Clinical application of immediate prepectoral implant-based breast reconstruction with TiLoop Bra after skin-sparing or nipple-areola-complex-sparing mastectomy for breast cancer patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIAO Xiao , LONG Quanyi ,  LI Hongjiang

1. Center for Breast Disease, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

LI Hongjiang, Email: lihongjiang@sohu.com

Keywords：

Breast cancer; immediate breast reconstruction; breast implant

DOI：

10.7507/1007-4848.202212067

Video：

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Objective To explore the surgical technique and preliminary safety and aesthetics results of immediate prepectoral implant-based breast reconstruction (BR) with titanium-coated polypropylene mesh (TiLoop Bra) after skin-sparing mastectomy (SSM) or nipple-areola-complex-sparing mastectomy (NSM) for breast cancer patients. Methods The clinical data of consecutive patients who underwent immediate prepectoral implant-based BR with TiLoop Bra after SSM or NSM in West China Hospital from January to July 2022 were retrospectively analyzed. The operation time, intraoperative blood loss, early complication were collected. The preliminary aesthetics results were assessed with the Ueda score and Harris score. Results All the patients were female with a mean age of 39.0±6.8 years. One patient had bilateral breast malignant tumors, and the others had unilateral malignant tumors. Six patients received neoadjuvant chemotherapy before surgery. The mean diameter of the tumors was 24.4±11.9 mm under the color ultrasound before the neoadjuvant chemotherapy. The mean operation time was 153.9±49.4 min. The mean intraoperative blood loss was 29.2±18.3 mL. There were 3 patients with tumor stage 0, 10 patients with stage Ⅰ, 6 patients with stage Ⅱ, 3 patients with stage Ⅲ and 1 patient was found no residual cancer after neoadjuvant chemotherapy. All the patients were successfully followed up with a median follow-up time of 4.8 (3.0-9.2) months. There were 2 (8.3%) patients with major complications, including 1 wound dehiscence and 1 hematoma, and 4 (16.7%) minor complications, including 2 wound dehiscence and 2 infection. The patients with excellent and good Ueda score and Harris score accounted for 82.6% and 87.0%, respectively. None of the patients had animation deformity, capsular contracture, nipple-areola or skin flaps necrosis, or implant loss. During the follow-up period, no local/regional recurrence or distant metastasis was found. Conclusion For selected reliable patients, immediate prepectoral implant-based BR with TiLoop Bra after SSM or NSM for breast cancer patients is safe and has good aesthetics results in the early postoperative period. It has broad application space in patients with suitable indications, and can be promoted as a routine operation.

Citation： XIAO Xiao, LONG Quanyi, LI Hongjiang. Clinical application of immediate prepectoral implant-based breast reconstruction with TiLoop Bra after skin-sparing or nipple-areola-complex-sparing mastectomy for breast cancer patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(4): 538-545. doi: 10.7507/1007-4848.202212067 Copy

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2.	Lancet. GLOBOCAN 2018: Counting the toll of cancer. Lancet, 2018, 392(10152): 985.
3.	Fitzal F, Bolliger M, Dunkler D, et al. Retrospective, multicenter analysis comparing conventional with oncoplastic breast conserving surgery: Oncological and surgical outcomes in women with high-risk breast cancer from the OPBC-01/iTOP2 study. Ann Surg Oncol, 2022, 29(2): 1061-1070.
4.	Veronesi U, Zurrida S. Preserving life and conserving the breast. Lancet Oncol, 2009, 10(7): 736.
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6.	Alderman AK, McMahon L, Wilkins EG. The national utilization of immediate and early delayed breast reconstruction and the effect of sociodemographic factors. Plast Reconstr Surg, 2003, 111(2): 695-703.
7.	Wilkins EG, Alderman AK. Breast reconstruction practices in north america: Current trends and future priorities. Semin Plast Surg, 2004, 18(2): 149-155.
8.	Eltahir Y, Werners LLCH, Dreise MM, et al. Quality-of-life outcomes between mastectomy alone and breast reconstruction: Comparison of patient-reported BREAST-Q and other health-related quality-of-life measures. Plast Reconstr Surg, 2013, 132(2): 201e-209e.
9.	Sbitany H. Breast reconstruction. Surg Clin North Am, 2018, 98(4): 845-857.
10.	Chandarana MN, Jafferbhoy S, Marla S, et al. Acellular dermal matrix in implant-based immediate breast reconstructions: A comparison of prepectoral and subpectoral approach. Gland Surg, 2018, 7(Suppl 1): S64-S69.
11.	Snyderman RK, Guthrie RH. Reconstruction of the female breast following radical mastectomy. Plast Reconstr Surg, 1971, 47(6): 565-567.
12.	Walia GS, Aston J, Bello R, et al. Prepectoral versus subpectoral tissue expander placement: A clinical and quality of life outcomes study. Plast Reconstr Surg Glob Open, 2018, 6(4): e1731.
13.	Bernini M, Calabrese C, Cecconi L, et al. Subcutaneous direct-to-implant breast reconstruction: Surgical, functional, and aesthetic results after long-term follow-up. Plast Reconstr Surg Glob Open, 2016, 3(12): e574.
14.	Ueda S, Tamaki Y, Yano K, et al. Cosmetic outcome and patient satisfaction after skin-sparing mastectomy for breast cancer with immediate reconstruction of the breast. Surgery, 2008, 143(3): 414-425.
15.	Harris JR, Levene MB, Svensson G, et al. Analysis of cosmetic results following primary radiation therapy for stages Ⅰ and Ⅱ carcinoma of the breast. Int J Radiat Oncol Biol Phys, 1979, 5(2): 257-261.
16.	Regnault P. Breast ptosis. Definition and treatment. Clin Plast Surg, 1976, 3(2): 193-203.
17.	Ding BW, Wang HQ, He SS, et al. Application of acellular bovine pericardium patch in implant based immediate breast reconstruction. Zhonghua Wai Ke Za Zhi, 2022, 60(3): 237-243.
18.	吴杰, 赵夷, 王鲁飞, 等. 乳腺癌术后即刻乳房重建与单纯改良根治术效果比较. 肿瘤研究与临床, 2019, 31(8): 535-539.
19.	Bishop CC, Singh S, Nash AG. Mastectomy and breast reconstruction preserving the nipple. Ann R Coll Surg Engl, 1990, 72(2): 87-89.
20.	Breuing KH, Warren SM. Immediate bilateral breast reconstruction with implants and inferolateral AlloDerm slings. Ann Plast Surg, 2005, 55(3): 232-239.
21.	Jones G, Antony AK. Single stage, direct to implant pre-pectoral breast reconstruction. Gland Surg, 2019, 8(1): 53-60.
22.	Reitsamer R, Peintinger F. Prepectoral implant placement and complete coverage with porcine acellular dermal matrix: A new technique for direct-to-implant breast reconstruction after nipple-sparing mastectomy. J Plast Reconstr Aesthet Surg, 2015, 68(2): 162-167.
23.	Sbitany H, Piper M, Lentz R. Prepectoral breast reconstruction: A safe alternative to submuscular prosthetic reconstruction following nipple-sparing mastectomy. Plast Reconstr Surg, 2017, 140(3): 432-443.
24.	Ribuffo D, Berna G, De Vita R, et al. Dual-plane retro-pectoral versus pre-pectoral DTI breast reconstruction: An Italian multicenter experience. Aesthetic Plast Surg, 2021, 45(1): 51-60.
25.	Plachinski SJ, Boehm LM, Adamson KA, et al. Comparative analysis of prepectoral versus subpectoral implant-based breast reconstruction. Plast Reconstr Surg Glob Open, 2021, 9(7): e3709.
26.	Schaeffer CV, Dassoulas KR, Thuman J, et al. Early functional outcomes after prepectoral breast reconstruction: A case-matched cohort study. Ann Plast Surg, 2019, 82(6S Suppl 5): S399-S403.
27.	Arnaout A, Zhang J, Frank S, et al. A randomized controlled trial comparing alloderm-RTU with DermACELL in immediate subpectoral implant-based breast reconstruction. Curr Oncol, 2020, 28(1): 184-195.
28.	Wow T, Kolacinska-Wow A, Wichtowski M, et al. A retrospective study assessing the outcomes of immediate prepectoral and subpectoral implant and mesh-based breast reconstruction. Cancers (Basel), 2022, 14(13): 3188.
29.	Chopra K, Singh D, Hricz N, et al. Two-stage prosthetic prepectoral breast reconstruction: Comparing tissue expansion with carbon dioxide and saline. Plast Reconstr Surg Glob Open, 2019, 7(3): e2051.
30.	Nahabedian MY, Jacobson SR. Two-stage prepectoral breast reconstruction. Gland Surg, 2019, 8(1): 43-52.
31.	Casella D, Di Taranto G, Marcasciano M, et al. Evaluation of prepectoral implant placement and complete coverage with TiLoop Bra mesh for breast reconstruction: A prospective study on long-term and patient-reported BREAST-Q outcomes. Plast Reconstr Surg, 2019, 143(1): 1e-9e.
32.	王永南, 张安秦, 连臻强, 等. 保留乳头、乳晕的乳房切除术加一期假体乳房重建术的回顾性临床对照研究. 中华乳腺病杂志(电子版), 2020, 14(3): 156-161.

1. Akram M, Iqbal M, Daniyal M, et al. Awareness and current knowledge of breast cancer. Biol Res, 2017, 50(1): 33.
2. Lancet. GLOBOCAN 2018: Counting the toll of cancer. Lancet, 2018, 392(10152): 985.
3. Fitzal F, Bolliger M, Dunkler D, et al. Retrospective, multicenter analysis comparing conventional with oncoplastic breast conserving surgery: Oncological and surgical outcomes in women with high-risk breast cancer from the OPBC-01/iTOP2 study. Ann Surg Oncol, 2022, 29(2): 1061-1070.
4. Veronesi U, Zurrida S. Preserving life and conserving the breast. Lancet Oncol, 2009, 10(7): 736.
5. Dean C, Chetty U, Forrest AP. Effects of immediate breast reconstruction on psychosocial morbidity after mastectomy. Lancet, 1983, 1(8322): 459-462.
6. Alderman AK, McMahon L, Wilkins EG. The national utilization of immediate and early delayed breast reconstruction and the effect of sociodemographic factors. Plast Reconstr Surg, 2003, 111(2): 695-703.
7. Wilkins EG, Alderman AK. Breast reconstruction practices in north america: Current trends and future priorities. Semin Plast Surg, 2004, 18(2): 149-155.
8. Eltahir Y, Werners LLCH, Dreise MM, et al. Quality-of-life outcomes between mastectomy alone and breast reconstruction: Comparison of patient-reported BREAST-Q and other health-related quality-of-life measures. Plast Reconstr Surg, 2013, 132(2): 201e-209e.
9. Sbitany H. Breast reconstruction. Surg Clin North Am, 2018, 98(4): 845-857.
10. Chandarana MN, Jafferbhoy S, Marla S, et al. Acellular dermal matrix in implant-based immediate breast reconstructions: A comparison of prepectoral and subpectoral approach. Gland Surg, 2018, 7(Suppl 1): S64-S69.
11. Snyderman RK, Guthrie RH. Reconstruction of the female breast following radical mastectomy. Plast Reconstr Surg, 1971, 47(6): 565-567.
12. Walia GS, Aston J, Bello R, et al. Prepectoral versus subpectoral tissue expander placement: A clinical and quality of life outcomes study. Plast Reconstr Surg Glob Open, 2018, 6(4): e1731.
13. Bernini M, Calabrese C, Cecconi L, et al. Subcutaneous direct-to-implant breast reconstruction: Surgical, functional, and aesthetic results after long-term follow-up. Plast Reconstr Surg Glob Open, 2016, 3(12): e574.
14. Ueda S, Tamaki Y, Yano K, et al. Cosmetic outcome and patient satisfaction after skin-sparing mastectomy for breast cancer with immediate reconstruction of the breast. Surgery, 2008, 143(3): 414-425.
15. Harris JR, Levene MB, Svensson G, et al. Analysis of cosmetic results following primary radiation therapy for stages Ⅰ and Ⅱ carcinoma of the breast. Int J Radiat Oncol Biol Phys, 1979, 5(2): 257-261.
16. Regnault P. Breast ptosis. Definition and treatment. Clin Plast Surg, 1976, 3(2): 193-203.
17. Ding BW, Wang HQ, He SS, et al. Application of acellular bovine pericardium patch in implant based immediate breast reconstruction. Zhonghua Wai Ke Za Zhi, 2022, 60(3): 237-243.
18. 吴杰, 赵夷, 王鲁飞, 等. 乳腺癌术后即刻乳房重建与单纯改良根治术效果比较. 肿瘤研究与临床, 2019, 31(8): 535-539.
19. Bishop CC, Singh S, Nash AG. Mastectomy and breast reconstruction preserving the nipple. Ann R Coll Surg Engl, 1990, 72(2): 87-89.
20. Breuing KH, Warren SM. Immediate bilateral breast reconstruction with implants and inferolateral AlloDerm slings. Ann Plast Surg, 2005, 55(3): 232-239.
21. Jones G, Antony AK. Single stage, direct to implant pre-pectoral breast reconstruction. Gland Surg, 2019, 8(1): 53-60.
22. Reitsamer R, Peintinger F. Prepectoral implant placement and complete coverage with porcine acellular dermal matrix: A new technique for direct-to-implant breast reconstruction after nipple-sparing mastectomy. J Plast Reconstr Aesthet Surg, 2015, 68(2): 162-167.
23. Sbitany H, Piper M, Lentz R. Prepectoral breast reconstruction: A safe alternative to submuscular prosthetic reconstruction following nipple-sparing mastectomy. Plast Reconstr Surg, 2017, 140(3): 432-443.
24. Ribuffo D, Berna G, De Vita R, et al. Dual-plane retro-pectoral versus pre-pectoral DTI breast reconstruction: An Italian multicenter experience. Aesthetic Plast Surg, 2021, 45(1): 51-60.
25. Plachinski SJ, Boehm LM, Adamson KA, et al. Comparative analysis of prepectoral versus subpectoral implant-based breast reconstruction. Plast Reconstr Surg Glob Open, 2021, 9(7): e3709.
26. Schaeffer CV, Dassoulas KR, Thuman J, et al. Early functional outcomes after prepectoral breast reconstruction: A case-matched cohort study. Ann Plast Surg, 2019, 82(6S Suppl 5): S399-S403.
27. Arnaout A, Zhang J, Frank S, et al. A randomized controlled trial comparing alloderm-RTU with DermACELL in immediate subpectoral implant-based breast reconstruction. Curr Oncol, 2020, 28(1): 184-195.
28. Wow T, Kolacinska-Wow A, Wichtowski M, et al. A retrospective study assessing the outcomes of immediate prepectoral and subpectoral implant and mesh-based breast reconstruction. Cancers (Basel), 2022, 14(13): 3188.
29. Chopra K, Singh D, Hricz N, et al. Two-stage prosthetic prepectoral breast reconstruction: Comparing tissue expansion with carbon dioxide and saline. Plast Reconstr Surg Glob Open, 2019, 7(3): e2051.
30. Nahabedian MY, Jacobson SR. Two-stage prepectoral breast reconstruction. Gland Surg, 2019, 8(1): 43-52.
31. Casella D, Di Taranto G, Marcasciano M, et al. Evaluation of prepectoral implant placement and complete coverage with TiLoop Bra mesh for breast reconstruction: A prospective study on long-term and patient-reported BREAST-Q outcomes. Plast Reconstr Surg, 2019, 143(1): 1e-9e.
32. 王永南, 张安秦, 连臻强, 等. 保留乳头、乳晕的乳房切除术加一期假体乳房重建术的回顾性临床对照研究. 中华乳腺病杂志(电子版), 2020, 14(3): 156-161.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical application of immediate prepectoral implant-based breast reconstruction with TiLoop Bra after skin-sparing or nipple-areola-complex-sparing mastectomy for breast cancer patients

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