A Single Surgeon??s 12-Year Experience with Tissue Expander/Implant Breast Reconstruction: Part II. An Analysis of Long-Term Complications, Aesthetic Outcomes, and Patient Satisfaction

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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Novel Pre-Mastectomy Permanent Implant Reconstruction

Journal of Clinical Review & Case Reports ◽

10.33140/jcrc.06.02.04 ◽

2021 ◽

Vol 6 (2) ◽

Keyword(s):

Patient Satisfaction ◽

Breast Reconstruction ◽

Short Form ◽

Tissue Expander ◽

Silicone Implants ◽

Life Questionnaire ◽

Dermal Substitute ◽

Breast Cancer Patients ◽

Permanent Implant ◽

Implant Reconstruction

Background: Breast reconstruction has been shown to have significant psychosocial benefits for breast cancer patients. Multiple techniques have been used to improve patient satisfaction, aesthetic outcomes, and decrease complications. However, while these techniques are advantageous, they have some significant disadvantages. We are presenting a novel two-stage, pre-mastectomy permanent implant reconstruction (PPIR) technique in an attempt to overcome some of these disadvantages. Methods: Five patients met the essential criteria: they underwent PPIR by insertion of silicone implants three weeks before a proposed mastectomy. The Short Form-36 quality of life questionnaire and the Michigan Breast Reconstruction Outcomes Survey were used before and after the surgery to assess outcome and patient satisfaction. Paired sample t-tests were used to compare changes in the survey scores for various psychosocial subscales and to determine whether score changes after reconstruction were significant. Result: Five patients underwent seven breast reconstructions using PPIR. None of the patients experienced surgical complications (e.g. mastectomy flap complication, wound dehiscence, surgical site infection, or implant-related complications). The PPIR technique resulted in improved psychosocial outcomes and body image with high patient satisfaction. Conclusion: Pre-mastectomy permanent implant reconstruction is a promising potential technique with good aesthetic outcome and patient satisfaction that carries no tissue expander complications and eliminates multiple clinic visits and the usage of a dermal substitute.

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Assessing the Influence of Failed Implant Reconstruction on Patient Satisfaction and Decision Regret after Salvage Free-Flap Breast Reconstruction

Journal of Reconstructive Microsurgery ◽

10.1055/s-0041-1735224 ◽

2021 ◽

Author(s):

Ronnie L. Shammas ◽

Amanda R. Sergesketter ◽

Mahsa Taskindoust ◽

Sonali Biswas ◽

Scott T. Hollenbeck ◽

...

Keyword(s):

Patient Satisfaction ◽

Breast Reconstruction ◽

Free Flap ◽

Well Being ◽

Flap Reconstruction ◽

Free Flap Reconstruction ◽

Decision Regret ◽

History Of ◽

Implant Reconstruction

Abstract Background Free-flap breast reconstruction after failed implant reconstruction is associated with improved patient outcomes. How the level of satisfaction achieved compares between patients with and without previously failed implant reconstruction remains unknown. The aim of this study was to assess the influence of prior failed implant-based reconstruction on long-term patient-reported outcomes after free-flap breast reconstruction. Methods All patients undergoing free-flap breast reconstruction between 2015 and 2019 were identified. Patient satisfaction using the BREAST-Q and decisional regret using the Decision Regret Scale were compared between patients with and without a history of implant breast reconstruction. Results Overall, 207 patients were contacted and 131 completed the BREAST-Q and Decision Regret Scale. A total of 23 patients had a history of failed implant-based reconstruction requiring free-flap-flap salvage, most commonly due to infection (39.1%), chronic pain (34.8%), capsular contracture (26%), and implant malposition (26.1%). Following definitive free-flap reconstruction, patients with prior failed implant reconstruction had significantly lower BREAST-Q scores for satisfaction with breast (61.2 ± 16.7 vs. 70.4 ± 18.7; p = 0.04) and sexual well-being (38.5 ± 18.2 vs. 52.8 ± 24.7; p = 0.01) and reported higher decision regret (19.1 ± 18.6 vs. 9.6 ± 15.6, respectively). There were no significant differences for psychosocial well-being (p = 0.67), physical well-being (chest; p = 0.27), and physical well-being (abdomen; p = 0.91). Conclusion A history of failed implant-based reconstruction is associated with reduced satisfaction and increased decision regret with the final reconstructive outcome. This data underscores the importance of appropriate patient selection at the initial consultation, and informed preoperative counseling regarding long-term outcomes in patients presenting for free-flap reconstruction after a failed implant-based reconstruction.

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