Outcomes of Immediate Alloplastic Breast Reconstruction in Patients Receiving Post-Mastectomy Radiotherapy

2020 ◽  
pp. 229255032096964
Author(s):  
Stacy Fan ◽  
Hanny Chen ◽  
Aaron Grant ◽  
Tanya DeLyzer
Keyword(s):  
Breast Reconstruction ◽  
Revision Surgery ◽  
Capsular Contracture ◽  
Tissue Expander ◽  
Wound Dehiscence ◽  
Fisher Exact Test ◽  
Adjuvant Radiation ◽  
Complication Rates ◽  
Alloplastic Breast Reconstruction ◽  
Alloplastic Reconstruction

Background: Immediate alloplastic breast reconstruction is traditionally avoided in patients who require post-mastectomy radiation therapy (PMRT). However, a subset of patients who undergo alloplastic reconstruction may unpredictably require adjuvant radiation. The purpose of this study was to compare outcomes and complications in patients at our institution who had undergone immediate alloplastic breast reconstruction and received PMRT to either the permanent implant or temporary tissue expander. Materials and Methods: A retrospective cohort study was performed looking at patients who underwent immediate alloplastic breast reconstruction over a 10-year period (2009-2019) at our regional breast centre. All patients who underwent immediate alloplastic breast reconstruction and had PMRT were included in the study. Major (wound dehiscence with device exposure, or reconstructive failure) and minor (infection, capsular contracture, revision surgery) complication rates between those patients receiving radiation to a tissue expander versus implant were compared using Fisher exact test ( P < .05). Results: Six-hundred ninety-two patients were identified, and 43 patients met inclusion criteria. Of this group, 29 received PMRT to implants and 14 received PMRT to tissue expanders. Complication rates were similar between groups for superficial wound infection (3.4% vs 7.1%), periprosthetic infection (3.4% vs 7.1%), capsular contracture (41.4% vs 21.4%), revision surgery for aesthetics (41.4% vs 21.4%), wound dehiscence and device exposure (3.4% vs 21.3%), and reconstructive failure (10.3% vs 6.7%). Total complication rates were similar between groups (51.7% vs 42.9%). Discussion: Overall 6.4% of patients who underwent immediate alloplastic breast reconstruction required PMRT over a 10-year period. Complication rates for infection, capsular contracture, revision surgery, wound dehiscence and device exposure, and reconstructive failure were similar between both groups. Total complication rates were similar between groups. This information will help to inform decision-making regarding immediate alloplastic reconstruction and expected complications when PMRT is needed.

scholarly journals 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 ◽  
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.

Outcomes of Combined Treatment for Breast Cancer with Immediate Implant-Based Breast Reconstruction, Chemotherapy and Conformal Radiotherapy

2018 ◽  
pp. 19-25
Author(s):  
Е. Тимошкина ◽  
E. Timoshkina ◽  
Сергей Ткачев ◽  
Sergey Tkachev ◽  
А. Назаренко ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Reconstruction ◽  
Cancer Patients ◽  
Capsular Contracture ◽  
Late Complication ◽  
Combined Treatment ◽  
Tissue Expander ◽  
Complication Rates ◽  
Breast Cancer Patients ◽  
Immediate Implant

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.

Use of PEAK PlasmaBlade in implant-based breast reconstruction and radiotherapy: new strategy to reduce complications

2021 ◽  
pp. 030089162110560
Author(s):  
Laura Sala ◽  
Stefano Bonomi ◽  
Alessandra Fabbri ◽  
Chiara Maura Ciniselli ◽  
Annalisa Bardelli ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Protective Factor ◽  
Capsular Contracture ◽  
Wound Dehiscence ◽  
Acellular Dermal Matrix ◽  
Complication Rates ◽  
Dermal Matrix ◽  
Plastic Reconstructive Surgery ◽  
Surgeon Satisfaction

Background: Implant-based breast reconstruction in the setting of radiotherapy often leads to higher complications rates (mainly capsular contracture and wound dehiscence) and poor cosmetic outcomes. We hypothesized that the combination of pulsed-electron avalanche knife (PEAK) PlasmaBlade (a pulsed radiofrequency electrosurgery) and acellular dermal matrix Veritas® in postmastectomy radiotherapy implant-based breast reconstruction could result in lower complications rate, better reconstructive results, and patient satisfaction. Methods: A prospective observational study focused on the use of PEAK PlasmaBlade in implant-based breast reconstruction and radiotherapy was carried out in the Plastic Reconstructive Surgery Unit at Fondazione IRCCS Istituto Nazionale Tumori Milano between December 2017 and 2019 (2017–2018: enrollment; 2018–2019: follow-up). Patient demographics were queried and complication rates and patient and surgeon satisfaction were assessed. Results: A total of 88 patients were enrolled; 2 patients received bilateral reconstruction, leading to a total of 90 procedures. Sixty-two women received contralateral symmetrization. Seroma was the most frequent minor complication (8.8%); implant exposure was the most recorded among major complications (5.5%). Preoperative lipofilling was the most substantial protective factor for preventing complications ( p < 0.001). A significant association between capsular thermal damage thickness and the type of electrosurgery used (traditional electrosurgery vs PEAK PlasmaBlade) was observed, with lower values with PEAK PlasmaBlade ( p < 0.0001). Conclusions: Our protocol results in low rates of surgical complications and a high level of patient and surgeon satisfaction although longer follow-up is needed.

scholarly journals Overall Complication Rates of DIEP Flap Breast Reconstructions in Germany—A Multi-Center Analysis Based on the DGPRÄC Prospective National Online Registry for Microsurgical Breast Reconstructions

2021 ◽  
Vol 10 (5) ◽  
pp. 1016
Author(s):  
Paul I. Heidekrueger ◽  
Nicholas Moellhoff ◽  
Raymund E. Horch ◽  
Jörn A. Lohmeyer ◽  
Mario Marx ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Revision Surgery ◽  
National Level ◽  
Length Of Hospital Stay ◽  
High Standard ◽  
High Volume ◽  
National Registry ◽  
Wound Complications ◽  
Diep Flap ◽  
Complication Rates

While autologous breast reconstruction has gained momentum over recent years, there is limited data on the structure and quality of care of microsurgical breast reconstruction in Germany. Using the breast reconstruction database established by the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC), the presented study investigated the overall outcomes of deep inferior epigastric perforator (DIEP) flap reconstructions in Germany. Data of 3926 patients and 4577 DIEP flaps performed by 22 centers were included in this study. Demographics, patient characteristics, perioperative details and postoperative outcomes were accounted for. Centers performing < Ø 40 (low-volume (LV)) vs. ≥ Ø 40 (high-volume (HV)) annual DIEP flaps were analyzed separately. Overall, total and partial flap loss rates were as low as 2.0% and 1.1% respectively, and emergent vascular revision surgery was performed in 4.3% of cases. Revision surgery due to wound complications was conducted in 8.3% of all cases. Mean operative time and length of hospital stay was significantly shorter in the HV group (LV: 385.82 min vs. HV: 287.14 min; LV: 9.04 (18.87) days vs. HV: 8.21 (5.04) days; both p < 0.05). The outcome and complication rates deduced from the national registry underline the high standard of microsurgical breast reconstruction on a national level in Germany.

scholarly journals Does Acellular Dermal Matrix Thickness Affect Complication Rate in Tissue Expander Based Breast Reconstruction?

2016 ◽  
Vol 2016 ◽  
pp. 1-6
Author(s):  
Jessica F. Rose ◽  
Sarosh N. Zafar ◽  
Warren A. Ellsworth IV
Keyword(s):  
Breast Reconstruction ◽  
Skin Necrosis ◽  
Tissue Expander ◽  
Retrospective Chart Review ◽  
Acellular Dermal Matrix ◽  
Complication Rates ◽  
Dermal Matrix ◽  
Drain Removal ◽  
Dermal Matrices ◽  
Acellular Dermal

Background. While the benefits of using acellular dermal matrices (ADMs) in breast reconstruction are well described, their use has been associated with additional complications. The purpose of this study was to determine if ADM thickness affects complications in breast reconstruction. Methods. A retrospective chart review was performed including all tissue expander based breast reconstructions with AlloDerm (LifeCell, Branchburg, NJ) over 4 years. We evaluated preoperative characteristics and assessed postoperative complications including seroma, hematoma, infection, skin necrosis, and need for reintervention. We reviewed ADM thickness and time to Jackson-Pratt (JP) drain removal. Results. Fifty-five patients underwent 77 ADM-associated tissue expander based breast reconstructions, with average age of 48.1 years and average BMI of 25.9. Average ADM thickness was 1.21 mm. We found higher complication rates in the thick ADM group. Significant associations were found between smokers and skin necrosis (p<0.0001) and seroma and prolonged JP drainage (p=0.0004); radiated reconstructed breasts were more likely to suffer infections (p=0.0085), and elevated BMI is a significant predictor for increased infection rate (p=0.0037). Conclusion. We found a trend toward increased complication rates with thicker ADMs. In the future, larger prospective studies evaluating thickness may provide more information.

scholarly journals Comprehensive Comparison Between Shaped Versus Round Implants for Breast Reconstruction: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 41 (1) ◽  
pp. 34-44 ◽  
Author(s):  
So-Eun Han ◽  
Kyeong-Tae Lee ◽  
Saik Bang
Keyword(s):  
Breast Reconstruction ◽  
Meta Analysis ◽  
Breast Implant ◽  
Capsular Contracture ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Relative Risks ◽  
Patient Reported ◽  
Aesthetic Results ◽  
Retrospective Cohort Studies

Abstract Background Prosthetic breast reconstruction has been gaining popularity and a variety of implant options are currently available. Therefore, it is important to evaluate the safety and efficacy of newly developed shaped implants compared with those of conventional round implants. To date, few studies have investigated the outcomes of breast reconstruction with shaped versus round implants. Objectives The present study aimed to comprehensively compare, via meta-analytic methodology, shaped and round breast implant reconstruction in terms of complication profiles and aesthetic satisfaction. Methods PubMed/MEDLINE, Ovid, and Cochrane databases were searched to identify relevant studies presenting the complication rates for shaped and round implant groups. The relative risks of the following complications between the groups were calculated: infection, seroma, capsular contracture, rupture, rippling, reconstruction failure, and implant exchange or removal. Outcomes of aesthetic satisfaction included aesthetic results and patient-reported outcomes. Results Meta-analysis of 8 retrospective cohort studies, representing 2490 cases of implant-based breast reconstruction, was performed. There were no significant differences in the risks of infection, seroma, capsular contracture, and reconstruction failure between the 2 groups. The risks of implant rupture and rippling were significantly reduced with shaped implants. In a subgroup analysis of shaped/textured and round/smooth implants, the risk of infection was significantly enhanced in the former, whereas incidences of other complications, including capsular contracture and reconstruction failure, were similar. Aesthetic satisfaction analysis of the 2 groups demonstrated similar outcome scores with favorable overall results. Conclusions Our results suggest that both shaped and round implants might provide favorable breast reconstruction outcomes with similarly low complication rates and aesthetic results. Level of Evidence: 4

Allograft vs Xenograft Bioprosthetic Mesh in Tissue Expander Breast Reconstruction: A Blinded Prospective Randomized Controlled Trial

2021 ◽  
Author(s):  
Malke Asaad ◽  
Jesse C Selber ◽  
David M Adelman ◽  
Donald P Baumann ◽  
Victor J Hassid ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Breast Reconstruction ◽  
Controlled Trial ◽  
Tissue Expander ◽  
Final Analysis ◽  
Immediate Breast Reconstruction ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Dermal Matrix ◽  
Randomized Controlled

Abstract Background With the increased use of acellular dermal matrix (ADM) in breast reconstruction, the number of available materials has increased. There is a relative paucity of high-quality outcomes data for use of different ADMs. Objectives The goal of this study was to compare the outcomes between a human (HADM) and a bovine ADM (BADM) in implant-based breast reconstruction. Methods A prospective, single-blinded, randomized controlled trial was conducted to evaluate differences in outcomes between HADM and BADM for patients undergoing immediate tissue expander breast reconstruction. Patients with prior radiation to the index breast were excluded. Patient and surgical characteristics were collected and analyzed. Results From April 2011 to June 2016, a total of 90 patients were randomized to a mesh group, with 68 patients (HADM, 36 patients/55 breasts; BADM, 32 patients/48 breasts) included in the final analysis. Baseline characteristics were similar between the 2 groups. No significant differences in overall complication rates were identified between HADM (n = 14, 25%) and BADM (n = 13, 27%) (P = 0.85). Similar trends were identified for major complications and complications requiring reoperation. Tissue expander loss was identified in 7% of HADM patients (n = 4) and 17% of BADM patients (n = 8) (P = 0.14). Conclusions Similar complication and implant loss rates were found among patients undergoing immediate tissue expander breast reconstruction with HADM or BADM. Regardless of what material is used, careful patient selection and counseling, and cost consideration, help to improve outcomes and sustainability in immediate breast reconstruction. Level of Evidence: 2

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