Patient Selection and Technical Considerations in Nipple-Sparing and Areola-Sparing Mastectomy

Dieterich, M.; Gerber, Bernd

doi:10.1007/s12609-011-0039-3

Cited by 10 publications

(5 citation statements)

References 63 publications

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“…With the improvement of surgical techniques and enhanced implant technology implantbased BR experiences new importance [1]. The invention of new materials like acellular dermal matrix (ADM) and the new titanium-coated polypropylene mesh (TCPM; Ti-LOOP Ò Bra, pfm medical, Cologne, Germany) gives breast surgeons and patients new perspectives [2]. Disadvantages and difficulties of a subpectoral placement of the implant can be resolved through the use of supporting and covering materials like ADM or TCPM.…”

Section: Introductionmentioning

confidence: 99%

Using a titanium-coated polypropylene mesh (TiLOOP® Bra) for implant-based breast reconstruction: case report and histological analysis

Dieterich

Dieterich²,

Timme

et al. 2012

Arch Gynecol Obstet

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Section: Introductionmentioning

confidence: 99%

Using a titanium-coated polypropylene mesh (TiLOOP® Bra) for implant-based breast reconstruction: case report and histological analysis

Dieterich

Dieterich²,

Timme

et al. 2012

Arch Gynecol Obstet

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“…In addition to the fear of this life-changing diagnosis, women are concerned about disfiguring surgical procedures. Although it is possible to treat 70 % of all BC patients with breast conserving surgery (BCS), mastectomy is indicated in the remaining 30 % of patients [2]. To overcome the psychosocial and emotional distress after mastectomy, immediate breast reconstruction (IBR) can be offered to affected patients.…”

mentioning

confidence: 99%

Patient-Reported Outcomes in Implant-Based Breast Reconstruction Alone or in Combination with a Titanium-Coated Polypropylene Mesh – A Detailed Analysis of the BREAST-Q and Overview of the Literature

Dieterich

Stubert

et al. 2015

Geburtshilfe Frauenheilkd

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Background: Complication rates and surgical outcomes are well reported for implant-based breast reconstruction (IBBR) using supportive materials for the inferior pole of the breast. Patient-reported outcomes (PRO) are underrepresented. The aim of this study was to compare PRO in IBBR using implants alone or in combination with a synthetic mesh. Methods and Methods: PRO was measured in patients undergoing IBBR alone or in combination with a titanium-covered polypropylene mesh (Ti-LOOP ® Bra). In this non-randomized observational trial PRO was retrospectively assessed using the validated self-reporting BREAST-Q. The raw responses of all questions applied in each domain and transformed BREAST-Q data using the Q-Score are presented. Results: Of 90 eligible women, 42 received IBBR alone and 48 received IBBR in combination with mesh. No differences in complication rates were observed. The return rate was 67.7 % and was comparable between the groups (p = 0.117). PRO revealed no differences regarding satisfaction with breast shape (p = 0.079), outcome (p = 0.604), nipple sensitivity (p = 0.502), preoperative information (p = 0.195), office staff (p = 0.462), psychosocial well-being (p = 0.370), sexual well-being (p = 0.508) and physical wellbeing (p = 0.654). Significant differences were noted regarding satisfaction with the surgeon (p = 0.013) and medical staff (p = 0.035) as well as the response behavior of certain questions of the sub-domains, thus helping to further stratify PRO with regards to aesthetic outcome. However, no differences were observed in the main BREAST-Q results. Conclusion: Use of the TiLOOP ® Bra in IBBR results in comparable BREAST-Q scores compared with IBBR alone. Evaluating the BREAST-Q subdomains helps to stratify PRO more profoundly Zusammenfassung !

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“…Synthetic meshes are much thinner than biological matrices and not suitable for soft tissue replacement. They are useful in primary cases to define the inframammary fold, stabilize the implant laterally and prevent the implant from bottoming out [40]. Especially in secondary cases or revisionary breast surgery (aesthetic or reconstructive), the skin-soft tissue conditions are poor, compared to primary cases.…”

Section: Discussionmentioning

confidence: 99%

Biological Matrices and Synthetic Meshes Used in Implant-based Breast Reconstruction – a Review of Products Available in Germany

Dieterich

Faridi

2013

Geburtsh Frauenheilk

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Background !Since skin-and nipple-sparing mastectomies (SSM/NSM) have proven to be oncologically safe procedures, the number of immediate breast reconstruction (BR) procedures has substantially increased [1]. With SSM and NSM, the gland is completely removed and the skin envelope preserved, facilitating subsequent reconstruction. Historically, BR was performed in less than 25 % of all breast cancer (BC) patients [2]. Whilst autologous BR used to be the treatment of choice, the last decade has seen a shift from autologous BR towards implant-based breast reconstruction (IBBR), which is now used in 37 % of all BC patients in the USA [2]. As the number of autologous procedures has remained approximately the same, the increase in the number of immediate BR procedures can be primarily attributed to an increase in implant/expander reconstructions. Whether these data can be transferred to Germany is debatable, as the reimbursement systems in Germany differ from those in the US. The reimbursement of complex reconstructive procedures (pedicle and free flaps) is not the same in the US as in Germany, and these procedures are reimbursed proportionally less than IBBR, contributing to an increase in IBBR procedures [3]. Reasons for the increase in IBBR in Germany include increasing numbers of prophylactic contralateral mastectomies, improvements in the safety of silicone implants, a higher patient acceptance of silicone implants and the development of new surgical procedures and products for IBBR. Compared to autologous BR procedures, donor site morbidity has improved and the extent of surgery required and patient morbidity have decreased [4][5][6]. With the development of biological matrices and synthetic meshes, patients who were initially unsuited for, or who did not desire, autologous BR can now be offered implant-based reconstruction. In IBBR the implant is usually placed in a sub-pectoral pocket. The pectoral muscle serves as cover towards the maximal thinned out mastectomy flap. Implant coverage can often be achieved only Abstract ! While autologous breast reconstruction was considered the procedure of choice for immediate breast reconstruction, there has been a shift towards implant-based breast reconstruction (IBBR) in recent years. The proven safety of silicone breast implants and the development of biological matrices and synthetic meshes have contributed to the growing popularity of this approach. Although these different products are widely used, only limited clinical data are available with regard to breast surgery. The aim of this review was to give an overview of available biological matrices and synthetic meshes and discuss their use in clinical practice. Zusammenfassung

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Patient Selection and Technical Considerations in Nipple-Sparing and Areola-Sparing Mastectomy

Cited by 10 publications

References 63 publications

Using a titanium-coated polypropylene mesh (TiLOOP® Bra) for implant-based breast reconstruction: case report and histological analysis

Using a titanium-coated polypropylene mesh (TiLOOP® Bra) for implant-based breast reconstruction: case report and histological analysis

Patient-Reported Outcomes in Implant-Based Breast Reconstruction Alone or in Combination with a Titanium-Coated Polypropylene Mesh – A Detailed Analysis of the BREAST-Q and Overview of the Literature

Biological Matrices and Synthetic Meshes Used in Implant-based Breast Reconstruction – a Review of Products Available in Germany

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