Single-stage Breast Reconstruction Research Articles

Buried Autologous Breast Reconstruction: Outcomes and Technical Considerations.

The purpose of this study is to compare outcomes in patients undergoing buried and non-buried free flaps for breast reconstruction, in addition to evaluating the safety and reliability of venous flow couplers. A retrospective review was performed of all patients undergoing free flap breast reconstruction between 2013 and 2023. The primary outcomes were free flap failure, complications and the number of procedures required to complete the reconstructive journey. A total of 322 flaps were performed in 254 consecutive patients, with 47.5% (n = 153) being buried and 52.0% (n = 169) being non-buried reconstructions. The most common flap of choice being deep inferior epigastric artery perforator flaps (81.9%) followed by profunda artery perforator flaps (14.3%). There was no significant difference between the two groups in complications, including flap failure (buried 2.0% vs. non-buried 1.8% p = 0.902). There was a significant reduction in the number of procedures required to complete the reconstructive journey, with 52.2% (n = 59) of patients undergoing single-stage breast reconstruction in the buried group compared with only 25.5% (n = 36) in the non-buried group (p < 0.001). Two (0.6%) patients experienced a false negative in which the signal of the flow coupler was lost but the flap was perfused during re-exploration. No flap losses occurred without being identified in advance by a loss of audible venous flow signal. Buried free flap breast reconstruction is safe and requires fewer operations to complete patients' reconstructive journey. Flow couplers are a safe and effective method of monitoring buried free flaps in breast reconstruction.

P231 Prepectoral versus subpectoral single stage breast reconstruction after conservative mastectomy for breast cancer: surgical and oncological outcomes

P231 Prepectoral versus subpectoral single stage breast reconstruction after conservative mastectomy for breast cancer: surgical and oncological outcomes

Complications Including Capsular Contracture in Direct-to-Implant Breast Reconstruction With Textured Anatomical Versus Smooth Round Implants: A Single Center Retrospective Analysis.

Implant-based breast reconstruction is the most common reconstruction method used after mastectomy in breast cancer patients. Many studies have compared the smooth round implants and textured anatomical implants. This study aimed to compare the complications, including capsular contracture, between these two implants used in direct-to-implant (DTI) breast reconstruction. This retrospective chart review was performed using a prospectively maintained database from a single center. We identified patients who underwent mastectomy with DTI single-stage breast reconstruction at our hospital between August 2011 and June 2021. The overall complications, including capsular contracture, postoperative infection, seroma, hematoma, implant rupture, implant exposure, rippling, implant malposition, and nipple necrosis, were analyzed. In total, 340 breasts of 323 patients were reconstructed by the DTI approach using either textured anatomical (n = 203) or smooth round (n = 137) implants. The incidence of overall complications and capsular contracture was significantly lower with smooth round implants than with textured anatomical implants. Multivariate analysis showed that smooth round implants were associated with a reduced risk of overall complications (odds ratio [OR], 0.465; 95% confidence interval [CI], 0.265-0.813) and capsular contracture (OR, 0.475; 95% CI, 0.235-0.962). Particularly, smooth round implants were associated with a decreased risk of overall complications in patients not receiving adjuvant chemotherapy and a decreased risk of capsular contracture in patients with body mass index < 25 kg/m² and in those not receiving adjuvant radiotherapy. Smooth round implants demonstrated a decreased risk of overall complications and capsular contracture when compared with textured anatomical implants. These results may be utilized in counseling patients regarding the advantages and disadvantages of smooth round implants in DTI breast reconstruction.

Immediate Breast Reconstruction Using the Autologous Dermal Flap

IntroductionDespite the development of breast-conserving surgery in breast cancer treatment, there still remain indications for total mastectomy. Since mastectomy has a significant negative impact on the patients’ quality of life, breast reconstruction is increasingly popular. However, for patients with large ptotic breasts who do not choose tissue-based reconstruction techniques and prefer implant-based breast reconstruction, there is no single-stage breast reconstruction technique other than the classic technique using Acellular Dermal Matrix (ADM). MethodsThis study presents a novel technique for Nipple-Sparing Mastectomy (NSM) and Immediate Breast reconstruction (IBR) in 11 operations (in seven patients) whose treatment decision-making was based on NCCN guidelines. In this technique, the implant/tissue expander is covered by the pectoral muscle in the upper part and an autologous dermal flap in the lower part, replacing an ADM. The dermal flap is created from the de-epithelialized lower mastectomy flap in these large ptotic breasts. Maintaining the nipple-areola complex (NAC) is possible by re-implanting a free nipple split-thickness graft from the NAC of the ipsilateral breast prepared at the beginning of the operation. ResultsAll seven patients had large ptotic breasts ranging from C cup to double D in size and grade 2 and higher breast ptosis. The mean BMI of the patients was 28 (range: 26-33). No major complications occurred postoperatively. There were three minor complications, all managed conservatively. Surgical indications were risk reduction surgery in three patients with BRCA mutations and therapeutic in the remaining patients (three multifocal invasive ductal carcinomas and one diffused ductal carcinoma in situ). None of the patients had a previous reduction mammoplasty as preparation for NSM, and all the patients underwent a single operation. No breast tissue remained under the NAC, which is ideal with the NSM technique. ConclusionsThe proposed technique is excellent for implant-based IBR in patients with large ptotic breasts. It eliminates the use of ADM mesh and reduces the cost and postoperative complication rate associated with ADM. Furthermore, using a free nipple graft technique can eliminate the need for a preparatory mastopexy. This technique can also theoretically reduce the risk of recurrence or new primary breast cancer as there are no remaining ducts beneath the nipple-areola complex.

Direct-to-Implant Breast Reconstruction After Unilateral and Bilateral Mastectomy: Cross-Sectional Study of Patient Satisfaction and Quality of Life with BREAST-Q.

Immediate single stage breast reconstruction is a challenging procedure with the goal of improving the quality of life of patients with breast cancer. The aim of this study is to evaluate using the BREAST-Q patient satisfaction, body perception and quality of life after direct-to-implant breast reconstruction comparing unilateral and bilateral reconstructions. In this study we enrolled 56 women who underwent mastectomy and immediate single-stage direct-to-implant (DTI) breast reconstruction at Campus Bio-Medico University of Rome between 2013 and 2020. One year after surgery they were administered electronically the BREAST-Q post-operative module. Our two cohorts of patients consisted in 34 women who received unilateral nipple-sparing mastectomy and DTI breast reconstruction and 22 women who underwent bilateral nipple-sparing mastectomy and DTI breast reconstruction. Twenty-four of the 34 patients belonging to the unilateral group responded to the questionnaire (70.5%), while in the bilateral group responders were 16 out of 22 (72.7%). The BREAST-Q scores were compared between the two groups: patients undergoing bilateral mastectomy and breast reconstruction showed higher scores in every BREAST-Q domain compared to patients undergoing unilateral mastectomy and breast reconstruction with a statistically significant difference in the Satisfaction with breast (P = 0.01), Sexual well-being (P = 0.03), and Satisfaction with implants (P = 0.01) domains. Patients undergoing bilateral DTI breast reconstruction have a favorable postoperative surgical cosmetic outcome with a better patient's body image perception and a higher post-operative level of satisfaction compared to unilateral DTI reconstruction after nipple-sparing mastectomy. 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.

A systematic review and meta-analysis on the prepectoral single-stage breast reconstruction.

The use of acellular dermal matrices (ADMs) and mesh reopened the possibility for the prepectoral single-stage breast reconstruction (PBR). The complications of single-stage breast reconstruction after PRB are controversial. We conducted a systematic review and meta-analysis of the impact of implant plane on single-stage breast reconstruction. Our aim was to evaluate the different postoperative complications between patients receiving prepectoral breast reconstruction and subpectoral breast reconstruction (SBR) on single-stage breast reconstruction. A comprehensive research on databases including PubMed, Embase, and Cochrane libraries was performed to retrieve literature evaluating the effect of implant plane on single-stage breast reconstruction from 2010 to 2020. All included studies were evaluated the complications after single-stage breast reconstruction. Only studies comparing patients who underwent prepectoral reconstruction with a control group who underwent subpectoral reconstruction were included. A total of 13 studies were included in the meta-analysis, with a total of 1724 patients. In general, compared with SBR group, the PBR significantly reduced the risk of total complications (including seroma, hematoma, necrosis, wound dehiscence, infection, capsular contraction, implant loss/remove, and rippling) after single-stage breast reconstruction (OR: 0.54, 95% CI: 0.44-0.67, p < 0.001). Compared with the SBR group, the PBR had remarkably decreased capsular contracture (OR: 0.40, 95% CI: 0.27-0.58, p < 0.001) and postoperative infection (OR: 0.58, 95% CI: 0.36-0.95, p = 0.03). The PBR is a safe single-stage breast reconstruction with fewer postoperative complications. It is an alternative surgical method for SBR.

Single stage breast reconstruction - a district hospital experience in 2020

Background: Acellular dermal matrices are grafts created by decellularisation of tissue and leaving only the extracellular matrix and collagen scaffold. Reported advantages include better control and definition of implant pocket and inframamary fold, control of lower pole projection, less rippling, reduced capsule formation and decreased possibility of implant migration. Reported complications include seroma formation , infection, skin necrosis and higher cost.

Association between aesthetic satisfaction and chronic postsurgical pain in breast cancer patients treated with one stage prosthesis implantation

This study retrospectively studied the incidence of chronic post-surgical pain (CPSP) following single-stage implant-based breast reconstruction (IBBR) and evaluated the possible risk factors. This was a retrospective cohort study, involving all patients undergoing single-stage IBBR between January and December 2019. The follow-up was completed between January and March 2021. The scores for satisfaction (SS) were based on the BREAST-Q, while the pain burden index (PBI) was used to assess the degree of CPSP. The questionnaires were completed by 159 patients. CPSP occurred in 48.43% of the patients, 2.52% of them being severe cases. Significant predictors for the development of CPSP in the univariate analysis included severe acute postoperative pain (PP), a history of preoperative chronic pain, psychological disorders, SS with the reconstructed breasts, and whether there were any regrets about having had the reconstruction. Multivariate analysis identified severe acute PP (odds ratio (OR) = 2.80, 95% confidence interval (CI) = 1.16–6.79, p = 0.023), a history of preoperative chronic pain (OR = 3.39, 95% CI = 1.42–8.10, p = 0.006), and the SS (OR = 0.86, 95% CI = 0.75–0.99, p = 0.034) as being independently associated with the development of CPSP. In subgroup analysis, the PBI of the patients in the SS < 12 group (p < 0.001), the bilateral group (p < 0.01), and the severe acute PP group (p < 0.005) was significantly higher than the PBI of those in the control groups. This study demonstrated a significant incidence of CPSP following single-stage IBBR, and the patients with lower SS of their reconstructed breasts developed more CPSP. Lower SS, bilateral procedures, and severe acute PP were predictors of higher PBI.Trial registration: Registered in Chictr.org.cn registry system on 24 February 2020 (ChiCTR2000030139).

Blossom smart expander technology for tissue expander-based breast reconstruction facilitates shorter duration to full expansion: A pilot study.

BackgroundThis study evaluated the Blossom system, an innovative self-filling, rate-controlled, pressure-responsive saline tissue expander (TE) system. We investigated the feasibility of utilizing this technology to facilitate implant-based and combined flap with implant-based breast reconstruction in comparison to conventional tissue expansion.MethodsIn this prospective, single-center, single-surgeon pilot study, participants underwent either implant-based breast reconstruction or a combination of autologous flap and implantbased breast reconstruction. Outcome measures included time to full expansion, complications, total expansion volume, and pain scores.ResultsFourteen patients (TEs; n=22), were included in this study. The mean time to full expansion was 13.4 days (standard error of the mean [SEM], 1.3 days) in the combination group and 11.7 days (SEM, 1.4 days) in the implant group (P=0.78). The overall major complication rate was 4.5% (n=1). No statistically significant differences were found in the complication rate between the combination group and the implant group. The maximum patient-reported pain scores during the expansion process were low, but were significantly higher in the combination group (mean, 2.00±0.09) than in the implant group (mean, 0.29±0.25; P=0.005).ConclusionsThe reported average duration for conventional subcutaneous TE expansion is 79.4 days, but this pilot study using the Blossom system achieved an average expansion duration of less than 14 days in both groups. The Blossom system may accommodate single-stage breast reconstruction. The overall complication rate of this study was 4.5%, which is promising compared to the reported complication rates of two-stage breast reconstruction with TEs (20%–45%).

Breast reconstruction using a laparoscopically harvested pedicled omental flap after endoscopic mastectomy for patients with breast cancer: an observational study of a minimally invasive method.

Breast reconstruction is typically performed using autologous tissue from a laparoscopically harvested omental flap. Because open surgery and another abdominal wall incision for a subcutaneous tunnel cannot be avoided, minimal scars typically cannot be achieved. This study explored a minimally invasive method of pedicled omental flap breast reconstruction in which omentum harvesting, mastectomy, and subcutaneous tunnel establishing were performed laparoscopically and endoscopically, and large incisions on the thoracic and abdominal wall were unnecessary. Ten patients with breast cancer were enrolled. They underwent endoscopic subcutaneous mastectomy (ESM) and single-stage breast reconstruction using a laparoscopically harvested pedicled omental flap (LHPOF), which was pulled through a subcutaneous tunnel that was created under laparoscopic vision. The incisions made on the abdominal wall were no wider than 12 mm, and the thoracic wall incisions were no wider than 30 mm. Three of the patients had a prosthetic implant placed for reconstruction at the same time because of the large breast volume, and the omental flaps were used to cover the prostheses. All patients underwent successful single-stage breast reconstruction surgery, and laparotomy was not required. Eight of the patients (80%) had satisfactory aesthetic results (five had excellent results and three had good results). The incisions at the thoracic wall and in the donor site area were short and hidden. The mean operation time was 367.6 min and the mean time for harvesting the omental flap was 62.9 min, similar to previous studies. The total mean blood loss was 37.0 mL. No serious donor-site complications occurred. LHPOF breast reconstruction combined with ESM is minimally invasive, and satisfactory aesthetic results are achievable. In patients who undergo ESM combined with prosthetic implant reconstruction, the pedicled omental flap can be used to cover the prosthesis instead of using acellular dermal matrix.

The decline of textured implants in single-stage breast reconstruction in Alberta.

The decline of textured implants in single-stage breast reconstruction in Alberta.

Single-Stage Immediate Breast Reconstruction Using Anatomical Silicone-Based Implant and The Hammock Technique of Dermal-Muscle Flap in Large and Ptotic breasts: A Multicenter Study.

This study revisits the previously described technique of inverted-T skin-reducing mastectomy and dermal-muscle pocket as a single-stage breast reconstruction using anatomical implants in large and ptotic breasts. Refinements have been added to enhance the quality of implant coverage, improve aesthetic outcome, and augment the implant volume than previously described in the literature. The study was performed in three centers in the UK, Egypt, and Libya. It included patients with large ptotic breasts with a breast cup size of D or larger. The areola-to-inframammary fold distance is of 8cm or more, and a nipple-sternal notch distance is 25cm or more. Modification of the dermal-muscle flap was made through dividing the medial and lateral ends of the de-epithelialized flap at a distance of one inch to create wings that could be sutured to the free edge of pectoralis major muscle to act as a hammock. It included 42 patients, and the mean age of the patients was 44.4years (range 28-62). The mean body mass index was 34.2 (range 24-42). The reconstruction was unilateral in 32 (76.2%) patients and bilateral in ten (23.8%) patients. The average implant volume was 498.5 CC (range 375-650). Seventeen (40.5%) patients had a symmetrizing breast reduction. The average follow-up time was 52weeks. Major complications were noticed in four (7.7%) breasts: Three breasts had major skin necrosis and one breast had hematoma that necessitated surgical evacuation. There were no reported cases of implant extrusion. Minor complications were recorded in six (11.5%) breasts; two had wound infection, and three had minor skin necrosis. The hammock technique of dermal-muscle flap is safe and versatile in large and ptotic breasts. It also creates a natural-looking breast with bigger implants.

MEDICAL AND STATISTICAL CHARACTERISTICS OF BREAST CANCER IN ST. PETERSBURG FEMALE RESIDENTS

Purpose.To analyze the main medical and statistical parameters, allowing to evaluate the results of breast cancer treatment.Patients and methods.Data on 4689 breast cancer (BC) patients were analyzed retrospectively. Inclusion criteria were: female, residence in St. Petersburg, diagnosis of BC established in 2011, 2012. The study also includes information on the options of BC surgical treatment, one-year mortality in breast cancer patients and index of the contingent accumulation in St. Petersburg in 2011–2017. For statistical data processing Statistica 12.0 for Windows, Population Cancer Register and MedInfo-4 were used. The differences in the groups of studies were considered statistically significant at p &lt; 0.05.Results.The prevalence of breast cancer among women in St. Petersburg varies from 532.6 per 100 000 population in 2011 to 545.00/0000 in 2012. In 2011 the incidence of BC in women in St. Petersburg was 46.210/0000 (standard deviation 1.05) and in 2012 – 49.50/0000 (standard deviation 1.05). The mean age of breast cancer patients is 64 years (standard deviation 12.25). Localization of a tumor in one of the glands was found in 4617 (98.5%) clinical observations. In 2,846 (60.7%) cases, the tumor sizes varied from 2 to 5 cm. Signs of infiltrative ductal carcinoma were histologically verified in 3689 (80%) cases. The proportion of single-stage breast reconstruction after mastectomy in the overall structure of surgeries in breast cancer patients increased in 2011–2017 more than 6.5 times. The 5-year survival rate in study groups was 64.4% and 63.3%.ConclusionsThe main statistical parameters of medical care (MC) analysis in breast cancer patients in St. Petersburg in 2011–2017 allow to state generally positive trends in the anticancer fight organization. The increase of the breast cancer incidence rates is partly due to the improved quality of examination and treatment of patients through the creation in the city of a system of high-tech MC, as well as to the particularly wary of doctors in detecting breast tumors.

Reoperation and Postoperative Outcomes for Single-Stage versus Two-Stage Breast Reconstruction Following Mastectomy: A Meta-Analysis

Introduction Implant based breast reconstructions has become widely accepted as an appropriate reconstruction method following mastectomy for breast cancer. The two most common techniques include immediate reconstruction and implantation (single-stage procedure) or the use of a tissue expander with delayed insertion of implant and reconstruction (two-stage procedure). Using existing studies and available data, a meta-analysis was performed analyzing reoperation rates and postoperative complications between these two methods based upon available literature. Methods A literature search was performed by two individual investigators using the databases PubMed, Cochrane, and Medline. All articles comparing implant based single and two stage breast reconstructions outcomes between 2006 and 2016 were utilized. The primary endpoint of interest was reoperation rates. Secondary endpoints included postoperative complications such as infection, seroma, hematoma, and necrosis. Results A total of five studies met the inclusion criteria, for a total of 12,357 breast reconstructions. 2,281 breast reconstructions were singlestage and 10,076 were two-staged. The primary endpoint of reoperation was increased reoperation rate in the single-stage breast reconstruction (OR=0.78, CI 0.67-0.91; p&lt;0.05). Secondary endpoints demonstrated no statistical significance in infections (OR 1.06, CI 0.84-1.34; p=0.40), hematoma (OR=1.66, CI 0.91-3.05; p=0.09) and necrosis (OR=1.13, CI 0.76-1.68; p=0.29). However, there was an increased incidence of seroma formation in two-stage reconstruction (OR=1.86, CI 1.05-3.28; p&lt;0.005). Conclusions Single and two-staged implant breast reconstructions had similar infection, hematoma, and necrosis rates. Single-stage reconstructions resulted in a significant increase in reoperation/revision rates.

Is single-stage implant-based breast reconstruction\xa0(SSBR) with an acellular matrix safe?

BackgroundAcellular matrices (AM) might enable a direct single-stage breast reconstruction procedure resulting in an improved efficacy of the reconstruction phase for patients. Safety concerns are an important issue due to a recent study which shows that single-stage breast reconstruction with Strattice™ resulted in more complications versus a two-stage reconstruction. Therefore, the goal of this study is to compare the short- and long-term complications of a single-stage breast reconstruction with the use of two types of AM (Strattice™ and Meso Biomatrix®) versus two-stage breast reconstruction without the use of an AM.MethodsCohort study with single-stage breast reconstruction with Strattice™ (n = 28) or Meso BioMatrix® (n = 20) or two-stage breast reconstruction without an AM (n = 36) at the Maastricht Academic Hospital, the Netherlands. All complications, in particular major complications with the need for re-admission to the hospital, re-exploration, and implant explantation, were the primary outcome measures. A 1-year follow-up was achieved for all patients.ResultsBaseline characteristics of all 52 patients were similar between groups. There was a significantly higher complication rate in the single-stage AM groups with loss of the implant in 40.0% of the breasts from the Meso BioMatrix® group and in 10.7% of the Strattice™ group compared to no implant loss in the control group.ConclusionsThis cohort study clearly suggests that the use of a single-stage breast reconstruction is not safe with the use of these AMs. Well-designed prospective studies that guarantee the safety of those matrices should be published before these AMs are used in implant-based surgery.Level of Evidence: Level III, risk / prognostic study.

RADICAL BREAST RESECTION WITH SKIN-MUSCULAR LATISSIMUS DORSI FLAP GRAFTING

The oncological breast surgeries with single-stage replacement of the lost volume by means of autogeneous tissue using distant flaps grafting (particularly by skin — muscular flaps of the latissimus dorsi ) allow obtaining satisfactory and stable aesthetic results without the decrease of indices of relapse-free and general survival. The early results of the application of the skin-muscular flaps of the latissimus dorsi for single-stage breast reconstruction after radical breast resection are presented in this work in 3 patients with breast cancer. The technique allows performance of the extensive radical resection with single-stage grafting in patients with breast cancer and obtaining an objective clinical response against the background of neoadjuvant therapy with subsequent applying radiation therapy and systemic treatment.

Individual difference in pectoralis major muscle thickness and its effect on single-stage breast reconstruction using a tissue expander.

In breast reconstruction using a tissue expander (TE), sufficient coverage of the TE with the pectoralis major (PM) muscle, particularly with a musculofascial flap, is highly important for avoiding postoperative complications. In patients in whom the PM is thin, intraoperative trauma often occurs, leading to troublesome repair. The present study aimed to investigate the usefulness of preoperative measurement of PM thickness in planning of breast reconstruction using a TE. In this case-control study, we identified 68 patients (70 breasts) with mammary carcinoma treated with simple mastectomy and TE insertion from April 2014 to December 2016. We measured average PM thickness at two specific points, sternocostal PM distance on the long axis and sternocostal PM area preoperatively using magnetic resonance imaging. Then, we analyzed the difference in PM thickness among individuals and its relationship to intraoperative trauma to the PM or surgical difficulty creating a muscular pocket (delicate PM). Average PM thickness was significantly larger in younger patients (p=0.046) and those with larger breasts (p<0.01). In addition, average PM thickness on the affected side was significantly smaller in patients with delicate PM (12 breasts) (p<0.01). PM thickness had a significant influence on delicate or firm PM (odds ratio 27.40; 95% confidence interval 2.01-372.00; p=0.013). These findings demonstrate the usefulness of preoperative measurement of PM thickness in planning of breast reconstruction using a TE. Dissection should be performed more carefully in patients with average PM thickness less than 2.9mm.

One stage placement of permanent implant compared to two stage tissue expander reconstruction

With the advent of the skin sparing mastectomy, immediate breast reconstruction with placement of the definitive prosthesis at the time of mastectomy is possible. The question remains: does single-stage prosthetic reconstruction result in greater numbers of complications or rates of re-operation, compared to two-stage tissue expander reconstruction? A retrospective cohort study of a single centre?s experience with these techniques was carried out. From 2004 to 2012, 54 cases of immediate breast reconstruction with implant were identified, and 108 cases of immediate breast reconstruction using a tissue expander were identified. Gathered preoperative data included tumour, prior exposure to radiation, preoperative chemotherapy, smoking, and comorbidities. Complication rates, as well as the rate of secondary operations, were examined. There were no significant increased risks in the rate of post-operative complications (p = .910, odds ratio = 0.9) nor in the rate of re-operation (p = 0.421, odds ratio = 1.4) associated with the insertion of a definitive prosthesis at the time of skin sparing mastectomy. However, previously radiated breasts experienced a 100% rate of wound complications in our subset of 9 breasts that underwent one stage breast reconstruction with immediate final prosthesis placement. Our study suggests that patients with early stage disease can undergo single stage breast reconstruction without increased risk of complications nor need for secondary operations. While the mean time to completion of the reconstructive process is shortened by 5 months with the single stage technique, implant based breast reconstruction requires careful counseling and patient selection in radiated patients.

Single-stage breast reconstruction using Strattice™: A retrospective study

Strattice™, a porcine acellular dermal matrix, has emerged as a product to augment implant-based breast reconstruction. It aims to resolve problems related to poor tissue coverage of the implant. Presently, evidence justifying the use of Strattice in breast reconstruction is lacking. The objective of this study is to assess the clinical outcomes of a patient cohort that underwent single-stage implant-based breast reconstruction with the additional use of Strattice. We conducted a retrospective chart review of patients who underwent single-stage breast reconstruction with the use of Strattice. All cases of breast reconstruction after oncologic or prophylactic mastectomy between 2010 and 2014 in one of eight different centres in the Netherlands were included. Patient demographics, treatment characteristics and clinical outcome data were collected. The outcomes were presented using descriptive statistics, and the associations were evaluated using Fisher's exact test. Eighty-eight patients who underwent either unilateral (60 patients) or bilateral (25 patients) (n = 110 breasts) single-stage breast reconstruction with the use of Strattice were identified. The indication for mastectomy was therapeutic in 69.1% (76) of cases and prophylactic in 30.9% (34) of cases. The reported minor complications included seroma (20.9%), skin necrosis (20.0%), wound dehiscence (11.8%), erythema/inflammation (14.5%) and infection (11.8%). In 22 breasts (22.7%), reoperation was necessary, with explantation of the implant in 11 breasts (11.8%). In this cohort, the total complication rate was very high (78%). Although most complications were minor, reoperation was performed in 22.7%, with explantation of the implant in 11.8% of breasts. We suggest that patient selection, experience of the surgeon and handling of early complications are factors playing a crucial role in the success of the operation. The use of a Strattice sheet in single-stage implant-based breast reconstruction may be a promising technique, but more evidence from prospective, randomized studies is necessary to justify its use. IV.

Intérêt de la symétrisation immédiate au cours de la reconstruction mammaire unilatérale différée par DIEP. À propos de 33 cas

After unilateral breast reconstruction, a procedure on the contralateral breast is often needed to achieve symmetry. Here, we present a single surgeon's experience with performing contralateral symmetry procedures simultaneously with DIEP flap. We evaluated 33 consecutive patients (mean age, 52.1 years) who underwent DIEP flap unilateral breast reconstruction and a simultaneous contralateral breast procedure performed and 2 patients with delayed controlateral symmetry procedures. A single-stage breast cancer reconstruction is successful if after the original reconstruction no correction for revision of breast mound, or contralateral breast procedures are performed, under general anesthetic, to complete the reconstruction. In 24 patients (73%), breast reconstruction was completed after a single stage with one general anesthetic, and in 8 patients (24%), revisions were performed with two general anesthetic (7 patients) and three general anesthetic in one case. Reconstructions requiring more than one general anesthetic were due to 4 of 39 (10%) postoperative complications. Mean operating time was 485 minutes. For patients who need contralateral reduction mammoplasty or mastopexy for symmetry, performing these procedures and breast reconstruction simultaneously facilitates single-stage breast reconstruction in most patients.