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Total skin sparing mastectomy

Arjen A W M van Turnhout, Charlotte J J Franke, Eline J C Vriens-Nieuwenhuis, Wouter B van der Sluis
INTRODUCTION: Little is reported on surgical outcomes of SERI Surgical Scaffold, a bioresorbable silk-derived surgical scaffold, developed to provide soft-tissue support and repair, in implant/expander breast reconstruction. METHODS: A retrospective chart study was conducted of all patients who underwent direct-to-implant reconstruction with a SERI surgical scaffold after skin-sparing mastectomy, recording surgical characteristics, perioperative complications and reoperations...
February 1, 2018: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Fatma Umit Malya, Huseyin Kadioglu, Huseyin Kazim Bektasoglu, Zuhal Gucin, Seyma Yildiz, Mehmet Guzel, Ezgi Basak Erdogan, Serap Yucel, Yeliz Emine Ersoy
Objective To investigate the role of positron emission tomography (PET) and magnetic resonance imaging (MRI) in evaluating the feasibility of skin-sparing mastectomy in patients with locally-advanced breast cancer (LABC) who will undergo neoadjuvant chemotherapy (NAC) by evaluating the sensitivity and specificity of PET and MRI compared with skin biopsy results before and after NAC treatment. Methods Patients with LABC who were treated with NAC between November 2013 and November 2015 were included in this study...
January 1, 2018: Journal of International Medical Research
Christian Eichler, Carolin Schulz, Nadine Vogt, Mathias Warm
The use of acellular dermal matrices (ADM), sometimes referred to as extracellular matrix (ECM), has become an interesting aspect of breast reconstruction. A great deal of literature is available, totaling over 7000 ADM-based reconstructions. Most often, ADMs are used in a skin sparing mastectomy (SSM) scenario, although heterologous breast augmentation with a sub-pectoral fixation may also require an ADM application. Their use has become an attractive, but expensive option. Available data shows head to head comparisons between individual ADMs to be mostly retrospective in nature with only a few prospective trials available...
December 22, 2017: Surgical Technology International
Giuseppe Carlo Iorio, Pierfrancesco Franco, Elena Gallio, Stefania Martini, Francesca Arcadipane, Sara Bartoncini, Nadia Rondi, Francesca Romana Giglioli, Ada Ala, Mario Airoldi, Michela Donadio, Corrado De Sanctis, Isabella Castellano, Umberto Ricardi
To evaluate feasibility, safety, toxicity profile and dosimetric results of volumetric modulated arc therapy (VMAT) to deliver regional nodal irradiation (RNI) after either mastectomy or breast conservation (BCS) in high-risk breast cancer patients. Between January 2015 and January 2017, a total of 45 patients were treated with VMAT to deliver RNI together with whole breast or post-mastectomy radiotherapy. The fractionation schedule comprised 50 Gy in 25 fractions given to supraclavicular and axillary apex nodes and to whole breast (after BCS) or chest wall (after mastectomy)...
November 24, 2017: Medical Oncology
Min Ho Yun, Eul Sik Yoon, Byung-Il Lee, Seung-Ha Park
BACKGROUND: Skin flap necrosis is a common complication after mastectomy and breast reconstruction. It has been proven that nitroglycerin ointment, as a topical vasodilator, can decrease the rate of skin flap necrosis after mastectomy and breast reconstruction. However, nitroglycerin can cause several side effects, including headache, dizziness, and hypotension. The purpose of this study was to evaluate whether the application of a low dose of nitroglycerin ointment reduced the rate of skin flap necrosis in breast reconstruction after skin-sparing or nipple-sparing mastectomy...
November 2017: Archives of Plastic Surgery
Lyndsey Highton, Richard Johnson, Cliona Kirwan, John Murphy
BACKGROUND: The development of acellular dermal matrices (ADMs) has facilitated single-stage implant breast reconstruction (IBR) following skin-sparing mastectomy. The conventional approach of postpectoral implant placement with lower pole ADM confers a good cosmetic result by improving lower pole projection and control, while minimizing issues of implant visibility, palpability, and rippling. This is balanced with potential disadvantages including pain, disruption of pectoral muscle function, and animation...
September 2017: Plastic and Reconstructive Surgery. Global Open
T Muller, A Baratte, C Bruant-Rodier, F Bodin, C Mathelin
INTRODUCTION: The objective of our study was to evaluate the risk of cancer after prophylactic nipple-sparing mastectomy (PNSM). MATERIAL AND METHODS: The PubMed database was consulted using the following key-words: "nipple-sparing mastectomy", "prophylactic", "locoregional recurrence", "oncological risk". Articles published between January 1995 and December 2016 were searched. RESULTS: Out of the 270 articles found, 19 were included. Overall, 15 studies were retrospective, 2 prospective, 2 prospective and retrospective and 3 were multicentric...
October 10, 2017: Annales de Chirurgie Plastique et Esthétique
Amanda L Zimmerman, Bugra Tugertimur, Paul D Smith, Ambuj Kumar, Deniz Dayicioglu
BACKGROUND: Augmentation mammoplasty remains the most common cosmetic surgery procedure performed. The objective of this article is to evaluate the impact of augmented volume of the reconstructed breast in patients that undergo nipple-sparing mastectomy and patients previously augmented who undergo mastectomy with tissue expander/implant-based reconstruction. METHODS: Patients undergoing skin-sparing mastectomy, nipple-sparing mastectomy, and mastectomy after previous augmentation followed by tissue expander/implant-based reconstruction between June 2011 and April 2015 by 2 surgeons at the same institution were included...
October 2017: Cancer Control: Journal of the Moffitt Cancer Center
Gustavo Nader Marta, Philip Poortmans, Alfredo C de Barros, José Roberto Filassi, Ruffo Freitas Junior, Riccardo A Audisio, Max Senna Mano, Sarkis Meterissian, Sarah M DeSnyder, Thomas A Buchholz, Tarek Hijal
PURPOSE/OBJECTIVE(S): Skin sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) have entered routine surgical practice for breast cancer, though their oncologic safety has not been established in randomized controlled trials. The aim of this study was to evaluate and compare radiation oncologists' and breast surgeons' opinions concerning the indications of post-operative radiation therapy (PORT) after SSM and NSM. MATERIALS/METHODS: Radiation oncologists and breast surgeons from North America, South America and Europe were invited to contribute in this study...
November 2017: European Journal of Surgical Oncology
Yana Puckett, Theophilus Pham, Shirley McReynolds, Catherine A Ronaghan
We present a case report on the successful healing of a Pseudomonas infection wound in a 52-year-old female with morbid obesity, noninsulin dependent diabetes mellitus and a history of tobacco use, who presented with Stage IIIA (T3, N2, Mo) infiltrating ductal carcinoma. The patient received neoadjuvant chemotherapy prior to her bilateral skin-sparing total mastectomies with right axillary sentinel lymphadenectomy. She also had staged reconstruction with temporary breast implants and plans for deep inferior epigastric perforator flaps...
July 10, 2017: Curēus
Jordan D Frey, Ara A Salibian, Mihye Choi, Nolan S Karp
BACKGROUND: Ischemic complications after nipple-sparing mastectomy (NSM) have been associated with numerous variables. However, the impact of NSM flap thickness has been incompletely evaluated. METHODS: NSM flap thickness was determined for all NSMs from 2006 to 2016 with available pre- or postoperative breast magnetic resonance imaging (MRIs). Demographics and outcomes were stratified by those with and without ischemic complications. RESULTS: Of 1,037 NSM reconstructions, 420 NSMs had MRI data available, which included 379 preoperative MRIs and 60 postoperative MRIs...
August 2017: Plastic and Reconstructive Surgery. Global Open
Niels Hammer-Hansen, Alexander Andersen Juhl, Tine Engberg Damsgaard
OBJECTIVE: Necrosis in implant-based immediate breast reconstruction is a feared complication. Accurate evaluation of mastectomy skin flaps per-operatively is necessary to decrease this risk. The present study is the first in Scandinavia to review the effects of perioperative evaluation with laser-assisted indocyanine green fluorescence angiography (LA-ICGA). METHOD: A retrospective review was performed using data from the electronic patient record at the Department of Plastic and Breast Surgery at Aarhus University Hospital in Denmark on all patients who underwent implant-based skin-sparing immediate breast reconstruction with ADM in the time period March 2012 to October 2015...
August 30, 2017: Journal of Plastic Surgery and Hand Surgery
Andrew L Cooke, Julian Diaz-Abele, Tom Hayakawa, Ed Buchel, Kimberly Dalke, Pascal Lambert
PURPOSE: To determine whether adjuvant radiation therapy (RT) is associated with adverse patient-reported outcomes and surgical complications 1 year after skin-sparing mastectomy and immediate autologous free flap reconstruction for breast cancer. METHODS AND MATERIALS: We compared 24 domains of patient-reported outcome measures 1 year after autologous reconstruction between patients who received adjuvant RT and those who did not. A total of 125 patients who underwent surgery between 2012 and 2015 at our institution were included from the Mastectomy Reconstruction Outcomes Consortium study database...
September 1, 2017: International Journal of Radiation Oncology, Biology, Physics
Zeina Ayoub, Eric A Strom, Valentina Ovalle, George H Perkins, Wendy A Woodward, Welela Tereffe, Benjamin D Smith, Simona F Shaitelman, Michael C Stauder, Karen E Hoffman, Sarah M DeSnyder, Patrick B Garvey, Mark W Clemens, Carlos H Barcenas, Henry M Kuerer, Steven Kronowitz
BACKGROUND: An integrated approach to skin sparing mastectomy with tissue expander placement followed by radiotherapy and delayed reconstruction was initiated in our institution in 2002. The purpose of this study was to assess the surgical outcomes of this strategy. METHODS: Between September 2002 and August 2013, a total of 384 reconstructions had a tissue expander placed at the time of mastectomy and subsequently underwent radiotherapy. Rates and causes of tissue expander explantation before, during, and after radiotherapy, as well as tumor specific outcomes and reconstruction approaches, were collected...
October 2017: Annals of Surgical Oncology
Anna Maria Murante, Silvio Candelori, Paola Rucci, Sabina Nuti, Manuela Roncella, Matteo Ghilli, Andrea Mercatelli, Maria Pia Fantini
BACKGROUND: The evolution in the surgical and diagnostic procedures, the attention to women's preferences, the case mix, and differences in professional practices may lead to a variability in the quality of breast cancer clinical pathway. To catch and manage this variability it is important to use valid measures. The aim of this paper is to examine the concurrent validity of the breast-conserving surgery (BCS) indicator and to provide evidence to guide the quality improvement process...
July 17, 2017: BMC Research Notes
Young Woo Chang, Hwan Soo Kim, Seung Pil Jung, Sang Uk Woo, Jae Bok Lee, Jeoung Won Bae, Gil Soo Son
BACKGROUND: Skin-sparing mastectomy (SSM) is increasingly used in patients with breast cancer. We compared the differences between use of electrocautery and LigaSure™ Small Jaw in patients with breast cancer who underwent SSM. METHODS: Between January 2012 and December 2015, 81 patients with breast cancer who underwent SSM were selected and were divided into the electrocautery group and the LigaSure™ Small Jaw group based on the devices that were used. Clinicopathological characteristics, body mass index, operative time, and weight of removed breast were obtained from medical records...
July 14, 2017: World Journal of Surgical Oncology
Anne Warren Peled, Marie Sears, Frederick Wang, Robert D Foster, Michael Alvarado, Jasmine Wong, Cheryl A Ewing, Hani Sbitany, Laura J Esserman, Barbara Fowble
BACKGROUND: Many patients undergoing total-skin sparing mastectomy (TSSM) and 2-staged expander-implant (TE-I) reconstruction require postmastectomy radiation therapy (PMRT). Additionally, many patients undergoing TSSM for recurrent cancer have a history of lumpectomy and radiation therapy (XRT). Few studies have looked at the impact of XRT on the stages of TE-I reconstruction. METHODS: Patients undergoing TSSM and immediate TE-I reconstruction between 2006 and 2013 were identified from a prospectively maintained database...
June 1, 2017: Annals of Plastic Surgery
Kyong-Je Woo, Joo Myong Paik, Goo-Hyun Mun, Jai-Kyong Pyon, Byung-Joon Jeon, Sa Ik Bang
BACKGROUND: Placement of a closed suction drain is a common cause of patient complaints, such as postoperative pain or discomfort following immediate expander-implant breast reconstruction. This study aims to identify factors that affect drainage volume, time to drain removal, and seroma formation. METHODS: A retrospective chart review of prospectively collected data was conducted on patients who underwent immediate expander-implant breast reconstructions following nipple-sparing or skin-sparing mastectomy without skin excision (nipple areolar complex excision only) between February 2010 and April 2015...
June 12, 2017: Journal of Plastic Surgery and Hand Surgery
Jean-Claude D Schwartz, Piotr P Skowronksi
Nipple-sparing mastectomy (NSM) is challenging in patients with significant ptosis and skin excess. We previously described the first use of a surgical delay (a supraareolar incision with undermining off the breast mound) to facilitate a second-stage pedicled NSM and reconstruction. Here, we present an improvement in our surgical delay technique-a total skin and NSM through Wise incisions. This technique obviates concerns regarding delays in cancer care and more aggressively delays the nipple, allowing for more reliable and extreme NAC transpositions...
March 2017: Plastic and Reconstructive Surgery. Global Open
Jason Corban, Hani Shash, Tyler Safran, Nicolas Sheppard-Jones, Omar Fouda-Neel
INTRODUCTION: With proven oncological safety and improved aesthetic outcomes, the Type IV or "Wise pattern" skin-sparing mastectomy (SSM) is a procedure that is being performed with increasing frequency. Unfortunately, it is also associated with an increased risk of complications. The purpose of this investigation was to determine the complications associated with direct-to-implant and two-step tissue-expander breast reconstruction following Wise pattern SSM. METHODS: Systematic electronic searches were performed using PubMed, MEDLINE, and Embase databases...
September 2017: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
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