One-step breast reconstruction with polyurethane-covered implants after skin-sparing mastectomy.
OBJECTIVE
Skin-sparing mastectomy (SSM) and immediate one-step breast reconstruction with implants has become an increasingly popular, effective treatment for selected patients with breast carcinoma. However, it is associated with high complication rates. Breast augmentation with polyurethane-covered implants (PCIs) has consistently had optimal short-term and long-term results with low rates of capsular contracture. The aim of this study was to evaluate the clinical and aesthetic outcomes of immediate one-step breast reconstruction with PCI after SSM in early breast cancer patients at a single institution.


METHODS
We reviewed the records of 221 consecutive breast cancer patients who underwent one-stage immediate reconstruction with PCI after SSM from 1995 through 2005. Patient and tumour characteristics, type of reconstruction, postoperative complications, aesthetic results and recurrence rate were analysed.


RESULTS
The mean age of the patients was 52±11 years (range, 30-76; standard deviation (SD), 11). The American Joint Committee on Cancer (AJCC) pathologic stages were 0 (10%), I (63.3%) and II (26.7%). Thirty-nine (17.65%; confidence interval (CI)=13.04-23.1) of the 221 patients had complications; seven had prosthesis extrusion requiring an implant (five due to skin necrosis, one due to infection and one due to late haematoma). In six of these seven cases, the procedure was indicated for local recurrence after conservative breast surgery with adjunctive radiation therapy (rescue procedure). Thirty-two (14.4%) patients had minor complications: 12 had cutaneous rash, four had malpositioned implants and 16 had inadequate implant projection. At long-term follow-up, four (1.8%) patients had developed grade IV capsular contracture associated with postoperative radiation therapy. At a median follow-up of 98 months (range, 36-156), 14 (6.3%) patients had tumour recurrence and 12.2% had distant metastasis. Nineteen patients had died of cancer, and 192 (86.8%) remained disease free.


CONCLUSIONS
One-stage immediate breast reconstruction with PCI after SSM appears to be oncologically safe and provides a high level of patient satisfaction.
Universidad de Buenos Aires, Instituto Oncológico Henry Moore, Ciudad Autónoma de Buenos Aires, Argentina. Electronic address: rancati@gmail.com.
Alberto
A
Rancati
Alejandro
A
Soderini
Julio
J
Dorr
Gustavo
G
Gercovich
Luciano
L
Tessari
Eduardo
E
Gonzalez
D000328:Adult; D000368:Aged; D019928:Breast Implantation / Q000379:methods*; D018427:Breast Implants; D001943:Breast Neoplasms / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000601:surgery; D018275:Carcinoma, Lobular / Q000601:surgery; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D017060:Patient Satisfaction; D011140:Polyurethanes; D011474:Prosthesis Design; D011788:Quality of Life; D012189:Retrospective Studies
D011140:Polyurethanes
One-step breast reconstruction; Polyurethane-covered implants; Skin-sparing mastectomy