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Khan N, Wickman M, Schultz I. A Long-term Evaluation of Acellular Dermal Matrix for Immediate Implant-based Breast Reconstruction following Risk-reducing Mastectomy. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5951. [PMID: 38957718 PMCID: PMC11219151 DOI: 10.1097/gox.0000000000005951] [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: 10/01/2023] [Accepted: 04/25/2024] [Indexed: 07/04/2024]
Abstract
Background Acellular dermal matrices (ADMs) are sometimes used in implant-based breast reconstructions (IBR), but long-term ADM-related evaluations are scarce. In this study, we evaluated early and late complications and patient-related outcomes (PROs) over an 8-year postoperative period in women who had undergone immediate IBR following risk-reducing mastectomy with bovine ADM (SurgiMend). Methods This prospective observational single-center analysis involved 34 women at high risk for breast carcinoma. Complications were prospectively recorded during the first year, followed by 4 years of postoperative retrospective chart reviews. Long-term evaluations were done using a questionnaire. Preoperative, 1 year, and 5- to 8-year postoperative PRO assessments were obtained based on results from the BREAST-Q questionnaire. Results In 56 breasts, complications after a mean of 12.4 months follow-up included implant loss (7.1%), implant change (1.8%), hematoma (7.1%), breast redness (41.1%), and seroma (8.9%). Most breasts (80.3%) were graded Baker I/II, which indicated a low capsular contracture incidence. After a mean of 6.9 years, the total implant explantation rate was 33.9%, and the revision surgery rate was 21.4%. Two cases of breast cancer were reported during the long-term evaluation. BREAST-Q results indicated significantly decreased satisfaction with outcome (P = 0.024). A positive trend regarding psychosocial well-being and declining trend regarding satisfaction with both breast physical- and sexual well-being parameters were reported. Conclusions The observed complication rates agree with previous findings concerning ADM-assisted IBR. A high demand for revision surgery exists, and PROs remain relatively stable over time.
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Affiliation(s)
- Nida Khan
- From the Division of Reconstructive Plastic Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Marie Wickman
- From the Division of Reconstructive Plastic Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
| | - Inkeri Schultz
- From the Division of Reconstructive Plastic Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
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2
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Eyuboglu AA, Akdemir O, Aydogan F, Isken MT. Implant-Based Breast Reconstruction with Bovine Pericardium: Our Approach Using Tutopatch ® and Review of Literature. Aesthetic Plast Surg 2024; 48:285-296. [PMID: 37973674 DOI: 10.1007/s00266-023-03732-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/17/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES To describe the usage and advantages of bovine pericardium mesh (Tutopatch®) in breast reconstruction and to compare different mesh materials used in immediate breast reconstruction. METHODS Our study involved a single-center, retrospective analysis of 103 patients (comprising 114 breasts) who underwent immediate implant-based breast reconstruction using bovine pericardium bovine matrix. The procedures were performed by the same surgical team between April 2018 and May 2023. RESULTS The rates of early and late complications were examined after a median follow-up period of 30.2 ± 5.5 months. The results revealed that the rates of early complications stood at 9.7%, while late complications were observed in 14.5% of the cases. The most common late complication was seroma formation (7.7%) which six were resolved without any surgical intervention. CONCLUSION Tutopatch® can be used as an extension of the muscle to cover the prosthesis. It forms an extra layer over the silicone implant that helps to decrease the complications as capsular contracture and implant exposure. It also represents a significant 85 % reduction in cost when compared to a similar-sized mesh materials. 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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Affiliation(s)
- Atilla Adnan Eyuboglu
- Department of Plastic and Reconstructive Surgery, Arel University Faculty of Medicine, Bahcelievler Memorial Hospital, Bahcelievler Mah. Adnan Kahveci Bulvari no: 227, 34180, Bahcelievler, Istanbul, Turkey.
| | - Ovunc Akdemir
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Aydın University, Istanbul, Turkey
| | - Fatih Aydogan
- Department of Breast Surgery, General Surgery, Bahcelievler Memorial Hospital, Istanbul, Turkey
| | - Mustafa Tonguc Isken
- Department of Plastic and Reconstructive Surgery, Bahcesehir University Faculty of Medicine, Bahcelievler Memorial Hospital, Istanbul, Turkey
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Shih S, Askinas C, Caughey S, Vernice N, Berri N, Dong X, Spector JA. Sourcing and development of tissue for transplantation in reconstructive surgery: A narrative review. J Plast Reconstr Aesthet Surg 2023; 83:266-275. [PMID: 37279636 DOI: 10.1016/j.bjps.2023.05.001] [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: 03/30/2023] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 06/08/2023]
Abstract
The wealth of allogeneic and xenogeneic tissue products available to plastic and reconstructive surgeons has allowed for the development of novel surgical solutions to challenging clinical problems, often obviating the need to inflict donor site morbidity. Allogeneic tissue used for reconstructive surgery enters the tissue industry through whole body donation or reproductive tissue donation and has been regulated by the FDA as human cells, tissues, and cellular and tissue-based products (HCT/Ps) since 1997. Tissue banks offering allogeneic tissue can also undergo voluntary regulation by the American Association of Tissue Banks (AATB). Tissue prepared for transplantation is sterilized and can be processed into soft tissue or bone allografts for use in surgical reconstruction, whereas non-transplant tissue is prepared for clinical training and drug, medical device, and translational research. Xenogeneic tissue, which is most often derived from porcine or bovine sources, is also commercially available and is subject to strict regulations for animal breeding and screening for infectious diseases. Although xenogeneic products have historically been decellularized for use as non-immunogenic tissue products, recent advances in gene editing have opened the door to xenograft organ transplants into human patients. Herein, we describe an overview of the modern sourcing, regulation, processing, and applications of tissue products relevant to the field of plastic and reconstructive surgery.
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Affiliation(s)
- Sabrina Shih
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medical Center/New York-Presbyterian Hospital, New York, NY, United States of America
| | - Carly Askinas
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medical Center/New York-Presbyterian Hospital, New York, NY, United States of America
| | - Sarah Caughey
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medical Center/New York-Presbyterian Hospital, New York, NY, United States of America
| | - Nicholas Vernice
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medical Center/New York-Presbyterian Hospital, New York, NY, United States of America
| | - Nabih Berri
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medical Center/New York-Presbyterian Hospital, New York, NY, United States of America
| | - Xue Dong
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medical Center/New York-Presbyterian Hospital, New York, NY, United States of America
| | - Jason A Spector
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medical Center/New York-Presbyterian Hospital, New York, NY, United States of America.
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4
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Sağir M, Güven E, Eröz S, Uras C. Implant selection in natural and stable direct-to-implant reconstruction with ten steps at nipple-sparing mastectomy. Medicine (Baltimore) 2023; 102:e33758. [PMID: 37171305 PMCID: PMC10174419 DOI: 10.1097/md.0000000000033758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Direct-to-implant reconstruction is one of the breast repair techniques after mastectomy. Implant selection is critical in the short- and long-term success of direct-to-implant reconstruction after nipple-sparing mastectomy. In this study we developed a 10-step algorithm that we use before and during surgery. We aimed to obtain natural and stable breast reconstruction with this algorithm. In addition, we also aimed to evaluate which implants were selected using this algorithm and their short- and long-term outcomes. This retrospective study included 218 patients aged 27 to 60 years who underwent mastectomy and direct-to-implant reconstruction between November 2018 and December 2021. The patients were assigned into 4 groups according to amount of breast tissue removed. We developed a 10-step algorithm and these included: breast base, amount of breast tissue removed, evaluation of mastectomy skin flap, breast projection, ptosis, unilateral/bilateral reconstruction, chest wall deformity, patient's request, comorbid conditions and stabilization and arrangement of novel sulcus. The evaluation was made when the patient's photographs were taken at least 1 year after the surgery. The highest number of patients was recorded in group 3; in addition, mean age was also highest in group 3. The lowest number of patients was recorded in group 4. The body mass index showed a progressive increase from group 1 to group 4. Medium height moderate profile prosthesis was used in 81.7% while medium height moderate plus profile prosthesis was used in 18.3% of breasts included. We used larger prosthesis up to 58.1% when compared to the tissue removed in group 1 while we used smaller prosthesis by 25.6% in group 4. In the anterior view, the medial and lateral arch of the lower pole of the breast was obtained in all patients. Obvious asymmetry developed in 4 patients. In lateral and oblique views, upper and lower pole natural breast images were obtained in all patients, except for 5 patients. There was no sulcus inferior displacement in any patient. Implant extrusion did not occur in any patient. This algorithm is an easy to use and effective method to obtain a stable and natural breast image in the long-term.
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Affiliation(s)
- Mehmet Sağir
- Specialist in Department of Plastic Surgery, Private Acibadem Maslak Hospital, Sariyer, İstanbul, Turkey
| | - Erdem Güven
- Specialist in Department of Plastic Surgery, Private Acibadem Maslak Hospital, Sariyer, İstanbul, Turkey
| | - Seda Eröz
- Specialist in Department of Radiation Oncolog, Private Acibadem Maslak Hospital, Sariyer, İstanbul, Turkey
| | - Cihan Uras
- Specialist in Department of General Surgery, Private Acibadem Maslak Hospital, Sariyer, İstanbul, Turkey
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Waxman S, Strzalkowska A, Wang C, Loewen R, Dang Y, Loewen NA. Tissue-engineered anterior segment eye cultures demonstrate hallmarks of conventional organ culture. Graefes Arch Clin Exp Ophthalmol 2022; 261:1359-1368. [PMID: 36565327 PMCID: PMC10148776 DOI: 10.1007/s00417-022-05915-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/11/2022] [Accepted: 11/16/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Glaucoma is a blinding disease largely caused by dysregulation of outflow through the trabecular meshwork (TM), resulting in elevated intraocular pressure (IOP). We hypothesized that transplanting TM cells into a decellularized, tissue-engineered anterior segment eye culture could restore the outflow structure and function. METHODS Porcine eyes were decellularized with freeze-thaw cycles and perfusion of surfactant. We seeded control scaffolds with CrFK cells transduced with lentiviral vectors to stably express eGFP and compared them to scaffolds seeded with primary TM cells as well as to normal, unaltered eyes. We tracked the repopulation behavior, performed IOP maintenance challenges, and analyzed the histology. RESULTS Transplanted cells localized to the TM and progressively infiltrated the extracellular matrix, reaching a distribution comparable to normal, unaltered eyes. After a perfusion rate challenge to mimic a glaucomatous pressure elevation, transplanted and normal eyes reestablished a normal intraocular pressure (transplanted = 16.5 ± 0.9 mmHg, normal = 16.9 ± 0.9). However, eyes reseeded with eGFP-expressing CrFK cells could not regulate IOP, remaining high and unstable (27.0 ± 6.2 mmHg) instead. CONCLUSION Tissue-engineered anterior segment scaffolds can serve as readily available, scalable ocular perfusion cultures. This could reduce dependency on scarce donor globes in outflow research and may allow engineering perfusion cultures with specific geno- and phenotypes.
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Affiliation(s)
- Susannah Waxman
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Chao Wang
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ralitsa Loewen
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Ophthalmology, University of Würzburg, Würzburg, Germany
| | - Yalong Dang
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Sanmenxia Central Hospital, Sanmenxia, Henan, China
| | - Nils A Loewen
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. .,Department of Ophthalmology, University of Würzburg, Würzburg, Germany. .,Artemis Eye Centers of Frankfurt, Hanauer Landstr. 147-149, 60314, Frankfurt, Germany.
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6
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Innocenti A, Melita D, Affortunati M, Susini T, Innocenti M. Immediate-implant-based-breast-reconstruction with two-stage expander-implant reconstruction versus one-stage-reconstruction with acellular dermal matrix: analysis of patients' satisfaction. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021228. [PMID: 34212931 PMCID: PMC8343747 DOI: 10.23750/abm.v92i3.9916] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 11/23/2022]
Abstract
Background. The aim of this retrospective study is to evaluate the patient-reported outcome after immediate ADM-assisted implant- based breast reconstruction. Material and Methods: Patients underwent breast reconstruction from 2015 to 2019 have been retrospectively divided into group A (partial subpectoral implant and ADM and group B (expander/implant). For each patient we evaluated retrospectively postoperative complications and patients’ satisfaction. Results: 26 patients from the case group and 40 from the control group completed the BREAST-Q. The incidence of complications in the cases was 18.4%, while in the control group was 20.4%. We found no statistical difference in most of the domains and in the mean score of the questionnaire (mean score cases=69.0±14.4 vs controls=68.4±15.7; p=0.888). A significant difference results only in the domains Q2a and Q2b, sensation of rippling. Conclusions: The use of ADM in one-stage reconstruction allows to perform breast reconstruction in only one surgery, with similar complication rates and patient satisfaction. (www.actabiomedica.it)
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Affiliation(s)
- Alessandro Innocenti
- Plastic and Reconstructive Microsurgery - Careggi University Hospital - Florence.
| | - Dario Melita
- Plastic and Reconstructive Microsurgery - Careggi University Hospital - Florence.
| | - Marco Affortunati
- Plastic and Reconstructive Microsurgery - Careggi University Hospital - Florence.
| | - Tommaso Susini
- Breast Unit - Ginecology Section - Department of Health Science - Careggi University Hospital - Florence- Italy.
| | - Marco Innocenti
- Plastic and Reconstructive Microsurgery - Careggi University Hospital - Florence.
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7
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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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Eichler C, Stephan S, Thangarajah F, Puppe J, Rahmani N, Kurbacher C, Malter W, Warm M. Intraoperative central nipple biopsy in nipple-sparing mastectomy- A retrospective analysis of 211 patients. Breast J 2021; 27:363-368. [PMID: 33619792 DOI: 10.1111/tbj.14197] [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: 12/11/2020] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Abstract
Subcutaneous nipple sparing mastectomies (NSM) are an important tool in modern oncoplastic surgery. Especially when an immediate implant-based reconstruction (IBR) is desired, clean margins are of the utmost importance. Central nipple biopsies during surgery serve two main purposes. Most importantly, it is hypothesized that intraoperative pathological evaluation of this biopsy may increase clean margin resection rates. In addition, a general recurrence risk reduction may occur due to the elimination of glandular and ductal components within the nipple. This analysis is a single center, multi-surgeon, retrospective, head to head analysis. Starting in March 2015, intraoperative central nipple biopsy in NSMs with IBR was introduced at the Municipal Breast Cancer Centre Cologne, Holweide, Germany. This trial retrospectively evaluates global complication rates, clean margin status and local recurrence rates for cohort 1 (NSM/no nipple biopsy, n = 103) vs. cohort 2 (NSM with nipple biopsy, n = 108) Median follow-up was 15 months. All implant-based reconstruction procedures used an epipectoral implant pocket. Cohorts were comparable. Global complication rates slightly favored the nipple biopsy cohort with respects to implant loss rate. An involved central nipple biopsy was found in 4.6% (n = 5/108) of the performed NSM procedures leading to the immediate removal of the nipple areola complex. All positive retro-areolar biopsies correlated with a positive nipple biopsy. However, in n = 1 case we found DCIS discontinual proliferation with an involved nipple biopsy, without a correlating positive retro-areolar biopsy (ie, 1 false-negative case was prevented). For the 15 month follow-up, there was no case of local recurrence within nipple areola complex for both cohorts. With this retrospective head to head analysis of 211 patients, it was shown that the central nipple biopsy correlates well with the retro-areolar biopsy. There may be a reduction in false negative rates. The procedure is safe to use and should be offered to NSM patients.
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Affiliation(s)
- Christian Eichler
- Department of Gynaecology and Obstetrics, Faculty of Medicine University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sophia Stephan
- Breast Cancer Centre, Municipal Hospital Holweide, Cologne, Germany
| | - Fabinshy Thangarajah
- Department of Gynaecology and Obstetrics, Faculty of Medicine University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julian Puppe
- Department of Gynaecology and Obstetrics, Faculty of Medicine University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Neda Rahmani
- Department of Gynaecology and Obstetrics, Faculty of Medicine University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christian Kurbacher
- Department of Gynaecology and Obstetrics, Faculty of Medicine University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Wolfram Malter
- Department of Gynaecology and Obstetrics, Faculty of Medicine University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Mathias Warm
- Department of Gynaecology and Obstetrics, Faculty of Medicine University Hospital Cologne, University of Cologne, Cologne, Germany.,Breast Cancer Centre, Municipal Hospital Holweide, Cologne, Germany
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9
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Platelet-Rich Plasma (PRP) in Breast Cancer Patients: An Application Analysis of 163 Sentinel Lymph Node Biopsies. BIOMED RESEARCH INTERNATIONAL 2020; 2020:3432987. [PMID: 33145346 PMCID: PMC7599401 DOI: 10.1155/2020/3432987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/26/2020] [Accepted: 10/05/2020] [Indexed: 11/25/2022]
Abstract
Introduction Literature shows platelet-rich plasma (PRP) to improve overall outcomes in orthopedics, dermatology, ophthalmology, gynecology, and plastic surgery. Data on oncological patients is very limited. Only one publication is available on PRP in breast cancer patients. This work evaluated PRP in sentinel node biopsy procedures for breast cancer patients in terms of complication rates and oncological short-term follow-up. Methods The evaluated PRP was ACP®, i.e., autologous conditioned plasma by Arthrex®. Between 2015 and 2018, 163 patients were offered to receive an ACP®/PRP injection in their lymph node biopsy site. Recruitment resulted in an approximate one-to-one ratio for analysis. Endpoints were major (revision) and minor (seroma, hematoma, and infection) complications rates as well as distant metastases, local recurrence, and overall survival. Median follow-up was 30 months. Results Complication rates and oncological follow-up showed PRP to be applicable to use in a sentinel node biopsy scenario in breast cancer patients. There were 0 revisions in the ACP®/PRP group and 1.2% revisions in the control group (not significant). Oncological follow-up showed zero (0) distant metastases and local recurrences as well as a 100% 30-month overall survival. Conclusions This is the first analysis of ACP®/PRP used in breast cancer patients in a sentinel node biopsy setting worldwide. PRP does not seem to increase rates of local recurrence within this 30-month follow-up time frame. Also, trend towards decreasing complication rates could be shown.
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10
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Berna G, Cagli B, Persichetti P, Cogliandro A, Silan F, Maritan M, Dell'Antonia F. Feasibility study on equine acellular pericardium matrix (APM): A new tool for breast reconstruction. J Plast Reconstr Aesthet Surg 2020; 73:2150-2155. [PMID: 32513644 DOI: 10.1016/j.bjps.2020.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 03/06/2020] [Accepted: 05/09/2020] [Indexed: 11/19/2022]
Abstract
The advent of acellular dermal matrix (ADM) for lower pole coverage allows immediate reconstructions with improved aesthetic outcomes and faster recovery. This study describes for the first time, the use of a new acellular pericardium matrix (APM) in implant-based breast reconstruction and characterises its safety profile. Equity is a membrane with a natural cross-linked structure with many of the properties of ADMs, but improved resistance and reduced thickness. A retrospective data collection of all Equity APM reconstructions was conducted at two Italian hospital centres with substantial experience using biomaterials. Between May 2013 and October 2018, a total of 63 APM-assisted breast reconstructions were performed in 55 women. The reconstructed breasts were small to medium and the mean implant weight was 285 g, ranging from 145 g to 685 g. Two patients were previously irradiated while seven received post-operative radiation; five were active smokers and six were hypertensive. Complications included visibility in the upper pole (9.5%), seroma (1.6%), dehiscence, infection and necrosis (3.2% for each). Implant loss occurred in 3.2% of the cases. The patients were highly satisfied, reporting scores above 50 for each section of the Breast-Q questionnaire. With an acceptable complication rate, the use of the equine APM can be considered safe with satisfactory aesthetic results. Although the retrospective nature of this study limits its clinical impact, the use of Equity can be considered a viable alternative to thicker and expensive ADMs.
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Affiliation(s)
- Giorgio Berna
- Ca' Foncello Hospital, ULSS2 Marca Trevigiana, via S. Ambrogio di Fiera, n. 37, 31100, Treviso, Italy.
| | - Barbara Cagli
- Policlinico Universitario Campus Bio-Medico, via Alvaro del Portillo 200, 00128, Roma, Italy
| | - Paolo Persichetti
- Policlinico Universitario Campus Bio-Medico, via Alvaro del Portillo 200, 00128, Roma, Italy
| | - Annalisa Cogliandro
- Policlinico Universitario Campus Bio-Medico, via Alvaro del Portillo 200, 00128, Roma, Italy
| | - Francesco Silan
- Ca' Foncello Hospital, ULSS2 Marca Trevigiana, via S. Ambrogio di Fiera, n. 37, 31100, Treviso, Italy
| | - Monia Maritan
- Ca' Foncello Hospital, ULSS2 Marca Trevigiana, via S. Ambrogio di Fiera, n. 37, 31100, Treviso, Italy
| | - Francesco Dell'Antonia
- Ca' Foncello Hospital, ULSS2 Marca Trevigiana, via S. Ambrogio di Fiera, n. 37, 31100, Treviso, Italy
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11
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Cornwell KG, Jessee CB, Adelman DM. Clinically available reinforcing materials for soft tissue reconstruction. Br J Hosp Med (Lond) 2020; 81:1-10. [PMID: 32240006 DOI: 10.12968/hmed.2018.0428b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Navigating the rapidly evolving field of materials for soft tissue reinforcement is challenging given the volume of clinically available options. Additionally, the current generally accepted classifications of these mesh materials confound the understanding of their utility by grouping disparate materials that have attributes overlapping category boundaries and that do not fully consider their clinically functionality. This review article highlights, from a materials science perspective, the most important attributes of these materials to improve the clinical decision-making process in the selection of the most appropriate features and design for the patient, surgery and clinical need. These characteristics include the physical attributes that directly impact the surgical procedure and immediate postoperative mechanical requirements as well as the post-implantation properties such as an adequate reinforcement time, strength of the resulting tissue and infection risk profile.
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Affiliation(s)
| | | | - David M Adelman
- MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
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12
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Prosthetic Breast Reconstruction and Red Breast Syndrome: Demystification and a Review of the Literature. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2108. [PMID: 31333922 PMCID: PMC6571326 DOI: 10.1097/gox.0000000000002108] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/27/2018] [Indexed: 01/08/2023]
Abstract
Supplemental Digital Content is available in the text. Red breast syndrome (RBS) represents an inflammatory condition that rarely occurs in the setting of acellular dermal matrix use after prosthetic reconstruction. It is characterized by erythema or rubor that occurs directly over the ADM, and its appearance resembles that of a cellulitis. There have been many explanations with regard to etiology, but none have addressed the physiologic alterations leading to the onset and resolution of RBS. RBS is postulated to be the result of lymphatic disruption and is self-limiting. Resolution is postulated to be the result of angiolymphatic regeneration and the re-establishment of lymphatic flow within the mastectomy skin flap and the ADM, resulting in the clearance of inflammatory mediators responsible for the localized erythema.
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13
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Thangarajah F, Treeter T, Krug B, Hellmich M, Eichler C, Hanstein B, Mallmann P, Malter W. Comparison of Subpectoral versus Prepectoral Immediate Implant Reconstruction after Skin- and Nipple-Sparing Mastectomy in Breast Cancer Patients: A Retrospective Hospital-Based Cohort Study. Breast Care (Basel) 2019; 14:382-387. [PMID: 31933584 DOI: 10.1159/000496696] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction Implant-based immediate breast reconstruction (IBR) is a common surgical procedure in breast cancer patients. Comparative analysis concerning the placement of implants is still lacking. Hence, we aimed to analyze pre- versus subpectoral IBR in breast cancer patients. Patients A single-center experience with implant-based IBR following skin/nipple-sparing mastectomy was evaluated. Patient demographics, incidence of major complications, and quality of life assessed with BREAST-Q were compared between the pre- and subpectoral cohort. Results A total of 63 patients were included in this analysis of whom 29 underwent subpectoral and 34 underwent prepectoral IBR. Median duration of surgery was prolonged in the subpectoral versus the prepectoral group (104 ± 28 vs. 80 ± 91 min; p < 0.05). The mean number of major complications was significantly increased in the subpectoral group (1.41 ± 1.76 vs. 0.47 ± 0.75 per patient; p < 0.05). Detailed analysis showed a significantly increased incidence of implant dislocation (p < 0.05) and a trend concerning capsular contracture (p = 0.086, not significant) and necrosis (p = 0.092, not significant) in the subpectoral group. Quality of life was equal in both groups. Conclusion The mean number of major complications in the subpectoral group should be considered when IBR is indicated. Prepectoral IBR seems to be a feasible alternative surgical treatment option with less major complications in selected patients.
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Affiliation(s)
- Fabinshy Thangarajah
- Department of Obstetrics and Gynecology, Faculty of Medicine and University Hospital, University of Cologne, Cologne.,Breast Center, University Hospital Cologne, Cologne
| | - Timo Treeter
- Department of Obstetrics and Gynecology, Faculty of Medicine and University Hospital, University of Cologne, Cologne
| | - Barbara Krug
- Department of Diagnostical and Interventional Radiology, University of Cologne Medical School, Cologne
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany
| | - Christian Eichler
- Department of Obstetrics and Gynecology, Faculty of Medicine and University Hospital, University of Cologne, Cologne.,Breast Center, University Hospital Cologne, Cologne
| | - Bettina Hanstein
- Department of Obstetrics and Gynecology, Faculty of Medicine and University Hospital, University of Cologne, Cologne.,Breast Center, University Hospital Cologne, Cologne
| | - Peter Mallmann
- Department of Obstetrics and Gynecology, Faculty of Medicine and University Hospital, University of Cologne, Cologne
| | - Wolfram Malter
- Department of Obstetrics and Gynecology, Faculty of Medicine and University Hospital, University of Cologne, Cologne.,Breast Center, University Hospital Cologne, Cologne
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Comparing the Outcome of Different Biologically Derived Acellular Dermal Matrices in Implant-based Immediate Breast Reconstruction: A Meta-analysis of the Literatures. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1701. [PMID: 29707460 PMCID: PMC5908498 DOI: 10.1097/gox.0000000000001701] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 01/19/2018] [Indexed: 11/29/2022]
Abstract
Background: Acellular dermal matrices (ADMs) have been used extensively in implant-based breast reconstruction. It was reported that due to the different sources and processing methods, the outcomes of ADMs in implant-based breast reconstructions are expected to differ. We designed this study to statistically analyze and discuss the outcome of 3 commonly used ADMs, Alloderm, Strattice, and Surgimend in implant-based breast reconstruction. Methods: Comprehensive review of the literatures searched on electronic databases was done to identify studies published between 2006 and 2017 comparing the outcome of ADMs. Pooled random effect estimates for each complication and 95% confidence interval (CI) were calculated. One-way analysis of variance and Bonferroni test were used to compare statistical significance between and within groups, respectively. Multiple linear regression was done to include confounding factors and R statistic program for forest plot. Results: Twenty-one studies met the inclusion with a total of 1,659, 999, and 912 breasts reconstructions in Alloderm, Strattice, and Surgimend, respectively. Seven complications extracted including major and minor infection, seroma, implant loss, hematoma, capsular contracture, and localized erythema. Pooled total complication rates were 23.82% (95% CI, 21.18–26.47%) in Strattice, 17.98% (95% CI, 15.49–20.47%) in Surgimend, 16.21% (95% CI, 14.44–17.99%) in Alloderm. Seroma rate was the highest in Strattice group (8.61%; 95% CI, 6.87–10.35%). There was no statistical significance between and within groups. Conclusion: Although Strattice exhibited a higher overall pooled complication rate compared with Alloderm and Surgimend, the incidence of individual complication varies between studies. A cost analysis of different ADMs may aid in choosing the type of ADMs to be used.
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