Diego Ribuffo1, Giorgio Berna2, Roy De Vita3, Giovanni Di Benedetto4, Emanuele Cigna5, Manfredi Greco6, Luigi Valdatta7, Maria Giuseppina Onesti1, Federico Lo Torto1, Marco Marcasciano1, Ugo Redi8, Vittorio Quercia1, Juste Kaciulyte1, Mario Cherubino7, Luigi Losco5, Francesco Luca Rocco Mori1,3, Alessandro Scalise4. 1. Plastic Surgery Unit, Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Viale Regina Margherita 302, 00198, Rome, Italy. 2. Department of Plastic and Reconstructive Surgery, Ulss 9 General Hospital, Treviso, Italy. 3. Department of Plastic and Reconstructive Surgery, Instituti Fisioterapici Ospitalieri, Regina Elena National Cancer Institute, Rome, Italy. 4. Clinic of Plastic and Reconstructive Surgery, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Via Conca 71, 60126, Ancona, Italy. 5. Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy. 6. Plastic and Reconstructive Surgery Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy. 7. Section of Medical and Surgical Sciences, Department of Biotechnology and Life Sciences, University of Insubria, 21100, Varese, Italy. 8. Plastic Surgery Unit, Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Viale Regina Margherita 302, 00198, Rome, Italy. ugoredi88@gmail.com.
Abstract
BACKGROUND: The use of conservative mastectomies has risen significantly during the last few years. The reconstructive choice of direct-to-implant reconstruction has become more practicable with modern mastectomy techniques. The initial trend in Italian centers was to use dual-plane hybrid reconstruction. However, a high level of complications has been registered. From 2015 onward, in our centers, a pre-pectoral approach has been adopted. The authors sought to describe the Italian trend to gradually discard the sub-pectoral technique with lower lateral pole coverage of the prosthesis using ADMs comparing it with the pre-pectoral approach with ADMs, without any muscle dissection, in terms of complication rates. MATERIALS AND METHODS: A multicenter retrospective clinical study was performed from January 2010 to June 2018. The enrolled patients were divided into two groups: Cases with an ADM-only coverage pre-pectoral reconstruction made up the first group (Group 1). Those with the retro-pectoral muscular position + ADM implant coverage comprised the second one (Group 2). Complications such as seroma, hematoma, wound dehiscence, surgical site infection, reconstruction failure, animation deformity and capsular contracture were recorded. RESULTS: We performed 716 direct-to-implant reconstructions: 509 were partially sub-pectoral and 207 were pre-pectoral. Minimum follow-up was 1 year. Incidence of complications was higher in dual-plane reconstructions. There were statistical significant differences in the rates of seroma and hematoma. CONCLUSION: Using the pre-pectoral approach, the authors have experienced favorable aesthetics and superior clinical and functional outcomes. Retro-pectoral muscular ADM implant coverage has to be considered only in specific complicated second-stage surgeries. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
BACKGROUND: The use of conservative mastectomies has risen significantly during the last few years. The reconstructive choice of direct-to-implant reconstruction has become more practicable with modern mastectomy techniques. The initial trend in Italian centers was to use dual-plane hybrid reconstruction. However, a high level of complications has been registered. From 2015 onward, in our centers, a pre-pectoral approach has been adopted. The authors sought to describe the Italian trend to gradually discard the sub-pectoral technique with lower lateral pole coverage of the prosthesis using ADMs comparing it with the pre-pectoral approach with ADMs, without any muscle dissection, in terms of complication rates. MATERIALS AND METHODS: A multicenter retrospective clinical study was performed from January 2010 to June 2018. The enrolled patients were divided into two groups: Cases with an ADM-only coverage pre-pectoral reconstruction made up the first group (Group 1). Those with the retro-pectoral muscular position + ADM implant coverage comprised the second one (Group 2). Complications such as seroma, hematoma, wound dehiscence, surgical site infection, reconstruction failure, animation deformity and capsular contracture were recorded. RESULTS: We performed 716 direct-to-implant reconstructions: 509 were partially sub-pectoral and 207 were pre-pectoral. Minimum follow-up was 1 year. Incidence of complications was higher in dual-plane reconstructions. There were statistical significant differences in the rates of seroma and hematoma. CONCLUSION: Using the pre-pectoral approach, the authors have experienced favorable aesthetics and superior clinical and functional outcomes. Retro-pectoral muscular ADM implant coverage has to be considered only in specific complicated second-stage surgeries. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Entities:
Keywords:
ADM; Breast reconstruction; Direct-to-implant; Dual plane; Pre-pectoral
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