Surgical Studies of Reconstructive Breast Surgery - An Overview of the Topics at the 2019 Annual Meeting of the Working Group for Reconstructive Surgery in Oncology-Gynecology

Abstract

This year's annual AWOgyn meeting focused on studies of reconstructive breast surgery. As the majority of breast reconstructions are implant-based, most studies also focused on implant-based reconstruction. Since 2011, the guidelines have recommended using interposed mesh materials as support. The basic idea behind every type of material is to provide coverage and stabilization for the implant by constructing an "internal bra" which will create the appropriate implant shape and maintain the position, stability and flexibility of the implant. The Working Group for Reconstructive Surgery in Oncology-Gynecology (AWOgyn) has undertaken to analyze different materials with regard to indications, success rates and side effects as documented in registers, clinical assessments and study protocols. This has increased application safety and is expected to improve it even further in future. Prospective studies are being carried out to investigate issues such as the optimal material, optimal implant site and best cosmetic results. The first results for porcine and human acellular matrices and for partially resorbable titanium-coated synthetic polypropylene meshes are now available. In 2019, the AWOgyn working group will be launching further studies to evaluate a perforated acellular dermal matrix (Fortiva ^® ), a titanium-coated implant pocket (TiLOOP ^® Bra Pocket) and a fully resorbable synthetic mesh (TIGR ^® mesh).

Keywords: application safety; implant position; reconstructive breast surgery.

Fig. 1

A 34-year-old patient at 7 months after subcutaneous mastectomy (s/p primary chemotherapy, s/p radiotherapy). She underwent immediate reconstruction with subpectoral implant placement and caudal mesh interpolation. Currently affected by jumping-breast phenomena, capsular fibrosis III°, cranialization of the implant and volume loss in the caudal quadrants.

Fig. 2

Synthetic mesh developed especially for pre-pectoral implant placement (TiLOOP ^® Bra Pocket).

Fig. 3

A 53-year-old patient, s/p right-sided breast cancer, segmental resection, SLNB in 2015 for luminal B breast cancer subtype, adjuvant chemotherapy and radiotherapy, and s/p contralateral left-sided TNBC, PALB2 mutation, primary systemic chemotherapy, recent bilateral subcutaneous, nipple-sparing mastectomy and SLNB on the left side and port removal. The patient underwent immediate reconstruction with pre-pectoral implant placement and medium coverage with a TiLOOP ^® Bra Pocket. a  Preoperative image, b  on the 4th postoperative day, c  at 8 weeks postoperatively.

Fig. 4

Fortiva – perforated porcine acellular dermal matrix.

Fig. 5

Completely resorbable synthetic TIGR mesh.

Abb. 1

34-jährige Patientin 7 Monate nach subkutaner Mastektomie (Z. n. primärer Chemotherapie, Z. n. Bestrahlung) Sofortrekonstruktion durch subpektorale Implantateinlage mit kaudaler Netzinterponation. Aktuell mit Jumping-Breast-Phänomen, Kapselfibrose III°, Kranialisierung des Implantats und Volumenleere in den kaudalen Quadranten.

Abb. 2

Speziell für die präpektorale Implantateinlage gefertiges synthetisches Netz (TiLOOP ^® Bra Pocket).

Abb. 3

53-jährige Patientin; Z. n. Mammakarzinom rechts mit Segmententfernung und SLNB 2015 bei Luminal-B-Subtyp, adjuvanter Chemotherapie und Strahlentherapie und kontralateralem TNBC-Mammakarzinom links; PALB2-Mutation, primär-systemischer Chemotherapie und aktuell beidseitiger subkutaner, Nipple-sparender Mastektomie und SLNB links, Portentfernung. Sofortrekonstruktion mit präpektoraler Implantateinlage und TiLOOP ^® Bra Pocket medium-Bedeckung. a  Präoperatives Bild, b  4. postoperativer Tag, c  8 Wochen postoperativ.

Abb. 4

Fortiva – perforierte, azelluläre derrmale Matrix porcinen Ursprungs.

Abb. 5

Voll resorbierbares synthetisches TIGR-Mesh.