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Melemenidis S, Viswanathan V, Dutt S, Kapadia N, Lau B, Soto LA, Ashraf MR, Thakur B, Mutahar AZI, Skinner LB, Yu AS, Surucu M, Casey KM, Rankin EB, Horst KC, Graves EE, Loo BW, Dirbas FM. Effectiveness of FLASH vs. Conventional Dose Rate Radiotherapy in a Model of Orthotopic, Murine Breast Cancer. Cancers (Basel) 2025; 17:1095. [PMID: 40227580 PMCID: PMC11988084 DOI: 10.3390/cancers17071095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2025] [Revised: 03/15/2025] [Accepted: 03/17/2025] [Indexed: 04/15/2025] Open
Abstract
Introduction: Radiotherapy is effective for breast cancer treatment but often causes undesirable side effects that impair quality of life. Ultra-high dose rate radiotherapy (FLASH) has shown reduced normal tissue toxicity while achieving comparable tumor growth delay compared to conventional dose rate radiotherapy (CONV). This study evaluated whether FLASH could achieve similar tumor control as CONV with tumor eradication as the primary endpoint, in an orthotopic breast cancer model. Methods: Non-metastatic, orthotopic tumors were generated in the left fourth mammary fat pad using the Py117 mammary tumor cell line in syngeneic C57BL/6J mice. Two sequential irradiation studies were performed using FLASH (93-200 Gy/s) and CONV (0.08 Gy/s) electron beams. Single fractions of 20, 25, or 30 Gy were applied to tumors with varying abdominal wall treatment fields (~3.75 or 2.5 mm treatment margin to tumor). Results: Both FLASH and CONV demonstrated comparable efficacy. Small tumors treated with 30 Gy and larger abdominal wall treatment fields appeared to have complete eradication at 30 days but also exhibited the highest skin toxicity, limiting follow-up and preventing confirmation of eradication. Smaller abdominal wall treatment fields reduced skin toxicity and allowed for extended follow-up, which resulted in 75% tumor-free survival at 48 days. Larger tumors showed growth delay but no eradication. Conclusions: In this preclinical, non-metastatic orthotopic breast cancer model, FLASH and CONV demonstrated equivalent tumor control with single-fraction doses of 20, 25, or 30 Gy. Overall, 30 Gy achieved the highest eradication rate but also resulted in the most pronounced skin toxicity.
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Affiliation(s)
- Stavros Melemenidis
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.M.); (V.V.); (S.D.); (B.L.); (L.A.S.); (M.R.A.); (L.B.S.); (A.S.Y.); (M.S.); (E.B.R.); (K.C.H.); (E.E.G.); (B.W.L.J.)
| | - Vignesh Viswanathan
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.M.); (V.V.); (S.D.); (B.L.); (L.A.S.); (M.R.A.); (L.B.S.); (A.S.Y.); (M.S.); (E.B.R.); (K.C.H.); (E.E.G.); (B.W.L.J.)
| | - Suparna Dutt
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.M.); (V.V.); (S.D.); (B.L.); (L.A.S.); (M.R.A.); (L.B.S.); (A.S.Y.); (M.S.); (E.B.R.); (K.C.H.); (E.E.G.); (B.W.L.J.)
| | - Naviya Kapadia
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.M.); (V.V.); (S.D.); (B.L.); (L.A.S.); (M.R.A.); (L.B.S.); (A.S.Y.); (M.S.); (E.B.R.); (K.C.H.); (E.E.G.); (B.W.L.J.)
| | - Brianna Lau
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.M.); (V.V.); (S.D.); (B.L.); (L.A.S.); (M.R.A.); (L.B.S.); (A.S.Y.); (M.S.); (E.B.R.); (K.C.H.); (E.E.G.); (B.W.L.J.)
| | - Luis A. Soto
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.M.); (V.V.); (S.D.); (B.L.); (L.A.S.); (M.R.A.); (L.B.S.); (A.S.Y.); (M.S.); (E.B.R.); (K.C.H.); (E.E.G.); (B.W.L.J.)
| | - M. Ramish Ashraf
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.M.); (V.V.); (S.D.); (B.L.); (L.A.S.); (M.R.A.); (L.B.S.); (A.S.Y.); (M.S.); (E.B.R.); (K.C.H.); (E.E.G.); (B.W.L.J.)
| | - Banita Thakur
- Department of Surgery, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA 94305, USA; (B.T.); (A.Z.I.M.)
| | - Adel Z. I. Mutahar
- Department of Surgery, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA 94305, USA; (B.T.); (A.Z.I.M.)
| | - Lawrie B. Skinner
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.M.); (V.V.); (S.D.); (B.L.); (L.A.S.); (M.R.A.); (L.B.S.); (A.S.Y.); (M.S.); (E.B.R.); (K.C.H.); (E.E.G.); (B.W.L.J.)
| | - Amy S. Yu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.M.); (V.V.); (S.D.); (B.L.); (L.A.S.); (M.R.A.); (L.B.S.); (A.S.Y.); (M.S.); (E.B.R.); (K.C.H.); (E.E.G.); (B.W.L.J.)
| | - Murat Surucu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.M.); (V.V.); (S.D.); (B.L.); (L.A.S.); (M.R.A.); (L.B.S.); (A.S.Y.); (M.S.); (E.B.R.); (K.C.H.); (E.E.G.); (B.W.L.J.)
| | - Kerriann M. Casey
- Department of Comparative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Erinn B. Rankin
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.M.); (V.V.); (S.D.); (B.L.); (L.A.S.); (M.R.A.); (L.B.S.); (A.S.Y.); (M.S.); (E.B.R.); (K.C.H.); (E.E.G.); (B.W.L.J.)
| | - Kathleen C. Horst
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.M.); (V.V.); (S.D.); (B.L.); (L.A.S.); (M.R.A.); (L.B.S.); (A.S.Y.); (M.S.); (E.B.R.); (K.C.H.); (E.E.G.); (B.W.L.J.)
| | - Edward E. Graves
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.M.); (V.V.); (S.D.); (B.L.); (L.A.S.); (M.R.A.); (L.B.S.); (A.S.Y.); (M.S.); (E.B.R.); (K.C.H.); (E.E.G.); (B.W.L.J.)
| | - Billy W. Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.M.); (V.V.); (S.D.); (B.L.); (L.A.S.); (M.R.A.); (L.B.S.); (A.S.Y.); (M.S.); (E.B.R.); (K.C.H.); (E.E.G.); (B.W.L.J.)
| | - Frederick M. Dirbas
- Department of Surgery, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA 94305, USA; (B.T.); (A.Z.I.M.)
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Desai A, Mangal R, Padilla C, McClintock K, Choi S, Mella-Catinchi JR, Oeltjen JC, Singh DP, Takita C, Kassira W. Revision Surgeries After Proton vs Photon Postmastectomy Radiation Therapy in Prepectoral Implant-Based Breast Reconstruction. Aesthet Surg J 2025; 45:163-170. [PMID: 39431294 DOI: 10.1093/asj/sjae216] [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: 08/10/2024] [Revised: 10/12/2024] [Accepted: 10/17/2024] [Indexed: 10/22/2024] Open
Abstract
BACKGROUND Postmastectomy radiation therapy (PMRT) improves disease-free survival in breast cancer but reduces aesthetic satisfaction. Proton PMRT has gained popularity because it results in fewer systemic complications. There is a lack of data regarding revision surgeries for prepectoral implant-based breast reconstruction (PP-IBBR) following radiation. OBJECTIVES The aim of this study was to compare revision surgeries in PP-IBBR with photon vs proton PMRT. METHODS A single-institution retrospective cohort study was performed that included breast cancer patients undergoing mastectomy and PP-IBBR with PMRT between January 2020 and October 2022. The mean follow-up duration for the cohort was 1056.4 days (2.89 years). Revision surgeries evaluated were fat grafting, conversion to autologous flaps, implant replacement, implant removal, capsulectomy, and scar revision. RESULTS The 116 PP-IBBR subjects were divided into 2 cohorts, receiving either photon (75, 64.66%) or proton (41, 35.34%) radiation. Overall corrective surgeries were higher with photon therapy (27.5% overall; 32.4% photon vs 19.5% proton, P = .132). The odds of any revision surgery were nearly double with photon therapy (odds ratio [OR] = 1.98), and the conversion to an autologous flap was significantly more likely with photon therapy (OR = 4.55, P = .025). Multivariable analysis showed an increased tendency for photon therapy patients to require any revision surgeries (OR = 1.62, P = .359), autologous flaps (OR = 5.97, P = .049), fat grafting (OR = 1.52, P = .664), and scar revision (OR = 4.51, P = .273). CONCLUSIONS Compared to proton therapy, traditional photon therapy has a higher conversion rate to autologous flaps with PP-IBBR. Photon therapy had higher rates of overall revision surgeries, but the difference was not statistically significant. Proton therapy is safer and requires fewer revision surgeries, warranting larger studies and broader utilization. LEVEL OF EVIDENCE: 3 (THERAPEUTIC)
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Jang SY, Ahn IY, Bae TH, Kang SH, Woo SH, Kim WJ, Kim MK, Sutthiwanjampa C, Kim HK. Comparison of Effects of Acellular Dermal Matrix and Latissimus Dorsi Muscle Flap on Radiation-induced Peri-implant Capsular Contracture in a Rabbit Model. Arch Plast Surg 2024; 51:581-591. [PMID: 39544515 PMCID: PMC11560322 DOI: 10.1055/a-2368-1813] [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: 08/09/2023] [Accepted: 07/13/2024] [Indexed: 11/17/2024] Open
Abstract
Background Capsular contracture of breast implants is a major complication in breast surgery. Clinically, covering a breast implant with acellular dermal matrix (ADM) or autologous tissue is considered to be the most effective technique to prevent capsular contracture. This study was designed to compare the protective effects of ADM and latissimus dorsi (LD) muscle flap placement on capsular contracture by increasing the rate of capsular contracture through controlled radiation exposure in a rabbit model. Methods Twenty New Zealand white rabbits were divided into three groups. After the implant was placed beneath the pectoralis major muscle, the lateral third of the implant was left exposed in the control group ( n = 6). In the ADM group ( n = 7), the exposed implant was covered with AlloDerm. In the LD flap group ( n = 7), the exposed implant was covered with a pedicled LD muscle flap. All groups were irradiated 3 weeks after implant insertion. After 6 months, peri-implant tissues were harvested and analyzed. Results ADM showed markedly lower myofibroblast activity than the LD flap. However, transforming growth factor-β1 levels and the activity of collagen types I and III produced in fibroblasts were significantly lower in the ADM group than in the LD flap group. Conclusion Based on the findings of our rabbit experiments, ADM is expected to have a comparative advantage in reducing the risk of capsular contracture compared to the LD flap.
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Affiliation(s)
- Suk Yoon Jang
- Department of Plastic and Reconstructive Surgery, Chung-Ang University, Graduate School of Medicine, Seoul, Republic of Korea
| | - Il Young Ahn
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Tae Hui Bae
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Gwangmyeong Hospital, Gyeonggi-do, Republic of Korea
| | - Shin Hyuk Kang
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Soo Hyun Woo
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Woo Ju Kim
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Gwangmyeong Hospital, Gyeonggi-do, Republic of Korea
| | - Mi Kyung Kim
- Department of Pathology, Chung-Ang University Hospital, Seoul, Republic of Korea
| | | | - Han Koo Kim
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Seoul, Republic of Korea
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Francis SD, Kang AW, Maheta BJ, Sangalang BR, Salingaros S, Wu RT, Nazerali RS. National trends in revision procedures in post-mastectomy breast reconstruction: Autologous vs implant-based approaches. J Plast Reconstr Aesthet Surg 2024; 95:127-133. [PMID: 38905789 PMCID: PMC11465625 DOI: 10.1016/j.bjps.2024.05.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/22/2024] [Accepted: 05/31/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Breast reconstruction involves collaborative decision-making between patients and surgeons, but the need for multiple revisions after the initial reconstructive surgery process can burden patients and the healthcare system. This study explored how the type of breast reconstruction (autologous [ABR], immediate implant-based reconstruction [IBR], or two-stage IBR) impacts postreconstruction revision rates. METHOD Using MarketScan Databases, a retrospective database study (2007-2021) was conducted, identifying revision procedures through Current Procedural Terminology codes. Statistical analysis with linear models, adjusted for patient characteristics and surgical factors, used a significance threshold of p < 0.05. RESULTS Among 58,264 patients, 6.2% of ABR patients, 3.8% of immediate IBR patients, and 3.6% of two-stage IBR patients underwent future revisions. IBR had a 51% lower incidence rate of revision operations than ABR (incidence rate ratio = 0.49, p < 0.001). Within IBR, there was no significant difference in the number of operations between immediate IBR (0.06 ± 0.32) and two-stage IBR (0.05 ± 0.32, p = 0.95). Immediate IBR demonstrated 12% (OR = 0.88, p = 0.0022) and 70% (OR = 0.30, p < 0.001) lower odds of requiring breast revision and fat grafting compared to ABR, respectively. Two-stage reconstruction had 66 % lower odds of requiring only fat grafting than ABR (OR = 0.34, p < 0.001). CONCLUSION ABR necessitated a higher number of total revision procedures after completion of the initial reconstruction. These findings will better equip providers and patients to counsel patients in understanding their reconstructive journey, planning their reconstructions and timing, and provide more accurate estimates of the number of procedures that will be required to reach their aesthetic goals and final outcome.
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Affiliation(s)
| | | | - Bhagvat J Maheta
- California Northstate University College of Medicine, Elk Grove, CA, USA
| | - Brian R Sangalang
- University of California Riverside School of Medicine, Riverside, CA, USA
| | | | - Robin T Wu
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Rahim S Nazerali
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
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Camargo CP, Santos DLDS, Cerqueira Dantas VAN, Furuya TK, Freitas-Marchi BL, Alves MJF, Uno M, Gemperli R. Effect of ASC Injection in the Inflammatory Reaction in Silicone Implant Capsule: Animal Model. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5977. [PMID: 39081810 PMCID: PMC11288612 DOI: 10.1097/gox.0000000000005977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 05/17/2024] [Indexed: 08/02/2024]
Abstract
Background Capsular contracture is a common complication affecting about 80% of patients who receive radiotherapy after breast reconstruction with silicone prostheses. This study examines the use of adipocyte stem cells (ASCs) to treat capsular contracture. Methods Thirty rats were operated on to implant a minisilicone prosthesis in the dorsal region. The rats were divided into three groups: control (saline solution injection), radiotherapy (RDT), and RDT + ASC. After 3 months, the capsules were collected and submitted to histological analysis for inflammatory cell presence, vascular density, and collagen fibers, and gene expression of Tnf, Il1rap, Il10, Cd68, Mmp3, and Mmp9 by qPCR. Results In macroscopic analysis, the RTGO score showed a two-point reduction in RDT + ASC compared with the RDT (P = 0.003). In histological analysis, ASC exhibited less than 50% of inflammatory cells compared with RDT (P = 0.004), which was similar to control. This study demonstrated that Il1rap gene expression was identical in both RDT and RTD + ASC. Compared with control, treatment with ASC reduced Il1rap expression by 30%. Cd68 and Mmp3 expression levels were similar in both the control and RTD + ASC. Conclusion This study suggests that ASC treatment decreases silicone prosthesis capsule inflammation.
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Affiliation(s)
- Cristina Pires Camargo
- From the Microsurgery and Plastic Surgery Laboratory, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Deborah Luisa de Sousa Santos
- Multiprofessional Residency Program in Oncology Care for Adults, Comissão de Residência Multiprofissional (COREMU), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
- Center for Translational Research in Oncology (LIM24), Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Sao Paulo, SP, Brazil
| | | | - Tatiane Katsue Furuya
- Center for Translational Research in Oncology (LIM24), Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Sao Paulo, SP, Brazil
- Comprehensive Center for Precision Oncology, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Bruna Leticia Freitas-Marchi
- Laboratório de Fisiologia da Pele e Bioengenharia Tecidual, Escola de Artes, Ciências e Humanidades (EACH—USP), São Paulo, SP, Brazil
| | - Maria José Ferreira Alves
- Center for Translational Research in Oncology (LIM24), Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Sao Paulo, SP, Brazil
- Comprehensive Center for Precision Oncology, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Miyuki Uno
- Center for Translational Research in Oncology (LIM24), Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Sao Paulo, SP, Brazil
- Comprehensive Center for Precision Oncology, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Rolf Gemperli
- Plastic Surgery Division, School of Medicine, Universida de São Paulo, São Paulo, SP, Brazil
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Escandón JM, Ali-Khan S, Christiano JG, Gooch JC, Olzinski AT, Prieto PA, Skinner KA, Langstein HN, Manrique OJ. Simultaneous Fat Grafting During Tissue Expander-to-Implant Exchange: A Propensity Score-Matched Analysis. Aesthetic Plast Surg 2023; 47:1695-1706. [PMID: 36271157 DOI: 10.1007/s00266-022-03152-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/13/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Implant-based breast reconstruction (IBBR) is the most common technique for breast reconstruction. The primary resource for correcting deformities, once patients have achieved an adequate volume with two-stage IBBR, is autologous fat grafting. We compared the surgical outcomes of simultaneous fat grafting during TE-to-implant exchange (SFG + TtIE) versus no fat grafting during TE-to-implant exchange (No-FGX). METHODS A retrospective review was performed of all consecutive patients undergoing two-stage implant-based breast reconstruction with TE from January 2011 to December 2020. Propensity score matching was implemented to optimize comparability. The control group did not receive fat grafting at the time of TE-to-implant exchange. RESULTS After propensity score matching, 196 reconstructions were evaluated, 98 in each group. Reconstructions in the SFG + TtIE received larger implants during exchange in comparison with the No-FGX group (539 ± 135.1-cc versus 495.97 ± 148-cc, p=0.035). The mean volume of fat lipoinjected during TE-to-implant exchange in the SFG + TtIE group was 88.79 ± 41-ml. A higher proportion of reconstructions in the SFG + TtIE group underwent additional fat grafting after exchange versus the No-FGX group (19% versus 9%, p = 0.041). After propensity score matching, only the rate of fat necrosis after exchange was significantly higher in the SFG + TtIE group (10% versus 2%, p = 0.017). The rate of breast cancer recurrence (3% versus 5%, p = 1.00) was comparable between the groups. CONCLUSION SFG + TtIE is a safe procedure to improve the envelope of reconstructed breasts during two-stage IBBR. SFG + TtIE does not increase the rate of periprosthetic infection or wound-related complication versus no fat grafting during TE-to-implant exchange, but increases the rate of fat necrosis. LEVEL OF EVIDENCE III Therapeutic study. 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)
- Joseph M Escandón
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Safi Ali-Khan
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Jose G Christiano
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Jessica C Gooch
- Division of Surgical Oncology, Department of Surgery, Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Ann Therese Olzinski
- Division of Surgical Oncology, Department of Surgery, Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Peter A Prieto
- Division of Surgical Oncology, Department of Surgery, Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Kristin A Skinner
- Division of Surgical Oncology, Department of Surgery, Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA
| | - Howard N Langstein
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Oscar J Manrique
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA.
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Chen Y, Qin N, Wang ML, Black GG, Vaeth A, Asadourian P, Chinta M, Bernstein JL, Otterburn DM. An Evaluation of Native Breast Dimension and Tissue Expander Inflation Rate on the Risk of Capsular Contracture Development in Postmastectomy Reconstruction. Ann Plast Surg 2023; 90:S462-S465. [PMID: 37115940 DOI: 10.1097/sap.0000000000003514] [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: 04/30/2023]
Abstract
INTRODUCTION Capsular contracture is a common complication after 2-stage breast reconstruction. The relationships between native breast size, the rate of tissue expander expansion, and capsule formation have not been elucidated. This study aims to evaluate how these factors contribute to capsular contracture and establish cutoff values for increased risk. METHODS A data set consisting of 229 patients who underwent 2-stage breast reconstruction between 2012 and 2021 was included in the study. The rate of expansion is estimated as the final expanded volume subtracted by the initial filling volume of the tissue expander over time elapsed. The native breast size was estimated using various preoperative breast measurements and the weight of mastectomy specimen (grams). Further stratified analysis evaluated patients separately based on postoperative radiation status. RESULTS Greater nipple-inframammary fold distance and faster tissue expander enlargement rate conferred decreased odds of developing capsular contracture ( P < 0.05). On stratified analysis, faster tissue expansion rate was not significant in the nonradiated cohort but remained a significant negative predictor in the radiation group (odds ratio, 0.996; P < 0.05). Cut-point analysis showed an expansion rate of <240 mL/mo and a nipple-inframammary fold value of <10.5 cm as conferring a greater risk of capsular contracture. CONCLUSION Smaller inframammary fold distance may be associated with a higher risk of capsular contracture. Slower expansion rates correlate with increased odds of contracture in patients undergoing adjuvant radiation. Breast geometry should be considered when risk stratifying various reconstruction approaches (implant vs autologous). In addition, longer delays between implant exchange and initial tissue expansion should be avoided if clinically feasible.
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Affiliation(s)
- Yunchan Chen
- From the Division of Plastic & Reconstructive Surgery, Weill Cornell Medicine, New York, NY
| | - Nancy Qin
- From the Division of Plastic & Reconstructive Surgery, Weill Cornell Medicine, New York, NY
| | - Marcos Lu Wang
- From the Division of Plastic & Reconstructive Surgery, Weill Cornell Medicine, New York, NY
| | - Grant G Black
- From the Division of Plastic & Reconstructive Surgery, Weill Cornell Medicine, New York, NY
| | - Anna Vaeth
- From the Division of Plastic & Reconstructive Surgery, Weill Cornell Medicine, New York, NY
| | - Paul Asadourian
- Division of Plastic & Reconstructive Surgery, Columbia University Irving Medical Center, New York, NY
| | - Malini Chinta
- From the Division of Plastic & Reconstructive Surgery, Weill Cornell Medicine, New York, NY
| | - Jaime L Bernstein
- From the Division of Plastic & Reconstructive Surgery, Weill Cornell Medicine, New York, NY
| | - David M Otterburn
- From the Division of Plastic & Reconstructive Surgery, Weill Cornell Medicine, New York, NY
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8
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Escandón JM, Nazerali R, Ciudad P, Lo Torto F, Maruccia M, Butterfield JA, Vizcay M, Galán N, Manrique OJ. Minimally invasive harvest of the latissimus dorsi flap for breast reconstruction: A systematic review. Int J Med Robot 2022; 18:e2446. [DOI: 10.1002/rcs.2446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Joseph M. Escandón
- Division of Plastic and Reconstructive Surgery Strong Memorial Hospital University of Rochester Medical Center Rochester New York USA
| | - Rahim Nazerali
- Division of Plastic and Reconstructive Surgery Department of Surgery Stanford University Palo Alto California USA
| | - Pedro Ciudad
- Department of Plastic, Reconstructive and Burn Surgery Arzobispo Loayza National Hospital Lima Peru
| | - Federico Lo Torto
- Unit of Plastic and Reconstructive Surgery Department of Surgery “P. Valdoni” Policlinico Umberto I Sapienza University of Rome Rome Italy
| | - Michele Maruccia
- Division of Plastic and Reconstructive Surgery Department of Emergency and Organ Transplantation University of Bari Aldo Moro Bari Italy
| | - James A. Butterfield
- Division of Plastic and Reconstructive Surgery Strong Memorial Hospital University of Rochester Medical Center Rochester New York USA
| | - Macarena Vizcay
- Department of Plastic and Reconstructive Surgery Hospital Nacional A. Posadas Buenos Aires Argentina
| | - Natalia Galán
- Division of Plastic Surgery Hospital Militar Central Universidad Militar Nueva Granada Bogotá DC Colombia
| | - Oscar J. Manrique
- Division of Plastic and Reconstructive Surgery Strong Memorial Hospital University of Rochester Medical Center Rochester New York USA
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9
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Li M, Shi Y, Li Q, Guo X, Han X, Li F. Oncological Safety of Autologous Fat Grafting in Breast Reconstruction: A Meta-analysis Based on Matched Cohort Studies. Aesthetic Plast Surg 2022; 46:1189-1200. [PMID: 34981157 DOI: 10.1007/s00266-021-02684-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/14/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Autologous fat grafting has become a commonly used procedure for breast reconstruction after breast cancer surgical treatment. Nevertheless, oncological considerations remain concerning autologous fat grafting after breast cancer surgery. OBJECTIVE This meta-analysis aimed to summarize the current matched cohort studies and provide high-quality evidence-based conclusions on the oncological safety of fat grafting in breast reconstruction. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were followed. A literature search was performed on August 1, 2021, using PubMed. All relevant matched cohort studies of patients undergoing autologous fat grafting after breast cancer surgery were included. After independently screening the studies and extracting the data, pooled estimates for local and regional recurrence as well as distant metastases were conducted using Review Manager software (RevMan, version 5.3). Outcomes were expressed as odds ratios and 95% confidence intervals. RESULTS Seventeen studies involving 7494 patients were included. The observed outcomes indicated that no significant differences existed in the risks of local and regional recurrence or distant metastases between autologous fat grafting and control groups. Also, there was no significant heterogeneity among the studies. CONCLUSION This study provided evidence-based conclusions that support the use of autologous fat grafting in breast reconstruction. LEVEL OF EVIDENCE III 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)
- Ming Li
- Beijing Badachu Medical Aesthetic Plastic Clinic, Plastic Surgery Hospital, Chaoyang, Beijing, China
| | - Yao Shi
- Beijing Badachu Medical Aesthetic Plastic Clinic, Plastic Surgery Hospital, Chaoyang, Beijing, China
| | - Qiuyue Li
- Beijing Badachu Medical Aesthetic Plastic Clinic, Plastic Surgery Hospital, Chaoyang, Beijing, China
| | - Xin Guo
- Beijing Badachu Medical Aesthetic Plastic Clinic, Plastic Surgery Hospital, Chaoyang, Beijing, China
| | - Xuefeng Han
- Department of Body Contouring and Liposuction Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Chaoyang, Beijing, China
| | - Facheng Li
- Department of Body Contouring and Liposuction Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Chaoyang, Beijing, China.
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10
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Nepon H, Safran T, Reece EM, Murphy AM, Vorstenbosch J, Davison PG. Radiation-Induced Tissue Damage: Clinical Consequences and Current Treatment Options. Semin Plast Surg 2021; 35:181-188. [PMID: 34526866 PMCID: PMC8432995 DOI: 10.1055/s-0041-1731464] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Radiation therapy is a valuable tool in the treatment of numerous malignancies but, in certain cases, can also causes significant acute and chronic damage to noncancerous neighboring tissues. This review focuses on the pathophysiology of radiation-induced damage and the clinical implications it has for plastic surgeons across breast reconstruction, osteoradionecrosis, radiation-induced skin cancers, and wound healing. The current understanding of treatment modalities presented here include hyperbaric oxygen therapy, autologous fat grafting and stem cells, and pharmaceutical agents.
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Affiliation(s)
- Hillary Nepon
- Division of Experimental Surgery, McGill University, Montreal, Quebec, Canada
| | - Tyler Safran
- Division of Plastic Surgery, McGill University, Montreal, Quebec, Canada
| | - Edward M. Reece
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
| | - Amanda M. Murphy
- Division of Plastic Surgery, McGill University, Montreal, Quebec, Canada
| | | | - Peter G. Davison
- Division of Plastic Surgery, McGill University, Montreal, Quebec, Canada
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