 PMCID: PMC11385603 DOI: 10.3389/fonc.2024.1439293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 08/06/2024] [Indexed: 09/12/2024] Open
Abstract
Introduction This meta-analysis aims to evaluate the complications associated with prepectoral breast reconstruction (PBR) compared to subpectoral breast reconstruction (SBR) in patients diagnosed with breast cancer. Materials and methods A comprehensive search was performed in four databases, including Medline, Embase, Web of Science and CENTRAL, to collect literature published up until December 31, 2024. In addition, we conducted a thorough manual examination of the bibliographies of the identified papers, as well as pertinent reviews and meta-analyses. We conducted a search on three clinical trial registries, namely ClinicalTrials.gov, Controlled-trials.com, and Umin.ac.jp/ctr/index.htm. Meta-analyses were conducted on total complications, hematoma, infection, wound healing issues, necrosis, capsular contracture, rippling, animation deformity, and reoperation. Results A total of 40 studies were included in the meta-analysis. Compared with SBR, PBR significantly reduced the incidence of animated malformations (OR=0.37, 95% CI: 0.19 to 0.70, P=0.003, I ²=12%), but increased the incidence of ripples (OR=2.39, 95% CI: 1.53 to 3.72, P=0.0001, I ²=10%) and seroma (OR=1.55, 95% CI: 1.02 to 2.35, P=0.04, increasing I ²=70%). Conclusions Our findings indicate that PBR and SBR have comparable safety profiles, with similar total complication rates. Specifically, PBR is more likely to cause rippling and seroma, whereas SBR is more prone to causing animation deformity. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024565837, identifier CRD42024565837.
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Affiliation(s)
- Yongxiao Wu
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Lizhi Yu
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Miaoyan Huang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Yanping Huang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Chunyan Li
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Yiwen Liang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Weiming Liang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Tian Qin
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
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Rampal R, Jones SJ, Hartup S, Robertson C, Tahir W, Jones SL, McKenzie S, Savage JA, Kim B. Three and twelve-month analysis of the PROM-Q study: comparison of patient-reported outcome measures using the BREAST-Q questionnaire in pre- vs. sub-pectoral implant-based immediate breast reconstruction. Breast Cancer Res Treat 2024:10.1007/s10549-024-07416-5. [PMID: 38985220 DOI: 10.1007/s10549-024-07416-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 06/19/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE Implant-based breast reconstruction (IBR) is being increasingly performed with implant placed above the pectoral muscle (pre-pectoral), instead of below the pectoral muscle (sub-pectoral). Currently, there is a lack of comparative data on clinical and patient-perceived outcomes between pre- vs. sub-pectoral IBR. We investigated whether this difference in surgical approach influenced clinical or patient-perceived outcomes. METHODS This prospective non-randomised longitudinal cohort study (ClinicalTrials.gov identifier: NCT04842240) recruited patients undergoing immediate IBR at the Leeds Breast Unit (Sep 2019-Sep 2021). Data collection included patient characteristics and post-operative complications. Patient-Reported Outcome Measures were collected using the BREAST-Q questionnaire at baseline, 2 weeks, 3- and 12-months post-surgery. RESULTS Seventy-eight patients underwent IBR (46 patients pre-pectoral; 59% vs. 32 patients sub-pectoral; 41%). Similar complication rates were observed (15.2% pre-pectoral vs. 9.4% sub-pectoral; p = 0.44). Overall implant loss rate was 3.8% (6.5% pre-pectoral vs. 0% sub-pectoral; p = 0.13). Respective median Breast-Q scores for pre- and sub-pectoral IBR at 3 months were: breast satisfaction (58 vs. 48; p = 0.01), psychosocial well-being (60 vs. 57; p = 0.9), physical well-being (68 vs. 76; p = 0.53), and Animation Q scores (73 vs. 76; p = 0.45). Respective Breast-Q scores at 12 months were: breast satisfaction (58 vs. 53; p = 0.3), psychosocial well-being (59 vs. 60; p = 0.9), physical well-being (68 vs. 78; p = 0.18), and Animation Q scores (69 vs. 73; p = 0.4). CONCLUSIONS This study demonstrates equivalent clinical and patient-perceived outcomes between pre- and sub-pectoral IBR. The study findings can be utilised to aid informed decision making regarding either surgical option.
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Affiliation(s)
- Ritika Rampal
- The Breast Unit at the Leeds Cancer Centre, St. James's University Hospital, Leeds, LS9 7TF, UK.
| | - Stacey Jessica Jones
- Department of Breast Surgery, Huddersfield Royal Infirmary, Huddersfield, HD3 3EA, UK
| | - Sue Hartup
- The Breast Unit at the Leeds Cancer Centre, St. James's University Hospital, Leeds, LS9 7TF, UK
| | - Clare Robertson
- The Breast Unit at the Leeds Cancer Centre, St. James's University Hospital, Leeds, LS9 7TF, UK
| | - Wasif Tahir
- The Breast Unit at the Leeds Cancer Centre, St. James's University Hospital, Leeds, LS9 7TF, UK
| | - Sian Louise Jones
- The Breast Unit at the Leeds Cancer Centre, St. James's University Hospital, Leeds, LS9 7TF, UK
| | - Shireen McKenzie
- The Breast Unit at the Leeds Cancer Centre, St. James's University Hospital, Leeds, LS9 7TF, UK
| | - Jessica Anne Savage
- Department of Plastic Surgery, Salisbury District Hospital, Salisbury, SP2 8BJ, UK
| | - Baek Kim
- The Breast Unit at the Leeds Cancer Centre, St. James's University Hospital, Leeds, LS9 7TF, UK
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Villanueva K, Patel H, Ghosh D, Klomhaus A, Slack G, Festekjian J, Da Lio A, Tseng C. A Single-center Comparison of Surgical Outcomes following Prepectoral and Subpectoral Implant-based Breast Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5880. [PMID: 38859804 PMCID: PMC11163997 DOI: 10.1097/gox.0000000000005880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/17/2024] [Indexed: 06/12/2024]
Abstract
Background Prepectoral implant placement continues to gain widespread acceptance as a safe and effective option for breast reconstruction. Current literature demonstrates comparable rates of complications and revisions between prepectoral and subpectoral placement; however, these studies are underpowered and lack long-term follow-up. Methods We performed a retrospective cohort study of patients who underwent immediate two-staged tissue expander or direct-to-implant breast reconstruction at a single center from January 2017 to March 2021. Cases were divided into prepectoral and subpectoral cohorts. The primary outcomes were postoperative complications, aesthetic deformities, and secondary revisions. Descriptive statistics and multivariable regression models were performed to compare the demographic characteristics and outcomes between the two cohorts. Results We identified 996 breasts (570 patients), which were divided into prepectoral (391 breasts) and subpectoral (605 breasts) cohorts. There was a higher rate of complications (P < 0.001) and aesthetic deformities (P = 0.02) with prepectoral breast reconstruction. Secondary revisions were comparable between the two cohorts. Multivariable regression analysis confirmed that prepectoral reconstruction was associated with an increased risk of complications (odds ratio 2.39, P < 0.001) and aesthetic deformities (odds ratio 1.62, P = 0.003). Conclusions This study evaluated outcomes in patients undergoing prepectoral or subpectoral breast reconstruction from a single center with long-term follow-up. Prepectoral placement was shown to have an inferior complication and aesthetic profile compared with subpectoral placement, with no difference in secondary revisions. These findings require validation with a well-designed randomized controlled trial to establish best practice for implant-based breast reconstruction.
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Affiliation(s)
- Karie Villanueva
- From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, Calif
| | - Harsh Patel
- From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, Calif
| | - Durga Ghosh
- Los Angeles David Geffen School of Medicine, University of California, Los Angeles, Calif
| | - Alexandra Klomhaus
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, Calif
| | - Ginger Slack
- From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, Calif
| | - Jaco Festekjian
- From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, Calif
| | - Andrew Da Lio
- From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, Calif
| | - Charles Tseng
- From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, Calif
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6
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Seitz AJ, MacKenzie EL, Edalatpour A, Janssen DA, Doubek WG, Afifi AM. Quantifying the Impact of Prepectoral Implant Conversion on Patient Satisfaction and Quality of Life. Plast Reconstr Surg 2024; 153:884e-894e. [PMID: 37335561 DOI: 10.1097/prs.0000000000010829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND Conversion of subpectoral reconstruction to the prepectoral plane has been increasing in popularity. However, there is a paucity of research assessing patient-reported outcomes after this operation. The primary aim of this study was to examine patient-reported outcomes after conversion of implants from the subpectoral to prepectoral plane using the BREAST-Q. METHODS The authors retrospectively examined patients who underwent subpectoral-to-prepectoral implant conversion by three surgeons at two separate centers from 2017 through 2021. Patient demographics, primary indication for the conversion, surgical characteristics, postoperative outcomes, and BREAST-Q scores were obtained. RESULTS Sixty-eight breasts in 39 patients underwent implant conversion. The most common primary indications for implant conversion were chronic pain (41%), animation deformity (31%), and cosmetic concerns (28%). Average BREAST-Q scores improved significantly preoperatively to postoperatively in all the domains measured (satisfaction with breasts, satisfaction with implants, physical well-being, psychosocial well-being, and sexual well-being) ( P < 0.01). When examined by primary indication, all cohorts had significant preoperative to postoperative score improvement in satisfaction with breasts ( P < 0.001) and physical well-being ( P < 0.01) domains. Fifteen breasts (22%) developed postoperative complications, with implant loss in 9% of breasts. CONCLUSIONS Conversion of subpectoral implants to the prepectoral plane significantly improves BREAST-Q outcomes in all aspects, including patient satisfaction with breasts and implants, as well as psychosocial, physical, and sexual well-being. Implant conversion to the prepectoral plane is becoming the authors' primary solution for most patients with chronic pain, animation deformity, or cosmetic concerns after subpectoral reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Allison J Seitz
- From the Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health
| | - Ethan L MacKenzie
- From the Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health
| | - Armin Edalatpour
- From the Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health
| | | | | | - Ahmed M Afifi
- From the Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health
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Danilla S, Cayupán C, Cala L, Durán H. Long-Term Satisfaction with Breast Augmentation and Augmentation Mastopexy in the Latin American Population. Aesthetic Plast Surg 2024:10.1007/s00266-024-03900-x. [PMID: 38438758 DOI: 10.1007/s00266-024-03900-x] [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: 11/29/2023] [Accepted: 01/30/2024] [Indexed: 03/06/2024]
Abstract
OBJECTIVE The primary objective of this study was to determine the long-term satisfaction levels of women who have undergone breast augmentation and augmentation mastopexy procedures, while identifying the factors influencing patient satisfaction. METHODS A self-reported retrospective case study design was used to collect data from women with breast implants. The study employed a survey that included demographic information, preoperative diagnosis, implant details, and patient-reported outcomes measured using the Breast-Q Instrument, which evaluates satisfaction with breasts, self-esteem, sexual well-being, and physical symptoms. Statistical analyses were conducted to identify correlations and differences in outcomes between the different variables. RESULTS The survey was completed by 1022 women from 19 countries, with Chile, Mexico, and Colombia being the most represented. Augmentation was performed on 72.2% of the patients, while 27.7% underwent augmentation mastopexy. Patient satisfaction with breast size and shape varied significantly between the two procedures, with patients undergoing augmentation mastopexy showing less satisfaction. In addition, patients who were unaware of their implant shape or placement reported lower satisfaction scores. The study also found that patient satisfaction decreased over time in the augmentation mastopexy cases and that patients with high body mass index had lower satisfaction. CONCLUSION Augmentation mastopexy in patients with breast ptosis yields lower satisfaction than augmentation alone. Dissatisfaction escalates with overweight/obesity (BMI), post-surgery time, and misinformation. Implant pocket (pre-vs. subpectoral), shape (round vs. anatomical), and size did not impact satisfaction. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Stefan Danilla
- Clínica Aurea, Juan XXIII 6130, Vitacura, Santiago, Chile.
| | - Claudia Cayupán
- School of Public Health, University of Chile, Santiago, Chile
| | - Laura Cala
- Eternal Beauty, Private Practice, Bogotá, Colombia
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Allam O, Dinis J, Almeida MN, Junn A, Mozaffari MA, Shah R, Chong L, Olawoyin O, Mehta S, Park KE, Avraham T, Alperovich M. Smooth versus Textured Tissue Expanders: Comparison of Outcomes and Complications in 536 Implants. Arch Plast Surg 2024; 51:42-51. [PMID: 38425846 PMCID: PMC10901592 DOI: 10.1055/s-0043-1775592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/27/2023] [Indexed: 03/02/2024] Open
Abstract
Background Increasing concerns regarding the safety of textured surface implants have resulted in surgeons transitioning from textured tissue expanders (TEs) to smooth TEs. Given this change has only recently occurred, this study evaluated outcomes between smooth and textured TEs. Methods Women who underwent two-stage breast reconstruction using TEs from 2013 to 2022 were included. TE-specific variables, perioperative information, pain scores, and complications were collected. Chi-squared, t -test, and linear regression analyses were performed. Results A total of 320 patients received a total of 384 textured and 152 smooth TEs. Note that 216 patients received bilateral reconstruction. TEs were removed in 9 cases. No significant differences existed between groups regarding comorbidities. Smooth TEs had a higher proportion of prepectoral placement ( p < 0.001). Smooth TEs had less fills (3 ± 1 vs. 4 ± 2, p < 0.001), shorter expansion periods (60 ± 44 vs. 90 ± 77 days, p < 0.001), smaller expander fill volumes (390 ± 168 vs. 478 ± 177 mL, p < 0.001), and shorter time to exchange (80 ± 43 vs. 104 ± 39 days, p < 0.001). Complication rates between textured and smooth TEs were comparable. Smooth TE had a greater proportion of TE replacements ( p = 0.030). On regression analysis, pain scores were more closely associated with age ( p = 0.018) and TE texture ( p = 0.046). Additional procedures at time of TE exchange ( p < 0.001) and textured TE ( p = 0.017) led to longer operative times. Conclusion As many surgeons have transitioned away from textured implants, our study shows that smooth TEs have similar outcomes to the textured alternatives.
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Affiliation(s)
- Omar Allam
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Jacob Dinis
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Mariana N. Almeida
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Alexandra Junn
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Mohammad Ali Mozaffari
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Rema Shah
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | | | - Olamide Olawoyin
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Sumarth Mehta
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Kitae Eric Park
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Tomer Avraham
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Michael Alperovich
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
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Han WY, Han SJ, Eom JS, Kim EK, Han HH. A Comparative Study of Wraparound versus Anterior Coverage Placement of Acellular Dermal Matrix in Prepectoral Breast Reconstruction. Plast Reconstr Surg 2023; 152:716-724. [PMID: 36862962 DOI: 10.1097/prs.0000000000010347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Prepectoral direct-to-implant insertion (DTI) with acellular dermal matrix (ADM) is the currently preferred operation for breast reconstruction. There are different placements of ADM, which are largely classified as wraparound placement or anterior coverage placement. Because there are limited data comparing these two placements, this study aimed to compare the outcomes of these two methods. METHODS This was a retrospective study of immediate prepectoral DTI breast reconstructions performed by a single surgeon between 2018 and 2020. Patients were classified depending on the ADM placement type used. Surgical outcomes and breast shape changes using nipple position during follow-up were compared. RESULTS A total of 159 patients were included in the study, with 87 in the wraparound group and 72 in the anterior coverage group. Demographics were similar between the two groups, excluding ADM amount used (154.1 cm 2 versus 137.8 cm 2 ; P = 0.01). There were no significant differences in the overall rate of complications between the two groups, including seroma (6.90% versus 5.56%; P = 1.0), total drainage amount (762.1 mL versus 805.9 mL; P = 0.45), and capsular contracture (4.6% versus 1.39%; P = 0.38). The wraparound group had a significantly longer distance change than that of the anterior coverage group in the sternal notch-to-nipple distance (4.44% versus 2.08%; P = 0.03) and midclavicle-to-nipple distance (4.94% versus 2.64%; P = 0.04). CONCLUSIONS Wraparound and anterior coverage placement of ADM in prepectoral DTI breast reconstruction showed similar complication rates, including seroma, drainage amount, and capsular contracture. However, wraparound placement can make the breast more ptotic in shape compared with anterior coverage placement. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Woo Yeon Han
- From the Department of Plastic and Reconstructive Surgery, Yongin Severance Hospital, Yonsei University College of Medicine
| | - Seong John Han
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Jin Sup Eom
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Eun Key Kim
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Hyun Ho Han
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine
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10
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Vingan PS, Kim M, Rochlin D, Allen RJ, Nelson JA. Prepectoral Versus Subpectoral Implant-Based Reconstruction: How Do We Choose? Surg Oncol Clin N Am 2023; 32:761-776. [PMID: 37714642 DOI: 10.1016/j.soc.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
Aspects of a patient's lifestyle, their state of health, breast size, and mastectomy skin flap quality are factors that influence the suggested plane of dissection in implant-based breast reconstruction. This article aims to review developments in prosthetic breast reconstruction and provide recommendations to help providers choose whether prepectoral or subpectoral reconstruction in the best approach for each of their patients.
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Affiliation(s)
- Perri S Vingan
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Minji Kim
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Danielle Rochlin
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Robert J Allen
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Jonas A Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Supper P, Semmler L, Placheta-Györi E, Teufelsbauer M, Harik-Chraim E, Radtke C. [Update and Trends in Breast Reconstruction After Mastectomy]. HANDCHIR MIKROCHIR P 2023; 55:253-261. [PMID: 37487507 PMCID: PMC10415025 DOI: 10.1055/a-2082-1542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 02/15/2023] [Indexed: 07/26/2023] Open
Abstract
Due to refinements in operating techniques, autologous breast reconstruction has become part of standard care. It has become more difficult to advise patients due to the expansion of oncologic options for mastectomy, radiation therapy and the variety of reconstructive techniques. The goal of reconstruction is to achieve oncologically clear margins and a long-term aesthetically satisfactory result with a high quality of life. Immediate reconstruction preserves the skin of the breast and its natural form and prevents the psychological trauma associated with mastectomy. However, secondary reconstructions often have a higher satisfaction, since here no restitutio ad integrum is assumed. Alloplastic, i. e., implant-based, breast reconstruction and autologous breast reconstruction are complementary techniques. This article provides an overview of current options for breast reconstruction including patients' satisfaction and quality of life following breast reconstruction. Although immediate reconstruction is still the preferred choice of most patients and surgeons, delayed reconstruction does not appear to compromise clinical or patient-reported outcomes. Recent refinements in surgical techniques and autologous breast reconstruction include stacked-flaps, as well as microsurgical nerve coaptation to restore sensitivity, which lead to improved outcomes and quality of life. Nowadays Skin-sparing and nipple-sparing mastectomy, accompanied by improved implant quality, allows immediate prosthetic breast reconstruction as well as reemergence of the prepectoral implantation. The choice of breast reconstruction depends on the type of mastectomy, necessary radiation, individual risk factors, as well as the patient's habitus and wishes. Overall, recent developments in breast reconstruction led to an increase in patient satisfaction, quality of life and aesthetic outcome with oncological safety.
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Affiliation(s)
- Paul Supper
- Universitätsklinik für Plastische, Rekonstruktive und
Ästhetische Chirurgie, Medizinische Universität
Wien
| | - Lorenz Semmler
- Universitätsklinik für Plastische, Rekonstruktive und
Ästhetische Chirurgie, Medizinische Universität
Wien
| | - Eva Placheta-Györi
- Universitätsklinik für Plastische, Rekonstruktive und
Ästhetische Chirurgie, Medizinische Universität
Wien
| | - Maryana Teufelsbauer
- Universitätsklinik für Plastische, Rekonstruktive und
Ästhetische Chirurgie, Medizinische Universität
Wien
| | - Elissa Harik-Chraim
- Universitätsklinik für Plastische, Rekonstruktive und
Ästhetische Chirurgie, Medizinische Universität
Wien
| | - Christine Radtke
- Universitätsklinik für Plastische, Rekonstruktive und
Ästhetische Chirurgie, Medizinische Universität
Wien
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Caputo G, Scarabosio A, Di Filippo J, Contessi Negrini F, Albanese R, Mura S, Parodi PC. Optimizing Acellular Dermal Matrix Integration in Heterologous Breast Reconstructive Surgery: Surgical Tips and Post-Operative Management. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1231. [PMID: 37512043 PMCID: PMC10383214 DOI: 10.3390/medicina59071231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/13/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023]
Abstract
Background and Objective: Prepectoral implant placement in breast reconstruction is currently a must-have in the portfolios of breast surgeons. The introduction of new tools and conservative mastectomies is a game changer in this field. The prepectoral plane usually goes hand-in-hand with the ADM wrapping of the implant. It is a cell-free dermal matrix comprising a structurally integrated basement membrane complex and an extracellular matrix. The literature reports that ADMs may be useful, but proper patient selection, surgical placement, and post-operative management are essential to unlock the potential of this tool, as these factors contribute to the proper integration of the matrix with surrounding tissues. Materials and Methods: A total of 245 prepectoral breast reconstructions with prostheses or expanders and ADMs were performed in our institution between 2016 and 2022. A retrospective study was carried out to record patient characteristics, risk factors, surgical procedures, reconstructive processes, and complications. Based on our experience, we developed a meticulous reconstruction protocol in order to optimize surgical practice and lower complication rates. The DTI and two-stage reconstruction were compared. Results: Seroma formation was the most frequent early complication (less than 90 days after surgery) that we observed; however, the majority were drained in outpatient settings and healed rapidly. Secondary healing of wounds, which required a few more weeks of dressing, represented the second most frequent early complication (10.61%). Rippling was the most common late complication, particularly in DTI patients. After comparing the DTI and two-stage reconstruction, no statistically significant increase in complications was found. Conclusions: The weakness of prepectoral breast reconstruction is poor matrix integration, which leads to seroma and other complications. ADM acts like a graft; it requires firm and healthy tissues to set in. In order to do so, there are three key steps to follow: (1) adequate patient selection; (2) preservative and gentle handling of intra-operative technique; and (3) meticulous post-operative management.
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Affiliation(s)
- Glenda Caputo
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine (Italy), 33100 Udine, Italy
| | - Anna Scarabosio
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine (Italy), 33100 Udine, Italy
| | - Jacopo Di Filippo
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine (Italy), 33100 Udine, Italy
| | - Filippo Contessi Negrini
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine (Italy), 33100 Udine, Italy
| | - Roberta Albanese
- Clinic of Plastic and Reconstructive Surgery, Ospedale Santa Maria della Misericordia, 33100 Udine, Italy
| | - Sebastiano Mura
- Clinic of Plastic and Reconstructive Surgery, Ospedale Santa Maria della Misericordia, 33100 Udine, Italy
| | - Pier Camillo Parodi
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine (Italy), 33100 Udine, Italy
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Wignarajah P, Malata CM, Benson JR. Oncoplastic and reconstructive breast surgery. Front Oncol 2023; 13:1176915. [PMID: 37448512 PMCID: PMC10338173 DOI: 10.3389/fonc.2023.1176915] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/15/2023] [Indexed: 07/15/2023] Open
Abstract
This article provides an overview of the principles and techniques of oncoplastic and reconstructive breast surgery for patients with early-stage breast cancer. Oncoplastic breast surgery (OPBS) with partial breast reconstruction is a natural evolution in the application of breast conserving surgery and permits wide surgical resection of tumours that might otherwise mandate mastectomy and whole breast reconstruction. These reconstructive techniques must be optimally selected and integrated with ablative breast surgery together with non-surgical treatments such as radiotherapy and chemotherapy that may be variably sequenced with each other. A multidisciplinary approach with shared decision-making is essential to ensure optimal clinical and patient-reported outcomes that address oncological, aesthetic, functional and psychosocial domains. Future practice of OPBS must incorporate routine audit and comprehensive evaluation of outcomes.
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Affiliation(s)
- Primeera Wignarajah
- Department of Breast Surgery, Royal Marsden Hospital NHS Trust, London, United Kingdom
- Department of Breast Surgery, Cambridge Breast Unit, Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Charles M Malata
- Department of Breast Surgery, Cambridge Breast Unit, Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Department of Plastic and Reconstructive Surgery, Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Anglia Ruskin University School of Medicine, Cambridge/Chelmsford, United Kingdom
| | - John R Benson
- Department of Breast Surgery, Cambridge Breast Unit, Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Anglia Ruskin University School of Medicine, Cambridge/Chelmsford, United Kingdom
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Ceravolo MP, de Vita R. INVITED DISCUSSION ON: Prepectoral Versus Subpectoral Direct-to-Implant Breast Reconstruction: Evaluation of Patient's Quality of Life and Satisfaction with BREAST-Q. Aesthetic Plast Surg 2023:10.1007/s00266-023-03393-0. [PMID: 37261493 DOI: 10.1007/s00266-023-03393-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/02/2023] [Indexed: 06/02/2023]
Affiliation(s)
| | - Roy de Vita
- Plastic and Reconstructive Surgery Department, IRCSS - "Regina Elena" National Cancer Institute, Rome, Italy
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15
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Saiga M, Nakagiri R, Mukai Y, Matsumoto H, Kimata Y. Trends and issues in clinical research on satisfaction and quality of life after mastectomy and breast reconstruction: a 5-year scoping review. Int J Clin Oncol 2023:10.1007/s10147-023-02347-5. [PMID: 37160493 DOI: 10.1007/s10147-023-02347-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/20/2023] [Indexed: 05/11/2023]
Abstract
Breast reconstruction (BR) aims to improve the satisfaction and quality of life (QOL) of breast cancer survivors. Clinical studies using patient-reported outcomes (PROs) can therefore provide relevant information to the patients and support decision-making. This scoping review was conducted to analyze recent trends in world regions, methods used, and factors investigated. The literature search was conducted in August 2022. Databases of PubMed, MEDLINE, and CINAHL were searched for relevant English-language studies published from 2017 to 2022. Studies involving women with breast cancer who underwent BR after mastectomy and investigated PROs after BR using BR-specific scales were included. Data on the country, publication year, study design, PRO measures (PROMs) used, time points of surveys, and research themes were collected. In total, 147 articles met the inclusion criteria. BREAST-Q was the most widely used, contributing to the increase in the number and diversification of studies in this area. Such research has been conducted mainly in North America and Europe and is still developing in Asia and other regions. The research themes involved a wide range of clinical and patient factors in addition to surgery, which could be influenced by research methods, time since surgery, and even cultural differences. Recent BR-specific PROMs have led to a worldwide development of research on factors that affect satisfaction and QOL after BR. PRO after BR may be influenced by local cultural and social features, and it would be necessary to accumulate data in each region to draw clinically useful conclusion.
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Affiliation(s)
- Miho Saiga
- Department of Plastic Surgery, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, Okayama City, Okayama, 700-8558, Japan.
| | - Ryoko Nakagiri
- Department of Plastic Surgery, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Yuko Mukai
- Department of Plastic Surgery, Okayama Rosai Hospital, Okayama, Japan
| | - Hiroshi Matsumoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshihiro Kimata
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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16
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Montorfano L, Hung YC, Chaker S, Saad M, Kalmar CL, Ferri F, Higdon KK, Perdikis G. Examination of Outcome Disparities in Reports of Prepectoral and Subpectoral Direct-to-Implant Reconstruction: A Systematic Review and Meta-analysis. Ann Plast Surg 2023; 90:506-515. [PMID: 36975095 DOI: 10.1097/sap.0000000000003524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND There are mixed results in surgical complications regarding the usage of prepectoral versus subpectoral implant placement in direct-to-implant breast reconstruction. This study aimed to provide a comprehensive synthesis of surgical complications between the subpectoral and prepectoral reconstructive method. METHODS PubMed, Embase, and Cochrane were searched for literature published up until December 2022. Studies that compared subpectoral and prepectoral breast reconstruction and reported at least one postoperative complication were included. The following 8 major outcomes were included: revision and reoperation, capsular contracture, explantation, seroma, hematoma, infection, skin necrosis, and animation deformity. Systematic review and meta-analysis were performed to compare outcomes of the 2 techniques. Subgroup analysis was performed to compare whether practice differences in different countries may have an impact on outcomes. RESULTS A total of 18 studies were identified in our literature search. Two thousand three hundred sixty patients were included, representing a total of 3135 breasts. Our analysis demonstrated that prepectoral reconstruction had significantly lower odds of developing postoperative hematoma [odds ratio (OR), 0.62; P = 0.05], seroma (OR, 0.67; P = 0.01), infection (OR, 0.64; P = 0.03), revision and reoperation (OR, 0.44; P < 0.00001), and animation deformity (OR, 0.01; P < 0.00001), compared with the subpectoral method. Subgroup analysis showed that differences between 3 countries (United States, Korea, Italy) are low (all subgroup heterogeneity test P > 0.1). CONCLUSIONS While both subpectoral and prepectoral are safe methods for breast reconstruction, the prepectoral technique may lead to lower odds of developing multiple major postoperative complications.
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Affiliation(s)
- Lisandro Montorfano
- From the Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Ya-Ching Hung
- From the Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Sara Chaker
- From the Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Mariam Saad
- From the Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Christopher L Kalmar
- From the Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Francisco Ferri
- Department of Plastic Surgery, Cleveland Clinic Florida, Weston, FL
| | - Kent K Higdon
- From the Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Galen Perdikis
- From the Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
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17
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Cogliandro A, Salzillo R, De Bernardis R, Loria FS, Petrucci V, Barone M, Tenna S, Cagli B, Persichetti P. Prepectoral Versus Subpectoral Direct-to-Implant Breast Reconstruction: Evaluation of Patient's Quality of Life and Satisfaction with BREAST-Q. Aesthetic Plast Surg 2023:10.1007/s00266-023-03316-z. [PMID: 36944866 DOI: 10.1007/s00266-023-03316-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/26/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Over the years, plastic surgery has acquired a central role in the integrated treatment of breast cancer. Direct-to-implant (DTI) reconstruction using the prepectoral approach has emerged as an alternative to reconstruction using the subpectoral technique to overcome the complications arising from this type of surgery resulting as a consequence of muscle elevation. The satisfaction and quality of life of patients undergoing DTI breast reconstruction were evaluated using the BREAST-Q questionnaire, comparing the prepectoral and the subpectoral technique. METHODS A single-center cross-sectional study on patients who underwent mastectomy and DTI breast reconstruction at our institution between 2013 and 2021 was conducted. Eighty-one patients were included and mainly divided into two groups based on the surgical procedure: 52 patients undergoing a subpectoral breast reconstruction approach and 29 patients receiving a prepectoral breast reconstruction. In order to assess the quality of life, the postoperative BREAST-Q module was administered electronically to the enrolled patients. RESULTS Higher scores in BREAST-Q domains were recorded from patients who underwent mastectomy and breast reconstruction with prepectoral technique: psychosocial well-being (P<0.0085), sexual well-being (P<0.0120), physical well-being: lymphoedema (P<0.0001) and satisfaction with information received (P<0.0045). There were further statistically significant differences between the two groups with regard to postoperative complications (p<0.0465) and the need for reoperation (p<0.0275). CONCLUSIONS Patients who underwent DTI breast reconstruction with prepectoral technique were more satisfied in terms of psychosocial, sexual and also physical well-being. These patients also had statistically lower complications and reoperations compared to patients who received breast reconstruction with the subpectoral technique. LEVEL OF EVIDENCE IV This journal requires that authors 38 assign a level of evidence to each article. For a full 39 description of these Evidence-Based Medicine ratings, 40 please refer to the Table of Contents or the online 41 Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Annalisa Cogliandro
- Fondazione Policlinico Universitario, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy.
| | - Rosa Salzillo
- Fondazione Policlinico Universitario, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
| | - Riccardo De Bernardis
- Fondazione Policlinico Universitario, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
| | - Francesco Saverio Loria
- Fondazione Policlinico Universitario, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
| | - Valeria Petrucci
- Fondazione Policlinico Universitario, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
| | - Mauro Barone
- Fondazione Policlinico Universitario, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
- Research group "To be and to appear: Objective indication to Plastic Surgery" of Campus Bio-Medico University in Rome, Rome, Italy
| | - Stefania Tenna
- Fondazione Policlinico Universitario, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
| | - Barbara Cagli
- Fondazione Policlinico Universitario, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
| | - Paolo Persichetti
- Fondazione Policlinico Universitario, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
- Research group "To be and to appear: Objective indication to Plastic Surgery" of Campus Bio-Medico University in Rome, Rome, Italy
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18
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Ostapenko E, Nixdorf L, Devyatko Y, Exner R, Wimmer K, Fitzal F. Prepectoral Versus Subpectoral Implant-Based Breast Reconstruction: A Systemic Review and Meta-analysis. Ann Surg Oncol 2023; 30:126-136. [PMID: 36245049 PMCID: PMC9726796 DOI: 10.1245/s10434-022-12567-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/04/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Implant-based breast reconstruction (IBBR) remains the standard and most popular option for women undergoing breast reconstruction after mastectomy worldwide. Recently, prepectoral IBBR has resurged in popularity, despite limited data comparing prepectoral with subpectoral IBBR. METHODS A systematic search of PubMed and Cochrane Library from January 1, 2011 to December 31, 2021, was performed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) reporting guidelines, data were extracted by independent reviewers. Studies that compared prepectoral with subpectoral IBBR for breast cancer were included. RESULTS Overall, 15 studies with 3,101 patients were included in this meta-analysis. Our results showed that patients receiving prepectoral IBBR experienced fewer capsular contractures (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.32-0.92; P = 0.02), animation deformity (OR, 0.02; 95% CI, 0.00-0.25; P = 0.002), and prosthesis failure (OR, 0.58; 95% CI, 0.42-0.80; P = 0.001). There was no significant difference between prepectoral and subpectoral IBBR in overall complications (OR, 0.83; 95% CI, 0.64-1.09; P = 0.19), seroma (OR, 1.21; 95% CI, 0.59-2.51; P = 0.60), hematoma (OR, 0.76; 95% CI, 0.49-1.18; P = 0.22), infection (OR, 0.87; 95% CI, 0.63-1.20; P = 0.39), skin flap necrosis (OR, 0.70; 95% CI, 0.45-1.08; P = 0.11), and recurrence (OR, 1.31; 95% CI, 0.52-3.39; P = 0.55). Similarly, no significant difference was found in Breast-Q scores between the prepectoral and subpectoral IBBR groups. CONCLUSIONS The results of our systematic review and meta-analysis demonstrated that prepectoral, implant-based, breast reconstruction is a safe modality and has similar outcomes with significantly lower rates of capsular contracture, prosthesis failure, and animation deformity compared with subpectoral, implant-based, breast reconstruction.
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Affiliation(s)
- Edvin Ostapenko
- Department of General Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria ,Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Larissa Nixdorf
- Department of General Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Yelena Devyatko
- Department of General Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Ruth Exner
- Department of General Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Kerstin Wimmer
- Department of General Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Florian Fitzal
- Department of General Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
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Kim SE, Chun YS, Park HK, Kim YJ, Cheon YW. A prospective comparison of prepectoral and subpectoral methods for immediate breast reconstruction with acellular dermal matrix: the cogwheel-shaped anterior wrapping method. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2022. [DOI: 10.14730/aaps.2022.00570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Prepectoral breast reconstruction has recently gained wide recognition for its advantages, such as rapid recovery and less pain. This study compared the effectiveness of and differences between the prepectoral and subpectoral breast reconstruction techniques.Methods Eighty-three patients (90 breasts) who underwent prepectoral or subpectoral breast reconstruction surgery between January 2019 and December 2020 were prospectively recruited. Patient demographics, comorbidities, oncological treatment, and intraoperative and postoperative data were evaluated to investigate the validity and stability of each surgical technique. The follow-up period was a minimum of 18 months.Results The surgical cohorts (22 prepectoral and 68 subpectoral) had comparable demographics. No significant differences in postoperative complications were observed between the two groups. The prepectoral group showed shorter operation times than the subpectoral group (mean: 97.27 and 127.63 minutes, respectively; P<0.001). Fewer days elapsed until drain removal and the total amount of drainage was less in the prepectoral group than in the subpectoral group (mean: postoperative day [POD] 8.95 and 10.06, respectively; P=0.048) and (501.72 mL and 671.19 mL, respectively; P=0.009). The numeric pain rating scale (NPRS) scores at POD 7 were significantly lower in the prepectoral group than in the subpectoral group (mean: 0.41 and 1.82, respectively; P=0.029). There were no statistically significant differences in the NPRS scores at POD 1 or the BREAST-Q questionnaire scores at 3 months.Conclusions Prepectoral breast reconstruction using acellular dermal matrix can feasibly replace the conventional subpectoral breast reconstruction technique and has the advantages of reducing operation time, length of hospitalization, and long-term postoperative pain.
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20
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Soni SE, Le NK, Buller M, Modica AD, Kumar A, Smith PD, Laronga C. Complication Profile of Total Submuscular Versus Prepectoral Tissue Expander Placement: A Retrospective Cohort Study. Ann Plast Surg 2022; 88:S439-S442. [PMID: 35502960 DOI: 10.1097/sap.0000000000003165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We sought to compare the safety profile of prepectoral breast reconstruction with total submuscular tissue expander reconstruction, previously our standard. Primary outcomes of interest in this retrospective cohort study were incidence of infection, hematoma, seroma, mastectomy flap necrosis, and reconstruction loss. METHODS Total submuscular and prepectoral with acellular dermal matrix reconstructions consecutively performed by a single surgeon (P.D.S.) between January 1, 2016, and December 31, 2019, were compared. Demographic and clinical characteristics, as well as complications and complication types, were extracted for all patients. A t test was used to assess differences in continuous variables. Multivariate logistics regression was used to assess the association between type of reconstruction and complication rate. The statistical significance was set at 0.05 for all comparisons. RESULTS A total of 133 patients (234 breasts) were included. There was a significantly greater incidence of infection (16.5% vs 5.5%, P < 0.01) in the prepectoral/acellular dermal matrix cohort. However, reconstructive loss was low in both cohorts (2.5% and 3.0%, P = 0.83). Adjusted odds ratio for complications in the prepectoral cohort was 2.26, but this was not statistically significant (adjusted P = 0.24). CONCLUSIONS Prepectoral breast reconstruction shares an overall complication profile that is not greater than that of total submuscular reconstruction. It is associated with a greater risk of infection; however, the ability to salvage the reconstruction with early, aggressive intervention results in low rates of reconstructive loss, comparable with those of total submuscular reconstruction.
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Affiliation(s)
- Sara E Soni
- From the Department of Plastic Surgery, University of South Florida Morsani College of Medicine
| | - Nicole K Le
- From the Department of Plastic Surgery, University of South Florida Morsani College of Medicine
| | - Mitchell Buller
- From the Department of Plastic Surgery, University of South Florida Morsani College of Medicine
| | - Ashley D Modica
- From the Department of Plastic Surgery, University of South Florida Morsani College of Medicine
| | - Ambuj Kumar
- Department of Health Outcomes and Behavior, University of South Florida Morsani College of Medicine
| | | | - Christine Laronga
- Department of Women's Oncology, Breast Program, H. Lee Moffitt Cancer Center, Tampa, FL
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