Moffitt Cancer Center Experience of Tissue Expander Breast Reconstruction

176 Background: Mastectomy is a life-saving management but can cause significant adverse reactions. So, breast reconstruction is a concern in recovery after mastectomy. We report our experience with immediate breast reconstruction using implant or tissue expander, which confirmed the oncologic safety and high patients’ satisfaction. Methods: This study is a retrospective review of all patients who underwent reconstruction with implant or tissue expander immediately after mastectomy. Seventy-seven patients underwent breast reconstruction at a general hospital breast cancer center from January of 2008 to December of 2010 and 14 patients were excluded because of follow-up loss. Therefore 63 patients were included. To access patient’s satisfaction, questionnaire was sent to all patients. Results: Mean age of the patients is 44.1 years. ( range: 29-64) After median follow-up periods of 22.4 months, there was 1 case of locoregional recurrence, 1 case of distant metastasis and overall breast cancer specific survival was 100%. Overall major complication rate was 11.1% (7 patients), such as nipple areolar complex (NAC) necrosis and implant removal. Among 10 patients who had NAC necrosis, 6 patients improved after observation, and 4 patients performed NAC excision. Three patients were removed their implant due to severe infection, leakage or dissatisfaction. There were 32 cases of total mastectomy, 12 cases of skin sparing mastectomy (SSM), 19 cases of NAC sparing mastectomy (NSM). According to the result of questionnaire, 84.1% was satisfied with generalized operational result, 77.8% with cosmetic result. Among 19 patients who had performed NSM, 89.5% was satisfied with general result, 84.2% with cosmetic result. Conclusions: Immediate breast reconstruction using implant after mastectomy is technically feasible and oncologically safe as well as relatively good patient’s satisfaction. But we need more long-term experience.

Download Full-text

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.

Download Full-text