Medical University of Vienna, Austria
Prof. Daphne Gschwantler-Kaulich has completed her specialization in Obstetrics and Gynaecology at the Medical University of Vienna, Austria, in 2009 with further specialization in senology, hereditary breast cancer and breast reconstruction. She has published more than 30 papers in reputed journals
Background: Comparative studies on the use of meshes and acellular dermal matrices(ADM) in implant- based breast reconstruction (IBBR) have not yet been performed.
Methods: This prospective, randomized, controlled, multicenter pilot study was performed atfour Austrian breast cancer centers. Fifty patients with oncologic or prophylactic indication for mastectomy and IBBR were randomized to immediate IBBR with either an ADM (Protexa®) or a titanized mesh (TiLOOP® Bra). Complications, failed reconstruction,cosmetic outcome, patients’ quality of life and the thickness of the overlying tissue were recorded immediately postoperatively and 3 and 6 months after surgery.
Results: 48 patients participated in the study (Protexa® group: 23 ; TiLOOP® Bra group: 25patients). The overall complication rate was 31.25% with similar rates in both groups(Protexa® group 9 vs.in and 6 in TiLOOP® Bra group; p=0.188). There was a higher incidenceof severe complications leading to failed reconstructions with implant loss in the Protexa®group than in the TiLOOP® Bra group (7 vs. 2; p<0.0001). An inverted T-incision techniqueled to significantly more complications and reconstructive failure with Protexa® (p=0.037,p=0.012, respectively). There were no significant differences in patients’ satisfaction withcosmetic results (p=0.632), but surgeons and external specialists graded significantly betteroutcomes with TiLOOP® Bra (p=0.034, p=0.032).
Conclusion: This pilot study showed use of TiLOOP® Bra or Protexa® in IBBR is feasibleleading to good cosmetic outcomes and high patient satisfaction. To validate the higher failurerates in the Protexa® group, data from a larger trial are required.