title: Subcutaneous Direct-to-Implant Breast Reconstruction: Surgical, Functional, and Aesthetic Results after Long-Term Follow-Up.
abstract: Direct-to-implant breast reconstruction can be achieved more easily by means of soft-tissue replacement devices such as dermal matrices and synthetic meshes. The feasibility of a subcutaneous approach has been recently investigated by some studies with different devices functioning as implant support. Aim of this study is to analyze the long-term results, both objective and subjective, of a previous nonrandomized trial comparing prepectoral (subcutaneous) and retropectoral breast reconstructions.
  
  
  METHODS
  Patients enrolled in a nonrandomized prospective trial, comparing the standard retropectoral reconstruction and the prepectoral subcutaneous approach, using a titanium-coated mesh in both techniques, were followed up and evaluated for long-term results. Cases were compared in terms of the causes and rate of reinterventions, of the postoperative BREAST-Q questionnaire results, and of an objective surgical evaluation.
  
  
  RESULTS
  The subcutaneous group had a rate of implant failure and removal of 5.1% when compared with 0% in the retropectoral group. Aesthetic outcome was significantly better for the subcutaneous group both at a subjective and at an objective evaluation. Capsular contracture rate was 0% in the subcutaneous group.
  
  
  CONCLUSIONS
  A higher rate of implant failure and removal, although not significant, always because of skin flaps and wound problems, should be taken into account for a careful patients selection. The subcutaneous breast reconstruction shows good long-term results. A coherent subjective and objective cosmetic advantage of this approach emerges. Moreover, no capsular contracture is evident, albeit in a relatively limited number of cases.
authors.affiliation: Oncologic and Reconstructive Breast Surgery, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy; Statistics, Department of Statistics, Informatics and Application "G. Parenti," University of Florence, Florence, Italy; Breast Unit Surgery, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy; Diagnostic Senology Unit, Radiology Department, Careggi University Hospital, Florence, Italy; and Radiology, Diagnostic Imaging Department, Le Scotte University Hospital, Siena, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Bernini
authors.affiliation: Oncologic and Reconstructive Breast Surgery, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy; Statistics, Department of Statistics, Informatics and Application "G. Parenti," University of Florence, Florence, Italy; Breast Unit Surgery, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy; Diagnostic Senology Unit, Radiology Department, Careggi University Hospital, Florence, Italy; and Radiology, Diagnostic Imaging Department, Le Scotte University Hospital, Siena, 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; Statistics, Department of Statistics, Informatics and Application "G. Parenti," University of Florence, Florence, Italy; Breast Unit Surgery, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy; Diagnostic Senology Unit, Radiology Department, Careggi University Hospital, Florence, Italy; and Radiology, Diagnostic Imaging Department, Le Scotte University Hospital, Siena, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Cecconi
authors.affiliation: Oncologic and Reconstructive Breast Surgery, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy; Statistics, Department of Statistics, Informatics and Application "G. Parenti," University of Florence, Florence, Italy; Breast Unit Surgery, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy; Diagnostic Senology Unit, Radiology Department, Careggi University Hospital, Florence, Italy; and Radiology, Diagnostic Imaging Department, Le Scotte University Hospital, Siena, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Santi
authors.affiliation: Oncologic and Reconstructive Breast Surgery, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy; Statistics, Department of Statistics, Informatics and Application "G. Parenti," University of Florence, Florence, Italy; Breast Unit Surgery, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy; Diagnostic Senology Unit, Radiology Department, Careggi University Hospital, Florence, Italy; and Radiology, Diagnostic Imaging Department, Le Scotte University Hospital, Siena, Italy.
authors.forename: Ulpjana
authors.initials: U
authors.lastname: Gjondedaj
authors.affiliation: Oncologic and Reconstructive Breast Surgery, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy; Statistics, Department of Statistics, Informatics and Application "G. Parenti," University of Florence, Florence, Italy; Breast Unit Surgery, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy; Diagnostic Senology Unit, Radiology Department, Careggi University Hospital, Florence, Italy; and Radiology, Diagnostic Imaging Department, Le Scotte University Hospital, Siena, Italy.
authors.forename: Jenny
authors.initials: J
authors.lastname: Roselli
authors.affiliation: Oncologic and Reconstructive Breast Surgery, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy; Statistics, Department of Statistics, Informatics and Application "G. Parenti," University of Florence, Florence, Italy; Breast Unit Surgery, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy; Diagnostic Senology Unit, Radiology Department, Careggi University Hospital, Florence, Italy; and Radiology, Diagnostic Imaging Department, Le Scotte University Hospital, Siena, Italy.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Nori
authors.affiliation: Oncologic and Reconstructive Breast Surgery, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy; Statistics, Department of Statistics, Informatics and Application "G. Parenti," University of Florence, Florence, Italy; Breast Unit Surgery, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy; Diagnostic Senology Unit, Radiology Department, Careggi University Hospital, Florence, Italy; and Radiology, Diagnostic Imaging Department, Le Scotte University Hospital, Siena, Italy.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Fausto
authors.affiliation: Oncologic and Reconstructive Breast Surgery, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy; Statistics, Department of Statistics, Informatics and Application "G. Parenti," University of Florence, Florence, Italy; Breast Unit Surgery, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy; Diagnostic Senology Unit, Radiology Department, Careggi University Hospital, Florence, Italy; and Radiology, Diagnostic Imaging Department, Le Scotte University Hospital, Siena, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Orzalesi
authors.affiliation: Oncologic and Reconstructive Breast Surgery, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy; Statistics, Department of Statistics, Informatics and Application "G. Parenti," University of Florence, Florence, Italy; Breast Unit Surgery, Breast Unit, Oncology Department, Careggi University Hospital, Florence, Italy; Diagnostic Senology Unit, Radiology Department, Careggi University Hospital, Florence, Italy; and Radiology, Diagnostic Imaging Department, Le Scotte University Hospital, Siena, Italy.
authors.forename: Donato
authors.initials: D
authors.lastname: Casella