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Breast reconstruction with polyurethane implants: preliminary report

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Abstract

Today, immediate breast reconstruction is widely accepted in breast cancer surgery. There are many reconstruction procedures that combine cancer indications with patient's expectations. Improved techniques in the use of textured or polyurethane-coated implants and tissue expanders, associated with increasingly more conservative mastectomy procedures, may result in better cosmetic outcomes and less complications, even in patients that require postoperative radiotherapy. From June 2002 to December 2008, 166 unilateral breast reconstructions were performed immediately using definite prosthesis with polyurethane-coated (6) or textured (24) implants, or later, after implant of 136 tissue expanders, using polyurethane-coated (113) or textured (23) implants. Eighty-six two-stage breast reconstructions were irradiated where later 63 polyurethane-coated implants and 23 textured implants have been inserted. Results were analysed evaluating complications associated with temporary expanders and with the two definite implants, with or without RT, respectively. Excluding capsular contracture, total complication rate was 14.7% with expanders, 5.0% with polyurethane implants and 12.8% with textured implants. In this study, severe capsular contracture was reported in 21.7% of cases with textured prosthesis and in 6.3% of cases with polyurethane implants in patients receiving RT. This difference was statistically significant. As of today, no case of clinically noticeable capsular contracture was seen in non-irradiated patients receiving breast reconstruction with polyurethane-coated implants. These results allow us to establish RT, which is not a severe contraindication to breast reconstruction with implants. Polyurethane implants have provided encouraging results either in terms of lower complication rate and likelihood of capsular contracture.

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References

  1. Overgaard M, Hansen PS, Overgaard J et al (1997) Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med 337:949–955

    Article  PubMed  CAS  Google Scholar 

  2. Overgaard M, Jensen MB, Overgaard J et al (1999) Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial. Lancet 353:1641–1648

    Article  PubMed  CAS  Google Scholar 

  3. Ragaz J, Olivotto IA, Spinelli JJ et al (2005) Locoregional radiation therapy in patients with highrisk breast cancer receiving adjuvant chemotherapy: 20-year results of the British Columbia randomized trial. J Natl Cancer Inst 97:116–126

    Article  PubMed  Google Scholar 

  4. Whelan TJ, Julian J, Wright J et al (2000) Does locoregional radiation therapy improve survival in breast cancer? A meta-analysis. J Clin Oncol 18:1220–1229

    PubMed  CAS  Google Scholar 

  5. Whitfield GA, Horan G, Irwin MS et al (2009) Incidence of severe capsular contracture following implant-based immediate breast reconstruction with or without postoperative chest wall radiotherapy using 40 Gray in 15 fractions. Radiother Oncol 90:141–147

    Article  PubMed  Google Scholar 

  6. Behranwala KA, Dua RS, Ross GM, Ward A, A'Hern R, Gui GPH (2006) The influence of radiotherapy on capsule formation and aesthetic outcome after immediate breast reconstruction using biodimensional anatomical expander implants. J Plast Reconstr Aesthet Surg 59:1043–1051

    Article  PubMed  CAS  Google Scholar 

  7. Spear S, Boehmler JH, Bogue DP, Mafi AA (2008) Options in reconstructing the irradiated breast. Plast Reconstr Surg 122(2):379–388

    Article  PubMed  CAS  Google Scholar 

  8. Tallet AV, Salem N, Moutardier V (2003) Radiotherapy and immediate two-stage breast reconstruction with a tissue expander and implant: Complications and esthetic results in patients with primary breast carcinoma. Int J Radiat Oncol Biol Phys 57:136–142

    Article  PubMed  Google Scholar 

  9. Cicchetti S, Leone MS, Franchelli S, Santi PL (2006) One-stage breast reconstruction using McGhan Style 150 biodimensional expanders: A review of 107 implants with six years experience. Plast Reconstr Aesth Surg 59:1037–1042

    Article  Google Scholar 

  10. Cordeiro PG, Pusic AL, Disa JJ, McCormick B, VanZee K (2004) Irradiation after immediate tissue expander/implant breast reconstruction: outcomes, complications, aesthetic results, and satisfaction among 156 patients. Plast Reconstr Surg 113(3):877–881

    Article  PubMed  Google Scholar 

  11. Handel N, Cordray T, Gutierrez J, Jensen JA (2006) A long-term study of outcomes, complications, and patient satisfaction with breast implants. Plast Reconstr Surg 117(3):757–767

    Article  PubMed  CAS  Google Scholar 

  12. Ashley FL (1970) A new type of breast prosthesis: preliminary report. Plast Reconstr Surg 45(5):421–424

    Article  PubMed  CAS  Google Scholar 

  13. Ashley FL (1972) Further studies on the natural-Y breast prosthesis. Plast Reconstr Surg 49(4):414–419

    Article  PubMed  CAS  Google Scholar 

  14. Brand G (1988) Foam-covered mammary implants. Clin Plast Surg 15(4):533

    PubMed  CAS  Google Scholar 

  15. Rigdon RH (1973) Local reaction to polyurethane: a comparative study in the mouse, rat and rabbit. J Biomed Mater Res 7:79–93

    Article  PubMed  CAS  Google Scholar 

  16. Imber G, Schwager RG, Guthrie RH, Gray GF (1974) Fibrous capsule formation after subcutaneous implantation of synthetic materials in experimental animals. Plast Reconstr Surg 54:183–186

    Article  PubMed  CAS  Google Scholar 

  17. Malata CM, Feldberg L, Coleman DJ, Foo IT, Scarpe DT (1997) Textured or smooth implants for breast augmentation? Three year follow-up of a prospective randomised controlled trial. Br J Plas Surg 50(2):99–105

    Article  CAS  Google Scholar 

  18. Tebbetts JB (2001) A surgical perspective from two decades of breast augmentation. Clin Plast Surg 28(3):425–434

    PubMed  CAS  Google Scholar 

  19. Food and Drug Administration (FDA): update (1995): study of TDA released from polyurethane foam-covered breast implants. June 27.

  20. Santerre JP, Wang FGB, Labor RS (1998) Biodegradation of microthane polyester polyurethane by the lissome enzyme cholesterol esterase and identification of degradation products. 24th Annual Meeting of the Society for Biomaterials, San Diego

  21. Vazquez G (1999) A ten-year experience using polyurethane breast implants. Aesthet Plast Surg 23(3):189–196

    Article  CAS  Google Scholar 

  22. Cordeiro PG, McCarthy CM (2006) A single surgeon's 12-years experience with tissue expander/implant breast reconstruction: part II. An analysis of long-term complication, aesthetic outcomes and patient satisfaction. Plast Reconstr Surg 118(4):832–839

    Article  PubMed  CAS  Google Scholar 

  23. Pusic AL, Cordeiro PG (2003) An accelerated approach to tissue expansion for breast reconstruction: experience with intraoperative and rapid postoperative expansion in 370 reconstructions. Plast Reconstr Surg 111(6):1871–1875

    Article  PubMed  Google Scholar 

  24. Brown MH, Shenker R, Silver AA (2005) Cohesive silicone gel breast implant in aesthetic and reconstructive breast surgery. Plast Reconstr Surg 116(3):768–779

    Article  PubMed  CAS  Google Scholar 

  25. Bengtson BP, Van Natta BW, Murphy DK, Slicton A, Maxwell GP (2007) Style 410 highly cohesive silicone breast implant core study results at 3 years. Plast Reconstr Surg 120(7):40–48

    Article  Google Scholar 

  26. Hester TR (1990) Diagnosis and treatment of complication occurring with polyurethane breast implants. Plast Reconstr Surg 4:105–111

    Google Scholar 

  27. Nahabedian MY, Tsangaris T, Momen B et al (2003) Infectious complications following breast reconstruction with expander and implants. Plast Reconstr Surg 112(2):467–476

    Article  PubMed  Google Scholar 

  28. Mc Carthy CM, Mehrara BJ, Riedel E, Davidge K, Hinson A, Disa JJ, Cordeiro PG (2008) Predicting complications following expander/implant breast reconstruction: an outcomes analysis based on preoperative clinical risk. Plast Reconstr Surg 121(6):1886–1892

    Article  CAS  Google Scholar 

  29. Handel N, Gutierrez J (2006) Long-term safety and efficacy of polyurethane breast implants. Aesthet Surg J 26(3):265–274

    Article  PubMed  CAS  Google Scholar 

  30. Artz JS, Dinner MI, Foglietti MA, Sampliner J (1991) Breast reconstruction utilizing subcutaneous tissue expansion followed by polyurethane-covered silicone implants: a 6 year experience. Plast Reconstr Surg 88(4):635–641

    Article  PubMed  CAS  Google Scholar 

  31. Vazquez G, Pellon A (2007) Polyurethane-coated silicone gel breast implants used for 18 years. Aesthet Plast Surg 31:330–336

    Article  Google Scholar 

  32. Spear SL, Maxwell GP (1995) Discussion: reconstruction and the radiated breast: is there a role for implants? Plast Reconstr Surg 96:1116–1118

    Article  Google Scholar 

  33. Clough KB, O'Donoghue JM, Fitoussi AD et al (2001) Prospective evaluation of late cosmetic results following breast reconstruction: implant reconstruction. Plast Reconstr Surg 107(7):1702–1709

    Article  PubMed  CAS  Google Scholar 

  34. Krueger EA, Wilkins EG, Strawderman M et al (2001) Complications and patient satisfaction following expander/implant breast reconstruction with and without radiotherapy. Int J Radiat Oncol Biol Phys 49(3):713–721

    Article  PubMed  CAS  Google Scholar 

  35. Vandeweyer E, Deraemaecker R (2000) Radiation therapy after immediate breast reconstruction with implants. Plast Reconstr Surg 106(1):56–58 [discussion 59–60]

    Article  PubMed  CAS  Google Scholar 

  36. Contant CM, Van Geel AN, Van der Holt B et al (2000) Morbidity of immediate breast reconstruction (IBR) after mastectomy by subpectorally placed silicone prosthesis: the adverse effect of radiotherapy. Eur J Surg Oncol 26(4):344–350

    Article  PubMed  CAS  Google Scholar 

  37. Collis N, Sharpe DT (2000) Breast reconstruction by tissue expansion. A retrospective technical review of 197 two-stage delayed reconstructions following mastectomy for malignant breast disease in 189 patients. Br J Plast Surg 53(1):37–41

    Article  PubMed  CAS  Google Scholar 

  38. Ringberg A, Tengrup I, Aspegren K et al (1999) Immediate breast reconstruction after mastectomy for cancer. Eur J Surg Oncol 25(5):470–476

    Article  PubMed  CAS  Google Scholar 

  39. Forman DL, Chiu J, Restifo RJ et al (1998) Breast reconstruction in previously irradiated patients using tissue expanders and implants: a potentially unfavorable result. Ann Plast Surg 40(4):360–363 [discussion 363–4]

    Article  PubMed  CAS  Google Scholar 

  40. Wickman M, Jurell G, Sandelin K (1998) Technical aspects of immediate breast reconstruction—two-year follow-up of 100 patients treated consecutively. Scand J Plast Reconstr Surg Hand Surg 32(3):265–273

    Article  PubMed  CAS  Google Scholar 

  41. Pusic AL, Cordeiro PG (2003) An accelerated approach to tissue expansion for breast reconstruction: experience with intraoperative and rapid postoperative expansion in 370 reconstructions. Plast Reconstr Surg 11:1871–1875

    Article  Google Scholar 

  42. Evans GR, Schusterman MA, Kroll SS (1995) Reconstruction and the radiated breast: Is there a role for implants? Plast Reconstr Surg 96:1111–1115

    Article  PubMed  CAS  Google Scholar 

  43. Spear SL, Majidian A (1998) Immediate breast reconstruction in two stages using textured, integrated-valve tissue expanders and breast implants: a retrospective review of 171 consecutive reconstructions from 1989 to 1996. Plast Reconstr Surg 101(1):53–63

    Article  PubMed  CAS  Google Scholar 

  44. Kraemer O, Andersen M, Sim E (1996) Breast reconstruction and tissue expansion in irradiated versus not irradiated women after mastectomy. Scand J Plast Reconstr Hand Surg 30:201–206

    Article  CAS  Google Scholar 

  45. Kronowitz SJ, Robb GL (2009) Radiation therapy and breast reconstruction: a critical review of the literature. Plast Reconstr Surg 124(2):395–408

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Plastic and Reconstructive Surgery Unit, Sandro Pertini Hospital, Rome, Italy

    Stefano Pompei, Floriana Arelli, Lara Labardi, Fabio Marcasciano, Guido Caravelli & Ornella Abate

  2. Breast Surgery Unit, Sandro Pertini Hospital, Rome, Italy

    Claudio Cesarini

  3. Via dei Monti Tiburtini, 385, 00157, Rome, Italy

    Floriana Arelli

Authors
  1. Stefano Pompei
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  2. Floriana Arelli
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  3. Lara Labardi
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  4. Fabio Marcasciano
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  5. Guido Caravelli
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  6. Claudio Cesarini
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  7. Ornella Abate
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Correspondence to Floriana Arelli.

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Pompei, S., Arelli, F., Labardi, L. et al. Breast reconstruction with polyurethane implants: preliminary report. Eur J Plast Surg 35, 441–447 (2012). https://doi.org/10.1007/s00238-011-0612-z

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  • DOI: https://doi.org/10.1007/s00238-011-0612-z

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