Background
Implant‐based reconstruction accounts for the majority of breast reconstructive procedures performed in Australia. More recently, immediate prepectoral implant reconstruction using the TiLOOP Bra Pocket has gained popularity. This study compares post‐surgical complications and patient‐reported quality of life outcomes between immediate prepectoral and dual plane implant reconstruction.
Methods
A retrospective study of 80 consecutive patients who underwent nipple‐sparing mastectomies and immediate implant reconstruction was conducted. Implants were either completely covered with TiLOOP Bra and/or TiLOOP Bra Pocket (pfm medical, Cologne, Germany) and secured in the prepectoral space (prepectoral group) or placed in the subpectoral plane with inferolateral mesh coverage (dual plane group). Data surrounding patient demographics, clinical details and post‐surgical outcomes were compared. Patient‐related quality of life outcomes were assessed with the Breast‐Q questionnaire.
Results
A total of 80 patients (109 breasts) operated on between June 2016 and December 2018 were included. The prepectoral and dual plane groups comprised of 40 patients each, including 50 and 59 operated breasts, respectively. Post‐operative complications were comparable with 11 (22%) overall complications in the prepectoral group and eight (14%) in the dual plane group (P = 0.313). Implant loss was uncommon with four (8%) cases in the prepectoral group and five (8.5%) in the dual plane group (P = 0.929). Patient‐reported quality of life outcomes were superior after prepectoral reconstruction with patients reporting a significantly higher score in the satisfaction with breasts domain (68.9 versus 57.5; P = 0.036).
Conclusion
Immediate prepectoral implant reconstruction with the TiLOOP Bra Pocket was associated with improved patient satisfaction and demonstrated no difference in early post‐operative outcomes.
Melanoma metastatic to the liver has a very poor prognosis, and has traditionally been treated using systemic chemotherapy with limited efficacy. Surgery is increasingly being explored as a therapeutic option for melanoma liver metastases, with varying levels of success. A systematic review was undertaken to explore the short-term and long-term outcomes associated with hepatectomy for melanoma metastases, in addition to identifying prognostic factors favouring increased survival. All eligible studies were identified through an electronic search of Medline and Embase (January 1990-March 2013). Each study was independently analysed by two reviewers, with relevant data extracted and tabulated according to predetermined criteria. Thirteen studies were selected that fulfilled the selection criteria, with a total of 551 patients undergoing hepatic resection for melanoma metastases. Metastases to the liver occurred at a median interval of 54 months. The median perioperative morbidity and mortality were 10% (range 0-28.6%) and 0% (range 0-7.1%), respectively. The median overall survival for operative patients was 24 months, with median survival being greater in the R0 resection group (25 months; range 9.5-65.6 months) compared with the R1/2 resection group (16 months; range 11.7-29 months). Overall median 1-, 3- and 5-year survival rates were 70% (range 39-100%), 36% (range 10.2-53%) and 24% (range 3-53%), respectively. Positive prognostic factors may include single hepatic metastases, a longer time to development of hepatic metastases and R0 resection. Hepatic resection for metastatic melanoma might confer a distinct survival benefit in a select group of patients, although disease recurrence is the norm.
Pure cutaneous recurrence after breast-conserving surgery is rare and presents a unique challenge to clinicians. Some carefully selected patients may be amenable to further breast-conserving therapy. We present the case of a 45-year-old female with a cutaneous recurrence of previously treated right breast cancer along the operative scar in the upper outer quadrant. The patient underwent a further wide local excision with lateral intercostal artery perforator flap with a skin paddle reconstruction. We achieved volume replacement with this technique, disease control, and a pleasing cosmetic result.
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