Implants For Reconstruction Research Articles

ThP1.13 - Short term safety outcomes of immediate pre-pectoral implant based reconstruction

Abstract Aims In the UK up to 43% of women undergo immediate breast reconstruction (IBR) following mastectomy for breast cancer. Implant reconstruction is the commonest form of breast reconstruction and pre-pectoral techniques have been introduced with the aim of improving cosmetic outcome and avoiding animation. To assess the safety of pre-pectoral implant based breast reconstruction (PPBR), including infection rates, 30 day re-admission to hospital, need for unplanned surgery and implant loss at 3 months. Methods A retrospective study of 80 consecutive women who underwent PPBR for breast cancer or risk reduction between October 2020 and October 2023. Demographic, operative and complication data were collected. Results Eighty women (70 cancer, 8 risk reducing and 2 cancer/risk reducing) underwent 94 PPBR procedures (80 Skin sparing mastectomies and 14 Nipple and skin sparing mastectomies) with a mean age of 51.5 (range 28 to 79) years and a BMI of 25.2 kg/m2. 7 (8.8%) of women were smokers. The mean implant size used was 385cc (range 160cc to 650cc) with a mean breast weight of 448.6g (range 45g to 1700g). 10 (12.5%) women required oral antibiotics for wound infection with a further 2 (2.5%) women requiring re-admission within 30 days for IV antibiotics. 17 (21.3%) developed a seroma with 8 (47.1%) requiring drainage. No implant losses were recorded within 3 months of reconstruction. Conclusion We have demonstrated that PPBR is a good option for patients of a wide age range with a large variation in breast size with minimal complications and no implant losses.

A Comparative Study on Aesthetic and Pain Outcomes in Flap Versus Implant Breast Reconstruction After Mastectomy.

Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death among women worldwide. Surgical treatments, including mastectomy and subsequent breast reconstruction, are critical components of breast cancer management. This systematic review compares the outcomes of flap versus implant reconstruction post-mastectomy, focusing on aesthetic differences, pain, recovery, and psychological adaptation. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA) 2020 guidelines, we conducted a comprehensive literature search across PubMed, Cochrane, and ScienceDirect databases. Inclusion criteria targeted studies comparing aesthetic outcomes, pain, recovery costs, duration, and psychological adaptation between flap and implant breast reconstructions. We excluded non-English and non-Spanish studies, case reports, and those without full-text availability. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). From an initial pool of 25,881 articles, 16 high-quality studies involving 14,196 participants were selected for synthesis. Flap reconstruction was associated with higher patient satisfaction regarding aesthetic outcomes and psychological well-being but also had higher complication rates, including infections and wound dehiscence. Implant reconstruction showed fewer complications but did not achieve the same level of patient satisfaction. Flap reconstruction, despite its higher complication rates, tends to provide superior aesthetic and psychological outcomes compared to implant reconstruction. These findings highlight the importance of personalized treatment plans considering individual patient needs and preferences. Future research should focus on long-term randomized controlled trials (RCTs) and standardized outcome measures to further delineate the comparative effectiveness of these reconstruction techniques. Personalized care and ongoing research are essential to improving the quality of life for breast cancer survivors undergoing reconstruction.

A Phase II Study Evaluating the Effect of Intensity Modulated Postmastectomy Radiation Therapy on Implant Failure Rates in Breast Cancer Patients With Immediate, 2-Stage Implant Reconstruction With an MRI Imaging Correlative Substudy

BackgroundPostmastectomy radiation therapy (PMRT) is a mainstay in the adjuvant treatment of node-positive breast cancer, but it poses risks for women with breast reconstruction. Multi-beam intensity-modulated radiation therapy (IMRT) improves dose conformality and homogeneity, potentially reducing complications in breast cancer patients with implant-based reconstruction. To investigate this hypothesis, we conducted a single-arm phase II clinical trial of breast cancer patients who underwent mastectomy/axillary dissection and prosthesis-based reconstruction. MethodsThe primary endpoint was the rate of implant failure within 24 months of permanent implant placement, which would be considered an improvement over historical controls if below 16%. Implant failure (IF) was defined as removal leading to a flat chest wall or replacement with another reconstruction. Patients were analyzed in two cohorts. Cohort 1 (RT-PI) received RT to the permanent implant (PI). Cohort 2 (RT-TE) received RT to the TE. Implant failure rates, adverse events, and quality of life (QOL) were analyzed. Follow-up/post-RT assessments were compared to the baseline/pre-RT assessments at 3-10 weeks after exchange surgery. A subgroup underwent serial MRIs to explore the association of MRI-detected changes with capsular contracture, a known adverse effect of RT. ResultsBetween June 2014 and March 2017, 119 women were enrolled. Cohort 1 included 45 patients, and Cohort 2 had 74 patients. Among 100 evaluable participants, 25 experienced IF during the study period. IF occured in 8/42 (19%) and 17/58 (29%) in Cohorts 1 and 2, respectively. Among the IFs, the majority were due to capsular contracture (13), infection (7), exposure (3), and other reasons (2). Morphological shape features observed in longitudinal MRI images were associated with the development of Baker grade 3-4 contracture. ConclusionsThe rate of implant failure in reconstructed breast cancer patients treated with IMRT was similar to, but not improved over, conventional, 3D-conformal methods. MRI imaging features show promise for predicting capsular contracture but require validation in larger studies.

Breast Implant Reconstruction in the Ptotic Patient: Evaluation of Wise and Vertical Skin Sparing Mastectomy

Introduction: Post-mastectomy reconstruction in patients with severe breast ptosis can be challenging. Traditionally, a skin sparing mastectomy (SSM) with a circumareolar incision or a horizontal elliptical extension results in a long, horizontally-oriented scar in the central breast. The Wise pattern SSM with an inferiorly-based dermal flap addresses skin redundancy and provides added vascularized implant coverage in ptotic patients with macromastia. The purpose of this study is to compare outcomes in ptotic patients undergoing SSM with Wise pattern and a modified vertical technique which also uses de-epithelialized excess skin under the incision. Methods: A retrospective chart review was performed on patients that underwent SSM using a Wise or vertical skin reducing technique. The Wise pattern was performed using an inferiorly-based dermal flap and the vertical method used a laterally-based dermal flap covering the implant/tissue expander (TE). Results: SSM with the use of autoderm was performed in 42 patients (67 breasts) using either the Wise (n = 49 breasts) or vertical (n = 18 breasts) method. Both groups had similar BMI (35.4). The prepectoral plane was used in 93.5% of Wise pattern patients and all vertical patients. All cases of seroma and hematoma occurred in the Wise pattern group (10.2%). Mastectomy skin necrosis requiring unplanned return to surgery for debridement occurred in 20.4% of those undergoing Wise pattern SSM and 11.1% undergoing the vertical pattern (p = 0.49). Conclusion: Severely ptotic patients undergoing SSM have a high risk of skin necrosis. A dermal flap under the closure has the advantage of vascularized tissue reinforcing the wound in implant based reconstruction. The vertical pattern SSM using a laterally-based dermal flap may be a safe, simple alternative to the Wise pattern in select patients.

A Retrospective Study of the Dual-Main Surgeons’ Endoscopy-Assisted Insufflation Bilateral Nipple-Sparing Mastectomy with Immediate Implant Reconstruction

Background: Endoscopy-assisted breast surgery (EABS) is widely accepted, especially for young breast cancer women. But single-main surgeon’s EABS (SMS-EABS) has a long operation time and lots of blood loss during the surgery. Therefore, we advocate applying dual-main surgeons’ EABS (DMS-EABS) to improve surgical technique. Materials and Methods: This retrospective cohort study analyzed 34 patients with endoscopy-assisted insufflation bilateral nipple-sparing mastectomy with immediate implant reconstruction from March 2021 to December 2023 in The Sixth Affiliated Hospital of Sun Yat-sen University medical database and compared the blood loss, operation time, post-operation hospital stay, implant volume, operation costs, operation complications and breast-Q questionnaire between SMS-EABS and DMS-EABS with statistical analysis. Results: The blood loss (29.38 ml vs 51.67 ml, p<0.05) and operation time (4.38 h vs 5.56 h, p=0.01) in the DMS-EABS group are significantly better than SMS-EABS. There is no statistical difference in post-operation hospital stay, implant volume, operation costs, operation complications, and aesthetic evaluation between the two groups. Conclusion: DMS-EABS has the advantage of reducing blood loss and operation time and it also keeps its aesthetic advantages as same as SMS-EABS. Therefore, it can be widely applied.

Implant reconstruction after mastectomy–A review and summary of current literature

IntroductionThe landscape of breast reconstruction has changed significantly with a shift in focus to include the restoration of a patient's quality of life after cancer. Reconstructive options can be divided into alloplastic (implant based) and autologous (tissue based). This paper aims to provide a current educational summary regarding implant-based reconstruction after breast cancer surgery and review the current literature. MethodA review of the literature was conducted utilising standard PRISMA flowchart. Databases searched included Pubmed, EMBASE, and MEDLINE. ResultsCurrent practice is explored within the text, including types of implants, indications, and surgical approaches. Heterogenous cohorts, surgical technique variation, and selection bias can make comparison of the literature challenging. The major evidence reviews of implant-based reconstruction topics are discussed including, ADM use, radiotherapy, and complications. Despite the benefits of autologous reconstruction, implant-based techniques still represent a significant proportion of reconstructive breast procedures. However, implant-reconstruction is not without its risks and limitations and, with such variety in practice, there remains a lack of high-quality evidence guiding practice. Most importantly, patients need to be counselled about the pros and cons of each choice, particularly with the increasing utilisation of radiotherapy post-reconstruction. Ultimately, the patient and surgeon should reach a decision in full knowledge of the risks and potential outcomes. ConclusionsFurther research is required into implant-based reconstructive therapy, which will allow a greater consensus for management and a pathway for both surgeons and patients.

Comparison between Pre-Pectoral and Post-Pectoral Implant Reconstruction and Different Radiation Modalities on Breast Reconstruction Complications

Single Stage direct to implant (DTI) is a rising reconstruction approach. It has been speculated that prepectoral implant placement reduces reconstruction complications as well as using newer postmastectomy radiation (PMRT) modalities as protons. Largest series in this topic included 350 DTI patients with less than 30 patients receiving PMRT. We reviewed the charts of 2,187 patients (pts) who underwent mastectomy and reconstruction at our institution between 2000 and 2020. Pts only receiving DTI with and without PMRT were included. PMRT was delivered either with 3D conformal photon +/- chest wall electron boost (CWB) or proton therapy mainly with pencil beam scanning. All pts received conventional fractionation (50-50.4 Gy in 25-28 fractions). Patients on active protons clinical trials were excluded. Primary endpoints were reconstruction complications defined as infection/necrosis (I/N) requiring debridement; capsular contracture (CC) requiring capsulotomy and overall reconstruction failure (ORF: removal of permanent implant for any complication with and without salvage reconstruction). Subgroup analysis for pts receiving PMRT was done to explore impact of proton and photons on complications. Logistic and cox regression were used. Eight hundred nine pts received DTI, with an overall median follow-up of 6.2 years. Among the entire cohort, 78/809 (9.7%) had prepectoral implants while the rest had subpectoral implants with and without alloderm support. Of the entire cohort 391/809 (48.5%) received PMRT, among those 43/391 (11%) received protons. The 5 years cumulative incidence of CC was 8.5% and 6.6% among prepectoral vs subpectoral implants (HR = 1.2, p = 0.7). The 5 years cumulative incidence of ORF was 32.2% and 28.2% among prepectoral vs subpectoral implants (HR 1.1, p = 0.6). For pts receiving PMRT, the 5 years cumulative incidence of CC were 26.0% and 8.6% among protons vs photons (HR 3.7, p < 0.0005). The 5 years cumulative incidence of ORF were 38.2% and 30.1% among protons vs photons (HR 1.4, p = 0.2). Multivariable logistic regression analysis accounting for BMI, smoking history, diabetes, and PMRT showed no significant difference between prepectoral implants versus subpectoral coverage for CC (OR = 0.7, p = 0.5), and for ORF (OR = 0.9, p = 0.8). Subgroup multivariable analysis for those receiving PMRT only showed protons compared to photons significantly increased the risk of CC (OR = 5.3, p < 0.0001) and ORF (OR = 2.1, p = 0.03). No significant difference in I/N was noted between photons and protons or between prepectoral and subpectoral pts. For breast cancer patients receiving single stage direct to implant reconstruction with and without PMRT, prepectoral implant placement did not reduce the risk of complications. Proton therapy compared to photons significantly increased the risk of capsular contracture requiring capsulotomies and significantly increased overall reconstruction failures with implants removal.

A Systematic Approach to Restoring Full Arch Length with Maxillary Fixed Implant Reconstruction: The PATZi Protocol.

The traditional configuration of four maxillary implants to restore full-arch maxillary fixed implant prostheses is not without pitfalls. Intraoperative variability, such as bone quality and quantity, may lead to unexpected intraoperative challenges that may not allow for execution of the original treatment plan. Additionally, extensive maxillary sinus pneumatization may inhibit posterior spread and lead to a shortened dental arch or excessive cantilever forces. The PATZi protocol is a systematized algorithm for maxillary full-arch implant treatment planning that addresses such intraoperative surprises and achieves full arch length in the planned prosthesis. PATZi also assigns a numbering classification to each implant configuration, which leads to uniform communication and grading of surgical difficulty, as well as predictable planning for developing future salvage plans. By using the PATZi protocol as a guideline, the surgeon may improve composite torque value and anteroposterior (AP) spread, eliminate distal cantilever forces, and ultimately improve the predictability of the prosthetic treatment plan.

Effect of Post-Mastectomy Autologous versus Implant Reconstruction on Body Image and Quality of Life among Egyptian Women

Abstract Purpose The ultimate goal is to evaluate patient satisfaction with autologous versus implant breast reconstruction, as well as the influence of these surgeries on the quality of life and body image of women who have had a mastectomy for breast cancer. Method A multicenter, retrospective, cross-sectional study included 117 patients who underwent mastectomy and subsequent breast reconstruction surgery at El Demerdash University Hospital and Alexandria Main University Hospital between January 2017 and March 2021. A BREAST-Q 2-0 Reconstruction module questionnaire was given to each patient. Result 117 patients were divided into two groups: autologous breast reconstruction ABR (n = 77) and implant-based breast reconstruction IBR (n = 40). The ABR group was operated on using Transverse Rectus Abdominis Myocutaneous (TRAM) or latissimus Doris (LD) flaps. The average age of the participants in the study was 44.51 ± 6.88. Patients with silicone implants were younger on average than those with LD or TRAM flaps. The patient's quality of life in the two areas evaluated (psychosocial and physical well-being) was excellent in implant repair but poor in TRAM flap, according to our findings. In TRAM flap, we also discovered that overall satisfaction with the breast was low. Conculsion TRAM flap produces a low quality of life and overall satisfaction with the breast, whereas implant reconstruction provides a high quality of life.

D12. Impact of Breast Reconstruction Modality on Breast Cancer Recurrence Detection

PURPOSE: Post-mastectomy reconstruction is not expected to have different oncologic outcomes than mastectomy alone. However, given the disparate masking of the posterior mastectomy margin by various reconstructive modalities, we evaluate the long-term impact of reconstructive choices on oncologic outcomes, including local recurrence rate, time to detection, and size of recurrence, in a single-institution cohort of breast reconstruction patients. METHODS: A retrospective cohort analysis of patients (n=917) with primary breast cancer who underwent either implant-based (n=502) or autologous (n=415) breast reconstruction was conducted. Kaplan-Meier curve estimated cumulative incidence of local breast cancer recurrence over specific time intervals (<13, 13-18, >18 years). A Cox proportion hazard model stratified by time enabled time to recurrence analysis comparing groups. RESULTS: While unsurprising, 52 patients recurred locally (10.3%) with implant-based reconstruction compared to 66 (15.8%) with autologous reconstruction (p=0.02). Average time to detection was 63.5±47.0 months after implant versus 86.5±61.5 after autologous reconstruction (p=0.02). At the time of recurrence, tumor was larger (p=0.01) and of higher stage (p=0.02) in the autologous cohort. Recurrence free survival was initially similar between groups for the first 13 years. Interestingly, it became significantly higher during years 13-18 for the autologous compared to the implant group (82.7% versus 72.8%, p=0.03), but after 18 years, trended lower than implant reconstruction. CONCLUSION: Our findings highlight an interesting but often neglected consideration when selecting breast reconstructive modality. Implant reconstruction may allow for earlier cancer recurrence detection. While there are significant premiums in autologous reconstruction, those patients may warrant increased long-term recurrence surveillance.

Risk of Squamous Cell Carcinoma of the Breast Following Postmastectomy Implant Reconstruction in Women With Breast Cancer and Carcinoma in Situ

This cohort study uses national surveillance data to describe the incidence and risk of squamous cell carcinoma after postmastectomy implant reconstruction in women with breast cancer.

P107 Evaluation of Patient Satisfaction with Breast Q after Post-mastectomy Hypofractionated Radiotherapy with Immediate Implant Reconstruction

P107 Evaluation of Patient Satisfaction with Breast Q after Post-mastectomy Hypofractionated Radiotherapy with Immediate Implant Reconstruction

Digital Workflow for Fully Guided Full-Arch Implant Reconstruction

Digital Workflow for Fully Guided Full-Arch Implant Reconstruction

Abstract P2-15-07: Current status of latissimus dorsi flaps with or without implants for breast reconstruction in patients with breast tumor: A single-center retrospective study

Abstract Background: Asian women have relatively small breast sizes compared to European American women, so the latissimus dorsi flap (LDF) is the most commonly used autologous flap for breast reconstruction in Chinese patients with breast tumor. To explore the current status of LDF with or without implants (IMP) breast reconstruction in China, we conducted this study. Methods: This study was a single-center retrospective study that included breast tumor patients who underwent LDF breast reconstruction in Fudan University Shanghai Cancer Center (FUSCC) from 2000 to 2019. The basic clinicopathological information, the timing and type of reconstruction, postoperative hospitalization time and serious complications requiring surgical intervention were analyzed. Continuous variables were expressed as mean values or median values, while categorical variables were expressed as frequencies. Data were analyzed by using Chi-square and Kruskal-Wallis tests. All P values reported were two-sided and were calculated at a significance level of 0.05. Results: A total of 2868 patients who underwent breast reconstruction for breast tumor were analyzed in this study, 785 (27.4%) patients used LDF for breast reconstruction, and 397 (13.8%) patients underwent autologous breast reconstruction utilizing abdominal flap. The number of breast reconstruction patients and the diversity of reconstruction procedures were increasing year by year. Breast reconstructions utilizing LDF have decreased as a percentage of breast reconstructions, but have increased in number in the past few years. Among patients with LDF breast reconstruction, the majority (97.3%) underwent immediate reconstruction, 11 patients underwent delay reconstruction, and 10 patients underwent immediate-delay reconstruction. 448 patients underwent expanded LDF breast reconstruction, and 337 (42.9%) patients underwent LDF combined with IMP breast reconstruction. 13 patients underwent restoration of reconstructed breast with LDF, 12 of which were changed to LDF±IMP reconstruction due to unsatisfactory outcome of expander reconstruction or failed implant reconstruction, and one patient was changed to LDF reconstruction from failed abdominal flap reconstruction. In terms of pathological type, 629 (80.1%) patients had invasive carcinoma, 129 (16.4%) had carcinoma in situ, 18 (2.3%) patients had phyllodes tumor and 9 (1.1%) patients had other malignancies. The median reconstruction age of the patients was 37 years old, the mean BMI was 21.76kg/cm2, and the mean postoperative length of stay was 11.13 days. There were no significant differences in postoperative hospitalization time, reconstruction age, BMI, pT, ER, PR, HER2, Ki67, and radiotherapy between patients with expanded LDF and LDF combined with IMP breast reconstruction. Patients with neoadjuvant therapy (P=0.045), phyllodes tumors or other malignant tumors (P=0.023), and those with more metastatic lymph nodes (P=0.031) were tent to expanded latissimus dorsi flap reconstruction. Serious complications requiring surgical intervention occurred in 13 patients (1.65%), including 7 patients who underwent surgical debridement or scar repair due to wound infection and poor healing, and 3 patients who removed the implant due to implant infection. The reconstructed latissimus dorsi flaps necrosis occurred in 3 patients, and the reconstructed breasts were removed in these patients. There was no significant difference in the incidence of serious complications requiring surgical intervention between patients with expanded LDF and those with LDF combined with implant reconstruction, P=0.79. Conclusions: LDF±IMP breast reconstruction is a mature breast reconstruction procedure in our center with high safety. Whether combined with implant reconstruction did not affect the postoperative hospitalization time and the incidence of serious complications. Citation Format: Shuyue Zheng, Jiajian Chen, Shuang Hao, Benlong Yang, Xiaoyan Huang, Guangyu Liu, Jiong Wu. Current status of latissimus dorsi flaps with or without implants for breast reconstruction in patients with breast tumor: A single-center retrospective study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-15-07.

From Sub-Pectoral to Pre-Pectoral Implant Reconstruction: A Decisional Algorithm to Optimise Outcomes of Breast Replacement Surgery

Innovations and advancements with implant-based breast reconstruction, such as the use of ADMs, fat grafting, NSMs, and better implants, have enabled surgeons to now place breast implants in the pre-pectoral space rather than under the pectoralis major muscle. Breast implant replacement surgery in post-mastectomy patients, with pocket conversion from retro-pectoral to pre-pectoral, is becoming increasingly common, in order to solve the drawbacks of retro-pectoral implant positioning (animation deformity, chronic pain, and poor implant positioning). A multicentric retrospective study was conducted, considering all patients previously submitted to implant-based post-mastectomy breast reconstruction who underwent a breast implant replacement with pocket conversion procedure at the University Hospital of Udine-Plastic and Reconstructive Surgery Department-and "Centro di Riferimento Oncologico" (C.R.O.) of Aviano, from January 2020 to September 2021. Patients were candidates for a breast implant replacement with pocket conversion procedure if they met the following inclusion criteria: they underwent a previous implant-based post-mastectomy breast reconstruction and developed animation deformity, chronic pain, severe capsular contracture, or implant malposition. Patient data included age, body mass index (BMI), comorbidities, smoking status, pre- or post-mastectomy radiotherapy (RT), tumour classification, type of mastectomy, previous or ancillary procedures (lipofilling), type and volume of implant used, type of ADM, and post-operative complications (breast infection, implant exposure and malposition, haematoma, or seroma). A total of 31 breasts (30 patients) were included in this analysis. Just three months after surgery, we recorded 100% resolution of the problems for which pocket conversion was indicated, which was confirmed at 6, 9, and 12 months post-operative. We also developed an algorithm describing the correct steps for successful breast-implant pocket conversion. Our results, although only early experience, are very encouraging. We realized that, besides gentle surgical handling, one of the most important factors in proper pocket conversion selection is an accurate pre-operative and intra-operative clinical evaluation of the tissue thickness in all breast quadrants.

ASO Visual Abstract: Impact of Same-Day Discharge and Enhanced Recovery on Patient Quality of Life After Mastectomy with Implant Reconstruction.

ASO Visual Abstract: Impact of Same-Day Discharge and Enhanced Recovery on Patient Quality of Life After Mastectomy with Implant Reconstruction.

The Impact of Same-Day Discharge and Enhanced Recovery on Patient Quality of Life After Mastectomy with Implant Reconstruction.

This study aimed to evaluate how enhanced recovery (ER) protocols and same-day discharge (SDD) influences patients' postoperative quality of life (QOL). Patients who underwent mastectomy with implant-based breast reconstruction from 2008 to 2020 were identified in a prospective database. The study assessed QOL with BREAST-Q and Was It Worth It? (WIWI) questionnaires. Responses were compared between the ER and pre-ER groups and between the SDD and hospital stay (HS) groups using one-way analysis of variance (ANOVA) and chi-square tests. The inclusion criteria were met by 568 patients, with a 43% response rate, and 217 patients were included for analysis. Chest physical well-being was lower for the ER cohort, but postoperative breast satisfaction was higher. Psychosocial status, sexual well-being, and satisfaction with information given did not differ significantly between the ER group and the pre-ER or SDD group. In the compared groups, QOL did not differ significantly. Enhanced recovery with SDD after mastectomy using implant-based reconstruction did not have an adverse impact on patient postoperative QOL.

Evaluating the Impact of Breast and Nipple Sensation on Quality-of-Life after Nipple-sparing Mastectomy with Implant Reconstruction: Long-term Outcomes Utilizing Breast-Q

Evaluating the Impact of Breast and Nipple Sensation on Quality-of-Life after Nipple-sparing Mastectomy with Implant Reconstruction: Long-term Outcomes Utilizing Breast-Q

Risk of Anaplastic Large Cell Lymphoma Following Postmastectomy Implant Reconstruction in Women With Breast Cancer and Ductal Carcinoma in Situ

This cohort study examines the risk of anaplastic large cell lymphoma (ALCL) following postmastectomy implant reconstruction among US women with breast cancer and ductal carcinoma in situ (DCIS).

"Hook Shape" Nipple-Sparing Mastectomy and Prepectoral Implant Reconstruction: Technique, Results and Outcomes from a Preliminary Case Series.

Nipple-sparing mastectomy (NSM) is a surgical procedure increasingly performed for breast cancer or risk reduction surgeries. The site of skin incision seems to affect not only cosmesis but also technical ease in operating and vascular viability of the nipple. We present a series of patients who underwent a modified vertical surgical approach for NSM, which resulted to be safe, reliable, and with good esthetic results. From December 2016 to February 2019, 27 "Hook Shape" incision NSMs were performed. All patients underwent an immediate subcutaneous muscle-sparing reconstruction with tissue expander covered by a titanium-coated polypropylene mesh, followed by a second surgical step with expander substitution and lipofilling on the definitive implant when indicated. Preoperative and postoperative BREAST-Q patient-reported outcomes measure was performed in all cases. Postoperative morbidity was evaluated: One patient developed seroma and another presented a systemic infection that resolved with intravenous infusion of antibiotics. One patient experienced vertical wound dehiscence, recovered after conservative treatment and without implant exposure. No implant loss was observed. Nipple-areola complex necrosis or ischemia rate was 0%. The BREAST-Q outcomes reported significant increases in the overall satisfaction with breast (p < 0.05), psychosocial well-being (p < 0.05), and sexual well-being (p < 0.05) sections. Scores in the physical impact of surgery section appeared to decline from preoperative to postoperative evaluations, with no statistically significant results. The mastectomy incision pattern can burden the surgical challenge, impact vascular viability of the nipple and significantly affect the aesthetic outcomes in breast reconstruction. We report our experience with an alternative approach for NSM, which appears a safe, practical, and reproducible method for patients with small- to medium-sized breasts and little/medium ptosis (grade I or II). This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.