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Yesantharao PS, Arquette C, Cheesborough JE, Lee GK, Nazerali RS. Paradigm Shifts in Alloplastic Breast Reconstruction: A Nationwide Analysis of Direct-to-Implant Trends. Plast Reconstr Surg 2024; 153:989-998. [PMID: 37352460 DOI: 10.1097/prs.0000000000010826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
BACKGROUND Direct-to-implant breast reconstruction is an attractive choice for appropriately selected patients, as a single-stage procedure can enhance global metrics of care. In an era of high-value health care, therefore, it is important to investigate use of such procedures. This study investigated direct-to-implant trends over the past decade on a nationwide basis. METHODS This was a retrospective investigation of direct-to-implant reconstruction between 2010 and 2018 in the United States, using the National Inpatient Sample database. All study analyses were undertaken using Stata version 15.0. RESULTS The weighted sample included 287,093 women who underwent implant-based reconstruction between 2010 and 2018, of whom 43,064 (15%) underwent direct-to-implant reconstruction. Across the study period, the proportion of direct-to-implant procedures increased significantly ( P = 0.03), relative to staged and delayed implant-based procedures. Although direct-to-implant patients were younger and more likely to be White and privately insured, the proportion of non-White, publicly insured patients undergoing direct-to-implant reconstruction increased significantly by 2018 ( P < 0.05). Furthermore, direct-to-implant use among Medicaid patients was 2.2 times the rate in Medicaid expansion states compared with nonexpansion states. Direct-to-implant patients had significantly higher All Patient Refined Diagnosis Related Group risk scores in 2018 than in 2010 ( P = 0.02), indicating expanding clinical indications for this procedure. Direct-to-implant reconstruction had significantly lower inpatient charges than staged procedures ( P = 0.03), when considering expander placement and expander-to-implant exchange. CONCLUSIONS Overall, use of direct-to-implant breast reconstruction has significantly increased over the past decade, facilitated by expanding clinical indications and improved insurance coverage. However, certain disparities continue to exist. Further work should investigate drivers of disparities to allow continued expansion of direct-to-implant reconstruction as clinically appropriate. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Pooja S Yesantharao
- From the Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine
| | - Connor Arquette
- From the Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine
| | - Jennifer E Cheesborough
- From the Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine
| | - Gordon K Lee
- From the Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine
| | - Rahim S Nazerali
- From the Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine
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2
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Chahine F, Habr N. The NIU (Nipple-Inframammary Fold-Upper Breast Border) Principle: Preoperative Marking of the Ideal Nipple Position in Augmentation Mastopexy. Plast Reconstr Surg 2024; 153:902e-909e. [PMID: 37163481 DOI: 10.1097/prs.0000000000010633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Although the beauty of the breast depends on aesthetic proportions, the position of the nipple-areola complex (NAC) on the breast mound and in relation to the implant during breast augmentation or mastopexy augmentation is critical. In fact, lack of nipple position determination in relation to the breast footprint is a deficiency of most currently applied measurements and evaluation tools. The authors hereby present a simple formula that allows accurate and proper prediction of the ideal NAC positioning for every patient depending on the chosen implant in case of mastopexy augmentation, or revision mastopexy with exchange of implants. METHODS A prospective level IV analysis of all consecutive patients undergoing primary mastopexy augmentation or revision mastopexy with exchange of implants was performed between January of 2021 and January of 2022. Forty-eight consecutive patients were included in the study. The nipple-inframammary fold-upper breast border (NIU) principle was applied to all patients to determine the ideal position of the NAC. Patients were photographed preoperatively and postoperatively in a standardized manner. The main endpoint was to determine whether the NAC is located at the most projected point of the breast on follow-up. RESULTS The NIU principle was applied to 48 patients between January of 2021 and January of 2022. Of those patients, 27 underwent primary augmentation mastopexy, and 21 underwent revision augmentation mastopexy with exchange of implants. The mean follow-up duration was 9.2 months (range, 6 to 18 months). All patients demonstrated proper NAC positioning on follow-up. CONCLUSION The NIU principle is a simple and reliable method to determine the ideal NAC position during mastopexy augmentation or mastopexy with implant exchange. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Fadel Chahine
- From the Department of Plastic and Reconstructive Surgery, Trad Hospital and Medical Center
| | - Natasha Habr
- From the Department of Plastic and Reconstructive Surgery, Trad Hospital and Medical Center
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Barnes LL, Chew J, Lem M, Park C, Yang JC, Prionas N, Piper M. Modifiable Postmastectomy Radiation Therapy Factors and Impact on Implant-Based Breast Reconstruction Outcomes. Plast Reconstr Surg 2024; 153:1000-1009. [PMID: 37335545 DOI: 10.1097/prs.0000000000010824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND Intensity-modulated radiation therapy and other modifiable radiation factors have been associated with decreased radiation toxicity. These factors could allow for improved reconstructive outcomes in patients requiring postmastectomy radiation therapy (PMRT). However, they have not yet been well studied in implant-based breast reconstruction. METHODS The authors performed a retrospective chart review of patients who underwent mastectomy with immediate tissue expander placement followed by PMRT. Radiation characteristics were collected, including radiation technique, bolus regimen, x-ray energy, fractionation, maximum radiation hot spot, and tissue volume receiving more than 105% or more than 107% of the prescription dose. Reconstructive complications occurring after initiation of PMRT were analyzed with respect to these radiation characteristics. RESULTS Sixty-eight patients (70 breasts) were included in this study. The overall complication rate was 28.6%, with infection being the most common complication (24.3%), requiring removal of the tissue expander or implant in greater than half of infections (15.7%). Maximum radiation hot spot was greater in patients who required explantation after PMRT, and this approached statistical significance (114.5% ± 7.2% versus 111.4% ± 4.4%; P = 0.059). Tissue volume receiving more than 105% and 107% were also greater in patients who required explantation after PMRT (42.1% ± 17.1% versus 33.0% ± 20.9% and 16.4% ± 14.5% versus 11.3% ± 14.6%, respectively); however, this was not statistically significant ( P = 0.176 and P = 0.313, respectively). There were no significant differences in complication rates between patients with respect to radiation technique or other radiation characteristics studied. CONCLUSION Minimizing the radiation hot spots and volumes of tissue receiving greater than the prescription dose of radiation may improve reconstructive outcomes in patients undergoing implant-based breast reconstruction followed by PMRT. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
| | - Jessica Chew
- Department of Radiation Oncology, University of California, San Francisco
| | - Melinda Lem
- From the Division of Plastic and Reconstructive Surgery
| | - Catherine Park
- Department of Radiation Oncology, University of California, San Francisco
| | - Joanna C Yang
- Department of Radiation Oncology, Washington University
| | - Nicolas Prionas
- Department of Radiation Oncology, University of California, San Francisco
| | - Merisa Piper
- From the Division of Plastic and Reconstructive Surgery
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van Rooij JAF, Bijkerk E, van der Hulst RRJW, Tuinder SMH. The influence of a previous implant-based breast reconstruction on postoperative sensation of the deep inferior epigastric artery perforator flap. Breast Cancer 2024; 31:456-466. [PMID: 38580855 PMCID: PMC11045600 DOI: 10.1007/s12282-024-01558-6] [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: 06/13/2023] [Accepted: 02/20/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Implants and DIEP flaps have different outcomes regarding postoperative breast sensation. When compared to the preoperative healthy breast, implant-based breast reconstruction (IBBR) negatively influences postoperative breast sensation. However, it is currently unknown whether a prior IBBR also influences postoperative sensation of a replacing DIEP flap. The goal of this cohort study is to evaluate the influence of an IBBR on the postoperative sensation of a replacing DIEP flap. METHODS Women were included if they received a DIEP flap reconstruction after mastectomy, with or without prior tissue expander (TE) and/or definitive breast implant. Sensation was measured at four intervals in 9 areas of the breast with Semmes-Weinstein monofilaments: T0 (preoperative, implant/no reconstruction), T1 (2-7 months postoperative, DIEP), T2 (± 12 months postoperative, DIEP), Tmax (maximum follow-up, DIEP). Linear mixed-effects models were used to investigate the relationship between an implant/TE prior to the DIEP flap and recovery of breast sensation. RESULTS 142 women comprising 206 breasts were included. 48 (23.3%) breasts did, and 158 (76.7%) breasts did not have a TE/IBBR prior to their DIEP. No statistically significant or clinically relevant relationships were found between a prior implant/TE and recovery of DIEP flap breast sensation for the flap skin, native skin, or total breast skin at T1, T2, or Tmax. There were also no relationships found after adjustment for the confounders radiation therapy, BMI, diabetes, age, flap weight, follow-up, and nerve coaptation. CONCLUSIONS An implant/TE prior to a DIEP flap does not influence the recovery of postoperative breast sensation of the DIEP flap.
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Affiliation(s)
- Joep A F van Rooij
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center (MUMC+), P. Debyelaan 25, 6229 HX, Maastricht, Limburg, The Netherlands
| | - Ennie Bijkerk
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center (MUMC+), P. Debyelaan 25, 6229 HX, Maastricht, Limburg, The Netherlands
| | - René R J W van der Hulst
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center (MUMC+), P. Debyelaan 25, 6229 HX, Maastricht, Limburg, The Netherlands
| | - Stefania M H Tuinder
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center (MUMC+), P. Debyelaan 25, 6229 HX, Maastricht, Limburg, The Netherlands.
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre (MUMC+), P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
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Segreto F, Carotti S, Marangi GF, Francesconi M, Calia E, Cagli B, Cimmino A, Rossi C, Morini S, Persichetti P. Cathelicidin LL-37 Expression in Human Breast Implant Capsules. Plast Reconstr Surg 2024; 153:1066-1073. [PMID: 37220260 DOI: 10.1097/prs.0000000000010733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Capsular contracture is the most common complication following breast implant placement. Cathelicidin LL-37 is a cationic peptide involved in innate immunity. Initially investigated for its antimicrobial role, it was found to have pleiotropic activities, such as immunomodulation, angiogenesis stimulation, and tissue healing. The aim of the study was to investigate the expression and localization of LL-37 in human breast implant capsules and its relationship with capsular formation, remodeling, and clinical outcomes. METHODS The study enrolled 28 women (29 implants) who underwent expander substitution with definitive implant. Contracture severity was evaluated. Specimens were stained with hematoxylin and eosin, Masson trichrome, immunohistochemistry, and immunofluorescence for LL-37, CD68, α-smooth muscle actin, collagen type I and type III, CD31, and Toll-like receptor-4. RESULTS LL-37 was expressed in macrophages and myofibroblasts of capsular tissue in 10 (34%) and nine (31%) of the specimens, respectively. In eight cases (27.5%), it was expressed by both macrophages and myofibroblasts of the same specimen. In infected capsules, expression by both cell types was found in all (100%) specimens. LL-37 expression by myofibroblasts positively correlated with its expression by macrophages ( P < 0.001). Moreover, LL-37 expression by macrophages of periexpander capsules negatively correlated with the severity of capsular contracture on definitive implants ( P = 0.04). CONCLUSIONS This study demonstrates the expression of LL-37 in macrophages and myofibroblasts of capsular tissue and its negative correlation with the severity of capsular contracture following permanent implant placement. Expression or up-regulation of LL-37 may be involved in myofibroblast and macrophage modulation, thus playing a role in the pathogenic fibrotic process underlying capsular contracture. CLINICAL RELEVANCE STATEMENT This is the first study to demonstrate LL37 expression in capsular tissue and to hypothesize its role in contracture and as a prognostic marker for contracture severity. If confirmed, medical strategies or implant coating could be implemented to reduce the risk of contracture for high-risk patients.
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Affiliation(s)
- Francesco Segreto
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery
| | - Simone Carotti
- Center for Integrated Biomedical Research, Laboratory of Microscopic and Ultrastructural Anatomy
| | | | - Maria Francesconi
- Center for Integrated Biomedical Research, Laboratory of Microscopic and Ultrastructural Anatomy
| | - Eleonora Calia
- Department of Obstetrics and Gynecology, Campus Bio-Medico of Rome University
| | - Barbara Cagli
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery
| | - Andrea Cimmino
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery
| | - Caterina Rossi
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery
| | - Sergio Morini
- Center for Integrated Biomedical Research, Laboratory of Microscopic and Ultrastructural Anatomy
| | - Paolo Persichetti
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery
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Aquino JU, Felix GDAA, Feitosa RGF, Tumeh RA, Neto MS. Congenital and Acquired Symmastia: Experience from 100 Cases Treated. Plast Reconstr Surg 2024; 153:873e-883e. [PMID: 37921632 DOI: 10.1097/prs.0000000000010827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND Symmastia, first defined by Spence et al. in 1984, is a medical condition characterized by the convergence of breast tissues in the midline, resulting in the absence of adhesion between the skin and subcutaneous tissue over the presternal area. It can be either congenital or acquired. Currently, there is no universally accepted treatment for symmastia. This study presents a surgical approach and preoperative and postoperative care for the correction of symmastia. METHODS Between January of 2014 and December of 2020, a surgical technique was performed on 100 patients, including 59 with congenital symmastia and 41 with acquired symmastia. The technique involved creating a thin skin flap and attaching it to the sternum to reconstruct the intermammary V-shaped region. RESULTS All patients in both groups underwent subglandular implant placement, with textured/polyurethane prostheses used in 97% of cases. Three cases did not use any implants. In the corrective surgery, patients received smaller, round implants, following the steps of the surgical approach devised by the author. The median satisfaction scores were high in both groups. CONCLUSIONS The surgical approach described in this study is a safe, one-time procedure with a low risk of complications and high patient satisfaction. The technique is reproducible and provides consistent outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Ng TP, Loo BYK, Yong N, Chia CLK, Lohsiriwat V. Review: Implant-Based Breast Reconstruction After Mastectomy for Breast Cancer: A Meta-analysis of Randomized Controlled Trials and Prospective Studies Comparing Use of Acellular Dermal Matrix (ADM) Versus Without ADM. Ann Surg Oncol 2024; 31:3366-3376. [PMID: 38285304 DOI: 10.1245/s10434-024-14943-4] [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: 09/15/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Breast cancer is the world's most prevalent cancer, and many breast cancer patients undergo mastectomy as the choice of treatment, often with post-mastectomy breast reconstruction. Acellular dermal matrix (ADM) use has become a method to improve outcomes of reconstruction for these patients. We aimed to compare postoperative complications and patient-reported outcomes, which are still poorly characterized, between groups utilizing acellular dermal matrix during reconstruction and those without. MATERIALS AND METHODS We searched electronic databases from inception to 16 June 2022 for randomized controlled trials and prospective cohort studies comparing the outcomes of patients who have and have not received acellular dermal matrix in implant-based breast reconstruction. The results were quantitatively combined and analyzed using random-effects models. RESULTS A total of nine studies were included, representing 3161 breasts. There was no significant difference in postoperative outcomes, such as seroma formation (p = 0.51), hematomas (p = 0.20), infections (p = 0.21), wound dehiscence (p = 0.09), reoperations (p = 0.70), implant loss (p = 0.27), or skin necrosis (p = 0.21). Only two of the studies included evaluated patient-reported outcomes between the use and non-use of ADM in implant-based breast reconstruction using BREAST-Q questionnaire, as well as self-reported pain. There was no reported significant difference in BREAST-Q or pain scores. CONCLUSIONS This meta-analysis shows comparable short- and long-term outcomes between ADM and non-ADM breast reconstruction, suggesting that the use of ADM may not be necessary in all cases given their additional cost. However, there is a paucity of data for patient-reported outcomes, and further research is required to determine whether ADM use affects patient-reported outcomes.
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Affiliation(s)
- Trina Priscilla Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Breast Surgery Service, Department of Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Brandon Yong Kiat Loo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Breast Surgery Service, Department of Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Nicole Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Breast Surgery Service, Department of Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Clement Luck Khng Chia
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Breast Surgery Service, Department of Surgery, Khoo Teck Puat Hospital, Singapore, Singapore.
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Visnu Lohsiriwat
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Seitz AJ, MacKenzie EL, Edalatpour A, Janssen DA, Doubek WG, Afifi AM. Quantifying the Impact of Prepectoral Implant Conversion on Patient Satisfaction and Quality of Life. Plast Reconstr Surg 2024; 153:884e-894e. [PMID: 37335561 DOI: 10.1097/prs.0000000000010829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND Conversion of subpectoral reconstruction to the prepectoral plane has been increasing in popularity. However, there is a paucity of research assessing patient-reported outcomes after this operation. The primary aim of this study was to examine patient-reported outcomes after conversion of implants from the subpectoral to prepectoral plane using the BREAST-Q. METHODS The authors retrospectively examined patients who underwent subpectoral-to-prepectoral implant conversion by three surgeons at two separate centers from 2017 through 2021. Patient demographics, primary indication for the conversion, surgical characteristics, postoperative outcomes, and BREAST-Q scores were obtained. RESULTS Sixty-eight breasts in 39 patients underwent implant conversion. The most common primary indications for implant conversion were chronic pain (41%), animation deformity (31%), and cosmetic concerns (28%). Average BREAST-Q scores improved significantly preoperatively to postoperatively in all the domains measured (satisfaction with breasts, satisfaction with implants, physical well-being, psychosocial well-being, and sexual well-being) ( P < 0.01). When examined by primary indication, all cohorts had significant preoperative to postoperative score improvement in satisfaction with breasts ( P < 0.001) and physical well-being ( P < 0.01) domains. Fifteen breasts (22%) developed postoperative complications, with implant loss in 9% of breasts. CONCLUSIONS Conversion of subpectoral implants to the prepectoral plane significantly improves BREAST-Q outcomes in all aspects, including patient satisfaction with breasts and implants, as well as psychosocial, physical, and sexual well-being. Implant conversion to the prepectoral plane is becoming the authors' primary solution for most patients with chronic pain, animation deformity, or cosmetic concerns after subpectoral reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Allison J Seitz
- From the Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health
| | - Ethan L MacKenzie
- From the Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health
| | - Armin Edalatpour
- From the Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health
| | | | | | - Ahmed M Afifi
- From the Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health
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Catanuto G, Virzì D, Latino M, Musmeci N, Fichera D, Balafa K, Cannata I, Rocco N, Marino M, Castiglione G, Caruso F. One-Stage Implant-Based Breast Reconstruction With Polyurethane-Coated Device: Standardized Assessment of Outcomes. Aesthet Surg J 2024; 44:491-498. [PMID: 37738139 DOI: 10.1093/asj/sjad301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/06/2023] [Accepted: 09/19/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Nipple-sparing mastectomies (NSMs) and implant-based breast reconstructions have evolved from 2-stage reconstructions with tissue expansion and implant exchange to direct-to-implant procedures. In this study, we tested safety and efficacy of polyurethane-based implants according to standard assessment tools. OBJECTIVES This study aimed to test safety and feasibility of polyurethane-coated implants with standardized assessment employing internationally acknowledged evaluation criteria. METHODS Cases of NSMs followed by breast reconstruction in 1 stage with immediate prepectoral polyurethane-coated implant placement were retrospectively reviewed. Preoperative characteristics of the population have been collected. Adherence to quality assurance criteria of the Association of Breast Surgery-British Association of Plastic Reconstructive and Aesthetic Surgeons was verified. Complications were assessed with the Clavien Dindo classification, modified for the breast. Rippling, implant rotation, and malposition were also evaluated. RESULTS Sixty-three consecutive patients underwent 74 NSMs and immediate breast reconstruction with micro polyurethane foam-coated anatomic implants. In 5 cases we had unplanned readmissions with return to the operating room under general anesthesia (6.7%) and implant loss within 3 months from breast reconstruction (5 implants, 6.7%). Postoperative complications according to Clavien Dindo were grade 1 in 6 cases (8.1%), grade 2 in 3 cases (4%), and 3b in 5 cases (6.7%). CONCLUSIONS Polyurethane-coated implants may prevent rotation and malposition and capsular contracture in the short term. Unplanned readmission rates and implant loss rates in the short term may be slightly higher.See the abstract translated into Hindi, Portuguese, Korean, German, Italian, Arabic, Chinese, and Taiwanese online here: https://doi.org/10.1093/asj/sjad301. LEVEL OF EVIDENCE: 4
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Brown CA, Carlson GW. The Impact of Radiation on Nipple Symmetry After Bilateral Nipple-Sparing Mastectomy and Implant-Based Reconstruction: An Objective Analysis. Ann Plast Surg 2024; 92:379-382. [PMID: 38527341 DOI: 10.1097/sap.0000000000003827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
INTRODUCTION Radiation therapy can adversely affect outcomes of implant-based breast reconstruction, potentially complicating procedures like nipple-sparing mastectomy (NSM), which is increasingly popular in breast cancer management. This study aims to evaluate the impact of radiation on nipple symmetry in patients undergoing bilateral NSM with implant-based reconstruction. METHODS We conducted a retrospective analysis using data from an Emory University review board-approved database. This encompassed bilateral NSMs coupled with immediate implant-based reconstructions. The BCCT.core software was employed to objectively measure nipple asymmetry preoperatively and postoperatively. Metrics, such as Breast Retraction Assessment values, upper nipple retraction, lower breast contour, and nipple to midline (NML) discrepancies were quantified. The study included 80 patients with a minimum of 1 year of follow-up; among them, 15 received radiation therapy (RT) while 65 did not. RESULTS The reconstructions were divided into tissue expander, used in 39 cases (48.8%), and direct-to-implant (DTI), employed in 41 cases (51.2%). The DTIs were further categorized based on the location of the implant: 22 subpectoral and 19 prepectoral. Radiation was applied to 15 breasts, distributed among prepectoral DTI (4), subpectoral DTI (6), and tissue expander (5). Breast Retraction Assessment scores significantly differed between the nonirradiated and irradiated groups (1.49 vs 2.64, P < 0.0004). Nipple to midline differences and Upper Nipple Retraction also significantly varied postradiation, especially when comparing subpectoral and prepectoral implant placements. CONCLUSIONS Radiation therapy has a detrimental effect on nipple symmetry after bilateral NSM and implant-based reconstruction, with variations seen regardless of the implant's placement or the reconstructive technique utilized. Specifically, subpectoral reconstructions irradiated were prone to lateral nipple displacement, likely related to radiation-induced pectoralis muscle changes, while prepectoral irradiated reconstructions tended to have increased vertical displacement. These insights are crucial for patient education and surgical planning in the context of radiation and breast reconstruction.
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Affiliation(s)
- Ciara A Brown
- From the Division of Plastic Surgery, Emory University School of Medicine, Atlanta GA
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11
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De Lorenzi F, Sala P, Catapano S, Mazzocconi L, Lorenzano V, Borelli F, Ioppolo L, Caldarella P. Postmastectomy dual-plane submuscular-subcutaneous implant-based reconstruction: a series of 100 consecutive patients. Updates Surg 2024; 76:613-621. [PMID: 37964047 DOI: 10.1007/s13304-023-01683-5] [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: 08/04/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Advances in cancer knowledge and surgical techniques over the last decades have enabled plastic surgeons to use muscle-sparing procedures and more conservative approaches for implant-based reconstructions. In this paper, the authors describe an innovative subpectoral/subcutaneous implant pocket that represents an evolution of the classical submuscular technique and they report on the first consecutive hundred patients undergoing this procedure. METHODS Between April 2019 and May 2022, 100 consecutive patients underwent immediate postmastectomy implant-based reconstruction using the subpectoral/subcutaneous space, for a total of 122 procedures. Medical records were retrospectively reviewed and patients were prospectively followed. During plastic consultations, medical photographs were taken and aesthetic outcomes were scored with patients. RESULTS Mean follow-up was 18 months (range 6-46). Implant loss was observed in two patients (2%). Early minor complications were registered in 19 patients. A total of 80 out of 100 patients completed satisfaction survey assessing their postoperative outcomes. Results were considered satisfactory or very satisfactory by the surgeons and patients in more than 90% of cases. CONCLUSION The submuscular/subcutaneous pocket can be considered a new tool in the armamentarium of reconstructive procedures, in between submuscular/subfascial procedures and prepectoral ones. It is a one-stage procedure, its a simple and short time surgery, reproducible, its very well accepted by patients. It has specific indications, advantages, and drawbacks, a careful indication and an accurate surgical technique are mandatory to achieve good results.
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Affiliation(s)
- Francesca De Lorenzi
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology (IEO), IRCCS, Via Ripamonti, 435, 20141, Milan, Italy
| | - Pietro Sala
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology (IEO), IRCCS, Via Ripamonti, 435, 20141, Milan, Italy
| | - Simone Catapano
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology (IEO), IRCCS, Via Ripamonti, 435, 20141, Milan, Italy
| | - Luca Mazzocconi
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology (IEO), IRCCS, Via Ripamonti, 435, 20141, Milan, Italy.
| | - Valerio Lorenzano
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology (IEO), IRCCS, Via Ripamonti, 435, 20141, Milan, Italy
| | - Francesco Borelli
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology (IEO), IRCCS, Via Ripamonti, 435, 20141, Milan, Italy
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Hospital Galeazzi - Sant'Ambrogio, Milan, Italy
| | - Leonardo Ioppolo
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology (IEO), IRCCS, Via Ripamonti, 435, 20141, Milan, Italy
- Marrelli Hospital, Via Gioacchino da Fiore 5, 88900, Crotone, Italy
| | - Pietro Caldarella
- Department of Breast Surgery, European Institute of Oncology (IEO), IRCCS, Via Ripamonti, 435, 20141, Milan, Italy
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Correia-Pinto JM, Andresen C, Barbosa JP, Poleri F, Casimiro R, Gonçalves D, Baptista D, Coelho G, Cunha C, Costa H. Impact of polyurethane versus acellular dermal matrix coating on prepectoral reconstruction outcomes: Interface does matter. J Plast Reconstr Aesthet Surg 2024; 91:15-23. [PMID: 38401273 DOI: 10.1016/j.bjps.2024.01.025] [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: 05/26/2023] [Revised: 01/09/2024] [Accepted: 01/29/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Interfaces continue to be used in prepectoral breast reconstruction to refine breast appearance, but more clinical data are required to assess their effectiveness. This study compares the rates of capsular contracture, breast esthetics, and patient satisfaction between two commonly used interface materials, acellular dermal matrix (ADM) and polyurethane (PU) foam. METHODS A cross-sectional assessment was conducted on all patients who underwent prepectoral direct-to-implant reconstruction with an interface material between June 2018 and June 2022. We compared capsular contracture rates (assessed in-person), esthetic outcomes (evaluated by a three-member panel using a specially designed scale), and patient satisfaction (measured using the Breast-Q questionnaire) among the members of the interface groups. RESULTS Among the 79 reconstructed breasts (20 bilateral cases), 35 were reconstructed using ADM and 44 using PU implants. The ADM group had a significantly higher frequency of Baker III/IV capsular contracture compared with the PU group (14.3% vs. 0%, p = 0.014) and lower ratings from the panel in terms of capsular contracture (median 3.7 vs. 4.0, p < 0.001). PU reconstructions scored worse in implant visibility (median 2.3 vs. 3.3, p < 0.001) and rippling (median 3.0 vs. 3.7, p < 0.001). However, after appropriate adjustment for confounders, no significant differences in overall appearance and patient satisfaction were found. CONCLUSIONS ADM reconstructions are prone to capsular contracture with all their related esthetic issues, but PU implants have certain cosmetic flaws, such as implant visibility and malposition. Since each technique has its own limitations, neither the experienced surgeons nor patients exhibited a clear preference for either approach.
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Affiliation(s)
- Jorge M Correia-Pinto
- Serviço de Cirurgia Plástica Reconstrutiva, Craniomaxilofacial e Mão - Unidade de Microcirurgia; Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal; Serviço de Cirurgia Plástica; Hospital da Prelada, Rua de Sarmento de Beires 153, 4250-449 Porto, Portugal.
| | - Carolina Andresen
- Serviço de Cirurgia Plástica Reconstrutiva, Craniomaxilofacial e Mão - Unidade de Microcirurgia; Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
| | - José P Barbosa
- Departamento de Medicina da Comunidade, Informação e Decisão em Saúde (MEDCIDS); Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Filipa Poleri
- Serviço de Cirurgia Plástica Reconstrutiva, Craniomaxilofacial e Mão - Unidade de Microcirurgia; Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal; Serviço de Cirurgia Plástica; Hospital da Prelada, Rua de Sarmento de Beires 153, 4250-449 Porto, Portugal
| | - Rui Casimiro
- Serviço de Cirurgia Plástica Reconstrutiva, Craniomaxilofacial e Mão - Unidade de Microcirurgia; Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal; Serviço de Cirurgia Plástica; Hospital da Prelada, Rua de Sarmento de Beires 153, 4250-449 Porto, Portugal
| | - David Gonçalves
- Serviço de Cirurgia Plástica Reconstrutiva, Craniomaxilofacial e Mão - Unidade de Microcirurgia; Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal; Serviço de Cirurgia Plástica; Hospital da Prelada, Rua de Sarmento de Beires 153, 4250-449 Porto, Portugal
| | - Daniel Baptista
- Serviço de Cirurgia Plástica Reconstrutiva, Craniomaxilofacial e Mão - Unidade de Microcirurgia; Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal; Serviço de Cirurgia Plástica; Hospital da Prelada, Rua de Sarmento de Beires 153, 4250-449 Porto, Portugal
| | - Gustavo Coelho
- Serviço de Cirurgia Plástica Reconstrutiva, Craniomaxilofacial e Mão - Unidade de Microcirurgia; Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
| | - Cristina Cunha
- Serviço de Cirurgia Plástica Reconstrutiva, Craniomaxilofacial e Mão - Unidade de Microcirurgia; Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
| | - Horácio Costa
- Serviço de Cirurgia Plástica Reconstrutiva, Craniomaxilofacial e Mão - Unidade de Microcirurgia; Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
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Rubenstein RN, Kim M, Plotsker EL, Chu JJ, Bell T, McGriff D, Allen R, Dayan JH, Stern CS, Coriddi M, Disa JJ, Mehrara BJ, Matros E, Nelson JA. Early Complications in Prepectoral Tissue Expander-Based Breast Reconstruction. Ann Surg Oncol 2024; 31:2766-2776. [PMID: 38245651 DOI: 10.1245/s10434-023-14861-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/18/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Prepectoral implant placement for postmastectomy breast reconstruction has increased in recent years. Benefits of prepectoral reconstruction may include lack of animation deformities and reduced postoperative pain, but its complication profile is currently unclear. This study aimed to examine the complication profile of prepectoral tissue expanders (TEs) to determine factors associated with TE loss. METHODS A retrospective review was performed to identify all patients who underwent immediate prepectoral TE reconstruction from January 2018 to June 2021. The decision to use the prepectoral technique was based on mastectomy skin quality and patient comorbidities. Patient demographics, comorbidities, and operative details were evaluated. Outcomes of interest included TE loss, seroma, hematoma, infection/cellulitis, mastectomy skin flap necrosis requiring revision, and TE exposure. Logistic regression analysis was performed to identify factors associated with TE loss. RESULTS The study identified 1225 TEs. The most frequent complications were seroma (8.7%, n = 106), infection/cellulitis (8.2%, n = 101), and TE loss (4.2%, n = 51). Factors associated with TE loss in the univariate analysis included ethnicity, history of smoking, body mass index, mastectomy weight, and neoadjuvant chemotherapy. In the multivariate regression analysis, only mastectomy weight had a positive association with TE loss (odds ratio, 1.001; p = 0.016). CONCLUSION Prepectoral two-stage breast reconstruction can be performed safely with an acceptable early complication profile. The study data suggest that increasing mastectomy weight is the most significant factor associated with TE loss. Further research examining the quality of the soft tissue envelope and assessing patient-reported outcomes would prove beneficial.
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Affiliation(s)
- Robyn N Rubenstein
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Minji Kim
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ethan L Plotsker
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jacqueline J Chu
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tajah Bell
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - De'von McGriff
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert Allen
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joseph H Dayan
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carrie S Stern
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michelle Coriddi
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joseph J Disa
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Babak J Mehrara
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Evan Matros
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonas A Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Qiu M, Liang F, Xie Y, Yang H, Zhang Q, Zhong J, Dai H, Du Z. ASO Author Reflections: A Novel Technique of Transaxillary Reverse-Sequence Endoscopic Nipple-Sparing Mastectomy and Direct-to-Implant Prepectoral Breast Reconstruction. Ann Surg Oncol 2024; 31:2791-2792. [PMID: 38185728 DOI: 10.1245/s10434-023-14847-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 12/12/2023] [Indexed: 01/09/2024]
Affiliation(s)
- Mengxue Qiu
- Breast Centre, West China Hospital, Sichuan University, Chengdu, China
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Faqing Liang
- Breast Centre, West China Hospital, Sichuan University, Chengdu, China
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yanyan Xie
- Breast Centre, West China Hospital, Sichuan University, Chengdu, China
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Huanzuo Yang
- Breast Centre, West China Hospital, Sichuan University, Chengdu, China
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Zhang
- Breast Centre, West China Hospital, Sichuan University, Chengdu, China
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jiayuan Zhong
- Breast Centre, West China Hospital, Sichuan University, Chengdu, China
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hui Dai
- Breast Centre, West China Hospital, Sichuan University, Chengdu, China
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenggui Du
- Breast Centre, West China Hospital, Sichuan University, Chengdu, China.
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China.
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Qiu M, Liang F, Xie Y, Yang H, Zhang Q, Zhong J, Dai H, Du Z. ASO Visual Abstract: Clinical Outcomes of Transaxillary Reverse-Sequence Endoscopic Nipple-Sparing Mastectomy and Direct-to-Implant Prepectoral Breast Reconstruction-A Prospective Study of Initial 68 Procedures. Ann Surg Oncol 2024; 31:2794-2795. [PMID: 38147224 DOI: 10.1245/s10434-023-14797-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Affiliation(s)
- Mengxue Qiu
- Breast Centre, West China Hospital, Sichuan University, Chengdu, China
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Faqing Liang
- Breast Centre, West China Hospital, Sichuan University, Chengdu, China
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yanyan Xie
- Breast Centre, West China Hospital, Sichuan University, Chengdu, China
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Huanzuo Yang
- Breast Centre, West China Hospital, Sichuan University, Chengdu, China
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Zhang
- Breast Centre, West China Hospital, Sichuan University, Chengdu, China
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jiayuan Zhong
- Breast Centre, West China Hospital, Sichuan University, Chengdu, China
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hui Dai
- Breast Centre, West China Hospital, Sichuan University, Chengdu, China
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenggui Du
- Breast Centre, West China Hospital, Sichuan University, Chengdu, China.
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China.
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16
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Marangi GF, Savani L, Gratteri M, Arcari L, Segreto F, Cagli B, Cogliandro A, Vega R, Mirra C, Persichetti P. Main Factors Influencing Patient Satisfaction After Primary Breast Augmentation: A Prospective Study Based on Patient-Reported Outcome Measures. Aesthet Surg J 2024; 44:375-382. [PMID: 38114077 DOI: 10.1093/asj/sjad372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/25/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Primary breast augmentation is one of the most sought-after procedures in cosmetic surgery. It is generally related to a high degree of patient satisfaction, but it is not always obvious which factors have greater influence on patient satisfaction. OBJECTIVES The aim of this prospective study was to evaluate how anthropometric, psychological, and social parameters, in association with the main surgical variables, influenced patients' satisfaction with their breasts after surgery. METHODS Patients undergoing primary breast augmentation between October 2018 and February 2022, who completed a 12-month follow-up without complications, were enrolled in the study. For each patient we recorded: BMI, pinch test (upper pole of the breast), surgical access, implant pocket, implant volume, bra size increase, age, smoking habit, civil status, education level, pregnancies, and psychiatric disorders. Each variable was statistically correlated with patient's satisfaction, assessed by BREAST-Q questionnaire preoperatively and 12 months postoperatively. RESULTS Analyzing the data of the 131 patients, we found 3 factors affecting their satisfaction (P<.05); BMI: underweight patients were less satisfied than normal and overweight patients; pinch test: patients with a pinch test >2 cm were more satisfied; volume of the implant and bra size increase: patients with implant volume <300 cc and a less than 2 bra size increase were less satisfied than patients with larger augmentation. CONCLUSIONS BMI, pinch test, implant volume, and extent of volumetric enhancement should be taken into careful consideration by the surgeon during preoperative consultation and surgical planning, because they can be critical to patient satisfaction. LEVEL OF EVIDENCE: 3
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17
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Suzuki M, Komiya T, Asai M, Ayabe N, Hanano M, Kawai Y, Shimada K, Ishikawa T, Matsumura H. Effectiveness of SCAR-Q for assessment of incisional SCAR after implant-based reconstruction in breast cancer patients: Can it be a tool for incision selection? Int Wound J 2024; 21:e14822. [PMID: 38468433 PMCID: PMC10928237 DOI: 10.1111/iwj.14822] [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: 01/20/2024] [Revised: 02/10/2024] [Accepted: 02/18/2024] [Indexed: 03/13/2024] Open
Abstract
Incisional scarring is a factor of cosmetic appearance evaluated after breast reconstruction, along with the shape, position, and size of the breast. This study aimed to examine the effect of the incision scar location on patient satisfaction after breast reconstruction. Using the Japanese version of the SCAR-Q, we assessed the scar appearance, symptoms and psychosocial effects. Plastic surgeons performed assessments using the Manchester Scar Scale. The patients were divided into two groups: those with scars on the margins of the breast (MB group) and those with scars in the breast area (IB group). The results revealed that patients in the MB group reported significantly higher satisfaction with the scar appearance and psychological impact than those in the IB group. However, assessments using the Manchester Scar Scale did not reveal any significant differences between the two groups. In conclusion, this study underscores the importance of patient-reported outcomes in the evaluation of scar satisfaction after breast reconstruction. Patients tend to prefer and have higher satisfaction with scars along the breast margin, which offers valuable insights into surgical decisions. Further studies with larger and more diverse sample sizes are required for validation.
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Affiliation(s)
- Misa Suzuki
- Department of Plastic and Reconstructive SurgeryTokyo Medical UniversityTokyoJapan
| | - Takako Komiya
- Department of Plastic and Reconstructive SurgeryTokyo Medical UniversityTokyoJapan
| | - Maiko Asai
- Department of Plastic and Reconstructive SurgeryTokyo Medical UniversityTokyoJapan
| | - Nanako Ayabe
- Department of Plastic and Reconstructive SurgeryTokyo Medical UniversityTokyoJapan
| | - Mai Hanano
- Department of Plastic and Reconstructive SurgeryTokyo Medical UniversityTokyoJapan
| | - Yuichiro Kawai
- Department of Plastic and Reconstructive SurgeryTokyo Medical UniversityTokyoJapan
| | - Kazuki Shimada
- Department of Plastic and Reconstructive SurgeryTokyo Medical UniversityTokyoJapan
| | - Takashi Ishikawa
- Department of Breast Oncology and SurgeryTokyo Medical UniversityTokyoJapan
| | - Hajime Matsumura
- Department of Plastic and Reconstructive SurgeryTokyo Medical UniversityTokyoJapan
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Pelegrina Perez TC, Desai A, Tadisina KK, Singh DP, Kesmodel SB, Rojas KE, Mella-Catinchi JR. Prevalence, clinical characteristics, and management of silicone lymphadenopathy: A systematic review of the literature. J Plast Reconstr Aesthet Surg 2024; 90:76-87. [PMID: 38364672 DOI: 10.1016/j.bjps.2024.01.011] [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: 10/29/2023] [Revised: 12/04/2023] [Accepted: 01/29/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Implant-based breast augmentations and reconstructions are one of the most common surgical procedures performed by plastic surgeons in the United States, which has rapidly increased in popularity since the 2000s. Silicone lymphadenopathy (SL) is a complication of breast implants that involves migration of silicone to nearby soft tissue/lymph nodes. Data on its clinical features and management is scarce. METHODS SL-related search terms were used to find articles in 3 databases. Of 598 articles, 101 studies met the inclusion criteria. Demographics, clinical presentation, workup, and management data were analyzed. RESULTS Of 279 cases of SL and 107 with information on initial diagnosis, 35 (33%) were incidental. The most common symptom was painless lymphadenopathy, followed by painful lymphadenopathy. 251 (95%) and 13 (5%) patients had silicone and saline implants, respectively. 149 (68%) patients had implant rupture. Axillary lymphadenopathy was the most affected region (136 cases, 72%), followed by internal mammary (40 cases, 21%), cervical/supraclavicular (36 cases, 19%), and mediastinal (24 cases, 13%) regions. 25% of patients underwent fine-needle aspiration, 12% core needle biopsy, and 59% excisional biopsy. 32% of cases underwent explantation and/or implant exchange. The most common indication for surgery was implant rupture. Histology showed multinucleated giant cells, large histiocytes, and silicone accumulation. CONCLUSIONS SL is a complication associated with breast implants. The majority of patients are asymptomatic, and most cases are managed conservatively. Minority need a biopsy and surgical interventions due to abnormal imaging, persistent symptoms, and/or implant rupture. Workup and management should be tailored to the patient.
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Affiliation(s)
| | - Anshumi Desai
- DeWitt Daughtry Family Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Kashyap K Tadisina
- DeWitt Daughtry Family Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Devinder P Singh
- DeWitt Daughtry Family Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Susan B Kesmodel
- DeWitt Daughtry Family Department of Surgery, Division of Surgical Oncology, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Kristin E Rojas
- DeWitt Daughtry Family Department of Surgery, Division of Surgical Oncology, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Juan R Mella-Catinchi
- DeWitt Daughtry Family Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Chan A, Auclair R, Gao Q, Ghione P, Horwitz S, Dogan A, Roshal M, Lin O. Role of flow cytometric immunophenotyping in the diagnosis of breast implant-associated anaplastic large cell lymphoma: A 6-year, single-institution experience. Cytometry B Clin Cytom 2024; 106:117-125. [PMID: 38297808 PMCID: PMC10978229 DOI: 10.1002/cyto.b.22162] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/05/2024] [Accepted: 01/18/2024] [Indexed: 02/02/2024]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon mature T-cell neoplasm occurring in patients with textured breast implants, typically after 7-10 years of exposure. Although cytopathologic or histopathologic assessment is considered the gold standard diagnostic method for BIA-ALCL, flow cytometry (FC)-based immunophenotyping is recommended as an adjunct test. However, the diagnostic efficacy of FC is not well reported. We reviewed 290 FC tests from breast implant pericapsular fluid and capsule tissue from 182 patients, including 16 patients with BIA-ALCL over a 6-year period, calculating diagnostic rates and test efficacy. FC showed an overall sensitivity of 75.9%, specificity of 100%, and negative and positive predictive values of 95.4% and 100%, respectively. Blinded expert review of false-negative cases identified diagnostic pitfalls, improving sensitivity to 96.6%. Fluid samples had better rates of adequate samples for FC testing compared with tissue samples. Paired with FC testing of operating room (OR)-acquired fluid samples, capsulectomy FC specimens added no diagnostic value in patients with concurrent fluid samples; no cases had positive capsule FC with negative fluid FC. Fluid samples are adequate for FC testing more often than tissue. Capsule tissue FC specimens do not improve FC efficacy when paired with OR-acquired fluid FC samples and are often inadequate samples. FC is 100% specific for BIA-ALCL and can serve as a confirmatory test but should not be the sole diagnostic method. Awareness of sample-specific diagnostic pitfalls greatly improves the sensitivity of BIA-ALCL testing by FC.
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Affiliation(s)
- Alexander Chan
- Department of Pathology, Hematopathology Service, Memorial Sloan Kettering Cancer Center
| | - Romany Auclair
- Department of Pathology, Hematopathology Service, Memorial Sloan Kettering Cancer Center
| | - Qi Gao
- Department of Pathology, Hematopathology Service, Memorial Sloan Kettering Cancer Center
| | - Paola Ghione
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center
| | - Steven Horwitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center
| | - Ahmet Dogan
- Department of Pathology, Hematopathology Service, Memorial Sloan Kettering Cancer Center
| | - Mikhail Roshal
- Department of Pathology, Hematopathology Service, Memorial Sloan Kettering Cancer Center
| | - Oscar Lin
- Department of Pathology, Hematopathology Service, Memorial Sloan Kettering Cancer Center
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Avila FR, Mazer LS, Borna S, Torres-Guzman RA, Maita KC, Garcia JP, Forte AJ, Ho OA. Breast Pocket Lavage With Clindamycin Solution for Silicone Removal After Implant Rupture. Aesthet Surg J 2024; 44:NP233-NP235. [PMID: 37966376 DOI: 10.1093/asj/sjad346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/28/2023] [Accepted: 11/08/2023] [Indexed: 11/16/2023] Open
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21
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Escandón JM, Christiano JG, Gooch JC, Olzinski AT, Prieto PA, Skinner KA, Langstein HN, Manrique OJ. Two-Stage Implant-Based Breast Reconstruction Using Intraoperative Fluorescence Imaging: A Propensity Score-Matched Analysis. Plast Reconstr Surg 2024; 153:291-303. [PMID: 37104496 DOI: 10.1097/prs.0000000000010602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND Limited comparability between study groups can generate significant selection and observer bias when evaluating the efficacy of the SPY system and fluorescence imaging for implant-based breast reconstruction. In this study, the authors compared the surgical outcomes and complications during the first stage of reconstruction between reconstructions evaluated intraoperatively with fluorescence imaging using the SPY system and clinical assessment using a matched analysis. METHODS The authors conducted a retrospective review of patients undergoing total mastectomy and immediate two-stage implant-based breast reconstruction with TEs from January of 2011 to December of 2020. The rate of complication, time for TE-to-implant exchange, and time to start radiotherapy were compared between groups (intraoperative fluorescence imaging versus clinical assessment) using a propensity score-matched analysis. RESULTS After propensity score matching, 198 reconstructions were evaluated. There were 99 reconstructions in each group. The median time for TE-to-implant exchange (140 days versus 185 days; P = 0.476) and time to initiate adjuvant radiotherapy (144 days versus 98 days; P = 0.199) were comparable between groups. The 30-day rate of wound-related complications (21% versus 9%; P = 0.017) and 30-day rate of wound-related unplanned interventions were significantly higher in reconstructions evaluated with clinical assessment when compared with the SPY system (16% versus 5%; P = 0.011). A higher 30-day rate of seroma (19% versus 14%; P = 0.041) and hematoma (8% versus 0%; P = 0.004) were found in reconstructions assessed intraoperatively with the SPY system. CONCLUSIONS After matching, reconstructions evaluated with fluorescence imaging exhibited a lower incidence of early wound-related complications when compared with clinical evaluation alone. Nonetheless, the Wise pattern for mastectomy was found to be the only independent predictor associated with early wound-related complications. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Joseph M Escandón
- From the Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital
| | - Jose G Christiano
- From the Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital
| | - Jessica C Gooch
- Division of Surgical Oncology, Department of Surgery, Wilmot Cancer Center, University of Rochester Medical Center
| | - Ann Therese Olzinski
- Division of Surgical Oncology, Department of Surgery, Wilmot Cancer Center, University of Rochester Medical Center
| | - Peter A Prieto
- Division of Surgical Oncology, Department of Surgery, Wilmot Cancer Center, University of Rochester Medical Center
| | - Kristin A Skinner
- Division of Surgical Oncology, Department of Surgery, Wilmot Cancer Center, University of Rochester Medical Center
| | - Howard N Langstein
- From the Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital
| | - Oscar J Manrique
- From the Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital
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22
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Eyuboglu AA, Akdemir O, Aydogan F, Isken MT. Implant-Based Breast Reconstruction with Bovine Pericardium: Our Approach Using Tutopatch ® and Review of Literature. Aesthetic Plast Surg 2024; 48:285-296. [PMID: 37973674 DOI: 10.1007/s00266-023-03732-1] [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: 08/24/2023] [Accepted: 10/17/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES To describe the usage and advantages of bovine pericardium mesh (Tutopatch®) in breast reconstruction and to compare different mesh materials used in immediate breast reconstruction. METHODS Our study involved a single-center, retrospective analysis of 103 patients (comprising 114 breasts) who underwent immediate implant-based breast reconstruction using bovine pericardium bovine matrix. The procedures were performed by the same surgical team between April 2018 and May 2023. RESULTS The rates of early and late complications were examined after a median follow-up period of 30.2 ± 5.5 months. The results revealed that the rates of early complications stood at 9.7%, while late complications were observed in 14.5% of the cases. The most common late complication was seroma formation (7.7%) which six were resolved without any surgical intervention. CONCLUSION Tutopatch® can be used as an extension of the muscle to cover the prosthesis. It forms an extra layer over the silicone implant that helps to decrease the complications as capsular contracture and implant exposure. It also represents a significant 85 % reduction in cost when compared to a similar-sized mesh materials. 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)
- Atilla Adnan Eyuboglu
- Department of Plastic and Reconstructive Surgery, Arel University Faculty of Medicine, Bahcelievler Memorial Hospital, Bahcelievler Mah. Adnan Kahveci Bulvari no: 227, 34180, Bahcelievler, Istanbul, Turkey.
| | - Ovunc Akdemir
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Aydın University, Istanbul, Turkey
| | - Fatih Aydogan
- Department of Breast Surgery, General Surgery, Bahcelievler Memorial Hospital, Istanbul, Turkey
| | - Mustafa Tonguc Isken
- Department of Plastic and Reconstructive Surgery, Bahcesehir University Faculty of Medicine, Bahcelievler Memorial Hospital, Istanbul, Turkey
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23
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Ioppolo L, Alessandri Bonetti M, De Lorenzi F. Tuberous Breasts Associated with Chest Wall Deformity: A Challenging Planning for Breast Augmentation. Aesthetic Plast Surg 2024; 48:282-284. [PMID: 38157013 DOI: 10.1007/s00266-023-03784-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 11/25/2023] [Indexed: 01/03/2024]
Abstract
Tuberous breast deformity is characterized by a deficiency in the vertical and horizontal dimensions of the breast, as well as breast underdevelopment and asymmetry. Concomitant chest wall deformities are not uncommon and increase the difficulty when planning breast augmentation in such patients. We present a unique case of tuberous breasts and chest wall deformity successfully treated employing a novel technique that incorporated breast implants and fat grafting. A 24-year-old patient with no significant past medical history presented to the plastic surgery clinic seeking correction of a severe breast asymmetry and desiring increase in breast volume. The right breast was Grolleau type 1 cup A, while the left breast was Grolleau type 3 cup C. The left hemithorax presented an accentuated prominence of the costochondral junction of 4th left rib, along with minor prominence of the 3rd and 5th left ribs. In addition, the 5th and 6th ribs were fused together. The surgical plan involved bilateral augmentation with implant and fat grafting. A 285 cc Motiva implant was placed subfascial on the right. Multiple refinements were necessary to the left breast, including areolar reduction, inframammary fold adjustment, and medial glandular modifications. A 140 cc Motiva implant was placed subfascial. Fat grafting was used in both breasts to enhance contour, projection and conceal the chest wall deformity. Postoperative recovery was uneventful, and results at 3-month follow-up showed improved breast symmetry and aesthetics.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)
- Leonardo Ioppolo
- Marrelli Hospital, Via Gioacchino da Fiore 5, 88900, Crotone, Italy
| | - Mario Alessandri Bonetti
- Department of Plastic Surgery, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy.
| | - Francesca De Lorenzi
- Department of Plastic Surgery, European Institute of Oncology - IRCCS, Via Ripamonti 435, 20141, Milan, Italy
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24
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Marquez JL, French M, Ormiston L, Pires G, Martheswaran T, Eddington D, Tuncer F, Agarwal JP, Kwok AC. Outcomes after tissue expander exchange to implant in two-stage prepectoral breast reconstruction with and without acellular dermal matrix: A retrospective cohort study. J Plast Reconstr Aesthet Surg 2024; 89:97-104. [PMID: 38160591 DOI: 10.1016/j.bjps.2023.12.008] [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: 09/07/2023] [Revised: 11/20/2023] [Accepted: 12/06/2023] [Indexed: 01/03/2024]
Abstract
As prepectoral implant placement becomes widely adopted, recent studies investigating the use of acellular dermal matrix (ADM) during tissue expander placement have demonstrated no major benefit with regard to postoperative outcomes. We sought to evaluate second-stage outcomes 1 year after tissue expander exchange to implant with and without ADM. Consecutive patients who underwent prepectoral tissue expander-based breast reconstruction with and without ADM were identified. Patients were followed up for 1 year after tissue expander exchange to implant. Second-stage outcomes of interest including implant rippling, capsular contracture, implant explantation, additional revision surgeries, and patient-reported outcomes were collected and compared. Sixty-eight breasts in the ADM cohort and sixty-one breasts in the no ADM cohort underwent tissue expander exchange to implant. Second-stage outcomes of interest were similar between the ADM and no ADM cohorts with no statistically significant differences identified regarding incidences of implant rippling (24.6% vs. 12.1%, p = 0.08), capsular contracture (4.5% vs. 3.3%, p = 1.00), and explantation (6.6% vs. 1.7%, p = 0.67) between the two cohorts. BREAST-Q scores were similar between the two cohorts with the exception of physical wellbeing and satisfaction in terms of implant rippling, as can be seen, which improved in the no ADM cohort (p = 0.04). Our study reports no major benefit for the inclusion of ADM with respect to implant rippling, capsular contracture, explantation, need for additional revision surgeries, and patient-reported satisfaction in prepectoral second-stage implant-based breast reconstruction.
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Affiliation(s)
- Jessica L Marquez
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Mackenzie French
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Laurel Ormiston
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Giovanna Pires
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Tanisha Martheswaran
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Devin Eddington
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Fatma Tuncer
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jayant P Agarwal
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Alvin C Kwok
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA.
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25
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Lu L, Hou Q, Hu Z, Yao Z, Xiong J, Ying J, Sun M, Wang H, Jiang H. Harmonic Scalpel Versus Monopolar Electrotome in Endoscopic-Assisted Transaxillary Dual-Plane Augmentation Mammaplasty: A Retrospective Study in 122 Patients. Aesthetic Plast Surg 2024; 48:273-281. [PMID: 38030915 DOI: 10.1007/s00266-023-03747-8] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND The transaxillary approach of breast augmentation is the most popular method in Asia, but longer period of recovery was observed in spite of the assistance of endoscope. OBJECTIVES Introducing the ultrasonic dissection devices might be a solution to minimizing tisue damage thus relieving pain and shortening the period of recovery. METHOD Between March 2020 and September 2022, we retrospectively reviewed the cases of 122 patients underwent endoscopic augmentation mammoplasty via the transaxillary approach using either the monopolar electrotome (ME) alone or assisted with Harmonic Scalpel (HS) in defining the retropectoral pocket and severing the pectoralis major muscle. RESULT The total drainage volume was significantly lower in the HS group than ME group (74.33 ± 48.81 vs. 180.30 ± 125.10 mL; p < 0.0001). VAS score of the first 24 hour after surgery of the ME group was significantly higher than that of the HS group (6.10 ± 1.27 vs. 2.88 ± 1.29, p < 0.0001). Operation time in HS group was reduced compared to ME group (113.1 ± 14.46 mins vs. 131.3 ± 35.51 mins, p < 0.001). The duration of drainage placement (1.08 ± 0.27 vs. 2.72 ± 1.18 days) and hospital stay after surgery (3.08 ± 0.42 vs. 5.64 ± 2.78 days; p < 0.0001) were largely reduced in HS group. CONCLUSION The assistance of Harmonic Scalpel significantly reduced total postoperative drainage, relieved pain and shortened operation time, length of drainage placement and hospital stay compared to using monopolar electrotome alone in endoscopic-assisted transaxillary dual-plane augmentation mammaplasty. 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)
- Lu Lu
- Department of Plastic and Reconstructive Surgery, Shanghai East Hospital, Tongji University School of Medicine, No.150, Jimo Rd, Shanghai, 200120, China
| | - Qiang Hou
- Department of Plastic and Reconstructive Surgery, Shanghai East Hospital, Tongji University School of Medicine, No.150, Jimo Rd, Shanghai, 200120, China
| | - Zheyuan Hu
- Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Zuochao Yao
- Department of Plastic and Reconstructive Surgery, Shanghai East Hospital, Tongji University School of Medicine, No.150, Jimo Rd, Shanghai, 200120, China
| | - Jiachao Xiong
- Department of Plastic and Reconstructive Surgery, Shanghai East Hospital, Tongji University School of Medicine, No.150, Jimo Rd, Shanghai, 200120, China
| | - Jianghui Ying
- Department of Plastic and Reconstructive Surgery, Shanghai East Hospital, Tongji University School of Medicine, No.150, Jimo Rd, Shanghai, 200120, China
| | - Meiqing Sun
- Department of Plastic and Reconstructive Surgery, Shanghai East Hospital, Tongji University School of Medicine, No.150, Jimo Rd, Shanghai, 200120, China
- Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Hui Wang
- Department of Plastic and Reconstructive Surgery, Shanghai East Hospital, Tongji University School of Medicine, No.150, Jimo Rd, Shanghai, 200120, China.
| | - Hua Jiang
- Department of Plastic and Reconstructive Surgery, Shanghai East Hospital, Tongji University School of Medicine, No.150, Jimo Rd, Shanghai, 200120, China.
- Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China.
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26
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Xie Y, Hu X, Du Z, Liang F, Lv Q, Li B. Minimally Invasive and Innovative Management of Prosthesis Infections in Endoscopic-Assisted Breast Reconstruction. Aesthetic Plast Surg 2024; 48:266-272. [PMID: 37605028 DOI: 10.1007/s00266-023-03525-6] [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: 06/22/2023] [Accepted: 07/08/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Implant infection continues to be the most common complication of breast reconstruction, and it can lead to serious consequences of implant loss. Recently, endoscopic-assisted nipple-sparing mastectomy with direct-to-implant breast reconstruction is being performed more frequently, with similar prosthetic infection incidence compared to conventional techniques. But there is little information published in the literature on the management of periprosthetic infection in endoscopic-assisted breast reconstruction. METHODS A retrospective review was performed of patients who underwent endoscope-assisted breast reconstruction and developed periprosthetic infection between January 2020 and December 2022. Prosthesis infection was defined as any case where antibiotics were given, beyond the surgeon's standard perioperative period, in response to clinical signs such as swelling, pain, erythema, increased temperature, fever, etc. We summarized our clinical approach and treatment protocol for periprosthetic infection patients. Collected data include preoperative basic information, surgical details, postoperative data, and outcomes. RESULTS A total of 580 patients (713 reconstructions) underwent endoscopic-assisted immediate breast reconstruction. There were 58 patients developed periprosthetic infection, 14 of whom had bilateral prosthesis reconstruction with unilateral prosthesis infection. The incidence of infection was 10.0%. Average follow-up was 17.3 ± 8.9 months (range = 2-37 months). Of the 58 patients, 53 (91.4%) patients successful salvaged implant and 5(8.6%) patients removed prosthesis. During follow-up, Baker III capsular contracture occurred in 2 patients (3.8%) who had radiotherapy. CONCLUSION Our management of prosthesis infections in endoscopic-assisted breast reconstruction is easy, minimally invasive, and inexpensive. This method can be repeated if the implant infection does not improve after the first drainage. What's more, our data suggest that our prosthesis salvage of periprosthetic infection is effective. 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)
- Yanyan Xie
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoxia Hu
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenggui Du
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, China
| | - Faqing Liang
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Lv
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China.
- Breast Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Bo Li
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China.
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27
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Montemurro P, Gupta T. Devil's Advocate: Evidence-Based Recommendation for "One Breast-One Insertion Funnel" Policy. Aesthet Surg J 2024; 44:160-164. [PMID: 37647888 DOI: 10.1093/asj/sjad288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/23/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Rates of capsular contracture have reduced significantly since the use of insertion funnels to place breast implants became routine. However, due to financial constraints, the same funnel is usually used for implantation of both sides. OBJECTIVES The aim of this study was to determine whether the risk of capsular contracture is higher for the second breast when the same insertion funnel is used for both breasts. METHODS The authors collected a sample of the insertion funnel tip immediately after removing the funnel from its sterile packaging and another tip sample after the funnel had been used to insert the first implant. These samples were sent for microbiological culture evaluations. Capsular contracture rates in the first implanted breast vs the second implanted breast were then retrospectively analyzed. RESULTS All samples taken from the funnel before the first implantation showed no bacterial growth. All 10 samples taken from the funnel after the first implantation showed organism growth (8 were positive for Staphylococcus epidermidis and 2 for Cutibacterium acnes). Retrospective analysis of the results revealed that the overall capsular contracture rate had reduced after the authors began to use insertion funnels. However, this complication was still more common on the second implanted breast. CONCLUSIONS Surgeons should consider the use of separate insertion funnels for each breast. This might help to slightly reduce the incidence of capsular contracture.See the abstract translated into Hindi, Portuguese, Korean, German, Italian, Arabic, and Chinese (Simplified and Traditional) online here: https://doi.org/10.1093/asj/sjad288. LEVEL OF EVIDENCE: 4
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28
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Álvarez-Trejo H, Dorado-Hernández E, Jimenez-Pavón KE, Cuevas-Gutierrez R, Romero-Algara E, Rodríguez-García F, Torres-Salazar QL. Introduction of Breast Implants through the Abdominal Route: Analysis of a Cohort. Plast Reconstr Surg 2024; 153:46-52. [PMID: 37104028 DOI: 10.1097/prs.0000000000010601] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND Simultaneous breast reshaping and abdominoplasty offer patients the opportunity to undergo body reshaping in a single surgical session involving one anesthesia induction and one incision. In Latin America, abdominal implant placement is an infrequently used technique, likely because there is little evidence on its efficacy and safety. This study aimed to evaluate the efficacy and safety of implant placement through the abdominal route. METHODS A retrospective cohort was analyzed, including 350 records of patients who underwent abdominal breast implants from 2013 to 2021 with a minimum follow-up of 1 year. The procedure was performed under epidural anesthesia. RESULTS No intraoperative complications were reported. After a minimum 12-month follow-up, complications were detected in 5% of cases; the most frequent was asymmetry (4.6%), followed by abdominal migration and one case of symmastia. During the follow-up period, no capsular contracture was detected in any case. A satisfaction percentage of 98.1% was obtained. The only independent factor associated with complications was distance from the sternal notch to the nipple-areola complex greater than 21 cm. CONCLUSION In this case series, mammaplasty with abdominal implant placement was an effective and safe procedure, with reduced risk of infection or capsular contracture and no scarring in or near the breasts for patients with properly selected comorbidities. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
| | - Emmanuel Dorado-Hernández
- Institute of Social Security and Services for State Workers, Hospital Regional Dr. Valentín Gómez Farias
| | | | - Rubén Cuevas-Gutierrez
- Institute of Social Security and Services for State Workers, Hospital Regional Dr. Valentín Gómez Farias
| | - Enrique Romero-Algara
- Institute of Social Security and Services for State Workers, Hospital Regional Dr. Valentín Gómez Farias
| | - Francisco Rodríguez-García
- Institute of Social Security and Services for State Workers, Hospital Regional Dr. Valentín Gómez Farias
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29
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Liu C, Chen Y, Wang Z, Qu Q, Fan Y, Xu Y. Acquired Symmastia: Classification, Causes, and Repair Strategy. Ann Plast Surg 2024; 92:28-33. [PMID: 37994444 DOI: 10.1097/sap.0000000000003725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND Acquired symmastia is a rare complication after breast augmentation that is difficult to fix. METHODS The medical records of 18 female patients with symmastia treated by our team were reviewed. Data collected included preoperative medical history, implant size, and breast base width. Surgical techniques were systematically reviewed and analyzed based on postoperative follow-up results. RESULTS Of the 18 patients, 15 patients had undergone implanted breast augmentation and 3 had injected breast augmentation. All 18 patients underwent comprehensive repair with various surgical techniques. Three patients showed recurrence after operation. Four patients were dissatisfied with postoperative breast size and underwent 2-stage replacement surgery. CONCLUSIONS Symmastia is an intractable surgical complication. Surgical classification can help assess the difficulty of surgery in advance, and the surgical strategy plan can help the surgeon to control the quality of the repair surgery.
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30
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Munhoz AM, Marques Neto ADA, Maximiliano J, Fraga M. Outcome analysis and assessment of the lower pole expansion following breast augmentation with ergonomic implants: Optimizing results with patient selection based on 5-year data. J Plast Reconstr Aesthet Surg 2024; 88:73-82. [PMID: 37956630 DOI: 10.1016/j.bjps.2023.10.105] [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: 05/03/2023] [Revised: 08/21/2023] [Accepted: 10/18/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Silicone implants have gone through adaptations to improve esthetic outcomes. With the progress of technology, including gel rheology, different properties have been introduced. Ergonomic style implants (ESI) feature enhanced rheological properties and provide a shaped contour with a round base. OBJECTIVES This study investigated outcomes for ESI in breast augmentation concerning lower pole stretching (LPS) and implant stability and describes an algorithm to assist in decision-making. METHODS A total of 148 patients (296 breasts) underwent breast augmentation with ESI; this procedure was indicated in patients with good skin quality and <6 cm between the nipple-areola complex and the inframammary fold. RESULTS The mean patient age was 29.6 years (range: 19-39), and 93 patients (62.8%) underwent primary breast augmentation with demi/full projection (average volume of 245 cc [175-375 cc]). Axillary incision and subfascial pocket were indicated in 115 (77.7%) and 72 (48%) cases, respectively. Average LPS values were 32.2% (24.91 mm) and 10.86% (9.42 mm) at up to 10 days and 10 days to 12 months postprocedure, respectively. Patients were followed for a mean of 29.9 ± 26.4 months (range: 6-66). Complication rates per breast and per patient were 5% and 10%, respectively, and included subcutaneous banding in the axilla (1.6%), implant displacement (1.2%), and wound dehiscence (0.8%). No cases of infection, seroma, or rippling complications were observed. CONCLUSIONS The present decision-making algorithm summarizes the process involved in breast augmentation using ESI and is intended to help standardize decisions. With correct planning, long-lasting outcomes can be achieved due to favorable interactions between ESI and the patient's tissues.
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Affiliation(s)
- Alexandre Mendonça Munhoz
- Plastic Surgery Division, Hospital Sírio-Libanês, São Paulo, São Paulo, Brazil; Breast Surgery Group, Plastic Surgery Division, School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil; Plastic Surgery Department, Hospital Moriah, São Paulo, São Paulo, Brazil; Brazilian Society of Plastic Surgery (SBCP), São Paulo, São Paulo, Brazil.
| | - Ary de Azevedo Marques Neto
- Breast Surgery Group, Plastic Surgery Division, School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil; Brazilian Society of Plastic Surgery (SBCP), São Paulo, São Paulo, Brazil; Plastic Surgery Department, Hospital Moriah, São Paulo, São Paulo, Brazil
| | - João Maximiliano
- Brazilian Society of Plastic Surgery (SBCP), São Paulo, São Paulo, Brazil; Plastic Surgery Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Murillo Fraga
- Brazilian Society of Plastic Surgery (SBCP), São Paulo, São Paulo, Brazil; Plastic Surgery Department, Hospital Israelita Albert Einstein and Sírio-Libanês, São Paulo, São Paulo, Brazil
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31
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Hefel K, Mahrhofer M, Russe E, Moncher J, Wechselberger G, Schwaiger K. [Breast implant removal and simultaneous aesthetic optimization : Possibilities, technical considerations and outcome analysis]. Chirurgie (Heidelb) 2024; 95:63-70. [PMID: 37878065 DOI: 10.1007/s00104-023-01972-0] [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] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Breast augmentation is currently the leading aesthetic surgical procedure worldwide. Thus, there is a high prevalence of women with breast implants demanding serious know-how and expertise concerning long-term complication management. Breast implant carriers can suffer from problems and pathologies making implant removal the best solution. The authors of this article have also been confronted more and more with the unspecified complex of symptoms named breast implant disease (BID), also called breast implant illness (BII). The treatment of choice for BID is implant removal. OBJECTIVE Analysis of problems and solutions regarding implant removal. Specific patient analysis according to patients' breast and body configuration. Technical considerations for surgery and preoperative planning. Evaluation of the authors' techniques. PATIENTS AND METHODS Evaluation of all patients over a period of 3 years requesting implant removal after esthetic augmentation mammoplasty at the authors' department. All patients were treated according to their specific demands regarding breast shape after implant removal. They either received additional mastopexy, lipofilling or both or simple implant removal without further intervention. Demographic, implant-specific, perioperative and postoperative data have been evaluated for all patients. Additionally, all patients were asked to complete a questionnaire regarding satisfaction and outcome. RESULTS We observed a trend for more satisfied patients with less invasive procedures (simple implant removal or simultaneous lipofilling vs. explantation and mastopexy ± lipofilling, 1.8 vs. 2.0 or 2.6, p = 0.198). Patients' average scoring was better if they suffered from an implant rupture (1.55 vs. 2.17, p = 0.053). Overall, a high patient satisfaction has been observed for all procedures. CONCLUSION Breast implant carriers can suffer from problems and pathologies making implant removal the best solution. Exactly these patients, consulting their doctor for those problems and questions seem to profit from implant removal. Simultaneous lipofilling and mastopexy of the breast are good options to nevertheless generate an esthetically pleasing result.
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Affiliation(s)
- Kerstin Hefel
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Krankenhaus der Barmherzigen Brüder Salzburg, Paracelsus Medizinische Universität Salzburg, Kajetanerplatz 1, 5020, Salzburg, Österreich.
| | - Maximilian Mahrhofer
- Abteilung für Hand‑, Mikro- und rekonstruktive Brustchirurgie, Marienhospital Stuttgart, Lehrkrankenhaus der Eberhard Karls Universität Tübingen, Boeheimstr 37, 70199, Stuttgart, Deutschland
| | - Elisabeth Russe
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Krankenhaus der Barmherzigen Brüder Salzburg, Paracelsus Medizinische Universität Salzburg, Kajetanerplatz 1, 5020, Salzburg, Österreich
| | - Johanna Moncher
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Krankenhaus der Barmherzigen Brüder Salzburg, Paracelsus Medizinische Universität Salzburg, Kajetanerplatz 1, 5020, Salzburg, Österreich
| | - Gottfried Wechselberger
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Krankenhaus der Barmherzigen Brüder Salzburg, Paracelsus Medizinische Universität Salzburg, Kajetanerplatz 1, 5020, Salzburg, Österreich
| | - Karl Schwaiger
- Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Krankenhaus der Barmherzigen Brüder Salzburg, Paracelsus Medizinische Universität Salzburg, Kajetanerplatz 1, 5020, Salzburg, Österreich
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Hachenberg J, Gundermann J, Fritsch H, Malter W, Steinkassserer L, Hillemanns P, Eichler C. A Retrospective Multicenter Analysis of Diagon/Gel ® 4Two Implant in 209 Cases of Reconstructive Breast Surgery. In Vivo 2024; 38:380-384. [PMID: 38148063 PMCID: PMC10756432 DOI: 10.21873/invivo.13449] [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: 09/03/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND/AIM Breast cancer was the most common cancer in women in 2020. Breast reconstruction is an elementary component of modern breast surgery. This is especially important after oncological treatments. This is a retrospective multicenter study comparing Diagon\Gel® 4Two implants with different implants chosen by the treating surgeon. Diagon\Gel® 4Two (Polytech Health & Aesthetics, Germany) are anatomical silicone implants. PATIENTS AND METHODS A total of 209 patients underwent surgery. All patients were treated in the period from 2001 to 2019. All procedures were subcutaneous mastectomies. The surgical techniques used were either skin-sparing mastectomies or nipple-sparing mastectomies. Surgery was performed with Diagon/Gel® 4Two implant or treatment of choice implant by the treating physician. Endpoints were major and minor complication rates. The average follow-up time was 5 years. In total, 110 subjects were asked about their satisfaction with the treatment. RESULTS A total of 155 procedures were performed in the Diagon/Gel® 4Two implant group. One hundred and sixty procedures were done in the comparison group. Concerning either minor or major complications, there were no significant differences between both groups. The postoperative patient survey showed high satisfaction scores for both. There was significantly higher patient satisfaction among the study participants in the Diagon/Gel® 4Two implant group compared to the comparison group (p<0.01). CONCLUSION The Diagon/Gel® 4Two implants are safe alternatives in direct comparison to previously used breast implants. Our study even demonstrated a slight superiority concerning patient satisfaction. Based on this study, further implants can be compared concerning both the direct perioperative complication rate and patient satisfaction.
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Affiliation(s)
- Jens Hachenberg
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany;
| | - Johanna Gundermann
- Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany
| | - Hannah Fritsch
- Breast Center, St. Franziskus-Hospital, Münster, Germany
| | - Wolfram Malter
- Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany
| | - Lena Steinkassserer
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Peter Hillemanns
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Christian Eichler
- Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany
- Breast Center, St. Franziskus-Hospital, Münster, Germany
- Department of Gynecology and Obstetrics, Frauenklinik Holweide, Kliniken der Stadt Köln, Cologne, Germany
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Kim YH, Yang YJ, Lee DW, Song SY, Lew DH, Yang EJ. Prevention of Postoperative Complications by Prepectoral versus Subpectoral Breast Reconstruction: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2024; 153:10e-24e. [PMID: 37010460 DOI: 10.1097/prs.0000000000010493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
BACKGROUND Implant-based breast reconstruction has evolved over time. However, the effects of prepectoral breast reconstruction (PBR) compared with those of subpectoral breast reconstruction (SBR) have not been clearly defined. Therefore, this study aimed to compare the occurrence of surgical complications between PBR and SBR to determine the procedure that is effective and relatively safe. METHODS The PubMed, Cochrane Library, and EMBASE databases were searched for studies published until April of 2021 comparing PBR and SBR following mastectomy. Two authors independently assessed the risk of bias. General information on the studies and surgical outcomes were extracted. Among 857 studies, 34 and 29 were included in the systematic review and meta-analysis, respectively. Subgroup analysis was performed to clearly compare the results of patients who underwent postmastectomy radiation therapy. RESULTS Pooled results showed that prevention of capsular contracture (OR, 0.57; 95% CI, 0.41 to 0.79) and infection control (OR, 0.73; 95% CI, 0.58 to 0.92) were better with PBR than with SBR. Rates of hematoma, implant loss, seroma, skin-flap necrosis, and wound dehiscence were not significantly different between PBR and SBR. PBR considerably improved postoperative pain, BREAST-Q score, and upper arm function compared with SBR. Among postmastectomy radiation therapy patients, the incidence rates of capsular contracture were significantly lower in the PBR group than in the SBR group (OR, 0.14; 95% CI, 0.05 to 0.35). CONCLUSIONS The results showed that PBR had fewer postoperative complications than SBR. The authors' meta-analysis suggests that PBR could be used as an alternative technique for breast reconstruction in appropriate patients.
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Affiliation(s)
- Yo-Han Kim
- From the Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine
| | - Yun-Jung Yang
- Department of Convergence Science, College of Medicine, Catholic Kwandong University International St. Mary's Hospital
| | - Dong-Won Lee
- From the Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine
| | - Seung-Yong Song
- From the Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine
| | - Dae-Hyun Lew
- From the Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine
| | - Eun-Jung Yang
- From the Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine
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Mohan AS, Sullivan J, Tenenbaum MM, Broderick KB, Myckatyn TM. Toward a Consensus Aproach for Assessing Capsular Contracture Severity and Progression: A Systematic Review. Plast Reconstr Surg 2024; 153:7-22. [PMID: 37075286 PMCID: PMC10729898 DOI: 10.1097/prs.0000000000010573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/11/2022] [Indexed: 04/21/2023]
Abstract
BACKGROUND Breast implants are the most commonly used medical devices in plastic surgery, and capsular contracture (CC) is one of the most common complications. However, our assessment of CC is based largely on Baker grade, which is problematically subjective and affords only four possible values. METHODS The authors performed a systematic review concluding in September of 2021 in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. It identified 19 articles that propose approaches to measuring CC. RESULTS In addition to Baker grade, the authors identified several modalities reported to measure CC. These included magnetic resonance imaging, ultrasonography, sonoelastography, mammacompliance measuring devices, applanation tonometry, histologic evaluation, and serology. Capsule thickness and other measures of CC inconsistently correlated with Baker grade, whereas the presence of synovial metaplasia was consistently associated with Baker grade I and II, but not III and IV capsules. CONCLUSIONS There remains no particular method to reliably and specifically measure the contracture of capsules that form around breast implants. As such, we would recommend that research investigators use more than one modality to measure CC. Other variables that can impact breast implant stiffness and associated discomfort beyond CC need to be considered when evaluating patient outcomes. Given the value placed on CC outcomes in assessing breast implant safety, and the prevalence of breast implants overall, the need for a more reliable approach to measuring this outcome persists.
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Affiliation(s)
- Abee S. Mohan
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine
| | - Janessa Sullivan
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine
| | - Marissa M. Tenenbaum
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine
| | - Kristen B. Broderick
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine
| | - Terence M. Myckatyn
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine
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35
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Graziano FD, Plotsker EL, Rubenstein RN, Haglich K, Stern CS, Matros E, Nelson JA. National Trends in Acellular Dermal Matrix Utilization in Immediate Breast Reconstruction. Plast Reconstr Surg 2024; 153:25e-36e. [PMID: 37092982 DOI: 10.1097/prs.0000000000010575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND Implant-based reconstruction is the most common method of immediate breast reconstruction in the United States, with acellular dermal matrices (ADMs) playing a significant role in implant support and coverage. This study evaluated recent national trends in ADM use in immediate breast reconstruction and assessed patient characteristics and 30-day complication rates. METHODS The authors queried the American College of Surgeons National Surgical Quality Improvement Program database for all patients undergoing immediate breast reconstruction from 2015 to 2020. Primary outcomes were major surgical and medical complications, as well as ADM use per year. Subset analysis was performed to compare patients undergoing immediate breast reconstruction with ADM in 2015 versus 2020. RESULTS In 39,800 immediate breast reconstructions, ADMs were used in 55.5% of cases ( n = 22,087). ADM usage increased annually from 2015 through 2020. Direct-to-implant reconstruction was significantly associated with ADM use ( P < 0.001). Compared with the no-ADM cohort, there was a significantly increased rate of return to the operating room for any reason ( P < 0.001). When comparing the 2015 and 2020 ADM cohorts, the 2020 ADM cohort had a significantly higher rate of superficial infections. Obesity, smoking history, and insulin-dependent diabetes were independent risk factors for superficial wounds in patients receiving ADM. CONCLUSIONS ADM use in immediate breast reconstruction increased significantly from 2015 to 2020, likely reflecting national trends in increasing direct-to-implant and prepectoral breast reconstruction. Obesity, smoking history, and insulin-dependent diabetes were independent risk factors for superficial wound infections in the ADM cohort. Patients with ADM had a slight increased incidence of return to the operating room. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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Affiliation(s)
- Francis D Graziano
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Ethan L Plotsker
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Robyn N Rubenstein
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Kathryn Haglich
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Carrie S Stern
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Evan Matros
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Jonas A Nelson
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
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36
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Govrin-Yehudain Y, Hadad E, Heller L. Updated trends of breast implant surgeries: An Israeli analysis. J Plast Reconstr Aesthet Surg 2024; 88:517-523. [PMID: 38103534 DOI: 10.1016/j.bjps.2023.11.022] [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: 09/28/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Breast augmentation remains one of the most prevalent procedures in plastic surgery. While most patients experience high satisfaction with the outcomes, a subset may encounter various complications or dissatisfaction with achieved results necessitating subsequent surgical intervention including implant removal or exchange. MATERIALS AND METHODS We collected information from three pivotal private medical centers in Israel where a considerable number of breast surgeries are performed. We examined the number of breast augmentations, implant exchange and implant removal surgeries with or without breast lift that were performed on a biannual basis for each center for the period 2018-2022. Trends in surgery types were analyzed and compared to registries in other countries. RESULTS Between the years 2018 and 2022, 20,075 surgeries were done in three main private medical centers in Israel. Data show a gradual increase in implant removal surgeries from 2018 (n = 80, 2.9%) to 2019 (n = 269, 9.9%), followed by a significant increase in 2020 (n = 1436, 27.3%), and a gradual decline between 2021 (n = 1019, 22.8%) and 2022 (n = 916, 18.5%). The overall number of breast implant insertion procedures (breast augmentation procedures and exchange procedures) was 2659 in 2018 (97%), 2424 in 2019 (90.0%), 3816 in 2020 (72.6%), 3437 in 2021 (77.1%), and 4019 in 2022 (81.4%). SUMMARY We present updated trends in breast implant surgeries in Israel. 2020 was a key year in which the rate of explantations was the highest, and the percentage rate of implantations was the lowest and a year in which the trend changed. These patterns partly align with trends seen in other countries worldwide.
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Affiliation(s)
- Yoad Govrin-Yehudain
- Department of Plastic Surgery, Shamir Medical Center, Tel Aviv University, Zerifin, Israel.
| | - Eran Hadad
- Department of Plastic Surgery, Shamir Medical Center, Tel Aviv University, Zerifin, Israel.
| | - Lior Heller
- Department of Plastic Surgery, Shamir Medical Center, Tel Aviv University, Zerifin, Israel.
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Lonie S, Abesamis GM, Law J, Mohaghegh MH, Vickery K, Deva A, Tavakoli K. Topical Tranexamic Acid in Primary Breast Augmentation Surgery: Short- and Long-term Outcomes. Aesthet Surg J 2023; 44:NP23-NP27. [PMID: 37427875 DOI: 10.1093/asj/sjad219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/03/2023] [Accepted: 07/03/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Breast augmentation mammaplasty (BAM) remains the most popular cosmetic procedure done worldwide. Bleeding in this procedure increases the chance of capsular contracture. Tranexamic acid (TXA), an antifibrinolytic, has been widely used by other surgical specialties to reduce bleeding. OBJECTIVES We aimed to evaluate the use of TXA in BAM surgery. METHODS This was a single-surgeon case series of all patients who underwent primary BAM from March 2017 to March 2018 and received topical TXA spray to the implant pocket before implant insertion. Early postoperative complications and long-term outcomes, such as capsular contracture and revisional surgery, were recorded and described. RESULTS Two hundred and eighty-eight patients were included in the study with an overall complication rate of 2.8% over 5 years. No patients had postoperative bleeding or hematoma formation. One patient had a seroma, managed with ultrasound drainage. Complications requiring reoperation included rippling (3, 1.0%), pocket revision (2, 0.7%), capsule contracture (1, 0.3%) and rupture (1, 0.3%). CONCLUSIONS This study highlights the safety and potential benefits of the use of topical TXA in breast augmentation, with low bleeding and capsular contracture rates. LEVEL OF EVIDENCE: 4
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Samuels K, Millet E, Wong L. Efficacy of Acellular Dermal Matrix Type in Treatment of Capsular Contracture in Breast Augmentation: A Systematic Review and Meta-Analysis. Aesthet Surg J 2023; 44:26-35. [PMID: 37595294 DOI: 10.1093/asj/sjad265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Capsular contracture is a known complication of breast augmentation and is among the top reasons for revisional breast augmentation procedures. The use of acellular dermal matrix (ADM) has been shown to reduce the rate of capsular contracture in breast reconstruction and augmentation, theorizing that it acts as a protective barrier between the implant capsule and inflammatory process responsible for capsular contracture. The role of ADM in treatment of capsular contracture has been investigated in numerous studies, with a variety of ADMs. OBJECTIVES The aim of this study was to perform a systematic review of existing literature on the use of ADM for treatment of capsular contracture in aesthetic breast augmentation patients to investigate differences in efficacy of ADM types. METHODS The PubMed, Embase, and CINAHL databases were systematically reviewed for articles pertaining to capsular contracture, acellular dermal matrices, and breast augmentation. Number of patients, type of ADM, Baker grade, follow-up time, complication rate, and capsular contracture rate were recorded from identified articles. Data was pooled from studies to calculate a capsular contracture rate for each ADM type, with a chi-squared test performed for analysis. Identified studies with a comparative group were included in a meta-analysis utilizing risk ratio (RR) to assess the efficacy of ADM. RESULTS Nine articles including ADM for treatment of capsular contracture in breast augmentation met criteria for inclusion, with a total of 481 breasts. Strattice was the most commonly utilized ADM (n = 391), followed by AlloDerm (n = 57). There was a statistically significant difference in efficacy of ADM among the studied ADM types (P < .001). AlloDerm, FlexHD, and DermaMatrix had the lowest capsular contracture rates (0%). NeoForm and SurgiMend had the highest capsular contracture rates (each 25%, but with n = 4 and n = 8, respectively). Strattice had a capsular contracture rate of 1.53% in the pooled data, and meta-analysis showed that Strattice reduced the risk of capsular contracture (RR 0.14 [95% CI 0.06, 0.31]) compared with conventional treatment. CONCLUSIONS Acellular dermal matrices appear to be effective at treating capsular contracture after breast augmentation while maintaining a low complication rate. Overall capsular contracture rates are low with the use of ADM. There is a statistically significant difference in efficacy among ADM types. Meta-analysis shows that Strattice is effective at reducing the risk of capsular contracture in breast augmentation patients when compared to conventional treatment. Future research, especially in the form of randomized controlled trials, is needed to further investigate the efficacy of various ADMs in the treatment of capsular contracture. LEVEL OF EVIDENCE: 4
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Gronovich Y, Maisel-Lotan A. An Innovative Surgical Device for Removal of Breast Implants. Plast Reconstr Surg 2023; 152:1186-1189. [PMID: 37010465 DOI: 10.1097/prs.0000000000010486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
SUMMARY The use of breast implants is consistently on the rise owing to increases in aesthetic and reconstructive breast surgery. Implant rupture is a potential complication, the rate of which has increased over time. Therefore, implant removal or replacement is a common procedure, and needed for most breast implants at some point during the patient's lifetime. Surgical removal of ruptured implants is messy, cumbersome, time-consuming, and, overall, unpleasant. The authors have developed a custom-made device that effectively removes a silicone implant, whether ruptured or intact. To determine its efficiency, the authors conducted a prospective clinical trial of 25 women (45 breasts) undergoing removal or replacement of breast implants with the device between January of 2019 and January of 2022. Device safety and efficiency were assessed, and the need for the device was evaluated through a survey among 25 board-certified plastic surgeons. The mean implant age was 12.8 years, and mean volume was 370 g. The mean time to extract the implant with the device was 10.7 seconds. Twenty-two implants (49%) were ruptured. There were no minor or major complications during the procedure or follow-up. The mean follow-up period was 6 months. Surgeons' intention to use this device in their own practices for removal of intact and ruptured implants was very high. This novel device may prove indispensable for explantation of both intact and ruptured silicone implants. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Yoav Gronovich
- From the Department of Plastic and Reconstructive Surgery, Shaare Zedek Medical Center; and Faculty of Medicine, Hebrew University of Jerusalem
| | - Adi Maisel-Lotan
- From the Department of Plastic and Reconstructive Surgery, Shaare Zedek Medical Center; and Faculty of Medicine, Hebrew University of Jerusalem
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Ma IZ, Chung JH, Kim J, Hong KY. Bilateral late hematomas after breast augmentation mimicking anaplastic large cell lymphoma: A case report. Medicine (Baltimore) 2023; 102:e36231. [PMID: 38050280 PMCID: PMC10695614 DOI: 10.1097/md.0000000000036231] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/31/2023] [Indexed: 12/06/2023] Open
Abstract
RATIONALE Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is rare, but its incidence has recently increased. It is characterized by a sudden onset of seroma collection after implantation of textured breast implants. However, BIA-ALCL may be confused with late hematoma, which is also a rare finding in aesthetic breast surgery. The cause of late hematoma is mostly unknown, and patients rarely present with specific symptoms. PATIENT CONCERNS We presented a case of late hematoma that occurred in a patient who underwent augmentation mammoplasty 25 years ago and was on anticoagulants for 7 years. DIAGNOSES Ultrasonography and magnetic resonance imaging could not rule out the possibility of BIA-ALCL. INTERVENTIONS Bilateral implant removal was performed, and massive amounts of late hematoma and organizing tissues were removed. OUTCOMES The pathologists confirmed the biopsy results as late hematoma with organizing tissues. Capsules from both sides were confirmed as fibrous capsules with chronic inflammation and foamy macrophage infiltration. LESSONS Although malignancy needs to be primarily ruled out, late hematoma can occur beyond expectations, especially in anticoagulated patients, and must be included in the differential diagnosis.
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Affiliation(s)
- I Zhen Ma
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jee Hyeok Chung
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jinhyun Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ki Yong Hong
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Cho J, Kim KH, Lee W, Kim SH. Endoscopically Assisted Correction of Malpositioned Breast Implants Using Absorbable Barbed Sutures. Aesthetic Plast Surg 2023; 47:2277-2282. [PMID: 37640813 DOI: 10.1007/s00266-023-03564-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/26/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Breast implant malpositioning is the second most common reason for revisional breast surgery. Multiple correction methods are suggested, depending on the malposition, but most of the methods, such as the inframammary fold incision, result in additional scars. We performed transaxillary endoscopic breast implant bottoming out corrections and used V-Loc thread for capsulorrhaphy. METHODS Fourteen patients who underwent correction for breast implant bottoming out after transaxillary breast augmentation were included in this study. Transaxillary endoscopic correction was performed using a V-Loc thread. RESULTS All the 14 patients were satisfied with the result immediately after surgery. One case of overcorrection and one with implant bottoming out occurred, but did not require additional surgery. CONCLUSIONS Transaxillary endoscopic bottoming out correction is a useful technique for those individuals who underwent primary transaxillary incisional breast augmentation. V-Loc thread is useful for endoscopic capsulorrhaphy. 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)
- Jeongmok Cho
- Department of Plastic and Reconstructive Surgery, Etonne Plastic Surgery Clinic, Seoul, Republic of Korea
| | - Ki Hyun Kim
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singillo, Yongdeongpo-gu, Seoul, 07441, Republic of Korea
| | - Won Lee
- Department of Plastic and Reconstructive Surgery, Yonsei E1 Plastic Surgery Clinic, Anyang, Republic of Korea
| | - Seong Hwan Kim
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singillo, Yongdeongpo-gu, Seoul, 07441, Republic of Korea.
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Lisa A, Carbonaro R, Bottoni M, Ostapenko E, Rietjens M. Bovine Acellular Dermal Matrix-Based Breast Reconstruction in Previously Irradiated Breasts: Complications and Outcomes From a Single-Center Experience. Ann Plast Surg 2023; 91:686-692. [PMID: 37624913 DOI: 10.1097/sap.0000000000003667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
ABSTRACT Radiation therapy is considered today an integral part of the management of breast cancer. However, radiotherapy significantly increases the incidence of total complications in breast reconstruction. Several procedures have been adopted to reduce complication rates in irradiated fields, including the use of acellular dermal matrices (ADMs). We conducted a retrospective analysis of our single-center experience with ADM-assisted implant-based reconstruction or revision surgeries for capsular contracture treatment in irradiated breasts. We divided our population into 4 groups based on prior surgical history: group A (previous quadrantectomy), group B (previous mastectomy and expander reconstruction), group C (previous mastectomy and implant reconstruction), and group D (prior quadrantectomy followed by mastectomy and implant reconstruction). At the European Oncology Institute in Milan, Italy, between June 2017 and April 2019, we identified 84 patients for a total of 86 irradiated breasts reconstructed with implant and ADM. We observed a total of 12 reconstructive failure, with the highest rate of failure in group B (16.6%) and in group D (15.38%). Overall, we recorded 22 total complications (24.4%): 12 major complications and 10 minor complications. The most common complication was infection, with 9 cases (10.4%), 6 of which were classified as severe and required implant removal. In group B, we observed the highest complication rate, both major and minor, with 7 of 42 patients (16.6%) experiencing each. Before reconstruction with ADM, the Baker grade ranged from 3 to 4, with a mean of 3.25. At the 2-year follow-up, the Baker grade ranged from 1 to 4, with a mean of 1.9. Surgeons were highly satisfied with the aesthetic result in 72.1% of cases, moderately in 8.1% and unsatisfied in 5.81%, and in 13.9%, the outcome was not assessable because of reconstructive failure. The worst aesthetic result was in group B. We observed significant reduction in capsular contracture in revision surgeries despite a moderately high rate of complications in previous quadrantectomy and radiotherapy. In our experience, breast reconstruction with implant and ADM is not the primary surgical indication in case of prior irradiation, but it can be considered as a valid alternative with reasonable safety profile, to be used in selected cases.
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Affiliation(s)
| | | | - Manuela Bottoni
- From the Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico)
| | | | - Mario Rietjens
- From the Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico)
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Federica G, Tommaso F, Alessia C, Agostino C, Florian B, Antonio G, Domenico Nicola M, Abdallah R, Carmela S, Lorenzo S, Sergio B. Use of Antimicrobial Irrigation and Incidence of Capsular Contracture in Breast Augmentation and Immediate Implant-Based Breast Reconstruction. Aesthetic Plast Surg 2023; 47:2345-2350. [PMID: 37410129 PMCID: PMC10784374 DOI: 10.1007/s00266-023-03453-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/04/2023] [Indexed: 07/07/2023]
Abstract
Capsular contracture (CC) is one of the most common complications of implant-based breast reconstruction or augmentation surgery. Common risk factors of CC include biofilm, surgical site infections, history of prior CC or fibrosis, history of radiation therapy, and implant characteristics. Though bacterial contamination of breast protheses is associated with adverse sequelae, there are not universally accepted guidelines and limited best practice recommendations for antimicrobial breast pocket irrigation. Despite advanced molecular biology, the exact mechanism of this complication is not fully understood. Interventions that decrease the rate of CC include antibiotic prophylaxis or irrigation, acellular dermal matrix, leukotriene inhibitors, surgical techniques, and others. However, there is inconsistent evidence supporting these risk factors, and the current data was based on broad heterogeneous studies. The objective of this review was to provide a summary of the current data of contributing risk factors as well as preventative and treatment measures for CC.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 http://www.springer.com/00266.
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Affiliation(s)
- Giuzio Federica
- Department of Sciences, University of Basilicata, Potenza, Italy
- Spinoff TNcKILLERS s.r.l, Ateneo Lucano street 10, 85100, Potenza, Italy
- U.O.C. Primary Care and Territorial Health, Social and Health Department, State Hospital, Falciano, Republic of San Marino
| | - Fabrizio Tommaso
- Department of Plastic Surgery, IRCCS, Referral Cancer Center of Basilicata, Rionero in Vulture, PZ, Italy
| | - Catalano Alessia
- Department of Pharmacy-Drug Sciences, University of Bari "Aldo Moro", Bari, Italy
| | - Ceccarini Agostino
- U.O.C. Primary Care and Territorial Health, Social and Health Department, State Hospital, Falciano, Republic of San Marino
| | - Bodog Florian
- Department of Surgery, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Giuliani Antonio
- U.O.C. of General and Emergency Surgery A.O.R. "San Carlo", Potenza, Basilicata, Italy
| | | | - Raweh Abdallah
- Cardiac Surgery Department, Yas Clinic, Abu Dhabi, United Arab Emirates
| | | | - Svolacchia Lorenzo
- Departments of Medical-Surgical Sciences and Biotechnologies, La Sapienza University, Rome, Italy
| | - Brongo Sergio
- Department of Plastic Surgery, University of Salerno, Campania, Italy.
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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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de Bakker E, Zada L, Schmidt RW, van Haasterecht L, Vethaak AD, Ariese F, Dijkman HBPM, Bult P, Gibbs S, Niessen FB. Baker Grade IV Capsular Contracture Is Correlated with an Increased Amount of Silicone Material: An Intrapatient Study. Plast Reconstr Surg 2023; 152:1191-1200. [PMID: 36877628 PMCID: PMC10666937 DOI: 10.1097/prs.0000000000010359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 10/07/2022] [Indexed: 03/07/2023]
Abstract
BACKGROUND Breast implant surgery is one of the most frequently performed procedures by plastic surgeons worldwide. However, the relationship between silicone leakage and the most common complication, capsular contracture, is far from understood. This study aimed to compare Baker grade I with Baker grade IV capsules regarding their silicone content in an intradonor setting, using two previously validated imaging techniques. METHODS Twenty-two donor-matched capsules from 11 patients experiencing unilateral complaints were included after bilateral explantation surgery. All capsules were examined using both stimulated Raman scattering (SRS) imaging and staining with modified oil red O (MORO). Evaluation was done visually for qualitative and semiquantitative assessment and automated for quantitative analysis. RESULTS Using both SRS and MORO techniques, silicone was found in more Baker grade IV capsules (eight of 11 and 11 of 11, respectively) than in Baker grade I capsules (three of 11 and five of 11, respectively). Baker grade IV capsules also showed significantly more silicone content compared with the Baker grade I capsules. This was true for semiquantitative assessment for both SRS and MORO techniques ( P = 0.019 and P = 0.006, respectively), whereas quantitative analysis proved to be significant for MORO alone ( P = 0.026 versus P = 0.248 for SRS, respectively). CONCLUSIONS In this study, a significant correlation between capsule silicone content and capsular contracture is shown. An extensive and continued foreign body response to silicone particles is likely to be responsible. Considering the widespread use of silicone breast implants, these results affect many women worldwide and warrant a more focused research effort. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
- Erik de Bakker
- From the Department of Plastic, Reconstructive and Hand Surgery
- Department of Molecular Cell Biology and Immunology, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit
| | - Liron Zada
- LaserLaB Amsterdam, Department of Physics and Astronomy, Faculty of Sciences
- Department of Environment and Health, Vrije Universiteit Amsterdam
| | - Robert W. Schmidt
- LaserLaB Amsterdam, Department of Physics and Astronomy, Faculty of Sciences
| | - Ludo van Haasterecht
- From the Department of Plastic, Reconstructive and Hand Surgery
- LaserLaB Amsterdam, Department of Physics and Astronomy, Faculty of Sciences
| | - A. Dick Vethaak
- Department of Environment and Health, Vrije Universiteit Amsterdam
- Deltares, Marine and Coastal Systems
| | - Freek Ariese
- LaserLaB Amsterdam, Department of Physics and Astronomy, Faculty of Sciences
| | | | - Peter Bult
- Department of Pathology, Radboud University Medical Center
| | - Susan Gibbs
- Department of Molecular Cell Biology and Immunology, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam
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Cazzato V, Scarabosio A, Bottosso S, Rodda A, Vita L, Renzi N, Caputo G, Ramella V, Parodi PC, Papa G. Early Seroma Treatment Protocol Based on US-Guided Aspiration in DTI Prepectoral Reconstruction: A Prospective Study. Clin Breast Cancer 2023; 23:e542-e548. [PMID: 37806916 DOI: 10.1016/j.clbc.2023.09.003] [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: 08/08/2023] [Revised: 08/17/2023] [Accepted: 09/01/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Seroma is a common complication after prepectoral prosthetic breast reconstruction with ADM, leading to wound dehiscencse, infection, and even loss of reconstruction at last. A new ultrasound (US) guided follow-up protocol has been applied to compare primary and secondary complications incidence and their treatment, and evaluate the effect of precocious seroma detection and its evacuation in reducing secondary complications. METHODS We enrolled 406 patients from January 1st, 2021 to July 1st, 2023 who underwent mastectomy and 1-stage prepectoral reconstruction with ADM. Experimental group counted 96 patients, whom have been treated as protocol fashion, therefore with multiple US-guided evaluations and eventual evacuations along with postoperative period; control group (310 patients) has exclusively been clinically evaluated. RESULTS Seroma incidence detected rate among experimental group, after 1-year follow-up, was 32.2%, compared to 16.8% in control cohort, additionally no other secondary complications were detected in the first group. Referring to the wound dehiscence incidence, a statistically significant higher frequency was observed in control group compared with treatment 1 (21.2% vs. 0%; P = .0027). CONCLUSIONS Seroma and correlated secondary complications may lead to additional surgeries, higher sanitary costs and even reconstructive failure. With a seriated US follow-up protocol application, the surgeon could promptly manage and treat seroma, decreasing additional complications rate, particularly wound dehiscence. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Vito Cazzato
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Anna Scarabosio
- Department of Medical Area (DIME), Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, University of Udine, Udine, Italy
| | - Stefano Bottosso
- Department of Plastic and Reconstructive Surgery, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste University Hospital, Trieste, Italy
| | - Agostino Rodda
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Ludovica Vita
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Nadia Renzi
- Department of Plastic and Reconstructive Surgery, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste University Hospital, Trieste, Italy
| | - Glenda Caputo
- Department of Medical Area (DIME), Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, University of Udine, Udine, Italy
| | - Vittorio Ramella
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Pier Camillo Parodi
- Department of Medical Area (DIME), Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, University of Udine, Udine, Italy.
| | - Giovanni Papa
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; Department of Plastic and Reconstructive Surgery, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste University Hospital, Trieste, Italy
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Scarabosio A, Contessi Negrini F, Pisano G, Beorchia Y, Castriotta L, De Francesco F, Riccio M, Parodi PC, Zingaretti N. Prepectoral Direct-To-Implant One-Stage Reconstruction With ADMs: Safety and Outcome in "Thin Patients". Clin Breast Cancer 2023; 23:e507-e514. [PMID: 37735018 DOI: 10.1016/j.clbc.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Prepectoral direct-to-implant reconstruction with acellular dermal matrix (ADM) represents a safe, fast, and successful option in breast reconstruction in a selected cohort of patients. Nowadays, this procedure is considered challenging in thin. Meanwhile, his cohort has not been accurately analyzed yet. METHODS A single institution retrospective cohort study was performed between January 2019 and March 2023 in all women who underwent mastectomy. Biometrical and clinical data were recorded. Also, surgical technique, operating room (OR) time, mastectomy weights, implant choice, and acellular dermal matrix (ADM) types were properly noted. Postoperative complications represented the main topic: these were classified into early and late ones based on onset time. At least 12-month follow-up was required. A comparison between thin and ideal body mass index (BMI) populations was performed. RESULTS Early complications did not seem to differ between the 2 groups with 37.8% and 38.9% of women having at least 1 early complication in thin and ideal-weight women, respectively (P = .919). In univariable regression analysis, compared with women with a BMI of 22.1 to 25.0, women with a BMI ≤ 22.0 were associated with an increased risk of late complications of 2.84 (1.13-7.14). Specifically, thin women appeared to have a 3-fold increased risk (OR = 2.97, 95% CI 1.08-8.18) of ripples/wrinkles compared with women with ideal weight. CONCLUSIONS Prepectoral reconstruction with ADM in thin patients may be considered as safe as in standard BMI patients. Rippling may be more frequent, but, whenever needed, easy to correct with a few sessions of lipo-grafts. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Anna Scarabosio
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Filippo Contessi Negrini
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Gaetano Pisano
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Yvonne Beorchia
- Institute of Hygiene and Evaluative Epidemiology, Friuli Centrale University Health Authority, Udine, Italy
| | - Luigi Castriotta
- Institute of Hygiene and Evaluative Epidemiology, Friuli Centrale University Health Authority, Udine, Italy
| | - Francesco De Francesco
- Department of Reconstructive Surgery and Hand Surgery, AOU "Ospedali Riuniti", Ancona, Italy; Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Jesi, Italy
| | - Michele Riccio
- Department of Reconstructive Surgery and Hand Surgery, AOU "Ospedali Riuniti", Ancona, Italy; Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Jesi, Italy
| | - Pier Camillo Parodi
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine, Udine, Italy; Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Jesi, Italy.
| | - Nicola Zingaretti
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine, Udine, Italy; Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Jesi, Italy
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Salgarello M, Barone Adesi L, Macrì G, Visconti G. When to Consider Prepectoral Implant Conversion After Subpectoral Implant Breast Reconstruction and How to Plan It. Aesthet Surg J 2023; 43:NP1071-NP1077. [PMID: 37668406 DOI: 10.1093/asj/sjad290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/30/2023] [Accepted: 09/02/2023] [Indexed: 09/06/2023] Open
Abstract
Many deformities occur after subpectoral implant-based breast reconstruction. Today, immediate prepectoral reconstruction with implants shows a significant increase in popularity because it has many advantages over subpectoral positioning: absence of muscle deficit and breast animation deformity, reduced implant dislocation, and less postoperative pain and easy recovery. Implant pocket conversion from the submuscular to prepectoral plane has become our preferred strategy for solving most problems related to the submuscular implant position. The authors performed a retrospective review (from June 2018 to December 2022) of patients who underwent prepectoral implant conversion for correction of animation deformity, dysfunctional chronic pain, or to ameliorate poor cosmetic results. Acellular dermal matrix (ADM) was utilized in the first 7 cases; in the remaining 56 patients polyurethane-covered implants were placed. Resolution of animation deformity and chronic pain were evaluated, as were cosmetic results and any postoperative complications. Sixty-three patients (87 breasts) underwent prepectoral implant conversion with complete resolution of animation deformity and chronic pain as well as improved cosmetic results. Preventive lipofilling was done in 18 patients. Complication rate included 3 periprosthetic seromas in ADM group. All resolved after ultrasound-guided aspiration. Rippling was noted in 3 patients, and edge visibility was documented in 1 patient. There were no incidences of grade 3 or 4 capsular contracture. The prepectoral implant conversion improves functional and aesthetic results, reaching excellent outcomes. Preparation for this surgery with fat grafting is considered a complementary procedure that increases the indications for prepectoral implant conversion. LEVEL OF EVIDENCE: 4
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Sözer SO, Sibar S. Inferior and Medially Based Breast Parenchymal Rotation Flap: A New Mastopexy Technique for Replacing Breast Volume After Breast Implant Explantation. Aesthet Surg J 2023; 43:1458-1467. [PMID: 37463484 DOI: 10.1093/asj/sjad220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/30/2023] [Accepted: 06/30/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Recently, a growing number of patients have been opting for the removal of breast implants. This often results in a degree of volume loss that can vary from mild to substantial, contingent on the size of the implant, with many patients requiring a mastopexy. Although autoaugmentation mastopexy serves as the primary surgical approach to restore shape and fill the void left by the implant, the fullness attained with the implant cannot be replicated through autoaugmentation. OBJECTIVES Our goal was to present the technical details and utilization of an inferomedial pedicle-based breast parenchymal flap, without rotational restriction from the parenchyma, for autoaugmentation after explantation. METHODS A retrospective chart review was performed of 12 patients who underwent surgery with this technique between the years of 2019 to 2022, with emphasis on reasons for explantation, early and late complications, and satisfaction scores on a Likert scale. RESULTS Capsular contracture was the most common reason for explantation, and only 2 patients experienced minor wound dehiscence in the early postoperative period. With a mean follow-up of nearly 2 years, no bottoming out was encountered in any of the patients, and satisfactory breast shape was obtained. Further, postoperative satisfaction was significantly higher than preoperative satisfaction. CONCLUSIONS The inferomedial-based parenchymal rotation flap is a new procedure that can be applied in this patient group because of its wide rotation arc and reliable vascularity. It is also an effective option for creating the desired conical breast shape in patients who do not want breast implants over the long term. LEVEL OF EVIDENCE: 4
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Alderman A, Caplin D, Hammond DC, Keane A, Turetzky J, Kane WJ. Clinical Results of Mentor MemoryGel Xtra Breast Implants From the GLOW Clinical Trial. Aesthet Surg J 2023; 43:NP1021-NP1032. [PMID: 37610252 PMCID: PMC10653354 DOI: 10.1093/asj/sjad272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/08/2023] [Accepted: 08/21/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Mentor MemoryGel Xtra breast implants (Mentor Worldwide LLC, Irvine, CA) were designed to maintain the soft, natural feel of MemoryGel implants while increasing fullness and projection and minimizing wrinkling, rippling, and related complications through optimization of shell gel-fill. OBJECTIVES To measure 3-year safety and effectiveness of MemoryGel Xtra breast implants in the Mentor MemoryGel and MemoryShape Combined Cohort Clinical Study. METHODS Participants were implanted with MemoryGel Xtra breast implants in a prospective, multicenter clinical trial. Rates of complications and reoperations were analyzed to assess device safety and BREAST-Q was employed to assess device effectiveness. RESULTS Two hundred eighty-seven females receiving MemoryGel Xtra breast implants were enrolled. Complication rates in the primary augmentation cohort included rates of 1.5% for implant-related reoperation, 2.3% for explantation, and 1.5% for Baker grade III or IV capsular contracture. For the revisional augmentation cohort, these rates were 2.8% for implant-related reoperation, 4.3% for explantation, and 3.0% for capsular contracture. For the primary reconstruction cohort, these rates were 12.0% for implant-related reoperation, 12.3% for explantation, and 7.3% for capsular contracture. For the revisional reconstruction cohort, these rates were 7.1% for capsular contracture, with zero implant-related reoperations or explantations. There were no reports of infection or implant malposition or displacement in any of these cohorts. Each cohort showed significantly improved satisfaction with breasts and psychosocial and sexual well-being at 1 year following the primary procedure. CONCLUSIONS These data are consistent with legacy clinical data for MemoryGel and provide the first published safety and effectiveness data regarding the use of MemoryGel Xtra breast implants for breast augmentation and reconstruction. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | | | | | | | - Jay Turetzky
- Corresponding Author: Dr Jay Turetzky, 31 Technology Drive Building 29B, Irvine, CA 92618, USA. E-mail: ; Instagram: @breastimplantsbymentor
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