Evaluation of prepectoral implant placement and complete coverage with TiLoop® Bra mesh for breast reconstruction: a prospective study on long-term and patient reported BREAST-Q outcomes.

Background: Breast reconstruction is rapidly evolving, owing to the changing face of cancer surgery and the growing acceptance of acellular dermal matrices (ADM) and synthetic meshes. Although some early reports showed encouraging results after prepectoral breast reconstruction, there is a paucity of data on long term outcomes. Methods: Between January 2012 and March 2015, 179 patients undergoing mastectomy were enrolled at our institution. Patients underwent mastectomy and immediate prepectoral breast reconstruction with the definitive implant entirely wrapped in a titanium-coated polypropylene mesh (TiLoop®). BREAST-Q questionnaire was administered prior to surgery and after 2 years. Capsular contracture was evaluated by Baker scale. Oncological, surgical and aesthetic outcomes along with the changes in BREAST-Q score were analyzed over time. Results: Patients were followed up for an average of 38.5 months. A total of 250 mastectomies were performed. Locoregional recurrence rate was 2.1 %. Complications requiring a reoperation were recorded in 6 patients (2.4%) and implant removal was necessary in 3 cases (1.2%), followed by reconstruction with submuscular expanders. Grade IV capsular contracture was detected in 5 breasts (2%), while 212 breasts were evaluated as grade I (84.8%), 28 breasts as grade II (11.2%) and 5 breast as grade III (2%). Patients reported significant high rates in the BREAST-Q overall satisfaction with outcome (73.8), overall satisfaction with breasts (72.5), psychosocial well-being (77.7) and sexual well-being (57.9), scoring a significant increase in these domains from the preoperative to the postoperative period (p