Immediate implant-based breast reconstruction using a titanium-coated polypropylene mesh (TiLOOP Bra): Complication rates and risk factors in a single-institution experience

Abstract Background: Immediate implant reconstruction after a skin sparing or a nipple sparing mastectomy is an attractive option made easier by the use of mesh to cover the lower implant pole. Acellular dermal matrices (ADM) have been widely used and described in the literature. A titanium-coated polypropylene mesh (TCPM) is an alternative to ADM but only few clinical data have been published. Methods: 209 patients who underwent single or bilateral immediate implant breast reconstruction after conservative mastectomies using TCPM were retrospectively evaluated accounting for 260 procedures. We analyzed short-term outcomes and surgical complications. Univariate and multivariable logistic regression analyses were performed to evaluate the predictive character of patients and procedure-related characteristics on postoperative complications. Major complications were defined as implant loss and implant replacement by an expander. Results: Among 260 mastectomies, 170 were skin-sparing mastectomies, 66 nipple-sparing mastectomies and 24 skin-reducing mastectomies with an inferior deepithelialized dermal flap associated with TCPM. The median age was 52.5 years (range: 25-84), 26.3% of patients were smokers and 21.3% had previously received radiotherapy. The overall complication rate was 34.6% and major complications occurred in 8.9% of cases. Implant infection occurred in 8.8%, delayed wound healing in 20.8% and skin or nipple areola complex necrosis in 2.7% of cases. In univariate analyses, smoking, a high breast weight and implant infection occurrences were associated with major complications. Risk factors for implant infection were high body mass index (BMI), smoking, a high breast and implant weight and long drainage duration. Risk factors for delayed wound healing were smoking, a high breast and implant weight and skin reducing mastectomies. Cutaneous abdominal flap was reported as a protective factor for delayed wound healing and implant infection probably allowed by a tension-free closure. In multivariable analysis, smoking and a high breast weight were independently correlated with postoperative complication occurrence. Major complications were associated with smoking and implant infection while an inferior deepithelialized dermal flap associated with TCPM was reported as a protective factor. Conclusion: Titanium-coated polypropylene mesh (TCPM) in immediate breast reconstruction reported acceptable complication rates. Cutaneous abdominal flap and an inferior deepithelialized dermal flap associated with TCPM may help reducing the complication rate particularly when complication risk factors are present. Tension-free closure and careful handle of the cutaneous flap during mastectomy could help reducing the complication rate. Citation Format: Laure Delmond, Flavie Sire, Simon Thezenas, Philippe Rouanet, Pierre-Emmanuel Colombo, Anne Mourregot, Marian Gutowski. Immediate implant-based breast reconstruction using a titanium-coated polypropylene mesh (TiLOOP Bra): Complication rates and risk factors in a single-institution experience [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-20-16.