Single-Stage Immediate Breast Reconstruction with Acellular Dermal Matrix after Breast Cancer: Comparative Study and Evaluation of Breast Reconstruction Outcomes.

We evaluate postoperative complications, aesthetic results and satisfaction outcomes in patients with breast cancer after intervening with a skin-sparing or nipple-sparing mastectomy with an immediate prosthetic reconstruction with or without a biological mesh. Patients with multifocal breast cancer, ductal carcinoma in situ with an indication for a mastectomy and cT2 tumors with no response to primary systemic treatment were included, whereas patients aged >75 years, with inflammatory carcinoma, and severe circulatory disorders were excluded. Patients in the control group were reconstructed using a prosthesis, whereas the study group included patients reconstructed using a prosthesis and biological acellular porcine dermal mesh (Strattice™). In both groups, the result was assessed using the BREAST-Q instrument. A total of 51 patients (62 intervened breasts) were included in the study group and 38 patients (41 intervened breasts) in the control group. Implant loss and removal occurred in three patients in the study group (5.9%) and nine patients in the control group (24.3%; p = 0.030). Infections appeared in three patients in the study group (4.8%) and three patients in the control group (7.3%; p = 1.00). Skin necrosis appeared in 5 patients in the study group (12.2%) and 11 patients in the control group (21.6%; p = 0.367). Seroma appeared in five patients in the study group (12.2%) and five patients in the control group (8.1%; p = 0.514). The BREAST-Q questionnaire is a comparison between both groups regarding "satisfaction with breasts after surgery" (p = 0.026), "sexual well-being after intervention" (p = 0.010) and "satisfaction with the information received" (p = 0.049). We have noted a statistically significant decrease in implant loss in women receiving an implant with a biological mesh. A higher satisfaction was observed in patients reconstructed using Strattice™, with statistically significant differences in three items.

Intraoperative assessment of sentinel lymph node by one-step nucleic acid amplification in breast cancer patients after neoadjuvant treatment reduces the need for a second surgery for axillary lymph node dissection.

PURPOSE: Sentinel lymph node (SLN) biopsy has been shown to be both accurate and feasible for women who receive neoadjuvant chemotherapy (NAC). Intraoperative assessment of SLN by frozen sections can produce false negative results. The aim of this study was to compare two different techniques of intraoperative assessment of SLN in breast cancer patients treated with NAC: frozen section (FS) and molecular assay (OSNA). METHODS: A multicenter cohort of 320 consecutive breast cancer patients treated with NAC between 2010 and 2014 was analyzed. FS was performed intraoperatively in 166 patients (H&E cohort) and OSNA in 154 patients (OSNA cohort). RESULTS: A mean of 2.15 SLNs by FS and 1.22 SLNs by OSNA was assessed (p = 0.03). SLN metastasis was found in 44 patients (26.5%) by FS and in 48 (31.2%) by OSNA (p = 0.4). There was no statistical significance in rates of macrometastasis (75%), micrometastasis (20.5%) or ITCs (4.5%) when assessed by FS compared to OSNA (52.3%, 36.3% and 11.4%, respectively) (p = 0.06). There were 10 patients in the H&E cohort with positive-SLN in the definitive pathology assessment with negative intraoperative FS. When OSNA and definitive pathology were compared, there were no differences in rates of macrometastasis (61.1%), micrometastasis (33.3%) nor ITCs (5.6%) (p = 0.5). Fifty-four patients in the H&E cohort and 44 in the OSNA cohort had ALND after positive-SLNs. ALND was performed in a second surgery in 10 patients (18.5%) in the H&E cohort for intraoperative FS false negative results, 90% being micrometastasis. 42 out of 44 patients (95.5%) in the OSNA cohort had an ALND in the same surgery (p = 0.03). CONCLUSIONS: OSNA assay detects SLNs metastases as accurately as conventional pathology in the NAC setting. Intraoperative definitive assessment of the SLN by OSNA reduces the need for a second surgery for ALND in 18.5% of breast cancer patients with a positive-SLN after NAC.

Estudio comparativo del uso de implante mamario únicamente o implante y malla biológica en reconstrucción inmediata tras mastectomía ahorradora de piel / Comparative study of the use of immediate implant-based breast reconstruction with or without biological dermal mesh after skin-sparing mastectomy

Objetivo. Valorar las complicaciones postoperatorias en pacientes intervenidas mediante mastectomía ahorradora de piel o piel y aréola-pezón, con reconstrucción inmediata e implantación de prótesis o prótesis más malla biológica. Pacientes y métodos. Estudio prospectivo. Periodo de estudio: octubre de 2011-octubre de 2014. Criterios de inclusión: cáncer de mama multicéntrico, carcinoma ductal in situ con indicación de mastectomía y tumores cT2 que no tuvieron respuesta a tratamiento sistémico primario. Criterios de exclusión: edad > 75 años. Grupo control: pacientes reconstruidas mediante prótesis. Grupo estudio: pacientes reconstruidas mediante prótesis y malla biológica de dermis porcina acelular, no entrecruzada, de 1,6 mm e hidratada. Resultados. Se incluyeron en el grupo de estudio 34 pacientes, y en el grupo control, 38 pacientes. Extrusión de prótesis: grupo estudio uno (2,9%); grupo control 9 (23,7%) (p = 0,015). Infecciones: grupo estudio 3 (8,8%); grupo control 3 (7,9%) (p = 1). Necrosis cutánea: grupo estudio 5 (14,7%); grupo control 5 (13,2%) (p = 1). Seroma: grupo estudio 5 (14,7%); grupo control 5 (13,2%) (p = 1). Conclusión. Se ha observado una disminución significativa de la extrusión de la prótesis en las mujeres en las que se implantaron mallas biológicas. En seromas, infección y necrosis cutánea no observamos diferencias significativas (AU)

Objective. To evaluate postoperative complications after skin- or nipple-sparing mastectomy with immediate implant-based breast reconstruction with or without biological dermal mesh. Patients and methods. Prospective study. Study period: October 2011-October 2014. Inclusion criteria: multicentre breast cancer, ductal carcinoma in situ with indication for mastectomy, and cT2 tumours with no response to primary systemic treatment. Exclusion criteria: patients older than 75 years. Control group: breast reconstructions with mammary prosthesis exclusively. Study group: breast reconstructions with implant and non-crosslinked biological 1.6 mm hydrated acellular porcine dermal mesh. Results. Thirty-four patients were included in the treatment group and 38 patients in the control group. Number of prosthesis extrusions: study group one (2.9%); control group 9 (23.7%) (P = .015). Infections: study group 3 (8.8%); control group 3 (7.9%) (P = 1). Skin necrosis: study group 5 (14.7%); control group 5 (13.2%) (P = 1). Seroma: study group 5 (14.7%); control group 5 (13.2%) (P = 1). Conclusion. The number of extrusions was significantly lower in breast reconstructions with prosthesis and biological mesh. No significant differences were observed in seroma, infection, or skin necrosis (AU)

Angiosarcoma secundario de mama: recidiva multifocal en colgajo autólogo utilizado en la reconstrucción / Secondary breast angiosarcoma: Multifocal recurrence in a postmastectomy breast reconstruction flap

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Eficacia de la biopsia intraoperatoria del ganglio centinela mediante el método one step nucleic acid amplification para evitar la linfadenectomía axilar en mujeres con cáncer de mama tratadas previamente con quimioterapia neoadyuvante / Effectiveness of intra-operative sentinel node biopsy by one-step nucleic acid amplification to avoid axillary lymphadenectomy in women with breast cancer treated with neoadjuvant chemotherapy

Objetivos. Evaluar en pacientes con ganglios axilares clínicamente negativos de inicio, la efectividad de la biopsia selectiva del ganglio centinela (BSGC) intraoperatoria mediante el método one step nucleic acid amplification (OSNA) para detectar metástasis microscópicas o celulares tras quimioterapia neoadyuvante, y evitar la duplicidad de procedimientos quirúrgicos. Pacientes y métodos. Se evaluó la efectividad de la BSGC mediante OSNA en pacientes con cáncer de mama que previamente tenían una axila clínica y ecográficamente negativa tras quimioterapia neoadyuvante (44 pacientes) o antes de la quimioterapia neoadyuvante (33 pacientes). Resultados. La tasa de identificación del ganglio centinela (GC) fue del 100% en ambos grupos. En las pacientes con BSGC previa a la quimioterapia se detectaron 13 mujeres con ganglios positivos (11 macrometástasis y 2 micrometástasis). En las pacientes tratadas primero con quimioterapia, se detectaron 10 mujeres con GC positivos, que fueron todos macrometástasis. El valor predictivo negativo de la prueba de ultrasonidos fue del 60,6% en pacientes con BSGC previa a quimioterapia y del 77,3% en pacientes con quimioterapia y posterior BSGC. Conclusiones. La BSGC mediante el método OSNA en mujeres que presentan clínicamente ganglios linfáticos negativos tras haber recibido quimioterapia neoadyuvante predice el estado axilar con gran precisión. Permite de forma inmediata tomar decisiones sobre la indicación o no de realizar una linfadenectomía axilar, evitando así el retraso en la administración de la quimioterapia y beneficiándose las pacientes de un solo procedimiento quirúrgico(AU)

Objectives. To evaluate in patients with clinically negative axillary nodes at initial presentation, the effectiveness of sentinel lymph node biopsy (SLNB) using intraoperative the one step nucleic acid amplification (OSNA) method to detect microscopic metastases or isolated tumor cells after neoadjuvant chemotherapy. Thus, axillary dissection and duplication of surgical procedures will be avoided. Patients and methods. We evaluated in patients with breast cancer and clinically negative axilla, the effectiveness of SLNB by OSNA after neoadjuvant chemotherapy (44 patients) or prior to neoadjuvant chemotherapy (33 patients). Results. The rate of SLN identification was 100% in both groups. In patients with SLNB prior to systemic treatment, 13 women showed positive nodes (11 macrometastases and 2 micrometastases), and those with SLNB after neoadjuvant chemotherapy, positive SLNB were detected in 10 women, which were all of them macrometastases. The negative predictive value of ultrasonography was 60.6% in patients with SLNB prior to neoadjuvant therapy and 77.3% in patients with chemotherapy followed by SLNB. Conclusions. Intraoperative SLNB using OSNA in women with clinically negative axillary lymph nodes at initial presentation who received neoadjuvant chemotherapy, predicts axillary status with high accuracy. Also it allows immediately make decisions about the indication or not to perform an axillary dissection, thus avoiding delay in the administration of chemotherapy and benefit the patients for a single surgical procedure(AU)