title: Clinical experiences with the use of ULTRAPRO®mesh in single-stage direct-to-implant immediate postmastectomy breast reconstruction in 102 patients: A retrospective cohort study.
abstract: BACKGROUND
  Acellular dermal matrices have been used for direct-to-implant (DTI) breast reconstruction (BR), eliminating the load of the lower pole skin envelope. However, the available allograft matrices add considerable health care costs. This study examined the long-term follow-up of synthetic ULTRAPRO®mesh as a low-cost potential alternative to biological matrices.
  
  
  METHODS
  A retrospective cohort study was performed between January 2013 and January 2016, involved 112 early-stage breast cancer and/or BRCA 1/2 patients, and evaluated 189 immediate DTI BRs following skin-, areola- or nipple-sparing mastectomy using ULTRAPRO®mesh. Patient characteristics and postoperative complications were recorded, and quality of life was rated by the patients using the EORTC-QLQ-C30-BR23 questionnaire. Aesthetic outcomes and palpability of the implants were evaluated by four breast surgeons on a 5-point Likert scale. All recorded parameters were statistically analysed.
  
  
  RESULTS
  Ten patients were lost-to-follow-up, resulting in 102 patients and 174 breast surgery cases analysed. The mean age was 43 years, with 23.4 months of follow-up on average. Forty-six patients (45.1%) had previous radiotherapy with pre-existing scars. In total, 32 complications (18.3%) were recorded, including 12 minor (6.9%) and 20 major (11.4%) complications requiring revision. All median quality of life scores were above 83 points, representing a high score, with an average 4-point rating for the aesthetic outcome and natural consistency of the breast.
  
  
  CONCLUSIONS
  Partially absorbable ULTRAPRO®mesh could be used successfully in DTI BR, offering a safe, less expensive alternative to biological matrices. Adequate indications and patient selection are necessary.
authors.affiliation: National Institute of Oncology, Department of Breast and Sarcoma Surgery, Ráth György Str. 7-9, 1122 Budapest, Hungary. Electronic address: d.pukancsik@gmail.com.
authors.forename: D
authors.initials: D
authors.lastname: Pukancsik
authors.affiliation: National Institute of Oncology, Department of Breast and Sarcoma Surgery, Ráth György Str. 7-9, 1122 Budapest, Hungary.
authors.forename: P
authors.initials: P
authors.lastname: Kelemen
authors.affiliation: National Institute of Oncology, Department of Breast and Sarcoma Surgery, Ráth György Str. 7-9, 1122 Budapest, Hungary.
authors.forename: G
authors.initials: G
authors.lastname: Gulyás
authors.affiliation: National Institute of Oncology, Department of Breast and Sarcoma Surgery, Ráth György Str. 7-9, 1122 Budapest, Hungary.
authors.forename: M
authors.initials: M
authors.lastname: Újhelyi
authors.affiliation: National Institute of Oncology, Department of Radiological Diagnostics, Ráth György Str. 7-9, 1122 Budapest, Hungary.
authors.forename: E
authors.initials: E
authors.lastname: Kovács
authors.affiliation: National Institute of Oncology, Department of Surgical and Molecular Pathology, Ráth György Str. 7-9, 1122 Budapest, Hungary.
authors.forename: K
authors.initials: K
authors.lastname: Éles
authors.affiliation: National Institute of Oncology, Department of Radiotherapy, Ráth György Str. 7-9, 1122 Budapest, Hungary.
authors.forename: N
authors.initials: N
authors.lastname: Mészáros
authors.affiliation: National Institute of Oncology, National Cancer Registry, Ráth György Str. 7-9, 1122 Budapest, Hungary; Semmelweis University, 2nd Department of Pathology, Üllői Str. 93, 1091 Budapest, Hungary.
authors.forename: I
authors.initials: I
authors.lastname: Kenessey
authors.affiliation: Semmelweis University, Department of Anatomy, Histology and Embryology, Tűzoltó Str. 58, 1094 Budapest, Hungary.
authors.forename: P
authors.initials: P
authors.lastname: Pálházi
authors.affiliation: Guy's and St Thomas's Hospitals NHS Foundation Trust, Department of Breast Surgery, Great Maze Pond, London SE1 9RT, United Kingdom.
authors.forename: T
authors.initials: T
authors.lastname: Kovács
authors.affiliation: National Institute of Oncology, Ráth György Str. 7-9, 1122 Budapest, Hungary.
authors.forename: M
authors.initials: M
authors.lastname: Kásler
authors.affiliation: National Institute of Oncology, Department of Breast and Sarcoma Surgery, Ráth György Str. 7-9, 1122 Budapest, Hungary.
authors.forename: Z
authors.initials: Z
authors.lastname: Mátrai
mesh_terms: D020341:Absorbable Implants; D000328:Adult; D001943:Breast Neoplasms / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000295:instrumentation*; D015414:Mastectomy, Subcutaneous; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology*; D011788:Quality of Life; D012086:Reoperation; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000009:adverse effects; D011795:Surveys and Questionnaires
keywords: Direct-to-implant; Immediate breast reconstruction