The use of SERI™ Surgical Scaffolds in direct-to-implant reconstruction after skin-sparing mastectomy: A retrospective study on surgical outcomes and a systematic review of current literature.

INTRODUCTION: Little is reported on surgical outcomes of SERI Surgical Scaffold, a bioresorbable silk-derived surgical scaffold, developed to provide soft-tissue support and repair, in implant/expander breast reconstruction. METHODS: A retrospective chart study was conducted of all patients who underwent direct-to-implant reconstruction with a SERI surgical scaffold after skin-sparing mastectomy, recording surgical characteristics, perioperative complications and reoperations. A systematic literature review was conducted focusing on preclinical and clinical studies reporting on use of SERI in breast surgery. RESULTS: A total of 16 patients (22 breasts) were identified (mean age at surgery was 47 ± 6.8 years, mean BMI 23.1 ± 3.1 kg/m2, mean ablation weight 530 ± 221 g, median clinical follow-up time 27 months (range 25-37)). There were no intraoperative complications. Postoperative bleeding, that required reoperation occurred in one (5%) breast, postoperative seroma in 10 (45%) and surgical site infection in 2 (9%). Scaffold-related complications occurred in 3 (14%) breasts, comprising lack of scaffold integration in all, resulting in skin ulceration in 2 and the scaffold lying free in the breast pocket surrounded with seroma in one. Nine articles were selected and reviewed from the 170 identified. DISCUSSION: The role of silk-derived scaffolds in breast reconstruction is yet to be determined. Though first reports have shown promising results, our and others results suggest that scaffold-related complications, such as lack of scaffold integration, may occur more frequently than previously described. Further research is necessary to determine possible (dis)advantages of the scaffold in specific patient groups.

Surgical Outcome and Cosmetic Results of Autologous Fat Grafting After Breast Conserving Surgery and Radiotherapy for Breast Cancer: A Retrospective Cohort Study of 222 Fat Grafting Sessions in 109 Patients.

BACKGROUND: Breast conserving surgery (BCS) and radiotherapy (RT) often lead to breast deformity. Reconstruction of these defects is a surgical challenge. Lately, the popularity of autologous fat grafting in these patients is growing. The purpose of this study was to assess clinical outcomes and aesthetic results of autologous fat grafting after BCS and RT. MATERIALS AND METHODS: A database of all patients who underwent fat grafting after BCS and RT was prospectively maintained. Patient demographics, clinical and surgical characteristics and intra- and postoperative complications were analysed. Preoperative and 6-month postoperative photographs were evaluated by a four-member expert-panel assessing the aesthetic outcome (Harvard scale, five-point aesthetic scale and an overall score). RESULTS: Between June 2008 and January 2016, 109 consecutive patients (114 breasts) underwent 222 fat grafting procedures. The mean clinical postoperative follow-up was 26 ± 19 months (range 10-97). The median number of fat grafting sessions sufficient for a satisfactory surgical result was two (range 1-6). Localized infections occurred in four patients, all treated effectively with oral antibiotics. Fat necrosis that required excision under local anaesthesia occurred once. The overall cosmetic appearance was rated 5.1/10 before and 7.2/10 after reconstruction (p < 0.01). A significant improvement was noted in breast symmetry, volume, shape and scarring. CONCLUSION: Fat grafting after BCS and RT provides significant aesthetic improvement of the breast. It has a positive effect on the postsurgical scar and irradiated tissue and helps to restore the volume deficit, which makes it suitable as a reconstructive approach in this patient group. 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 www.springer.com/00266 .