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Pili N, Pasteris A, Serra PL, Sini G, Pinna M, Trignano E, Rubino C. Comparative evaluation using PRO of an algorithm of one-stage immediate alloplastic breast reconstruction versus two-stage reconstruction. J Plast Reconstr Aesthet Surg 2023; 84:487-495. [PMID: 37418847 DOI: 10.1016/j.bjps.2023.06.027] [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: 01/24/2023] [Revised: 05/30/2023] [Accepted: 06/03/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND One-stage direct-to-implant (DTI) immediate breast reconstruction has proven to be an oncologically safe technique, but there are some conditions that do not allow its performance. The introduction of new surgical techniques and the recent COVID-19 pandemic have pushed us to introduce a breast reconstruction algorithm in our clinical practice. This allows a one-stage immediate reconstruction for all patients, regardless of their anatomical characteristics, the type of implants used, and the need for postoperative radiotherapy. METHODS A total of 40 patients were recruited and divided into two cohorts, 20 patients underwent immediate one-stage breast reconstruction in the period between October 2019 and January 2021, and 20 patients completed the two-stage reconstructive process in the period prior to October 2019. During the follow-up at 6 months, all patients who had completed the reconstructive process filled out the Breast-Q Reconstruction Module Pre and Postoperative scales questionnaire. The outcomes of the questionnaires were compared between the two cohorts, and statistical analysis was carried out using SPSS Statistics 20 (IBM Corporation, Armonk, NY, USA). RESULTS The analysis of patient-reported outcomes showed that patients from the one-stage group reported better outcomes in all items evaluated. We did not find statistically significant differences concerning the rate of complications and length of hospital stay between the two groups. CONCLUSIONS The analysis of the results shows that the outcomes reported by patients who completed breast reconstruction according to our algorithm are statistically better than those with the two-stage technique.
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Affiliation(s)
- Nicola Pili
- Plastic Surgery Unit, Department of Oncology and Hematology, University Hospital Trust of Sassari, Viale San Pietro, 10, 07100 Sassari, Sardinia, Italy.
| | - Andrea Pasteris
- Plastic Surgery Unit, Department of Oncology and Hematology, University Hospital Trust of Sassari, Viale San Pietro, 10, 07100 Sassari, Sardinia, Italy
| | - Pietro L Serra
- Plastic Surgery Unit, Department of Oncology and Hematology, University Hospital Trust of Sassari, Viale San Pietro, 10, 07100 Sassari, Sardinia, Italy
| | - Germana Sini
- Plastic Surgery Unit, Department of Oncology and Hematology, University Hospital Trust of Sassari, Viale San Pietro, 10, 07100 Sassari, Sardinia, Italy
| | - Michela Pinna
- Plastic Surgery Unit, Department of Oncology and Hematology, University Hospital Trust of Sassari, Viale San Pietro, 10, 07100 Sassari, Sardinia, Italy
| | - Emilio Trignano
- Plastic Surgery Unit, Department of Oncology and Hematology, University Hospital Trust of Sassari, Viale San Pietro, 10, 07100 Sassari, Sardinia, Italy
| | - Corrado Rubino
- Plastic Surgery Unit, Department of Oncology and Hematology, University Hospital Trust of Sassari, Viale San Pietro, 10, 07100 Sassari, Sardinia, Italy
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József Z, Újhelyi M, Ping O, Domján S, Fülöp R, Ivády G, Tislér R, Rubovszky G, Mészáros N, Kenessey I, Mátrai Z. Long-Term Dynamic Changes in Cosmetic Outcomes and Patient Satisfaction after Implant-Based Postmastectomy Breast Reconstruction and Contralateral Mastopexy with or without an Ultrapro Mesh Sling Used for the Inner Bra Technique. A Retrospective Correlational Study. Cancers (Basel) 2020; 13:cancers13010073. [PMID: 33383874 PMCID: PMC7795018 DOI: 10.3390/cancers13010073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/11/2020] [Accepted: 12/24/2020] [Indexed: 12/21/2022] Open
Abstract
Simple Summary Immediate implant-based postmastectomy breast reconstruction (IPMBR) with contralateral symmetrization has mostly short-term limited evidence of cosmetic outcomes. Ageing after IPMBR and symmetrization may contribute to symmetry worsening. This non-interventional retrospective correlational study presents the clinical and aesthetic results of synthetic ULTRAPRO® mesh inner bra sling symmetrization mastopexy with standard mastopexies. A total of 59 patients were enrolled in the mesh group (MG), and 58 patients were enrolled in the non-mesh group (NMG). There were no significant differences in surgical complications (p = 0.521; chi-square. The median sternal notch-to-nipple distance difference was 1 cm in the MG and 3.5 cm in the NMG from the last follow-up, and the median nipple-to-inferior mammary fold distance differences were 0.5 cm and 0.75 cm. ULTRAPRO® mesh sling symmetrization can be successfully used to decrease pseudoptosis and nipple down-migration, offering a safe alternative for long-lasting symmetry and high patient satisfaction. Abstract Immediate implant-based postmastectomy breast reconstruction (IPMBR) with contralateral symmetrization has mostly short-term limited evidence of cosmetic outcomes. Because 84% of early-stage breast cancer patients have overall survival of more than 10 years, reconstructed breast symmetry should provide long-lasting results and acceptable patient satisfaction. Ageing, changes in body weight, and biomechanical changes after IPMBR and symmetrization may contribute to symmetry worsening. This non-interventional single-centre retrospective correlational study presents the clinical and aesthetic results of synthetic ULTRAPRO® mesh inner bra sling symmetrization mastopexy with standard mastopexies. According to the results, a total of 59 patients were enrolled in the mesh group (MG), and 58 patients were enrolled in the non-mesh group (NMG). There were no significant differences in surgical complications (p = 0.521; chi-square). The median sternal notch-to-nipple distance difference was 1 cm in the MG and 3.5 cm in the NMG from the last follow-up, and the median nipple-to-inferior mammary fold distance differences were 0.5 cm and 0.75 cm. The mesh did not hinder the follow-up investigation. In conclusion, ULTRAPRO® mesh sling symmetrization can be successfully used to decrease pseudoptosis and nipple down-migration, offering a safe alternative for long-lasting symmetry and high patient satisfaction.
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Affiliation(s)
- Zsófia József
- St. Imre Teaching Hospital, Department of Plastic Surgery, 12-16. Tétényi Rd., 1115 Budapest, Hungary;
| | - Mihály Újhelyi
- National Institute of Oncology, Department of Breast and Sarcoma Surgery, 7-9. Ráth György Str., 1122 Budapest, Hungary; (O.P.); (S.D.); (Z.M.)
- Correspondence: ; Tel.: +36-308380140
| | - Orsolya Ping
- National Institute of Oncology, Department of Breast and Sarcoma Surgery, 7-9. Ráth György Str., 1122 Budapest, Hungary; (O.P.); (S.D.); (Z.M.)
| | - Szilárd Domján
- National Institute of Oncology, Department of Breast and Sarcoma Surgery, 7-9. Ráth György Str., 1122 Budapest, Hungary; (O.P.); (S.D.); (Z.M.)
| | - Rita Fülöp
- National Institute of Oncology, Centre of Radiological Diagnostics, 7-9. Ráth György Str., 1122 Budapest, Hungary;
| | - Gabriella Ivády
- National Institute of Oncology, Centre of Pathology, 7-9. Ráth György Str., 1122 Budapest, Hungary;
| | - Ráhel Tislér
- Faculty of Medicine, Semmelweis University, 7-9. Ráth György Str., 1122 Budapest, Hungary;
| | - Gábor Rubovszky
- National Institute of Oncology, Department of Oncological Internal Medicine and Clinical Pharmacology, 7-9. Ráth György Str., 1122 Budapest, Hungary;
| | - Norbert Mészáros
- National Institute of Oncology, Centre of Radiotherapy, 7-9. Ráth György Str., 1122 Budapest, Hungary;
| | - István Kenessey
- National Institute of Oncology, National Cancer Registry, 7-9. Ráth György Str., 1122 Budapest, Hungary;
- Second Department of Pathology, Semmelweis University, 26. Üllői Str., 1085 Budapest, Hungary
| | - Zoltán Mátrai
- National Institute of Oncology, Department of Breast and Sarcoma Surgery, 7-9. Ráth György Str., 1122 Budapest, Hungary; (O.P.); (S.D.); (Z.M.)
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Huttin-Marquelet C, Huttin C. [Breast reconstruction with temporary tissue expander]. ANN CHIR PLAST ESTH 2018; 63:545-558. [PMID: 30041835 DOI: 10.1016/j.anplas.2018.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Tissue expansion in breast reconstruction is a technique based on a simple principle but subjected to numerous traps. Its success relies on the patient selection, a good preparation of the skin pocket, no rush during the inflating time, and a specific care during the definitive implant placement inside the skin pocket. This article aims to list and detail point-by-point the different surgical timings, their practical application, the pitfalls and the possible traps to avoid, in order to succeed in breast reconstruction using tissue expander.
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Affiliation(s)
- C Huttin-Marquelet
- Chirurgie plastique, reconstructrice, et esthétique, clinique Saint-Nabor, 75, rue des Généraux-Altmayer, 57500 Saint-Avold, France.
| | - C Huttin
- Service de chirurgie plastique, reconstructrice, et esthétique, hôpital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
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Opuchlik A, Włoch A, Biskup M, Ridan T, Wróbel P, Jonak R, Curyło M. The effect of oncological treatment in breast cancer patients on functional effi ciency of the upper limb and the principles of physiotherapeutic management. REHABILITACJA MEDYCZNA 2018. [DOI: 10.5604/01.3001.0012.0912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Breast cancer is the most common malignant tumour and the second cause of death among women in Poland following lung cancer. Its therapy includes a number of procedures, including surgical treatment, the choice of which depends, among others, on the histological form of the cancer and disease severity. In recent years, radical surgical techniques have been replaced by conserving ones, and in the context of routine resection of the axillary lymph nodes (lymphadenectomy), biopsy was introduced, i.e. sentinel lymph node biopsy (SNB). Also, wide access to reconstructive treatments carried out with various techniques, using patients’ own tissues or artificial materials (breast implants) have been applied.
Study aim: The aim of the work is to present the current state of knowledge on the principles of breast cancer treatment and its undesirable consequences, as well as the selection of physiotherapeutic methods depending on the type of upper limb dysfunction as a result of the performed surgery.
Research materials: The research materials consist of patients treated using various surgical and oncological methods as well as physiotherapeutic procedures at the Holy Cross Oncology Centre in Kielce, from 2014 to 2016. The written consent of the Clinic Chief and patients for the publication of their image was obtained. The authors of the work do not indicate any conflict of interest.
Research Methods: The research methodology was based on the presentation of selected patients treated using various oncological and surgical methods for breast cancer treatment, as well as characterization of the physiotherapeutic methods necessary in restoring expected functional upper limb status in these patients.
Conclusions: Modern methods used in breast cancer treatment should be conditioned by good cooperation of an entire team of specialists from various clinical areas and physiotherapists. The purpose of this procedure is to cure the patient, minimize the occurrence of complications and adverse side effects, and restore functional capacity. An integral part of such breast cancer treatment patients is, among others, their effective rehabilitation.
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Affiliation(s)
- Anna Opuchlik
- Wszechnica Świętokrzyska w Kielcach, Wydział Wychowania Fizycznego i Turystyki, Katedra Fizjoterapii / Department of Physiotherapy, Faculty of Physical Education and Tourism, Holy Cross University in Kielce, Poland
| | - Anna Włoch
- Uniwersytet Jana Kochanowskiego w Kielcach, Wydział Lekarski i Nauk o Zdrowiu, Instytut Fizjoterapii / Institute of Physiotherapy, Faculty of Medicine and Health Sciences, Jan Kochanowski University in Kielce, Poland
| | - Małgorzata Biskup
- Uniwersytet Jana Kochanowskiego w Kielcach, Wydział Lekarski i Nauk o Zdrowiu, Instytut Fizjoterapii / Institute of Physiotherapy, Faculty of Medicine and Health Sciences, Jan Kochanowski University in Kielce, Poland
| | - Tomasz Ridan
- Akademia Wychowania Fizycznego, Zakład Kinezyterapii, Katedra Fizjoterapii, Kraków / Department of Physiotherapy, Kinesiotherapy Unit, University of Physical Education, Krakow, Poland
| | - Piotr Wróbel
- Krakowska Akademia im. A. F. Modrzewskiego, Wydział Zdrowia i Nauk Medycznych, Kraków / Faculty of Medicine and Health Sciences, Krakow A. F. Modrzewski Academy, Poland
| | - Robert Jonak
- Wszechnica Świętokrzyska w Kielcach, Wydział Wychowania Fizycznego i Turystyki, Katedra Fizjoterapii / Department of Physiotherapy, Faculty of Physical Education and Tourism, Holy Cross University in Kielce, Poland
| | - Mateusz Curyło
- Akademia Wychowania Fizycznego, Zakład Kinezyterapii, Katedra Fizjoterapii, Kraków / Department of Physiotherapy, Kinesiotherapy Unit, University of Physical Education, Krakow, Poland
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Szychta P, Raine C, Butterworth M, Stewart K, Witmanowski H, Zadrozny M, Rykala J. Preoperative implant selection for two stage breast reconstruction with 3D imaging. Comput Biol Med 2014; 44:136-43. [DOI: 10.1016/j.compbiomed.2013.09.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 09/12/2013] [Accepted: 09/16/2013] [Indexed: 11/25/2022]
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