title: TiLoop® Bra mesh used for immediate breast reconstruction: comparison of retropectoral and subcutaneous implant placement in a prospective single-institution series.
abstract: BACKGROUND
  Immediate implant reconstruction after a conservative mastectomy is an attractive option made easier by prosthetic devices. Titanized polypropylene meshes are used as a hammock to cover the lower lateral implant pole. We conducted a prospective nonrandomized single-institution study of reconstructions using titanium-coated meshes either in a standard muscular mesh pocket or in a complete subcutaneous approach. The complete subcutaneous approach means to wrap an implant with titanized mesh in order to position the implant subcutaneously and spare muscles.
  
  
  METHODS
  Between November 2011 and January 2014, we performed immediate implant breast reconstructions after conservative mastectomies using TiLoop® Bra, either with the standard retropectoral or with a prepectoral approach. Selection criteria included only women with normal Body Mass Index (BMI), no large and very ptotic breasts, no history of smoking, no diabetes, and no previous radiotherapy. We analyzed short-term outcomes of such procedures and compared the outcomes to evaluate implant losses and surgical complications.
  
  
  RESULTS
  A total of 73 mastectomies were performed. Group 1 comprised 29 women, 5 bilateral procedures, 34 reconstructions, using the standard muscular mesh pocket. Group 2 comprised 34 women, 5 bilateral procedures, 39 reconstructions with the prepectoral subcutaneous technique. Baseline and oncologic characteristics were homogeneous between the two groups. After a median follow-up period of 13 and 12 months, respectively, no implant losses were recorded in group 1, and one implant loss was recorded in group 2. We registered three surgical complications in group 1 and two surgical complications in group 2.
  
  
  CONCLUSIONS
  Titanium-coated polypropylene meshes, as a tool for immediate definitive implant breast reconstruction, resulted as safe and effective in a short-term analysis, both for a retropectoral and a totally subcutaneous implant placement. Long-term results are forthcoming. A strict selection is mandatory to achieve optimal results. Level of Evidence: Level II, therapeutic study.
authors.affiliation: Breast Unit Surgery, Oncology Department, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy.
authors.forename: Donato
authors.initials: D
authors.lastname: Casella
authors.affiliation: Breast Unit Surgery, Oncology Department, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Bernini
authors.affiliation: Surgical Oncology, Oncology Department, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy.
authors.forename: Lapo
authors.initials: L
authors.lastname: Bencini
authors.affiliation: Breast Unit Surgery, Oncology Department, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy.
authors.forename: Jenny
authors.initials: J
authors.lastname: Roselli
authors.affiliation: Breast Unit Surgery, Oncology Department, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Lacaria
authors.affiliation: General Surgery, Emergency Department, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Martellucci
authors.affiliation: Drugs and Devices Service, Pharmacy Department, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Banfi
authors.affiliation: Breast Unit Surgery, Oncology Department, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Calabrese
authors.affiliation: Breast Unit Surgery, Oncology Department, Careggi University Hospital, L.go Brambilla 3, 50134 Florence, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Orzalesi
keywords: Conservative mastectomy; Immediate breast reconstruction; Implant-based breast reconstruction; Subcutaneous implant positioning; Titanium-coated mesh