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Park BC, Alving-Trinh AL, Prigmore HL, Harrell FE, Sarhane K, Joseph JT, Thomas H, Lupi AL, Perdikis G, Higdon KK. Impact of Tissue Expander Surface Texture on Two-Stage Breast Reconstruction Outcomes: A Combined Analysis. Plast Reconstr Surg 2024; 153:1053e-1062e. [PMID: 37252917 DOI: 10.1097/prs.0000000000010763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND With ongoing investigations of the impact of device texturing on breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL), studies have begun comparing complication profiles of tissue expanders. However, there is a paucity of timing and severity data of complications. The aim of this study was to provide a comparative survival analysis of postoperative complications between smooth (STEs) and textured tissue expanders (TTEs) in breast reconstruction. METHODS A single-institution experience with tissue expander breast reconstruction was reviewed for complications up to 1 year after second-stage reconstruction from 2014 to 2020. Demographics, comorbidities, operation-related variables, and complications were evaluated. Kaplan-Meier curves, Cox proportional hazard models, and a consensus-based ordinal logistic regression model were used to compare complication profiles. RESULTS Of 919 total patients, 600 (65.3%) received TTEs and 319 (34.7%) received STEs. There was increased risk of infection ( P < 0.0001), seroma ( P = 0.046), expander malposition ( P < 0.0001), and wound dehiscence ( P = 0.019) in STEs compared with TTEs. However, there was also a decreased risk of capsular contracture ( P = 0.005) in STEs compared with TTEs. Failure of breast reconstruction ( P < 0.001) and wound dehiscence ( P = 0.018) occurred significantly earlier in STEs compared with TTEs. Predictors for significantly higher severity complications included the following: smooth tissue expander use ( P = 0.007), shorter time to complication ( P < 0.0001), higher body mass index ( P = 0.005), smoking history ( P = 0.025), and nipple-sparing mastectomy ( P = 0.012). CONCLUSIONS Differences in the timing and severity of complications contribute to the safety profiles of tissue expanders. STEs are associated with increased odds of higher severity and earlier complications. Therefore, tissue expander selection may depend on underlying risk factors and severity predictors. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
| | | | | | | | - Karim Sarhane
- Plastic Surgery, Vanderbilt University Medical Center
| | - Jeremy T Joseph
- Division of Plastic and Cosmetic Surgery, Eastern Virginia Medical School
| | | | | | | | - Kent K Higdon
- Plastic Surgery, Vanderbilt University Medical Center
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2
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Wu SS, Katabi L, DeSimone R, Borsting E, Ascha M. A Cross-Sectional Evaluation of Publication Bias in the Plastic Surgery Literature. Plast Reconstr Surg 2024; 153:1032e-1045e. [PMID: 37467390 DOI: 10.1097/prs.0000000000010931] [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: 07/21/2023]
Abstract
BACKGROUND Publication bias (PB) is the preferential publishing of studies with statistically significant results. PB can skew findings of systematic reviews (SRs) and meta-analyses (MAs), with potential consequences for patient care and health policy. This study aims to determine the extent to which SRs and MAs in the plastic surgery literature evaluate and report PB. METHODS This cross-sectional study assessed PB reporting and analysis from plastic surgery studies published between January 1, 2015, and June 19, 2020. Full texts of SRs and MAs were assessed by two reviewers for PB assessment methodology and analysis. Post hoc assessment of studies that did not originally analyze PB was performed using Egger regression, Duval, Tweedie trim-and-fill, and Copas selection models. RESULTS There were 549 studies evaluated, of which 531 full texts were included. PB was discussed by 183 studies (34.5%), and formally assessed by 97 studies (18.3%). Among SRs and MAs that formally assessed PB, PB was present in 24 studies (10.7%), not present in 52 (23.1%), and inconclusive in eight (3.6%); 141 studies (62.7%) did not report the results of their PB assessment. Funnel plots were the most common assessment method [ n = 88 (39.1%)], and 60 studies (68.2%) published funnel plots. The post hoc assessment revealed PB in 17 of 20 studies (85.0%). CONCLUSIONS PB is inadequately reported and analyzed among studies in the plastic surgery literature. Most studies that assessed PB found PB, as did post hoc analysis of nonreporting studies. Increased assessment and reporting of PB among SRs and MAs would improve the quality of evidence in plastic surgery.
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Affiliation(s)
- Shannon S Wu
- From the Cleveland Clinic Lerner College of Medicine
| | - Leila Katabi
- Department of Anesthesia, University of Michigan School of Medicine
| | - Robert DeSimone
- Department of Plastic Surgery, University of California, Irvine
| | - Emily Borsting
- Department of Plastic Surgery, University of California, Irvine
| | - Mona Ascha
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital
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Ng TP, Loo BYK, Yong N, Chia CLK, Lohsiriwat V. Review: Implant-Based Breast Reconstruction After Mastectomy for Breast Cancer: A Meta-analysis of Randomized Controlled Trials and Prospective Studies Comparing Use of Acellular Dermal Matrix (ADM) Versus Without ADM. Ann Surg Oncol 2024; 31:3366-3376. [PMID: 38285304 DOI: 10.1245/s10434-024-14943-4] [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: 09/15/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Breast cancer is the world's most prevalent cancer, and many breast cancer patients undergo mastectomy as the choice of treatment, often with post-mastectomy breast reconstruction. Acellular dermal matrix (ADM) use has become a method to improve outcomes of reconstruction for these patients. We aimed to compare postoperative complications and patient-reported outcomes, which are still poorly characterized, between groups utilizing acellular dermal matrix during reconstruction and those without. MATERIALS AND METHODS We searched electronic databases from inception to 16 June 2022 for randomized controlled trials and prospective cohort studies comparing the outcomes of patients who have and have not received acellular dermal matrix in implant-based breast reconstruction. The results were quantitatively combined and analyzed using random-effects models. RESULTS A total of nine studies were included, representing 3161 breasts. There was no significant difference in postoperative outcomes, such as seroma formation (p = 0.51), hematomas (p = 0.20), infections (p = 0.21), wound dehiscence (p = 0.09), reoperations (p = 0.70), implant loss (p = 0.27), or skin necrosis (p = 0.21). Only two of the studies included evaluated patient-reported outcomes between the use and non-use of ADM in implant-based breast reconstruction using BREAST-Q questionnaire, as well as self-reported pain. There was no reported significant difference in BREAST-Q or pain scores. CONCLUSIONS This meta-analysis shows comparable short- and long-term outcomes between ADM and non-ADM breast reconstruction, suggesting that the use of ADM may not be necessary in all cases given their additional cost. However, there is a paucity of data for patient-reported outcomes, and further research is required to determine whether ADM use affects patient-reported outcomes.
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Affiliation(s)
- Trina Priscilla Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Breast Surgery Service, Department of Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Brandon Yong Kiat Loo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Breast Surgery Service, Department of Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Nicole Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Breast Surgery Service, Department of Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Clement Luck Khng Chia
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Breast Surgery Service, Department of Surgery, Khoo Teck Puat Hospital, Singapore, Singapore.
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Visnu Lohsiriwat
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Zingaretti N, Piana M, Battellino L, Galvano F, De Francesco F, Riccio M, Beorchia Y, Castriotta L, Parodi PC. Pre-pectoral Breast Reconstruction: Surgical and Patient-Reported Outcomes of Two-Stages vs Single-Stage Implant-Based Breast Reconstruction. Aesthetic Plast Surg 2024; 48:1759-1772. [PMID: 37644192 PMCID: PMC11093833 DOI: 10.1007/s00266-023-03601-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Two-stages pre-pectoral breast reconstruction may confer advantages over direct to implant (DTI) and subpectoral reconstruction in selected patients who have no indication for autologous reconstruction. The primary endpoint of the study was to evaluate and compare the incidence of capsular contracture in the pre-pectoral two-stages technique versus the direct to implant technique. Complications related to the two surgical techniques and patient satisfaction were also evaluated. METHODS A retrospective review of 45 two stages and 45 Direct-to-implant, DTI patients was completed. Acellular dermal matrix was used in all patients. An evaluation of anthropometric and clinical parameters, surgical procedures and complications was conducted. Minimum follow-up was 12 months after placement of the definitive implant. RESULTS There was no statistically significant difference in the rate of capsular contracture in the two groups. Rippling occurred more in DTI reconstruction. In the two-stages reconstruction, lipofilling was applied more often and there was a higher incidence of seroma. Patient satisfaction extrapolated from the Breast Q questionnaire was better for patients submitted to two-stage implant-based breast reconstruction. CONCLUSION Dual-stage pre-pectoral reconstruction with acellular dermal matrix appears to be a good reconstructive solution in patients with relative contraindications for one-stage heterologous reconstruction with definitive prosthesis and no desire for autologous reconstruction.
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Affiliation(s)
- Nicola Zingaretti
- Department of Medical Area (DAME), Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, University of Udine, Udine, Italy.
- Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Jesi, Italy.
| | - Michele Piana
- Department of Medical Area (DAME), Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, University of Udine, Udine, Italy
| | | | - Francesca Galvano
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Francesco De Francesco
- Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Jesi, Italy
- Department of Reconstructive Surgery and Hand Surgery, AOU "Ospedali Riuniti", Ancona, Italy
| | - Michele Riccio
- Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Jesi, Italy
- Department of Reconstructive Surgery and Hand Surgery, AOU "Ospedali Riuniti", Ancona, Italy
| | - Yvonne Beorchia
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy
| | - Luigi Castriotta
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy
| | - Pier Camillo Parodi
- Department of Medical Area (DAME), Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, University of Udine, Udine, Italy
- Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Jesi, Italy
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De Lorenzi F, Sala P, Catapano S, Mazzocconi L, Lorenzano V, Borelli F, Ioppolo L, Caldarella P. Postmastectomy dual-plane submuscular-subcutaneous implant-based reconstruction: a series of 100 consecutive patients. Updates Surg 2024; 76:613-621. [PMID: 37964047 DOI: 10.1007/s13304-023-01683-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Advances in cancer knowledge and surgical techniques over the last decades have enabled plastic surgeons to use muscle-sparing procedures and more conservative approaches for implant-based reconstructions. In this paper, the authors describe an innovative subpectoral/subcutaneous implant pocket that represents an evolution of the classical submuscular technique and they report on the first consecutive hundred patients undergoing this procedure. METHODS Between April 2019 and May 2022, 100 consecutive patients underwent immediate postmastectomy implant-based reconstruction using the subpectoral/subcutaneous space, for a total of 122 procedures. Medical records were retrospectively reviewed and patients were prospectively followed. During plastic consultations, medical photographs were taken and aesthetic outcomes were scored with patients. RESULTS Mean follow-up was 18 months (range 6-46). Implant loss was observed in two patients (2%). Early minor complications were registered in 19 patients. A total of 80 out of 100 patients completed satisfaction survey assessing their postoperative outcomes. Results were considered satisfactory or very satisfactory by the surgeons and patients in more than 90% of cases. CONCLUSION The submuscular/subcutaneous pocket can be considered a new tool in the armamentarium of reconstructive procedures, in between submuscular/subfascial procedures and prepectoral ones. It is a one-stage procedure, its a simple and short time surgery, reproducible, its very well accepted by patients. It has specific indications, advantages, and drawbacks, a careful indication and an accurate surgical technique are mandatory to achieve good results.
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Affiliation(s)
- Francesca De Lorenzi
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology (IEO), IRCCS, Via Ripamonti, 435, 20141, Milan, Italy
| | - Pietro Sala
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology (IEO), IRCCS, Via Ripamonti, 435, 20141, Milan, Italy
| | - Simone Catapano
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology (IEO), IRCCS, Via Ripamonti, 435, 20141, Milan, Italy
| | - Luca Mazzocconi
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology (IEO), IRCCS, Via Ripamonti, 435, 20141, Milan, Italy.
| | - Valerio Lorenzano
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology (IEO), IRCCS, Via Ripamonti, 435, 20141, Milan, Italy
| | - Francesco Borelli
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology (IEO), IRCCS, Via Ripamonti, 435, 20141, Milan, Italy
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Hospital Galeazzi - Sant'Ambrogio, Milan, Italy
| | - Leonardo Ioppolo
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology (IEO), IRCCS, Via Ripamonti, 435, 20141, Milan, Italy
- Marrelli Hospital, Via Gioacchino da Fiore 5, 88900, Crotone, Italy
| | - Pietro Caldarella
- Department of Breast Surgery, European Institute of Oncology (IEO), IRCCS, Via Ripamonti, 435, 20141, Milan, Italy
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Williams S, Menon A, Shauly O, Van Natta B, Gould D, Losken A. Reviewing Outcomes and Complications with the Use of Mesh in Breast Reduction Surgery. Aesthetic Plast Surg 2024:10.1007/s00266-024-03896-4. [PMID: 38448602 DOI: 10.1007/s00266-024-03896-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/30/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Reduction mammoplasty is a common reconstructive and esthetic procedure with variable long-term outcomes regarding breast shape, projection, and nipple-areolar complex. One common complaint is recurrent breast ptosis, which may be mitigated by sufficient support of the inferior pole. This review will look at the effects of mesh in mitigating postoperative ptosis following reduction mammoplasty. METHODS A comprehensive review of the literature was performed using the PubMed database. Manuscripts that provided data with respect to the effects of mesh on cosmetic outcomes, patient-reported outcomes, complications, and surveillance were utilized. RESULTS Six studies with a total of 634 patients were included in this review. There is limited evidence to support a cosmetic benefit with the use of mesh in reduction mammoplasty patients. While subjective satisfaction was demonstrated in one paper, few others had objective measurements of the impact of mesh. Complications included infection, skin necrosis, and loss of nipple sensation. Mammography was found to not be affected by mesh placement. DISCUSSION The use of mesh during reduction mammoplasty is a relatively modern innovation that does not appear to have a significantly different risk profile than that of traditional reduction procedures. There is limited cosmetic value based on currently available data. More objective future analysis is necessary in order to justify the use of mesh in reduction mammoplasty for its claimed cosmetic benefits. 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 Table of Contents or online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
| | | | - Orr Shauly
- Emory Division of Plastic and Reconstructive Surgery, 3200 Downwood Circle Northwest, Atlanta, GA, 30327, USA.
| | | | | | - Albert Losken
- Emory Division of Plastic and Reconstructive Surgery, 3200 Downwood Circle Northwest, Atlanta, GA, 30327, USA
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7
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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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Guo L, Lin X, Lin X, Wang Y, Zhang Y, Lin J, Zhang Y, Chen X, Zhang G. Application of TiLOOP bra in implant-based breast reconstruction is associated with decreased complication risk compared with other meshes: A systematic review and meta-analysis. World J Surg 2024; 48:631-641. [PMID: 38353413 DOI: 10.1002/wjs.12003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND TiLOOP bra has been used for over 15 years, however, evidence regarding its safety in implant-based breast reconstruction (IBBR) for patients with breast cancer after mastectomy is still limited. We performed this meta-analysis to evaluate its risks and benefits in IBBR comparing with other meshes. METHODS Electronic databases were searched to identify relevant studies comparing postoperative complications between TiLOOP bra and other reconstruction techniques in IBBR with or without meshes. We also compared patient satisfaction in physical well-being between two groups. Risk ratios (RRs) and mean differences with 95% confidence interval (CI) were calculated. RESULTS Seven studies representing 1203 cases were analyzed. Compared with other meshes, the use of TiLOOP bra significantly reduced the risk of infection (RR = 0.53, 95% CI, 0.32-0.86), seroma (RR = 0.21, 95% CI, 0.07-0.61), red breast syndrome (RR = 0.10, 95% CI, 0.02-0.45), and capsular contracture (RR = 0.20, 95% CI, 0.05-0.75). Patient satisfaction in physical well-being was comparable between two groups. CONCLUSIONS TiLOOP bra in IBBR has a favored safety profile over other meshes, which significantly reduced postoperative complication risk and did not affect patient satisfaction. Although prospective well-designed controlled studies are still warranted, TiLOOP bra is safe and reliable at present.
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Affiliation(s)
- Lijuan Guo
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
- Department of Breast Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Xin Lin
- Department of Breast Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
- Southern Medical University, The Second School of Clinical Medicine, Guangzhou, Guangdong, China
| | - Xiaoyi Lin
- Department of Breast Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
- Shantou University Medical College, Shantou, Guangdong, China
| | - Yulei Wang
- Department of Breast Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Yifang Zhang
- Department of Breast Cancer, Guangdong Provincial People's Hospital's Nanhai Hospital, Foshan, Guangdong, China
| | - Jiali Lin
- Department of Breast Cancer, Guangdong Provincial People's Hospital's Nanhai Hospital, Foshan, Guangdong, China
| | - Yi Zhang
- Department of Breast Cancer, Guangdong Provincial People's Hospital's Nanhai Hospital, Foshan, Guangdong, China
| | - Xiangqing Chen
- Department of Breast Cancer, Guangdong Provincial People's Hospital's Nanhai Hospital, Foshan, Guangdong, China
| | - Guochun Zhang
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
- Department of Breast Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
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9
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Graziano FD, Plotsker EL, Rubenstein RN, Haglich K, Stern CS, Matros E, Nelson JA. National Trends in Acellular Dermal Matrix Utilization in Immediate Breast Reconstruction. Plast Reconstr Surg 2024; 153:25e-36e. [PMID: 37092982 DOI: 10.1097/prs.0000000000010575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND Implant-based reconstruction is the most common method of immediate breast reconstruction in the United States, with acellular dermal matrices (ADMs) playing a significant role in implant support and coverage. This study evaluated recent national trends in ADM use in immediate breast reconstruction and assessed patient characteristics and 30-day complication rates. METHODS The authors queried the American College of Surgeons National Surgical Quality Improvement Program database for all patients undergoing immediate breast reconstruction from 2015 to 2020. Primary outcomes were major surgical and medical complications, as well as ADM use per year. Subset analysis was performed to compare patients undergoing immediate breast reconstruction with ADM in 2015 versus 2020. RESULTS In 39,800 immediate breast reconstructions, ADMs were used in 55.5% of cases ( n = 22,087). ADM usage increased annually from 2015 through 2020. Direct-to-implant reconstruction was significantly associated with ADM use ( P < 0.001). Compared with the no-ADM cohort, there was a significantly increased rate of return to the operating room for any reason ( P < 0.001). When comparing the 2015 and 2020 ADM cohorts, the 2020 ADM cohort had a significantly higher rate of superficial infections. Obesity, smoking history, and insulin-dependent diabetes were independent risk factors for superficial wounds in patients receiving ADM. CONCLUSIONS ADM use in immediate breast reconstruction increased significantly from 2015 to 2020, likely reflecting national trends in increasing direct-to-implant and prepectoral breast reconstruction. Obesity, smoking history, and insulin-dependent diabetes were independent risk factors for superficial wound infections in the ADM cohort. Patients with ADM had a slight increased incidence of return to the operating room. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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Affiliation(s)
- Francis D Graziano
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Ethan L Plotsker
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Robyn N Rubenstein
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Kathryn Haglich
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Carrie S Stern
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Evan Matros
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Jonas A Nelson
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
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10
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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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12
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Cavalcante FP, Lima TO, Alcantara R, Cardoso A, Ulisses F, Novita G, Zerwes F, Millen E. Inframammary versus Periareolar Incision: A Comparison of Early Complications in Nipple-sparing Mastectomy. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5367. [PMID: 37928633 PMCID: PMC10624459 DOI: 10.1097/gox.0000000000005367] [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: 06/23/2023] [Accepted: 09/14/2023] [Indexed: 11/07/2023]
Abstract
Background Nipple-sparing mastectomy (NSM), either used therapeutically or prophylactically, may yield more complications than conventional mastectomy. The incision may affect aesthetic outcome and complication rates, with periareolar incisions being associated with nipple-areolar complex (NAC) necrosis. Methods Early complications were compared between NSM performed in 2015-2022 using inframammary fold (IMF) or periareolar incisions. Results Overall, 180 procedures in 152 patients (bilateral NSM = 28) were included (IMF = 104; periareolar = 76). Mean age (47 versus 43.9 years; P < 0.038), mastectomy weight (312.7 versus 246.8 grams; P < 0.001), implant volume (447.5 versus 409.0 mL; P = 0.002), and use of tissue expanders (68.4% versus 50.0%; P = 0.013) were all greater with periareolar incisions. Prepectoral reconstruction was more common with IMF (18.3% versus 3.9%; P = 0.004). Forty-three complications (23.9%) were recorded (periareolar n = 27, 35%; IMF n = 16, 15.3%; P = 0.0002). NAC necrosis accounted for 17 complications (22.4%) in the periareolar group versus nine (8.5%) in the IMF group (P = 0.002). Necrosis was predominantly moderate (n = 6, 8.3% versus n = 1, 1.0%, respectively) (P = 0.014). Unadjusted odds ratios (OR) for complications [3.05; 95% confidence interval (CI): 1.27-7.26] and necrosis (3.04; 95% CI: 1.27-7.27) were higher in the periareolar group. In the multivariate analysis, necrosis was associated with periareolar incisions [adjusted odds ratio (aOR): 2.92; 95% CI: 1.14-7.44]. Prepectoral reconstruction was associated with IMF incisions (aOR: 25.51; 95% CI: 3.53-184.23; P = 0.001) and with body mass index of more than 25-30 (aOR: 37.09; 95% CI: 5.95-231.10; P < 0.001). Therapeutic mastectomies (aOR: 68.56; 95% CI: 2.50-188.36; P = 0.012) and tissue expanders (aOR: 18.36; 95% CI: 1.89-178.44; P = 0.026) were associated with seromas. Conclusions Both incisions are viable options; however, the risk of NAC necrosis increased with the periareolar approach. Further research is required.
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Affiliation(s)
| | | | | | - Amanda Cardoso
- From Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil
| | - Flora Ulisses
- From Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil
| | | | - Felipe Zerwes
- Pontificia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, Rio Grande do Sul, Brazil
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13
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Yao C, Yang H, Guan Z, Liu C, Xian J, Chen M, Huang W. Is a soft tissue reinforcing mesh necessary in immediate prosthetic breast reconstruction for early breast cancer in patients with low-volume breast? A single-center, retrospective Chinese clinical study. Updates Surg 2023; 75:2005-2015. [PMID: 37432568 DOI: 10.1007/s13304-023-01585-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/05/2023] [Indexed: 07/12/2023]
Abstract
It is controversial as to whether soft tissue reinforcement mesh should be used for immediate prosthetic breast reconstruction after nipple-sparing mastectomy for low-volume breast early breast cancer (LVBEBC) in Chinese adult women. We collected data on 89 patients with LVBEBC who underwent such a surgery and divided them into two groups: 39 patients in the totally subpectoral prosthesis-only breast reconstruction group (simple group) and 50 patients in the prosthesis-combined titanium-coated polypropylene mesh (TCPM) group (or the so-called "dual plane" or "mesh-assisted partially subpectoral breast reconstruction group") (combined group). The results demonstrated no difference in operative time, intraoperative bleeding, and postoperative complications between the two groups; however, total drainage volume and extubation time were less and shorter, respectively, in the combined group. The median follow-up time was 18.6 months without local recurrence or distant metastasis in both groups. At 24 months after surgery, the excellent and good rates of breast reconstruction were higher in the combined group. However, patients' BMI, breast morphology, and breast volume of 300 mL or more had an effect on the shape of the reconstructed breast; in addition, in patients with higher BMI, conical breast morphology, and breast volume over 300 mL, the shape of the breast was more perfect with the prosthesis combined with TCPM reconstruction.Trial registration: This retrospective study was "retrospectively registered" in the Sixth Affiliated Hospital of South China University of Technology of China on March 15, 2022 (No. 2022018) and in the National Medical Research Registry filing system of China ( https://www.medicalresearch.org.cn ) (No. MR-44-22-003618).
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Affiliation(s)
- Chengcai Yao
- Department of Breast Surgery, Sixth Affiliated Hospital of South China University of Technology, and Sixth Clinical College of South China University of Technology, No.120 Guidan Road, Nanhai District, Foshan, 528225, Guangdong, People's Republic of China.
| | - Huangyun Yang
- Xiamen Maternal and Child Health Hospital, Xiamen University Women and Children's Hospital of China, Xiamen, 361000, People's Republic of China
| | - Ziyun Guan
- Sixth Affiliated Hospital of South China University of Technology, Foshan, 528200, People's Republic of China
| | - Changchun Liu
- Department of Breast Surgery, Sixth Affiliated Hospital of South China University of Technology, and Sixth Clinical College of South China University of Technology, No.120 Guidan Road, Nanhai District, Foshan, 528225, Guangdong, People's Republic of China
| | - Jiayi Xian
- Department of Breast Surgery, Sixth Affiliated Hospital of South China University of Technology, and Sixth Clinical College of South China University of Technology, No.120 Guidan Road, Nanhai District, Foshan, 528225, Guangdong, People's Republic of China
| | - Ming Chen
- Department of Breast Surgery, Sixth Affiliated Hospital of South China University of Technology, and Sixth Clinical College of South China University of Technology, No.120 Guidan Road, Nanhai District, Foshan, 528225, Guangdong, People's Republic of China
| | - Wenjian Huang
- Department of Breast Surgery, Sixth Affiliated Hospital of South China University of Technology, and Sixth Clinical College of South China University of Technology, No.120 Guidan Road, Nanhai District, Foshan, 528225, Guangdong, People's Republic of China
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14
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Park-Simon TW, Müller V, Jackisch C, Albert US, Banys-Paluchowski M, Bauerfeind I, Blohmer JU, Budach W, Dall P, Ditsch N, Fallenberg EM, Fasching PA, Fehm T, Friedrich M, Gerber B, Gluz O, Harbeck N, Hartkopf AD, Heil J, Huober J, Kolberg-Liedtke C, Kreipe HH, Krug D, Kühn T, Kümmel S, Loibl S, Lüftner D, Lux MP, Maass N, Mundhenke C, Reimer T, Rhiem K, Rody A, Schmidt M, Schneeweiss A, Schütz F, Sinn HP, Solbach C, Solomayer EF, Stickeler E, Thomssen C, Untch M, Witzel I, Wöckel A, Wuerstlein R, Janni W, Thill M. Arbeitsgemeinschaft Gynäkologische Onkologie Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2023. Breast Care (Basel) 2023; 18:289-305. [PMID: 37900552 PMCID: PMC10601667 DOI: 10.1159/000531578] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 10/31/2023] Open
Abstract
Background Each year the interdisciplinary Arbeitsgemeinschaft Gynäkologische Onkologie (AGO), German Gynecological Oncology Group Breast Committee on Diagnosis and Treatment of Breast Cancer provides updated state-of-the-art recommendations for early and metastatic breast cancer. Summary The updated evidence-based treatment recommendation for early and metastatic breast cancer has been released in March 2023. Key Messages This paper concisely captures the updated recommendations for early breast cancer chapter by chapter.
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Affiliation(s)
- Tjoung-Won Park-Simon
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach GmbH, Offenbach, Germany
| | - Ute-Susann Albert
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Maggie Banys-Paluchowski
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Kiel, Germany
| | - Ingo Bauerfeind
- Frauenklinik, Klinikum Landshut gemeinnützige GmbH, Landshut, Germany
| | - Jens-Uwe Blohmer
- Klinik für Gynäkologie und Brustzentrum des Universitätsklinikums der Charite, Berlin, Germany
| | - Wilfried Budach
- Klinik für Strahlentherapie und Radioonkologie Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Peter Dall
- Klinik für Gynäkologie und Geburtshilfe, Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | - Nina Ditsch
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Eva Maria Fallenberg
- Institut für diagnostische und Interventionelle Radiologie, Klinikum der Technischen Universität München, Rechts der Isar, Munich, Germany
| | - Peter A. Fasching
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Tanja Fehm
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe, Helios Klinikum Krefeld GmbH, Krefeld, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Oleg Gluz
- Brustzentrum, Evang. Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Nadia Harbeck
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany
| | - Andreas D. Hartkopf
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Joerg Heil
- Brustzentrum Heidelberg, Klinik St. Elisabeth und Klinik für Frauenheilkunde und Geburtshilfe, Sektion Senologie, Universitäts-Klinikum Heidelberg, Heidelberg, Germany
| | - Jens Huober
- Brustzentrum, Kantonspital St. Gallen, St. Gallen, Switzerland
| | - Cornelia Kolberg-Liedtke
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Essen, Phaon GmbH, Wiesbaden, Germany
| | - Hans H. Kreipe
- Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thorsten Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany
| | - Sherko Kümmel
- Klinik für Senologie, Evangelische Kliniken Essen Mitte, Essen, Germany
| | - Sibylle Loibl
- German Breast Group Forschungs GmbH, Frankfurt, Germany
| | - Diana Lüftner
- Immanuel Klinik Märkische Schweiz (Buckow) & Immanuel Klinik Rüdersdorf/Medizinische Hochschule Brandenburg Theodor Fontane (Rüdersdorf), Rüdersdorf, Germany
| | - Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn und St. Josefs-Krankenhaus, Salzkotten, St. Vincenz-Krankenhaus GmbH, Paderborn, Germany
| | - Nicolai Maass
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - Toralf Reimer
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Kerstin Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs, Centrum für Integrierte Onkologie (CIO), Universitätsklinikum Köln, Cologne, Germany
| | - Achim Rody
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Kiel, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
| | - Andreas Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum und Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Florian Schütz
- Klinik für Gynäkologie und Geburtshilfe, Diakonissen Krankenhaus Speyer, Speyer, Germany
| | - Hans Peter Sinn
- Sektion Gynäkopathologie, Pathologisches Institut, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Christine Solbach
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Erich-Franz Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, Aachen, Germany
| | | | - Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Isabell Witzel
- Department of Gynecology, University Medical Center Zurich, University of Zurich, Zurich, Switzerland
| | - Achim Wöckel
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Rachel Wuerstlein
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany
| | - Wolfgang Janni
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt, Germany
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Supper P, Semmler L, Placheta-Györi E, Teufelsbauer M, Harik-Chraim E, Radtke C. [Update and Trends in Breast Reconstruction After Mastectomy]. HANDCHIR MIKROCHIR P 2023; 55:253-261. [PMID: 37487507 PMCID: PMC10415025 DOI: 10.1055/a-2082-1542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 02/15/2023] [Indexed: 07/26/2023] Open
Abstract
Due to refinements in operating techniques, autologous breast reconstruction has become part of standard care. It has become more difficult to advise patients due to the expansion of oncologic options for mastectomy, radiation therapy and the variety of reconstructive techniques. The goal of reconstruction is to achieve oncologically clear margins and a long-term aesthetically satisfactory result with a high quality of life. Immediate reconstruction preserves the skin of the breast and its natural form and prevents the psychological trauma associated with mastectomy. However, secondary reconstructions often have a higher satisfaction, since here no restitutio ad integrum is assumed. Alloplastic, i. e., implant-based, breast reconstruction and autologous breast reconstruction are complementary techniques. This article provides an overview of current options for breast reconstruction including patients' satisfaction and quality of life following breast reconstruction. Although immediate reconstruction is still the preferred choice of most patients and surgeons, delayed reconstruction does not appear to compromise clinical or patient-reported outcomes. Recent refinements in surgical techniques and autologous breast reconstruction include stacked-flaps, as well as microsurgical nerve coaptation to restore sensitivity, which lead to improved outcomes and quality of life. Nowadays Skin-sparing and nipple-sparing mastectomy, accompanied by improved implant quality, allows immediate prosthetic breast reconstruction as well as reemergence of the prepectoral implantation. The choice of breast reconstruction depends on the type of mastectomy, necessary radiation, individual risk factors, as well as the patient's habitus and wishes. Overall, recent developments in breast reconstruction led to an increase in patient satisfaction, quality of life and aesthetic outcome with oncological safety.
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Affiliation(s)
- Paul Supper
- Universitätsklinik für Plastische, Rekonstruktive und
Ästhetische Chirurgie, Medizinische Universität
Wien
| | - Lorenz Semmler
- Universitätsklinik für Plastische, Rekonstruktive und
Ästhetische Chirurgie, Medizinische Universität
Wien
| | - Eva Placheta-Györi
- Universitätsklinik für Plastische, Rekonstruktive und
Ästhetische Chirurgie, Medizinische Universität
Wien
| | - Maryana Teufelsbauer
- Universitätsklinik für Plastische, Rekonstruktive und
Ästhetische Chirurgie, Medizinische Universität
Wien
| | - Elissa Harik-Chraim
- Universitätsklinik für Plastische, Rekonstruktive und
Ästhetische Chirurgie, Medizinische Universität
Wien
| | - Christine Radtke
- Universitätsklinik für Plastische, Rekonstruktive und
Ästhetische Chirurgie, Medizinische Universität
Wien
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Caputo G, Scarabosio A, Di Filippo J, Contessi Negrini F, Albanese R, Mura S, Parodi PC. Optimizing Acellular Dermal Matrix Integration in Heterologous Breast Reconstructive Surgery: Surgical Tips and Post-Operative Management. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1231. [PMID: 37512043 PMCID: PMC10383214 DOI: 10.3390/medicina59071231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/13/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023]
Abstract
Background and Objective: Prepectoral implant placement in breast reconstruction is currently a must-have in the portfolios of breast surgeons. The introduction of new tools and conservative mastectomies is a game changer in this field. The prepectoral plane usually goes hand-in-hand with the ADM wrapping of the implant. It is a cell-free dermal matrix comprising a structurally integrated basement membrane complex and an extracellular matrix. The literature reports that ADMs may be useful, but proper patient selection, surgical placement, and post-operative management are essential to unlock the potential of this tool, as these factors contribute to the proper integration of the matrix with surrounding tissues. Materials and Methods: A total of 245 prepectoral breast reconstructions with prostheses or expanders and ADMs were performed in our institution between 2016 and 2022. A retrospective study was carried out to record patient characteristics, risk factors, surgical procedures, reconstructive processes, and complications. Based on our experience, we developed a meticulous reconstruction protocol in order to optimize surgical practice and lower complication rates. The DTI and two-stage reconstruction were compared. Results: Seroma formation was the most frequent early complication (less than 90 days after surgery) that we observed; however, the majority were drained in outpatient settings and healed rapidly. Secondary healing of wounds, which required a few more weeks of dressing, represented the second most frequent early complication (10.61%). Rippling was the most common late complication, particularly in DTI patients. After comparing the DTI and two-stage reconstruction, no statistically significant increase in complications was found. Conclusions: The weakness of prepectoral breast reconstruction is poor matrix integration, which leads to seroma and other complications. ADM acts like a graft; it requires firm and healthy tissues to set in. In order to do so, there are three key steps to follow: (1) adequate patient selection; (2) preservative and gentle handling of intra-operative technique; and (3) meticulous post-operative management.
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Affiliation(s)
- Glenda Caputo
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine (Italy), 33100 Udine, Italy
| | - Anna Scarabosio
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine (Italy), 33100 Udine, Italy
| | - Jacopo Di Filippo
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine (Italy), 33100 Udine, Italy
| | - Filippo Contessi Negrini
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine (Italy), 33100 Udine, Italy
| | - Roberta Albanese
- Clinic of Plastic and Reconstructive Surgery, Ospedale Santa Maria della Misericordia, 33100 Udine, Italy
| | - Sebastiano Mura
- Clinic of Plastic and Reconstructive Surgery, Ospedale Santa Maria della Misericordia, 33100 Udine, Italy
| | - Pier Camillo Parodi
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine (Italy), 33100 Udine, Italy
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Timeline and Incidence of Postoperative Complications in Prepectoral, Dual-Plane, and Total Submuscular Alloplastic Reconstruction With and Without Biosynthetic Scaffold Usage. Ann Plast Surg 2023:00000637-990000000-00184. [PMID: 36880719 DOI: 10.1097/sap.0000000000003482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
INTRODUCTION Acellular dermal matrices and synthetic meshes are commonly used to improve inframammary-fold definition, minimize muscle excision, and allow for greater control over the surgical technique in implant-based breast reconstruction. The aims of this study are to compare various combinations of placement planes and biosynthetic scaffolds and to further examine the respective incidences of postoperative complications and the timeline of capsular contracture development. METHODS A data set consisting of 220 patients (393 samples) who underwent 2-stage reconstruction between 2012 and 2021 was used in the study. χ2, Fisher exact test, and 1-way analysis of variance were used to identify significant differences between the 4 subgroups. Cox proportional-hazards model and Kaplan-Meier estimator were used for survival analysis. RESULTS On univariate logistic regression (odds ratio, 0.21; P = 0.005), survival analysis (P = 0.0082), and Cox-proportional hazard model (hazard ratio, 1.6; P = 0.01), poly-4-hydroxybutyrate mesh usage was linked to an increased risk of capsular contracture development. Prepectoral placement with no mesh and dual-plane placement with acellular dermal matrix showed similar timelines of capsular contracture development. The lowest incidences of capsular contracture occurred in the prepectoral placement and no mesh (49/161, 30.4%) and total submuscular subgroups (3/14, 21.4%). Infection, necrosis, and revision surgery rates did not differ significantly between the 4 groups. CONCLUSIONS The use of poly-4-hydroxybutyrate mesh in 2-stage breast reconstruction is correlated with a statistically significant increase in capsular contracture. Prepectoral placement with no biosynthetic scaffold had one of the lowest rates of contracture and may provide the most optimal balance between economic and clinical considerations in implant-based reconstruction.
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Kaviani A, Ashraf-Ganjouei A, Vasigh M, Zand S, Patocskai E. Immediate Breast Reconstruction Using the Autologous Dermal Flap. J Surg Res 2023; 283:713-718. [PMID: 36462381 DOI: 10.1016/j.jss.2022.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/05/2022] [Accepted: 11/02/2022] [Indexed: 12/05/2022]
Abstract
INTRODUCTION Despite the development of breast-conserving surgery in breast cancer treatment, there still remain indications for total mastectomy. Since mastectomy has a significant negative impact on the patients' quality of life, breast reconstruction is increasingly popular. However, for patients with large ptotic breasts who do not choose tissue-based reconstruction techniques and prefer implant-based breast reconstruction, there is no single-stage breast reconstruction technique other than the classic technique using Acellular Dermal Matrix (ADM). METHODS This study presents a novel technique for Nipple-Sparing Mastectomy (NSM) and Immediate Breast reconstruction (IBR) in 11 operations (in seven patients) whose treatment decision-making was based on NCCN guidelines. In this technique, the implant/tissue expander is covered by the pectoral muscle in the upper part and an autologous dermal flap in the lower part, replacing an ADM. The dermal flap is created from the de-epithelialized lower mastectomy flap in these large ptotic breasts. Maintaining the nipple-areola complex (NAC) is possible by re-implanting a free nipple split-thickness graft from the NAC of the ipsilateral breast prepared at the beginning of the operation. RESULTS All seven patients had large ptotic breasts ranging from C cup to double D in size and grade 2 and higher breast ptosis. The mean BMI of the patients was 28 (range: 26-33). No major complications occurred postoperatively. There were three minor complications, all managed conservatively. Surgical indications were risk reduction surgery in three patients with BRCA mutations and therapeutic in the remaining patients (three multifocal invasive ductal carcinomas and one diffused ductal carcinoma in situ). None of the patients had a previous reduction mammoplasty as preparation for NSM, and all the patients underwent a single operation. No breast tissue remained under the NAC, which is ideal with the NSM technique. CONCLUSIONS The proposed technique is excellent for implant-based IBR in patients with large ptotic breasts. It eliminates the use of ADM mesh and reduces the cost and postoperative complication rate associated with ADM. Furthermore, using a free nipple graft technique can eliminate the need for a preparatory mastopexy. This technique can also theoretically reduce the risk of recurrence or new primary breast cancer as there are no remaining ducts beneath the nipple-areola complex.
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Affiliation(s)
- Ahmad Kaviani
- Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran; Department of Surgical Oncology, University of Montreal, Montreal, Canada.
| | | | - Mahtab Vasigh
- Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Sanaz Zand
- Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Erica Patocskai
- Department of Surgical Oncology, University of Montreal, Montreal, Canada
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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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Kayahan M. Can Skin Sparing Mastectomy and Immediate Submuscular Implant-Based Reconstruction Be a Better Choice in Treatment of Early-Stage Breast Cancer? Eur J Breast Health 2022; 18:55-62. [DOI: 10.4274/ejbh.galenos.2021.2021-6-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/05/2021] [Indexed: 12/01/2022]
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Luo J, Moss WD, Pires GR, Rhemtulla IA, Rosales M, Stoddard GJ, Agarwal JP, Kwok AC. A Nationwide Analysis Evaluating the Safety of Using Acellular Dermal Matrix with Tissue Expander-Based Breast Reconstruction. Arch Plast Surg 2022; 49:716-723. [PMID: 36523919 PMCID: PMC9747277 DOI: 10.1055/s-0042-1758638] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 07/08/2022] [Indexed: 12/23/2022] Open
Abstract
Background In March 2021, the United States Food and Drug Administration (FDA) safety communication cautioned against the use of acellular dermal matrix (ADM) products in breast reconstruction and reiterated that the FDA does not approve ADM use in breast surgery. This study aims to assess the safety of ADM use in breast reconstruction. Methods Women who underwent ADM and non-ADM assisted tissue expander (TE)-based breast reconstruction were identified using the National Surgical Quality Improvement Program database (2012-2019). Trends of ADM use over time, and 30-day outcomes of surgical site infection (SSI), dehiscence, and unplanned reoperation were assessed. Results Of the 49,049 TE-based breast reconstructive cases, 42.4% were ADM assisted and 57.6% non-ADM assisted. From 2012 to 2019, the use of ADM increased from 26.1 to 55.6% (relative risk [RR] =1.10; p < 0.01). Higher rates of SSI (3.9 vs. 3.4%; p = 0.003) and reoperation (7.4 vs. 6.0%; p < 0.001) were seen in the ADM cohort. There was no significant difference seen in dehiscence rates (0.7 vs. 0.7%; p = 0.73). The most common reoperation within 30 days for the ADM group (17.6%) was removal of TE without insertion of implant (current procedural terminology: 11,971). ADM-assisted breast reconstruction was associated with increased relative risk of SSI by 10% (RR = 1.10, confidence interval [CI]: 1.01-1.21; p = 0.03) and reoperation by 15% (RR = 1.15, CI: 1.08-1.23; p < 0.001). Conclusions ADM-assisted breast reconstruction more than doubled from 2012 to 2019. There are statistically higher complication rates of SSI (0.5%) and reoperation (1.4%) with ADM use in TE-based breast reconstruction, suggesting that reconstruction without ADM is safe when comparing immediate postoperative outcomes.
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Affiliation(s)
- Jessica Luo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Whitney D. Moss
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Giovanna R. Pires
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Irfan A. Rhemtulla
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Megan Rosales
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Gregory J. Stoddard
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jayant P. Agarwal
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Alvin C. Kwok
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
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22
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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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Banys-Paluchowski M, Thill M, Kühn T, Ditsch N, Heil J, Wöckel A, Fallenberg E, Friedrich M, Kümmel S, Müller V, Janni W, Albert US, Bauerfeind I, Blohmer JU, Budach W, Dall P, Fasching P, Fehm T, Gluz O, Harbeck N, Huober J, Jackisch C, Kolberg-Liedtke C, Kreipe HH, Krug D, Loibl S, Lüftner D, Lux MP, Maass N, Mundhenke C, Nitz U, Park-Simon TW, Reimer T, Rhiem K, Rody A, Schmidt M, Schneeweiss A, Schütz F, Sinn HP, Solbach C, Solomayer EF, Stickeler E, Thomssen C, Untch M, Witzel I, Gerber B. AGO Recommendations for the Surgical Therapy of Breast Cancer: Update 2022. Geburtshilfe Frauenheilkd 2022; 82:1031-1043. [PMID: 36186147 PMCID: PMC9525149 DOI: 10.1055/a-1904-6231] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
The recommendations of the AGO Breast Committee on the surgical therapy of breast cancer were last updated in March 2022 (www.ago-online.de). Since surgical therapy is one of several partial steps in the treatment of breast cancer, extensive diagnostic and oncological expertise of a breast surgeon and good interdisciplinary cooperation with diagnostic radiologists is of great importance. The most important changes concern localization techniques, resection margins, axillary management in the neoadjuvant setting and the evaluation of the meshes in reconstructive surgery. Based on meta-analyses of randomized studies, the level of recommendation of an intraoperative breast ultrasound for the localization of non-palpable lesions was elevated to "++". Thus, the technique is considered to be equivalent to wire localization, provided that it is a lesion which can be well represented by sonography, the surgeon has extensive experience in breast ultrasound and has access to a suitable ultrasound device during the operation. In invasive breast cancer, the aim is to reach negative resection margins ("no tumor on ink"), regardless of whether an extensive intraductal component is present or not. Oncoplastic operations can also replace a mastectomy in selected cases due to the large number of existing techniques, and are equivalent to segmental resection in terms of oncological safety at comparable rates of complications. Sentinel node excision is recommended for patients with cN0 status receiving neoadjuvant chemotherapy after completion of chemotherapy. Minimally invasive biopsy is recommended for initially suspect lymph nodes. After neoadjuvant chemotherapy, patients with initially 1 - 3 suspicious lymph nodes and a good response (ycN0) can receive the targeted axillary dissection and the axillary dissection as equivalent options.
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Affiliation(s)
- Maggie Banys-Paluchowski
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany,Correspondence/Korrespondenzadresse Priv.-Doz. Dr. med. Maggie Banys-Paluchowski Klinik für Frauenheilkunde und GeburtshilfeUniversitätsklinikum
Schleswig-Holstein Campus LübeckRatzeburger Allee 16023538
LübeckGermany
| | - Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Thorsten Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany
| | - Nina Ditsch
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Jörg Heil
- Klinik für Frauenheilkunde und Geburtshilfe, Sektion Senologie, Universitäts-Klinikum Heidelberg, Heidelberg, Germany
| | - Achim Wöckel
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Eva Fallenberg
- Institut für Radiologie, Klinikum Rechts der Isar, Technische Universität München, München, Germany
| | - Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe, Helios Klinikum Krefeld, Krefeld, Germany
| | - Sherko Kümmel
- Klinik für Senologie, Evangelische Kliniken Essen Mitte, Essen, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Janni
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Ute-Susann Albert
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Ingo Bauerfeind
- Frauenklinik, Klinikum Landshut gemeinnützige GmbH, Landshut, Germany
| | - Jens-Uwe Blohmer
- Klinik für Gynäkologie mit Brustzentrum des Universitätsklinikums der Charite, Berlin, Germany
| | - Wilfried Budach
- Strahlentherapie, Radiologie Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Peter Dall
- Frauenklinik, Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | - Peter Fasching
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Tanja Fehm
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Oleg Gluz
- Brustzentrum, Evang. Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Nadia Harbeck
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, München, Germany
| | - Jens Huober
- Brustzentrum, Kantonspital St. Gallen, St. Gallen, Schweiz
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach GmbH, Offenbach, Germany
| | | | - Hans H. Kreipe
- Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sibylle Loibl
- German Breast Group c/o GBG Forschungs GmbH, Neu-Isenburg, Neu-Isenburg, Germany,Zentrum für Hämatologie und Onkologie Bethanien, Frankfurt am Main, Goethe Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Diana Lüftner
- Medical University of Brandenburg Theodor-Fontane & Immanuel Hospital Märkische Schweiz, Buckow, Germany
| | - Michael Patrick Lux
- Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn und St. Josefs-Krankenhaus, Salzkotten, St. Vincenz-Krankenhaus
GmbH, Paderborn, Germany
| | - Nicolai Maass
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christoph Mundhenke
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Bayreuth, Bayreuth, Germany
| | - Ulrike Nitz
- Brustzentrum, Evang. Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Tjoung Won Park-Simon
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | - Toralf Reimer
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Kerstin Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln, Köln, Germany
| | - Achim Rody
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
| | - Andreas Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum und Deutsches Krebsforschungszentrum, Heidelberg, Germany
| | - Florian Schütz
- Klinik für Gynäkologie und Geburtshilfe, Diakonissen Krankenhaus Speyer, Speyer, Germany
| | - H. Peter Sinn
- Sektion Gynäkopathologie, Pathologisches Institut, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Christine Solbach
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Erich-Franz Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, Aachen, Germany
| | - Christoph Thomssen
- Universitätsfrauenklinik, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
| | - Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Isabell Witzel
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
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Co-Graft of Acellular Dermal Matrix and Split Thickness Skin Graft—A New Reconstructive Surgical Method in the Treatment of Hidradenitis Suppurativa. Bioengineering (Basel) 2022; 9:bioengineering9080389. [PMID: 36004913 PMCID: PMC9404734 DOI: 10.3390/bioengineering9080389] [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: 07/06/2022] [Revised: 08/04/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
Hidradenitis suppurativa is a chronic disease that significantly reduces patients’ quality of life. Patients are chronically treated with systemic therapies, which are often ineffective. Surgical treatment for severe cases of hidradenitis suppurativa is one option for affected patients. Surgical treatment has its limitations, and wound closure may be particularly problematic. This requires the use of reconstructive techniques. The methods of choice for wound closure are split-thickness skin grafts or local flaps reconstructions. However, each method has its limitations. This is a presentation of a new reconstructive surgical method in hidradenitis suppurativa surgery: the use of a co-graft of Acellular dermal matrix and split thickness skin graft as a novel method in wound closure after wide excisions, based on two cases. The results of this method are very promising: we achieved very fast wound closure with good aesthetic results regarding scar formation. In this paper, we used several examinations: laser speckle analysis, cutometer tests, and health-related quality of life (QoL) questionnaire to check the clinical impact of this method. Our initial results are very encouraging. ADM with STSG as a co-graft could be widely used in reconstructive surgery. This is a preliminary study, which should be continued in further, extended research.
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Paganini A, Meyer S, Hallberg H, Hansson E. Are patients most satisfied with a synthetic or a biological mesh in dual-plane immediate breast reconstruction after 5 years? A randomised controlled trial comparing the two meshes in the same patient. J Plast Reconstr Aesthet Surg 2022; 75:4133-4143. [DOI: 10.1016/j.bjps.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/18/2022] [Accepted: 08/16/2022] [Indexed: 11/29/2022]
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Impact of Dermal Matrix Brand in Implant-Based Breast Reconstruction Outcomes. Plast Reconstr Surg 2022; 150:17-25. [PMID: 35499525 DOI: 10.1097/prs.0000000000009178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Implant-based reconstruction is the most common procedure for breast reconstruction after mastectomy. Acellular dermal matrix is used to provide additional coverage in subpectoral and prepectoral implant placement. In this study, the authors compared postoperative outcomes between AlloDerm (LifeCell, Branchburg, N.J.) and DermACELL (Stryker, Kalamazoo, Mich.), two acellular dermal matrix brands. METHODS A retrospective review of implant-based breast reconstruction from 2016 to 2020 was conducted. Patient demographics and comorbidities, implant size and location, acellular dermal matrix choice, and postoperative outcomes were recorded. Primary outcomes assessed were seroma and infection compared between two acellular dermal matrix brands. Independent clinical parameters were assessed with multiple logistic regression models for the primary outcomes. RESULTS Reconstruction was performed in 150 patients (241 breasts). Eighty-eight patients underwent expander placement with AlloDerm and 62 patients with DermACELL. There were no significant differences in patient characteristics between the two groups. There was a significantly higher incidence of seroma in the AlloDerm group in univariate (AlloDerm 21.7 percent versus DermACELL 8.2 percent, p < 0.005) and multivariate analyses ( p = 0.04; 95 percent CI, 1.02 to 6.07). Acellular dermal matrix use (regardless of type) was not associated with higher rates of infection ( p = 0.99), but body mass index was ( p = 0.004). CONCLUSIONS Both AlloDerm and DermACELL had similar infection rates regardless of contributing risk factors. AlloDerm was found to be a risk factor for seroma formation in the postoperative period. As such, it is important to be aware of this complication when performing implant-based reconstruction with this brand of acellular dermal matrix. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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DermACELL Acellular Dermal Matrix in Oncologic Breast Reconstruction: A Cohort Study and Systematic Review. Plast Reconstr Surg Glob Open 2022; 10:e4396. [PMID: 35747252 PMCID: PMC9208874 DOI: 10.1097/gox.0000000000004396] [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: 03/04/2022] [Accepted: 05/06/2022] [Indexed: 11/26/2022]
Abstract
Acellular dermal matrices (ADMs) are commonly used in tissue expander and direct-to-implant reconstruction following mastectomy. Few studies have reported outcomes of DermACELL use or compared DermACELL with AlloDerm ADM. This study sought to compare outcomes of DermACELL and AlloDerm in oncologic breast reconstruction and to review the literature reporting outcomes of patients undergoing reconstruction using DermACELL.
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Urquia LN, Henderson SP, Farewell JT, Duque S, Garibay M, Nevin J, Zhang AY. Tissue Expander-Based Breast Reconstruction at a Major Safety-Net Hospital: Managing the Outsized Risk of Infection. Aesthet Surg J Open Forum 2022; 4:ojac036. [PMID: 35673613 PMCID: PMC9167491 DOI: 10.1093/asjof/ojac036] [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] [Indexed: 11/13/2022] Open
Abstract
Background Immediate tissue expander (TE) breast reconstruction is reported to have the highest rate of postoperative infection among reconstructive modalities. The risk of infection is higher among patients treated at safety-net hospitals. Objectives The goal of this study was to identify significant contributing factors to the elevated infection risk at our major safety-net institution. Methods A retrospective chart review was conducted on all TE-based reconstruction patients with a diagnosis of postoperative infection between 2015 and 2019. Preoperative, perioperative, and postoperative risk factors for infection were determined and compared across patient and procedure demographics. Results Two hundred forty-three patients, for a total of 412 breast reconstructions, were included in our study. Significant preoperative selection factors were identified to contribute to the elevated risk of infection, including the following: older age, higher BMI, and diabetes. Significant intraoperative and postoperative contributing factors included greater mastectomy weight, larger TE's and intraoperative fill volume, and longer drain duration. Doxycycline treatment for infected patients resulted in a significantly higher rate of resolution. Conclusions Safety-net hospital population patients undergoing TE breast reconstruction are at higher risk for postoperative infection. Personal and procedural risk factors are identified. Balancing the benefits of immediate breast reconstruction with TEs with the elevated risk of postoperative infection remains challenging. Implementation of more stringent eligibility criteria may help mitigate the risk of infection. Level of Evidence 4
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Affiliation(s)
- Lindsey N Urquia
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Silas P Henderson
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jordyn T Farewell
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sofia Duque
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Maycie Garibay
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Julia Nevin
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Andrew Y Zhang
- Corresponding Author:Dr Andrew Y. Zhang, Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, 4th Floor, Dallas, TX 75390, USA. E-mail:
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Hillberg N, Hogenboom J, Hommes J, Van Kuijk S, Keuter X, van der Hulst R. Risk of major postoperative complications in breast reconstructive surgery with and without an acellular dermal matrix; Development of a prognostic prediction model. JPRAS Open 2022; 33:92-105. [PMID: 35812357 PMCID: PMC9260237 DOI: 10.1016/j.jpra.2022.04.007] [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: 12/19/2021] [Accepted: 04/21/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Acellular dermal matrices (ADM) have been suggested to allow for different approaches and reduce the risk of postoperative complications in implant-based breast surgery. Surgeons seem to embrace ADMs around the world, although a lack of consistent evidence regarding the factors that increase the risk of major postoperative complications remains. Purpose To develop and internally validate a model to predict the risk of a major postoperative complication in breast reconstructive surgery with and without an ADM. Methodology The DBIR is an opt-out registry that holds characteristics of all breast implant surgeries in the Netherlands since 2015. Using a literature-driven preselection of predictors, multivariable mixed-effects logistic regression modelling was used to develop the prediction model. Results A total of 2939 breasts were eligible, of which 11% underwent an ADM-assisted procedure (single-stage or two-stage). However, 31% underwent a two-stage procedure (with or without the use of ADM). Of all breasts, 10.2% developed a major postoperative complication. Age (OR 1.01), delayed timing (OR 0.71), and two-stage technique (OR 4.46) were associated with the outcome. Conclusion The data suggest that ADM use was not associated with a major postoperative complication, while two-stage reconstructions were strongly associated with an increased risk of major complications. Despite these findings, ADMs are not as popular in the Netherlands as in the USA. The predictive capabilities of the developed model are mediocre to poor, but because of the above findings, we believe that the role of the two-stage technique as a golden standard should be put up for debate.
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Affiliation(s)
- N.S. Hillberg
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Postal box 5800, 6202 Maastricht, The Netherlands
- School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Postal box 616, 6200 MD Maastricht, The Netherlands
- Author responsible for editorial correspondence: N.S. Hillberg, Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Postal box 5800, 6202 Maastricht, The Netherlands. +31 433877000.
| | - J. Hogenboom
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J. Hommes
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Postal box 5800, 6202 Maastricht, The Netherlands
| | - S.M.J. Van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - X.H.A. Keuter
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Postal box 5800, 6202 Maastricht, The Netherlands
| | - R.R.W.J. van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Postal box 5800, 6202 Maastricht, The Netherlands
- School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Postal box 616, 6200 MD Maastricht, The Netherlands
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Delayed Hypersensitivity Reaction to Titanium-coated Polypropylene Mesh in Breast Reconstruction. Plast Reconstr Surg Glob Open 2022; 10:e4232. [PMID: 35441070 PMCID: PMC9010120 DOI: 10.1097/gox.0000000000004232] [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: 08/02/2021] [Accepted: 02/09/2022] [Indexed: 11/25/2022]
Abstract
Breast implant reconstructions increasingly incorporate meshes like the synthetic nonresorbable titanium-coated polypropylene mesh commercialized as Tiloop (Pfm medical). We report the case of a 48-year-old woman, with a medical history of nickel allergy, who presented with an extensive erythematous eruption, a periprosthetic reaction, and an axillary node reaction, 18 months after a unilateral prophylactic mastectomy. We excluded infectious, sarcoidosis and carcinomatosis. The patient’s medical history, the clinical evolution, and the particularly fast and complete healing after removal of the mesh were suggestive of an unusual allergic reaction to the titanium in the titanium-coated polypropylene mesh. Titanium allergies are very rare events, predominantly described in the dental and orthopedic fields. We also discussed the hypothesis of a tardive red breast syndrome related to a synthetic mesh, also mediated by immunological response as described recently in another case report.
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Luo J, Willis RN, Ohlsen SM, Piccinin M, Moores N, Kwok AC, Agarwal JP. Meshed Acellular Dermal Matrix for Two-Staged Prepectoral Breast Reconstruction: An Institutional Experience. Arch Plast Surg 2022; 49:166-173. [PMID: 35832668 PMCID: PMC9045533 DOI: 10.1055/s-0042-1744408] [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: 11/06/2022] Open
Abstract
The introduction of acellular dermal matrix (ADM) to breast reconstruction has allowed surgeons to reexplore the prepectoral implant placement technique in postmastectomy breast reconstruction. Our institution adopted a novel approach using meshed ADM to lessen the financial burden of increased ADM utilization with the prepectoral breast reconstruction. This is a retrospective, single-center review of two-stage prepectoral breast reconstruction using meshed human-derived ADM for anterior prosthesis coverage. Patient demographics, oncologic data, perioperative characteristics, and complications were examined and reported as means with standard deviations. Cost-saving with the meshed technique was evaluated. Forty-eight patients (72 breasts) with a mean age of 48.5 ± 15.0 years (range 26–70 years) were included in the study. The mean follow-up time was 13.2 ± 4.4 months (range 4.1–25.8 months). Nineteen breasts (24.6%) experienced complications, with seromas being the most common complication (12.5%,
n
= 9). Expander removal and reoperation occurred at a rate of 8.3 and 9.7%, respectively. The average time to drain removal was 18.8 ± 6.6 days (range 8–32 days). Meshed ADM provided an average cost savings of $6,601 for unilateral and $13,202 for bilateral reconstructions. Our study found that human-derived meshed ADM can be safely used in two-staged prepectoral tissue expander-based breast reconstruction and can result in significant cost savings.
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Affiliation(s)
- Jessica Luo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Rhett N. Willis
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Suzanna M. Ohlsen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Meghan Piccinin
- Michigan State University College of Osteopathic Medicine, East Lansing, Michigan
| | - Neal Moores
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Alvin C. Kwok
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Jayant P. Agarwal
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
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Fontdevila J, Descarrega J. Invited Discussion On: A Pure Autologous Dermal Graft and Dermal Flap Pocket in Prepectoral Implant Reconstruction After Skin-Reducing Mastectomy: A One-Stage Autologous Reconstruction Alternative to Acellular Dermal Matrices. Aesthetic Plast Surg 2022; 46:1686-1688. [PMID: 35376993 DOI: 10.1007/s00266-022-02870-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 11/01/2022]
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Tondu T, Thiessen F, Hubens G, Tjalma W, Blondeel P, Verhoeven V. Delayed two-stage nipple sparing mastectomy and simultaneous expander-to-implant reconstruction of the large and ptotic breast. Gland Surg 2022; 11:524-534. [PMID: 35402205 PMCID: PMC8984988 DOI: 10.21037/gs-21-734] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/28/2022] [Indexed: 08/10/2023]
Abstract
BACKGROUND Large and ptotic breasts are considered an anatomical contraindication for nipple sparing mastectomy (NSM). Necrosis rates can be as high as 76%. The authors examined whether targeted preshaping mastopexy/reduction combined with simultaneous two-stage preshaping of the implant pocket prepares for an uneventful implant reconstruction. METHODS Macromastia and ptosis patients opting for risk-reducing NSM or having a peripherally localized carcinoma in situ, were offered a two-stage mastopexy/reduction simultaneously with preshaping of the implant pocket by subpectoral expansion. Only the inferior pedicle bearing the nipple-areola complex (NAC), remained. A delayed secondary NSM and tissue expander-to-implant reconstruction was scheduled 3 months later. The use of an acellular dermal matrix (ADM) was not necessary because the capsule around the expander created a hammock supporting the definite prosthesis. Follow up was at 2 weeks, 3 months, and 6 months. RESULTS Forty-one procedures were performed in 24 patients. The mean age was 45±12.08 years (range, 22 to 72 years). Patients' mean body mass index (BMI) was 26.79 kg/m2 (range, 19 to 35 kg/m2). One patient had diabetes and two smoked. One transient epidermolysis of the NAC occurred in each stage. No NAC or skin necrosis occurred; no implant had to be removed. CONCLUSIONS A two-stage mastopexy/reduction, simultaneously with preshaping of the implant pocket by tissue expansion and followed by a 3-month delayed secondary NSM with tissue expander-to-implant reconstruction is a safe technique in large ptotic breasts.
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Affiliation(s)
- Thierry Tondu
- Department of Abdominal, Pediatric and Reconstructive Surgery, Plastic Surgery Unit, Antwerp University Hospital, Antwerp, Belgium
- Multidisciplinary Breast Clinic, Unit of Gynecologic Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Filip Thiessen
- Department of Abdominal, Pediatric and Reconstructive Surgery, Plastic Surgery Unit, Antwerp University Hospital, Antwerp, Belgium
- Multidisciplinary Breast Clinic, Unit of Gynecologic Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Guy Hubens
- Department of Abdominal, Pediatric and Reconstructive Surgery, Plastic Surgery Unit, Antwerp University Hospital, Antwerp, Belgium
| | - Wiebren Tjalma
- Multidisciplinary Breast Clinic, Unit of Gynecologic Oncology, Antwerp University Hospital, Antwerp, Belgium
- Department of Obstetrics and Gynecology, Antwerp University Hospital, Antwerp, Belgium
| | - Phillip Blondeel
- Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Veronique Verhoeven
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Impact of Chemotherapy and Radiation Therapy on Inflammatory Response, Neovascularization, and Capsule Formation of Acellular Dermal Matrix in Breast Reconstruction: Analysis of the BREASTrial Biopsy Specimens. Plast Reconstr Surg 2022; 149:378e-385e. [PMID: 35196668 DOI: 10.1097/prs.0000000000008824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Breast Reconstruction Evaluation of Acellular Dermal Matrix as a Sling Trial is a single-center, blinded, prospective, randomized, controlled trial established to compare outcomes using two popular types of acellular dermal matrices, AlloDerm and DermaMatrix, in tissue expander breast reconstruction. This study used the acellular dermal matrix biopsy specimens from the trial to evaluate how adjuvant therapy influences inflammation, neovascularization, and capsule formation of the acellular dermal matrix. METHODS Punch biopsy specimens were taken at the time of expander exchange and were analyzed by a blinded pathologist. The inflammatory response was quantified by the number of fibroblasts, giant cells, and lymphocytes. Neovascularization and capsule formation were similarly quantified by the number of new capillaries and capsule presence and thickness, respectively. RESULTS Histology specimens were collected from 109 patients (170 breasts). In the absence of adjuvant therapy, there was no significant difference between AlloDerm and DermaMatrix in terms of inflammation, neovascularization, or capsule thickness. Both acellular dermal matrices showed a significant decrease in inflammation and neovascularization with adjuvant therapy. When chemotherapy and radiation therapy were used, the decrease in inflammation was greatest for the group reconstructed with DermaMatrix (p < 0.039). CONCLUSIONS Adjuvant therapy influences the inflammatory response, neovascularization, and capsule formation in both acellular dermal matrices. Adjuvant therapy has a protective effect on the inflammatory response toward both acellular dermal matrices in breast reconstruction. In the setting of chemotherapy and radiation therapy, DermaMatrix produced the greatest reduction in inflammation. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Tampaki EC, Tampakis A. Breast Reconstruction: Necessity for Further Standardization of the Current Surgical Techniques Attempting to Facilitate Scientific Evaluation and Select Tailored Individualized Procedures Optimizing Patient Satisfaction. Breast Care (Basel) 2022; 16:574-583. [PMID: 35087360 DOI: 10.1159/000518745] [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: 06/06/2021] [Accepted: 07/28/2021] [Indexed: 11/19/2022] Open
Abstract
Background Various breast cancer reconstruction methods and novel surgical techniques include autologous or allogenic procedures, which can increase patient's quality of life and provide options when dealing with patients seen as challenging clinical scenarios. Summary Our aim was to review the current literature and present published evidence on innovative standards in whole breast reconstruction. Advances in flap monitoring or newly published data regarding neurotization in breast reconstruction, arm lymphedema management, breast implant-associated anaplastic large cell lymphoma reconstruction treatment, and robotic surgery with regard to radiotherapy define innovative standards in the breast reconstruction setting. The role of meshes/acellular dermal matrix and fat grafting as well as optimal sequencing of postmastectomy radiotherapy in autologous and alloplastic breast reconstruction appear highly debatable also in expert panel meetings rendering further clinical research including RCTs imperative. Key Messages There is an abundance of novel available techniques, which mandate further standardization, facilitating scientific evaluation in an attempt to help surgeons select tailored procedures for each patient with the goal to promote informed decision-making in breast reconstruction.
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Affiliation(s)
| | - Athanasios Tampakis
- Department of General and Visceral Surgery, Basel University Hospital, Basel, Switzerland
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Jayasinghe RT, Ruseckaite R, Gartoulla P, Elder E, Hopper I. Patient Reported Outcome Measures After Breast Augmentation - Using the BREAST-Q IS. Patient Relat Outcome Meas 2022; 13:1-8. [PMID: 35046741 PMCID: PMC8761034 DOI: 10.2147/prom.s330163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Cosmetic breast augmentation procedures are commonly performed breast device surgeries. The Australian Breast Device Registry (ABDR) administers a five-question patient reported outcome measure (PROM), the BREAST-Q Implant Surveillance module (BREAST-Q IS), to patients 1, 2 and 5 years after breast device surgery. The measure includes an open-ended question to add any comments. This study aimed to use the responses to this open-ended question to assess participants' experiences of breast devices 1 and 2 years after breast augmentation. The secondary objective was to identify emerging and important issues relating to breast augmentation and devices. PATIENTS AND METHODS This qualitative descriptive study was conducted using a randomly selected sample of 268 responses to the open-ended question in the BREAST-Q IS, from the ABDR database. These responses were from patients who underwent breast augmentation between 2015 and 2018. Comments were analyzed using conventional content analysis in NVivo 12. RESULTS Four major themes were identified: satisfaction following breast augmentation, dissatisfaction following breast augmentation, complications and breast symptoms following breast augmentation and other comments. Two dominant themes were regarding satisfaction (n = 112) with overall surgical outcome, medical team, and post-operative appearance and complications and breast symptoms (n = 177) following breast augmentation. Emerging issues identified were rippling of breast implants and breast implant illness (BII). CONCLUSION PROMs can be used to understand patients' perspectives on various aspects of their own surgical experiences. Participants provided responses regarding complications and breast symptoms experienced, and rippling of the breast implants and BII are emerging issues after breast augmentation.
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Affiliation(s)
- Randi T Jayasinghe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rasa Ruseckaite
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Pragya Gartoulla
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Elisabeth Elder
- Westmead Breast Cancer Institute and Breast Surgeons of Australia and New Zealand, Westmead, NSW, Australia
| | - Ingrid Hopper
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Gao P, Bai P, Ren Y, Kong X, Wang Z, Fang Y, Wang J. Biological Matrix-Assisted One-Stage Implant-Based Breast Reconstruction Versus Two-Stage Implant-Based Breast Reconstruction: Patient-Reported Outcomes and Complications. Aesthetic Plast Surg 2021; 45:2581-2590. [PMID: 34350500 DOI: 10.1007/s00266-021-02509-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/24/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Biological matrix-assisted one-stage implant-based breast reconstruction (IBBR) could improve the inframammary fold to achieve good esthetic results. However, whether biological matrix-assisted one-stage IBBR yields better postoperative outcomes compared with two-stage IBBR remains unclear. We aimed to compare and analyze surgical complications and patient-reported outcomes (PROs) based on the BREAST-Q version 2.0 questionnaire between biological matrix-assisted one-stage IBBR and traditional two-stage IBBR. METHODS From May 2015 to June 2019, eligible patients who underwent SIS matrix-assisted one-stage IBBR or two-stage IBBR were enrolled in this retrospective cohort study. PROs were measured with BREAST-Q version 2.0, which scored the health-related quality of life, satisfaction, and experience domains. Complications were divided into major complications (patients requiring reoperation) and minor complications (patients who could be treated in the dressing room). PROs and complications were compared between the SIS matrix-assisted one-stage IBBR and two-stage IBBR groups. A multivariate linear regression analysis was used to identify the social and surgical factors that affected PROs. RESULTS At our institution, 124 eligible patients were recruited. Seventy-nine patients (63.7%) underwent SIS matrix-assisted one-stage IBBR reconstruction, and 45 patients (36.3%) underwent tissue expander/implant reconstruction (two-stage IBBR). Postoperative BREAST-Q version 2.0 was completed by 68 of 79 patients (86.1%) in the SIS matrix-assisted one-stage IBBR group and by 35 of 45 patients (77.8%) in the two-stage IBBR group. In the satisfaction-related quality of life domain, satisfaction with breast was 9.27 points higher in the SIS matrix-assisted one-stage IBBR group (p = 0.012) compared with the two-stage IBBR group. The multivariate linear regression analysis showed that implant volume (p = 0.031) and postoperative radiotherapy (p = 0.036) significantly influenced the PRO of satisfaction with breast. However, patients in the SIS matrix-assisted one-stage IBBR group had a higher minor complication rate compared with patients in the two-stage IBBR group (p = 0.026). CONCLUSIONS Our retrospective study showed that although patients treated with biological matrix-assisted one-stage IBBR tended to have higher postoperative complication rates, this technique correlated with better PROs compared with two-stage IBBR. 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)
- Peng Gao
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Ping Bai
- Department of The Operating Room, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yinpeng Ren
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xiangyi Kong
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zhongzhao Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Yi Fang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Jing Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Kalstrup J, Balslev Willert C, Brinch-Møller Weitemeyer M, Hougaard Chakera A, Hölmich LR. Immediate direct-to-implant breast reconstruction with acellular dermal matrix: Evaluation of complications and safety. Breast 2021; 60:192-198. [PMID: 34688959 PMCID: PMC8551207 DOI: 10.1016/j.breast.2021.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Immediate direct-to-implant breast reconstruction with acellular dermal matrix (ADM) is the method of choice for many plastic surgeons and patients, but the use of ADM remains a controversial subject in the literature. This study aimed to investigate complications, reconstructive failure and possible risk factors in direct-to-implant breast reconstruction with ADM (primarily Strattice™). METHODS We retrospectively examined all patients undergoing immediate direct-to-implant breast reconstruction with ADM, during a five-year period (2014-2019) at a university clinic. Study outcomes were all complications and explantations. Complications were stratified within and after 6 months postoperatively and subcategorized by type of intervention. Explantations were subcategorized into loss of implant or salvage with immediate insertion of a tissue expander, the same or a new implant. RESULTS We included 154 patients and 232 breasts. Complications within 6 months per patient included hematoma (4%), seroma (8%), infection (9%), necrosis, wound dehiscence and delayed wound healing (19%). The total complication rate per patient was 34%. Explantation occurred in 20 patients (13%) of which 9 (6% of all) had implant loss. Preoperative radiotherapy was a significant predictor of explantation (adjusted OR 4.9, 95% confidence interval (CI), 1.0-23.5; p = 0.045), and smoking was also associated with risk of explantation, although only borderline significant (adjusted OR 4.0, 95% CI, 1.0-15.8; p = 0.050). CONCLUSION This study demonstrates acceptable rates of re-operations and implant loss compared to other studies but highlights the importance of proper patient selection with regards to risk factors to minimize complications.
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Affiliation(s)
- Julie Kalstrup
- Department of Plastic and Reconstructive Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - Cecilie Balslev Willert
- Department of Plastic and Reconstructive Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Marie Brinch-Møller Weitemeyer
- Department of Plastic and Reconstructive Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - Annette Hougaard Chakera
- Department of Plastic and Reconstructive Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Lisbet Rosenkrantz Hölmich
- Department of Plastic and Reconstructive Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.
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Beier L, Faridi A, Neumann C, Paepke S, Mau C, Keller M, Strittmatter HJ, Gerber-Schäfer C, Bauer L, Karsten MM, Kümmel S, Blohmer JU. Human Acellular Dermal Matrix (Epiflex®) in Immediate Implant-Based Breast Reconstruction after Skin- and Nipple-Sparing Mastectomy and Treatment of Capsular Fibrosis: Results of a Multicenter, Prospective, Observational NOGGO-AWOGyn Study. Breast Care (Basel) 2021; 16:461-467. [PMID: 34720805 DOI: 10.1159/000512201] [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: 01/06/2020] [Accepted: 09/24/2020] [Indexed: 11/19/2022] Open
Abstract
Background Over the last decades, the number of acellular dermal matrix (ADM)-assisted implant-based breast reconstructions (IBBR) has substantially increased. However, there is still a lack of prospective data on complication rates. Methods We performed a non-interventional, multicenter, prospective cohort study to evaluate complication rates of a human ADM in patients undergoing an IBBR after skin- and nipple-sparing mastectomies. Patients with primary reconstruction (cohort A) and patients undergoing a secondary reconstruction after capsular fibrosis (cohort B) using the human ADM Epiflex® (DIZG gGmbH, Berlin, Germany) were enrolled in this study. Patients were followed-up for 12 months after surgery. Results Eighty-four eligible patients were included in this study of whom 28 women underwent a bilateral breast reconstruction, leading to 112 human ADM-assisted reconstructions in total (cohort A: 73, cohort B: 39). In 33.0% of the reconstructed breasts at least one of the complications of primary interest occurred, including implant loss 7.1%, seroma 15.2%; infection 5.4%, rash 8.0%, and Baker grade III/IV capsular fibrosis 2.7%, with no statistically significant differences between the cohorts. Previous radiation therapy was significantly associated with occurrence of any postoperative complication (OR 20.41; p value 0.027). Conclusion The rates of most complications were comparable to the rates reported for other ADMs with relatively low rates of capsular fibrosis and infections. The rate of seroma was increased in our study. Prior radiation therapy increased the risk of any postoperative complications. Therefore, the use of ADM in these patients should be considered carefully.
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Affiliation(s)
- Lea Beier
- Gynecology and Breast Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V., Berlin, Germany
| | - Andree Faridi
- Senology and Breast Center, University Hospital Bonn, Bonn, Germany
| | - Corina Neumann
- Breast Center, St. Franziskus Hospital, Münster, Germany
| | - Stefan Paepke
- Comprehensive Cancer Center, Brustzentrum der Technischen Universität München Klinikum Rechts der Isar, Munich, Germany
| | - Christine Mau
- Gynecology, Breast Center, HELIOS Hospital Berlin-Buch, Berlin, Germany
| | - Maren Keller
- Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V., Berlin, Germany
| | | | | | - Lelia Bauer
- Gynecology, GRN Hospital Weinheim, Weinheim, Germany
| | | | - Sherko Kümmel
- Breast Unit, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Essen, Germany
| | - Jens-Uwe Blohmer
- Gynecology and Breast Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Marongiu F, Bertozzi N, Sibilio A, Tognali D, Mingozzi M, Curcio A. The First Use of Human-Derived ADM in Prepectoral Direct-to-Implant Breast Reconstruction after Skin-Reducing Mastectomy. Aesthetic Plast Surg 2021; 45:2048-2057. [PMID: 33782725 DOI: 10.1007/s00266-021-02231-5] [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: 01/07/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Large and ptotic breasts always represented a great reconstructive challenge for plastic surgeons. In order to deal with these patients, we started performing Wise-pattern skin-reducing mastectomies (SRM) followed by direct-to-implant breast reconstructions (DTI-BR) in the prepectoral space where the implants were covered with the autologous adipo-dermal flap and a human acellular dermal matrix called MODA. MATERIALS AND METHOD We retrospectively reviewed all patients that underwent Wise-pattern SRM followed by MODA-assisted, prepectoral, DTI-BR between January 2017 and November 2019 at our Institution. Inclusion criteria were large ptotic breast and pinch test >2cm, while exclusion criteria were smoking >10 cigarettes/day, history of prior radiotherapy, patients supposedly requiring breast implants bigger than 550cc or post-mastectomy radiotherapy. Patients' data were collected through their electronic medical records. Both short- and long-term outcomes were reported. RESULTS Seventeen patients underwent Wise-pattern SRM followed by MODA-assisted, prepectoral, DTI-BR for a total of twenty-one breast reconstruction and fourteen matching procedures. Mean follow-up was 13.4 months (SD= ±3.67). No major complication was reported. Three (14.3%) reconstructed breasts had minor complications: 2 (9.5%) minimal (<1cm2) wound dehiscence and 1 (4.8%) de-epithelization of the skin at the T junction that were treated conservatively. Drainages gave mean output of 410.59 ml (SD= ±214.83) and were kept in place on average for 8.59 days (SD= ±3.45). CONCLUSION Few are the reports in the literature regarding DTI-BR following SRM and even fewer are those where BR was performed in the prepectoral space. Our work demonstrated the safety of prepectoral DTI-BR following SRM in selected patients in accordance with the "conservative reconstruction" principles. Furthermore, we confirmed the reliability of MODA in accordance with previously published works. 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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41
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Yang B, Zuo W, Wu J. Review of guidelines regarding mesh implants. Eur J Surg Oncol 2021; 47:2709-2710. [PMID: 34462142 DOI: 10.1016/j.ejso.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Benlong Yang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, No. 270, Dongan Rd., Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, China
| | - Wenjia Zuo
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, No. 270, Dongan Rd., Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, China
| | - Jiong Wu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, No. 270, Dongan Rd., Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, China; Collaborative Innovation Center for Cancer Medicine, China.
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42
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Liu H, Jain S, Ahlinder A, Fuoco T, Gasser TC, Finne-Wistrand A. Pliable, Scalable, and Degradable Scaffolds with Varying Spatial Stiffness and Tunable Compressive Modulus Produced by Adopting a Modular Design Strategy at the Macrolevel. ACS POLYMERS AU 2021; 1:107-122. [PMID: 36855428 PMCID: PMC9954393 DOI: 10.1021/acspolymersau.1c00013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Clinical results obtained when degradable polymer-based medical devices are used in breast reconstruction following mastectomy are promising. However, it remains challenging to develop a large scaffold structure capable of providing both sufficient external mechanical support and an internal cell-like environment to support breast tissue regeneration. We propose an internal-bra-like prototype to solve both challenges. The design combines a 3D-printed scaffold with knitted meshes and electrospun nanofibers and has properties suitable for both breast tissue regeneration and support of a silicone implant. Finite element analysis (FEA) was used to predict the macroscopic and microscopic stiffnesses of the proposed structure. The simulations show that introduction of the mesh leads to a macroscopic scaffold stiffness similar to the stiffness of breast tissue, and mechanical testing confirms that the introduction of more layers of mesh in the modular design results in a lower elastic modulus. The compressive modulus of the scaffold can be tailored within a range from hundreds of kPa to tens of kPa. Biaxial tensile testing reveals stiffening with increasing strain and indicates that rapid strain-induced softening occurs only within the first loading cycle. In addition, the microscopic local stiffness obtained from FEA simulations indicates that cells experience significant heterogeneous mechanical stimuli at different places in the scaffold and that the local mechanical stimulus generated by the strand surface is controlled by the elastic modulus of the polymer, rather than by the scaffold architecture. From in vitro experiments, it was observed that the addition of knitted mesh and an electrospun nanofiber layer to the scaffold significantly increased cell seeding efficiency, cell attachment, and proliferation compared to the 3D-printed scaffold alone. In summary, our results suggest that the proposed design strategy is promising for soft tissue engineering of scaffolds to assist breast reconstruction and regeneration.
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Affiliation(s)
- Hailong Liu
- Department
of Fibre and Polymer Technology, KTH Royal
Institute of Technology, 100 44, Stockholm, Sweden,Department
of Engineering Mechanics, KTH Royal Institute
of Technology, 100 44, Stockholm, Sweden
| | - Shubham Jain
- Department
of Fibre and Polymer Technology, KTH Royal
Institute of Technology, 100 44, Stockholm, Sweden
| | - Astrid Ahlinder
- Department
of Fibre and Polymer Technology, KTH Royal
Institute of Technology, 100 44, Stockholm, Sweden
| | - Tiziana Fuoco
- Department
of Fibre and Polymer Technology, KTH Royal
Institute of Technology, 100 44, Stockholm, Sweden
| | - T. Christian Gasser
- Solid
Mechanics, Department of Engineering Mechanics, KTH Royal Institute of Technology, 100 44, Stockholm, Sweden,Faculty
of Health Sciences, University of Southern
Denmark, 5230, Odense, Denmark,
| | - Anna Finne-Wistrand
- Department
of Fibre and Polymer Technology, KTH Royal
Institute of Technology, 100 44, Stockholm, Sweden,
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43
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Blohmer JU, Beier L, Faridi A, Ankel C, Krause-Bergmann B, Paepke S, Mau C, Keller M, Strittmatter HJ, Karsten MM. Patient-Reported Outcomes and Aesthetic Results after Immediate Breast Reconstruction Using Human Acellular Dermal Matrices: Results of a Multicenter, Prospective, Observational NOGGO-AWOGyn Study. Breast Care (Basel) 2021; 16:335-342. [PMID: 34594165 PMCID: PMC8436721 DOI: 10.1159/000509568] [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: 02/18/2020] [Accepted: 06/15/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND With the increased use of acellular dermal matrices (ADMs) in implant-based breast reconstructions (IBBRs), the evaluation of patient-reported outcomes becomes more important. METHODS Patients who underwent an immediate human ADM-assisted, submuscular IBBR were included in this noninterventional, multicenter, prospective cohort study. Patients with primary reconstruction (cohort A) and patients with a revision surgery after capsular fibrosis (cohort B) were followed up for 12 months after surgery. Quality of life (EORTC BR-23) and patient and surgeon satisfaction scores (1 ["very satisfied"] to 6 ["not satisfied"]) with the outcome and the aesthetic result evaluated by 2 independent, external experts were assessed. RESULTS Eighty-four patients were enrolled in the study. The mean patient satisfaction score was 2.1 ± 0.8, with higher satisfaction in cohort B (p = 0.041). The score did not change significantly during the follow-up (p = 0.479). The mean satisfaction score of the surgeons was 2.0 ± 0.7; it was also higher in cohort B (p = 0.016) and showed no changes over time (p = 0.473). The mean aesthetic result was 2.2 ± 0.7. 92.9% of the patients completed at least 1 quality of life questionnaire. Body image and sexual functioning increased during follow-up. One year after surgery, the mean scores were 77.2 ± 22.5 and 44.7 ± 27.3, respectively. CONCLUSION The level of satisfaction among patients and surgeons and the score of the aesthetic result were constantly high among patients after ADM-assisted IBBR. Higher satisfaction scores could be observed after revision surgery caused by capsular fibrosis (cohort B) compared to primary reconstruction (cohort A). Quality of life increased during the first year after surgery.
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Affiliation(s)
- Jens-Uwe Blohmer
- Gynecology and Breast Center, Charité − Universitätsmedizin Berlin, Berlin, Germany
- AWOGyn, Berlin, Germany
- Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V., Berlin, Germany
| | - Lea Beier
- Gynecology and Breast Center, Charité − Universitätsmedizin Berlin, Berlin, Germany
- Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V., Berlin, Germany
| | - Andree Faridi
- AWOGyn, Berlin, Germany
- Senology and Breast Center, University Hospital Bonn, Bonn, Germany
| | | | | | - Stefan Paepke
- AWOGyn, Berlin, Germany
- Brustzentrum der Technischen Universität München Klinikum Rechts der Isar Comprehensive Cancer Center, Munich, Germany
- Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V., Berlin, Germany
| | - Christine Mau
- Breast Center, Department of Gynecology, HELIOS Hospital Berlin-Buch, Berlin, Germany
- Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V., Berlin, Germany
| | - Maren Keller
- Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V., Berlin, Germany
| | - Hans Joachim Strittmatter
- AWOGyn, Berlin, Germany
- Nord-Ostdeutsche Gesellschaft für Gynäkologische Onkologie e.V., Berlin, Germany
- Department of Gynecology, Rems-Murr-Hospital Winnenden, Winnenden, Germany
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44
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Commentary on: "Usefulness of Incisional Negative Pressure Wound Therapy for Decreasing Wound Complication Rates and Seroma Formation Following Prepectoral Breast Reconstruction". Aesthetic Plast Surg 2021; 45:1946-1949. [PMID: 33666737 DOI: 10.1007/s00266-021-02195-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 02/14/2021] [Indexed: 10/22/2022]
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45
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An J, Kwon H, Lim W, Moon BI, Paik NS. The Comparison of Breast Reconstruction Using Two Types of Acellular Dermal Matrix after Breast-Conserving Surgery. J Clin Med 2021; 10:jcm10153430. [PMID: 34362213 PMCID: PMC8347910 DOI: 10.3390/jcm10153430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/23/2021] [Accepted: 07/28/2021] [Indexed: 12/12/2022] Open
Abstract
Breast reconstruction during breast-conserving surgery (BCS) can improve the breast shape. This study introduces breast reconstruction in BCS with two types of acellular dermal matrix (ADM). The study included 134 patients who underwent BCS due to breast cancer from February 2018 to May 2021. This study was conducted by one surgeon, and is the result of a three-year study. The patient group who underwent BCS using ADM was mainly targeted at patients with minor to severe defects after the operation. The average age of the patients was 51.8 years, and the body mass index (BMI) was 23.8 kg/m. The specimen weight was 30–120 g. The average surgical time, including reconstruction, was 100.4 min, combined with reconstruction. There were minor complications in six patients. The advantage of using ADM is that it can quickly correct the shape of the breast after conventional BCS surgery. Pellet-type ADM, rather than sheet-type, can create a breast shape similar to that before surgery. Breast reconstruction using ADM can be an easy and convenient method for making a better shape from BCS.
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Ditsch N, Kolberg-Liedtke C, Friedrich M, Jackisch C, Albert US, Banys-Paluchowski M, Bauerfeind I, Blohmer JU, Budach W, Dall P, Fallenberg EM, Fasching PA, Fehm T, Gerber B, Gluz O, Harbeck N, Heil J, Huober J, Kreipe HH, Krug D, Kühn T, Kümmel S, Loibl S, Lüftner D, Lux MP, Maass N, Mundhenke C, Nitz U, Park-Simon TW, Reimer T, Rhiem K, Rody A, Schmidt M, Schneeweiss A, Schütz F, Sinn HP, Solbach C, Solomayer EF, Stickeler E, Thomssen C, Untch M, Witzel I, Wöckel A, Müller V, Janni W, Thill M. AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2021. Breast Care (Basel) 2021; 16:214-227. [PMID: 34248462 DOI: 10.1159/000516419] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 12/12/2022] Open
Affiliation(s)
- Nina Ditsch
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Augsburg, Augsburg, Germany
| | | | - Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe, Helios Klinikum Krefeld, Krefeld, Germany
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach GmbH, Offenbach, Germany
| | - Ute-Susann Albert
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Maggie Banys-Paluchowski
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.,Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Ingo Bauerfeind
- Frauenklinik, Klinikum Landshut gemeinnützige GmbH, Landshut, Germany
| | - Jens-Uwe Blohmer
- Klinik für Gynäkologie mit Brustzentrum des Universitätsklinikums der Charité, Berlin, Germany
| | - Wilfried Budach
- Strahlentherapie, Radiologie Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Peter Dall
- Frauenklinik, Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | - Eva M Fallenberg
- Institut für klinische Radiologie, Klinikum der Universität München, Campus Großhadern, Munich, Germany
| | | | - Tanja Fehm
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Oleg Gluz
- Brustzentrum, Evangelisches Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Nadia Harbeck
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany
| | - Jörg Heil
- Klinik für Frauenheilkunde und Geburtshilfe, Sektion Senologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Jens Huober
- Brustzentrum, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | - David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thorsten Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany
| | - Sherko Kümmel
- Klinik für Senologie, Evangelische Kliniken Essen Mitte, Essen, Germany
| | - Sibylle Loibl
- German Breast Group Forschungs GmbH, Frankfurt, Germany
| | - Diana Lüftner
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charité, Berlin, Germany
| | - Michael P Lux
- Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn und St. Josefs-Krankenhaus, Salzkotten, St. Vincenz-Krankenhaus GmbH, Paderborn, Germany
| | - Nicolai Maass
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Christoph Mundhenke
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Essen, Essen, Germany
| | - Ulrike Nitz
- Brustzentrum, Evangelisches Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Tjoung-Won Park-Simon
- Klinik für Frauenheilkunde und Geburtshilfe, Helios Klinikum Krefeld, Krefeld, Germany
| | - Toralf Reimer
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Kerstin Rhiem
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach GmbH, Offenbach, Germany
| | - Achim Rody
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marcus Schmidt
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Andreas Schneeweiss
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Florian Schütz
- Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Hans-Peter Sinn
- Frauenklinik, Klinikum Landshut gemeinnützige GmbH, Landshut, Germany
| | - Christine Solbach
- Strahlentherapie, Radiologie Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | - Elmar Stickeler
- Institut für klinische Radiologie, Klinikum der Universität München, Campus Großhadern, Munich, Germany
| | | | - Michael Untch
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Isabell Witzel
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Achim Wöckel
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Volkmar Müller
- Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany
| | - Wolfgang Janni
- Brustzentrum, Evangelisches Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Marc Thill
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany
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Whisker L, Barber M, Egbeare D, Gandhi A, Gilmour A, Harvey J, Martin L, Tillett R, Potter S. Biological and synthetic mesh assisted breast reconstruction procedures: Joint guidelines from the Association of Breast Surgery and the British Association of Plastic, Reconstructive and Aesthetic Surgeons. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 47:2807-2813. [PMID: 34088587 DOI: 10.1016/j.ejso.2021.05.036] [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: 04/16/2021] [Revised: 05/16/2021] [Accepted: 05/19/2021] [Indexed: 11/29/2022]
Abstract
These guidelines have been produced with the involvement of the Association of Breast Surgery and the British Association of Plastic, Reconstructive and Aesthetic Surgeons. Recommendations have been derived after a review of published data regarding the use of acellular dermal matrix (ADM), biological and synthetic mesh in breast reconstruction. The guidelines represent a consensus opinion on the optimal management of patients having biological or synthetic mesh assisted breast reconstruction informed by peer-review publications. The Guidelines should be used to inform clinical decision making. Ultimately, members of the MDT remain responsible for the treatment of patients under their care.
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Affiliation(s)
- Lisa Whisker
- Nottingham Breast Institute, City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK.
| | - Matthew Barber
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, EH4 2XU, Scotland, UK.
| | - Donna Egbeare
- The Breast Centre, Cardiff and the Vale University Health Board, UK.
| | - Ashu Gandhi
- The Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK; Manchester Academic Health Sciences Centre, Manchester, UK.
| | - Adam Gilmour
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Scotland, UK.
| | - James Harvey
- The Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.
| | - Lee Martin
- Liverpool Breast Unit, Liverpool University Foundation Trust, UK.
| | | | - Shelley Potter
- Population Health Sciences, Bristol Medical School and Bristol Breast Care Centre, North Bristol NHS Trust, UK.
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Riis M. Management of patients with BRCA mutation from the point of view of a breast surgeon. Ann Med Surg (Lond) 2021; 65:102311. [PMID: 33996049 PMCID: PMC8091883 DOI: 10.1016/j.amsu.2021.102311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 12/24/2022] Open
Abstract
Germ-line mutation in BRCA (BReast CAncer gene) 1 or BRCA2 are found in 3–4% of all women with breast cancer. These patients have a significant increased risk of breast and ovarian cancer. They are often younger when diagnosed with the mutation, and the possible breast cancer they get is often aggressive with inferior outcome. There are risk reducing strategies, and the most powerful strategy is risk reducing surgery, both risk reducing bilateral mastectomy (RRM) and risk reducing bilateral salpino-oophorectomy (PBSO). This review is meant to address breast surgery in patients with germline BRCA mutation. The guidelines and techniques applied is under continuous change and it is important for the clinicians to be well informed to provide the patient with the information needed for them to make an informed decision on what risk strategy to choose. Patients with germ-line mutation in BRCA1 or BRCA2 have a significant increased risk of breast and ovarian cancer. There are different risk reducing strategies and the most powerful strategy is risk-reducing surgery, both risk reducing bilateral mastectomy and risk reducing bilateral salpingo-oophorectomy. Guidelines and techniques for the risk reducing surgery of the breast are under continuous change and improvement. Breast conserving therapy is not associated with worse survival and is a good option for a BRCA mutation carrier diagnosed with breast cancer. Risk-reducing mastectomy can be performed in a later setting. The management of BRCA mutation carriers, both affected and unaffected, should be performed in a multidisciplinary team. Physicians need to be systematically educated and updated on the most recent literature.
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49
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Sewart E, Turner NL, Conroy EJ, Cutress RI, Skillman J, Whisker L, Thrush S, Barnes N, Holcombe C, Potter S. Patient-reported outcomes of immediate implant-based breast reconstruction with and without biological or synthetic mesh. BJS Open 2021; 5:6145787. [PMID: 33609398 PMCID: PMC7896806 DOI: 10.1093/bjsopen/zraa063] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/02/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Biological and synthetic meshes may improve the outcomes of immediate implant-based breast reconstruction (IBBR) by facilitating single-stage procedures and improving cosmesis. Supporting evidence is, however, limited. The aim of this study was to explore the impact of biological and synthetic mesh on patient-reported outcomes (PROs) of IBBR 18 months after surgery. METHODS Consecutive women undergoing immediate IBBR between February 2014 and June 2016 were recruited to the study. Demographic, operative, oncological and 3-month complication data were collected, and patients received validated BREAST-Q questionnaires at 18 months. The impact of different IBBR techniques on PROs were explored using mixed-effects regression models adjusted for clinically relevant confounders, and including a random effect to account for clustering by centre. RESULTS A total of 1470 participants consented to receive the questionnaire and 891 completed it. Of these, 67 women underwent two-stage submuscular reconstructions. Some 764 patients had a submuscular reconstruction with biological mesh (495 women), synthetic mesh (95) or dermal sling (174). Fourteen patients had a prepectoral reconstruction. Compared with two-stage submuscular reconstructions, no significant differences in PROs were seen in biological or synthetic mesh-assisted or dermal sling procedures. However, patients undergoing prepectoral IBBR reported better satisfaction with breasts (adjusted mean difference +6.63, 95 per cent c.i. 1.65 to11.61; P = 0.009). PROs were similar to those in the National Mastectomy and Breast Reconstruction Audit 2008-2009 cohort, which included two-stage submuscular procedures only. CONCLUSION This study found no difference in PROs of subpectoral IBBR with or without biological or synthetic mesh, but provides early data to suggest improved satisfaction with breasts following prepectoral reconstruction. Robust evaluation is required before this approach can be adopted as standard practice.
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Affiliation(s)
- E Sewart
- Population Health Sciences, Bristol Centre for Surgical Research, Bristol Medical School, Bristol, UK
| | - N L Turner
- Population Health Sciences, Bristol Centre for Surgical Research, Bristol Medical School, Bristol, UK
| | - E J Conroy
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - R I Cutress
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, University Hospital Southampton, Southampton, UK
| | - J Skillman
- Department of Plastic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - L Whisker
- Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Thrush
- Breast Unit, Worcester Royal Hospital, Worcester, UK
| | - N Barnes
- Nightingale Breast Unit, Manchester University NHS Foundation Trust, Manchester, UK
| | - C Holcombe
- Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK
| | - S Potter
- Population Health Sciences, Bristol Centre for Surgical Research, Bristol Medical School, Bristol, UK.,Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, UK
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Abstract
Breast reconstruction is most frequently performed using implants or expanders. Adjunctive materials such as acellular dermal matrix and synthetic meshes are used to support the implant or expander. A paucity of large studies exist on the use of synthetic mesh for breast reconstruction.
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