Introduction: After mastectomy, immediate breast reconstruction is paramount. With the growing number of nipple-sparing mastectomies, the chances of successful one-stage reconstruction with implants are also increasing. Local safety is one of the main issues. This study investigated the factors that could lead to major or minor complications after expander-based versus direct-to-implant (DTI) reconstruction. Methods: The studied factors were age, body mass index (BMI), hypertension, smoking, diabetes, type of mastectomy (nipple-sparing/total), implant size, neoadjuvant/adjuvant chemotherapy, and radiotherapy. The study sample included 294 immediate reconstructions over 3 years. The primary outcome was the incidence of complications, major or minor depending on the necessity of revision surgery. For the DTI pocket, we applied a variant of the conventional submuscular technique. Results: In DTI reconstructions (median follow-up 26 months), the complication rate was 17.2% (4.3% major and 12.8% minor) with no significant association with clinical variables. In expander-based reconstructions (median follow-up 19 months), the complication rate was 18.3% (12.5% major and 5.8% minor). Univariate analysis showed a significant association between overall complications and radiotherapy (P = 0.01) as well as between major complications and expander size (P < 0.005), BMI (P < 0.005), and radiotherapy (P < 0.01); radiotherapy and BMI retained significance in multivariate analysis. Neoadjuvant/adjuvant chemotherapy did not affect the complication rate. Conclusions: There was evidence of an association between major complications and clinical variables in the expander-based cohort. Larger expander size was a predictor of failure, especially combined with radiation. Direct-to-implant reconstruction proved to be safe. We describe a reliable method of reconstruction and a safe range of implant sizes even beyond 500 g.
Local safety of immediate reconstruction during primary treatment of breast cancer : direct-to-implant versus expander-based surgery / E. Riggio, E. Toffoli, C. Tartaglione, G. Marano, E. Biganzoli. - In: JOURNAL OF PLASTIC, RECONSTRUCTIVE & AESTHETIC SURGERY. - ISSN 1748-6815. - 72:2(2019 Feb), pp. 232-242.
|Titolo:||Local safety of immediate reconstruction during primary treatment of breast cancer : direct-to-implant versus expander-based surgery|
|Parole Chiave:||Acellular dermal matrix; Breast cancer; Breast surgery; Chemotherapy; Direct-to-implant reconstruction; Expander-based reconstruction; Immediate reconstruction; Local safety; Mastectomy; Radiotherapy; Surgery|
|Settore Scientifico Disciplinare:||Settore MED/01 - Statistica Medica|
Settore MED/06 - Oncologia Medica
|Data di pubblicazione:||feb-2019|
|Data ahead of print / Data di stampa:||2-nov-2018|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1016/j.bjps.2018.10.016|
|Appare nelle tipologie:||01 - Articolo su periodico|
File in questo prodotto:
|Local safety of immediate reconstruction PREPRINT.pdf||articolo principale PREPRINT||Pre-print (manoscritto inviato all'editore)||Open Access Visualizza/Apri|
|1-s2.0-S1748681518303681-main.pdf||Publisher's version/PDF||Administrator Richiedi una copia|