D Pukancsik1, P Kelemen2, G Gulyás2, M Újhelyi2, E Kovács3, K Éles4, N Mészáros5, I Kenessey6, P Pálházi7, T Kovács8, M Kásler9, Z Mátrai2. 1. National Institute of Oncology, Department of Breast and Sarcoma Surgery, Ráth György Str. 7-9, 1122 Budapest, Hungary. Electronic address: d.pukancsik@gmail.com. 2. National Institute of Oncology, Department of Breast and Sarcoma Surgery, Ráth György Str. 7-9, 1122 Budapest, Hungary. 3. National Institute of Oncology, Department of Radiological Diagnostics, Ráth György Str. 7-9, 1122 Budapest, Hungary. 4. National Institute of Oncology, Department of Surgical and Molecular Pathology, Ráth György Str. 7-9, 1122 Budapest, Hungary. 5. National Institute of Oncology, Department of Radiotherapy, Ráth György Str. 7-9, 1122 Budapest, Hungary. 6. National Institute of Oncology, National Cancer Registry, Ráth György Str. 7-9, 1122 Budapest, Hungary; Semmelweis University, 2nd Department of Pathology, Üllői Str. 93, 1091 Budapest, Hungary. 7. Semmelweis University, Department of Anatomy, Histology and Embryology, Tűzoltó Str. 58, 1094 Budapest, Hungary. 8. Guy's and St Thomas's Hospitals NHS Foundation Trust, Department of Breast Surgery, Great Maze Pond, London SE1 9RT, United Kingdom. 9. National Institute of Oncology, Ráth György Str. 7-9, 1122 Budapest, Hungary.
Abstract
BACKGROUND: Acellular dermal matrices have been used for direct-to-implant (DTI) breast reconstruction (BR), eliminating the load of the lower pole skin envelope. However, the available allograft matrices add considerable health care costs. This study examined the long-term follow-up of synthetic ULTRAPRO® mesh as a low-cost potential alternative to biological matrices. PATIENTS AND METHODS: A retrospective cohort study was performed between January 2013 and January 2016, involved 112 early-stage breast cancer and/or BRCA 1/2 patients, and evaluated 189 immediate DTI BRs following skin-, areola- or nipple-sparing mastectomy using ULTRAPRO® mesh. Patient characteristics and postoperative complications were recorded, and quality of life was rated by the patients using the EORTC-QLQ-C30-BR23 questionnaire. Aesthetic outcomes and palpability of the implants were evaluated by four breast surgeons on a 5-point Likert scale. All recorded parameters were statistically analysed. RESULTS: Ten patients were lost-to-follow-up, resulting in 102 patients and 174 breast surgery cases analysed. The mean age was 43 years, with 23.4 months of follow-up on average. Forty-six patients (45.1%) had previous radiotherapy with pre-existing scars. In total, 32 complications (18.3%) were recorded, including 12 minor (6.9%) and 20 major (11.4%) complications requiring revision. All median quality of life scores were above 83 points, representing a high score, with an average 4-point rating for the aesthetic outcome and natural consistency of the breast. CONCLUSION: Partially absorbable ULTRAPRO® mesh could be used successfully in DTI BR, offering a safe, less expensive alternative to biological matrices. Adequate indications and patient selection are necessary.
BACKGROUND: Acellular dermal matrices have been used for direct-to-implant (DTI) breast reconstruction (BR), eliminating the load of the lower pole skin envelope. However, the available allograft matrices add considerable health care costs. This study examined the long-term follow-up of synthetic ULTRAPRO® mesh as a low-cost potential alternative to biological matrices. PATIENTS AND METHODS: A retrospective cohort study was performed between January 2013 and January 2016, involved 112 early-stage breast cancer and/or BRCA 1/2 patients, and evaluated 189 immediate DTI BRs following skin-, areola- or nipple-sparing mastectomy using ULTRAPRO® mesh. Patient characteristics and postoperative complications were recorded, and quality of life was rated by the patients using the EORTC-QLQ-C30-BR23 questionnaire. Aesthetic outcomes and palpability of the implants were evaluated by four breast surgeons on a 5-point Likert scale. All recorded parameters were statistically analysed. RESULTS: Ten patients were lost-to-follow-up, resulting in 102 patients and 174 breast surgery cases analysed. The mean age was 43 years, with 23.4 months of follow-up on average. Forty-six patients (45.1%) had previous radiotherapy with pre-existing scars. In total, 32 complications (18.3%) were recorded, including 12 minor (6.9%) and 20 major (11.4%) complications requiring revision. All median quality of life scores were above 83 points, representing a high score, with an average 4-point rating for the aesthetic outcome and natural consistency of the breast. CONCLUSION: Partially absorbable ULTRAPRO® mesh could be used successfully in DTI BR, offering a safe, less expensive alternative to biological matrices. Adequate indications and patient selection are necessary.
Authors: Heather R Faulkner; Lauren Shikowitz-Behr; Matthew McLeod; Eric Wright; John Hulsen; William G Austen Journal: Plast Reconstr Surg Date: 2020-12 Impact factor: 5.169