Reconstruction of the breast by tissue expansion

Argenta, Luiz Carlos; Pap, George S.

doi:10.1097/00006534-198508000-00058

Cited by 8 publications

(9 citation statements)

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“…1–3 Advantages of implant-based breast reconstruction compared to autologous breast reconstruction include shorter procedure time, decreased length of hospital stay, and quicker overall recovery. 4–5 However, the risk of surgical site infection (SSI) is a major concern as it can lead to reconstructive failure, ultimately requiring removal of the breast TE or implant. 6 …”

Section: Introductionmentioning

confidence: 99%

Late Surgical-Site Infection in Immediate Implant-Based Breast Reconstruction

Sinha

Pusic

Wilkins

et al. 2017

Plastic &Amp; Reconstructive Surgery

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Introduction Surgical site infection (SSI) can cause devastating reconstructive failure in implant-based breast reconstructions. Many large national database studies have offered insights into complication rates, but only capture early outcomes within 30-days post-operatively. This study evaluates both early and late SSI in immediate implant-based reconstruction and identifies predictors. Methods As part of the Mastectomy Reconstruction Outcomes Consortium Study (MROC), 1662 implant-based breast reconstructions in 1024 patients were evaluated for early vs. late SSI. Early SSI was defined as infection occurring within 30 days post-operatively and late SSI as infection occurring 31 days to 1 year. Minor infection required oral antibiotics only, and major infection required hospitalization and/or surgical treatment. Direct-to-implant (DTI) patients had one-year follow-up, and tissue-expander (TE) patients had one-year post-exchange follow-up. Results Among 1491 TE and 171 DTI reconstructions, overall SSI rate for TE was 5.7% (85/1491) after first-stage, 2.5% (31/1266) after second-stage, and 9.9% (17/171) for DTI. Over 47–71% of SSI complications occurred as late SSI. Multivariate analysis identified radiotherapy and BMI as significant predictors of late SSI. No significant difference between DTI and TE group in the occurrence of early, late, or overall SSI was found. Conclusions The majority of SSI complications in immediate implant-based breast reconstructions are late infections occurring more than 30 days following both first-stage and second-stage procedures. Radiotherapy and obesity are significantly associated with late-onset SSI. Current studies limited to early complications do not present an accurate or complete assessment of infection complications associated with implant-based breast reconstructions or their long-term clinical outcomes.

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Section: Introductionmentioning

confidence: 99%

Late Surgical-Site Infection in Immediate Implant-Based Breast Reconstruction

Sinha

Pusic

Wilkins

et al. 2017

Plastic &Amp; Reconstructive Surgery

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“…1 Using an air-filled rubber balloon implanted subcutaneously in the temporal region and inflated from outside the body, he reconstructed an ear after traumatic ablation. But the method was not widely accepted until the 1970s when Radovan 2 and Argenta 3 improved the technique. The device-now a silicone balloon gradually inflated by a saline solution via a subcutaneously located filling port (Fig.…”

Section: Introductionmentioning

confidence: 99%

Biomaterial properties and biocompatibility in cell culture of a novel self-inflating hydrogel tissue expander

Wiese¹,

Heinemann²,

Ostermeier

et al. 2000

J. Biomed. Mater. Res.

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The aim of this study was to investigate the swelling properties and the biocompatibility of a novel tissue expander material. The self-inflating material is a hydrogel consisting of a modified copolymer of methylmethacrylate and N-vinyl-2-pyrrolidone, which takes up water by osmosis. To increase the swelling volume, the primarily neutral gel material was modified by converting it into an ionized gel. To study the swelling and pressure behavior of the material, the anhydrous gel cylinders were equilibrated in distilled water, saline, and sugar solutions. The biocompatibility was investigated in cell culture. We tested the hydrogel eluate after swelling for cytotoxicity and mutagenicity using the cell lines MRC-5 and P3X63 Ag8 653 (Ag8). Furthermore, particles of the material were added to cell cultures to induce foreign body reactions and to verify its influence on monocyte differentiation. The material has a swelling capacity (Q = maximum swelling volume/anhydrous volume) of 5 to 50 depending on the degree of ionization of the polymer network. In this study, two polymer modifications with a swelling equilibrium of Q = 11.1 and 30 in water were tested. The swelling ratio also depends on concentration and ion content of the equilibration medium. The highest swelling capacity was found in water, the lowest in Ringer's solution. The swelling of the anhydrous material with the swelling capacity of Q = 11.1 fits best the average purpose of material properties for tissue expansion and generates a maximal hydrostatic pressure of approximately 235 mmHg. Effects on cell proliferation were detected only at the highest eluate concentration tested (i.e., eluate: culture medium = 1:1), which was far beyond physiological values, whereas mutagenicity was absent. Monocytes neither migrated nor tightly attached to the hydrogel. They neither phagocytose the material nor did they show any sign of a foreign body reaction, e.g., formation of multinucleated giant cells or monocyte proliferation. In the presence of hydrogel material, the differentiation processes of monocytes to macrophages or dendritic cells, respectively, were found to be undisturbed. From these results, we conclude that there is a high biocompatibility of the expander material, which may be a favorable and interesting candidate for further clinical applications.

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“…Since then, the technique has greatly improved with the introduction of double-lumen expanders [2][3][4][5][6] and, later, differential expanders with an integrated valve and anatomic prosthesis. [7][8][9] To avoid expander extrusion, the expander should be placed in a submuscular position.…”

mentioning

confidence: 99%

Mammary Reconstruction Using Tissue Expander and Partial Detachment of the Pectoralis Major Muscle to Expand the Lower Breast Quadrants

Serra-Renom

Fontdevila

Monner

et al. 2004

Annals of Plastic Surgery

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The techniques commonly used in breast reconstruction with tissue expanders do not provide a good definition of the lower breast quadrant. With the authors technique a better profile of the breast is achieved. Partial detachment of the pectoral muscle is performed, suturing it to the lower skin flap and thereby avoiding cranial migration of the expander. In addition a rounded shape of the lower quadrants is achieved and the expander remains in a subcutaneous position.

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Reconstruction of the breast by tissue expansion

Cited by 8 publications

References 0 publications

Late Surgical-Site Infection in Immediate Implant-Based Breast Reconstruction

Late Surgical-Site Infection in Immediate Implant-Based Breast Reconstruction

Biomaterial properties and biocompatibility in cell culture of a novel self-inflating hydrogel tissue expander

Mammary Reconstruction Using Tissue Expander and Partial Detachment of the Pectoralis Major Muscle to Expand the Lower Breast Quadrants

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