title: Subcutaneous Tissue Expander Placement with Synthetic Titanium-Coated Mesh in Breast Reconstruction: Long-term Results.
abstract: A subcutaneous, prepectoral, muscle-sparing approach has been recently described for implant-based breast reconstruction. This is a preliminary series of 2-stage breast reconstructions by means of tissue expander placed subcutaneously with the support of a titanium-coated polypropylene mesh. A pilot series of cases was started in 2012. Inclusion criteria were informed consent, age less than 80 years, normal body mass index (range, 18.5-24.9), no T4 and metastatic cancers, no comorbidities, and nonsmoking patients. Expander losses, infections, seromas, skin/nipple necrosis, wound dehiscence, and reinterventions were registered in follow-up visits. Furthermore, patients were followed up in second-stage procedures and for at least 1 year from implant positioning to collect any surgical complication, reinterventions, cosmetic outcome, and oncological data. Between June 2012 and March 2014, 25 cases were enrolled in the study. Expander/implant loss rate was 0%. Skin/nipple necrosis rate was 4%. Infections rate was 12% after first-stage and 4% after second-stage procedure. Seromas rate was 0%. Five (20%) fat graft procedures were performed over the expander before second-stage reconstruction, and no reinterventions were required after second stage. Patients mean score was 99 for cosmetic outcome satisfaction, in a 0-100 scale. Subcutaneous 2-stage reconstruction with synthetic mesh proved safe and feasible. Patients satisfaction is very good after 14 months median follow-up form definitive implant placement. Although the present study involved only a small number of cases, a tissue-expander subcutaneous reconstruction seems to have promising results. Whenever pectoralis major muscle can be spared, a conservative reconstruction might be an option.
authors.affiliation: Oncologic and Reconstructive Breast Surgery, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy; Pathology Division, Department of Surgery and Translational Medicine, Careggi University Hospital, Florence, Italy; and Radiation-Oncology Division, Oncology Department, Careggi University Hospital, Florence, Italy.
authors.forename: Donato
authors.initials: D
authors.lastname: Casella
authors.affiliation: Oncologic and Reconstructive Breast Surgery, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy; Pathology Division, Department of Surgery and Translational Medicine, Careggi University Hospital, Florence, Italy; and Radiation-Oncology Division, Oncology Department, Careggi University Hospital, Florence, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Calabrese
authors.affiliation: Oncologic and Reconstructive Breast Surgery, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy; Pathology Division, Department of Surgery and Translational Medicine, Careggi University Hospital, Florence, Italy; and Radiation-Oncology Division, Oncology Department, Careggi University Hospital, Florence, Italy.
authors.forename: Simonetta
authors.initials: S
authors.lastname: Bianchi
authors.affiliation: Oncologic and Reconstructive Breast Surgery, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy; Pathology Division, Department of Surgery and Translational Medicine, Careggi University Hospital, Florence, Italy; and Radiation-Oncology Division, Oncology Department, Careggi University Hospital, Florence, Italy.
authors.forename: Icro
authors.initials: I
authors.lastname: Meattini
authors.affiliation: Oncologic and Reconstructive Breast Surgery, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy; Pathology Division, Department of Surgery and Translational Medicine, Careggi University Hospital, Florence, Italy; and Radiation-Oncology Division, Oncology Department, Careggi University Hospital, Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Bernini