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Koenig ZA, Koenig NI, Climov M, Uygur HŞ. Safety and Feasibility of Oncoplastic Reconstruction in the Setting of Prior Breast Reduction. Eplasty 2024; 24:e19. [PMID: 38685994 PMCID: PMC11056623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Background Breast conservation therapy typically consists of lumpectomy, which often leads to poor cosmetic outcomes. Concurrent oncoplastic reductions are performed to maximize aesthetics and patient outcome. We present an oncoplastic breast reconstruction in a breast re-reduction case in this study. Methods A 62-year-old female was diagnosed with invasive ductal carcinoma of the left upper outer breast by core needle biopsy. The patient had a prior bilateral breast reduction using a superior-central pedicle approach 15 years ago and desired breast conservation therapy. Results The oncoplastic reconstruction technique used was a superomedial pedicle Wise-pattern bilateral breast reduction. The lump was excised lateral to the pedicle after initial de-epithelialization and incision of the superomedial pedicle's lateral aspect. The remainder of the pedicle was developed, and the same procedure was performed on the right breast at the same time. Excess tissue was excised bilaterally from the medial, superior, and inferior, and the optimal new nipple position was obtained. Both nipples were viable and well perfused following closure of the incisions. Conclusions Breast cancer is uncommon in patients who have had bilateral breast reductions. Oncoplastic reduction is an uncommon procedure used in patients who want to preserve their breasts while maintaining their aesthetic appearance. There is currently no agreement on the most effective and safest surgical technique for breast re- reduction surgery, and no reports on oncoplastic reconstruction in patients requiring breast re-reductions. In an oncoplastic reconstruction case, we achieved an acceptable outcome with our superomedial pedicled Wise-pattern bilateral breast reduction technique.
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Affiliation(s)
- Zachary A. Koenig
- West Virginia University Division of Plastic, Reconstructive, & Hand Surgery, Morgantown, West Virginia
| | | | - Mihail Climov
- West Virginia University Division of Plastic, Reconstructive, & Hand Surgery, Morgantown, West Virginia
| | - H. Şafak Uygur
- West Virginia University Division of Plastic, Reconstructive, & Hand Surgery, Morgantown, West Virginia
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Crowley C, Bank J. Beyond the Breast: Body Contouring in the Context of Abdominally Based Microsurgical Breast Reconstruction. JPRAS Open 2024; 39:121-126. [PMID: 38226355 PMCID: PMC10788364 DOI: 10.1016/j.jpra.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/26/2023] [Indexed: 01/17/2024] Open
Abstract
With continued advances in abdominally based microsurgical breast reconstruction, the operative goal is no longer the creation of a simple breast mound but rather the formation of an aesthetically pleasing breast. While a substantial body of work has been dedicated to accomplishing this result, a similar progression has yet to be reflected in the literature with regard to the contour and shape of the abdominal donor site. Operative advances including muscle, fascial, and nerve preservation have been effective in minimizing the physiologic donor site morbidity of this procedure but have focused less on its cosmesis. Additionally, the published techniques aimed at the aesthetics of the abdomen have focused on the initial procedure and have not utilized the multistage process of breast reconstruction. In this paper, we will describe our approach to optimize the aesthetic result of the abdomen in abdominally based microsurgical breast reconstruction.
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Affiliation(s)
| | - Jonathan Bank
- New York Breast Reconstruction & Aesthetic Plastic Surgery, 833 Northern BLVD, Suite 160, Great Neck, NY 11021
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Timothy N, Patrick M, Dayicioglu D. Management of 2-Stage Breast Reconstruction in Ehlers-Danlos Syndrome: A Case Report. Eplasty 2024; 24:e5. [PMID: 38476521 PMCID: PMC10929067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
Background Ehlers-Danlos syndrome (EDS) refers to a group of heritable connective tissue disorders (HCTDs). Clinical hallmarks of EDS include tissue fragility, joint hypermobility, and skin hyperextensibility. One of the consequences of tissue fragility is abnormal wound healing and scar formation, posing potential challenges for surgeons treating these patients. There are limited previous reports of EDS patients undergoing mastectomy and/or breast reconstruction, and none wherein the patient had diagnoses of both vascular EDS (vEDS) and classical EDS (cEDS). Case A 41-year-old female was referred to the plastic surgery clinic for breast reconstruction consultation after diagnosis of left breast lobular carcinoma in situ (LCIS). She has a past medical history of cEDS and vEDS with associated pectus carinatum, thoracic root dilation, and hypermobile joints. After shared decision making with the patient and her breast surgeon, it was decided the patient would benefit from bilateral prophylactic mastectomies with immediate 2-stage tissue expander (TE) reconstruction. Results The patient reported here had an unremarkable postoperative course. Her complications were limited to more than average bleeding during the first stage of reconstruction, which was easily managed with meticulous intraoperative hemostasis, and a small uncomplicated submuscular seroma 1week postoperative. She had no complications following TE to implant exchange and continues to heal well. Conclusions This case report documents a case in which a patient with both cEDS and vEDS had an unremarkable surgical and postoperative course following bilateral prophylactic mastectomies with 2-stage TE reconstruction.
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Affiliation(s)
- Nehila Timothy
- USF Health Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Madison Patrick
- FSU College of Medicine, Florida State University, Tallahassee, Florida
| | - Deniz Dayicioglu
- Department of Plastic Surgery, Morsani College of Medicine, University of South Florida, Tampa, Florida
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Patel AA, Feng CL, Marquez J, Spaw JP, Garza RM, Lee GK, Nazerali RS. Prioritizing Native Breast Skin Preservation or Scar Symmetry in Autologous Breast Reconstruction? Using Crowdsourcing to Assess Preference. Eplasty 2023; 23:e75. [PMID: 38229965 PMCID: PMC10790140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Background Recent literature on autologous breast reconstruction suggests that such factors as scar symmetry and skin paddle size impact patient preferences more than preservation of native breast skin. Since patient satisfaction with plastic surgery procedures can be largely influenced by beauty standards set by the general public, this study used a novel crowdsourcing method to evaluate laypeople's aesthetic preferences for different bilateral autologous breast reconstructions to determine the relative importance of scar and skin paddle symmetry and preservation of native skin. Methods Using Amazon's Mechanical Turk crowdsourcing marketplace, participants ranked images of reconstructions based on overall aesthetic appearance. Images were digitally modified to reflect 4 types of reconstruction: immediate (IR), delayed symmetric (DS), delayed asymmetric (DA), or mixed (MR). Results DS was ranked most favorably (1.74), followed by IR (1.95), DA (2.93), and MR (3.34). Friedman rank sum and pairwise tests showed statistical significance for comparisons of all 4 reconstruction types. Likert ratings were higher for IR than for DA reconstructions for skin quality (P = .002), scar visibility (P < .001), scar position (P < .001), and breast symmetry, shape, and position (P < .001). Ratings increased for all aesthetic factors following nipple-areolar-complex reconstruction (P < .001). Conclusions More symmetric breast scars were rated aesthetically higher than nonsymmetric scarring, and our participants preferred maintenance of scar symmetry over preservation of native breast skin. These findings are consistent with previous studies that surveyed non-crowdsourced participants, which demonstrates the potential for crowdsourcing to be used to better understand the general public's preferences in plastic surgery.
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Affiliation(s)
- Ashraf A. Patel
- Division of Plastic Surgery, University of Utah Hospitals & Clinics, Salt Lake City, Utah
| | - Carol L. Feng
- Division of Urology, Rush University Medical Center, Chicago, Illinois
| | - Jessica Marquez
- Division of Plastic Surgery, University of Utah Hospitals & Clinics, Salt Lake City, Utah
| | | | | | - Gordon K. Lee
- Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, California
| | - Rahim S. Nazerali
- Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, California
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Adler N, Carmon E, Houri P. Revision Rate of Direct-to-Implant Breast Reconstruction: Is it Truly a Single-Stage Reconstruction? A Single-Surgeon Experience. Aesthetic Plast Surg 2023; 47:1707-1712. [PMID: 36307562 DOI: 10.1007/s00266-022-03136-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/01/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION There has been increased interest in direct-to-implant (DTI) reconstruction in recent years. The goal of this study was to focus on the re-operation rate of DTI in comparison with two-stage tissue expander (TE) reconstruction. PATIENTS AND METHODS In total, 165 consecutive patients (222 breasts) underwent skin sparing mastectomy and immediate implant-based reconstruction between January 2010 and December 2019. Patients were divided to TE procedure and DTI (42,180 breasts, respectively). Data collected included demographics, operative details and oncological medical treatment, complications classified according to Clavien-Dindo, capsular contracture Baker 3-4 and re-operation due to complication or due to patient's wish to improve aesthetic appearance. RESULTS There were significantly more prophylactic mastectomies and BRCA gene mutation in the DTI breast reconstruction group, and more smokers and diabetic patients in the TE group. No significant difference was found in the complication rates between the groups (DTI-26.1%, TE-40.5%). However, major complication and re-operation rate due to complications were significantly different ( DTI-16.7% and 10.6%, TE-26.2% and 31%, respectively, p= 0.035, p = 0.008). No significant differences were found in Clavien-Dindo stages between the groups except for Grade 3b. Re-operation due to desire for aesthetic improvement was significantly higher in the TE group (DTI-38%. TE-69%, p=0.0003). CONCLUSION DTI immediate breast reconstruction can provide a good alternative to the traditional two-stage TE/implant operation. Both patients and surgeons can be reassured that the majority of the cases are one-stage reconstruction. 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)
- Neta Adler
- Department of Plastic and Reconstructive Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Einat Carmon
- Department of General Surgery, Asuta Hospital, Ashdod, Israel
| | - Pnina Houri
- Department of Plastic and Reconstructive Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Department of General Surgery, Asuta Hospital, Ashdod, Israel
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Li A, Luaces MA, De Souza M. Cultural Beliefs Regarding Breast Reconstruction in a Minority Group. Eplasty 2023; 23:e45. [PMID: 37664817 PMCID: PMC10472427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Background The diagnosis and treatment of breast cancer can significantly affect a woman's health and well-being. Several studies have identified factors contributing to disparities in breast reconstruction among ethnic groups, but few have examined the experience of Hispanic women. Methods Hispanic women who had undergone breast reconstruction were interviewed in retrospective focus groups. Data were collected to identify themes that affected decision-making regarding the type and timing of reconstruction. Results Most participants chose to undergo reconstruction to regain normalcy and maintain their previous "feminine" appearance. Most (75%) received silicone breast implants, and 25% received autologous reconstruction. Safety was the most important consideration when choosing the type of reconstruction. All but 1 participant relied on a spouse or other family member for support during recovery. Although most found the experience overwhelming, they felt their community was supportive and encouraging throughout the process. Conclusions Several themes underlying the decision to undergo reconstruction were identified, including maintaining femininity and choosing the safest procedure. Overall, participants described the experience as overwhelming but found support from community and family. These findings, which could be applied broadly to women regardless of ethnicity, can be used to improve communication between surgeon and patient throughout the reconstruction process.
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Affiliation(s)
- Angela Li
- University of Kansas School of Medicine, Kansas City, Kansas
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Ibelli TJ, Chennareddy S, Mandelbaum M, Henderson PW. Vascular Mapping for Abdominal-Based Breast Reconstruction: A Comprehensive Review of Current and Upcoming Imaging Modalities. Eplasty 2023; 23:e44. [PMID: 37664815 PMCID: PMC10472443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Background Preoperative vascular imaging is a very common element of surgical planning for abdominal-based breast reconstruction (ABBR). Surgeons must tailor which flap is best suited for each respective patient based on the patient's health and vascular anatomy. The goal of this review is to give surgeons practical tools for choosing which imaging technology best suits their patient's needs for successful breast reconstruction. Methods A review of literature was undertaken on Google scholar to assess preoperative imaging modalities used for ABBR. Search terms included breast reconstruction, deep inferior epigastric perforator (DIEP) flap, and abdominal imaging. Articles were included based on relevance and significance to ABBR. Advantages and disadvantages of each imaging modality were then classified according to clinically relevant utility. Results Overall, imaging technologies that produce 3-dimensional images were found to have greater resolution for identifying perforators and the pedicle network than 2- dimensional images. Conclusions This paper addresses the strengths and weaknesses of the currently used imaging modalities described and also discusses new technologies that may be helpful in the future for planning of ABBR.
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Affiliation(s)
- Taylor J Ibelli
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sumanth Chennareddy
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Max Mandelbaum
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Peter W Henderson
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
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Westrick E, Mostovych A, MacDavid J, Simpson A, Wilhelmi BJ. The Double Donut: A Safe and Simple Option for Immediate Nipple Areolar Complex Reconstruction in Skin-Sparing Mastectomy Patients With Contraindications to Nipple-Sparing Mastectomy. Eplasty 2023; 23:e37. [PMID: 37465479 PMCID: PMC10350881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Background Restoration of the nipple areolar complex (NAC) has been shown to improve quality of life (QoL) in post-mastectomy patients. Despite expansion of nipplesparing mastectomy inclusion criteria, many patients remain ineligible and are relegated to bilateral skin-sparing mastectomy. In this study, we evaluated immediate NAC reconstruction with the double donut areolar graft and split nipple composite graft reconstruction (DDSNS). Methods A single-center prospective study was performed for patients undergoing immediate post-mastectomy reconstruction with the DDSNS technique. Demographics and post-reconstruction endpoints were collected, focusing on aesthetic and functional outcomes. Results A total of 31 patients and 62 breasts underwent immediate reconstruction with the DDSNS technique. Four of 62 (6.4%) nipple composite grafts and 1 of 62 (1.6%) areolar grafts experienced partial graft loss. All incidents of initial loss healed to a satisfactory result. All patients were able to proceed with adjuvant therapy, if indicated, without delay. Conclusions The DDSNS technique can be successfully applied to achieve cosmetically satisfactory results in the post-mastectomy patient. This technique has shown reliable outcomes with respect to graft success and patient satisfaction with their NAC reconstruction.
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Affiliation(s)
- Evan Westrick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Alexander Mostovych
- School of Medicine, University of Louisville of Louisville, Louisville, Kentucky
| | - Joshua MacDavid
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Alyssa Simpson
- Division of General Surgery, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Bradon J. Wilhelmi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, Kentucky
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Mandelbaum M, Townsend A, Fontana S, Harmaty M, Torina P. Autologous Breast Reconstruction in a Patient With End-Stage Renal Disease and Systemic Lupus Erythematosus. Eplasty 2023; 23:e29. [PMID: 37305011 PMCID: PMC10257201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Background Patients with end-stage renal disease (ESRD) secondary to systemic lupus erythematosus (SLE) have historically been deterred from free flap breast reconstruction due to perceived complication risks. Numerous studies examining patients with ESRD have cited free flap complications, including increased incidences of infection and wound breakdown, with some surgeons suggesting ESRD is an independent risk factor for flap failure.15 Due to perceived risks, autologous breast reconstruction has not been extensively explored as an option in patients with ESRD on hemodialysis with comorbid connective tissue/autoimmune disorders, such as SLE. To the authors' knowledge, there are currently no published reports of successful free flap breast reconstruction in patients with ESRD due to SLE. Methods This case report describes a patient requiring hemodialysis for ESRD caused by SLE who underwent left mastectomy and immediate autologous breast reconstruction. Deep inferior epigastric perforator flap technique was employed. Conclusions This successful case report suggests the use of free flaps is a feasible option that should be considered for oncologic breast reconstruction in patients with ESRD secondary to SLE who require hemodialysis. The authors believe that further investigation is warranted to evaluate the safety of autologous breast reconstruction as an option for patients with either comorbidity. While ESRD and SLE are not explicit contraindications to free flap reconstruction, careful patient selection and appropriate indication is paramount for immediate surgical and long-term reconstructive success.
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Affiliation(s)
- Max Mandelbaum
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alexandra Townsend
- Florida International University, Herbert Wertheim College of Medicine, Miami, FL
| | - Stefani Fontana
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Marco Harmaty
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Philip Torina
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
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Malekpour M, Malekpour F, Wang HTH. Breast reconstruction: Review of current autologous and implant-based techniques and long-term oncologic outcome. World J Clin Cases 2023; 11:2201-2212. [PMID: 37122510 PMCID: PMC10131028 DOI: 10.12998/wjcc.v11.i10.2201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/13/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Implant-based reconstruction is the most common method of breast reconstruction. Autologous breast reconstruction is an indispensable option for breast reconstruction demanding keen microsurgical skills and robust anatomical understanding. The reconstructive choice is made by the patient after a discussion with the plastic surgeon covering all the available options. Advantages and disadvantages of each technique along with long-term oncologic outcome are reviewed.
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Affiliation(s)
- Mahdi Malekpour
- Department of Plastic and Reconstructive Surgery, University of Texas Health San Antonio, San Antonio, TX 78229, United States
| | - Fatemeh Malekpour
- Department of Plastic and Reconstructive Surgery, University of Texas Health San Antonio, San Antonio, TX 78229, United States
| | - Howard Tz-Ho Wang
- Department of Plastic and Reconstructive Surgery, University of Texas Health San Antonio, San Antonio, TX 78229, United States
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Kadakia N, Swisher AR, Lewis PG, Landau MJ, Kubiak J, Mohiuddin W, Kim HY. Are Large Intraoperative Fill Volumes Associated With Increased Complications After Tissue Expander Placement? Eplasty 2023; 23:e12. [PMID: 36919155 PMCID: PMC10008373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Background With the increased adoption of skin-sparing mastectomies, immediate 2-stage breast reconstruction is a common option for breast cancer patients. During the first stage of the procedure with tissue expander placement, higher intraoperative percent fill has been identified as a risk factor for complications. However, the postoperative outcomes of higher intraoperative fill volumes are not well established. The authors sought to evaluate if a higher initial intraoperative tissue expander fill volume is associated with higher complication rates in patients undergoing immediate breast reconstruction with tissue expander placement. Methods A retrospective review of patients who underwent immediate breast reconstruction with a tissue expander placement from 2016 to 2018 was conducted. Patient demographics and perioperative data were recorded. Large intraoperative fill was defined as saline fill volume greater than 350 mL. The primary outcome evaluated was skin and nipple necrosis. Secondary outcomes were major infections, minor infections, seroma, and hematoma. Results A total of 147 breasts in 86 patients were included. Mean intraoperative fill volume was 246.4 ± 106.6 mL. Thirty-five tissue expanders were filled with greater than 350 mL of saline intraoperatively. Patients with large intraoperative fill volume were older (mean age, 52.6 vs 47.9 years; P = .04), had a higher mean body mass index (BMI; 33.2 vs 25.9 kg/m2; P < .0001), and had larger preoperative breast anthropometrics (P < .0001). During a mean follow-up period of 20.1 months (range, 3-55 months), 9 breasts were noted to have skin/nipple necrosis. After multivariate analysis, large tissue expander fill volume was not a significant predictor of skin or nipple necrosis (P = .62). Hypertension and anticoagulant use were associated with increased skin and nipple necrosis (P = .04 and P = .03, respectively). Large fill volume was not associated with statistically significant increases in rates of other complications like major infections, minor infections, seroma, or hematoma. Conclusions Larger fill volumes are often required and benefit patients with higher BMI or bra sizes. This also reduces the number of postoperative fills required. In this patient population, larger intraoperative tissue expander saline fill volume (greater than 350 mL) was not associated with increased postoperative complications. After careful patient selection and perfusion evaluation, larger fill volumes may be considered a safe option to improve the aesthetic outcomes in patients with high BMI.
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Affiliation(s)
- Nikita Kadakia
- Department of Plastic Surgery, Loma Linda University Health, Loma Linda, CA
| | - Austin R Swisher
- University of California, Riverside School of Medicine, Riverside, CA
| | - Priya G Lewis
- Department of Plastic Surgery, Loma Linda University Health, Loma Linda, CA
| | - Mark J Landau
- Department of Plastic Surgery, Loma Linda University Health, Loma Linda, CA
| | - Jeremy Kubiak
- Department of Plastic Surgery, Loma Linda University Health, Loma Linda, CA
| | - Waseem Mohiuddin
- Department of Plastic Surgery, Loma Linda University Health, Loma Linda, CA
| | - Hahns Y Kim
- Department of Plastic Surgery, Loma Linda University Health, Loma Linda, CA
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Costanzo D, Romeo A. Surgical Site Infections in Breast Surgery - A Primer for Plastic Surgeons. Eplasty 2023; 23:e18. [PMID: 37187867 PMCID: PMC10176482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Surgical site infection (SSI) is defined as an infection related to an operative procedure that occurs at or near the surgical incision within 30 days of the procedure or within 90 days if prosthetic material is implanted at surgery. Substantial research has been performed to identify the etiological agents, risk factors, and potential treatment options for SSIs. As breast surgery becomes increasingly popular, plastic surgeons are likely to encounter more patients presenting with SSIs. This article summarizes current evidence on pathogens, risk factors, and management strategies for SSIs and highlights further areas of study.
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Affiliation(s)
- Domenico Costanzo
- Humanitas Research Hospital, Humanitas University, Pieve Emanuele, Italy
- Correspondence: Domenico Costanzo, MD;
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13
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Omranipour R, Mohammadizavieh M, Alipour S. Use of Inguinal Hernia Mesh (DynaMesh-ENDOLAP) in Immediate Implant-based Breast Reconstruction. Aesthetic Plast Surg 2022; 46:677-682. [PMID: 34590167 DOI: 10.1007/s00266-021-02581-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The rate of immediate implant-based breast reconstruction after mastectomy is increasing, and providing enough coverage for the implant is mandatory; however the choice of appropriate mesh for implant coverage is controversial. Considering the high cost and the limited availability of breast-dedicated meshes in our country, we conducted this study to investigate the consequences of using a polyvinylidene fluoride (PVDF) mesh designed for endoscopic and laparoscopic hernia repair (ENDOLAP) as a coverage for breast prostheses in breast reconstruction. MATERIALS AND METHODS A retrospective cross-sectional study was performed on data of patients who had underwent immediate implant-based breast reconstruction between 2012 and 2019. After skin sparing mastectomy and subpectoral implant insertion, the exposed lower and lateral parts were covered with the mesh. RESULTS Seventy-nine reconstructions were performed on 62 patients. The average follow-up was 31.9 months (ranges 6-102 months). Postoperative complications including small flap necrosis (3.8%), seroma (8.9%), infection (5.1%), hematoma (3.8%), malposition (1.3%), rippling (1.3%), grade two and three capsular contracture (2.5%), and chronic pain (1.3%) occurred in 19% of the operated breasts. The complication rate requiring intervention was 5.3%, and no implant loss was observed. None of the patients who received radiation developed complications. CONCLUSION ENDOLAP mesh is a cost-effective and safe option for implant coverage in immediate implant-based breast reconstruction, with an acceptable complication rate. 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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Witmer TJK, Kouwenberg CAE, Bargon CA, de Leeuw DM, Koiter E, Siemerink EJM, Mureau MAM, Rakhorst HA. Comparing costs of standard Breast-Conserving Surgery to Oncoplastic Breast-Conserving Surgery and Mastectomy with Immediate two-stage Implant-Based Breast Reconstruction. J Plast Reconstr Aesthet Surg 2022; 75:2569-2576. [PMID: 35398000 DOI: 10.1016/j.bjps.2022.02.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 02/19/2022] [Accepted: 02/22/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Conventional breast-conserving surgery (C-BCS) has equal oncological outcomes and superior cosmetic and patient-reported outcomes compared to mastectomy with immediate two-stage implant-based breast reconstruction (M-IBR). Oncoplastic breast-conserving surgery (OP-BCS) is increasingly being used, as it often has better cosmetic results and it enables larger tumour resection. However, OP-BCS and M-IBR compared to C-BCS lengthens operative time and might lead to more complications and consequently to additional costs. Therefore, this study aimed to compare costs and complication rates of C-BCS, OP-BCS and M-IBR. METHODS This single-centre, retrospective cohort study, calculated costs for all patients who had undergone breast cancer surgery between January 2014 and December 2016. Patient-, tumour- and surgery-related data of C-BCS, OP-BCS and M-IBR patients were retrieved by medical record review. Treatment costs were calculated using hospital financial data. Differences in costs and complications were analysed. RESULTS A total of 220 patients were included: 74 patients in the C-BCS, 78 in the OP-BCS and 68 in the M-IBR group. From most expensive to least expensive, differences in total costs were found between C-BCS vs. OP-BCS and C-BCS vs. M-IBR (p=<0.01 and p=0.04, respectively). Costs of OP-BCS and M-IBR were comparable. Complication rates were 5.5% for C-BCS, followed by 17% for OP-BCS, and 34% for M-IBR (p<0.01). CONCLUSION Considering total treatment costs, OP-BCS was financially non-inferior to M-IBR, whereas complication rates were higher following M-IBR. Therefore, when considering other benefits of OP-BCS, such as higher patient-reported outcomes and similar oncological outcomes, a shift from M-IBR to BCS using oncoplastic techniques seems justified.
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Affiliation(s)
- Tom J K Witmer
- Department of Plastic and Reconstructive Surgery, Ziekenhuisgroep Twente, Hengelo, The Netherlands.
| | - Casimir A E Kouwenberg
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Claudia A Bargon
- Department of Plastic and Reconstructive Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Daniëlle M de Leeuw
- Department of Surgical Oncology, Ziekenhuisgroep Twente, Hengelo, The Netherlands
| | - Eveline Koiter
- Department of Radiotherapy, Medisch Spectrum Twente, Enschede, The Netherlands
| | | | - Marc A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Hinne A Rakhorst
- Department of Plastic and Reconstructive Surgery, Ziekenhuisgroep Twente, Hengelo, The Netherlands.
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Liew B, Southall C, Kanapathy M, Nikkhah D. Does post-mastectomy radiation therapy worsen outcomes in immediate autologous breast flap reconstruction? A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2021; 74:3260-80. [PMID: 34565703 DOI: 10.1016/j.bjps.2021.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/25/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND There is great uncertainty regarding the practice of immediate autologous breast reconstruction (IBR) when post-mastectomy radiotherapy (PMRT) is indicated. Plastic surgery units differ in their treatment protocols, with some recommending delayed breast reconstruction (DBR) following PMRT. IBR offers significant cosmetic and psychosocial benefits; however, the morbidity of flap exposure to radiation remains unclear. OBJECTIVE The aim of this review was to comprehensively analyze the existing literature comparing autologous flaps exposed to PMRT and flaps with no radiation exposure. METHODS A comprehensive search in MEDLINE, EMBASE and CENTRAL databases was conducted in November 2020. Primary studies comparing IBR with and without adjuvant PMRT were assessed for the following primary outcomes: clinical complications, observer-reported outcomes and patient-reported satisfaction rates. Meta-analysis was performed to obtain pooled risk ratios of individual complications. RESULTS Twenty-one articles involving 3817 patients were included. Meta-analysis of pooled data gave risk ratios for fat necrosis (RR = 1.91, p < 0.00001), secondary surgery (RR = 1.62, p = 0.03) and volume loss (RR = 8.16, p < 0.00001) favoring unirradiated flaps, but no significant difference was observed in all other reported complications. The no-PMRT group scored significantly higher in observer-reported measures. However, self-reported aesthetic and general satisfaction rates were similar between groups. CONCLUSION IBR should be offered after mastectomy to patients requiring PMRT. The higher risks of fat necrosis and contracture appear to be less clinically relevant as corroborated by positive scores from patients developing these complications. Preoperative and intraoperative measures should be taken to further optimize reconstruction and mitigate post-radiation sequel. Careful management of patients' expectations is also imperative. LEVEL OF EVIDENCE Level III.
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Rayzah M, Ryu JM, Lee JH, Nam SJ, Kim SW, Lee SK, Yu J, Lee KT, Bang SI, Mun GH, Pyon JK, Jeon BJ, Lee JE. Changes in Korean National Healthcare Insurance Policy and Breast Cancer Surgery Trend in Korea. J Korean Med Sci 2021; 36:e194. [PMID: 34313035 PMCID: PMC8313396 DOI: 10.3346/jkms.2021.36.e194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/20/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Since April 2015, the Korean National Health Insurance (NHI) has reimbursed breast cancer patients, approximately 50% of the cost of the breast reconstruction (BR) procedure. We aimed to investigate NHI reimbursement policy influence on the rate of immediate BR (IBR) following total mastectomy (TM). METHODS We retrospectively analyzed breast cancer data between April 2011 and June 2016. We divided patients who underwent IBR following TM for primary breast cancer into "uninsured" and "insured" groups using their NHI statuses at the time of surgery. Univariate analyses determined the insurance influence on the decision to undergo IBR. RESULTS Of 2,897 breast cancer patients, fewer uninsured patients (n = 625) underwent IBR compared with those insured (n = 325) (30.0% vs. 39.8%, P < 0.001). Uninsured patients were younger than those insured (median age [range], 43 [38-48] vs. 45 [40-50] years; P < 0.001). Pathologic breast cancer stage did not differ between the groups (P = 0.383). More insured patients underwent neoadjuvant chemotherapy (P = 0.011), adjuvant radiotherapy (P < 0.001), and IBR with tissue expander insertion (P = 0.005) compared with those uninsured. CONCLUSION IBR rate in patients undergoing TM increased after NHI reimbursement.
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Affiliation(s)
- Musaed Rayzah
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Surgery, College of Medicine, Majmaah University, Ministry of Education, Riyadh, Saudi Arabia
| | - Jai Min Ryu
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Hee Lee
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Jin Nam
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok Won Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Kyung Lee
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jonghan Yu
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeong Tae Lee
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sa Ik Bang
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Goo Hyun Mun
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jai Kyong Pyon
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung Joon Jeon
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Eon Lee
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Deek RP, Lee IOK, van Essen P, Crittenden T, Dean NR. Predicted versus actual complications in Australian women undergoing post-mastectomy breast reconstruction: a retrospective cohort study using the BRA Score tool. J Plast Reconstr Aesthet Surg 2021; 74:3324-3334. [PMID: 34253489 DOI: 10.1016/j.bjps.2021.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 04/14/2021] [Accepted: 05/27/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The Breast Reconstruction Risk Assessment (BRA) Score tool is a risk calculator developed to predict the risk of complications in individual patients undergoing breast reconstruction. It was developed in a North American population exclusively undergoing immediate breast reconstruction. This study sought to assess the predictions of the BRA Score tool against the measured outcomes of surgery for an Australian public hospital population, including both immediate and delayed reconstructions. METHOD This was a retrospective cohort study of data from women at a single Australian public teaching hospital unit. Data from the Flinders Breast Reconstruction Database was retrieved and compared to BRA Scores calculated for each patient. Receiver operating curve area under the curve analysis was performed as well as Brier scores to compare predicted versus observed complications. RESULTS BRA Score predictions were reasonable or good (C-statistic >0.7, Brier score <0.09) for the complications of overall surgical complications, surgical site infection (SSI) and seroma at 30 days, and similarly accurate for prediction of the same complications for implant reconstructions at 12 months. There were similar findings between delayed and immediate reconstructions. CONCLUSION The BRA Score risk calculator is valid to detect some risks in both patients undergoing immediate and delayed breast reconstruction in an Australian public hospital setting. SSI is the best predicted complication and is well-predicted across both autologous and prosthetic reconstruction types.
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Affiliation(s)
- Roland P Deek
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Imogen O K Lee
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Phillipa van Essen
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia.
| | - Tamara Crittenden
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia; Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Nicola R Dean
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia; Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
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Johnson AC, Colakoglu S, Reddy A, Kerwin CM, Flores RA, Iorio ML, Mathes DW. Perioperative Blocks for Decreasing Postoperative Narcotics in Breast Reconstruction. Anesth Pain Med 2020; 10:e105686. [PMID: 34150564 PMCID: PMC8207839 DOI: 10.5812/aapm.105686] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/03/2020] [Accepted: 08/07/2020] [Indexed: 02/07/2023] Open
Abstract
Context High rates of mortality and chemical dependence occur following the overuse of narcotic medications, and the prescription of these medications has become a central discussion in health care. Efforts to curtail opioid prescribing include Enhanced Recovery After Surgery (ERAS) guidelines, which describe local anesthesia techniques to decrease or eliminate the need for opioids when used in a comprehensive protocol. Here, we review effective perioperative blocks for the decreased use of opioid medications post-breast reconstruction surgery. Evidence Acquisition A comprehensive review was conducted using keywords narcotics, opioid, surgery, breast reconstruction, pain pump, nerve block, regional anesthesia, and analgesia. Papers that described a local anesthetic option for breast reconstruction for decreasing postoperative narcotic consumption, written in English, were included. Results A total of 52 papers were included in this review. Local anesthetic options included single-shot nerve blocks, nerve block catheters, and local and regional anesthesia. Most papers reported equal or even superior pain control with decreased nausea and vomiting, length of hospital stay, and other outcomes. Conclusions Though opioid medications are currently the gold standard medication for pain management following surgery, strategies to decrease the dose or number of opioids prescribed may lead to better patient outcomes. The use of a local anesthetic technique has been shown to reduce narcotic use and improve patients’ pain scores after breast reconstruction surgery.
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Affiliation(s)
- Ariel Clare Johnson
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Salih Colakoglu
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Angela Reddy
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Clara Marie Kerwin
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Roland A Flores
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Matthew L Iorio
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - David W Mathes
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Corresponding Author: MD, Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
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Henn D, Momeni A. A standardized patient education class as a vehicle to improving shared decision-making and increasing access to breast reconstruction. J Plast Reconstr Aesthet Surg 2020; 73:1534-9. [PMID: 32241738 DOI: 10.1016/j.bjps.2020.02.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/25/2019] [Accepted: 02/11/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Shared decision-making is a key component of patient-centered care and has been shown to improve patient satisfaction and quality of life. Herein, we study the impact of a standardized patient education class for prospective breast reconstruction patients on clinic efficiency, access to care, and perception on shared decision-making. METHODS The number of new patient consultations per clinic, as well as average duration of the first individual clinic encounter, was compared before and after the introduction of a standardized education class given by the senior author to all new breast reconstruction patients. To evaluate patients' perception of shared decision-making, the 9-item Shared Decision-Making Questionnaire (SDM-Q9) and the Satisfaction with Information scale of the BREAST-Q Reconstruction Module were electronically distributed among the patients and compared between the two groups. RESULTS Introduction of the patient education class was associated with a significant reduction in the duration of new patient encounters compared to historic controls (31.8 min vs. 53.5 min, p < 0.01) along with permitting a 43% increase in new patient visits. No differences in self-perceived patient education and autonomy were seen between class participants and historic controls in the SDM-Q9 scores (p = 0.58) and BREAST-Q scores (p = 0.14). CONCLUSION The introducing a standardized patient education class translated into a significant reduction in the duration of individual new patient encounters, thereby increasing patient access to care, while maintaining high-quality standards of self-perceived patient education and shared decision-making.
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20
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O'Neill AC, Mughal M, Saggaf MM, Wisniewski A, Zhong T, Hofer SOP. A structured pathway for accelerated postoperative recovery reduces hospital stay and cost of care following microvascular breast reconstruction without increased complications. J Plast Reconstr Aesthet Surg 2019; 73:19-26. [PMID: 31628082 DOI: 10.1016/j.bjps.2019.06.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/16/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Accelerated recovery protocols have proved effective in many surgical procedures but are infrequently applied in breast reconstruction. In this study, we evaluate the impact of a structured pathway for accelerated postoperative recovery in patients undergoing microvascular breast reconstruction at a high-volume center. METHODS We describe our care pathway for patients undergoing deep inferior epigastric artery perforator (DIEP) flap breast reconstruction at our center. We compared length of stay (LOS), complication rates, readmission rates, and cost of inpatient care before (pre-protocol (Pre-P)) and after (post-protocol (Post-P)) the implementation of the protocol. RESULTS Patients in the Post-P group (n = 198) had a significant reduction in mean LOS as compared to those in the Pre-P (n = 183) group (3.6 +/- 0.85 vs. 4.7 +/-1.04 days, p = 0.006). There was no significant difference in the rates of major (Pre-P 16.9% vs. Post-P 14.7%, p = 0.71) or minor (Pre-P 21.3% vs. 17.1%, p = 0.22) postoperative complications between groups. The readmission rates were also similar (Pre-P 6.5% vs. Post-P 4.5, p = 0.69). Implementation of the protocol resulted in a significant reduction in the mean cost of in-patient care. CONCLUSION A simple protocol for accelerated and streamlined postoperative recovery effectively reduces LOS and patient care costs following DIEP flap breast reconstruction without compromising patient safety.
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Affiliation(s)
- Anne C O'Neill
- Division of Plastic and Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto. Toronto General Hospital, 200 Elizabeth Street, 8N-867, Toronto, Ontario M5G 2C4, Canada. anne.o'
| | - Maleeha Mughal
- Division of Plastic and Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto. Toronto General Hospital, 200 Elizabeth Street, 8N-867, Toronto, Ontario M5G 2C4, Canada
| | - Moaath M Saggaf
- Division of Plastic and Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto. Toronto General Hospital, 200 Elizabeth Street, 8N-867, Toronto, Ontario M5G 2C4, Canada
| | - Agnes Wisniewski
- Division of Plastic and Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto. Toronto General Hospital, 200 Elizabeth Street, 8N-867, Toronto, Ontario M5G 2C4, Canada
| | - Toni Zhong
- Division of Plastic and Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto. Toronto General Hospital, 200 Elizabeth Street, 8N-867, Toronto, Ontario M5G 2C4, Canada
| | - Stefan O P Hofer
- Division of Plastic and Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto. Toronto General Hospital, 200 Elizabeth Street, 8N-867, Toronto, Ontario M5G 2C4, Canada
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Sergesketter AR, Thomas SM, Lane WO, Shammas RL, Greenup RA, Hollenbeck ST. The Influence of Marital Status on Contemporary Patterns of Postmastectomy Breast Reconstruction. J Plast Reconstr Aesthet Surg 2018; 72:795-804. [PMID: 30595415 DOI: 10.1016/j.bjps.2018.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 12/10/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Marital status is known to influence quality of life, survival, and treatment decision-making after breast cancer diagnosis. We aimed to determine whether relationship status impacts contemporary patterns of immediate breast reconstruction. METHODS Surveillance, Epidemiology, and End Results (SEER)-18 was used to identify females undergoing mastectomy for stage 0-III breast cancer from 1998 to 2014. Multivariate logistic regression was used to estimate the association of relationship status with the likelihood of postmastectomy reconstruction. Patients were grouped by diagnosis year to assess change in the reconstructed population with time. Among younger patients ≤45 years, a generalized logistic model was used to predict reconstruction subtype. RESULTS Among 346,418 patients, reconstruction after mastectomy was more likely to occur in women with relationship support in the form of a marriage or partner [odds ratio (OR) 1.31; 95% confidence interval (CI), 1.28-1.34; p<0.001]. Women who were separated (OR 0.76), single (OR 0.73), or widowed (OR 0.56) were significantly less likely than married women to undergo reconstruction (all p<0.001). During the 17-year study period, change in reconstruction rates with time varied by relationship status (interaction p=0.02), with reconstruction rates among divorced patients increasing more slowly than those among married and partnered women. Among younger women, subtype patterns varied by relationship status (p=0.004), with divorced women less likely to receive autologous over implant reconstruction (OR 0.87; p = 0.03). CONCLUSION Relationship status may influence decision-making regarding pursuit and type of postmastectomy reconstruction. Consideration of support networks of patients with breast cancer could facilitate tailored preoperative counseling by reconstructive surgeons.
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Affiliation(s)
- Amanda R Sergesketter
- Division of Plastic, Maxillofacial & Oral Surgery, Duke University Medical Center, Durham, NC
| | - Samantha M Thomas
- Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Durham, NC; Duke Cancer Institute, Durham, NC
| | - Whitney O Lane
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Ronnie L Shammas
- Division of Plastic, Maxillofacial & Oral Surgery, Duke University Medical Center, Durham, NC
| | - Rachel A Greenup
- Department of Surgery, Duke University Medical Center, Durham, NC; Duke Cancer Institute, Durham, NC
| | - Scott T Hollenbeck
- Division of Plastic, Maxillofacial & Oral Surgery, Duke University Medical Center, Durham, NC.
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Magill LJ, Tanska A, Keshtgar M, Mosahebi A, Jell G. Mechanical and surface chemical analysis of retrieved breast implants from a single centre. J Mech Behav Biomed Mater 2018; 91:24-31. [PMID: 30529983 DOI: 10.1016/j.jmbbm.2018.10.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 10/30/2018] [Accepted: 10/31/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Breast implants are associated with complications such as capsular contracture, implant rupture and leakage often necessitating further corrective surgery. Re-operation rates have been reported to occur in up to 15.4% of primary augmentation patients and up to 27% in primary reconstructions patients within the first three years (Cunningham, 2007). The aim of this study was to examine the mechanical and surface chemical properties as well as the fibroblast response of retrieved breast implants in our unit to determine the in vivo changes which occur over time. METHODS Ethical approval was obtained. 47 implants were retrieved. Implantation time ranged from 1 month to 388 months (Mean 106.1 months). Tensile strength, elongation, Young's modulus and tear strength properties were measured using Instron 5565 tensiometer on anterior and posterior aspects of the implant. Attenuated total reflectance-fourier transform infra-red spectroscopy (ATR-FTIR), wettability and scanning electron microscopy (SEM) analysis was performed on the shell surfaces. Bicinchoninic acid assay was performed to determine shell protein content. The fibroblast response was determined by seeding HDFa cells on the retrieved implants and cell metabolism measured using Alamar Blue™ assay. RESULTS Mechanical properties fall with increasing duration of implantation. There were no significant changes in ATR-FTIR spectra between ruptured and intact implants nor significant changes in wettability in implants grouped into 5 year categories. SEM imaging reveals surface degradation changes with increasing duration of implantation. CONCLUSIONS With increasing duration of implantation, mechanical properties of the breast implants fall. However this was not associated with surface chemical changes as determined by ATR-FTIR and wettability nor protein content of the shells. Thus the reduction in mechanical properties is associated with breast implant failure but further research is required to elucidate the mechanisms.
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Affiliation(s)
- Louise J Magill
- Division of Surgery and Interventional Science, Royal Free Campus, University College London, Pond Street, London NW3 2QG, United Kingdom.
| | - Aleksandra Tanska
- Division of Surgery and Interventional Science, Royal Free Campus, University College London, Pond Street, London NW3 2QG, United Kingdom
| | - Mohammed Keshtgar
- Division of Surgery and Interventional Science, Royal Free Campus, University College London, Pond Street, London NW3 2QG, United Kingdom
| | - Ashfin Mosahebi
- Division of Surgery and Interventional Science, Royal Free Campus, University College London, Pond Street, London NW3 2QG, United Kingdom; Department of Plastic and Reconstructive Surgery, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, United Kingdom
| | - Gavin Jell
- Division of Surgery and Interventional Science, Royal Free Campus, University College London, Pond Street, London NW3 2QG, United Kingdom
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Yan WH, Mang JB, Ren LL, Liu DL. Natural History of Seroma Following the Immediate Latissimus Dorsi Flap Method of Breast Reconstruction. Chin Med J (Engl) 2018; 131:1674-1679. [PMID: 29998886 PMCID: PMC6048921 DOI: 10.4103/0366-6999.235877] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The latissimus dorsi (LD) flap procedure remains a popular and useful breast reconstruction tool in China and Western countries, and donor site seroma formation is the main complication. This study was conducted in Chinese patients to determine whether stable cases of seromas would resolve without treatment. METHODS A. retrospective review of 45 consecutive cases of immediate breast reconstruction with LD flap from April 2012 to February 2017 was conducted. The scope of the seroma was demarcated with a marker pen, and cases that remained stable over time (i.e. the size of the seroma did not increase) were observed without treatment. The measured outcomes included the incidence of seromas, the volume and duration of postoperative wound drainage, and other demographic characteristics. RESULTS Twenty-four patients (53.3%) developed a seroma at the donor site. Of these, 21 patients (87.5%) did not require treatment, and the seroma resolved over time. The mean duration of a sustained seroma was 6.8 ± 1.4 weeks (range: 4-9 weeks). CONCLUSIONS This study observed the scope and progression of the seromas and found that seromas at the LD donor sites resolved over time without treatment.
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Affiliation(s)
- Wen-Hui Yan
- Department of Plastic Surgery, Zhujiang Hospital, Southern Medical University/The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong 510280, China
- Department of Breast Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, Guangdong 518116, China
- Department of Breast Surgery, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong 518020, China
| | - Jian-Bo Mang
- Department of Breast Surgery, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong 518020, China
| | - Li-Li Ren
- Cytotherapy Laboratory, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong 518020, China
| | - Da-Lie Liu
- Department of Plastic Surgery, Zhujiang Hospital, Southern Medical University/The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong 510280, China
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Ciancio F, Parisi D, Portincasa A, Innocenti A. Innovative Management of Implant Exposure in ADM/Implant-Based Breast Reconstruction with Negative Pressure Wound Therapy. Aesthetic Plast Surg 2017; 41:1237-1238. [PMID: 28374296 DOI: 10.1007/s00266-017-0850-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 03/06/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Francesco Ciancio
- Department of Plastic and Reconstructive Surgery, University of Bari, Viale Luigi Pinto n 1, 71122, Foggia, Italy.
| | - Domenico Parisi
- Department of Plastic and Reconstructive Surgery, University of Foggia, Foggia, Italy
| | - Aurelio Portincasa
- Department of Plastic and Reconstructive Surgery, University of Foggia, Foggia, Italy
| | - Alessandro Innocenti
- Plastic and Reconstructive Microsurgery, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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Accurso A, Rocco N, Mattera E, D'Andrea F. Reply: Innovative Management of Implant Infection and Exposure in ADM/Implant-Based Breast Reconstruction with Negative Pressure Wound Therapy. Aesthetic Plast Surg 2017; 41:1239-40. [PMID: 28337618 DOI: 10.1007/s00266-017-0845-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 03/01/2017] [Indexed: 10/19/2022]
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Echazarreta-Gallego E, Pola-Bandrés G, Arribas-Del Amo MD, Gil-Romea I, Sousa-Domínguez R, Güemes-Sánchez A. Treatment of Implant Exposure due to Skin Necroses after Skin Sparing Mastectomy: Initial Experiences Using a Not Selective Random Epigastric Flap. World J Surg 2017; 41:2559-2565. [PMID: 28466362 DOI: 10.1007/s00268-017-4041-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Breast prostheses exposure is probably the most devastating complication after a skin sparing mastectomy (SSM) and implant-based, one-stage, breast reconstruction. This complication may occur in the immediate post-operative period or in the weeks and even months after the procedure. In most cases, the cause is poor skin coverage of the implant due to skin necrosis. PATIENTS AND METHODS Eight consecutive cases of implant exposure (or risk of exposure) due to skin necrosis in SSM patients over a period of 5 years, all patients were treated using a random epigastric rotation flap, executed by the same medical team. RESULTS A random epigastric flap (island or conventional rotation flap) was used to cover the skin defect. All the patients completed the procedure and all prostheses were saved; there were no cases of flap necrosis or infection. CONCLUSIONS Cases of skin necrosis after SSM and immediate implant reconstruction, in which the implant is at risk of exposure, can be successfully treated with a random epigastric rotation flap.
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Affiliation(s)
- Estíbaliz Echazarreta-Gallego
- Breast Unit. Department of Surgery, Hospital Clínico Universitario de Zaragoza, Avenida San Juan Bosco 15, 50005, Saragossa, Spain.
| | - Guillermo Pola-Bandrés
- Breast Unit. Department of Surgery, Hospital Clínico Universitario de Zaragoza, Avenida San Juan Bosco 15, 50005, Saragossa, Spain
| | - María Dolores Arribas-Del Amo
- Breast Unit. Department of Surgery, Hospital Clínico Universitario de Zaragoza, Avenida San Juan Bosco 15, 50005, Saragossa, Spain
| | - Ismael Gil-Romea
- Breast Unit. Department of Surgery, Hospital Clínico Universitario de Zaragoza, Avenida San Juan Bosco 15, 50005, Saragossa, Spain
| | - Ramón Sousa-Domínguez
- Breast Unit. Department of Surgery, Hospital Clínico Universitario de Zaragoza, Avenida San Juan Bosco 15, 50005, Saragossa, Spain
| | - Antonio Güemes-Sánchez
- Breast Unit. Department of Surgery, Hospital Clínico Universitario de Zaragoza, Avenida San Juan Bosco 15, 50005, Saragossa, Spain
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Seon Kim Y. Ultrasonography Findings of AlloDerm ® Used in Postmastectomy Alloplastic Breast Reconstruction: A Case Report and Literature Review. Iran J Radiol 2016; 13:e38252. [PMID: 27878067 PMCID: PMC5110931 DOI: 10.5812/iranjradiol.38252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 04/21/2016] [Indexed: 11/16/2022]
Abstract
AlloDerm® (LifeCell Corp.; Brancburg, NJ) is an acellular dermal matrix (ADM) that serves as an immunologically inert scaffold in plastic surgery. In breast reconstruction, it is used as a filler for lumpectomy defects and can be used to create the inferolateral portion of the tissue expander pocket or implant pocket in postmastectomy patients. However, there are limited reports of the radiologic findings of AlloDerm® in patients who have undergone postmastectomy reconstruction. Familiarity with the imaging features of AlloDerm® is essential for correct diagnosis. We report the ultrasonography features of AlloDerm® in a 43-year-old female patient 3 months after postmastectomy reconstruction. It may help distinguish AlloDerm® from tumor recurrence or other foreign body materials such as gossypiboma. This is important as misdiagnosis can often lead to unnecessary surgical intervention.
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Affiliation(s)
- Young Seon Kim
- Department of Radiology, College of Medicine, Yeungnam University, Daegu, Korea
- Corresponding author: Young Seon Kim, Department of Radiology, College of Medicine, Yeungnam University, 170, Hyeonchung-ro, Nam-gu, Daegu, Korea. Tel: +82-26204129, Fax: +50-43738795, E-mail:
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Unkart JT, Padwal JA, Ilfeld BM, Wallace AM. Treatment of Post-Latissimus Dorsi Flap Breast Reconstruction Pain With Continuous Paravertebral Nerve Blocks: A Retrospective Review. Anesth Pain Med 2016; 6:e39476. [PMID: 27847703 PMCID: PMC5101420 DOI: 10.5812/aapm.39476] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/24/2016] [Accepted: 06/26/2016] [Indexed: 12/29/2022] Open
Abstract
Objectives The addition of a perioperative continuous paravertebral nerve block (cPVB) to a single-injection thoracic paravertebral nerve block (tPVB) has demonstrated improved analgesia in breast surgery. However, its use following isolated post-mastectomy reconstruction using a latissimus dorsi flap (LDF) has not previously been examined. Methods We performed a retrospective review of patients who underwent salvage breast reconstruction with a unilateral LDF by a single surgeon. Preoperatively, all patients received a single-injection tPVB with 0.5% ropivacaine. Additionally, patients had the option for catheter placement to receive a continuous 0.2% ropivacaine infusion with intermittent boluses. Infusions commenced in the recovery room and the catheters were removed on the morning of discharge. The primary endpoint was the mean pain numeric rating scale (NRS) scores for the 24-hour period beginning at 7:00 on post-operative day 1. Results A total of 22 patients were included in this study (11-cPVB and 11-tPVB). The mean NRS pain score of cPVB patients (3.5 (standard deviation (SD) 1.8) was lower than that of the single-injection tPVB patients (4.4 (SD 2.1), however this difference was not statistically significant (P = 0.31). The length of hospital stay and opioid use was not statistically different between groups. Conclusions Patients receiving a cPVB in addition to tPVB after LDF reconstruction experienced similar pain to those receiving tPVB alone. A larger, randomized clinical trial is warranted to fully determine the benefits of using cPVB in addition to tPVB for this procedure.
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Affiliation(s)
- Jonathan T. Unkart
- Department of Surgery, University of California, San Diego, USA
- Corresponding author: Jonathan T. Unkart, Department of Surgery, 200 West Arbor Drive, MC 0739, San Diego, California, USA. Tel: +1-4157069274, Fax: +1-8588226194, E-mail:
| | | | - Brian M. Ilfeld
- Department of Anesthesiology, University of California, California, USA
| | - Anne M. Wallace
- Department of Surgery, University of California, San Diego, USA
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