摘要
Breast reconstruction is rapidly evolving,thanks to the growing acceptance of synthetic meshes as innovative biomaterials.276 patients undergoing mastectomy(total of 328 mastectomies)were analyzed in a retrospective observational study to evaluate the pre-pectoral immediate breast reconstruction(IBR)using an implant wrapped with Titanium-Coated Polypropylene Mesh(TCPM)vs.patients treated with tissue expander(TE),equally placed pre-pectorally(and wrapped with the same TCPM in 74.3%of the control group’breasts).163 patients,of the study group(SG),underwent mastectomy and pre-pectoral IBR with implant wrapped with TCPM,in a one-step surgery,called direct-to-implant technique(DTI),while 113 patients control group(CG)underwent mastectomy and TE.DTI technique has been performed in 192 breasts of the SG while TE procedure in 136 breasts of the CG.The BREAST-Q questionnaire has been provided before the treatment and 2 years later.Baker scale has been used to evaluate capsular contracture.Oncologic,surgical,and aesthetic outcomes along with BREAST-Q scores were analyzed.Additionally,a histologic evaluation was conducted in 11 capsules’samples randomly chosen(6 derived from SG patients and 5 derived from CG).Complications were recorded in 43 cases(29SG-14CG):8 skin-nipple necrosis(5SG-3CG),8 wound dehiscence(6SG-2CG),3 hematomas(1SG-2CG),and 24 infections(8SG-16CG).Grade IV capsular contracture was detected in 9 breasts(1SG-8CG),whereas 254 breasts were grade I(110SG-144CG),33(10SG-23CG)grade II,and 32(4SG-28CG)grade III.Implant wrinkling was detected in 18 cases(10SG-8CG)after 30 months.The local tumor recurrence rate was 5.8%.Three recurrences were on the nipple-areola complex(1.9%).SG patients showed significantly higher rates in the BREAST-Q overall Satisfaction with Outcome(74.1),overall Satisfaction with Breasts(69.1),Psychosocial Well-being(81.9),and Sexual Well-being(63.1),versus CG’s patients(p<0.05).Histological analysis showed a process of normal tissue repair with a complete mesh integration and normal healing.Conservative mastectomies with pre-pectoral IBR assisted by TCPM proved themselves oncologically safe,biologically integrated into native tissues,and highly accepted in terms of quality of life guaranteeing a more natural and aesthetic breast appearance.Core tip:This retrospective observational study provided clinical and histological outcomes of the pre-pectoral IBR using an implant wrapped with TCPM vs.patients treated with TE,equally placed pre-pectorally.The efficacy of IBR using an implant wrapped with TCPM was confirmed by the cosmetic results obtained and by a rate of side effects comparable to TE.All the histological analyses performed confirmed the TCPM mesh complete integration with the physiological aspects of healing:The Collagen 1 and 3 expressions did not differ,between TCPM and NO TCPM samples to confirm a process of healing overlapping to perfect device incorporation and normal healing.
