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Horatiu Muresan, Gretl Lam, Benjamin T Cooper, Carmen A Perez, Alexes Hazen, Jamie P Levine, Pierre B Saadeh, Mihye Choi, Nolan S Karp, Daniel J Ceradini
BACKGROUND: Patients undergoing implant-based reconstruction in the setting of postmastectomy radiation therapy suffer from increased complications and inferior outcomes compared with those not irradiated, but advances in radiation delivery have allowed for more nuanced therapy. The authors investigated whether these advances impact patient outcomes in implant-based breast reconstruction. METHODS: Retrospective chart review identified all implant-based reconstructions performed at a single institution from November of 2010 to November of 2013...
June 2017: Plastic and Reconstructive Surgery
Laurel S Karian, Paul J Therattil, Philip D Wey, Kevin T Nini
BACKGROUND: Rare but serious complications of nipple-sparing mastectomy (NSM) include necrosis of the nipple-areolar complex (NAC) and mastectomy skin flaps. NAC and mastectomy flap delay procedures are novel techniques designed to avoid these complications and may be combined with retroareolar biopsy as a first-stage procedure. We performed a systematic review of the literature to evaluate various techniques for NAC and mastectomy flap delay. METHODS: PubMed and Cochrane databases were searched from January 1975 through April 15, 2016...
February 2017: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
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...
May 2017: Breast Cancer: the Journal of the Japanese Breast Cancer Society
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...
December 2016: Breast: Official Journal of the European Society of Mastology
A de Runz, D Boccara, F Bekara, M Chaouat, M Mimoun
BACKGROUND: Delayed breast reconstruction with tissue expansion may be risky after radiotherapy, due to the poor skin quality. To permit the use of the tissue expansion procedure, we propose a scarless latissimus dorsi flap to bring tissue trophicity, by a healthy vascularized muscular interface with no donor scar and no patch effect. The objective of this study is to assess the outcome of the tissue expansion technique with scarless latissimus dorsi flap after post-mastectomy radiotherapy...
September 7, 2016: Annales de Chirurgie Plastique et Esthétique
Mark Sisco, Alexandra M Kyrillos, Brittany R Lapin, Chihsiung E Wang, Katharine A Yao
PURPOSE: For many women, nipple-sparing mastectomy (NSM) provides aesthetic and quality-of-life outcomes superior to skin-sparing mastectomy. Accumulating data suggest that NSM provides similar oncologic outcomes in select breast cancer patients. This study sought to determine national trends in NSM use. METHODS: Using the National Cancer Data Base, 6254 women with breast cancer who underwent NSM between 2010 and 2013 were identified. NSM rates were determined relative to the number of patients who received a mastectomy with reconstruction (n = 114,849)...
November 2016: Breast Cancer Research and Treatment
Adrian Sh Ooi, David H Song
Implant-based procedures are the most commonly performed method for postmastectomy breast reconstruction. While donor-site morbidity is low, these procedures are associated with a higher risk of reconstructive loss. Many of these are related to infection of the implant, which can lead to prolonged antibiotic treatment, undesired additional surgical procedures, and unsatisfactory results. This review combines a summary of the recent literature regarding implant-related breast-reconstruction infections and combines this with a practical approach to the patient and surgery aimed at reducing this risk...
2016: Breast Cancer: Targets and Therapy
Ashley B Simpson, Devina McCray, Craig Wengler, Joseph P Crowe, Risal Djohan, Rahul Tendulkar, Colin O'Rourke, Stephen R Grobmyer, Stephanie A Valente
BACKGROUND: Inflammatory breast cancer (IBC) is an aggressive disease that is treated with trimodality therapy consisting of neoadjuvant chemotherapy, surgery, and post-mastectomy radiation therapy (PMRT). Traditionally, modified radical mastectomy without reconstruction has been the operation of choice for patients with IBC due to fears of high rates of margin positivity, risk of local recurrence, and the need for PMRT. METHODS: A retrospective review was performed to evaluate women with IBC at our institution from 2006 to 2014 who completed trimodality therapy...
December 2016: Annals of Surgical Oncology
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)...
November 2016: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Eliana F R Duraes, Paul Durand, Leonardo C Duraes, Susan Orra, Andrea Moreira-Gonzalez, Joao Batista de Sousa, Risal S Djohan, James Zins, Steven Bernard, Graham S Schwarz
A breast cancer diagnosis imposes significant emotional and psychological duress. The purpose of this study is to assess the baseline quality of life (QOL) of immediate, delayed, and secondary breast reconstruction patients, comparing these results with QOL in women seeking plastic surgery for cosmetic breast, and non-breast procedures. From 2012 through 2013, immediate (group 1), delayed (group 2), and secondary (Group 3) reconstruction patients, aesthetic breast (group 4) and non-breast plastic surgery patients (group 5) answered Breast-Q questionnaires...
November 2016: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Abram Recht, Elizabeth A Comen, Richard E Fine, Gini F Fleming, Patricia H Hardenbergh, Alice Y Ho, Clifford A Hudis, E Shelley Hwang, Jeffrey J Kirshner, Monica Morrow, Kilian E Salerno, George W Sledge, Lawrence J Solin, Patricia A Spears, Timothy J Whelan, Mark R Somerfield, Stephen B Edge
A joint American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology panel convened to develop a focused update of the American Society of Clinical Oncology guideline concerning use of postmastectomy radiotherapy (PMRT). METHODS: A recent systematic literature review by Cancer Care Ontario provided the primary evidentiary basis. The joint panel also reviewed targeted literature searches to identify new, potentially practice-changing data...
November 2016: Practical Radiation Oncology
Jakob Nedomansky, Stefanie Nickl, Bernhard Maier, Peter Dubsky, Werner Haslik, Klaus F Schroegendorfer
BACKGROUND: Management of the nipple-areola complex is an important issue in primary breast reconstruction. When nipple-sparing mastectomy is not suitable, alternatives are immediate nipple-areola complex replantation and delayed reconstruction. The aim of this study was to examine whether patients benefit more from nipple-areola complex preservation by immediate replantation or delayed nipple-areola complex reconstruction. METHODS: Postoperative results and patient satisfaction after 54 primary breast reconstructions with immediate nipple-areola complex replantation or delayed nipple-areola complex reconstruction were retrospectively evaluated...
August 8, 2016: Annals of Plastic Surgery
Diana L Caragacianu, Erica L Mayer, Yoon S Chun, Stephanie Caterson, Jennifer R Bellon, Julia S Wong, Susan Troyan, Esther Rhei, Laura S Dominici, Katherine E Economy, Nadine M Tung, Lidia Schapira, Ann Partridge, Katherina Zabicki Calvillo
BACKGROUND: Surgical management of breast cancer in pregnancy (BCP) requires balancing benefits of therapy with potential risks to the developing fetus. Minimal data describe outcomes after mastectomy with immediate breast reconstruction (IR) in pregnant patients. METHODS: Retrospective review was performed of patients who underwent IR after mastectomy within a BCP cohort. Parameters included intra- and post-operative complications, short-term maternal/fetal outcomes, surgery duration, and delayed reconstruction in non-IR cohort...
August 2016: Journal of Surgical Oncology
Candemir Ceran, Ersin Aksam, Cagla Cicek, Soner Tezcan, Mustafa Erol Demirseren
BACKGROUND: Many methods have been used for correcting tethered and depressed scars, but most of these methods have had unsatisfying results and ended up with recurrence. The aim of this study is to present a new surgical technique that overcomes these problems. MATERIALS AND METHODS: Twenty-two depressed scars were corrected using the layered dermal support technique. With this technique, the depressed part of the scar is deepithelialized and used in a layered fashion to support the skin flaps...
October 2016: Aesthetic Plastic Surgery
Peter G Cordeiro, Leila Jazayeri
BACKGROUND: Over a two-decade period, the senior author (P.G.C.) has had extensive experience with two-stage implant-based breast reconstruction with total musculofascial coverage. During this period, the approach has evolved substantially. The evolution has been based on changes in breast cancer treatment, available technology and, most importantly, yearly evaluation of surgical outcomes. METHODS: This article describes changes in the conceptual approach to breast reconstruction, and the resulting evolution of surgical techniques...
July 2016: Plastic and Reconstructive Surgery
Melissa Mastroianni, Alex M Lin, Barbara L Smith, William G Austen, Amy S Colwell
BACKGROUND: Nipple preservation at the time of mastectomy is increasingly performed to enhance the overall result from the reconstruction. Unfortunately, some of these patients may lose their nipples for oncologic reasons or because of necrosis. Several studies have investigated risk factors associated with nipple loss, but few data exist on the incidence of cancer in the nipple specimen, nipple removal for cosmesis or symmetry, and whether these patients subsequently pursue nipple reconstruction...
July 2016: Plastic and Reconstructive Surgery
Hannah Headon, Abdul Kasem, Aisling Manson, Christina Choy, Amtul R Carmichael, Kefah Mokbel
INTRODUCTION: The advent of acellular dermal matrix devices (ADMs) has enhanced both the scope of implant-based immediate breast reconstruction (IBR) following skin sparing mastectomy (SSM) for the treatment or risk reduction of breast cancer. Currently, there are a wide range of options available for the use of ADMs. METHODS: This is a prospective observational single institution study of 118 consecutive patients undergoing a total of 164 SSM and IBR procedures either for treatment for breast cancer or for risk reduction, between 2012 and 2014...
June 2016: Surgical Oncology
Alessandro Sanguinetti, Andrea Polistena, Giovanni Bistoni, Roberta Lucchini, Massimo Monacelli, Roberta Triola, Stefano Avenia, Ivan Barillaro, Roberto Cirocchi, Nicola Avenia
INTRODUCTION: Some techniques for the total reconstruction of the breast, regardless of the complexity, have specific complications, with varying degrees of morbidity. Therefore, we wanted to identify the most frequent complications of the main techniques used for breast reconstruction, and compare the relation to the relevant independent variables. METHODS: Our study was conducted by examining the medical records of patients who had received complete reconstruction of the breast after a mastectomy due to breast cancer from January 2008 to December 2010, with a minimum follow-up of 3 years postoperatively...
February 29, 2016: Annali Italiani di Chirurgia
Ellen S Satteson, Michael F Reynolds, Austin M Bond, Ivo A Pestana
Nipple-areola reconstruction represents the completion of the breast restorative process and is associated with significant positive psychological implications. While factors such as medical comorbidities, smoking status, and radiation therapy have been shown to be associated with an increase in complications following breast reconstruction, their impact on nipple reconstruction remains largely unaddressed in the literature. An IRB-approved, retrospective review of 472 patients who underwent nipple reconstruction at Wake Forest University over a 15-year period was completed...
July 2016: Breast Journal
Donato Casella, Claudio Calabrese, Simonetta Bianchi, Icro Meattini, Marco Bernini
A subcutaneous, prepectoral, muscle-sparing approach has been recently described for implant-based breast reconstruction. This is a preliminary series of 2-stage breast reconstructions by means of tissue expander placed subcutaneously with the support of a titanium-coated polypropylene mesh. A pilot series of cases was started in 2012. Inclusion criteria were informed consent, age less than 80 years, normal body mass index (range, 18.5-24.9), no T4 and metastatic cancers, no comorbidities, and nonsmoking patients...
December 2015: Plastic and Reconstructive Surgery. Global Open
2016-03-09 00:13:09
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