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Nipple reconstruction

Sukru Yazar, E Cigdem Karadag, Altug Altinkaya, Halil Kara, Cihan Uras
BACKGROUND: Breast reconstruction with a Becker-type expander is a common technique following mastectomy. However, inconsistency remains in the literature regarding risk factors for the survival of a Becker-type expander following immediate breast reconstruction. This study's purpose is to investigate possible risk factors for the Becker-type expander survival and to evaluate the complications related to expander removal following immediate breast reconstruction. METHODS: We performed a retrospective chart review of consecutive women who underwent a mastectomy followed by immediate breast reconstruction with a Becker-type expander from November 2010 to November 2016...
March 9, 2018: Aesthetic Plastic Surgery
Johanna Olson-Kennedy, Jonathan Warus, Vivian Okonta, Marvin Belzer, Leslie F Clark
Importance: Transmasculine youth, who are assigned female at birth but have a gender identity along the masculine spectrum, often report considerable distress after breast development (chest dysphoria). Professional guidelines lack clarity regarding referring minors (defined as people younger than 18 years) for chest surgery because there are no data documenting the effect of chest surgery on minors. Objective: To examine the amount of chest dysphoria in transmasculine youth who had had chest reconstruction surgery compared with those who had not undergone this surgery...
March 5, 2018: JAMA Pediatrics
Ralph Verstappen, Gabriel Djedovic, Evi Maria Morandi, Dietmar Heiser, Ulrich Michael Rieger, Thomas Bauer
Background: A persistent problem in autologous breast reconstruction in skin-sparing mastectomies is skin restoration after skin necrosis or secondary oncological resection. As a solution to facilitate reconstruction, skin banking of free-flap skin has been proposed in cases where the overlying skin envelope must be resected, as this technique spares the patient an additional donor site. Herein, we present the largest series to date in which this method was used. We investigated its safety and the possibility of skin banking for prolonged periods of time...
March 5, 2018: Archives of Plastic Surgery
Hung-Wen Lai, Shih-Lung Lin, Shou-Tung Chen, Ka-Man Kuok, Shu-Ling Chen, Ya-Ling Lin, Dar-Ren Chen, Shou-Jen Kuo
BACKGROUND: A new hybrid technique for single-axillary-incision endoscopic-assisted nipple-sparing mastectomy (E-NSM) was introduced. Preliminary results are reported. METHODS: Patients who received single-axillary-incision E-NSM from August 2013 to August 2017 were searched from a single institution. Data were analyzed to determine the effectiveness and oncologic safety of single-axillary-incision E-NSM. Patient-oriented cosmetic outcome report was also obtained...
February 26, 2018: Annals of Surgical Oncology
Alexander J Gougoutas, Hakim K Said, Grace Um, Anne Chapin, David W Mathes
LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Understand how to determine nipple-areola complex positioning on the reconstructed breast. 2. Understand the multitude of local flap and distant graft options for nipple-areola complex reconstruction. 3. Draw at least three fundamental nipple-areola complex reconstruction patterns. 4. Understand the forces that are responsible for flattening of the reconstructed papule. 5. Understand the current techniques used in secondary nipple-areola complex reconstructions...
March 2018: Plastic and Reconstructive Surgery
Lawrence Z Cai, John A M Paro, Gordon K Lee, Rahim S Nazerali
BACKGROUND: Aesthetics plays a large role in determining a successful outcome in plastic and reconstructive surgery. As such, understanding perceptions of favorable aesthetics is crucial for optimizing patient satisfaction. Eye-tracking technology offers an unbiased way of measuring how viewers evaluate breast reconstructions. METHODS: Twenty-nine raters with varied plastic surgery experience were shown 20 images of breast reconstruction at various stages. Breasts were divided into those with nipples and no reconstruction scars, those with nipples and reconstruction scars, and those with reconstruction scars and no nipples...
March 2018: Plastic and Reconstructive Surgery
Ryo Miyake, Satoki Kinoshita, Naoko Shimada, Ken Uchida, Hiroshi Takeyama, Toshiaki Morikawa
PURPOSE: Skin-sparing mastectomy (SSM) enables a radical cure of breast cancer while overcoming the cosmetic issues related to surgery. We review our experience of performing SSMs and assess whether preservation of the nipple-areola complex (NAC) could have been an option for some patients who underwent SSM. METHODS: The subjects of this retrospective study were women who underwent SSM that utilized four incision types; namely, the so-called tennis racket incision, a periareolar and midaxillary incision, an areola-sparing and midaxillary incision, and a small transverse elliptical incision...
February 21, 2018: Surgery Today
Andrea Hiller, Thomas J Lee, Joshua Henderson, Nicolas Ajkay, Bradon J Wilhelmi
Objective: Oncoplastic surgery was developed to allow for large tumor excision and immediate breast reconstruction with the goal of optimal breast shape and symmetry. Although initially used in women who underwent lumpectomy for breast malignancy, these techniques can be useful for cosmetic issues caused by benign breast disease. We describe a modification of an inferior pedicle with Wise-pattern reduction mammoplasty for oncoplastic reconstruction of a giant fibroadenoma. Methods: A 30-year-old woman with size 32 DD breasts was referred by the surgical oncologist with a biopsy-proven fibroadenoma of the right breast...
2018: Eplasty
Lene Nyhøj Heidemann, Gudjon L Gunnarsson, C Andrew Salzberg, Jens Ahm Sørensen, Jørn Bo Thomsen
Background: Acellular dermal matrix was introduced in breast reconstruction in 2001 and is gradually becoming a standard component for immediate breast reconstruction and nipple-sparing mastectomy. The reconstructive technique allows for improved aesthetic outcomes. However, there seems to be uncertainty regarding complication rates. The aim of this review was to systematically evaluate complication rates related to this method. Methods: This systematic review was conducted according to the recommendations outlined in the Cochrane Handbook for reviews and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement...
January 2018: Plastic and Reconstructive Surgery. Global Open
O Ortenzia, R Rossi, M Bertolini, A Nitrosi, C Ghetti
The aim of this article was to characterise the performance of four different digital breast tomosynthesis (DBT) systems in terms of dose and image quality parameters. One of them, GE Pristina, has never been tested before. Average glandular doses were measured both in DBT and 2D full field digital mammography mode. Several phantoms were employed to perform signal difference to noise ratio, slice sensitivity profile, slice to slice incrementation, chest wall offset, z-axis geometry, artefact spread function, low contrast detectability, contrast detail evaluations, image uniformity and in-plane MTF in chest wall-nipple and in tube-travel directions...
February 15, 2018: Radiation Protection Dosimetry
D Casella, G Di Taranto, M Marcasciano, S Sordi, A Kothari, T Kovacs, F Lo Torto, E Cigna, D Ribuffo, C Calabrese
BACKGROUND: Although demand for prophylactic mastectomy is increasing over time among women at a high risk for breast cancer, there is a paucity of studies on long term patient-reported outcomes after this procedure. METHODS: Between January 2011 and January 2015, 46 patients documented BRCA1/2 mutation carriers, eligible for prophylactic nipple-sparing mastectomy (NSM) and immediate breast prosthetic reconstruction were registered at our institutions. Patients underwent NSM and subcutaneous reconstruction with implant covered by a titanium-coated polypropylene mesh (TiLoop® )...
February 15, 2018: Breast: Official Journal of the European Society of Mastology
Joon Seok Lee, Joon Hyun Kwon, Jeong Woo Lee, Kang Young Choi, Ho Yun Chung, Byung Chae Cho, Jung Dug Yang
BACKGROUND: The final stage of breast reconstruction after mastectomy for breast cancer is nipple reconstruction. However, a consistent and reliable method resulting in the most ideal aesthetic results has yet to be clarified. This study analysed the long-term outcomes of nipple reconstruction using Rapiplug. METHODS: Forty-one patients who underwent immediate breast reconstruction after mastectomy between January 2014 and February 2017 were enrolled. Nipple reconstruction was performed with C-V flap and Hammond flap, and hat-shaped Rapiplug was implanted at the flap core...
February 8, 2018: ANZ Journal of Surgery
S Struk, Q Qassemyar, N Leymarie, J-F Honart, H Alkhashnam, K De Fremicourt, A Conversano, J-B Schaff, F Rimareix, F Kolb, B Sarfati
Robot-assisted surgery is more and more widely used in urology, general surgery and gynecological surgery. The interest of robotics in plastic and reconstructive surgery, a discipline that operates primarily on surfaces, has yet to be conclusively proved. However, the initial applications of robotic surgery in plastic and reconstructive surgery have been emerging in a number of fields including transoral reconstruction of posterior oropharyngeal defects, nipple-sparing mastectomy with immediate breast reconstruction, microsurgery, muscle harvesting for pelvic reconstruction and coverage of the scalp or the extremities...
February 2, 2018: Annales de Chirurgie Plastique et Esthétique
Arthur H Salibian, Jay K Harness, Donald S Mowlds
BACKGROUND: The acceptance of nipple-sparing mastectomy for the treatment of breast cancer in selected patients has introduced ancillary procedures to improve breast shape, correct ptosis, and enhance breast symmetry. Mastopexy before or at the time of nipple-sparing mastectomy has been performed to correct ptosis, but there have been no reports on secondary Wise pattern mastopexy after completion of staged subcutaneous expander/implant reconstruction. METHODS: Between 2005 and 2015, 155 patients (255 breasts) underwent staged subcutaneous implant/expander-based reconstruction after inframammary nipple-sparing mastectomy...
February 2, 2018: Annals of Plastic Surgery
Chi-Yu Wang, Chin-Hsin Wang, Yuan-Sheng Tzeng, Chin-Ta Lin, Chang-Yi Chou, I-Han Chiang, Chien-Ju Wu, Shyi-Gen Chen
INTRODUCTION: Nipple-sparing mastectomy (NSM) and immediate breast reconstruction with gel implants have grown in popularity because of superior aesthetic outcomes. One risk of this procedure is overexcision of the flap leading to inadequate circulation in the breast envelope. METHODS: We investigated 17 cases of NSM and gel implant breast reconstruction. Patients were divided into an infra-areolar incision group and a supra-areolar incision group. Nipple-areolar complex perfusion was evaluated using the SPY imaging system after NSM and gel implant breast reconstruction...
February 2018: Annals of Plastic Surgery
Ali A Qureshi, Jeremie D Oliver, Rajiv P Parikh, Marissa M Tenenbaum, Terence M Myckatyn
Background: Implant-based breast reconstruction (IBR) after nipple-sparing mastectomies (NSM) can have complications that require explantation of a tissue expander or permanent prosthesis. When complications occur, preservation of the nipple-areola complex (NAC) remains critical to ensure aesthetic breast reconstruction. To date, there are minimal data on outcomes for patients experiencing unplanned explantations in IBR after NSM. Objectives: To evaluate final reconstructive outcomes for NSM patients who undergo IBR and have an unplanned explanation and to separately analyze the outcome of the NAC aesthetic subunit...
January 18, 2018: Aesthetic Surgery Journal
Secondo Folli, Annalisa Curcio, Davide Melandri, Elena Bondioli, Nicola Rocco, Giuseppe Catanuto, Fabio Falcini, Valeria Purpura, Matteo Mingozzi, Federico Buggi, Francesco Marongiu
INTRODUCTION: The introduction of acellular dermal matrices (ADMs) contributed to the growing diffusion of direct-to-implant breast reconstruction (DTI-BR) following mastectomy for breast cancer. According to specific legislations, European specialists could not benefit from the use of human-derived ADMs, even though most evidence in the literature are available for this kind of device, showed optimal outcomes in breast reconstruction. The Skin Bank of the Bufalini Hospital (Cesena, Italy) obtained in 2009 the approval for the production and distribution of a new human cadaver-donor-derived ADM (named with the Italian acronym, MODA, for matrice omologa dermica acellulata) from the Italian National Transplant Center and National Health Institute...
January 4, 2018: Aesthetic Plastic Surgery
Shoichi Tomita, Katsuya Mori, Takeshi Miyawaki
BACKGROUND: Reconstruction of the nipple-areola complex is the final process in breast reconstruction. Local flaps and paramedical pigmentation is one of the major procedures for this. However, fading after paramedical pigmentation leads to a color difference between the selected pigment and its color in the skin. The aim of this study is to make a proposition in color choice of paramedical pigmentation for nipple-areola complex. METHODS: Our research focused on investigating the color changes over time after unilateral nipple-areola complex reconstruction using paramedical pigmentation in 25 patients to propose suitable color selections...
January 4, 2018: Aesthetic Plastic Surgery
Russell J Bramhall, Jason Lee, Mae Concepcion, David Westbroek, Sarah Huf, Kabir Mohammed, Paul Thiruchelvam, Gerald P Gui
Background: The central round block repair is a volume displacement technique to reconstruct large wide local excision (WLE) defects in breasts with moderate ptosis or hypertrophy. There are limited published data on the outcomes of this technique. Methods: Data were collected prospectively for 57 consecutive patients and follow up information obtained from patient records. The volume of breast resection was estimated geometrically from mammography. Aesthetic outcomes were assessed from clinical measurements and panel review of patient photographs...
December 2017: Gland Surgery
Sadaf Jafferbhoy, Mihir Chandarana, Maria Houlihan, Rishikesh Parmeshwar, Sankaran Narayanan, Soni Soumian, Simon Harries, Lucie Jones, Dayalan Clarke
Background: The last two decades have seen significant changes in surgical management of breast cancer. The offer of immediate breast reconstruction (IBR) following mastectomy is currently standard practice. Skin sparing and nipple sparing mastectomy with implant-based IBR have emerged as oncologically safe treatment options. Prepectoral implant placement and complete coverage of implant with acellular dermal matrix (ADM) eliminates the need to detach the muscle from underlying chest wall in contrast to the subpectoral technique...
December 2017: Gland Surgery
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