Pre-pectoral implant-based breast reconstruction after mastectomy: a narrative review

Micco, Rosa Di; Santurro, Letizia; Lapiana, Gaetano; Socci, Davide; Zuber, Veronica; Cisternino, G; Baleri, Sara; Rottino, Stefano; Ceccarino, Raffaele; Gentilini, Oreste Davide

doi:10.21037/abs-21-147

Cited by 2 publications

(4 citation statements)

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“…Breast reconstruction is a central component of the comprehensive management of breast cancer patients, offering physical and psychological restoration for mastectomised women. Reconstructive procedures have evolved significantly over the years, providing improved outcomes and enhanced patient satisfaction ( 1 ). Optimal aesthetic outcomes with long-term functional and clinical stability are reported worldwide with pre-pectoral breast reconstruction (PPBR), turning now from innovation to new gold standard in implant-based reconstructive surgery ( 2 , 3 ).…”

Section: Introductionmentioning

confidence: 99%

Pre-pectoral breast reconstruction with tissue expander entirely covered by acellular dermal matrix: feasibility, safety and histological features resulting from the first 64 procedures

Bernini,

Gigliucci,

Cassetti

et al. 2024

Gland Surg

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Background Reconstructive options that can be used following conservative mastectomy, skin-, nipple-sparing and skin-reducing mastectomies, allow a remarkable variety of safe methods to restore the natural shape and aesthetics of the breast mound. In case of two-stage breast reconstruction, tissue expanders (TEs) are usually placed in a subpectoral position. The purpose of this retrospective cohort study is to evaluate the feasibility and safety of two-step reconstruction with TE in pre-pectoral position covered by acellular dermal matrix (ADM). Methods Between March 2021 and May 2023, at the Azienda Ospedaliero Universitaria Careggi, University of Florence, 55 patients with BRCA 1/2 mutations or early breast cancer underwent conservative mastectomy with immediate pre-pectoral reconstruction using TE covered with ADM, followed by a second surgery with replacement of the expander with definitive prosthesis. Demographic, oncological, and histological data along with surgical complications were recorded. Results A total of 64 conservative mastectomies were performed. In 2 patients (3.1%) complications were found that required reintervention and, in both cases, the TE had to be removed. Two patients developed hematoma and one patient developed seroma. Two patients showed wound dehiscence, both healed after conservative treatment and without implant exposure. No case of necrosis of the skin or nipple-areola complex has been observed, neither of capsular contracture. Capsule formed around TE was populated with cells and blood vessels and showed a thin area of synovial metaplasia. Conclusions In selected cases it may be more cautious to perform a two-stage breast reconstruction after radical breast surgery by means of TEs. The placement of TEs in pre-pectoral position combines the excellent aesthetic and functional results of the pre-pectoral philosophy with a quite safer and more prudent two-step approach. Our experience reports optimistic results: the ADM covering the TE is seen successfully integrating during tissue expansion and becoming a vascularised new self-tissue. Complications rates are low and such ADM-assisted two-stage pre-pectoral reconstructive technique is a safe, practical, and reproducible method.

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Section: Introductionmentioning

confidence: 99%

Pre-pectoral breast reconstruction with tissue expander entirely covered by acellular dermal matrix: feasibility, safety and histological features resulting from the first 64 procedures

Bernini,

Gigliucci,

Cassetti

et al. 2024

Gland Surg

View full text Add to dashboard Cite

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“…In a world increasingly demanding quick and cost-effective medical care strategies, the evolution of techniques and the advancement of biomaterials have raised a global interest in the areas of health management and quality-of-life safekeeping ( 1 ).…”

Section: Introductionmentioning

confidence: 99%

“…Breast cancer care and treatment is a prime example of how research and progress have supported high life-enhancing standards for oncological patients ( 1 , 2 ). Until 60 years ago, while therapeutic approaches were extremely aggressive, causing huge chest wall defects and significant scarring, breast reconstruction was a subject of great controversy, which was regarded as a worthless and risky procedure by highly respected physicians ( 2 , 3 ).…”

Section: Introductionmentioning

confidence: 99%

“…Today, psychophysical impairment caused by such a demolitive surgery is of primary concern, especially considering the global dimension of breast cancer ( 2 , 4 ). With a progressively aging population and improved diagnostic tools, more than two million women worldwide are diagnosed with breast malignancies every year, thus representing the most frequent cause of female cancer death ( 1 , 5 ). Driven by such high incidences, medical–surgical research has evolved toward optimized management of breast cancer patients, resulting in less aggressive surgeries and enhanced direct-to-implant (DTI) procedures ( 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

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Braxon®-assisted prepectoral breast reconstruction: A decade later

et al. 2022

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We are sitting on the cusp of the bioengineered breast era, in which implant-based breast reconstruction is seeing a growing trend and biotechnology research progressively empowers clinical practice. As never before, the choice of biomaterials has acquired great importance for achieving reconstructive outcomes, and the increase in the use of acellular dermal matrices (ADMs) in the field of senology tells us a story of profound upheaval and progress. With the advent of prepectoral breast reconstruction (PPBR), plenty of devices have been proposed to wrap the silicone prosthesis, either completely or partially. However, this has caused a great deal of confusion and dissent with regard to the adoption of feasible reconstructive strategies as well as the original scientific rationale underlying the prepectoral approach. Braxon® is the very first device that made prepectoral implant positioning possible, wrapping around the prosthesis and exerting the proven ADM regenerative potential at the implant–tissue interface, taking advantage of the body's physiological healing mechanisms. To date, the Braxon® method is among the most studied and practiced worldwide, and more than 50 publications confirm the superior performance of the device in the most varied clinical scenarios. However, a comprehensive record of the working of this pioneering device is still missing. Therefore, our aim with this review is to lay a structured knowledge of surgery with BRAXON® and to provide a decision-making tool in the field of PPBR through a complete understanding on the very first device for prepectoral, one decade after its introduction.

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Pre-pectoral implant-based breast reconstruction after mastectomy: a narrative review

Cited by 2 publications

References 0 publications

Pre-pectoral breast reconstruction with tissue expander entirely covered by acellular dermal matrix: feasibility, safety and histological features resulting from the first 64 procedures

Pre-pectoral breast reconstruction with tissue expander entirely covered by acellular dermal matrix: feasibility, safety and histological features resulting from the first 64 procedures

Braxon®-assisted prepectoral breast reconstruction: A decade later

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