This video demonstrates a sternal resection, followed by reconstruction with a titanium mesh, for a local recurrence of breast cancer. Anterior chest wall involvement after mastectomy in patients with breast cancer is an uncommon situation. Surgical excision is an important part of the multimodality treatment of the local recurrence of breast cancer. Yet, the large defect after resection of the sternum and the ribs constitutes a major challenge. Among the options in covering the anterior chest wall after sternal resection, titanium mesh may be preferred with its "easy to implant" feature. In this short video, the authors present a sternal resection and reconstruction with titanium mesh in a 41-year-old female patient, who had a local recurrence of the tumor three years after surgery and chemotherapy for breast cancer.
Congrats fort his challenging and demonstrative surgery;l would like to ask why you didnt use the both Pectoralis major muscle flaps to cover on the the Titanium mesh instead of using another soft tissue dual mesh underneath the defect?As far as l can see those pectoralis major muscles are viable and you wouldnt have to use extra soft tisue mesh under the Titanium to fix the defect and avoid paradoxical movement of the chest Wall and skin, thanks
Dear Murat, thank you for the comment. Indeed, I was expecting this question since we also discussed it during the operation whether it was really necessary to cover the area with a dual mesh or not. First, the muscle was in appropriate to pull it from each side in sufficient traction power. The area would still have been weak with covering it with pectoralis muscle. Second, I thought that the dual mesh could avoid the consequences of ‘touching’ the heart to metalic (titanium) material in every beat. Because the area is quite hard, no paradoxical movement has been observed so far, 6 months after surgery.
Ok , good work thanks alot
Great case, well done. I have to get some of that titanium mesh. looks perfect. better than methyl methacrylate as it would be less rigid
Thank you Joel. It is also much easier to implant than all other rigid materials. Re-shaping capability is another bonus.
Congratulations, a very interesting alternative for chest wall reconstruction.
Would you please name the company which produces the titanium mesh and the screws you used? Thanks a lot!
Dr Scriba, thank you for the comment. The company is Zimmer Biomet. Screws, screwdriver and the scisors are brought by the company representative in a set when the mesh is ordered.
Dr. Halezeroglu,
Great case; I have a few questions:
1. I am not sure if I missed it but what did you sew the mesh to?
2. How did you avoid injurying the internal mammary artery?
3. Lastly, where did you place your drains?
Thank you