Why Do We Need Anatomical Implants? the Science and Rationale for Maintaining Their Availability and Use in Breast Surgery

Montemurro, Paolo; Adams, William P.; Mallucci, Patrick; Vita, Roy De; Layt, Craig; Calobrace, M. Bradley; Brown, Mitchell H.; Nava, Maurizio; Teitelbaum, Steven; Yerro, Jose L. Martín del; Bengtson, Bradley P.; Maxwell, G. Patrick; Hedén, Per

doi:10.1007/s00266-019-01595-z

Cited by 15 publications

(11 citation statements)

References 43 publications

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“…Anatomical, textured implants had previously been favored for breast reconstruction because of the reported decreased risk of implant malrotation, malposition, and capsular contracture, although more recently this has been questioned. [31][32][33] An increasing body of evidence links highly textured devices with BIA-ALCL, and has led to the voluntary withdrawal and suspension of many implants from the market. 34,35 This has reduced the choices of textured implants available for breast reconstruction in Australia because of patient and surgeon anxiety regarding the risk of BIA-ALCL with textured implants.…”

Section: Discussionmentioning

confidence: 99%

Comparing direct-to-implant and two-stage breast reconstruction in the Australian Breast Device Registry

Hoque¹,

Zhou²,

Gartoulla³

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Breast cancer affects almost 20,000 Australians annually, 1 and the national average rate of breast reconstruction is 18.3%. 2 For women undergoing mastectomy, the positive effects of breast reconstruction after mastectomy are well established. 2 Prosthetic breast reconstruction is either twostage expander/implant reconstruction or single-stage direct-to-implant (DTI) reconstruction. The choice of reconstructive method continues to spark debate. Proponents of DTI argue that it Background: There remains a lack of clarity surrounding the benefits, risks, and outcomes between two-stage expander/implant reconstruction and singlestage direct-to-implant (DTI) reconstruction. This study used a national data set to examine real-world outcomes of two-stage and DTI reconstructions. Methods: A cohort study was conducted examining patients in the Australian Breast Device Registry (ABDR) from 2015 to 2018 who underwent prosthetic breast reconstruction following mastectomy. DTI and two-stage cohorts after definitive implant insertion were compared. Rate of revision surgery, reasons for revision, and patient-reported outcome measures were recorded. Statistical analysis was undertaken using Fisher exact or chi-square, Wilcoxon rank sum, or t tests; Nelson-Aalen cumulative incidence estimates; and Cox proportional hazards regression. Results: A total of 5152 breast reconstructions were recorded, including 3093 two-stage and 2059 DTI reconstructions. Overall revision surgery rates were 15.6% for DTI (median follow-up, 24.7 months), compared with 9.7% in the two-stage cohort (median follow-up, 26.5 months; P < 0.001). The most common reasons for revision for DTI and two-stage reconstruction were capsular contracture (25.2% versus 26.7%; P = 0.714) and implant malposition (26.7% versus 34.3%; P = 0.045). Multivariate analysis found acellular dermal matrix use (P = 0.028) was significantly associated with a higher risk of revision. The influence of radiotherapy on revision rates was unable to be studied. Patient satisfaction levels were similar between reconstructive groups; however, patient experience was better in the DTI cohort than in the two-stage cohort. Conclusions:The ABDR data set demonstrated that DTI reconstruction had a higher revision rate than two-stage, but with comparable patient satisfaction and better patient experience. Capsular contracture and device malposition were leading causes of revision in both cohorts.

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Section: Discussionmentioning

confidence: 99%

Comparing direct-to-implant and two-stage breast reconstruction in the Australian Breast Device Registry

Hoque¹,

Zhou²,

Gartoulla³

et al. 2022

Plastic &Amp; Reconstructive Surgery

View full text Add to dashboard Cite

show abstract

“…Although shaped implants have been available for nearly 30 years, their use and indications have been an area of polarizing opinions. 15 Surface texturing of breast implants was introduced to improve adherence and decrease malpositioning and CC rates. Whereas initial studies supported these effects, more recent data showed the association of double capsules, late seromas, and BIA-ALCL in proportion to the degree of texturing.…”

Section: Discussionmentioning

confidence: 99%

“…In our survey, we noticed a clear trend in surgeons opting for less aggressive textured surfaces as well as using a range of surface characteristics. 15…”

Section: Discussionmentioning

confidence: 99%

Modified Delphi technique to identify management of primary and secondary aesthetic breast augmentation. Will we reach a consensus?

Montemurro

Cheema²,

Hedén

2022

Plastic &Amp; Reconstructive Surgery

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Background: Breast augmentation is a common operation. Evidence has grown with experience and long-term studies, but variation in practice exists. The authors detail the existing practices of a group of surgeons for primary and secondary aesthetic breast augmentation. Methods: Seventy-two plastic surgeons with a specialist interest in aesthetic breast surgery were asked to participate in the survey about aesthetic breast augmentation. A 54-point online survey was given, covering demographics about the surgeon and practice, implant choice and perioperative technique, use of emerging evidence and surgical techniques, preferences about secondary surgery, and opinions about topics of controversy. Results: All 72 surgeons completed the survey. Their mean age was 57.6 years, 56.9% had been in surgical practice for over 20 years, and 88.9% were performing more than 50 primary breast augmentations per year. The most commonly used measurement for implant selection was breast width, the most common implant type was silicone (81.9%), and volume range was 250 to 350 cc (86.1%). A total of 36.1% of surgeons use anatomic implants in more than half of their cases. Opinions were divided about postoperative return to work, use of insertion funnel, and acellular dermal matrix. Conclusions: Multiple factors affect clinical outcome in primary and secondary aesthetic breast surgery. A few well-established techniques have gained common acceptance, but opinions are more diverse for difficult, complicated, or challenging scenarios. This survey helps clarify the decision-making process of expert surgeons with an interest in aesthetic breast surgery.

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“…Consequently, women with challenging anatomy such as complex asymmetries, constricted lower poles, pseudoptosis, chest wall anomalies, tuberous breasts, complex revision surgery or those who simply want as natural a look as possible can benefit from these devices, achieving outcomes that would not have been possible or as good with a round smooth equivalent. 9 , 33 , 34 Given the life-changing impact these interventions can have on women who have been burdened by poor body image or the lack of self-esteem as a result of their appearance, the importance of achieving the best possible outcome cannot be underestimated and sheds a different perspective on the concept of risk.…”

Section: No Risk No Benefitsmentioning

confidence: 99%

BIA-ALCL-Horizon Scanning

Mallucci¹,

Bistoni

2022

JPRAS Open

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Why Do We Need Anatomical Implants? the Science and Rationale for Maintaining Their Availability and Use in Breast Surgery

Cited by 15 publications

References 43 publications

Comparing direct-to-implant and two-stage breast reconstruction in the Australian Breast Device Registry

Comparing direct-to-implant and two-stage breast reconstruction in the Australian Breast Device Registry

Modified Delphi technique to identify management of primary and secondary aesthetic breast augmentation. Will we reach a consensus?

BIA-ALCL-Horizon Scanning

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