by Casella, Donato; Di
Taranto, Giuseppe; Marcasciano, Marco; Sordi, Silvia; Kothari, Ashutosh;
Kovacs, Tibor; Lo Torto, Federico; Cigna, Emanuele; Calabrese, Claudio;
Ribuffo, Diego
Background:
Breast reconstruction is rapidly evolving, because of the changing face of
cancer surgery and the growing acceptance of acellular dermal matrices and
synthetic meshes. Although some early reports showed encouraging results after
prepectoral breast reconstruction, there is a paucity of data on long-term
outcomes.
Methods:
Between January of 2012 and March of 2015, 179 patients undergoing mastectomy
were enrolled at the authors’ institution. Patients underwent mastectomy and
immediate prepectoral breast reconstruction with the definitive implant
entirely wrapped in a titanium-coated polypropylene mesh (TiLoop). The BREAST-Q
questionnaire was administered before surgery and after 2 years. Capsular
contracture was evaluated using the Baker scale. Oncologic, surgical, and
aesthetic outcomes and changes in BREAST-Q score were analyzed over time.
Results: Average
follow-up was 38.5 months. A total of 250 mastectomies were performed. The
locoregional recurrence rate was 2.1 percent. Complications requiring reoperation
were recorded in six patients (2.4 percent) and implant removal was necessary
in three cases (1.2 percent), followed by reconstruction with submuscular
expanders. Grade IV capsular contracture was detected in five breasts (2
percent), whereas 212 breasts were evaluated as grade I (84.8 percent), 28
breasts as grade II (11.2 percent), and five breasts as grade III (2 percent).
Patients reported significant high rates in the BREAST-Q overall Satisfaction
with Outcome (73.8), overall Satisfaction with Breasts (72.5), Psychosocial
Well-being (77.7), and Sexual Well-being (57.9), scoring a significant increase
in these domains from the preoperative period to the postoperative period (p
< 0.05).
Conclusion: The
authors report encouraging results of a prepectoral direct-to-implant
reconstruction technique using a synthetic mesh, supporting the evaluation of
the muscle-sparing subcutaneous approach as a valid alternative to traditional
submuscular reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic,
IV.
