Multicenter Study on Breast Reconstruction Outcome Using Becker Implants |
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Authors: | Nicol?? Scuderi Carmine Alfano Gian Vittorio Campus Corrado Rubino Stefano Chiummariello Antonella Puddu Marco Mazzocchi |
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Institution: | (1) Department of Plastic Surgery, University “La Sapienza”, Rome, Italy;(2) Department of Plastic Surgery, University of Perugia, Perugia, Italy;(3) Plastic Surgery Unit, University of Sassari, Sassari, Italy;(4) Via Portuense 331, 00149 Roma, Italy; |
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Abstract: | The use of tissue expanders and implants is the simplest option for breast reconstruction following mastectomy. In the 1980s,
Hilton Becker introduced a round, inflatable breast implant that could be used as a permanent implant. Since then, the original
implant has been improved in both design and architecture. The new Becker device consists of an anatomical implant composed
of 35% cohesive silicone gel in the outer chamber and 65% normal saline in the inner chamber. This multicenter study describes
our experience with the new anatomical Becker implants in a large series of patients, in both immediate and delayed breast
reconstruction. We reviewed the clinical records of 204 patients who underwent a breast reconstruction with an anatomical
Becker-type implant in the sub-muscular position between November 2004 and December 2006. Data on the patients’ characteristics,
indications for reconstruction, operative technique, device size used, complications, and need for further operations were
collected and analyzed. A total of 248 breast reconstructions were performed in 204 patients. One hundred forty-three patients
(70%) underwent an immediate reconstruction; in the remaining 61 cases (30%), the breast reconstruction was performed later.
The patients’ age ranged from 26 to 66 years, with a median age of 47.5 years. The implant was placed unilaterally in 160
women (78.5%) and bilaterally in the remaining 44 (21.5%). Complications occurred in 85 cases (34.2%), in both the immediate
and delayed reconstruction groups, and were related to wound healing, bleeding, seroma, and problems with the inflatable expanders.
Iatrogenic implant rupture was documented in one case (0.4%). Inflation was impossible in 7 cases (2.8%) as a result of valve
obstruction (3 cases, 1.2%) and valve displacement (4 cases, 1.6%). Implant malposition was the most troublesome complication;
indeed, 34 patients (13.7%) complained of device malposition. Capsular contracture was assessed in all the patients. Significant
capsular contracture (Baker grade III and IV) was detected in 6 cases (2.4%) at the follow-up approximately 1 year after surgery.
Breast reconstruction with permanent inflatable expanders is widely acknowledged as a useful technique for breast cancer patients
undergoing simple or modified radical mastectomy. The use of this device eliminates the need to replace a temporary tissue
expander with a breast implant, thus avoiding a second operation. Although we believe autologous tissues afford the best method
of reconstruction in the majority of patients, the results of our study show that expander implant placement may yield a reasonable
reconstruction. |
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