Comparison of Immediate Implant Placement versus the Staged Tissue Expander Technique in Breast Reconstruction

Purpose: To evaluate the oncological results and late complication rate in breast cancer patients who underwent immediate implant-based breast reconstruction and adjuvant radiotherapy. Material and methods: 32 patients with I–IIIC breast cancer after combined treatment which included immediate implant-based breast reconstruction, chemotherapy and radiotherapy, were reviewed. Results: All 32 patients got skin erythema as an acute adverse effect. 6 (18 %) of them got acute mucositis. Median follow-up was 35 months (range 12–112 months). 2 (6 %) patients had local recurrence after 46 and 31 months since the operation day. Locoregional control rate was 94 %. 9 (28 %) patients presented distant metastases at term 8–71 months since the operation day, and metastases in bones, brain, lungs, liver and non-regional lymph nodes were diagnosed. 2 (6 %) patients died because of disease progression. Late adverse effects of skin and soft tissue in irradiated area were found in 4 (13 %) patients – capsular contracture was diagnosed 1 (n = 1), 2 (n = 2) and 3 (n = 1) stages. In two cases of four, capsular contracture was asymptomatic and found during the second stage of breast reconstruction while changing tissue expander to implant. Capsulotomy was performed, and aesthetic effect was good. In one case capsular contracture was the reason of implant removal, and then second reconstruction using tissue expander was performed. Conclusion: Nowadays immediate implant-based breast reconstruction is an essential part of combined treatment. Breast cancer patients after immediate implant-based breast reconstruction can be treated in adequate manner, and breast reconstruction is not a contraindication for radiotherapy. Low complication rates can still be acquired with the use of state-of-art 3D and 4D radiotherapy techniques and supportive care.

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Immediate two-stage tissue expander vs single-stage direct-to-implant breast reconstruction: two case reports of identical twins with BRCA 2 mutation

Slovenian Medical Journal ◽

10.6016/zdravvestn.1283 ◽

2015 ◽

Vol 84 (11) ◽

Author(s):

Aleš Porčnik ◽

Uroš Ahčan

Keyword(s):

Breast Reconstruction ◽

Case Reports ◽

Tissue Expander ◽

Single Stage ◽

Two Stage ◽

Aesthetic Result ◽

Advantages And Disadvantages ◽

Brca 2 ◽

Immediate Implant ◽

Implant Breast Reconstruction

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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Stacked Deep Inferior Epigastric Perforator Free Flaps with Immediate Implant Placement for Unilateral Breast Reconstruction

Journal of Reconstructive Microsurgery Open ◽

10.1055/s-0037-1604155 ◽

2017 ◽

Vol 02 (01) ◽

pp. e72-e74

Author(s):

Keith Hood ◽

Nishant Kumar ◽

Stephane Braun ◽

Kent Higdon

Keyword(s):

Breast Reconstruction ◽

Capsular Contracture ◽

Free Flaps ◽

Left Breast ◽

Diep Flap ◽

Augmentation Mammoplasty ◽

Aesthetic Result ◽

Implant Placement ◽

Deep Inferior Epigastric Perforator ◽

Immediate Implant

Background Autologous flaps can be used in combination with prosthesis in postmastectomy breast reconstruction. The deep inferior epigastric perforator (DIEP) flap is considered the preferred choice among autologous tissue transfer techniques. In patients with a breast volume asymmetry, there are several options for attaining an optimal reconstructive and aesthetic result. Methods This report presents a patient who underwent a combination of reconstructive techniques to achieve volumetric symmetry. Results The patient had a previous bilateral augmentation mammoplasty, was then treated for left breast carcinoma with a lumpectomy and radiation, and since that time had a recalcitrant left capsular contracture despite multiple operative interventions. The patient ultimately chose to have autologous left breast reconstruction and a stacked DIEP flap with simultaneous implant placement was performed. Conclusion In cases of significant volumetric asymmetry, a stacked DIEP flap in combination with a prosthesis is a novel and safe solution.

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Guided implant surgery and immediate implant placement in esthetic zone

International Journal of Medical and Dental Case Reports ◽

10.15713/ins.ijmdcr.92 ◽

2018 ◽

Vol 5 (1) ◽

pp. 1-5

Author(s):

Afsheen Tabassum

Keyword(s):

Implant Surgery ◽

Implant Placement ◽

Immediate Implant

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