Breast reconstruction has become an integral part of the therapeutic pathway for breast cancer, allowing the restoration of a natural breast volume after the radical curative procedure of mastectomy. Advances in surgical techniques and in the properties of the devices used have enabled excellent clinical and aesthetic outcomes. However, the development of complications remains common, compromising patient satisfaction and well-being. The introduction of acellular dermal matrices in breast surgery has led to significant progress: complete coverage of the implant with ADM has reduced the rate of capsular contracture, the most common complication requiring secondary surgery. Therefore, one-stage pre-pectoral reconstruction with ADM is now considered the gold standard for post-mastectomy treatment. The Braxon matrix is the most studied material in breast surgery: many studies describe its active role in promoting tissue regeneration and full implant integration, while inhibiting excessive inflammatory and fibrotic reactions. These findings have introduced interest in extending the use of this matrix to revision surgery as well. However, the available literature on this application remains limited, and further studies are needed to assess the effectiveness of Braxon in the treatment and prevention of complications. Aim:The aim of this study is to evaluate the effectiveness of complete prosthetic coverage using Braxon Fast in resolving and preventing post-revision complications. In addition, patients' perceptions were assessed to determine the role of ADM in improving sexual, physical, and psychosocial well-being, as well as overall satisfaction. An additional objective was to investigate the benefits achieved through the replacement with B-Lite implants. Materials and methods: A prospective, observational, single-center study was conducted on 8 patients who underwent revision breast reconstruction following capsular contracture, with prosthesis replacement assisted by Braxon Fast, at the Plastic Surgery Department of U.H. in Padua. Preoperative consultations were performed, followed by capsulectomy and implantation of a B-Lite prosthesis wrapped in ADM. Patients were monitored through regular follow-up visits to assess clinical outcomes and the development of any complications. In conclusion, each patient completed a questionnaire designed to evaluate quality of life and satisfaction after the procedure. Results:From October 2024 to June 2025, a total of 8 patients were treated and followed. During this period, no major complications were observed; one minor complication (Red Breast Syndrome) occurred and resolved spontaneously after 3 months.The results from the Breast-Q module show postoperative improvement across all domains. The data indicate an overall moderate level of satisfaction, with the highest scores recorded in CHEST and OUTCOME domains. Conclusions:In accordance with the limited literature available, our analysis demonstrates that the use of Braxon in revision surgery allows for the resolution and prevention of recurrent capsular contracture. Moreover, when combined with the implantation of B-Lite prostheses, the use of ADM in patients with complications contributes to improved well-being and postoperative satisfaction.
La ricostruzione mammaria è diventata parte integrante del percorso terapeutico del tumore al seno, permettendo di riproporre un naturale volume mammario dopo il radicale intervento curativo di mastectomia. Gli avanzamenti nella tecnica chirurgica e nelle proprietà dei dispositivi utilizzati hanno permesso di ottenere ottimi risultati clinici ed estetici. Tuttavia, risulta ancora comune lo sviluppo di complicanze, che alterano la soddisfazione e il benessere delle pazienti. L’introduzione delle matrici dermiche acellulari nella chirurgia mammaria ha comportato significativi progressi: la completa copertura con ADM della protesi ha permesso di ridurre il tasso di contrattura capsulare, più comune problematica causa di chirurgia secondaria. Pertanto, la ricostruzione pre-pettorale one-stage con ADM è ora il gold standard per il trattamento dopo mastectomia. La matrice Braxon è il materiale più studiato in chirurgia mammaria: numerosi studi riconoscono in essa l’attiva modulazione verso una rigenerazione tissutale e una completa integrazione dell’impianto, inibendo reazioni infiammatorie e fibrotiche esagerate. Queste evidenze accendono l’interesse verso l’estensione dell’utilizzo di questa matrice anche in chirurgia di revisione. La letteratura a riguardo è però ancora limitata, sono necessari ulteriori studi per definire l’efficacia di Braxon nella cura e nella prevenzione delle complicanze. Scopo dello studio:Il presente studio si propone di valutare l'efficacia dell'avvolgimento protesico completo con Braxon Fast nella risoluzione e nella prevenzione delle complicanze post-revisione. Inoltre, sono state misurate le percezioni delle pazienti al fine di stabilire il ruolo dell’ADM nel miglioramento del benessere sessuale, fisico, psicosociale e nella soddisfazione generale. Un ulteriore obiettivo è stato quello di indagare i benefici ottenuti dalla sostituzione con protesi B-lite. Materiali e metodi: È stato condotto uno studio prospettico osservazionale monocentrico su 8 pazienti sottoposte a revisione dopo contrattura capsulare con sostituzione protesica assistita da Braxon Fast presso il reparto di Chirurgia Plastica U.O.C di Padova. Sono state eseguite visite preoperatorie, seguite dall’intervento di capsulectomia e impianto di protesi B-lite avvolta da ADM. Le pazienti sono state monitorate con visite ambulatoriali periodiche per valutare il risultato clinico e lo sviluppo di eventuali complicanze. In tale occasione ogni paziente ha compilato un questionario dedicato alla valutazione della qualità di vita e della soddisfazione dopo l’intervento. Risultati:Da ottobre 2024 a giugno 2025 sono state trattate e seguite 8 pazienti. In questo primo follow up non sono state riscontrate complicanze maggiori, si è manifestata un'unica complicanza minore (Red Breast Syndrome) risoltasi spontaneamente dopo 3 mesi. I risultati del modulo BreastQ dimostrano un miglioramento postoperatorio in tutti i domini. I dati descrivono una complessiva soddisfazione di grado moderato, con i valori più elevati nei domini CHEST e OUTCOME. Conclusioni:In accordo con la limitata letteratura, le nostre analisi dimostrano come l’impiego di Braxon nella chirurgia di revisione permetta di risolvere e prevenire le recidive di contrattura capsulare. Inoltre, in associazione all’impianto di protesi B-lite, l’utilizzo di ADM in pazienti con complicanze permette di migliorare il benessere e la soddisfazione post-chirurgica.
Chirurgia di revisione nella ricostruzione mammaria: ruolo dell'impianto di una matrice dermica acellulare di origine suina.
VIANELLO, LUDOVICA
2024/2025
Abstract
Breast reconstruction has become an integral part of the therapeutic pathway for breast cancer, allowing the restoration of a natural breast volume after the radical curative procedure of mastectomy. Advances in surgical techniques and in the properties of the devices used have enabled excellent clinical and aesthetic outcomes. However, the development of complications remains common, compromising patient satisfaction and well-being. The introduction of acellular dermal matrices in breast surgery has led to significant progress: complete coverage of the implant with ADM has reduced the rate of capsular contracture, the most common complication requiring secondary surgery. Therefore, one-stage pre-pectoral reconstruction with ADM is now considered the gold standard for post-mastectomy treatment. The Braxon matrix is the most studied material in breast surgery: many studies describe its active role in promoting tissue regeneration and full implant integration, while inhibiting excessive inflammatory and fibrotic reactions. These findings have introduced interest in extending the use of this matrix to revision surgery as well. However, the available literature on this application remains limited, and further studies are needed to assess the effectiveness of Braxon in the treatment and prevention of complications. Aim:The aim of this study is to evaluate the effectiveness of complete prosthetic coverage using Braxon Fast in resolving and preventing post-revision complications. In addition, patients' perceptions were assessed to determine the role of ADM in improving sexual, physical, and psychosocial well-being, as well as overall satisfaction. An additional objective was to investigate the benefits achieved through the replacement with B-Lite implants. Materials and methods: A prospective, observational, single-center study was conducted on 8 patients who underwent revision breast reconstruction following capsular contracture, with prosthesis replacement assisted by Braxon Fast, at the Plastic Surgery Department of U.H. in Padua. Preoperative consultations were performed, followed by capsulectomy and implantation of a B-Lite prosthesis wrapped in ADM. Patients were monitored through regular follow-up visits to assess clinical outcomes and the development of any complications. In conclusion, each patient completed a questionnaire designed to evaluate quality of life and satisfaction after the procedure. Results:From October 2024 to June 2025, a total of 8 patients were treated and followed. During this period, no major complications were observed; one minor complication (Red Breast Syndrome) occurred and resolved spontaneously after 3 months.The results from the Breast-Q module show postoperative improvement across all domains. The data indicate an overall moderate level of satisfaction, with the highest scores recorded in CHEST and OUTCOME domains. Conclusions:In accordance with the limited literature available, our analysis demonstrates that the use of Braxon in revision surgery allows for the resolution and prevention of recurrent capsular contracture. Moreover, when combined with the implantation of B-Lite prostheses, the use of ADM in patients with complications contributes to improved well-being and postoperative satisfaction.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/86196