Valutazione clinica di un nuovo protocollo farmacologico quale adiuvante alla ricostruzione mammaria tramite espansione tissutale

Post-mastectomy breast reconstruction by the aid of tissue expansion is a reliable and safe procedure, whose major drawback is related to the time requested for its completion, which is mainly due to the formation of a periprosthetic fibrous capsule and the local ischemia determined by the compression of the implant itself on the surrounding tissues. According to these observations, the aim of this study was to evaluate the effectiveness of topical 60% dimethyl sulfoxide (DMSO), a drug possessing collagenolytic and vasodilator properties, prior to tissue expansion for breast reconstruction in order to reduce expander pressure, length of treatment, and patient's discomfort. From June 1994 to August 1995, 40 patients undergoing immediate breast reconstruction with tissue expanders following modified radical mastectomy were consecutively divided into two groups of twenty subjects: Group A (control) and Group B (experimental). Patients from Group A underwent traditional tissue expansion, while, to patients of Group B, before each filling session, topical 60% DMSO was applied to the skin overlying the expander by soaking-wet surgical sponges left in place far 30 minutes. The expansion time ranged from 4 to 10 weeks (mean 6 weeks) for Group A, and from 2 to 6 weeks (mean 4 weeks) for Group B. Clinical benefits of pre-filling topical applications of 60% DMSO observed in this trial included ease in expansion, lessened patient pain following expansion, a pliable soft-tissue cover at the time of expander removal, and, above all, an enhancement of the total volume inflatable per session.