Casella Donato, Bernini Marco, Bencini Lapo, Roselli Jenny, Lacaria Maria Teresa, Martellucci Jacopo, Banfi Roberto, Calabrese Claudio, Orzalesi Lorenzo
Breast Unit Surgery, Oncology Department, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy.
Surgical Oncology, Oncology Department, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy.
Eur J Plast Surg. 2014;37(11):599-604. doi: 10.1007/s00238-014-1001-1. Epub 2014 Aug 3.
Immediate implant reconstruction after a conservative mastectomy is an attractive option made easier by prosthetic devices. Titanized polypropylene meshes are used as a hammock to cover the lower lateral implant pole. We conducted a prospective nonrandomized single-institution study of reconstructions using titanium-coated meshes either in a standard muscular mesh pocket or in a complete subcutaneous approach. The complete subcutaneous approach means to wrap an implant with titanized mesh in order to position the implant subcutaneously and spare muscles.
Between November 2011 and January 2014, we performed immediate implant breast reconstructions after conservative mastectomies using TiLoop® Bra, either with the standard retropectoral or with a prepectoral approach. Selection criteria included only women with normal Body Mass Index (BMI), no large and very ptotic breasts, no history of smoking, no diabetes, and no previous radiotherapy. We analyzed short-term outcomes of such procedures and compared the outcomes to evaluate implant losses and surgical complications.
A total of 73 mastectomies were performed. Group 1 comprised 29 women, 5 bilateral procedures, 34 reconstructions, using the standard muscular mesh pocket. Group 2 comprised 34 women, 5 bilateral procedures, 39 reconstructions with the prepectoral subcutaneous technique. Baseline and oncologic characteristics were homogeneous between the two groups. After a median follow-up period of 13 and 12 months, respectively, no implant losses were recorded in group 1, and one implant loss was recorded in group 2. We registered three surgical complications in group 1 and two surgical complications in group 2.
Titanium-coated polypropylene meshes, as a tool for immediate definitive implant breast reconstruction, resulted as safe and effective in a short-term analysis, both for a retropectoral and a totally subcutaneous implant placement. Long-term results are forthcoming. A strict selection is mandatory to achieve optimal results. Level of Evidence: Level II, therapeutic study.
保乳切除术后即刻植入重建是一种颇具吸引力的选择，而假体装置使其变得更为简便。钛化聚丙烯网片被用作吊床以覆盖植入物的下外侧极。我们开展了一项前瞻性非随机单机构研究，对比了在标准肌肉网袋或完全皮下入路中使用钛涂层网片进行重建的效果。完全皮下入路是指用钛化网片包裹植入物，以便将植入物置于皮下并保留肌肉。
2011年11月至2014年1月期间，我们使用TiLoop®胸罩在保乳切除术后进行即刻植入式乳房重建，采用标准胸后或胸前入路。入选标准仅包括体重指数（BMI）正常、乳房无巨大及重度下垂、无吸烟史、无糖尿病且无既往放疗史的女性。我们分析了此类手术的短期结果，并比较结果以评估植入物丢失和手术并发症情况。
共进行了73例乳房切除术。第1组包括29名女性，5例双侧手术，34例重建，采用标准肌肉网袋。第2组包括34名女性，5例双侧手术，39例采用胸前皮下技术重建。两组之间的基线和肿瘤学特征相似。分别经过13个月和12个月的中位随访期后，第1组未记录到植入物丢失，第2组记录到1例植入物丢失。我们在第1组记录到3例手术并发症，在第2组记录到2例手术并发症。
在短期分析中，钛涂层聚丙烯网片作为即刻确定性植入式乳房重建的工具，对于胸后和完全皮下植入物放置均安全有效。长期结果即将得出。必须进行严格筛选以获得最佳结果。证据级别：二级，治疗性研究。
