scholarly journals Immediate Prosthetic Breast Reconstruction after Nipple-Sparing Mastectomy: Traditional Subpectoral Technique versus Direct-to-Implant Prepectoral Reconstruction without Acellular Dermal Matrix

2021 ◽  
Vol 11 (2) ◽  
pp. 153
Author(s):  
Gianluca Franceschini ◽  
Lorenzo Scardina ◽  
Alba Di Leone ◽  
Daniela Andreina Terribile ◽  
Alejandro Martin Sanchez ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Length Of Hospital Stay ◽  
Major Complication ◽  
Complication Rates ◽  
Breast Cancer Patients ◽  
Sports Activity ◽  
Dermal Matrix ◽  
Shoulder Dysfunction ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

Background: The aim of this study was to compare outcomes of immediate prosthetic breast reconstruction (IPBR) using traditional submuscular (SM) positioning of implants versus prepectoral (PP) positioning of micropolyurethane-foam-coated implants (microthane) without further coverage. Methods: We retrospectively reviewed the medical records of breast cancer patients treated by nipple-sparing mastectomy (NSM) and IPBR in our institution during the two-year period from January 2018 to December 2019. Patients were divided into two groups based on the plane of implant placement: SM versus PP. Results: 177 patients who received IPBR after NSM were included in the study; implants were positioned in a SM plane in 95 patients and in a PP plane in 82 patients. The two cohorts were similar for mean age (44 years and 47 years in the SM and PP groups, respectively) and follow-up (20 months and 16 months, respectively). The mean operative time was 70 min shorter in the PP group. No significant differences were observed in length of hospital stay or overall major complication rates. Statistically significant advantages were observed in the PP group in terms of aesthetic results, chronic pain, shoulder dysfunction, and skin sensibility (p < 0.05), as well as a trend of better outcomes for sports activity and sexual/relationship life. Cost analysis revealed that PP-IPBR was also economically advantageous over SM-IPBR. Conclusions: Our preliminary experience seems to confirm that PP positioning of a polyurethane-coated implant is a safe, reliable and effective method to perform IPBR after NSM.

scholarly journals Human Acellular Dermal Matrix (Epiflex®) in Immediate Implant-Based Breast Reconstruction after Skin- and Nipple-Sparing Mastectomy and Treatment of Capsular Fibrosis: Results of a Multicenter, Prospective, Observational NOGGO-AWOGyn Study

Breast Care ◽  
2020 ◽  
pp. 1-7
Author(s):  
Lea Beier ◽  
Andree Faridi ◽  
Corina Neumann ◽  
Stefan Paepke ◽  
Christine Mau ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Breast Reconstruction ◽  
Acellular Dermal Matrix ◽  
Complication Rates ◽  
Dermal Matrix ◽  
Capsular Fibrosis ◽  
Multicenter Prospective Cohort Study ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing ◽  
Acellular Dermal

<b><i>Background:</i></b> Over the last decades, the number of acellular dermal matrix (ADM)-assisted implant-based breast reconstructions (IBBR) has substantially increased. However, there is still a lack of prospective data on complication rates. <b><i>Methods:</i></b> We performed a non-interventional, multicenter, prospective cohort study to evaluate complication rates of a human ADM in patients undergoing an IBBR after skin- and nipple-sparing mastectomies. Patients with primary reconstruction (cohort A) and patients undergoing a secondary reconstruction after capsular fibrosis (cohort B) using the human ADM Epiflex® (DIZG gGmbH, Berlin, Germany) were enrolled in this study. Patients were followed-up for 12 months after surgery. <b><i>Results:</i></b> Eighty-four eligible patients were included in this study of whom 28 women underwent a bilateral breast reconstruction, leading to 112 human ADM-assisted reconstructions in total (cohort A: 73, cohort B: 39). In 33.0% of the reconstructed breasts at least one of the complications of primary interest occurred, including implant loss 7.1%, seroma 15.2%; infection 5.4%, rash 8.0%, and Baker grade III/IV capsular fibrosis 2.7%, with no statistically significant differences between the cohorts. Previous radiation therapy was significantly associated with occurrence of any postoperative complication (OR 20.41; <i>p</i> value 0.027). <b><i>Conclusion:</i></b> The rates of most complications were comparable to the rates reported for other ADMs with relatively low rates of capsular fibrosis and infections. The rate of seroma was increased in our study. Prior radiation therapy increased the risk of any postoperative complications. Therefore, the use of ADM in these patients should be considered carefully.

scholarly journals Risk Factors for Complications after Skin-Sparing and Nipple-Sparing Mastectomy

Breast Care ◽  
2019 ◽  
Vol 14 (5) ◽  
pp. 289-297
Author(s):  
Felix J. Paprottka ◽  
Christopher L. Schlett ◽  
Rosalia Luketina ◽  
Karolin Paprottka ◽  
Dalius Klimas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Breast Reconstruction ◽  
Breast Tissue ◽  
Patient Characteristics ◽  
Personal History ◽  
Complication Rates ◽  
History Of ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

Introduction: In order to achieve a complication-free breast reconstruction, it is fundamental for each individual patient case to determine preoperatively certain risk factors that might have a negative impact on the postoperative result after skin-sparing (SSM) or nipple-sparing mastectomy (NSM). Methods: A retrospective study of 39 female breast cancer patients who received SSM or NSM breast reconstruction in our department (time interval: 2010–2015), was performed. The study focus is on determining patient characteristics (e.g., demographics, history of radiotherapy/chemotherapy, menopausal status, amount of resected breast tissue) leading to higher complication rates. Results: Overall, 50 mastectomies (27 SSM and 23 NSM) with 6 immediate and 35 immediate 2-stage tissue expander breast reconstructions amounting to a total of 41 surgical interventions (n = 41) were carried out. Median follow-up time was 2 years and 5 months (range 121–1,863 days). Increased complication rates were associated with the following patient characteristics: age >50 years (p < 0.05) and personal history of cardiovascular disease (p < 0.05). Increased but not significant risk factors included postmenopausal status (p = 0.07), radiotherapy prior to SSM/NSM (p = 0.06), and weight of resected breast tissue >438 g (p = 0.09). Conclusion: This work identified age >50 years and personal history of cardiovascular disease to be risk factors for increased complication rates following SSM and NSM. Therefore, the given findings should be taken into account when selecting patients for these 2 procedures.

Prepectoral Implant-Based Breast Reconstruction Using Meshed ADM

2020 ◽  
pp. 229255032093368
Author(s):  
Alessandra Fin ◽  
Fabrizio De Biasio ◽  
Sebastiano Mura ◽  
Samuele Massarut ◽  
Giovanna Zaccaria ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Normal Skin ◽  
Case Series ◽  
Acellular Dermal Matrix ◽  
Immediate Breast Reconstruction ◽  
Dermal Matrix ◽  
Scale Scores ◽  
The Mean ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

Prepectoral prosthetic breast reconstruction has been widely reassessed in recent years and is taking on an increasingly important role in the field of immediate breast reconstruction. We report here a case series of 32 patients who underwent nipple-sparing mastectomy for breast carcinoma and prepectoral breast reconstruction involving an acellular dermal matrix (ADM) treated by means of a skin-graft mesher in our hospital from January 2015 to March 2016. The indications for this type of reconstruction were body mass index (BMI) less than 30 kg/m2; no history of radiotherapy; no active smokers; moderate grade breast; and good viability of mastectomy flap: normal skin colour, active bleeding at the fresh cut edges, and thicker than 1 cm mastectomy flaps; the viability of lower thicknesses was ascertained by the fluorescent dye indocyanine green xenon-based imaging technology (4 patients). The mean age of the patients was 56.4 years (range: 39-77 years). Their mean BMI was 27.4 kg/m2. Until the end of follow-up (mean: 17 months), major complications requiring reoperation occurred in 9% of patients and minor complications in 22% of patients. The mean of the 3 pain visual analogue scale scores taken in the first 24 hours after surgery was 1.8. Mean duration of hospital stay has been 2.2 days. Our complication rate was similar to those reported in other studies on prepectoral breast reconstruction featuring total ADM coverage of the implant.

scholarly journals Early postoperative complications and local relapses after nipple sparing mastectomy and immediate breast reconstruction using silicone implants

2019 ◽  
Vol 25 (1) ◽  
pp. 9-12 ◽  
Author(s):  
Vladimir Selakovic ◽  
Milan Ranisavljevic ◽  
Zoran Radovanovic ◽  
Ferenc Vicko ◽  
Dejan Lukic ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Reconstruction ◽  
Immediate Breast Reconstruction ◽  
Silicone Implants ◽  
Breast Cancer Patients ◽  
Early Complications ◽  
Total Percentage ◽  
Reconstruction Methods ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

Purpose: Purpose of this study was to evaluate early complications and risk factors associated with nipple sparing mastectomy and immediate breast reconstruction. Methods: This retrospective study was made using data from 246 breast cancer patients treated at the Oncology Institute of Vojvodina in the period from January 2010 to December 2015. In all patients nipple sparing mastectomy was performed along with primary breast reconstruction. Results: The mean indication for nipple sparing mastectomy was multicentricity of the tumor (114 patients; 46.3%). The majority of surgically treated patients were in stage II of the disease. The total percentage of local relapses after the nipple sparing mastectomy was 1.6% (4 patients). Total percentage of early complications was 15% (37 patients). Median follow-up after nipple sparing mastectomy was 260 weeks (ranging from 417 to 104 weeks). Conclusion: Primary reconstruction of the breasts using heterologous implants is standard surgical procedure for breast cancer that does not lead to increased number of complications, nor to increased percentage of the local recurrence.

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