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Immediate breast tissue expander-implant reconstruction with inferolateral AlloDerm hammock and postoperative radiation: a preliminary report.

Breuing KH, Colwell AS - Eplasty (2009)

Bottom Line: We hypothesized that the AlloDerm hammock may allow greater intraoperative volume expansion and potentially avoid the need for an autologous construct.Histology of irradiated and nonirradiated capsules was compared.Further investigation is warranted to determine whether complete implant coverage with the pectoralis muscle and AlloDerm hammock mitigates the deleterious effects of radiation.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. kbreuing@partners.org

ABSTRACT

Objective: To preserve the mastectomy skin envelope in select patients destined to receive radiation following mastectomy, we performed immediate tissue expander-implant reconstruction with a subpectoral tissue expander and an inferolateral AlloDerm hammock for complete implant coverage. We hypothesized that the AlloDerm hammock may allow greater intraoperative volume expansion and potentially avoid the need for an autologous construct.

Methods: Tissue expanders were filled to 75%-85% capacity intraoperatively and 85%-100% prior to radiation therapy. This allowed for maximum preservation of the mastectomy skin envelope prior to radiation therapy and provided a sizable breast mound immediately following mastectomy. Histology of irradiated and nonirradiated capsules was compared.

Results: Five patients aged 29-51 years had immediate implant (1) or expander-implant (4) breast reconstruction followed by postreconstruction radiation 2-6 months following the procedure. Patients were followed for 2.5-5.5 years following implant reconstruction and 2-5 years following radiation. No capsular contracture or implant loss was observed in any patient. No patients required or requested autologous reconstruction following radiation and all currently have silicone implants. Capsular biopsies from radiated and nonradiated implants showed identical collagen architecture on histology, confirming clinical observations.

Conclusion: Tissue expander-implant breast reconstruction following mastectomy preserves the skin envelope in patients who receive postmastectomy radiation. Further investigation is warranted to determine whether complete implant coverage with the pectoralis muscle and AlloDerm hammock mitigates the deleterious effects of radiation.

No MeSH data available.


Related in: MedlinePlus

Histology of tissue expander-AlloDerm capsule at the time of bilateral                        implant exchange. The upper photo shows the nonradiated left breast capsule                        and the bottom photo shows radiated capsule. The two capsules are                        indistinguishable (Verhoff stain).
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Figure 4: Histology of tissue expander-AlloDerm capsule at the time of bilateral implant exchange. The upper photo shows the nonradiated left breast capsule and the bottom photo shows radiated capsule. The two capsules are indistinguishable (Verhoff stain).

Mentions: Five patients aged 29–51 years had immediate implant (1) or expander-implant (4) breast reconstruction followed by postreconstruction radiation (Table 1). Radiation was given 2–6 months following the procedure. Patients were followed for 2.5–5.5 years following implant reconstruction and 2–5 years following radiation (Figs 1–3). Histology of the implant capsules in a patient with bilateral reconstruction and radiation on one side showed indistinguishable collagen architecture 1 year after radiation therapy (Fig 4). Complications included one small wound dehiscence following implant reconstruction but before radiation. This was treated with local excision and closure. Neither infection, capsular contracture, or implant extrusion nor loss of implant was observed in any patient.


Immediate breast tissue expander-implant reconstruction with inferolateral AlloDerm hammock and postoperative radiation: a preliminary report.

Breuing KH, Colwell AS - Eplasty (2009)

Histology of tissue expander-AlloDerm capsule at the time of bilateral                        implant exchange. The upper photo shows the nonradiated left breast capsule                        and the bottom photo shows radiated capsule. The two capsules are                        indistinguishable (Verhoff stain).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2683576&req=5

Figure 4: Histology of tissue expander-AlloDerm capsule at the time of bilateral implant exchange. The upper photo shows the nonradiated left breast capsule and the bottom photo shows radiated capsule. The two capsules are indistinguishable (Verhoff stain).
Mentions: Five patients aged 29–51 years had immediate implant (1) or expander-implant (4) breast reconstruction followed by postreconstruction radiation (Table 1). Radiation was given 2–6 months following the procedure. Patients were followed for 2.5–5.5 years following implant reconstruction and 2–5 years following radiation (Figs 1–3). Histology of the implant capsules in a patient with bilateral reconstruction and radiation on one side showed indistinguishable collagen architecture 1 year after radiation therapy (Fig 4). Complications included one small wound dehiscence following implant reconstruction but before radiation. This was treated with local excision and closure. Neither infection, capsular contracture, or implant extrusion nor loss of implant was observed in any patient.

Bottom Line: We hypothesized that the AlloDerm hammock may allow greater intraoperative volume expansion and potentially avoid the need for an autologous construct.Histology of irradiated and nonirradiated capsules was compared.Further investigation is warranted to determine whether complete implant coverage with the pectoralis muscle and AlloDerm hammock mitigates the deleterious effects of radiation.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. kbreuing@partners.org

ABSTRACT

Objective: To preserve the mastectomy skin envelope in select patients destined to receive radiation following mastectomy, we performed immediate tissue expander-implant reconstruction with a subpectoral tissue expander and an inferolateral AlloDerm hammock for complete implant coverage. We hypothesized that the AlloDerm hammock may allow greater intraoperative volume expansion and potentially avoid the need for an autologous construct.

Methods: Tissue expanders were filled to 75%-85% capacity intraoperatively and 85%-100% prior to radiation therapy. This allowed for maximum preservation of the mastectomy skin envelope prior to radiation therapy and provided a sizable breast mound immediately following mastectomy. Histology of irradiated and nonirradiated capsules was compared.

Results: Five patients aged 29-51 years had immediate implant (1) or expander-implant (4) breast reconstruction followed by postreconstruction radiation 2-6 months following the procedure. Patients were followed for 2.5-5.5 years following implant reconstruction and 2-5 years following radiation. No capsular contracture or implant loss was observed in any patient. No patients required or requested autologous reconstruction following radiation and all currently have silicone implants. Capsular biopsies from radiated and nonradiated implants showed identical collagen architecture on histology, confirming clinical observations.

Conclusion: Tissue expander-implant breast reconstruction following mastectomy preserves the skin envelope in patients who receive postmastectomy radiation. Further investigation is warranted to determine whether complete implant coverage with the pectoralis muscle and AlloDerm hammock mitigates the deleterious effects of radiation.

No MeSH data available.


Related in: MedlinePlus