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Comparison of outcomes between immediate implantbased and autologous reconstruction: 15-year, single-center experience in a propensity score-matched Chinese cohort

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Cancer Biology & Medicine 2022年第9期19卷 1410-1421页

作者： Shanshan He Bowen Ding Gang Li Yubei Huang Chunyong Han Jingyan Sun Qingfeng Huang Jing Liu Zhuming Yin Shu Wang Jian Yin Department of breast reconstruction Key Laboratory of Breast Cancer Prevention and TherapyTianjin Medical UniversityMinistry of EducationSino‐Russian Joint Research Center for Oncoplastic Breast SurgeryTianjin Medical University Cancer Institute&HospitalNational Clinical Research Center for CancerKey Laboratory of Cancer Prevention and TherapyTianjinTianjin’s Clinical Research Center for CancerTianjin 300060China School of Pharmacy University College LondonLondon WC1N 1AXUK Department of Cancer Epidemiology and Biostatistics Tianjin Medical University Cancer Institute&HospitalNational Clinical Research Center for CancerKey Laboratory of Cancer Prevention and TherapyTianjinTianjin’s Clinical Research Center for CancerTianjin 300060China

Objective:The number of immediate breast reconstruction(IBR)procedures has been increasing in China.This study aimed to investigate the oncological safety of IBR,and to compare the survival and surgical outcomes between implant-based and autologous reconstruction.Methods:Data from patients diagnosed with invasive breast cancer who underwent immediate total breast reconstruction between 2001 and 2016 were retrospectively reviewed.Long-term breast cancer-specific survival(BCSS),disease-free survival(DFS),and locoregional recurrence-free survival(LRFS)were evaluated.Patient satisfaction with the breast was compared between the implantbased and autologous groups.BCSS,DFS,and LRFS were compared between groups after propensity score matching(PSM).Results:A total of 784 IBR procedures were identified,of which 584 were performed on patients with invasive breast cancer(implantbased,n=288;autologous,n=296).With a median follow-up of 71.3 months,the 10-year estimates of BCSS,DFS,and LRFS were 88.9%[95%confidence interval(CI)(85.1%–93.0%)],79.6%[95%CI(74.7%–84.8%)],and 94.0%[95%CI(90.3%–97.8%)],respectively.A total of 124 patients completed the breast-Q questionnaire,and no statistically significant differences were noted between groups(P=0.823).After PSM with 27 variables,no statistically significant differences in BCSS,DFS,and LRFS were found between the implant-based(n=177)and autologous(n=177)groups.Further stratification according to staging,histological grade,lymph node status,and lymph-venous invasion status revealed no significant survival differences between groups.Conclusions:Both immediate implant-based and autologous reconstruction were reasonable choices with similar long-term oncological outcomes and patient-reported satisfaction among patients with invasive breast cancer in China.

关键词： Oncological safety immediate breast reconstruction implant-based autologous Chinese propensity-score matched

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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(p<0.05).Histological analysis showed a process of normal tissue repair with a complete mesh integration and normal healing.

关键词： Mastectomy Pre-pectoral breast reconstruction Titanium-coated polypropylene mesh immediate breast reconstruction

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Effect of neoadjuvant chemotherapy on skin-sparing mastectomy and breast reconstruction modalities in 409 patients

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Plastic and Aesthetic Research 2015年第1期2卷 17-21页

作者： Sameh Goubran Jon Ver Halen Department of Plastic Surgery University of Tennessee Health Science CenterMemphisTN 38103USA Department of Surgery Division of PlasticReconstructiveand Hand SurgeryBaptist Memorial Healthcare CorporationMemphisTN 38120USA Department of Surgery Vanderbilt-Ingram Cancer CenterNashvilleTN 37232USA Department of Surgery St.Jude Children’s Research HospitalMemphisTN 38105USA

Aim:While skin-sparing mastectomy(SSM)can be performed in patients with stage II-III breast cancer,the impact of neoadjuvant chemotherapy(NAC)on SSM rates and reconstructive modalities in these patients is not known.Methods:Between January 2007 and December 2009,409 immediate breast reconstructions(IBRs)were performed in patients with Stage II-III breast cancer.Data were collected on preoperative,operative,and postoperative factors.Results:There was a statistically significant relationship between clinical stage of disease and the utilization of SSM or non-SSM(Pimmediate reconstruction,in spite of having a greater proportion of stage III patients(Pbreast skin,which can subsequently enhance reconstructive outcomes in patients with clinical stage II and III breast cancer.Specifically,our data suggest that NAC patients with stage II and III breast cancer and larger tumors can reliably and safely undergo SSM in nearly half of cases,thus improving reconstructive outcomes and patient well-being.

关键词： immediate breast reconstruction neoadjuvant chemotherapy review skin‑sparing mastectomy

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Lessons Learned from Three Different Acellular Dermal Matrices in Direct-to-Implant breast reconstruction

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Modern Plastic Surgery 2021年第1期11卷 22-35页

作者： Claas Spengler Roland Mett Frank Masberg Peter M. Vogt Tobias R. Mett Department of Plastic Reconstructive Aesthetic Surgery HELIOS Klinik Schwerin Schwerin Germany Department of Plastic Aesthetic Hand and Reconstructive Surgery Hannover Medical School Hannover Germany

The aim of the study was to show significant differences regarding postoperative complications and outcomes using three different Acellular Dermal Matrices (ADM), namely Epiflex®, Strattice® and Braxon®, in immediate implant-based subpectoral breast reconstruction cases. Background: The use of Acellular Dermal Matrices for implant-based breast reconstruction cases continues to evolve. There is a wide variety of products which differ significantly in their biological features. It remains unclear if and how these differences manifest in clinical practice. Methods: 82 cases of primary breast reconstruction in the Department of Plastic and Aesthetic Surgery of HELIOS Clinics Schwerin, Germany between 2010 and 2018 were analyzed. 25 patients received Strattice® acellular dermal matrix (SADM), 22 cases Epiflex® acellular dermal matrix (EADM) and the remaining 35 cases Braxon® acellular dermal matrix (BADM). The mean follow-up was 1.8 years. Cases were analyzed regarding minor or major complications and rate of capsular contracture grade III or IV (Baker Classification). Results: The overall complication rate was 34.1% for all groups (SADM = 40%, EADM = 50%, BADM = 20%, p-value = 0.051). Of all cases, 6 patients underwent implant exchange or secondary autologous reconstruction due to capsular contracture (7.3%). The mean time between revision due to capsular contracture and reconstruction was

关键词： breast reconstruction Acellular Dermal Matrix ADM Direct-to-Implant DTI immediate breast reconstruction IBR breast Cancer Skin Sparing Mastectomy EPIFLEX Strattice BRAXON

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