Single Stage Direct-to-Implant Breast Reconstruction Has Lower Complication Rates Than Tissue Expander and Implant and Comparable Rates to Autologous Reconstruction in Patients Receiving Postmastectomy Radiation

In order to achieve the best aesthetic result after immediate implant-based breast reconstruction, all the advantages and disadvantages of two-stage tissue expander and single-stage direct-to-implant breast reconstruction should be considered. Decision about the type of implant-based reconstruction is based on the consultations outcomes after multidisciplinary team meeting of breast and reconstructive specialist, but patients own wishes should be prioritised.

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Postmastectomy Radiation Therapy (PMRT) before and after 2-Stage Expander-Implant Breast Reconstruction: A Systematic Review

Medicina ◽

10.3390/medicina55060226 ◽

2019 ◽

Vol 55 (6) ◽

pp. 226 ◽

Cited By ~ 5

Author(s):

Jeremie D. Oliver ◽

Daniel Boczar ◽

Maria T. Huayllani ◽

David J. Restrepo ◽

Andrea Sisti ◽

...

Keyword(s):

Systematic Review ◽

Radiation Therapy ◽

Breast Reconstruction ◽

Tissue Expander ◽

Optimal Timing ◽

Implant Placement ◽

Postmastectomy Radiation ◽

Postmastectomy Radiation Therapy ◽

The Impact ◽

Implant Breast Reconstruction

Background: In those undergoing treatment for breast cancer, evidence has demonstrated a significant improvement in survival, and a reduction in the risk of local recurrence in patients who undergo postmastectomy radiation therapy (PMRT). There is uncertainty about the optimal timing of PMRT, whether it should be before or after tissue expander or permanent implant placement. This study aimed to summarize the data reported in the literature on the effect of the timing of PMRT, both preceding and following 2-stage expander-implant breast reconstruction (IBR), and to statistically analyze the impact of timing on infection rates and the need for explantation. Methods: A comprehensive systematic review of the literature was conducted using the PubMed/Medline, Ovid, and Cochrane databases without timeframe limitations. Articles included in the analysis were those reporting outcomes data of PMRT in IBR published from 2009 to 2017. Chi-square statistical analysis was performed to compare infection and explantation rates between the two subgroups at p < 0.05. Results: A total of 11 studies met the inclusion criteria for this study. These studies reported outcomes data for 1565 total 2-stage expander-IBR procedures, where PMRT was used (1145 before, and 420 after, implant placement). There was a statistically significant higher likelihood of infection following pre-implant placement PMRT (21.03%, p = 0.000079), compared to PMRT after implant placement (9.69%). There was no difference in the rate of explantation between pre-implant placement PMRT (12.93%) and postimplant placement PMRT (11.43%). Conclusion: This study suggests that patients receiving PMRT before implant placement in 2-stage expander–implant based reconstruction may have a higher risk of developing an infection.

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Abstract P4-17-08: Tissue Expander/Implant Breast Reconstruction with and without Postmastectomy Radiation: Predictive Factors for Complications

10.1158/0008-5472.sabcs12-p4-17-08 ◽

2012 ◽

Author(s):

SKA Nguyen ◽

P Oxley ◽

R Rastegar ◽

M Joffres ◽

W Kwan

Keyword(s):

Breast Reconstruction ◽

Predictive Factors ◽

Tissue Expander ◽

Postmastectomy Radiation ◽

Implant Breast Reconstruction

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The Effect of Acellular Dermal Matrix Use on Complication Rates in Tissue Expander/Implant Breast Reconstruction

Annals of Plastic Surgery ◽

10.1097/sap.0b013e3181dba892 ◽

2010 ◽

Vol 64 (5) ◽

pp. 674-678 ◽

Cited By ~ 53

Author(s):

Steven T. Lanier ◽

Eric D. Wang ◽

John J. Chen ◽

Balvant P. Arora ◽

Steven M. Katz ◽

...

Keyword(s):

Breast Reconstruction ◽

Tissue Expander ◽

Acellular Dermal Matrix ◽

Complication Rates ◽

Dermal Matrix ◽

Acellular Dermal ◽

Implant Breast Reconstruction

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Long-term outcomes of two-stage, immediate and delayed breast reconstruction with polyurethane-covered versus textured implants: protocol of a prospective, multicentre randomised controlled trial (TIPI trial)

BMJ Open ◽

10.1136/bmjopen-2020-044219 ◽

2021 ◽

Vol 11 (5) ◽

pp. e044219

Author(s):

J X Harmeling ◽

Kevin Peter Cinca ◽

Eleni-Rosalina Andrinopoulou ◽

Eveline M L Corten ◽

M A Mureau

Keyword(s):

Randomised Controlled Trial ◽

Breast Reconstruction ◽

Controlled Trial ◽

Capsular Contracture ◽

Tissue Expander ◽

Complication Rates ◽

Two Stage ◽

Randomised Controlled

IntroductionTwo-stage implant-based breast reconstruction is the most commonly performed postmastectomy reconstructive technique. During the first stage, a tissue expander creates a sufficiently large pocket for the definite breast implant placed in the second stage. Capsular contracture is a common long-term complication associated with implant-based breast reconstruction, causing functional complaints and often requiring reoperation. The exact aetiology is still unknown, but a relationship between the outer surface of the implant and the probability of developing capsular contracture has been suggested. The purpose of this study is to determine whether polyurethane-covered implants result in a different capsular contracture rate than textured implants.Methods and analysisThe Textured Implants versus Polyurethane-covered Implants (TIPI) trial is a multicentre randomised controlled trial with a 1:1 allocation rate and a follow-up of 10 years. A total of 321 breasts of female adults undergoing a two-stage breast reconstruction will be enrolled. The primary outcome is capsular contracture at 10-year follow-up which is graded with the modified Baker classification. It is analysed with survival analysis using a frailty model for clustered interval-censored data, with both an intention-to-treat and per-protocol approach. Secondary outcomes are other complication rates, surgical revision rate, patient satisfaction and quality of life and user-friendliness. Outcomes are measured 2 weeks, 6 months, 1, 2, 3, 5 and 10 years postoperatively. Interim analysis is performed when 1-year, 3-year and 5-year follow-up is completed.Ethics and disseminationThe trial has been reviewed and approved by the Medical Research Ethics Committee of the Erasmus MC, University Medical Centre Rotterdam (MEC-2018-126) and locally by each participating centre. Written informed consent will be obtained from each study participant. The results will be disseminated by publication in peer-reviewed journals.Trial registrationNTR7265.

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Letter to the Editor: Sub-muscular Reconstruction After NAC Sparing Mastectomy—Direct to Implant Breast Reconstruction with Human ADM Versus Tissue Expander

Aesthetic Plastic Surgery ◽

10.1007/s00266-020-02058-6 ◽

2021 ◽

Author(s):

Bishara S. Atiyeh ◽

Fadl Chahine

Keyword(s):

Breast Reconstruction ◽

Tissue Expander ◽

Letter To The Editor ◽

Implant Breast Reconstruction

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Obesity and the Latissimus Dorsi Flap: A Radiologic Study

Plastic Surgery ◽

10.1177/22925503211031927 ◽

2021 ◽

pp. 229255032110319

Author(s):

Joshua H. Choo ◽

Bradley J. Vivace ◽

Luke T. Meredith ◽

Swapnil Kachare ◽

Thomas J. Lee ◽

...

Keyword(s):

Breast Reconstruction ◽

Latissimus Dorsi ◽

Normal Weight ◽

Latissimus Dorsi Flap ◽

Class I ◽

Autologous Reconstruction ◽

Complication Rates ◽

Obese Patients ◽

Weight Category ◽

Flap Thickness

Introduction: The increasing prevalence of obesity in patients with breast cancer has prompted a reappraisal of the role of the latissimus dorsi flap (LDF) in breast reconstruction. Although the reliability of this flap in obese patients is well-documented, it is unclear whether sufficient volume can be achieved through a purely autologous reconstruction (eg, extended harvest of the subfascial fat layer). Additionally, the traditional combined autologous and prosthetic approach (LDF + expander/implant) is subject to increased implant-related complication rates related to flap thickness in obese patients. The purpose of this study is to provide data on the thicknesses of the various components of the latissimus flap and discuss the implications for breast reconstruction in patients with increasing body mass index (BMI). Methods: Measurements of back thickness in the usual donor site area of an LDF were obtained in 518 patients undergoing prone computed tomography–guided lung biopsies. Thicknesses of the soft tissue overall and of individual layers (e.g., muscle, subfascial fat) were obtained. Patient, demographics including age, gender, and BMI were obtained. Results: A range of BMI from 15.7 to 65.7 was observed. In females, total back thickness (skin, fat, muscle) ranged from 0.6 to 9.4 cm. Every 1-point increase in BMI resulted in an increase of flap thickness by 1.11 mm (adjusted R 2 of 0.682, P < .001) and an increase in the thickness of the subfascial fat layer by 0.513 mm (adjusted R 2 of 0.553, P < .001). Mean total thicknesses for each weight category were 1.0, 1.7, 2.4, 3.0, 3.6, and 4.5 cm in underweight, normal weight, overweight, and class I, II, III obese individuals, respectively. The average contribution of the subfascial fat layer to flap thickness was 8.2 mm (32%) overall and 3.4 mm (21%), 6.7 mm (29%), 9.0 mm (30%), 11.1 mm (32%), and 15.6 mm (35%) in normal weight, overweight, class I, II, III obese individuals, respectively. Conclusion: The above findings demonstrate that the thickness of the LDF overall and of the subfascial layer closely correlated with BMI. The contribution of the subfascial layer to overall flap thickness tends to increase as a percentage of overall flap thickness with increasing BMI, which is favourable for extended LDF harvests. Because this layer cannot be separated from overall thickness on examination, these results are useful in estimating the amount of additional volume obtained from an extended latissimus harvest technique.

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