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

BACKGROUND: The 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 p...

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Autores principales: Klinger, Francesco, Lisa, Andrea, Testori, Alberto, Vaccari, Stefano, Bandi, Valeria, Lorenzano, Valerio, Klinger, Marco, Tinterri, Corrado, Vinci, Valeriano
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9339688/
https://www.ncbi.nlm.nih.gov/pubmed/35923444
http://dx.doi.org/10.3389/fsurg.2022.935410
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author Klinger, Francesco
Lisa, Andrea
Testori, Alberto
Vaccari, Stefano
Bandi, Valeria
Lorenzano, Valerio
Klinger, Marco
Tinterri, Corrado
Vinci, Valeriano
author_facet Klinger, Francesco
Lisa, Andrea
Testori, Alberto
Vaccari, Stefano
Bandi, Valeria
Lorenzano, Valerio
Klinger, Marco
Tinterri, Corrado
Vinci, Valeriano
author_sort Klinger, Francesco
collection PubMed
description BACKGROUND: The 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. METHODS: Retrospective 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. RESULTS: A 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). CONCLUSIONS: This 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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spelling pubmed-93396882022-08-02 Immediate direct-to-implant breast reconstruction: A single center comparison between different procedures Klinger, Francesco Lisa, Andrea Testori, Alberto Vaccari, Stefano Bandi, Valeria Lorenzano, Valerio Klinger, Marco Tinterri, Corrado Vinci, Valeriano Front Surg Surgery BACKGROUND: The 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. METHODS: Retrospective 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. RESULTS: A 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). CONCLUSIONS: This 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. Frontiers Media S.A. 2022-07-18 /pmc/articles/PMC9339688/ /pubmed/35923444 http://dx.doi.org/10.3389/fsurg.2022.935410 Text en © 2022 Klinger, Lisa, Testori, Vaccari, Bandi, Lorenzano, Klinger, Tinterri and Vinci. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Surgery
Klinger, Francesco
Lisa, Andrea
Testori, Alberto
Vaccari, Stefano
Bandi, Valeria
Lorenzano, Valerio
Klinger, Marco
Tinterri, Corrado
Vinci, Valeriano
Immediate direct-to-implant breast reconstruction: A single center comparison between different procedures
title Immediate direct-to-implant breast reconstruction: A single center comparison between different procedures
title_full Immediate direct-to-implant breast reconstruction: A single center comparison between different procedures
title_fullStr Immediate direct-to-implant breast reconstruction: A single center comparison between different procedures
title_full_unstemmed Immediate direct-to-implant breast reconstruction: A single center comparison between different procedures
title_short Immediate direct-to-implant breast reconstruction: A single center comparison between different procedures
title_sort immediate direct-to-implant breast reconstruction: a single center comparison between different procedures
topic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9339688/
https://www.ncbi.nlm.nih.gov/pubmed/35923444
http://dx.doi.org/10.3389/fsurg.2022.935410
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