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Correia-Pinto JM, Andresen C, Barbosa JP, Poleri F, Casimiro R, Gonçalves D, Baptista D, Coelho G, Cunha C, Costa H. Impact of polyurethane versus acellular dermal matrix coating on prepectoral reconstruction outcomes: Interface does matter. J Plast Reconstr Aesthet Surg 2024; 91:15-23. [PMID: 38401273 DOI: 10.1016/j.bjps.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 01/09/2024] [Accepted: 01/29/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Interfaces continue to be used in prepectoral breast reconstruction to refine breast appearance, but more clinical data are required to assess their effectiveness. This study compares the rates of capsular contracture, breast esthetics, and patient satisfaction between two commonly used interface materials, acellular dermal matrix (ADM) and polyurethane (PU) foam. METHODS A cross-sectional assessment was conducted on all patients who underwent prepectoral direct-to-implant reconstruction with an interface material between June 2018 and June 2022. We compared capsular contracture rates (assessed in-person), esthetic outcomes (evaluated by a three-member panel using a specially designed scale), and patient satisfaction (measured using the Breast-Q questionnaire) among the members of the interface groups. RESULTS Among the 79 reconstructed breasts (20 bilateral cases), 35 were reconstructed using ADM and 44 using PU implants. The ADM group had a significantly higher frequency of Baker III/IV capsular contracture compared with the PU group (14.3% vs. 0%, p = 0.014) and lower ratings from the panel in terms of capsular contracture (median 3.7 vs. 4.0, p < 0.001). PU reconstructions scored worse in implant visibility (median 2.3 vs. 3.3, p < 0.001) and rippling (median 3.0 vs. 3.7, p < 0.001). However, after appropriate adjustment for confounders, no significant differences in overall appearance and patient satisfaction were found. CONCLUSIONS ADM reconstructions are prone to capsular contracture with all their related esthetic issues, but PU implants have certain cosmetic flaws, such as implant visibility and malposition. Since each technique has its own limitations, neither the experienced surgeons nor patients exhibited a clear preference for either approach.
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Affiliation(s)
- Jorge M Correia-Pinto
- Serviço de Cirurgia Plástica Reconstrutiva, Craniomaxilofacial e Mão - Unidade de Microcirurgia; Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal; Serviço de Cirurgia Plástica; Hospital da Prelada, Rua de Sarmento de Beires 153, 4250-449 Porto, Portugal.
| | - Carolina Andresen
- Serviço de Cirurgia Plástica Reconstrutiva, Craniomaxilofacial e Mão - Unidade de Microcirurgia; Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
| | - José P Barbosa
- Departamento de Medicina da Comunidade, Informação e Decisão em Saúde (MEDCIDS); Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Filipa Poleri
- Serviço de Cirurgia Plástica Reconstrutiva, Craniomaxilofacial e Mão - Unidade de Microcirurgia; Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal; Serviço de Cirurgia Plástica; Hospital da Prelada, Rua de Sarmento de Beires 153, 4250-449 Porto, Portugal
| | - Rui Casimiro
- Serviço de Cirurgia Plástica Reconstrutiva, Craniomaxilofacial e Mão - Unidade de Microcirurgia; Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal; Serviço de Cirurgia Plástica; Hospital da Prelada, Rua de Sarmento de Beires 153, 4250-449 Porto, Portugal
| | - David Gonçalves
- Serviço de Cirurgia Plástica Reconstrutiva, Craniomaxilofacial e Mão - Unidade de Microcirurgia; Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal; Serviço de Cirurgia Plástica; Hospital da Prelada, Rua de Sarmento de Beires 153, 4250-449 Porto, Portugal
| | - Daniel Baptista
- Serviço de Cirurgia Plástica Reconstrutiva, Craniomaxilofacial e Mão - Unidade de Microcirurgia; Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal; Serviço de Cirurgia Plástica; Hospital da Prelada, Rua de Sarmento de Beires 153, 4250-449 Porto, Portugal
| | - Gustavo Coelho
- Serviço de Cirurgia Plástica Reconstrutiva, Craniomaxilofacial e Mão - Unidade de Microcirurgia; Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
| | - Cristina Cunha
- Serviço de Cirurgia Plástica Reconstrutiva, Craniomaxilofacial e Mão - Unidade de Microcirurgia; Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
| | - Horácio Costa
- Serviço de Cirurgia Plástica Reconstrutiva, Craniomaxilofacial e Mão - Unidade de Microcirurgia; Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
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Lee MK, Hwang JW, Park JW, Woo KJ. Serial Comparison of Patient-Reported Outcomes of Immediate Breast Reconstruction: Direct-to-Implant Versus Deep Inferior Epigastric Perforator Flap. Aesthetic Plast Surg 2024; 48:1352-1361. [PMID: 37464217 DOI: 10.1007/s00266-023-03505-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/30/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Direct-to-implant (DTI) and deep inferior epigastric artery perforator (DIEP) flaps are the two most common methods of immediate breast reconstruction. This study aimed to compare patient-reported outcomes between the two methods and to evaluate whether outcomes change over time. METHODS The data of patients who underwent immediate breast reconstruction using DTI or DIEP flaps between July 2017 and October 2021 were retrospectively reviewed. Patients who completed the BREAST-Q Reconstruction Module at 6 months and > 12 months after reconstruction were analyzed. Mann-Whitney and Wilcoxon signed-rank test were used to compare outcome between DTI and DIEP groups, and serial comparisons were performed. RESULTS Of 375 patients included in the analysis, 146 patients completed questionnaires > 1 year of follow-up (20.79 ± 8.55 months). The DTI and DIEP groups had 102 (69.9%) and 44 (30.1%) patients, respectively. There were no intergroup differences in the mean scores representing any of the domains at 6 postoperative months. After > 1 year of follow-up, patients who underwent DIEP-flap reconstruction had greater satisfaction with their breast reconstructions (p < 0.001) and greater satisfaction with their overall outcomes (p < 0.001). In the DTI group, satisfaction scores did not change over time in any of the domains. In the DIEP group, however, the mean scores reflecting satisfaction with the breast (p = 0.001), overall outcome (p = 0.045), psychosocial well-being (p = 0.015), and sexual well-being (p = 0.042) significantly increased over long-term follow-up relative to the scores at 6 postoperative months. CONCLUSIONS Patient-reported outcomes improved over time in association with DIEP reconstructions, reflecting higher satisfaction levels than those associated with DTI reconstruction. 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)
- Mi Kyung Lee
- Department of plastic and reconstructive surgery, College of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Ji Won Hwang
- Department of Plastic and Reconstructive Surgery, College of Medicine, Ewha Womans University Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, Republic of Korea
| | - Jin-Woo Park
- Department of Plastic and Reconstructive Surgery, College of Medicine, Ewha Womans University Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, Republic of Korea
| | - Kyong-Je Woo
- Department of Plastic and Reconstructive Surgery, College of Medicine, Ewha Womans University Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, Republic of Korea.
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Hwang JW, Park JW, Jeon BJ, Woo KJ. Separate axillary incision for surgery of axillary lymph node can decrease drain amount and days to drain removal of the breast in direct-to-implant breast reconstruction. J Plast Reconstr Aesthet Surg 2024; 91:6-14. [PMID: 38401279 DOI: 10.1016/j.bjps.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/29/2023] [Accepted: 01/29/2024] [Indexed: 02/26/2024]
Abstract
PURPOSE Sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) can be performed either with a separate axillary incision or through the mastectomy incision. The authors hypothesized that after SLNB or ALND through a single incision, connection of the axilla with mastectomy pocket could increase drainage. This study investigated whether a separate incision decreases drainage amount and duration in implant-based breast reconstruction. METHODS Medical records of breast cancer patients who underwent nipple-sparing or skin-sparing mastectomy with immediate breast reconstruction with prosthesis from March 2018 to February 2021 in a single tertiary center were reviewed. Demographic data, intraoperative details, and postoperative complications were reviewed. Breast drains were removed if the drain amount was less than 30cc for two consecutive days. Total breast drain amount, duration until removal, and prolonged drainage were compared with multivariate analysis. RESULTS A total of 206 patients were included in the study, with separate incisions placed in 145 breasts and a single breast incision placed in 70 breasts. Mean duration and amount until drain removal were 12.8 ± 4.9 days and 817 ± 520 cc in the single incision group, respectively, and 9.9 ± 3.1 days and 434 ± 228 cc in the separate incision group, respectively Separate incision placement (p < 0.001), lower mastectomy weight (p < 0.001), and prepectoral plane of insertion (p < 0.001) were significantly associated with less drain amount and duration. None-separate incision placement (p = 0.01) and preoperative radiation therapy (p = 0.023) were significant factors for prolonged drainage. CONCLUSION Placing a separate incision for axillary surgery during mastectomy and immediate implant-based reconstruction can decrease both drain amount and duration and reduce the risk of prolonged drainage.
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Affiliation(s)
- Ji Won Hwang
- Department of Plastic and Reconstructive Surgery, Ewha Womans University College of Medicine, Mokdong Hospital, Seoul, Republic of Korea
| | - Jin-Woo Park
- Department of Plastic and Reconstructive Surgery, Ewha Womans University College of Medicine, Mokdong Hospital, Seoul, Republic of Korea
| | - Byung-Joon Jeon
- Department of Plastic and Reconstructive Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Kyong-Je Woo
- Department of Plastic and Reconstructive Surgery, Ewha Womans University College of Medicine, Mokdong Hospital, Seoul, Republic of Korea; Department of Plastic and Reconstructive Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Shauly O, Olson B, Marxen T, Menon A, Losken A, Patel KM. Direct-to-implant versus autologous tissue transfer: A meta-analysis of patient-reported outcomes after immediate breast reconstruction. J Plast Reconstr Aesthet Surg 2023; 84:93-106. [PMID: 37329749 DOI: 10.1016/j.bjps.2023.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND The effect of immediate implant and autologous breast reconstruction on complication rates has been studied extensively; however, the patient-reported outcomes for these procedures during immediate, one-stage reconstruction has yet to be comprehensively investigated. OBJECTIVE This study compared the patient-reported outcomes for immediate implant reconstruction with those associated with immediate autologous reconstruction to determine the advantages and disadvantages for each modality from the patient's perspective. METHODS A literature search of PubMed between 2010 and 2021 was performed, and 21 studies containing patient-reported outcomes were selected for the analysis. A meta-analysis of patient-reported outcome scores was performed separately for immediate breast reconstruction using autologous tissue transfer and synthetic implants. RESULTS Nineteen manuscripts were included, representing data on a total of 1342 patients across all studies. The pooled mean of patients' satisfaction with their breasts was 70.7 (95% CI, 69.4-72.0) after immediate autologous reconstruction and 68.5 (95% CI, 67.1-69.9) after immediate implant reconstruction, showing a statistically significant difference in outcomes (p < 0.05). The pooled mean of patients' sexual well-being was 59.3 (95% CI, 57.8-60.8) after immediate autologous reconstruction and 62.8 (95% CI, 60.7-64.8) after immediate implant reconstruction (p < 0.01). The pooled mean of patients' satisfaction with their outcome was 78.8 (95% CI, 76.2-81.3) after immediate autologous reconstruction and 82.3 (95% CI, 80.4-84.1) after immediate implant reconstruction (p < 0.05). The results of each meta-analysis were summarized on forest plots depicting the distribution of patient-reported outcome scores from each study. CONCLUSIONS Immediate reconstruction with implants may have a similar or greater capacity to achieve patient satisfaction and improve patients' QoL compared to those associated with immediate reconstruction with autologous tissue transfer when both procedures are available.
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Affiliation(s)
- Orr Shauly
- Emory University School of Medicine, Division of Plastic and Reconstructive Surgery, GA, United States
| | - Blade Olson
- University of Southern California, Keck School of Medicine, Division of Plastic and Reconstructive Surgery, CA, United States
| | - Troy Marxen
- Emory University School of Medicine, Division of Plastic and Reconstructive Surgery, GA, United States.
| | - Ambika Menon
- Emory University School of Medicine, Division of Plastic and Reconstructive Surgery, GA, United States
| | - Albert Losken
- Emory University School of Medicine, Division of Plastic and Reconstructive Surgery, GA, United States
| | - Ketan M Patel
- University of Southern California, Keck School of Medicine, Division of Plastic and Reconstructive Surgery, CA, United States
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Qiu M, Yang H, Zhou J, Feng Y, Liu X, Zhang Q, Du Z. Short-term safety and cosmetic outcomes of endoscopic direct-to-implant breast reconstruction and simultaneous contralateral breast augmentation for breast cancer: a prospective analysis of 33 patients. World J Surg Oncol 2023; 21:201. [PMID: 37424000 DOI: 10.1186/s12957-023-03089-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/28/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND For patients with small breasts, breast-conserving surgery (BCS) and unilateral nipple-/skin-sparing mastectomy (N/SSM) with breast reconstruction may result in visible breast deformities or asymmetry, and contralateral breast augmentation often require a two-staged operation. We propose a novel endoscopic technique, direct-to-implant breast reconstruction and simultaneous contralateral breast augmentation (DTI-BR-SCBA), and report its short-term safety and cosmetic outcomes. METHODS In this prospective study, patients with early breast cancer who underwent endoscopic DTI-BR-SCBA between November 2020 and August 2022 were followed for more than 3 months to analysed short-term postoperative safety (complications and oncological safety) and cosmetic outcomes (doctor-assessed results by Ueda scale and patient-reported results by Breast-Q scale). RESULTS A total of 33 patients, including 30 treated with endoscopic prepectoral DTI-BR-SCBA, 1 with endoscopic dual-plane DTI-BR-SCBA and 2 with endoscopic subpectoral DTI-BR-SCBA, were analysed. The mean age was 39.7 ± 6.7 years. The mean operation time was 165.1 ± 36.1 min. The overall surgical complication rate was 18.2%. All complications were minor, including haemorrhage (3.0%), cured by compression haemostasis, surgical site infection (9.1%), cured by oral antibiotics, and self-healing nipple-areolar complex ischaemia (6.1%). Furthermore, rippling and implant edge visibility occurred in 6.2% of them. The outcome was graded as "Excellent" and "Good" in 87.9% and 12.1% of patients in the doctor cosmetic assessment, respectively, and patient satisfaction with breasts was significantly improved (55.0 ± 9.5 vs. 58.8 ± 7.9, P = 0.046). CONCLUSIONS The novel endoscopic DTI-BR-SCBA method may be an ideal alternative for patients with small breasts because it can improve cosmetic results with a relatively low complications rate, which makes it worthy of clinical promotion.
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Affiliation(s)
- Mengxue Qiu
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, WuHou District, Chengdu, 610041, China
- Breast Center, West China Hospital, Sichuan University, 37 Guoxue Street, WuHou District, Chengdu, 610041, China
| | - Huanzuo Yang
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, WuHou District, Chengdu, 610041, China
- Breast Center, West China Hospital, Sichuan University, 37 Guoxue Street, WuHou District, Chengdu, 610041, China
| | - Jiao Zhou
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, WuHou District, Chengdu, 610041, China
- Breast Center, West China Hospital, Sichuan University, 37 Guoxue Street, WuHou District, Chengdu, 610041, China
| | - Yu Feng
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, WuHou District, Chengdu, 610041, China
- Breast Center, West China Hospital, Sichuan University, 37 Guoxue Street, WuHou District, Chengdu, 610041, China
| | - Xinran Liu
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, WuHou District, Chengdu, 610041, China
- Breast Center, West China Hospital, Sichuan University, 37 Guoxue Street, WuHou District, Chengdu, 610041, China
| | - Qing Zhang
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, WuHou District, Chengdu, 610041, China
- Breast Center, West China Hospital, Sichuan University, 37 Guoxue Street, WuHou District, Chengdu, 610041, China
| | - Zhenggui Du
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, WuHou District, Chengdu, 610041, China.
- Breast Center, West China Hospital, Sichuan University, 37 Guoxue Street, WuHou District, Chengdu, 610041, China.
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Abstract
Implant-based breast reconstruction remains the most commonly performed type of restorative surgery after mastectomy for breast cancer. Placement of a tissue expander at the time of mastectomy allows gradual skin envelope expansion but requires additional surgery and time to completion of a patient's reconstruction. Direct-to-implant reconstruction provides a one-stage, final implant insertion, thereby bypassing the need for serial tissue expansion. With proper patient selection, successful preservation of the breast skin envelope, and accurate implant size and placement, direct-to-implant reconstruction has a very high rate of success and patient satisfaction.
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Affiliation(s)
- Jordan M S Jacobs
- Icahn School of Medicine, Mount Sinai Hospital, 1 Gustave Levy Place, New York, NY 10029, USA
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Riggio E, Alfieri S, Toffoli E, Borreani C. A descriptive comparison of satisfaction and well-being between expander-based and direct-to-implant breast reconstruction after Nipple-Sparing Mastectomy. Aesthetic Plast Surg 2023; 47:30-39. [PMID: 36018329 DOI: 10.1007/s00266-022-03061-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/04/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND The literature that has explored differences between direct-to-implant (DTI) and expander-based (EB) breast reconstruction has mainly focused on complications, with results not always unambiguous. Moreover, there are limited data 1) comparing DTI and EB breast reconstruction after nipple-sparing mastectomy (NSM) and 2) from the patient's perspective. AIM The aim of this study was to compare satisfaction and well-being in patients undergoing DTI and EB reconstruction after NSM in a Comprehensive Cancer Center, exploring what factors can be related to satisfaction and well-being. METHOD The study design is monocentric, observational and retrospective. The participants completed an online questionnaire containing the Breast-Q and some socio-demographic variables (year of birth, level of education, civil status). Clinical information was obtained from the institutional database. Surgical techniques in the two branches of NSM were similar: all skin incisions, lateral to the areola; all implants, subpectoral (EB: conventionally submuscular; DTI: dual-plane pocket); all without synthetic mesh or acellular tissue matrix. RESULTS A total of 120 patients (45% with EB and 55% with DTI) completed the questionnaire. We found that there are no differences between EB and DTI concerning the satisfaction and well-being of NSM patients, except for satisfaction with information, which is greater in the DTI group. In EB patients, no variables among those explored are related to satisfaction and well-being. In DTI patients, level of education is positive related to satisfaction with implants and physical well-being, Tumor-Node-Metastasis (TNM) and body mass index (BMI) are negative related to satisfaction with information and TNM also with satisfaction for plastic surgery. CONCLUSION EB and DTI do not differ in terms of patient well-being, but EB requires a more careful counselling by the surgeon. 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)
- Egidio Riggio
- Unit of Plastic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sara Alfieri
- Clinical Psychology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Elisa Toffoli
- Unit of Plastic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Borreani
- Clinical Psychology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Ribuffo D, Berna G, De Vita R, Di Benedetto G, Cigna E, Greco M, Valdatta L, Onesti MG, Lo Torto F, Marcasciano M, Redi U, Quercia V, Kaciulyte J, Cherubino M, Losco L, Mori FLR, Scalise A. Dual-Plane Retro-pectoral Versus Pre-pectoral DTI Breast Reconstruction: An Italian Multicenter Experience. Aesthetic Plast Surg 2021; 45:51-60. [PMID: 32860077 DOI: 10.1007/s00266-020-01892-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/19/2020] [Indexed: 11/30/2022]
Abstract
Background The use of conservative mastectomies has risen significantly during the last few years. The reconstructive choice of direct-to-implant reconstruction has become more practicable with modern mastectomy techniques. The initial trend in Italian centers was to use dual-plane hybrid reconstruction. However, a high level of complications has been registered. From 2015 onward, in our centers, a pre-pectoral approach has been adopted. The authors sought to describe the Italian trend to gradually discard the sub-pectoral technique with lower lateral pole coverage of the prosthesis using ADMs comparing it with the pre-pectoral approach with ADMs, without any muscle dissection, in terms of complication rates. Materials and Methods A multicenter retrospective clinical study was performed from January 2010 to June 2018. The enrolled patients were divided into two groups: Cases with an ADM-only coverage pre-pectoral reconstruction made up the first group (Group 1). Those with the retro-pectoral muscular position + ADM implant coverage comprised the second one (Group 2). Complications such as seroma, hematoma, wound dehiscence, surgical site infection, reconstruction failure, animation deformity and capsular contracture were recorded. Results We performed 716 direct-to-implant reconstructions: 509 were partially sub-pectoral and 207 were pre-pectoral. Minimum follow-up was 1 year. Incidence of complications was higher in dual-plane reconstructions. There were statistical significant differences in the rates of seroma and hematoma. Conclusion Using the pre-pectoral approach, the authors have experienced favorable aesthetics and superior clinical and functional outcomes. Retro-pectoral muscular ADM implant coverage has to be considered only in specific complicated second-stage surgeries. 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. Electronic supplementary material The online version of this article (10.1007/s00266-020-01892-y) contains supplementary material, which is available to authorized users.
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Castagnetti F, Bertani C, Foroni M, Falco G, Cenini E, De Bonis F, Ferrari G. The Bovine Pericardium Matrix in Immediate Implant-Based Breast Reconstruction. Aesthetic Plast Surg 2020; 44:2051-2060. [PMID: 32112193 DOI: 10.1007/s00266-020-01651-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 02/13/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Acellular dermal matrices have been introduced to optimize direct-to-implant breast reconstruction. We selected a bovine pericardium noncross-linked matrix. METHODS The study consists in the retrospective analysis of 123 patients (141 breasts) who underwent conservative mastectomy and immediate implant-based breast reconstruction with bovine pericardium matrix Veritas® from March 2012 to October 2017. RESULTS The overall rates of early and late complications, after a median follow-up of 51.84 months, were, respectively, 37.6% and 24.1%. The most noticeable early complications were flap ischemia [n = 39 (27.7%)], hematoma [n = 5 (3.6%)], marginal skin flap necrosis [n = 5 (3.6%)] and dehiscence of the surgical wound [n = 2 (1.4%)]. The most common late complications were rippling [n = 18 (12.7%)] and seroma [n = 4 (2.8%)]. The rate of clinically relevant capsular contracture was low: 12.1% (n = 17) presented grade II and only 2.1%% (n = 3) grade III. Implant substitution became necessary for five patients (3.6%). Early complications occurred more frequently in patients undergoing therapeutic mastectomy (p = 0.031). Patients undergoing preoperative radiotherapy more frequently developed late complications (p = 0.012). A clinically relevant capsular contracture (grade II-III) was found in higher average patients age (p = 0.0019). The left side developed less frequently late complications except for rippling (p = 0.002). Rippling occurred more frequently in patients who sustained a nipple skin-sparing mastectomy (p = 0.035). CONCLUSION Our results further support the safety of Veritas® in immediate implant-based breast reconstruction. 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)
- Fabio Castagnetti
- Breast Surgery Unit, AZIENDA USL-IRCCS Reggio Emilia, Viale Risorgimento no. 80, 42123, Reggio Emilia, Italy.
| | - Chiara Bertani
- Breast Surgery Unit, AZIENDA USL-IRCCS Reggio Emilia, Viale Risorgimento no. 80, 42123, Reggio Emilia, Italy
| | - Monica Foroni
- Breast Surgery Unit, AZIENDA USL-IRCCS Reggio Emilia, Viale Risorgimento no. 80, 42123, Reggio Emilia, Italy
| | - Giuseppe Falco
- Breast Surgery Unit, AZIENDA USL-IRCCS Reggio Emilia, Viale Risorgimento no. 80, 42123, Reggio Emilia, Italy
| | - Eugenio Cenini
- Breast Surgery Unit, AZIENDA USL-IRCCS Reggio Emilia, Viale Risorgimento no. 80, 42123, Reggio Emilia, Italy
| | - Filomena De Bonis
- Breast Surgery Unit, AZIENDA USL-IRCCS Reggio Emilia, Viale Risorgimento no. 80, 42123, Reggio Emilia, Italy
| | - Guglielmo Ferrari
- Breast Surgery Unit, AZIENDA USL-IRCCS Reggio Emilia, Viale Risorgimento no. 80, 42123, Reggio Emilia, Italy
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Okumura S, Hyodo I, Iwata HI, Kamei Y. Immediate one-stage implant-based breast reconstruction without the use of acellular dermal matrix in Japanese breast cancer patients. Breast Cancer 2020; 27:759-764. [PMID: 32130649 DOI: 10.1007/s12282-020-01073-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND In immediate one-stage implant-based breast reconstruction, acellular dermal matrix (ADM) is widely used around the world due to its ability to cover the outside part of the pectoralis major muscle. Unfortunately, ADM has not yet been approved in Japan. Consequently, in our institution, we have performed safe one-stage implant-based breast reconstruction without ADM by employing several unique techniques and have obtained excellent results. METHODS The data of 186 patients were reviewed. In each case, we performed three unique steps to determine which cases were suitable for one-stage implant-based breast reconstruction as follows. First, ICG fluorescence imaging was performed to confirm the blood flow of the skin after mastectomy. Next, a serratus anterior muscle/fascial and external oblique fascial flap was elevated to completely cover the implant together with the pectoralis major muscle. We used a sizer to confirm the skin tension and the form of the breast. After confirming correct size, shape and coverage, we selected cases in which implant could be safely performed. We evaluated the final cosmetic outcome based on three measurements: the inframammary fold position, and the bilateral balance of both breast size and form. RESULTS The rate of immediate one-stage implant-based reconstruction was 85.7%. An implant was removed in one case because of complications, and infection developed in five cases. Among all patients, the overall cosmetic evaluation of the final outcome was evaluated as good, fair and poor in 84.3%, 13.5% and 2.2% of cases, respectively. CONCLUSIONS Immediate one-stage implant-based breast reconstruction without ADM can be a useful and safe procedure, based on our unique techniques in breast cancer patients who hope for immediate prosthetic breast reconstruction in Japan.
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Affiliation(s)
- Seiko Okumura
- Department of Plastic and Reconstructive Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan.
| | - Ikuo Hyodo
- Department of Plastic and Reconstructive Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - HIroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Yuzuru Kamei
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Allué Cabañuz M, Arribas Del Amo MD, Gil Romea I, Val-Carreres Rivera MP, Sousa Domínguez R, Güemes Sánchez AT. Direct-to-implant breast reconstruction after neoadjuvant chemotherapy: A safe option? Cir Esp 2019; 97:575-581. [PMID: 31530386 DOI: 10.1016/j.ciresp.2019.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Immediate reconstruction (IBR) after mastectomy in patients who have received neoadjuvant chemotherapy (NACT) remains controversial. The aim of this study is to analyze and compare oncological results as well as complication and reoperation rates in patients undergoing NACT and a control group. METHODS Retrospective observational case-control study of patients with breast cancer who underwent bilateral mastectomy and direct-to-implant IBR (BMIBR) from 2000-2016. The group that received NACT was matched 1:5 to patients without NACT (Control group). We evaluated differences between groups using the χ2 or Fisher test (qualitative variables), Mann-Whitney U or Student's t-test (quantitative variables). The survival analysis was performed using Kaplan-Meier curves and log-rank test (SPSS 22.0). RESULTS The study included a total of 171 patients with BMIBR: 62 patients (36.3%) after NACT and 109 patients (63.7%) in the control group without NACT. Median follow-up was 52.0 (IQR: 23.0-94.0) months. In both groups, the indication for BMIBR was patient choice (32.7%). There were no statistically significant differences between groups in terms of complication rate (24.2% in the NACT group and 19.3% in the control group [P=.44]), but differences in oncological results were found. Patients in the NACT Group had three times more risk of recurrence at a given time than patients in the control group (3.009 [1.349-6.713]) according to the univariate analysis. CONCLUSIONS Direct-to-implant IBR after skin-sparing mastectomy is a viable option for breast cancer patients undergoing NACT.
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Affiliation(s)
- Marta Allué Cabañuz
- Unidad de Mama, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
| | | | - Ismael Gil Romea
- Unidad de Mama, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | | | | | - Antonio Tomás Güemes Sánchez
- Unidad de Mama, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España; Universidad de Zaragoza, Zaragoza, España
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de Vita R, Buccheri EM, Villanucci A, Pozzi M. Breast Reconstruction Actualized in Nipple-sparing Mastectomy and Direct-to-implant, Prepectoral Polyurethane Positioning: Early Experience and Preliminary Results. Clin Breast Cancer 2019; 19:e358-63. [PMID: 30691930 DOI: 10.1016/j.clbc.2018.12.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/17/2018] [Accepted: 12/17/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Implant-based breast reconstruction after nipple-sparing mastectomy has been the most common breast reconstruction procedure performed, for both breast cancer treatment and prophylactically. Subpectoral implant placement with partial detachment of the pectoralis major muscle has been the procedure of choice for staged reconstruction and direct-to-implantation. Prepectoral implant placement has recently increased in popularity among plastic surgeons owing to the high rates of animation deformity, loss of muscle function, and chronic pain observed with submuscular implant placement. Acellular dermal matrices or synthetic meshes have been used for implant coverage and support to avoid capsular contracture and implant visibility. In the present study, we have introduced breast reconstruction actualized in nipple-sparing mastectomy and direct-to-implant with prepectoral polyurethane positioning (BRAND4P). PATIENTS AND METHODS A total of 34 nipple-sparing mastectomies and immediate direct-to-implant breast reconstructions with prepectoral polyurethane-coated implant placement were performed in 21 patients (13 bilateral and 8 unilateral). The implant was placed subcutaneously in the exact place of the excised breast parenchyma with no further coverage. RESULTS After a mean follow-up of 4 months, no major complications had been observed. No patient presented with animation deformity or grade III-IV capsular contracture. Patient satisfaction, assessed using the BREAST-Q, was excellent. CONCLUSIONS The BRAND4P method represents a novel prepectoral approach and a feasible alternative to subpectoral implant placement among the available implant-based breast reconstruction techniques.
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Pukancsik D, Kelemen P, Gulyás G, Újhelyi M, Kovács E, Éles K, Mészáros N, Kenessey I, Pálházi P, Kovács T, Kásler M, Mátrai Z. 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; 43:1244-51. [PMID: 28215734 DOI: 10.1016/j.ejso.2017.01.236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [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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