Netzunterstützte Techniken in der plastisch-rekonstruktiven Mammachirurgie

Breast cancer surgery has taken a turn over the past decades. New surgical strategies have generated advanced methods concerning oncologic safety combined with improved cosmetic results. Several studies have now been published proving that skin-sparing mastectomy has similar incidence rates on local recurrence and distant metastasis than modified radical mastectomy. As the skin envelope stays intact, immediate reconstruction has become a common procedure in the adjuvant operative setting. Because of the good cosmetic results and nonetheless preserved safety, immediate reconstructive methods have been implemented in the AGO-guidelines in Germany since the year 2010. Generally increasing numbers of immediate breast reconstruction have brought up nouvelle techniques especially for procedures with prosthetic inserts. Quite a few publications outlined that the application of tissue-supporting materials result in improved cosmetic outcome, as shaping of the breast mound and implant bed can be optimized. Even the German AGO guidelines have added the usage of tissue-supporting extraneous materials to the section of reconstructive breast surgery in the year 2011 (Oxford LoE 2b). Titanized alloplasts were evaluated regarding shrinkage, adhesions, tissue integration, local inflammatory and recurrence rate. Results showed an excellent tissue integration, a less pronounced inflammatory reaction, lower recurrence rate, shorter convaslence time and lower shrinkage rate. Considering the insertion of the titanized polypropylene meshs into breast reconstructive surgery, shape and size were optimized specifically for breast surgery.