Evaluation of Prepectoral Implant Placement and Complete Coverage with TiLoop Bra Mesh for Breast Reconstruction: A Prospective Study on Long-Term and Patient-Reported BREAST-Q Outcomes

Abstract

Background: Breast reconstruction is rapidly evolving, because of the changing face of cancer surgery and the growing acceptance of acellular dermal matrices and synthetic meshes. Although some early reports showed encouraging results after prepectoral breast reconstruction, there is a paucity of data on long-term outcomes. Methods: Between January of 2012 and March of 2015, 179 patients undergoing mastectomy were enrolled at the authors’ institution. Patients underwent mastectomy and immediate prepectoral breast reconstruction with the definitive implant entirely wrapped in a titanium-coated polypropylene mesh (TiLoop). The BREAST-Q questionnaire was administered before surgery and after 2 years. Capsular contracture was evaluated using the Baker scale. Oncologic, surgical, and aesthetic outcomes and changes in BREAST-Q score were analyzed over time. Results: Average follow-up was 38.5 months. A total of 250 mastectomies were performed. The locoregional recurrence rate was 2.1 percent. Complications requiring reoperation were recorded in six patients (2.4 percent) and implant removal was necessary in three cases (1.2 percent), followed by reconstruction with submuscular expanders. Grade IV capsular contracture was detected in five breasts (2 percent), whereas 212 breasts were evaluated as grade I (84.8 percent), 28 breasts as grade II (11.2 percent), and five breasts as grade III (2 percent). Patients reported significant high rates in the BREAST-Q overall Satisfaction with Outcome (73.8), overall Satisfaction with Breasts (72.5), Psychosocial Well-being (77.7), and Sexual Well-being (57.9), scoring a significant increase in these domains from the preoperative period to the postoperative period (p < 0.05). Conclusion: The authors report encouraging results of a prepectoral direct-to-implant reconstruction technique using a synthetic mesh, supporting the evaluation of the muscle-sparing subcutaneous approach as a valid alternative to traditional submuscular reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

A prospective study on combined lymphedema surgery: Gastroepiploic vascularized lymph nodes transfer and lymphaticovenous anastomosis followed by suction lipectomy

“…This study was designed as a pilot study to validate our protocol combining LVA and VLNT followed by SL and we applied a simple criteria for dichotomize our population, as previously described (Casella, Di Taranto, Marcasciano, et al, 2019; Fino, Di Taranto, Toscani, & Scuderi, 2016; Tarallo et al, 2018). Patients were selected from among those diagnosed for lymphedema at our Institution between January 2016 and October 2018.…”

Synthetic Mesh in Immediate Breast Reconstruction

“…Two-year follow-up demonstrated no capsular contracture in the prepectoral cohort and 12% in the partial subpectoral cohort [52]. Other paper by Casella et al on 250 cases of prepectoral implant immediate reconstruction and TiLOOP recounts complications in 2.4% of the cases, but aesthetic complications are brought to reoperations in 19.5% of the breasts [53].…”

Body Mass Index Can Predict Outcomes in Direct-to-Implant Prepectoral Breast Reconstruction

“…In the TSE group, we found no significant association between complications rate and the variables considered in the analysis 3 . In the DTI group, a multiple regression model found a significant association between surgical complications and BMI and adjuvant radiotherapy 2,4,5 . The association remained significant only for BMI, when investigated for the onset of aesthetic complications.…”