Early post-operative outcome of pre-pectoral implant-based immediate total breast reconstruction with Polyglactin 910 (Vicryl™) mesh - low cost solution for a low-middle income country.
Humans
Female
Surgical Mesh
/ economics
Retrospective Studies
Adult
Middle Aged
Polyglactin 910
Postoperative Complications
/ epidemiology
Mastectomy
Breast Neoplasms
/ surgery
Pakistan
Treatment Outcome
Breast Implantation
/ economics
Mammaplasty
/ economics
Breast Implants
/ economics
Developing Countries
Immediate breast reconstruction
Implant-based mastectomy
Polyglactin 910 (Vicryl™, Ethicon) mesh
Journal
BMC surgery
ISSN: 1471-2482
Titre abrégé: BMC Surg
Pays: England
ID NLM: 100968567
Informations de publication
Date de publication:
31 Aug 2024
31 Aug 2024
Historique:
received:
25
09
2023
accepted:
22
08
2024
medline:
1
9
2024
pubmed:
1
9
2024
entrez:
31
8
2024
Statut:
epublish
Résumé
The incidence of breast cancer in Pakistan has been rising with approximately one third of these patients requiring mastectomy. Among breast reconstruction treatment options, the use of Acellular Dermal Matrix (ADM) for pre-pectoral breast implant surgery has proven effective with improved cosmetic outcome. However, due to high cost it cannot be regularly implemented in a developing country like Pakistan. An alternative to ADM, Polyglactin 910 (Vicryl™, Ethicon) mesh has been introduced in pre-pectoral breast reconstructive surgery which has shown to be almost 10 times lower in cost. We set out to determine the frequency of early postoperative complications when using Polyglactin 910 mesh for pre-pectoral implant-based breast reconstruction surgery. A single centre, retrospective, chart review was conducted, and a total 28 women were included in the study. Thirty-two pre-pectoral implant-based mastectomies with Polyglactin 910 mesh were performed. Early post-operative outcomes (within 12 months of procedure) including duration of antibiotic use, post-operative infection, implant displacement, flap necrosis, seroma formation, wound dehiscence, hematoma formation, capsular contracture and reconstruction failure, were recorded. Only 4 (12.5%) women experienced early post-operative morbidity. One patient developed a wound dehiscence, which eventually led to reconstruction failure and removal of the implant. Another patient had seroma formation and flap necrosis. None of the patients developed postoperative implant displacement, hematoma formation or capsular contracture in the early post-operative period. This study reveals that early post-operative outcomes with Polyglactin 910 mesh in breast reconstructive surgery are few, thus making it a cost effective, reliable, and safe treatment option, especially in developing countries like Pakistan.
Sections du résumé
BACKGROUND
BACKGROUND
The incidence of breast cancer in Pakistan has been rising with approximately one third of these patients requiring mastectomy. Among breast reconstruction treatment options, the use of Acellular Dermal Matrix (ADM) for pre-pectoral breast implant surgery has proven effective with improved cosmetic outcome. However, due to high cost it cannot be regularly implemented in a developing country like Pakistan. An alternative to ADM, Polyglactin 910 (Vicryl™, Ethicon) mesh has been introduced in pre-pectoral breast reconstructive surgery which has shown to be almost 10 times lower in cost. We set out to determine the frequency of early postoperative complications when using Polyglactin 910 mesh for pre-pectoral implant-based breast reconstruction surgery.
METHODS
METHODS
A single centre, retrospective, chart review was conducted, and a total 28 women were included in the study. Thirty-two pre-pectoral implant-based mastectomies with Polyglactin 910 mesh were performed. Early post-operative outcomes (within 12 months of procedure) including duration of antibiotic use, post-operative infection, implant displacement, flap necrosis, seroma formation, wound dehiscence, hematoma formation, capsular contracture and reconstruction failure, were recorded.
RESULTS
RESULTS
Only 4 (12.5%) women experienced early post-operative morbidity. One patient developed a wound dehiscence, which eventually led to reconstruction failure and removal of the implant. Another patient had seroma formation and flap necrosis. None of the patients developed postoperative implant displacement, hematoma formation or capsular contracture in the early post-operative period.
CONCLUSION
CONCLUSIONS
This study reveals that early post-operative outcomes with Polyglactin 910 mesh in breast reconstructive surgery are few, thus making it a cost effective, reliable, and safe treatment option, especially in developing countries like Pakistan.
Identifiants
pubmed: 39217330
doi: 10.1186/s12893-024-02540-x
pii: 10.1186/s12893-024-02540-x
doi:
Substances chimiques
Polyglactin 910
34346-01-5
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
245Informations de copyright
© 2024. The Author(s).
Références
Sohail S, Alam SN. Breast cancer in Pakistan-awareness and early detection. J Coll Physicians Surg Pak. 2007;17(12):711–2.
pubmed: 18182132
Yasmeen F, Zaheer S. Functional time series models to estimate future age-specific breast cancer incidence rates for women in Karachi. Pak J Health Sci. 2014;2(5):213–21.
Zaheer S, Shah N, Maqbool SA, Soomro NM. Estimates of past and future time trends in age-specific breast cancer incidence among women in Karachi, Pakistan: 2004–2025. BMC Public Health. 2019;19(1):1–9.
doi: 10.1186/s12889-019-7330-z
Begum N. Breast cancer in Pakistan: a looming epidemic. J Coll Physicians Surg Pak. 2018;28(2):87–8.
doi: 10.29271/jcpsp.2018.02.87
pubmed: 29394963
Cokkinides V, Albano J, Samuels A, Ward ME, Thum JM. American cancer society: cancer facts and figures. Atlanta: American Cancer Society; 2005.
Katz SJ, Lantz PM, Janz NK, Fagerlin A, Schwartz K, Liu L, Deapen D, Salem B, Lakhani I, Morrow M. Patient involvement in surgery treatment decisions for breast cancer. J Clin Oncol. 2005;23(24):5526–33.
doi: 10.1200/JCO.2005.06.217
pubmed: 16110013
Gruber RP, Kahn RA, Lash H, Maser MR, Apfelberg DB, Laub DR. Breast reconstruction following mastectomy: a comparison of submuscular and subcutaneous techniques. Plast Reconstr Surg. 1981;67(3):312–7.
doi: 10.1097/00006534-198103000-00007
pubmed: 7232564
Kuwahara M, Hatoko M, Tada H, Tanaka A, Yurugi S, Mashiba K. Distortion and movement of the expander during skin expansion. Scand J Plast Reconstr Surg Hand Surg. 2003;37(1):22–7.
doi: 10.1080/alp.37.1.22.27
pubmed: 12625391
Sbitany H, Langstein HN. Acellular dermal matrix in primary breast reconstruction. Aesthet Surg J. 2011;31(7_Supplement):30S-7S.
doi: 10.1177/1090820X11417577
pubmed: 21908822
Breuing KH, Warren SM. Immediate bilateral breast reconstruction with implants and inferolateral AlloDerm slings. Ann Plast Surg. 2005;55(3):232–9.
doi: 10.1097/01.sap.0000168527.52472.3c
pubmed: 16106158
Schmitz M, Bertram M, Kneser U, Keller AK, Horch RE. Experimental total wrapping of breast implants with acellular dermal matrix: a preventive tool against capsular contracture in breast surgery? J Plast Reconstr Aesthet Surg. 2013;66(10):1382–9.
doi: 10.1016/j.bjps.2013.05.020
pubmed: 23764323
Reitsamer R, Peintinger F. Prepectoral implant placement and complete coverage with porcine acellular dermal matrix: a new technique for direct-to-implant breast reconstruction after nipple-sparing mastectomy. J Plast Reconstr Aesthet Surg. 2015;68(2):162–7.
doi: 10.1016/j.bjps.2014.10.012
pubmed: 25455288
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.
doi: 10.1097/PRS.0000000000002331
pubmed: 27064232
Berna G, Cawthorn SJ, Papaccio G, Balestrieri N. Evaluation of a novel breast reconstruction technique using the Braxon® acellular dermal matrix: a new muscle-sparing breast reconstruction. ANZ J Surg. 2017;87(6):493–8.
doi: 10.1111/ans.12849
pubmed: 25266930
Zammit D, Kanevsky J, Meng FY, Dionisopoulos T. Meshed acellular dermal matrix: technique and application in implant based breast reconstruction. Plast Aesthet Res. 2016;14(3):254–6.
doi: 10.20517/2347-9264.2015.128
Rodriguez-Unda N, Leiva S, Cheng HT, Seal SM, Cooney CM, Rosson GD. Low incidence of complications using polyglactin 910 (Vicryl) mesh in breast reconstruction: a systematic review. J Plast Reconstr Aesthet Surg. 2015;68(11):1543–9.
doi: 10.1016/j.bjps.2015.06.018
pubmed: 26275493
Tessler O, Reish RG, Maman DY, Smith BL, Austen WG Jr. Beyond biologics: absorbable mesh as a low-cost, low-complication sling for implant-based breast reconstruction. Plast Reconstr Surg. 2014;133(2):90e-e99.
doi: 10.1097/01.prs.0000437253.55457.63
pubmed: 24469217
Howard-McNatt MM. Patients opting for breast reconstruction following mastectomy: an analysis of uptake rates and benefit. Breast Cancer Targets Ther. 2013;5:9.
pubmed: 24648753
Scheflan M, Colwell AS. Tissue reinforcement in implant-based breast reconstruction. Plast Reconstr Surg Glob Open. 2014;2(8):e192.
doi: 10.1097/GOX.0000000000000140
pubmed: 25426375
pmcid: 4236353
Lee KT, Eom Y, Mun GH, Bang SI, Jeon BJ, Pyon JK. Efficacy of partial-versus full-sling acellular dermal matrix use in implant-based breast reconstruction: a head-to-head comparison. Aesthet Plast Surg. 2018;42:422–33.
doi: 10.1007/s00266-018-1084-3
Hartzell TL, Taghinia AH, Chang J, Lin SJ, Slavin SA. The use of human acellular dermal matrix for the correction of secondary deformities after breast augmentation: results and costs. Plast Reconstr Surg. 2010;126(5):1711–20.
doi: 10.1097/PRS.0b013e3181ef900c
pubmed: 21042128
Haynes DF, Kreithen JC. Vicryl mesh in expander/implant breast reconstruction: long-term follow-up in 38 patients. Plast Reconstr Surg. 2014;134(5):892–9.
doi: 10.1097/PRS.0000000000000610
pubmed: 25347625
Kobraei EM, Cauley R, Gadd M, Austen WG Jr, Liao EC. Avoiding breast animation deformity with pectoralis-sparing subcutaneous direct-to-implant breast reconstruction. Plast Reconstr Surg Glob Open. 2016;4(5):e708.
doi: 10.1097/GOX.0000000000000681
pubmed: 27579232
pmcid: 4995704
Ho G, Nguyen TJ, Shahabi A, Hwang BH, Chan LS, Wong AK. A systematic review and meta-analysis of complications associated with acellular dermal matrix-assisted breast reconstruction. Ann Plast Surg. 2012;68(4):346–56.
doi: 10.1097/SAP.0b013e31823f3cd9
pubmed: 22421476