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Patient-reported outcomes of mesh in minimally invasive (laparoscopic/robot-assisted) immediate subpectoral prosthesis breast reconstruction: a retrospective study

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Abstract

Background

Although there is increasing interest in minimally invasive prosthesis breast reconstruction (PBR), whether meshes application in minimally invasive PBR can improve complications and cosmetic effects remains controversial. The author retrospectively analyzed postoperative complications and evaluated patient-reported quality-of-life outcomes in minimally invasive PBR with and without mesh.

Methods

This study enrolled patients who underwent minimally invasive nipple-sparing mastectomy (NSM) followed by PBR. We used the TiLOOP bra for the mesh-assisted procedure. Patient demographics and postoperative complications data were compared between the procedures. Patient-reported outcomes were evaluated with the Breast-Q.

Results

A total of 158 patients underwent 160 minimally invasive NSM-PBR (with mesh, n = 64; without, n = 94). Postoperative complications were comparable in the mesh-assisted (5 [7.7%]) and non-mesh-assisted (5 [5.3%]) groups (p = 0.533). The most common complication in non-mesh-assisted group was infection, with four (4.2%) cases. In mesh-assisted group, implant exposure occurred in two (3.1%) patients. Removal of prosthesis was uncommon, with two (3.1%) and three (3.2%) cases in the mesh-assisted and non-mesh groups, respectively (p = 0.977). The BREAST-Q questionnaire was completed by 52 (81.3%) patients in the mesh-assisted group and 68 (72.3%) in the non-mesh-assisted group. Comparing the non-mesh group, patients in mesh-assisted group had improved scores on the BREAST-Q Satisfaction with breast (66.0) (p < 0.05), Physical Well-being (80.0), and Sexual Well-being (56.0).

Conclusions

Mesh-assisted minimally invasive NSM-PBR has good aesthetic outcomes and high patient satisfaction. There were no significant differences in complication rates between the mesh-assisted and non-mesh-assisted groups.

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Data availability

The data that support the findings of this study are available on request from the corresponding author upon reasonable request.

References

  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality Worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49.

    Article  PubMed  Google Scholar 

  2. Gui Y, Liu X, Chen X, Yang X, Li S, Pan Q, et al. A network meta-analysis of surgical treatment in patients with early breast cancer. JNCI J Natl Cancer Inst. 2019;111(9):903–15.

    Article  PubMed  Google Scholar 

  3. Harcourt D, Rumsey N. Psychological aspects of breast reconstruction: a review of the literature. J Adv Nurs. 2001;35(4):477–87.

    Article  CAS  PubMed  Google Scholar 

  4. Harcourt DM, Rumsey NJ, Ambler NR, Cawthorn SJ, Reid CD, Maddox PR, et al. The psychological effect of mastectomy with or without breast reconstruction: a prospective. Multicenter Study Plast Reconstr Surg. 2003;111(3):1060–8.

    Article  PubMed  Google Scholar 

  5. Jagsi R, Jiang J, Momoh AO, Alderman A, Giordano SH, Buchholz TA, et al. Trends and variation in use of breast reconstruction in patients with breast cancer undergoing mastectomy in the United States. J Clin Oncol. 2014;32(9):919–26.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Xiu BQ, Guo R, Yang BL, Zhang Q, Wang J, Su YH, et al. Current trends of breast reconstruction after mastectomy in China: a cross-sectional study. Zhonghua Zhong Liu Za Zhi. 2019;41(7):546–51.

    CAS  PubMed  Google Scholar 

  7. Joyce CW, Murphy S, Murphy S, Kelly JL, Morrison CM. Scar wars: preferences in breast surgery. Arch Plast Surg. 2015;42(5):596–600.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Wan A, Liang Y, Chen L, Wang S, Shi Q, Yan W, et al. Association of long-term oncologic prognosis with minimal access breast surgery vs conventional breast surgery. JAMA Surg. Published online October 5, 2022:e224711.

  9. Lai HW, Chen ST, Lin SL, Chen CJ, Lin YL, Pai SH, et al. Robotic nipple-sparing mastectomy and immediate breast reconstruction with gel implant: technique, preliminary results and patient-reported cosmetic outcome. Ann Surg Oncol. 2019;26(1):42–52.

    Article  PubMed  Google Scholar 

  10. Gui Y, Chen Q, Li S, Yang X, Liu J, Wu X, et al. Safety and feasibility of minimally invasive (laparoscopic/robotic-assisted) nipple-sparing mastectomy combined with prosthesis breast reconstruction in breast cancer: a single-center retrospective study. Ann Surg Oncol. Published online 2022

  11. Lai HW, Chen ST, Mok CW, Lin YJ, Wu HK, Lin SL, et al. Robotic versus conventional nipple sparing mastectomy and immediate gel implant breast reconstruction in the management of breast cancer- a case control comparison study with analysis of clinical outcome, medical cost, and patient-reported cosmetic results. J Plast Reconstr Aesthet Surg. 2020;73(8):1514–25.

    Article  PubMed  Google Scholar 

  12. Zhang Y, Zhong L, Liu J, Liu HX, Chen L, Zhang Y, et al. The comparative study of endoscope versus open surgery on nipple sparing mastectomy with immediate reconstruction using prosthesis implantation. Zhonghua Wai Ke Za Zhi. 2019;57(10):51–6 (Chinese).

    CAS  PubMed  Google Scholar 

  13. Vardanian AJ, Clayton JL, Roostaeian J, Shirvanian V, Da Lio A, Lipa JE, et al. Comparison of implant-based immediate breast reconstruction with and without acellular dermal matrix. Plast Reconstr Surg. 2011;128(5):403e–10e.

    Article  PubMed  Google Scholar 

  14. Krueger EA, Wilkins EG, Strawderman M, Cederna P, Goldfarb S, Vicini FA, et al. Complications and patient satisfaction following expander/implant breast reconstruction with and without radiotherapy. Int J Radiat Oncol. 2001;49(3):713–21.

    Article  CAS  Google Scholar 

  15. Dikmans RE, Negenborn VL, Bouman MB, Winters HA, Twisk JW, Ruhé PQ, et al. Two-stage implant-based breast reconstruction compared with immediate one-stage implant-based breast reconstruction augmented with an acellular dermal matrix: an open-label, phase 4, multicentre, randomised, controlled trial. Lancet Oncol. 2017;18(2):251–8.

    Article  PubMed  Google Scholar 

  16. Salzberg CA, Ashikari AY, Berry C, Hunsicker LM. Acellular dermal matrix-assisted direct-to-implant breast reconstruction and capsular contracture: a 13-year experience. Plast Reconstr Surg. 2016;138(2):329–37.

    Article  CAS  PubMed  Google Scholar 

  17. Gschwantler-Kaulich D, Schrenk P, Bjelic-Radisic V, Unterrieder K, Leser C, Fink-Retter A, et al. Mesh versus acellular dermal matrix in immediate implant-based breast reconstruction – a prospective randomized trial. Eur J Surg Oncol EJSO. 2016;42(5):665–71.

    Article  CAS  PubMed  Google Scholar 

  18. Potter S, Conroy EJ, Cutress RI, Williamson PR, Whisker L, Thrush S, et al. Short-term safety outcomes of mastectomy and immediate implant-based breast reconstruction with and without mesh (iBRA): a multicentre, prospective cohort study. Lancet Oncol. 2019;20(2):254–66.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Headon H, Kasem A, Manson A, Choy C, Carmichael AR, Mokbel K. Clinical outcome and patient satisfaction with the use of bovine-derived acellular dermal matrix (SurgiMendTM) in implant based immediate reconstruction following skin sparing mastectomy: a prospective observational study in a single centre. Surg Oncol. 2016;25(2):104–10.

    Article  PubMed  Google Scholar 

  20. Cano SJ, Klassen A, Pusic AL. The science behind quality-of-life measurement: a primer for plastic surgeons. Plast Reconstr Surg. 2009;123(3):98e–106e.

    Article  PubMed  Google Scholar 

  21. Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg. 2009;124(2):345–53.

    Article  CAS  PubMed  Google Scholar 

  22. Cohen WA, Mundy LR, Ballard TN, Klassen A, Cano SJ, Browne J, et al. The BREAST-Q in surgical research: a review of the literature 2009–2015. J Plast Reconstr Aesthet Surg. 2016;69(2):149–62.

    Article  PubMed  Google Scholar 

  23. Chun YS, Verma K, Rosen H, Lipsitz S, Morris D, Kenney P, et al. Implant-based breast reconstruction using acellular dermal matrix and the risk of postoperative complications. Plast Reconstr Surg. 2010;125(2):429–36.

    Article  CAS  PubMed  Google Scholar 

  24. Gao P, Wang X, Bai P, Kong X, Wang Z, Fang Y, et al. Clinical outcomes and patient satisfaction with the use of biological and synthetic meshes in one-stage implant-based breast reconstruction. Breast Cancer. 2022;29(3):450–7.

    Article  PubMed  Google Scholar 

  25. Eichler C, Schulz C, Thangarajah F, Malter W, Warm M, Brunnert K. A retrospective head-to-head comparison between TiLoop Bra/TiMesh® and Seragyn® in 320 cases of reconstructive breast surgery. Anticancer Res. 2019;39(5):2599–605.

    Article  CAS  PubMed  Google Scholar 

  26. JoAnna Nguyen T, Carey JN, Wong AK. Use of human acellular dermal matrix in implant- based breast reconstruction: Evaluating the evidence. J Plast Reconstr Aesthet Surg. 2011;64(12):1553–61.

    Article  CAS  PubMed  Google Scholar 

  27. Mundy LR, Homa K, Klassen AF, Pusic AL, Kerrigan CL. Breast cancer and reconstruction: normative data for interpreting the BREAST-Q. Plast Reconstr Surg. 2017;139(5):1046e–55e.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Sigalove S, Maxwell GP, Sigalove NM, Storm-Dickerson TL, Pope N, Rice J, et al. Prepectoral implant-based breast reconstruction: rationale, indications, and preliminary results. Plast Reconstr Surg. 2017;139(2):287–94.

    Article  CAS  PubMed  Google Scholar 

  29. Fracol M, Feld LN, Chiu WK, Kim JYS. An overview of animation deformity in prosthetic breast reconstruction. Gland Surg. 2019;8(1):95–101.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Kim MK, Kim T, Moon HG, Jin US, Kim K, Kim J, et al. Effect of cosmetic outcome on quality of life after breast cancer surgery. Eur J Surg Oncol EJSO. 2015;41(3):426–32.

    Article  CAS  PubMed  Google Scholar 

  31. Potter S, Chambers A, Govindajulu S, Sahu A, Warr R, Cawthorn S. Early complications and implant loss in implant-based breast reconstruction with and without acellular dermal matrix (Tecnoss Protexa®): a comparative study. Eur J Surg Oncol EJSO. 2015;41(1):113–9.

    Article  CAS  PubMed  Google Scholar 

  32. Casella D, Di Taranto G, Marcasciano M, Sordi S, Kothari A, Kovacs T, et al. 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. Plast Reconstr Surg. 2019;143(1):1e–9e.

    Article  CAS  PubMed  Google Scholar 

  33. Ng EI, Quah GS, Graham S, Kanesalingam K, Meybodi F, Hsu J, et al. Immediate prepectoral implant reconstruction using TiLOOP Bra Pocket results in improved patient satisfaction over dual plane reconstruction. ANZ J Surg. 2021;91(4):701–7.

    Article  PubMed  Google Scholar 

  34. Jayasinghe RT, Ruseckaite R, Gartoulla P, Elder E, Hopper I. Patient reported outcome measures after breast augmentation - using the BREAST-Q IS. Patient Relat Outcome Meas. 2022;13:1–8.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Leonardis JM, Lyons DA, Giladi AM, Momoh AO, Lipps DB. Functional integrity of the shoulder joint and pectoralis major following subpectoral implant breast reconstruction. J Orthop Res. 2019;37(7):1610–9.

    Article  PubMed  Google Scholar 

  36. Nguyen KT, Mioton LM, Smetona JT, Seth AK, Kim JY. Esthetic outcomes of ADM-assisted expander-implant breast reconstruction. Eplasty. 2012;12: e58.

    PubMed  PubMed Central  Google Scholar 

  37. Ibrahim AM, Koolen PG, Ganor O, Markarian MK, Tobias AM, Lee BT, et al. Does acellular dermal matrix really improve aesthetic outcome in tissue expander/implant-based breast reconstruction? Aesthetic Plast Surg. 2015;39(3):359–68.

    Article  PubMed  Google Scholar 

  38. Topol BM, Dalton EF, Ponn T, Campbell CJ. Immediate single-stage breast reconstruction using implants and human acellular dermal tissue matrix with adjustment of the lower pole of the breast to reduce unwanted lift. Ann Plast Surg. 2008;61(5):494–9.

    Article  CAS  PubMed  Google Scholar 

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Funding

This work was supported by the grants from the National Key Research and Development Program of China (Grant No. 2018YFC1707503).

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Author notes

  1. Xin Wu, Yu Gui, and Jing Liu have contributed equally to this work.

Authors and Affiliations

  1. Breast Disease Center, The First Affiliated Hospital, Army Medical University, Gaotanyan Main Street 30, Shapingba District, Chongqing, China

    Xin Wu, Yu Gui, Jing Liu, Shichao Li, Xi Yang, Zhen Zeng, Yi Zhang, Linjun Fan, Jun Jiang & Li Chen

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  1. Xin Wu
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Wu, X., Gui, Y., Liu, J. et al. Patient-reported outcomes of mesh in minimally invasive (laparoscopic/robot-assisted) immediate subpectoral prosthesis breast reconstruction: a retrospective study. Breast Cancer 31, 243–251 (2024). https://doi.org/10.1007/s12282-023-01529-3

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  • DOI: https://doi.org/10.1007/s12282-023-01529-3

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