Polyurethane Implants in 2-Stage Breast Reconstruction: 9-Year Clinical Experience

S, Pompei; Arelli, Floriana; Labardi, Lara; Marcasciano, Fabio; Evangelidou, Dora; Ferrante, Gianluigi

doi:10.1093/asj/sjw183

Cited by 27 publications

(14 citation statements)

References 38 publications

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“…Textured implants used were from Allergan (Natrelle™ 410, Allergan, Inc., Irvine, California) and Silimed (NUANCE 20646, Silimed, Rio de Janeiro, Brazil), and PU covered implants were from Polytech (Microthane®, POLYTECH Health & Aesthetics, Dieburg, Germany). PU implants were more intensively used since 2016, when it was reported an advantage performing breast reconstruction with PU implant [32,35,36].…”

Section: Surgical Techniquementioning

confidence: 99%

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Immediate Breast Reconstruction after mastectomy with polyurethane implants versus textured implants: A retrospective study with focus on capsular contracture

et al. 2020

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Background: Capsular contracture (CC) is the most common complication following Immediate Breast Reconstruction (IBR) with breast implants. Different implant surfaces were developed aiming to reduce the incidence of CC. We evaluated the incidence and degree of CC after Direct-to-Implant (DTI) IBR with insertion of textured (TE) or polyurethane (PU) covered implants. Methods: A retrospective review of consecutive patients treated at our Institution with mastectomy and one-stage IBR and implant reconstruction between 2013 and 2018, with or without post mastectomy radiation therapy (PMRT), was conducted. Immediate breast reconstruction was performed by implanting 186 PU covered implants and 172 TE implants. Results: Three-hundred-twelve women underwent 358 DTI IBR with PU or TE implants, were analyzed with a median follow-up time of 2.3 years (range 1.0e3.0). The overall rate of CC Baker grade III and IV was 11.8% (95%CI: 8.4e16.3), while, after PU and TE implant placement it was 8.1% (95% CI: 4.1e15.7) and 15.8% (95% CI: 4.1e15.7) [p ¼ 0.009]), respectively. Irradiated breasts developed CC more frequently rather than non-irradiated breasts (HR ¼ 12.5, p < 0.001), and the relative risk was higher in the TE group compared with the PU group (HR ¼ 0.3, p ¼ 0.003). Conclusions: After mastectomy and one-stage IBR, the use of PU covered implants is associated with a lower incidence of CC compared to TE implants. This advantage is amplified several folds for patients who necessitate PMRT. Footnote: Capsular contracture (CC); Immediate Breast Reconstruction (IBR); Directto-Implant (DTI); Textured (TE); Polyurethane (PU); Post mastectomy radiation therapy (PMRT); Nipple Sparing mastectomy (NSM).

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Section: Surgical Techniquementioning

confidence: 99%

“…Thereafter, textured (TE) surfaces have been developed to mimic the shape and the benefits of the PU foam, and several studies have indicated that PU implants have a lower incidence of CC [17,26e36]. Furthermore, two studies have suggested that PU implants are associated with a lower incidence of CC in case PMRT is delivered [32,35].…”

Section: Introductionmentioning

confidence: 99%

Immediate Breast Reconstruction after mastectomy with polyurethane implants versus textured implants: A retrospective study with focus on capsular contracture

et al. 2020

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“…Support for use of polyurethane implants for breast reconstruction in the setting of radiotherapy is based on level IV evidence only at the present time. However, reports show a trend towards lower rates of complications using polyurethane compared with silicone implants after radiotherapy. The role of fat grafting as an adjunct in breast reconstruction in either previously irradiated patients or those having PMRT, remains contentious and is based on case series showing favourable outcomes using fat grafting before the second stage of an implant‐based reconstruction.…”

Section: Resultsmentioning

confidence: 98%

International multidisciplinary expert panel consensus on breast reconstruction and radiotherapy

Nava

Benson

Audretsch

et al. 2019

British Journal of Surgery

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Background Conflicting evidence challenges clinical decision‐making when breast reconstruction is considered in the context of radiotherapy. Current literature was evaluated and key statements on topical issues were generated and discussed by an expert panel at the International Oncoplastic Breast Surgery Meeting in Milan 2017. Methods Studies on radiotherapy and breast reconstruction (1985 to September 2017) were screened using MEDLINE, Embase and CENTRAL. The literature review yielded 30 controversial key questions. A set of key statements was derived and the highest levels of clinical evidence (LoE) for each of these were summarized. Nineteen panellists convened for dedicated discussions at the International Oncoplastic Breast Surgery Meeting to express agreement, disagreement or abstention for the generated key statements. Results The literature review identified 1522 peer‐reviewed publications. A list of 22 key statements was produced, with the highest LoE recorded for each statement. These ranged from II to IV, with most statements (11 of 22, 50 per cent) supported by LoE III. There was full consensus for nine (41 per cent) of the 22 key statements, and more than 75 per cent agreement was reached for half (11 of 22). Conclusion Poor evidence exists on which to base patient‐informed consent. Low‐quality studies are conflicting with wide‐ranging treatment options, precluding expert consensus regarding optimal type and timing of breast reconstruction in the context of radiotherapy. There is a need for high‐quality evidence from prospective registries and randomized trials in this field.

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“…Deflation-lipofilling sessions are conducted to prevent complications during the reconstructive step, limiting the onset of postoperative complications. As other authors promote the use of polyurethane implants as a first step in breast reconstruction to reduce complication rates [40,41] and not only as a rescue tool after a failure, in the same way, the present study investigated the beneficial effect of fat grafting as a part of the standard two-stage breast implant reconstruction for all postmastectomy patients in order to reduce overall capsular contracture and improve the esthetic result. This is the first report of 84 patients, a case-control study, with a mean follow-up time of 34.87 months.…”

Section: Discussionmentioning

confidence: 99%

Long-term impact of lipofilling in hybrid breast reconstruction: retrospective analysis of two cohorts

et al. 2019

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Lipofilling has recently gained popularity as a tool in primary treatment of breast cancer, and its association with two-stage implant breast reconstruction is considered as standard treatment in many centers. However, no data are available about the longterm results of the association of lipofilling in combination with expander-implant reconstruction. A retrospective analysis was conducted on patients treated between January 2010 and December 2014. Two groups were compared. Group 1 had a standard expander-implant two-stage reconstruction. Group 2 underwent hybrid breast reconstruction (HBR). Patient characteristics, hospitalization, outcomes, reoperation details, outpatient visits, and evaluation questionnaires were taken into consideration. Intergroup comparison was performed using Wilcoxon Mann-Whitney U test and Pearson's chi-square test or Fisher's exact test for categorical variables. Two hundred fourteen patients were evaluated: 130 patients in group 1 and 84 patients in group 2. Group 2 showed significant benefits over group 1 in terms of capsular contracture rate, breast pain, and displacement/rotation of the implant (p = 0.005). The HBR protocol is associated with lower rate of capsular contracture, less breast pain at long follow-up times, and lower overall rates of revision surgery compared to standard expander-implant reconstruction. A specific cost analysis will help further clarify the advantages of this protocol over a standard procedure. Level of Evidence: Level III, risk/prognostic, therapeutic study.

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Polyurethane Implants in 2-Stage Breast Reconstruction: 9-Year Clinical Experience

Abstract: Radiation therapy increases the risk of high-grade CC with textured or smooth implants. PU implants are associated with a much lower cumulative incidence of CC following 2-stage breast reconstruction, even when radiotherapy is performed. LEVEL OF EVIDENCE 3.

Cited by 27 publications

References 38 publications

Immediate Breast Reconstruction after mastectomy with polyurethane implants versus textured implants: A retrospective study with focus on capsular contracture

Immediate Breast Reconstruction after mastectomy with polyurethane implants versus textured implants: A retrospective study with focus on capsular contracture

International multidisciplinary expert panel consensus on breast reconstruction and radiotherapy

Long-term impact of lipofilling in hybrid breast reconstruction: retrospective analysis of two cohorts

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