Revisions in Implant-Based Breast Reconstruction: How Does Direct-to-Implant Measure Up?

Clarke-Pearson, Emily M.; Lin, A. T.; Hertl, Catherine; Austen, William G.; Colwell, Amy S.

doi:10.1097/prs.0000000000002173

Cited by 59 publications

(46 citation statements)

References 21 publications

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“…Indeed, similar findings have been seen in some previous studies (e.g. [27,28]). In brief, the scientific evidence for the hypothesis that meshes give a lower capsular frequency is still weak and not supported by our study.…”

Section: Discussionsupporting

confidence: 92%

Complications, long-term outcome and quality of life following Surgisis® and muscle-covered implants in immediate breast reconstruction: a case-control study with a 6-year follow-up

et al. 2018

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Background Matrices are now commonly used in breast reconstruction, but the scientific evidence is still scares. The main aim was to compare complications and the need for corrections in immediate breast reconstruction with the porcine-derived Surgisis ® with the traditional muscle-covered technique. The secondary aim was to compare long-term quality of life and satisfaction. Methods All consecutive patients who had their breast reconstructed with a Surgisis ® or muscle-covered tissue expander/implant were included. Patients were followed clinically and with BREAST-Q. Results During the study period, 116 reconstructions (71 patients) were operated in the Surgisis ® group and 132 reconstructions (90 patients) in the control group. The median follow-up time was 74 months (min 43-max 162). The total early complication rate was 37% in the Surgisis ® group and 27% in the control group. There were no differences in implant loss (p = 0.68) or total number of complications (p = 0.24) between the two groups. Risk factors for complications were mainly patient characteristics and the use of a tissue expander. There was a slightly higher capsular contracture frequency in the Surgisis ® patients (4.2% vs. 2.5%). The need for corrections and patient satisfaction and quality of life were similar in the two groups. Conclusions The use of Surgisis ® in implant-based reconstruction seems to result in an acceptable total early complication rate. The rate might be higher in tissue expander-based reconstruction. Risk factors are mainly patient characteristics. The capsular contracture rate and need for corrections, as well as patient satisfaction and quality of life, are similar in the Surgisis ® patients and muscle-covered controls. Level of evidence: III

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Section: Discussionsupporting

confidence: 92%

Complications, long-term outcome and quality of life following Surgisis® and muscle-covered implants in immediate breast reconstruction: a case-control study with a 6-year follow-up

et al. 2018

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“…It is possible to place the implant in either the dual plane under the pectoralis superiorly and supported inferiorly by an ADM sling or in the subcutaneous plane. 47,50,51 A known requirement for postmastectomy radiation therapy is a relative contraindication for single-stage breast reconstruction, regardless of the plane; therefore, there are very few studies commenting on radiation in direct-to-implant reconstruction. Using a twostage approach is thought to be safer and allows additional opportunities to thwart radiation-related capsular contracture and malposition, by overexpanding or adjunctive techniques performed at the time of the implant exchange.…”

Section: Radiation In Direct-to-implant Reconstructionmentioning

confidence: 99%

“…50 Clarke-Pearson et al found that radiation was predictive of capsular contracture and reoperation for revision in single-stage reconstructions. 51 If the requirement for postmastectomy radiation therapy is known preoperatively or highly suspected, reconstruction should be performed using two stages to optimize aesthetic results and minimize complications.…”

Section: Radiation In Direct-to-implant Reconstructionmentioning

confidence: 99%

Breast Implants and Radiation

Mericli

Sharabi

2019

Seminars in Plastic Surgery

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One of the most influential factors in the success of breast reconstruction is whether or not radiation therapy has or will be performed. While traditional teaching is that all breasts treated with radiation therapy must be reconstructed with an autologous component, many reconstructive surgeons perform implant-based breast reconstruction without an autologous component and have success doing so. The purpose of this article is to explore the risks, benefits, and nuances of performing implant-based breast reconstruction in the setting of radiation therapy. The authors performed a review of the literature of all topics relevant to performing implant-based reconstruction with radiation therapy.

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“…The difference in revision rates between the prophylactic breast and the diseased breast was no longer significant when adjusting for all confounding variables in the penalized regression model. Nevertheless, the revision rates of this study compare favorably with previously published revision rates for immediate implant-based reconstruction [57,85]. In addition to overall postoperative outcomes, we were also interested in determining whether certain outcomes were influenced by specific treatments or risk factors.…”

Section: Discussionmentioning

confidence: 58%

“…For example, if a patient underwent lumpectomy with sentinel lymph node biopsy and then proceeded with a completion mastectomy, we included them in the sentinel lymph node biopsy group. Mastectomies and reconstructions were performed as previously described by our group [53][54][55][56][57]. Evaluation of the post-mastectomy flap thickness, skin color, and capillary refill was coupled with patient risk factors and the surgeon experience to determine final candidacy for the type of mastectomy and reconstruction.…”

Section: Data Collectionmentioning

confidence: 99%

Assessing the additional surgical risk of contralateral prophylactic mastectomy and immediate breast implant reconstruction

Nealon

Sobti

Gadd

et al. 2019

Breast Cancer Res Treat

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Introduction There has been a sharp rise in the rate of contralateral prophylactic mastectomy over the last decade, despite the low incidence of new primary cancers predicted for the contralateral breast. This study compares the postoperative complication rates between the diseased breast treated with mastectomy and the contralateral breast that underwent prophylactic mastectomy, followed by immediate bilateral breast implant reconstruction. We hypothesized that there will be no difference in postoperative outcomes between prophylactic and diseased groups, as the surgical approach would be comparable. Methods After IRB approval, a retrospective chart review identified consecutive unilateral breast cancer patients who underwent bilateral mastectomy and immediate breast reconstruction between May 2008 and May 2018 at a tertiary academic medical center. A paired sample t-test and a penalized logic regression model were constructed to identify relationships between breast laterality and outcomes. Results A total of 1117 patients with unilateral breast cancer who underwent bilateral mastectomy and immediate breast implant reconstruction were identified. Rates of capsular contracture and infection were significantly greater in the diseased breast, while rates of revision were significantly greater in the contralateral prophylactic breast. There were no statistically significant differences between breasts in rates of explant, skin flap necrosis or hematoma. When adjusted for confounding variables, a higher infection rate was observed in the diseased breast. Conclusion This study detected significant differences in postoperative complication rates between the diseased and prophylactic breasts following bilateral mastectomy and immediate breast implant reconstruction. Postoperative complications occurred more frequently in the diseased breast compared with low rates of complications in the contralateral prophylactic breast. This information is helpful for preoperative decision making, as surgeons and patients carefully weigh the additional risks of contralateral prophylactic procedure.

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Revisions in Implant-Based Breast Reconstruction: How Does Direct-to-Implant Measure Up?

Abstract: Therapeutic, III.

Cited by 59 publications

References 21 publications

Complications, long-term outcome and quality of life following Surgisis® and muscle-covered implants in immediate breast reconstruction: a case-control study with a 6-year follow-up

Complications, long-term outcome and quality of life following Surgisis® and muscle-covered implants in immediate breast reconstruction: a case-control study with a 6-year follow-up

Breast Implants and Radiation

Assessing the additional surgical risk of contralateral prophylactic mastectomy and immediate breast implant reconstruction

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