Immediate Breast Reconstruction with Prosthesis and Titanized Mesh Using a Dual-Plane Approach: Complications and Risk Factors Analysis.

INTRODUCTION: The immediate breast reconstruction after mastectomy has gained prominence in recent years and is considered one of the main procedures in oncoplastic surgery. In the case of reconstruction with prostheses, the use of a mesh to extend the pectoralis major muscle is often required to partially cover the implant. The main objective of this study was to determine the percentage of complications in immediate breast reconstructions with a titanized mesh using a dual-plane approach and establish risk factors for prosthesis complications and extrusion. MATERIALS AND METHODS: A retrospective study that included women who received postmastectomy reconstructions from January 2012 to December 2019 in a secondary hospital in Spain. RESULTS: A total of 57 immediate reconstructions were performed in 47 women. There were complications in 16 mastectomies (28.1%), of which seven (12.3%) were Clavien-Dindo ≤ IIIa and nine (15.7%) were IIIb. A total of three patients presented prosthetic extrusion, and the prosthesis was removed in five. The degree of contracture according to the Baker scale was I-II in 50 mastectomies (87.7%) and III-IV in seven (12.3%). CONCLUSION: The immediate breast reconstruction with a titanized mesh using a dual-plane approach is a technique with an acceptable percentage of complications. The need for a Wise pattern and the necrosis of the nipple-areola complex in the postoperative period are risk factors for implant loss. Patients undergoing radiotherapy and/or chemotherapy and with a previous surgery are more likely to present capsular contracture. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors.

Repercusión en el manejo quirúrgico de la ecografía de reevaluación para caracterización de lesiones detectadas en resonancia magnética / Effect on surgical management of second-look ultrasound to characterise lesions detected by magnetic resonance imaging

INTRODUCCIÓN: La ecografía de reevaluación, o de «second-look» (ESL), es útil para caracterizar lesiones de nueva aparición identificadas durante el estudio mediante resonancia magnética (RM). También puede ayudar a optimizar el tratamiento quirúrgico, ya que permite realizar biopsias y obtener un resultado anatomopatológico de las lesiones. El objetivo de este estudio es determinar la utilidad de la ESL para la identificación y la caracterización de lesiones detectadas incidentalmente por RM, así como la repercusión posterior en el manejo quirúrgico. MATERIAL Y MÉTODO: Se realizó un estudio observacional retrospectivo en el que se incluyen mujeres diagnosticadas de cáncer de mama a las que se les realiza ESL tras RM, entre 2013 y 2015. Se recogieron datos epidemiológicos, del tumor primario, características de las lesiones identificadas por RM y posteriormente por ESL, procedimientos quirúrgicos y resultados anatomopatológicos. RESULTADOS: Se identificaron 168 lesiones nuevas mediante RM en 110 pacientes. De ellas, 123 (73,2%) fueron objetivadas posteriormente en la ESL. De acuerdo con el sistema BI-RADS, 88 (71,6%) lesiones se caracterizaron como BI-RADS3 y 24 (19,5%) como BI-RADS4. El resultado de la biopsia tras ESL fue de malignidad en 17 lesiones, lo cual conlleva un cambio de actitud quirúrgica en 15 pacientes. CONCLUSIONES: La ESL puede ser útil para optimizar el tratamiento quirúrgico de las pacientes con cáncer de mama en las que se detecta una nueva lesión mediante RM, permitiendo caracterizar, localizar dicha lesión y realizar biopsias para obtener un resultado anatomopatológico que nos ayude a decidir si es necesaria su exéresis

INTRODUCTION: Second-look ultrasound (SLU) is useful to characterise new lesions identified by magnetic resonance imaging (MRI). SLU may also help to optimise surgical treatment since it allows the performance of biopsies and histopathological analysis of the lesions. The aim of this study was to determine the utility of SLU to identify and characterise lesions initially detected by MRI, as well as its subsequent influence on surgical management. MATERIAL AND METHOD: We performed an observational retrospective study that included women diagnosed with breast cancer who underwent SLU after MRI between 2013 and 2015. We collected data on epidemiological factors, the primary tumour, the characteristics of the lesions identified by MRI and subsequently by SLU, surgical procedures, and histopathological results. RESULTS: A total of 168 new lesions were identified by MRI in 110 patients. Of these, 123 (73.2%) were subsequently identified in SLU. Using the BI-RADS system, 88 (71.6%) lesions were classified as BI-RADS3 and 24 (19.5%) as BI-RADS4. The result of biopsy after SLU was malignancy in 17 lesions, leading to a change of surgical management in 15 patients. CONCLUSIONS: SLU can be useful to optimise the surgical treatment of patients with breast cancer and detection of a new lesion by MRI. SLU allows these lesions to be characterised and localised and biopsies to be taken. This in turn allows histopathological analysis, which helps to determine the need for extirpation of the lesion