Skin-Sparing Mastectomy and Immediate Breast Reconstruction by Use of Implants: An Assessment of Risk Factors for Complications and Cancer Control in 120 Patients

Woerdeman, Leonie A. E.; Hage, J. Joris; Smeulders, M.J.C.; Rutgers, Emiel J. T.; Horst, Chantal M.A.M. van der

doi:10.1097/01.prs.0000234049.91710.ba

Cited by 80 publications

(60 citation statements)

References 32 publications

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“…If a drain is hastily removed before drainage decreases adequately, seroma can occur [7,11,15,16]. Few studies have reported the exact removal time of the drain postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Amount of Drainage in 3 Acellular Dermal Matrices in Implant-Based Breast Reconstruction: A Retrospective Study

Kim

2017

Arch Aesthetic Plast Surg

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Background Acellular dermal matrix (ADM)-assisted breast reconstruction has gained popularity because it has several advantages. Some studies have reported that the use of ADM was strongly associated with postoperative complications, especially seroma formation. We performed direct-to-implant breast reconstruction using 3 types of human allograft products (CGDerm . The purpose of this study was to obtain information useful for the selection of an ADM product by comparing the amount of collected serum and the maintenance period of the drain. Methods Seventy-three patients with breast cancer who underwent ADM-assisted implant breast reconstruction between March 2011 and January 2016 were included in this study. The patients were divided into 3 groups based on the type of ADM that was used. The demographic characteristics collected were: age, body mass index (BMI), breast reconstruction location, smoking history, axillary dissection, comorbidities (such as hypertension and diabetes mellitus [DM]), breast implant size, breast implant type, amount of ADM, the total amount of serum that was collected in the drain, and the maintenance period of the drain. Results We obtained significant results after adjusting for variables including age, BMI, DM, axillary dissection, ADM amount, and breast implant size. Compared to AlloDerm, MegaDerm showed a significantly smaller amount of total drained serum and a significantly shorter drain maintenance period. Conclusions The use of MegaDerm led to smaller amounts of drained serum and a shorter drain maintenance period than when AlloDerm was used. In contrast, no significant differences were found between CGDerm and AlloDerm, or between CGDerm and MegaDerm.

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“…If a drain is hastily removed before drainage decreases adequately, seroma can occur [7,11,15,16]. Few studies have reported the exact removal time of the drain postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Amount of Drainage in 3 Acellular Dermal Matrices in Implant-Based Breast Reconstruction: A Retrospective Study

Kim

2017

Arch Aesthetic Plast Surg

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“…The study recommended particular caution in obese patients who smoke (32% loss of implant) and in large breasted women (27% loss of implant) [29]. In a separate study, the same authors found patient age and experience of the operating surgeon to be associated with a greater risk of post-operative complications [30].…”

Section: Prosthetic Implantsmentioning

confidence: 98%

Skin-Sparing Mastectomy and Breast Reconstruction: An Update for Clinical Practice

Kasem¹,

Choy²,

Mokbel³

2014

JCT

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Aim: To provide an up-to-date review of the literature on skin-sparing mastectomy (SSM) for breast cancer (BC). The article also reviews the oncological safety, effects of radiotherapy (RT) on immediate breast reconstruction (IBR), the indications for preserving the nipple-areola complex (NAC) and the emerging role of allogenic grafts as adjuncts to implant in IBR. Methods: Review of the English literature from 1965 to 2013 was carried out using Medline and PubMed research engines. Results: SSM is oncologically safe in appropriately selected cases of invasive breast cancer (IBC) and ductal carcinoma in-situ (DCIS) including IBC < 5 cm, multi-centric tumours, DCIS and for risk-reduction surgery. Inflammatory breast cancer and tumours with extensive skin involvement represent contra-indications to SSM due to an unacceptable risk of local recurrence. Prior breast irradiation or the need for post-mastectomy radiotherapy (PMRT) do not preclude SSM with IBR, however the aesthetic outcome may be compromised by radiation. Preservation of the nippleareola complex (NAC) has aesthetic and psychological benefits and is safe for peripherally located node negative unifocal tumours. An intraoperative frozen section protocol for the retro-areolar tissue should be performed when NAC preservation is considered. The advent of acellular dermal matrix has enhanced the scope of implant-based immediate reconstruction following SSM. Cell-assisted fat transfer is emerging as a promising technique to optimise the aesthetics outcome. There is no sufficient evidence to support the role of endoscopic mastectomy in clinical practice. Conclusion: Numerous retrospective and prospective studies show that SSM is oncolgically safe in appropriately selected cases and is aesthetically superior to non-SSM mastectomy. New techniques such as the use of acellular dermal matrix (ADM) and cell-assisted fat transfer have increased the use of implants for volume replacement following SSM. In the absence of randomized clinical trials, an updated systematic meta-analysis of published studies is required in order to consolidate the evidence.

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“…Patients with evidence of direct nipple involvement of tumor, Paget's disease, inflammatory breast cancer, tumor size > 3 cm, or tumor < 2 cm from nipple center may not be suitable candidates for NASM because of an increased risk of local tumor recurrence (Brachtel et al, 2009;Cunnick & Mokbel, 2006). Following NASM, the quality of the preserved skin is an important consideration for direct-to-implant reconstruction because extremely thin skin or compromised skin increases the risk of ischemia and skin necrosis which can eventually lead to implant loss (Woerdeman et al, 2006). Moreover, patients with preoperative macromastia or breast ptosis who undergo direct-to-implant reconstruction are at increased risk of perioperative complications and revisionary surgery (Roostaeian et al, 2011).…”

Section: Review Of Experiencementioning

confidence: 99%

Acellular Dermal Matrix for Optimizing Outcomes in Implant-Based Breast Reconstruction: Primary and Revisionary Procedures

Israeli¹

2012

Selected Topics in Plastic Reconstructive Surgery

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Skin-Sparing Mastectomy and Immediate Breast Reconstruction by Use of Implants: An Assessment of Risk Factors for Complications and Cancer Control in 120 Patients

Cited by 80 publications

References 32 publications

Comparison of the Amount of Drainage in 3 Acellular Dermal Matrices in Implant-Based Breast Reconstruction: A Retrospective Study

Comparison of the Amount of Drainage in 3 Acellular Dermal Matrices in Implant-Based Breast Reconstruction: A Retrospective Study

Skin-Sparing Mastectomy and Breast Reconstruction: An Update for Clinical Practice

Acellular Dermal Matrix for Optimizing Outcomes in Implant-Based Breast Reconstruction: Primary and Revisionary Procedures

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