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Zhu KJ, Heron MJ, Tiongco RFP, Biswas A, Weitzner AS, Duclos OA, Atayeva R, Cooney CM, Cooney DS, Broderick KP. Hyperbaric Oxygen Therapy in Immediate Tissue Expander-Based Breast Reconstruction. Ann Plast Surg 2025; 94:S305-S310. [PMID: 40167090 DOI: 10.1097/sap.0000000000004321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2025]
Abstract
BACKGROUND Prepectoral tissue expander (TE) placement is an increasingly used breast reconstruction technique but may have a higher risk for mastectomy skin flap ischemia compared to subpectoral TE placement. Hyperbaric oxygen therapy (HBOT) has been shown to salvage compromised mastectomy skin flaps, but there is limited evidence on which patients require HBOT and benefit most from this treatment. METHODS We retrospectively reviewed patients undergoing immediate TE breast reconstruction over a 6-year period. Patient demographics, intraoperative data, HBOT treatment, complications, and final breast reconstruction type were collected. Analyses were performed by patient and by breast. RESULTS Among 348 patients (552 breasts), 299 (86%) patients (477 breasts) had prepectoral and 49 (14%) patients (75 breasts) had subpectoral TE placement. Only prepectoral patients received HBOT (19 patients/33 breasts vs 0 patients/breasts, P = 0.037). Breasts receiving HBOT had higher rates of mastectomy skin necrosis (30-day: 73% vs 5.6%, P < 0.001; 90-day: 76% vs 6.5%, P < 0.001), returns to the OR for necrosis excision (30-day: 18% vs 3.2%, P = 0.001; 90-day: 21% vs 5.4%, P = 0.003), and TE explantation (30-day: 21% vs 1.8%, P < 0.001; 90-day: 24% vs 3.8%, P < 0.00001) at the 30- and 90-day postoperative periods. However, these rates did not significantly increase from 30 to 90 days. For those with mastectomy skin necrosis, HBOT salvaged significantly more mastectomy pockets (76% vs 41%, P < 0.0001). CONCLUSIONS Patients with prepectoral TE placement were significantly more likely to receive HBOT. Compared to no treatment, HBOT was able to salvage almost twice as many mastectomy pockets, providing valuable information for mastectomy skin flap ischemia treatment options.
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Affiliation(s)
- Katherine J Zhu
- From the Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Lorenzano V, Lisa AVE, Vinci V, Agnelli B, Lozito A, Klinger M, Mela A, Caruso M, Klinger F. BRM: From Skin-Reducing Mastectomy to the New Concept of Breast Reshaping Mastectomy. J Clin Med 2025; 14:1350. [PMID: 40004879 PMCID: PMC11855976 DOI: 10.3390/jcm14041350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Revised: 01/29/2025] [Accepted: 02/12/2025] [Indexed: 02/27/2025] Open
Abstract
Background: Macromastia is a well-known issue in breast reconstruction. Skin-reducing mastectomy (SRM) was introduced as a skin-sparing mastectomy that utilizes a skin reduction pattern similar to breast reduction or breast lift surgery, specifically to manage hypertrophic and pendulous breasts. Over time, numerous authors have contributed to refining the SRM technique, leading to the development of various technical variants. However, the diversity of approaches inspired by SRM has created confusion, and clear surgical indications are lacking. Methods: We propose a unifying concept called breast reshaping mastectomy (BRM), which encompasses all techniques based on SRM principles. The BRM aims not only to preserve and reduce the breast skin envelope but also to immediately reshape it for a more aesthetic outcome. This approach is applicable to all mastectomies where skin envelope preservation (with or without the nipple-areola complex) is oncologically safe, a modification of breast skin coverage is needed for better aesthetic results, and an implant-based reconstruction is planned. Results: To define the BRM concept, we reviewed the existing literature on SRM and its related techniques. Our analysis focused on four key elements: skin incision pattern, implant coverage strategy, nipple-areola complex (NAC) management, and the choice between two-stage and direct-to-implant reconstruction. Conclusions: By integrating these four components into a single surgical framework, BRM provides a structured approach to breast reconstruction that enhances both oncologic safety and aesthetic outcomes. Standardizing these techniques could help clarify surgical indications and improve reconstructive planning for patients undergoing skin-sparing mastectomy.
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Affiliation(s)
- Valerio Lorenzano
- Scuola di Specializzazione in Chirurgia Plastica, Ricostruttiva ed Estetica, Università Degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy; (V.L.); (A.M.)
| | - Andrea Vittorio Emanuele Lisa
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, 20141 Milan, Italy
- PhD Program in Applied Medical-Surgical Sciences, Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (V.V.); (B.A.); (A.L.); (M.C.)
| | - Valeriano Vinci
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (V.V.); (B.A.); (A.L.); (M.C.)
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Via Manzoni 56, Rozzano, 20090 Milan, Italy; (M.K.); (F.K.)
| | - Benedetta Agnelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (V.V.); (B.A.); (A.L.); (M.C.)
| | - Alessia Lozito
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (V.V.); (B.A.); (A.L.); (M.C.)
| | - Marco Klinger
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Via Manzoni 56, Rozzano, 20090 Milan, Italy; (M.K.); (F.K.)
| | - Alessandro Mela
- Scuola di Specializzazione in Chirurgia Plastica, Ricostruttiva ed Estetica, Università Degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy; (V.L.); (A.M.)
| | - Martina Caruso
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; (V.V.); (B.A.); (A.L.); (M.C.)
| | - Francesco Klinger
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Via Manzoni 56, Rozzano, 20090 Milan, Italy; (M.K.); (F.K.)
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Du F, Liu R, Zhang H, Xiao Y, Long X. Post-mastectomy adjuvant radiotherapy for direct-to-implant and two-stage implant-based breast reconstruction: A meta-analysis. J Plast Reconstr Aesthet Surg 2022; 75:3030-3040. [DOI: 10.1016/j.bjps.2022.06.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 05/14/2022] [Accepted: 06/10/2022] [Indexed: 10/17/2022]
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Yazar S, Bengur FB, Altinkaya A, Kara H, Uras C. Nipple-Sparing Mastectomy and Immediate Implant-Based Reconstruction with or Without Skin Reduction in Patients with Large Ptotic Breasts: A Case-Matched Analysis. Aesthetic Plast Surg 2021; 45:956-967. [PMID: 33095302 DOI: 10.1007/s00266-020-02000-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/29/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Nipple-sparing mastectomy (NSM) and implant-based immediate breast reconstruction are becoming preferred options with improved outcomes. However, reconstruction in patients with large and ptotic breasts is challenging. When mastectomy and skin reduction are combined in a single-staged procedure, the vasculature of the skin is disturbed leading to increased complication rates. This paper aims to compare complication rates of NSM and immediate implant-based reconstruction with or without reduction to determine the safety of reduction in this patient group. METHODS Breast cancer patients that underwent NSM and implant-based immediate breast reconstruction between November 2010 and 2018 were analyzed. All implants were placed submuscularly. Patients with skin reduction and nipple-areolar complex transposition were matched in a 1:1 fashion with patients without reduction. RESULTS There were 50 patients (72 procedures) in each group. Demographics of the groups were similar as a part of matching process. Mean implant volume in the reduction group was higher (399.93 ± 97.54 vs. 360.21 ± 82.54, p = 0.009). Full thickness skin necrosis rate was higher in the reduction group [12/72 (%17) vs. 2/72 (3%), p = 0.009], and the most common site was over the suture line [6/12 (50%)]. Complications in the reduction group were more common in reconstructions with implant volumes greater than 500 cc (p = 0.008). CONCLUSIONS When compared with no reduction, the skin necrosis rate of NSM and immediate implant-based reconstruction with skin reduction is higher. The described technique can only be considered in patients with moderate breast volumes, grade II-III ptosis, and when the planned implant volume is low (< 500 cc). LEVEL OF EVIDENCE IV. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Sukru Yazar
- Department of Plastic Reconstructive and Aesthetic Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Kayisdagi Caddesi, No:32 Atasehir, 34752, Istanbul, Turkey.
| | - Fuat Baris Bengur
- Department of Plastic Reconstructive and Aesthetic Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Kayisdagi Caddesi, No:32 Atasehir, 34752, Istanbul, Turkey
| | - Altug Altinkaya
- Department of Plastic Reconstructive and Aesthetic Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Kayisdagi Caddesi, No:32 Atasehir, 34752, Istanbul, Turkey
| | - Halil Kara
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Cihan Uras
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
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Therapeutic Reversal of Radiotherapy Injury to Pro-fibrotic Dysfunctional Fibroblasts In Vitro Using Adipose-derived Stem Cells. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2706. [PMID: 32537359 PMCID: PMC7253248 DOI: 10.1097/gox.0000000000002706] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/27/2020] [Indexed: 01/13/2023]
Abstract
Cancer patients often require radiotherapy (RTx) to enhance their survival. Unfortunately, RTx also damages nearby healthy non-cancer tissues, leading to progressive fibrotic soft-tissue injury, consisting of pain, contracture, tissue-breakdown, infection, and lymphoedema. Mechanisms underlying the clinically observed ability of fat grafting to ameliorate some of these effects, however, are poorly understood. It was hypothesized that RTx significantly alters fibroblast cell function and the paracrine secretome of adipose-derived stem cells (ADSC) may mitigate these changes. Methods To investigate cellular changes resulting in the fibrotic side-effects of RTx, cultured normal human dermal fibroblasts (NHDF) were irradiated (10Gy), then studied using functional assays that reflect key fibroblast functions, and compared with unirradiated controls. RNA-Seq and targeted microarrays (with specific examination of TGFβ) were performed to elucidate altered gene pathways. Finally, conditioned-media from ADSC was used to treat irradiated fibroblasts and model fat graft surgery. Results RTx altered NHDF morphology, with cellular functional changes reflecting transition into a more invasive phenotype: increased migration, adhesion, contractility, and disordered invasion. Changes in genes regulating collagen and MMP homeostasis and cell-cycle progression were also detected. However, TGFβ was not identified as a key intracellular regulator of the fibroblast response. Finally, treatment with ADSC-conditioned media reversed the RTx-induced hypermigratory state of NHDF. Conclusions Our findings regarding cellular and molecular changes in irradiated fibroblasts help explain clinical manifestations of debilitating RTx-induced fibrosis. ADSC-secretome-mediated reversal indicated that these constituents may be used to combat the devastating side-effects of excessive unwanted fibrosis in RTx and other human fibrotic diseases.
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Kanda MH, da Costa Vieira RA, Lima JPSN, Paiva CE, de Araujo RLC. Late locoregional complications associated with adjuvant radiotherapy in the treatment of breast cancer: Systematic review and meta-analysis. J Surg Oncol 2020; 121:766-776. [PMID: 31879978 DOI: 10.1002/jso.25820] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 12/14/2019] [Indexed: 02/06/2023]
Abstract
This systematic review with meta-analysis addressed late locoregional complications associated with adjuvant radiotherapy (RT) in breast cancer. Among 2120 titles, ten comparative studies in patients undergoing surgery vs surgery and radiotherapy reporting complications were evaluated. RT was associated with an increased risk of capsular contracture and decreased the mobility of the upper limb. A borderline association of lymphedema risk using RT was noted in the random-effects model but was significant in the fixed-effects model.
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Affiliation(s)
- Márcia Helena Kanda
- Programa de Pós-Graduação em Oncologia, Hospital de Câncer de Barretos, Barretos, São Paulo, Brasil
- Departamento de Oncologia Clínica do Hospital de Câncer de Barretos, São Paulo, Brasil
| | - René Aloisio da Costa Vieira
- Programa de Pós-Graduação em Oncologia, Hospital de Câncer de Barretos, Barretos, São Paulo, Brasil
- Programa de Pós-Graduação em Ginecologia, Obstetricia e Mastologia, Faculdade de Medicina de Botucatu. UNESP, Botucatu, São Paulo, Brasil
| | - João Paulo S N Lima
- Departamento de Oncologia Clínica e Laboratório de Bioinformática, A.C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Carlos Eduardo Paiva
- Programa de Pós-Graduação em Oncologia, Hospital de Câncer de Barretos, Barretos, São Paulo, Brasil
- Departamento de Oncologia Clínica do Hospital de Câncer de Barretos, São Paulo, Brasil
| | - Raphael Leonardo Cunha de Araujo
- Programa de Pós-Graduação em Oncologia, Hospital de Câncer de Barretos, Barretos, São Paulo, Brasil
- Departamento de Cirurgia do Aparelho Digestivo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
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Higher reconstruction failure and less patient-reported satisfaction after post mastectomy radiotherapy with immediate implant-based breast reconstruction compared to immediate autologous breast reconstruction. Breast Cancer 2019; 27:435-444. [PMID: 31858435 DOI: 10.1007/s12282-019-01036-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/08/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE To improve shared decision making, clinical- and patient-reported outcomes between immediate implant-based and autologous breast reconstruction followed by postmastectomy radiotherapy (PMRT) were compared. METHODS All women with in situ and/or invasive breast cancer who underwent skin sparing mastectomy with immediate breast reconstruction (IBR) (autologous- or implant based, one- or two staged) followed by PMRT in the Utrecht region between 2012 and 2016 were selected from the Netherlands Cancer Registry, of which 112 (59%) agreed to participate. The primary outcome was reconstruction failure after the start of radiotherapy, and secondary outcomes were patient-reported outcomes measured with BREAST-Q. RESULTS 109 patients underwent skin-sparing mastectomy, of which 29 (27%) underwent immediate autologous reconstruction and 80 (73%) received immediate implant-based reconstruction. After PMRT, reconstruction failure occurred in 17 patients (21%) with implant-based reconstruction, while no failure was seen in the autologous group (p = 0.04). Mean patient-reported 'Satisfaction with Breasts' (50.9 vs. 63.7, p = 0.001) and 'Sexual Well-being' (46.0 vs. 55.5, p = 0.037) were lower after implant-based reconstruction compared to autologous reconstruction. Thirteen patients with autologous flaps underwent surgical cosmetic corrections compared to ten patients in the implant group (45 vs. 13%, p = 0.001). IBR and PMRT in this study resulted in a high rate of severe capsular contraction in implant-based reconstruction (16.9%) and fibrosis in autologous reconstruction (13.8%). CONCLUSIONS Patients treated with PMRT and one or two stage immediate implant-based reconstruction were at greater risk of developing reconstruction failure and were less satisfied when compared to one or two stage immediate autologous reconstruction. Since fairly high complication rates in both reconstruction methods after PMRT are observed, it raises the question whether immediate breast reconstruction should be considered at all when PMRT is indicated. Patients considering or potential candidates for IBR should be informed about the consequences of PMRT and especially when opting for autologous reconstruction one should possibly perform reconstruction in a secondary setting.
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Jepsen C, Hallberg H, Pivodic A, Elander A, Hansson E. Complications, patient-reported outcomes, and aesthetic results in immediate breast reconstruction with a dermal sling: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2019; 72:369-380. [PMID: 30665838 DOI: 10.1016/j.bjps.2018.12.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/19/2018] [Accepted: 12/21/2018] [Indexed: 11/18/2022]
Abstract
An inferior dermal flap ("sling") can be used to cover an implant with two layers of tissue following Wise pattern skin-reducing mastectomies. Here, we performed a systematic review of the risks and benefits of this technique, specifically regarding complications, patient-reported outcomes, and aesthetic outcomes. PubMed and other relevant databases were searched using specific key words, with inclusion criteria comprising studies of dermal sling use involving ≥ 5 patients and performance according to the PICO framework. A meta-analysis was performed using a random-effects model involving a binomial distribution with logit-link function. For each study, the 95% confidence interval (CI) was obtained based on exact limits from a binomial distribution, and heterogeneity testing was performed using a chi-squared test. A total of 428 abstracts were retrieved, with 24 studies meeting the inclusion criteria and including a total of 879 patients and 1184 reconstructed breasts. The mean complication rate was 21.6% (95% CI: 16.9-27.2%), with the most common complication involving wound-healing problems (mean, 11.4%; 95% CI: 8.5-15.2%), and the frequency of implant loss (< 3 months) varied from 0% to 14% (mean, 2.2%; 95% CI: 1.1-4.4%). Seven articles reported patient-reported outcomes, and four reported aesthetic outcomes, with the quality of evidence classified as low for complications and very low for patient-reported outcomes and aesthetic outcomes. Our findings showed that although implant-based reconstruction with a dermal sling is widely used, there is little scientific evidence supporting the method.
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Affiliation(s)
- Christian Jepsen
- Department of plastic and reconstructive surgery, Sahlgrenska University Hospital, Gröna Stråket 8, SE-41345 Gothenburg, Sweden; Department of clinical sciences, The Sahlgrenska Academy, Gothenburg University, Medicinaregatan 3, SE-413 45 Gothenburg, Sweden.
| | - Håkan Hallberg
- Department of plastic and reconstructive surgery, Sahlgrenska University Hospital, Gröna Stråket 8, SE-41345 Gothenburg, Sweden; Department of clinical sciences, The Sahlgrenska Academy, Gothenburg University, Medicinaregatan 3, SE-413 45 Gothenburg, Sweden
| | - Aldina Pivodic
- Statistiska konsultgruppen, Thorild Wulffsgatan 1, SE-413 19 Gothenburg, Sweden
| | - Anna Elander
- Department of plastic and reconstructive surgery, Sahlgrenska University Hospital, Gröna Stråket 8, SE-41345 Gothenburg, Sweden; Department of clinical sciences, The Sahlgrenska Academy, Gothenburg University, Medicinaregatan 3, SE-413 45 Gothenburg, Sweden
| | - Emma Hansson
- Department of plastic and reconstructive surgery, Sahlgrenska University Hospital, Gröna Stråket 8, SE-41345 Gothenburg, Sweden; Department of clinical sciences, The Sahlgrenska Academy, Gothenburg University, Medicinaregatan 3, SE-413 45 Gothenburg, Sweden; Department of clinical sciences, Malmö, Lund University, Jan Waldenströms gata 35, SE-205 02 Malmö, Lund, Sweden
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Hansson E, Jepsen C, Hallberg H. Breast reconstruction with a dermal sling: a systematic review of surgical modifications. J Plast Surg Hand Surg 2018; 53:1-13. [PMID: 30557054 DOI: 10.1080/2000656x.2018.1533840] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A dermal sling (DS) is used to cover the implant with two layers of tissue when immediate breast reconstruction is performed in women with large and ptotic breasts. It works as an autologous acellular dermal matrix/mesh that can be used to control the implant pocket and inframammary fold, without inferring an extra foreign material and higher costs. There is relatively little published about the DS technique. The primary aim of this study was to systematically review published surgical modifications to the dermal sling (DS). The secondary aim was to investigate what implants have been used. Relevant databases were searched for articles and abstracts published between January 1990 and September 2018. Inclusion criteria were studied and case reports on DS meeting the criteria defined in a PICO. Review articles were excluded. Total evidence for the different types of DSs was graded according to GRADE. A total of 428 abstracts were retrieved. Of these 373 abstracts did not meet the inclusion criteria and were excluded, leaving 54 abstracts. Nine categories of surgical modifications could be identified: classic dermal sling (DS) with minor modifications, non Wise-pattern mastectomy DS, nipple areola complex bearing DS, DS in combination with a matrix/mesh, DS as a suture line protection technique, DS with a modified circulatory basis, DS without an implant, DS as an immediate-delayed technique and pre-pectoral DS. The evidence for DS as a surgical technique is very low (GRADE ⊕). The DS can be used with both permanent implants and tissue expanders (GRADE ⊕).
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Affiliation(s)
- Emma Hansson
- a Department of clinical sciences , University of Gothenburg. The Sahlgrenska Academy , Gothenburg , Sweden.,b Department of Reconstructive Plastic Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden.,c Department of clinical sciences Malmö , Lund University , Malmö , Sweden
| | - Christian Jepsen
- a Department of clinical sciences , University of Gothenburg. The Sahlgrenska Academy , Gothenburg , Sweden.,b Department of Reconstructive Plastic Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Håkan Hallberg
- a Department of clinical sciences , University of Gothenburg. The Sahlgrenska Academy , Gothenburg , Sweden.,b Department of Reconstructive Plastic Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden
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Kozak K, Wojcik R, Czerwonka M, Mandziuk S, Madej-Czerwonka B. Oncoplastic breast surgery techniques - a new look at surgical treatment of breast cancer. CURRENT ISSUES IN PHARMACY AND MEDICAL SCIENCES 2018. [DOI: 10.1515/cipms-2018-0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Breast cancer is the most common cancer among Polish women [1], thus, the problem of surgical treatment of breasts, especially with regard to conserving and/or reconstruction surgery, is extensively discussed. Currently, in Poland, efforts are made to increase the number of oncologic and reconstructive breast centers which offer specialized treatment of this cancer, the so-called ‘Breast Units’ [1]. This paper analyzes methods of reconstructions, discusses the techniques used in particular types of surgeries and additionally informs the reader of the oncological aspects of the procedures. Based on literature, statistical data of breast reconstructions from Poland and the world are presented. Moreover, complications and psychological aspects of mammary gland surgery are dealt with, and the aesthetic effects of breast reconstructions are discussed. To support of our findings, we also present selected clinical cases from the oncological and reconstructive point of view.
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Affiliation(s)
- Krzysztof Kozak
- Chair and Department of Human Anatomy , Medical University of Lublin , Jaczewskiego 4, 20-090 Lublin , Poland
- Breast Surgery Department of the Cardinal Rev. Wyszynski’s Voivodship Specialistic Hospital in Lublin , Poland
| | - Rafal Wojcik
- Chair and Department of Human Anatomy , Medical University of Lublin , Jaczewskiego 4, 20-090 Lublin , Poland
- Breast Surgery Department of the Cardinal Rev. Wyszynski’s Voivodship Specialistic Hospital in Lublin , Poland
| | - Maciej Czerwonka
- Chair and Department of Human Anatomy , Medical University of Lublin , Jaczewskiego 4, 20-090 Lublin , Poland
- Breast Surgery Department of the Cardinal Rev. Wyszynski’s Voivodship Specialistic Hospital in Lublin , Poland
| | - Slawomir Mandziuk
- Chair and Clinic of Pneumology, Oncology and Allergology , Independent Public Clinical Hospital No. 4 in Lublin, Jaczewskiego 8, 20-954 Lublin , Poland
| | - Barbara Madej-Czerwonka
- Chair and Department of Human Anatomy , Medical University of Lublin , Jaczewskiego 4, 20-090 Lublin , Poland
- Breast Surgery Department of the Cardinal Rev. Wyszynski’s Voivodship Specialistic Hospital in Lublin , Poland
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The satisfaction of patients with breast cancer undergone immediate reconstruction with implant and the effect of radiotherapy. Contemp Oncol (Pozn) 2018; 22:27-30. [PMID: 29692660 PMCID: PMC5909727 DOI: 10.5114/wo.2018.74390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 03/04/2018] [Indexed: 11/17/2022] Open
Abstract
Aim of the study Postmastectomy reconstructive surgery for cosmetic satisfaction of patients is rapidly increasing. Postoperative complications such as infection, capsular contracture, implant loss are more common in patients who receive adjuvant radiotherapy (RT) than those who do not. Satisfaction levels in patients is still a controversial issue. Therefore, we wanted to investigate our patient population for the effects of RT and planned a study evaluating the satisfaction rates of our patients who received implants. Material and methods Seventy five breast cancer patients who went through mastectomy and went through reconstruction using expanders or silicone implants were surveyed. Complication and cosmetic satisfaction rates were separately compared between irradiated and nonirradiated implants. Responses of 46 patients who answered the survey were analyzed using χ2 test and Mann Whitney U test. p < 0.05 was considered statistically significant. Results Thirty-one of the patients received adjuvant RT and 15 did not receive RT (NRT). There was no difference between the RT and NRT groups in the terms of touch, size, shape of silicones, pain and satisfaction level in look of clothing. Only satisfaction in symmetry was significantly lower in the RT group than in the NRT group (p = 0.02). Additionally, patients receiving chemotherapy were less satisfied with silicone size than those who did not (p = 0.02). Conclusion We did not find negative effects, other than symmetry, of adjuvant radiotherapy in breast cancer patients who underwent reconstructive surgery in terms of cosmetic satisfaction.
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Magill LJ, Robertson FP, Jell G, Mosahebi A, Keshtgar M. Determining the outcomes of post-mastectomy radiation therapy delivered to the definitive implant in patients undergoing one- and two-stage implant-based breast reconstruction: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2017; 70:1329-1335. [DOI: 10.1016/j.bjps.2017.05.057] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 05/23/2017] [Accepted: 05/30/2017] [Indexed: 01/03/2023]
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13
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Pechevy L, Carloni R, Guerid S, Vincent PL, Toussoun G, Delay E. Skin-Reducing Mastectomy in Immediate Reconstruction: How to Limit Complications and Failures. Aesthet Surg J 2017; 37:665-677. [PMID: 28171481 DOI: 10.1093/asj/sjw258] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In hypertrophic and/or very ptotic breasts, skin-reducing mastectomy (SRM) is challenging and the risk of complications is high. Few publications have reported the use of an autologous latissimus dorsi flap (ALDF) in this indication. Most studies opt for implant reconstructions, with a high failure rate. OBJECTIVES We aimed to identify and present the technical refinements that reduce the risk of reconstruction failure in patients with hypertrophic and/or ptotic breasts with breast cancer or at risk of breast cancer after SRM with immediate breast reconstruction (IBR) utilizing an ALDF. METHODS Our retrospective study, covering a period of 18 years, included a series of 60 patients with hypertrophic and/or ptotic breasts who underwent 67 SRM and IBR procedures utilizing an ALDF. The complications were recorded and the risk factors analyzed. RESULTS Sixty-seven SRMs were reviewed. Forty-nine procedures were performed with an inverted-T scar technique and 18 with a vertical scar technique. The nipple-areola complex (NAC) was preserved in 10 cases. There were eight (11.9%) cases of minor mastectomy flap necrosis after skin-reducing reconstructions, 16 (23.8%) wound dehiscences, no infections, no breast seromas, and no reconstruction failures. Smoking increased the risk of minor mastectomy flap necrosis (P = 0.048) and wound dehiscence (P = 0.002). Previous radiotherapy was associated with minor mastectomy flap necrosis (P = 0.001). CONCLUSIONS The use of an ALDF together with technical refinements that preserve the vascular supply of the skin envelope leads to successful IBR with consistently good aesthetic results. Above all, it avoids failure of the reconstruction in very large or ptotic breasts. LEVEL OF EVIDENCE 4
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Affiliation(s)
- Lolita Pechevy
- From the Department of Plastic and Reconstructive Surgery, Léon Bérard Center, Lyon, France
| | - Raphael Carloni
- From the Department of Plastic and Reconstructive Surgery, Léon Bérard Center, Lyon, France
| | - Samia Guerid
- From the Department of Plastic and Reconstructive Surgery, Léon Bérard Center, Lyon, France
| | - Pierre-Luc Vincent
- From the Department of Plastic and Reconstructive Surgery, Léon Bérard Center, Lyon, France
| | - Gilles Toussoun
- From the Department of Plastic and Reconstructive Surgery, Léon Bérard Center, Lyon, France
| | - Emmanuel Delay
- From the Department of Plastic and Reconstructive Surgery, Léon Bérard Center, Lyon, France
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14
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Becker Expander-Based Breast Reconstruction Following Wise Pattern Skin-Reducing Mastectomy: Complication Rates and Risk Factors. Aesthetic Plast Surg 2017; 41:304-311. [PMID: 28130562 DOI: 10.1007/s00266-016-0732-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 11/02/2016] [Indexed: 10/20/2022]
Abstract
Our aim is to analyze the results of immediate breast reconstruction in women with macromastia after skin-reducing mastectomy (SRM), with an emphasis on complications and risk factors. Between 2008 and 2013, fifty women with hypertrophic breasts, aged 21-74 years, underwent immediate expander-based breast reconstruction after Wise pattern SRM. An inferiorly based de-epithelialized skin flap was sutured to the inferolateral border of the pectoralis major muscle and covered the expander. Thirty-five women had a unilateral and fifteen a bilateral procedure (total 65 breasts). In all cases, Becker-35 expanders of volume ranging from 365 to 685 cc were used. Risk factors (BMI, smoking, expander's size, preoperative irradiation, chemotherapy) and complications were recorded. Follow-up up to 60 months was compiled. In all cases, the myodermal pouch provided safe coverage and support of the expander. Postoperative complications occurred in 18 out of 65 breasts (27.6%) and included skin ischemia in 11 breasts (16.9%), late infection in two (3%), seroma and expander rotation in four and one, respectively (6.1 and 1.5%), and severe peri-prosthetical contraction in five breasts (7.6%). Statistical analysis showed that complications were significantly related to preoperative radiotherapy and smoking; no significant correlation was documented between complication rates and chemotherapy, BMI, age or expander's size. We suggest that the inverted-T SRM, creating a combined "myodermal" flap for the coverage of a Becker expander, is a useful single-stage reconstructive option for patients with macromastia. Preoperative radiotherapy is significantly related to higher postoperative complication rates, and may result in a less optimal reconstructive outcome. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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15
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Weenk M, Wunschel P, Heine E, Strobbe LJ. Factors influencing the decision to pursue immediate breast reconstruction after mastectomy for breast cancer. Gland Surg 2017; 6:43-48. [PMID: 28210551 DOI: 10.21037/gs.2016.11.11] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Immediate breast reconstruction (IBR) after mastectomy has shown to be oncologically safe and to improve quality of life in breast cancer patients. However, most women undergoing mastectomy do not undergo IBR. In this study, we aim to identify breast surgeon-related factors in considering IBR and factors affecting patients' decision to choose for IBR. METHODS Retrospective analysis of the records of breast cancer patients who underwent mastectomy with or without IBR between 2010 and 2013. We documented all information whether or not a patient underwent IBR after mastectomy. RESULTS Of 437 patients, 97 (22.2%) underwent IBR, 89.8% of which received tissue expanders. Patient who did not undergo IBR had a higher age (62.2 versus 51.9 years, P<0.001) and higher body mass index (BMI) (27.0 versus 24.3, P<0.001). Hundred three patients declined IBR, mainly because considering reconstruction as too much trouble. In 128 cases the breast surgeon did not offer IBR, mostly because of the predicted need for post mastectomy radiation. Approximately 11% of the patients were not informed about IBR. CONCLUSIONS Anticipated radiation therapy, higher age and higher BMI were important breast surgeon-related factors in refraining from IBR. Almost one third of all patients declined IBR. In almost 10% of all patients, IBR was not discussed.
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Affiliation(s)
- Mariska Weenk
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Philipp Wunschel
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Erwin Heine
- Department of Plastic Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Luc J Strobbe
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
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De Vita R, Pozzi M, Zoccali G, Costantini M, Gullo P, Buccheri EM, Varanese A. Skin-reducing mastectomy and immediate breast reconstruction in patients with macromastia. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2015; 34:120. [PMID: 26467095 PMCID: PMC4606835 DOI: 10.1186/s13046-015-0227-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 09/29/2015] [Indexed: 11/10/2022]
Abstract
INTRODUCTION In women with macromastia, a type IV skin sparing mastectomy is often required to achieve an aesthetically pleasing reconstruction. The introduction of "skin-reducing mastectomy", which inserts a permanent prosthetic device into a large pouch made by the pectoralis major muscle and an inferior pedicle dermal flap, allows the surgeon to achieve a safe oncologic result plus a cosmetically satisfying reconstruction. OBJECTIVE We report here our experience with the skin-reducing mastectomy with the aim of emphasizing the problems associated with the technique. MATERIALS AND METHOD A study was conduced from April 2009 to November 2012, 74 patients with breast cancer were selected then received a skin-reducing mastectomy. The enrolled women satisfied the criteria of Nava. Statistical analysis was conduced to estimate the significance of the outcome results and complication rate. RESULT A total of 88 SRMs were performed and the outcomes were as follows: excellent in 34 patients, good in 21, and poor in 8. We recorded 25 % of adverse events and statistic helped us to identify patient related factors whose can increase the complications onset. CONCLUSION Skin-reducing mastectomy is an indispensable procedure to treat cancer in large and pendulous breasts. The correct patient selection is mandatory to reduce the not negligible complication risk. Skin reducing mastectomy when is well conduced allow to obtain good results with patient satisfaction but, like other breast-conserving surgeries, in some case is not the ultimate solution, because it may require some revisions to maintain the optimum results. To day it be consider relatively safe in selected patient and the gold standard in macormastia immediate reconstruction.
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Affiliation(s)
- Roy De Vita
- Department of Plastic and Reconstructive Surgery, IFO - "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, Rome, Italy.
| | - Marcello Pozzi
- Department of Plastic and Reconstructive Surgery, IFO - "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, Rome, Italy.
| | - Giovanni Zoccali
- Department of Plastic and Reconstructive Surgery, IFO - "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, Rome, Italy. .,Department of Life, Health and Environmental Sciences, Plastic Reconstructive and Aesthetic Surgery Section, L'Aquila University, L'Aquila, Italy.
| | - Maurizio Costantini
- Department of Plastic and Reconstructive Surgery, IFO - "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, Rome, Italy.
| | - Pierpaolo Gullo
- Department of Plastic and Reconstructive Surgery, IFO - "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, Rome, Italy.
| | - Ernesto Maria Buccheri
- Department of Plastic and Reconstructive Surgery, IFO - "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, Rome, Italy.
| | - Antonio Varanese
- Department of Plastic and Reconstructive Surgery, IFO - "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, Rome, Italy.
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