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Lakatta AC, Steppe C, Teotia SS, Haddock NT. Head-to-Head Analysis of Vertical vs Horizontal Incision Patterns in Breast Reconstruction: Surgical Outcomes and Aesthetic Implications. Aesthet Surg J 2024; 44:286-294. [PMID: 37824425 DOI: 10.1093/asj/sjad331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/08/2023] [Accepted: 10/09/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Modern aesthetically optimized breast reconstruction requires collaboration between the patient, breast surgeon, and plastic surgeon. To optimize both surgical outcome and aesthetic results, incision patterns must be carefully planned. OBJECTIVES We aimed to determine whether vertical or horizontal orientation of mastectomy incision was preferred in the general population and to analyze corresponding complication profiles. METHODS A retrospective review was performed of all patients undergoing bilateral mastectomy followed by autologous breast reconstruction utilizing either vertical or horizontal incision from January 2011 to November 2022. Postoperative complications of the 2 incision patterns were analyzed. Additionally, crowdsourcing was utilized to assess aesthetic implications of horizontal and vertical incision patterns on postoperative pictures of completed breast reconstruction. Survey rater demographics were also analyzed to assess differences in scoring based on voter characteristics. RESULTS There were no significant differences in postoperative breast complications between patients with horizontal or vertical incisions when considering wound, infection, seroma, hematoma, fat necrosis, or overall complications (P > .05). Crowdsourcing showed that, regardless of voter demographics, vertical incisions were preferred over horizontal incisions (P < .001). Additionally, voters who knew someone who had undergone breast reconstruction were more likely to rate all incision patterns higher than other voters (P < .001). CONCLUSIONS Although there are no significant differences in complication profiles between vertical and horizontal incisions in autologous breast reconstruction patients, vertical incision patterns are preferred aesthetically by the general population. LEVEL OF EVIDENCE: 4
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Su H, Danioni A, Mira RM, Ungari M, Zhou X, Li J, Hu Y, Ferrigno G, De Momi E. Experimental validation of manipulability optimization control of a 7-DoF serial manipulator for robot-assisted surgery. Int J Med Robot 2020; 17:1-11. [PMID: 33113264 DOI: 10.1002/rcs.2193] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Both safety and accuracy are of vital importance for surgical operation procedures. An efficient way to avoid the singularity of the surgical robot concerning safety issues is to maximize its manipulability in robot-assisted surgery. The goal of this work was to validate a dynamic neural network optimization method for manipulability optimization control of a 7-degree of freedom (DoF) robot in a surgical operation. METHODS Three different paths, a circle, a sinusoid and a spiral were chosen to simulate typical surgical tasks. The dynamic neural network-based manipulability optimization control was implemented on a 7-DoF robot manipulator. During the surgical operation procedures, the manipulability of the robot manipulator and the accuracy of the surgical operation are recorded for performance validation. RESULTS By comparison, the dynamic neural network-based manipulability optimization control achieved optimized manipulability but with a loss of the accuracy of trajectory tracking (the global error was 1 mm compare to the 0.5 mm error of non-optimized method). CONCLUSIONS The method validated in this work achieved optimized manipulability with a loss of error. Future works should be introduced to improve the accuracy of the surgical operation.
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Affiliation(s)
- Hang Su
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano Piazza Leonardo da Vinci, Milano, Italy
| | - Andrea Danioni
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano Piazza Leonardo da Vinci, Milano, Italy
| | - Robert Mihai Mira
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano Piazza Leonardo da Vinci, Milano, Italy
| | - Matteo Ungari
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano Piazza Leonardo da Vinci, Milano, Italy
| | - Xuanyi Zhou
- State Key Laboratory of High Performance Complicated, Central South University Changsha, Changsha, China
| | - Jiehao Li
- State Key Laboratory of Intelligent Control and Decision of Complex Systems, Beijing Institute of Technology, Beijing, China
| | - Yingbai Hu
- Department of Informatics, Technical University of Munich, Munich, Germany
| | - Giancarlo Ferrigno
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano Piazza Leonardo da Vinci, Milano, Italy
| | - Elena De Momi
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano Piazza Leonardo da Vinci, Milano, Italy
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Wang M, Huang J, Chagpar AB. Is nipple sparing mastectomy associated with increased complications, readmission and length of stay compared to skin sparing mastectomy? Am J Surg 2020; 219:1030-1035. [DOI: 10.1016/j.amjsurg.2019.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/26/2019] [Accepted: 09/10/2019] [Indexed: 11/26/2022]
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Cuperjani F, Gashi L, Kurshumliu F, Dreshaj S, Selimi F. Relationship between Ribosomal Protein S6-pS240 Expression and other Prognostic Factors in Non-Special Type Invasive Breast Cancer. Breast Care (Basel) 2018; 14:171-175. [PMID: 31316316 DOI: 10.1159/000491427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background The aim of this study was to investigate the immunohistochemical expression of ribosomal protein (RP) S6-pS240 in non-special type invasive breast cancer in relation to other prognostic markers and gain new insights to facilitate more individualized treatment. Methods The following clinical and histopathological parameters of 120 patients were determined: S6-pS240 expression, age, menopausal status, tumor size and grade, TNM stage, Nottingham Prognostic Index (NPI), lymph node stage, estrogen and progesterone receptor (ER/PR) expression, HER2/neu amplification, lymphovascular invasion, and proliferative index as measured by Ki-67. Treatment protocol and disease-free survival were evaluated accordingly. Results Significant positive correlations were seen between S6-pS240 expression and Ki-67 values (rho = 0.530, p < 0.001), and NPI (rho = 0.370, p < 0.001) and HER2/neu amplification (rho = 0.368, p < 0.001). A negative correlation was found between S6-pS240 and ER/PR expression (rho = 0.362, p < 0.001). Patients with negative RP S6-pS240 expression had significantly longer disease-free survival (log-rank test, p = 0.005). Conclusion Immunohistochemical analysis of RP S6-pS240 is a valuable additional prognostic marker in patients with invasive breast cancer. Routine use of S6-pS240 immunohistochemistry is recommended.
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Affiliation(s)
- Frederik Cuperjani
- Thoracic Surgery Clinic, University Clinical Center Kosovo, Pristina, Kosovo
| | - Lumturije Gashi
- Pathology Institute, University Clinical Center Kosovo, Pristina, Kosovo
| | - Fisnik Kurshumliu
- Thoracic Surgery Clinic, University Clinical Center Kosovo, Pristina, Kosovo
| | - Shemsedin Dreshaj
- Infectious Diseases Clinic, University Clinical Center Kosovo, Pristina, Kosovo
| | - Fitim Selimi
- Thoracic Surgery Clinic, University Clinical Center Kosovo, Pristina, Kosovo
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Miyake R, Kinoshita S, Shimada N, Uchida K, Takeyama H, Morikawa T. Preservation of the nipple-areola complex in skin-sparing mastectomy for early breast cancer. Surg Today 2018; 48:591-597. [PMID: 29468434 DOI: 10.1007/s00595-018-1633-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 01/05/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE Skin-sparing mastectomy (SSM) enables a radical cure of breast cancer while overcoming the cosmetic issues related to surgery. We review our experience of performing SSMs and assess whether preservation of the nipple-areola complex (NAC) could have been an option for some patients who underwent SSM. METHODS The subjects of this retrospective study were women who underwent SSM that utilized four incision types; namely, the so-called tennis racket incision, a periareolar and midaxillary incision, an areola-sparing and midaxillary incision, and a small transverse elliptical incision. We assessed whether preservation of the NAC would have been an option in SSM, based on histologic examination of three serial cut surfaces of the specimen around the nipple, ruling out the option when evidence of the malignant lesion/s was found in at least one of the following locations: in the nipple, within a 1-cm radius from the base of the nipple, or within 1 cm from the surface of the NAC. RESULTS We performed 193 SSMs. The cumulative 10-year local disease-free survival rate was 98%, with 89% of patients reporting levels of satisfaction with the reconstructed breast, of excellent, very good, or good. We evaluated that 70 of the 193 procedures could have been performed as nipple-sparing mastectomy (NSM). CONCLUSIONS The outcomes of SSM in this series were excellent and NSM might have been an option for about one-third of the patients.
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Affiliation(s)
- Ryo Miyake
- Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Satoki Kinoshita
- Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Naoko Shimada
- Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Ken Uchida
- Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hiroshi Takeyama
- Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Toshiaki Morikawa
- Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
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Dayicioglu D, Tugertimur B, Zemina K, Dallarosa J, Killebrew S, Wilson A, Atisha D, Khakpour N. Vertical Mastectomy Incision in Implant Breast Reconstruction After Skin Sparing Mastectomy: Advantages and Outcomes. Ann Plast Surg 2017; 76 Suppl 4:S290-4. [PMID: 27187251 DOI: 10.1097/sap.0000000000000676] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The type of since skin-sparing mastectomy (SSM) incision directly impacts the final aesthetic and functional results of reconstruction. Different incisions are used for SSM depending on tumor location, previous biopsy scars, breast weight, and ptosis degree. A vertical scar is less visible to the patient, reminiscent of a mastopexy, and patients may not have the stigma of mastectomy. OBJECTIVE This study investigates complication rates, patient demographics, patient reported outcomes, and plastic surgeon evaluations to compare vertical incision mastectomy to other incisions. METHODS After institutional review board approval, a retrospective chart review was performed. A total population of 167 patients that underwent mastectomy with tissue expander reconstruction was separated into vertical incision and nonvertical incision mastectomy groups consisting of 38 and 129 patients, respectively. Patient demographics, complications, tumor margins, staging, breast weight, and breast implant volume were compared. BREASTQ Survey analysis was conducted using patient reported outcomes from the patient's perspective. Aesthetic evaluations of postoperative photos were systematically scored by plastic surgeons to obtain data from the plastic surgeon's perspective. RESULTS Vertical incision orientation did not increase surgical complication rates or mastectomy skin necrosis (P = 0.142). Vertical incisions did not interfere with obtaining adequate tumor margins (P = 0.907). Vertical incisions did not have a significantly different breast weight or implant volume. There was no statistical difference for patient satisfaction or plastic surgeon aesthetic evaluation. CONCLUSIONS The use of vertical incision does not increase complication rates; does not interfere with tumor margins; and can be applied to all age, BMI, breast weight, and breast implant volume groups.
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Affiliation(s)
- Deniz Dayicioglu
- From the *Department of Surgery, Division of Plastic Surgery, University of South Florida, Morsani College of Medicine, Tampa, FL; †University of South Florida, Morsani College of Medicine, Tampa, FL; and ‡Moffitt Cancer Center, Center for Women's Oncology, Tampa, FL
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Du J, Liang Q, Qi X, Ming J, Liu J, Zhong L, Fan L, Jiang J. Endoscopic nipple sparing mastectomy with immediate implant-based reconstruction versus breast conserving surgery: a long-term study. Sci Rep 2017; 7:45636. [PMID: 28361955 PMCID: PMC5374499 DOI: 10.1038/srep45636] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 03/02/2017] [Indexed: 01/04/2023] Open
Abstract
To evaluate the differences between endoscopic nipple sparing mastectomy (ENSM) with immediate implant-based reconstruction and breast conserving surgery(BCS) applied to early-stage breast cancer in postoperative outcomes, function, and cosmesis. we made a prospective, non-randomized study reviewed a total of 346 cases of breast cancer from January 2007 to December 2011, including 189 cases of BCS and 157 cases of ENSM. All the patients were followed up to April 2016, with a median follow-up time of 74 months. The operative time, blood loss and drainage, postoperative complications, postoperative cosmesis, local recurrence rate, disease-free survival rate and overall survival rate of the two groups were compared. we found out that the operative time of ENSM was longer than that of BCS. There was no difference in blood loss and drainage, the postoperative complications, the disease-free survival rate and overall survival rate between the two groups. In regarding to cosmesis, patients in the ENSM group were more likely to get a satisfactory postoperative breast appearance. we reached a conclusion that ENSM is a safe and effective operative method retainingadvantages of TSSM to further improve the postoperative cosmetic effect, without increasing other risks. The surgery provides a new choice for patients with early-stage breast cancer.
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Affiliation(s)
- Junze Du
- Breast surgery, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China
| | - Quankun Liang
- Head-neck surgery, Tumor Hospital, Guangxi Medical University, Guangxi, 530021, China
| | - Xiaowei Qi
- Breast surgery, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China
| | - Jia Ming
- Three glands surgery, the Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
| | - Jing Liu
- Breast surgery, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China
| | - Ling Zhong
- Breast surgery, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China
| | - Linjun Fan
- Breast surgery, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China
| | - Jun Jiang
- Breast surgery, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China
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Aesthetic design of skin-sparing mastectomy incisions for immediate autologous tissue breast reconstruction in asian women. Arch Plast Surg 2014; 41:366-73. [PMID: 25075359 PMCID: PMC4113696 DOI: 10.5999/aps.2014.41.4.366] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 06/27/2014] [Accepted: 07/01/2014] [Indexed: 11/08/2022] Open
Abstract
Background The advent of skin-sparing mastectomy has allowed for the reconstruction of the breast and nipple with improved cosmesis. However, the nipple-areolar complex (NAC) in Asian patients is more pigmented and scars easily. Therefore, commonly described incisions tend to result in poor aesthetic outcomes in Asian patients with breast cancer. Methods We describe an algorithmic approach to skin-sparing mastectomy incisions in Asian patients on the basis of the location of the biopsy scar and the tumor site and size. Four incision types are described: peri-areolar, a peri-areolar incision with a second distant skin paddle, "racquet handle," and peri-areolar with adjacent skin excision. Results 281 immediate breast reconstructions were performed between May 2001 and February 2012 after skin-sparing mastectomy. The mastectomy incisions used included the peri-areolar design (n=124, 44%), peri-areolar design with a second distant skin paddle (n=39, 14%), "racquet handle" (n=21, 7.5%), and peri-areolar design with adjacent skin excision (n=42, 14%). The traditional elliptical incision and other variants where the NAC outline was not preserved were performed in the remaining 55 patients. The average follow-up was 44.7 months during which there was 1 case of total flap loss and 7 cases of partial flap necrosis; all remaining flaps survived. 24% of the patients (68/281) underwent subsequent nipple reconstruction. Conclusions Our algorithm avoids breast incisions that are randomly placed or excessively long and prevents the unnecessary sacrifice of normal breast skin. This allows skin-sparing mastectomy and immediate breast reconstruction to be performed with a consistently achievable aesthetic result in Asian women without neglecting oncological safety.
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