Pre-pectoral breast reconstruction: early and long-term safety evaluation of 146 unselected cases of the early pre-pectoral era of a single-institution, including cases with previous breast irradiation and post-mastectomy radiation therapy

Bernini, Marco; Meattini, Icro; Saieva, Calogero; Becherini, Carlotta; Salvestrini, Viola; Visani, Luca; Stocchi, G.; Bellini, Chiara; Lorenzetti, Victoria; Sordi, S.; Nori, Jacopo; Benedetto, Diego De; Desideri, Isacco; Bianchi, Simonetta; Livi, Lorenzo; Orzalesi, Lorenzo

doi:10.1007/s12282-021-01314-0

Cited by 3 publications

(2 citation statements)

References 50 publications

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“…Recently, this new technique is increasing in the high-volume centers owing to its more minimal approach. Indeed, a retrospective analysis of 146 patients showed that immediate prepectoral breast reconstruction was effective and safe with five locoregional recurrences after 4 years of follow-up and a low acute and early-late complication rates [ 17 ]. According to our data, 25% and 75% of patients received subpectoral and prepectoral breast reconstruction, respectively.…”

Section: Discussionmentioning

confidence: 99%

Anatomical assessment of local recurrence site in breast cancer patients after breast reconstruction and post-mastectomy radiotherapy: implications for radiation volumes and techniques

Salvestrini,

Valzano,

Meattini

et al. 2024

Radiol med

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Introduction Post-mastectomy radiotherapy (PMRT) improves local control rates and survival in patients with adverse prognostic features. The dose coverage to target volumes is critical to yield maximum benefit to treated patients, increasing local control and reducing risk of toxicity. This study aims to assess patterns of breast cancer relapse in patients treated with mastectomy, breast reconstruction and PMRT. Methods Breast cancer patients treated with PMRT between 1992 and 2017 were retrospectively reviewed. Clinical and pathological characteristics of patients were collected. Recurrences were defined as “in field,” “marginal” or “out of field.” Survival analyses were performed in relation to progression-free survival (PFS) and overall survival (OS). Correlation between baseline features was explored. Results Data of 140 patients are collected. After a median follow-up time of 72 months, median PFS and OS of 63 and 74 months were detected, respectively. Neoadjuvant chemotherapy, lympho-vascular space invasion (LVI) and size of primary tumor were all significantly associated with worst PFS and OS. Ten patients developed local recurrence: 30% "in field," 30% marginal recurrences, 20% "out of field" and 20% both “in field” and “out of field.” No recurrence was detected under the expander, 80% above the device and 20% patients relapsed on IMN chain. The mean distant relapse-free survival was 39 months. Overall, 39 of 140 patients developed distant metastases. Conclusions The onset of local–regional relapses occurred mainly above the expander/prosthesis, underlying the importance of inclusion of the subcutaneous tissues within the target volume. In order to refine new contouring recommendations for PMRT and breast reconstruction, future prospective studies are needed.

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Section: Discussionmentioning

confidence: 99%

Anatomical assessment of local recurrence site in breast cancer patients after breast reconstruction and post-mastectomy radiotherapy: implications for radiation volumes and techniques

Salvestrini,

Valzano,

Meattini

et al. 2024

Radiol med

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“…Surgical expertise and careful patient selection are the basis to achieve an excellent result with PP-IPBR [33,34]. During surgery, thickness and perfusion of skin flaps should be evaluated, in addition to individual risk factors [35], before choosing the type of reconstruction (PP vs. SM) [36,37].…”

Section: Discussionmentioning

confidence: 99%

Prepectoral vs. Submuscular Immediate Breast Reconstruction in Patients Undergoing Mastectomy after Neoadjuvant Chemotherapy: Our Early Experience

Scardina

Leone

Biondi

et al. 2022

JPM

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Background: Conservative mastectomy with immediate prosthetic breast reconstruction (IPBR) is an oncologically accepted technique that offers improved esthetic results and patient quality of life. Traditionally, implants have been placed in a submuscular (SM) plane beneath the pectoralis major muscle (PMM). Recently, prepectoral (PP) placement of the prosthesis has been increasingly used in order to avoid morbidities related to manipulation of the PMM. The aim of this study was to compare outcomes of SM vs. PP IPBR after conservative mastectomy in patients with histologically proven breast cancer treated with neoadjuvant chemotherapy (NAC). Methods: In this retrospective observational study, we analyzed two cohorts of patients that underwent mastectomy with IPBR after NAC in our institution from January 2018 to December 2021. Conservative mastectomy was performed in 146 of the 400 patients that underwent NAC during the study period. Patients were divided into two groups based on the positioning of implants: 56 SM versus 90 PP. Results: The two cohorts were similar for age (mean age 42 and 44 years in the SM and PP group respectively) and follow-up (33 and 20 months, respectively). Mean operative time was 56 min shorter in the PP group (300 and 244 min in the SM and PP group). No significant differences were observed in overall major complication rates. Implant loss was observed in 1.78% of patients (1/56) in the SM group and 1.11% of patients (1/90) in PP group. No differences were observed between the two groups in local or regional recurrence. Conclusions: Our preliminary experience, which represents one of the largest series of patients undergoing PP-IPBR after NAC at a single institution documented in the literature, seems to confirm that PP-IPBR after NAC is a safe, reliable and effective alternative to traditional SM-IPBR with excellent esthetic and oncological outcomes; it is easy to perform, reduces operative time and minimizes complications related to manipulation of PPM. However, this promising results need to be confirmed in prospective trials with longer follow-up.

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Actualisation des indications et techniques de reconstruction mammaire immédiate, notamment en cas de radiothérapie adjuvante

Vincent,

Laville,

Jacinto

et al. 2024

Gynécologie Obstétrique Fertilité & Sénologie

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Pre-pectoral breast reconstruction: early and long-term safety evaluation of 146 unselected cases of the early pre-pectoral era of a single-institution, including cases with previous breast irradiation and post-mastectomy radiation therapy

Cited by 3 publications

References 50 publications

Anatomical assessment of local recurrence site in breast cancer patients after breast reconstruction and post-mastectomy radiotherapy: implications for radiation volumes and techniques

Anatomical assessment of local recurrence site in breast cancer patients after breast reconstruction and post-mastectomy radiotherapy: implications for radiation volumes and techniques

Prepectoral vs. Submuscular Immediate Breast Reconstruction in Patients Undergoing Mastectomy after Neoadjuvant Chemotherapy: Our Early Experience

Actualisation des indications et techniques de reconstruction mammaire immédiate, notamment en cas de radiothérapie adjuvante

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