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Tissue expander breast

Ashley Nadia Boustany, Shady Elmaraghi, Nneamaka Agochukwu, Benjamin Cloyd, Adam J Dugan, Brian Rinker
Background: Infection following augmentation and prosthetic-based breast reconstruction can cause significant physical and psychological distress for patients. It may delay adjuvant therapies and compromise aesthetic outcomes. The aim of this study is to identify modifiable risk factors for infection and identify common bacterial isolates to achieve optimal outcomes for patients. Methods: A retrospective cohort study was performed for patients undergoing implant-based breast reconstruction over a 2-year period...
January 2018: Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India
Kyle S Gabrick, Nickolay P Markov, Fouad Chouairi, Robin Wu, Sarah M Persing, Paul Abraham, Tomer Avraham, Michael Alperovich
Background: Two-stage tissue expander (TE)/permanent implant (PI) breast reconstruction remains the most commonly performed technique in breast reconstruction. Predictions for the PI size preoperatively impact on the number and range of implants made available at TE exchange. This study aims to identify critical preoperative variables and create a predictive model for PI size. Methods: Patients who underwent 2-stage implant breast reconstruction from 2011 to 2017 were included in the study...
May 2018: Plastic and Reconstructive Surgery. Global Open
Allen Gabriel, G Patrick Maxwell
Background: AlloDerm Ready To Use (RTU) is a sterile version of AlloDerm regenerative tissue matrix, developed in response to concerns regarding the potential risk of infectious complications with the latter aseptic matrix. Clinical data on AlloDerm RTU use is, however, limited, particularly with respect to histologic evidence of graft integration and clinical outcomes. Methods: Consecutive patients who underwent tissue-expander/implant reconstruction with the use of AlloDerm RTU from March 2011 to September 2012 were included in this analysis...
May 2018: Plastic and Reconstructive Surgery. Global Open
Hyun Ho Han, Hyung Bae Kim, Eun Key Kim, Jin Sup Eom
BACKGROUND: Immediate single-stage direct-to-implant breast reconstruction requires caution owing to the possibility of skin necrosis and implant failure. Nevertheless, this method has been performed widely for breast reconstruction. This study aimed to analyze the safety of single-stage implant reconstruction by comparing it with 2-stage reconstruction (TSR). METHODS: Immediate single-stage reconstructions (SSRs) and TSRs with a tissue expander, performed from January 2011 to December 2016, were retrospectively reviewed...
June 19, 2018: Annals of Plastic Surgery
L de la Cruz-Merino, N Palazón-Carrión, F Henao-Carrasco, E Nogales-Fernández, M Álamo-de la Gala, A Vallejo-Benítez, M Chiesa, V Sánchez-Margalet
Immunology and immunotherapy of cancer is an expanding field in oncology, with recent great achievements obtained through the new successful approaches implemented to circumvent immune evasion, which is undoubtedly considered a novel hallmark of cancer. Translational research in this topic has revealed targets that can be modulated in the clinical setting with new compounds and strategies. Like most of the tumors, breast cancer is considered a complex and heterogeneous disease in which host immune responses have been also recently demonstrated of critical relevance...
June 18, 2018: Clinical & Translational Oncology
Sagit Meshulam-Derazon, Tamir Shay, Sivan Lewis, Neta Adler
BACKGROUND: One-stage direct-to-implant post-mastectomy breast reconstruction has been gaining popularity over the traditional two-stage/tissue-expander approach. OBJECTIVES: To evaluate the outcome of the two post-mastectomy breast reconstruction procedures in terms of patient satisfaction. METHODS: Clinical data were collected by file review for patients who underwent mastectomy with immediate breast reconstruction at two tertiary medical centers in 2010-2013...
June 2018: Israel Medical Association Journal: IMAJ
Yujin Myung, Bomi Choi, Heeyeon Kwon, Chan Yeong Heo, Eun-Kyu Kim, Eunyoung Kang, Jae Hoon Jeong, Eun Joo Yang
Immediate breast reconstruction (IBR) after mastectomy has been proven to affect patient quality of life, psychological well-being, and functional capacities. In the present study, we aimed to investigate the effect of breast reconstruction on postoperative shoulder function and muscle performance by evaluating isokinetic muscle performance tests.A retrospective chart review to collect data on shoulder function analysis with isokinetic muscle performance testing was performed among patients who received mastectomy with IBR from July 2013 to March 2015...
June 2018: Medicine (Baltimore)
Sergey Y Turin, Daniel D Li, Elbert E Vaca, Neil Fine
BACKGROUND: Mastectomy flap necrosis (MFN) remains a challenging complication in immediate tissue expander breast reconstruction (ITEBR). Nitroglycerin ointment has been shown to reduce the incidence of MFN in a randomized controlled study, using 45g per breast and treating one side only in bilateral cases. This study was conducted to determine the efficacy of 15g of nitroglycerin ointment per breast - therefore permitting application to both breasts in cases of bilateral mastectomy. METHODS: A retrospective cohort study of patients undergoing ITEBR by a single reconstructive surgeon was conducted...
June 2, 2018: Plastic and Reconstructive Surgery
Geok- Hoon Lim, Andrew Baildam
BACKGROUND: Risk-reducing mastectomy (RRM) with tissue expander then implant-based breast reconstruction conventionally involved immediate submuscular placement of tissue expanders during mastectomy, then after expansion, replacement of expanders for permanent implants in a second stage operation. Use of acellular dermal matrix (ADM) can achieve a single staged operation but ADMs are costly and may have potential complications. We aim to assess the feasibility of placement of implants as a first stage before RRM as a novel technique of reconstruction which avoids the need for serial outpatient expansion and ADM...
June 2, 2018: Plastic and Reconstructive Surgery
Sarah M Elswick, Christin A Harless, Sarah N Bishop, Cathy D Schleck, Jay Mandrekar, Ryan D Reusche, Robert W Mutter, Judy C Boughey, Steven R Jacobson, Valerie Lemaine
BACKGROUND: Two-stage subpectoral implant-based breast reconstruction (IBBR) is the most common method for breast reconstruction. Recent advances in surgical techniques and technology have made prepectoral IBBR feasible. There is limited data on outcomes after prepectoral IBBR and post-mastectomy radiation therapy (PMRT). METHODS: A retrospective review of consecutive patients undergoing immediate two-stage prepectoral IBBR with PMRT was performed. Outcomes of radiated breasts were compared with non-radiated breasts in bilateral cases...
March 26, 2018: Plastic and Reconstructive Surgery
Gurjot S Walia, Jeffrey Aston, Ricardo Bello, Gina A Mackert, Rachel A Pedreira, Brian H Cho, Hannah M Carl, Erin M Rada, Gedge D Rosson, Justin M Sacks
Background: Traditionally, tissue expanders (TEs) for breast reconstruction have been placed beneath the pectoralis major muscle with or without acellular dermal matrix. More recently, full acellular dermal matrix coverage has been described for prepectoral TE placement. Our study aims to explore differences in clinical and quality-of-life (QOL) outcomes for prepectoral versus subpectoral TE breast reconstruction. Methods: We identified patients who underwent postmastectomy breast reconstruction with prepectoral or subpectoral TE placement between 2011 and 2015 and completed QOL surveys...
April 2018: Plastic and Reconstructive Surgery. Global Open
Keyianoosh Z Paydar, Garrett A Wirth, Donald S Mowlds
Fenestrated acellular dermal matrix (ADM) has improved patient outcomes in both direct-to-implant and 2-stage tissue expander/implant breast reconstruction. This technical alteration utilizes optimal fenestration overlap to enhance the breast reconstruction experience. We present a novel, surgeon-designed shaped fenestrated ADM, placed in the recently repopularized prepectoral pocket for anterior coverage of implants in direct-to-implant and 2-stage breast reconstruction. A retrospective review of 10 patients (18 breasts) who underwent direct-to-implant or 2-stage breast reconstruction utilizing fenestrated shaped ADM in the prepectoral plane at a major academic institution in 2016 was conducted...
April 2018: Plastic and Reconstructive Surgery. Global Open
Håkan Hallberg, Richard Lewin, Anna Elander, Emma Hansson
In recent years, it has become increasingly popular to use matrices, such as acellular dermal matrices, in implant-based breast reconstruction. To lower the cost and to avoid implanting biological material, the use of synthetic meshes has been proposed. This is the first study examining TIGR® Mesh in a larger series of immediate breast reconstruction. The aims of the study were to examine complications and predictors for complications. All consecutive patients operated on with breast reconstruction with TIGR® Matrix Surgical Mesh and tissue expanders (TEs) or permanent implant between March 2015 and September 2016 in our department were prospectively included...
June 7, 2018: Journal of Plastic Surgery and Hand Surgery
Sung Jae Ahn, Tae Yong Woo, Dong Won Lee, Dae Hyun Lew, Seung Yong Song
INTRODUCTION: Nipple-sparing mastectomy (NSM), combined with immediate breast reconstruction, has become the preferred surgical option to achieve better patient satisfaction and aesthetic outcome. However, nipple-areolar complex (NAC) ischemia and necrosis are common complications following nipple-sparing technique. MATERIALS AND METHODS: We performed a retrospective analysis of 220 breasts that underwent NSM and immediate reconstruction from May 2010 to December 2016 at our institute...
May 18, 2018: European Journal of Surgical Oncology
LiCheng Kuo, Åse M Ballangrud, Alice Y Ho, James G Mechalakos, Guang Li, Linda Hong
Locally advanced breast cancer patients with expander or implant reconstructions who require comprehensive postmastectomy radiotherapy (PMRT) can pose unique treatment planning challenges. Traditional 3D conformal radiation techniques often result in large dose inhomogeneity throughout the treatment volumes, inadequate target coverage, or excessive normal tissue doses. We have developed a volumetric modulated arc therapy (VMAT) planning technique without entering through the ipsilateral arm that produced adequate target volume coverage, excellent homogeneity throughout the target volume, and acceptable doses to the normal structures...
May 22, 2018: Medical Dosimetry: Official Journal of the American Association of Medical Dosimetrists
Elizabeth S Craig, Mark W Clemens, John C Koshy, James Wren, Zhang Hong, Charles Butler, Patrick Garvey, Jesse Selber, Steven Kronowitz
Background: Despite increasing literature support for the use of acellular dermal matrix (ADM) in expander-based breast reconstruction, the effect of ADM on clinical outcomes in the presence of post-mastectomy radiation therapy (PMRT) has not been well described. Objectives: To analyze the impact ADM plays on clinical outcomes on immediate tissue expander (ITE) reconstruction undergoing PMRT. Methods: We retrospectively reviewed patients who underwent ITE breast reconstruction from 2004 to 2014 at MD Anderson Cancer Center...
May 24, 2018: Aesthetic Surgery Journal
Elizabeth Stirling Craig, Rachel Lentz, Dhivya Srinivasa, Carolyn Chuang, Marc E Walker, Susan A Higgins, Jeffrey Salomon, Stefano Fusi
BACKGROUND: The deep inferior epigastric perforator (DIEP) flap has gained popularity for autologous free flap breast reconstruction. Historically, patients receiving post mastectomy radiation therapy (PMRT) were not candidates for immediate autologous reconstruction due to concerns for flap volume depletion, fat necrosis, and flap failure. However, this literature is anecdotal and lacks case controls. We objectively analyzed the effects radiation imparts on immediate DIEP flap reconstruction using 3-dimensional software and inherent controls...
May 23, 2018: Annals of Plastic Surgery
Chae-Eun Yang, Soon Won Chung, Dong Won Lee, Dae Hyun Lew, Seung Yong Song
BACKGROUND: For implant-based breast reconstruction, inadequate tissue perfusion may cause devastating complications. Tissue tension by inadequate implant volume may reduce tissue perfusion by stretching and collapsing the capillaries. The SPY system is used to perform intraoperative fluorescence angiography with indocyanine green to assess visually the blood flow and evaluate tissue perfusion. However, there is no report yet about how mastectomy flap perfusion changes with the expander-filling volume...
May 21, 2018: Annals of Surgical Oncology
Andrea Barnow, Todd Canfield, Ray Liao, Sashi Yadalam, Iftekhar Kalsekar, Rahul Khanna
INTRODUCTION: This study evaluated trends related to breast reconstruction and the factors associated with reconstruction. METHODS: Women with breast cancer aged 19 to 64 years who underwent a mastectomy procedure between July 1, 2011, and September 30, 2014, were identified from the MarketScan Commercial Claims and Encounters Database. The first date of surgical procedure during this period was defined as the index date. Continuous enrollment during the 12-month preindex and postindex period was required, and the patient sample was followed for 12 months postindex...
May 17, 2018: Annals of Plastic Surgery
Bixiao Wang, Chunfang Xi, Mingwei Liu, Haichen Sun, Shuang Liu, Lei Song, Hua Kang
Background: Breast cancer stem cells (BCSCs) are associated with the invasion of breast cancer. In recent years, studies have demonstrated different phenotypes among BCSCs. Furthermore, BCSCs of diverse phenotypes are present at different tumour sites and different histological stages. Fibroblasts are involved in the phenotypic transformation of BCSCs. Cancer-associated fibroblasts (CAFs) participate in the induction of epithelial-mesenchymal transition, thereby promoting the acquisition of stem cell characteristics, but little is known about the role of normal fibroblasts (NFs) in the phenotypic transformation of BCSCs or about the effect of CAFs and NFs on BCSC phenotypes...
2018: PeerJ
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