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Immediate surgical mesh-free implant-based breast reconstruction with fascial flap in breast cancer patients after mastectomy

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Surgical meshes are often used in retro-pectoral implant-based breast reconstruction (IBBR) to improve lower pole expansion. However, using of surgical meshes is associated with increased complications and costs. To solve this problem, we have adopted a modified fascia-based IBBR technique using fasciae of pectoral major, serratus anterior, and external oblique muscles to form a sling covering the lower pole of prosthesis since 2014.

Methods

Data of 788 retro-pectoral IBBR cases, including 250 fascia-based IBBR cases (fascial group) and 538 traditional IBBR cases (control group), treated between 2014 and 2019 were retrospectively analyzed. The surgical outcomes of the fascial and control group were compared. The primary endpoint was the rate of post-operative complications requiring interventions. The secondary endpoint was the rate of explantation. The exploratory endpoint was the time from surgery to complication and explantation.

Results

The fascial group had significantly lower rates of developing major post-operative complications (1.2 vs. 6.1%, p = 0.002) and losing prostheses (1.2 vs. 4.3%, p = 0.025), as compared with the control group. The median time from surgery to complication and explantation were 61 (range, 35–115) days and 92 (range, 77–134) days for the fascial group and 35 (range, 6–239) days and 63 (range, 23–483) days for the control group, respectively.

Conclusion

Fascia-based IBBR technique had low rates of major post-operative complications and explantation. Fascia-based IBBR technique could be considered as an alternative reconstruction method in properly selected patients.

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Availability of data and material

The datasets of the current study are available from the corresponding author on reasonable request.

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Funding

This work was supported by the National Natural Science Foundation of China (No. 81502300, NO. 82172827, and NO. 82172835) and Tianjin Key Medical Disciplines (Specialty) Construction Project (TJYXZDXK-009A).

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Authors and Affiliations

  1. The First Department of Breast Surgery, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Hexi District, Tianjin, 300060, China

    Ao-Xiang Chen, Xiao Chen, Yue Yu, Xin Wang, Bin Zhang & Xu-Chen Cao

  2. Tianjin’s Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, 300060, China

    Ao-Xiang Chen, Xiao Chen, Yue Yu, Xin Wang, Bin Zhang & Xu-Chen Cao

Authors
  1. Ao-Xiang Chen
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  2. Xiao Chen
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  3. Yue Yu
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  4. Xin Wang
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  5. Bin Zhang
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  6. Xu-Chen Cao
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Contributions

A-XC: data collection and analysis, manuscript writing. XC: data collection. YY: data collection. XW: data collection, manuscript editing. BZ: project development, manuscript editing. X-CC: project development, data management, and manuscript editing.

Corresponding author

Correspondence to Xu-Chen Cao.

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Conflict of interest

Ao-Xiang Chen, Xiao Chen, Yue Yu, Xin Wang, Bin Zhang, and Xu-Chen Cao have no conflict of interest to declare.

Ethical approval

This study was conducted in accordance with the current guidelines for good and sound research practice (including the 1964 Helsinki declaration and its later amendments) after approval from The Ethic Committee of Tianjin Medical University Cancer Institute and Hospital. As a retrospective study, there was no testing or manipulation of the patient’s standard of care. For this type of study, formal consent is not required.

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Chen, AX., Chen, X., Yu, Y. et al. Immediate surgical mesh-free implant-based breast reconstruction with fascial flap in breast cancer patients after mastectomy. Arch Gynecol Obstet 307, 1941–1948 (2023). https://doi.org/10.1007/s00404-022-06871-z

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  • DOI: https://doi.org/10.1007/s00404-022-06871-z

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