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Capella-Monsonís H, Crum RJ, Hussey GS, Badylak SF. Advances, challenges, and future directions in the clinical translation of ECM biomaterials for regenerative medicine applications. Adv Drug Deliv Rev 2024; 211:115347. [PMID: 38844005 DOI: 10.1016/j.addr.2024.115347] [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: 03/26/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 06/11/2024]
Abstract
Extracellular Matrix (ECM) scaffolds and biomaterials have been widely used for decades across a variety of diverse clinical applications and have been implanted in millions of patients worldwide. ECM-based biomaterials have been especially successful in soft tissue repair applications but their utility in other clinical applications such as for regeneration of bone or neural tissue is less well understood. The beneficial healing outcome with the use of ECM biomaterials is the result of their biocompatibility, their biophysical properties and their ability to modify cell behavior after injury. As a consequence of successful clinical outcomes, there has been motivation for the development of next-generation formulations of ECM materials ranging from hydrogels, bioinks, powders, to whole organ or tissue scaffolds. The continued development of novel ECM formulations as well as active research interest in these materials ensures a wealth of possibilities for future clinical translation and innovation in regenerative medicine. The clinical translation of next generation formulations ECM scaffolds faces predictable challenges such as manufacturing, manageable regulatory pathways, surgical implantation, and the cost required to address these challenges. The current status of ECM-based biomaterials, including clinical translation, novel formulations and therapies currently under development, and the challenges that limit clinical translation of ECM biomaterials are reviewed herein.
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Affiliation(s)
- Héctor Capella-Monsonís
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Pittsburgh, PA 15219, USA; Department of Surgery, School of Medicine, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA; Viscus Biologics LLC, 2603 Miles Road, Cleveland, OH 44128, USA
| | - Raphael J Crum
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Pittsburgh, PA 15219, USA; Department of Surgery, School of Medicine, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - George S Hussey
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Pittsburgh, PA 15219, USA; Department of Pathology, School of Medicine, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Stephen F Badylak
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Pittsburgh, PA 15219, USA; Department of Surgery, School of Medicine, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh, 3700 O'Hara Street, Pittsburgh, PA 15261, USA.
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Hu Y, Diao W, Wen S, Kpegah JKSK, Xiao Z, Zhou X, Zhou J, Li P. The Usage of Mesh and Relevant Prognosis in Implant Breast Reconstruction Surgery: A Meta-analysis. Aesthetic Plast Surg 2024:10.1007/s00266-024-03879-5. [PMID: 38438762 DOI: 10.1007/s00266-024-03879-5] [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: 12/14/2023] [Accepted: 01/25/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Although mesh-based implant breast reconstruction surgery is emerging as the primary surgical procedure for breast reconstruction, mesh use remains controversial in implant breast reconstruction surgery, especially in terms of how to select the ideal mesh. Our aim is to elaborate relevant prognosis in the mesh-based implant breast reconstruction surgery. METHODS Relevant studies were identified from PubMed, Web of Science, EMBASE, and Cochrane library searches. Extracted data included study type, basic characteristics, mesh information, complications, etc. We analyzed the included cohort studies and randomized controlled trials that reported mesh-related implant breast reconstruction complications and breast quality scale scores. RESULTS A total of 32 studies including 7475 subjects were included. The results showed that the overall complication rate was 2.07 times higher in the biological mesh group than in the synthetic mesh group (risk ratio [RR]: 2.07, 95% CI 1.14-3.78). The risk of seroma was 4.50 times higher in the biological mesh group than in the synthetic mesh group (RR: 4.50, 95% CI 2.27-8.95). In terms of comparing breast quality scale scores, the mesh group had scores that were 1.49 (95% CI 0.19-2.78) higher than the non-mesh group for "physical well-being" and 2.05 (95% CI 0.08-4.02) higher for "sexual well-being." CONCLUSIONS Our study found that the risk of total complications was higher with biological mesh than with synthetic mesh in implant breast reconstruction surgery. Based on short-term cost, healthcare burden, and healthcare benefits, synthetic meshes are superior to biological meshes. 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)
- Yang Hu
- Department of Plastic Surgery of Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Wuliang Diao
- Department of Plastic Surgery of Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Shiyi Wen
- Department of Plastic Surgery of Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Julius K S K Kpegah
- Department of Plastic Surgery of Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Zhenyang Xiao
- Department of Plastic Surgery of Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Xuan Zhou
- Center for Medical Research, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jianda Zhou
- Department of Plastic Surgery of Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, China.
| | - Ping Li
- Department of Plastic Surgery of Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, China.
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Gruber J, Schlagnitweit P, Koulaxouzidis G. Safety and aesthetic outcomes of SERASYNTH Ⓡ MESH BR for direct-to-implant breast reconstruction: A retrospective single center analysis of 32 consecutive cases. JPRAS Open 2023; 38:82-90. [PMID: 37745008 PMCID: PMC10514390 DOI: 10.1016/j.jpra.2023.08.001] [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: 05/21/2023] [Accepted: 08/06/2023] [Indexed: 09/26/2023] Open
Abstract
Background Bilateral mastectomy for both therapeutic and prophylactic reasons is becoming increasingly important. To achieve good results after mastectomy, synthetic meshes are often used as an alternative to acellular dermal matrices (ADMs). The aim of this study is to analyze the results of subcutaneous mastectomies and direct-to-implant breast reconstruction using SERASYNTHⓇ MESH BR. Methods In this work, data from mastectomies (n = 32) in 22 patients without prior radiation after breast reconstruction with SERASYNTHⓇ MESH BR from a single center were retrospectively analyzed with 1 year follow-up. Complications were categorized as serious (need for revision surgery) and minor events. Statistical analysis was performed using the t-test in SPSS. Data were compared with the existing literature. Results Major complications occurred in 15.6% (n = 5). Two out of five revisions were due to hematoma. In three cases, a seroma followed by other complications (e.g., infections, necrosis) necessitated revision. Minor complications occurred in 12.5% of cases. Due to the safety aspect, implants were replaced in each revision. There was no significant difference in complication rates between prophylactic and therapeutic mastectomies (p = 0.3815, SE = 0.171). There was no statistically significant difference in esthetic outcomes (p = 0.3846). Conclusion The application of the absorbable polymer poly-p-dioxanone SERASYNTHⓇ MESH BR has complication rates comparable to those reported in the existing literature. Careful patient selection is paramount in order to limit the complication rate. SERASYNTHⓇ MESH BR can be considered a safe tool to achieve esthetic results in combination with direct-to-implant breast reconstruction.
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Affiliation(s)
- Julia Gruber
- Department of Plastic, Aesthetic and Reconstructive Surgery, Sisters of Mercy Hospital Linz, Austria
- Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital Wels-Grieskirchen, Austria
| | - Paul Schlagnitweit
- Department of Plastic, Aesthetic and Reconstructive Surgery, Sisters of Mercy Hospital Linz, Austria
| | - Georgios Koulaxouzidis
- Department of Plastic, Aesthetic and Reconstructive Surgery, Sisters of Mercy Hospital Linz, Austria
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Dueñas-Rodríguez B, Navarro-Cecilia J, Luque-López C, Sánchez-Andujar B, Garcelán-Trigo JA, Ramírez-Expósito MJ, Martínez-Martos JM. Single-Stage Immediate Breast Reconstruction with Acellular Dermal Matrix after Breast Cancer: Comparative Study and Evaluation of Breast Reconstruction Outcomes. Cancers (Basel) 2023; 15:5349. [PMID: 38001609 PMCID: PMC10670310 DOI: 10.3390/cancers15225349] [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: 10/10/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
We evaluate postoperative complications, aesthetic results and satisfaction outcomes in patients with breast cancer after intervening with a skin-sparing or nipple-sparing mastectomy with an immediate prosthetic reconstruction with or without a biological mesh. Patients with multifocal breast cancer, ductal carcinoma in situ with an indication for a mastectomy and cT2 tumors with no response to primary systemic treatment were included, whereas patients aged >75 years, with inflammatory carcinoma, and severe circulatory disorders were excluded. Patients in the control group were reconstructed using a prosthesis, whereas the study group included patients reconstructed using a prosthesis and biological acellular porcine dermal mesh (Strattice™). In both groups, the result was assessed using the BREAST-Q instrument. A total of 51 patients (62 intervened breasts) were included in the study group and 38 patients (41 intervened breasts) in the control group. Implant loss and removal occurred in three patients in the study group (5.9%) and nine patients in the control group (24.3%; p = 0.030). Infections appeared in three patients in the study group (4.8%) and three patients in the control group (7.3%; p = 1.00). Skin necrosis appeared in 5 patients in the study group (12.2%) and 11 patients in the control group (21.6%; p = 0.367). Seroma appeared in five patients in the study group (12.2%) and five patients in the control group (8.1%; p = 0.514). The BREAST-Q questionnaire is a comparison between both groups regarding "satisfaction with breasts after surgery" (p = 0.026), "sexual well-being after intervention" (p = 0.010) and "satisfaction with the information received" (p = 0.049). We have noted a statistically significant decrease in implant loss in women receiving an implant with a biological mesh. A higher satisfaction was observed in patients reconstructed using Strattice™, with statistically significant differences in three items.
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Affiliation(s)
- Basilio Dueñas-Rodríguez
- Unit of Breast Pathology, Department of Surgery, Hospital Complex of Jaén, 23007 Jaén, Spain; (B.D.-R.); (J.N.-C.); (B.S.-A.)
| | - Joaquín Navarro-Cecilia
- Unit of Breast Pathology, Department of Surgery, Hospital Complex of Jaén, 23007 Jaén, Spain; (B.D.-R.); (J.N.-C.); (B.S.-A.)
| | - Carolina Luque-López
- Department of Gynecology and Obstetrics, Hospital Complex of Jaén, 23007 Jaén, Spain;
| | - Belén Sánchez-Andujar
- Unit of Breast Pathology, Department of Surgery, Hospital Complex of Jaén, 23007 Jaén, Spain; (B.D.-R.); (J.N.-C.); (B.S.-A.)
| | | | - María Jesús Ramírez-Expósito
- Experimental and Clinical Physiopathology Research Group CTS-1039, Department of Health Sciences, School of Experimental and Health Sciences, University of Jaén, 23071 Jaén, Spain;
| | - José Manuel Martínez-Martos
- Experimental and Clinical Physiopathology Research Group CTS-1039, Department of Health Sciences, School of Experimental and Health Sciences, University of Jaén, 23071 Jaén, Spain;
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Karoobi M, Yazd SMM, Nafissi N, Zolnouri M, Khosravi M, Sayad S. Comparative clinical outcomes of using three-dimensional and TIGR mesh in immediate breast reconstruction surgery for breast cancer patients. J Plast Reconstr Aesthet Surg 2023; 86:321-328. [PMID: 37826925 DOI: 10.1016/j.bjps.2023.07.038] [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: 04/05/2023] [Revised: 06/21/2023] [Accepted: 07/16/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Breast reconstruction (BR) surgery is a widely utilized approach for women who have undergone mastectomy. Using synthetic mesh can offer advantages over other materials providing long-lasting support and natural-looking results. This study aims to compare the effectiveness of 3DMax™ mesh to TIGR mesh in BR surgery, providing clear information about the non-inferiority of 3DMax™ mesh to TIGR. METHODS This retrospective cohort study evaluates postoperative complications in breast cancer patients who underwent subcutaneous mastectomy with direct-to-implant immediate BR using silicone implants and either 3DMax™ mesh or TIGR® Matrix Surgical Mesh. RESULTS This study involved BR surgeries in 82 patients, including 57 surgeries in the 3D mesh group and 49 in the TIGR mesh group. The two groups had no significant differences regarding age, body mass index (BMI), cancer stage, or surgical complications. However, patients with neoadjuvant chemotherapy or radiotherapy had higher incidence rates of long-term complications than other patients. Patients with infection or partial necrosis had a heightened risk of implant loss. CONCLUSION The clinical results obtained in this study suggest that among synthetic meshes used in immediate BR, 3DMax™ is not inferior to TIGR Matrix Surgical Mesh regarding complications.
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Affiliation(s)
| | | | - Nahid Nafissi
- Department of General Surgery, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), Iran University of Medical Sciences, Tehran, Iran.
| | - Mina Zolnouri
- Department of General Surgery, school of medicine, rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Khosravi
- Department of General Surgery, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Soheila Sayad
- Department of Surgery, Firoozgar Clinical Research Development Center, Iran University of Medical Sciences, Tehran, Iran
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Grous A, Mazur S, Winter P, Kozak K, Jagiello-Gruszfeld A, Napierała M, Nowecki Z. Immediate breast reconstruction in breast cancer patients with the use of Serasynth and SeragynBR synthetic meshes. Single-oncological center experience, analysis of complications. POLISH JOURNAL OF SURGERY 2023; 96:11-20. [PMID: 38629281 DOI: 10.5604/01.3001.0016.3172] [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: 04/19/2024]
Abstract
<br><b>Introduction:</b> The use of meshes in mastectomies with immediate breast reconstruction (IBR) has become the gold standard.</br> <br><b>Aim:</b> The use of meshes in mastectomies with immediate breast reconstruction (IBR) has become a gold standard. The purpose of the study was to analyze the complications and own experience with the use of Serasynth fully absorbable and SeragynBR partially absorbable synthetic meshes.</br> <br><b>Material and methods:</b> In the period from December 2017 to July 2020, 118 IBR were performed in the Author's Department with the use of SeragynBR and Serasynth meshes in 93 patients operated for breast cancer. 78 Serasynth meshes (Group 1) and 40 SeragynBR meshes (Group 2) were implanted.</br> <br><b>Results:</b> The most common complication was persistent seroma collection, which was reported in 17.9% of cases in Group 1 and 25% in Group 2. Skin inflammation was reported in 7.6% and 17.5%, while infections in 2.5% and 5% of the operated breasts in Group 1 and Group 2. Reoperation was required in 5.1% and 5% of the patients in Group 1 and Group 2. The percentage of complications was lower when Serasynth rather than Seragyn BR meshes were implanted. The frequent incidence of the seroma collection did not contribute in any significant way to serious complications such as removal of mesh/implant or infection. The complications, which developed following the implantation of both mesh types, were similar to those presented in other publications concerning mastectomy with IBR with the use of synthetic meshes. The percentage of implant losses/explanations in the discussed groups was lower than that reported in the literature.</br> <br><b>Conclusion:</b> Despite the complications, both types of meshes can be considered as safe additions to reconstructive breast surgeries.</br> <br><b>Level of Evidence:</b> Level III.</br>.
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Affiliation(s)
- Aleksander Grous
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska Curie Memorial Cencer Center and Institute of Oncology, Warsaw, Poland
| | - Slawomir Mazur
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska Curie Memorial Cencer Center and Institute of Oncology, Warsaw, Poland
| | - Paweł Winter
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska Curie Memorial Cencer Center and Institute of Oncology, Warsaw, Poland
| | - Krzysztof Kozak
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska Curie Memorial Cencer Center and Institute of Oncology, Warsaw, Poland
| | - Agnieszka Jagiello-Gruszfeld
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska Curie Memorial Cencer Center and Institute of Oncology, Warsaw, Poland
| | - Marcin Napierała
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska Curie Memorial Cencer Center and Institute of Oncology, Warsaw, Poland
| | - Zbigniew Nowecki
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska Curie Memorial Cencer Center and Institute of Oncology, Warsaw, Poland
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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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Makarewicz N, Perrault D, Sharma A, Shaheen M, Kim J, Calderon C, Sweeney B, Nazerali R. Comparing the Outcomes and Complication Rates of Biologic vs Synthetic Meshes in Implant-Based Breast Reconstruction: A Systematic Review. Ann Plast Surg 2023; 90:516-527. [PMID: 37146317 DOI: 10.1097/sap.0000000000003512] [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: 05/07/2023]
Abstract
OBJECTIVE This systematic review evaluates all published studies comparing biologic and synthetic meshes in implant-based breast reconstruction (IBBR), to determine which category of mesh produces the most favorable outcomes. SUMMARY BACKGROUND DATA Breast cancer is the most common cancer in women globally. Implant-based breast reconstruction is currently the most popular method of postmastectomy reconstruction, and recently, the use of surgical mesh in IBBR has become commonplace. Although there is a long-standing belief among surgeons that biologic mesh is superior to synthetic mesh in terms of surgical complications and patient outcomes, few studies exist to support this claim. METHODS A systematic search of the EMBASE, PubMed, and Cochrane databases was performed in January 2022. Primary literature studies comparing biologic and synthetic meshes within the same experimental framework were included. Study quality and bias were assessed using the validated Methodological Index for Non-Randomized Studies criteria. RESULTS After duplicate removal, 109 publications were reviewed, with 12 meeting the predetermined inclusion criteria. Outcomes included common surgical complications, histological analysis, interactions with oncologic therapies, quality of life measures, and esthetic outcomes. Across all 12 studies, synthetic meshes were rated as at least equivalent to biologic meshes for every reported outcome. On average, the studies in this review tended to have moderate Methodological Index for Non-Randomized Studies scores. CONCLUSION This systematic review offers the first comprehensive evaluation of all publications comparing biologic and synthetic meshes in IBBR. The consistent finding that synthetic meshes are at least equivalent to biologic meshes across a range of clinical outcomes offers a compelling argument in favor of prioritizing the use of synthetic meshes in IBBR.
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Affiliation(s)
- Nathan Makarewicz
- From the Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA
| | - David Perrault
- From the Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA
| | - Ayushi Sharma
- From the Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA
| | - Mohammed Shaheen
- From the Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA
| | - Jessica Kim
- Loma Linda School of Medicine, Loma Linda, CA
| | - Christian Calderon
- From the Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA
| | - Brian Sweeney
- From the Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA
| | - Rahim Nazerali
- From the Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA
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Samaha Y, Chen J, Ray EC. ADMs and synthetic meshes improve implant-based breast reconstruction aesthetics, but at what cost? J Plast Reconstr Aesthet Surg 2023; 80:178-181. [PMID: 37028245 DOI: 10.1016/j.bjps.2023.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/08/2023] [Accepted: 03/15/2023] [Indexed: 04/09/2023]
Abstract
Acellular dermal matrices (ADMs) have shown promise for use in reconstructive breast surgery as they improve aesthetic outcomes and decrease capsular contracture rates. However, concerns about their use remain because of the higher cost and complication profile. We report a single institution's implant-based-reconstruction (IBR) experience between 2007 and 2021, including cases performed by 51 plastic surgeons. For each stage of IBR, data on age, comorbidities, type of mesh used, and acute complications were collected. Of 1379 patients who underwent subpectoral IBR, 937 received an ADM or synthetic mesh as part of their reconstruction. 256 patients out of 264 treated with prepectoral IBR received an ADM or mesh. Infection and wound dehiscence rates were highest for patients who underwent prepectoral IBR with ADM. Both subpectoral and prepectoral IBR with ADM were associated with higher rates of infection and wound complications compared to without ADM or mesh, but only the difference among the subpectoral cohort reached statistical significance. Prepectoral IBR with ADM or mesh had the lowest rates of capsular contracture and aesthetic reoperations. Although the use of Vicryl® mesh in subpectoral IBR was associated with a higher risk of capsular contracture and skin flap necrosis compared to reconstruction with ADMs (10.53% versus 3.29%; p < 0.05), Vicryl® was associated with fewer aesthetic revisions. Our study demonstrated that prepectoral IBR with ADM or mesh resulted in the fewest aesthetic reoperations and the lowest rates of capsular contracture. Infection and wound dehiscence rates were notably higher for patients who had reconstruction with ADM.
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Affiliation(s)
- Yasmina Samaha
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jiaxi Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Edward C Ray
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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10
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Jaiswal S, Hannineh R, Nadimpalli S, Lieber S, Chester SA. Characterization and modeling of the in-plane collagen fiber distribution in the porcine dermis. Med Eng Phys 2023; 115:103973. [PMID: 37120170 DOI: 10.1016/j.medengphy.2023.103973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/06/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023]
Abstract
The structural arrangement of collagen fibers in the plane of the dermis layer plays a critical role in accurately predicting the mechanical behavior of skin tissues. This paper combines a histological analysis with statistical modeling to characterize and model the in-plane collagen fiber distribution in the porcine dermis. The histology data reveals that the fiber distribution in the plane of the porcine dermis is non-symmetric. The histology data forms the basis of our model, which employs a combination of two π-periodic von-Mises distribution density functions to create a non-symmetric distribution. We demonstrate that a non-symmetric in-plane fiber distribution is a significant improvement over a symmetric distribution.
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11
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Rampazzo S, Spissu N, Pinna M, Sini GAM, Trignano E, Nonnis R, Sanna C, Rodio M, Tettamanzi M, Rubino C. One-Stage Immediate Alloplastic Breast Reconstruction in Large and Ptotic Breasts: An Institutional Algorithm. J Clin Med 2023; 12:jcm12031170. [PMID: 36769816 PMCID: PMC9917996 DOI: 10.3390/jcm12031170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Immediate implant-based breast reconstruction in patients with large and ptotic breasts may be challenging due to skin redundancy. The use of a reduction mammoplasty pattern for the mastectomy skin excision has proven to be a reliable option for these patients as it allows for a better shape, projection, and symmetrization. This approach has been described in the literature for both one- and two-stage reconstruction with either sub- or pre-pectoral reconstruction with an acellular dermal matrix (ADM) or non-biological mesh. One-stage immediate breast reconstructions have a positive significant impact on patients' psychosocial well-being and quality of life. The purpose of this paper is to describe an institutional algorithm that allows one to perform one-stage implant-based breast reconstructions in patients with large and ptotic breasts.
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Affiliation(s)
- Silvia Rampazzo
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy
- Plastic, Reconstructive and Aesthetic Surgery Training Program, University of Sassari, 07100 Sassari, Italy
| | - Noemi Spissu
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy
| | - Michela Pinna
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy
| | - Germana A. M. Sini
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy
| | - Emilio Trignano
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Rita Nonnis
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy
| | - Claudia Sanna
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy
- Plastic, Reconstructive and Aesthetic Surgery Training Program, University of Sassari, 07100 Sassari, Italy
- Correspondence:
| | - Manuela Rodio
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy
- Plastic, Reconstructive and Aesthetic Surgery Training Program, University of Sassari, 07100 Sassari, Italy
| | - Matilde Tettamanzi
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy
- Plastic, Reconstructive and Aesthetic Surgery Training Program, University of Sassari, 07100 Sassari, Italy
| | - Corrado Rubino
- Plastic Surgery Unit, University Hospital Trust of Sassari, 07100 Sassari, Italy
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
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12
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Baychorov EA, Zikiryakhodzhaev AD, Ismagilov AK, Przhedetskiy YV. The influence of synthetic and biologic matrices on the choice of the implant plane during breast reconstruction. The modern state of the problem. TUMORS OF FEMALE REPRODUCTIVE SYSTEM 2022. [DOI: 10.17650/1994-4098-2022-18-3-64-70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Immediately after silicone implants were described, the technique of prepectoral implant placement dominated in breast reconstructive surgery. However, this plane soon had to be abandoned due to the high frequency of complications, such as infection, capsular contracture, explantation. For these reasons, surgeons soon had to switch to the subpectoral plane. Several decades later, thanks to the discovery of synthetic and biological meshes, surgeons returned to the prepectoral plane, but at a technically new level.The purpose of this review was to analyze the role of biological and synthetic matrices as factors influencing the choice of the implant plane in one-stage breast reconstruction.
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Affiliation(s)
| | - A. D. Zikiryakhodzhaev
- P. Hertsen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Centre of the Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia
| | - A. Kh. Ismagilov
- Kazan State Medical Academy – branch of Federal State Budgetary Educational Institution of Higher Professional Education of Russian Medical Academy of Postgraduate Education of Ministry of Health of Russia; Republican Clinical Сancer Center named after prof. M. Z. Sigal
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13
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Biological Cover Mitigates Disruption of the Dermal Structure in Mechanically Expanded Skin in a Porcine Model. Int J Mol Sci 2022; 23:ijms232113091. [PMID: 36361876 PMCID: PMC9659138 DOI: 10.3390/ijms232113091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 12/05/2022] Open
Abstract
Tissue expansion is an integral procedure of the vast majority of breast reconstruction and has a significant impact on the final clinical outcomes. Therefore, technological advances leading to a fewer number of unfavorable outcomes and a decrease in complication rates are imperative. In this study, using a porcine model, we investigated an effect of acellular dermal matrix (ADM) used as a tissue expander cover on the dermal changes induced by mechanical forces during tissue expansion. After 14 days of expansion, skin samples were collected from one animal, while the second animal underwent radiation, and tissue was collected 8 weeks later. Tissue expanded without the use of ADM and unexpanded skin served as the controls. Collected skin biopsies were used for histological and immunohistochemical evaluation, and for gene expression analysis. We revealed that the biological cover incorporation into host tissue is facilitated by macrophages without inducing a broad inflammatory response. The utilization of ADM mitigated disruption in the dermal structure, excessive collagen deposition, and capsule formation in non-irradiated expanded skin. The protective effect was not fully maintained in irradiated skin. These results demonstrate that tissue expansion might be improved by using the tissue expander cover.
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14
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Overbeck N, Beierschmitt A, May BCH, Qi S, Koch J. In-Vivo Evaluation of a Reinforced Ovine Biologic for Plastic and Reconstructive Procedures in a Non-human Primate Model of Soft Tissue Repair. EPLASTY 2022; 22:e43. [PMID: 36160663 PMCID: PMC9490877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Biologic matrices are used in plastic and reconstructive surgical procedures to aid in the kinetics of soft tissue repair and promote functional tissue formation. The human acellular dermal matrix AlloDerm is widely used; however, it is offered at a relatively high cost, and its dermal composition may not provide an ideal remodeling scaffold. OviTex Plastic and Reconstructive Surgery (PRS) Resorbable and Permanent are reinforced biologic matrices engineered with layers of ovine forestomach matrix embroidered with small amounts of polymer to optimize biophysical performance. This study compared the healing outcomes of these matrices in a non-human primate model of soft tissue repair. METHODS Animals were implanted with test articles in surgically created full-thickness midline abdominal wall defects and evaluated macroscopically and histologically at 2, 4, 12, and 24 weeks. RESULTS Both OviTex PRS Permanent and Resorbable matrices exhibited earlier host cell infiltration, neovascularization, and collagen deposition and also fully remodeled into the host tissue by 12 weeks post implantation. AlloDerm had less host cell infiltration and neovascularization at early time points and never fully integrated into the surrounding host tissue. There was no statistical difference in overall inflammation between AlloDerm and either OviTex PRS product at any time point, despite small amounts of polymer reinforcement in OviTex products. CONCLUSIONS In a primate soft tissue repair model, OviTex PRS Permanent and Resorbable matrices performed comparably with the leading human acellular dermal matrix. OviTex PRS Permanent and Resorbable are less expensive than alternatives like AlloDerm and may promote faster host cell proliferation and functional remodeling in some soft tissue repair applications.
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Affiliation(s)
| | - Amy Beierschmitt
- Behavioural Science Foundation, Basseterre, Saint Kitts and Nevis
| | | | - Shijie Qi
- University of Montreal, Montreal, QC, Canada
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15
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Guimier E, Carson L, David B, Lambert JM, Heery E, Malcolm RK. Pharmacological Approaches for the Prevention of Breast Implant Capsular Contracture. J Surg Res 2022; 280:129-150. [PMID: 35969932 DOI: 10.1016/j.jss.2022.06.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 06/17/2022] [Accepted: 06/29/2022] [Indexed: 11/15/2022]
Abstract
Capsular contracture is a common complication associated with breast implants following reconstructive or aesthetic surgery in which a tight or constricting scar tissue capsule forms around the implant, often distorting the breast shape and resulting in chronic pain. Capsulectomy (involving full removal of the capsule surrounding the implant) and capsulotomy (where the capsule is released and/or partly removed to create more space for the implant) are the most common surgical procedures used to treat capsular contracture. Various structural modifications of the implant device (including use of textured implants, submuscular placement of the implant, and the use of polyurethane-coated implants) and surgical strategies (including pre-operative skin washing and irrigation of the implant pocket with antibiotics) have been and/or are currently used to help reduce the incidence of capsular contracture. In this article, we review the pharmacological approaches-both commonly practiced in the clinic and experimental-reported in the scientific and clinical literature aimed at either preventing or treating capsular contracture, including (i) pre- and post-operative intravenous administration of drug substances, (ii) systemic (usually oral) administration of drugs before and after surgery, (iii) modification of the implant surface with grafted drug substances, (iv) irrigation of the implant or peri-implant tissue with drugs prior to implantation, and (v) incorporation of drugs into the implant shell or filler prior to surgery followed by drug release in situ after implantation.
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Affiliation(s)
| | - Louise Carson
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Benny David
- NuSil Technology LLC, Carpinteria, California
| | | | | | - R Karl Malcolm
- School of Pharmacy, Queen's University Belfast, Belfast, UK.
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16
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Chiemi JA, Kelishadi SS. "Never Trust the Skin": A Rationale for Using Polydioxanone Internal Support Matrix to Minimize Scarring in Primary Mastopexy-Augmentation-An Observational Study. Aesthet Surg J Open Forum 2022; 4:ojac048. [PMID: 35795883 PMCID: PMC9252024 DOI: 10.1093/asjof/ojac048] [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] [Indexed: 11/20/2022] Open
Abstract
Background The process of scar formation is complex and multi-factorial. Basic plastic surgery tenets focus on tension-free techniques to optimize aesthetic outcomes and minimize scarring. Objectives Prophylactic use of a polydioxanone (PDO) internal support matrix in cosmetic mastopexy-augmentation to decrease scar burden has never before been described. Methods A high volume (n = 41) single-surgeon mastopexy-augmentation experience (S.S.K.) followed scar quality in consecutive cases from June 2020 to July 2021. A minimum of 6 months of postoperative evaluation was required to assess scar quality. Fitzpatrick scores were also evaluated and compared. All surgeries in this study were performed in the dual plane using silicone gel implants, a superior or superomedial dermal pedicle blood supply, and a wise-pattern or vertical scar. Scar quality was evaluated by photography and scored according to an internally developed scar quality scale. Results There have been no cases of hypertrophic or keloid scarring. All patients receiving mastopexy-augmentation with prophylactic PDO mesh have a favorable appearance with fine line scars, and the mean scar quality scale score across the cohort was 4.341/5. The mean Fitzpatrick scale score across the cohort was 2.97, and, of the patients who scored a 5 on the scar quality index, the mean Fitzpatrick scale score was 3.545. Conclusions Prophylactic use of PDO internal support matrix in silicone gel mastopexy-augmentation offers further protection against poor scarring in patients across the Fitzpatrick scale, with varying degrees of skin quality, and across medium to high-volume implant augmentations. Patients who received PDO prophylaxis demonstrated a better-than-average scar appearance. Level of Evidence 4
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Affiliation(s)
| | - Shahrooz Sean Kelishadi
- Corresponding Author:Dr Shahrooz Sean Kelishadi, 500 Superior Avenue Suite 340, Newport Beach, CA 92663, USA. E-mail: ; Twitter @sskplasticsurg
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17
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Omranipour R, Mohammadizavieh M, Alipour S. Use of Inguinal Hernia Mesh (DynaMesh-ENDOLAP) in Immediate Implant-based Breast Reconstruction. Aesthetic Plast Surg 2022; 46:677-682. [PMID: 34590167 DOI: 10.1007/s00266-021-02581-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The rate of immediate implant-based breast reconstruction after mastectomy is increasing, and providing enough coverage for the implant is mandatory; however the choice of appropriate mesh for implant coverage is controversial. Considering the high cost and the limited availability of breast-dedicated meshes in our country, we conducted this study to investigate the consequences of using a polyvinylidene fluoride (PVDF) mesh designed for endoscopic and laparoscopic hernia repair (ENDOLAP) as a coverage for breast prostheses in breast reconstruction. MATERIALS AND METHODS A retrospective cross-sectional study was performed on data of patients who had underwent immediate implant-based breast reconstruction between 2012 and 2019. After skin sparing mastectomy and subpectoral implant insertion, the exposed lower and lateral parts were covered with the mesh. RESULTS Seventy-nine reconstructions were performed on 62 patients. The average follow-up was 31.9 months (ranges 6-102 months). Postoperative complications including small flap necrosis (3.8%), seroma (8.9%), infection (5.1%), hematoma (3.8%), malposition (1.3%), rippling (1.3%), grade two and three capsular contracture (2.5%), and chronic pain (1.3%) occurred in 19% of the operated breasts. The complication rate requiring intervention was 5.3%, and no implant loss was observed. None of the patients who received radiation developed complications. CONCLUSION ENDOLAP mesh is a cost-effective and safe option for implant coverage in immediate implant-based breast reconstruction, with an acceptable complication rate. 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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18
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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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19
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Mok HP, Wen L, Lin X, Lin X, Liao N, Zhang G. Submuscular Implant-Based Breast Reconstruction Using a Musculofascial Pocket Formed by the Pectoralis Major Muscle and the Serratus Anterior Muscle Fascia: A Novel Surgical Approach. World J Surg 2022; 46:1451-1456. [PMID: 35355101 DOI: 10.1007/s00268-022-06522-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Subpectoral implant-based breast reconstruction following mastectomy commonly severs the inferior border of the pectoralis major muscle for better projection of the lower pole. This can affect a patient's postoperative motor function and result in animation deformity. Implant-based breast reconstruction using partial muscle coverage with an acellular dermal matrix (ADM) can be costly. There is an unmet clinical need for a novel surgical method for submuscular implant-based breast reconstruction. METHODS We describe an innovative technique for submuscular implant-based breast reconstruction following mastectomy. The approach utilizes the serratus anterior muscle fascia connected to the lateral margin of the pectoralis major muscle to form a lateral tissue pocket for implant coverage. This method preserves the inferior border of the pectoralis major muscle and minimizes the size of ADM coverage. Patient satisfaction on the BREAST-Q Reconstruction Module and complications were assessed 12 months after surgery. RESULTS The novel surgical design was safe and used minimal ADM (6 × 5cm2). Mean satisfaction with breasts was 61 ± 4.7 (range, 48-73), mean psychosocial well-being was 66 ± 10 (range, 50-93), and mean sexual well-being was 47 ± 7.8 (range, 27-70). Animation deformity was avoided by preserving the inferior border of the pectoralis major muscle. Rates of revision (7.6%) and postsurgical seroma (3.4%) were low, and capsular contracture was minimal. CONCLUSIONS Submuscular implant-based breast reconstruction following mastectomy utilizing the serratus anterior muscle fascia connected to the lateral margin of the pectoralis major muscle to form a lateral tissue pocket for implant coverage is safe, feasible, and generates good aesthetic outcomes.
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Affiliation(s)
- Hsiao-Pei Mok
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2 Road, Guangzhou, 510120, Guangdong, China
| | - Lingzhu Wen
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2 Road, Guangzhou, 510120, Guangdong, China
| | - Xiaoyi Lin
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2 Road, Guangzhou, 510120, Guangdong, China
| | - Xin Lin
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2 Road, Guangzhou, 510120, Guangdong, China
| | - Ning Liao
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2 Road, Guangzhou, 510120, Guangdong, China.
| | - Guochun Zhang
- Department of Breast Cancer, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2 Road, Guangzhou, 510120, Guangdong, China.
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20
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Chiemi JA, Kelishadi SS. Polydioxanone Internal Support Matrix: A Rationale for Prophylactic Internal Bra Support in Breast Augmentation. Aesthet Surg J Open Forum 2022; 4:ojac021. [PMID: 35592182 PMCID: PMC9113087 DOI: 10.1093/asjof/ojac021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Textured breast implants have been used in aesthetic breast surgery to decrease the rates of implant malposition. A recent analysis of a large-volume single-surgeon experience found statistically similar rates of malposition in smooth vs micro-textured breast implants. Objectives Prophylactic use of a polydioxanone (PDO) internal support matrix in breast augmentation was hypothesized to prevent scar malposition and increase pocket control. Methods In total, 200 patients received silicone gel primary augmentations performed by a single surgeon from January 2018 to December 2020; 84 patients received smooth implants alone; 49 patients received micro-textured implants; and 67 patients received smooth implants plus PDO internal support matrix. All surgeries were performed in the dual plane using an inframammary incision. Implant-related complications and scar malposition were recorded and compared. Results No significant difference in implant-related complication rates was found between shell types (3.57% for smooth devices alone and 2.04% for textured devices [P = 0.62; 95% CI −0.06 to 0.01]). There were zero complications in the smooth plus mesh study arm. A comparison of scar malposition rates between the smooth alone and textured groups revealed no significant difference (15.4% for smooth devices and 8.16% for textured devices [P = 0.23; 95% CI −0.12 to 0.01]). The smooth implant group with the prophylactic placement of PDO mesh had the lowest scar malposition rate of 4.48%, a significant difference compared with the smooth devices alone (P = 0.03; 95% CI −0.21 to −0.01). Conclusions Micro-textured devices show a trend toward decreased scar malposition, although not significant. Prophylactic use of PDO internal support matrix in silicone gel breast augmentation is safe and has the lowest incidence of scar malposition. Level of Evidence: 3
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21
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Pérez-Rubio Á, Estellés Vidagany N, Martínez López E, Martínez García R, Sospedra Ferrer R. Immediate Breast Reconstruction with Prosthesis and Titanized Mesh Using a Dual-Plane Approach: Complications and Risk Factors Analysis. Aesthetic Plast Surg 2022; 46:115-122. [PMID: 34331098 DOI: 10.1007/s00266-021-02489-9] [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: 05/11/2021] [Accepted: 07/18/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The immediate breast reconstruction after mastectomy has gained prominence in recent years and is considered one of the main procedures in oncoplastic surgery. In the case of reconstruction with prostheses, the use of a mesh to extend the pectoralis major muscle is often required to partially cover the implant. The main objective of this study was to determine the percentage of complications in immediate breast reconstructions with a titanized mesh using a dual-plane approach and establish risk factors for prosthesis complications and extrusion. MATERIALS AND METHODS A retrospective study that included women who received postmastectomy reconstructions from January 2012 to December 2019 in a secondary hospital in Spain. RESULTS A total of 57 immediate reconstructions were performed in 47 women. There were complications in 16 mastectomies (28.1%), of which seven (12.3%) were Clavien-Dindo ≤ IIIa and nine (15.7%) were IIIb. A total of three patients presented prosthetic extrusion, and the prosthesis was removed in five. The degree of contracture according to the Baker scale was I-II in 50 mastectomies (87.7%) and III-IV in seven (12.3%). CONCLUSION The immediate breast reconstruction with a titanized mesh using a dual-plane approach is a technique with an acceptable percentage of complications. The need for a Wise pattern and the necrosis of the nipple-areola complex in the postoperative period are risk factors for implant loss. Patients undergoing radiotherapy and/or chemotherapy and with a previous surgery are more likely to present capsular contracture. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors.
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Affiliation(s)
- Álvaro Pérez-Rubio
- Department of General and Digestive System Surgery, Doctor Peset University Hospital, Avenida Gaspar Aguilar, 90, 46017, Valencia, Spain.
| | - Nuria Estellés Vidagany
- Department of General and Digestive System Surgery, Doctor Peset University Hospital, Avenida Gaspar Aguilar, 90, 46017, Valencia, Spain
| | - Elías Martínez López
- Department of General and Digestive System Surgery, Doctor Peset University Hospital, Avenida Gaspar Aguilar, 90, 46017, Valencia, Spain
| | - Rosario Martínez García
- Department of General and Digestive System Surgery, Doctor Peset University Hospital, Avenida Gaspar Aguilar, 90, 46017, Valencia, Spain
| | - Rafael Sospedra Ferrer
- Department of General and Digestive System Surgery, Hospital Vithas Valencia 9 de Octubre, Valencia, Spain
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22
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Early Clinical Outcomes of Polydioxanone Mesh for Prepectoral Prosthetic Breast Reconstruction. Plast Reconstr Surg Glob Open 2022; 10:e4082. [PMID: 35186635 PMCID: PMC8849407 DOI: 10.1097/gox.0000000000004082] [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: 07/24/2021] [Accepted: 11/29/2021] [Indexed: 11/26/2022]
Abstract
Many biologic matrices and synthetic meshes are available as adjuncts for prosthetic and autologous breast reconstructions to help control implant position and to reinforce abdominal flap donor sites. Absorbable synthetic meshes may have advantages over biologic matrices and permanent meshes, such as lower cost and better long-term biocompatibility. We present a prospective case series of patients undergoing two-stage, prepectoral breast reconstruction with polydioxanone (PDO) mesh.
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23
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O'Donnell JPM, Murphy D, Ryan ÉJ, Gasior SA, Sugrue R, O'Neill BL, Boland MR, Lowery AJ, Kerin MJ, McInerney NM. Optimal reconstructive strategies in the setting of post-mastectomy radiotherapy - A systematic review and network meta-analysis. Eur J Surg Oncol 2021; 47:2797-2806. [PMID: 34301444 DOI: 10.1016/j.ejso.2021.07.001] [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: 03/18/2021] [Revised: 05/17/2021] [Accepted: 07/05/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND A third of breast cancer patients require mastectomy. In some high-risk cases postmastectomy radiotherapy (PMRT) is indicated, threatening reconstructive complications. Several PMRT and reconstruction combinations are used. Autologous flap (AF) reconstruction may be immediate (AF→PMRT), delayed-immediate with tissue expander (TE [TE→PMRT→AF]) or delayed (PMRT→AF). Implant-based breast reconstruction (IBBR) includes immediate TE followed by PMRT and conversion to permanent implant (PI [TE→PMRT→PI]), delayed TE insertion (PMRT→TE→PI), and prosthetic implant conversion prior to PMRT (TE→PI→PMRT). AIM Perform a network metanalysis (NMA) assessing optimal sequencing of PMRT and reconstructive type. METHODS A systematic review and NMA was performed according to PRISMA-NMA guidelines. NMA was conducted using R packages netmeta and Shiny. RESULTS 16 studies from 4182 identified, involving 2322 reconstructions over three decades, met predefined inclusion criteria. Studies demonstrated moderate heterogeneity. Multiple comparisons combining direct and indirect evidence established AF-PMRT as the optimal approach to avoid reconstructive failure, compared with IBBR strategies (versus PMRT→TE→PI; OR [odds ratio] 0.10, CrI [95% credible interval] 0.02 to 0.55; versus TE→PMRT→PI; OR 0.13, CrI 0.02 to 0.75; versus TE→PI→PMRT OR 0.24, CrI 0.05 to 1.05). PMRT→AF best avoided infection, demonstrating significant improvement versus PMRT→TE→PI alone (OR 0.12, CrI 0.02 to 0.88). Subgroup analysis of IBBR found TE→PI→PMRT reduced failure rates (OR 0.35, CrI 0.15-0.81) compared to other IBBR strategies but increased capsular contracture. CONCLUSION Immediate AF reconstruction is associated with reduced failure in the setting of PMRT. However, optimal reconstructive strategy depends on patient, surgeon and institutional factors. If IBBR is chosen, complication rates decrease if performed prior to PMRT. PROSPERO REGISTRATION CRD 42020157077.
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Affiliation(s)
- J P M O'Donnell
- Department of Plastics and Reconstructive Surgery, Galway University Hospitals, Galway, Ireland; Department of Surgery, Galway University Hospitals, Galway, Ireland.
| | - D Murphy
- Department of Plastics and Reconstructive Surgery, Galway University Hospitals, Galway, Ireland; Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - É J Ryan
- Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - S A Gasior
- University of Limerick School of Medicine, University of Limerick, Ireland
| | - R Sugrue
- Department of Plastics and Reconstructive Surgery, Galway University Hospitals, Galway, Ireland; Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - B Lane O'Neill
- Department of Plastics and Reconstructive Surgery, Galway University Hospitals, Galway, Ireland; Department of Surgery, Galway University Hospitals, Galway, Ireland
| | - M R Boland
- Department of Surgery, The Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, Ireland
| | - A J Lowery
- Department of Surgery, Galway University Hospitals, Galway, Ireland; The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - M J Kerin
- Department of Surgery, Galway University Hospitals, Galway, Ireland; The Lambe Institute for Translational Research, National University of Ireland, Galway, Ireland
| | - N M McInerney
- Department of Plastics and Reconstructive Surgery, Galway University Hospitals, Galway, Ireland; Department of Surgery, Galway University Hospitals, Galway, Ireland
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Gentile P, Bernini M, Orzalesi L, Sordi S, Meattini I, Lessi F, Kothari A, Calabrese C. Titanium-coated polypropylene mesh as innovative bioactive material in conservatives mastectomies and pre-pectoral breast reconstruction. Bioact Mater 2021; 6:4640-4653. [PMID: 34095622 PMCID: PMC8144114 DOI: 10.1016/j.bioactmat.2021.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/03/2021] [Accepted: 05/03/2021] [Indexed: 11/26/2022] Open
Abstract
Breast reconstruction is rapidly evolving, thanks to the growing acceptance of synthetic meshes as innovative biomaterials. 276 patients undergoing mastectomy (total of 328 mastectomies) were analyzed in a retrospective observational study to evaluate the pre-pectoral immediate breast reconstruction (IBR) using an implant wrapped with Titanium-Coated Polypropylene Mesh (TCPM) vs. patients treated with tissue expander (TE), equally placed pre-pectorally (and wrapped with the same TCPM in 74.3% of the control group’ breasts). 163 patients, of the study group (SG), underwent mastectomy and pre-pectoral IBR with implant wrapped with TCPM, in a one-step surgery, called direct-to-implant technique (DTI), while 113 patients control group (CG) underwent mastectomy and TE. DTI technique has been performed in 192 breasts of the SG while TE procedure in 136 breasts of the CG. The BREAST-Q questionnaire has been provided before the treatment and 2 years later. Baker scale has been used to evaluate capsular contracture. Oncologic, surgical, and aesthetic outcomes along with BREAST-Q scores were analyzed. Additionally, a histologic evaluation was conducted in 11 capsules' samples randomly chosen (6 derived from SG patients and 5 derived from CG). Complications were recorded in 43 cases (29SG-14CG): 8 skin-nipple necrosis (5SG-3CG), 8 wound dehiscence (6SG-2CG), 3 hematomas (1SG-2CG), and 24 infections (8SG-16CG). Grade IV capsular contracture was detected in 9 breasts (1SG-8CG), whereas 254 breasts were grade I (110SG-144CG), 33 (10SG-23CG) grade II, and 32 (4SG-28CG) grade III. Implant wrinkling was detected in 18 cases (10SG-8CG) after 30 months. The local tumor recurrence rate was 5.8%. Three recurrences were on the nipple-areola complex (1.9%). SG patients showed significantly higher rates in the BREAST-Q overall Satisfaction with Outcome (74.1), overall Satisfaction with Breasts (69.1), Psychosocial Well-being (81.9), and Sexual Well-being (63.1), versus CG's patients (p < 0.05). Histological analysis showed a process of normal tissue repair with a complete mesh integration and normal healing. Conservative mastectomies with pre-pectoral IBR assisted by TCPM proved themselves oncologically safe, biologically integrated into native tissues, and highly accepted in terms of quality of life guaranteeing a more natural and aesthetic breast appearance. Core tip This retrospective observational study provided clinical and histological outcomes of the pre-pectoral IBR using an implant wrapped with TCPM vs. patients treated with TE, equally placed pre-pectorally. The efficacy of IBR using an implant wrapped with TCPM was confirmed by the cosmetic results obtained and by a rate of side effects comparable to TE. All the histological analyses performed confirmed the TCPM mesh complete integration with the physiological aspects of healing: The Collagen 1 and 3 expressions did not differ, between TCPM and NO TCPM samples to confirm a process of healing overlapping to perfect device incorporation and normal healing. This retrospective observational study, reports the results of pre-pectoral immediate breast reconstruction (IBR) using a prosthesis wrapped with Titanium-Coated Polypropylene Mesh (TCPM) vs. patients treated with tissue expander (TE) equally placed pre-pectorally (and wrapped with the same TCPM in 74% of the control group), with the aim to reduce the risk of reconstruction failure after conservative mastectomy. The primary end-points of the study were the clinical outcomes. These outcomes were: the incidence of perioperative and postoperative complications (safety profile), quality of life (QoL) at 2 years after surgery, measured as the change between the pre- and post-op BREAST-Q scores, the aesthetic outcomes, and the capsular contracture grade. Two methods for the clinical analysis of the results have been used: Surgical-Team and patient self-evaluation. The Surgical-team evaluation was an objective evaluation based on clinical assessment, using a scale of six degrees (excellent, good, discreet, enough, poor, inadequate). The subjective patient-based self-evaluation applied the same six degrees. Moreover, secondary end-point of the study, was a histopathological capsule assessment to evaluate the integration of the TCPM in the mastectomy flap as a bioactive material. Histological, and bio-molecular evaluation of TCPM samples were analyzed. In particular, Hematoxylin-eosin staining of post-operative biopsies of wrapping tissue TCPM mesh was performed focusing on the collagen presence and fibroblasts amount and specifically, on the complete healing and TCPM incorporation without side effects. Additionally, the immunofluorescence using specific markers CD 45 and Collagen 1, and immunohistochemistry using CD 45 on paraffin samples were performed. The endpoint was to evaluate the grade of inflammation represented by the number of lymphocytes in the treated site, and the eventual different collagen type expression (Collagen 1 and Collagen 3) in tissues underwent and not to radiotherapy and during the use of TCPM. Analyzing the side effects with the use of t-test, the complication rate between SG and CG did not showed statistically significant differences (p=0,8472), although it was slightly higher in the SG. Despite the study group was bigger than the control group (+42%) the side effects' number did not statistically differ, confirming the safety and reliability of the TCPM procedure during DTI. Overall Satisfaction with Breasts, Psychosocial Well-being, and Sexual Well-being scores were all significantly increased after sub-cutaneous pre-pectoral DTI immediate reconstruction with TCPM mesh (p < 0.05) compared to CG. Mean satisfaction with the overall aesthetic result was high after breast reconstruction (8.72) in patients who underwent DTI pre-pectoral immediate reconstruction (SG) after 2 years from surgery. The histological analysis of fragments of implant's wrapping tissue incorporating TCPM mesh displayed complete incorporation of the mesh with physiological aspects of healing. The immunochemistry concluded the Collagen 1, and 3 expressions did not differ, with statistical significance, between TCPM and NO TCPM samples, showing a process of physiological healing overlapping to perfect device incorporation, confirming that TCPM was a bioactive material. Conservative mastectomies with pre-pectoral IBR assisted by TCPM are resulted oncologically safe preserving breast appearance.
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Affiliation(s)
- Pietro Gentile
- Department of Surgical Science, University of Rome "Tor Vergata", Rome, 00133, Italy
| | - Marco Bernini
- Breast Surgery, Breast Unit, Oncology Department, Careggi University Hospital, 50134, Florence, Italy
| | - Lorenzo Orzalesi
- Breast Surgery, Breast Unit, Oncology Department, Careggi University Hospital, 50134, Florence, Italy
| | - Silvia Sordi
- Breast Surgery, Breast Unit, Oncology Department, Careggi University Hospital, 50134, Florence, Italy
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence Radiation Oncology Unit - Oncology, Careggi University Hospital, Florence, Italy
| | | | - Ashutosh Kothari
- Breast Surgery Unit, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
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Wang S, He S, Zhang X, Sun J, Huang Q, Liu J, Han C, Yin Z, Ding B, Yin J. Acellular bovine pericardium matrix in immediate breast reconstruction compared with conventional implant-based breast reconstruction. JPRAS Open 2021; 29:1-9. [PMID: 33937472 PMCID: PMC8079238 DOI: 10.1016/j.jpra.2021.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 03/09/2021] [Indexed: 11/26/2022] Open
Abstract
Background Acellular Bovine Pericardium Matrix (ABPM) is a new material in implant-based breast reconstruction (IBBR). Few studies have reported on its outcome and complications worldwide and most studies were without a control group. Our aim was to compare its use in IBBR with the other two conventional implant-based reconstruction methods. Methods A retrospective review of patients undergoing IBBR from January to December 2018 was performed. Patients were assigned to the ABPM-assisted IBBR (group A), latissimus dorsi-assisted IBBR (group B) and two-stage IBBR (group C). Patients’ post-operative complications, cost-effectiveness and Quality of Life were compared. Results 100 patients with 100 breasts were included in the study. No complications occurred in group C (n = 11). No significant differences were noted between group A (n = 44) and group B (n = 45) in terms of overall complications (9.1% vs 11.1%, p = 0.973). Group B had the longest operative duration (310.8 ± 62.3 min, p<0.001). The cost of hospitalization forthe three groups was $8051.3 ± 849.2, $7566.0 ± 1172.7 and $7896.5 ± 1762.2, respectively (p = 0.128). The postoperative Breast-Q scores were similar across the three groups. Conclusions ABPM demonstrated acceptable complication rates, cost-effectiveness and quality of life outcomes when compared to LD-assisted IBBR and two-stage IBBR.
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Affiliation(s)
- S Wang
- The Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Treatment of Tianjin, Tianjin, China.,Tianjin Clinical Research Center for Cancer, Tianjin, China.,The Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China
| | - S He
- The Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Treatment of Tianjin, Tianjin, China.,Tianjin Clinical Research Center for Cancer, Tianjin, China.,The Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China
| | - X Zhang
- The Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Treatment of Tianjin, Tianjin, China.,Tianjin Clinical Research Center for Cancer, Tianjin, China.,The Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China
| | - J Sun
- The Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Treatment of Tianjin, Tianjin, China.,Tianjin Clinical Research Center for Cancer, Tianjin, China.,The Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China
| | - Q Huang
- The Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Treatment of Tianjin, Tianjin, China.,Tianjin Clinical Research Center for Cancer, Tianjin, China.,The Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China
| | - J Liu
- The Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Treatment of Tianjin, Tianjin, China.,Tianjin Clinical Research Center for Cancer, Tianjin, China.,The Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China
| | - C Han
- The Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Treatment of Tianjin, Tianjin, China.,Tianjin Clinical Research Center for Cancer, Tianjin, China.,The Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China
| | - Z Yin
- The Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Treatment of Tianjin, Tianjin, China.,Tianjin Clinical Research Center for Cancer, Tianjin, China.,The Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China
| | - B Ding
- The Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Treatment of Tianjin, Tianjin, China.,Tianjin Clinical Research Center for Cancer, Tianjin, China.,The Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China
| | - J Yin
- The Department of Breast Oncoplastic Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China.,Key Laboratory of Cancer Prevention and Treatment of Tianjin, Tianjin, China.,Tianjin Clinical Research Center for Cancer, Tianjin, China.,The Sino-Russian Joint Research Center for Oncoplastic Breast Surgery, Tianjin, China
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Mora-Navarro C, Ozpinar EW, Sze D, Martin DP, Freytes DO. Transcriptome-targeted analysis of human peripheral blood-derived macrophages when cultured on biomaterial meshes. Biomed Mater 2021; 16:025006. [PMID: 33445160 DOI: 10.1088/1748-605x/abdbdb] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Surgical meshes are commonly used to repair defects and support soft tissues. Macrophages (Mφs) are critical cells in the wound healing process and are involved in the host response upon foreign biomaterials. There are various commercially available permanent and absorbable meshes used by surgeons for surgical interventions. Polypropylene (PP) meshes represent a permanent biomaterial that can elicit both inflammatory and anti-inflammatory responses. In contrast, poly-4-hydroxybutyrate (P4HB) based meshes are absorbable and linked to positive clinical outcomes but have a poorly characterized immune response. This study evaluated the in vitro targeted transcriptomic response of human Mφs seeded for 48 h on PP and P4HB surgical meshes. The in vitro measured response from human Mφs cultured on P4HB exhibited inflammatory and anti-inflammatory gene expression profiles typically associated with wound healing, which aligns with in vivo animal studies from literature. The work herein provides in vitro evidence for the early transcriptomic targeted signature of human Mφs upon two commonly used surgical meshes. The findings suggest a transition from an inflammatory to a non-inflammatory phenotype by P4HB as well as an upregulation of genes annotated under the pathogen response pathway.
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Affiliation(s)
- Camilo Mora-Navarro
- The Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina-Chapel Hill, 4208D Engineering Building III, Raleigh, NC, United States of America. The Comparative Medicine Institute, North Carolina State University, Raleigh, NC, United States of America
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27
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Grossi S, Grimaldi A, Congiu T, Parnigoni A, Campanelli G, Campomenosi P. Human Primary Dermal Fibroblasts Interacting with 3-Dimensional Matrices for Surgical Application Show Specific Growth and Gene Expression Programs. Int J Mol Sci 2021; 22:ijms22020526. [PMID: 33430241 PMCID: PMC7825678 DOI: 10.3390/ijms22020526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/28/2020] [Accepted: 01/05/2021] [Indexed: 01/06/2023] Open
Abstract
Several types of 3-dimensional (3D) biological matrices are employed for clinical and surgical applications, but few indications are available to guide surgeons in the choice among these materials. Here we compare the in vitro growth of human primary fibroblasts on different biological matrices commonly used for clinical and surgical applications and the activation of specific molecular pathways over 30 days of growth. Morphological analyses by Scanning Electron Microscopy and proliferation curves showed that fibroblasts have different ability to attach and proliferate on the different biological matrices. They activated similar gene expression programs, reducing the expression of collagen genes and myofibroblast differentiation markers compared to fibroblasts grown in 2D. However, differences among 3D matrices were observed in the expression of specific metalloproteinases and interleukin-6. Indeed, cell proliferation and expression of matrix degrading enzymes occur in the initial steps of interaction between fibroblast and the investigated meshes, whereas collagen and interleukin-6 expression appear to start later. The data reported here highlight features of fibroblasts grown on different 3D biological matrices and warrant further studies to understand how these findings may be used to help the clinicians choose the correct material for specific applications.
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Affiliation(s)
- Sarah Grossi
- Department of Biotechnology and Life Sciences, University of Insubria, DBSV, Via J.H. Dunant 3, 21100 Varese, Italy; (S.G.); (A.G.); (A.P.)
| | - Annalisa Grimaldi
- Department of Biotechnology and Life Sciences, University of Insubria, DBSV, Via J.H. Dunant 3, 21100 Varese, Italy; (S.G.); (A.G.); (A.P.)
| | - Terenzio Congiu
- Department of Surgical Sciences, University of Cagliari, 09100 Cagliari, Italy;
| | - Arianna Parnigoni
- Department of Biotechnology and Life Sciences, University of Insubria, DBSV, Via J.H. Dunant 3, 21100 Varese, Italy; (S.G.); (A.G.); (A.P.)
| | - Giampiero Campanelli
- Milano Hernia Center, Department of Surgical Science, Istituto Clinico Sant’Ambrogio, Via Luigi Giuseppe Faravelli 16, 20149 Milan, Italy;
- Department of Medicine and Surgery, University of Insubria, DMC, Via Guicciardini 9, 21100 Varese, Italy
| | - Paola Campomenosi
- Department of Biotechnology and Life Sciences, University of Insubria, DBSV, Via J.H. Dunant 3, 21100 Varese, Italy; (S.G.); (A.G.); (A.P.)
- Correspondence: ; Tel.: +39-0332-421322
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28
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Next-generation surgical meshes for drug delivery and tissue engineering applications: materials, design and emerging manufacturing technologies. Biodes Manuf 2021. [DOI: 10.1007/s42242-020-00108-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Abstract
Surgical meshes have been employed in the management of a variety of pathological conditions including hernia, pelvic floor dysfunctions, periodontal guided bone regeneration, wound healing and more recently for breast plastic surgery after mastectomy. These common pathologies affect a wide portion of the worldwide population; therefore, an effective and enhanced treatment is crucial to ameliorate patients’ living conditions both from medical and aesthetic points of view. At present, non-absorbable synthetic polymers are the most widely used class of biomaterials for the manufacturing of mesh implants for hernia, pelvic floor dysfunctions and guided bone regeneration, with polypropylene and poly tetrafluoroethylene being the most common. Biological prostheses, such as surgical grafts, have been employed mainly for breast plastic surgery and wound healing applications. Despite the advantages of mesh implants to the treatment of these conditions, there are still many drawbacks, mainly related to the arising of a huge number of post-operative complications, among which infections are the most common. Developing a mesh that could appropriately integrate with the native tissue, promote its healing and constructive remodelling, is the key aim of ongoing research in the area of surgical mesh implants. To this end, the adoption of new biomaterials including absorbable and natural polymers, the use of drugs and advanced manufacturing technologies, such as 3D printing and electrospinning, are under investigation to address the previously mentioned challenges and improve the outcomes of future clinical practice. The aim of this work is to review the key advantages and disadvantages related to the use of surgical meshes, the main issues characterizing each clinical procedure and the future directions in terms of both novel manufacturing technologies and latest regulatory considerations.
Graphic abstract
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Arnaout A, Zhang J, Frank S, Momtazi M, Cordeiro E, Roberts A, Ghumman A, Fergusson D, Stober C, Pond G, Jeong A, Vandermeer L, Hutton B, Clemons M. A Randomized Controlled Trial Comparing Alloderm-RTU with DermACELL in Immediate Subpectoral Implant-Based Breast Reconstruction. ACTA ACUST UNITED AC 2020; 28:184-195. [PMID: 33704185 PMCID: PMC7816190 DOI: 10.3390/curroncol28010020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/01/2020] [Accepted: 12/16/2020] [Indexed: 12/15/2022]
Abstract
Background: The effectiveness of different acellular dermal matrices (ADM) used for implant-based reconstruction immediately following mastectomy is an important clinical question. A prospective randomized clinical trial was performed to evaluate the superiority of DermACELL over Alloderm-RTU in reducing drain duration. Methods: Patients undergoing mastectomy with subpectoral immediate and permanent implant-based breast reconstruction were randomized to Alloderm-RTU or DermACELL. The primary outcome was seroma formation, measured by the duration of postoperative drain placement. Secondary outcomes included: post drain removal seroma aspiration, infection, redbreast syndrome, wound dehiscence, loss of the implant, and unplanned return to the operating room. Results: 62 patients were randomized for 81 mastectomies (41 Alloderm-RTU, 40 DermACELL). Baseline characteristics were similar. There was no statistically significant difference in mean drain duration (p = 0.16), with a trend towards longer duration in the Alloderm-RTU group (1.6 days; 95%CI, 0.7 to 3.9). The overall rate of minor and major complications were statistically similar between the two groups; although patients with Alloderm-RTU had 3 times as many infections requiring antibiotics (7.9% vs. 2.5%) with a risk difference of 5.4 (95%CI −4.5 to 15.2), and twice as many unplanned returns to the operating room (15.8% vs. 7.5%) with a risk difference of 8.3 (95% CI −5.9 to 22.5) as DermACELL. Conclusion: This is the first prospective randomized clinical trial comparing the two most commonly used human-derived ADMs. There was no statistically significant difference in drain duration, minor, or major complications between DermACELL over Alloderm-RTU in immediate subpectoral permanent implant-based breast reconstruction post-mastectomy.
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Affiliation(s)
- Angel Arnaout
- Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON K1Y 4E9, Canada; (A.A.); (J.Z.); (S.F.); (M.M.); (E.C.); (A.R.); (A.G.)
| | - Jing Zhang
- Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON K1Y 4E9, Canada; (A.A.); (J.Z.); (S.F.); (M.M.); (E.C.); (A.R.); (A.G.)
| | - Simon Frank
- Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON K1Y 4E9, Canada; (A.A.); (J.Z.); (S.F.); (M.M.); (E.C.); (A.R.); (A.G.)
| | - Moein Momtazi
- Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON K1Y 4E9, Canada; (A.A.); (J.Z.); (S.F.); (M.M.); (E.C.); (A.R.); (A.G.)
| | - Erin Cordeiro
- Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON K1Y 4E9, Canada; (A.A.); (J.Z.); (S.F.); (M.M.); (E.C.); (A.R.); (A.G.)
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON K1H 8L6, Canada; (D.F.); (C.S.); (A.J.); (L.V.); (B.H.)
| | - Amanda Roberts
- Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON K1Y 4E9, Canada; (A.A.); (J.Z.); (S.F.); (M.M.); (E.C.); (A.R.); (A.G.)
| | - Ammara Ghumman
- Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON K1Y 4E9, Canada; (A.A.); (J.Z.); (S.F.); (M.M.); (E.C.); (A.R.); (A.G.)
| | - Dean Fergusson
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON K1H 8L6, Canada; (D.F.); (C.S.); (A.J.); (L.V.); (B.H.)
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
| | - Carol Stober
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON K1H 8L6, Canada; (D.F.); (C.S.); (A.J.); (L.V.); (B.H.)
| | - Gregory Pond
- Juravinski Cancer Center, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Ahwon Jeong
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON K1H 8L6, Canada; (D.F.); (C.S.); (A.J.); (L.V.); (B.H.)
| | - Lisa Vandermeer
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON K1H 8L6, Canada; (D.F.); (C.S.); (A.J.); (L.V.); (B.H.)
| | - Brian Hutton
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON K1H 8L6, Canada; (D.F.); (C.S.); (A.J.); (L.V.); (B.H.)
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
| | - Mark Clemons
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON K1H 8L6, Canada; (D.F.); (C.S.); (A.J.); (L.V.); (B.H.)
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, ON K1H 8L6, Canada
- Correspondence: ; Tel.: +1-613-737-7700 (ext. 70170)
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Hansson E, Edvinsson AC, Elander A, Kölby L, Hallberg H. First-year complications after immediate breast reconstruction with a biological and a synthetic mesh in the same patient: A randomized controlled study. J Surg Oncol 2020; 123:80-88. [PMID: 33051871 PMCID: PMC7821308 DOI: 10.1002/jso.26227] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/29/2020] [Accepted: 09/08/2020] [Indexed: 12/02/2022]
Abstract
Background Even though meshes and matrices are widely used in breast reconstruction, there is little high‐quality scientific evidence for their risks and benefits. The aim of this study was to compare first‐year surgical complication rates in implant‐based immediate breast reconstruction with a biological mesh with that of a synthetic mesh, in the same patient. Methods This study is a clinical, randomized, prospective trial. Patients operated on with bilateral mastectomy and immediate breast reconstruction were randomized to biological mesh on one side and synthetic mesh on the other side. Results A total of 48 breasts were randomized. As the synthetically and the biologically reconstructed breasts that were compared belonged to the same woman, systemic factors were exactly the same in the two groups. The most common complication was seroma formation with a frequency of 38% in the biological group and 3.8% in the synthetical group (p = .011). A higher frequency of total implant loss could be seen in the biologic mesh group (8.5% vs. 2%), albeit not statistically significant (p = .083). Conclusions In the same patient, a synthetic mesh seems to yield a lower risk for serious complications, such as implant loss, than a biological mesh.
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Affiliation(s)
- Emma Hansson
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Plastic and Reconstructive Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ann-Chatrin Edvinsson
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Anna Elander
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Plastic and Reconstructive Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Kölby
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Plastic and Reconstructive Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Håkan Hallberg
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Plastic and Reconstructive Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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Montrief T, Bornstein K, Ramzy M, Koyfman A, Long BJ. Plastic Surgery Complications: A Review for Emergency Clinicians. West J Emerg Med 2020; 21:179-189. [PMID: 33207164 PMCID: PMC7673892 DOI: 10.5811/westjem.2020.6.46415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/11/2020] [Indexed: 12/04/2022] Open
Abstract
The number of aesthetic surgical procedures performed in the United States is increasing rapidly. Over 1.5 million surgical procedures and over three million nonsurgical procedures were performed in 2015 alone. Of these, the most common procedures included surgeries of the breast and abdominal wall, specifically implants, liposuction, and subcutaneous injections. Emergency clinicians may be tasked with the management of postoperative complications of cosmetic surgeries including postoperative infections, thromboembolic events, skin necrosis, hemorrhage, pulmonary edema, fat embolism syndrome, bowel cavity perforation, intra-abdominal injury, local seroma formation, and local anesthetic systemic toxicity. This review provides several guiding principles for management of acute complications. Understanding these complications and approach to their management is essential to optimizing patient care.
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Affiliation(s)
- Tim Montrief
- University of Miami Miller School of Medicine, Department of Emergency Medicine, Miami, Florida
| | - Kasha Bornstein
- University of Miami Miller School of Medicine, Miami, Florida
| | - Mark Ramzy
- Maimonides Medical Center, Department of Emergency Medicine, Brooklyn, New York
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, Dallas, Texas
| | - Brit J Long
- Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas
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Skin-Reducing Mastectomy and Pre-pectoral Breast Reconstruction in Large Ptotic Breasts. Aesthetic Plast Surg 2020; 44:664-672. [PMID: 31970455 DOI: 10.1007/s00266-020-01616-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Pre-pectoral breast reconstruction is increasingly offered to breast cancer patients, as the one-stage technique has proved surgical and oncological safety and aesthetic effectiveness. Nevertheless, there are limited data on outcomes after pre-pectoral breast reconstruction in large and ptotic breasts. The aim of the paper is to present the authors' experience in performing Wise pattern mastectomy with pre-pectoral implant and complete acellular dermal matrix (ADM) coverage as a single-stage procedure in patients with large ptotic breasts. MATERIALS AND METHODS A retrospective review of protective collected data from January 2017 to June 2019 of patients who presented with large and ptotic breasts undergoing skin-reducing mastectomy and immediate pre-pectoral breast reconstruction with complete ADM coverage and inferior dermal sling was performed. Oncological and surgical outcomes were collected. Satisfaction with reconstruction and related quality of life were evaluated through BREAST-Q questionnaire. RESULTS Nineteen patients met the inclusion criteria. The average patient age was 55.6 years, and the mean body mass index was 31.2. Mean follow-up was 23.2 months from the initial reconstruction. One patient experienced seroma, and two cases of wound dehiscence at the T junction were observed and treated conservatively with no implant loss. All patients were satisfied with the final reconstruction. CONCLUSION The Wise pattern skin-reducing mastectomy and pre-pectoral breast reconstruction could be offered to patients presenting with large and ptotic breasts. Future studies should better define long-term outcomes. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Quinn EM, Barry M, Kell M. Immediate implant reconstruction using absorbable TIGR mesh after nipple-sparing mastectomy. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-019-01603-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schettini AV, Servaes M, Berners A, Lafosse A, Fosseprez P. The use of cadaveric fascia lata in single-stage implant-based breast reconstruction: A two-center experience. J Plast Reconstr Aesthet Surg 2020; 73:1897-1916. [PMID: 32327375 DOI: 10.1016/j.bjps.2020.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 01/25/2020] [Accepted: 03/15/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Adriano-Valerio Schettini
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU UCL Namur - Sainte-Elisabeth, Place Louise Godin, 15, 5000 Namur, Belgium.
| | - Maxime Servaes
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU UCL Namur - Sainte-Elisabeth, Place Louise Godin, 15, 5000 Namur, Belgium
| | - Aline Berners
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU UCL Namur - Sainte-Elisabeth, Place Louise Godin, 15, 5000 Namur, Belgium
| | - Aurore Lafosse
- Department of Plastic, Reconstructive and Aesthetic Surgery, Clinic Ste-Anne St-Remi - CHIREC, Boulevard Jules Graindor, 66, 1070 Brussels, Belgium
| | - Philippe Fosseprez
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU UCL Namur - Sainte-Elisabeth, Place Louise Godin, 15, 5000 Namur, Belgium
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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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Skin-Reducing Mastectomy and Direct-to-Implant Breast Reconstruction With Submuscular-Dermal-Mesh Pocket. Ann Plast Surg 2020; 82:19-27. [PMID: 30247191 DOI: 10.1097/sap.0000000000001614] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Despite skin-sparing mastectomy techniques have significantly improved reconstructive options and aesthetic outcomes, patients with large and ptotic breasts remain a challenging group to treat satisfactorily. The Wise-pattern skin-reducing mastectomy (SRM) has been designed for this kind of patients but is not without morbidity. To improve safety, the authors reviewed their experience with a modified SRM and immediate 1-stage implant-based breast reconstruction, using a synthetic absorbable mesh combined with a dermal flap. METHODS A retrospective review was undertaken to identify women with medium to large ptotic breast and medium minimally ptotic breast who had undergone SRM and direct-to-implant breast reconstruction using definitive anatomical gel implant, de-epithelialized dermal flap, and absorbable synthetic mesh, between October 2014 and December 2016. Patient demographics were queried, and complication rates, aesthetic outcomes, and patients satisfaction were assessed. RESULTS Sixty-two procedures of SRM were performed in 56 patients. Forty-five women received contralateral symmetrization. Twenty-one overall complications occurred in 16 patients. Statistical correlation between risk factors and complications onset was assessed. Body mass index resulted the most substantial risk factor (P = 0.0028) for developing complications, whereas preoperative chemotherapy (P = 0.0050) and comorbidities (P = 0.0117) played a decent role. Smoking attitude (P = 0.1122), age (P = 0.9990), and implant weight (P = 0.1583) did not result as significant risk factors. The reconstructive outcomes were good to excellent in 92.8%, with patient satisfaction ranking very to highly satisfied in 84%. CONCLUSIONS The authors' series suggests that SRM with direct-to-implant breast reconstruction can be easily performed when an appropriate SRM pattern is designed, providing complete implant coverage with submuscular-dermal-mesh pocket.
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Veritas in Immediate Implant-based Breast Reconstruction Is Associated with Higher Complications Compared with TiLOOP. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2533. [PMID: 32537291 PMCID: PMC7288872 DOI: 10.1097/gox.0000000000002533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 09/10/2019] [Indexed: 01/20/2023]
Abstract
Biologic and synthetic meshes are used in immediate implant-based breast reconstruction for coverage of the lower pole of the implant. This study aimed to compare outcomes of Veritas with TiLOOP bra (TiLOOP group [TG]).
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Hansson E, Burian P, Hallberg H. Comparison of inflammatory response and synovial metaplasia in immediate breast reconstruction with a synthetic and a biological mesh: a randomized controlled clinical trial. J Plast Surg Hand Surg 2019; 54:131-136. [PMID: 31859575 DOI: 10.1080/2000656x.2019.1704766] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of this study was to compare inflammatory response and synovial metaplasia in implant-based immediate breast reconstruction with a biological mesh (Veritas®) with that of a synthetic mesh (TIGR® Matrix Surgical Mesh). We hypothesize that the inflammatory response and formation of synovial metaplasia might be different and the rate of capsular contracture therefore different. The patients were recruited from the Gothenburg TIGR®/Veritas® Study (ClinicalTrials.Gov identifier NCT02985073). All referrals for bilateral immediate breast reconstruction were assessed for inclusions. During the operation, the patients were randomized to which sides the biological and the synthetic mesh were going to be applied. During the implant exchange biopsies were taken. Biopsies were taken from 30 breasts in 15 patients. There seem to be more myofibroblast and neovascularization in the biological meshes than in the synthetic and the collagen fibers seem to be aligned in an irregular pattern with both parallel and vertical fibers. In the synthetic meshes, there were more giant cells and foreign body reaction and the collagen fibers were loosely and well aligned, oriented parallel to the surface of the implant. Synovial metaplasia was seen in the majority of both the biological and the synthetic meshes. The histological patterns in early capsules from biological and synthetic meshes vary considerably. Nonetheless, it is unknown what role different cell types have in capsular formation in the long run and there was no difference in clinical capsular contracture at the clinical follow-up in this study.
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Affiliation(s)
- Emma Hansson
- The Sahlgrenska Academy, Department of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Plastic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Faculty of Medicine, Lund University, Lund, Sweden
| | - Pawel Burian
- Department of Pathology, Unilabs, Skövde, Sweden
| | - Håkan Hallberg
- The Sahlgrenska Academy, Department of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Plastic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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Evaluation of Prepectoral Implant Placement and Complete Coverage with TiLoop Bra Mesh for Breast Reconstruction: A Prospective Study on Long-Term and Patient-Reported BREAST-Q Outcomes. Plast Reconstr Surg 2019; 143:1e-9e. [PMID: 30303929 DOI: 10.1097/prs.0000000000005078] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Breast reconstruction is rapidly evolving, because of the changing face of cancer surgery and the growing acceptance of acellular dermal matrices and synthetic meshes. Although some early reports showed encouraging results after prepectoral breast reconstruction, there is a paucity of data on long-term outcomes. METHODS Between January of 2012 and March of 2015, 179 patients undergoing mastectomy were enrolled at the authors' institution. Patients underwent mastectomy and immediate prepectoral breast reconstruction with the definitive implant entirely wrapped in a titanium-coated polypropylene mesh (TiLoop). The BREAST-Q questionnaire was administered before surgery and after 2 years. Capsular contracture was evaluated using the Baker scale. Oncologic, surgical, and aesthetic outcomes and changes in BREAST-Q score were analyzed over time. RESULTS Average follow-up was 38.5 months. A total of 250 mastectomies were performed. The locoregional recurrence rate was 2.1 percent. Complications requiring reoperation were recorded in six patients (2.4 percent) and implant removal was necessary in three cases (1.2 percent), followed by reconstruction with submuscular expanders. Grade IV capsular contracture was detected in five breasts (2 percent), whereas 212 breasts were evaluated as grade I (84.8 percent), 28 breasts as grade II (11.2 percent), and five breasts as grade III (2 percent). Patients reported significant high rates in the BREAST-Q overall Satisfaction with Outcome (73.8), overall Satisfaction with Breasts (72.5), Psychosocial Well-being (77.7), and Sexual Well-being (57.9), scoring a significant increase in these domains from the preoperative period to the postoperative period (p < 0.05). CONCLUSION The authors report encouraging results of a prepectoral direct-to-implant reconstruction technique using a synthetic mesh, supporting the evaluation of the muscle-sparing subcutaneous approach as a valid alternative to traditional submuscular reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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A biological or a synthetic mesh in immediate breast reconstruction? A cohort-study of long-term Health related Quality of Life (HrQoL). EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2019; 45:1812-1816. [PMID: 30905394 DOI: 10.1016/j.ejso.2019.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/14/2019] [Accepted: 03/10/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Meshes/matrices are commonly used in immediate breast reconstruction. There are few studies comparing biological and synthetic meshes and it is unknown what type of mesh gives the best long-term results. The aim of this study was to compare long-term health-related quality of life (HrQoL) and patient satisfaction in implant-based immediate breast reconstruction with a biological mesh (Surgisis®) with that of patients reconstructed with a synthetic mesh (TIGR ® Matrix Surgical Mesh). MATERIAL AND METHODS Both cohorts were prospectively included and consecutively operated. Clinical data was collected. HrQoL was evaluated with EuroQoL-5 dimension - 3 levels questionnaire (EQ-5D-3L) and the Hospital Anxiety and Depression Scale (HADS) and the Breast-Q. RESULTS AND CONCLUSION Seventy-one patients were operated on in the biological group and 49 in the synthetic group. The response rates were 75 and 84 per cent, respectively. Mean follow-up time was 74 months and 23 months, respectively. There were no statistical differences in satisfaction and quality of life between the two groups. Complications and radiation seem to lead to a lower satisfaction. Our findings could indicate that biological and synthetic meshes give an equal long-term result as regards patients' perceived quality of life.
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Pregnancy following Unilateral Immediate Breast Reconstruction with Titanized Polypropylene Mesh (TiLOOP(R) Bra) without Compromising the Result. Plast Reconstr Surg Glob Open 2018; 6:e1919. [PMID: 30349788 PMCID: PMC6191232 DOI: 10.1097/gox.0000000000001919] [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: 01/19/2018] [Accepted: 07/11/2018] [Indexed: 12/02/2022]
Abstract
Immediate breast reconstruction after mastectomy due to cancer or as a prophylactic treatment is widely preferred to avoid psychosocial distress, poor body image, and diminished sexual well-being. An increasing number of women undergoing breast reconstruction are in childbearing age; however, only limited data are available on the cosmetic outcome of patients undergoing implant-based breast reconstruction with a surgical mesh and subsequent pregnancy. This is a case report of a female patient who underwent unilateral implant-based breast reconstruction with a titanized surgical mesh implant (TiLOOP Bra). Twenty-two months after reconstruction, the woman delivered a healthy child. No adverse events occurred. The patient breastfed with the contralateral breast. The cosmetic result and patient-reported outcome was excellent. Pregnancy after breast reconstruction with a synthetic surgical mesh is not contradictory to an excellent cosmetic outcome.
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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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Gunnarsson GL, Heidemann LN, Bille C, Sørensen JA, Thomsen JB. Nipple sparing mastectomy and the evolving direct to implant breast reconstruction. Gland Surg 2018; 7:267-272. [PMID: 29998076 DOI: 10.21037/gs.2017.08.06] [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] [Indexed: 01/06/2023]
Abstract
In this paper, we describe the evolving use of the nipple-sparing mastectomy (NSM) and direct to implant breast reconstruction according to existing literature and our own experience. The surgical method enables superior aesthetic results resembling that of a natural breast while maintaining oncologic safety. Acellular dermal matrix enables direct to implant breast reconstruction by serving as a hammock and can be used with acceptable rates of complications. A successful nipple-sparing mastectomy and direct to implant breast reconstruction approach with acceptable postoperative complication rates relies upon quality of the mastectomy skin flaps and correct patient selection. The surgical method has developed with a rapid pace and expected to evolve further in terms of technical modalities, safety measure and lasting results.
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Affiliation(s)
| | | | - Camilla Bille
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Jens Ahm Sørensen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Jørn Bo Thomsen
- Department of Plastic Surgery, Lillebaelt Hospital/Odense University Hospital, Vejle, Denmark.,Institute of Regional Health Services Research Center, Lillebaelt Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Hallberg H, Rafnsdottir S, Selvaggi G, Strandell A, Samuelsson O, Stadig I, Svanberg T, Hansson E, Lewin R. Benefits and risks with acellular dermal matrix (ADM) and mesh support in immediate breast reconstruction: a systematic review and meta-analysis. J Plast Surg Hand Surg 2018; 52:130-147. [PMID: 29320921 DOI: 10.1080/2000656x.2017.1419141] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In modern implant-based immediate breast reconstruction, it has become common to use biological acellular dermal and synthetic matrices in combination with a tissue expander or an implant. The aim of this systematic review was to examine differences in recurrence of cancer, impact on oncological treatment, health related quality of life, complications and aesthetic outcome between matrix and no matrix in immediate breast reconstruction. Systematic searches, data extraction and assessment of methodological quality were performed according to predetermined criteria. Fifty-one studies were eligible and included in the review. The certainty of evidence for overall complication rate and implant loss is low (GRADE ⊕⊕□ □). The certainty of evidence for delay of adjuvant treatment, implant loss, infection, capsular contraction and aesthetic outcome is very low (GRADE ⊕□ □ □). No study reported data on recurrence of cancer or health related quality of life. In conclusion, there is a lack of high quality studies that compare the use of matrix with no matrix in immediate breast reconstruction. Specifically, there are no data on risk of recurrence of cancer, delay of adjuvant treatment and Health related quality of life (HRQoL). In addition, there is a risk of bias in many studies. It is often unclear what complications have been included and how they have been diagnosed, and how and when capsular contracture and aesthetic outcome have been evaluated. Controlled trials that further analyse the impact of radiotherapy, type of matrix and type of procedure (one or two stages) are necessary.
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Affiliation(s)
- Håkan Hallberg
- a Department of clinical sciences , University of Gothenburg, The Sahlgrenska Academy , Gothenburg , Sweden.,b Department of Reconstructive Plastic Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Svanheidur Rafnsdottir
- a Department of clinical sciences , University of Gothenburg, The Sahlgrenska Academy , Gothenburg , Sweden.,c Department of Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Gennaro Selvaggi
- a Department of clinical sciences , University of Gothenburg, The Sahlgrenska Academy , Gothenburg , Sweden.,b Department of Reconstructive Plastic Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Annika Strandell
- d Health Technology Assessment centre , Region Västra Götaland , Gothenburg , Sweden
| | - Ola Samuelsson
- d Health Technology Assessment centre , Region Västra Götaland , Gothenburg , Sweden
| | - Ida Stadig
- e Medical Library , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Therese Svanberg
- d Health Technology Assessment centre , Region Västra Götaland , Gothenburg , Sweden
| | - Emma Hansson
- a Department of clinical sciences , University of Gothenburg, The Sahlgrenska Academy , Gothenburg , Sweden.,b Department of Reconstructive Plastic Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Richard Lewin
- a Department of clinical sciences , University of Gothenburg, The Sahlgrenska Academy , Gothenburg , Sweden.,b Department of Reconstructive Plastic Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden
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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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Echazarreta-Gallego E, Pola-Bandrés G, Arribas-Del Amo MD, Gil-Romea I, Sousa-Domínguez R, Güemes-Sánchez A. Treatment of Implant Exposure due to Skin Necroses after Skin Sparing Mastectomy: Initial Experiences Using a Not Selective Random Epigastric Flap. World J Surg 2017; 41:2559-2565. [PMID: 28466362 DOI: 10.1007/s00268-017-4041-4] [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: 11/27/2022]
Abstract
Breast prostheses exposure is probably the most devastating complication after a skin sparing mastectomy (SSM) and implant-based, one-stage, breast reconstruction. This complication may occur in the immediate post-operative period or in the weeks and even months after the procedure. In most cases, the cause is poor skin coverage of the implant due to skin necrosis. PATIENTS AND METHODS Eight consecutive cases of implant exposure (or risk of exposure) due to skin necrosis in SSM patients over a period of 5 years, all patients were treated using a random epigastric rotation flap, executed by the same medical team. RESULTS A random epigastric flap (island or conventional rotation flap) was used to cover the skin defect. All the patients completed the procedure and all prostheses were saved; there were no cases of flap necrosis or infection. CONCLUSIONS Cases of skin necrosis after SSM and immediate implant reconstruction, in which the implant is at risk of exposure, can be successfully treated with a random epigastric rotation flap.
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Affiliation(s)
- Estíbaliz Echazarreta-Gallego
- Breast Unit. Department of Surgery, Hospital Clínico Universitario de Zaragoza, Avenida San Juan Bosco 15, 50005, Saragossa, Spain.
| | - Guillermo Pola-Bandrés
- Breast Unit. Department of Surgery, Hospital Clínico Universitario de Zaragoza, Avenida San Juan Bosco 15, 50005, Saragossa, Spain
| | - María Dolores Arribas-Del Amo
- Breast Unit. Department of Surgery, Hospital Clínico Universitario de Zaragoza, Avenida San Juan Bosco 15, 50005, Saragossa, Spain
| | - Ismael Gil-Romea
- Breast Unit. Department of Surgery, Hospital Clínico Universitario de Zaragoza, Avenida San Juan Bosco 15, 50005, Saragossa, Spain
| | - Ramón Sousa-Domínguez
- Breast Unit. Department of Surgery, Hospital Clínico Universitario de Zaragoza, Avenida San Juan Bosco 15, 50005, Saragossa, Spain
| | - Antonio Güemes-Sánchez
- Breast Unit. Department of Surgery, Hospital Clínico Universitario de Zaragoza, Avenida San Juan Bosco 15, 50005, Saragossa, Spain
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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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Clinical experiences with the use of ULTRAPRO ® mesh in single-stage direct-to-implant immediate postmastectomy breast reconstruction in 102 patients: A retrospective cohort study. Eur J Surg Oncol 2017; 43:1244-1251. [PMID: 28215734 DOI: 10.1016/j.ejso.2017.01.236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/04/2016] [Accepted: 01/03/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Acellular dermal matrices have been used for direct-to-implant (DTI) breast reconstruction (BR), eliminating the load of the lower pole skin envelope. However, the available allograft matrices add considerable health care costs. This study examined the long-term follow-up of synthetic ULTRAPRO® mesh as a low-cost potential alternative to biological matrices. PATIENTS AND METHODS A retrospective cohort study was performed between January 2013 and January 2016, involved 112 early-stage breast cancer and/or BRCA 1/2 patients, and evaluated 189 immediate DTI BRs following skin-, areola- or nipple-sparing mastectomy using ULTRAPRO® mesh. Patient characteristics and postoperative complications were recorded, and quality of life was rated by the patients using the EORTC-QLQ-C30-BR23 questionnaire. Aesthetic outcomes and palpability of the implants were evaluated by four breast surgeons on a 5-point Likert scale. All recorded parameters were statistically analysed. RESULTS Ten patients were lost-to-follow-up, resulting in 102 patients and 174 breast surgery cases analysed. The mean age was 43 years, with 23.4 months of follow-up on average. Forty-six patients (45.1%) had previous radiotherapy with pre-existing scars. In total, 32 complications (18.3%) were recorded, including 12 minor (6.9%) and 20 major (11.4%) complications requiring revision. All median quality of life scores were above 83 points, representing a high score, with an average 4-point rating for the aesthetic outcome and natural consistency of the breast. CONCLUSION Partially absorbable ULTRAPRO® mesh could be used successfully in DTI BR, offering a safe, less expensive alternative to biological matrices. Adequate indications and patient selection are necessary.
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Innovative Management of Implant Exposure in ADM/Implant-Based Breast Reconstruction with Negative Pressure Wound Therapy. Aesthetic Plast Surg 2017; 41:36-39. [PMID: 28032164 DOI: 10.1007/s00266-016-0739-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 11/06/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION One-stage implant-based breast reconstruction has been recently improved by the introduction of biological [acellular dermal matrix (ADM)] and synthetic meshes. Advantages of ADMs in implant-based breast reconstruction derive from the expansion of the space available for the direct positioning of an implant, but their use could be associated with several complications. Although the majority of complications can be easily managed, mistakes in dealing with the first clinical signs of a potential adverse event can lead to implant loss. CASE PRESENTATION We report a case of ADM/implant exposure following NAC-sparing mastectomy and immediate implant-based reconstruction, successfully managed with an innovative staged treatment using negative pressure wound therapy, which allowed a rapid re-positioning of the prosthesis after complete clearance of bacteria from the implant pocket. DISCUSSION The safest strategy to manage implant exposure and concomitant bacterial growth is reported to be implant removal and delayed re-positioning after several months, following prolonged targeted antibiotic therapy. Our case shows how a short-time implant re-positioning following implant removal for implant exposure could be successfully pursued thanks to the shrewd use of negative pressure wound therapy with great advantages in terms of patient satisfaction and post-operative quality of life, offering women experiencing this complication the option of not delaying reconstruction for months after resolution of the complication, potentially avoiding major surgical procedures such as autologous tissue reconstructions. LEVEL OF EVIDENCE V 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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Bordoni D, Cadenelli P, Rocco N, Tessone A, Falco G, Magalotti C. Serratus Anterior Fascia Flap Versus Muscular Flap for Expander Coverage in Two-stage Breast Reconstruction Following Mastectomy: Early Post-operative Outcomes. Aesthetic Plast Surg 2017; 41:26-30. [PMID: 28032155 DOI: 10.1007/s00266-016-0770-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 12/11/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The demand for reconstructive breast surgery after mastectomy is increasing among women and the two-stage option remains the most commonly performed technique. We conducted a self-controlled prospective clinical trial comparing the use of the serratus anterior fascia with the serratus anterior detached fibers to cover the inferolateral aspect of the expander in immediate two-stage breast reconstruction following conservative mastectomies as oncological or risk-reducing procedures. PATIENTS AND METHODS We analyzed the surgical outcome of 29 bilateral mastectomies and immediate reconstruction with the positioning of a tissue expander in a pocket beneath the pectoralis major and serratus anterior muscle on one side and in a pocket beneath the pectoralis major and a serratus anterior fascia flap on the other side. We considered all complications presenting in the first month after surgery and patient-reported early post-operative pain. RESULTS Complication rates in the two groups did not significantly differ (p = 0.237). The total amount of drainage and the time of drainage permanence were significantly lower for the subfascial group (p < 0.05). Patient-reported early post-operative pain was significantly different between the two groups both at 24 h (p < 0.05) and at 5 days (p < 0.05) with significantly lower pain scores reported by the patients in the subfascial group. DISCUSSION Our self-controlled prospective trial demonstrated an advantage in performing an implant-based two-stage breast reconstruction using a serratus anterior fascia flap when compared with the serratus muscle fibers use for inferolateral implant coverage following mastectomy. The use of the anterior serratus fascia flap for inferolateral implant coverage in two-stage breast reconstructions following mastectomy could be considered as a safe and effective technique, presenting lower morbidity for the patient when compared with the serratus muscle fibers use and lower costs when compared with biological and synthetic meshes use, achieving good outcomes in terms of post-operative complications and women's quality of life and satisfaction levels. 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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