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Sub-Muscular Direct-to-Implant Immediate Breast Reconstruction in Previously Irradiated Patients Avoiding the Use of ADM: A Preliminary Study

Background: The aim of this paper is to present a preliminary experience of sub-muscular primary direct-to-implant (DTI) breast reconstruction without acellular dermal matrix (ADM), after salvage mastectomy for local recurrence following prior irradiation. Methods: A retrospective investigation was...

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Autores principales: Pacchioni, Lucrezia, Sapino, Gianluca, Lusetti, Irene Laura, Zaccaria, Giovanna, Di Summa, Pietro G., De Santis, Giorgio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9573151/
https://www.ncbi.nlm.nih.gov/pubmed/36233723
http://dx.doi.org/10.3390/jcm11195856
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author Pacchioni, Lucrezia
Sapino, Gianluca
Lusetti, Irene Laura
Zaccaria, Giovanna
Di Summa, Pietro G.
De Santis, Giorgio
author_facet Pacchioni, Lucrezia
Sapino, Gianluca
Lusetti, Irene Laura
Zaccaria, Giovanna
Di Summa, Pietro G.
De Santis, Giorgio
author_sort Pacchioni, Lucrezia
collection PubMed
description Background: The aim of this paper is to present a preliminary experience of sub-muscular primary direct-to-implant (DTI) breast reconstruction without acellular dermal matrix (ADM), after salvage mastectomy for local recurrence following prior irradiation. Methods: A retrospective investigation was performed on a prospectively maintained database of breast reconstruction cases at our institution between January 2015 and December 2020. We considered only immediate DTI breast reconstructions without ADM following radiotherapy and salvage mastectomy for local recurrence, with at least a 12-month follow-up. Results: The study considered 18 female patients with an average of 68 years. According to the BREAST-Q questionnaire, all patients reported high levels of “satisfaction with outcome” with good “psychosocial wellness” and “physical impact” related to the reconstruction. The aesthetic evaluation showed a significant difference between the VAS score gave by the patient (mean 6.9) and the surgeon (mean 5.4). No implant exposure occurred in this series. In terms of complications, four patients (22%) suffered from wound dehiscence and were managed conservatively. Three patients (17%) required primary closure in day surgery following superficial mastectomy flap necrosis. Late capsular contracture was seen in seven patients (four Baker stage II and three Baker stage III, totally 39%); however, no patient was willing to undergo implant exchange. Conclusions: DTI breast reconstruction following prior irradiation can be considered as an option in patients who are not good candidates for autologous breast reconstruction. Our general outcomes compared favorably with literature data regarding the use of staged procedures, with acceptable complication rates and levels of patient satisfaction.
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spelling pubmed-95731512022-10-17 Sub-Muscular Direct-to-Implant Immediate Breast Reconstruction in Previously Irradiated Patients Avoiding the Use of ADM: A Preliminary Study Pacchioni, Lucrezia Sapino, Gianluca Lusetti, Irene Laura Zaccaria, Giovanna Di Summa, Pietro G. De Santis, Giorgio J Clin Med Article Background: The aim of this paper is to present a preliminary experience of sub-muscular primary direct-to-implant (DTI) breast reconstruction without acellular dermal matrix (ADM), after salvage mastectomy for local recurrence following prior irradiation. Methods: A retrospective investigation was performed on a prospectively maintained database of breast reconstruction cases at our institution between January 2015 and December 2020. We considered only immediate DTI breast reconstructions without ADM following radiotherapy and salvage mastectomy for local recurrence, with at least a 12-month follow-up. Results: The study considered 18 female patients with an average of 68 years. According to the BREAST-Q questionnaire, all patients reported high levels of “satisfaction with outcome” with good “psychosocial wellness” and “physical impact” related to the reconstruction. The aesthetic evaluation showed a significant difference between the VAS score gave by the patient (mean 6.9) and the surgeon (mean 5.4). No implant exposure occurred in this series. In terms of complications, four patients (22%) suffered from wound dehiscence and were managed conservatively. Three patients (17%) required primary closure in day surgery following superficial mastectomy flap necrosis. Late capsular contracture was seen in seven patients (four Baker stage II and three Baker stage III, totally 39%); however, no patient was willing to undergo implant exchange. Conclusions: DTI breast reconstruction following prior irradiation can be considered as an option in patients who are not good candidates for autologous breast reconstruction. Our general outcomes compared favorably with literature data regarding the use of staged procedures, with acceptable complication rates and levels of patient satisfaction. MDPI 2022-10-03 /pmc/articles/PMC9573151/ /pubmed/36233723 http://dx.doi.org/10.3390/jcm11195856 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Pacchioni, Lucrezia
Sapino, Gianluca
Lusetti, Irene Laura
Zaccaria, Giovanna
Di Summa, Pietro G.
De Santis, Giorgio
Sub-Muscular Direct-to-Implant Immediate Breast Reconstruction in Previously Irradiated Patients Avoiding the Use of ADM: A Preliminary Study
title Sub-Muscular Direct-to-Implant Immediate Breast Reconstruction in Previously Irradiated Patients Avoiding the Use of ADM: A Preliminary Study
title_full Sub-Muscular Direct-to-Implant Immediate Breast Reconstruction in Previously Irradiated Patients Avoiding the Use of ADM: A Preliminary Study
title_fullStr Sub-Muscular Direct-to-Implant Immediate Breast Reconstruction in Previously Irradiated Patients Avoiding the Use of ADM: A Preliminary Study
title_full_unstemmed Sub-Muscular Direct-to-Implant Immediate Breast Reconstruction in Previously Irradiated Patients Avoiding the Use of ADM: A Preliminary Study
title_short Sub-Muscular Direct-to-Implant Immediate Breast Reconstruction in Previously Irradiated Patients Avoiding the Use of ADM: A Preliminary Study
title_sort sub-muscular direct-to-implant immediate breast reconstruction in previously irradiated patients avoiding the use of adm: a preliminary study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9573151/
https://www.ncbi.nlm.nih.gov/pubmed/36233723
http://dx.doi.org/10.3390/jcm11195856
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