“To Pre or Not to Pre”: Introduction of a Prepectoral Breast Reconstruction Assessment Score to Help Surgeons Solving the Decision-Making Dilemma. Retrospective Results of a Multicenter Experience

Casella, Donato; Kaciulyte, Juste; Torto, Federico Lo; Mori, Francesco; Barellini, Leonardo; Fausto, Alfonso; Fanelli, Benedetta; Greco, Manfredi; Ribuffo, Diego; Marcasciano, Marco

doi:10.1097/prs.0000000000008120

Cited by 22 publications

(13 citation statements)

References 45 publications

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“…Importantly, pre-operative patient selection is essential to ensure successful operative intervention and mitigate post-operative complication. While our institution did not use risk-assessment scores to evaluate patients prior to selection of reconstruction plane, central factors, such as skin flap viability, patient activity status, and functional goals, were considered in the shared decision making process between surgeon and patient 64 .…”

Section: Discussionmentioning

confidence: 99%

Cost analysis of pre-pectoral implant-based breast reconstruction

Chinta

Koh

Sobti

et al. 2022

Sci Rep

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With improvement in mastectomy skin flap viability and increasing recognition of animation deformity following sub-pectoral implant placement, there has been a transition toward pre-pectoral breast reconstruction. While studies have explored the cost effectiveness of implant-based breast reconstruction, few investigations have evaluated cost with respect to pre-pectoral versus sub-pectoral breast reconstruction. A retrospective review of 548 patients who underwent mastectomy and implant-based breast reconstruction was performed from 2017 to 2020. The demographic and surgical characteristics of the pre-pectoral and sub-pectoral cohorts were well matched, except for reconstructive staging, as patients who underwent pre-pectoral reconstruction were more likely to undergo single-stage instead of two-stage reconstruction. Comparison of institutional cost ratios by reconstructive technique revealed that the sub-pectoral approach was more costly (1.70 ± 0.44 vs 1.58 ± 0.31, p < 0.01). However, further stratification by laterality and reconstructive staging failed to demonstrate difference in cost by reconstructive technique. These results were confirmed by multivariable linear regression, which did not reveal reconstructive technique to be an independent variable for cost. This study suggests that pre-pectoral breast reconstruction is a cost-effective alternative to sub-pectoral breast reconstruction and may confer cost benefit, as it is more strongly associated with direct-to-implant breast reconstruction.

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Section: Discussionmentioning

confidence: 99%

Cost analysis of pre-pectoral implant-based breast reconstruction

Chinta

Koh

Sobti

et al. 2022

Sci Rep

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“…This fact suggests that the cost of the ADM is offset by avoiding a complicated outpatient management of complications and reoperations ( 40 , 41 ).…”

Section: Discussionmentioning

confidence: 99%

Immediate direct-to-implant breast reconstruction: A single center comparison between different procedures

et al. 2022

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BackgroundThe increased incidence of conservative mastectomy operations (nipple- and skin- sparing) has increased the frequency of immediate breast reconstructions (IBR). In order to guarantee patients the best possible aesthetic outcome, the least chance of complications and moreover, the least postoperative pain, the technique with prepectoral prosthetic pocket was recently reconsidered with the use of ADM. This is the first study using Fortiva® in prepectoral breast reconstruction, and it compares the outcomes of three different patient populations (undergoing retromuscular, prepectoral and prepectoral reconstruction with ADM). The authors suggest that prepectoral breast reconstruction with ADM may bring benefits compared to the current standard technique (retromuscular) as well as compared to the prepectoral reconstruction without ADM.MethodsRetrospective data analysis of patients who underwent mastectomy followed by immediate breast reconstruction with silicone implants (DTI), performed by a team of breast surgeons and plastic surgeons. Logistic factor regressions were performed in order to investigate the effects of the three different intervention techniques on the incidence of complications. Fisher's exact test was used to analyze the differences in the occurrence of each complication. Mann Whitney test was used to compare the averages of referred pain. A p value <0.05 was considered significant.ResultsA total of 67 patients underwent DTI reconstruction, of which 43 with retromuscular prosthesis, 13 prepectoral and 11 prepectoral with ADM. We found a significantly lower incidence of surgical complications with ADM, exclusively in comparison with retromuscular reconstruction (p = 0.028). It emerges prepectoral reconstruction with ADM involves significantly less visibility of the implant than both the prepectoral surgery without ADM (p = 0.013) and the retromuscular technique (p = 0.029). Finally, postoperative pain referred at twelfth month is significantly less relevant in the group with prepectoral prosthesis and ADM, both in the group with retromuscular (p < 0.001) and prepectoral without ADM (p = 0.001).ConclusionsThis study demonstrates that immediate prepectoral breast reconstruction with ADM is a safe and reliable technique, able to exceed some type of limits imposed by prepectoral reconstruction. Moreover, it provides benefits if compared to the current standard technique. In the future, this technique could also be added to it, after a proper selection of patients in pre- and intraoperative time.

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“…Complications after breast reconstructive procedures are relatively commonplace and may impact the final aesthetic and reconstructive outcome, or potentially even influence the timing of adjuvant breast cancer therapy. 31,32 Compared with a population-based assessment, automated risk calculators provide a more nuanced view of an individual patient’s risk and may help guide preoperative discussions and treatment decisions. In this study, we review the existing risk calculators in the breast reconstruction literature, identify several traditional statistical models and simple risk score tools, and describe promising advanced machine learning–based tools currently in development.…”

Section: Discussionmentioning

confidence: 99%

An Ounce of Prediction is Worth a Pound of Cure: Risk Calculators in Breast Reconstruction

Oleck

Keshri

Shammas

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: Preoperative risk calculators provide individualized risk assessment and stratification for surgical patients. Recently, several general surgery-derived models have been applied to the plastic surgery patient population, and several plastic surgery-specific calculators have been developed. In this scoping review, the authors aimed to identify and critically appraise risk calculators implemented in postmastectomy breast reconstruction. Methods: A systematic review of the literature was conducted. Included studies described the development of a novel risk calculator, or validation of an existing calculator, in postmastectomy breast reconstruction. Results: In total, 4641 studies met criteria for title and abstract screening. Fortyseven were eligible for full-text review, and 28 met final inclusion criteria. The most common risk calculators included the Breast Reconstruction Risk Assessment score (n = 6 studies), modified frailty index (n = 3), Caprini score (n = 3), and ACS NSQIP calculator (n = 2). Calculators were applied to institutional data (n = 17), NSQIP (n = 6), and Tracking Outcomes in Plastic Surgery (n = 1) databases. Predicted outcomes included general postoperative complications (n = 17), venous thromboembolism/pulmonary embolism (n = 4), infection (n = 2), and patient reported outcomes (n = 2). Model accuracy was reported in 18 studies, and it varied significantly (accurate risk calculator 0.49-0.85). Conclusions: This is the first study to provide a systematic review of available risk calculators for breast reconstruction. Models vary significantly in their statistical basis, predicted outcomes, and overall accuracy. Risk calculators are valuable tools that may aid in individualized risk assessments, preoperative counseling, and expectation management in breast reconstruction.

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“To Pre or Not to Pre”: Introduction of a Prepectoral Breast Reconstruction Assessment Score to Help Surgeons Solving the Decision-Making Dilemma. Retrospective Results of a Multicenter Experience

Abstract: long with the increase of breast cancer incidence, mastectomy rates have presented a large increase in the past decade. 1,2 Implantbased reconstruction represents the most common form of breast reconstruction after mastectomy. 3 The

Cited by 22 publications

References 45 publications

Cost analysis of pre-pectoral implant-based breast reconstruction

Cost analysis of pre-pectoral implant-based breast reconstruction

Immediate direct-to-implant breast reconstruction: A single center comparison between different procedures

An Ounce of Prediction is Worth a Pound of Cure: Risk Calculators in Breast Reconstruction

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