Update in Direct-to-Implant Breast Reconstruction

Perdanasari, Aurelia Trisliana; Abu‐Ghname, Amjed; Raj, Sarth; Winocour, Sebastian; Largo, René D.

doi:10.1055/s-0039-1697028

Cited by 12 publications

(15 citation statements)

References 40 publications

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“…Moreover, there is no need for a secondary procedure, decreasing potential surgical morbidity. Patient and implant selection is of paramount importance; patients with small to moderate breast size and mild ptosis (I or II degree) are the most suitable candidates for this technique, that relies on good thickness and viability of the mastectomy flap to avoid further complications [ 23 ]. Naoum et al analyzed in depth the effects of postmastectomy radiotherapy (PMRT) on three different breast reconstruction approaches (DTI, tissue expander and implant, and autologous), including more than 1800 breast reconstructions over a 20-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

Sub-Muscular Direct-to-Implant Immediate Breast Reconstruction in Previously Irradiated Patients Avoiding the Use of ADM: A Preliminary Study

Pacchioni¹,

Sapino

Lusetti³

et al. 2022

JCM

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Background: The aim of this paper is to present a preliminary experience of sub-muscular primary direct-to-implant (DTI) breast reconstruction without acellular dermal matrix (ADM), after salvage mastectomy for local recurrence following prior irradiation. Methods: A retrospective investigation was performed on a prospectively maintained database of breast reconstruction cases at our institution between January 2015 and December 2020. We considered only immediate DTI breast reconstructions without ADM following radiotherapy and salvage mastectomy for local recurrence, with at least a 12-month follow-up. Results: The study considered 18 female patients with an average of 68 years. According to the BREAST-Q questionnaire, all patients reported high levels of “satisfaction with outcome” with good “psychosocial wellness” and “physical impact” related to the reconstruction. The aesthetic evaluation showed a significant difference between the VAS score gave by the patient (mean 6.9) and the surgeon (mean 5.4). No implant exposure occurred in this series. In terms of complications, four patients (22%) suffered from wound dehiscence and were managed conservatively. Three patients (17%) required primary closure in day surgery following superficial mastectomy flap necrosis. Late capsular contracture was seen in seven patients (four Baker stage II and three Baker stage III, totally 39%); however, no patient was willing to undergo implant exchange. Conclusions: DTI breast reconstruction following prior irradiation can be considered as an option in patients who are not good candidates for autologous breast reconstruction. Our general outcomes compared favorably with literature data regarding the use of staged procedures, with acceptable complication rates and levels of patient satisfaction.

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Section: Discussionmentioning

confidence: 99%

Sub-Muscular Direct-to-Implant Immediate Breast Reconstruction in Previously Irradiated Patients Avoiding the Use of ADM: A Preliminary Study

Pacchioni¹,

Sapino

Lusetti³

et al. 2022

JCM

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“…NSM with prepectoral DTIR using cohesive implants and acellular dermal matrix can provide patients with excellent aesthetic results in a single outpatient surgery. 2 This relies on preservation of the skin envelope and nipple, if oncologically safe. Unfortunately, surgeons still encounter patients with extensive disease that requires sacrifice of significant skin and the nipple, even if the NAC is distant from the cancer and can be salvaged.…”

Section: Discussionmentioning

confidence: 99%

“…The preservation of skin facilitates direct-to-implant reconstruction (DTIR). 2 DTIR coupled with prepectoral implant placement has allowed many women to undergo a single outpatient surgery with definitive reconstruction without the need for additional surgery. 3 This approach is often not possible in women with more advanced cancers that require extensive skin resection.…”

Section: Introductionmentioning

confidence: 99%

Immediate Skin Replacement Allows for Nipple-sparing, Direct-to-implant Reconstruction in Patients with Advanced Breast Cancers

Schwartz

Binstock

2022

Plastic and Reconstructive Surgery - Global Open

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Summary: Mastectomy has evolved from approaches that involved extensive skin resection to nipple-sparing mastectomy (NSM). However, patients with advanced breast cancers who require extensive skin resection usually also have their nipple areola complexes (NACs) removed, even if they are distant from the cancer. Implant reconstruction in these patients is challenging as they require tissue expansion and, typically, radiotherapy with additional surgeries to complete their reconstruction. The aesthetic results of this approach are inferior to NSM and direct-to-implant reconstruction. In patients who require significant skin resection but whose NACs are free of tumor, we have found that immediate skin replacement using a muscle-sparing latissimus dorsi flap allows for NSM and direct-to-implant reconstruction, obviating the need for tissue expansion, delayed implant placement, and NAC reconstruction. Here, we report on 12 patients in whom this approach is utilized.

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“…Patients who had immediate tissue expander placement followed by permanent implant exchange were included, while those who had delayed tissue expander placement, direct-to-implant reconstruction, or delayed-immediate reconstruction were excluded. 20…”

Section: Methodsmentioning

confidence: 99%

Development and Assessment of Machine Learning Models for Individualized Risk Assessment of Mastectomy Skin Flap Necrosis

et al. 2022

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Objective: To develop, validate, and evaluate ML algorithms for predicting MSFN. Background: MSFN is a devastating complication that causes significant distress to patients and physicians by prolonging recovery time, compromising surgical outcomes, and delaying adjuvant therapy. Methods: We conducted comprehensive review of all consecutive patients who underwent mastectomy and immediate implant-based reconstruction from January 2018 to December 2019. Nine supervised ML algorithms were developed to predict MSFN. Patient data were partitioned into training (80%) and testing (20%) sets. Results: We identified 694 mastectomies with immediate implant-based reconstruction in 481 patients. The patients had a mean age of 50 ± 11.5 years, years, a mean body mass index of 26.7 ± 4.8 kg/m 2 , and a median follow-up time of 16.1 (range, 11.9-23.2) months. MSFN developed in 6% (n = 40) of patients. The random forest model demonstrated the best discriminatory performance (area under curve, 0.70), achieved a mean accuracy of 89% (95% confidence interval, 83-94), and identified 10 predictors of MSFN. Decision curve analysis demonstrated that ML models have a superior net benefit regardless of the probability threshold. Higher body mass index, older age, hypertension, subpectoral device placement, nipple-sparing mastectomy, axillary nodal dissection, and no acellular dermal matrix use were all independently associated with a higher risk of MSFN. Conclusions: ML algorithms trained on readily available perioperative clinical data can accurately predict the occurrence of MSFN and aid in individualized patient counseling, preoperative optimization, and surgical planning to reduce the risk of this devastating complication.

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Update in Direct-to-Implant Breast Reconstruction

Cited by 12 publications

References 40 publications

Sub-Muscular Direct-to-Implant Immediate Breast Reconstruction in Previously Irradiated Patients Avoiding the Use of ADM: A Preliminary Study

Sub-Muscular Direct-to-Implant Immediate Breast Reconstruction in Previously Irradiated Patients Avoiding the Use of ADM: A Preliminary Study

Immediate Skin Replacement Allows for Nipple-sparing, Direct-to-implant Reconstruction in Patients with Advanced Breast Cancers

Development and Assessment of Machine Learning Models for Individualized Risk Assessment of Mastectomy Skin Flap Necrosis

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