Breast reconstruction with TiLOOP® Bra: Another arrow in plastic surgeons' quiver?

BACKGROUND: The use of lower-pole sling products has made immediate breast reconstruction a feasible option in women undergoing skin-nipple sparing and skin-reducing mastectomies. To date, available data on the comparative efficacy of biological and synthetic meshes regarding postoperative complications are scattered and limited. METHODS: A systematic literature search was performed to screen three different databases (PubMed, Web of Sciences, and Embase) using the following keywords: "breast reconstruction" AND "TiLOOP®" OR "Titanium-Coated Polypropylene Mesh" OR "TCPM". The perioperative and demographic characteristics of patients, complications profiles, and patient-reported outcomes were considered. RESULTS: We initially identified 234 articles, of which only 41, including 3923 patients and 5042 reconstructed breasts, fully satisfied the inclusion criteria. CONCLUSION: TiLOOP® Bra could be considered a safe and aesthetically valid alternative to Acellular Dermal Matrices (ADMs) in non-smokers patients undergoing skin-nipple sparing and skin-reducing mastectomies and immediate reconstruction. In such populations, complications are more likely to develop in patients with extreme body mass index values. The incidence of seroma with TiLOOP® Bra is comparable to that of ADMs as it is the beneficial effect in radiated patients, where TiLOOP® Bra seems superior to implant alone reconstruction. It has a good bio-integration with host tissues and resistance to infections in patients with a weakened immune system as a consequence of oncologic perioperative treatments.

Nodal staging in localized melanoma. The experience of the Brescia Melanoma Unit.

BACKGROUND AND OBJECTIVES: We report our experience with patients affected by cutaneous melanoma undergoing sentinel node (SN) biopsy. METHODS: From November 1997 to October 2000 we performed 128 selective lymphadenectomies (SN biopsy) on 127 patients with cutaneous melanoma with Breslow thickness>1 mm or regression or ulceration. Age, sex, tumour location ad histology were recorded. RESULTS: Two hundred and thirty eight SNs were identified by lymphoscintigraphy in 167 lymphatic stations, 236 of them were identified intraoperatively using a gamma probe and patent blue V injection. Twenty-one patients had SNs with melanoma metastases (15.8%), 12 patients in the groin, eight patients in the axilla and one patient in the neck. After therapeutic lymphadenectomy eight more lymph nodes with metastases of melanoma were found in the specimens of three patients. After a follow-up ranging from 10 to 56 months the results are that 111 patients are free of disease. Ten patients died. Three patients have visceral metastases and are alive. One patient has developed two more melanomas. One patient was lost to follow-up. CONCLUSIONS: Our data confirm the clinical reliability of the SN technique in melanoma; for optimisation of the therapeutic strategy, this technique might be considered the standard method of nodal staging in the evaluation of melanoma patients.