Leonardo Cattelani1, Susanna Polotto2, Maria Francesca Arcuri3, Giuseppe Pedrazzi4, Chiara Linguadoca5, Elena Bonati3. 1. Breast Surgical Unit, University Hospital of Parma, Parma, Italy. Electronic address: cattelanil@hotmail.com. 2. University Plastic and Reconstructive Unit, University Hospital of Parma, Parma, Italy. 3. Breast Surgical Unit, University Hospital of Parma, Parma, Italy. 4. Neuroscience Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy. 5. Pharmacological and Drug Clinical Governance Service, University Hospital of Parma, Parma, Italy.
Abstract
BACKGROUND: The breast reconstructive subpectoral technique commonly leads to functional consequences. Recently, a new conservative prepectoral breast reconstruction (PPBR) technique was proposed and its surgical safety and aesthetic effectiveness proved. The aim of this prospective nonrandomized study was to compare the functional and economical outcomes of the PPBR procedure versus the subpectoral one. PATIENTS AND METHODS: From February 2015 to September 2016, 86 patients underwent mastectomy with immediate implant-based reconstruction. Thirty-nine patients were assigned to group 1 and received prepectoral acellular dermal matrix-wrapped implant reconstruction. The remaining 45 patients were assigned to group 2 and received a subpectoral implant or tissue expander. We recorded the operating time, length of hospital stay, analgesic consumption, postoperative pain, upper limb function, esthetic satisfaction, and quality of life. Additional surgical procedures for reconstruction completion or contralateral operation for symmetrization were also recorded. RESULTS: Compared to group 2 patients, group 1 patients showed less postoperative pain and faster upper limb functional recovery. Patients in group 1 also recorded a lower analgesic consumption and an earlier return to usual work. Moreover, the muscle-sparing technique improved aesthetic outcomes and largely reduced the need for symmetrization. CONCLUSION: Immediate breast reconstruction by using prepectoral muscle-sparing acellular dermal matrix-wrapped implant resulted in lower pain intensity and significant upper limb functional advantages compared to submuscular implant placement. Furthermore, when considering a series of ascertained benefits, PPBR is also economically advantageous, although future studies should better define its cost-effectiveness.
BACKGROUND: The breast reconstructive subpectoral technique commonly leads to functional consequences. Recently, a new conservative prepectoral breast reconstruction (PPBR) technique was proposed and its surgical safety and aesthetic effectiveness proved. The aim of this prospective nonrandomized study was to compare the functional and economical outcomes of the PPBR procedure versus the subpectoral one. PATIENTS AND METHODS: From February 2015 to September 2016, 86 patients underwent mastectomy with immediate implant-based reconstruction. Thirty-nine patients were assigned to group 1 and received prepectoral acellular dermal matrix-wrapped implant reconstruction. The remaining 45 patients were assigned to group 2 and received a subpectoral implant or tissue expander. We recorded the operating time, length of hospital stay, analgesic consumption, postoperative pain, upper limb function, esthetic satisfaction, and quality of life. Additional surgical procedures for reconstruction completion or contralateral operation for symmetrization were also recorded. RESULTS: Compared to group 2 patients, group 1 patients showed less postoperative pain and faster upper limb functional recovery. Patients in group 1 also recorded a lower analgesic consumption and an earlier return to usual work. Moreover, the muscle-sparing technique improved aesthetic outcomes and largely reduced the need for symmetrization. CONCLUSION: Immediate breast reconstruction by using prepectoral muscle-sparing acellular dermal matrix-wrapped implant resulted in lower pain intensity and significant upper limb functional advantages compared to submuscular implant placement. Furthermore, when considering a series of ascertained benefits, PPBR is also economically advantageous, although future studies should better define its cost-effectiveness.
Authors: Fabinshy Thangarajah; Timo Treeter; Barbara Krug; Martin Hellmich; Christian Eichler; Bettina Hanstein; Peter Mallmann; Wolfram Malter Journal: Breast Care (Basel) Date: 2019-02-26 Impact factor: 2.860
Authors: Susanna Polotto; Maria Luisa Bergamini; Giuseppe Pedrazzi; Maria F Arcuri; Francesca Gussago; Leonardo Cattelani Journal: Gland Surg Date: 2020-04