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BRAXON® study: One-stage breast reconstruction techniques inelderly patients to preserve quality of life

BRAXON® study: One-stage breast reconstruction techniques inelderly patients to preserve quality of life
Autor: M. MARUCCIA, M. MAZZOCCHI, L.A. DESSY, M.G. ONESTI
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European Review for Medical and Pharmacological Sciences 2016; 20: 5058-5066

 

One-stage breast reconstruction techniques in elderly patients to preserve quality of life


M. MARUCCIA1, M. MAZZOCCHI2, L.A. DESSY1, M.G. ONESTI1


1Department of Surgery “P. Valdoni”, Unit of Plastic and Reconstructive Surgery Sapienza University,
Rome, Italy
2Department of Plastic and Reconstructive Surgery, University of Perugia, Perugia, Italy

 

 

 

Abstract. – OBJECTIVE: The aim of this study
was to review one-stage breast reconstruction
techniques performed in elderly patients at our
institution to identify the criteria of selection of
each in terms of outcomes and quality of life.
PATIENTS AND METHODS: Patients older
than 65 years who underwent one-stage breast
reconstruction between January 2004 and July
2014 at our hospital were included. Patients
and procedure-related data were collected from
the medical records. In particular, patient’s age,
comorbidities and related ASA physical status,
type of one-stage breast reconstruction technique,
and criteria of selection were analyzed.
Outcomes and results were also evaluated
in terms of quality of life using the EORTC
QLQ-C30 and -BR23 questionnaires 1 year after
surgery.
RESULTS: A total of 840 women underwent
breast reconstruction, of whom 138 elderly women
received one-stage breast reconstruction.
There were 118 cases (85.5%) of monolateral reconstructions
and 20 cases (14.5%) of bilateral
reconstructions, resulting in 138 breast reconstructions.
These were performed with permanent
inflatable expanders in the sub-muscular
position (Group A, n= 50), with acellular dermal
matrix and partial sub-muscular anatomic implant
(Group B, n= 50), and with Braxon® acellular
dermal matrix and anatomic implant with
muscle-sparing technique (Group C, n= 38). The
EORTC questionnaires showed the best results
in Group C regarding the quality of life.
CONCLUSIONS: The elderly population is rapidly
increasing, and 50% of all breast cancers
occur in women older than 65 years; among
them, only 2% undergo breast reconstruction.
A major aspect of breast cancer treatment and
subsequent quality of life is the opportunity for
a post-mastectomy reconstructive surgery. As
survival rates are improving, a larger proportion
of patients live with the long-term consequences
of their treatment, and breast reconstruction
ensures a better quality of life. To increase the
reconstruction rates, surgery should be onestage,
less invasive as possible, allowing rapid
recovery, especially in elderly women, in whom
comorbidities are often present with a higher

anaesthetic risk. Our study highlighted that nonskin
sparing mastectomy (SSM) and delayed reconstructions
should be addressed with Becker
implants; immediate reconstructions after SSM
should be followed by acellular dermal matrix
(ADM)-assisted implant reconstruction, preferring
the wrap technique offers a better quality of
life in elderly patients.


Key Words:
Breast cancer, Breast reconstruction, Elderly patient,
Quality of life, Acellular dermal matrix, Muscle sparing
technique.