Aesthetic and oncologic outcomes after one-stage immediate breast reconstruction using a permanent biodimensional expandable implant

Agusti, Ana; Ward, Ann; Montgomery, Catherine; Mohammed, Kabir; Gui, Gerald

doi:10.1016/j.bjps.2015.09.017

Cited by 14 publications

(17 citation statements)

References 21 publications

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“…Agusti, et al [24] conducted a study using tissue expanders and found that more than 75% of the parameters of symmetry between both breasts were rated as good or excellent. The results were rated as excellent in 82% of the women, while 88% of the women would choose the same reconstructive procedure.…”

Section: Discussionmentioning

confidence: 99%

Postmastectomy Mammary Reconstruction with the Use of Tissue Expanders Plus Endoprotesis

García¹

2019

IJTPS

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Introduction: The reconstruction of the breast after mastectomy is included in the treatment of breast cancer and one of the most used techniques is tissue expansion. Objective: To evaluate the use of tissue expansion in postmastectomy breast reconstruction. Material and methods: A descriptive and retrospective study was carried out in the plastic surgery service of Hermanos Ameijeiras Hospital. We included 25 patients from the consultation of oncological deformities of the breast, from January 2016 to August 2018. Tissue expansion consists of expanding the skin and placing a silicone prosthesis. A temporary prosthesis is introduced with a valve, under the muscular plane in a deferred form. In the postoperative period, it will be filled until it reaches the necessary size that allows to place a definitive implant. Results: 96% of women were over 30 years of age, 68% were white and histologically diagnosed with infiltrating ductal carcinoma 60%. 64% were reconstructed before the 2 years after the radical mastectomy and in the healthy breast; reductive mastoplasty was performed to achieve symmetry. Complications were present in 20% of the patients and the results obtained were good in 82.6% of the patients. Conclusions: The use of tissue expanders with endoprotesis in postmastectomy breast reconstruction is a safe and effective technique with a high degree of satisfaction for the majority of patients.

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Section: Discussionmentioning

confidence: 99%

Postmastectomy Mammary Reconstruction with the Use of Tissue Expanders Plus Endoprotesis

García¹

2019

IJTPS

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“…The estimated mastectomy weight should not exceed 600 g [ 58 ]. Characteristics of the breast soft tissue, skin elasticity of the trunk and overall body habitus are commonly evaluated preoperative parameters [ 10 ].…”

Section: Immediate Breast Reconstructionmentioning

confidence: 99%

“…Well-vascularized mastectomy skin flaps with an at least 1 cm thick subcutaneous layer are unanimously considered to be essential to achieve successful outcomes [ 10 , 72 ]. The intraoperative judgment of the surgeon is recognized as the single most important factor influencing the success of direct-to-implant IBR [ 17 , 34 , 73 , 74 ].…”

Section: Immediate Breast Reconstructionmentioning

confidence: 99%

“…One-stage immediate breast reconstruction (IBR) is a method to reconstruct a definitive breast mound at the time of oncologic resection without the need for tissue expansion or tissue expander/implant exchange. However, the likelihood of requiring secondary procedure (e.g., scar revision, autologous fat grafting, nipple-areola complex (NAC) reconstruction, and matching surgery to the contralateral breast) is not lower after one-stage IBR than after two-stage implant-based IBR [ 10 ]. Given the fewer hospital accesses required, IBR may be convenient for both patients and the healthcare system [ 10 ], and this partially explains the increasing number of IBRs performed [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, the likelihood of requiring secondary procedure (e.g., scar revision, autologous fat grafting, nipple-areola complex (NAC) reconstruction, and matching surgery to the contralateral breast) is not lower after one-stage IBR than after two-stage implant-based IBR [ 10 ]. Given the fewer hospital accesses required, IBR may be convenient for both patients and the healthcare system [ 10 ], and this partially explains the increasing number of IBRs performed [ 11 , 12 ]. The recent introduction of acellular dermal matrices (ADMs) and synthetic meshes has also widened the indications for IBR [ 13 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

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One-Stage Immediate Breast Reconstruction: A Concise Review

Bertozzi

Pesce

Santi

et al. 2017

BioMed Research International

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Background One-stage direct-to-implant immediate breast reconstruction (IBR) is performed simultaneously with breast cancer resection. We explored indications, techniques, and outcomes of IBR to determine its feasibility, safety, and effectiveness. Material and Methods We reviewed the available literature on one-stage direct-to-implant IBR, with or without acellular dermal matrix (ADM), synthetic mesh, or autologous fat grafting. We analyzed the indications, preoperative work-up, surgical technique, postoperative care, outcomes, and complications. Results IBR is indicated for small-to-medium nonptotic breasts and contraindicated in patients who require or have undergone radiotherapy, due to unacceptably high complications rates. Only patients with thick, well-vascularized mastectomy flaps are IBR candidates. Expandable implants should be used for ptotic breasts, while anatomical shaped implants should be used to reconstruct small-to-medium nonptotic breasts. ADMs can be used to cover the implant during IBR and avoid muscle elevation, thereby minimizing postoperative pain. Flap necrosis, reoperation, and implant loss are more common with IBR than conventional two-staged reconstruction, but IBR has advantages such as lack of secondary surgery, faster recovery, and better quality of life. Conclusions IBR has good outcomes and patient-satisfaction rates. With ADM use, a shift from conventional reconstruction to IBR has occurred. Drawbacks of IBR can be overcome by careful patient selection.

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Indocyanine green angiography guidance for vascular preservation in skin and nipple sparing mastectomy

Stead,

Lu,

Geletzke

et al. 2024

Breast Cancer Res Treat

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The skin and/or nipple-sparing approach has become an oncologically sound and desirable choice for women choosing mastectomy. Indocyanine green (ICG) perfusion imaging has been shown to reduce ischemic complications in mastectomy skin aps. Immediate reconstruction requires a well-vascularized skin ap capable of tolerating full expansion.Identi cation of the perforating subcutaneous vessels to the skin envelope may allow for better and more consistent blood vessel preservation and ap perfusion. MethodsThe authors conducted an institutional review board-approved prospective study with 41 patients to assess the feasibility of using ICG perfusion imaging to visualize, cutaneously map, and preserve the vessels that supply the skin ap and nippleareolar complex. For each patient, the number of vessels initially mapped, the number of vessels preserved, the extent to which each vessel was preserved, and the proportion of the ap with adequate perfusion (as de ned by the SPY-Q > 20% threshold) were recorded and analyzed. ResultsVessels were able to be identi ed and marked in a high majority of patients (90%). There was a moderate linear relationship between the number of vessels marked and the number preserved. Successful mapping of vessels was associated with lower rates of wound breakdown (p = 0.036). Mapping and preserving at least one vessel led to excellent ap perfusion (> 90%). No increase in complications was observed from utilizing ICG angiography preoperatively. ConclusionThis prospective study using preoperative ICG perfusion mapping demonstrated safety, feasibility, and good prognostic outcomes.

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Aesthetic and oncologic outcomes after one-stage immediate breast reconstruction using a permanent biodimensional expandable implant

Cited by 14 publications

References 21 publications

Postmastectomy Mammary Reconstruction with the Use of Tissue Expanders Plus Endoprotesis

Postmastectomy Mammary Reconstruction with the Use of Tissue Expanders Plus Endoprotesis

One-Stage Immediate Breast Reconstruction: A Concise Review

Indocyanine green angiography guidance for vascular preservation in skin and nipple sparing mastectomy

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