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titanium-coated polypropylene mesh as innovative bioactive material in conservatives mastectomies and pre-pectoral breast reconstruction

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Bioactive Materials 2021年第12期6卷 4640-4653页

作者： Pietro Gentile Marco Bernini Lorenzo Orzalesi Silvia Sordi Icro Meattini Francesca Lessi Ashutosh Kothari Claudio Calabrese Department of Surgical Science University of Rome“Tor Vergata”Rome00133Italy Breast Surgery Breast UnitOncology DepartmentCareggi University Hospital50134FlorenceItaly Department of Experimental and Clinical Biomedical Sciences“M.Serio” University of Florence Radiation Oncology Unit-OncologyCareggi University HospitalFlorenceItaly Fondazione Pisana per la Scienza onlus Pisa 56122Italy Breast Surgery Unit Guy’s HospitalGuy’s and St.Thomas’NHS Foundation TrustLondonUnited Kingdom San Rossore Breast Unit Pisa 56122Italy

Breast reconstruction is rapidly evolving,thanks to the growing acceptance of synthetic meshes as innovative biomaterials.276 patients undergoing mastectomy(total of 328 mastectomies)were analyzed in a retrospective observational study to evaluate the pre-pectoral immediate breast reconstruction(IBR)using an implant wrapped with titanium-coated polypropylene mesh(TCPM)vs.patients treated with tissue expander(TE),equally placed pre-pectorally(and wrapped with the same TCPM in 74.3%of the control group’breasts).163 patients,of the study group(SG),underwent mastectomy and pre-pectoral IBR with implant wrapped with TCPM,in a one-step surgery,called direct-to-implant technique(DTI),while 113 patients control group(CG)underwent mastectomy and TE.DTI technique has been performed in 192 breasts of the SG while TE procedure in 136 breasts of the CG.The BREAST-Q questionnaire has been provided before the treatment and 2 years later.Baker scale has been used to evaluate capsular contracture.Oncologic,surgical,and aesthetic outcomes along with BREAST-Q scores were analyzed.Additionally,a histologic evaluation was conducted in 11 capsules’samples randomly chosen(6 derived from SG patients and 5 derived from CG).Complications were recorded in 43 cases(29SG-14CG):8 skin-nipple necrosis(5SG-3CG),8 wound dehiscence(6SG-2CG),3 hematomas(1SG-2CG),and 24 infections(8SG-16CG).Grade IV capsular contracture was detected in 9 breasts(1SG-8CG),whereas 254 breasts were grade I(110SG-144CG),33(10SG-23CG)grade II,and 32(4SG-28CG)grade III.Implant wrinkling was detected in 18 cases(10SG-8CG)after 30 months.The local tumor recurrence rate was 5.8%.Three recurrences were on the nipple-areola complex(1.9%).SG patients showed significantly higher rates in the BREAST-Q overall Satisfaction with Outcome(74.1),overall Satisfaction with Breasts(69.1),Psychosocial Well-being(81.9),and Sexual Well-being(63.1),versus CG’s patients(pmesh integration and normal healing.

关键词： Mastectomy Pre-pectoral breast reconstruction titanium-coated polypropylene mesh Immediate breast reconstruction

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