ORCID Profile
0000-0001-6050-898X
Current Organisation
Istituto Europeo di Oncologia
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Publisher: Springer Science and Business Media LLC
Date: 21-07-2016
DOI: 10.1007/S00266-016-0683-0
Abstract: Periprosthetic capsule formation is a physiological phenomenon occurring around breast implants. In case of capsular contracture, several surgical techniques are described among them, total capsulectomy is considered the gold standard, but it is not free of complications. A more conservative procedure is the use of "precapsular space", leaving intact the preexisting capsule. The method presents minor complications and further advantages over total capsulectomy. From November 2010 to June 2014, we treated 92 postmastecttomy patients who previously underwent implant-based reconstruction. They presented implant malposition (bottoming-out, double bubble deformity, upward migration) and different degrees of capsular contracture. The implant was repositioned in a neoprecapsular pocket. Sixty-eight out of 92 patients presented a follow-up longer than 24 months, and they are included in the present study. They were evaluated with a questionnaire 1 month before surgery, at 6 months and 2 years postoperatively. Moreover, two independent plastic surgeons completed the same questionnaire at 6 months and 2 years after surgery. Mean follow-up is 29 months. Baker III-IV capsular contracture occurred in 9.5 % of the patients, implant malposition in 2.9 % of the cases and no implant displacement rotation was observed. Patient self-assessment preoperatively and postoperatively (at 2 years) revealed improved cosmetic outcomes (p < 0.01). Surgeon assessment correlated with patient self-assessment. The use of precapsular space, first described for aesthetic augmentation, is a valid alternative to total capsulectomy for the treatment of capsular contracture or implant malposition, even in the reconstructive field. This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors 0266 .
Publisher: Springer Science and Business Media LLC
Date: 03-04-2017
DOI: 10.1007/S00266-017-0867-2
Abstract: Healthy breast surgery constitutes an important step to achieve symmetry in unilateral implant-based reconstructions. We analysed long-term results of breast symmetry obtained with reduction mammaplasties, and we evaluated whether different glandular pedicles may better preserve long-term stability. Between 2006 and 2012, 90 patients underwent mastectomy and immediate reconstruction with tissue expanders and simultaneous contralateral reduction mammaplasty. In 30 patients, a superior nipple-areola pedicle was harvested (GROUP A), in another 30 patients a medial pedicle was performed (GROUP B), and an inferior pedicle was used in the remaining 30 women (GROUP C). An objective evaluation of the reconstructed breast and the reduced one was performed at 1 and 24 months after surgery. One-way ANOVA and Tukey's HSD tests were used for analysis. Furthermore, three independent plastic surgeons filled out a questionnaire to assess aesthetic results. Measurements of the reconstructed breasts showed similar variations between 1- and 24-month evaluations within the three groups with no significant difference (P value >0.05). Measurements of the reduced breast at the 1- and 24-month follow-up (Tukey's test) revealed significant differences among the three groups. Patients from GROUP C showed a significantly higher decrease in Δ nipple-lower clavicle margin distance and Δ nipple-inframammary fold compared to GROUP A and B (P value = 0.01). Surgeons' assessments revealed no statistically significant difference between the three groups. Superior or medial pedicle reduction mammaplasties seem to better preserve breast shape and position, and they maintain a more similar appearance to the contralateral prosthetic breast over time. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors 0266 .
No related grants have been discovered for Francesca De Lorenzi.