Background: The continuous increase in the rate of nipple sparing mastectomy (NSM), the development of several reconstructive techniques and the following introduction of acellular derma matrix (ADM) has revolutionized implant-based breast reconstruction. This study aimed to investigate postoperative complications, health-related QoL and patient’s satisfaction in patients undergoing NSM and breast reconstruction with or without ADM Methods: Enrolled patients were divided into three groups: immediate breast reconstruction (IBR) with de�nitive breast implant and ADM (Group A), IBR only with de�nitive breast implant (Group B), and two-stage breast reconstruction (Group C). The postoperative complications and BREAST-Q outcomes were compared. Results: A total of 105 BC patients were enrolled and a total of 139 post-mastectomy breast reconstructions were performed. Seroma was the most prevalent complication observed: 8% in Group A, 3% in Group B and 6% in Group C. Postoperative infection occurred in two patients of Group A (5,5%), one patient of Group B (3%) and one of Group C (3%). Group A patients reported larger drain volume (1125 ± 243.5 cc), longer drain period (13.2 ± 2.8 days), and the lowest incidence of capsular contracture (5.6%). The BREAST-Q patient-reported outcome measures document that all patients aged ≥ 50 years presented a higher score in “Satisfaction with breast” (beta:5.198; p<0.001) and “satisfaction with outcome” domains (beta:5.421; p<0.05). Performing a bilateral breast reconstruction was associated to higher scores in “Physical Wellbeing Chest domain” (beta:3.278; p<0.05). In addition patients in Group A and Group B reported higher score in “Satisfaction with the breast” domain (p<0.001) but only in Group B we reported a higher score in “Satisfaction with outcome” (p<0.001). Conclusion: Subpectoral IBR results in manageable complications and greater personal satisfaction. The ADM could improve breast reconstruction reducing the rate of capsular contracture. The pre pectoral placement of ADM could minimize

Breast cancer patients’ postoperative outcomes in nipple-sparing mastectomy and reconstruction with subpectoral implant placement: a single center experience

On 22 November 2018, the French Society for Plastic, Reconstructive and Aesthetic Surgery recommended that Allergan® macrotextured breast implants be recalled, a decision endorsed by the French national health products safety agency (ANSM) on 2nd April 2019. At the Georges-François Leclerc Cancer Center (CGFL) in Dijon, we decided to stop using macrotextured implants as of November 2018 in favor of smooth implants. The purpose of this study is to evaluate the impact of the recall of macrotextured implants on breast reconstruction surgical practices and their complications.This is a single-centre, retrospective study performed at the CGFL in Dijon, France. Reconstruction techniques and complications were compared between two periods, i.e. before the recall of macrotextured breast implants (period 1: 1st September 2017-November 22, 2018) and after the recall (period 2: 23 November 2018-31st March 2020). All patients who underwent breast reconstruction for the first time were included.Data were collected from 168 reconstructions in period 2, and 159 in period 2. The rate of use of breast implants during reconstructions decreased significantly in period 2 (53.6% vs. 23.9%; P<0.001). The rate of autologous reconstructions increased significantly for muscle sparing latissimus dorsi (2.4% vs. 12.6%; P<0.001) and exclusive fat grafting (9.5% vs. 21.5%; P<0.01). Clavien-Dindo Stage IIIb complications decreased in period 2 (10% vs. 18.4%; P=0.04).Since the recall of macrotextured breast implants, the reconstruction rate has decreased in our centre in favor of autologous techniques with lower complication rates. 

Impact of the withdrawal of macrotextured implant on reconstruction practices

Abstract Background: The continuous increase in the rate of nipple sparing mastectomy (NSM), the development of several reconstructive techniques and the following introduction of acellular derma matrix (ADM) has revolutionized implant-based breast reconstruction. This study aimed to investigate postoperative complications, health-related QoL and patient’s satisfaction in patients undergoing NSM and breast reconstruction with or without ADM Methods: Enrolled patients were divided into three groups: immediate breast reconstruction (IBR) with definitive breast implant and ADM (Group A), IBR only with definitive breast implant (Group B), and two-stage breast reconstruction (Group C). The postoperative complications and BREAST-Q outcomes were compared. Results: A total of 105 BC patients were enrolled and a total of 139 post-mastectomy breast reconstructions were performed. Seroma was the most prevalent complication observed: 8% in Group A, 3% in Group B and 6% in Group C. Postoperative infection occurred in two patients of Group A (5,5%), one patient of Group B (3%) and one of Group C (3%). Group A patients reported larger drain volume (1125 ± 243.5 cc), longer drain period (13.2 ± 2.8 days), and the lowest incidence of capsular contracture (5.6%). The BREAST-Q patient-reported outcome measures document that all patients aged ≥50 years presented a higher score in “Satisfaction with breast” (beta:5.198; p&lt;0.001) and “satisfaction with outcome” domains (beta:5.421; p&lt;0.05). Performing a bilateral breast reconstruction was associated to higher scores in “Physical Wellbeing Chest domain” (beta:3.278; p&lt;0.05). In addition patients in Group A and Group B reported higher score in “Satisfaction with the breast” domain (p&lt;0.001) but only in Group B we reported a higher score in “Satisfaction with outcome” (p&lt;0.001). Conclusion : Subpectoral IBR results in manageable complications and greater personal satisfaction. The ADM could improve breast reconstruction reducing the rate of capsular contracture. The pre pectoral placement of ADM could minimize complications and optimize aesthetic results. 

Breast cancer patient’s postoperative outcomes in nipple-sparing mastectomy and reconstruction with subpectoral implant placement: a single center experience

The demand of breast reconstruction is growing, the purpose of this study is to evaluate the satisfaction and quality of life of patients who underwent bilateral breast reconstruction.In this cohort retrospective study, patients who underwent bilateral breast reconstruction in our department between September 2009 and December 2019 were asked to complete BREAST-Q questionnaire based on the timing of the reconstruction received following mastectomy, thus dividing them into three groups: (1) bilateral immediate breast reconstruction(BIBR), (2) immediate breast reconstruction in one side and delayed reconstruction on the other side (mixed group), (3) bilateral delayed breast reconstruction(BDBR). Surgical techniques were divided into prosthesthetic (permanent implant and expander), flaps (pedicle or free), mixed technique (associating flap and prosthesis).Seventy-one out of 94 patients responded to our BREAST-Q questionnaire, with a response rate of 84.5%. A high score is associated with a better result, except in physical well-being where a lower score indicates better outcome. The average score for psychosocial well-being is 63.0 (±17.2) achieving the lowest among the BDBR group. Physical well-being score is 26.0 (±18.6) scoring the highest in BIBR group. Sexual well-being score is 52.2 (±17.4) and seen highest among BDBR group. Satisfaction with breast score is 54.1 (±10.0) and was highest among mixed group.The therapeutic proposal was personalized based on patient profile and choice. The best reconstruction treatment enhancing the quality of life and patient satisfaction remains the option chosen by the patient and whose advantages and disadvantages are accepted by them. 

Evaluation of satisfaction and the quality of life after bilateral breast reconstruction using the BREAST-Q questionnaire.

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Evaluation of satisfaction and the quality of life after bilateral breast reconstruction using the BREAST-Q questionnaire.