Aselüler dermal matriks kullanılmadan gerçekleştirilen direkt implant ile tek aşamalı anında meme rekonstrüksiyonunun uzun dönem onkolojik güvenirliliği

Öz

Amaç: Bu çalışmada, primer meme kanseri olan hastalarda meme başı koruyucu ve cilt koruyucu mastektomi sonrası hücresiz dermal matris veya mesh kullanılmaksızın gerçekleştirilen doğrudan implant ile yapılan anında meme rekonstrüksiyonunun onkolojik güvenliğini değerlendirmek amaçlandı. Gereç ve Yöntemler: 2014-2022 yılları arasında İstanbul Üniversitesi Onkoloji Enstitüsü'nde mastektomi sonrası doğrudan implant ile tek aşamalı meme rekonstrüksiyonu yapılan 175 hastanın tıbbi kayıtları geriye dönük incelendi. Birincil hedef, bölgesel nüks, uzak metastaz ve sağkalım analizleri dahil olmak üzere onkolojik güvenliği değerlendirmekti. İkincil hedef ise rekonstrüksiyonla ilişkili komplikasyonları değerlendirmekti. Bulgular: Hastaların medyan yaş 44 yıl (aralık: 25-74) olup, medyan takip süresi 53 ay (aralık: 19-101) idi. HR+/HER2-, HR+/HER2+ ve saf HER2+ alt tipleri sırasıyla 101 (%57,7), 26 (%14,9) ve 23 (%13,1) hastada gözlemlendi. Üçlü negatif meme kanseri ise 16 (%9,1) hastada mevcuttu. Neoadjuvan kemoterapi 87 (%49,7) hastaya uygulanmış olup, patolojik tam yanıt (pCR) oranı %17,2 idi. Cilt nekrozu (%9,1) ve kapsüler kontraktür (%8,6) en sık görülen komplikasyonlardı ve komplikasyon nedeniyle yedi hastada implant kaybı yaşandı. Lokal-bölgesel nüks ve uzak metastaz oranları sırasıyla %9,7 ve %13,1 olarak kaydedildi. Beş yıllık lokal-bölgesel nükssüz sağkalım ve uzak metastazsız sağkalım oranları sırasıyla %95,4 ve %90,3 olarak bulundu. Ayrıca, hastaların %83,5’i memnuniyetlerini "mükemmel" veya "iyi" olarak bildirildi. Sonuçlar: Hücresiz dermal matris veya mesh kullanılmadan doğrudan implant ile yapılan tek aşamalı anında meme rekonstrüksiyonu, onkolojik olarak güvenli olup kabul edilebilir komplikasyon oranlarına sahiptir. Ayrıca iki aşamalı meme rekonstrüksiyonu veya konvansiyonel mastektomiye iyi bir alternatif oluşturmaktadır.

Anahtar Kelimeler

• direkt implant
• kontraktür
• anında meme rekonstrüksiyonu
• meş

Long-term oncologic safety of one-stage direct-to-implant immediate breast reconstruction without the use of acellular dermal matrix

Öz

Aim: This study aimed to evaluate the oncologic safety of direct-to-implant immediate breast reconstruction without the use of an acellular dermal matrix (ADM) or mesh following nipple-sparing and skin-sparing mastectomy in patients with primary breast cancer. Materials and Methods: The medical records of 175 patients who underwent one-stage direct-to-implant breast reconstruction following mastectomy at the Istanbul University Oncology Institute between 2014 and 2022 were retrospectively reviewed. The primary objective was to assess the oncologic safety, including locoregional recurrence, distant metastasis, and survival outcomes. The secondary objective was to evaluate reconstruction-related complications. Results: The median age of the patients was 44 years (range: 25-74), with a median follow-up period of 53 months (range: 19-101). HR+/HER2-, HR+/HER2+, and pure HER2+ subtypes were observed in 101 patients (57.7%), 26 (14.9%), 23 (13.%), respectively. Triple-negative breast cancer was present in 16 patients (9.1%). Neoadjuvant chemotherapy was administered to 87 patients (49.7%), with a pathological complete response (pCR) rate of 17.2%. Skin necrosis (9.1%) and capsular contracture (8.6%) were the most common complications, with implant loss occuring in seven patients. Locoregional recurrence and distant metastasis rates were 9.7% and 13.1%, respectively. The five-year locoregional recurrence-free survival and distant metastasis-free survival rates were 95.4% and 90.3%. Additionally, 83.5% of patients reported their satisfaction as "excellent" or "good." Conclusion: One-stage direct-to-implant immediate breast reconstruction without the use of an acellular dermal matrix or mesh is oncologically safe, with acceptable complication rates, making it a viable alternative to two-stage breast reconstruction or conventional mastectomy.

Anahtar Kelimeler

• direct-to-implant
• contracture
• immediate breast reconstruction
• mesh

Destekleyen Kurum

There is no person/organization that financially supports the study and the authors have no conflict of interest

Etik Beyan

This study received approval from the Istanbul University Ethics Committee (Approval Date: 23.12.2024 with number 3075139)

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