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dc.contributor.authorHallberg, Håkan
dc.date.accessioned2019-01-09T13:30:26Z
dc.date.available2019-01-09T13:30:26Z
dc.date.issued2019-01-09
dc.identifier.isbn978-91-7833-263-2 (PRINT)
dc.identifier.isbn978-91-7833-264-9 (PDF)
dc.identifier.urihttp://hdl.handle.net/2077/57908
dc.description.abstractThere are few high-quality studies evaluating use of meshes in implant-based immediate breast reconstruction (IBR). This thesis analyzed current evidence of matrices and compared outcomes from the use of biological or synthetic meshes and traditional muscle-covered implants. The comparisons examined short- and long-term complications and corrections, predictors of complications, and patient satisfaction and quality of life (QOL). Manuscript I describes a systematic review and meta-analysis specifically assessing differences in outcomes between reconstructions with and without matrices. Manuscript II presents the results of reconstruction using a synthetic mesh [TIGR®; n = 49 patients (65 breasts)]. Manuscript III compares reconstruction outcomes using a biological mesh [Surgisis®; n = 71 (116 breasts)] with those from a traditional muscle-covered technique (n = 90; 132 breasts) regarding complications and health-related QOL. Manuscript IV compared outcomes from use of either a synthetic mesh (TIGR®; n = 41) or a biological mesh (Surgisis®; n = 53) regarding long-term patient satisfaction and health-related QOL. All patients were followed between 17 and 162 months. Meta-analysis revealed a possible increased risk of infection upon use of an acelullar dermal matrix (ADM), but not with synthetic meshes. The result must be interpreted with caution due to severe limitations in the included studies. Additionally, the results suggested that IBR with a synthetic mesh can be performed with a relatively low complication rate. The overall complication rate was higher using biological mesh as compared to muscle-covered implants; however, no significant difference was noted in implant loss rates between the groups. Predictors of complications were mainly patient-related, although high complication rates were associated with the use of tissue expanders, especially in patients with a history of irradiation. Furthermore, long-term patient satisfaction and QOL were similar when using a synthetic, biologic or no mesh, except for complications that affected patient satisfaction with the outcome. Our findings suggest that biological and synthetic meshes provide similar long-term quality of life.sv
dc.language.isoengsv
dc.relation.haspartI. Benefits and risks with acellular dermal matrix (ADM) and mesh support in immediate breast reconstruction: a systematic review and meta-analysis. ::doi::10.1080/2000656X.2017.1419141sv
dc.relation.haspartII. TIGR® matrix surgical mesh - a two-year follow-up study and complication analysis in 65 immediate breast reconstructions. ::doi::10.1080/2000656X.2018.1478841sv
dc.relation.haspartIII. Complications, long-term outcome and quality of life following Surgisis® and muscle-covered implants in immediate breast reconstruction a case-control study with a 6-year follow-up ::doi::10.1007/s00238-018-1444-xsv
dc.relation.haspartIV. Hallberg H, Elander E, Kölby L, Hansson E. A biological or a synthetic mesh in immediate breast reconstruction? A cohort-study of long-term Health Related Quality of Life (HrQoL). Submittedsv
dc.subjectImmediate breast reconstructionsv
dc.subjectacellular dermal matrixsv
dc.subjectmeshsv
dc.subjectplastic surgerysv
dc.subjectquality of lifesv
dc.titleMesh-Based Immediate Breast Reconstruction. Complicantions and long-term resultssv
dc.typetexteng
dc.type.svepDoctoral thesiseng
dc.gup.mailhakan.p.hallberg@vgregion.sesv
dc.type.degreeDoctor of Philosophy (Medicine)sv
dc.gup.originUniversity of Gothenburg. Sahlgrenska Academysv
dc.gup.departmentInstitute of Clinical Sciences. Department of Plastic Surgerysv
dc.gup.defenceplaceFredagen den 1 februari 2019, kl. 13.00, Hjärtats Aula, Vita Stråket 12, Sahlgrenska Universitetssjukhuset, Göteborgsv
dc.gup.defencedate2019-02-01
dc.gup.dissdb-fakultetSA


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