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Autologous Breast Reconstruction

Eva A Huis ʼt Veld, Chao Long, Gloria R Sue, Arhana Chattopadhyay, Gordon K Lee
BACKGROUND: Patients with breast cancer frequently opt to undergo breast reconstruction after mastectomy. The timing and aesthetic outcome of the breast reconstruction may be affected by the need for radiation therapy (RT). Delayed-immediate autologous reconstruction (DIAR) is a novel surgical approach for patients in whom the need for adjuvant RT after mastectomy is preoperatively unknown. AIM: We sought to evaluate the difference in clinical outcomes, patient satisfaction, and cosmetic results between DIAR and patients who underwent delayed autologous reconstruction...
March 16, 2018: Annals of Plastic Surgery
Dorothee Boehm, Konstantin Bergmeister, Emre Gazyakan, Thomas Kremer, Ulrich Kneser, Volker J Schmidt
AIMS: Reconstruction of breasts and chest wall deformities in female patients after severe burn injury is a challenge for reconstructive surgeons. In these patients, neither implant-based procedures nor standard free flaps are sometimes applicable because of limited skin quality and unavailability of donor sites at the abdomen, back, buttock, or medial thigh. METHODS: We present a case of a young female patient with a history of 80 % total body surface area burn after electric high-voltage injury...
March 13, 2018: Annals of Plastic Surgery
Adriana C Panayi, Riaz A Agha, Brady A Sieber, Dennis P Orgill
BACKGROUND:  Increased rates of both breast cancer and obesity have resulted in more obese women seeking breast reconstruction. Studies demonstrate that these women are at increased risk for perioperative complications. A systematic review was conducted to assess the outcomes in obese women who underwent breast reconstruction following mastectomy. METHODS:  Cochrane, PUBMED, and EMBASE electronic databases were screened and data were extracted from included studies...
March 6, 2018: Journal of Reconstructive Microsurgery
Nicholas L Berlin, Jennifer B Hamill, Ji Qi, Hyungjin M Kim, Andrea L Pusic, Edwin G Wilkins
BACKGROUND: Survey-based research is essential for evaluating the outcomes of health care in an era of patient-centered care. However, many such studies are hampered by poor response rates in completion of study questionnaires, thus limiting the generalizability of any findings. The objectives of this analysis were to identify independent variables associated with nonresponse to surveys following breast reconstruction to improve future patient-reported outcomes research. MATERIALS AND METHODS: The Mastectomy Reconstruction Outcomes Consortium is a prospective cohort study involving 11 leading medical centers from the United States and Canada...
April 2018: Journal of Surgical Research
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
N D Thimmappa, J V Vasile, C Y Ahn, J L Levine, M R Prince
Autologous breast reconstruction using muscle-sparing free flaps are becoming increasingly popular, although microvascular free flap reconstruction has been utilised for autologous breast reconstructions for >20 years. This innovative microsurgical technique involves meticulous dissection of artery-vein bundle (perforators) responsible for perfusion of the subcutaneous fat and skin of the flap; however, due to unpredictable anatomical variations, preoperative imaging of the donor site to select appropriate perforators has become routine...
February 27, 2018: Clinical Radiology
Hannah Matthews, Andrew Turner, Iain Williamson, Wendy Clyne
OBJECTIVE: In the United Kingdom, the number of women undergoing post-mastectomy breast reconstruction is increasing. Consequently, exploring patient-reported outcomes in breast surgery has become increasingly important. This study investigated satisfaction and quality of life following post-mastectomy breast reconstruction. DESIGN: Qualitative research design. METHODS: In-depth, semi-structured telephone interviews were conducted with 25 women (age, M = 53...
March 2, 2018: British Journal of Health Psychology
Maurice Y Nahabedian
Prosthetic breast reconstruction has evolved over the years to provide results that now mimic that of a natural breast. This is due to a variety of innovations and advancements related to mastectomy techniques, acellular dermal matrices, autologous fat grafting, and improved breast implants. The evolution of prosthetic breast reconstruction has gone full-circle and included prepectoral placement in the 1970s and 80s, partial or total subpectoral placement from 1985 to 2015, and now gradually trending back to prepectoral...
March 2, 2018: Breast Journal
Gloria R Sue, Beatrice J Sun, Gordon K Lee
BACKGROUND: Two-stage expander implant breast reconstruction is commonly performed after mastectomy. Salvage and long-term outcomes after development of complications have not been well described. We examined a single surgeon's experience to study the rate of reoperation secondary to complications after first-stage expander placement and to evaluate their outcomes. Better understanding of salvage techniques may help guide future management. METHODS: We performed a retrospective analysis of consecutive patients who underwent placement of a tissue expander (TE) for breast reconstruction between December 2006 and August 2015 with the senior author...
February 27, 2018: Annals of Plastic Surgery
Gloria R Sue, Gordon K Lee
BACKGROUND: Mastectomy skin necrosis is a significant problem after breast reconstruction. We sought to perform a comparative analysis on this complication between patients undergoing autologous breast reconstruction and patients undergoing 2-stage expander implant breast reconstruction. METHODS: A retrospective review was performed on consecutive patients undergoing autologous breast reconstruction or 2-stage expander implant breast reconstruction by the senior author from 2006 through 2015...
February 27, 2018: Annals of Plastic Surgery
Nicholas L Berlin, Vickram J Tandon, Ji Qi, Hyungjin M Kim, Jennifer B Hamill, Adeyiza O Momoh, Andrea L Pusic, Edwin G Wilkins
OBJECTIVE: Our objectives were to investigate case-mix adjusted hospital variations in 2-year clinical and patient-reported outcomes following immediate breast reconstruction. BACKGROUND: Over the past few decades, variations in medical practice have been viewed as opportunities to promote best practices and high-value care. METHODS: The Mastectomy Reconstruction Outcomes Consortium Study is an National Cancer Institute-funded longitudinal, prospective cohort study assessing clinical and patient-reported outcomes of immediate breast reconstruction after mastectomy at 11 leading medical centers...
February 27, 2018: Annals of Surgery
Angie Zhang, Deniz Dayicioglu
BACKGROUND: The deep inferior epigastric perforator (DIEP) flap has gradually become the superior choice for autologous breast reconstruction because it reduces donor site morbidity, abdominal wall complications, and postoperative recovery time when compared with other flap types. METHODS: The purposes of this study are to report on the experience and clinical outcomes of consecutive DIEP flap breast reconstructions performed by a single surgeon at a cancer center between April 2011 and May 2016 and to characterize the trends among these flaps...
February 23, 2018: Annals of Plastic Surgery
Patrick Bletsis, Alexandra Bucknor, Anmol Chattha, Parisa Kamali, Austin Chen, Renata Flecha-Hirsch, Berend van der Lei, Bernard T Lee, Samuel J Lin
BACKGROUND: Over the last decade, there has been a 12% increase in prophylactic mastectomy (PM) per year. The aim of the study was to analyze complication rates and associated risk factors in patients undergoing PM and reconstruction. METHODS: We reviewed patients undergoing PM (contralateral and bilateral) from 2010 to 2015 at a single academic institution. Data on patient characteristics and postoperative outcomes were obtained. Postoperative complications were categorized into minor and major groups...
February 23, 2018: Annals of Plastic Surgery
Yoshiko Toyoda, Karel-Bart Celie, Jonathan T Xu, Justin S Buro, Julia Jin, Alexandra J Lin, Kristy A Brown, Jason A Spector
INTRODUCTION: Obesity is a known risk factor for the development and prognosis of breast cancer. Adipocytes have been identified as a source of exogenous lipids in other cancer types and may similarly provide energy to fuel malignant survival and growth in breast cancer. This relationship is of particular relevance to plastic surgery, because many reconstructions after oncologic mastectomy achieve optimal aesthetics and durability using adjunctive autologous fat transfer (AFT). Despite the increasing ubiquity and promise of AFT, many unanswered questions remain, including safety in the setting of breast cancer...
February 23, 2018: Annals of Plastic Surgery
Chris Devulapalli, Ricardo J Bello, Emily Moin, James Alsobrooks, Pablo Baltodano Fallas, Rika Ohkuma, Michele A Manahan, Justin M Sacks, Carisa M Cooney, Gedge D Rosson
BACKGROUND: Despite well-established correlation of postmastectomy radiotherapy and surgical complications in breast reconstruction, its impact on patient reported outcomes is less clear. We sought to determine the effect of postmastectomy radiotherapy on patient reported outcomes throughout the breast reconstruction process. METHODS: Patients undergoing prosthetic and autologous breast reconstruction from November 2010 to June 2013 were prospectively followed with BREAST-Q surveys (preoperatively, after expander placement, and 6 and 12 months after final reconstruction)...
March 2018: Plastic and Reconstructive Surgery
Jason M Weissler, Peter F Koltz, Martin J Carney, Joseph M Serletti, Liza C Wu
BACKGROUND: An untoward outcome following breast reconstruction is diminished or complete loss of sensation. As the reconstructive paradigm continues to evolve, sensory restoration following reconstruction remains a research focus. Despite the multitude of published outcomes, there is marked heterogeneity across studies, thus confounding published outcomes. This study critically appraises the literature to summarize outcomes and establish a framework to guide clinical practice and future research...
March 2018: Plastic and Reconstructive Surgery
Charalampos Siotos, Mohamad E Sebai, Eric L Wan, Ricardo J Bello, Mehran Habibi, Damon S Cooney, Michele A Manahan, Carisa M Cooney, Stella M Seal, Gedge D Rosson
BACKGROUND: Lymphedema remains a significant complication following breast cancer surgery when there is axillary lymph node intervention. Previous systematic reviews have identified risk factors for breast cancer-related lymphedema, including increased BMI, number of lymph nodes dissected and radiotherapy. However, they have not examined the effect of breast reconstruction on lymphedema occurrence. In this systematic review and meta-analysis, we sought to evaluate the association between breast reconstruction (BR) and lymphedema...
February 21, 2018: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Michelle B Locke, William LE Malins, Jia Le See, John Kenealy
BACKGROUND: External beam radiotherapy (XRT) to the breast has been shown to increase complication rates in women undergoing implant-based breast reconstruction (IBBR). Owing to concerns about high complication and failure rates, our department began to favour autologous reconstructive in patients requiring XRT in 2013. This study assesses the outcomes of IBBR prior to and following this policy change. METHODS: The records of all patients who underwent first-stage IBBR in 2012 and 2013 in our department were reviewed...
February 23, 2018: New Zealand Medical Journal
Christodoulos Kaoutzanis, Nishant Ganesh Kumar, Dillon O'Neill, Blair Wormer, Julian Winocour, John Layliev, Matthew McEvoy, Adam King, Stephane A Braun, K Kye Higdon
BACKGROUND: Enhanced Recovery Pathway (ERP) programs have demonstrated improved perioperative care and shorter length of hospital stay (LOS) in several surgical disciplines. The purpose of this study was to compare outcomes of patients undergoing autologous tissue-based breast reconstruction (ABR) before and after the implementation of an ERP program. METHODS: We retrospectively reviewed consecutive patients who underwent ABR by two surgeons before and after the implementation of the ERP at a university center over a three-year period...
February 9, 2018: Plastic and Reconstructive Surgery
James M Economides, David H Song
Background: Despite the popularity of latissimus dorsi (LD) flap in breast reconstruction, a breast implant is often necessary to achieve sufficient volume. Prior reports describe fat grafting to the LD flap as a secondary procedure to correct contour deformities and improve volume. Our institution has instituted autologous breast reconstruction with an LD flap and immediate fat transfer (LIFT). Methods: A retrospective review of all patients undergoing the LIFT procedure was undertaken...
January 2018: Plastic and Reconstructive Surgery. Global Open
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