Evaluation of Prepectoral Implant Placement and Complete Coverage with TiLoop Bra Mesh for Breast Reconstruction: A Prospective Study on Long-Term and Patient-Reported BREAST-Q Outcomes

Donato Casella, Giuseppe Di Taranto, Marco Marcasciano, Silvia Sordi, Ashutosh Kothari, T. Kovács, Federico Lo Torto, Emanuele Cigna, Claudio Calabrese, Diego Ribuffo

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

BACKGROUND: Breast reconstruction is rapidly evolving, because of the changing face of cancer surgery and the growing acceptance of acellular dermal matrices and synthetic meshes. Although some early reports showed encouraging results after prepectoral breast reconstruction, there is a paucity of data on long-term outcomes. METHODS: Between January of 2012 and March of 2015, 179 patients undergoing mastectomy were enrolled at the authors' institution. Patients underwent mastectomy and immediate prepectoral breast reconstruction with the definitive implant entirely wrapped in a titanium-coated polypropylene mesh (TiLoop). The BREAST-Q questionnaire was administered before surgery and after 2 years. Capsular contracture was evaluated using the Baker scale. Oncologic, surgical, and aesthetic outcomes and changes in BREAST-Q score were analyzed over time. RESULTS: Average follow-up was 38.5 months. A total of 250 mastectomies were performed. The locoregional recurrence rate was 2.1 percent. Complications requiring reoperation were recorded in six patients (2.4 percent) and implant removal was necessary in three cases (1.2 percent), followed by reconstruction with submuscular expanders. Grade IV capsular contracture was detected in five breasts (2 percent), whereas 212 breasts were evaluated as grade I (84.8 percent), 28 breasts as grade II (11.2 percent), and five breasts as grade III (2 percent). Patients reported significant high rates in the BREAST-Q overall Satisfaction with Outcome (73.8), overall Satisfaction with Breasts (72.5), Psychosocial Well-being (77.7), and Sexual Well-being (57.9), scoring a significant increase in these domains from the preoperative period to the postoperative period (p < 0.05). CONCLUSION: The authors report encouraging results of a prepectoral direct-to-implant reconstruction technique using a synthetic mesh, supporting the evaluation of the muscle-sparing subcutaneous approach as a valid alternative to traditional submuscular reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Original languageEnglish
Pages (from-to)1e-9e
JournalPlastic and Reconstructive Surgery
Volume143
Issue number1
DOIs
Publication statusPublished - Jan 1 2019

Fingerprint

Mammaplasty
Breast
Prospective Studies
Mastectomy
Contracture
Acellular Dermis
Simple Mastectomy
Preoperative Period
Polypropylenes
Titanium
Esthetics
Reoperation
Postoperative Period
Recurrence
Muscles
Neoplasms

ASJC Scopus subject areas

  • Surgery

Cite this

Evaluation of Prepectoral Implant Placement and Complete Coverage with TiLoop Bra Mesh for Breast Reconstruction : A Prospective Study on Long-Term and Patient-Reported BREAST-Q Outcomes. / Casella, Donato; Di Taranto, Giuseppe; Marcasciano, Marco; Sordi, Silvia; Kothari, Ashutosh; Kovács, T.; Lo Torto, Federico; Cigna, Emanuele; Calabrese, Claudio; Ribuffo, Diego.

In: Plastic and Reconstructive Surgery, Vol. 143, No. 1, 01.01.2019, p. 1e-9e.

Research output: Contribution to journalArticle

Casella, Donato ; Di Taranto, Giuseppe ; Marcasciano, Marco ; Sordi, Silvia ; Kothari, Ashutosh ; Kovács, T. ; Lo Torto, Federico ; Cigna, Emanuele ; Calabrese, Claudio ; Ribuffo, Diego. / Evaluation of Prepectoral Implant Placement and Complete Coverage with TiLoop Bra Mesh for Breast Reconstruction : A Prospective Study on Long-Term and Patient-Reported BREAST-Q Outcomes. In: Plastic and Reconstructive Surgery. 2019 ; Vol. 143, No. 1. pp. 1e-9e.
@article{b8e1f4d02962478f9f7149977d47f7fe,
title = "Evaluation of Prepectoral Implant Placement and Complete Coverage with TiLoop Bra Mesh for Breast Reconstruction: A Prospective Study on Long-Term and Patient-Reported BREAST-Q Outcomes",
abstract = "BACKGROUND: Breast reconstruction is rapidly evolving, because of the changing face of cancer surgery and the growing acceptance of acellular dermal matrices and synthetic meshes. Although some early reports showed encouraging results after prepectoral breast reconstruction, there is a paucity of data on long-term outcomes. METHODS: Between January of 2012 and March of 2015, 179 patients undergoing mastectomy were enrolled at the authors' institution. Patients underwent mastectomy and immediate prepectoral breast reconstruction with the definitive implant entirely wrapped in a titanium-coated polypropylene mesh (TiLoop). The BREAST-Q questionnaire was administered before surgery and after 2 years. Capsular contracture was evaluated using the Baker scale. Oncologic, surgical, and aesthetic outcomes and changes in BREAST-Q score were analyzed over time. RESULTS: Average follow-up was 38.5 months. A total of 250 mastectomies were performed. The locoregional recurrence rate was 2.1 percent. Complications requiring reoperation were recorded in six patients (2.4 percent) and implant removal was necessary in three cases (1.2 percent), followed by reconstruction with submuscular expanders. Grade IV capsular contracture was detected in five breasts (2 percent), whereas 212 breasts were evaluated as grade I (84.8 percent), 28 breasts as grade II (11.2 percent), and five breasts as grade III (2 percent). Patients reported significant high rates in the BREAST-Q overall Satisfaction with Outcome (73.8), overall Satisfaction with Breasts (72.5), Psychosocial Well-being (77.7), and Sexual Well-being (57.9), scoring a significant increase in these domains from the preoperative period to the postoperative period (p < 0.05). CONCLUSION: The authors report encouraging results of a prepectoral direct-to-implant reconstruction technique using a synthetic mesh, supporting the evaluation of the muscle-sparing subcutaneous approach as a valid alternative to traditional submuscular reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.",
author = "Donato Casella and {Di Taranto}, Giuseppe and Marco Marcasciano and Silvia Sordi and Ashutosh Kothari and T. Kov{\'a}cs and {Lo Torto}, Federico and Emanuele Cigna and Claudio Calabrese and Diego Ribuffo",
year = "2019",
month = "1",
day = "1",
doi = "10.1097/PRS.0000000000005078",
language = "English",
volume = "143",
pages = "1e--9e",
journal = "Plastic and Reconstructive Surgery",
issn = "0032-1052",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Evaluation of Prepectoral Implant Placement and Complete Coverage with TiLoop Bra Mesh for Breast Reconstruction

T2 - A Prospective Study on Long-Term and Patient-Reported BREAST-Q Outcomes

AU - Casella, Donato

AU - Di Taranto, Giuseppe

AU - Marcasciano, Marco

AU - Sordi, Silvia

AU - Kothari, Ashutosh

AU - Kovács, T.

AU - Lo Torto, Federico

AU - Cigna, Emanuele

AU - Calabrese, Claudio

AU - Ribuffo, Diego

PY - 2019/1/1

Y1 - 2019/1/1

N2 - BACKGROUND: Breast reconstruction is rapidly evolving, because of the changing face of cancer surgery and the growing acceptance of acellular dermal matrices and synthetic meshes. Although some early reports showed encouraging results after prepectoral breast reconstruction, there is a paucity of data on long-term outcomes. METHODS: Between January of 2012 and March of 2015, 179 patients undergoing mastectomy were enrolled at the authors' institution. Patients underwent mastectomy and immediate prepectoral breast reconstruction with the definitive implant entirely wrapped in a titanium-coated polypropylene mesh (TiLoop). The BREAST-Q questionnaire was administered before surgery and after 2 years. Capsular contracture was evaluated using the Baker scale. Oncologic, surgical, and aesthetic outcomes and changes in BREAST-Q score were analyzed over time. RESULTS: Average follow-up was 38.5 months. A total of 250 mastectomies were performed. The locoregional recurrence rate was 2.1 percent. Complications requiring reoperation were recorded in six patients (2.4 percent) and implant removal was necessary in three cases (1.2 percent), followed by reconstruction with submuscular expanders. Grade IV capsular contracture was detected in five breasts (2 percent), whereas 212 breasts were evaluated as grade I (84.8 percent), 28 breasts as grade II (11.2 percent), and five breasts as grade III (2 percent). Patients reported significant high rates in the BREAST-Q overall Satisfaction with Outcome (73.8), overall Satisfaction with Breasts (72.5), Psychosocial Well-being (77.7), and Sexual Well-being (57.9), scoring a significant increase in these domains from the preoperative period to the postoperative period (p < 0.05). CONCLUSION: The authors report encouraging results of a prepectoral direct-to-implant reconstruction technique using a synthetic mesh, supporting the evaluation of the muscle-sparing subcutaneous approach as a valid alternative to traditional submuscular reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

AB - BACKGROUND: Breast reconstruction is rapidly evolving, because of the changing face of cancer surgery and the growing acceptance of acellular dermal matrices and synthetic meshes. Although some early reports showed encouraging results after prepectoral breast reconstruction, there is a paucity of data on long-term outcomes. METHODS: Between January of 2012 and March of 2015, 179 patients undergoing mastectomy were enrolled at the authors' institution. Patients underwent mastectomy and immediate prepectoral breast reconstruction with the definitive implant entirely wrapped in a titanium-coated polypropylene mesh (TiLoop). The BREAST-Q questionnaire was administered before surgery and after 2 years. Capsular contracture was evaluated using the Baker scale. Oncologic, surgical, and aesthetic outcomes and changes in BREAST-Q score were analyzed over time. RESULTS: Average follow-up was 38.5 months. A total of 250 mastectomies were performed. The locoregional recurrence rate was 2.1 percent. Complications requiring reoperation were recorded in six patients (2.4 percent) and implant removal was necessary in three cases (1.2 percent), followed by reconstruction with submuscular expanders. Grade IV capsular contracture was detected in five breasts (2 percent), whereas 212 breasts were evaluated as grade I (84.8 percent), 28 breasts as grade II (11.2 percent), and five breasts as grade III (2 percent). Patients reported significant high rates in the BREAST-Q overall Satisfaction with Outcome (73.8), overall Satisfaction with Breasts (72.5), Psychosocial Well-being (77.7), and Sexual Well-being (57.9), scoring a significant increase in these domains from the preoperative period to the postoperative period (p < 0.05). CONCLUSION: The authors report encouraging results of a prepectoral direct-to-implant reconstruction technique using a synthetic mesh, supporting the evaluation of the muscle-sparing subcutaneous approach as a valid alternative to traditional submuscular reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

UR - http://www.scopus.com/inward/record.url?scp=85059236115&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85059236115&partnerID=8YFLogxK

U2 - 10.1097/PRS.0000000000005078

DO - 10.1097/PRS.0000000000005078

M3 - Article

C2 - 30303929

AN - SCOPUS:85059236115

VL - 143

SP - 1e-9e

JO - Plastic and Reconstructive Surgery

JF - Plastic and Reconstructive Surgery

SN - 0032-1052

IS - 1

ER -