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Nipple replacement in breast reconstruction

Miguel De La Parra Marquez, Ricardo Fernandez-Riera, Hector Vela Cardona, Jesus María Rangel Flores
BACKGROUND: Implant-based immediate breast reconstruction after skin-sparing mastectomy has shown a significant improvement in patients' quality of life, making the procedure steadily more popular year after year. However, this technique has a high morbidity rate, including skin necrosis and implant exposure. METHODS: A retrospective review of a prospectively held database for autologous breast reconstruction in our institution of the last 5 years found eight cases with exposed implants after nipple-sparing mastectomy and immediate reconstruction...
April 17, 2018: World Journal of Surgical Oncology
Tomoko Ogawa, Tomomi Yamakawa
INTRODUCTION: Prosthetic-based breast reconstruction can be used in combination with autologous flaps such as a latissimus dorsi (LD) flap or a thoracodorsal artery perforator (TDAP) flap to achieve symmetry. However, the LD and TDAP flaps require a different skin incision from that which is used for the mastectomy. As a new autologous flap for use in combination with prosthetic-based breast reconstruction after nipple-sparing mastectomy (NSM), we used an inframammary adipofascial flap...
2016: International Journal of Surgery Case Reports
Warren Matthew Rozen, Nakul Gamanlal Patel, Venkat V Ramakrishnan
For autologous breast reconstruction, there are cases where one free flap cannot provide the volume of tissue required, and the concept of 'stacked' bilateral deep inferior epigastric artery (DIEP) flaps was developed, in which hemi-abdominal flaps are raised on each deep inferior epigastric artery (DIEA), and both flaps transferred to the chest. In cases of bilateral breast reconstruction, stacked flaps may be required to achieve volume replacement, however options are not described. We demonstrate the use of stacked free flaps for bilateral breast reconstruction, using one DIEP flap stacked with one transverse upper gracilis (TUG) flap for each side...
April 2016: Gland Surgery
Giuseppe Catanuto, Nicola Rocco, Maurizio Bruno Nava
We present some clinical advice to drive the decision process in performing conservative mastectomies. Several factors are taken into consideration to indicate these techniques. First of all, we need to identify patients who need a mastectomy due to the extension of the disease. In this case we suggest assessing patients anthropometric characteristics (breast volume-ptosis), and personal preferences regarding the extension of surgical treatment. Small, medium size, without ptosis or with moderate ptosis can be better served by standard nipple-sparing mastectomy...
February 2016: Gland Surgery
Alexander Govshievich, Ron B Somogyi, Mitchell H Brown
BACKGROUND: In recent years, a novel approach to immediate breast reconstruction has been introduced with the advent of acellular dermal matrix (ADM). In the setting of conservative mastectomies where the native skin envelope is preserved, placement of ADM at the lower pole in continuity with the pectoralis major muscle (PMM) provides additional support, allowing direct-to-implant breast reconstruction. The following manuscript presents the senior author's experience with ADM-assisted reconstruction and provides a detailed description of surgical technique along with a comprehensive discussion of patient selection and potential complications...
December 2015: Gland Surgery
Ugur Anil Bingol, Can Cinar
Nipple-sparing mastectomy (NSM) and immediate breast reconstruction have replaced radical surgical interventions for the treatment of selected patients with breast cancer undergoing prophylactic mastectomy. NSM is technically a difficult procedure. After dissection, the remaining breast skin and nipple-areola complex (NAC) must be thin enough to be free of tumor tissue and thick enough to preserve tissue perfusion. Factor V Leiden mutation is the most common cause of hereditary thrombophilia; thrombosis almost always develops in the venous system...
October 2015: Plastic and Reconstructive Surgery. Global Open
Yoshiko Iwahira, Tomohisa Nagasao, Yusuke Shimizu, Kumiko Kuwata, Yoshio Tanaka
Purposes. The present paper reports clinical cases where nummular eczema developed during the course of breast reconstruction by means of implantation and evaluates the occurrence patterns and ratios of this complication. Methods. 1662 patients undergoing breast reconstruction were reviewed. Patients who developed nummular eczema during the treatment were selected, and a survey was conducted on these patients regarding three items: (1) the stage of the treatment at which nummular eczema developed; (2) time required for the lesion to heal; (3) location of the lesion on the reconstructed breast(s)...
2015: Plastic Surgery International
Fabio Santanelli di Pompeo, Rosaria Laporta, Michail Sorotos, Arianna Di Napoli, Maria Rosaria Giovagnoli, Maria Cristina Cox, Antonella Campanale, Benedetto Longo
BACKGROUND: The authors report four cases of breast implant-associated anaplastic large cell lymphoma (ALCL) from a single institution and propose a multidisciplinary protocol. METHODS: From 2012 to 2014, four breast implant-associated ALCL cases were diagnosed. The authors performed the original operation, and no patients were referred to their practice. Cases 1, 2, and 4 were CD4/CD30/ALK ALCL with previous textured-implant reconstruction, whereas case 3 was CD8/CD30/ALK ALCL with previous polyurethane-implant augmentation...
August 2015: Plastic and Reconstructive Surgery
Hisamitsu Zaha
BACKGROUND: In breast-conserving surgery (BCS), a large defects in the upper inner quadrant (UIQ) named the no man's land of the breast will cause shift the nipple in an unnatural upward or medial fashion. We have developed oncoplastic volume replacement techniques using a laparoscopically harvested omental flap (OF). This paper presents our experiences performing partial breast reconstruction for the defect in the UIQ using the OF. METHODS: A wide excision (>20% of the breast tissue) was performed mainly through a periareolar incision...
June 2015: Gland Surgery
Barbara Fowble, Catherine Park, Frederick Wang, Anne Peled, Michael Alvarado, Cheryl Ewing, Laura Esserman, Robert Foster, Hani Sbitany, Alex Hanlon
OBJECTIVES: Mastectomy rates for breast cancer have increased, with a parallel increase in immediate reconstruction. For some women, tissue expander and implant (TE/I) reconstruction is the preferred or sole option. This retrospective study examined the rate of TE/I reconstruction failure (ie, removal of the TE or I with the inability to replace it resulting in no final reconstruction or autologous tissue reconstruction) in patients receiving postmastectomy radiation therapy (PMRT). METHODS AND MATERIALS: Between 2004 and 2012, 99 women had skin-sparing mastectomies (SSM) or total nipple/areolar skin-sparing mastectomies (TSSM) with immediate TE/I reconstruction and PMRT for pathologic stage II to III breast cancer...
July 1, 2015: International Journal of Radiation Oncology, Biology, Physics
Roland Reitsamer, Florentia Peintinger
BACKGROUND: Nipple-sparing mastectomy (NSM) and implant-based breast reconstruction are increasingly replacing conventional mastectomy for risk-reducing purposes in high-risk patients as well as for therapeutic purposes in breast cancer patients. For implant-based breast reconstruction, generally, subpectoral implant placement with partial detachment of the pectoralis major muscle (PMM) is recommended. The advantage of a potentially better cosmetic result has to be balanced with the disadvantages, such as partial injury of the PMM with subsequent muscular deficit, breast animation, and postoperative pain...
February 2015: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Lena Carstensen, Janne Bigaard
BACKGROUND: Breast conserving surgery (BCS) for central breast tumours with immediate reconstruction of the nipple-areola complex (NAC) is a relatively new addition to the surgical palette of the oncoplastic surgeon. Most oncoplastic techniques presented to date have only been suitable for women with large breasts. METHODS: From 2012 to 2013, a series of eligible women with central breast cancers were treated with BCS and NAC reconstruction. According to breast size and shape, three different procedures were performed...
February 2015: Breast: Official Journal of the European Society of Mastology
Lin Zhu, Qiang Sun, Zhifei Liu, Ang Zeng, Yihong Jia, Xiaojun Wang
OBJECTIVE: To investigate the feasibility of immediate breast and nipple-areola reconstruction after skin-sparing mastectomy. METHODS: 24 patients who received skin-sparing mastectomy underwent immediate breast reconstruction with or without breast implants. The nipple-areola complex is also reconstructed with the skin paddle of the latissimus dorsi flap in one stage. RESULTS: All the latissimus dorsi myocutaneous flaps survived completely...
March 2014: Zhonghua Zheng Xing Wai Ke za Zhi, Zhonghua Zhengxing Waike Zazhi, Chinese Journal of Plastic Surgery
Rosaria Laporta, Benedetto Longo, Michail Sorotos, Marco Pagnoni, Fabio Santanelli Di Pompeo
Although clinical examination alone or in combination with other techniques is the only ubiquitous method for flap monitoring, it becomes problematic with buried free-tissue transfer. We present a DIEP flap sentinel skin paddle (SSP) positioning algorithm and its reliability is also investigated using a standardized monitoring protocol. All DIEP flaps were monitored with hand-held Doppler examination and clinical observation beginning immediately after surgery in recovery room and continued postoperatively at the ward...
February 2015: Microsurgery
Zoltán Mátrai, Gusztáv Gulyás, Csaba Kunos, Akos Sávolt, Emil Farkas, András Szollár, Miklós Kásler
Due to the development in medical science and industrial technology, minimally invasive procedures have appeared in the surgery of benign and malignant breast diseases. In general , such interventions result in significantly reduced breast and chest wall scars, shorter hospitalization and less pain, but they require specific, expensive devices, longer surgical time compared to open surgery. Furthermore, indications or oncological safety have not been established yet. It is quite likely, that minimally invasive surgical procedures with high-tech devices - similar to other surgical subspecialties -, will gradually become popular and it may form part of routine breast surgery even...
February 1, 2014: Orvosi Hetilap
Zoltán Mátrai, Csaba Kunos, Dávid Pukancsik, Akos Sávolt, Gusztáv Gulyás, Miklós Kásler
Skin- and nipple-sparing mastectomies made immediate breast reconstruction possible on a systemic level within breast cancer surgery. Mass reconstruction needs brought by the most common malignancy in women can only be met by the use of implant-based techniques, providing excellent cosmetic results and high patient satisfaction. For these postmastectomy reconstructions the replacement of the skin is no longer a challenge, but the well vascularized, good quality soft tissue coverage of the implant. Oncoplastic breast surgery today is able to conduct oncologically radical complete removal of the glandular tissue through an incision of 6-10 cm made in the armpit, with the nearly scarless retention of the natural skin envelope of the breast, and in the same time adequate axillary staging (sentinel node biopsy/axillary lymphadenectomy) is performed, then using the same incision, the implementation of one-step or multi-step breast reconstruction is possible...
January 19, 2014: Orvosi Hetilap
Jie Chen, Qing Lü, Xiaodong Wang, Hongjiang Li, Yujuan Chen, Xiaoqin Yang, Helin Zeng
OBJECTIVE: To evaluate the feasibility, oncological safety, and aesthetic result of skin-spring mastectomy (SSM) or nipple-spring mastectomy (NSM) in breast reconstruction of implant (permanent gel or expander) for breast cancer patients who were not fit for the breast conserving surgery (BCS). METHODS: Between October 2005 and July 2011, 89 women with breast caner underwent SSM or NSM, with an average age of 42.4 years (range, 19-55 years) and an average disease duration of 5...
July 2013: Chinese Journal of Reparative and Reconstructive Surgery
Sung Jun Yang, Jin Sup Eom, Taik Jong Lee, Sei Hyun Ahn, Byung Ho Son
BACKGROUND: Nipple-sparing mastectomy (NSM) is gaining popularity due to its superior aesthetic results. When reconstructing the breast with free abdominal tissue transfer, we must readdress the recipient vessel, because NSM can cause difficulty in access to the chest vessel. METHODS: Between June 2006 and March 2011, a total of 92 women underwent NSM with free abdominal tissue transfer. A lateral oblique incision was used for the nipple-sparing mastectomy. For recipient vessels, the internal mammary vessels were chosen if the mastectomy flap did not block access to the vessels...
May 2012: Archives of Plastic Surgery
Hamdy H El-Marakby, Magdy H Kotb
BACKGROUND: Oncoplastic breast conservative surgery has evolved as a safe alternative to the standard mastectomy in the treatment of early breast cancer. The procedure involves tumour resection with an adequate safety margin and either breast reshaping with volume displacement procedures (large or ptotic breasts) or volume replacement with latissimus dorsi myocutaneous flap (LDF) (small to medium sized non-ptotic breasts). A contra lateral mastopexy procedure is usually necessary with the volume displacement oncoplastic surgery, a procedure that is often rejected by a significant number of patients...
December 2011: Journal of the Egyptian National Cancer Institute
Petrus V van Deventer, Frank R Graewe, Elisabeth Würinger
BACKGROUND: The reasons for recurrent ptosis in mastopexy and breast reduction procedures are twofold. First, available surgical techniques do not reconstruct the normal breast anatomy responsible for maintaining breast shape. Second, in many instances the techniques rely on atrophied tissue to provide long-term support. The discovery in 1997 of the ligamentous suspension (the supporting system of the breast) gave rise to the concept that reconstruction of this anatomical structure was needed to ensure a sustained postoperative result...
June 2012: Aesthetic Plastic Surgery
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