Titanized polypropylene mesh (TPM) Tiloop®Bra in reconstructive breast surgery – indication and complication rate
New surgical strategies in breast cancer have generated advanced methods concerning oncologic safety combined with improved cosmetic results. Immediate reconstruction has become a common procedure. The AGO guidelines have recommend the usage of muscle-fixation extraneous materials in 2014 (Oxford LoE 2b). TPM showed an excellent tissue integration, a less pronounced inflammatory reaction, shorter convalescence time and lower shrinkage rate. Considering the insertion of the TPM into breast reconstructive surgery, shape and size were optimized.
Material and methods:
Postoperative maintenance of drainage, antibiotics, hematoma, seroma, infection, capsule and necrosis rate were documented. In 65,5% an immediate- and in 34,5% a secondary/delayed reconstructive procedure could be seen via nipple- or skin sparing mastectomy and implant placement in 40,2% and expander placement in 23%. MRM and immediate implant/expander placement took place in 2,2%. Exchange from expander to implant or switch of implants was performed in 11,5% and accordingly 16%. Complications occured in 4.8% as seroma, 9.5% superficial hematoma, 6.1% skin infection, 3.9% skin necrosis, 3.5% partial nipple necrosis, 7.8% re-operations with removal of the mesh and in 2.2% capsular fibrosis. Neither nicotine abuse, hypertension, diabetes mellitus, age > 50 Jahre, BMI > 27, nor radio- or chemotherapy are significant factors for complications.
Long term data is now required to provide more detailed information about cosmetic outcome. Patient satisfaction will be part of further follow up in a prospective trial (ProBra Surveillance).