Comparison of one-stage direct-to-implant with acellular dermal matrix and two-stage immediate implant-based breast reconstruction—a cohort study

Brunbjerg, Mette Eline; Jensen, Thomas Bo; Overgaard, Jens; Christiansen, Peer; Damsgaard, Tine Engberg

doi:10.21037/gs-20-581

Cited by 9 publications

(5 citation statements)

References 31 publications

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“…To improve the psychological well-being of the patients, SSM and/or SNSM are increasingly followed by one-stage breast reconstruction. Despite the higher risk of post-operative complications [ 2 , 14 ], patients had major aesthetic satisfaction and psychological well-being [ 4 , 5 , 19 ], also because they did not need a second operative time and a longer recovery. However, the two-stage reconstruction remains the gold standard for selected cases, thanks to its easy of healing [ 2 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Mastectomy with one-stage or two-stage reconstruction in breast cancer: analysis of early outcomes and patient’s satisfaction

et al. 2022

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Aim of this study is to compare early post-operative outcomes and patient’s satisfaction after skin-sparing and/or nipple-sparing mastectomy (SSM/SNSM) followed either by breast reconstruction with one-stage prepectoral implantation or two-stage technique for breast cancer (BC) or BRCA1/2 mutation.From January 2018 to December 2021, 96 patients (mean age of 51.12 ± 10.9) underwent SSM/SNSM and were divided into two groups: in group A (65 patients, 67.7%), mastectomy was followed by one-stage reconstruction; in group B (31 patients, 32.3%) by two-stage. Operative time was significantly longer in A vs. B (307.6 ± 95.7 vs. 254.4 ± 90.91; P < 0.05). Previous breast surgery was more common in B vs. A (29.0% vs. 7.7%; P < 0.05), while bilateral surgery was performed more frequently in A vs. B (40% vs. 6.5%; P = 0.001). All SSM/SNSM for BRCA1/2 mutation were followed by immediate prepectoral implantation. No significant differences were found between groups in terms of post-operative complications. At pathology, DCIS and invasive ST forms, such as multicentric/multifocal forms, were detected more frequently in B, while NST type in A (all P < 0.05). A multivariate analysis showed improved post-operative satisfaction at BREAST-Q survey in Group A (P = 0.001). Encouraging oncologic outcomes after SSM/SNSM for BC enabled the improvement of breast reconstructive techniques. One-stage reconstruction is characterized by better aesthetic outcomes and by greater patient’s satisfaction. When SSM/SNSM is technically difficult to perform, as in multicentric/multifocal forms or previous breast surgery, mastectomy followed by two-stage reconstruction should be considered to achieve a radical surgery.

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Section: Discussionmentioning

confidence: 99%

Mastectomy with one-stage or two-stage reconstruction in breast cancer: analysis of early outcomes and patient’s satisfaction

et al. 2022

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“…As mentioned earlier, the view that a full-volume implant in DTI reconstruction will create pressure on the mastectomy flap and increase the risk of implant failure as a result of ischemia is one of the most important discussion topics related to this technique. In the literature, this rate has been reported as 0.4%-16% for DTI reconstructions (11,21). Azouz et al (8) and Roostaeian et al (22) found that the implant failure rates in DTI and EI reconstruction were similar.…”

Section: Discussionmentioning

confidence: 97%

“…The results obtained in studies comparing both methods are contradictory. While some studies report increased complication rates in DTI reconstruction (5,6), others report that the complication rates are high in EI reconstructions, or there is no statistically significant difference between both methods in terms of complication rates (7)(8)(9)(10)(11). On the account of the conflicting results in the literature, the selection of a method for immediate reconstruction with an implant after mastectomy is a matter of debate.…”

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confidence: 99%

Direct to Implant versus 2-Stage Expander Implant Immediate Breast Reconstruction: Comparison of Incidence and Predictors of Complications

ALTİNKAYA,

YAZAR,

KARA

et al. 2023

Acibadem Univ Saglik Bilim Derg

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Purpose: The most important discussion about the direct-to-implant (DTI) reconstruction is the risk of ischemic problems. Therefore, there is an ongoing debate about the effectiveness and reliability of DTI reconstruction. The current study aimed to compare the outcomes of patients undergoing DTI and expander implant (EI) reconstruction and to determine the factors that may affect the occurrence of complications. Methods: Sixty patients who underwent immediate implant reconstruction over a two-year period were included in the study. Demographic characteristics, operative characteristics and postoperative complications of the patients were retrieved retrospectively from patient records. Results: Reconstruction was performed on 34 and 27 breasts in the DTI and EI groups, respectively. The mean follow-up period of the patients was 13.8 months (range 6–28 months). Although the postoperative complication rates were high in the DTI group, no statistically significant difference was found between the two groups (p = 0.585). No statistically significant difference was found between the two groups in terms of implant failure (p = 0.579). Implant volumes of patients with complications in the DTI group were significantly higher than those without complications (p = 0.049). Conclusion: While DTI was similar to EI reconstruction in terms of implant failure, overall complication rates were higher than those in EI reconstruction. The volume of the implant is a factor that affects the development of complications in DTI reconstruction. DTI reconstruction is a reliable method that can achieve similar results to EI reconstruction with fewer surgical procedures in suitably selected patients.

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“…We specifically propose the use of M-TDP as a foundation for such variables because prior literature has shown that when different mastectomy patterns, [12][13][14] reconstructive timing, 15,16 devices, 15,[17][18][19] or pockets [20][21][22][23] are compared, outcomes may differ. Moreover, these variables, especially the latter three, reflect factors that are directly under the control of the reconstructive surgeon (as opposed to patient-related factors such as hemoglobin A1c levels or body mass index).…”

Section: M-tdp: a Single Nomenclature For Better Communication And Be...mentioning

confidence: 99%

“…This article extends concepts from earlier publications that describe improvement in the survival of the NAC by using a surgical delay. 17 , 46 A wealth of literature exists supporting the reconstructive use of a VD to develop more robust flaps and improve flap survival. 8 , 47 , 48 Although Zenn described his methods as a “staged-immediate” breast reconstruction, we believe that the use of the term “staged” to describe reconstructive timing is inconsistent with historical precedent and does not best reflect physiological intent.…”

Section: Introductionmentioning

confidence: 99%

The Language of Implant-based Breast Reconstruction: Can We Do Better?

Prabhu

Llull

Katz

2022

Plastic and Reconstructive Surgery - Global Open

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The management of breast cancer has experienced tremendous changes in the last half-century. In today’s multimodal approach to breast cancer, patients have the prospect of achieving a sense of normalcy after mastectomy thanks to advancements in oncology and breast reconstruction. Although the oncologic management of breast cancer has evolved over multiple centuries, implant-based breast reconstruction (IBBR) has only been around since the 1960s. The last half century has seen the conception of multiple techniques, novel devices, and new possibilities in hopes of achieving outcomes that are similar to or even better than the patient’s premorbid state. However, with all these changes, a new problem has arisen—inconsistencies in the literature on how IBBR is described. In this article, we will discuss potential sources of confusion in the IBBR literature and lexicon, highlighting specific terms that may have multiple meanings or interpretations depending on perspective, context, and/or intent. As a first step toward clarifying what we perceive as a muddied landscape, we propose a naming convention for IBBR that centers around four important variables especially pertinent to IBBR—the type of mastectomy performed, the timing of reconstruction, the type of device that is placed, and the pocket location for device placement. We believe that adoption of a more standardized, consistent, and descriptive lexicon for IBBR will help provide clearer communication and easier comparisons in the literature so that we may continue to deliver the best outcomes for our patients.

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Comparison of one-stage direct-to-implant with acellular dermal matrix and two-stage immediate implant-based breast reconstruction—a cohort study

Cited by 9 publications

References 31 publications

Mastectomy with one-stage or two-stage reconstruction in breast cancer: analysis of early outcomes and patient’s satisfaction

Mastectomy with one-stage or two-stage reconstruction in breast cancer: analysis of early outcomes and patient’s satisfaction

Direct to Implant versus 2-Stage Expander Implant Immediate Breast Reconstruction: Comparison of Incidence and Predictors of Complications

The Language of Implant-based Breast Reconstruction: Can We Do Better?

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