Titanium-coated polypropylene mesh as innovative bioactive material in conservatives mastectomies and pre-pectoral breast reconstruction

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.

Fungal mycobiome-mediated immune response:a non-negligible promoter in pancreatic oncogenesis and chemoresistance

Pancreatic ductal adenocarcinoma(PDAC)is one of the most lethal cancers in humans due to late diagnosis and poor response to treatments.The tumor microenvironment(TME)of PDAC is characterized by a distinctive,suppressive immune profile,which inhibits the protective functions of anti-tumor immunity and thereby contributes to PDAC progression.Recently,the study of Alam et al.discovered for the first time that the intratumoral fungal mycobiome could contribute to the recruitment and activation of type 2 immune cells in the TME of PDAC via enhancing the secretion of a chemoattractant,interleukin(IL-)33.In this article,we reviewed the important findings of this study.Together with our findings,we synthetically discussed the role of the fungal mycobiome in orchestrating the immune response and thereby modulating tumor progression.