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Cho MJ, Farhadi RV, Nash DW, Kaleeny J, Povoski SP, Chao AH. The current use of tissue expanders in breast reconstruction: device design, features, and technical considerations. Expert Rev Med Devices 2024; 21:27-35. [PMID: 38032224 DOI: 10.1080/17434440.2023.2288911] [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: 08/15/2023] [Accepted: 11/24/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION The use of tissue expanders (TE) in post-mastectomy breast reconstruction is a widely accepted practice, especially in patients desiring implant-based breast reconstruction. It has become the standard of care to perform a two-staged breast reconstruction using tissue expanders for the past 50 years due to its reliability, safety, cost-effectiveness, and versatility. Due to its popularity, there are numerous types and features of breast tissue expanders and various surgical approaches available for plastic surgeons. AREAS COVERED In this article, we will review the role of tissue expanders in breast reconstruction, the types and features of breast tissue expanders, and technical considerations. EXPERT OPINION The use of tissue expanders in breast reconstruction offers significant advantages of preserving the breast skin envelope and reestablishing the breast mound. With evolving approaches to breast reconstruction, tissue expander design, and application underwent several refinements and modifications. Due to these advances, studies on its long-term efficacy and safety profile typically fall behind and more studies with higher levels of evidence are needed to better evaluate the efficacy and safety profile of tissue expanders. With increased understanding, reconstructive surgeons can minimize complications and maximize reconstructive, aesthetic outcomes with high patient satisfaction.
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Affiliation(s)
- Min-Jeong Cho
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Rana V Farhadi
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - David W Nash
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Joseph Kaleeny
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Albert H Chao
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Tevlin R, Sharma AD, Griffin M, Wan D, Momeni A. Technical Tips to Reduce Implant Rippling in Staged Pre-pectoral Breast Reconstruction. Aesthetic Plast Surg 2023; 47:2351-2359. [PMID: 37704858 DOI: 10.1007/s00266-023-03616-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/10/2023] [Indexed: 09/15/2023]
Abstract
INTRODUCTION Pre-pectoral implant-based breast reconstruction (IBR) is becoming increasingly popular, permitting optimal implant positioning on the chest wall, prevention of animation deformity, and reduced patient discomfort. There are, however, concerns related to increased rates of breast implant rippling in pre-pectoral (versus submuscular) IBR, which can prompt a patient to seek revisionary surgery. The aim of this study is to identify factors that can be implemented to reduce implant rippling in the setting of pre-pectoral IBR. METHODS A literature review was conducted using the PubMed database to determine the rate of rippling in pre-pectoral IBR. Clinical studies in English were included. Further review was then performed to explore technical strategies associated with reduced rates of rippling in pre-pectoral two-stage breast reconstruction. RESULTS Implant rippling has been reported with a rate varying from 0 to 53.8% in 25 studies of pre-pectoral IBR (including both direct-to-implant and two-stage IBR). The majority of studies reviewed did not demonstrate a significant association between BMI and rippling, suggesting that other factors, likely technical and device-related, contribute to the manifestation of implant rippling. Hence, we explored whether specific technical modifications could be implemented that would reduce the risk of rippling in patients undergoing pre-pectoral IBR. Specifically, we highlight the need for close attention to expansion protocol and pocket dimension, expander fill medium and implant characteristics, and the rationale behind adjunctive procedures to reduce implant rippling. CONCLUSION Surgical modifications may reduce the incidence of rippling in pre-pectoral breast reconstruction. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Ruth Tevlin
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, 770 Welch Road, Suite 400, Palo Alto, CA, 94304, USA
- Royal College of Surgeons in Ireland, St Stephen's Green, Dublin, Ireland
| | - Ayushi Dutt Sharma
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, 770 Welch Road, Suite 400, Palo Alto, CA, 94304, USA
- School of Medicine, Creighton University, Omaha, Nebraska, USA
| | - Michelle Griffin
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, 770 Welch Road, Suite 400, Palo Alto, CA, 94304, USA
| | - Derrick Wan
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, 770 Welch Road, Suite 400, Palo Alto, CA, 94304, USA
- Royal College of Surgeons in Ireland, St Stephen's Green, Dublin, Ireland
- School of Medicine, Creighton University, Omaha, Nebraska, USA
| | - Arash Momeni
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, 770 Welch Road, Suite 400, Palo Alto, CA, 94304, USA.
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van der Wielen A, Negenborn V, Burchell GL, Remmelzwaal S, Lapid O, Driessen C. Less is more? One-stage versus two-stage implant-based breast reconstruction: A systematic review and meta-analysis of comparative studies. J Plast Reconstr Aesthet Surg 2023; 86:109-127. [PMID: 37716248 DOI: 10.1016/j.bjps.2023.08.021] [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: 05/22/2023] [Revised: 07/19/2023] [Accepted: 08/13/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Most breast reconstructions are implant-based and can be performed either in a one-stage, direct-to-implant or in a two-stage, expander-implant-based reconstruction. The objective of this systematic review is to compare the safety and patient satisfaction of the two reconstruction approaches. METHODS A literature search was conducted on 27 September 2022 using various databases. Studies comparing one-stage and two-stage implant reconstructions and reporting the following outcomes were included: patient satisfaction, aesthetics, complications, and/or costs. Reviews, case reports, or series with less than 20 patients and letters or comments were excluded. Comparisons were made between the one-stage reconstruction with and without acellular dermal matrix (ADM) and two-stage implant-based breast reconstruction groups. The data extracted from all articles were analysed using random-effects meta-analyses. RESULTS Of the 1381 records identified, a total of 33 articles were included, representing 21529 patients. There were no significant differences between the one-stage and two-stage groups, except for the costs. The one-stage operation without ADM had lower costs than the two-stage operation without ADM, although the use of an ADM substantially increased the price of the operation to more than a two-stage reconstruction. DISCUSSION Equal patient satisfaction, aesthetic outcomes, and complication rates with lower costs justify one-stage breast reconstruction in carefully selected patients. This review shows that there is no evidence-based superior surgical approach. Future research should focus on the costs of the ADM versus an additional stage and patient-reported outcomes.
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Affiliation(s)
- Alexander van der Wielen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Vera Negenborn
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, De Boelelaan 1117, Amsterdam, the Netherlands
| | - George Louis Burchell
- Amsterdam UMC location Vrije Universiteit Amsterdam, Medical Library, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Sharon Remmelzwaal
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology & Data Science, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Oren Lapid
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Caroline Driessen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, De Boelelaan 1117, Amsterdam, the Netherlands.
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Liang J, Cao T, Wang Y, Wang B, Qian J, Chen Q, Zhang Q. A modified tissue expander method for ear reconstruction in patients with excessively insufficient postauricular skin. Ear Nose Throat J 2023; 102:NP449-NP456. [PMID: 37139961 DOI: 10.1177/01455613231172332] [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] [Indexed: 05/05/2023] Open
Abstract
OBJECTIVE For microtia patients with excessively insufficient postauricular skin, it is difficult to obtain a satisfied outcome with existing strategies. In this study, we developed a modified tissue expander method for auricular reconstruction. METHODS The modified tissue expander method divided into 4 stages. In the first stage, a 30 ml or 50 ml kidney-shaped tissue expander was implanted in the mastoid region. A short time expansion (average 33.5 days) was conducted subsequently. In the second stage, the expander was removed and a modified cartilage framework without tragus was inserted through the same incision. A crescent-shaped cartilage pad was inserted into the incision of cartilage-harvest site at the same time. In the third stage, the reconstructed ear was elevated. Lobule rotation and remanent modification were performed in the fourth stage. The patients were followed up between half a year and 10 years. The outcomes of the reconstructed ears were scored with evaluation criteria. RESULTS From January 2010 to December 2019, a total of 45 microtia patients with excessively insufficient postauricular skin were performed the modified tissue expander method. Fourty-two patients showed satisfied outcomes. Complications such as hyperpigmentation in the skin graft area (3, 6.7%), scar hyperplasia (3, 6.7%) and folliculitis (1, 2.2%) were found. There were no complications related to the tissue expander. CONCLUSION The modified tissue expander method is an effective and safe technique for auricular reconstruction in patients having excessively insufficient postauricular skin, with satisfying medium-term results.
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Affiliation(s)
- Jiaxin Liang
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Tongyu Cao
- Department of Burns and Plastic Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Yue Wang
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Bingqing Wang
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jin Qian
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Qi Chen
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Qingguo Zhang
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Shiraishi M, Sowa Y, Tsuge I, Shiraishi A, Inafuku N, Morimoto N, Nakayama I. Characteristics and distribution of chronic pain after mastectomy and breast reconstruction: a long-term prospective cohort study. Surg Today 2023:10.1007/s00595-023-02676-y. [PMID: 37000256 DOI: 10.1007/s00595-023-02676-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/21/2022] [Indexed: 04/01/2023]
Abstract
PURPOSE Chronic pain following breast surgery is a concern for breast cancer survivors; however, few studies have investigated the localization of persistent postoperative pain. We conducted this study to identify the location of pain following breast reconstruction. METHODS A total of 213 Japanese women undergoing mastectomy only or breast reconstruction with a tissue expander/implant (TE/Imp) or a deep inferior epigastric perforator (DIEP) flap were enrolled in the study. Questionnaires related to pain location were sent to patients at the end of postoperative year (POY) 1 and POY 5. Multiple comparisons of the types of operation and cross-tabulation were made between the two time points. RESULTS Surveys were completed by 107 of the women. Severe pain in the upper medial breast was significantly more common in POY 1 after DIEP reconstruction than after mastectomy only (P = 0.01), whereas abdominal pain was worse in POY 5 after DIEP reconstruction than after mastectomy only (P = 0.04). Pain in the medial arm and axilla had resolved better after TE/Imp (P = 0.03) and DIEP reconstruction (P = 0.01) than after mastectomy only by POY 5, but the difference between TE/Imp and DIEP reconstruction was not significant. CONCLUSIONS These results show that localization of prolonged postoperative pain following breast reconstruction differs depending on the surgical strategy.
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Affiliation(s)
- Makoto Shiraishi
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Yoshihiro Sowa
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyou-ku, Kyoto, 606-8507, Japan.
| | - Itaru Tsuge
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyou-ku, Kyoto, 606-8507, Japan
| | - Akiko Shiraishi
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naoki Inafuku
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naoki Morimoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyou-ku, Kyoto, 606-8507, Japan
| | - Ichiro Nakayama
- Department of Breast Surgery, Kyoto Miniren Chuo Hospital, Kyoto, Japan
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Caziuc A, Fagarasan V, Fagarasan G, Dindelegan GC. Adverse Outcome of Two-Staged Breast Reconstruction: More Than One Culprit. Clin Breast Cancer 2023; 23:e267-e272. [PMID: 37085378 DOI: 10.1016/j.clbc.2023.03.005] [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: 02/02/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Two-stage prosthetic breast reconstruction with initial insertion of a tissue expander followed by change-over to an implant after a period of inflation has become a well-established option in breast reconstruction. Our aim was to analyze the feasibility of two-stage breast reconstruction in our center by following the surgical technique, number of complications and associated risk factors. PATIENTS AND METHODS We studied 91 patients who underwent skin sparring mastectomy and tissue expander placement in our surgical unit, between January 2017 and December 2021. Axillary surgery was performed in all patients. We collected data on age, smoker status, breast size, comorbidities, tumor characteristics, neoadjuvant treatment and surgical intervention details. RESULTS Skin necrosis (12.08%) and seroma (16.48%) were the most common complications. 7.69% of the patients required reintervention. Patients underwent delayed reconstruction after more than 6 months in 69.7% of the cases, while the overall reconstruction rate was 86.08%. Smoker status, an increased body mass index, comorbidities, neoadjuvant treatment, type of incision and location of the implant were the main factors that led to adverse outcomes. CONCLUSIONS Tissue expanders are a viable option for reconstruction; however, we observed a higher incidence of skin complications in smokers and in cases where periareolar incision was used.
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Affiliation(s)
- Alexandra Caziuc
- 1st Surgical Clinic, University of Medicine and Pharmacy Cluj Napoca, Cluj-Napoca, Romania.
| | - Vlad Fagarasan
- 1st Surgical Clinic, University of Medicine and Pharmacy Cluj Napoca, Cluj-Napoca, Romania
| | - Giorgiana Fagarasan
- 1st Surgical Clinic, University of Medicine and Pharmacy Cluj Napoca, Cluj-Napoca, Romania
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Cagli B, Morelli Coppola M, Augelli F, Segreto F, Tenna S, Cogliandro A, Persichetti P. Postmastectomy Radiation Therapy in the Setting of Two-Stage Retropectoral Implant-Based Breast Reconstruction: Should It be Delivered Before or After Implant Exchange? A Retrospective Analysis on 183 Patients. Aesthetic Plast Surg 2022; 46:2643-2654. [PMID: 35854008 DOI: 10.1007/s00266-022-03001-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/19/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Postmastectomy radiation therapy (PMRT) has a primary role in the treatment of locally advanced breast cancer; however, the most appropriate timing of irradiation in immediate tissue expander breast reconstruction (ITEBR) still remains unknown. METHODS A retrospective review was performed on all women undergoing mastectomy and retropectoral ITEBR at Campus Bio-Medico University Hospital in Rome, Italy, between 2010 and 2019. The patients were categorized into three cohorts: patients undergoing PMRT with the tissue expander (TE) in situ, patients with PMRT delivered to the permanent implant (PI), patients who were not administered RT. Complications and failure rates were analysed and compared. Potential predictors of adverse outcomes were analysed. RESULTS Over 10 years, 183 patients underwent retropectoral ITEBR (55 PMRT-TE, 50 PMRT-PI, 78 no-PMRT). The three groups were well matched with respect to patient- and treatment-related factors (p > 0.05), with the exception of neoadjuvant chemotherapy and irradiation. The mean follow-up was, respectively, 4.58, 7 and 5.75 years. Radiotherapy either to the TE or to the PI was independently associated with failure and conversion to autologous procedures (p < 0.0001). Failure rate was significantly higher when TE was irradiated (p = 0.03). PMRT was associated with severe capsular contracture development (p < 0.00001), the odds being higher when irradiation was delivered after implant exchange (p = 0.04). Increased BMI was significantly associated with failure. CONCLUSIONS When PMRT is delivered to the TE, the risk of failure is higher (OR 2.77); when the PI is irradiated, reconstruction will more likely be affected by severe capsular contracture (OR 2.7). However, considering that the overall risk of severe capsular contracture correlated to PMRT is higher than failure, we believe that irradiation should be delivered to the TE. Performing a proper capsuloplasty at the time of implant exchange, indeed, allows to correct the deformities related to radiation-induced capsular contracture. Patients with unfavourable outcomes after TE placement and RT, instead, can be directly switched to autologous 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)
- Barbara Cagli
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Rome, Italy
| | - Marco Morelli Coppola
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Rome, Italy.
| | - Federica Augelli
- Department of Plastic Surgery and Burn Unit, Niguarda Hospital, Milan, Italy
| | - Francesco Segreto
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Rome, Italy
| | - Stefania Tenna
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Rome, Italy
| | - Annalisa Cogliandro
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Rome, Italy
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Rome, Italy
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Thakur N, Eibach M, Ghanaati S, Weise L, Seifert V, Marquardt G, Quick-Weller J. Tissue expansion for challenging DBS hardware erosions in patients with Parkinson's disease. Brain Spine 2022; 2:101188. [PMID: 36248105 PMCID: PMC9562251 DOI: 10.1016/j.bas.2022.101188] [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] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/27/2022] [Accepted: 09/07/2022] [Indexed: 11/28/2022]
Abstract
•Consider tissue expanders for challenging DBS cases in PD patients with hardware erosion.•Placement of tissue expander is essential in planning the reconstruction.•MRI-compatibility of the tissue expander is paramount for shortening the total duration of anesthesia.•Role of routine skin biopsies to identify PD patients at additional risk for developing scalp defects should be investigated.
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Affiliation(s)
- Nikhil Thakur
- Department of Neurosurgery, Johann Wolfgang Goethe University Hospital, Frankfurt, Germany
| | - Michael Eibach
- Department of Neurosurgery, Johann Wolfgang Goethe University Hospital, Frankfurt, Germany
| | - Shahram Ghanaati
- Department of Oral- Cranio- Maxillofacial and Facial Plastic Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt, Germany
| | - Lutz Weise
- Division of Neurosurgery, Dalhousie University, Halifax, Canada
| | - Volker Seifert
- Department of Neurosurgery, Johann Wolfgang Goethe University Hospital, Frankfurt, Germany
| | - Gerhard Marquardt
- Department of Neurosurgery, Johann Wolfgang Goethe University Hospital, Frankfurt, Germany
| | - Johanna Quick-Weller
- Department of Neurosurgery, Johann Wolfgang Goethe University Hospital, Frankfurt, Germany
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Shiraishi M, Sowa Y, Tsuge I, Shiraishi A, Inafuku N, Nakayama I, Morimoto N. Risk factors associated with chronic pain after mastectomy: a prospective study with a 5-year follow-up in Japan. Breast Cancer 2022; 29:1133-1139. [PMID: 36018439 DOI: 10.1007/s12282-022-01392-8] [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: 06/17/2022] [Accepted: 07/29/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic pain is a major complication following breast surgery including breast reconstruction. We previously examined prospective patient-specific and medical/surgical factors that predict chronic pain a year after breast surgery in the Japanese population. Five-year survivorship is essential for breast cancer patients. This report is a 4-year follow-up study following the previous research. METHODS A follow-up observation study was performed 5 years after breast operations. The subjects were patients who underwent breast surgery, including tissue expander/implant (TE/implant), DIEP procedures and mastectomy only. Pain at 5 years was assessed using the Japanese Version of the Short-Form McGill Pain Questionnaire (SF-MPQ-JV). A multiple linear regression model was used to examine the relationships of clinical factors with chronic pain. RESULTS Questionnaires were completed by 132 subjects. No factor related to chronic pain was significantly related to the MPQ pain ratings. Among patient characteristics, a psychotic or neurological medical history was related to significantly lower visual analog scale (p = 0.02) and present pain index (p = 0.04) scores. A history of chemotherapy and/or hormone therapy was significantly associated with the frequency of use of pain medication postoperatively (p = 0.05) and effect on the social life of the patients (p = 0.02). CONCLUSIONS A psychotic or neurological history and a history of chemotherapy and/or hormone therapy were identified as risk factors for chronic pain after breast surgery, but the type of operation was not associated with chronic pain.
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Affiliation(s)
- Makoto Shiraishi
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 54 Shogoin Kawahara-cho, Sakyou-ku, Kyoto, 606-8507, Japan.,Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - Yoshihiro Sowa
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 54 Shogoin Kawahara-cho, Sakyou-ku, Kyoto, 606-8507, Japan. .,Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan.
| | - Itaru Tsuge
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Akiko Shiraishi
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 54 Shogoin Kawahara-cho, Sakyou-ku, Kyoto, 606-8507, Japan
| | - Naoki Inafuku
- Department of Plastic and Reconstructive Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 54 Shogoin Kawahara-cho, Sakyou-ku, Kyoto, 606-8507, Japan
| | - Ichiro Nakayama
- Department of Breast Surgery, Kyoto Miniren Chuo Hospital, Kyoto, Japan
| | - Naoki Morimoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
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Tevlin R, Cemaj SL, Azad AD, Borrelli MR, Silverstein ML, Posternak V, Nguyen D, Lee GK, Nazerali RS. Smooth versus textured tissue expanders in breast reconstruction - A retrospective review of post-operative surgical site infections. J Plast Reconstr Aesthet Surg 2022; 75:3060-3067. [PMID: 35768293 DOI: 10.1016/j.bjps.2022.04.087] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 05/11/2021] [Revised: 04/05/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Textured tissue expanders (TTEs) were introduced to limit migration and reduce capsular contracture, which were inherent to smooth tissue expanders (STEs). Previous reports suggest that textured devices have increased rates of bacterial contamination and biofilm formation in comparison with smooth devices. Recently, the relative increased association of anaplastic large cell lymphoma (ALCL) with textured versus smooth devices has led to increased adoption of smooth devices. The aim of our study is to evaluate the post-operative surgical site infection (SSI) rates of STEs versus TTEs. METHODS A retrospective case series was conducted at a single academic teaching hospital from April 2016 to December 2019. The primary outcome variable was the development of a post-operative SSI. RESULTS One hundred seventy-seven breasts underwent reconstruction with TTEs and 109 breasts underwent reconstruction with STE. In total, 54 SSIs were recorded (n = 34 TTE; n = 20 STE), with the majority of infections occurring within the first 30 post-operative days (TTE 65%, STE 70%). There was no statistically significant difference in overall post-operative infection rates between TTE and STE groups when broken down into the following time points: <30 day, 30-60 days, and >90 days (p = 0.924). There was no statistically significant difference between infection type (superficial vs. deep, p = 0.932), infection management (medical, surgical, or both, p = 0.409) or salvage results (p = 0.078) seen in STE versus TTE cohort. On multivariate analysis, seroma history was associated with SSI development (OR 3.18, p = 0.041). CONCLUSION There was no significant difference in the rate of post-operative SSI following breast reconstruction with STE relative to TTE.
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Affiliation(s)
- Ruth Tevlin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA, United States; Royal College of Surgeons in Ireland, St. Stephen's Green, Dublin, Ireland
| | - Sophie L Cemaj
- Section of Plastic and Reconstructive Surgery, University of Chicago Medicine, Chicago, IL, United States; University of Nebraska Medical Center, Omaha, NE, United States
| | - Amee D Azad
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA, United States
| | - Mimi R Borrelli
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Brown University, Providence, RI, United States
| | - Max L Silverstein
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA, United States; Larner College of Medicine the University of Vermont, Burlington, VT, United States
| | - Victoria Posternak
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA, United States
| | - Dung Nguyen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA, United States
| | - Gordon K Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA, United States
| | - Rahim S Nazerali
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University Medical Center, Stanford, CA, United States.
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11
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Kitazawa M, Futamura M, Tokumaru Y, Kohyama K, Nakakami A, Yoshida K. Breast reconstruction using a tissue expander after enucleation of a giant fibroadenoma: A case report. Int J Surg Case Rep 2022; 90:106723. [PMID: 34991047 PMCID: PMC8741496 DOI: 10.1016/j.ijscr.2021.106723] [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: 11/26/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Fibroadenomas are among the most common benign tumors in women. Juvenile giant fibroadenomas account for nearly 0.5% of all fibroadenomas. Due to its size, a giant juvenile fibroadenoma leaves a large defect or deformity after its resection. The optimal surgical management strategy for giant juvenile fibroadenomas remains unclear. Here, we report a case of successful breast reconstruction without residual deformity through gradual deflation of a saline-filled tissue expander after resection of a giant juvenile fibroadenoma. PRESENTATION OF CASE A 14-year-old girl with a growing tumor in her left breast presented to a private clinic. Given that the tumor was 8 cm in size, phyllodes could not be ruled out. Consequently, she was referred to our hospital for further examination and treatment. Core needle biopsy confirmed the tumor to be a fibroadenoma. We resected the tumor and inserted a tissue expander filled with 120 mL of saline, matching the area of the large defect caused by tumor resection. We removed approximately 25 mL of saline every 3 weeks to aid normal mammary tissue enlargement. After completely draining saline from the tissue expander and confirming an acceptable enlargement of the residual mammary gland, we performed an operation to remove the tissue expander. Follow-up revealed that the symmetry and contour of the breast were excellent after the second operation. CONCLUSIONS Our observations suggest that using a tissue expander to enlarge normal mammary tissue may help reconstruct large defects caused by excision of benign tumors.
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Affiliation(s)
- Mai Kitazawa
- Breast Surgery, Department of Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Manabu Futamura
- Breast Surgery, Department of Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.
| | - Yoshihisa Tokumaru
- Breast Surgery, Department of Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Keishi Kohyama
- Department of Plastic and Reconstructive Surgery, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Akira Nakakami
- Breast Surgery, Department of Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Kazuhiro Yoshida
- Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.
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Elia R, Maruccia M, Nacchiero E, De Cosmo A, Giudice G. The Expander-Implant Breast Reconstruction in the COVID Era: Which is the "Unhappy" Tissue Expander Priority? Aesthetic Plast Surg 2021; 45:3090-3091. [PMID: 33913018 PMCID: PMC8080861 DOI: 10.1007/s00266-021-02321-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 01/21/2023]
Abstract
Breast surgeons seem to agree on the fact that a same-day surgery (mastectomy and breast reconstruction) protocol provides appropriate cancer treatment during times of unprecedented resource limitations, such as in the COVID era. In this scenario, pre-pectoral implant-based breast reconstruction can be definitively considered a sustainable technique. Nevertheless, the authors focus on the management of patients who had already undergone a same day procedure with two-stage breast reconstruction, implanting a breast tissue expander during the last two-year period and have been progressively delayed according to a surgical care based on priority. We coined the expression “unhappy tissue expander” to define all those symptomatic patients for which surgery should not be delayed even during an epidemic context. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- R Elia
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy.
| | - M Maruccia
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - E Nacchiero
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - A De Cosmo
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - G Giudice
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
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Sullivan B, Ryan I, Henderson PW. Objective Comparison of FDA-Approved Breast Implant Products in the USA: 5-Year Update. Aesthetic Plast Surg 2021; 45:2568-2577. [PMID: 34128092 DOI: 10.1007/s00266-021-02395-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are currently four companies offering FDA-approved breast implants: Allergan, Sientra, Mentor, and Ideal Implant. In 2015, our paper "Objective Comparison of Commercially Available Breast Implant Devices" sought to provide a unique conceptual framework to better understand the similarities and differences between FDA-approved breast implant products and tissue expanders. This paper uses the same variables, such as fill material, shape, relative dimensions, and surface coating, to aid understanding of both the surgical trainee and the operating surgeon of what devices each company offers, with a focus on how the market has evolved over the ensuing 5 years. METHODS The product catalogs of each FDA-approved company were carefully explored to determine the current available breast implants and tissue expanders. Subsequently, flow charts were created to provide a clear and objective survey of each companies' offerings, highlighting where there are overlap and deficiencies, and where there has been contraction or growth. RESULTS Disruptions to the industry, including both technological innovation and the recognition of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), have caused a significant shift in the details of the available permanent breast implants, breast tissue expanders, sizers, and warranty programs. CONCLUSION As it has been in 2015, company jargon and brand names continue to make it challenging to discern the similarities and differences between company devices and programs. This project remained independent of any company's funding, support, or input, making it a uniquely objective and informative survey of the current breast implant market that should assist surgeons in decision-making regarding the breast implant procedures. 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)
- Brianne Sullivan
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Isabel Ryan
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter W Henderson
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Dolen UC, Law J, Tenenbaum MM, Myckatyn TM. Breast reconstruction is a viable option for older patients. Breast Cancer Res Treat 2021. [PMID: 34609642 DOI: 10.1007/s10549-021-06389-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 09/06/2021] [Indexed: 01/02/2023]
Abstract
PURPOSE Breast cancer is diagnosed at a median age of 62 years in the USA. At the same time, mortality rates for breast cancer continue to decrease, falling by 40% from 1989 to 2016. In the coming decades, the number of elderly patients with breast cancer, potentially seeking reconstruction, is expected to increase. METHODS A retrospective chart review of 309 patients, aged 60 years or older, undergoing immediate or delayed breast reconstruction, was conducted. Patient characteristics, clinical information and major complications requiring reoperation were evaluated. Multivariate analyses identified factors contributing to complications such as BMI, comorbidities, smoking status, history of previous breast conservation therapy (BCT), total expander volume, radiotherapy, and chemotherapy. RESULTS 26.7% of patients had at least one complication requiring reoperation, and 6.9% of patients suffered reconstructive failure. Logistic regression analysis of all patients (n = 309) found a statistically significant relationship between major complication and history of ipsilateral BCT (p = 0.026) and adjuvant chemotherapy (p = 0.005). Logistic regression analysis in patients undergoing tissue expander (TE) reconstruction (n = 215) showed that major complications were related to BMI over 35 kg/m2 (p = 0.04), history of ipsilateral BCT (p = 0.048), and adjuvant chemotherapy (p = 0.033). CONCLUSION Breast reconstruction in women over 60 years old was not independently associated with higher major complication rates in our series.
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15
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Hammond DC, Geisler E, Little AK. Chronic Persisting Hematoma: Report of a Case and Literature Review. Aesthetic Plast Surg 2021; 45:2131-2134. [PMID: 34231020 DOI: 10.1007/s00266-021-02364-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/17/2021] [Indexed: 10/20/2022]
Abstract
The authors present a unique case of chronic persisting hematoma formation at the site of a remote congenital melanocytic nevus excision with tissue expander reconstruction. Similarities between chronic persisting hematoma and chronic encapsulated seroma are addressed to provide guidance on the appropriate workup and management for the plastic surgeon. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Chang Y, Zhang F, Liu F, Shi L, Zhang L, Zhu H. Self-swelling tissue expander for soft tissue reconstruction in the craniofacial region: An in vitro and in vivo evaluation. Biomed Mater Eng 2021; 33:77-90. [PMID: 34250925 DOI: 10.3233/bme-211224] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Craniofacial soft-tissue defects mostly have an impact on the treatment of various oral diseases. Tissue expander is an important technique for tissue reconstruction, especially for soft tissues in reconstructive surgery. OBJECTIVE This research aimed to develop a new self-swelling tissue expander, namely hydrogel, for soft tissue reconstruction in craniofacial region. METHODS In vitro, the chemical and physical characteristics of hydrogel were evaluated by SEM, swelling rate, mechanical testing, EDS, and FT-IR. In vivo, the craniofacial implant model of SD rats were divided into group A as control, group B with hydrogels for 1 week expansion, group C for 2 weeks and group D for 4 weeks (n = 5), and the effects were analyzed by HE staining, histological and radiographic evaluation. RESULTS The in vitro results suggested that dry hydrogel possessed a uniform surface with micropores, the surface of post-swelling hydrogel formed three-dimensional meshwork. Within 24 hours, hydrogels expanded markedly, then slowed down. The mechanical property of hydrogels with longer expansion was better, whose main elements were carbon and oxygen. FT-IR also verified its molecular structure. In vivo, the wounds of rats recovered well, hydrogels could be removed as one whole piece with original shape and examined by radiographic evaluation, besides, the expanded skin and developed fibrous capsule formed surrounding hydrogels. CONCLUSION The new expander was designed successfully with good chemical and physical characteristics, and could be applied in an animal model to help tissue reconstruction.
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Affiliation(s)
- Yili Chang
- Department of Ophthalmology, Affiliated Eye Hospital of Nanchang University, China.,The Graduate School of Nanchang University, China
| | - Fubao Zhang
- The Graduate School of Nanchang University, China.,Department of Stomatology, The Third Affiliated Hospital of Nanchang University, China
| | - Feng Liu
- College of Chemistry, Nanchang University, China
| | - Lianshui Shi
- Department of Prosthodontics, Affiliated Stomatological Hospital of Nanchang University, China
| | - Lin Zhang
- Department of Prosthodontics, Affiliated Stomatological Hospital of Nanchang University, China
| | - Hongshui Zhu
- Department of Prosthodontics, Affiliated Stomatological Hospital of Nanchang University, China
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17
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Hassayoune N, Mhallem Gziri M, Lentini A, Chrelias T, Hammer J, Berlière M, Lengelé B, Coyette M. Severe Gestational Gigantomastia: from Mastectomy to Staged Autologous Breast Reconstruction. A Case Report. JPRAS Open 2021; 29:65-70. [PMID: 34189231 PMCID: PMC8220097 DOI: 10.1016/j.jpra.2021.04.011] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/29/2021] [Indexed: 11/03/2022] Open
Abstract
Gestational gigantomastia (GGM) is a rare condition characterized by a massive overgrowth of breast tissue during pregnancy. Surgical sanction may be required when conservative measures fail. In this study, we report the case of a 29-year-old woman who presented with an evolutive GGM responsible for physical and emotional distress, despite medical treatment. A multidisciplinary decision was made to induce delivery at 32 weeks. In the postdelivery period, the patient developed breast wounds, complicated with septic cardiomyopathy. An emergency bilateral mastectomy was then carried out, together with banking of both nipple-areola complexes. Thereafter, delayed bilateral 2-stage breast reconstruction was started at 12 months with subcutaneous tissue expanders, later on followed by implants removal and autologous reconstruction with bilateral deep inferior epigastric artery perforator flaps and bilateral nipple replantation.
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Affiliation(s)
- Noureddine Hassayoune
- Department of Plastic and Reconstructive Surgery, Cliniques Universitaires Saint-Luc, UCLouvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Mina Mhallem Gziri
- Department of Obstetrics, Cliniques Universitaires Saint-Luc, UCLouvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Audrey Lentini
- Department of Plastic and Reconstructive Surgery, Cliniques Universitaires Saint-Luc, UCLouvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Theodoros Chrelias
- Department of Plastic and Reconstructive Surgery, Cliniques Universitaires Saint-Luc, UCLouvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Jennifer Hammer
- Department of Plastic and Reconstructive Surgery, Cliniques Universitaires Saint-Luc, UCLouvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Martine Berlière
- Department of Gynecology, Cliniques Universitaires Saint-Luc, UCLouvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Benoît Lengelé
- Department of Plastic and Reconstructive Surgery, Cliniques Universitaires Saint-Luc, UCLouvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Maude Coyette
- Department of Plastic and Reconstructive Surgery, Cliniques Universitaires Saint-Luc, UCLouvain, Avenue Hippocrate 10, 1200, Brussels, Belgium
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18
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Omejc A, Vegan L, Omejc M, Velenik V. Laparoscopic insertion of pelvic tissue expander prior radiotherapy for sacral metastasis of alveolar maxillary rhabdomyosarcoma to prevent radiation enteritis. Int J Surg Case Rep 2021; 81:105718. [PMID: 33735735 PMCID: PMC7988321 DOI: 10.1016/j.ijscr.2021.105718] [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: 02/09/2021] [Revised: 02/27/2021] [Accepted: 02/28/2021] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Rhabdomyosarcoma is the most common soft tissue sarcoma seen in childhood and adolescence. The most frequent sites are head and neck. PRESENTATION OF CASE A young female with maxillary rhabdomyosarcoma involving region of maxillary sinus with skeletal metastases was primary treated acccording to RMS 2005 protocol. She received 9 cycles of chemotherapy. Primary tumor of maxillary sinus was surgicaly removed after 4 cycles of chemotherapy, with 6th cycle of chemotherapy a radical radiotherapy of primary tumor location and metastasis in spinal vertebras, ribs, pelvic bone and left femoral bone started what leads to complete regression of skeletal metastases. In course of maintenance therapy MRI scan showed 12 × 28 × 23 mm lesion in sacrum in the vicinity of right sacroiliacal joint with caracteristics of metastasis. Because the region of right sacroiliacal joint with bowel was already included in primary radiation treatment, tissue expander was laparoscopicaly inserted in lower pelvis to displace bowel loops from radiation field to prevent radiation enteritis. After external beam radiotherapy to her sacrum, a good response without any side effects was achieved. DISCUSSION Laparoscopic insertion of pelvic tissue expander prior EBRT and it's subsequent removal after EBRT is safe and effective method for displacing loops of bowel out of the pelvis. With minimal morbidity converts untreatable disease to treatable by allowing delivering high doses of radiation to the patient. CONCLUSION After 2 years of follow up the disease is in remission and the patient without any major complaint.
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Affiliation(s)
- Andrej Omejc
- Medical Faculty, University of Ljubljana, Slovenia
| | - Lucija Vegan
- Medical Faculty, University of Ljubljana, Slovenia
| | - Mirko Omejc
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Zaloska 7, 1000 Ljubljana, Slovenia.
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Al-Majhali SH, Khairuddin NH, Abdul Razak IS, Radzi Z, Rahman MT, Sapalo JT, Mayaki AM, Czernuszka JT. Biomechanical Effects of Unidirectional Expansion Using Anisotropic Expanders in Horse Skin Tissue. J Equine Vet Sci 2021; 99:103399. [PMID: 33781409 DOI: 10.1016/j.jevs.2021.103399] [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: 08/12/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 11/27/2022]
Abstract
The use of a self-inflating tissue expander is a technique to stretch cutaneous tissues for potential use in reconstructive skin surgeries. This study investigates the mechanical properties of horse skin stretched by the subcutaneous implantation of anisotropic tissue expanders at the forehead, right shoulder, and dorsomedial part of the cannon region of the right forelimb in six (n = 6) horses. After 14 days of skin expansion, expanded and normal (control) skin samples were harvested and their mechanical properties of elastic modulus (EM), maximum force (MF), maximum stress (MSs) and maximum strain (MSr) were evaluated using uniaxial tension test. The expanded skin from shoulder area has higher EM, MSs, MSr and MF than the normal skin when compared to the forehead and lower forelimb. Statistically, there was a significant (P= .02) mean difference for MSs between the expanded shoulder and lower forelimb skin, but the pairwise comparison of EM, MSr and MF showed no significant difference between the locations. The overall effect of locations on EM and MSs was statistically significant (P < .05), however, there was no overall effect of horse factor, treatment factor (normal and expanded skin) and location interaction on the EM, MSS, MF and MSr. In conclusion, the expanded skin from the frontal head and the distal limb are less elastic (stiffer) compared to that of the expanded skin of the shoulder, thus anatomical location of the skin has some degree of effect on EM and MSs.
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Affiliation(s)
| | - Nurul Hayah Khairuddin
- Department of Farm and Exotic Animal Medicine and Surgery, Faculty of Veterinary Medicine, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia.
| | - Intan Shameha Abdul Razak
- Department of Veterinary Preclinical Science, Faculty of Veterinary Medicine, Universiti Putra Malaysia
| | - Zamri Radzi
- Faculty of Dentistry, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | | | | | - Abubakar Musa Mayaki
- Department of Veterinary Medicine, Usmanu Danfodiyo University, PMB 2346, Sokoto, Nigeria
| | - Jan T Czernuszka
- Department of Materials, University of Oxford, Parks Road, OX1 3PH, United Kingdom
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Dong C, Zhu M, Huang L, Liu W, Liu H, Jiang K, Yu Z, Ma X. Risk factors for tissue expander infection in scar reconstruction: a retrospective cohort study of 2374 consecutive cases. Burns Trauma 2021; 9:tkaa037. [PMID: 33426134 PMCID: PMC7780061 DOI: 10.1093/burnst/tkaa037] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/07/2020] [Indexed: 11/14/2022]
Abstract
Background Tissue expansion is used for scar reconstruction owing to its excellent clinical outcomes; however, the complications that emerge from tissue expansion hinder repair. Infection is considered a major complication of tissue expansion. This study aimed to analyze the perioperative risk factors for expander infection. Methods A large, retrospective, single-institution observational study was carried out over a 10-year period. The study enrolled consecutive patients who had undergone tissue expansion for scar reconstruction. Demographics, etiological data, expander-related characteristics and postoperative infection were assessed. Univariate and multivariate logistic regression analysis were performed to identify risk factors for expander infection. In addition, we conducted a sensitivity analysis for treatment failure caused by infection as an outcome. Results A total of 2374 expanders and 148 cases of expander infection were assessed. Treatment failure caused by infection occurred in 14 expanders. Multivariate logistic regression analysis identified that disease duration of ≤1 year (odds ratio (OR), 2.07; p < 0.001), larger volume of expander (200–400 ml vs <200 ml; OR, 1.74; p = 0.032; >400 ml vs <200 ml; OR, 1.76; p = 0.049), limb location (OR, 2.22; p = 0.023) and hematoma evacuation (OR, 2.17; p = 0.049) were associated with a high likelihood of expander infection. Disease duration of ≤1 year (OR, 3.88; p = 0.015) and hematoma evacuation (OR, 10.35; p = 0.001) were so related to high risk of treatment failure. Conclusions The rate of expander infection in patients undergoing scar reconstruction was 6.2%. Disease duration of <1 year, expander volume of >200 ml, limb location and postoperative hematoma evacuation were independent risk factors for expander infection.
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Affiliation(s)
- Chen Dong
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, People's Republic of China
| | - Minhui Zhu
- Department of Burn and Plastic Surgery, the Sixth Medical Center of Chinese PLA General Hospital, Beijing, 100048, People's Republic of China
| | - Luguang Huang
- Information Center, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, People's Republic of China
| | - Wei Liu
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, People's Republic of China
| | - Hengxin Liu
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, People's Republic of China
| | - Kun Jiang
- Information Center, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, People's Republic of China
| | - Zhou Yu
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, People's Republic of China
| | - Xianjie Ma
- Department of Plastic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi, People's Republic of China
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21
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Ozturk C, Ozturk CN, Platek M, Soucise A, Laub P, Morin N, Lohman R, Moon W. Management of Expander- and Implant-Associated Infections in Breast Reconstruction. Aesthetic Plast Surg 2020; 44:2075-82. [PMID: 32840671 DOI: 10.1007/s00266-020-01923-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Periprosthetic infection remains the most common complication after implant-based breast reconstruction. Objectives of the study were to (1) describe our clinical approach and treatment protocol for managing patients with suspected periprosthetic infection, (2) identify the microorganisms causing periprosthetic infections at our institute, and (3) report on outcomes of implant salvage versus explantation. METHODS A retrospective chart review of patients who were treated with parenteral antibiotics for periprosthetic infection was carried out. Patient characteristics, clinical and laboratory findings, outcomes, treatment modalities and complications were extracted from electronic medical records. Data were compared between patients whose implants were salvaged versus explanted. RESULTS Fifty-nine patients with 67 tissue expander (TE)/implants underwent parenteral antibiotic treatment for suspected infection. Thirty-three (49%) of the TE/implants were salvaged. Mean follow-up was 14.3 months. The most commonly cultured organisms were P. aeruginosa followed by S. epidermidis. All suspected infections were treated with broad spectrum parenteral antibiotics with MRSA coverage. The most common combination was daptomycin 6 mg/kg combined with Zosyn 4.5 g. Explantations were significantly more common in patients with history of chemotherapy (p = 0.03), hypertension (p = 0.04) and those who underwent therapeutic mastectomy (p = 0.04). CONCLUSION Risk factors for explantation due to postoperative periprosthetic infections following TE/implant-based breast reconstruction include chemotherapy, hypertension and therapeutic mastectomy. Prompt diagnosis and effective treatment of periprosthetic infection, particularly in these high-risk patients, are imperative to salvage the breast reconstruction. Gram-negative bacteria are increasingly found in breast implant infections and should be covered when employing empiric antibiotherapy. 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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22
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Souto LRM. Invited Discussion on: Management of Expander and Implant Associated Infections in Breast Reconstruction. Aesthetic Plast Surg 2020; 44:2083-2088. [PMID: 32959129 DOI: 10.1007/s00266-020-01974-x] [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: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 11/25/2022]
Abstract
The author presents an objective review on "Management of Expander and Implant Associated Infections in Breast Reconstruction," discussing different points related to this subject, such as infection definition, identification of risk factors, related microorganisms, surgical techniques, preventive measures, antibiotic prophylaxis and therapy. Flaws in methodologies are identified and points of discrepancy in data and treatment results from previously published studies are pointed out, with discussion of possible causes for these inconsistencies. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Luís Ricardo Martinhão Souto
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculdade de Medicina de Marília (FAMEMA), Avenida Presidente Roosevelt, 41, Marília, SP, 17501-480, Brazil.
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Luan A, Patel AA, Martin SA, Nazerali RS. Single-Unit technique for the use of acellular dermal matrix in immediate expander-based breast reconstruction. J Plast Reconstr Aesthet Surg 2021; 74:981-6. [PMID: 33248935 DOI: 10.1016/j.bjps.2020.10.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/20/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The use of acellular dermal matrices (ADMs) in immediate two-stage prosthetic breast reconstruction following mastectomy is now a common practice. The procedure confers several compelling benefits, including coverage of the inferior pole, enhanced definition of the inframammary fold, and reduction of capsular contracture. However, operative techniques used to create the ADM inferolateral sling can be unwieldy in practice, typically involving the placement of the ADM followed by positioning and anchoring of the prosthetic expander. At best, this may be a relatively minor nuisance, but may potentially influence outcomes, including discrepancies in symmetry. METHODS We present a novel modification that aims to streamline this procedure. Perforations are made through the allograft, through which the tissue expander tabs are brought through and sutured together ex vivo to allow the ADM and expander to be placed into the inframammary fold position as a single unit. A retrospective chart review was then performed of patients who underwent breast reconstruction utilizing this technique between July 2015 and December 2018. Outcomes including postsurgical complications such as infection, malposition, and reoperation were analyzed. RESULTS Sixty-two patients met the inclusion criteria, corresponding to 108 breasts. The average follow-up was 18 months. The overall complication rate was 29.6% of breasts. The most commonly observed complications were mastectomy skin necrosis (9.3%) and major infection (8.3%). There was a 7.4% rate of malposition. CONCLUSIONS This simple but effective modification in ADM technique is associated with a comparable complication rate and allows for greater ease and consistency in tissue expander placement.
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Lee KT, Lee H, Jeon BJ, Mun GH, Bang SI, Pyon JK. Impact of overweight/obesity on the development of hematoma following tissue expander-based breast reconstruction. J Plast Reconstr Aesthet Surg 2020; 74:S1748-6815(20)30434-4. [PMID: 34756415 DOI: 10.1016/j.bjps.2020.08.105] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 12/07/2019] [Accepted: 08/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Overweight and obesity are well-known risk factors for postoperative complications; however, their impacts on hematoma formation have not been clarified. Several studies have suggested that overweight/obesity could have procoagulative effects, potentially reducing a risk for developing postoperative bleeding complications. This study aimed to investigate the effects of overweight/obesity on hematoma formation following tissue expander-based breast reconstruction. METHOD Patients who underwent immediate tissue expander-based unilateral breast reconstruction between January 2010 and November 2018 were reviewed. They were categorized into four groups according to body mass index (BMI): underweight (<18.5 kg/m2), normal weight (18.5-25.0 kg/m2), overweight (25.0-30.0 kg/m2), and obesity (>30.0 kg/m2). The outcome was major postoperative hematoma, defined as one requiring emergent surgical intervention. Independent impacts of variables on hematoma development were evaluated via uni- and multivariable analyses. RESULTS A total of 1,431 patients were analyzed, including 133 cases (9.3%) with underweight, 952 (66.5%) with normal weight, 302 (21.1%) with overweight, and 44 (3.1%) with obesity. Postoperative major hematoma developed in 29 cases (2.0%). The rate of hematoma formation was 2.3%, 2.6%, 0.3%, and 0% in the underweight, normal weight, overweight, and obesity groups, respectively, showing a significantly decreasing trend (p = 0.009), while those of other complications including seroma and mastectomy flap necrosis revealed the opposite trends, being significantly elevated as patient BMI increased. Multivariate analyses found overweight to be an independent protector against major hematoma compared with normal weight (p = 0.014; odds ratio=0.071). CONCLUSION Overweight/obesity might have a protective effect on development of major bleeding complications following tissue expander-based breast reconstruction.
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Affiliation(s)
- Kyeong-Tae Lee
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-dong 50, Gangnam-gu, Seoul 135-710, South Korea
| | - Hojune Lee
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-dong 50, Gangnam-gu, Seoul 135-710, South Korea
| | - Byung Joon Jeon
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-dong 50, Gangnam-gu, Seoul 135-710, South Korea
| | - Goo-Hyun Mun
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-dong 50, Gangnam-gu, Seoul 135-710, South Korea
| | - Sa Ik Bang
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-dong 50, Gangnam-gu, Seoul 135-710, South Korea
| | - Jai-Kyong Pyon
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-dong 50, Gangnam-gu, Seoul 135-710, South Korea.
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Chen H, Teng X, Hu XH, Cheng L, Du WL, Shen YM. Application of a pre-filled tissue expander for preventing soft tissue incarceration during tibial distraction osteogenesis. World J Clin Cases 2020; 8:2181-2189. [PMID: 32548148 PMCID: PMC7281070 DOI: 10.12998/wjcc.v8.i11.2181] [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: 03/14/2020] [Revised: 04/19/2020] [Accepted: 05/12/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Bone transport and distraction osteogenesis has been widely used to treat bone defects after traumatic surgery, but, skin and soft tissue incarceration can be as high as 27.6%.
AIM To investigate the efficacy of inserting a tissue expander to prevent soft tissue incarceration.
METHODS Between January 2016 and December 2018, 12 patients underwent implantation of a tissue expander in the subcutaneous layer in the vicinity of a tibial defect to maintain the soft tissue in position. A certain amount of normal saline was injected into the tissue expander during surgery and was then gradually extracted to shrink the expander during the course of transport distraction osteogenesis. The tissue expander was removed when the two ends of the tibial defect were close enough.
RESULTS In all 12 patients, the expanders remained intact in the subcutaneous layer of the bone defect area during the course of transport distraction osteogenesis. When bone transport was adequate, the expander was removed and the bone transport process was completed. During the whole process, there was no incarceration of skin and soft tissue in the bone defect area. Complications occurred in one patient, who experienced poor wound healing.
CONCLUSION The pre-filled expander technique can effectively avoid soft tissue incarceration. The authors’ primary success with this method indicates that it may be a valuable tool in the management of incarcerated soft tissue.
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Affiliation(s)
- Hui Chen
- Department of Burns and Plastic Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Xing Teng
- Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Xiao-Hua Hu
- Department of Burns and Plastic Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Lin Cheng
- Department of Burns and Plastic Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Wei-Li Du
- Department of Burns and Plastic Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Yu-Ming Shen
- Department of Burns and Plastic Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
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Ollivier L, Guilloit JM, Dos Santos M, Guillemette L, Florescu C, M'vondo CM, Meyer E, Galais MP, Corbinais S, Parzy A, Varatharajah S, Lesueur P. Implantation of tissue expander prior to irradiation in the era of intensity modulated radiotherapy: impact on the management of patients with pelvic digestive cancers. Int J Colorectal Dis 2020; 35:559-564. [PMID: 31853620 DOI: 10.1007/s00384-019-03475-z] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Before the introduction of intensity-modulated radiation therapy (IMRT), few teams used to implant a pelvic tissue expander to keep the bowel away from the radiation field, so as to reduce the risk of acute and late enteritis. However, this unexpected surgery could impact patient's overall treatment and may be no more necessary in the era of modern radiotherapy. MATERIAL AND METHODS This is a retrospective cross-sectional study including 13 patients who underwent tissue expander implantation before radiotherapy or chemoradiotherapy for rectal or anal carcinoma between November 2008 and March 2019. First, we aim to show that IMRT could sometimes be insufficient to respect dosimetric constraints, and then we aim to report the impact of tissue expander implantation on the global strategy of care of patients with anal and rectal cancers. RESULTS Seventy-seven percent of the included patients were treated for anal neoplasms, while the remaining 23% had locally advanced rectal cancer. The median follow-up since implantation of the expander was 51 months [3.7-115]. Three patients recurred. One patient developed grade III toxicity related to the implantation of a tissue expander. The delay between diagnosis and the start of irradiation was significantly prolonged (median of 3 months), requiring unusual induction chemotherapy. CONCLUSION Implantation of tissue expander prior to chemoradiotherapy should be considered, even in the era of IMRT, when irradiated peritoneal cavity volume (V15Gy-V45Gy) far exceeds usual dose constraints. However, it impacts the global strategy of care by delaying the start of irradiation, by introducing induction chemotherapy, and rarely by causing post-operative complications.
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Affiliation(s)
- Luc Ollivier
- Centre François Baclesse, Radiation oncology Department, 3 avenue du general Harris, 14000, Caen, France
- CHRU de Brest, Radiation oncology department, 29200, Brest, France
| | | | - Mélanie Dos Santos
- Centre François Baclesse, Medical Oncology Department, 14000, Caen, France
- Normandy University, Université de Caen Basse Normandie, 14000, Caen, France
| | - Laura Guillemette
- Centre François Baclesse, Radiation oncology Department, 3 avenue du general Harris, 14000, Caen, France
| | - Carmen Florescu
- Centre François Baclesse, Radiation oncology Department, 3 avenue du general Harris, 14000, Caen, France
| | - Che Mabubu M'vondo
- Centre François Baclesse, Radiation oncology Department, 3 avenue du general Harris, 14000, Caen, France
| | - Emmanuel Meyer
- Centre François Baclesse, Radiation oncology Department, 3 avenue du general Harris, 14000, Caen, France
| | | | - Stéphane Corbinais
- Centre François Baclesse, Medical Oncology Department, 14000, Caen, France
| | - Aurelie Parzy
- Centre François Baclesse, Medical Oncology Department, 14000, Caen, France
| | | | - Paul Lesueur
- Centre François Baclesse, Radiation oncology Department, 3 avenue du general Harris, 14000, Caen, France.
- Normandy University, Université de Caen Basse Normandie, 14000, Caen, France.
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Ma JX, Xia YC, Li B, Zhao HM, Lei YT. Unilateral Tissue Expander/Implant Two-Stage Breast Reconstruction with the Assistance of Three-Dimensional Surface Imaging. Aesthetic Plast Surg 2020; 44:60-69. [PMID: 31598769 DOI: 10.1007/s00266-019-01513-3] [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: 06/16/2019] [Accepted: 09/26/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND In China, traditional preoperative planning of unilateral breast reconstruction mainly depends on anthropometric measurement and visual assessment. Thus, the lack of objective assessment of breast volume and shape would likely result in suboptimal reconstruction outcomes. Three-dimensional surface imaging (3D-SI), which could provide objective measurement data of the breast, may be a promising solution to this problem. METHODS A retrospective review of patients undergoing tissue expander (TE)/implant breast reconstruction without any mammoplasty surgery on the contralateral sides in our hospital from August 2013 to May 2018 was performed. All the patients underwent unilateral mastectomy with immediate or delayed insertion of TE, followed by an exchange of a silicone gel implant without contralateral procedures. 3D images were obtained at the time of preoperation, the routine expansion visit, and post-exchange of implant. The breast volume measured by 3D-SI served as a guide to conduct the surgery management, such as in deciding the total volume of expansion and guiding the final implant size selection. 3D-SI also provided objective data to evaluate the final outcomes of the reconstruction. RESULTS Fifty-one patients were included in this study, in which eighteen patients underwent immediate TE insertion and thirty-three patients underwent delayed TE insertion. The ptosis degree of contralateral breasts was assessed as follows: forty-four were normal, and seven showed mild ptosis. The average expansion degree was controlled at 161.6% ± 14.1% compared to the contralateral breasts. The volume of implants exchanged had a strong linear correlation with the 3D volume of the contralateral breasts at the end of expansion (P < 0.01). The mean time of follow-up was 9.1 ± 6.6 months. There was only one patient who experienced TE leakage with secondary infection and received TE exchange. For the immediate reconstruction group, the overall breast symmetry improved at the completion of implant exchange (P < 0.01), with an average asymmetry of 5.3% ± 4.0% compared with 10.6% ± 6.1% initially. For the delayed reconstruction group, the reconstructed side achieved good volume symmetry to the contralateral side (P > 0.05). There was no significant difference in breast basal width between bilateral breasts post-reconstruction (P > 0.05). CONCLUSION 3D-SI serves as a valuable adjunct by providing accurate 3D volume of breasts within TE/implant breast reconstruction in Chinese patients without obvious breast ptosis, which could facilitate surgeons to achieve good reconstructive outcomes. 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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Lim YM, Lew DH, Roh TS, Song SY. Analysis of factors that affect drainage volume after expander-based breast reconstruction. Arch Plast Surg 2020; 47:33-41. [PMID: 31964121 DOI: 10.5999/aps.2019.00283] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 11/15/2019] [Indexed: 11/29/2022] Open
Abstract
Background Closed-suction drains are widely used in expander-based breast reconstruction. These drains are typically removed using a volume-based criterion. The drainage volume affects the hospital stay length and the recovery time. However, few studies have analyzed the factors that influence drainage volume after expander-based breast reconstruction. Methods We retrospectively analyzed data regarding daily drainage from patients who underwent expander-based breast reconstruction between April 2014 and January 2018 (159 patients, 176 expanders). Patient and operative factors were analyzed regarding their influence on total drainage volume and drain placement duration using univariate and multivariate analyses and analysis of variance. Results The mean total drainage volume was 1,210.77±611.44 mL. Univariate analysis showed correlations between total drainage volume and age (B=19.825, P<0.001), body weight (B=17.758, P<0.001), body mass index (B=51.817, P<0.001), and specimen weight (B=1.590, P<0.001). Diabetes history (P<0.001), expander type (P<0.001), and the surgical instrument used (P<0.001) also strongly influenced total drainage. The acellular dermal matrix type used did not affect total drainage (P=0.626). In the multivariate analysis, age (B=11.907, P=0.004), specimen weight (B=0.927, P<0.001), and expander type (B=593.728, P<0.001) were significant predictors of total drainage. Conclusions Our findings suggest that the total drainage and the duration of drain placement needed after expander-based breast reconstruction can be predicted using preoperative and intraoperative data. Patient age, specimen weight, and expander type are important predictors of drainage volume. Older patients, heavier specimens, and use of the Mentor rather than the Allergan expander corresponded to a greater total drainage volume and a longer duration of drain placement.
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Giang NT, Dung LT, Hien NT, Thiet TT, Hiep PS, Vu NT, Pho DC, Van Nam N, Hung PN. Hemoptysis from complex pulmonary aspergilloma treated by cavernostomy and thoracoplasty. BMC Surg 2019; 19:187. [PMID: 31805919 DOI: 10.1186/s12893-019-0650-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In high-risk patients with complex pulmonary aspergilloma but unable for lung resection, cavernostomy and thoracoplasty could be performed. This study aimed to evaluate this surgery compared two compressing materials. METHODS A total of 63 in high-risk patients who suffered from hemoptysis due to complex pulmonary aspergilloma and underwent cavernostomy and thoracoplasty surgery from November 2011 to September 2018 at Pham Ngoc Thach hospital were evaluated prospectively studied. Patients were allocated to two groups: the table tennis ball group and tissue expander group. We evaluated at the time of before operation, 6 months and 24 months after operation. RESULTS Tuberculosis was the most common comorbidity diseases in both groups. Upper lobe occupied almost in location. Hemoptysis symptoms plunged from time to time. Statistically significant Karnofsky score was observed in both groups. Postoperative pulmonary functions (FVC and FEV1) have remained in both groups at all time points. The remarkable results were no deaths related to surgery and low complications both short and long-term. There was no statistical significance between two groups in operative time, blood loss during operation, ICU length-stay time. Four patients died because of co-morbidity in 24 months follow-up. CONCLUSION Cavernostomy and thoracoplasty was safe and effective surgery for the treatment of complex pulmonary aspergilloma with hemoptysis in high-risk patients. No mortality related to surgery and low complications were recorded. The was no inferiority when compared two compressing materials .
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Tripathee S, Xiong M, Zhang J. Microtia Ear Reconstruction Using Tissue Expander and Autologous Costal Cartilage: Our Experience and Comparing Two Age Groups. World J Plast Surg 2019; 8:324-330. [PMID: 31620334 PMCID: PMC6790269 DOI: 10.29252/wjps.8.3.324] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Ear reconstruction is one of the most challenging surgeries faced by reconstructive surgeons because of its complex three-dimensional structure. Various surgical methods and materials have been used over the years. The process of microtia reconstruction using tissue expander is performed in three stages of first that is implantation of tissue expander, second stage involves framework fabrication using autologous costal cartilage and implantation in the pocket and third stage involves tragus and concha reconstruction. METHODS Totally 180 cases of microtia reconstruction using tissue expander and autologous costal cartilage over 2 years were enrolled, while two age groups were compared regarding operative time, tissue expansion, number of autologous costal cartilage harvested and complications during and after reconstruction. RESULTS The overall complication in microtia reconstruction was 25%. No major difference was found between complication rates among the 2 age groups. Similarly, no significant difference was found between two groups in term of surgical time and tissue expansion. The major difference was found in number of costal cartilage harvested for the framework fabrication among the two groups. CONCLUSION Microtia reconstruction using tissue expander and autologous costal cartilage is a standard method of ear reconstruction with good satisfaction rate for surgeons and patients. Although the complication rate was high in our study, most of the cases were managed with acceptable results. Therefore, a standard protocol should be developed regarding the timing of the surgery for microtia reconstruction, considering pre-operative radiological analysis of the costal cartilage development along with age and weight of the patient.
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Affiliation(s)
| | - Meng Xiong
- Zhongda Hospital, Southeast University, Nanjing, China
| | - Jue Zhang
- Zhongda Hospital, Southeast University, Nanjing, China
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Chan DKH, Cheo T, Cheong WK. Successful use of tissue expander and pelvic sling to exclude small bowel for high-dose pelvic irradiation. Int J Colorectal Dis 2019; 34:1043-1046. [PMID: 30953142 DOI: 10.1007/s00384-019-03280-8] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Our study seeks to describe our surgical technique of the use of a tissue expander and a pelvic sling in order to perform high-dose pelvic irradiation without incurring radiation toxicity to the small bowel. High-dose radiation therapy for pelvic tumours comes at a risk of radiation toxicity to the small bowel. Our study discusses our novel surgical technique of compartmentalising the abdomen and the pelvis through the use of a tissue expander and pelvic sling to avoid small bowel radiation toxicity. METHODS We present a patient with an unresectable sacral chordoma. We describe our surgical technique incorporating both a tissue expander and an absorbable pelvic mesh sling to successfully compartmentalise the abdomen from the pelvis. RESULTS The patient underwent an uneventful surgical procedure to place the tissue expander within the pelvis and deploy the pelvic mesh sling. Following surgery, a separation of at least 8 cm was achieved between bowel loops and the tumour. A dose of 70 Gy delivered over 35 fractions using intensity modulated radiotherapy (IMRT) was administered to the sacral chordoma, whilst managing to constrain the maximum bowel dose to 35.7 Gy. Surgery to remove the tissue expander was uneventful. The patient has not suffered any small bowel irradiation toxicity. CONCLUSIONS Our technique to exclude small bowel from the pelvis is effective and safe. This technique not only can be applied in the setting of unresectable sacral chordomas but also may be applicable to other pelvic cancers which require radiation therapy.
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Affiliation(s)
- Dedrick Kok Hong Chan
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore. .,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Timothy Cheo
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - Wai Kit Cheong
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore
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De Rose F, Fogliata A, Franceschini D, Cozzi S, Iftode C, Stravato A, Tomatis S, Masci G, Torrisi R, Testori A, Tinterri C, Lisa AVE, Maione L, Vinci V, Klinger M, Santoro A, Scorsetti M. Postmastectomy radiation therapy using VMAT technique for breast cancer patients with expander reconstruction. Med Oncol 2019; 36:48. [PMID: 31028487 DOI: 10.1007/s12032-019-1275-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 03/01/2019] [Accepted: 04/19/2019] [Indexed: 11/28/2022]
Abstract
Postmastectomy radiotherapy (PMRT) following immediate breast reconstruction is increasingly adopted in the management of breast cancer patients. We retrospectively evaluate the complication rates of PMRT using VMAT technique to immediate tissue expander-based reconstructions and the possible impact of tissue expander volume on radiotherapy planning. We reviewed the data of patients who underwent immediate expander breast reconstruction and received PMRT with VMAT (50 Gy in 25 fractions) on the reconstructed breast and axillary levels III-IV. Neoadjuvant or adjuvant systemic therapy was administered in most of the patients. Autologous fat grafting was routinely performed at the time of second-stage reconstruction. Between 2015 and 2017, PMRT was delivered to 46 consecutive patients (median age 50 years) with expander reconstruction. Median follow-up was 27 months (range 10-41). Two patients (4.3%) had a reconstruction failure, as expander rupture and infection, following the first- and the second-stage reconstruction, respectively. In most cases expanders were completely inflated before PMRT (65.2%). Median expander volume before PMRT was 425 cm3 (range 150-700 cm3). The amount of expander inflation did not significantly affect dosimetry, except for skin dose, with a surface receiving more than 30 Gy of 36.6 ± 0.9 cm2 and 47.0 ± 2.5 cm2 for a volume expander below or above the median, respectively. However, this variable was not predictor for complications. Disease progression was recorded in 15.2% of patients. PMRT using VMAT technique for breast cancer patients with expander reconstruction is associated with a very low complication rate. The expander volume before PMRT does not significantly compromise radiotherapy dose distribution.
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Affiliation(s)
- Fiorenza De Rose
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Antonella Fogliata
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Milan, Rozzano, Italy.
| | - Davide Franceschini
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Salvatore Cozzi
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Cristina Iftode
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Antonella Stravato
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Stefano Tomatis
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Giovanna Masci
- Medical Oncology Department, Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Rosalba Torrisi
- Medical Oncology Department, Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Alberto Testori
- Breast Surgery Department, Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Corrado Tinterri
- Breast Surgery Department, Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Andrea V E Lisa
- Plastic Surgery Department, Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Luca Maione
- Plastic Surgery Department, Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Valeriano Vinci
- Plastic Surgery Department, Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Marco Klinger
- Plastic Surgery Department, Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Armando Santoro
- Medical Oncology Department, Humanitas Research Hospital, Milan, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Rozzano, Italy
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Milan, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Rozzano, Italy
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Hallberg H, Elander A, Kölby L, Hansson E. A biological or a synthetic mesh in immediate breast reconstruction? A cohort-study of long-term Health related Quality of Life (HrQoL). Eur J Surg Oncol 2019; 45:1812-6. [PMID: 30905394 DOI: 10.1016/j.ejso.2019.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/14/2019] [Accepted: 03/10/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Meshes/matrices are commonly used in immediate breast reconstruction. There are few studies comparing biological and synthetic meshes and it is unknown what type of mesh gives the best long-term results. The aim of this study was to compare long-term health-related quality of life (HrQoL) and patient satisfaction in implant-based immediate breast reconstruction with a biological mesh (Surgisis®) with that of patients reconstructed with a synthetic mesh (TIGR ® Matrix Surgical Mesh). MATERIAL AND METHODS Both cohorts were prospectively included and consecutively operated. Clinical data was collected. HrQoL was evaluated with EuroQoL-5 dimension - 3 levels questionnaire (EQ-5D-3L) and the Hospital Anxiety and Depression Scale (HADS) and the Breast-Q. RESULTS AND CONCLUSION Seventy-one patients were operated on in the biological group and 49 in the synthetic group. The response rates were 75 and 84 per cent, respectively. Mean follow-up time was 74 months and 23 months, respectively. There were no statistical differences in satisfaction and quality of life between the two groups. Complications and radiation seem to lead to a lower satisfaction. Our findings could indicate that biological and synthetic meshes give an equal long-term result as regards patients' perceived quality of life.
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Karimi H, Latifi NA, Momeni M, Sedigh-Maroufi S, Karimi AM, Akhoondinasab MR. Tissue expanders; review of indications, results and outcome during 15 years' experience. Burns 2019; 45:990-1004. [PMID: 30685190 DOI: 10.1016/j.burns.2018.11.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 09/04/2018] [Revised: 11/20/2018] [Accepted: 11/30/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Tissue expanders (TE) are frequently used worldwide. In this study we surveyed outcome of our patients retrospectively during 15 years. MATERIALS AND METHODS We had 1105 patients for whom 3059 TEs have been used. Demographic data, age, sex, indications, type of tissue expander devices, volume of devices, site of scar and site TE insertion, our technique for tissue expander insertion and flap design, complications and outcome were gathered. A complete and through technical points and tips will be discussed. RESULTS In 91% of patients overexpansion was done. (Expansion ratio=2.1-4.5). Re-expansion has been done in about 12% of patients. Complications were perforation of skin of pocket (11%) or exposure, infection (6%), dehiscence of the wound (1.5%), perforation of the port or disconnection of the tubes (2.1%), expansion of the scar itself (1%), saggy flap (3%), dog ear (5%), lack of adhesions of flap to its new site (4%). OUTCOME In 93% of the patients we could totally remove the scar. Around 9.1% of our patients had two sessions of expansion in the same area and 2.9% had three sessions of expansion. 51% of our patients were highly satisfied and 42% were satisfied of the results of expansion. CONCLUSION Our patients were satisfied with the results. In 12% cases we have done re-expansion. Re-expansion is possible as long as you have enough thickness of dermis in the skin. More than 50% of our patients were optimistic for 2nd or 3rd session of re-expansion.
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Affiliation(s)
- Hamid Karimi
- Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Noor-Ahmad Latifi
- Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahnoush Momeni
- Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Hattami S, Khalatbari B, Karimi M. The Impact of Verapamil Gel on Efficiency of Tissue Expander Device in Plastic and Reconstructive Surgery. World J Plast Surg 2018; 7:198-203. [PMID: 30083503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND One of the weaknesses of recovering the skin defects by tissue expander device is that it needs relatively long time and it has complications. Since verapamil gel reduces the production of these capsules around silicone prosthesis and reduces the formation of collagen in the capsule areas. The aim of this study was to examine the effect of verapamil gel on efficiency of tissue expander device. METHODS Twenty patients were allocated equally into control and case groups based on age, sex, and location of the device. In both groups, the devices were placed in the areas needed and the conditions were identical. During the first operation, the length and width of the flaps and the initial size of prosthesis were determined. In the case group, verapamil gel was used daily, while a hydrogel was used as placebo locally in the control group. Then, other indicators were assessed. RESULTS Verapamil gel had no impact on the length, width, area, and size of placed flaps. The opening degree and necrosis of tissue were not improved in patients of case group after using the gel. The effect of verapamil gel in different age groups and gender of people had no significant difference. CONCLUSION Verapamil gel was shown not to have any significant impact on efficiency of tissue expander device.
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Lee KT, Eom Y, Mun GH, Bang SI, Jeon BJ, Pyon JK. Efficacy of Partial- Versus Full-Sling Acellular Dermal Matrix Use in Implant-Based Breast Reconstruction: A Head-to-Head Comparison. Aesthetic Plast Surg 2018; 42:422-433. [PMID: 29368031 DOI: 10.1007/s00266-018-1084-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 01/15/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Acellular dermal matrix (ADM), popularly used in tissue expander-based breast reconstruction, is applied either as a partial or full sling, but without any consensus regarding which method of application produces better outcomes. We aimed to compare the outcomes between two patient groups who underwent tissue expander-based breast reconstruction using these techniques. METHODS A retrospective review was conducted for consecutive patients who underwent immediate two-stage implant-based breast reconstruction using ADM between January 2013 and June 2016. They were categorized into two cohorts: cohort 1 included patients in whom ADM was applied using the partial-sling technique, insetting it obliquely after releasing the pectoralis major muscle from its costal origin, and cohort 2 included those who underwent a full-sling technique, insetting it transversely after releasing the muscle from its costal and lower sternal origin. Postoperative complications and aesthetic outcomes were compared between the two groups. RESULTS We analysed 329 cases (167 in cohort 1 and 162 in cohort 2) with similar baseline characteristics in both cohorts. Reconstruction failure occurred in 2.4% of overall patients. The rates of each and overall acute complications did not differ significantly between the cohorts. Cohort 2 showed significantly lower rates of tissue expander displacement and malposition following the first-stage operation and rippling following the second-stage operation, differences that retained the influences in multivariate analyses. Higher aesthetic scores were obtained in cohort 2. CONCLUSION Using the full-sling ADM might reduce unintended migration of prostheses and enable proper tissue expansion, resulting in better overall outcomes without increasing morbidities. 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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Kubo K, Takei H, Hamahata A, Matsumoto H, Sakurai H. Complication analysis of complete versus partial coverage of tissue expanders using serratus anterior musculofascial flaps in immediate breast reconstruction. Surg Today 2018; 48:703-8. [PMID: 29504033 DOI: 10.1007/s00595-018-1645-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 02/06/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE To prevent tissue expander (TE) exposure following mastectomy flap necrosis in immediate breast reconstruction, the TE is usually covered completely or partially with a musculofascial (MF) flap. This study compares the complications of the two coverage methods. METHODS We reviewed, retrospectively, 106 cases of immediate TE-based breast reconstruction. The patients were divided into two groups according to whether complete or partial TE coverage was done. In the complete coverage group, the serratus anterior MF flap was dissected and sutured to the pectoralis major muscle to cover the TE completely. In the partial coverage group, the serratus anterior MF flap was not dissected, and the lateral border of the pectoralis major muscle was sutured to the mastectomy skin flaps. RESULTS The TEs were covered completely in 60 breasts and partially in 46 breasts. The mastectomy flap necrosis rate was significantly higher in the complete coverage group (p < 0.01), but there was no incidence of TE exposure in either groups. The lateral migration rate was significantly higher in the partial coverage group (p = 0.033). There were no significant differences in the cranial migration rate (p = 0.133). CONCLUSIONS The complete coverage method is a better option if there is a high risk of mastectomy flap necrosis; however, surgeons should monitor carefully for cranial migration.
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Ozturk CN, Ozturk C, Soucise A, Platek M, Ahsan N, Lohman R, Moon W, Djohan R. Expander/Implant Removal After Breast Reconstruction: Analysis of Risk Factors and Timeline. Aesthetic Plast Surg 2018; 42:64-72. [PMID: 29270693 DOI: 10.1007/s00266-017-1031-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 10/31/2017] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Removal of tissue expanders (TE) or implants is a dire consequence of breast reconstruction, and has the potential to halt the reconstructive efforts. Our goals were to characterize a cohort of patients with TE/implant removal, to perform a time-based analysis, and to review the bacteriology associated with explanted devices. MATERIALS AND METHODS Review of a prospectively maintained database was performed to identify patients who underwent TE/implant removal. Patient characteristics, surgical technique, adjuvant therapies, indications, complications, culture results were obtained. Data were analyzed according to timing of explantation. RESULTS A total of 55 TE and implants were removed in 43 patients. Reasons for explantation were infection (58%), patient request (22%), and wound-related complications (20%). The majority of explantations occurred after 30 days (62%), and after Stage I (81%). Median days to explantation was 62. Patients of older age (p = 0.01) and higher BMI (p = 0.02) were more likely to undergo explantation after Stage I. The most commonly cultured organisms were S. epidermidis (10.9%), S. aureus (10.9%) and P. aeruginosa (10.9%). Antibiotic resistance was commonly encountered for ampicillin, cefazolin, penicillin, and erythromycin. CONCLUSION Infection is the most common reason for explantation after prosthetic breast reconstruction. Patients should be carefully monitored for a prolonged period of time after Stage I, as the majority of explantations occur in this stage but beyond 30 days. For oral treatment, fluoroquinolones and trimethoprim-sulfamethoxazole and for IV treatment a combination of vancomycin or daptomycin with piperacillin-tazobactam or imipenems/carbapenems appear to be appropriate choices according to our culture results. 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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Marano AA, Henderson PW, Prince MR, Dashnaw SM, Rohde CH. Effect of MRI on breast tissue expanders and recommendations for safe use. J Plast Reconstr Aesthet Surg 2017; 70:1702-1707. [PMID: 29046262 DOI: 10.1016/j.bjps.2017.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 06/07/2017] [Accepted: 07/26/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Ferromagnetic port-containing breast tissue expanders are currently labeled MRI-unsafe because of the presumption that magnets should not enter the machine. However, designating these devices as MRI-unsafe can lead to unnecessary procedures or suboptimal imaging choices. This study provides an ex vivo analysis of how breast tissue expanders behave when subjected to strong magnetic fields to determine which variables might affect clinical risk. METHODS Three different brands of tissue expanders were evaluated in three MRI environments. Translational force was determined using the deflection angle method. Torque on empty, saline-filled, and air-filled expanders was evaluated on a 0-4 scale. Magnetic field was measured using a gaussmeter. The weight required to prevent displacement of the expanders was determined for both air- and saline-filled expanders. Temperature over time was measured using an alcohol thermometer. RESULTS Magnetic field strength, deflection angle, and torque were the greatest in 3T MRI environments and varied by device manufacturer (Sientra > Mentor > Allergan). Saline-filled expanders required 240 mL and air-filled required 360 mL volume to make the torque undetectable, and the effect of torque could be mitigated with prone positioning. A weight of 120 g was required to prevent displacement of a saline-filled tissue expander and 870 g for an empty expander. There were no appreciable changes in temperature. CONCLUSIONS Previously described risks may be reduced by using a 1.5T MRI, device selection, filling expanders with saline, and prone positioning. MRI can be considered in patients with breast tissue expanders when appropriate peri-procedural choices have been made so that the benefits of undergoing MRI outweigh the risks.
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Affiliation(s)
- Andrew A Marano
- Division of Plastic and Reconstructive Surgery, Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Peter W Henderson
- Division of Plastic and Reconstructive Surgery, Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Martin R Prince
- Division of Plastic and Reconstructive Surgery, Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Stephen M Dashnaw
- Division of Plastic and Reconstructive Surgery, Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Christine H Rohde
- Division of Plastic and Reconstructive Surgery, Department of Radiology, Columbia University Medical Center, New York, NY, USA.
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Garner J, Davidson D, Eckert GJ, Barco CT, Park H, Park K. Reshapable polymeric hydrogel for controlled soft-tissue expansion: In vitro and in vivo evaluation. J Control Release 2017; 262:201-211. [PMID: 28751248 PMCID: PMC5603415 DOI: 10.1016/j.jconrel.2017.07.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/10/2017] [Accepted: 07/24/2017] [Indexed: 11/20/2022]
Abstract
Tissue expansion is the process by which extra skin is generated using a device that applies pressure from underneath the skin. Over the course of weeks to months, stretching by this pressure creates a flap of extra tissue that can be used to cover a defect area or enclose a permanent implant. Conventional tissue expanders require a silicone shell inflated either by external injections of saline solution or air, or by internal osmotic pressure generated by a hydrophilic polymer. In this study, a shell-free tissue expander comprised only of a chemically cross-linked biocompatible polymeric hydrogel is developed. The cross-linked network of hydrophilic polymer provides for intrinsically controlled swelling in the absence of an external membrane. The new type of hydrogel expanders were characterized in vitro as well as in vivo using a rat-skin animal model. It was found that increasing the hydrophobic polyester content in the hydrogel reduced the swelling velocity to a rate and volume that eliminate the danger of premature swelling rupturing the sutured area. Additionally, increasing the crosslinking density resulted in enough mechanical strength of the hydrogel to allow for complete post-swelling removal, without the hydrogel cracking or crumbling. No systemic toxicity was noted with the expanders and histology showed the material to be highly biocompatible. These expanders have an advantage of tissue expansion without requiring an external silicone membrane, and thus, they can be cut or reshaped at the time of implantation for applications in small or physically constrained regions of the body.
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Affiliation(s)
- John Garner
- Akina, Inc., West Lafayette, IN, United States
| | - Darrel Davidson
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - George J Eckert
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Clark T Barco
- Roudebush Veterans Affairs Medical Center, Indianapolis, IN, United States
| | - Haesun Park
- Akina, Inc., West Lafayette, IN, United States
| | - Kinam Park
- Akina, Inc., West Lafayette, IN, United States; Purdue University, Department of Biomedical Engineering, West Lafayette, IN, United States; Purdue University, Department of Pharmaceutics, West Lafayette, IN, United States.
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Bohac M, Varga I, Polak S, Dragunova J, Fedeles J, Koller J. Delayed post mastectomy breast reconstructions with allogeneic acellular dermal matrix prepared by a new decellularizationmethod. Cell Tissue Bank 2017; 19:61-68. [PMID: 28812172 DOI: 10.1007/s10561-017-9655-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 05/25/2017] [Accepted: 08/08/2017] [Indexed: 01/08/2023]
Abstract
Acellular dermal matrix (ADM) is a tissue graft of allogeneic origin from post-mortem tissue donors prepared by an innovative decellularization process. The newly developed non-toxic and low cost decellularization process of cadaver origin dermis included ADM in breast reconstruction procedures proved to help coverage of the lower-pole of breast expanders or implants. As the results have shown, it did help to eliminate autologous dermis donor site morbidity along with shortening the operation time by avoiding elevation of additional muscle or fascia during the operation. Main aims of this article include histology evaluation of allogeneic acellular dermal matrix prepared by a new decellularization method and presentation of clinical results of its use. A total of 22 patients underwent 26 ADM based breast reconstructions. The mean patient's follow up was 12.6 months. Average total size of ADM used for one breast was 273 cm2. Post-operative complications occurred in 3 patients including one expander infection, one expander extrusion and one expander pocket disfiguration. Microscopic analysis of tissue samples has confirmed incorporation of the acellular dermal matrices into the surrounding connective tissue without any noticeable immune reaction. In a majority of the ADM samples we found pseudocapsullar formation on implant side of samples without acute or chronic inflammatory cells. The use of ADM prepared by new preparation method in expansive post mastectomy breast reconstruction was associated by a relatively low complication rate resulting in good outcomes.
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Affiliation(s)
- Martin Bohac
- Department of Plastic Surgery, Faculty of Medicine, University Hospital Bratislava, Comenius University in Bratislava, Ruzinovska 6, 826 06, Bratislava, Slovakia. .,Regenmed Ltd., Medena 29, 811 02, Bratislava, Slovakia.
| | - Ivan Varga
- Faculty of Medicine, Institute of Histology and Embryology, Comenius University in Bratislava, Sasinkova 4, 811 08, Bratislava, Slovakia
| | - Stefan Polak
- Faculty of Medicine, Institute of Histology and Embryology, Comenius University in Bratislava, Sasinkova 4, 811 08, Bratislava, Slovakia
| | - Jana Dragunova
- Department of Burns and Reconstructive Surgery, Faculty of Medicine, University Hospital Bratislava, Comenius University in Bratislava, Bratislava, Slovakia
| | - Jozef Fedeles
- Department of Plastic Surgery, Faculty of Medicine, University Hospital Bratislava, Comenius University in Bratislava, Ruzinovska 6, 826 06, Bratislava, Slovakia
| | - Jan Koller
- Department of Burns and Reconstructive Surgery, Faculty of Medicine, University Hospital Bratislava, Comenius University in Bratislava, Bratislava, Slovakia
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Ishii N, Ando J, Harao M, Takemae M, Kishi K. Individual difference in pectoralis major muscle thickness and its effect on single-stage breast reconstruction using a tissue expander. Breast Cancer 2017; 25:68-73. [PMID: 28567608 DOI: 10.1007/s12282-017-0785-9] [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: 03/07/2017] [Accepted: 05/27/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND In breast reconstruction using a tissue expander (TE), sufficient coverage of the TE with the pectoralis major (PM) muscle, particularly with a musculofascial flap, is highly important for avoiding postoperative complications. In patients in whom the PM is thin, intraoperative trauma often occurs, leading to troublesome repair. The present study aimed to investigate the usefulness of preoperative measurement of PM thickness in planning of breast reconstruction using a TE. METHODS In this case-control study, we identified 68 patients (70 breasts) with mammary carcinoma treated with simple mastectomy and TE insertion from April 2014 to December 2016. We measured average PM thickness at two specific points, sternocostal PM distance on the long axis and sternocostal PM area preoperatively using magnetic resonance imaging. Then, we analyzed the difference in PM thickness among individuals and its relationship to intraoperative trauma to the PM or surgical difficulty creating a muscular pocket (delicate PM). RESULTS Average PM thickness was significantly larger in younger patients (p = 0.046) and those with larger breasts (p < 0.01). In addition, average PM thickness on the affected side was significantly smaller in patients with delicate PM (12 breasts) (p < 0.01). PM thickness had a significant influence on delicate or firm PM (odds ratio 27.40; 95% confidence interval 2.01-372.00; p = 0.013). CONCLUSION These findings demonstrate the usefulness of preoperative measurement of PM thickness in planning of breast reconstruction using a TE. Dissection should be performed more carefully in patients with average PM thickness less than 2.9 mm.
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Affiliation(s)
- Naohiro Ishii
- Department of Plastic and Reconstructive Surgery, Keio University of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Jiro Ando
- Department of Breast Surgery, Tochigi Cancer Center, Tochigi, Japan
| | - Michiko Harao
- Department of Breast Surgery, Tochigi Cancer Center, Tochigi, Japan
| | - Masaru Takemae
- Department of Breast Surgery, Tochigi Cancer Center, Tochigi, Japan
| | - Kazuo Kishi
- Department of Plastic and Reconstructive Surgery, Keio University of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
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Ortiz JA. Clinical Outcomes in Breast Reconstruction Patients Using a Sterile Acellular Dermal Matrix Allograft. Aesthetic Plast Surg 2017; 41:542-550. [PMID: 28280894 DOI: 10.1007/s00266-017-0817-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 11/04/2016] [Accepted: 02/03/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Human acellular dermal matrices (ADMs) have enabled successful breast reconstructions while decreasing muscle donor morbidity and pain for the patient. However, some literature reports indicate an increase in complications, especially infection. The decellularization and terminal sterilization properties of DermACELL (D-ADM), a human ADM, may reduce the rate of complications in augmented breast reconstruction while still maintaining successful outcomes. In the study presented here, we evaluate the quality and safety of outcomes with the use of D-ADM during tissue expander breast reconstruction. METHODS A retrospective chart review was conducted of patients who underwent breast reconstruction with the use of D-ADM, at a single-military hospital-based practice, resulting in a population of 38 subjects and 58 breasts who had breast reconstruction augmented with D-ADM. RESULTS Fifty-six breasts (96.6%) in thirty-six patients demonstrated successful outcomes with a median 27 weeks' time to complete healing. Post-reconstruction radiation and chemotherapy were applied to 24.1 and 25.9% of reconstructions, respectively. Complications rates were minimal with rates of 1.7% for surgical site infection and 1.7% for red breast syndrome. CONCLUSION The low complication rates combined with the high success and patient satisfaction rates observed for D-ADM support the use of this ADM in breast 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)
- Juan A Ortiz
- Womack Army Medical Center, Fort Bragg, NC, 28310, USA.
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Khavanin N, Qiu CS, Mlodinow AS, Vu MM, Dorfman RG, Fine NA, Kim JYS. External validation of the breast reconstruction risk assessment calculator. J Plast Reconstr Aesthet Surg 2017; 70:876-83. [PMID: 28539245 DOI: 10.1016/j.bjps.2017.04.010] [Citation(s) in RCA: 14] [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: 02/09/2017] [Revised: 03/22/2017] [Accepted: 04/14/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The Breast reconstruction Risk Assessment (BRA) Score estimates patient-specific risk for postsurgical complications using an individual's unique combination of preoperative variables. In this report, we externally validate the BRA Score models for surgical site infection, seroma, and explantation in a large sample of intra-institutional patients who underwent prosthetic breast reconstruction. METHODS We reviewed all initiated tissue expander/implant reconstructions by the senior authors from January 2004 to December 2015. BRA Score risk estimates were computed for each patient and compared against observed rates of complications. Hosmer-Lemeshow goodness-of-fit test, concordance statistic, and Brier score were used to assess the calibration, discrimination, and accuracy of the models, respectively. RESULTS Of the 1152 patients (1743 breasts) reviewed, 855 patients (1333 breasts) had complete data for BRA-score calculations and were included for analysis. Hosmer-Lemeshow tests for calibration demonstrated a good agreement between observed and predicted outcomes for surgical site infection (SSI) and seroma models (P-values of 0.33 and 0.16, respectively). In contrast, predicted rates of explantation deviated from observed rates (Hosmer-Lemeshow P-value of 0.04). C statistics demonstrated good discrimination for SSI, seroma, and explantation (0.73, 0.69, and 0.78, respectively). CONCLUSIONS In this external validation study, the BRA Score tissue expander/implant reconstruction models performed with generally good calibration, discrimination, and accuracy. Some weaknesses in certain models were identified as targets for future improvement. Taken together, these analyses validate the clinical utility of the BRA score risk models in predicting 30-day outcomes.
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Fujii T, Yajima R, Kuwano H. Implications of Long-term Indwelling of Tissue Expander in Breast Reconstruction: Risk of Expander Rupturing. Anticancer Res 2016; 36:4337-4340. [PMID: 27466553] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 07/08/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND/AIM Breast reconstruction with a tissue expander (TE) is associated with postoperative complications, including rupturing of the TE. Any device can have a mechanical failure, and a TE may rupture over time. Although an interval of around one year from initial TE insertion to the second stage of two-stage surgery is historically considered the standard, the optimal interval has not yet been determined. Furthermore, the durability of a TE and the influence of long-term indwelling on TE rupture are uncertain. In this study, we retrospectively investigated the effects of long-term indwelling on TE durability and rupturability. PATIENTS AND METHODS We analyzed 24 patients and 25 breasts with breast cancer that had undergone breast reconstruction with an expander that was indwelling for more than a year. The resected margins were all clear, and none of the patients required postoperative radiotherapy. RESULTS From a total of 25 reconstructed breast mounds, the TE ruptured in 4 cases. None of the clinicopathological features, including primary tumor progression, method of operation, presence of adjuvant chemotherapy, was significantly associated with TE rupture. Rupture was observed beginning at 1.5 years after the initial TE insertion. The rupture rate was 32.6% by the third year and 55.1% by five years. There were no ruptures among cases with TE exchange within a year. CONCLUSION Long-term indwelling of TE is associated with TE rupture. We recommend that the appropriate interval between the first and second stages of breast reconstructive surgery is aproximatelly one year.
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Affiliation(s)
- Takaaki Fujii
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Gunma, Japan
| | - Reina Yajima
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Gunma, Japan
| | - Hiroyuki Kuwano
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, Gunma, Japan
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Potanos K, Fullington N, Cauley R, Purcell P, Zurakowski D, Fishman S, Vakili K, Kim HB. Tissue expander stimulated lengthening of arteries (TESLA) induces early endothelial cell proliferation in a novel rodent model. J Pediatr Surg 2016; 51:617-21. [PMID: 26463500 DOI: 10.1016/j.jpedsurg.2015.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/02/2015] [Accepted: 09/02/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND We examine the mechanism of aortic lengthening in a novel rodent model of tissue expander stimulated lengthening of arteries (TESLA). METHODS A rat model of TESLA was examined with a single stretch stimulus applied at the time of tissue expander insertion with evaluation of the aorta at 2, 4 and 7day time points. Measurements as well as histology and proliferation assays were performed and compared to sham controls. RESULTS The aortic length was increased at all time points without histologic signs of tissue injury. Nuclear density remained unchanged despite the increase in length suggesting cellular hyperplasia. Cellular proliferation was confirmed in endothelial cell layer by Ki-67 stain. CONCLUSIONS Aortic lengthening may be achieved using TESLA. The increase in aortic length can be achieved without tissue injury and results at least partially from cellular hyperplasia. Further studies are required to define the mechanisms involved in the growth of arteries under increased longitudinal stress.
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Affiliation(s)
- Kristina Potanos
- Department of Surgery, Boston Children's Hospital, Boston, MA 02115, USA.
| | - Nora Fullington
- Department of Surgery, Boston Children's Hospital, Boston, MA 02115, USA.
| | - Ryan Cauley
- Department of Surgery, Boston Children's Hospital, Boston, MA 02115, USA.
| | - Patricia Purcell
- Department of Plastic Surgery, Boston Children's Hospital, Boston, MA 02115, USA.
| | - David Zurakowski
- Department of Surgery, Boston Children's Hospital, Boston, MA 02115, USA.
| | - Steven Fishman
- Department of Surgery, Boston Children's Hospital, Boston, MA 02115, USA.
| | - Khashayar Vakili
- Department of Surgery, Boston Children's Hospital, Boston, MA 02115, USA.
| | - Heung Bae Kim
- Department of Surgery, Boston Children's Hospital, Boston, MA 02115, USA.
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47
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Chang CW, Tai HC, Cheng NC, Li WT, Lai HS, Chien HF. Risk factors for complications following immediate tissue expander based breast reconstruction in Taiwanese population. J Formos Med Assoc 2016; 116:57-63. [PMID: 26947888 DOI: 10.1016/j.jfma.2016.01.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 12/02/2015] [Revised: 01/25/2016] [Accepted: 01/26/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND/PURPOSE Breast cancer patients in Asia show considerable disparities from Caucasian patients, such as younger age of onset and lower rates of smoking, obesity, and diabetes. Findings of prior studies regarding risk factors associated with complications in tissue expander may not hold for Asian populations, since most of these studies involved Caucasian patients. In this study, we surveyed risk factors in the Taiwanese population, providing additional evidence about the important differences and discuss the implications for clinical practice. METHODS Patients who underwent immediate, two-stage, tissue expander breast reconstruction from December 2008 to August 2014 in the National Taiwan University Hospital, Taipei, Taiwan were included. Follow-up observations of all patients were conducted until December 2014. Complications occurring during the tissue expander stage were evaluated. Multivariate regression modeling was used to identify risk factors for complications. RESULTS A total of 246 consecutive, immediate, smooth round tissue expander placements were performed for breast reconstruction. The most common complication was skin necrosis (4.9%), followed by wound dehiscence (4.1%). In the multivariate model, body mass index (BMI) ≥ 24 kg/m2 was the only risk factor that reached statistical significance (odds ratio: 2.41, 95% confidence interval: 1.17-4.96). CONCLUSION We provided evidence that racial disparities have an impact on the risk factors for complications associated with tissue expander breast reconstruction. BMI≥24 kg/m2 was the only risk factor significantly associated with complications. Clinically, BMI≥24 kg/m2, rather than the standard definition of obesity (BMI > 30 kg/m2), may be a more suitable cutoff point for risk in patients of Asian ethnicity.
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Affiliation(s)
- Che-Wei Chang
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Hao-Chih Tai
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Nai-Chen Cheng
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Wei-Tang Li
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Division of Plastic Surgery, Department of Surgery, Taipei Medical University Hospital and College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hong-Shiee Lai
- Division of Pediatric Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Hsiung-Fei Chien
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Division of Plastic Surgery, Department of Surgery, Taipei Medical University Hospital and College of Medicine, Taipei Medical University, Taipei, Taiwan.
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48
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Woo KJ, Paik JM, Mun GH, Pyon JK, Bang SI. Risk Factors for Complications in Immediate Expander-Implant Breast Reconstruction for Non-obese Patients: Impact of Breast Size on Complications. Aesthetic Plast Surg 2016; 40:71-8. [PMID: 26530484 DOI: 10.1007/s00266-015-0568-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 08/10/2015] [Accepted: 09/17/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although obesity is a well-known risk factor for complications in immediate expander-implant breast reconstruction, no studies have identified risk factors for non-obese patients. The purpose of this study was to identify risk factors for complications in non-obese patients. METHODS A retrospective analysis of prospectively collected data from 397 consecutive immediate expander-implant breast reconstructions in 367 non-obese patients at a single institution over a 5-year period was conducted. Univariable and multivariable analysis were performed to determine the influence of six patient-related and eight procedure-related characteristics on complications. RESULTS Mean BMI was 21.7 ± 2 kg/m(2) and median mastectomy weight was 298.0 g (range: 40-1164 g). Multivariable analysis showed that neither BMI nor the use of acellular dermal matrix was a predictor for complications. Adjuvant radiation (odds = 3.12, p < 0.001) and mastectomy weight (p < 0.001) were independent risk factors for complications. A 100 g increase in the mastectomy weight was significantly associated with a 23 % increase in the odds of overall complications (p = 0.003), major complications (p = 0.004), and skin flap complications (p = 0.007), as well as a 28 % increase in the odds of seroma (p = 0.044), but was not associated with reconstruction failure. Adjuvant radiation (p < 0.001) and hypertension (p < 0.001) were risk factors for reconstruction failure. CONCLUSIONS Breast size was an independent risk factor for complications in non-obese patients while BMI was not. In the reconstruction of large breasts, greater attention and additional adjunctive procedures would be needed to prevent complications. 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)
- Kyong-Je Woo
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul, 135-710, Korea
| | - Joo Myong Paik
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul, 135-710, Korea
| | - Goo-Hyun Mun
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul, 135-710, Korea
| | - Jai-Kyong Pyon
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul, 135-710, Korea
| | - Sa Ik Bang
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul, 135-710, Korea.
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49
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Ravn S, Pearcey R, Capstick V. Use of a tissue expander to protect small bowel during radiotherapy in a cervical cancer patient with severe Crohn's disease. Gynecol Oncol Rep 2016; 14:16-9. [PMID: 26793765 PMCID: PMC4688864 DOI: 10.1016/j.gore.2015.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 02/25/2015] [Revised: 08/26/2015] [Accepted: 08/31/2015] [Indexed: 11/29/2022] Open
Abstract
Inflammatory bowel disease increases the risk of radiation enteritis. Tissue expanders displace bowel from the radiation field. Thromboembolism and fistulae may be risks associated with tissue expander placement. A Vicryl mesh hammock may prevent bowel from entering the radiation field.
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Affiliation(s)
- Sarah Ravn
- Department of Obstetrics and Gynecology, University of Alberta, 5S 131 Lois Hole Hospital for Women, Robbins Pavilion, Royal Alexandra Hospital, 10240 Kingsway Avenue, Edmonton, Alberta T5H 3V9, Canada
| | - Robert Pearcey
- Division of Radiation Oncology, Department of Oncology, University of Alberta, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta T6G 1Z2, Canada
| | - Valerie Capstick
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alberta, 5S 131 Lois Hole Hospital for Women, Robbins Pavilion, Royal Alexandra Hospital, 10240 Kingsway Avenue, Edmonton, Alberta T5H 3V9, Canada
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50
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Zhu L, Mohan AT, Abdelsattar JM, Wang Z, Vijayasekaran A, Hwang SM, Tran NV, Saint-Cyr M. Comparison of subcutaneous versus submuscular expander placement in the first stage of immediate breast reconstruction. J Plast Reconstr Aesthet Surg 2016; 69:e77-86. [PMID: 26922050 DOI: 10.1016/j.bjps.2016.01.006] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [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: 07/22/2015] [Revised: 12/14/2015] [Accepted: 01/06/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIM Tissue expander-based two-stage reconstruction remains the most commonly used technique in immediate breast reconstruction. This study compares the subcutaneous expander placement to the traditional submuscular placement and describes our early experience with the expander insertion plane-choosing algorithm. METHODS A retrospective study of patients who underwent two-stage immediate breast reconstruction from May 2012 to October 2014 was conducted. All expander insertion planes were chosen using the same algorithm. Expansion, pain, and complications were compared between two groups. RESULTS The study included 88 patients (158 expanders; 50 subcutaneous and 108 submuscular). The subcutaneous group had a higher intraoperative expansion ratio (p < 0.001), high first postoperative expansion ratio (p < 0.001), shorter duration of expansion (p = 0.02), less number of expansion visits (p = 0.002), and less average pain during admission (p = 0.004). Significant differences in the intraoperative and first postoperative expansion ratios in patients with postmastectomy radiation therapy were also found between the two groups (p = 0.005 and 0.01, respectively). Complications during expansion and after second-stage autologous flap reconstruction were comparable between two groups. CONCLUSION The subcutaneous expander placement was associated with greater intraoperative and first postoperative expansion, shorter expansion duration, less expansion visits, and less pain. With the expander insertion plane-choosing algorithm, subcutaneous expander placement could be performed with comparable complications rates with the submuscular placement during expansion and after second-stage autologous flap reconstruction. Further studies can be performed due to the lack of long-term complications following second-stage implant reconstruction in the subcutaneous approach.
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Affiliation(s)
- Lin Zhu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China; Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Anita T Mohan
- Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA; Restoration of Appearance and Function charitable Trust (RAFT), UK
| | | | - Zhen Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Soyun M Hwang
- Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Nho V Tran
- Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA
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