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Autologous Breast Reconstruction

Arash Momeni, Suhail K Kanchwala
BACKGROUND: Autologous breast reconstruction is associated with long-term patient satisfaction that is superior to implant-based approaches. Occasionally, however, patients who desire autologous reconstruction present with inadequate donor-site volume. A hybrid approach, combining free flap reconstruction with simultaneous implant placement, is a solution. We present our experience with the use of mesh for improved pocket control using this reconstructive modality. METHODS: A retrospective analysis of a prospectively maintained database of patients undergoing autologous breast reconstruction was performed...
October 22, 2016: Microsurgery
Filip B J L Stillaert, Casper Sommeling, Salvatore D'Arpa, David Creytens, Koenraad Van Landuyt, Herman Depypere, Rudy Van den Broecke, Stan Monstrey, Phillip N Blondeel, Wayne A Morrison
BACKGROUND: Breast reconstruction involves the use of autologous tissues or implants. Occasionally, microsurgical reconstruction is not an option because of insufficient donor tissues. Fat grafting has become increasingly popular in breast surgery. The challenge with this technique is how to reconstruct a stable and living "scaffold" that resembles a breast. METHODS: Breast reconstruction (n = 7) was performed using intratissular expansion with serial deflation-lipofilling sessions...
September 27, 2016: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Ricardo J Bello, Melanie R Major, Damon S Cooney, Gedge D Rosson, Scott D Lifchez, Carisa M Cooney
BACKGROUND: In 2013, we developed the Operative Entrustability Assessment (OEA) to facilitate evaluation and documentation of resident operative skills. This web-based tool provides real-time, transparent feedback to residents on operative performance. This study evaluated the construct validity of the OEA, assessing its association with operative time. METHODS: We used simple and multiple linear regression to estimate associations between OEA scores and operative time in selected procedures performed...
October 8, 2016: American Journal of Surgery
Nelson A Rodriguez-Unda, Ricardo J Bello, Emily M Clarke-Pearson, Abanti Sanyal, Carisa M Cooney, Michele A Manahan, Gedge D Rosson
BACKGROUND: Changes in breast sensation after reconstruction are expected. Return of breast sensation after reconstruction and whether nipple-sparing mastectomy offers a substantial benefit in terms of sensation has been inconsistently documented in the literature. We conducted the current study using the pressure-specified sensory device to quantify postoperative breast sensation in patients undergoing nipple-sparing versus non-nipple-sparing mastectomy. METHODS: Consecutive adult women who underwent nipple-sparing (NSM) and non-NSM (NNSM) and were at least 18 months postreconstruction were included...
October 17, 2016: Annals of Plastic Surgery
Thomas C Lam, Caleb J Winch
: Reconstruction after mastectomy is an important milestone for many women treated for breast cancer. However, because many surgeons only offer their preferred method of reconstruction, it is not clear which approach women would choose if offered a genuine choice. METHODS: Between 1998 and 2010, the breast reconstruction service at a major Australian teaching hospital was staffed by a single plastic surgeon trained in both prosthetic and autologous breast reconstruction techniques...
September 2016: Plastic and Reconstructive Surgery. Global Open
Kristen S Higgins, Joshua Gillis, Jason G Williams, Martin LeBlanc, Michael Bezuhly, Jill M Chorney
Clinical experience suggests that flap failure after autologous breast reconstruction can be a devastating experience for women. Previous research has examined women's experiences with autologous breast reconstruction with and without complications, and patients' experiences with suboptimal outcomes from other medical procedures. The authors aimed to examine the psychosocial experience of flap failure from the patient's perspective. Seven women who had experienced unilateral flap failure after deep inferior epigastric perforator flap surgery in the past 12 years completed semistructured interviews about their breast cancer treatments, their experiences with flap failure, the impact of flap failure on their lives, and the coping strategies they used...
October 6, 2016: Annals of Plastic Surgery
Allen Gabriel, G Patrick Maxwell, Leah Griffin, Manish C Champaneria, Mousam Parekh, David Macarios
BACKGROUND: Centrifugation (Cf) is a common method of fat processing but may be time consuming, especially when processing large volumes. OBJECTIVES: To determine the effects on fat grafting time, volume efficiency, reoperations, and complication rates of Cf vs an autologous fat processing system (Rv) that incorporates fat harvesting and processing in a single unit. METHODS: We performed a retrospective cohort study of consecutive patients who underwent autologous fat grafting during reconstructive breast surgery with Rv or Cf...
October 11, 2016: Aesthetic Surgery Journal
Koichi Tomita, Kenji Yano, Akimitsu Nishibayashi, Shien Seike, Ko Hosokawa
BACKGROUND: When the inframammary fold (IMF) is excised in mastectomy procedures for oncologic reasons, it must be recreated to restore a natural breast shape. Despite refinements in surgical techniques, postoperative loss of a well-defined IMF can occur. This study aimed to assess the outcomes of IMF recreation after two-stage, implant-based breast reconstruction. METHODS: We retrospectively reviewed 75 consecutive patients who underwent unilateral, two-stage, implant-based breast reconstruction between 2013 and 2015 at the authors' institution...
2016: SpringerPlus
Jinhai Huo, Benjamin D Smith, Sharon H Giordano, Gregory P Reece, Ya-Chen Tina Shih
BACKGROUND: The objectives of this study were to compare, by patient obesity status, the contemporary utilization patterns of different reconstruction surgery types, understand postoperative complication profiles in the community setting, and analyze the financial impact on health care payers and patients. METHODS: Using data from the MarketScan Health Risk Assessment Database and Commercial Claims and Encounters Database, we identified breast cancer patients who received breast reconstruction surgery following mastectomy between 2009 and 2012...
September 30, 2016: Breast: Official Journal of the European Society of Mastology
Keith S Hansen, Luke G Gutwein, Brett C Hartman, Rajiv Sood, Juan Socas
Autologous breast reconstruction utilizing a perforator flap is an increasingly popular method for reducing donor site morbidity and implant-related complications. However, aberrant anatomy not readily visible on computed tomography angiography is a rare albeit real risk when undergoing perforator flap reconstruction. We present an operative case of a patient who successfully underwent a bilateral breast reconstruction sourced from a unilateral abdominal flap divided into deep superior epigastric artery and superficial circumflex iliac artery flap segments...
September 2016: Archives of Plastic Surgery
Thiago B de Araujo, Mary Jue Xu, Srinivas M Susarla, Karen Shmelev, Wei Jiang, Julian J Pribaz, Charles Hergrueter, Matthew J Carty, Stephanie Caterson, Yoon S Chun
BACKGROUND: The purpose of this study was to evaluate the impact of prior unilateral chest wall radiotherapy on reconstructive outcomes among patients undergoing bilateral immediate breast reconstruction. METHODS: A retrospective evaluation of patients with a history of unilateral chest wall radiotherapy was performed. In each patient, the previously irradiated and reconstructed breast was compared to the contralateral nonirradiated side, which served as an internal control...
October 2016: Plastic and Reconstructive Surgery
Toni Zhong, Jiayi Hu, Shaghayegh Bagher, Anthony Vo, Anne C OʼNeill, Kate Butler, Christine B Novak, Stefan O P Hofer, Kelly A Metcalfe
BACKGROUND: This is the first study to use generic distress, cancer-specific, and procedure-specific measures to prospectively evaluate psychological responses, body image, sexuality, and health-related quality of life in immediate compared with delayed breast reconstruction. METHODS: Consecutive patients undergoing autologous immediate and delayed breast reconstruction (June of 2009 to December of 2010) completed the Hospital Anxiety and Depression Scale, Body Image Scale, Sexuality Scale, and BREAST-Q preoperatively and postoperatively (6, 12, and 18 months)...
October 2016: Plastic and Reconstructive Surgery
Achilleas Thoma, Manraj Nirmal Kaur, Forough Farrokhyar, Daniel Waltho, Carolyn Levis, Peter Lovrics, Charlie H Goldsmith
You are a new plastic surgeon in the community and you are referred a patient interested in breast reconstruction. The patient is a 35-year-old female school teacher who had a bilateral prophylactic mastectomy 2 years earlier, as she was a BRCA gene carrier. Since she is of a petite build with very little subcutaneous tissue or extra skin in the lower abdomen, you decide that she is not a suitable candidate for an abdomen-based autologous tissue reconstruction. You recommend the technique of tissue expansion and silicone gel implants...
September 2016: Canadian Journal of Surgery. Journal Canadien de Chirurgie
Keisuke Kashiwagi, Yoshiro Abe, Soshi Ishida, Kazuhide Mineda, Yutaro Yamashita, Yutaka Fukunaga, Sho Yoshimoto, Ryosuke Yamato, Tatsuya Tsuda, Ichiro Hashimoto
BACKGROUND: Breast reconstruction generally involves autologous tissue transplantation and placement of a mammary prosthesis. When the patient's breasts are extremely large and ptotic, breast reconstruction often results in significantly asymmetrical appearance. However, a good aesthetic outcome after reconstruction surgery following cancer resection is an important quality-of-life factor. We evaluated the efficacy of touch-up surgery, either reduction mammaplasty or mastopexy, performed on the contralateral breast for symmetrization...
2016: Journal of Medical Investigation: JMI
Nicola R Dean, Tamara Crittenden
OBJECTIVE: To assess the clinical effectiveness of breast reconstruction and the utility of the BREAST-Q patient-reported outcomes measure for routine patient care. METHODS: The BREAST-Q was administered to all patients attending a breast reconstructive service (n = 343) at a University Hospital at each visit. RESULTS: The BREAST-Q was easy to administer in a clinic setting, with a high participation rate (64.2% completing the minimum dataset of three BREAST-Qs)...
September 6, 2016: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Scott L Spear, Courtney N Coles, Braden K Leung, Matthew Gitlin, Mousam Parekh, David Macarios
BACKGROUND: For years, the safety and effectiveness of autologous fat grafting (AFG) for breast reconstruction have been in question, with particular concern over fat necrosis, calcifications, cyst formation, and interfering with the detection of breast cancer. However, increasing evidence suggests that the complication rates and clinical results are generally acceptable to both clinicians and patients. The emerging challenge is the numerous AFG techniques and systems, where there are limited knowledge and data...
August 2016: Plastic and Reconstructive Surgery. Global Open
Dmytro Unukovych, Camilo Hernandez Gallego, Helena Aineskog, Andres Rodriguez-Lorenzo, Maria Mani
BACKGROUND: The deep inferior epigastric perforator (DIEP) procedure is regarded a safe option for autologous breast reconstruction. Reoperations, however, may occur, and there is no consensus in the literature regarding the risk factors. The aim of this study was to identify factors associated with reoperations in DIEP procedure. PATIENTS AND METHODS: A retrospective study of consecutive patients undergoing DIEP breast reconstruction 2007 to 2014 was performed and included a review of 433 medical charts...
August 2016: Plastic and Reconstructive Surgery. Global Open
Meagan E Brennan, Kathy Flitcroft, Sanjay Warrier, Kylie Snook, Andrew J Spillane
BACKGROUND: Immediate tissue expander/implant-based breast reconstruction (BR) is often avoided when post-mastectomy radiotherapy (PMRT) is planned due to concerns about high complication rates and poor aesthetic outcomes. This study evaluated surgical, aesthetic and quality of life (QoL) outcomes in women undergoing immediate implant-based BR (IIBR) followed by PMRT. METHODS: Participants were recruited at least six months after completing the final stage of BR...
September 6, 2016: Breast: Official Journal of the European Society of Mastology
Donato Casella, Claudio Calabrese, Lorenzo Orzalesi, Ilaria Gaggelli, Lorenzo Cecconi, Caterina Santi, Roberto Murgo, Stefano Rinaldi, Lea Regolo, Claudio Amanti, Manuela Roncella, Margherita Serra, Graziano Meneghini, Massimiliano Bortolini, Vittorio Altomare, Carlo Cabula, Francesca Catalano, Alfredo Cirilli, Francesco Caruso, Maria Grazia Lazzaretti, Icro Meattini, Lorenzo Livi, Luigi Cataliotti, Marco Bernini
BACKGROUND: Reconstruction options following nipple-sparing mastectomy (NSM) are diverse and not yet investigated with level IA evidence. The analysis of surgical and oncological outcomes of NSM from the Italian National Registry shows its safety and wide acceptance both for prophylactic and therapeutic cases. A further in-depth analysis of the reconstructive approaches with their trend over time and their failures is the aim of this study. METHODS: Data extraction from the National Database was performed restricting cases to the 2009-2014 period...
September 6, 2016: Breast Cancer: the Journal of the Japanese Breast Cancer Society
Girolamo Geraci, Federica Fatica, Massimo Cajozzo, Alessio Antonino Anzalone, Giuseppe Modica
BACKGROUND: Bone metastasis is a frequent and early complication of breast cancer. This case report describes a technique for a partial exeresis of the sternum and the reconstruction of the pleura with autologous dermis from the lower abdomen and the loss of substance with a myocutaneous flap. PATIENTS AND METHODS: We describe the case of a 50-year old woman with a sternal excavated lesion with pathologic fracture due to an invasive adenocarcinoma, treated with a partial exeresis of the sternum and the reconstruction with a myocutaneous flap...
2016: Annali Italiani di Chirurgia
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