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Sample records for microsurgical breast reconstruction

  1. Shaping the breast in secondary microsurgical breast reconstruction: single- vs. two-esthetic unit reconstruction.

    Science.gov (United States)

    Gravvanis, Andreas; Smith, Roger W

    2010-10-01

    The esthetic outcome is dictated essentially not only by the position, size, and shape of the reconstructed breast, but also by the extra scaring involved. In the present study, we conducted a visual analog scale survey to compare the esthetic outcome in delayed autologous breast reconstruction following two different abdominal flaps inset. Twenty-five patients had their reconstruction using the Single-esthetic Unit principle and were compared with 25 patients that their breast was reconstructed using the Two-Esthetic Unit principle. Photographic images were formulated to a PowerPoint presentation and cosmetic outcomes were assessed from 30 physicians, by means of a Questionnaire and a visual analog scale. Our data showed that the single-esthetic unit breast reconstruction presents significant advantages over the traditional two-esthetic units, due to inconspicuous flap reconstruction, better position of the inframammary fold, and more natural transition from native and reconstructed tissues. Moreover, patient self-evaluation of esthetic outcome and quality of life showed that single-esthetic unit reconstruction is associated with higher patient satisfaction, therefore should be considered the method of choice.

  2. Factor V Leiden associated with flap loss in microsurgical breast reconstruction.

    Science.gov (United States)

    Khansa, Ibrahim; Colakoglu, Salih; Tomich, David C; Nguyen, Minh-Doan; Lee, Bernard T

    2011-07-01

    Two cases are reported of flap loss following microsurgical perforator flap breast reconstruction in patients diagnosed with a factor V Leiden mutation. Factor V Leiden is the most common inherited cause of hypercoagulability, leading to an increased risk of thrombotic events. The first patient underwent a deep inferior epigastric artery perforator flap and then had recurrent arterial thrombosis both intraoperatively and postoperatively. This patient was subsequently diagnosed with a factor V Leiden mutation. The second patient had a known factor V Leiden mutation and underwent a superior gluteal artery perforator flap, which developed thrombosis and flap loss 2 days later. Preoperative assessment of a personal or family history of unexplained venous or arterial thrombosis should prompt suspicion of a factor V Leiden mutation. This mutation places patients at high risk for thromboembolic events in microvascular breast reconstruction, particularly when oral contraceptives or tamoxifen are used in conjunction. Copyright © 2011 Wiley-Liss, Inc.

  3. A Comparative Analysis of 2 National Breast Reconstruction Surveys: Concerns Regarding Autologous and Microsurgical Breast Reconstruction

    Directory of Open Access Journals (Sweden)

    Raffi Gurunluoglu, MD, PhD, FACS

    2014-05-01

    Conclusions: Comparative data suggest that there are fewer high volume BR cases being performed by US plastic surgeons and that there has been a reduction among plastic surgeons in the use of microsurgical BR from 2010 to 2012. We believe that these findings may indicate early signs of the changes in BR trends in the US.

  4. Modern use of smartphone applications in the perioperative management in microsurgical breast reconstruction

    Science.gov (United States)

    Rozen, Warren Matthew; Marsh, Daniel; Chow, Whitney T.H.; Vickers, Tobias; Khan, Lubna; Miller, George S.; Hunter-Smith, David J.; Ramakrishnan, Venkat V.

    2016-01-01

    Background Advances in mobile telecommunication, improved mobile internet and affordability have led to a significant increase in smartphone use within medicine. The capability of instant messaging, photography, videography, word processing, drawing and internet access allow significant potential in this small portable device. Smartphone use within medicine has grown tremendously worldwide given its affordability, improved internet and capabilities. Methods We have searched for apps specifically helpful in the perioperative care of microsurgical breast reconstructive patients. Results The useful apps have been subdivided: (I) communication apps—multimedia messaging, WhatsApp, PicSafeMedi: allow efficient communication via text, picture and video messages leading to earlier assessment and definitive management of free flaps; (II) storage apps—Notability, Elogbook: electronic storage of patient notes and logbooks of case which can be shared with others if required; (III) educational apps—FlapApp, Touch Surgery, PubMed on tap: step by step guides to surgical procedures to aid learning and medical journal database; (IV) flap monitoring app—SilpaRamanitor: free flap monitoring app based on photographic analysis for earlier detection of compromised flaps. Conclusions There has been remarkable growth in smartphones use among surgeons. Apps are being developed for every conceivable use. The future will be in wearable smart devices that allow continuous monitoring with the potential to instigate change should deviations from the norm occur. The smart watch is the start of this digital revolution. PMID:27047783

  5. Modern use of smartphone applications in the perioperative management in microsurgical breast reconstruction.

    Science.gov (United States)

    Patel, Nakul Gamanlal; Rozen, Warren Matthew; Marsh, Daniel; Chow, Whitney T H; Vickers, Tobias; Khan, Lubna; Miller, George S; Hunter-Smith, David J; Ramakrishnan, Venkat V

    2016-04-01

    Advances in mobile telecommunication, improved mobile internet and affordability have led to a significant increase in smartphone use within medicine. The capability of instant messaging, photography, videography, word processing, drawing and internet access allow significant potential in this small portable device. Smartphone use within medicine has grown tremendously worldwide given its affordability, improved internet and capabilities. We have searched for apps specifically helpful in the perioperative care of microsurgical breast reconstructive patients. The useful apps have been subdivided: (I) communication apps-multimedia messaging, WhatsApp, PicSafeMedi: allow efficient communication via text, picture and video messages leading to earlier assessment and definitive management of free flaps; (II) storage apps-Notability, Elogbook: electronic storage of patient notes and logbooks of case which can be shared with others if required; (III) educational apps-FlapApp, Touch Surgery, PubMed on tap: step by step guides to surgical procedures to aid learning and medical journal database; (IV) flap monitoring app-SilpaRamanitor: free flap monitoring app based on photographic analysis for earlier detection of compromised flaps. There has been remarkable growth in smartphones use among surgeons. Apps are being developed for every conceivable use. The future will be in wearable smart devices that allow continuous monitoring with the potential to instigate change should deviations from the norm occur. The smart watch is the start of this digital revolution.

  6. Cephalic vein: Saviour in the microsurgical reconstruction of breast and head and neck cancers

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    Vinay K Shankhdhar

    2012-01-01

    Full Text Available Background: Reconstruction with microvascular free flaps is considered the reconstructive option of choice in cancer of the head and neck regions and breast. Rarely, there is paucity of vessels, especially the veins, at the recipient site. The cephalic vein with its good caliber and constant anatomy is a reliable recipient vein available in such situations. Materials and Methods: It is a retrospective study from January 2010 to July 2012 and includes 26 patients in whom cephalic vein was used for free-flap reconstruction in head and neck (3 cases and breast cancers (23 cases. Results: All flaps in which cephalic vein was used survived completely. Conclusion: Cephalic vein can be considered as a reliable source of venous drainage when there is a non-availability/unusable of veins during free-flap reconstruction in the head and neck region and breast and also when additional source of venous drainage is required in these cases.

  7. To Resect or Not to Resect: The Effects of Rib-Sparing Harvest of the Internal Mammary Vessels in Microsurgical Breast Reconstruction.

    Science.gov (United States)

    Wilson, Stelios; Weichman, Katie; Broer, P Niclas; Ahn, Christina Y; Allen, Robert J; Saadeh, Pierre B; Karp, Nolan S; Choi, Mihye; Levine, Jamie P; Thanik, Vishal D

    2016-02-01

    The internal mammary vessels are the most commonly used recipients for microsurgical breast reconstructions. Often, the costal cartilage is sacrificed to obtain improved vessel exposure. In an effort to reduce adverse effects associated with traditional rib sacrifice, recent studies have described less-invasive, rib-sparing strategies. After obtaining institutional review board's approval, a retrospective review of all patients undergoing microsurgical breast reconstruction at a single institution between November 2007 and December 2013 was conducted. Patients were divided into two cohorts for comparison: rib-sacrificing and rib-sparing internal mammary vessel harvests. A total of 547 reconstructions (344 patients) met inclusion criteria for this study. A total of 64.9% (n = 355) underwent rib-sacrificing internal mammary vessel harvest. Cohorts were similar in baseline patient characteristics, indications for surgery, and cancer therapies. However, patients undergoing rib-sparing reconstructions had significantly shorter operative times (440 vs. 476 minutes; p rib-sparing techniques had greater incidence of fat necrosis requiring excision (12.5 vs. 2.8%; p rib-sacrificing patients. Rib-sparing harvest of internal mammary vessels is a feasible technique in microsurgical breast reconstruction. However, given the significant increase in fat necrosis requiring surgical excision, the trend toward increased postoperative complications, and no significant difference in postoperative revision rates, the purported benefits of this technique may fail to outweigh the possible risks. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  8. Rib-sparing and internal mammary artery-preserving microsurgical breast reconstruction with the free DIEP flap.

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    Kim, Hyungsuk; Lim, So-Young; Pyon, Jai-Kyong; Bang, Sa-Ik; Oh, Kap Sung; Lee, Jeong Eon; Nam, Seok Jin; Mun, Goo-Hyun

    2013-03-01

    Using an internal mammary artery as the recipient vessel in a free flap autologous breast reconstruction is common practice, but this vessel is often sacrificed for end-to-end anastomosis and is typically assessed by removing a costal cartilage segment. The authors studied the reliability of the end-to-side arterial anastomosis using a rib-sparing approach by comparing it with end-to-end anastomosis. The authors analyzed 100 consecutive medical records of patients who underwent autologous breast reconstruction with a free deep inferior epigastric artery perforator flap in which the internal mammary vessels were assessed using a rib-sparing technique. The study compared the complications between the two groups of end-to-side arterial anastomosis (50 cases) and end-to-end arterial anastomosis (50 cases). Exposure of the internal mammary artery using a rib-sparing technique was performed successfully in all 100 flaps. The second and third intercostal spaces were used in 46 and 54 cases, respectively. The mean width of the used intercostal space was 18.3 ± 2.4 mm in the end-to-side group and 18.3 ± 2.9 mm in the end-to-end group (p = 0.923). All flaps survived without partial or total necrosis. One case of venous insufficiency that required exploration occurred in the end-to-side group; the flap was totally saved with venous revision. There was no significant statistical difference between the end-to-side and end-to-end groups in all other variables, including mean flap ischemic time (p = 0.431) and fat necrosis (p = 0.339). The rib-sparing and internal mammary artery-preserving free deep inferior epigastric artery perforator flap transfer is an efficient and safe technique for microsurgical breast reconstruction.

  9. Quality of life and patient satisfaction after microsurgical abdominal flap versus staged expander/implant breast reconstruction: a critical study of unilateral immediate breast reconstruction using patient-reported outcomes instrument BREAST-Q.

    Science.gov (United States)

    Liu, Chunjun; Zhuang, Yan; Momeni, Arash; Luan, Jie; Chung, Michael T; Wright, Eric; Lee, Gordon K

    2014-07-01

    Staged expander-implant breast reconstruction (EIBR) and microsurgical abdominal flap breast reconstruction (MAFBR) are the most common modes of breast reconstruction (BR) in the United States. Whether the mode of breast reconstruction has an impact on patient quality of life (QoL) and satisfaction remains a question. A retrospective study was conducted identifying a population of 119 patients who underwent unilateral immediate BR. Only patients who were eligible for either EIBR or MAFBR based on preoperative characteristics were included in the study. The following parameters were retrieved: demographics, mode of reconstruction, cancer, recovery, QoL, and patient satisfaction. The latter two parameters were determined using the BREAST-Q BR module questionnaire. Two-way analysis of variance with mode of reconstruction and occurrence of complication as independent variables was used to determine the effect on patient satisfaction and QoL. The association between mode of reconstruction and patient response with each item of the QoL and satisfaction survey domains was analyzed. The overall response rate was 62.2 %. Non-respondents and respondents did not significantly differ in demographics, surgery type, cancer staging, adjuvant therapy, and complication rate. Age and BMI were significantly higher in MAFBR, while level of education was higher in EIBR. MAFBR had higher scores in psychosocial and sexual wellbeing, satisfaction with outcome, breast, information, and plastic surgeon when compared with patients who underwent EIBR. For patients eligible for both MAFBR and EIBR, MAFBR is associated with higher levels of satisfaction and QoL. Comprehensive pre-operative information of pros and cons of both modes of BR is crucial for patients to make a well-informed decision, thus, resulting in higher levels of satisfaction.

  10. Can the American College of Surgeons NSQIP surgical risk calculator identify patients at risk of complications following microsurgical breast reconstruction?

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    O'Neill, Anne C; Bagher, Shaghayegh; Barandun, Marina; Hofer, Stefan O P; Zhong, Toni

    2016-10-01

    The American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator is an open access online tool that estimates the risk of adverse post-operative events for a wide range of surgical procedures. This study evaluates the predictive value of the ACS NSQIP calculator in patients undergoing microvascular breast reconstruction. Details of 759 microvascular breast reconstructions in 515 patients were entered into the online calculator. The predicted rates of post-operative complications were recorded and compared to observed complications identified on chart review. The calculator was validated using three statistical measures described in the original development of the ACS NSQIP model. The calculator predicted that complications would occur in 11.1% of breast reconstructions while the observed rate was 10.5%. Hosmer-Lemeshow test did not find any statistical difference between these rates (p = 0.69) indicating that the calculator accurately measured what is was intended to measure. The area under the receiver operating curve or c-statistic (measure of discrimination) was found to be low at 0.548, indicating the model has random performance in this patient population. The Brier score was higher than that reported in the original ACS calculator development (0.094 vs 0.069) demonstrating poor correlation between predicted probability and actual probability. This study demonstrates that while the ACS NSQIP Universal risk calculator can predict the proportion of patients that will develop complications it cannot effectively discriminate between patients who are at risk of complications and those who are not. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  11. Breast Reconstruction

    Science.gov (United States)

    ... rebuild the shape of the breast. Instead of breast reconstruction, you could choose to wear a breast form ... one woman may not be right for another. Breast reconstruction may be done at the same time as ...

  12. Reconstrucción mamaria con colgajos microquirúrgicos de perforantes Breast reconstruction with microsurgical perforator flaps

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    J. A. Lozano

    2005-01-01

    Full Text Available La reconstrucción mamaria autógena se realiza frecuentemente con tejido abdominal, ya que se obtiene el mejor resultado estético perdurable en el tiempo, con una nueva mama muy similar en textura, consistencia y ptosis a la contralateral. La secuela a nivel de la zona donante abdominal es el principal problema que plantea este tipo de reconstrucciones. Los colgajos de perforantes se desarrollan como el gran recurso para solventar dicho problema, ya que apenas dañan el músculo y su fascia. El colgajo DIEP (Deep Inferior Epigastric Perforator ha demostrado ser una alternativa reconstructiva destinada a gran cantidad de mujeres, con bajas tasas de complicaciones locales, debido a la falta de sacrificio del músculo recto abdominal, e importante grado de satisfacción por el resultado obtenido. Como inconveniente presenta su mayor dificultad técnica y la necesidad de un equipo quirúrgico que domine la microcirugía vascular. No obstante, el colgajo DIEP se presenta como una técnica quirúrgica con una demanda en importante ascenso.Autogenous breast reconstruction is frequently carried out with abdominal tissue, since a better and lasting aesthetic result is obtained, providing a new breast that is very similar in texture, consistency and ptosis to the contralateral breast. The main problem presented by this type of reconstruction is the sequel at the level of the donor abdominal area. Perforator flaps are being developed as the main resource for solving this problem, as they hardly damage the muscle and its fascia. The DIEP flap (deep inferior epigastric perforator has proved itself to be an alternative for reconstruction for many women, with low rates of local complications, due to the absence of any sacrifice of the abdominis rectus muscle, and a significant level of satisfaction with the result obtained. One drawback is its greater technical difficulty and the need for a surgical team that is expert in vascular microsurgery. However, the

  13. Correlation between abdominal perforator vessels identified with preoperative CT angiography and intraoperative fluorescent angiography in the microsurgical breast reconstruction patient.

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    Pestana, Ivo A; Zenn, Michael R

    2014-01-01

    CT angiography (CTA) has become a reliable method of perforator vessel identification. Indocyanine green fluorescent angiography (ICGLA) produces a real-time image of large- and small-caliber blood vessels. The aim of this prospective study was to compare ICGLA with CTA to evaluate its reliability of vessel identification and correlation to perforator vessel size and number determined preoperatively by CTA. The effect of both imaging techniques on flap design or intraoperative plan was also evaluated. Over a 1-year period, patients presenting for free-tissue transfer breast reconstruction underwent preoperative CTA mapping of abdominal perforators followed by intraoperative ICGLA. Using visualization software, scaling factors were calculated so CTA and ICGLA data could be compared. Eighteen patients (24 breast reconstructions) were included. Larger CTA perforator size was associated with larger actual size (P = 0.04). The largest CTA perforator or largest actual perforator was used 78% of the time. Increasing body mass index was not associated with larger CTA perforator size (P = 0.67) or more intense ICGLA blushes (P = 0.13). No significant correlation was found between CTA perforator location and ICGLA skin blush location, size, or intensity. CTA or SPY guided intraoperative procedure adjustments in 72% of patients. ICGLA identified poor soft-tissue perfusion and guided flap resection in 46% of patients. ICGLA skin blush location, size, and intensity do not correlate with CTA-identified perforating vessel location or actual perforating vessel size. Despite this, the ICGLA information was useful for evaluation of soft-tissue perfusion and flap design.

  14. The evolving breast reconstruction

    DEFF Research Database (Denmark)

    Thomsen, Jørn Bo; Gunnarsson, Gudjon Leifur

    2014-01-01

    The aim of this editorial is to give an update on the use of the propeller thoracodorsal artery perforator flap (TAP/TDAP-flap) within the field of breast reconstruction. The TAP-flap can be dissected by a combined use of a monopolar cautery and a scalpel. Microsurgical instruments are generally...... not needed. The propeller TAP-flap can be designed in different ways, three of these have been published: (I) an oblique upwards design; (II) a horizontal design; (III) an oblique downward design. The latissimus dorsi-flap is a good and reliable option for breast reconstruction, but has been criticized...... for oncoplastic and reconstructive breast surgery and will certainly become an invaluable addition to breast reconstructive methods....

  15. Breast Reconstruction Alternatives

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    ... Breast Reconstruction Surgery Breast Cancer Breast Reconstruction Surgery Breast Reconstruction Alternatives Some women who have had a ... chest. What if I choose not to get breast reconstruction? Some women decide not to have any ...

  16. Breast Reconstruction

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    ... senos Preguntas Para el Médico Datos Para la Vida Komen El cuidado de sus senos:Consejos útiles ... can help . Cost Federal law requires most insurance plans cover the cost of breast reconstruction. Learn more ...

  17. Breast Reconstruction with Implants

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    Breast reconstruction with implants Overview By Mayo Clinic Staff Breast reconstruction is a surgical procedure that restores shape to ... treat or prevent breast cancer. One type of breast reconstruction uses breast implants — silicone devices filled with silicone ...

  18. Internal Mammary Recipient Site Breast Cancer Recurrence Following Delayed Microvascular Breast Reconstruction

    OpenAIRE

    Rosich-Medina, Anais; Wang, Susan; Erel, Ertan; Malata, Charles M.

    2013-01-01

    Objective: The internal mammary vessels are a popular recipient site for microsurgical anastomoses of free flap breast reconstructions. We, however, observed 3 patients undergoing internal mammary vessel delayed free flap breast reconstruction that subsequently developed tumor recurrence at this site. We reviewed their characteristics to determine whether there was a correlation between delayed microsurgical reconstruction and local recurrence. Methods: A retrospective review of a single surg...

  19. Correlation between Abdominal Perforator Vessels Identified with Preoperative Computed Tomography Angiography and Intraoperative Fluorescent Angiography in the Microsurgical Breast Reconstruction Patient.

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    Pestana, Ivo A; Crantford, J Clayton; Zenn, Michael R

    2014-05-06

    Background Computed tomography angiography (CTA) has become a reliable method of perforator vessel identification. Indocyanine green laser-assisted fluorescent angiography (ICGLA) produces a real-time image of large and small caliber blood vessels. The aim of this prospective study was to compare ICGLA with CTA to evaluate its reliability of vessel identification and correlation to perforator vessel size and number determined preoperatively by CTA. The effect of both imaging techniques on flap design or intraoperative plan was also evaluated. Methods Over a 1-year period, patients presenting for free-tissue transfer breast reconstruction underwent preoperative CTA mapping of abdominal perforators followed by intraoperative ICGLA. Using visualization software, scaling factors were calculated so that CTA and ICGLA data could be compared. Results A total of 18 patients (24 breast reconstructions) were included. Larger CTA perforator size was associated with larger actual size (p = 0.04). The largest CTA perforator or largest actual perforator was used 78% of the time. Increasing body mass index was not associated with larger CTA perforator size (p = 0.67) or more intense ICGLA blushes (p = 0.13). No significant correlation was found between CTA perforator location and ICGLA skin blush location, size, or intensity. CTA- or ICGLA-guided intraoperative procedure adjustments were done in 72% of the patients. ICGLA identified poor soft tissue perfusion and guided flap resection in 46% of the patients. Conclusions ICGLA skin blush location, size, and intensity does not correlate with CTA-identified perforating vessel location or actual perforating vessel size. Despite this, the ICGLA information was useful for evaluation of soft tissue perfusion and flap design. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  20. Internal Mammary Recipient Site Breast Cancer Recurrence Following Delayed Microvascular Breast Reconstruction

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    Rosich-Medina, Anais; Wang, Susan; Erel, Ertan; Malata, Charles M.

    2013-01-01

    Objective: The internal mammary vessels are a popular recipient site for microsurgical anastomoses of free flap breast reconstructions. We, however, observed 3 patients undergoing internal mammary vessel delayed free flap breast reconstruction that subsequently developed tumor recurrence at this site. We reviewed their characteristics to determine whether there was a correlation between delayed microsurgical reconstruction and local recurrence. Methods: A retrospective review of a single surgeon's delayed free flap breast reconstructions using the internal mammary vessels was conducted over a 7-year period to identify the time intervals between mastectomy and delayed breast reconstruction and between delayed breast reconstruction and recurrence. Results: Three patients developed local recurrence at the site of the microvascular anastomoses following delayed breast reconstruction. All patients had been disease-free following mastectomy. The median time interval between mastectomy and delayed breast reconstruction was 28 months (range = 20-120 months) while that between delayed breast reconstruction and local recurrence was 7 months (range = 4-10 months). Two patients died from metastatic disease, 36 and 72 months following their local recurrence. One patient remains alive 44 months after reconstruction. Conclusions: Local tumor recurrence at the internal mammary vessel dissection site following delayed breast reconstruction raises the question whether these 2 events may be related. Specifically, could internal mammary vessel dissection undertaken for delayed microsurgical reconstruction predispose to recurrence in the internal mammary lymph nodes? Further research is needed to ascertain whether delayed breast reconstruction increases the risk of local recurrence in this patient group. PMID:23383360

  1. Breast Reconstruction with Flap Surgery

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    Breast reconstruction with flap surgery Overview By Mayo Clinic Staff Breast reconstruction is a surgical procedure that restores shape to ... breast tissue to treat or prevent breast cancer. Breast reconstruction with flap surgery is a type of breast ...

  2. Should I Have Breast Reconstruction?

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    ... Reconstruction Surgery Breast Cancer Breast Reconstruction Surgery Should I Get Breast Reconstruction Surgery? Women who have surgery ... It usually responds well to treatment. What if I choose not to have breast reconstruction? Many women ...

  3. Breast reconstruction after mastectomy

    Directory of Open Access Journals (Sweden)

    Daniel eSchmauss

    2016-01-01

    Full Text Available Breast cancer is the leading cause of cancer death in women worldwide. Its surgical approach has become less and less mutilating in the last decades. However, the overall number of breast reconstructions has significantly increased lately. Nowadays breast reconstruction should be individualized at its best, first of all taking into consideration oncological aspects of the tumor, neo-/adjuvant treatment and genetic predisposition, but also its timing (immediate versus delayed breast reconstruction, as well as the patient’s condition and wish. This article gives an overview over the various possibilities of breast reconstruction, including implant- and expander-based reconstruction, flap-based reconstruction (vascularized autologous tissue, the combination of implant and flap, reconstruction using non-vascularized autologous fat, as well as refinement surgery after breast reconstruction.

  4. Microsurgical Reconstruction of Traumatic Lower Extremity Defects in the Pediatric Population.

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    Momeni, Arash; Lanni, Michael; Levin, L Scott; Kovach, Stephen J

    2017-04-01

    Few reports focus exclusively on microsurgical reconstruction of traumatic lower extremity defects in children. Hence, the authors felt it prudent to contribute to this area of clinical research. The authors hypothesized that reconstructive success would be comparable to success rates reported in adults, and that young age or concerns regarding vessel size or behavior do not negatively impact surgical outcome. A retrospective review of microsurgical lower extremity reconstruction cases at two academic medical centers was performed. All pediatric patients who underwent microsurgical reconstruction of traumatic lower extremity defects between 1997 and 2012 were included for analysis. Forty flaps transferred in 40 patients with a mean age of 11.4 years (range, 1 to 17 years) were included for analysis. Muscle flaps were predominantly used [n = 23 (57.5 percent)]; however, there was a recent increase in use of fasciocutaneous flaps [n = 16 (40 percent)]. Postoperative complications were seen in 25 percent of patients, with a total flap loss rate of 5 percent. No donor-site complications were observed. The mean postoperative length of hospital stay was 12.9 days (range, 4 to 41 days), with patients returning to full weight-bearing after a mean of 2.6 months (range, 1 to 8 months). Microsurgical reconstruction of traumatic lower extremity defects in the pediatric population is safe. Concerns related to patient age, vessel size, or vessel behavior (i.e., vasospasm) should not detract from offering free flap reconstruction, as they do not negatively impact outcomes. Therapeutic, IV.

  5. Factors Predicting Total Free Flap Loss after Microsurgical Reconstruction Following the Radical Ablation of Head and Neck Cancers

    OpenAIRE

    Fujioka, Masaki

    2013-01-01

    Background. With greater experience in microsurgical reconstruction, free tissue transfer has become common and reliable. However, total flap necrosis after microsurgical reconstruction is sometimes seen in patients who have undergone radical ablation of head and neck malignancies. We investigated factors predicting free flap loss in head and neck reconstruction. Methods. We reviewed the records of 111 free flap reconstructions carried out among 107 patients with head and neck cancer who requ...

  6. [Breast reconstruction after mastectomy].

    Science.gov (United States)

    Ho Quoc, C; Delay, E

    2013-02-01

    The mutilating surgery for breast cancer causes deep somatic and psychological sequelae. Breast reconstruction can mitigate these effects and permit the patient to help rebuild their lives. The purpose of this paper is to focus on breast reconstruction techniques and on factors involved in breast reconstruction. The methods of breast reconstruction are presented: objectives, indications, different techniques, operative risks, and long-term monitoring. Many different techniques can now allow breast reconstruction in most patients. Clinical cases are also presented in order to understand the results we expect from a breast reconstruction. Breast reconstruction provides many benefits for patients in terms of rehabilitation, wellness, and quality of life. In our mind, breast reconstruction should be considered more as an opportunity and a positive choice (the patient can decide to do it), than as an obligation (that the patient would suffer). The consultation with the surgeon who will perform the reconstruction is an important step to give all necessary informations. It is really important that the patient could speak again with him before undergoing reconstruction, if she has any doubt. The quality of information given by medical doctors is essential to the success of psychological intervention. This article was written in a simple, and understandable way to help gynecologists giving the best information to their patients. It is maybe also possible to let them a copy of this article, which would enable them to have a written support and would facilitate future consultation with the surgeon who will perform the reconstruction.

  7. Microsurgical reconstruction of hepatic artery in A-A LDLT:124 consecutive cases without HAT

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    AIM:To retrospectively investigate microsurgical hepatic artery(HA) reconstruction and management of hepatic thrombosis in adult-to-adult living donor liver transplantation(A-A LDLT).METHODS:From January 2001 to September 2009,182 recipients with end-stage liver disease underwent A-A LDLT.Ten of these patients received dual grafts.The 157 men and 25 women had an age range of 18 to 68 years(mean age,42 years).Microsurgical techniques and running sutures with back-wall first techniques were performed in all a...

  8. Microsurgical reconstruction of hepatic ar ter y in living donor liver transplantation:experiences and lessons

    Institute of Scientific and Technical Information of China (English)

    Sheng Yan; Shu-Sen Zheng; Qi-Yi Zhang; Yu-Sheng Yu; Jiang-Juan He; Wei-Lin Wang; Min Zhang; Yan Shen; Jian Wu; Xiao Xu

    2009-01-01

    BACKGROUND: Hepatic artery (HA) reconstruction is one of the key steps for living donor liver transplantation (LDLT). The incidence of HA thrombosis has been reduced by the introduction of microsurgical techniques under a high resolution microscope or loupe. METHODS: We report our experience in 101 cases of HA reconstruction in LDLTs using the graft-artery-unclamp and posterior-wall-ifrst technique. The reconstructions were completed by either a plastic surgeon or a transplant surgeon. RESULTS: The rate of HA thrombosis was 2%(2/101). The risk factors for failed procedures appeared to be reduced by participation of the transplant surgeon compared with the plastic surgeon. For a graft with duplicate arteries, we considered no branches should be discarded even with a positive clamping test. CONCLUSIONS: HA reconstruction without clamping the graft artery is a feasible and simpliifed technique, which can be mastered by transplant surgeons with considerable microsurgical training.

  9. Delayed breast implant reconstruction

    DEFF Research Database (Denmark)

    Hvilsom, Gitte B.; Hölmich, Lisbet R.; Steding-Jessen, Marianne;

    2012-01-01

    We evaluated the association between radiation therapy and severe capsular contracture or reoperation after 717 delayed breast implant reconstruction procedures (288 1- and 429 2-stage procedures) identified in the prospective database of the Danish Registry for Plastic Surgery of the Breast during...... reconstruction approaches other than implants should be seriously considered among women who have received radiation therapy....

  10. Breast reconstruction - slideshow

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    ... this page: //medlineplus.gov/ency/presentations/100156.htm Breast reconstruction - series—Indication, part 1 To use the sharing ... A.M. Editorial team. Related MedlinePlus Health Topics Breast Reconstruction A.D.A.M., Inc. is accredited by ...

  11. Breast reconstruction after breast cancer.

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    Serletti, Joseph M; Fosnot, Joshua; Nelson, Jonas A; Disa, Joseph J; Bucky, Louis P

    2011-06-01

    After reading this article, the participant should be able to: 1. Describe the mental, emotional, and physical benefits of reconstruction in breast cancer patients. 2. Compare the most common techniques of reconstruction in patients and detail benefits and risks associated with each. 3. Outline different methods of reconstruction and identify the method considered best for the patient based on timing of the procedures, body type, adjuvant therapies, and other coexisting conditions. 4. Distinguish between some of the different flaps that can be considered for autologous reconstruction. Breast cancer is unfortunately a common disease affecting millions of women, often at a relatively young age. Reconstruction following mastectomy offers women an opportunity to mollify some of the emotional and aesthetic effects of this devastating disease. Although varying techniques of alloplastic and autologous techniques are available, all strive to achieve the same goal: the satisfactory reformation of a breast mound that appears as natural as possible without clothing and at the very least is normal in appearance under clothing. This article summarizes the various approaches to breast reconstruction and offers a balanced view of the risks and benefits of each, all of which in the end offer the opportunity for excellent and predictable results with a high degree of patient satisfaction.

  12. Immediate Microsurgical Bone and Nerve Reconstruction in the Irradiated Patient: A Case Report.

    Science.gov (United States)

    Tursun, Ramzey; Green, J Marshall

    2016-12-11

    Microsurgical reconstructive techniques have revolutionized the treatment of large head and neck defects. These defects were once forever life altering because of the considerable morbidity to both the form and function of the patient. As time has progressed, microsurgical technique has improved dramatically and has become institutionalized in our training programs. Free flap outcomes in head and neck reconstruction have improved dramatically, and optimization of these outcomes is now key. One overlooked area has been neurosensory reconstruction. In our practice we have focused on this detail, which has proved to be quite important to the patient. This case report details one such case in which a mandibular resection was performed to treat osteoradionecrosis. We, as the reconstructive team, elected to perform a double-barrel fibular free flap procedure with simultaneous inferior alveolar nerve reconstruction using a 70-cm processed nerve allograft. Normal neurosensory function returned in this patient. As the state of the art advances with continued successful osseous and soft tissue reconstruction in the head and neck, we propose concomitant neurosensory functional reconstruction always be considered.

  13. Breast Reconstruction After Mastectomy

    Science.gov (United States)

    ... It also does not involve cutting of the abdominal muscle and is a free flap. This type of ... NCI fact sheet Mammograms . What are some new developments in breast reconstruction after mastectomy? Oncoplastic surgery. In ...

  14. Microsurgical Reconstruction of Plantar Ulcers of the Insensate Foot.

    Science.gov (United States)

    Kadam, Dinesh

    2016-06-01

    Background Plantar, neuropathic, or trophic ulcers are often found in patients with decreased sensation in the foot. These ulcers can be complicated by infection, deformity, and increased patient morbidity. Excision results in wider defects and local tissues are often insufficient for reconstruction Methods Total 26 free flaps were used in 25 patients to reconstruct plantar ulcers between years 2007 and 2013. The etiology included diabetic neuropathy (n = 13), leprosy (n = 3), spinal/peripheral nerve injury (n = 7), spina bifida (n = 1), and peripheral neuropathy (n = 1). The duration of the ulcer ranged from 1 to 18 years. Fifteen patients had associated systemic comorbidities and six had previous attempts. Free flaps used in reconstruction were the anterolateral thigh flap (n = 18), radial artery forearm flap (n = 4), and the gracilis muscle flap (n = 4). Recipient vessels were the posterior tibial artery (end to side) in 19 and the dorsalis pedis artery in 7. Results The average age at presentation was 44.6 years with mean duration of ulcer of 5.8 years predominantly located over weight-bearing areas. Mean size of ulcer was 59.45 cm(2) and mean follow-up period was 48 months. All flaps survived except a partial loss. Average time to resume ambulation was 6 weeks. Three patients had recurrence with mean follow-up of 48 months. Secondary flap reduction and bony resection was done in four. Conclusion Microvascular reconstruction of the sole has advantages of vascularity, adequate tissue, and leaving rest of the foot undisturbed for offloading. Three significant local conditions influencing selection and transfer of the flap include (1) distally located forefoot ulcers, (2) extensive subcutaneous fibrosis secondary to frequent inflammation, and (3) Charcot arthropathy. In our series, the anterolateral thigh flap is our first choice for reconstruction of these defects.

  15. Preparing for Breast Reconstruction Surgery

    Science.gov (United States)

    ... Cancer Breast Reconstruction Surgery Preparing for Breast Reconstruction Surgery Your surgeon can help you know what to ... The plan for follow-up Costs Understanding your surgery costs Health insurance policies often cover most or ...

  16. Lessons Learned from Delayed Versus Immediate Microsurgical Reconstruction of Complex Maxillectomy and Midfacial Defects: Experience in a Tertiary Center in Mexico.

    Science.gov (United States)

    Santamaria, Eric; de la Concha, Erika

    2016-10-01

    Microsurgical reconstruction of complex midfacial and maxillectomy defects is among the most challenging procedures in plastic surgery, and it often requires composite flaps to improve functional and aesthetic results. Various factors have been identified as having influence in the outcome of microsurgical reconstruction. In this article, the authors present their experience with immediate and delayed reconstruction of complex maxillectomy defects in a tertiary center in Mexico. The authors present a total of 37 patients with microsurgical reconstruction of a complex maxillectomy defect; 13 patients had immediate and 24 had delayed reconstructions. The authors recommend doing immediate reconstruction when feasible.

  17. Breast reconstruction using a latissimus dorsi flap after mastectomy

    DEFF Research Database (Denmark)

    Højvig, Jens B; Bonde, Christian Torsten

    2015-01-01

    INTRODUCTION: The latissimus dorsi (LD) myocutaneous flap has long been regarded as the second choice flap for autologous breast reconstruction following a mastectomy in our department. Despite uncertainty about donor-site morbidity, it is regarded as a relatively safe procedure; moreover......, in contrast to our first choice, the deep inferior epigastric perforator flap, no microsurgical expertise is needed. METHODS: This is a systematic review of patient files for all LD breast reconstructions performed in the 2004-2013 period, at Rigshospitalet, Copenhagen, Denmark. RESULTS: A total of 135...... unilateral LD breast reconstructions were performed in 126 women during the ten-year period. The median age of the women was 48.5 years, and they mainly had secondary reconstruction (90%). The average time to removal of the last drain was 6.3 days, and the average time to discharge was 6.9 days. A total...

  18. [Immediate breast reconstruction for breast cancer].

    Science.gov (United States)

    Yamamoto, Daigo; Tanaka, Yoshihito; Tsubota, Yu; Sueoka, Noriko; Endo, Kayoko; Ogura, Tsunetaka; Nagumo, Yoshinori; Kwon, A-Hon

    2014-11-01

    We performed immediate breast reconstruction after nipple-sparing mastectomy or skin-sparing mastectomy and evaluated the reconstruction procedure, cosmesis, and complications. Among the 30 patients included in the study, 6 received latissimus dorsi flaps, 1 received a transverse rectus abdominis myocutaneous flap, 7 received deep inferior epigastric perforator flaps, 1 received an implant, and 15 received tissue expanders. In addition, the results were excellent in 25 patients, good in 3 patients, and poor in 2 patients. As the number of patients with breast cancer is increasing, the demand for breast reconstruction will increase. Therefore, it is essential to choose an appropriate method of breast reconstruction for each case.

  19. What to Expect After Breast Reconstruction Surgery

    Science.gov (United States)

    ... En Español Category Cancer A-Z Breast Cancer Breast Reconstruction Surgery Women who have surgery as part of ... and after your surgery. Deciding Whether To Have Breast Reconstruction Many women choose to have reconstruction surgery, but ...

  20. Lessons Learned from Unfavorable Microsurgical Head and Neck Reconstruction: Japan National Cancer Center Hospital and Okayama University Hospital.

    Science.gov (United States)

    Kimata, Yoshihiro; Matsumoto, Hiroshi; Sugiyama, Narusi; Onoda, Satoshi; Sakuraba, Minoru

    2016-10-01

    The risk of surgical site infection (SSI) remains high after major reconstructive surgery of the head and neck. Clinical data regarding SSI in microsurgical tongue reconstruction are described at National Cancer Hospital in Japan, including discussions of unfavorable representative cases, the relationship between SSI and preoperative irradiation at Okayama University Hospital in Japan, and strategies for SSI control in head and neck reconstruction. Local complications are inevitable in patients undergoing reconstruction in the head and neck areas. The frequency of major complications can be decreased, and late postoperative complications can be prevented with the help of appropriate methods.

  1. [Deferred breast reconstruction - soul surgery?].

    Science.gov (United States)

    Kydlíček, Tomáš; Třešková, Inka; Třeška, Vladislav; Holubec, Luboš

    2013-01-01

    The loss or mutilation of a breast as a result of surgical treatment of neoplastic disease always represents a negative impact on a woman's psyche and negatively influences the quality of the woman's remaining life. The goal of our work was to implement deferred breast reconstruction into routine practice and the objectification of the influence of reconstruction on bodily integrity, quality of life, and the feeling of satisfaction in women. Women in remission from neoplastic disease after a radical mastectomy were indicated for breast reconstruction. Between January 2002 and December 2011 deferred breast reconstruction was carried out 174 × on 163 women, with an average age of 49.2 and an age range of 29-67 years. The most frequently used reconstruction method was a simple gel augmentation of the breast or a Becker expander/implant - 51 (29.3%) and 37 (21.3%), or in combination with a lateral thoracodorsal flap (31; 17.8% and 47; 27%); reconstruction using a free DIEP flap was carried out 7 × (4%). Complications occurred in 19 operations (10.9%) with a dominance of inflammation and pericapsular fibrosis, in a subjective analysis, satisfaction with the results prevailed, along with an increased quality of life after reconstruction. A growing number of deferred breast reconstructions, women's satisfaction with the results, the positive influence of renewed bodily integrity on the feeling of life satisfaction and the quality of life have elevated breast reconstructions to a qualitatively higher level.

  2. Breast reconstruction using a latissimus dorsi flap after mastectomy

    DEFF Research Database (Denmark)

    Højvig, Jens B; Bonde, Christian Torsten

    2015-01-01

    , in contrast to our first choice, the deep inferior epigastric perforator flap, no microsurgical expertise is needed. METHODS: This is a systematic review of patient files for all LD breast reconstructions performed in the 2004-2013 period, at Rigshospitalet, Copenhagen, Denmark. RESULTS: A total of 135...... of 13 patients (10%) had local complications and were re-operated within the first 30 days. We observed one flap loss and only one systemic complication; a urinary tract infection. In all, 38 patients (28%) received antibiotic treatment after the operations and 27 (20%) developed a seroma at the donor...

  3. Zygomatico-orbital artery as a recipient vessel for microsurgical head and neck reconstruction.

    Science.gov (United States)

    Higashino, Takuya; Sawamoto, Naoya; Hirai, Rintaro; Arikawa, Masaki

    2013-07-01

    The selection of recipient vessels in head and neck reconstruction is one of the key factors influencing its difficulty and outcome. We report a case of a microsurgical scalp reconstruction using the zygomatico-orbital artery as a recipient vessel.A 71-year-old woman had intractable skin ulcers on her head after neurosurgeries. Computed tomography angiography findings showed that the superficial temporal artery was obstructed and that the zygomatico-orbital artery ran forward and upward. She underwent scalp reconstruction using a free anterior lateral thigh flap. The zygomatico-orbital artery was dissected distally, cut, and turned over cranially. The diameter of the zygomatico-orbital artery was 1.2 mm. The blood flow through the zygomatico-orbital artery was sufficient. The thinned scalp area was excised, and some of the titanium devices and infectious tissues were removed. An anterior lateral thigh flap measuring 20 × 9 cm was harvested and transferred to the defect in the head. The discrepancy in calibers was within double, and the zygomatico-orbital artery fit the descending branch of the lateral circumflex femoral artery. The flap was transferred successfully.The zygomatico-orbital artery is one of the branches from the external carotid artery and supports the suprazygomatic territory. The zygomatico-orbital artery is present in 78% to 92% of people and originates from the superficial temporal artery and sometimes from the frontal branch of superficial temporal artery. The mean diameter of the zygomatico-orbital artery at origin is reported to be 1.20 mm. The zygomatico-orbital artery is another option as a recipient vessel in head and neck reconstruction.

  4. Coping and quality of life of patients following microsurgical treatment for breast cancer-related lymphedema.

    Science.gov (United States)

    Teo, Irene; Fingeret, Michelle Cororve; Liu, Jun; Chang, David W

    2016-12-01

    Breast cancer-related lymphedema is associated with numerous adverse outcomes. This study investigated the extent clinical factors, lymphedema symptoms, lymphedema-related appearance, and coping strategies predicted quality of life. Female patients who underwent microsurgical treatment for lymphedema (n = 54) participated. Lymphedema symptoms were associated with physical and functional well-being, but not emotional and social well-being. Clinical factors and lymphedema-related appearance were not significantly associated with quality of life. Compared to adaptive coping strategies, maladaptive coping strategies (e.g. denial, venting, self-blame) were more strongly associated with quality of life. This suggests psychosocial interventions aimed at modifying maladaptive coping behaviors can potentially improve quality of life for this patient population. © The Author(s) 2015.

  5. Breast reconstruction - implants

    Science.gov (United States)

    ... After a mastectomy , some women choose to have cosmetic surgery to remake their breast. This type of surgery ... to the breast or the new nipple. Having cosmetic surgery after breast cancer can improve your sense of ...

  6. Tug 'O' war: challenges of transverse upper gracilis (TUG) myocutaneous free flap breast reconstruction.

    Science.gov (United States)

    Locke, Michelle B; Zhong, Toni; Mureau, Marc A M; Hofer, Stefan O P

    2012-08-01

    Autologous tissue microsurgical breast reconstruction is increasingly requested by women following mastectomy. While the abdomen is the most frequently used donor site, not all women have enough abdominal tissue excess for a unilateral or bilateral breast reconstruction. A secondary choice in such women may be the transverse upper gracilis (TUG) myocutaneous flap. This study reviews our experience with TUG flap breast reconstruction looking specifically at reconstructive success rate and the requirement for secondary surgery. A total of 16 free TUG flaps were performed to reconstruct 15 breasts in eight patients over a period of five years. Data were collected retrospectively by chart review. Follow up ranged from 14 to 41 months. During the follow up period, there was one (6.3%) complete flap loss in an immediate breast reconstruction patient. Four further flaps (25%) failed in their primary aim of breast reconstruction, as they required additional significant reconstruction with either deep inferior epigastric perforator (DIEP) flaps (two flaps (12.5%), one patient) or augmentation with silicone breast implants (two flaps (12.5%), one patient), giving a successful breast reconstruction rate with the TUG flap of only 66.7%. In all of the remaining reconstructed breasts, deficient flap volume or breast contour was seen. Eight flaps were augmented by lipofilling. A total of 62.5% of the donor sites had complications, namely sensory disturbance of the medial thigh (25%) and poor scar (37.5%) requiring revision. This series demonstrates a high rate of reconstructive failure and unsatisfactory outcomes from TUG flap breast reconstruction. We feel this reinforces the necessity of adequate pre-operative patient assessment and counselling, including discussion regarding the likelihood of subsequent revisional surgery, before embarking on this form of autologous breast reconstruction.

  7. Implementation and Analysis of a Lean Six Sigma Program in Microsurgery to Improve Operative Throughput in Perforator Flap Breast Reconstruction.

    Science.gov (United States)

    Hultman, Charles Scott; Kim, Sendia; Lee, Clara N; Wu, Cindy; Dodge, Becky; Hultman, Chloe Elizabeth; Roach, S Tanner; Halvorson, Eric G

    2016-06-01

    Perforator flaps have become a preferred method of breast reconstruction but can consume considerable resources. We examined the impact of a Six Sigma program on microsurgical breast reconstruction at an academic medical center. Using methods developed by Motorola and General Electric, we applied critical pathway planning, workflow analysis, lean manufacturing, continuous quality improvement, and defect reduction to microsurgical breast reconstruction. Primary goals were to decrease preoperative-to-cut time and total operative time, through reduced variability and improved efficiency. Secondary goals were to reduce length of stay, complications, and reoperation. The project was divided into 3 phases: (1) Pre-Six Sigma (24 months), (2) Six Sigma (10 months), (3) and Post-Six Sigma (24 months). These periods (baseline, intervention, control) were compared by Student t test and χ analysis. Over a 5-year period, 112 patients underwent 168 perforator flaps for breast reconstructions, by experienced microsurgeons. Total operative time decreased from 714 to 607 minutes (P Six Sigma program in microsurgical breast reconstruction was associated with better operational and financial outcomes. These incremental gains were maintained over the course of the study, suggesting that these benefits were due, in part, to process improvements. However, continued reductions in total operative time and length of stay, well after the intervention period, support the possibility that "learning curve" phenomenon may have contributed to the improvement in these outcomes.

  8. MICROSURGICAL RECONSTRUCTION OF SOFT TISSUES OF KNEE REGION IN ABSENCE OF LOCAL PLASTIC RESOURCES IN PREPARATION FOR ARTHROPLASTY

    Directory of Open Access Journals (Sweden)

    D. I. Kutyanov

    2013-01-01

    Full Text Available A new method of microsurgical reconstruction of soft tissues defects of a knee in the conditions of inability to form pedicled flaps of thigh and shin has been offered. Prefabricated pedicled fasciocutaneous donor flap of the thickness needed is created on the anterior and anterior-medial surface of the same thigh. The donor flap is based on the previously transplanted radial forearm fascial free flap. This method provides recreation of wholesome periarticular soft tissues, eradication of the local infection, increase of range of motion in the knee joint and possibility to fulfill in the future perspective total knee arthroplasty as well as any other surgical operations.

  9. Alloplastic adjuncts in breast reconstruction

    Science.gov (United States)

    Cabalag, Miguel S.; Rostek, Marie; Miller, George S.; Chae, Michael P.; Quinn, Tam; Rozen, Warren M.

    2016-01-01

    Background There has been an increasing role of acellular dermal matrices (ADMs) and synthetic meshes in both single- and two-stage implant/expander breast reconstruction. Numerous alloplastic adjuncts exist, and these vary in material type, processing, storage, surgical preparation, level of sterility, available sizes and cost. However, there is little published data on most, posing a significant challenge to the reconstructive surgeon trying to compare and select the most suitable product. The aims of this systematic review were to identify, summarize and evaluate the outcomes of studies describing the use of alloplastic adjuncts for post-mastectomy breast reconstruction. The secondary aims were to determine their cost-effectiveness and analyze outcomes in patients who also underwent radiotherapy. Methods Using the PRSIMA 2009 statement, a systematic review was conducted to find articles reporting on the outcomes on the use of alloplastic adjuncts in post-mastectomy breast reconstruction. Multiple databases were searched independently by three authors (Cabalag MS, Miller GS and Chae MP), including: Ovid MEDLINE (1950 to present), Embase (1980 to 2015), PubMed and Cochrane Database of Systematic Reviews. Results Current published literature on available alloplastic adjuncts are predominantly centered on ADMs, both allogeneic and xenogeneic, with few outcome studies available for synthetic meshes. Outcomes on the 89 articles, which met the inclusion criteria, were summarized and analyzed. The reported outcomes on alloplastic adjunct-assisted breast reconstruction were varied, with most data available on the use of ADMs, particularly AlloDerm® (LifeCell, Branchburg, New Jersey, USA). The use of ADMs in single-stage direct-to-implant breast reconstruction resulted in lower complication rates (infection, seroma, implant loss and late revision), and was more cost effective when compared to non-ADM, two-stage reconstruction. The majority of studies demonstrated

  10. Choosing a Breast Reconstruction Surgeon and Questions to Ask

    Science.gov (United States)

    ... Reconstruction Surgery Questions to Ask Your Surgeon About Breast Reconstruction If you’ve had surgery to treat your ... reconstruction. Finding the right plastic surgeon for your breast reconstruction If you decide to have breast reconstruction, you’ ...

  11. MICROSURGICAL RECONSTRUCTION OF THE AERODIGESTIVE TRACT WITH COLONIC-ILEAL AUTOGENIC GRAFT IN PATIENTS WITH HYPOPHARYNX CANCER

    Directory of Open Access Journals (Sweden)

    M. V. Ratushny

    2014-01-01

    Full Text Available Study objective: development of the new method of reconstruction of upper section of the aerodigestive tract with the use of a microsurgical colonic-ileal autogenic graft that allows instant recovery of the food passage and voice function.A clinical case of successful treatment of a patient with locally distributed hypopharynx cancer is provided, regarding which microsurgical reconstruction of upper sections of the aerodigestive tract was performed with a free colonic-ileal autogenic graft at the surgical stage of therapy after laryngectomy with sleeve resection of the hypopharynx.The use of a colonic-ileal autogenic graft in the course of reconstruction of upper sections of the aerodigestive tract allowed instant recovery of both food passage and voice function for the patient after laryngectomy with sleeve resection of the hypopharynx.Conclusions:1. Application of this autogenic graft as a plastic material allows recovering both food passage and voice function instantly and completely with circular defects of upper sections of the aerodigestive tract.2. The ileocecal valve included into the structure of the combined autogenic graft prevents saliva and food aspiration into the trachea through the tracheo-oesophageal shunt.3. Mucous secretion of the autogenic graft has no aggressive action on the mucous membrane of the trachea, which allows implementation of the vocal rehabilitation plan.4. After the flap formation, there is no functional or aesthetic damage in the donor area.5. This reconstruction method cuts down the rehabilitation time significantly as well as decreases the patient’s disability level.

  12. Breast reconstruction - natural tissue

    Science.gov (United States)

    ... another method called the free flap procedure, skin, fat, and muscle tissue are removed from your lower belly. This tissue ... breast that was removed. The surgeon loosens skin, fat, and muscle from this area. This tissue is then tunneled under your skin to the ...

  13. Reconstruction for breast cancer in a nutshell.

    Science.gov (United States)

    Harmer, Victoria

    Breast cancer is a disease many will experience. Depending on the size of the cancer, the size of the host breast, and whether it is multi-focal, a mastectomy may be recommended as part of the treatment. If this is the case, an immediate breast reconstruction may be offered. This article will describe the three main types of breast reconstruction and discuss pertinent issues regarding this, including complications, surgery to the other (contraleteral) breast and potential psychological implications of this surgery.

  14. The oncological implications of immediate breast reconstruction.

    NARCIS (Netherlands)

    Knottenbelt, A.; Spauwen, P.H.M.; Wobbes, Th.

    2004-01-01

    AIMS: The timing of breast reconstruction following mastectomy has been an area of contention. The purpose of this study was to report the oncologic safety of mastectomy and immediate breast reconstruction, primarily with a tissue expander. METHODS: We offered 54 patients (58 reconstructions) an

  15. Breast reconstruction following amputation for cancer

    Directory of Open Access Journals (Sweden)

    Višnjić Milan

    2009-01-01

    Full Text Available Background/Aim. Today, breast reconstruction is a widely accepted method in the treatment of breast cancer after modified radical mastectomy. Reconstruction methods are associated with an acceptable number of complications and reconstruction favorably impacts quality of life. The aim of the study was to present our experience in breast reconstruction. Methods. We presented here a four-year experience with 84 patients with breast reconstruction after modified radical mastectomy. Results. Implant reconstructions were most common, 44 (52.3%, with primary reconstruction in 31(70.4% and secondary in 13 (29.5% women. Lattisimus dorsi flap (LDF and implant were utilized in 32 (38% of the patients, with primary reconstruction in 24 (75% and secondary in 8 (25% women. Transversal rectus abdominis myocutaneous (TRAM flap was rarely used - just in 8 (9.5% patients and only for secondary breast reconstruction. Postoperatively, some early complications such as hematoma, seroma, infections and partial flap necrosis were observed in 10 (11.9% patients. Late complications, such as implant rejection, hypertrophic scarring and hernias at the flap elevation site, were noted in 10 (11.9% cases. Implant loss occurred in 5 (5.9% cases. All the complications were successfully managed, and patients rated their reconstruction as follows: excellent, 49 (59% cases; very good, 20 (24%, and good, 14 (16.8%. In one case, disease progression was observed 6 months after the primary breast reconstruction. Conclusion. Breast reconstruction is an acceptable method in the treatment of breast cancer in patients in the need for or with already performed mastectomy. The choice of reconstruction approach depends on the breast volume, patient's wish and experience of surgical team. Our results suggest the advantage of breast reconstruction with LDF with implant, since the technique is safe, complications relatively rare and easily manageable, and the results are excellent or very good

  16. Total Male Breast Reconstruction with Fat Grafting

    Directory of Open Access Journals (Sweden)

    Tarik Al-Kalla, MD

    2014-11-01

    Full Text Available Summary: Cancer of a male breast represents less than 1% of all breast cancer. As with to female patients, mastectomy in men creates a substantial emotional burden. Breast reconstruction may improve the patient’s psychological well-being, compliance with adjuvant treatments, and overall outcome. However, due to the unique anatomy of the male breast, standard reconstructive strategies using anatomic or prosthetic modalities are not entirely applicable. We describe a case of a 68-year-old male patient who underwent successful unilateral breast reconstruction solely with fat grafting technique.

  17. Acellular dermis-assisted breast reconstruction.

    Science.gov (United States)

    Spear, S L; Parikh, P M; Reisin, E; Menon, N G

    2008-05-01

    In 2004, the authors reported their findings with placement of tissue expanders for breast reconstruction in the partial submuscular position, the equivalent of the "dual-plane" technique for breast augmentation. Limitations with subpectoral expander placement include difficulty controlling the lower pole of the pocket during expansion, unprotected device coverage by a thin inferior mastectomy flap, possible effacement of the inframammary fold, and limited control over the superior migration of the pectoralis major muscle. This study aimed to examine the safety and efficacy of an acellular dermal sling in providing inferolateral support to the device during immediate breast reconstruction and expansion. This study prospectively investigated 58 breasts of 43 consecutive women who underwent immediate breast reconstruction with tissue expanders and acellular dermis. After completion of adjuvant therapy and expansion, the devices were exchanged for implants. The patients were tracked through January, 2007. The study parameters included demographic information, oncologic data, complications, and aesthetic outcomes. The mean time required to complete reconstruction was 8.6 months. The overall complication rate after expander/acellular dermis placement was 12%, whereas the complication rate after exchange to implants was 2.2%. The aesthetic outcome for reconstructed breasts did not differ significantly from that for the control subjects who had no surgery. Acellular dermis appears to be a useful adjunct in immediate prosthetic breast reconstruction. Acellular dermis-assisted breast reconstruction has a low complication rate, helps to reconstruct an aesthetically pleasing breast, and facilitates expeditious completion of the reconstruction.

  18. Sensory reinnervation of free flaps in reconstruction of the breast and the upper and lower extremities

    Institute of Scientific and Technical Information of China (English)

    Nektarios Sinis; Androniki Lamia; Helml Gudrun; Thomas Schoeller; Frank Werdin

    2012-01-01

    There is long-standing debate about sensate versus non-sensate free microvascular flaps among microsurgeons.The principle of connecting not only the vascular supply,but also sensitive nerves,in free tissue transfer is attractive.However,increased operating time and partial spontaneous innervation led to the common decision to restrict microsurgical tissue transfer to the vascular anastomosis and to leave the nerves "untreated".Nevertheless,in special cases such as breast reconstruction or extremity reconstruction,the question about sensory nerve coaptation of the flaps remains open.We present our experience with free microvascular tissue transfer for breast and extremity reconstruction and compare the data with previous literature and conclude that most free flap surgeries do not benefit from nerve coaptation.

  19. The evolution of perforator flap breast reconstruction: twenty years after the first DIEP flap.

    Science.gov (United States)

    Healy, Claragh; Allen, Robert J

    2014-02-01

    It is over 20 years since the inaugural deep inferior epigastric perforator (DIEP) flap breast reconstruction. We review the type of flap utilized and indications in 2,850 microvascular breast reconstruction over the subsequent 20 years in the senior author's practice (Robert J. Allen). Data were extracted from a personal logbook of all microsurgical free flap breast reconstructions performed between August 1992 and August 2012. Indication for surgery; mastectomy pattern in primary reconstruction; flap type, whether unilateral or bilateral; recipient vessels; and adjunctive procedures were recorded. The DIEP was the most commonly performed flap (66%), followed by the superior gluteal artery perforator flap (12%), superficial inferior epigastric artery perforator flap (9%), inferior gluteal artery perforator flap (6%), profunda artery perforator flap (3%), and transverse upper gracilis flap (3%). Primary reconstruction accounted for 1,430 flaps (50%), secondary 992 (35%), and tertiary 425 (15%). As simultaneous bilateral reconstructions, 59% flaps were performed. With each flap, there typically ensues a period of enthusiasm which translated into surge in flap numbers. However, each flap has its own nuances and characteristics that influence patient and physician choice. Of note, each newly introduced flap, either buttock or thigh, results in a sharp decline in its predecessor. In this practice, the DIEP flap has remained the first choice in autologous breast reconstruction. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  20. Acellular Dermal Matrix in Postmastectomy Breast Reconstruction

    NARCIS (Netherlands)

    A.M.S. Ibrahim (Ahmed)

    2014-01-01

    markdownabstract__Abstract__ Over the last decade the use of acellular dermal matrix (ADM) in reconstructive breast surgery has been transformative. Some authors have gone as far as to suggest that it is the single most important advancement in prosthetic breast reconstruction. ADMs are able

  1. Motion-preserving wrist reconstruction using a microsurgical medial femur condylus bone graft and radio-scapho-lunate (RSL limited fusion after osteomyelitis following open distal radius fracture

    Directory of Open Access Journals (Sweden)

    Steinmann, Claudia

    2015-06-01

    Full Text Available This case presents the microsurgical management in the rare situation after sequestering osteomyelitis of the distal radius to achieve both bony stability and partially preserved wrist motion. A 38-year-old patient underwent after sequestrectomy microsurgical reconstruction using a medial femoral condyle as a prerequisite for simultaneous motion-preserving radio-scapho-lunate (RSL fusion. As a result, 11 months postoperatively, a good functional result was achieved with range of motion of 60° in extension/flexion and 40° in ulnar/radial deviation and grip strength of 12 kg correspondeding to 33% of the dominant contralateral side. Upper extremity usability as measured by Disability of Arm Shoulder and Hand (DASH questionnaire improved from preoperative 24 to after the reconstruction and enabled the patient to resume his work without pain.

  2. Breast reconstruction: current and future options

    Directory of Open Access Journals (Sweden)

    Paul Jr H

    2011-08-01

    Full Text Available Henry Paul Jr1, Tahira I Prendergast2, Bryson Nicholson2, Shenita White2, Wayne AI Frederick2,31Departments of Plastic Surgery, 2General Surgery, Howard University Hospital, 3Cancer Center, Howard University, Washington, DC, USAAbstract: When initiated by the devastating diagnosis of cancer, post ablative breast restoration has at its core the goal of restoring anatomic normalcy. The concepts of body image, wholeness, and overall well-being have been introduced to explain the paramount psychological influence the breast has on both individuals and society as a whole. Hence, a growing subspecialty has been established to recreate or simulate the lost breast. At least one third of breast cancer victims consider breast reconstruction. Breast reconstruction post mastectomy may be offered at the time of mastectomy or delayed post mastectomy after adjuvant therapy. This may be utilizing autologous tissues or implants and each has risks and benefits, especially when considering adjuvant therapy. In addition, there has been a move away from a traditional mastectomy to less invasive, but still curative procedures, such as skin-sparing and nipple-sparing mastectomy. These procedures provide the breast envelope to facilitate reconstruction. This paper reviews the primary issues in breast reconstruction, as well as their psychologic, oncologic, and social impact.Keywords: breast restoration, body image, breast reconstruction, mastectomy

  3. Surgical technique: The intercostal space approach to the internal mammary vessels in 463 microvascular breast reconstructions.

    Science.gov (United States)

    Darcy, Catharine M; Smit, Jeroen M; Audolfsson, Thorir; Acosta, Rafael

    2011-01-01

    The internal mammary vessels are one of the most frequently used recipient sites for microsurgical free-flap breast reconstruction, and an accepted technique to expose these vessels involves removal of a segment of costal cartilage of the rib. However, in some patients, cartilage removal may result in a visible medial chest-wall depression that requires corrective procedures. We, therefore, use an intercostal space approach to the internal mammary vessels, as there is minimal disturbance of the costal cartilage with this technique. We have developed and performed our technique over an 8-year period in 463 microvascular breast reconstructions, and present it here as it contains modifications not previously described that may be of interest to other surgeons. There was no serious morbidity associated with the intercostal space approach, the internal mammary vessels were reliably and safely exposed in all these cases and the flap success rate was 95.8%. Copyright © 2010. Published by Elsevier Ltd.

  4. Mastectomy and breast reconstruction - what to ask your doctor

    Science.gov (United States)

    Mastectomy - what to ask your doctor; Breast reconstruction - what to ask your doctor; TRAM flap - what to ... your doctor; What to ask your doctor about mastectomy and breast reconstruction; Breast cancer - mastectomy - what to ...

  5. Prosthetic breast reconstruction: indications and update

    Science.gov (United States)

    Quinn, Tam T.; Miller, George S.; Rostek, Marie; Cabalag, Miguel S.; Rozen, Warren M.

    2016-01-01

    Background Despite 82% of patients reporting psychosocial improvement following breast reconstruction, only 33% patients choose to undergo surgery. Implant reconstruction outnumbers autologous reconstruction in many centres. Methods A systematic review of the literature was undertaken. Inclusion required: (I) Meta-analyses or review articles; (II) adult patients aged 18 years or over undergoing alloplastic breast reconstruction; (III) studies including outcome measures; (IV) case series with more than 10 patients; (V) English language; and (VI) publication after 1st January, 2000. Results After full text review, analysis and data extraction was conducted for a total of 63 articles. Definitive reconstruction with an implant can be immediate or delayed. Older patients have similar or even lower complication rates to younger patients. Complications include capsular contracture, hematoma and infection. Obesity, smoking, large breasts, diabetes and higher grade tumors are associated with increased risk of wound problems and reconstructive failure. Silicone implant patients have higher capsular contracture rates but have higher physical and psychosocial function. There were no associations made between silicone implants and cancer or systemic disease. There were no differences in outcomes or complications between round and shaped implants. Textured implants have a lower risk of capsular contracture than smooth implants. Smooth implants are more likely to be displaced as well as having higher rates of infection. Immediate breast reconstruction (IBR) gives the best aesthetic outcome if radiotherapy is not required but has a higher rate of capsular contracture and implant failure. Delayed-immediate reconstruction patients can achieve similar aesthetic results to IBR whilst preserving the breast skin if radiotherapy is required. Delayed breast reconstruction (DBR) patients have fewer complications than IBR patients. Conclusions Implant reconstruction is a safe and popular

  6. Autologous Fat Grafting for Whole Breast Reconstruction

    Directory of Open Access Journals (Sweden)

    Benjamin H. L. Howes, MBBS

    2014-03-01

    Full Text Available Summary: This is the first reported case of a patient who had a single-stage large-volume breast reconstruction with autologous fat grafting, following rotation flap approach (RoFA mastectomy. The purpose of this case study was to evaluate the viability of reconstruction of the breast by autologous fat grafting alone, in the context of RoFA mastectomy. The hypothesis was that there would be minimal interval loss of autologous fat on the whole breast reconstruction side. Right RoFA mastectomy was used for resection of an invasive primary breast cancer and resulted in the right breast skin envelope. Eleven months later, the patient underwent grafting of 400 ml of autologous fat into the skin envelope and underlying pectoralis major muscle. Outcome was assessed by using a validated 3D laser scan technique for quantitative breast volume measurement. Other outcome measures included the BREAST-Q questionnaire and 2D clinical photography. At 12-month follow-up, the patient was observed to have maintenance of volume of the reconstructed breast. Her BREAST-Q scores were markedly improved compared with before fat grafting, and there was observable improvement in shape, contour, and symmetry on 2D clinical photography. The 2 new techniques, RoFA mastectomy and large-volume single-stage autologous fat grafting, were used in combination to achieve a satisfactory postmastectomy breast reconstruction. Novel tools for measurement of outcome were the 3D whole-body laser scanner and BREAST-Q questionnaire. This case demonstrates the potential for the use of fat grafting for reconstruction. Outcomes in a larger patient populations are needed to confirm these findings.

  7. Breast reconstruction: Correlation between different procedures, reconstruction timing and complications

    Directory of Open Access Journals (Sweden)

    Anđelkov Katarina

    2011-01-01

    Full Text Available Introduction. Improved psychophysical condition after breast reconstruction in women has been well documented Objective. To determine the most optimal technique with minimal morbidity, the authors examined their results and complications based on reconstruction timing (immediate and delayed reconstruction and three reconstruction methods: TRAM flap, latissimus dorsi flap and reconstruction with tissue expanders and implants. Methods. Reconstruction was performed in 60 women of mean age 51.1 years. We analyzed risk factors: age, body mass index (BMI, smoking history and radiation therapy in correlation with timing and method of reconstruction. Complications of all three methods of reconstruction were under 1.5-2-year follow-up after the reconstruction. All data were statistically analyzed. Results. Only radiation had significant influence on the occurrence of complications both before and after the reconstruction, while age, smoking and BMI had no considerable influence of the development of complications. There were no statistically significant correlation between the incidence of complications, time and method of reconstruction. Conclusion. Any of the aforementioned breast reconstruction techniques can yield good results and a low rate of re-operations. To choose the best method, the patient needs to be as well informed as possible about the options including the risks and benefits of each method.

  8. What Is the Ideal Free Flap for Soft Tissue Reconstruction? A Ten-Year Experience of Microsurgical Reconstruction Using 334 Latissimus Dorsi Flaps From a Universal Donor Site.

    Science.gov (United States)

    Kim, Jeong Tae; Kim, Sang Wha; Youn, Seungki; Kim, Youn Hwan

    2015-07-01

    Microsurgical free tissue transfer is regarded as the best available method of tissue reconstruction for intractable defects. The ideal soft tissue flap is thought to be the anterolateral thigh flap. On the basis of 334 procedures involving the latissimus dorsi (LD) flap, we discuss the advantages of the LD flap over the current universal option, and we aimed to establish whether the LD could also gain universal status in all reconstructive fields.Three hundred thirty-four reconstructive procedures using the LD flap were performed in 322 patients between September 2002 and July 2012. In accordance with defect characteristics, we performed 334 procedures using flaps, which included the LD muscle flap with skin graft, the myocutaneous flap, the muscle-sparing flap, the perforator flap, the chimeric flap, and the 2-flap technique using the serratus anterior branch.Flap-related complications occurred in 21 patients (6.3%), including total and partial flap failure. In 253 cases, the donor site was closed primarily, and in the remaining cases, we used split-thickness skin grafts. Donor-site complications occurred in 20 cases (6%). In 11 of the 182 cases, no suitable perforators were identified during surgery.The advantages of the LD as a donor site include the possibility of various harvesting positions without position change, versatility of components, availability of muscle to fill extensive defects, and presence of thick fascia to enable full abdominal reconstruction. On the basis of our experience, we concluded that this flap has the potential to be used as widely as, or in preference to, the anterolateral thigh flap in most reconstructive areas.

  9. Thermal injury in TAPIA breast reconstruction

    DEFF Research Database (Denmark)

    Børsen-Koch, Mikkel; Gunnarsson, Gudjon L.; Sørensen, Jens Ahm

    2017-01-01

    This paper presents two case reports on thermal injury to a breast reconstructed by the TAPIA method. In both cases the injuries were caused by excessive sun exposure. Thermal injury to flaps used in breast reconstruction has previously been described but most commonly in abdominal flaps, which may...... be due to the relative high frequency of this type of reconstructions. Reports of thermal injury to reconstructions using the Latissimus Dorsi flap are rare. The injuries previously described are most often caused by severe heat exposure. The thoracodorsal artery perforator (TAP)-flap can be used...

  10. Alternative venous outflow vessels in microvascular breast reconstruction.

    Science.gov (United States)

    Mehrara, Babak J; Santoro, Timothy; Smith, Andrew; Arcilla, Eric A; Watson, James P; Shaw, William W; Da Lio, Andrew L

    2003-08-01

    The lack of adequate recipient vessels often complicates microvascular breast reconstruction in patients who have previously undergone mastectomy and irradiation. In addition, significant size mismatch, particularly in the outflow veins, is an important contributor to vessel thrombosis and flap failure. The purpose of this study was to review the authors' experience with alternative venous outflow vessels for microvascular breast reconstruction. In a retrospective analysis of 1278 microvascular breast reconstructions performed over a 10-year period, the authors identified all patients in whom the external jugular or cephalic veins were used as the outflow vessels. Patient demographics, flap choice, the reasons for the use of alternative venous drainage vessels, and the incidence of microsurgical complications were analyzed. The external jugular was used in 23 flaps performed in procedures with 22 patients. The superior gluteal and transverse rectus abdominis musculocutaneous (TRAM) flaps were used in the majority of the cases in which the external jugular vein was used (72 percent gluteal, 20 percent TRAM flap). The need for alternative venous outflow vessels was usually due to a significant vessel size mismatch between the superior gluteal and internal mammary veins (74 percent). For three of the external jugular vein flaps (13 percent), the vein was used for salvage after the primary draining vein thrombosed, and two of three flaps in these cases were eventually salvaged. In three patients, the external jugular vein thrombosed, resulting in two flap losses, while the third was salvaged using the cephalic vein. A total of two flaps were lost in the external jugular vein group. The cephalic vein was used in 11 flaps (TRAM, 64.3 percent; superior gluteal, 35.7 percent) performed in 11 patients. In five patients (54.5 percent), the cephalic vein was used to salvage a flap after the primary draining vein thrombosed; the procedure was successful in four cases. In three

  11. Recurrent phyllodes tumor of the breast: defining the role for skin-sparing mastectomy and autologous reconstruction.

    Science.gov (United States)

    Atalla, Mohamed Anwar; Rozen, Warren Matthew; Grinsell, Damien; Hyett, Anthony; Prakash, Saurabh; Cham, Alvin

    2011-05-01

    Phyllodes tumors (PTs) are uncommon fibroepithelial tumors of the breast, noteworthy for their difficult excisions and high recurrence rates. In the setting of recurrence, there is no consensus in the literature as to the extent of excision or the impact on reconstructive options. Breast-conserving surgery and simple mastectomy have each been described with mixed reports. Despite a shift toward the selective use of skin-sparing mastectomy and nipple-areola complex-sparing mastectomy in breast carcinoma, neither the role for these techniques nor the role for breast reconstruction in recurrent PT has been described. A case report is presented demonstrating the utility of skin-sparing mastectomy and autologous breast reconstruction for locally recurrent PT of the breast, with a literature review of management options in this setting presented. The case presented highlights an appropriate setting for autologous microsurgical reconstruction of the breast in recurrent PT. The literature review highlights a lack of any published management consensus, with only the role for mastectomy suggested for recurrent high-grade or malignant lesions. A potential management algorithm is thus presented. Skin-sparing mastectomy, particularly for intermediate-grade lesions, may allow wider resections while enabling aesthetically pleasing reconstructive options without affecting recurrence rates.

  12. Biomechanange ical chof lumbar unilateral graded facetectomy and strategies of its microsurgical reconstruction: report of 23 cases

    Institute of Scientific and Technical Information of China (English)

    Zhou Yue; Luo Gang; Chu Tongwei; Wang Jian; Li Changqing; Zheng Wenjie; Zhang Zhengfeng; Hao Yong; Zhang Chao

    2008-01-01

    for microsurgical reconstruction, though the indications of the procedure should be carefully restricted.

  13. Breast Augmentation and Breast Reconstruction Demonstrate Equivalent Aesthetic Outcomes

    Science.gov (United States)

    Davis, Christopher R.; Nguyen, Dung H.

    2016-01-01

    Background: There is a perception that cosmetic breast surgery has more favorable aesthetic outcomes than reconstructive breast surgery. We tested this hypothesis by comparing aesthetic outcomes after breast augmentation and reconstruction. Methods: Postoperative images of 10 patients (cosmetic, n = 4; reconstructive, n = 6; mean follow-up, 27 months) were presented anonymously to participants who were blinded to clinical details. Participants were asked if they believed cosmetic or reconstructive surgery had been performed. Aesthetic outcome measures were quantified: (1) natural appearance, (2) size, (3) contour, (4) symmetry, (5) position of breasts, (6) position of nipples, (7) scars (1 = poor and 4 = excellent). Images were ranked from 1 (most aesthetic) to 10 (least aesthetic). Analyses included two-tailed t tests, Mann–Whitney U tests, and χ2 tests. Results: One thousand eighty-five images were quantified from 110 surveys (99% response rate). The accuracy of identifying cosmetic or reconstructive surgery was 55% and 59%, respectively (P = 0.18). Significantly more of the top 3 aesthetic cases were reconstructive (51% vs 49%; P = 0.03). Despite this, cases perceived to be reconstructive were ranked significantly lower (5.9 vs 5.0; P 0.05), with the exception of breast position that improved after reconstruction (2.9 vs 2.7; P = 0.009) and scars that were more favorable after augmentation (2.9 vs 3.1; P reconstructive breast surgery are broadly equivalent, though preconceptions influence aesthetic opinion. Plastic surgeons' mutually inclusive–reconstructive and aesthetic skill set maximizes aesthetic outcomes. PMID:27536490

  14. Contralateral breast symmetrisation in unilateral DIEP flap breast reconstruction.

    Science.gov (United States)

    Wade, Ryckie G; Marongiu, Francesco; Sassoon, Elaine M; Haywood, Richard M; Ali, Rozina S; Figus, Andrea

    2016-10-01

    Women undergoing unilateral deep inferior epigastric artery perforator (DIEP) flap breast reconstruction may be offered a contralateral symmetrisation either at the time of reconstruction (simultaneous/immediate) or at a later stage (delayed). Simultaneous contralateral breast symmetrisation may be more beneficial to patients and healthcare institutions by avoiding staged surgery, although there is limited evidence on which to base practice. This deficit formed the rationale for our study. The primary outcome was the overall rate of revision surgery. Over a 6-year period, this prospective cohort study recorded the demographics, cancer treatments and operative outcomes of all consecutive unilateral DIEP flap breast reconstructions with or without contralateral symmetrising surgery. Patients were categorised into three groups: (1) simultaneous symmetrisation, 2) delayed symmetrisation and (3) no symmetrisation for comparative analysis. During the study period, 371 women underwent unilateral DIEP flap breast reconstruction 194 (52.3%) were not symmetrised, 155 (41.8%) were simultaneously symmetrised and 22 (5.9%) underwent delayed symmetrisation. Simultaneous symmetrisation of the contralateral breast and unilateral DIEP flap breast reconstruction increased the mean total operative time by 28 min. There were no differences in the rates of peri-operative complications. There were significantly higher rates of all-cause revision surgery (OR 3.97 [1.58, 9.94], p = 0.003) in women undergoing delayed symmetrisation, because of higher rates of revision lipomodelling, scar revision and revision contralateral symmetrisation. Simultaneous contralateral breast symmetrisation was associated with a lower risk of all-cause revision surgery. It is safe, beneficial and likely to be more cost-effective for women undergoing unilateral free DIEP flap breast reconstruction. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier

  15. Breast reconstruction after mastectomy at a comprehensive cancer center

    OpenAIRE

    Connors, Shahnjayla K.; Goodman, Melody S.; Myckatyn, Terence; Margenthaler, Julie; Gehlert, Sarah

    2016-01-01

    Background Breast reconstruction after mastectomy is an integral part of breast cancer treatment that positively impacts quality of life in breast cancer survivors. Although breast reconstruction rates have increased over time, African American women remain less likely to receive breast reconstruction compared to Caucasian women. National Cancer Institute-designated Comprehensive Cancer Centers, specialized institutions with more standardized models of cancer treatment, report higher breast r...

  16. CAD/CAM-assisted breast reconstruction

    Energy Technology Data Exchange (ETDEWEB)

    Melchels, Ferry; Hutmacher, Dietmar Werner [Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD 4059 (Australia); Wiggenhauser, Paul Severin; Schantz, Jan-Thorsten [Department of Plastic and Hand Surgery, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich (Germany); Warne, David; Barry, Mark [High Performance Computing and Research Support, Queensland University of Technology, Gardens Point Road, Brisbane, QLD 4000 (Australia); Ong, Fook Rhu; Chong, Woon Shin, E-mail: Dietmar.Hutmacher@qut.edu.au, E-mail: jtschantz@lrz.tu-muenchen.de [Singapore Polytechnic, 500 Dover Road, 139651 Singapore (Singapore)

    2011-09-15

    The application of computer-aided design and manufacturing (CAD/CAM) techniques in the clinic is growing slowly but steadily. The ability to build patient-specific models based on medical imaging data offers major potential. In this work we report on the feasibility of employing laser scanning with CAD/CAM techniques to aid in breast reconstruction. A patient was imaged with laser scanning, an economical and facile method for creating an accurate digital representation of the breasts and surrounding tissues. The obtained model was used to fabricate a customized mould that was employed as an intra-operative aid for the surgeon performing autologous tissue reconstruction of the breast removed due to cancer. Furthermore, a solid breast model was derived from the imaged data and digitally processed for the fabrication of customized scaffolds for breast tissue engineering. To this end, a novel generic algorithm for creating porosity within a solid model was developed, using a finite element model as intermediate.

  17. Microsurgical techniques for the treatment of breast cancer-related lymphedema: a systematic review

    NARCIS (Netherlands)

    Penha, T.R.; Ijsbrandy, C.; Hendrix, N.A.; Heuts, E.M.; Voogd, A.C.; Meyenfeldt, M.F. von; Hulst, R.R. van der

    2013-01-01

    BACKGROUND: Upper limb lymphedema is one of the most underestimated and debilitating complications of breast cancer treatment. The aim of this review is to summarize the recent literature for evidence of the effectiveness of lymphatic microsurgery for the treatment of breast cancer-related lymphedem

  18. Microsurgical techniques for the treatment of breast cancer-related lymphedema: a systematic review

    NARCIS (Netherlands)

    Penha, T.R.; Ijsbrandy, C.; Hendrix, N.A.; Heuts, E.M.; Voogd, A.C.; Meyenfeldt, M.F. von; Hulst, R.R. van der

    2013-01-01

    BACKGROUND: Upper limb lymphedema is one of the most underestimated and debilitating complications of breast cancer treatment. The aim of this review is to summarize the recent literature for evidence of the effectiveness of lymphatic microsurgery for the treatment of breast cancer-related

  19. Advances and surgical decision‐making for breast reconstruction

    National Research Council Canada - National Science Library

    Kronowitz, Steven J; Kuerer, Henry M

    2006-01-01

    ...‐making for breast reconstruction after mastectomy include the breast cancer stage, status of axillary sentinel lymph node, smoking status, body habitus, preexisting scars, prior radiation therapy...

  20. Delayed breast reconstruction with implants after invasive breast cancer does not impair prognosis

    DEFF Research Database (Denmark)

    Hölmich, Lisbet Rosenkrantz; Düring, Maria; Henriksen, Trine Foged;

    2008-01-01

    We investigated if delayed breast implant reconstruction after breast cancer impairs prognosis. Using data from the Danish Breast Cancer Cooperative Group register, we identified all women......We investigated if delayed breast implant reconstruction after breast cancer impairs prognosis. Using data from the Danish Breast Cancer Cooperative Group register, we identified all women...

  1. Total endoscopic free flap harvest of a serratus anterior fascia flap for microsurgical lower leg reconstruction

    Directory of Open Access Journals (Sweden)

    Erdmann, Alfons

    2014-04-01

    Full Text Available [english] Background: A tremendous number of free flaps have been developed in the past. As the surgical result depends not only on a successful flap transfer but also on the harvest, this paper details the procedures for undertaking the first total endoscopic harvest of a serratus fascia flap for free flap transplantation to the lower leg. Patient and methods: In September 2012 we performed the first total endoscopic serratus anterior fascia free flap harvest. The incision of 2.5 cm length was made 10 cm in front of anterior muscle border of the latissimus dorsi at level with the midthorax. After insertion of a flexible laparoscopic single port system we started CO gas insufflation. We used this setting to meticulously prepare a neo cavity between atissimus dorsi and M. serratus anterior. The vessels were dissected and the thoraco-dorsal nerve was separated. With a second auxiliary incision we used a clamp to support the raising of the fascia flap from the underlying muscle. Finally we clipped the vessels to the latissimus dorsi muscle and the flap vessels at the Arteria and Vena axillaris. The flap was extracted via the 2.5 cm incision.Results: We were able to perform a total endoscopic harvest of a serratus fascia flap for free flap reconstruction of soft tissues. With this new operative technique we were able to avoid a long skin incision, which in our view lowers the morbidity at the harvest area.Conclusion: We describe a new method for the total endoscopic harvest of the serratus fascia flap for free flap transfer. The flap was harvested within reasonable time and following surgery leaves the patient with minimal donor site morbidity compared to the open technique.

  2. Does the use of arteriovenous loops increase complications rates in posttraumatic microsurgical lower extremity reconstruction?-A matched-pair analysis.

    Science.gov (United States)

    Momeni, Arash; Lanni, Michael A; Levin, Lawrence S; Kovach, Stephen J

    2017-06-28

    The use of arteriovenous (AV) loops in microsurgical lower extremity reconstruction is a controversial topic. The objective of the present study was to assess the impact of AV loops on complication rates following microsurgical reconstruction of posttraumatic lower extremity defects. Patients who underwent free flap coverage of posttraumatic defects in combination with an AV loop (Group 1) were identified and matched for age, body mass index (BMI), tobacco use, defect location, and flap type with patients who underwent reconstruction without vein grafts (Group 2). Outcomes of interest included complication rate and flap loss rate. Groups 1 and 2 consisted of 10 patients each with a mean age of 51 years (range, 21-79 years) and 47.3 years (range, 22-69 years), respectively (P = 0.596). No differences were noted regarding flap loss (P = 1.0), intraoperative (P = 0.474) or postoperative complication rate [surgical site infection (P = 1.0), bleeding (P = 1.0), delayed wound healing (P = 0.23), dehiscence (P = 0.58), and osseous non-union (P = 1.0)]. Only one flap loss was noted in Group 1. The only differences were increased operative time (P = 0.03) and increased length of stay (P = 0.009) in Group 1. Our results suggest that utilization of vein grafts with creation of AV loops followed by single-stage division and free flap transfer for reconstruction of posttraumatic lower extremity defects achieve reconstructive outcomes similar to those obtained in patients in whom no vein grafts are necessary. © 2017 Wiley Periodicals, Inc.

  3. Breast Reconstruction for Premalignant and Malignant Disease—An Update

    OpenAIRE

    Apfelberg, David B.; Maldowney, Bart; Laub, Donald R.; Maser, Morton R.; Lash, Harvey

    1981-01-01

    New concepts in the control of breast cancer and improvements in plastic surgery techniques have facilitated subsequent breast reconstruction. In a six-year period 72 breast reconstructions were carried out in 57 women after surgical treatment for premalignant or malignant breast disease and, in some cases, radiation therapy. The average age of the patients was 48 years and the average interval between the primary cancer operation and breast reconstruction was 42 months. Our experience in the...

  4. Changes in psychosocial functioning 1 year after mastectomy alone, delayed breast reconstruction, or immediate breast reconstruction.

    Science.gov (United States)

    Metcalfe, Kelly A; Semple, John; Quan, May-Lynn; Vadaparampil, Susan T; Holloway, Claire; Brown, Mitch; Bower, Bethanne; Sun, Ping; Narod, Steven A

    2012-01-01

    In this study, we report on the changes in psychosocial functioning over 1 year following breast cancer surgery in 3 groups of women, including those with mastectomy alone, those with mastectomy and immediate reconstruction, and those with delayed reconstruction. Women with breast cancer at 2 teaching hospitals in Ontario who were undergoing mastectomy alone, mastectomy with immediate reconstruction, or delayed reconstruction were asked to complete a battery of psychosocial questionnaires at their preoperative appointment and 1 year following surgery. A total of 190 women consented to participate in the study and completed the presurgical questionnaires. There were no presurgical differences between the 3 groups in quality of life, anxiety, depression, or sexual functioning. However, women who were undergoing delayed breast reconstruction (i.e., already had a mastectomy) had higher levels of body stigma (P = 0.01), body concerns (P = 0.002), and transparency (P = 0.002) than women who were undergoing mastectomy alone or mastectomy with immediate reconstruction. Of these women, 158 (83.2%) completed the 1-year follow-up. There were no significant differences in any of the psychosocial functioning scores between the 3 groups. Contrary to the assumed psychological benefits of breast reconstruction, psychological distress was evident among women regardless of reconstruction or timing of reconstruction. Further, psychosocial functioning (including quality of life, sexual functioning, cancer-related distress, body image, depression, and anxiety) was not different at 1-year postsurgery between women with mastectomy alone, mastectomy with immediate reconstruction, and delayed reconstruction. These results suggest that women need psychosocial support after breast cancer diagnosis, even if they have breast reconstruction.

  5. Reliability of Reconstructed Breast Flap after Chemotherapy and Radiotherapy in Immediate Breast Reconstruction

    Directory of Open Access Journals (Sweden)

    Keun-Cheol Lee

    2012-09-01

    Full Text Available BackgroundPostmastectomy adjuvant therapy is used to prevent locoregional recurrence and improve overall breast cancer specific survival rates. However, it can adversely affect the cosmetic results of reconstruction. Therefore, the authors examined flap stability and patients' satisfaction with immediate breast reconstruction after adjuvant therapy.MethodsWe retrospectively reviewed the medical records of 204 patients from January 2006 to November 2011. For complication rates, the authors categorized the patients who underwent the immediate breast reconstruction into 4 groups: adjuvant chemotherapy and radiotherapy group, adjuvant chemotherapy only group, adjuvant radiotherapy only group, and the group that did not undergo adjuvant therapy. For comparison of patients' satisfaction, the study was performed with an additional 16 patients who had undergone delayed breast reconstruction.ResultsRegarding complication rates, the group that had undergone adjuvant therapy showed no significant difference compared to the group that did not undergo adjuvant therapy. In evaluating the patients' satisfaction, there was no significant difference.ConclusionsEven after adjuvant therapy, immediate breast reconstruction showed good results with respect to flap stability and patients' satisfaction. Immediate breast reconstruction and adjuvant therapy is a safe and useful option for breast cancer patients.

  6. Analysis of the Effects of Breast Reconstruction in Breast Cancer Patients Receiving Radiotherapy after Mastectomy

    OpenAIRE

    Seong Hwan Kim; Jeong Min Kim; Sun Hyung Park; Sam Yong Lee

    2012-01-01

    Background Immediate breast reconstruction after mastectomy and delayed breast reconstruction with post-supplementary treatment are the two types of breast reconstruction currently performed when treating breast cancer. Post-mastectomy radiation therapy (PMRT) not only reduces local recurrence but also improves overall survival. However, the complications and survival rates associated with PMRT need to be clear when determining the timing of breast reconstruction. Accordingly, we investigated...

  7. Reliability of Reconstructed Breast Flap after Chemotherapy and Radiotherapy in Immediate Breast Reconstruction

    Directory of Open Access Journals (Sweden)

    Keun-Cheol Lee

    2012-09-01

    Full Text Available Background Postmastectomy adjuvant therapy is used to prevent locoregional recurrenceand improve overall breast cancer specific survival rates. However, it can adversely affectthe cosmetic results of reconstruction. Therefore, the authors examined flap stability andpatients’ satisfaction with immediate breast reconstruction after adjuvant therapy.Methods We retrospectively reviewed the medical records of 204 patients from January2006 to November 2011. For complication rates, the authors categorized the patients whounderwent the immediate breast reconstruction into 4 groups: adjuvant chemotherapyand radiotherapy group, adjuvant chemotherapy only group, adjuvant radiotherapy onlygroup, and the group that did not undergo adjuvant therapy. For comparison of patients’satisfaction, the study was performed with an additional 16 patients who had undergonedelayed breast reconstruction.Results Regarding complication rates, the group that had undergone adjuvant therapyshowed no significant difference compared to the group that did not undergo adjuvanttherapy. In evaluating the patients’ satisfaction, there was no significant difference.Conclusions Even after adjuvant therapy, immediate breast reconstruction showed goodresults with respect to flap stability and patients’ satisfaction. Immediate breast reconstructionand adjuvant therapy is a safe and useful option for breast cancer patients.

  8. Interactive digital education aid in breast reconstruction.

    Science.gov (United States)

    Heller, Lior; Parker, Patricia A; Youssef, Adel; Miller, Michael J

    2008-09-01

    An interactive digital education aid for breast reconstruction patients was developed because of a perceived need to provide patients with more education regarding the treatment so that they can make better informed treatment decisions. A prospective randomized study was conducted to assess its effectiveness. Breast cancer patients who were candidates for breast reconstruction were recruited and randomized into a control group and a study group. Both groups received routine assessment and education in the plastic surgery clinic, but the study group also watched the interactive digital education aid. Questionnaires assessing knowledge, anxiety, and satisfaction were administered (1) before the initial plastic surgery consultation, (2) immediately before surgery, and (3) 1 month after surgery. A total of 133 women participated, 66 in the control group and 67 in the study group. Women in both groups showed decreased anxiety, increased knowledge, and enhanced satisfaction with their decision-making ability associated with preoperative instructions about reconstructive surgery. However, the study group was significantly more satisfied than the control group with the method of receiving information and showed a less steep learning curve regarding the different techniques of breast reconstruction. They also tended to have a reduced mean level of anxiety and increased satisfaction with the treatment choice compared with the control group. An interactive digital education aid is a beneficial educational adjunct for patients contemplating breast reconstruction. Patients who use an interactive digital education aid demonstrate greater factual knowledge, reduced anxiety, and increased postoperative satisfaction compared with patients given preoperative instructions using standard methods alone. The benefit of an interactive digital education aid is expected to be higher in a broad-based practice setting outside of a comprehensive cancer center.

  9. Esthetic and functional reconstruction of the posttumoral interrupted mandible with double-barrel fibular free flap graft: rationale for a microsurgical and prosthodontic approach.

    Science.gov (United States)

    Paranque, Armand-Régis; Steve, Marc; Vazquez, Lydia; Bolleyn, Alain; Roze-Pellat, Marie-Andrée; Dohan Ehrenfest, David M

    2011-10-01

    Reconstruction after substantial osseous, cutaneous, and muscular tissue loss following a mandibular resection is a challenge. The use of a fibular free flap is an outstanding, but delicate, treatment option. These grafts, using the double-barrel technique, can achieve an almost complete reconstruction of the mandibular defect. The challenge posed by these treatments is to achieve an end result that is both functional and esthetically pleasing-an endeavor that requires a defined prosthetic plan prior to complete microsurgical reconstruction. Using a detailed clinical case, this article discusses the importance of planning the mandible reconstruction with double-barrel fibular graft in view of an implant-supported fixed partial denture. Immediate implant loading was even possible in this case. This approach allows improvement of the final esthetic and functional result of such a complex rehabilitation. Maxillofacial reconstructive surgery should seek to establish a near-as-normal anatomic situation that will allow a permanent implant rehabilitation that is both esthetic and durable.

  10. Immediate breast reconstruction using the free lumbar artery perforator flap and lateral thoracic vein interposition graft for recipient lateral thoracic artery anastomosis

    Directory of Open Access Journals (Sweden)

    Toshihiko Satake

    2016-01-01

    Full Text Available The lumbar artery perforator (LAP flap, which contains excess skin and fat tissue, love handles, that extends from the lower back to upper buttock, may provide an alternate tissue source for autologous breast reconstruction. However, LAP flap use during this procedure frequently requires vessel interposition grafts to correct the short flap pedicle length and mismatched recipient vessel calibre. A 46-year-old patient underwent a right nipple-sparing mastectomy using a lateral approach for ductal carcinoma in situ and immediate LAP flap breast reconstruction. The lateral thoracic vessel served as the recipient vessel, and a lateral thoracic vein interposition graft from the distal remnant was performed to adjust the arterial length and size discrepancy between the recipient lateral thoracic artery and pedicle artery. This procedure facilitates microsurgical anastomosis and medialisation of LAP flap to make a natural decollete line and create a cleavage for the reconstructed breast.

  11. Socioeconomic position and breast reconstruction in Danish women

    DEFF Research Database (Denmark)

    Hvilsom, Gitte B; Hölmich, Lisbet R; Frederiksen, Kirsten Skovsgaard

    2011-01-01

    Few studies have been conducted on the socioeconomic position of women undergoing breast reconstruction, and none have been conducted in the Danish population. We investigated the association between educational level and breast reconstruction in a nationwide cohort of Danish women with breast...

  12. The clinical course of immediate breast implant reconstruction after breast cancer

    DEFF Research Database (Denmark)

    Hvilsom, Gitte B.; Friis, Søren; Frederiksen, Kirsten

    2011-01-01

    The number of women suitable for breast conserving treatment as well as immediate reconstruction after breast cancer has been increasing, and studies of complications hereafter are needed.......The number of women suitable for breast conserving treatment as well as immediate reconstruction after breast cancer has been increasing, and studies of complications hereafter are needed....

  13. Quality of life among breast cancer patients undergoing autologous breast reconstruction versus breast conserving therapy.

    Science.gov (United States)

    Dian, D; Schwenn, K; Mylonas, I; Janni, W; Friese, K; Jaenicke, F

    2007-04-01

    Besides the quality of the aesthetic results, the quality of life after surgery is one of the most important criteria when reviewing different operation methods, especially in oncologic diseases. This study was performed to evaluate the difference in the health-related quality of life following breast conserving surgery and autologous breast reconstruction after mastectomy. Hundred and forty-four breast cancer patients were included in this study. Sixty seven patients underwent breast conserving surgery followed by radiotherapy. In 77 patients a mastectomy was performed with immediate or late reconstruction. To evaluate the health-related quality of life we used the SF-36 self-administered questionnaire. A significant difference was found in quality of life in the subscale "physical functioning" showing better results in the breast reconstruction group (P = 0.01). No significant difference was found in the other subscales, but there was a tendency to a better "emotional role" among the breast reconstruction patients. Our study demonstrated that autologous tissue breast reconstruction in breast cancer patients did not affect adversely the health-related quality of life compared to breast conserving therapy when the quality of life is assessed by the standardized questionnaire SF-36. In particular, the physical function is not reported to be significantly influenced negatively by the more extensive surgical therapy.

  14. Lymphatic microsurgical preventing healing approach (LYMPHA) for primary surgical prevention of breast cancer-related lymphedema: over 4 years follow-up.

    Science.gov (United States)

    Boccardo, Francesco; Casabona, Federico; De Cian, Franco; DeCian, Franco; Friedman, Daniele; Murelli, Federica; Puglisi, Maria; Campisi, Corrado C; Molinari, Lidia; Spinaci, Stefano; Dessalvi, Sara; Campisi, Corradino

    2014-09-01

    Breast cancer-related lymphedema (LE) represents an important morbidity that jeopardizes breast cancer patients' quality of life. Different attempts to prevent LE brought about improvements in the incidence of the pathology but LE still represents a frequent occurrence in breast cancer survivors. Over 4 years ago, Lymphatic Microsurgical Preventing Healing Approach (LYMPHA) was proposed and long-term results are reported in this study. From July 2008 to December 2012, 74 patients underwent axillary nodal dissection for breast cancer treatment together with LYMPHA procedure. Volumetry was performed preoperatively in all patients and after 1, 3, 6, 12 months, and once a year. Lymphoscintigraphy was performed in 45 patients preoperatively and in 30 also postoperatively after at least over 1 year. Seventy one patients had no sign of LE, and volumetry was coincident to preoperative condition. In three patients, LE occurred after 8-12 months postoperatively. Lymphoscintigraphy showed the patency of lymphatic-venous anastomoses at 1-4 years after operation. LYMPHA technique represents a successful surgical procedure for primary prevention of arm LE in breast cancer patients.

  15. Breast reconstruction by pedicled transverse rectus abdominis myocutaneous flap

    Directory of Open Access Journals (Sweden)

    Kozarski Jefta

    2004-01-01

    Full Text Available Reconstruction of the amputated breast in female patients after surgical management of breast carcinoma is possible with the use of autologous tissue, synthetic implants, or by combining autologous tissue and synthetic materials. Autologous tissue provides soft and sufficiently elastic tissue which is usable for breast reconstruction and eventually obtains original characteristics of the surrounding tissue on the chest wall. The use of the TRAM flap for breast reconstruction was introduced in 1982 by Hartrampf Scheflan, and Black. The amount of the TRAM flap tissue allows breast reconstruction in the shape most adequate to the remaining breast. The possibilities of using the TRAM flap as pedicled myocutaneous flap or as free TRAM flap make this flap a superior choice for breast reconstruction in comparison with other flaps.

  16. Analysis of the Effects of Breast Reconstruction in Breast Cancer Patients Receiving Radiotherapy after Mastectomy

    Directory of Open Access Journals (Sweden)

    Seong Hwan Kim

    2012-05-01

    Full Text Available BackgroundImmediate breast reconstruction after mastectomy and delayed breast reconstruction with post-supplementary treatment are the two types of breast reconstruction currently performed when treating breast cancer. Post-mastectomy radiation therapy (PMRT not only reduces local recurrence but also improves overall survival. However, the complications and survival rates associated with PMRT need to be clear when determining the timing of breast reconstruction. Accordingly, we investigated the optimal timing of breast reconstruction by observing patients who underwent mastectomy followed by PMRT, based on their overall health and aesthetic satisfaction.MethodsWe retrospectively reviewed 21 patients who underwent breast reconstruction with PMRT between November 2004 and November 2010. We collected data regarding the various methods of mastectomy, and the modality of adjuvant therapy, such as chemotherapy, hormone therapy, and radiotherapy. Telephone interviews were conducted to study the general and aesthetic satisfaction.ResultsPatients who received PMRT after breast reconstruction showed a greater complication rate than those undergoing breast reconstruction after PMRT (P=0.02. Aesthetic satisfaction was significantly higher in the groups undergoing breast reconstruction after PMRT (P=0.03. Patients who underwent breast reconstruction before PMRT developed complications more frequently, but they expressed greater aesthetic satisfaction with the treatment.ConclusionsIt is recommended that the complication rates and aesthetic satisfaction after breast reconstruction be carefully considered when determining the optimal timing for radiotherapy.

  17. Breast reconstruction with the denervated latissimus dorsi musculocutaneous flap.

    Science.gov (United States)

    Szychta, Pawel; Butterworth, Mark; Dixon, Mike; Kulkarni, Dhananjay; Stewart, Ken; Raine, Cameron

    2013-10-01

    To analyze clinical implications of the thoracodorsal nerve division in the latissimus dorsi musculocutaneous flap breast reconstruction. Prospective cohort study was conducted on 29 patients. Breast reconstruction with latissimus dorsi musculocutaneous flap was performed unilaterally in 20 patients or bilaterally in 9 women (38 breasts). Thoracodorsal nerve was divided during reconstruction of 20 breasts (group 1) and was preserved for 18 breasts (group 2). Height, width, projection, area of the covering skin and volume of the reconstructed and healthy breasts were measured on the 3D images of the anterior chest wall, taken 6 weeks and 6 months postoperatively with the Di3D 3D camera. Data regarding tissue consistency, painfulness and animation of the reconstructed breast, symmetry of both breasts and overall satisfaction after the surgery were collected at 6 months. The reconstructed and healthy breasts decreased in volume in group 1 (-45.85 cm(3) ± 48.41 cm(3), p = 0.0004; -29.13 cm(3) ± 14.98 cm(3), p = 0.0009) and in group 2 (-31.5 cm(3) ± 25.35 cm(3), p = 0.0001; -15.4 cm(3) ± 21.96 cm(3), p = 0.0537). There were no differences in decrease in volume between groups 1 and 2 (p > 0.05). Respondents in group 1 in comparison to group 2 showed similar satisfaction of the tissue consistency of the reconstructed breast (p > 0.05) and the level of symmetry between both breasts (p > 0.05), gave lower scores for painfulness (p reconstructed breast (p = 0.0001). We suggest that division of the thoracodorsal nerve during latissimus dorsi musculocutaneous flap breast reconstruction is a useful undertaking to minimize unnatural animation of the reconstructed breast. Copyright © 2013 Elsevier Ltd. All rights reserved.

  18. Cryptogenic stroke following abdominal free flap breast reconstruction surgery

    OpenAIRE

    Huizhuang Xie; Malata, Charles M.

    2014-01-01

    INTRODUCTION: Abdominal free flap breast reconstruction is regarded as the gold standard method of post-mastectomy breast reconstruction by many. It is a major surgery which can be associated with varied systemic complications. To date, there have been no reports of cerebrovascular complications in the literature which examine the possible relation between thromboembolism and patent foramen ovale (PFO) in patients undergoing microvascular breast reconstruction. PRESENTATION OF CASE: A 54-y...

  19. Breast reconstruction with an expander prosthesis following mastectomy does not cause additional persistent pain

    DEFF Research Database (Denmark)

    Klit, Anders; Mejdahl, Mathias Kvist; Gärtner, Rune

    2013-01-01

    Few studies have examined the prevalence of persistent pain after breast reconstruction with an implant after tissue expansion in comparison to mastectomy without breast reconstruction. Our primary objective was to evaluate the prevalence of persistent pain after breast reconstruction...

  20. Immediate Direct-To-Implant Breast Reconstruction Using Anatomical Implants

    Directory of Open Access Journals (Sweden)

    Sung-Eun Kim

    2014-09-01

    Full Text Available BackgroundIn 2012, a new anatomic breast implant of form-stable silicone gel was introduced onto the Korean market. The intended use of this implant is in the area of aesthetic breast surgery, and many reports are promising. Thus far, however, there have been no reports on the use of this implant for breast reconstruction in Korea. We used this breast implant in breast reconstruction surgery and report our early experience.MethodsFrom November 2012 to April 2013, the Natrelle Style 410 form-stable anatomically shaped cohesive silicone gel-filled breast implant was used in 31 breasts of 30 patients for implant breast reconstruction with an acellular dermal matrix. Patients were treated with skin-sparing mastectomies followed by immediate breast reconstruction.ResultsThe mean breast resection volume was 240 mL (range, 83-540 mL. The mean size of the breast implants was 217 mL (range, 125-395 mL. Breast shape outcomes were considered acceptable. Infection and skin thinning occurred in one patient each, and hematoma and seroma did not occur. Three cases of wound dehiscence occurred, one requiring surgical intervention, while the others healed with conservative treatment in one month. Rippling did not occur. So far, complications such as capsular contracture and malrotation of breast implant have not yet arisen.ConclusionsBy using anatomic breast implants in breast reconstruction, we achieved satisfactory results with aesthetics better than those obtained with round breast implants. Therefore, we concluded that the anatomical implant is suitable for breast reconstruction.

  1. Reconstructive surgery in young women with breast cancer.

    Science.gov (United States)

    Marín-Gutzke, Martina; Sánchez-Olaso, Alberto

    2010-09-01

    Recovery of body image after mastectomy is essential for physical and mental quality of life. Partial or total mastectomy deformities can be reversed by reconstructive surgical procedures. Young women with breast cancer have specific characteristics related to the age of onset of the disease, prognosis and reconstructive expectations. Patient individualization is the key to a successful breast reconstruction. Autologous and prosthetic reconstruction are the two main techniques used for breast reconstruction. Each reconstructive technique has its own indications, advantages and limitations. Timing of the surgery is primarily determined by the requirement for adjuvant radiotherapy, so an immediate or a delayed approach can be recommended. In patients in whom the need for adjuvant radiotherapy is in doubt, a delayed-immediate approach is the best to optimize aesthetic and oncologic outcomes. Prophylactic mastectomy is also being indicated in a growing number of patients. In these patients it is important to choose a similar reconstructive procedure on both sides to achieve breast symmetry.

  2. Microsurgical reconstruction of noma-related facial defects with folded free flaps: an overview of 31 cases.

    Science.gov (United States)

    Giessler, Goetz A; Fieger, Alexander; Cornelius, Carl-Peter; Schmidt, Andreas B

    2005-08-01

    Noma is primarily affecting children in underprivileged countries and results in disfiguring facial defects, loss of mandibular movement, and subsequent social disintegration. Plastic surgery in West Africa traditionally uses pedicled flaps. In large, complex, or central facial defects, though, pedicled flaps are apt to be too small or have a significant donor site morbidity. Since 1999, we have been using free microvascular flaps in Nigeria. In 5 Interplast missions, 31 patients (age 5-45 years, median 20 years, female to male ratio 18:13) underwent 31 free flap procedures in Nigeria, 27 of them for primary treatment. The operative time ranged from 3.75-8.75 hours (mean 5.5 hours). An external distractor/fixator to maintain mouth opening was mounted in 13 cases. All anastomoses were done with loupe magnification. Three flaps failed completely, 1 partly, and 4 patients showed minor wound infections. No donor-site complications occurred. Free flaps can be a suitable and safe closure for complex noma defects even in underprivileged circumstances, if patient profile and own microsurgical routine allows it. Patient disfigurement can be less than in pedicled flaps regarding the donor sites.

  3. Male infertility microsurgical training

    Institute of Scientific and Technical Information of China (English)

    Akanksha Mehta; Philip S Li

    2013-01-01

    Microsurgical training is imperative for urologists and clinical andrologists specializing in male infertility.Success in male infertility microsurgery is heavily dependent on the surgeon's microsurgical skills.Laboratory-based practice to enhance microsurgical skills improves the surgeon's confidence,and reduces stress and operating time,benefiting both the patient and the surgeon.This review provides guidelines for setting up a microsurgical laboratory to develop and enhance microsurgical skills using synthetic and animal models.The role of emerging techniques,such as robotic-assisted microsurgery,is also discussed.

  4. Breast reconstruction following conservative mastectomies: predictors of complications and outcomes

    Science.gov (United States)

    Voineskos, Sophocles H.; Frank, Simon G.

    2015-01-01

    Breast reconstruction can be performed using a variety of techniques, most commonly categorized into an alloplastic approach or an autologous tissue method. Both strategies have certain risk factors that influence reconstructive outcomes and complication rates. In alloplastic breast reconstruction, surgical outcomes and complication rates are negatively impacted by radiation, smoking, increased body mass index (BMI), hypertension, and prior breast conserving therapy. Surgical factors such as the type of implant material, undergoing immediate breast reconstruction, and the use of fat grafting can improve patient satisfaction and aesthetic outcomes. In autologous breast reconstruction, radiation, increased BMI, certain previous abdominal surgery, smoking, and delayed reconstruction are associated with higher complication rates. Though a pedicled transverse rectus abdominis myocutaneous (TRAM) flap is the most common type of flap used for autologous breast reconstruction, pedicled TRAMs are more likely to be associated with fat necrosis than a free TRAM or deep inferior epigastric perforator (DIEP) flap. Fat grafting can also be used to improve aesthetic outcomes in autologous reconstruction. This article focuses on factors, both patient and surgical, that are predictors of complications and outcomes in breast reconstruction. PMID:26645003

  5. Thin slice three dimentional (3D reconstruction versus CT 3D reconstruction of human breast cancer

    Directory of Open Access Journals (Sweden)

    Yi Zhang

    2013-01-01

    Full Text Available Background & objectives: With improvement in the early diagnosis of breast cancer, breast conserving therapy (BCT is being increasingly used. Precise preoperative evaluation of the incision margin is, therefore, very important. Utilizing three dimentional (3D images in a preoperative evaluation for breast conserving surgery has considerable significance, but the currently 3D CT scan reconstruction commonly used has problems in accurately displaying breast cancer. Thin slice 3D reconstruction is also widely used now to delineate organs and tissues of breast cancers. This study was aimed to compare 3D CT with thin slice 3D reconstruction in breast cancer patients to find a better technique for accurate evaluation of breast cancer. Methods: A total of 16-slice spiral CT scans and 3D reconstructions were performed on 15 breast cancer patients. All patients had been treated with modified radical mastectomy; 2D and 3D images of breast and tumours were obtained. The specimens were fixed and sliced at 2 mm thickness to obtain serial thin slice images, and reconstructed using 3D DOCTOR software to gain 3D images. Results: Compared with 2D CT images, thin slice images showed more clearly the morphological characteristics of tumour, breast tissues and the margins of different tissues in each slice. After 3D reconstruction, the tumour shapes obtained by the two reconstruction methods were basically the same, but the thin slice 3D reconstruction showed the tumour margins more clearly. Interpretation & conclusions: Compared with 3D CT reconstruction, thin slice 3D reconstruction of breast tumour gave clearer images, which could provide guidance for the observation and application of CT 3D reconstructed images and contribute to the accurate evaluation of tumours using CT imaging technology.

  6. Trismus Secondary Release Surgery and Microsurgical Free Flap Reconstruction After Surgical Treatment of Head and Neck Cancer.

    Science.gov (United States)

    Chang, Yang-Ming; Deek, Nidal Farhan Al; Wei, Fu-Chan

    2016-10-01

    This article addresses trismus following head and neck cancer ablation and free flap reconstruction whether or not radiotherapy has been utilized. The focus is to achieve durable and favorable outcomes and avoid untoward results. To aid surgeons in fulfilling these goals, key factors, including adequate release surgery, optimal free flap selection and reconstruction, long-lasting results, and the untoward outcomes specific to trismus release and reconstruction surgery and how to avoid them have been investigated and discussed based on the authors' experience in this surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Postmastectomy lymphedema: long-term results following microsurgical lymph node transplantation

    National Research Council Canada - National Science Library

    Becker, Corinne; Assouad, Jalal; Riquet, Marc; Hidden, Geneviève

    2006-01-01

    Lymphedema complicating breast cancer treatment remains a challenging problem. The purpose of this study was to analyze the long-term results following microsurgical lymph node (LN) transplantation...

  8. Reconstructive plastic operations in the treatment of patients with breast cancer

    Directory of Open Access Journals (Sweden)

    V. P. Letyagin

    2012-01-01

    Full Text Available The paper considers the efficiency of reconstructive plastic operations in treating patients with breast cancer. It describes the types of the similar operations, such as the application of silicone implants, a latissimus dorsi flap in its combination with the implants, free flaps using microsurgical techniques, tissue expanders, a TRAM flap and its various modifications, and other rarely used implants. The advantages and disadvantages of different reconstructive techniques are described.В.П. Летягин, Т.А. ГригорьеваФГБУ «РОНЦ им. Н.Н. Блохина РАМН», Москва Контакты: Виктор Павлович Летягин levipa@mail.ru

  9. Breast Cancer and Reconstruction: Normative Data for Interpreting the BREAST-Q.

    Science.gov (United States)

    Mundy, Lily R; Homa, Karen; Klassen, Anne F; Pusic, Andrea L; Kerrigan, Carolyn L

    2017-05-01

    The BREAST-Q is a patient-reported outcome instrument used to evaluate outcomes in patients undergoing breast cancer surgery and reconstruction. Normative values for the BREAST-Q breast cancer modules have not been established, limiting data interpretation. Participants were recruited by means of the Army of Women, an online community of women (with and without breast cancer), to complete Mastectomy, Breast Conserving Therapy, and Reconstruction preoperative BREAST-Q scales. Inclusion criteria were women aged 18 years or older without a history of breast surgery or breast cancer. Analysis included descriptive statistics, a linear multivariate regression, and a comparison of the generated normative data to previously published BREAST-Q findings. The BREAST-Q was completed by 1201 women. The mean patient age was 54 ± 13 years, mean body mass index 26 ± 6 kg/m, and 38 percent (n = 455) had a bra cup size of D or greater. Mean ± SD scores for BREAST-Q scales were as follows: Satisfaction with Breasts (58 ± 18), Psychosocial Well-being (71 ± 18), Sexual Well-being (56 ± 18), Physical Well-being-Chest (93 ± 11), and Physical Well-being Abdomen (78 ± 20). Women with a body mass index of 30 kg/m or greater, cup size of D or greater, age younger than 40 years, and annual income less than $40,000 reported lower scores. Comparing normative scores to published data in breast cancer patients, Satisfaction with Breasts scores were higher after autologous reconstruction and lower after mastectomy; Sexual Well-being scores were lower after mastectomy and breast conserving therapy; and Physical Well-being Chest scores were lower after mastectomy, breast conserving therapy, and reconstruction. These are the first published normative scores for the BREAST-Q breast cancer modules and provide a clinical reference point for the interpretation of data.

  10. Clinical outcome and health-related quality-of-life following microsurgical reconstruction in patients with oral and oropharyngeal cancer

    DEFF Research Database (Denmark)

    Al-Hayder, Shems; Elberg, Jens Jørgen; Charabi, Birgitte

    2016-01-01

    CONCLUSION: Radial forearm free flap (RFFF) and fibula free flap (FFF) provide high safety and reliability with low incidence of free flap failure and an acceptable level of complications and health-related quality-of-life (HRQoL). OBJECTIVES: To determine the clinical outcomes and long-term HRQoL.......8%) required re-surgery. Nine patients (47.4%) developed late complications, including mandibular osteoradionecrosis in six cases (31.6%). Most patients obtained acceptable values of global quality-of-life and relatively high scores on the functional scales....... in patients with oral or oropharyngeal cancer following free flap reconstruction. METHODS: A retrospective review of medical records and self-administered HRQoL questionnaires, EORTC QLQ-C30, and -H&N35. All patients who underwent surgery for oral or oropharyngeal cancer followed by primary reconstruction...

  11. Analysis of the Effects of Breast Reconstruction in Breast Cancer Patients Receiving Radiotherapy after Mastectomy

    Directory of Open Access Journals (Sweden)

    Seong Hwan Kim

    2012-05-01

    Full Text Available Background Immediate breast reconstruction after mastectomy and delayed breastreconstruction with post-supplementary treatment are the two types of breast reconstructioncurrently performed when treating breast cancer. Post-mastectomy radiation therapy (PMRTnot only reduces local recurrence but also improves overall survival. However, the complicationsand survival rates associated with PMRT need to be clear when determining the timing ofbreast reconstruction. Accordingly, we investigated the optimal timing of breast reconstructionby observing patients who underwent mastectomy followed by PMRT, based on their overallhealth and aesthetic satisfaction.Methods We retrospectively reviewed 21 patients who underwent breast reconstructionwith PMRT between November 2004 and November 2010. We collected data regarding thevarious methods of mastectomy, and the modality of adjuvant therapy, such as chemotherapy,hormone therapy, and radiotherapy. Telephone interviews were conducted to study the generaland aesthetic satisfaction.Results Patients who received PMRT after breast reconstruction showed a greater complicationrate than those undergoing breast reconstruction after PMRT (P=0.02. Aesthetic satisfactionwas significantly higher in the groups undergoing breast reconstruction after PMRT (P=0.03.Patients who underwent breast reconstruction before PMRT developed complications morefrequently, but they expressed greater aesthetic satisfaction with the treatment.Conclusions It is recommended that the complication rates and aesthetic satisfaction afterbreast reconstruction be carefully considered when determining the optimal timing forradiotherapy.

  12. Factors influencing the decision to pursue immediate breast reconstruction after mastectomy for breast cancer

    NARCIS (Netherlands)

    Weenk, M.; Wunschel, P.; Heine, E.; Strobbe, L.J.A.

    2017-01-01

    BACKGROUND: Immediate breast reconstruction (IBR) after mastectomy has shown to be oncologically safe and to improve quality of life in breast cancer patients. However, most women undergoing mastectomy do not undergo IBR. In this study, we aim to identify breast surgeon-related factors in

  13. Physical activity in women undergoing mastectomy and breast reconstruction

    OpenAIRE

    Sabino Neto, Miguel; Moreira, João Ricardo [UNIFESP; Resende,Vanessa; Ferreira, Lydia Masako

    2012-01-01

    BACKGROUND: Regular physical activity has been recommended for the prevention and treatment of coronary heart disease, diabetes mellitus, and hypertension. Besides being a protective factor against breast cancer, physical activity following the diagnosis of breast cancer has been associated with an improved quality of life and survival. The aim of this study was to assess levels of physical activity in women who had undergone mastectomy without breast reconstruction and in women who had under...

  14. Breast reconstruction after bilateral prophylactic mastectomy in women at high risk for breast cancer.

    Science.gov (United States)

    Eldor, Liron; Spiegel, Aldona

    2009-01-01

    Several studies have shown the effectiveness of bilateral prophylactic mastectomies (BPM) at reducing the risk of developing breast cancer in women by more than 90%. A growing number of women at high risk for breast cancer are electing to undergo prophylactic mastectomy as part of a risk reduction strategy. This unique group of women frequently chooses to undergo reconstructive surgery as a part of their immediate treatment plan. Breast reconstruction after BPM has profound physiological and emotional impact on body image, sexuality, and quality of life. These factors should be taken into consideration and addressed when consulting the patient prior to BPM and reconstructive surgery. The timing of reconstructive surgery, the type of mastectomy performed, the reconstructive modalities available, and the possibility to preserve the nipple-areola complex, should all be discussed with the patient prior to surgery. In this article, we review our experience and the current existing literature on breast reconstruction for high-risk women after BPM.

  15. Microsurgical free flap reconstructions of the head and neck region: Shanghai experience of 34 years and 4640 flaps.

    Science.gov (United States)

    Zhang, C; Sun, J; Zhu, H; Xu, L; Ji, T; He, Y; Yang, W; Hu, Y; Yang, X; Zhang, Z

    2015-06-01

    This study represents the surgical experience of 4481 microvascular free flap cases performed at the authors' institution in China, between 1979 and 2013. Four thousand four hundred and eighty-one patients underwent reconstruction with 4640 flaps: 56% radial forearm flaps, 8% iliac crest flaps, 13% fibula flaps, 10% anterolateral thigh flaps, and other flaps. In the overwhelming majority of cases, the flap transfer was required following tumour resection (97.5%). Three hundred and twenty minor complications (6.9%) occurred. One hundred and eighteen major complications (2.5%) were encountered: 114 cases of failure (2.4%) and four deaths. Among the 118 cases with major complications, 26 - 22.0% - had received radiotherapy; this proportion was higher than the 6.9% in the minor complications group and 8.1% in the non-intervention group. Venous thrombosis was the most common complication at the recipient site and was the main cause of flap failure. When a compromised flap is identified, surgical re-exploration should not be delayed. This study confirms that free flaps are reliable in achieving successful reconstruction in the head and neck region; however this technique requires extensive clinical experience. Owing to the large number of flap options, microsurgeons should always pay attention to the details of the different surgical defects and choose the most appropriate flap.

  16. DIEAP flap for safe definitive autologous breast reconstruction.

    Science.gov (United States)

    Seidenstuecker, Katrin; van Waes, Carl; Munder, Beatrix I; Claes, Karel E Y; Witzel, Christian; Roche, Nathalie; Stillaert, Filip; Mahajan, Ajay L; Andree, Christoph; Blondeel, Phillip N

    2016-04-01

    Breast cancer is the commonest form of cancer in women affecting almost a quarter of a million patients in the US annually. 30 percent of these patients and patients with genetic mutations undergo removal of the breast, as highlighted in a high profile celebrity patient. Although breast reconstruction with free microvascular transfer of a DIEAP flap from the abdomen is an ideal form of reconstruction, there have been misgivings about the complexity and potential complications. This study was aimed at clearing these misunderstandings and establishing the value of this form of breast reconstruction. 1036 DIEAP flap breast reconstructions carried out at the University Hospital, Gent (five year period) and at the Sana Kliniken, Düsseldorf (three year period) were included prospectively. Comorbid factors like chemotherapy, radiotherapy, patient age >65 years, BMI >30 and smoking were recorded. Outcomes were evaluated over a mean follow up of 2 years. Overall complication rate related to the reconstructed breast and donor abdominal area was 6.8 percent. Total flap loss was seen in only 0.8 percent. The mean operating time was less than five hours. Older age, higher BMI, chemotherapy and radiotherapy did not have a significant influence on complication rates, however smoking resulted in significant delay in wound healing in the breast (p = 0.025) and abdominal wounds (p = 0.019). The DIEAP flap is an excellent option for breast reconstruction, with a low level of donor site morbidity and complications. It is an autologous reconstruction that provides a stable long term result. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Current approaches to managing partial breast defects: the role of conservative breast surgery reconstruction.

    Science.gov (United States)

    Munhoz, Alexandre Mendonça; Montag, Eduardo; Filassi, José Roberto; Gemperli, Rolf

    2014-03-01

    Recently breast surgeons can offer patients a variety of treatment and reconstructive alternatives when early breast cancer is diagnosed. In fact, advances in reconstructive techniques have reduced surgical trauma and thus are capable of preserving the breast form as well as quality of life. Depending on a variety of different factors, including stage, tumor size, location, hystological type, but also breast volume, a reconstructive schedule is established. The main techniques are related to volume displacement or replacement procedures including local flaps, latissimus dorsi myocutaneous flap and reduction mammaplasty/ masthopexy. Regardless of the fact that there are is no consensus over the best approach, the criteria are determined by the surgeon's experience and the size of the defect in relation to the size of the remaining breast. Aim of every reconstructive procedure decision should be breast preservation and an adequate aesthetic outcome. Additionally, reconstruction permits wider excision of the tumor, with a superior mean volume of the specimen and potentially reducing the incidence of margin involvement. The objective of this review is to give an overview of reconstructive modalities for conservative breast surgery, based not only on traditional but also on the latest studies regarding the outcome of the main techniques employed. Surgical approaches, as well as conservative treatment options, such as lumpectomy and quadrantectomy, are further discussed. Surgical planning should include the patients' preferences, while chiefly addressing individual reconstructive requirements, and enabling each patient to receive an individual "custom-made" reconstruction.

  18. Cryptogenic stroke following abdominal free flap breast reconstruction surgery

    Directory of Open Access Journals (Sweden)

    Huizhuang Xie

    2014-01-01

    CONCLUSION: Surgeons and cardiologists should be aware of this cerebrovascular complication secondary to PFO following major reconstructive surgery such as microvascular breast reconstruction. It also serves to challenge microvascular surgeons to reconsider routine use of central venous pressure lines in free flap patients who might otherwise have good peripheral vessels for postoperative fluid and antibiotic administration.

  19. A Clinical Anatomic Study of Internal Mammary Perforators as Recipient Vessels for Breast Reconstruction

    Directory of Open Access Journals (Sweden)

    In-Soo Baek

    2013-11-01

    Full Text Available BackgroundPartially resecting ribs of the recipient site to facilitate easy anastomosis of the internal mammary vessels to free flaps during breast reconstruction can cause chest wall pain or deformities. To avoid this, the intercostal perforating branches of the internal mammary vessels can be used for anastomosis. The purpose of this study was to investigate the location and size of the internal mammary perforator vessels based on clinical intraoperative findings and to determine their reliability as recipient vessels for breast reconstruction with microsurgical free tissue transfer.MethodsTwelve patients were preoperatively screened for the presence of internal mammary perforators using Doppler tracing. After modified radical mastectomy was performed by a general surgeon, the location and size of the internal mammary perforator vessels were microscopically investigated. The external diameter was examined using a vessel-measuring gauge from a mechanical coupling device, and the distance from the mid-sternal line to the perforator was also measured.ResultsThe largest arterial perforator averaged 1.5 mm, and the largest venous perforator averaged 2.2 mm. Perforators emerging from the second intercostal space had the largest average external diameter; the second intercostal space also had the largest number of perforators arising from it. The average distance from the mid-sternal line to the perforator was 20.2 mm.ConclusionsInternal mammary perforators presented consistent and reliable anatomy in this study. Based on these results, the internal mammary perforators appear to have a suitable diameter for microvascular anastomosis and should be considered as an alternative recipient vessel to the internal mammary vessel.

  20. A Literature Review of Burns in Reconstructed Breasts After Mastectomy.

    Science.gov (United States)

    Jaeger, Marie; Wagman, Yonathan; Liran, Alon; Harats, Moti; Winkler, Eyal; Haik, Josef; Tessone, Ariel

    2016-12-01

    The goal of this literature review is to review and combine case studies of accidental burns to the breast, following mastectomy and immediate breast reconstruction with autologous tissue, implants, or tissue expanders. The authors searched PubMed and Cochrane Library and reviewed cases of burns of reconstructed breasts after mastectomy from July 1985 to May 2015. Only studies in the English language were included in their search. They also report 5 new cases of burns in patients with burns to the breast, which were either reconstructed with implants or tissue expanders at Sheba Medical Center (Ramat Gan, Israel). The authors found 21 publications regarding burns after breast reconstruction dating from 1985 to 2014, which equaled 59 cases of reported burns in the 21 included publications. The most common causes of burns were due to heat conduction (37/59) followed by solar radiation (19/59) and heat convection (3/59). The majority of the cases were treated by a conservative approach. The 5 new cases added were all due to thermal radiation (5/5). Two of these cases were treated conservatively (2/5), and 3 underwent surgery (3/5). The removal of thermoregulatory capabilities of the skin and the thickness of the remaining tissue in the mastectomy procedure are key to understanding the cause of burns to reconstructed breasts.

  1. Applications of acellular dermal matrix in revision breast reconstruction surgery.

    Science.gov (United States)

    Spear, Scott L; Sher, Sarah R; Al-Attar, Ali; Pittman, Troy

    2014-01-01

    Acellular dermal matrix has been used for over a decade in primary breast reconstruction. Few articles have specifically examined its use in revision breast reconstruction for fold malposition, capsular contracture, rippling, and symmastia. One hundred thirty-five revision breast reconstructive procedures using acellular dermal matrix (AlloDerm) in 118 patients (154 breasts) over a 5-year period were reviewed. Most procedures were revisions or part of the second stage of previous mastectomy reconstructions; three were revisions after reconstruction of congenital chest wall deformities. Fifty-seven revisions (37 percent) were for inferior fold malposition, followed by 40 (25.9 percent) for inferior pole support, 42 (27.2 percent) for capsular contracture, 10 (6.4 percent) for rippling, and five (3.2 percent) for symmastia. The overall complication rate was 5 percent. Revisions with acellular dermal matrix were successful in 147 of 154 breasts (95.5 percent). The most common complication was capsular contracture, occurring in five breasts (3.2 percent). There was one infection (0.6 percent), failure to lower the inframammary fold in one breast (0.6 percent), and one persistence of rippling (0.6 percent). The mean follow-up was 207 days. Acellular dermal matrix has proven to be a reliable tool for managing some of the most common and challenging problems in implant-based breast reconstruction. Although there are few published data on the success of more conventional solutions to fold malposition, lower pole support, and capsular contracture, the addition of acellular dermal matrix to buttress these repairs has been shown to provide a high likelihood of success with a low risk of complications.

  2. Thoraco-epigastric flap for breast reconstruction in cancer

    Directory of Open Access Journals (Sweden)

    A. D. Zikiryakhodzhayev,

    2015-01-01

    Full Text Available Reconstructive surgery for breast cancer are an integral method of rehabilitation of cancer patients. Breast reconstruction may be delayed and instantaneous. The article presents a description of the thoraco-epigastric flap for breast reconstruction in cancer. The operation involves the replacement of the remote volume (after radical resection of the breast and the breast skin adjacent tissues adjacent to the inframammary crease from the side of the anterior abdominal wall. Surgery is indicated when the tumor in the lower parts of the breast, closest to the skin, in combination with small size breast cancer. The article presents a clinical example of this operation. Described in detail the operation, received a good cosmetic result. The advantage of the application of thoraco-epigastric flap is in the simplicity of the technique of its execution, good blood supply, donor wound is easily sutured due to the possible wide separating cellular adjacent skin and subcutaneous tissue. The disadvantage of this method is limited and the need for careful monitoring of perforating branches of the upper epigastric artery. Thus, thoraco-epigastric flap, can be applicable when performing reconstructive operations for breast cancer in compliance with the necessary requirements for the formation of the flap and the correct attitude to feeding the flap vessels, and virtually eliminates possible complications with the healing of the flap. Undoubtedly, reconstructive plastic surgery for breast cancer, during the testimony and technical capabilities, are an essential component of surgical treatment.

  3. Complications After Mastectomy and Immediate Breast Reconstruction for Breast Cancer: A Claims-Based Analysis

    Science.gov (United States)

    Jagsi, Reshma; Jiang, Jing; Momoh, Adeyiza O.; Alderman, Amy; Giordano, Sharon H.; Buchholz, Thomas A.; Pierce, Lori J.; Kronowitz, Steven J.; Smith, Benjamin D.

    2016-01-01

    Objective To evaluate complications after post-mastectomy breast reconstruction, particularly in the setting of adjuvant radiotherapy. Summary-Background Data Most studies of complications after breast reconstruction have been conducted at centers of excellence; relatively little is known about complication rates in radiated patients treated in the broader community. This information is relevant for breast cancer patients' decision-making. Methods Using the claims-based MarketScan database, we described complications in 14,894 women undergoing mastectomy for breast cancer from 1998-2007 who received immediate autologous reconstruction (n=2637), immediate implant-based reconstruction (n=3007), or no reconstruction within the first two postoperative years (n=9250). We used a generalized estimating equation to evaluate associations between complications and radiotherapy over time. Results Wound complications were diagnosed within the first two postoperative years in 2.3% of patients without reconstruction, 4.4% with implants, and 9.5% with autologous reconstruction (preconstruction, 20.5% with implants, and 20.7% with autologous reconstruction (preconstruction (OR 1.48, preconstruction (OR=1.55; P=0.01). Conclusions Complication risks after immediate breast reconstruction differ by approach. Radiation therapy appears to modestly increase certain risks, including infection and implant removal. PMID:25876011

  4. The BREASTrial Stage II: ADM Breast Reconstruction Outcomes from Definitive Reconstruction to 3 Months Postoperative.

    Science.gov (United States)

    Mendenhall, Shaun D; Anderson, Layla A; Ying, Jian; Boucher, Kenneth M; Neumayer, Leigh A; Agarwal, Jayant P

    2017-01-01

    The Breast Reconstruction Evaluation of Acellular Dermal Matrix as a Sling Trial is a prospective randomized trial comparing outcomes of tissue expander breast reconstruction using either AlloDerm or DermaMatrix. The trial was divided into 3 outcome stages; this study reports stage II outcomes, which are those from the time of definitive reconstruction to 3 months postoperative. A randomized trial was conducted to compare complication rates between AlloDerm and DermaMatrix groups. The impact of matrix type, age, obesity, radiation therapy, chemotherapy, and reconstruction type on complications was analyzed with regression models. Of the 128 patients (199 breasts) who were randomly assigned into the trial, 111 patients (173 breasts) were available for analysis in stage II. There was no difference in overall rates of complications (15.4% vs 18.3%, P = 0.8) or implant loss (2.2% vs 3.7%, P = 0.5) between the AlloDerm and DermaMatrix groups, respectively. Obesity was the only significant predictor of complications on regression analysis (odds ratio, 4.31, P = 0.007). Matrix type, age, radiation therapy, chemotherapy, or reconstruction type had no impact on the incidence/severity of complications. Acellular dermal matrix (ADM) will likely continue to have a role in breast reconstructive surgery; however, caution should be taken when using ADM because of relatively high complication rates, especially in obese patients. The particular ADM product should be selected based on individual surgeon preference, experience, and success rates. These data and forthcoming long-term outcomes from the Breast Reconstruction Evaluation of Acellular Dermal Matrix as a Sling Trial will enable surgeons to carefully weigh the risks and benefits of ADM use in breast reconstruction.

  5. The BREASTrial Stage II: ADM Breast Reconstruction Outcomes from Definitive Reconstruction to 3 Months Postoperative

    Science.gov (United States)

    Mendenhall, Shaun D.; Anderson, Layla A.; Ying, Jian; Boucher, Kenneth M.; Neumayer, Leigh A.

    2017-01-01

    Background: The Breast Reconstruction Evaluation of Acellular Dermal Matrix as a Sling Trial is a prospective randomized trial comparing outcomes of tissue expander breast reconstruction using either AlloDerm or DermaMatrix. The trial was divided into 3 outcome stages; this study reports stage II outcomes, which are those from the time of definitive reconstruction to 3 months postoperative. Methods: A randomized trial was conducted to compare complication rates between AlloDerm and DermaMatrix groups. The impact of matrix type, age, obesity, radiation therapy, chemotherapy, and reconstruction type on complications was analyzed with regression models. Results: Of the 128 patients (199 breasts) who were randomly assigned into the trial, 111 patients (173 breasts) were available for analysis in stage II. There was no difference in overall rates of complications (15.4% vs 18.3%, P = 0.8) or implant loss (2.2% vs 3.7%, P = 0.5) between the AlloDerm and DermaMatrix groups, respectively. Obesity was the only significant predictor of complications on regression analysis (odds ratio, 4.31, P = 0.007). Matrix type, age, radiation therapy, chemotherapy, or reconstruction type had no impact on the incidence/severity of complications. Conclusions: Acellular dermal matrix (ADM) will likely continue to have a role in breast reconstructive surgery; however, caution should be taken when using ADM because of relatively high complication rates, especially in obese patients. The particular ADM product should be selected based on individual surgeon preference, experience, and success rates. These data and forthcoming long-term outcomes from the Breast Reconstruction Evaluation of Acellular Dermal Matrix as a Sling Trial will enable surgeons to carefully weigh the risks and benefits of ADM use in breast reconstruction. PMID:28203509

  6. Convergence of iterative image reconstruction algorithms for Digital Breast Tomosynthesis

    DEFF Research Database (Denmark)

    Sidky, Emil; Jørgensen, Jakob Heide; Pan, Xiaochuan

    2012-01-01

    solutions can aid in iterative image reconstruction algorithm design. This issue is particularly acute for iterative image reconstruction in Digital Breast Tomosynthesis (DBT), where the corresponding data model IS particularly poorly conditioned. The impact of this poor conditioning is that iterative......Most iterative image reconstruction algorithms are based on some form of optimization, such as minimization of a data-fidelity term plus an image regularizing penalty term. While achieving the solution of these optimization problems may not directly be clinically relevant, accurate optimization....... Math. Imag. Vol. 40, pgs 120-145) and apply it to iterative image reconstruction in DBT....

  7. Micro-surgical endodontics.

    Science.gov (United States)

    Eliyas, S; Vere, J; Ali, Z; Harris, I

    2014-02-01

    Non-surgical endodontic retreatment is the treatment of choice for endodontically treated teeth with recurrent or residual disease in the majority of cases. In some cases, surgical endodontic treatment is indicated. Successful micro-surgical endodontic treatment depends on the accuracy of diagnosis, appropriate case selection, the quality of the surgical skills, and the application of the most appropriate haemostatic agents and biomaterials. This article describes the armamentarium and technical procedures involved in performing micro-surgical endodontics to a high standard.

  8. Same Quality of Life for Polish Breast Cancer Patients Treated with Mastectomy and Breast Reconstruction or Breast-Conserving Therapy.

    Science.gov (United States)

    Szutowicz-Wydra, Beata; Wydra, Jacek; Kruszewski, Wiesław J; Ciesielski, Maciej; Szajewski, Mariusz; Walczak, Jakub; Hansdorfer-Korzon, Rita

    2016-10-01

    Breast cancer often requires combined oncologic treatments, the base of which is surgery. Quality of life (QoL) after each surgical procedure may influence the process of decision making among women, who qualify for multiple oncological strategies. Our knowledge about QoL in breast cancer patients is derived from comparative studies. Results may differ, depending on country, culture, and societal relations. The aim of the study was to investigate the quality of life of Polish patients treated with breast-conserving therapy (BCT) or mastectomy with breast reconstruction. The study involved women who underwent surgery for breast cancer in the Department of Surgical Oncology of the Gdynia Oncology Center from September 2010 to November 2013. Eighty-two breast reconstructions (in 79 patients) and 226 BCT procedures were performed. QoL was measured with the use of EORTC QLQ-C30 and QLQ-BR23 questionnaires. Global QoL was high in both groups and did not differ significantly. Body image was slightly better after BCT than after mastectomy with breast reconstruction, but sexual QoL was lower. Future perspective was quite low in both groups. Disease symptoms were not bothering. The global QoL among Polish breast cancer patients treated with BCT or mastectomy with breast reconstruction is high and does not differ between groups. There is a need for anxiety and disease-related fear prophylaxis and for the improvement of sex life of breast cancer survivors.

  9. Avoiding Breast Animation Deformity with Pectoralis-Sparing Subcutaneous Direct-to-Implant Breast Reconstruction.

    Science.gov (United States)

    Kobraei, Edward M; Cauley, Ryan; Gadd, Michele; Austen, William G; Liao, Eric C

    2016-05-01

    There is renewed interest in sparing the pectoralis major muscle in implant breast reconstruction, placing the implant in the subcutaneous position. This advance is made reliable by improvements in mastectomy skin flap quality, evolution of technique, and increased awareness of breast animation deformity. This retrospective review presents 13 patients (23 breasts) reconstructed immediately with placing the definitive implant in the subcutaneous space without disruption of the underlying chest muscles. None of the 13 patients had breast animation deformity postoperatively. One patient experienced an early hematoma, and 3 patients had small seromas that resolved uneventfully. One morbidly obese patient undergoing chemotherapy using a nearby chest port experienced infection requiring implant removal. This study describes an early experience, demonstrates feasibility, and discusses patient selection considerations that are important because we continue to evolve breast reconstruction approaches.

  10. Quality of life among Egyptian women with breast cancer after sparing mastectomy and immediate autologous breast reconstruction: a comparative study.

    Science.gov (United States)

    Denewer, Adel; Farouk, Omar; Kotb, Sherif; Setit, Ahmed; Abd El-Khalek, Seham; Shetiwy, Mosab

    2012-06-01

    Breast reconstruction is considered as an integrated part of the modern breast surgery. The aim of this study is to evaluate whether immediate autologous breast reconstruction influences QOL and patient satisfaction outcomes among Egyptian women with breast cancer in comparison to the traditional mastectomy. This is a prospective study in which 200 Egyptian women with non metastatic breast cancer were included; group I (100 patients) underwent sparing mastectomy with immediate autologous breast reconstruction and group II (100 patients) underwent traditional mastectomy. The patient satisfaction with breast reconstruction was evaluated by special questionnaire and the reasons given by traditional mastectomy patients for not having breast reconstruction were recorded. Both breast impact of treatment scale (BITS) and body satisfaction scale (BSS) were evaluated in both groups. Patient satisfaction with breast reconstruction had a high mean score of 14.44 out of total degrees of 20 and most of them voted yes for having the same reconstruction again if they were offered it and would recommend reconstruction to other patients. No difference was found between the two groups as regard the BITS score. However, the BSS score showed a higher score among the reconstruction group. Egyptian ladies with breast cancer show better QOL and body image satisfaction outcomes following immediate breast reconstruction.

  11. Breast-conserving therapy for breast cancer: Cosmetic results and options for delayed reconstruction.

    Science.gov (United States)

    Negenborn, Vera L; Volders, José H; Krekel, Nicole M A; Haloua, Max H; Bouman, Mark-Bram; Buncamper, Marlon E; Niessen, Frank B; Winters, Hay A H; Terwee, Caroline B; Meijer, Sybren; van den Tol, M Petrousjka

    2017-10-01

    Optimisation of the cosmetic outcome after breast-conserving therapy (BCT) is important. We aimed to determine the cosmetic outcome following BCT and factors influencing this cosmesis and identify the most favourable options for delayed breast reconstruction. Four reconstructive surgeons evaluated the cosmetic outcome of 109 patients after BCT. Additionally, the surgeons indicated which patients were amenable for delayed reconstruction and the preferred type of reconstruction. The inter- and intra-observer agreement of the surgeons was rated. The mean overall cosmetic outcome was rated as fair (2.7/4.0, SD 0.9, 1.0-4.0). Risk factors for a poor cosmesis were larger breast size (OR 3.81, p = 0.040), larger tumour (OR 1.63, p = 0.028) and axillary lymph node dissection (ALND) (OR 3.09, p = 0.013). Reconstruction of the ipsilateral side was recommended in 55.6% and 94.5% and contralateral reconstruction in 16.7% and 73.3% of patients with good and poor cosmesis, respectively. Flap reconstruction and lipofilling were most commonly reported for the ipsilateral, and breast reduction for the contralateral breast, with reasonable improvement expected (2.2/4.0, SD 0.5, 1.08-3.3). The inter- (0.5-0.7) and intra-observer (0.63-0.79) agreement of the cosmesis was moderate to good, however, poor regarding the recommended reconstruction techniques (mainly breast and tumour size and ALND. Although several reconstructive options are available, the optimal method for revision surgery has not yet been determined. Future studies are necessary to obtain evidence-based guidelines for reconstructive surgery after BCT. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  12. Sociodemographic Predictors of Breast Reconstruction Procedure Choice: Analysis of the Mastectomy Reconstruction Outcomes Consortium Study Cohort

    Directory of Open Access Journals (Sweden)

    Tiffany N. S. Ballard

    2015-01-01

    Full Text Available Background. To promote patient-centered care, it is important to understand the impact of sociodemographic factors on procedure choice for women undergoing postmastectomy breast reconstruction. In this context, we analyzed the effects of these variables on the reconstructive method chosen. Methods. Women undergoing postmastectomy breast reconstruction were recruited for the prospective Mastectomy Reconstruction Outcomes Consortium Study. Procedure types were divided into tissue expander-implant/direct-to-implant and abdominally based flap reconstructions. Adjusted odds ratios were calculated from logistic regression. Results. The analysis included 2,203 women with current or previous breast cancer and 202 women undergoing prophylactic mastectomy. Compared with women <40 years old with current or previous breast cancer, those 40 to 59 were significantly more likely to undergo an abdominally based flap. Women working or attending school full-time were more likely to receive an autologous procedure than those working part-time or volunteering. Women undergoing prophylactic mastectomy who were ≥50 years were more likely to undergo an abdominal flap compared to those <40. Conclusions. Our results indicate that sociodemographic factors affect the reconstructive procedure received. As we move forward into a new era of patient-centered care, providing tailored treatment options to reconstruction patients will likely lead to higher satisfaction and better outcomes for those we serve.

  13. Successful breast reconstruction using acellular dermal matrix can be recommended in healthy non-smoking patients

    DEFF Research Database (Denmark)

    Gunnarsson, Gudjon Leifur; Børsen-Koch, Mikkel; Arffmann, Susanne

    2013-01-01

    We present Scandinavia's first series of immediate alloplastic breast reconstructions with an acellular dermal matrix.......We present Scandinavia's first series of immediate alloplastic breast reconstructions with an acellular dermal matrix....

  14. Impact of contra-lateral breast reshaping on mammographic surveillance in women undergoing breast reconstruction following mastectomy for breast cancer.

    Science.gov (United States)

    Nava, Maurizio B; Rocco, Nicola; Catanuto, Giuseppe; Falco, Giuseppe; Capalbo, Emanuela; Marano, Luigi; Bordoni, Daniele; Spano, Andrea; Scaperrotta, Gianfranco

    2015-08-01

    The ultimate goal of breast reconstruction is to achieve symmetry with the contra-lateral breast. Contra-lateral procedures with wide parenchymal rearrangements are suspected to impair mammographic surveillance. This study aims to evaluate the impact on mammographic detection of mastopexies and breast reductions for contralateral adjustment in breast reconstruction. We retrospectively evaluated 105 women affected by uni-lateral breast cancer who underwent mastectomy and immediate two-stage reconstruction between 2002 and 2007. We considered three groups according to the contra-lateral reshaping technique: mastopexy or breast reduction with inferior dermoglandular flap (group 1); mastopexy or breast reduction without inferior dermoglandular flap (group 2); no contra-lateral reshaping (group 3). We assessed qualitative mammographic variations and breast density in the three groups. Statistically significant differences have been found when comparing reshaped groups with non reshaped groups regarding parenchymal distortions, skin thickening and stromal edema, but these differences did not affect cancer surveillance. The surveillance mammography diagnostic accuracy in contra-lateral cancer detection was not significantly different between the three groups (p = 0.56), such as the need for MRI for equivocal findings at mammographic contra-lateral breast (p = 0.77) and the need for core-biopsies to confirm mammographic suspect of contra-lateral breast cancer (p = 0.90). This study confirms previous reports regarding the safety of mastopexies and breast reductions when performed in the setting of contra-lateral breast reshaping after breast reconstruction. Mammographic accuracy, sensitivity and specificity are not affected by the glandular re-arrangement. These results provide a further validation of the safety of current reconstructive paradigms. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Evolución histórica de la reconstrucción mamaria Historical evolution of breast reconstruction

    Directory of Open Access Journals (Sweden)

    F. J. Escudero

    2005-01-01

    it was found that breast reconstruction did not have a negative influence on the neoplastic disease, but was instead of transcendental importance for the physical and psychological rehabilitation of the patient, its development benefited from several advances: the tendency towards less aggressive mastectomy techniques, which facilitate cutaneous covering; the introduction and progress of silicone breast prostheses; the submuscular implantation of the prostheses, which avoid local complications; the technique of breast tissue expansion; and great advances in the anatomical understanding of the different available flaps, especially musculocutaneous ones and those transferred microsurgically. Today the mastectomised patient can be offered reconstruction either using a silicone prosthesis or a completely autogenous reconstruction; the most recent advance is the introduction of microsurgical perforator flaps.

  16. Ocorrência de lesão pulmonar aguda relacionada com transfusão (TRALI - Transfusion Related Acute Lung Injury em pós-operatório de mastectomia com reconstrução microcirúrgica de mama Aparecimiento de lesión pulmonar aguda relacionada con la transfusión (TRALI - Transfusion Related Acute Lung Injury en postoperatorio de mastectomía con reconstrucción micro quirúrgica de mama Transfusion-related acute lung injury (Trali after mastectomy with microsur-gical breast reconstruction

    Directory of Open Access Journals (Sweden)

    Beatriz Garcia Sluminsky

    2009-02-01

    íficos, los relatos de casos son importantes. Es el primer relato de esta reacción transfusional indexado a la base de datos del LILACS. RELATO DEL CASO: Paciente femenino, de 36 años, sometida a la mastectomía con reconstrucción micro quirúrgica de mama bajo anestesia general. Inmediatamente después del término de la transfusión de un concentrado de hematíes, en la sala de recuperación postanestésica, evolucionó con insuficiencia respiratoria no necesitando re-intubación traqueal. Fue realizado el tratamiento de soporte en la unidad de cuidados intensivos después de descartar otras hipótesis diagnósticas. Evolucionó bien y recibió el alta al cuarto día del postoperatorio, sin secuelas. CONCLUSIONES: Resaltamos la importancia de la realización con criterio de la transfusión sanguínea, ya que a pesar de que la transmisión de enfermedades sea algo raro, el aparecimiento de TRALI es muy frecuente, sin embargo, se subestima por la diversidad de hipótesis diagnósticas. Por eso, es saludable que conozcamos y divulguemos esa enfermedad, sobre todo en nuestro medio.BACKGROUND AND OBJECTIVES: After its description more than 20 years ago, TRALI Transfusion Related Acute Lung Injury became the main cause of transfusion-related morbidity and mortality in the United States and England. Since reliable data on its epidemiology in Brazil are not available, the difficulty to diagnose, varied clinical presentation, and absence of specific laboratory data, case reports are important. This is the first report of this transfusion reaction indexed in the LILACS data base. CASE REPORT: A 36-year old female underwent mastectomy with microsurgical breast reconstruction under general anesthesia. Immediately after the transfusion of one unit of packed red blood cells in the post-anesthetic recovery room, she developed respiratory failure, which did not require reintubation. Supportive treatment was instituted in the intensive care unit after other diagnostic hypotheses were

  17. Cryptogenic stroke following abdominal free flap breast reconstruction surgery

    Science.gov (United States)

    Xie, Huizhuang; Malata, Charles M.

    2014-01-01

    INTRODUCTION Abdominal free flap breast reconstruction is regarded as the gold standard method of post-mastectomy breast reconstruction by many. It is a major surgery which can be associated with varied systemic complications. To date, there have been no reports of cerebrovascular complications in the literature which examine the possible relation between thromboembolism and patent foramen ovale (PFO) in patients undergoing microvascular breast reconstruction. PRESENTATION OF CASE A 54-year old female with a pre-existing PFO developed a stroke following bilateral mastectomies and immediate free flap breast reconstruction on postoperative day 5. This was attributed to an air embolus caused by central venous pressure line removal. After uneventful intra and early postoperative periods, the patient had collapsed suddenly on day 5 and become unresponsive immediately following the removal of a central venous line. Brain magnetic resonance imaging confirmed a cerebrovascular accident. This resolved within 48 h following therapeutic heparinisation. A clinical diagnosis of paradoxical embolism was made and she was subsequently referred to the cardiologists for angiographic closure of the PFO. DISCUSSION The case study herein reported gives an account that PFO can have considerable health implications in the early postoperative period and conceivably intraoperatively in patients undergoing major reconstructive surgeries. CONCLUSION Surgeons and cardiologists should be aware of this cerebrovascular complication secondary to PFO following major reconstructive surgery such as microvascular breast reconstruction. It also serves to challenge microvascular surgeons to reconsider routine use of central venous pressure lines in free flap patients who might otherwise have good peripheral vessels for postoperative fluid and antibiotic administration. PMID:25437687

  18. Tissue Expander Capsule for Abdominal Wall in Autologous Breast Reconstruction

    Directory of Open Access Journals (Sweden)

    Ronaldo Scholze Webster, MD, PhD

    2014-11-01

    Full Text Available Summary: Adjuvant treatment planning can change after breast cancer resection and definitive pathological examination. Radiation therapy is often chosen as a supplementary treatment. Rectus abdominis–based muscle flaps are one of the main choices when breast reconstruction plans must be changed from implant-based to autologous methods. We herein report a case in which the patient’s own tissue expander capsule was used to repair an abdominal wall defect after muscle-sparing transverse rectus abdominis myocutaneous flap reconstruction.

  19. Impact of different type of cancer treatment on the effectiveness of breast reconstruction

    OpenAIRE

    Szloch, Joanna; Marczyk, Elżbieta; Kołodziej-Rzepa, Marta; Komorowski, Andrzej L.

    2016-01-01

    For women undergoing mastectomy as part of their breast cancer treatment, breast reconstruction is an important part of therapy. However, neoadjuvant, adjuvant treatments as well as other patient-related factors can compromise the results of breast reconstruction techniques. In this article we have reviewed current approaches to the management of complications and risks that neoadjuvant and adjuvant therapies pose on breast reconstruction after mastectomy for breast cancer. Non-treatment rela...

  20. The psychological impact of breast reconstruction after prophylactic or therapeutic mastectomy for breast cancer

    NARCIS (Netherlands)

    Gopie, Jessica Premdee

    2013-01-01

    In this thesis the psychological impact of two types of breast reconstruction after prophylactic or therapeutic mastectomy for breast cancer was investigated with a prospective study including 202 patients from different hospitals in the South-West of the Netherlands between 2007-2012. With

  1. The psychological impact of breast reconstruction after prophylactic or therapeutic mastectomy for breast cancer

    NARCIS (Netherlands)

    Gopie, Jessica Premdee

    2013-01-01

    In this thesis the psychological impact of two types of breast reconstruction after prophylactic or therapeutic mastectomy for breast cancer was investigated with a prospective study including 202 patients from different hospitals in the South-West of the Netherlands between 2007-2012. With semi-str

  2. Video-assisted breast surgery: reconstruction after resection of more than 33% of the breast.

    Science.gov (United States)

    Yamashita, Koji; Shimizu, Kazuo

    2006-12-01

    Improvements in reconstructive mammoplasty methods have made it possible to resect more of the mammary gland while achieving good esthetic results in breast-conserving surgery. We report the esthetic results of extended wide resection of the breast with reconstruction procedures. Breast-conserving surgery was performed using a video-assisted breast surgery (VABS) technique. Breast reconstruction was simultaneously performed using the following three methods: mobilization of the remnant mammary gland, transplantation of the lateral tissue flap, and filling with an absorbent synthetic fiber mesh or cotton. The cosmetic results were evaluated with an original five-item-by-four-step scoring system: ABNSW-assessing asymmetry, breast shape, nipple shape, skin condition, and wound scar. From December 2001 through March 2006, we performed endoscopic VABS in 130 patients with breast diseases. The candidates were 29 patients with breast cancer who required resection of more than 33% of the mammary gland because of ductal carcinoma in situ (1 patient), multiple cancers (6 patients), widely extended lesions (20 patients), and lesions after preoperative systemic therapy (2 patients). Twenty-one patients underwent resection of 33% to 50% of the breast, and 8 underwent resection of more than 50% of the breast. All surgical margins were negative on examination of permanent histological preparations. The original shape of the breast was preserved. There was no local recurrence after follow-up times of 33 months (maximum) and 19 months (average). The newly devised reconstruction methods with VABS can markedly increase the mammary gland resection volume while achieving a good esthetic outcome, ensuring a precise disease-free surgical margin, and expanding the indications for breast-conserving therapy.

  3. Skin-Sparing Mastectomy with Immediate Breast and Nipple Reconstruction: A New Technique of Nipple Reconstruction

    Directory of Open Access Journals (Sweden)

    Raffaele Serra

    2013-01-01

    Full Text Available Background. Most women with breast cancer today can be managed with breast conservation; however, some women still require mastectomy for treatment of their disease. Skin-sparing mastectomy (SSM with immediate reconstruction has emerged as a favorable option for many of these patients. The authors combined the SSM technique with the preservation of a small part of the areola with immediate nipple together with with breast reconstruction. Methods. In an 8-year-period 155 female patients (age: 20–52 years old; mean age: 37.5 years with extensive ductal intraepithelial neoplasia (DIN or invasive breast cancer were treated with areola skin sparing mastectomy with immediate nipple and breast reconstruction. Patients were followed up prospectively by the breast surgeon, the plastic surgeon, and the oncologist for complications and recurrence. Results. After treatment, only 2 cases (1.29% had a local recurrence. 8 out of 155 (5.5% patients developed early complications (infections, seroma, haematoma, and 5 out of 155 patients (3.22% developed delayed complications (implant rotation, aestethic deterioration in the post operative time period. The final aesthetic outcome was judged as positive in 150 out of 155 patients (96.78%. Conclusion. In our experience, immediate nipple reconstruction after skin-sparing mastectomy is a technically feasible procedure which can give excellent cosmetic results.

  4. Essential elements of the preoperative breast reconstruction evaluation

    OpenAIRE

    Cheng, Angela; Losken, Albert

    2015-01-01

    A plethora of options exist for breast reconstruction and preoperative evaluation must be thorough to lead to a successful outcome. We review multiple components of the preoperative assessment including the patient’s history, goals, imaging, and key elements of the physical exam. Consideration for tumor biology, staging, need or response to chemotherapy or radiation therapy is important in deciding on immediate versus delayed reconstruction. It is also important to consider the patient’s anat...

  5. Comparison of Patient-reported Outcomes after Implant Versus Autologous Tissue Breast Reconstruction Using the BREAST-Q

    Science.gov (United States)

    Pirro, Ortensia; Vindigni, Vincenzo; Sukop, Andrej; Hromadkova, Veronika; Nguyenova, Alena; Vitova, Lenka; Bassetto, Franco

    2017-01-01

    Background: The demand for reconstructive breast procedures of various types has accelerated in recent years. Coupled with increased patient expectations, it has fostered the development of oncoplastic and reconstructive techniques in breast surgery. In the setting of postmastectomy reconstruction, patient satisfaction and quality of life are the most significant outcome variables when evaluating surgical success. The aim of this study was to evaluate the quality of life after implant breast reconstruction compared with autologous breast reconstruction. Materials and Methods: A cross-sectional study design was used. A total of 65 women who had completed postmastectomy implant-based or autologous reconstruction in the participating center were asked to complete the BREAST-Q (Reconstruction Module). Results: Data analysis demonstrated that women with autologous breast reconstruction were significantly more satisfied with their breasts (P = 0.0003) and with the overall outcome (P = 0.0001) compared with women with implant breast reconstruction. All other BREAST-Q parameters that were considered and observed were not significantly different between the 2 patient groups. Conclusions: Through statistical analysis, our results showed that patients who underwent autologous tissue reconstruction had better satisfaction with the reconstructed breast and the outcome, while both techniques appear to equally improve psychosocial well-being, sexual well-being, and chest satisfaction. PMID:28203513

  6. Comparison of Patient-reported Outcomes after Implant Versus Autologous Tissue Breast Reconstruction Using the BREAST-Q.

    Science.gov (United States)

    Pirro, Ortensia; Mestak, Ondrej; Vindigni, Vincenzo; Sukop, Andrej; Hromadkova, Veronika; Nguyenova, Alena; Vitova, Lenka; Bassetto, Franco

    2017-01-01

    The demand for reconstructive breast procedures of various types has accelerated in recent years. Coupled with increased patient expectations, it has fostered the development of oncoplastic and reconstructive techniques in breast surgery. In the setting of postmastectomy reconstruction, patient satisfaction and quality of life are the most significant outcome variables when evaluating surgical success. The aim of this study was to evaluate the quality of life after implant breast reconstruction compared with autologous breast reconstruction. A cross-sectional study design was used. A total of 65 women who had completed postmastectomy implant-based or autologous reconstruction in the participating center were asked to complete the BREAST-Q (Reconstruction Module). Data analysis demonstrated that women with autologous breast reconstruction were significantly more satisfied with their breasts (P = 0.0003) and with the overall outcome (P = 0.0001) compared with women with implant breast reconstruction. All other BREAST-Q parameters that were considered and observed were not significantly different between the 2 patient groups. Through statistical analysis, our results showed that patients who underwent autologous tissue reconstruction had better satisfaction with the reconstructed breast and the outcome, while both techniques appear to equally improve psychosocial well-being, sexual well-being, and chest satisfaction.

  7. Partial Breast Reconstruction with Goldilocks Technique After Excision of Giant Fibroadenoma: A Case Report

    Science.gov (United States)

    Ter Louw, Ryan P.; Bruce, Sara B.

    2017-01-01

    Summary: Giant juvenile fibroadenomas are relatively rare, accounting for less than 1% fibroadenomas. Large breast tumors create significant asymmetry and provide unique reconstructive challenges after removal. In this case, we describe a 21-year-old female with delayed presentation of a giant fibroadenoma of the right breast. This represents an unusual presentation of benign breast disease requiring reduction of the skin envelope, extensive glandular resection, lower pole reconstruction, and free nipple grafting to achieve symmetry with the opposite breast. A novel modification of the Goldilocks mastectomy technique is described for partial breast reconstruction. Adaptation of the Goldilocks mastectomy technique provides adequate soft tissue for partial breast reconstruction. Using the lower pole deepithelialization breast skin flap provides autologous vascularized tissue to supplement volume loss after tumor and glandular excision. Benign breast disease can create significant breast deformities. Application and combination of the Goldilocks mastectomy technique allow for partial breast reconstruction without the need for an additional donor site or prosthetic devices. PMID:28203501

  8. The Versatile Extended Thoracodorsal Artery Perforator Flap for Breast Reconstruction

    DEFF Research Database (Denmark)

    Jacobs, Jordan; Børsen-Koch, Mikkel; Gunnarsson, Gudjon Leifur;

    2016-01-01

    BACKGROUND: The thoracodorsal artery perforator (TAP) flap is a versatile tool that can be used to reconstruct the breast. The authors use preoperative perforator mapping using color Doppler ultrasonography and present a safe, efficient harvesting technique to demonstrate reliable use of the TAP...

  9. The Impact of Breast Reconstruction on the Delivery of Chemotherapy

    Science.gov (United States)

    Alderman, Amy K.; Collins, E. Dale; Schott, Anne; Hughes, Melissa E.; Ottesen, Rebecca A.; Theriault, Richard L.; Wong, Yu-Ning; Weeks, Jane C.; Niland, Joyce C.; Edge, Stephen B.

    2009-01-01

    Purpose Our purpose was to evaluate the impact of post-mastectomy breast reconstruction on the timing of chemotherapy. Methods We included Stage I–III breast cancer patients from eight National Comprehensive Cancer Network institutions for whom guidelines recommended chemotherapy. Surgery type was categorized as breast conserving surgery (BCS), mastectomy alone, mastectomy with immediate reconstruction (M+IR), or mastectomy with delayed reconstruction (M+DR). A Cox regression analysis was used to assess the association between surgery type and timing of chemotherapy initiation. Results Of the 3,643 patients, only 5.1% received it ≥ 8 weeks from surgery. In the multivariate analysis, higher stage, Caucasian and Hispanic race/ethnicity, lower body-mass index and absence of comorbid conditions were all significantly associated with earlier time to chemotherapy. There was also significant interaction between age, surgery and chemotherapy delivery. Among women breast reconstruction does not appear to lead to omission of chemotherapy, but it is associated with a modest, but statistically significant, delay in initiating treatment. For most, it is unlikely that this delay has any clinical significance. PMID:20143440

  10. TRAM flap in reconstructive operations in patients with breast cancer

    Directory of Open Access Journals (Sweden)

    A. D. Zikiryakhodzhaev

    2015-01-01

    Full Text Available The treatment of breast cancer (BC is a relevant problem. Surgery is a key treatment method for BC. The volume of its operations varies from radical mastectomies to lumpectomies and, in the areas of regional metastases, from three-level lymphadenectomy to sentinel lymph node biopsy. Objective: to assess whether a displaced TRAM flap may be used for reconstructive operations for BC. The paper presents some experience in treating 11 BC patients in whom a displaced TRAMP flap was employed for reconstruction. At this time, the displaced TRAM flap was applied for delayed reconstruction in 3 patients. The mean age of the patients was 45.5 ± 15.7 years. In 8 BC patients undergoing one-stage reconstruction with a displaced TRAM flap, the treatment schedule was as follows: surgical treatment in 1 patient, combined treatment in 2 patients, and multimodality treatment in 5. The patients received targeted therapy in 3 cases or hormone therapy in 6. A lower abdominal skin-and-fat flap on one vascular pedicle was used in all the 11 patients.Indications for using a displaced TRAM flap were determined; complications were analyzed. The percentage of complications due to the use of a displaced TRAM flap was 9.1 % in our study.To reduce the rate of complications after breast reconstruction with a displaced TRAM flap, we carefully selected patients for this choiceof a plastic component. The displaced TRAM flap is one of the variants for delayed breast reconstruction despite its duration and complexity. Corrective surgery is further used to achieve breast symmetry. Corrective operations, namely, breast liposuction and submammary fold formation, were performed in 2 patients. For full breast recovery, the nipple-areolar complex is to be formed following skin-sparing mastectomies and delayed breast reconstructions. The cosmetic effect was evaluated in 11 patients as excellent in 4 (36.4 % cases, good in 7 (63.6 %. Neither local recurrences nor distant

  11. Breast reconstruction with anatomical implants: A review of indications and techniques based on current literature

    Directory of Open Access Journals (Sweden)

    Marco Gardani

    2017-09-01

    Full Text Available One important modality of breast cancer therapy is surgical treatment, which has become increasingly less mutilating over the last century. Breast reconstruction has become an integrated part of breast cancer treatment due to long-term psychosexual health factors and its importance for breast cancer survivors. Both autogenous tissue-based and implant-based reconstruction provides satisfactory reconstructive options due to better surgeon awareness of “the ideal breast size”, although each has its own advantages and disadvantages. An overview of the current options in breast reconstruction is presented in this article.

  12. [Pedicled versus free TRAM flap for breast reconstruction].

    Science.gov (United States)

    Galla, T J; Lukas, B; Feller, A M

    1999-03-01

    In breast reconstruction, the free TRAM-flap offers many advantages over the pedicled TRAM-flap. Due to its superior perfusion, the free flap rarely develops necrosis. Shaping of the flap is easier due to the lack of the thick muscle pedicle. Because the rectus muscle is spared, there is minimal donor site morbidity. However, the necessary microvascular anastomoses reduced the acceptance of the free TRAM-flap. During a 13-months period, 51 breast reconstructions were performed in 41 patients, 31 unilateral and ten bilateral. 45 flaps served for delayed reconstruction and six flaps for immediate reconstruction. The operations were performed by two teams working simultaneously. The average operating time was 3.9 hours for unilateral and 6.9 hours for bilateral delayed reconstruction. For immediate reconstruction, 6.2 and 6.3 hours were required for uni- and bilateral procedures, respectively. In 38 flaps, the thoracodorsal vessels served as recipient vessels; 13 flaps were anastomosed to the internal mammary artery and vein. Postoperative complications were observed in 13 patients. Three vessel anastomoses had to be revised. In one flap, a partial necrosis occurred; in two flaps hematoma evacuation was necessary. Two patients suffered from fat necroses at the abdomen and one umbilicus was lost. Skin irritations and seromas at the abdomen occurred in five patients. Pulmonary embolism was diagnosed in one patient three weeks postoperatively. Abdominal hernias or bulging in the epigastric area were not observed up to 15 months after reconstruction. These results reveal a low complication rate for breast reconstruction with the free TRAM-flap. The advantages of this technique as compared to the pedicled technique are discussed.

  13. Nipple-areolar Complex Reconstruction following Postmastectomy Breast Reconstruction: A Comparative Utility Assessment Study

    Directory of Open Access Journals (Sweden)

    Ahmed M. S. Ibrahim, MD

    2015-04-01

    Conclusions: The absence of NAC in a reconstructed breast can be objectively assessed using utility scores (VAS, 0.84 ± 0.18; TTO, 0.92 ± 0.11; SG, 0.92 ± 0.11. In comparison to prior reported conditions, the quality of life in patients choosing to undergo NAC reconstruction is similar to that of persons living with a nasal deformity or an aging neck requiring rejuvenation.

  14. Quality of Patient Decisions About Breast Reconstruction After Mastectomy.

    Science.gov (United States)

    Lee, Clara Nan-Hi; Deal, Allison M; Huh, Ruth; Ubel, Peter Anthony; Liu, Yuen-Jong; Blizard, Lillian; Hunt, Caprice; Pignone, Michael Patrick

    2017-08-01

    Breast reconstruction has the potential to improve a person's body image and quality of life but has important risks. Variations in who undergoes breast reconstruction have led to questions about the quality of patient decisions. To assess the quality of patient decisions about breast reconstruction. A prospective, cross-sectional survey study was conducted from June 27, 2012, to February 28, 2014, at a single, academic, multidisciplinary oncology clinic among women planning to undergo mastectomy for stage I to III invasive ductal or lobular breast cancer, ductal carcinoma in situ, or prophylaxis. Mastectomy only and mastectomy with reconstruction. Knowledge, as ascertained using the Decision Quality Instrument; preference concordance, based on rating and ranking of key attributes; and decision quality, defined as having knowledge of 50% or more and preference concordance. During the 20-month period, 214 patients were eligible, 182 were approached, and 32 missed. We enrolled 145 patients (79.7% enrollment rate), and received surveys from 131 patients (72.0% participation rate). Five participants became ineligible. The final study population was 126 patients. Among the 126 women in the study (mean [SD] age, 53.2 [12.1] years), the mean (SD) knowledge score was 58.5% (16.2%) and did not differ by treatment group (mastectomy only, 55.2% [15.0%]; mastectomy with reconstruction, 60.5% [16.5%]). A total of 82 of 123 participants (66.7%) had a calculated treatment preference of mastectomy only; 39 of these women (47.6%) underwent mastectomy only. A total of 41 participants (32.5%) had a calculated treatment preference of mastectomy with reconstruction; 36 of these women (87.8%) underwent mastectomy with reconstruction. Overall, 52 of 120 participants (43.3%) made a high-quality decision. In multivariable analysis, white race/ethnicity (odds ratio [OR], 2.72; 95% CI, 1.00-7.38; P = .05), having private insurance (OR, 1.61; 95% CI, 1.35-1.93; P quality decision. A

  15. Pedicled dermoglandular flap reconstruction following breast conserving surgery.

    Science.gov (United States)

    Khafagy, M; Fakhr, I; Hamed, A; Youssef, O

    2012-06-01

    Breast conserving therapy is the gold standard treatment of early breast cancer. However, a balance between good cosmetic outcome and limiting the risk of locoregional recurrence remains the key of success. The aim of this work was to evaluate the outcome of partial breast reconstruction using pedicled dermo-glandular flap from the upper outer quadrant, for central quadrantectomy BCS. Thirty patients underwent wide excision of carcinoma of retroareolar or periareolar regions of the breast, from July 2008 to August 2011. Excisions included the nipple/areola complex down to the pectoralis fascia with a wide safety margin, and complete axillary dissection. Breast reconstruction was done by means of pedicled dermoglandular flap. Mean age of patients was 51.86 years (range from 30 to 70 years). Tumor size ranged from 1 to 4.2 cm. Postoperative pathological results came out with 21 (70.0%) patients mean (range) of the tumor safety margin 2.01 (0.5-2.8). Seventeen (56.7%) patients had positive axillary lymph nodes. All patients received postoperative radiation therapy to the breast, while 17/30 (56.67%) and 6/30 (20%) received endocrine therapy or adjuvant chemotherapy, respectively, and only 7/30 (23.34%) patients received both therapies. During a median follow-up period of 24 months, neither local nor distant metastasis, were detected. The postoperative cosmetic result was excellent in 80% patients, good in 13.3% patients, acceptable in 6.7% with no poor result. Following central quadrantectomy BCS for small centrally located breast cancer, a pedicled dermoglandular flap from the upper outer quadrant is a good reconstructive option. Copyright © 2012 National Cancer Institute, Cairo University. Published by Elsevier B.V. All rights reserved.

  16. An evaluation of the efficacy of microvascular breast reconstruction techniques.

    Science.gov (United States)

    Dobrut, Mirosław; Maciejewski, Adam; Półtorak, Stanisław

    2013-01-01

    The aim of the study was to evaluate the efficacy of different microvascular techniques in breast reconstruction with the analysis of postoperative complications. The additional goal of the study is to analyze the quality of life of patients after microvascular breast reconstruction in comparison to the control group of patients who underwent only mastectomy without any reconstructive procedures. Also the algorithm of breast reconstruction is presented as the result of own experiences. Clinical material contain 2 groups of patients - women after surgical treatment in Department of Oncological and Reconstructive Surgery, Cancer Center in Gliwice in the year 2004-2009 where in 53 cases immediate and in 26 delayed breast microvascular reconstruction were performed. In all cases the diagnosis of cancer was proved by histopathological biopsy before the treatment. The type of radical resection (mastectomy) depended on histopathological type of cancer and its localization. The reconstruction - immediate vs delayed was carefully planned together with oncological treatment of the cases. Everywhere this plan was established based on carefully examinations of inferior epigastric vessels and theirs perforators. The choice between immediate and delayed microvascular reconstruction was based on prognosis and predictive factors. The QOL was analyzed due to own questionnaire when functional, aesthetics and social effects were evaluated. Free flap survival rate for all types of free flap was 95%. In cases where classic TRAM was used the rate was 85%, in cases where muscle sparring TRAM was chosen the survival rate was 100% and in remaining cases of DIEP reconstructions the rate was 89%. Generally the complications after microvascular reconstruction occurred in 13 cases (16%). In 9 cases the problems with flaps perfusion were notified. Total flap necrosis was observed in 2 TRAM and in 2 DIEP cases. In all those cases salvage surgery was administered in which the microanastomoses

  17. Breast percent density estimation from 3D reconstructed digital breast tomosynthesis images

    Science.gov (United States)

    Bakic, Predrag R.; Kontos, Despina; Carton, Ann-Katherine; Maidment, Andrew D. A.

    2008-03-01

    Breast density is an independent factor of breast cancer risk. In mammograms breast density is quantitatively measured as percent density (PD), the percentage of dense (non-fatty) tissue. To date, clinical estimates of PD have varied significantly, in part due to the projective nature of mammography. Digital breast tomosynthesis (DBT) is a 3D imaging modality in which cross-sectional images are reconstructed from a small number of projections acquired at different x-ray tube angles. Preliminary studies suggest that DBT is superior to mammography in tissue visualization, since superimposed anatomical structures present in mammograms are filtered out. We hypothesize that DBT could also provide a more accurate breast density estimation. In this paper, we propose to estimate PD from reconstructed DBT images using a semi-automated thresholding technique. Preprocessing is performed to exclude the image background and the area of the pectoral muscle. Threshold values are selected manually from a small number of reconstructed slices; a combination of these thresholds is applied to each slice throughout the entire reconstructed DBT volume. The proposed method was validated using images of women with recently detected abnormalities or with biopsy-proven cancers; only contralateral breasts were analyzed. The Pearson correlation and kappa coefficients between the breast density estimates from DBT and the corresponding digital mammogram indicate moderate agreement between the two modalities, comparable with our previous results from 2D DBT projections. Percent density appears to be a robust measure for breast density assessment in both 2D and 3D x-ray breast imaging modalities using thresholding.

  18. Comparison of Patient-reported Outcomes after Implant Versus Autologous Tissue Breast Reconstruction Using the BREAST-Q

    OpenAIRE

    Pirro, Ortensia; Mestak, Ondrej; Vindigni, Vincenzo; Sukop, Andrej; Hromadkova, Veronika; Nguyenova, Alena; Vitova, Lenka; Bassetto, Franco

    2017-01-01

    Background: The demand for reconstructive breast procedures of various types has accelerated in recent years. Coupled with increased patient expectations, it has fostered the development of oncoplastic and reconstructive techniques in breast surgery. In the setting of postmastectomy reconstruction, patient satisfaction and quality of life are the most significant outcome variables when evaluating surgical success. The aim of this study was to evaluate the quality of life after implant breast ...

  19. Lateral thoracic artery perforator (LTAP) flap in partial breast reconstruction.

    Science.gov (United States)

    McCulley, Stephen J; Schaverien, Mark V; Tan, Veronique K M; Macmillan, R Douglas

    2015-05-01

    Partial breast reconstruction using pedicled perforator flaps from the thoracodorsal (TDAP) and lateral intercostal arteries (LICAP) is well described. The article introduces the lateral thoracic artery perforator (LTAP) flap as an additional valuable option from the lateral chest wall and reports clinical experience and outcomes. The anatomy of the LTAP flap is reviewed and the results of a consecutive series are reported. In a series of 75 consecutive cases of lateral chest wall perforator flaps used for reconstruction of partial breast defects, 12 (17%) were raised as pure LTAP flaps, and a further 19 (27%) as combined LTAP/LICAP flaps. The LTAP was therefore used in 44% of flaps overall. One LTAP flap (delayed case) had early venous compromise that settled spontaneously. The LTAP flap is a reliable option for partial breast reconstruction from the lateral chest wall, particularly in the immediate setting. It allows comparable flap size to be harvested compared to LICAP flaps. The LTAP flap can be raised on its own pedicle allowing greater mobilization or it can be incorporated into the more commonly used LICAP flap to augment perfusion. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  20. Quantifying dose to the reconstructed breast: Can we adequately treat?

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Eugene; Marsh, Robin B.; Griffith, Kent A.; Moran, Jean M. [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States); Pierce, Lori J., E-mail: ljpierce@umich.edu [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States)

    2013-04-01

    To evaluate how immediate reconstruction (IR) impacts postmastectomy radiotherapy (PMRT) dose distributions to the reconstructed breast (RB), internal mammary nodes (IMN), heart, and lungs using quantifiable dosimetric end points. 3D conformal plans were developed for 20 IR patients, 10 autologous reconstruction (AR), and 10 expander-implant (EI) reconstruction. For each reconstruction type, 5 right- and 5 left-sided reconstructions were selected. Two plans were created for each patient, 1 with RB coverage alone and 1 with RB + IMN coverage. Left-sided EI plans without IMN coverage had higher heart Dmean than left-sided AR plans (2.97 and 0.84 Gy, p = 0.03). Otherwise, results did not vary by reconstruction type and all remaining metrics were evaluated using a combined AR and EI dataset. RB coverage was adequate regardless of laterality or IMN coverage (Dmean 50.61 Gy, D95 45.76 Gy). When included, IMN Dmean and D95 were 49.57 and 40.96 Gy, respectively. Mean heart doses increased with left-sided treatment plans and IMN inclusion. Right-sided treatment plans and IMN inclusion increased mean lung V{sub 20}. Using standard field arrangements and 3D planning, we observed excellent coverage of the RB and IMN, regardless of laterality or reconstruction type. Our results demonstrate that adequate doses can be delivered to the RB with or without IMN coverage.

  1. Metabolic syndrome and outcome after breast reconstruction

    OpenAIRE

    Ounhasuttiyanon, Areerat; Lohsiriwat, Visnu

    2014-01-01

    Metabolic syndrome with its core components including obesity, insulin resistance, dyslipidemia and hypertension; is has been proven as a multiplex risk factor for cardiovascular disease. It is also recently shown by meta-analysis for its association with increased risk of common cancers including breast cancer. Multiple studies have shown metabolic syndrome prone to have poor perioperative outcome and complications for multiple type of surgery including vascular and flap surgery due to compr...

  2. Breast reconstruction: current and future options

    OpenAIRE

    Paul Jr H; Prendergast TI; Nicholson B; White S; Frederick WA

    2011-01-01

    Henry Paul Jr1, Tahira I Prendergast2, Bryson Nicholson2, Shenita White2, Wayne AI Frederick2,31Departments of Plastic Surgery, 2General Surgery, Howard University Hospital, 3Cancer Center, Howard University, Washington, DC, USAAbstract: When initiated by the devastating diagnosis of cancer, post ablative breast restoration has at its core the goal of restoring anatomic normalcy. The concepts of body image, wholeness, and overall well-being have been introduced to explain the paramount psycho...

  3. Patients opting for breast reconstruction following mastectomy: an analysis of uptake rates and benefit

    Science.gov (United States)

    Howard-McNatt, Marissa M

    2013-01-01

    For women with breast cancer who undergo a mastectomy, breast reconstruction offers improved psychological and cosmetic outcomes. We analyzed the rates of breast reconstruction and potential benefits to these women. The review was based on a PubMed search using the terms “reconstruction,” “mastectomy,” “rates,” “benefits,” and “breast cancer.” Breast-reconstruction rates have continued to rise in recent years; however, there are definite barriers to widespread use of this procedure. These barriers include age, ethnicity, income, tumor characteristics, and the need for adjuvant radiation therapy. There are notable psychological advantages to women who receive breast reconstruction. These women also express an improved quality of life. Breast reconstruction is an acceptable technique for women undergoing mastectomy. It should be offered to all women in an immediate or delayed fashion, with guidance from their physician about the benefits and risks. PMID:24648753

  4. Fat Grafting to the Breast, a Simple Procedure for a Very Complex Reconstruction.

    Science.gov (United States)

    Claro, Francisco; Pereira, Fernando Linhares; Pinto-Neto, Aarão M

    2016-01-01

    Usually, complicated reconstructions demand complex procedures. However, we report an unpublished situation where lipofilling was the only effective procedure for breast reconstruction, once 4 previous procedures, including 2 microvascular free flaps, had failed. The reported case describes a woman without subcutaneous tissue in the left breast topography, with radiation sequelae resulting in a fibrotic, hyperchromic, unexpandable skin that was tethered to her costal bone and pleura. The 4 previous attempts of breast reconstruction resulted in unavailable nearby recipient vessels, and this situation appointed breast lipofilling as the most feasible procedure. This report shows the power of breast lipofilling, a simple procedure that can be used even for the more complex reconstructions.

  5. Comparison of preoperative quality of life in breast reconstruction, breast aesthetic and non-breast plastic surgery patients: A cross-sectional study.

    Science.gov (United States)

    Duraes, Eliana F R; Durand, Paul; Duraes, Leonardo C; Orra, Susan; Moreira-Gonzalez, Andrea; Sousa, Joao Batista de; Djohan, Risal S; Zins, James; Bernard, Steven; Schwarz, Graham S

    2016-11-01

    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. Groups 1, 2, 3, 4, and 5 answered 141, 12, 23, 72 and 160 preoperative questionnaires respectively. There was no difference (p = NS) in breast satisfaction, psychosocial well-being, physical well-being-chest, and sexual well-being between groups 1 and 5. Group 1 had higher satisfaction with breast (p breasts (p breasts, psychosocial, and sexual well-being, compared to groups 2 and 3. Group 4 had lower scores in all domains, compared to groups 1 and 5 (p reconstruction patients had similar satisfaction with breasts, psychosocial well-being, and chest physical well-being, compared to non-breast plastic surgery patients. Aesthetic breast surgery patients demonstrate similar low scores in satisfaction with breasts, psychosocial well-being, and sexual well-being to those of patients prior to delayed breast reconstruction, or secondary salvage procedures. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  6. Comparison study of reconstruction algorithms for prototype digital breast tomosynthesis using various breast phantoms.

    Science.gov (United States)

    Kim, Ye-seul; Park, Hye-suk; Lee, Haeng-Hwa; Choi, Young-Wook; Choi, Jae-Gu; Kim, Hak Hee; Kim, Hee-Joung

    2016-02-01

    Digital breast tomosynthesis (DBT) is a recently developed system for three-dimensional imaging that offers the potential to reduce the false positives of mammography by preventing tissue overlap. Many qualitative evaluations of digital breast tomosynthesis were previously performed by using a phantom with an unrealistic model and with heterogeneous background and noise, which is not representative of real breasts. The purpose of the present work was to compare reconstruction algorithms for DBT by using various breast phantoms; validation was also performed by using patient images. DBT was performed by using a prototype unit that was optimized for very low exposures and rapid readout. Three algorithms were compared: a back-projection (BP) algorithm, a filtered BP (FBP) algorithm, and an iterative expectation maximization (EM) algorithm. To compare the algorithms, three types of breast phantoms (homogeneous background phantom, heterogeneous background phantom, and anthropomorphic breast phantom) were evaluated, and clinical images were also reconstructed by using the different reconstruction algorithms. The in-plane image quality was evaluated based on the line profile and the contrast-to-noise ratio (CNR), and out-of-plane artifacts were evaluated by means of the artifact spread function (ASF). Parenchymal texture features of contrast and homogeneity were computed based on reconstructed images of an anthropomorphic breast phantom. The clinical images were studied to validate the effect of reconstruction algorithms. The results showed that the CNRs of masses reconstructed by using the EM algorithm were slightly higher than those obtained by using the BP algorithm, whereas the FBP algorithm yielded much lower CNR due to its high fluctuations of background noise. The FBP algorithm provides the best conspicuity for larger calcifications by enhancing their contrast and sharpness more than the other algorithms; however, in the case of small-size and low

  7. Long-term outcome after mastectomy with immediate breast reconstruction

    DEFF Research Database (Denmark)

    Stralman, K.; Mollerup, C.L.; Kristoffersen, U.S.;

    2008-01-01

    . Furthermore, information of local recurrence rate, radiotherapy and death was obtained from the Danish Breast Cancer Cooperative Group register. Histopatological high and low risk patients were compared with respect to locoregional recurrence rate, recurrence free survival and death. Unpaired t......-test and Fisher's exact test were used to test for significance. RESULTS: The overall rate of revision surgery was 27%. Reconstruction with implants was associated with a significantly higher rate of revision surgery compared to reconstructions with transverse rectus abdominis myocutaneous flap or latissimus...

  8. Imaging approaches and findings in the reconstructed breast: a pictorial essay.

    Science.gov (United States)

    Scaranelo, Anabel M; Lord, Bridgette; Eiada, Riham; Hofer, Stefan O

    2011-02-01

    Advances in breast imaging over the last 15 years have improved early breast cancer detection and management. After treatment for breast cancer, many women choose to have reconstructive surgery. In addition, with the availability of widespread genetic screening for breast cancer, an increasing number of women are choosing prophylactic mastectomies and subsequent breast reconstruction. The purpose of this pictorial essay is to present the spectrum of imaging findings in the reconstructed breast. Copyright © 2011 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

  9. Immediate breast reconstruction with implants in breast cancer patients

    OpenAIRE

    Lagergren, Jakob

    2007-01-01

    Breast cancer is the most common form of cancer among Swedish women. The incidence has increased since the beginning of the 1970s. Simultaneously the age-standardized mortality has been relatively constant, which is probably explained by earlier tumour detection as a result of improved diagnostic methods and treatment advances. Most patients have surgery and additional therapy such as radiation, chemotherapy and/or endocrine therapy. For those subjected to mastectomy, a brea...

  10. An outcome analysis of intraoperative angiography for postmastectomy breast reconstruction.

    Science.gov (United States)

    Duggal, Claire S; Madni, Tarik; Losken, Albert

    2014-01-01

    Intraoperative angiography is a useful tool for predicting both tissue perfusion during postmastectomy breast reconstruction and mastectomy flap and free flap survival. The authors determine whether the routine use of laser-assisted indocyanine green (ICG) fluorescence angiography (SPY Imaging; LifeCell Corp, Branchburg, New Jersey) in breast reconstruction decreases the incidence of complications and whether this new technology is cost-effective. A retrospective review was conducted for 184 consecutive patients who underwent breast reconstruction using intraoperative ICG angiography from April 2009 to December 2011 at Emory University (Atlanta, Georgia). The incidence of complications (including mastectomy skin necrosis, flap necrosis, fat necrosis, unexpected reoperations, infections, and dehiscence) among these patients was compared with data for 184 consecutive patients who underwent breast reconstruction at Emory University from October 2007 to April 2009, prior to the introduction of ICG angiography. Patient data recorded included age, body mass index, smoking status, and history of preoperative radiation as well as the timing and type of reconstruction, along with complications. The cost of unexpected reoperations for perfusion-related complications and associated hospital stays was calculated. The 184 patients who underwent procedures using ICG angiography imaging had a lower incidence of mastectomy skin necrosis (13% vs 23.4%; P = .010) and unexpected reoperations for perfusion-related complications (5.9% vs 14.1%, P = .009). The 184 patients who underwent procedures without ICG angiography had a higher mean degree of severity of mastectomy skin necrosis (2.22 vs 1.83 on a scale of 1-3; P = .065). There were no significant differences in the degree of flap necrosis, nipple necrosis, fat necrosis, dehiscence, infection, implant exposure, flap loss, seroma, hematoma, or the number of overall complications between the 2 groups. The use of ICG angiography

  11. Breast Reconstruction Using Tram Flap: Prospective Outcome and Complications

    Directory of Open Access Journals (Sweden)

    Homayoon Zehtab

    2006-07-01

    Full Text Available Background:The transverse rectus abdominis musculocutaneous TRAM flap remains the gold standard for postmastectomy reconstruction either immediate or delayed.However,transfer of TRAM flap can be associated with donor site morbidities and complications in flap.A successful reconstruction consists of careful patient selection, surgical technique and meticulous preoperative planning.This study was designed to evaluate outcome and complications of breast reconstruction with TRAM flap in association with patient conditions and risk factors, prospectively. Methods: Breast reconstruction was performed in 44 women consecutively,using the TRAM flap during a 3-year period, 1999–2002. Modified radical mastectomy accompanying immediate reconstructions with TRAM flap was performed for 12 patients and delayed reconstruction was used for other patients with previous mastectomy. Results: The mean age of the patients was 40.41±4.43 years. Thirty (68.18% patients had comorbidities, consisting of radiation therapy, obesity, hypertension, diabetes mellitus, smoking and abdominal scar. Contralateral and ipsilateral TRAM flaps were used in 26(59.09% and 14(31.81% reconstructions, respectively. The abdominal defect was repaired in layers with the use of synthetic mesh in 30(68.18% patients. The overall complication rate was 31.82%, such as fat necrosis (15.91%, partial flap loss (13.64%, etc. Satisfaction rates were excellent in 10 (22.72%, good in 25 (56.82%, moderate in five (11.36%, and poor in four (9.09% patients. The mean of postoperative inpatient hospital days were 15.18±4.89 and 14.28±6.52 in patients with contralateral and ipsilateral flaps,respectively (p>0.05.A significant association was observed between overall complications and comorbidities. Partial flap loss and fat necrosis was associated with smoking, and abdominal hernia was associated with obesity marginally.Conclusions:The outcome of breast reconstruction using TRAM flap is similar by

  12. Efficient iterative image reconstruction algorithm for dedicated breast CT

    Science.gov (United States)

    Antropova, Natalia; Sanchez, Adrian; Reiser, Ingrid S.; Sidky, Emil Y.; Boone, John; Pan, Xiaochuan

    2016-03-01

    Dedicated breast computed tomography (bCT) is currently being studied as a potential screening method for breast cancer. The X-ray exposure is set low to achieve an average glandular dose comparable to that of mammography, yielding projection data that contains high levels of noise. Iterative image reconstruction (IIR) algorithms may be well-suited for the system since they potentially reduce the effects of noise in the reconstructed images. However, IIR outcomes can be difficult to control since the algorithm parameters do not directly correspond to the image properties. Also, IIR algorithms are computationally demanding and have optimal parameter settings that depend on the size and shape of the breast and positioning of the patient. In this work, we design an efficient IIR algorithm with meaningful parameter specifications and that can be used on a large, diverse sample of bCT cases. The flexibility and efficiency of this method comes from having the final image produced by a linear combination of two separately reconstructed images - one containing gray level information and the other with enhanced high frequency components. Both of the images result from few iterations of separate IIR algorithms. The proposed algorithm depends on two parameters both of which have a well-defined impact on image quality. The algorithm is applied to numerous bCT cases from a dedicated bCT prototype system developed at University of California, Davis.

  13. Nipple reconstruction after implant-based breast reconstruction: a "matched-pair" outcome analysis focusing on the effects of radiotherapy.

    Science.gov (United States)

    Momeni, Arash; Ghaly, Mina; Gupta, Deepak; Gurtner, Geoffrey; Kahn, David M; Karanas, Yvonne L; Lee, Gordon K

    2013-09-01

    The major focus of research when addressing nipple reconstruction has been on developing new techniques to provide for long-lasting nipple projection. Rarely, has the outcome of nipple reconstruction as it relates to postoperative morbidity, particularly after implant-based breast reconstruction, been analyzed. A "matched-pair" study was designed to specifically answer the question whether a history of radiotherapy predisposes to a higher complication rate after nipple reconstruction in patients after implant-based breast reconstruction. Only patients with a history of unilateral radiotherapy who underwent bilateral mastectomy and implant-based breast reconstruction followed by bilateral nipple reconstruction were included in the study. A total of 17 patients (i.e. 34 nipple reconstructions) were identified who met inclusion criteria. The mean age of the study population was 43.5 years (range, 23-69). Complications were seen after a total of 8 nipple reconstructions (23.5 percent). Of these, 7 complications were seen on the irradiated side (41.2 percent) (p = 0.03). While nipple reconstruction is a safe procedure after implant-based breast reconstruction in patients without a history of radiotherapy the presence of an irradiated field converts it to a procedure with a significant increase in postoperative complication rate. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  14. Direct delayed breast reconstruction with TAP flap, implant and acellular dermal matrix (TAPIA)

    DEFF Research Database (Denmark)

    Børsen-Koch, Mikkel; Gunnarsson, Gudjon L; Udesen, Ann;

    2015-01-01

    BACKGROUND: The latissimus dorsi (LD) flap is considered one of the working horses within the field of breast reconstruction and it offers several advantages. However, donor-site morbidity may pose a problem. This article describes a new and modified technique for delayed breast reconstruction co...... there is a learning curve, this simple modified technique does not demand any perforator or other vessel dissection. Any trained plastic surgeon should be able to adopt the technique into the growing armamentarium of breast reconstruction possibilities....

  15. Patients opting for breast reconstruction following mastectomy: an analysis of uptake rates and benefit

    OpenAIRE

    Howard-McNatt MM

    2013-01-01

    Marissa M Howard-McNattDepartment of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USAAbstract: For women with breast cancer who undergo a mastectomy, breast reconstruction offers improved psychological and cosmetic outcomes. We analyzed the rates of breast reconstruction and potential benefits to these women. The review was based on a PubMed search using the terms “reconstruction,” “mastectomy,” “rates,” &l...

  16. Predicting Microsurgical Aptitude.

    Science.gov (United States)

    Osborn, Heather A; Kuthubutheen, Jafri; Yao, Christopher; Chen, Joseph M; Lin, Vincent Y

    2015-08-01

    Microscopic techniques are an essential part of otolaryngologic practice. These procedures demand advanced psychomotor and visuospatial skills, and trainees possess these abilities to varying degrees. No method currently exists to predict who will possess an aptitude for microscopic surgery. Our goal was to determine whether performance can be predicted by background experiences or skills. Retrospective cohort study. Tertiary academic hospital. Students with no previous surgical experience. Subjects were surveyed on a wide range characteristics thought to affect surgical aptitude, with a primary focus on video gaming and musical training. Subjects performed a microsurgical task using a novel simulator and their performance was assessed by blinded investigators. Forty-six students were assessed. There was no correlation between video gaming and improved microsurgical performance. Rather, video gamers obtained worse scores, although this difference did not reach significance. The majority of students played a musical instrument. Within this group, musicians who began playing at younger ages obtained higher scores, with the highest scores obtained by musicians who began playing before age 6. However, musicians did not obtain higher scores than non-musicians, regardless of their age of initiation. No improvement in microsurgical aptitude was seen in subjects who had a history of video gaming or musical instrument playing.

  17. The association between complications and quality of life after mastectomy and breast reconstruction for breast cancer.

    Science.gov (United States)

    Browne, John P; Jeevan, Ranjeet; Gulliver-Clarke, Carmel; Pereira, Jerome; Caddy, Christopher M; van der Meulen, Jan H P

    2017-09-15

    Medical treatment for breast cancer is associated with substantial toxicity and patient burden. There is less known about the impact of surgical complications. Understanding this impact could provide important information for patients when they are considering surgical options. Between 2008 and 2009, the UK National Mastectomy and Breast Reconstruction Audit recorded surgical complications for a prospective cohort of 17,844 women treated for breast cancer at 270 hospitals; 6405 of these women were surveyed about their quality of life 18 months after surgery. Breast appearance, emotional well-being, and physical well-being were quantified on 0- to 100-point scales. Linear multiple regression models, controlling for a range of baseline prognostic factors, were used to compare the scores of patients who had complications with the scores of those who did not. The overall complication rate was 10.2%. Complications were associated with little or no impairment in women undergoing mastectomy without reconstruction or with delayed reconstruction. The association was much larger for flap-related complications suffered during immediate reconstruction. The breast-appearance scores (adjusted mean difference, -23.8; 95% confidence interval [CI], -31.0 to -16.6) and emotional well-being scores (adjusted mean difference, -14.0; 95% CI, -22.0 to -6.0) of these patients were much lower than those of any other patient group. Implant-related complications were not associated with a lower quality of life in any surgical group. There is a strong case for prospectively collecting flap-complication rates at the surgeon and surgical unit level and for allowing patients to access these data when they make choices about their breast cancer surgery. Cancer 2017;123:3460-7. © 2017 American Cancer Society. © 2017 American Cancer Society.

  18. The Transverse Musculocutaneous Gracilis Free Flap: Virtual Animation-Assisted Dissection and Application in Breast Reconstruction.

    Science.gov (United States)

    Gabert, Pierre-Elliott; Bodin, Frederic; Aljudaibi, Nawaf; Duquennoy-Martinot, Veronique; Guerreschi, Pierre

    2016-05-01

    The transverse musculocutaneous gracilis free flap is a valuable choice for autologous tissue, unilateral or bilateral breast reconstruction. This procedure is an excellent and customized option for immediate or delayed breast reconstruction in patients with small to moderate size breasts. Few descriptions of flap dissection and breast mound shaping are available. In this first educational video, the authors report the original dissection of the transverse musculocutaneous gracilis free flap used for breast reconstruction. Virtual animations insist on surgical key points and relevant details of the harvesting of the flap.

  19. Complications of Radiotherapy after Immediate Breast Reconstruction with Implant: Risk Factors and Management - Our Institute’s Experience

    National Research Council Canada - National Science Library

    Heba G. El-Sheredy; Rabie Ramadan; Yasser Hamed

    2016-01-01

    .... This study aims to evaluate the complications of radiotherapy after immediate breast reconstruction with implants in breast cancer patients who submitted to skin sparing mastectomy and nipple sparing...

  20. Improved immediate breast reconstruction as a result of oncoplastic multidisciplinary meeting

    Directory of Open Access Journals (Sweden)

    El Gammal MM

    2017-04-01

    Full Text Available Mohsen M El Gammal,1 Maria Lim,1 Rajan Uppal,2 Richard Sainsbury1 1Department of Breast Surgery, Parapet Breast Centre, Frimley Health Foundation Trust, Windsor, 2Department of Plastic and Reconstructive Surgery, Wexham and Heatherwood Hospital, Frimley Health Foundation Trust, Slough, UK Introduction: The National Institute for Health and Clinical Excellence guidelines recommend that breast reconstruction should be available to all women undergoing mastectomy and discussed at the initial surgical consultation (2002, and updated 2009. The National Mastectomy and Breast Reconstruction Audit (2009 showed that 21% of mastectomy patients underwent immediate breast reconstruction (IBR and 11% had delayed breast reconstruction (DBR. Breast reconstruction has been shown to have a positive effect on quality of life postmastectomy. This retrospective study investigated the impact of the introduction of a dedicated oncoplastic multidisciplinary meeting (OP MDM on our unit’s breast reconstruction rate.Patients and methods: A retrospective analysis of 229 women who underwent mastectomy, of whom 81 (35% underwent breast reconstruction between April 2014 and March 2016. Data were analyzed before and after introduction of OP MDM in April 2015. Data on patient age, type of surgery (mastectomy only, mastectomy and reconstruction, timing of reconstruction (IBR, DBR, and type of reconstruction (implant, autologous were collected.Results: Between April 2015 and March 2016, following establishment of OP multidisciplinary team in April 2015, of the 120 patients who had mastectomy, 50 (42% underwent breast reconstruction with 78% (39/50 choosing IBR (56% implant reconstruction and 22% autologous. Compared to the period between April 2014 and March 2015 preceding the OP MDM, of 109 patients who underwent mastectomy, only 31 (28% had breast reconstruction with 64% (20/31 choosing IBR (45% implant reconstruction and 19% autologous. The rate of DBR was lower, 22% (11

  1. Radiotherapy and breast reconstruction: a meta-analysis.

    LENUS (Irish Health Repository)

    Barry, M

    2011-05-01

    The optimum sequencing of breast reconstruction (BR) in patients receiving postmastectomy radiation therapy (PMRT) is controversial. A comprehensive search of published studies that examined postoperative morbidity following immediate or delayed BR with combined radiotherapy was performed. Medical (MEDLINE & EMBASE) databases were searched and cross-referenced for appropriate studies where morbidity following BR was the primary outcome measured. A total of 1,105 patients were identified from 11 appropriately selected studies. Patients undergoing PMRT and BR are more likely to suffer morbidity compared with patients not receiving PMRT (OR = 4.2; 95% CI, 2.4-7.2 [no PMRT vs. PMRT]). Reconstruction technique was also examined with outcome when PMRT was delivered after BR, and this demonstrated that autologous reconstruction is associated with less morbidity in this setting (OR = 0.21; 95% CI, 0.1-0.4 [autologous vs. implant-based]). Delaying BR until after PMRT had no significant effect on outcome (OR = 0.87; 95% CI, 0.47-1.62 [delayed vs. immediate]). PMRT has a detrimental effect on BR outcome. These results suggest that where immediate reconstruction is undertaken with the necessity of PMRT, an autologous flap results in less morbidity when compared with implant-based reconstruction.

  2. Trends in Immediate Postmastectomy Breast Reconstruction in the United Kingdom

    Science.gov (United States)

    Bottle, Alex; Mayer, Erik; Patten, Darren K.; Rao, Christopher; Aylin, Paul; Hadjiminas, Dimitri J.; Athanasiou, Thanos; Darzi, Ara; Gui, Gerald

    2015-01-01

    Background: The study aimed to evaluate local and national trends in immediate breast reconstruction (IBR) using the national English administrative records, Hospital Episode Statistics. Our prediction was an increase in implant-only and free flap procedures and a decline in latissimus flap reconstructions. Methods: Data from an oncoplastic center were interrogated to derive numbers of implant-only, autologous latissimus dorsi (LD), LD-assisted, and autologous pedicled or free flap IBR procedures performed between 2004 and 2013. Similarly, Hospital Episode Statistics data were used to quantify national trends in these procedures from 1996 to 2012 using a curve fitting analysis. Results: National data suggest an increase in LD procedures between 1996 (n = 250) and 2002 (n = 958), a gradual rise until 2008 (n = 1398) followed by a decline until 2012 (n = 1090). As a percentage of total IBR, trends in LD flap reconstruction better fit a quadratic (R2 = 0.97) than a linear function (R2 = 0.63), confirming a proportional recent decline in LD flap procedures. Conversely, autologous (non-LD) flap reconstructions have increased (1996 = 0.44%; 2012 = 2.76%), whereas implant-only reconstructions have declined (1996 = 95.42%; 2012 = 84.92%). Locally, 70 implant-assisted LD procedures were performed in 2003 -2004, but only 2 were performed in 2012 to 2013. Conclusions: Implants are the most common IBR technique; autologous free flap procedures have increased, and pedicled LD flap procedures are in decline. PMID:26495220

  3. [Breast reconstruction after skin-sparing mastectomy or nipple-sparing mastectomy for breast cancer].

    Science.gov (United States)

    Chen, Jie; Lü, Qing; Wang, Xiaodong; Li, Hongjiang; Chen, Yujuan; Yang, Xiaoqin; Zeng, Helin

    2013-07-01

    To evaluate the feasibility, oncological safety, and aesthetic result of skin-spring mastectomy (SSM) or nipple-spring mastectomy (NSM) in breast reconstruction of implant (permanent gel or expander) for breast cancer patients who were not fit for the breast conserving surgery (BCS). Between October 2005 and July 2011, 89 women with breast caner underwent SSM or NSM, with an average age of 42.4 years (range, 19-55 years) and an average disease duration of 5.7 months (range, 1-24 months). The pathological examination revealed invasive ductal carcinoma in 55 cases, ductal carcinoma in situ (DCIS) in 15 cases, invasive ductal carcinoma + DCIS in 8 cases, DCIS with infiltration in 10 cases, and occult breast cancer in 1 case. According to tumor staging criterion of American Joint Committee on Cancer (AJCC), 15 cases were rated as stage 0, 51 cases as stage I, 22 cases as stage II, and 1 case as unclear. Finally, 33 patients underwent SSM and 56 patients underwent NSM according to the location and diameter of tumor and the infiltration of tumor to nipple. Secondary breast reconstruction was performed with permanent gel replacement after axillary lymph node dissection in 9 patients with positive sentinel lymph node and 1 patient with occult breast cancer; immediate breast reconstruction was performed with permanent gel in the other patients. All the patients received the chemotherapy or/and radiotherapy according to the National Comprehensive Cancer Network (NCCN) guideline. Complications occurred in 5 patients undergoing breast reconstruction of permanent gel after NSM, including 1 case of haemorrhage, 2 cases of infection, and 2 cases of local skin necrosis. Primary healing of incision was obtained in the others. No nipple necrosis was observed in patients undergoing NSM. All the patients were followed up 14-88 months (median, 40 months). At 10 months after operation, the aesthetic results were excellent in 40 cases, good in 33 cases, fair in 14 cases, and poor in 2

  4. SAFETY OF LIPOFILLING AS A SECONDARY PROCEDURE IN BREAST RECONSTRUCTION

    Directory of Open Access Journals (Sweden)

    Lubna Noor

    2016-01-01

    Full Text Available Lipofilling is a useful surgical technique for breast reconstruction following cancer surgery. It has a unique place in the correction of both lumpectomy and post-mastectomy reconstruction defects. The procedure is mostly performed as lipofilling without ADRC. In this study, we included patients who had lipofilling with or without ADRC. We divided patients into two groups. Group I comprised of patients with lipofilling for lumpectomy defects and group II included patients with post mastectomy reconstruction defects. We compared the outcome of lipofilling with or without ADRC. The mean time from oncological surgery to the fat grafting procedure was 58 months (range 20 months to 17 years. An average of 232 ml of fat (80-420 ml was injected. No immediate postoperative complications were seen. The average follow-up was 50 months following lipofilling procedure. Benign imaging changes were observed in 18/53 (33 percent patients. A percutaneous biopsy was required in 6 patients (11.3%. No local recurrences were seen in either group of patients. Our results suggested no increase in the risk of local recurrence or new cancer development following lipofilling in breast cancer patients. Patients with stage III disease were found to be at a higher risk of distant metastasis.

  5. Selective capsulotomies of the expanded breast as a remodelling method in two-stage breast reconstruction.

    Science.gov (United States)

    Grimaldi, Luca; Campana, Matteo; Brandi, Cesare; Nisi, Giuseppe; Brafa, Anna; Calabrò, Massimiliano; D'Aniello, Carlo

    2013-06-01

    The two-stage breast reconstruction with tissue expander and prosthesis is nowadays a common method for achieving a satisfactory appearance in selected patients who had a mastectomy, but its most common aesthetic drawback is represented by an excessive volumetric increment of the superior half of the reconstructed breast, with a convexity of the profile in that area. A possible solution to limit this effect, and to fulfil the inferior pole, may be obtained by reducing the inferior tissue resistance by means of capsulotomies. This study reports the effects of various types of capsulotomies, performed in 72 patients after removal of the mammary expander, with the aim of emphasising the convexity of the inferior mammary aspect in the expanded breast. According to each kind of desired modification, possible solutions are described. On the basis of subjective and objective evaluations, an overall high degree of satisfaction has been evidenced. The described selective capsulotomies, when properly carried out, may significantly improve the aesthetic results in two-stage reconstructed breasts, with no additional scars, with minimal risks, and with little lengthening of the surgical time.

  6. Skin-sparing mastectomy and immediate reconstruction with DIEP flap after breast-conserving therapy

    Science.gov (United States)

    Andree, Christoph; Munder, Beatrix; Seidenstuecker, Katrin; Richrath, Philipp; Behrendt, Philipp; Köppe, Tobias; Hagouan, Mazen; Audretsch, Werner; Nestle-Krämling, Carolin; Witzel, Christian

    2012-01-01

    Summary Background Currently about 70% of women who suffer from breast cancer undergo breast-conserving therapy (BCT) without removing the entire breast. Thus, this surgical approach is the standard therapy for primary breast cancer. If corrections are necessary, the breast surgeon is faced with irritated skin and higher risks of complications in wound healing. After radiation, an implant-based reconstruction is only recommended in selected cases. Correction of a poor BCT outcome is often only solved with an additional extended operation using autologous reconstruction. Material/Methods In our plastic surgery unit, which focuses on breast reconstruction, we offer a skin-sparing or subcutaneous mastectomy, followed by primary breast reconstruction based on free autologous tissue transfer to correct poor BCT outcomes. Between July 2004 and May 2011 we performed 1068 deep inferior epigastric artery perforator (DIEP) flaps for breast reconstruction, including 64 skin-sparing or subcutaneous mastectomies, followed by primary DIEP breast reconstruction procedures after BCT procedures. Results In all free flap-based breast reconstruction procedures, we had a total flap loss in 0.8% (9 cases). Within the group of patients after BCT, we performed 41 DIEP flaps and 23 ms-2 TRAM flaps after skin-sparing or subcutaneous mastectomies to reconstruct the breast. Among this group we had of a total flap loss in 1.6% (1 case). Conclusions In cases of large tumour sizes and/or difficult tumour locations, the initial oncologic breast surgeon should inform the patients of a possibly poor cosmetic result after BCT and radiation. In our opinion a skin-sparing mastectomy with primary breast reconstruction should be discussed as a valid alternative. PMID:23197233

  7. Skin-sparing mastectomy and immediate reconstruction with DIEP flap after breast-conserving therapy

    OpenAIRE

    Andree, Christoph; Munder, Beatrix; Seidenstuecker, Katrin; Richrath, Philipp; Behrendt, Philipp; Köppe, Tobias; Hagouan, Mazen; Audretsch, Werner; Nestle-Krämling, Carolin; Witzel, Christian

    2012-01-01

    Summary Background Currently about 70% of women who suffer from breast cancer undergo breast-conserving therapy (BCT) without removing the entire breast. Thus, this surgical approach is the standard therapy for primary breast cancer. If corrections are necessary, the breast surgeon is faced with irritated skin and higher risks of complications in wound healing. After radiation, an implant-based reconstruction is only recommended in selected cases. Correction of a poor BCT outcome is often onl...

  8. Breast reconstruction: review of surgical methods and spectrum of imaging findings.

    Science.gov (United States)

    Pinel-Giroux, Fanny Maud; El Khoury, Mona M; Trop, Isabelle; Bernier, Christina; David, Julie; Lalonde, Lucie

    2013-01-01

    Breast reconstruction after mastectomy is often requested by women with breast cancer who are ineligible for breast-conserving therapy and women with a high genetic risk for breast cancer. Current breast reconstruction techniques are diverse and may involve the use of an autologous tissue flap, a prosthetic implant, or both. Regardless of the technique used, cancer may recur in the reconstructed breast; in addition, in breasts reconstructed with autologous tissue flaps, benign complications such as fat necrosis may occur. To detect breast cancer recurrences at a smaller size than can be appreciated clinically and as early as possible without evidence of metastasis, radiologists must be familiar with the range of normal and abnormal imaging appearances of reconstructed breasts, including features of benign complications as well as those of malignant change. Images representing this spectrum of findings were selected from the clinical records of 119 women who underwent breast magnetic resonance (MR) imaging at the authors' institution between January 2009 and March 2011, after mastectomy and breast reconstruction. In 32 of 37 women with abnormal findings on MR images, only benign changes were found at further diagnostic workup; in the other five, recurrent breast cancer was found at biopsy. Four of the five had been treated initially for invasive carcinoma, and one, for multifocal ductal carcinoma; three of the five were carriers of a BRCA gene mutation. On the basis of these results, the authors suggest that systematic follow-up examinations with breast MR imaging may benefit women with a reconstructed breast and a high risk for breast cancer recurrence.

  9. Automatic landmarks detection in breast reconstruction aesthetic assessment.

    Science.gov (United States)

    Núñez-Benjumea, Francisco J; Serrano, Carmen; Acha, Begoña

    2015-01-01

    This paper addresses a fully automatic landmarks detection method for breast reconstruction aesthetic assessment. The set of landmarks detected are the supraesternal notch (SSN), armpits, nipples, and inframammary fold (IMF). These landmarks are commonly used in order to perform anthropometric measurements for aesthetic assessment. The methodological approach is based on both illumination and morphological analysis. The proposed method has been tested with 21 images. A good overall performance is observed, although several improvements must be achieved in order to refine the detection of nipples and SSNs.

  10. The direct results of breast reconstruction using endoprotheses in patients with breast cancer

    Directory of Open Access Journals (Sweden)

    Юрий Алексеевич Винник

    2016-04-01

    Full Text Available Aim of research: the study of the direct results of using endoprotheses synchronously with the surgical stage of combined and complex treatment of patients with BC.The improvement of results of the complex treatment of patients with BC by means of determination of indications for using the different variants of reconstructive-plastic operations.Materials and methods. Under observation were 120 patients with BC who underwent the combined and complex treatment during the period 2012–2015years on the base of MIHP “Kharkov regional oncologic center”. For the study and comparative analysis of the treatment effect on the life quality (LQ indices all patients were separated into 2 groups by the method of temporal randomization. The 1group – 78 patients who underwent the breast reconstruction with the own tissues remodeling.The 2 group – 32 patients who underwent the hypodermic mastectomies with preservation of the nipple-alveolar complex (NAC and the momentary breast reconstruction with silicone endoprothesis.Results of research. At the all stages of observation the lines of the role and social functioning change in parallel that indicates the absence of the effect of using the reconstructive-plastic operations at the surgical stage of both combined and complex treatment of patients with BC on this LQ index.Conclusions1. The reconstructive-plastic surgical intervention using endoprotheses synchronously with the hypodermic mastectomy with preservation of NAC allow obtain the good cosmetic results that in its turn leads to the acceleration of psycho-emotional rehabilitation of patients with BC.2. On the base of research was established the absence of the effect of breast reconstruction on the widening of post-operative complications spectrum and on the planned individually adjuvant therapy in this category of patientsAim of research: the study of the direct results of using endoprotheses synchronously with the surgical stage of combined and

  11. Transferencia microquirúrgica del 2º dedo del pie para reconstrucción de mano catastrófica Microsurgical 2nd toe transfer for catastrophic hand reconstruction

    Directory of Open Access Journals (Sweden)

    A. Placer

    2007-12-01

    Full Text Available La reconstrucción correcta de la mano catastrófica requiere habitualmente técnicas quirúrgicas complejas. La transferencia microquirúrgica de un dedo del pie es una de las técnicas frecuentemente empleadas. Dicho procedimiento está indicado cuando las demás opciones reconstructivas se muestran inútiles para la reparación de la pinza manual. En este trabajo se expone el caso de un varón de 32 años que acude a urgencias tras sufrir un accidente de tráfico en el que presenta traumatismo grave de la mano izquierda (mano catastrófica, entre otras policontusiones. Se interviene de urgencia preservando las máximas estructuras viables, quedando como resultado una mano con 1º, 4º y 5º dedos funcionales. Como la función de la pinza entre 1º y 4º ó 5º dedos no es plenamente satisfactoria, se optó por la reconstrucción del 3er dedo de la mano con la transferencia del 2º dedo del pie ipsilateral. Se realizaron estudios preoperatorios, como el angio-TC, para determinar la vascularización del colgajo y, posteriormente, la intervención microquirúrgica, que fue exitosa. En la actualidad, tras una adecuada rehabilitación, el paciente ha recuperado en la mano intervenida la función de pinza gruesa y fina de manera satisfactoria. La transferencia de los dedos del pie a la mano se muestra como un tratamiento eficaz para la reconstrucción de los dedos amputados y consecuentemente la función de la pinza. La rehabilitación es imprescindible para conseguir una completa funcionalidad.The correct reconstruction of the catastrophic hand requires complex surgical techniques. The microsurgical transference of a toe is indicated when all other reconstructive options are shown to be useless for the reconstruction of the required clamp function. In this clinical note we set out the case of a 32 year old man, who came to our accident and emergency department after suffering a traffic accident. After exploration the diagnosis was that of

  12. Patients opting for breast reconstruction following mastectomy: an analysis of uptake rates and benefit

    Directory of Open Access Journals (Sweden)

    Howard-McNatt MM

    2013-02-01

    Full Text Available Marissa M Howard-McNattDepartment of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USAAbstract: For women with breast cancer who undergo a mastectomy, breast reconstruction offers improved psychological and cosmetic outcomes. We analyzed the rates of breast reconstruction and potential benefits to these women. The review was based on a PubMed search using the terms “reconstruction,” “mastectomy,” “rates,” “benefits,” and “breast cancer.” Breast-reconstruction rates have continued to rise in recent years; however, there are definite barriers to widespread use of this procedure. These barriers include age, ethnicity, income, tumor characteristics, and the need for adjuvant radiation therapy. There are notable psychological advantages to women who receive breast reconstruction. These women also express an improved quality of life. Breast reconstruction is an acceptable technique for women undergoing mastectomy. It should be offered to all women in an immediate or delayed fashion, with guidance from their physician about the benefits and risks.Keywords: breast reconstruction, breast cancer, rates, benefits

  13. A Multi-institutional Analysis of Insurance Status as a Predictor of Morbidity Following Breast Reconstruction

    Directory of Open Access Journals (Sweden)

    Brittany L. Vieira, BS

    2014-11-01

    Conclusions: This study is the first to investigate the differential effects of payer status on outcomes following breast reconstruction. Our results suggest that Medicaid and Medicare insurance status does not independently predict increased overall complication rates following breast reconstruction. This finding underscores the commitment of the plastic surgery community to providing consistent care for patients, irrespective of insurance status.

  14. Microvascular breast reconstruction and lymph node transfer for postmastectomy lymphedema patients.

    Science.gov (United States)

    Saaristo, Anne M; Niemi, Tarja S; Viitanen, Tiina P; Tervala, Tomi V; Hartiala, Pauliina; Suominen, Erkki A

    2012-03-01

    Postoperative lymphedema after breast cancer surgery is a challenging problem. Recently, a novel microvascular lymph node transfer technique provided a fresh hope for patients with lymphedema. We aimed to combine this new method with the standard breast reconstruction. During 2008-2010, we performed free lower abdominal flap breast reconstruction in 87 patients. For all patients with lymphedema symptoms (n = 9), we used a modified lower abdominal reconstruction flap containing lymph nodes and lymphatic vessels surrounding the superficial circumflex vessel pedicle. Operation time, donor site morbidity, and postoperative recovery between the 2 groups (lymphedema breast reconstruction and breast reconstruction) were compared. The effect on the postoperative lymphatic vessel function was examined. The average operation time was 426 minutes in the lymphedema breast reconstruction group and 391 minutes in the breast reconstruction group. The postoperative abdominal seroma formation was increased in patients with lymphedema. Postoperative lymphoscintigraphy demonstrated at least some improvement in lymphatic vessel function in 5 of 6 patients with lymphedema. The upper limb perimeter decreased in 7 of 9 patients. Physiotherapy and compression was no longer needed in 3 of 9 patients. Importantly, we found that human lymph nodes express high levels of endogenous lymphatic vessel growth factors. Transfer of the lymph nodes and the resulting endogenous growth factor expression may thereby induce the regrowth of lymphatic network in the axilla. No edema problems were detected in the lymph node donor area. Simultaneous breast and lymphatic reconstruction is an ideal option for patients who suffer from lymphedema after mastectomy and axillary dissection.

  15. [Progress in immediate breast reconstruction with skin sparing mastectomy].

    Science.gov (United States)

    Garbay, J-R; Saouma, S; Marsiglia, H

    2008-04-01

    Skin sparing mastectomy (SSM) and subcutaneous mastectomy (SCM) are recent techniques. They are always associated with immediate breast reconstruction (IBR). Their safety from an oncologic point of view and indications are of great concern. In early breast cancer, SSM and SCM are associated with the same risk of local recurrence as a modified radical mastectomy, when correctly indicated. This has been validated by numerous studies. In these non-randomised studies, overall survival cannot be evaluated. Such techniques can now be validated in the oncologic setting when correctly indicated and when decision-making is always concerted and multidisciplinary. Skin-sparing techniques are obviously associated with better cosmetic results than secondary reconstructions. Thus SSM with IBR are ideally indicated for ductal carcinoma in situ, pure infiltrating or mixed carcinomas requiring mastectomy without subsequent radiotherapy. The selection criterion of no postoperative radiotherapy allows the right candidates to be chosen for SSM. But often this criterion cannot be obtained preoperatively. In such cases, performing a two-step operation could be a good option. The interval between operations can be used by the patient to obtain more information and to make a mature decision regarding her choice of treatment. It seems essential to be able to offer every patient SSM with IBR which are validated standardised indications. Such is not the case everywhere in France today. The organisation of primary care through professional networks should provide us with an opportunity to fulfil these needs.

  16. Quantification of resolution in multiplanar reconstructions for digital breast tomosynthesis

    Science.gov (United States)

    Vent, Trevor L.; Acciavatti, Raymond J.; Kwon, Young Joon; Maidment, Andrew D. A.

    2016-03-01

    Multiplanar reconstruction (MPR) in digital breast tomosynthesis (DBT) allows tomographic images to be portrayed in various orientations. We have conducted research to determine the resolution of tomosynthesis MPR. We built a phantom that houses a star test pattern to measure resolution. This phantom provides three rotational degrees of freedom. The design consists of two hemispheres with longitudinal and latitudinal grooves that reference angular increments. When joined together, the hemispheres form a dome that sits inside a cylindrical encasement. The cylindrical encasement contains reference notches to match the longitudinal and latitudinal grooves that guide the phantom's rotations. With this design, any orientation of the star-pattern can be analyzed. Images of the star-pattern were acquired using a DBT mammography system at the Hospital of the University of Pennsylvania. Images taken were reconstructed and analyzed by two different methods. First, the maximum visible frequency (in line pairs per millimeter) of the star test pattern was measured. Then, the contrast was calculated at a fixed spatial frequency. These analyses confirm that resolution decreases with tilt relative to the breast support. They also confirm that resolution in tomosynthesis MPR is dependent on object orientation. Current results verify that the existence of super-resolution depends on the orientation of the frequency; the direction parallel to x-ray tube motion shows super-resolution. In conclusion, this study demonstrates that the direction of the spatial frequency relative to the motion of the x-ray tube is a determinant of resolution in MPR for DBT.

  17. Partner relationships after mastectomy in women not offered breast reconstruction.

    Science.gov (United States)

    Andrzejczak, Ewa; Markocka-Mączka, Krystyna; Lewandowski, Andrzej

    2013-07-01

    The present study assessed the degree to which undergoing a mastectomy without reconstructive surgery negatively impacts the patient's psychological state. We focus on body image and self-esteem as well as the influence of mastectomy on patient sex lives and partnership relations. The participants were 60 women, either married or in a relationship, who had had a mastectomy because of breast cancer and no subsequent reconstructive surgery. A marital happiness questionnaire was used to evaluate the research problem. Surgery negatively impacted partnership relations for 33% of participants. In particular, 31% reported deterioration in attractiveness; 31%, a feeling of malaise; and 30%, that their partners perceived them as less attractive. Moreover, 80% in the youngest group reported that they covered their body during intimate contact, whereas 58% in the oldest age group reported the same behaviour. Deterioration in satisfaction with sex life and in the pleasure of sexual intercourse was indicated by 71% and 77%, respectively. Correspondingly, 71% also noticed a decrease in sexual activity, with 76% of participants aged 50-65 years reporting such a decline. The oldest women were also less satisfied with their sexual intercourse. Breast excision due to cancer negatively impacted the quality of sexual life for 71% of participants. Partnership relations after surgery remained unchanged for 67% of them. There was significant impact of surgery on the perception of one's own body. Copyright © 2012 John Wiley & Sons, Ltd.

  18. Breast cancer in women under age 40 years: treatment by total mastectomy and reconstruction.

    Science.gov (United States)

    Vogel, Jeffery E; Chu, Carrie; McCullough, Meghan; Anderson, Erica; Losken, Albert; Carlson, Grant W

    2011-05-01

    Breast cancer in women under 40 years of age is rare, accounting for approximately 5% of cases. The disease tends to be more aggressive in younger women. Younger age has been shown to be an independent predictive of breast reconstruction after total mastectomy. Treatment by total mastectomy and reconstruction is examined in relation to patient age. A retrospective review of all breast cancer patients treated by total mastectomy and reconstruction between 2005 and 2009 was performed by querying a prospective database. A total of 671 patients underwent total mastectomy and reconstruction; of them, 106 (16%) aged mastectomy (P mastectomy.

  19. Bilateral Breast Reconstruction with Extended Thoracodorsal Artery Perforator Propeller Flaps and Implants

    DEFF Research Database (Denmark)

    Gunnarsson, Gudjon L; Børsen-Koch, Mikkel; Nielsen, Henrik Toft

    2015-01-01

    We present our experience of bilateral total breast reconstruction using a double-sided extended thoracodorsal artery perforator propeller flap in a case series of 10 patients. Reconstruction was successfully achieved in all cases with few complications. The median time for surgery was 275 minutes...... (200-330), and the average implant size used was 350 cm(3) (195-650). We demonstrate how the extended thoracodorsal artery perforator propeller flap allows for a swift and reliable direct to implant bilateral total breast reconstruction in a simple setting and is a valuable adjunct to our armamentarium...... of techniques for single-stage bilateral breast reconstruction....

  20. Impact of Prior Tissue Expander/Implant on Postmastectomy Free Flap Breast Reconstruction.

    Science.gov (United States)

    Roostaeian, Jason; Yoon, Alfred P; Ordon, Shannon; Gold, Chris; Crisera, Christopher; Festekjian, Jaco; Da Lio, Andrew; Lipa, Joan E

    2016-04-01

    Implant-based breast reconstructions can result in unsatisfactory results requiring surgical revision or salvage reconstructive surgery with autologous tissue. This study compares the outcomes and complications of salvage (tertiary) flap reconstruction after failed prosthesis placement to those of primary/secondary flap reconstruction. All patients undergoing free flap breast reconstruction after failed prosthesis between July 1, 2005, and June 30, 2014, were identified. A matched number of patients who underwent a de novo free flap breast reconstruction were selected randomly for review. The indication for prosthesis removal, demographic and operative data, flap type and inset, and complication rates were evaluated. Eighty-nine women with a history of failed implant-based reconstruction required free flap reconstruction for salvage in 121 breasts. Capsular contracture was the most common indication for prosthesis removal (62.0 percent). Recipient vessel scarring was 5.23 times more likely to occur in the prior prosthesis group (p breast reconstruction with autologous tissue after failed prosthesis can be safely performed, with success rates similar to those of primary free flap breast reconstruction. However, these procedures may have increased complexity because of recipient vessel scarring, higher rates of prior radiation therapy, and major complications, which may warrant appropriate preoperative planning and patient counseling. Therapeutic, III.

  1. Multiplanar Reconstructions of 3D Automated Breast Ultrasound Improve Lesion Differentiation by Radiologists

    NARCIS (Netherlands)

    Zelst, J.C.M. van; Platel, B.; Karssemeijer, N.; Mann, R.M.

    2015-01-01

    RATIONALE AND OBJECTIVES: To investigate the value of multiplanar reconstructions (MPRs) of automated three-dimensional (3D) breast ultrasound (ABUS) compared to transverse evaluation only, in differentiation of benign and malignant breast lesions. MATERIALS AND METHODS: Five breast radiologists eva

  2. Immediate postmastectomy breast reconstruction showed limited advantage in patient survival after stratifying by family income.

    Directory of Open Access Journals (Sweden)

    Yi-Zhou Jiang

    Full Text Available BACKGROUND: Postmastectomy breast reconstruction is widely used in breast cancer patients for its aesthetic effect. Although several studies have casted suspicion upon the oncological safety of immediate breast reconstruction after mastectomy, the potential impact of different reconstruction methods on patient survival remains unclear. PATIENTS AND METHODS: We identified 35,126 female patients diagnosed with breast cancer from January 1, 1998 to December 31, 2002 in the Surveillance, Epidemiology, and End Results database. Breast cancer-specific survival (BCSS and overall survival (OS were compared among patients who underwent mastectomy with or without immediate breast reconstruction (autologous reconstruction or implant reconstruction using Cox proportional hazard regression models. RESULTS: In multivariate analysis unadjusted for family income, patients undergoing immediate postmastectomy reconstruction exhibited improved BCSS [POOLED reconstruction (any types of reconstruction: hazard ratio (HR  =  0.87, 95% confidence interval (CI 0.80-0.95, P = 0.001] and OS (pooled reconstruction: HR = 0.70, 95% CI 0.65-0.75, P<0.001 compared to patients who underwent mastectomy alone. However, after stratifying by family income, patients receiving reconstruction showed limited advantage in BCSS and OS compared with those undergoing mastectomy alone. When comparing between the two reconstruction methods, no significant differences were observed in either BCSS (implant versus autologous reconstruction: HR = 1.11, 95%CI 0.90-1.35, P = 0.330 or OS (implant versus autologous reconstruction: HR = 1.07, 95% 0.90-1.28, P = 0.424. CONCLUSIONS: Compared to mastectomy alone, immediate postmastectomy reconstruction had limited advantage in survival after adjusting for confounding factor of family income. Our findings, if validated in other large databases, may help to illustrate the actual effect of immediate postmastectomy reconstruction on patient survival.

  3. Reconstruction

    Directory of Open Access Journals (Sweden)

    Stefano Zurrida

    2011-01-01

    Full Text Available Breast cancer is the most common cancer in women. Primary treatment is surgery, with mastectomy as the main treatment for most of the twentieth century. However, over that time, the extent of the procedure varied, and less extensive mastectomies are employed today compared to those used in the past, as excessively mutilating procedures did not improve survival. Today, many women receive breast-conserving surgery, usually with radiotherapy to the residual breast, instead of mastectomy, as it has been shown to be as effective as mastectomy in early disease. The relatively new skin-sparing mastectomy, often with immediate breast reconstruction, improves aesthetic outcomes and is oncologically safe. Nipple-sparing mastectomy is newer and used increasingly, with better acceptance by patients, and again appears to be oncologically safe. Breast reconstruction is an important adjunct to mastectomy, as it has a positive psychological impact on the patient, contributing to improved quality of life.

  4. Effects of microsurgical free flap transfer on oral and maxillofacial reconstruction%游离皮瓣移植修复口腔颌面部缺损的临床效果观察

    Institute of Scientific and Technical Information of China (English)

    翟沁凯; 王绪凯; 卢利; 孙长伏; 谭学新; 秦兴军; 黄绍辉

    2011-01-01

    Objective To analyze the clinical value of microsurgical free flap transfers for oral and maxillofacial region reconstruction.Methods One hundred and sixty-eight consecutive microsurgical free flap transfers performed on patients who had oral and maxillofacial defects from premodinantly surgical procedure due to carcinoma from March 2006 to August 2010 were reviewed.Concerning data include 90 free radial forearm flap,31 free fibular flap,39 anterolateral thigh flap and 8 latissmus dorsi musculocutaneous flap.Observe the microsurgical free plap survival rate and complication postoperatively.Results The overall success rate of flap was 97.6%(164/168).The overall complication rate was 6.5% (11/168).The flap crisis rate was 5.4% (9/168)including the vessel thrombosis rate 66.7% (6/9), and the flap salvage rate was 55.6% (5/9).Survival rate of radial forearm free flap,anterolateral thigh flap,fibular flap and latissmus dorsi musculocutaneous flap were 97.8% ,97.4% ,96.8%, 100% respectively.The features and functions of patients were mainly satisfactory after 2 ~ 2.5 years' follow-ups.Conclusions Mierosurgieal free flap transfer for oral and maxiilofaeial region defects is safe and reliable.The free radial forearm flap was most commonly used, followed by anterolateral thigh flap,fibular free flap and latissimus dorsi flap.%目的 探讨游离皮瓣在修复口腔颌面部缺损中的临床应用价值.方法 选择2006年03月-2010年08月中国医科大学口腔医学院口腔颌面外科用游离皮瓣修复口腔颌面部缺损病例168例,前臂游离皮瓣90例,股前外侧游离皮瓣39例,腓骨肌皮瓣31例,背阔肌皮瓣8例.术后观察皮瓣成活率和并发症.结果 成功164(97.6%)例,失败4例,患者出现术后早期局部并发症6.5%(11/168),术后皮瓣危象发生率为5.4%(9/168),其中静脉血栓形成66.7%(6/9),手术探查抢救成功率55.6%(5/9),前臂桡侧皮瓣成活率97.8%(88/90);股前外侧皮瓣成活率97

  5. RECURRENCE OF BREAST CANCER AFTER SUBCUTANEOUS MASTECTOMY WITH SIMULTANEOUS RECONSTRUCTION

    Directory of Open Access Journals (Sweden)

    A. D. Zikiryakhodzhaev

    2014-01-01

    revealed. The distribution of recurrence depending on the stage of breast cancer: in stage I of 5,5%, IIA - 3,5%, IIB - 5,7%, IIIA – 4,4% in S of 7,3%. In 2 cases after the first relapse of 16 was diagnosed with a relapse, which was 12.5%. In stage I breast cancer  as diagnosed with a relapse of 5,5%, which is probably due to the absence of radiation therapy in the postoperative period, since the initial stage and the operation volume is sufficient, the number of relapse - 10 and in any case, radiation therapy was not carried out.Conclusion. Over the 5 years of observation for patients with breast cancer after radical subcutaneous mastectomy/ konohana radical mastectomy with simultaneous reconstruction, recurrence developed in 34 cases (4.4% patients. The important fact is the detection of local recurrence after 10 years of follow-up (8,1% after treatment, which confirms the need for dynamic monitoring of patients throughout life. The frequency of relapses affected by stage of breast cancer, young age of patients, the histogenesis and subtype of the tumor. When combined adverse prognostic factors should be used for reoperation on the breast. Radical subcutaneous mastectomy or konohana radical mastectomy with simultaneous reconstruction of an adequate volume of transactions in the cancer plan, and effective method of reabilitacii breast cancer patients. Relapse of breast cancer after these surgeries is not different from the risk of recurrence after radical mastectomy. Despite the presence of repeated operations, the preservation of the reconstructed breast cancer after recurrence of breast cancer was possible in 65, 7% of cases in our study.

  6. Current Status of Implant-based Breast Reconstruction in Patients Receiving Postmastectomy Radiation Therapy

    Science.gov (United States)

    Kronowitz, Steven J.

    2014-01-01

    Background Increasing numbers of patients with breast cancer are being treated with postmastectomy radiation therapy (PMRT). The author reviewed the literature to determine the clinical impact of this increasing use of PMRT in patients with breast cancer who desire implant-based breast reconstruction. Methods The author searched the MEDLINE database for articles on breast reconstruction and radiation therapy published between January 2008 and June 2011, and reviewed the abstracts of those articles to identify articles with information about the impact of radiation on implant-based breast reconstruction. This subgroup of articles was reviewed in detail. Results Two-hundred eighty-five articles were identified. 19 papers were reviewed in detail. 8 papers provided level III evidence; one provided level I or II (n = 8) evidence from high-quality multicenter or single-center randomized controlled trials or prospective cohort studies. Two papers provided level IV evidence from case series and were included in the review because they offered a novel approach or perspective. The most recent studies find a significant need for unplanned or major corrective surgery in irradiated breasts reconstructed with implants. Although breast implant reconstruction in irradiated breasts is associated with high rates of complications; only a minority of patients require conversion to an autologous tissue flap. Conclusions Although the majority of patients who undergo implant-based reconstruction and receive radiation ultimately keep the implant reconstruction, patient surveys show that radiation has a significantly negative effect on patient satisfaction. PMID:23018711

  7. Trends and Variation in Use of Breast Reconstruction in Patients With Breast Cancer Undergoing Mastectomy in the United States

    Science.gov (United States)

    Jagsi, Reshma; Jiang, Jing; Momoh, Adeyiza O.; Alderman, Amy; Giordano, Sharon H.; Buchholz, Thomas A.; Kronowitz, Steven J.; Smith, Benjamin D.

    2014-01-01

    Purpose Concerns exist regarding breast cancer patients' access to breast reconstruction, which provides important psychosocial benefits. Patients and Methods Using the MarketScan database, a claims-based data set of US patients with employment-based insurance, we identified 20,560 women undergoing mastectomy for breast cancer from 1998 to 2007. We evaluated time trends using the Cochran-Armitage test and correlated reconstruction use with plastic-surgery workforce density and other treatments using multivariable regression. Results Median age of our sample was 51 years. Reconstruction use increased from 46% in 1998 to 63% in 2007 (P mastectomy also increased: from 3% in 1998 to 18% in 2007 (P mastectomy were more likely to receive reconstruction (odds ratio [OR], 2.3; P mastectomy (OR, 0.5; P < .001), or patients in the highest income quartile (OR, 0.7; P = .006). Delayed reconstruction was performed in 21% of patients who underwent reconstruction. Conclusion Breast reconstruction has increased over time, but it has wide geographic variability. Receipt of other treatments correlates with the use of and approaches toward reconstruction. Further research and interventions are needed to ensure equitable access to this important component of multidisciplinary treatment of breast cancer. PMID:24550418

  8. Stereotactic Image-Guided Navigation During Breast Reconstruction in Patients With Breast Cancer

    Science.gov (United States)

    2017-04-12

    Ductal Breast Carcinoma in Situ; Lobular Breast Carcinoma in Situ; Recurrent Breast Cancer; Stage IA Breast Cancer; Stage IB Breast Cancer; Stage II Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer; Stage IV Breast Cancer

  9. Porcine acellular dermis-based breast reconstruction: complications and outcomes following adjuvant radiotherapy

    OpenAIRE

    Ng, Cho Ee; Pieri, Andrew; Fasih, Tarannum

    2015-01-01

    Background Acellular dermal matrices (ADM) such as StratticeTM are increasingly used in UK during implant-based reconstruction. However, there are mixed opinions regarding the compatibility of radiotherapy treatment in pre- and post-reconstructed breasts. The aims of this study are to audit the rates of radiation induced complications in patients who underwent breast reconstruction using StratticeTM and establish whether there is an association between timing of radiotherapy and complication ...

  10. Immediate Bilateral Breast Reconstruction with Unilateral Deep Superior Epigastric Artery and Superficial Circumflex Iliac Artery Flaps

    Directory of Open Access Journals (Sweden)

    Keith S. Hansen

    2016-09-01

    Full Text Available 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.

  11. ["Skin reducing mastectomy" and immediate breast reconstruction with Becker 35 contour profile breast implant: our experience].

    Science.gov (United States)

    Chiummariello, S; Arleo, S; Pataia, E; Iera, M; Alfano, C

    2012-02-01

    We describe in this paper our experience with the technique of skin-reducing mastectomy in the treatment of breast cancer. Between October 2005 and April 2010 in our Center 33 patients underwent breast surgery utilizing the skin-reducing mastectomy technique and immediate breast reconstruction with expansor/definitive implant Becker 35 contour profile. Contralateral symmetrization was performed in the same operation. All selected patients satisfied inclusion critera either for nipple-sparing mastectomy or prophylactic mastectomy. We selected patients who had large ptosic breasts: areola-submammary fold >8 cm and jugular-nipple distance >25 cm. After histologic exam to confirm the lack of retroareolar tissue infiltration the nipple was preserved in a superior flap. Twenty-four out of 33 patients (72.7%) did not suffer from complications. In 9 patients (27.3%) we observed early complications. During follow-up we observed in 24 patients (72.7%) Baker I capsular contracture, in 9 patients (27.3%) Baker II capsular contracture. Esthetic results of symmetry, shape and volume were good to optimal. Patients' satisfaction was similar. During the follow up (6-33 months, average 17.7 months) no patient suffered from breast cancer recurrence. The "skin-reducing mastectomy" reduces mutilation and unsightly scar visibility. It gives a pleasant aesthetic outcome without hindering oncological safety.

  12. Factors influencing the decision to pursue immediate breast reconstruction after mastectomy for breast cancer

    Science.gov (United States)

    Wunschel, Philipp; Heine, Erwin; Strobbe, Luc J.

    2017-01-01

    Background Immediate breast reconstruction (IBR) after mastectomy has shown to be oncologically safe and to improve quality of life in breast cancer patients. However, most women undergoing mastectomy do not undergo IBR. In this study, we aim to identify breast surgeon-related factors in considering IBR and factors affecting patients’ decision to choose for IBR. Methods Retrospective analysis of the records of breast cancer patients who underwent mastectomy with or without IBR between 2010 and 2013. We documented all information whether or not a patient underwent IBR after mastectomy. Results Of 437 patients, 97 (22.2%) underwent IBR, 89.8% of which received tissue expanders. Patient who did not undergo IBR had a higher age (62.2 versus 51.9 years, Pmastectomy radiation. Approximately 11% of the patients were not informed about IBR. Conclusions Anticipated radiation therapy, higher age and higher BMI were important breast surgeon-related factors in refraining from IBR. Almost one third of all patients declined IBR. In almost 10% of all patients, IBR was not discussed. PMID:28210551

  13. Long-Term Follow-Up of Quality of Life following DIEP Flap Breast Reconstruction.

    Science.gov (United States)

    Hunsinger, Vincent; Hivelin, Mikael; Derder, Mohamed; Klein, Delphine; Velten, Michel; Lantieri, Laurent

    2016-05-01

    Sequelae resulting from breast cancer negatively impact patients' quality of life. Although the deep inferior epigastric perforator (DIEP) flap has become a standard for autologous breast reconstruction, there are limited data regarding long-term quality of life. The authors studied patients' quality of life more than 5 years after DIEP flap breast reconstruction and compare it with two French reference samples. A cross-sectional study of quality of life was performed in women who underwent DIEP flap breast reconstruction between 1995 and 2007 using the Medical Outcomes Study 36-Item Health Survey (Short Form-36). The first reference sample included subjects from the French general population (n = 3308), and the second included cancer survivors who underwent mastectomy with (n = 70) or without (n = 135) breast reconstruction. One hundred eleven respondents were analyzed among 186 eligible women. The mean follow-up period after reconstruction was 8.6 years (range, 5 to 15 years). There were no statistically significant differences in the quality of life between women from 45 to 64 years old who underwent DIEP flap breast reconstruction and from the French general population. Five of the eight Short Form-36 dimensions were significantly better in the DIEP flap breast reconstruction group in the 65- to 74-year-old cohort. In addition, quality of life of our study population was significantly higher than that of women who underwent mastectomy with or without any type of breast reconstruction. These results indicate that DIEP flap breast reconstruction allows patients with breast cancer to maintain a good postoperative quality of life comparable to that of the general population. Therapeutic, III.

  14. The Impact of Travel Distance on Breast Reconstruction in the United States

    Science.gov (United States)

    Albornoz, Claudia R.; Cohen, Wess A.; Razdan, Shantanu N.; Mehrara, Babak J.; McCarthy, Colleen M.; Disa, Joseph J.; Dayan, Joseph H.; Pusic, Andrea L.; Cordeiro, Peter G.; Matros, Evan

    2016-01-01

    Background Inadequate access to breast reconstruction was a motivating factor underlying passage of the Women’s Health and Cancer Rights Act. It remains unclear whether all patients interested in breast reconstruction undergo this procedure. The aim of this study was to determine whether geographic disparities are present that limit the rate and method of postmastectomy reconstruction. Methods Travel distance in miles between the patient’s residence and the hospital reporting the case was used as a quantitative measure of geographic disparities. The American College of Surgeons National Cancer Database was queried for mastectomy with or without reconstruction performed from 1998 to 2011. Reconstructive procedures were categorized as implant or autologous techniques. Standard statistical tests including linear regression were performed. Results Patients who underwent breast reconstruction had to travel farther than those who had mastectomy alone (p reconstruction rates (p reconstruction at community, comprehensive community, or academic programs were 10.3, 19.9, and 26.2 miles, respectively (p Reconstruction rates were significantly greater at academic programs. Patients traveled farther to undergo autologous compared with prosthetic reconstruction. Conclusions Although greater patient awareness and insurance coverage have contributed to increased breast reconstruction rates in the United States, the presence of geographic barriers suggests an unmet need. Academic programs have the greatest reconstruction rates, but are located farther from patients’ residences. Increasing the number of plastics surgeons, especially in community centers, would be one method of addressing this inequality. PMID:26710002

  15. Experience of quality of life among women who have undergone breast reconstruction after mastectomy

    OpenAIRE

    Johansson, Linus Somsak; Lindqvist, Josefin

    2008-01-01

    Background: In Sweden around 6500 women suffer each year from breast cancer and during lifetime every tenth women is affected. Mastectomy (removal of part of or the whole breast) is carried out mostly in purpose to remove malign tumours or in prophylactic purpose. The breast can be rebuilt through breast reconstruction. Method: The result analysis was based on nine articles. A Manifest content analysis was used and data from the articles where divided into themes and patterns, on the basis o...

  16. Reconstruction of the Irradiated Breast: A National Claims-Based Assessment of Postoperative Morbidity.

    Science.gov (United States)

    Chetta, Matthew D; Aliu, Oluseyi; Zhong, Lin; Sears, Erika D; Waljee, Jennifer F; Chung, Kevin C; Momoh, Adeyiza O

    2017-04-01

    Implant-based reconstruction rates have risen among irradiation-treated breast cancer patients in the United States. This study aims to assess the morbidity associated with various breast reconstruction techniques in irradiated patients. From the MarketScan Commercial Claims and Encounters database, the authors selected breast cancer patients who had undergone mastectomy, irradiation, and breast reconstruction from 2009 to 2012. Demographic and clinical treatment data, including data on the timing of irradiation relative to breast reconstruction were recorded. Complications and failures after implant and autologous reconstruction were also recorded. A multivariable logistic regression model was developed with postoperative complications as the dependent variable and patient demographic and clinical variables as independent variables. Four thousand seven hundred eighty-one irradiated patients who met the inclusion criteria were selected. A majority of the patients [n = 3846 (80 percent)] underwent reconstruction with implants. Overall complication rates were 45.3 percent and 30.8 percent for patients with implant and autologous reconstruction, respectively. Failure of reconstruction occurred in 29.4 percent of patients with implant reconstruction compared with 4.3 percent of patients with autologous reconstruction. In multivariable logistic regression, irradiated patients with implant reconstruction had two times the odds of having any complication and 11 times the odds of failure relative to patients with autologous reconstruction. Implant-based breast reconstruction in the irradiated patient, although popular, is associated with significant morbidity. Failures of reconstruction with implants in these patients approach 30 percent in the short term, suggesting a need for careful shared decision-making, with full disclosure of the potential morbidity. Therapeutic, III.

  17. Which Breast Is the Best? Successful Autologous or Alloplastic Breast Reconstruction : Patient-Reported Quality-of-Life Outcomes

    NARCIS (Netherlands)

    Eltahir, Yassir; Werners, Lisanne L. C. H.; Dreise, Marieke M.; Zeiffmans van Emmichoven, Ingeborg A.; Werker, Paul M. N.; de Bock, Geertruida H.

    2015-01-01

    Background: Breast reconstruction is an appropriate option offered to women who are diagnosed with breast cancer or gene mutations. It may be accomplished with implants or autologous procedures. This cross-sectional study evaluated the satisfaction and quality of life in addition to complications an

  18. Large variation between hospitals in immediate breast reconstruction rates after mastectomy for breast cancer in the Netherlands

    NARCIS (Netherlands)

    van Bommel, A C M; Mureau, M A M; Schreuder, K; van Dalen, T; Vrancken Peeters, M T F D; Schrieks, M; Maduro, J H; Siesling, S

    2016-01-01

    BACKGROUND: The present study aimed to describe the use of immediate breast reconstruction (IBR) after mastectomy for invasive breast cancer and ductal carcinoma in situ (DCIS) in hospitals in the Netherlands and determine whether patient and tumor factors account for the variation. METHODS: Patient

  19. Which Breast Is the Best? Successful Autologous or Alloplastic Breast Reconstruction : Patient-Reported Quality-of-Life Outcomes

    NARCIS (Netherlands)

    Eltahir, Yassir; Werners, Lisanne L. C. H.; Dreise, Marieke M.; Zeiffmans van Emmichoven, Ingeborg A.; Werker, Paul M. N.; de Bock, Geertruida H.

    Background: Breast reconstruction is an appropriate option offered to women who are diagnosed with breast cancer or gene mutations. It may be accomplished with implants or autologous procedures. This cross-sectional study evaluated the satisfaction and quality of life in addition to complications

  20. Microsurgical free flaps at Kathmandu Model Hospital.

    Science.gov (United States)

    Rai, S M; Grinsell, D; Hunter-Smith, D; Corlett, R; Nakarmi, K; Basnet, S J; Shakya, P; Nagarkoti, K; Ghartimagar, M; Karki, B

    2014-01-01

    Microsurgery is an emerging subspecialty in Nepal. Microsurgery was started at Kathmandu Model Hospital in 2007 with the support from Interplast Australia and New Zealand. This study will be useful for establishing a baseline for future comparisons of outcome variables and for defining the challenges of performing microsurgical free flaps in Nepal. A retrospective cross sectional study was conducted using the clinical records of all the microsurgical free flaps performed at Kathmandu Model Hospital from April 2007 to April 2014. Fifty-six free flaps were performed. The commonest indication was neoplasm followed by post-burn contracture, infection and trauma. Radial artery forearm flap was the commonest flap followed by fibula, antero-lateral thigh, rectus, tensor facia lata, lattisimus dorsi, deep inferior epigastric artery perforator, and deep circumflex iliac artery flap. Radial artery forearm flaps and anterolateral thigh flaps were mostly used for burn contracture reconstructions. Twelve of the 13 (92%) fibulae were used for mandibular reconstruction for oral cancer and ameloblastoma. Rectus flaps were used mainly for covering defects over tibia. Hospital stay ranged from six to 67 days with an average of fourteen. Fifteen patients (26%) developed complications. The duration of operation ranged from six hours to 10.5 hours with an average of nine hours. The longest follow up was for four years. Microsurgery can be started even in very resource-poor center if there is support from advanced centers and if there is commitment of the institution and surgical team.

  1. Fat injection to correct contour deformities of the reconstructed breast: a single surgeon experience

    Directory of Open Access Journals (Sweden)

    Youssef Tahiri

    2015-06-01

    Full Text Available Aim: Autologous fat grafting has gained acceptance as a technique to improve aesthetic outcomes in breast reconstruction. The purpose of this study was to share our clinical experience using autologous fat injection to correct contour deformities during breast reconstruction. Methods: A single surgeon, prospectively maintained database of patients who underwent autologous fat injection during breast reconstruction from January 2008 to November 2013 at McGill University Health Center was reviewed. Patient characteristics, breast history, type of breast reconstruction, volume of fat injected, and complications were analyzed. Results: One hundred and twenty-four patients benefited from autologous fat injection from January 2008 to November 2013, for a total of 187 treated breasts. The patients were on average 49.3 years old (΁ 8.9 years. Fat was harvested from the medial thighs (20.5%, flanks (39.1%, medial thighs and flanks (2.9%, trochanters (13.3%, medial knees (2.7%, and abdomen (21.9%. An average of 49.25 mL of fat was injected into each reconstructed breast. A total of 187 breasts in 124 patients were lipo-infiltrated during the second stage of breast reconstruction. Thirteen breasts (in 12 separate patients were injected several years after having undergone lumpectomy and radiotherapy. Of the 187 treated breasts, 118 were reconstructed with expanders to implants, 45 with deep inferior epigastric perforator flaps, 9 with latissimus dorsi flaps with implants, 4 with transverse rectus abdominis myocutaneous flaps, and 13 had previously undergone lumpectomy and radiotherapy. Six complications were noted in the entire series, for a rate of 3.2%. All were in previously radiated breasts. Average follow-up time was 12 months (range: 2-36 months. Conclusion: Fat injection continues to grow in popularity as an adjunct to breast reconstruction. Our experience demonstrates a low complication rate as compared to most surgical interventions of the breast

  2. Pathological internal mammary lymph nodes in secondary and tertiary deep inferior epigastric perforator flap breast reconstructions.

    Science.gov (United States)

    Hofer, Stefan O P; Rakhorst, Hinne A; Mureau, Marc A M; Moolenburgh, Sanne E; van Huizum, Martine A; van Geel, Albert N

    2005-12-01

    Use of internal mammary vessels during breast reconstruction provides information on part of the internal mammary chain lymph nodes (LNs). It was evaluated whether our current practice of screening should be changed to identify those delayed breast reconstruction patients with tumor-positive internal mammary nodes (IMNs) and whether breast reconstruction should be continued, in case suspicious IMNs were found intraoperatively. From February 2002 to December 2004, 81 patients had received 98 deep inferior epigastric perforator flaps for delayed breast reconstruction. Prospectively collected data for suspicious internal mammary LNs were evaluated. In 13 patients (16%) who had received a delayed breast reconstruction, macroscopically suspicious LNs were detected in the course of the internal mammary chain. Three patients (4%) had a pathologic diagnosis of malignancy, which was found to match their primary tumor. No relationship between positive internal mammary chain LNs and location of the primary tumor, TNM-stage, or previously administered adjuvant therapy was found. Suspicious internal mammary chain LNs found during recipient vessel dissection for breast reconstruction can have important consequences for treatment of malignant disease in individual patients. Presented data do not support changing the current perioperative approach of delayed breast reconstruction.

  3. Partial breast reconstruction with mini superficial inferior epigastric artery and mini deep inferior epigastric perforator flaps.

    Science.gov (United States)

    Spiegel, Aldona J; Eldor, Liron

    2010-08-01

    In this study, partial breast reconstruction was undertaken after breast conservation therapy using mini abdominal free flaps on both an immediate and delayed basis.Patient demographics, oncologic status, reconstructive data, and complications were collected from medical records.Twelve patients (age range 39-60) were included in this study with a mean follow-up time of 5 years. Ten mini superficial inferior epigastric artery flaps and 2 mini deep inferior epigastric perforator flaps were used (7 immediate and 5 delayed reconstructions). No flap lost, 1 minor abdominal wound dehiscence, and no local or distant recurrences were noted. Good to excellent results were reported by 91% of the women.In properly selected patients with high motivation toward breast conservation, tailored abdominal mini-free flaps can safely and satisfactorily be implemented for the reconstruction of partial mastectomy defects. Patients should be comprehensively educated on the potential future implications of using the abdominal donor site for partial breast reconstruction.

  4. Why women who have mastectomy decide not to have breast reconstruction?

    Science.gov (United States)

    Zieliński, Tomasz; Lorenc-Podgórska, Katarzyna; Antoszewski, Bogusław

    2015-02-03

    Breast cancer is the most common malignancy occurring in women. The treatment of breast cancer is a complex, multistep process involving surgical treatment, chemotherapy, radiotherapy, hormone therapy, targeted therapy, and very often rehabilitation. After the treatment of the underlying disease, or still in its course, there remains a problem of deformation of the chest. Although the number of women opting for breast reconstructive surgery increases every year, the number of such procedures in Poland is low. The aim of the study was to investigate the reasons why women after amputation of the breast due to cancer are not likely to undergo breast reconstructive surgery. The study comprised 73 women, residents of the province of Silesia, aged between 37 and 79 years, who had undergone mastectomy for malignancy in the years 1987-2013. From all of the reasons given by women for refraining from breast reconstruction, the most frequently pointed was the fear of being subjected to further surgery (38.3%). 23 women (31.5%) admitted that they were also afraid of postoperative pain. Similarly, a common response (35.6%) was that it is not essential for their mental state, and 30% of respondents fully accepted their appearance after mastectomy. Concern about the effect of failed reconstruction was reported by 24.6% of the women, and the fear that the surgery could negatively affect the process of cancer treatment by 27.4% of respondents. Lack of information about the capabilities and knowledge of breast reconstruction methods was not an important factor in decision-making. Most of the surveyed women who abandon breast reconstruction surgery, make this decision on the basis of more than one reasons. Fear of undergoing a second surgical procedure and pain related to it were the most important reasons for the refusal of breast reconstruction. An important factor in the decision to desist from breast reconstruction is the age of the patients.

  5. “Use what God has given me”: Difference and disparity in breast reconstruction

    Science.gov (United States)

    Chavez, Jessica; Alderman, Amy; Pusic, Andrea L

    2014-01-01

    African-American women are significantly less likely to undergo postmastectomy breast reconstruction compared White women in the US. These observed differences have been interpreted as evidence of a healthcare disparity. The current study examines breast reconstruction decision-making among African-American women, locating reconstruction decisions in a context of culture, racial inequality, and biomedicalization. Semi-structured interviews were conducted with 27 African-American women who underwent mastectomy for breast cancer to add patient-centred perspectives to existing conceptualizations of racial/ethnic differences in reconstruction. Participants were socio-demographically diverse, and resided in the New York metropolitan area. Data analysis was informed by grounded theory. Spiritually and culturally-informed body ethics often guided surgery decisions. Participants expressed reservations about breast implants, preferring autologous procedures that use “what God has given.” For some, breast reconstruction restored a sense of normalcy after cancer; others challenged an imperative to reconstruct. Several participants redirected our focus on access to reconstruction toward access to alternatives, noting the low reimbursement for prostheses, or their unavailability in patients' skin tones. We suggest that a framework of “stratified biomedicalization” better addresses the complexities of race, class, and gender that inform preference, access, and recommendations for breast reconstruction, and focuses attention on access to high and lower-tech interventions. PMID:23557084

  6. One-stage breast reconstruction techniques in elderly patients to preserve quality of life.

    Science.gov (United States)

    Maruccia, M; Mazzocchi, M; Dessy, L A; Onesti, M G

    2016-12-01

    The aim of this study was to review one-stage breast reconstruction techniques performed in elderly patients at our institution to identify the criteria of selection of each in terms of outcomes and quality of life. Patients older than 65 years who underwent one-stage breast reconstruction between January 2004 and July 2014 at our hospital were included. Patients and procedure-related data were collected from the medical records. In particular, patient's age, comorbidities and related ASA physical status, type of one-stage breast reconstruction technique, and criteria of selection were analyzed. Outcomes and results were also evaluated in terms of quality of life using the EORTC QLQ-C30 and -BR23 questionnaires 1 year after surgery. A total of 840 women underwent breast reconstruction, of whom 138 elderly women received one-stage breast reconstruction. There were 118 cases (85.5%) of monolateral reconstructions and 20 cases (14.5%) of bilateral reconstructions, resulting in 138 breast reconstructions. These were performed with permanent inflatable expanders in the sub-muscular position (Group A, n= 50), with acellular dermal matrix and partial sub-muscular anatomic implant (Group B, n= 50), and with Braxon® acellular dermal matrix and anatomic implant with muscle-sparing technique (Group C, n= 38). The EORTC questionnaires showed the best results in Group C regarding the quality of life. The elderly population is rapidly increasing, and 50% of all breast cancers occur in women older than 65 years; among them, only 2% undergo breast reconstruction. A major aspect of breast cancer treatment and subsequent quality of life is the opportunity for a post-mastectomy reconstructive surgery. As survival rates are improving, a larger proportion of patients live with the long-term consequences of their treatment, and breast reconstruction ensures a better quality of life. To increase the reconstruction rates, surgery should be one-stage, less invasive as possible, allowing

  7. A task-based comparison of two reconstruction algorithms for digital breast tomosynthesis

    Science.gov (United States)

    Mahadevan, Ravi; Ikejimba, Lynda C.; Lin, Yuan; Samei, Ehsan; Lo, Joseph Y.

    2014-03-01

    Digital breast tomosynthesis (DBT) generates 3-D reconstructions of the breast by taking X-Ray projections at various angles around the breast. DBT improves cancer detection as it minimizes tissue overlap that is present in traditional 2-D mammography. In this work, two methods of reconstruction, filtered backprojection (FBP) and the Newton-Raphson iterative reconstruction were used to create 3-D reconstructions from phantom images acquired on a breast tomosynthesis system. The task based image analysis method was used to compare the performance of each reconstruction technique. The task simulated a 10mm lesion within the breast containing iodine concentrations between 0.0mg/ml and 8.6mg/ml. The TTF was calculated using the reconstruction of an edge phantom, and the NPS was measured with a structured breast phantom (CIRS 020) over different exposure levels. The detectability index d' was calculated to assess image quality of the reconstructed phantom images. Image quality was assessed for both conventional, single energy and dual energy subtracted reconstructions. Dose allocation between the high and low energy scans was also examined. Over the full range of dose allocations, the iterative reconstruction yielded a higher detectability index than the FBP for single energy reconstructions. For dual energy subtraction, detectability index was maximized when most of the dose was allocated to the high energy image. With that dose allocation, the performance trend for reconstruction algorithms reversed; FBP performed better than the corresponding iterative reconstruction. However, FBP performance varied very erratically with changing dose allocation. Therefore, iterative reconstruction is preferred for both imaging modalities despite underperforming dual energy FBP, as it provides stable results.

  8. Combining autologous ventral hernia repair using component separation with DIEP breast reconstruction

    Directory of Open Access Journals (Sweden)

    Louis de Weerd

    2015-12-01

    Full Text Available Concern about flap viability and abdominal wall integrity would normally exclude a patient with a large ventral midline hernia from having a breast reconstruction with a deep inferior epigastric perforator (DIEP flap. Ventral hernia repair using the abdominoplasty approach has been reported before. The abdominoplasty flap would normally be discarded. This article presents a unique case of a patient with a large incisional midline hernia who had a combined procedure of autologous hernia repair using component separation technique and DIEP breast reconstruction. The indications for DIEP breast reconstruction are therewith expanded.

  9. Adipose regeneration and implications for breast reconstruction: update and the future

    Science.gov (United States)

    Jessop, Zita M.; Naderi, Naghmeh; Griffin, Michelle; Dobbs, Thomas; Ibrahim, Amel; Evans, Stephen; Burnell, Stephanie; Doak, Shareen H.; Whitaker, Iain S.

    2016-01-01

    The evolution of breast reconstruction and management of breast cancer has evolved significantly since the earliest descriptions in the Edwin Smith Papyrus (3,000 BC). The development of surgical and scientific expertise has changed the way that women are managed, and plastic surgeons are now able to offer a wide range of reconstructive options to suit individual needs. Beyond the gold standard autologous flap based reconstructions, regenerative therapies promise the elimination of donor site morbidity whilst providing equivalent aesthetic and functional outcomes. Future research aims to address questions regarding ideal cell source, optimisation of scaffold composition and interaction of de novo adipose tissue in the microenvironment of breast cancer. PMID:27047789

  10. Quadratus lumborum catheters for breast reconstruction requiring transverse rectus abdominis myocutaneous flaps.

    Science.gov (United States)

    Spence, Nicole Z; Olszynski, Patrycja; Lehan, Anne; Horn, Jean-Lois; Webb, Christopher A J

    2016-06-01

    Patients diagnosed with breast cancer may opt to undergo surgical reconstructive flaps at the time of or after mastectomies. These surgeries leave patients with significant postoperative pain and sometimes involve large surgical beds including graft sites from the abdomen to reconstruct the breast. Consequently, multimodal methods of pain management have become highly favored. Quadratus lumborum catheters offer an opioid-sparing technique that can be performed easily and safely. We present a case of a patient who underwent a breast flap reconstruction and had bilateral quadratus lumborum catheters placed for perioperative pain control.

  11. Reducing infection risk in implant-based breast-reconstruction surgery: challenges and solutions

    OpenAIRE

    Ooi ASH; Song DH

    2016-01-01

    Adrian SH Ooi,1,2 David H Song1 1Section of Plastic and Reconstructive Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA; 2Department of Plastic, Reconstructive, and Aesthetic Surgery, Singapore General Hospital, Singapore Abstract: 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...

  12. Multiscale regularized reconstruction for enhancing microcalcification in digital breast tomosynthesis

    Science.gov (United States)

    Lu, Yao; Chan, Heang-Ping; Wei, Jun; Hadjiiski, Lubomir; Zhou, Chuan

    2012-03-01

    Digital breast tomosynthesis (DBT) holds strong promise for improving the sensitivity of detecting subtle mass lesions. Detection of microcalcifications is more difficult because of high noise and subtle signals in the large DBT volume. It is important to enhance the contrast-to-noise ratio (CNR) of microcalcifications in DBT reconstruction. A major challenge of implementing microcalcification enhancement or noise regularization in DBT reconstruction is to preserve the image quality of masses, especially those with ill-defined margins and subtle spiculations. We are developing a new multiscale regularization (MSR) method for the simultaneous algebraic reconstruction technique (SART) to improve the CNR of microcalcifications without compromising the quality of masses. Each DBT slice is stratified into different frequency bands via wavelet decomposition and the regularization method applies different degrees of regularization to different frequency bands to preserve features of interest and suppress noise. Regularization is constrained by a characteristic map to avoid smoothing subtle microcalcifications. The characteristic map is generated via image feature analysis to identify potential microcalcification locations in the DBT volume. The MSR method was compared to the non-convex total pvariation (TpV) method and SART with no regularization (NR) in terms of the CNR and the full width at half maximum of the line profiles intersecting calcifications and mass spiculations in DBT of human subjects. The results demonstrated that SART regularized by the MSR method was superior to the TpV method for subtle microcalcifications in terms of CNR enhancement. The MSR method preserved the quality of subtle spiculations better than the TpV method in comparison to NR.

  13. Three-Dimensional Imaging as a Novel Approach to Breast Cancer Reconstruction

    Directory of Open Access Journals (Sweden)

    Lauren Rudolph

    2007-06-01

    Full Text Available Today surgical planning in reconstruction of female breast cancer patients is limited by the inability of plastic surgeons to define the necessary volume, shape and contour of the breast. A novel approach to breast cancer reconstruction is three-dimensional imaging, which has gained popularity in an array of industries. Three-dimensional (3D images of a patient’s breasts enable a surgeon to not only visually assess the size, shape, contour, and symmetry of the breasts, but also to obtain quantitative breast measurements and make volumetric calculations. The following study is a preliminary analysis of female patient volunteers undergoing unilateral tissue-expander/implant reconstruction by one of two senior authors. 3D images were obtained during routine preoperative and postoperative office visits and served as a guide by the surgeon for surgical planning. Twelve patients have completed 3D assisted unilateral breast reconstruction to date. Overall breast symmetry improved at the completion of reconstruction in the majority of patients. Average postoperative symmetry was 95% as compared to 88% preoperatively. With 3D images plastic surgeons are able to objectively assess their patient, which is an improvement to the current surgical planning that utilizes subjective two-dimensional images and visual estimates.

  14. One-Stage Nipple and Breast Reconstruction Following Areola-Sparing Mastectomy

    Directory of Open Access Journals (Sweden)

    Hye Ri Kim

    2013-09-01

    Full Text Available BackgroundSkin-sparing mastectomy with immediate breast reconstruction is increasingly becoming a proven surgical option for early-stage breast cancer patients. Areola-sparing mastectomy (ASM has also recently become a popular procedure. The purpose of this article is to investigate the reconstructive and aesthetic issues experienced with one-stage nipple and breast reconstruction using ASM.MethodsAmong the patients who underwent mastectomy between March 2008 and March 2010, 5 women with a low probability of nipple-areolar complex malignant involvement underwent ASM and immediate breast reconstruction with simultaneous nipple reconstruction using the modified C-V flap. The cosmetic outcomes of this series were reviewed by plastic surgeons and patient self-assessment and satisfaction were assessed via telephone interview.ResultsDuring the average 11-month follow-up period, there were no cases of cancer recurrence, the aesthetic outcomes were graded as excellent to very good, and all of the patients were satisfied. Two patients developed a gutter-like depression around the reconstructed nipple, and one patient developed skin erosion in a small area of the areola, which healed with conservative dressing. The other complications, such as necrosis of the skin flap or areola, seroma, hematoma, or fat necrosis did not occur.ConclusionsSince one-stage nipple and breast reconstruction following ASM is an oncologically safe, cost-effective, and aesthetically satisfactory procedure, it is a good surgical option for early breast cancer patients.

  15. The current pattern of reconstructive surgery for breast cancer

    Directory of Open Access Journals (Sweden)

    A. Kh. Ismagilov

    2015-01-01

    Full Text Available In Russia, breast cancer (BC occupies a leading place in the pattern of cancers, the incidence of which is 20.9 %, among the female population; in 2013 there were 60,717 new cases, including women under the age of 40 years (15 %. While considering the history of the development of breast surgery from the operation performed by W. S. Halsted to its technique modified by J. L. Madden and the identification of sentinel lymph nodes, we can observe improved quality of life in patients in reference to the lower rate of the manifestation of lymphedemas. However, patients who have undergone this or that mastectomy are observed to have lower self-appraisal scores, a change in their professional sphere, irritability and apprehensiveness Thus, the decreased rate of the manifestation of lymphedema and obvious postoperative traumatization are not the only components of quality of life in patients with BC. According to the data obtained by E. Frank et al. (1978, G.P. Maguire et al. (1978, and F. Meerwein (1981, removal of the breast itself leads to a woman’s loss of femininity, attractiveness, and sexiness, which was also confirmed and reported by L. Aerts et al. (2014. In this connection, classical radical mastectomy begins to give way to organ-sparing treatment. Taking into account that psychotherapy and external prosthetics do not alleviate the above problems and that there are always women with established BC who have contraindications to organ-sparing treatment, breast reconstructive plastic operations arouse more and more interest. Reconstruction of the breast implies restoration of both its shape and contours to be maximally brought closer to its preoperative level. However, with regard to cancer alertness to breast reconstructive surgery, not only aesthetic requirements are imposed. The next step in improving quality of life in patients with BC was the emergence and development of breast-sparing mastectomies, the first point of these

  16. Reducing infection risk in implant-based breast-reconstruction surgery: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Ooi ASH

    2016-09-01

    Full Text Available Adrian SH Ooi,1,2 David H Song1 1Section of Plastic and Reconstructive Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA; 2Department of Plastic, Reconstructive, and Aesthetic Surgery, Singapore General Hospital, Singapore Abstract: 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. Prevention of infection begins with appropriate reconstructive choice based on an assessment and optimization of risk factors. These include patient and disease characteristics, such as smoking, obesity, large breast size, and immediate reconstructive procedures, as well as adjuvant therapy, such as radiotherapy and chemotherapy. For implant-based breast reconstruction, preoperative planning and organization is key to reducing infection. A logical and consistent intraoperative and postoperative surgical protocol, including appropriate antibiotic choice, mastectomy-pocket creation, implant handling, and considered acellular dermal matrix use contribute toward the reduction of breast-implant infections. Keywords: implant infection, risk reduction, acellular dermal matrix

  17. A review of the surgical management of breast cancer: plastic reconstructive techniques and timing implications.

    Science.gov (United States)

    Rosson, Gedge D; Magarakis, Michael; Shridharani, Sachin M; Stapleton, Sahael M; Jacobs, Lisa K; Manahan, Michele A; Flores, Jaime I

    2010-07-01

    The oncologic management of breast cancer has evolved over the past several decades from radical mastectomy to modern-day preservation of chest and breast structures. The increased rate of mastectomies over recent years made breast reconstruction an integral part of the breast cancer management. Plastic surgery now offers patients a wide variety of reconstruction options from primary closure of the skin flaps to performance of microvascular and autologous tissue transplantation. Well-coordinated partnerships between surgical oncologists, plastic surgeons, and patients address concerns of tumor control, cosmesis, and patients' wishes. The gamut of breast reconstruction options is reviewed, particularly noting state-of-the-art techniques, as well as the advantages and disadvantages of various timing modalities.

  18. Numerical Methods for Coupled Reconstruction and Registration in Digital Breast Tomosynthesis

    CERN Document Server

    Yang, Guang; Hawkes, David J; Arridge, Simon R

    2013-01-01

    Digital Breast Tomosynthesis (DBT) provides an insight into the fine details of normal fibroglandular tissues and abnormal lesions by reconstructing a pseudo-3D image of the breast. In this respect, DBT overcomes a major limitation of conventional X-ray mammography by reducing the confounding effects caused by the superposition of breast tissue. In a breast cancer screening or diagnostic context, a radiologist is interested in detecting change, which might be indicative of malignant disease. To help automate this task image registration is required to establish spatial correspondence between time points. Typically, images, such as MRI or CT, are first reconstructed and then registered. This approach can be effective if reconstructing using a complete set of data. However, for ill-posed, limited-angle problems such as DBT, estimating the deformation is complicated by the significant artefacts associated with the reconstruction, leading to severe inaccuracies in the registration. This paper presents a mathemati...

  19. Acellular Dermal Matrix in Reconstructive Breast Surgery: Survey of Current Practice among Plastic Surgeons

    Directory of Open Access Journals (Sweden)

    Ahmed M. S. Ibrahim, MD

    2015-04-01

    Conclusions: Plastic surgeons currently use ADM in breast reconstruction for both immediate and staged procedures. Of those responding, a majority of plastic surgeons will incorporate drains and use postoperative antibiotics for more than 48 hours.

  20. Findings of a national comparative audit of mastectomy and breast reconstruction surgery in England.

    Science.gov (United States)

    Jeevan, Ranjeet; Cromwell, David A; Browne, John P; Caddy, Christopher M; Pereira, Jerome; Sheppard, Carmel; Greenaway, Kimberley; van der Meulen, Jan H P

    2014-10-01

    This paper summarises the findings of a national audit of mastectomy and breast reconstruction surgery carried out in England. It describes patterns of treatment, and the clinical and patient-reported quality of life outcomes associated with these types of procedure. Prospective cohort study. All 150 National Health Service hospital groups (NHS trusts) in England that provided mastectomy or breast reconstruction surgery, along with six NHS trusts in Wales and Scotland and 114 independent hospitals. Women aged 16 years and over undergoing mastectomy with or without immediate breast reconstruction, or primary delayed breast reconstruction, between 1st January 2008 and 31st March 2009. Reconstructive utilisation, post-operative complications and sequelae, and patient-reported satisfaction and quality of life. Overall, 21% of the 16,485 women who had mastectomy underwent immediate reconstruction. However, the proportion varied between regions from 9% to 43% (p quality of care were high. The proportion of women who experienced local complications was 10.30% (95% CI 9.78-10.84) for mastectomy surgery, ranged from 11.02% (9.31-12.92) to 18.24% (14.80-22.10) for different immediate reconstructive procedures, and from 5.00% (2.76-8.25) to 19.86% (16.21-23.94) for types of delayed reconstruction. Breast appearance and overall well-being scores reported 18 months after surgery were higher among women having immediate breast reconstruction compared to mastectomy only. Postoperative outcomes were similar across providers.. The Audit found women were highly satisfied with their peri-operative care, with hospital providers achieving similar outcomes. English providers should examine how to reduce the variation in rates of immediate reconstruction. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  1. A TRAM flap design refinement for use in delayed breast reconstruction.

    LENUS (Irish Health Repository)

    Patel, A J K

    2009-09-01

    Autologous breast reconstruction following mastectomy is commonly achieved using the free Transverse Rectus Abdominis Myocutaneous (TRAM) flap. Since its first description, refinements and modifications have resulted in improved operative techniques and more aesthetically pleasing reconstructions. Pre-operative flap design, however, is a relatively new concept that has not received much attention in the literature. Patients who undergo breast reconstruction may have large, ptotic contralateral breasts. In these patients there is a tendency to raise a large abdominal flap in an attempt to achieve symmetry, or simply a larger breast. This has the potential to lead to tight closure of the abdomen and the risk of subsequent wound problems. Reconstructions that are too small or have inadequate ptosis commit the patient to contralateral breast surgery to achieve symmetry. Pre-operatively designing the flap, using a template created from the opposite breast, can help achieve a good match, often reducing the need for contralateral breast surgery. Even when contralateral breast reduction surgery is planned in advance, many of these patients still require, and prefer, a large reconstruction in order to achieve a well-proportioned result. We present a design template that addresses these particular issues and in the senior author\\'s hands has proved to be a very effective technique. Our technique allows raising an abdominal flap of less vertical height than traditionally used (thus reducing the risk of tight abdominal closure) and incorporates an inverted V-shaped flap of skin from the inferior mastectomy skin flap into the reconstruction. This allows more flap tissue to be available to fill the upper poles of the reconstructed breast and at the same time produces good ptosis.

  2. Abdominal Closure after TRAM Flap Breast Reconstruction with Transversus Abdominis Muscle Release and Mesh

    Science.gov (United States)

    Avendano-Peza, Héctor; Novitsky, Yuri W.

    2016-01-01

    Summary: Breast reconstruction with a pedicled transverse rectus abdominis muscle (TRAM) flap can result in significant abdominal wall donor-site morbidity. Although the pedicled TRAM flap donor area reinforced with mesh results in decreased rates of postoperative abdominal bulging and hernias, the best technique to accomplish that is yet to be elucidated. We present our novel technique of posterior components separation with transversus abdominis muscle release and retromuscular mesh reinforcement for donor-area closure during pedicled TRAM flap breast reconstruction.

  3. Surgeon motivations behind the timing of breast reconstruction in patients requiring postmastectomy radiation therapy

    Science.gov (United States)

    Lee, Ming; Reinertsen, Erik; McClure, Evan; Liu, Shuling; Kruper, Laura; Tanna, Neil; Boyd, J. Brian; Granzow, Jay W.

    2015-01-01

    Summary Objectives Although postmastectomy radiation therapy (PMRT) has been shown to reduce breast cancer burden and improve survival, PMRT may negatively influence outcomes after reconstruction. The goal of this study was to compare current opinions of plastic and reconstructive surgeons (PRS) and surgical oncologists (SO) regarding the optimal timing of breast reconstruction for patients requiring PMRT. Methods Members of the American Society of Plastic Surgeons (ASPS), the American Society of Breast Surgeons (ASBS), and the Society of Surgical Oncology (SSO) were asked to participate in an anonymous web-based survey. Responses were solicited in accordance to the Dillman method, and they were analyzed using standard descriptive statistics. Results A total of 330 members of the ASPS and 348 members of the ASBS and SSO participated in our survey. PRS and SO differed in patient–payor mix (p reconstruction versus SO, overall timing did not significantly differ between the two specialists (p = 0.14). The primary rationale behind delayed breast reconstruction differed significantly between PRS and SO (p reconstructive outcome is significantly and adversely affected by radiation. Both PRS and SO cited “patient-driven desire to have immediate reconstruction” (p = 0.86) as the primary motivation for immediate reconstruction. Conclusions Although the optimal timing of reconstruction is controversial between PRS and SO, our study suggests that the timing of reconstruction in PMRT patients is ultimately driven by patient preferences and the desire of PRS to optimize aesthetic outcomes. PMID:26277336

  4. Skin Sparing Mastectomy and Immediate Breast Reconstruction (SSMIR for early breast cancer: Eight years single institution experience

    Directory of Open Access Journals (Sweden)

    Bobin Jean

    2008-04-01

    Full Text Available Abstract Background Skin Sparing Mastectomy (SSM and immediate breast reconstruction has become increasingly popular as an effective treatment for patients with breast carcinoma. The aim of this study was to evaluate the clinical outcome of skin sparing mastectomy in early breast cancer at a single population-based institution. Methods Records of ninety-five consecutive patients with operable breast cancer who had skin-sparing mastectomy and immediate breast reconstructions between 1995 and 2003 were reviewed. Patient and tumor characteristic, type of reconstruction, postoperative complications, aesthetic results and incidence of recurrence were analyzed. Results Mean age of the patients was 51.6(range 33–72 years. The AJCC pathologic stages were 0 (n = 51, 53.7%, I (n = 20, 21.1%, and II (n = 2, 2.1%. Twenty of the patients had recurrent disease (21.1%. The immediate breast reconstructions were performed with autologus tissue including latissimus dorsi musculocutaneous flap in 63 (66.3% patients and transverse rectus abdominis myocutaneous (TRAM flap in 4 (4.2% patients. Implants were used in 28 (29.4% patients. The average hospital stay was 7.7 days. Flap complication occurred in seven (10.4% patients resulting in four (6% re-operations and there were no delay in accomplishing postoperative adjuvant therapy. At a median follow-up of 69 months (range 48 to 144, local recurrence was seen in one patient (1.1% and systemic recurrence was seen in two patients (2.1%. Conclusion Skin sparing mastectomy and immediate breast reconstruction for early breast cancer is associated with low morbidity and low rate of local recurrence.

  5. Successful pregnancy "during" pedicled transverse rectus abdominis musculocutaneous flap for breast reconstruction with normal vaginal delivery

    Directory of Open Access Journals (Sweden)

    Siew Cheng Chai

    2015-01-01

    Full Text Available A transverse rectus abdominis myocutaneous (TRAM flap is a popular choice for breast reconstruction. Pregnancies in women following a TRAM flap present concerns regarding both safety and the integrity of the abdominal wall. We report a case of a patient who was pregnant during immediate breast reconstruction with pedicled TRAM flap and had a successful spontaneous vaginal delivery. We also conducted a literature review using PubMed on pregnancy post TRAM flap, type of reconstruction, timing of pregnancy after TRAM flap, complication, and mode of delivery, which are summarised in this report. We concluded that patients may have safe pregnancies and normal deliveries following TRAM flap breast reconstruction regardless of the time frame of pregnancy after the procedure. Therefore, TRAM flaps can continue to be a reconstruction option, even in women of childbearing age.

  6. DIEP Flap Breast Reconstruction Using 3-dimensional Surface Imaging and a Printed Mold

    Directory of Open Access Journals (Sweden)

    Koichi Tomita, MD, PhD

    2015-03-01

    Full Text Available Summary: Recent advances in 3-dimensional (3D surface imaging technologies allow for digital quantification of complex breast tissue. We performed 11 unilateral breast reconstructions with deep inferior epigastric artery perforator (DIEP flaps (5 immediate, 6 delayed using 3D surface imaging for easier surgery planning and 3D-printed molds for shaping the breast neoparenchyma. A single- or double-pedicle flap was preoperatively planned according to the estimated tissue volume required and estimated total flap volume. The DIEP flap was then intraoperatively shaped with a 3D-printed mold that was based on a horizontally inverted shape of the contralateral breast. Cosmetic outcomes were assessed as satisfactory, as confirmed by the postoperative 3D measurements of bilateral breasts. We believe that DIEP flap reconstruction assisted with 3D surface imaging and a 3D-printed mold is a simple and quick method for rebuilding a symmetric breast.

  7. [Current trends of breast reconstruction after mastectomy for breast cancer patients in China: a survey report].

    Science.gov (United States)

    Chen, Ying; Chen, Jiajian; Chen, Jiaying; Yang, Benlong; Li, Lin; Huang, Xiaoyan; Shao, Zhimin; Shen, Zhenzhou; Yu, Peirong; Wu, Jiong

    2014-11-01

    To explore the current trends of breast reconstruction (BR) for breast cancer patients in China. A questionnaire was designed for this study, and it included questions on surgeon demographics, number of mastectomy and BR, type and timing of BR, reconstructive choices in the setting of preoperative or postoperative radiotherapy or chemotherapy, etc. All data were collected until December 2012. Questionnaires were sent to 52 members of the Committee of Breast Cancer Society by e-mail or mail. By July 2013, 41 questionnaires had been returned. Among all, 5 were excluded for not performing BR. These 36 hospitals covered 22 provinces and municipalities in China. A total of 538 surgeons working in the general surgery or oncological surgery department, but only 123 (22.9%) were qualified to perform BR. In 2012, except for 4 missing data, 24, 763 mastectomies were performed in 32 hospitals; among them, 1120 (4.5%) received BR. According to these 36 respondents, 32 (88.9%) performed prosthetic (1, 843 cases in all) while 4 (11.1%) performed prosthetic BR with acellular dermal matrix (17 cases in all) from the time of their first BR operation to the end of 2012. During the same period, 965 latissimus dorsi myocutaneous flaps with implant were performed in 23 (63.9%) hospitals while 738 latissimus dorsi myocutaneous flaps without implant were performed in 32 (88.9%) hospitals. At the same time, 366 pedicled transverse rectus abdominis myocutaneous flap BRs were performed in 28 (77.8%) hospitals, while 155 abdominal free flap BRs were carried out in 9 (25.0%) hospitals. The overall complication rate was 18.2%. Postoperative radiotherapy had some effect on influencing the esthetic outcomes of BR, so the autologous BR was recommended, but the timing remained controversial. Regarding chemotherapy, most respondents concluded that it had no effect or only a mild effect. The overall cosmetic outcomes of the reconstructed breasts satisfied the majority of physicians and patients

  8. SERI Surgical Scaffold in 2-Stage Breast Reconstruction: 2-Year Data from a Prospective, Multicenter Trial.

    Science.gov (United States)

    Karp, Nolan; Choi, Mihye; Kulber, David A; Downey, Susan; Duda, Gloria; Kind, Gabriel M; Jewell, Mark L; Murphy, Diane K; Lehfeldt, Max R; Fine, Neil

    2017-05-01

    Soft-tissue support devices are used during breast reconstruction. This study investigated long-term clinical data following SERI Surgical Scaffold (SERI) implantation, a bioresorbable, silk-derived scaffold for soft-tissue support. This was a prospective, multicenter study in 103 subjects who received SERI during stage 1 of 2-stage breast reconstruction with subpectoral tissue expander placement (Natrelle Style 133V; Allergan plc, Dublin, Ireland) followed by subpectoral breast implant placement. Investigator satisfaction (11-point scale: 0, very dissatisfied and 10, very satisfied) at 6 months was the primary endpoint. Ease of use, satisfaction, scaffold palpability/visibility, breast anatomy measurements via 3D images, SERI integration, histology, and safety were also assessed through 2 years after stage 1 surgery. Analyses were performed on the per-protocol population (103 subjects; 161 breasts) with no protocol deviations that could affect outcomes. Ease of use and subject and investigator satisfaction with SERI were high throughout 2 years. Breast anatomy measurements with 3D images demonstrated long-term soft-tissue stability of the lower breast mound. Key complication rates per breast were tissue/skin necrosis and wrinkling/rippling (8.1% each) and seroma, wound dehiscence, and breast redness (5.0% each). Over 2 years, 4 breasts in 4 subjects underwent reoperation with explantation of any device; 2 breasts required SERI explantation. SERI was retained in 98.8% of breasts (159/161) at 2 years. SERI was associated with high and consistent levels of investigator and subject satisfaction and demonstrated soft-tissue stability in the lower breast through 2 years. SERI provides a safe, long-term benefit for soft-tissue support in 2-stage breast reconstruction.

  9. Long-term Follow-up with AlloDerm in Breast Reconstruction

    Directory of Open Access Journals (Sweden)

    Richard A. Baxter, MD, FACS

    2013-05-01

    Full Text Available Summary: Little is known about the long-term fate of acellular dermal matrices in breast implant surgery. A 12-year follow-up case with tissue analysis of AlloDerm in revision breast reconstruction reveals retention of graft volume and integration with an organized collagen structure, minimal capsule formation, and little or no indication of inflammation.

  10. The Scarless Latissimus Dorsi Flap Provides Effective Lower Pole Prosthetic Coverage in Breast Reconstruction

    Directory of Open Access Journals (Sweden)

    Mark A. Lee, MBBS, FRACS

    2014-05-01

    Conclusions: Breast reconstruction using the scarless latissimus dorsi flap is time effective, requires no patient repositioning, and uses standard breast instrumentation. It is safe and versatile while reducing the risk of exposed prosthesis if native skin necrosis occurs. It is a vascularized alternative to acellular dermal matrices.

  11. The effect of immediate breast reconstruction on the timing of adjuvant chemotherapy: a systematic review

    NARCIS (Netherlands)

    J. Xavier Harmeling; C.A.E. Kouwenberg (Casimir A. E.); E. Bijlard (Eveline); K.N.J. Burger (Koert N. J.); A. Jager (Agnes); M.A.M. Mureau (Marc)

    2015-01-01

    textabstractAdjuvant chemotherapy is often needed to achieve adequate breast cancer control. The increasing popularity of immediate breast reconstruction (IBR) raises concerns that this procedure may delay the time to adjuvant chemotherapy (TTC), which may negatively impact oncological outcome. The

  12. Double Back Cut in Post-mastectomy Breast Skin (Fish-Shaped Skin Paddle) in Delayed Pedicled TRAM Flap Breast Reconstruction.

    Science.gov (United States)

    Berezovsky, Alexander Bogdanov; Pagkalos, Vasileios A; Shoham, Yaron; Krieger, Yuval; Silberstein, Eldad

    2015-08-01

    Breast reconstruction has become standard of care for female patients with breast cancer. The transverse rectus abdominis musculo-cutaneous flap (TRAMf) is the most common method of immediate or delayed autologous breast reconstruction following mastectomy. We share our experience with modified, double back cut of post-mastectomy skin in delayed pedicled TRAMf breast reconstruction, resulting in fish-shaped skin paddle. This sort of back cut is a simple, reliable way to obtain a natural, esthetically pleasant breast mound with inconspicuous hidden scars.

  13. Receipt of delayed breast reconstruction after mastectomy: do women revisit the decision?

    Science.gov (United States)

    Alderman, Amy K; Hawley, Sarah T; Morrow, Monica; Salem, Barbara; Hamilton, Ann; Graff, John J; Katz, Steven

    2011-06-01

    Postmastectomy breast reconstruction is an important component of breast cancer care, but few receive it at the time of the mastectomy. Virtually nothing is known about receipt of reconstruction after initial cancer therapy and why treatment might be delayed. A 5-year follow-up survey was mailed to a population-based cohort of mastectomy-treated breast cancer patients who were initially surveyed at time of diagnosis in 2002 and reported to the Los Angeles and Detroit SEER registries (N = 645, response rate 60%). Outcomes were receipt of reconstruction (immediate [IR], delayed [DR], or none) and patient appraisal of their treatment decisions. About one-third (35.9%) had IR, 11.5% had DR, and 52.6% had no reconstruction. One-third delayed reconstruction because they focused more on other cancer interventions, and nearly half were concerned about surgical complications and interference with cancer surveillance. Two-thirds of those with no reconstruction said that the procedure was not important to them. A large proportion of all patients were satisfied with their reconstruction decision-making (89.4% IR, 78.4% DR, 80.4% no reconstruction, P = NS). However, only 59.3% of those with no reconstruction felt that they were adequately informed about their reconstructive options (vs 82.7% IR and 78.4% DR, P breast reconstruction after initial cancer treatment. Factors associated with delayed reconstruction were primarily related to uncertainty about the procedure, concern about cancer surveillance, and low priority. Those without reconstruction demonstrated significant informational needs, which should be addressed with future research efforts.

  14. Predictors of satisfaction and quality of life following post-mastectomy breast reconstruction.

    Science.gov (United States)

    Matthews, Hannah; Carroll, Natalie; Renshaw, Derek; Turner, Andrew; Park, Alan; Skillman, Jo; McCarthy, Kate; Grunfeld, Elizabeth A

    2017-02-13

    Breast reconstruction is associated with multiple psychological benefits. However, few studies have identified clinical and psychological factors associated with improved satisfaction and quality of life. This study examined factors, which predict satisfaction with breast appearance, outcome satisfaction and quality of life following post-mastectomy breast reconstruction. Women who underwent post-mastectomy breast reconstruction between 2010 and 2016 received a postal questionnaire consisting of The BREAST-Q Patient Reported Outcomes Instrument, The European Organisation for Research and Treatment of Cancer QLQ-30 Questionnaire, The Patient and Observer Scar Assessment Scale, and a series of Visual-Analogue Scales. One hundredforty-eight women completed the questionnaire, a 56% response rate. Hierarchical multiple regression analyses revealed psychosocial factors accounted for 75% of the variance in breast satisfaction, 68% for outcome satisfaction, and 46% forquality of life. Psychosocial well-being emerged as a significant predictor of satisfaction with breast appearance (β = .322) and outcome satisfaction (β = .406). Deep inferior epigastric perforator flap patients reported greater satisfaction with breast appearance (β = .120) and outcome satisfaction (β = .167). This study extends beyond the limited research by distinguishing between satisfaction with breast appearance and outcome satisfaction. The study provides evidence for the role of psychosocial factors predicting key patient reported outcomes and demonstrates the importance of psychosocial well-being and reconstruction type. The findings also highlight the need for healthcare providers to consider the psychosocial well-being of patients both preoperatively and post operatively and provide preliminary evidence for the use of deep inferior epigastric perforator reconstructions over other types of reconstructive procedures. Copyright © 2017 John Wiley & Sons, Ltd.

  15. What Would Women Choose When Given a Choice in Breast Reconstruction?

    Science.gov (United States)

    Winch, Caleb J.

    2016-01-01

    Background: 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. The choices of all 837 women who underwent reconstruction were compared across time for publicly and privately funded patients using binary logistic regression. Results: Overall, women chose prosthetic over autologous reconstruction at a ratio of 4.7:1. This ratio increasingly favored prosthetic reconstruction over time, though less strongly for private patients who did not face a 3-year waiting list for autologous reconstruction. Conclusions: Financial constraints affected these women’s reconstruction choices. Nevertheless, and in contrast to the situation in the United States, these women clearly favored prosthetic over autologous reconstruction.

  16. Immediate Single-stage Endoscopic Latissimus Dorsi Breast and Nipple Reconstruction

    Directory of Open Access Journals (Sweden)

    Joaquim Muñoz i Vidal, MD

    2014-03-01

    Full Text Available Summary: Immediate breast reconstruction usually is a multistep surgical treatment. We introduce a new technique with positive results that reduces the reconstruction to 1 single step. This new technique promises to reduce patient consequences from multistaged procedures while reducing the costs. A retrospective review of 7 patients is presented.

  17. Deep inferior epigastric perforator flap for breast reconstruction: experience with 43 flaps

    Institute of Scientific and Technical Information of China (English)

    YAN Xiao-qing; YANG Hong-yan; ZHAO Yu-ming; YOU Lei; XU Jun

    2007-01-01

    Background In the past decade, there has been increasing breast reconstructions after mastectomy. The ideal material for reconstruction of a breast is fat and skin. The transverse rectus abdominis myocutaneous (TRAM) flap has been the gold standard for breast reconstruction until recently. Abdominal wall function is a major concern for plastic surgeons in breast reconstruction with TRAM flaps. The deep inferior epigastric perforator (DIEP) free flap spares the whole rectus abdominis muscle, includes skin and fat only, and therefore preserves adequate abdominal wall competence. The aim of this study was to summarize our experience in breast reconstruction with DIEP flap.Methods Between March 2000 and August 2005, a total of 43 breast reconstructions were performed on 40 patients by our surgeons using DIEP flap (3 patients had bilateral procedures), 14 of them were immediate surgeries and 26 were delayed. Abdominal function, satisfaction with the donor site and reconstructed breast, and the sensation recovery was assessed respectively during follow-up.Results The mean age of the patients was 38.6 years (range, 28-50). The size of the flaps was 11 cm×26 cm in average (height 10-12 cm, width 15-33 cm). The mean length of the vascular pedicles was 9.3 cm (range, 7-12). The patients were followed up for a mean of 16 months (range, 6-30 months). During the follow-up, 2 (5%) patients had total flap loss, 2 (5%) had partial necrosis, 4 (9%) had wound edge necrosis in the abdomen, and 1 had axillary seroma. None of the patients had hernia, and all of them were able to resume their daily activities after the operation. Patient satisfaction with the reconstructed breast rated high, 95% of the patients achieved spontaneous return of sensation in the reconstructed breast, but none of them had a sensation equivalent or approximate to the normal.Conclusions The DIEP flap has the same benefits as the TRAM flap without destroying the continuity of the rectus muscle. It can reduce

  18. Quality of life following total mastectomy with and without reconstruction versus breast-conserving surgery for breast cancer: A case-controlled cohort study.

    Science.gov (United States)

    Howes, Benjamin H L; Watson, David I; Xu, Chris; Fosh, Beverley; Canepa, Maximiliano; Dean, Nicola R

    2016-09-01

    Patient-reported outcomes and quality of life following mastectomy are not well understood. This study evaluates the quality of life following surgery for breast cancer and compares outcomes following breast-conserving surgery versus total mastectomy with or without reconstruction. A case-controlled cross-sectional study was conducted using the validated BREAST-Q™ questionnaire and a study-specific questionnaire to determine patient's views about surgical outcomes. Questionnaires were completed by patients following breast-conserving surgery and total mastectomy with or without reconstruction and by controls without breast cancer. A one-way ANOVA was used to compare mean BREAST-Q™ scores between groups and post hoc analysis using Tukey's and Kruskal-Wallis tests. BREAST-Q™ questionnaires were completed by 400 women (123 controls, 97 breast conservations, 93 mastectomies without reconstruction, 87 mastectomies with reconstruction). Women who had undergone mastectomy and reconstruction had higher scores in satisfaction with breast and sexual well-being domains compared with women who had breast-conserving surgery, and women who had total mastectomy without reconstruction had the lowest scores in these two domains. There was no difference in psychosocial well-being between the groups. Women who had undergone breast-conserving surgery scored the lowest in the physical well-being chest domain and the majority reported breast asymmetry. Our study suggests that women who undergo total mastectomy and breast reconstruction for cancer achieve a quality-of-life outcome that is at least as good as that following breast-conserving surgery. Furthermore, breast conservation has been found to be associated with lower physical well-being (i.e., more pain and discomfort) in the chest area and poorer sexual well-being outcomes. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. All rights reserved.

  19. Personality Traits and Decision on Breast Reconstruction in Women after Mastectomy.

    Science.gov (United States)

    Miśkiewicz, Halina; Antoszewski, Bogusław; Iljin, Aleksandra

    2016-09-01

    The aim of the study was evaluation of the correlation between selected personality traits in women after mastectomy and their decision on breast reconstruction. The study was conducted between 2013‑2015, in the Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Lodz, and Department of Oncological and Breast Surgery, CZMP. Comparative analysis comprised 40 patients, in whom mastectomy and breast reconstruction was done, and 40 women after breast amputation, who did not undergo reconstructive surgery. Basing on self-constructed questionnaire, five features of personality were evaluated in these women: pursue of success in life, ability to motivate others, openness to other people, impact of belonging to a social group on sense of security and the importance of opinion of others about the respondent. Apart from the questionnaire, in both groups of women a psychologic tool was used (SUPIN S30 and C30 tests) to determine the intensity of positive and negative emotions. Women who did not choose the reconstructive option were statistically significantly older at mastectomy than women who underwent breast reconstruction. There were statistically significant differences between both groups in response to question on being open to other people and value of other people's opinion. The differences in responses to question on the impact of belonging to a social group on personal sense of safety were hardly statistically significant. In psychometric studies there were significant differences in responses to SUPIN C30 test for negative emotions and S-30 for positive emotions. The level of negative emotions - feature of group A was in 47.5% in the range of high scores and in 47.5% within low and low-average scores. Among women from group B 57.5% had high scores, while 37.5% low and average scores. There were significant differences in the results of positive emotions evaluation in S-30. Women who did not undergo breast reconstruction usually had

  20. One-Stage Nipple and Breast Reconstruction Following Areola-Sparing Mastectomy

    Directory of Open Access Journals (Sweden)

    Hye Ri Kim

    2013-09-01

    Full Text Available Background Skin-sparing mastectomy with immediate breast reconstruction is increasinglybecoming a proven surgical option for early-stage breast cancer patients. Areola-sparingmastectomy (ASM has also recently become a popular procedure. The purpose of this articleis to investigate the reconstructive and aesthetic issues experienced with one-stage nippleand breast reconstruction using ASM.Methods Among the patients who underwent mastectomy between March 2008 and March2010, 5 women with a low probability of nipple-areolar complex malignant involvement underwentASM and immediate breast reconstruction with simultaneous nipple reconstructionusing the modified C-V flap. The cosmetic outcomes of this series were reviewed by plasticsurgeons and patient self-assessment and satisfaction were assessed via telephone interview.Results During the average 11-month follow-up period, there were no cases of cancer recurrence,the aesthetic outcomes were graded as excellent to very good, and all of the patientswere satisfied. Two patients developed a gutter-like depression around the reconstructednipple, and one patient developed skin erosion in a small area of the areola, which healedwith conservative dressing. The other complications, such as necrosis of the skin flap or areola,seroma, hematoma, or fat necrosis did not occur.Conclusions Since one-stage nipple and breast reconstruction following ASM is an oncologicallysafe, cost-effective, and aesthetically satisfactory procedure, it is a good surgical optionfor early breast cancer patients.

  1. Herpes Zoster Lesions on Reconstructed Breast Skin: Rare Objective Proof of Reinervation.

    Science.gov (United States)

    Weitgasser, Laurenz; Valina, Stephan Wolfgang; Schoeller, Thomas; Ehebruster, Gudrun

    2017-01-01

    Blazed up Herpes zoster lesions have been described in very few patients after free and pedicled flap transfer for reconstructive purpose. Although sensory recovery after flap reconstructions has been studied extensively most studies addressed subjective perceptions of sensation. Objective investigations of spontaneous reinervation of free and pedicled flaps are rare. We would like to present a witnessed herpes zoster infection of a latissimus dorsi skin flap 2 years after breast reconstruction.

  2. Qualitatively Understanding Patients' and Health Professionals' Experiences of the BRECONDA Breast Reconstruction Decision Aid

    DEFF Research Database (Denmark)

    Sherman, Kerry A; Shaw, Laura-Kate; Jørgensen, Lone

    2017-01-01

    OBJECTIVE: Women diagnosed with breast cancer or ductal carcinoma in situ (DCIS), and those with a genetic susceptibility to developing this disease, face the challenging decision of whether or not to undergo breast reconstruction following mastectomy. As part of a large randomized controlled trial......, this qualitative study examined women's experiences of using the Breast RECONstruction Decision Aid (BRECONDA), and health professionals' feedback regarding the impact of this resource on patients' knowledge and decision-making about breast reconstruction. METHOD: Semi-structured interviews were conducted...... with women who accessed the BRECONDA intervention (N = 36), and with their healthcare providers (N = 6). All interviews were transcribed verbatim and subjected to thematic analysis by three independent coders. RESULTS: Participants reported an overall positive impression, with all interviewees endorsing...

  3. Reducing infection risk in implant-based breast-reconstruction surgery: challenges and solutions

    Science.gov (United States)

    Ooi, Adrian SH; Song, David H

    2016-01-01

    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. Prevention of infection begins with appropriate reconstructive choice based on an assessment and optimization of risk factors. These include patient and disease characteristics, such as smoking, obesity, large breast size, and immediate reconstructive procedures, as well as adjuvant therapy, such as radiotherapy and chemotherapy. For implant-based breast reconstruction, preoperative planning and organization is key to reducing infection. A logical and consistent intraoperative and postoperative surgical protocol, including appropriate antibiotic choice, mastectomy-pocket creation, implant handling, and considered acellular dermal matrix use contribute toward the reduction of breast-implant infections. PMID:27621667

  4. Acellular Dermal Matrix in Reconstructive Breast Surgery: Survey of Current Practice among Plastic Surgeons

    Science.gov (United States)

    Ibrahim, Ahmed M. S.; Koolen, Pieter G. L.; Ashraf, Azra A.; Kim, Kuylhee; Mureau, Marc A. M.; Lee, Bernard T.

    2015-01-01

    Background: Acellular dermal matrices (ADMs) in plastic surgery have become increasingly popular particularly for breast reconstruction. Despite their advantages, questions exist regarding their association with a possible increased incidence of complications. We describe a collective experience of plastic surgeons’ use of ADMs in reconstructive breast surgery using an internet-based survey. Methods: Members of the American Society of Plastic Surgeons were recruited through voluntary, anonymous participation in an online survey. The web-based survey garnered information about participant demographics and their experience with ADM use in breast reconstruction procedures. After responses were collected, all data were anonymously processed. Results: Data were ascertained through 365 physician responses of which 99% (n = 361) completed the survey. The majority of participants were men (84.5%) between 51 and 60 years (37.4%); 84.2% used ADM in breast reconstruction, including radiated patients (79.7%). ADM use was not favored for nipple reconstruction (81.5%); 94.6% of participants used drains, and 87.8% administered antibiotics postoperatively. The most common complications were seroma (70.9%) and infection (16%), although 57.4% claimed anecdotally that overall complication rate was unchanged after incorporating ADM into their practice. High cost was a deterrent for ADM use (37.5%). Conclusions: Plastic surgeons currently use ADM in breast reconstruction for both immediate and staged procedures. Of those responding, a majority of plastic surgeons will incorporate drains and use postoperative antibiotics for more than 48 hours. PMID:25973359

  5. Postoperative Expansion is not a Primary Cause of Infection in Immediate Breast Reconstruction with Tissue Expanders.

    Science.gov (United States)

    Avraham, Tomer; Weichman, Katie E; Wilson, Stelios; Weinstein, Andrew; Haddock, Nicholas T; Szpalski, Caroline; Choi, Mihye; Karp, Nolan S

    2015-01-01

    Perioperative infection is the most common and dreaded complication associated with tissue expander (TE) breast reconstruction. Historically, the expansion period was thought to be the time of greatest hazard to the implant. However, recent institutional observations suggest infectious complications occur prior to expansion. This investigation, therefore, was conducted to determine the timing of infectious complications associated with two-stage TE breast reconstructions. Following IRB approval, a retrospective review of all consecutive two-stage immediate TE breast reconstructions at a single institution from November 2007 to November 2011 was conducted. Reconstructions were then divided into two cohorts: those suffering infectious complications and those that did not. Infectious complications including minor cellulitis, major cellulitis, abscess drainage, and explantation were identified. Various operative and patient variables were evaluated in comparison. Eight hundred ninety immediate two-stage TE breast reconstructions met inclusion criteria. Patients suffering infection were older (55.4 years versus 49.3 years; p breast reconstructions are significant and occur mostly prior to the start of expansion. Thus, challenging the conventional wisdom that instrumentation during expander filling as the primary cause of implant infections. Possible etiologic factors include greater age, therapeutic mastectomy versus prophylactic mastectomy, larger initial TE fill, and the use of ADM. © 2015 Wiley Periodicals, Inc.

  6. Complications of Radiotherapy after Immediate Breast Reconstruction with Implant: Risk Factors and Management - Our Institute’s Experience

    OpenAIRE

    Heba G. El-Sheredy; Rabie Ramadan; Yasser Hamed

    2016-01-01

    Background: Breast cancer is the most frequent malignant tumor in women worldwide. In recent years, defined reconstruction principles along with numerous surgical techniques with volume replacement have been published. Autologous breast reconstruction is more natural but leaves donor site morbidity. It provides the opportunity to restore the breast mound without the need for scars. This study aims to evaluate the complications of radiotherapy after immediate breast reconstructi...

  7. Systematic review of effects of pregnancy on breast and abdominal contour after TRAM/DIEP breast reconstruction in breast cancer survivors.

    Science.gov (United States)

    Alipour, Sadaf; Eskandari, Amirhossein

    2015-07-01

    Transverse rectus abdominis myocutaneous (TRAM) and its derivatives are the most commonly performed autologous breast reconstruction procedures. These procedures were not recommended in the past for those who planned for subsequent childbearing because of the transposition of portions of the abdominal wall during the procedure into the anatomic position of the breast, implying possible adverse effects over the contour of these manipulated areas during pregnancy and delivery. We conducted a systematic review to assess the literature on esthetic or functional consequences of childbearing over the breast and abdomen after these procedures in patients that were affected by breast cancer. A comprehensive literature search in databases and citation indexes was conducted from February 2014 to April 2015. Any paper on pregnancy after breast reconstruction by TRAM or its derivatives and modifications, written in English or French, were included. The search results underwent a first screening to exclude duplicate and irrelevant papers. Full texts were then reviewed as to the criteria for inclusion, and data were extracted into data extraction forms from eligible papers. The initial search yielded 5132 articles. After screening and review, overall 17 papers met all criteria for inclusion in this review. Our work revealed that uneventful pregnancy and delivery can be anticipated in breast cancer survivors who had undergone breast reconstruction via TRAM or its derivatives with minor negative effects on either the breast or the abdomen.

  8. Does Veritas® play a role in breast reconstruction? a case report

    Directory of Open Access Journals (Sweden)

    De Vita F

    2011-12-01

    Full Text Available Alessandro Borgognone, Tommaso Anniboletti, Francesco De VitaDepartment of Plastic and Reconstructive Surgery, CTO Hospital, Rome, ItalyAbstract: To reduce operative times and surgical complications in implant-based breast reconstruction, many authors advocate the use of exogenous material (modified xenograft to support tissue regeneration. In this article, a case is presented in which a bovine collagen patch (Veritas® Collagen Matrix; Synovis Surgical Innovations, St Paul, MN was used in the immediate breast reconstruction with an implant. The good results obtained in this case confirm Veritas® as a viable alternative to AlloDerm® Regenerative Tissue Matrix (LifeCell Corporation, Branchburg, NJ and further support its ability to sustain and stimulate recovery of the surrounding tissues.Keywords: Veritas®, implant-based, breast reconstruction, bovine collagen, patch

  9. Measuring and managing patient expectations for breast reconstruction: impact on quality of life and patient satisfaction

    Science.gov (United States)

    Pusic, Andrea L; Klassen, Anne F; Snell, Laura; Cano, Stefan J; McCarthy, Colleen; Scott, Amie; Cemal, Yeliz; Rubin, Lisa R; Cordeiro, Peter G

    2014-01-01

    The goal of postmastectomy breast reconstruction is to restore a woman’s body image and to satisfy her personal expectations regarding the results of surgery. Studies in other surgical areas have shown that unrecognized or unfulfilled expectations may predict dissatisfaction more strongly than even the technical success of the surgery. Patient expectations play an especially critical role in elective procedures, such as cancer reconstruction, where the patient’s primary motivation is improved health-related quality of life. In breast reconstruction, assessment of patient expectations is therefore vital to optimal patient care. This report summarizes the existing literature on patient expectations regarding breast reconstruction, and provides a viewpoint on how this field can evolve. Specifically, we consider how systematic measurement and management of patient expectations may improve patient education, shared medical decision-making and patient perception of outcomes. PMID:22458616

  10. DIEP flap with implant: a further option in optimising breast reconstruction.

    Science.gov (United States)

    Figus, Andrea; Canu, Vanessa; Iwuagwu, Fortune C; Ramakrishnan, Venkat

    2009-09-01

    Recent advances in breast reconstruction allow for high expectations regarding long-term symmetry and aesthetic appearance. The DIEP flap is currently considered as an ideal autologous reconstruction. However, there are situations in which the amount of tissue from a DIEP flap is not enough to achieve adequate symmetry. Indications and outcomes for a combined use of DIEP flap and implants are discussed in order to describe and examine a further scenario in optimising breast reconstruction. Between January 2004 and January 2006, all patients who underwent combined DIEP/implant breast reconstruction have been collected and followed prospectively. When clinical assessment demonstrated inadequate amount of tissue in the abdominal region to achieve a suitable unilateral or bilateral reconstruction with DIEP flaps, the patients were counselled about the opportunity of primary augmentation of the DIEP flaps. In cases where DIEP breast reconstruction has been done previously and there is a considerable asymmetry, delayed flap augmentation was considered. Patient's age, indication for surgery, preoperative and postoperative radiotherapy (RT), operative procedure, implant size, location and timing of insertion, complications, outcomes, and follow-up have been gathered. In all cases, textured round silicone gel implants have been used. After 12 months, four-point scales were used to analyse patients' satisfaction and aesthetic outcome. During the study period, 156 patients underwent breast reconstruction with 174 DIEP flaps. Fourteen patients (8.9%) had breast reconstruction with 19 DIEP flaps and 18 implants. The mean follow-up was 20.6 months (range 12-32 months). Fourteen implants were placed primarily at the time of DIEP reconstruction. The average implant weight was 167.2g with range between 100 and 230 g. Implant/flap weight ratio is about 1:5 corresponding to 20%. In six flaps, the patients had RT before the reconstruction, whilst in three cases of delayed DIEP flap

  11. The Changing Face of Mastectomy (from Mutilation to Aid to Breast Reconstruction)

    Science.gov (United States)

    Zurrida, Stefano; Bassi, Fabio; Arnone, Paolo; Martella, Stefano; Del Castillo, Andres; Ribeiro Martini, Rafael; Semenkiw, M. Eugenia; Caldarella, Pietro

    2011-01-01

    Breast cancer is the most common cancer in women. Primary treatment is surgery, with mastectomy as the main treatment for most of the twentieth century. However, over that time, the extent of the procedure varied, and less extensive mastectomies are employed today compared to those used in the past, as excessively mutilating procedures did not improve survival. Today, many women receive breast-conserving surgery, usually with radiotherapy to the residual breast, instead of mastectomy, as it has been shown to be as effective as mastectomy in early disease. The relatively new skin-sparing mastectomy, often with immediate breast reconstruction, improves aesthetic outcomes and is oncologically safe. Nipple-sparing mastectomy is newer and used increasingly, with better acceptance by patients, and again appears to be oncologically safe. Breast reconstruction is an important adjunct to mastectomy, as it has a positive psychological impact on the patient, contributing to improved quality of life. PMID:22312537

  12. A Scientometric Analysis of 20 Years of Research on Breast Reconstruction Surgery: A Guide for Research Design and Journal Selection

    Directory of Open Access Journals (Sweden)

    Mehrdad Moghimi

    2013-03-01

    Full Text Available Background Breast reconstruction refers to the rebuilding of a woman’s breast usingautologous tissue or prosthetic material to form a natural-looking breast. It is increasinglyoffered to women undergoing mastectomy for breast cancer. However, there is no systematicanalysis available for the expanding area of research on breast reconstruction.Methods A bibliometric method was used to obtain a view of the scientific production aboutbreast reconstruction by data extracted from the Institute for Scientific Information (ISI.Specific parameters were retrieved from the ISI. Articles about breast reconstruction wereanalyzed to obtain a view of the topic’s structure, history, and document relationships usingHistCite software. Trends in the most influential publications and authors were analyzed.Results The number of articles was constantly increasing. Most highly cited articles describedthe methods of flap construction in the surgery. Other highly cited articles discussed thepsychological or emotional aspects of breast reconstruction, skin sparing mastectomy, andbreast reconstruction in the irradiated breast.Conclusions This was the first breast reconstruction scientometric analysis, representing thecharacteristics of papers and the trends of scientific production. A constant increase in thenumber of breast reconstruction papers and also the increasing number of citations showsthat there is an increasing interest in this area of medical science. It seems that most of theresearch in this field is focused on the technical aspects of surgery.

  13. Immediate breast reconstruction with anatomical implants following mastectomy: The radiation perspective

    Energy Technology Data Exchange (ETDEWEB)

    Ben-David, Merav, E-mail: Merav.ben-david@sheba.health.gov.il [Radiation Oncology Unit, Chaim Sheba Medical Center, Ramat Gan (Israel); Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel); Granot, Hila [Radiation Oncology Unit, Chaim Sheba Medical Center, Ramat Gan (Israel); Gelernter, Ilana [Statistical Laboratory, School of Mathematics, Tel Aviv University, Tel Aviv (Israel); Scheflan, Michael [Department of Surgery, Assuta and Herzliya Medical Centers, Ramat Gan (Israel)

    2016-07-01

    Immediate implant-based breast reconstruction followed by postmastectomy radiation therapy (PMRT) is controversial because of the risk of compromised treatment plans and concerns regarding cosmetic outcomes. We evaluated the effects of immediate direct-to-implant breast reconstruction with anatomical implants on the quality of PMRT delivered by 3-dimensional conformal radiotherapy (3D-CRT). In this retrospective, single-institution study, patients who had undergone reconstruction with direct anatomic implant, performed by a single surgeon, received 3D-CRT between 2008 and 2013. For each patient, 2 plans (including or excluding internal mammary nodes [IMN]) were created and calculated. The primary end point was the dose distribution among reconstructed breasts, heart, lungs, and IMNs, and between right and left breasts. Of 29 consecutive patients, 11 received right-sided and 18 received left-sided PMRT to a total dose of 50 Gy. For plans excluding IMN coverage, mean D{sub mean} for right and left reconstructed breasts was 49.09 Gy (98.2% of the prescribed dose) and 48.51 Gy (97.0%), respectively. For plans including IMNs, mean D{sub mean} was 49.15 Gy (98.3%) for right and 48.46 Gy (96.9%) for left reconstructed breasts; the mean IMN D{sub mean} was 47.27 Gy (right) and 47.89 Gy (left). Heart D{sub mean} was below 1.56 Gy for all plans. Mean total lung volume receiving a dose of ≥ 20 Gy was 13.80% to 19.47%. PMRT can be delivered effectively and safely by 3D-CRT after direct-to-implant breast reconstruction with anatomical implants, even if patients require IMN treatment.

  14. Immediate breast reconstruction with anatomical implants following mastectomy: The radiation perspective.

    Science.gov (United States)

    Ben-David, Merav; Granot, Hila; Gelernter, Ilana; Scheflan, Michael

    2016-01-01

    Immediate implant-based breast reconstruction followed by postmastectomy radiation therapy (PMRT) is controversial because of the risk of compromised treatment plans and concerns regarding cosmetic outcomes. We evaluated the effects of immediate direct-to-implant breast reconstruction with anatomical implants on the quality of PMRT delivered by 3-dimensional conformal radiotherapy (3D-CRT). In this retrospective, single-institution study, patients who had undergone reconstruction with direct anatomic implant, performed by a single surgeon, received 3D-CRT between 2008 and 2013. For each patient, 2 plans (including or excluding internal mammary nodes [IMN]) were created and calculated. The primary end point was the dose distribution among reconstructed breasts, heart, lungs, and IMNs, and between right and left breasts. Of 29 consecutive patients, 11 received right-sided and 18 received left-sided PMRT to a total dose of 50Gy. For plans excluding IMN coverage, mean Dmean for right and left reconstructed breasts was 49.09Gy (98.2% of the prescribed dose) and 48.51Gy (97.0%), respectively. For plans including IMNs, mean Dmean was 49.15Gy (98.3%) for right and 48.46Gy (96.9%) for left reconstructed breasts; the mean IMN Dmean was 47.27Gy (right) and 47.89Gy (left). Heart Dmean was below 1.56Gy for all plans. Mean total lung volume receiving a dose of ≥ 20Gy was 13.80% to 19.47%. PMRT can be delivered effectively and safely by 3D-CRT after direct-to-implant breast reconstruction with anatomical implants, even if patients require IMN treatment.

  15. Giant fibroadenoma of one breast : Immediate bilateral reconstruction

    NARCIS (Netherlands)

    Dolmans, Guido H. C. G.; Hoogbergen, Maarten M.; van Rappard, Julien H. A.

    2007-01-01

    A rare case of giant fibroadenoma of the left breast is presented. We performed a nipple sparing subcutaneous mastectomy of the left breast. Since the patient desired larger breasts, a contralateral augmentation mammaplasty was carried out in a single stage operation. A satisfactory result was achie

  16. Comparing oncoplastic breast conserving surgery with mastectomy and immediate breast reconstruction: Case-matched patient reported outcomes.

    Science.gov (United States)

    Kelsall, Jennett E; McCulley, Stephen J; Brock, Lisa; Akerlund, Malin T E; Macmillan, R Douglas

    2017-10-01

    Oncoplastic breast conserving surgery (OBCS) allows women who may otherwise have mastectomy and immediate reconstruction (MxIR) the choice to conserve their breast yet avoid deformity. We compared the outcome of these options. Two cohorts meeting study criteria were identified from prospectively audited series of women undergoing OBCS or MxIR. After case matching for age, tumour size and date of surgery, stratification by breast size and controlling for radiotherapy; body image scale (BIS) scores of psychosocial function and patient reported outcome measures (PROMs) for breast appearance and return to function were analysed. A total of 567 women (286 treated by OBCS and 281 by MxIR) fulfilled inclusion criteria. Demographics were similar between the two unmatched cohorts, except for radiotherapy, age and tumour size (all p < 0.001). Overall, BIS score (p = 0.002), self-rated breast appearance, return to work and function (all p < 0.001) significantly favoured OBCS. Case-matched women with larger breasts treated by OBCS reported better BIS scores (mean 3.30 vs. 5.37, p = 0.011) and self-rated breast appearance score (p < 0.001) than MxIR, whereas no significant difference was observed for smaller breasts. BIS and appearance favoured OBCS, regardless of whether radiotherapy would have been avoided if treated by MxIR. OBCS offers suitable women the option to avoid MxIR while providing faster recovery. Better psychosocial and self-rated satisfaction with breast appearance is achieved for OBCS in all groups, regardless of the need for radiotherapy, apart from those women with smaller breasts for whom the results are comparable. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  17. Postmastectomy radiation therapy and immediate autologous breast reconstruction: integrating perspectives from surgical oncology, radiation oncology, and plastic and reconstructive surgery.

    Science.gov (United States)

    Rochlin, Danielle H; Jeong, Ah-Reum; Goldberg, Leah; Harris, Timothy; Mohan, Kriti; Seal, Stella; Canner, Joe; Sacks, Justin M

    2015-03-01

    The effect of postmastectomy radiation therapy (PMRT) on immediately reconstructed abdominal wall-based tissue remains imprecisely defined. We evaluated evidence from all fields involved in care of the breast cancer patient in order to advance a unified recommendation regarding this therapeutic sequence. We performed a MEDLINE and manual reference search to identify studies of PMRT with immediate autologous breast reconstruction. Inclusion criteria required studies to describe patients, flaps, and complication rates. Analyses were based on a random effects model. Surgical and radiation oncology literature was reviewed. Eleven retrospective studies of 337 patients with an average follow-up of 18-60 months (out of 268 patients) were selected for inclusion. Overall rates of fat necrosis, revisional surgery, volume loss, and fibrosis/contracture ranged from 16.9% to 35.4%. One out of 260 patients experienced total flap loss. There was an increased probability of fat necrosis in the irradiated breast (OR = 3.13, 95% CI = 1.42-6.89, P = 0.005) among three studies with non-irradiated controls. Five studies evaluated aesthetics with variable outcomes. There is mixed evidence for the utility of PMRT with immediate autologous abdominal wall breast reconstruction. Further investigation requires prospective studies with collaboration among surgical oncologists, radiation oncologists, and plastic surgeons. © 2014 Wiley Periodicals, Inc.

  18. Salvage of Failed Prosthetic Breast Reconstructions by Autologous Conversion With Free Tissue Transfers

    Science.gov (United States)

    Rabey, N. G.; Lie, K. H.; Kumiponjera, D.; Erel, E.; Simcock, J. W.; Malata, C. M.

    2013-01-01

    Objective: Implant-based breast reconstructions are conceptually simple but prone to surgical revisions. Additional procedures often fail to address the problems associated with the reconstructive outcome, especially in patients who have received radiotherapy. However, conversion to free flaps may improve symptoms and aesthetic results. We reviewed our experience in the United Kingdom with autologous replacement of failed prosthetic reconstructions with the aims of documenting the indications for “tertiary” reconstructions and comparing our outcomes with those of other centers. Methods: Patients undergoing salvage surgery for suboptimal prosthetic breast reconstructions between 2000 and 2012 were retrospectively reviewed for their original reconstructive operation, previous radiotherapy, indications for revision, corrective procedures undertaken, and final outcomes. Results: Of 14 patients identified, 7 had delayed and 7 had immediate reconstructions. Twelve had received radiotherapy; 6 before the initial delayed prosthetic reconstructions and 6 after immediate reconstructions. Ten patients presented after undergoing previous revisions of their original reconstructions (average 1.6). Indications for autologous conversion were capsular contracture, persistent pain, and poor cosmetic outcomes (often in combination). Salvage comprised explantation, total capsulectomy, and abdominal free flap reconstruction using deep inferior epigastric artery flaps (9) and transverse rectus abdominis myocutaneous flaps (5). The average interval between initial reconstruction and salvage was 8 years (r = 1-14). All flap transfers were successful with satisfactory aesthetic outcomes (average 21 months follow-up). Conclusions: We recommend early salvage autologous conversion of implant-based reconstructions once initial prosthetic reconstructions become unsatisfactory, particularly in recipients of radiotherapy. Many of these patients may have been better served by initial

  19. Importance of classification ANDI for the inmediate breast reconstruction in recurrent phyllodes tumor.

    Directory of Open Access Journals (Sweden)

    Nora Beatriz Sánchez

    2009-11-01

    Full Text Available Immediate breast reconstructive surgery offers to a patient relief in secondary symptoms due to deformities caused by tumours that in spite of the fact of being harmless, for instance in some phyllodes tumours, alter life quality since they produce pain, malformations and inconveniences to clothes’ employment. These symptoms are in proportion to lesion size and disease duration. Integral management by the same experts’ surgical team allows a complete resection of a benign giant lesion as well as an immediate reconstruction. The immediate breast reconstruction was performed in a 39 year old patient with a homolateral extended latissimus dorsi flap that replaced the breast volume removed; for skin covering an autologous tissue kept during surgical procedure for tumour ablation was used. Results related to disease management were adequate. The tumour, which measured 17x15x9 cm, weight 1000 g and occupied almost 90 per cent of the breast, was completely extirpated. Aesthetic result for patient (and for the surgical team was acceptable and satisfactory. End outcome has persisted 30 months post-surgery; presently there are no symptoms and no tumour recurrences have been detected. This type of management establishes the importance of having in mind those concepts clearly given on breast benign pathology classification (ANDI in order to follow reconstructive surgical techniques in women older tan 35 years, with benign tumours in whom breast tissues’ involution have already begun.

  20. Improvement of Upper Extremity Lymphedema after Delayed Breast Reconstruction with an Extended Latissimus Dorsi Myocutaneous Flap

    Directory of Open Access Journals (Sweden)

    Kyeong Tae Lee

    2012-03-01

    Full Text Available Lymphedema is a common complication after mastectomy in breast cancer patients. Many treatment options are available, but no treatment results in a complete cure. We report a case of lymphedema that occurred after modified radical mastectomy in a breast cancer patient who showed objective improvement after delayed breast reconstruction with an latissimus dorsi myocutaneous flap. A 41-year-old female patient with left breast cancer had undergone modified radical mastectomy with axillary lymph node dissection and postoperative radiotherapy 12 years previously. Four years after surgery, lymphedema developed and increased in aggravation despite conservative treatment. Eight years after the first operation, the patient underwent delayed breast reconstruction using the extended latissimus dorsi myocutaneous flap method. After reconstruction, the patient's lymphedema symptoms showed dramatic improvement by subjective measures including tissue softness and feeling of lightness, and by objective measures of about 7 mL per a week, resulting in near normal ranges of volume. At a postoperative follow-up after 3 years, no recurrence was observed. Delayed breast reconstruction with extended latissimus dorsi myocutaneous flaps may be helpful to patients with lymphedema after mastectomy. This may be a good option for patients who are worried about the possibility of the occurrence or aggravation of secondary lymphedema.

  1. Does Acellular Dermal Matrix Thickness Affect Complication Rate in Tissue Expander Based Breast Reconstruction?

    Directory of Open Access Journals (Sweden)

    Jessica F. Rose

    2016-01-01

    Full Text Available Background. While the benefits of using acellular dermal matrices (ADMs in breast reconstruction are well described, their use has been associated with additional complications. The purpose of this study was to determine if ADM thickness affects complications in breast reconstruction. Methods. A retrospective chart review was performed including all tissue expander based breast reconstructions with AlloDerm (LifeCell, Branchburg, NJ over 4 years. We evaluated preoperative characteristics and assessed postoperative complications including seroma, hematoma, infection, skin necrosis, and need for reintervention. We reviewed ADM thickness and time to Jackson-Pratt (JP drain removal. Results. Fifty-five patients underwent 77 ADM-associated tissue expander based breast reconstructions, with average age of 48.1 years and average BMI of 25.9. Average ADM thickness was 1.21 mm. We found higher complication rates in the thick ADM group. Significant associations were found between smokers and skin necrosis (p<0.0001 and seroma and prolonged JP drainage (p=0.0004; radiated reconstructed breasts were more likely to suffer infections (p=0.0085, and elevated BMI is a significant predictor for increased infection rate (p=0.0037. Conclusion. We found a trend toward increased complication rates with thicker ADMs. In the future, larger prospective studies evaluating thickness may provide more information.

  2. Denoised ordered subset statistically penalized algebraic reconstruction technique (DOS-SPART) in digital breast tomosynthesis

    Science.gov (United States)

    Garrett, John; Li, Yinsheng; Li, Ke; Chen, Guang-Hong

    2017-03-01

    Digital breast tomosynthesis (DBT) is a three dimensional (3D) breast imaging modality in which projections are acquired over a limited angular span around the compressed breast and reconstructed into image slices parallel to the detector. DBT has been shown to help alleviate the breast tissue overlapping issues of two dimensional (2D) mammography. Since the overlapping tissues may simulate cancer masses or obscure true cancers, this improvement is critically important for improved breast cancer screening and diagnosis. In this work, a model-based image reconstruction method is presented to show that spatial resolution in DBT volumes can be maintained while dose is reduced using the presented method when compared to that of a state-of-the-art commercial reconstruction technique. Spatial resolution was measured in phantom images and subjectively in a clinical dataset. Noise characteristics were explored in a cadaver study. In both the quantitative and subjective results the image sharpness was maintained and overall image quality was maintained at reduced doses when the model-based iterative reconstruction was used to reconstruct the volumes.

  3. Effect of acetylsalicylic acid on microvascular thrombosis in autologous breast reconstruction.

    Science.gov (United States)

    Enajat, Morteza; Aziz Mohammadi, Mujzgan; Debeij, Jan; van der Hulst, Rene R W J; Mureau, Marc A M

    2014-01-01

    Although advances in microsurgery have increased success rates of autologous breast reconstruction, microvascular thrombosis still remains a major concern as a cause of flap failure. At present, no evidence-based guidelines on pharmacological prevention of microvascular thrombosis exist. This study investigates the effect of acetylsalicylic acid on the incidence of microvascular complications in patients undergoing autologous breast reconstruction. Patients undergoing deep inferior epigastric artery perforator or free transverse rectus abdominis myocutaneous flap breast reconstruction at two academic centers in the Netherlands between 2005 and 2011 were included. Patients at one center received once daily 0.6 mL of nadroparine and 40 mg acetylsalicylic acid, while patients at the other center received 0.6 mL nadroparine only. A total of 430 consecutive patients underwent 592 breast reconstructions. No statistically significant differences were found between the two groups in the incidence of flap failure (2.8 and 2.5%), microvascular thromboembolic complications (2.6 and 3.8%), venous congestion (3.4 and 2.8%), or overall complications (28.0 and 32.3%). Hematoma tended to occur more often in the group receiving acetylsalicylic acid (9.2 and 4.7%).It was found that no protective effect of acetylsalicylic acid on microvascular complications was present. Given its known risks and the somewhat increased occurrence of hematoma in the present study, we stopped to routinely administer acetylsalicylic acid after autologous breast reconstruction.

  4. Immediate two-stage tissue expander breast reconstruction compared with one-stage permanent implant breast reconstruction: a multi-institutional comparison of short-term complications.

    Science.gov (United States)

    Davila, Armando A; Mioton, Lauren M; Chow, Geoffrey; Wang, Edward; Merkow, Ryan P; Bilimoria, Karl Y; Fine, Neil; Kim, John Y S

    2013-10-01

    Prosthesis-based techniques are the predominant form of breast reconstruction worldwide, with two-stage tissue expander procedures being the most popular. In the past decade, there has been increasing interest in performing single-stage implant reconstruction immediately following mastectomy as an attempt to simplify the reconstructive course and improve psychosocial morbidity. However, there is a paucity of large-scale, multi-institutional data comparing the outcomes of these two reconstructive strategies. Patients who underwent immediate tissue expander or implant reconstruction following mastectomy from 2006-2010 were identified using standardised operation codes. Demographic information for patients, 30-day outcomes, and adverse events for each type of reconstruction were analysed and compared between groups. A total of 10,561 patients underwent immediate breast reconstruction. There were 9033 patients who underwent tissue expander placement (2752 bilateral), and 1528 patients who underwent immediate implant placement (485 bilateral). Patients who had implant placement demonstrated increased rates of overall complications (6.8% compared with 5.4%, p = 0.02) and prosthesis failure (1.4% compared with 0.8%, p = 0.04). There was no difference in the rate of any surgical site infections (3.9% compared with 3.4%, p = 0.39), reoperation (7.5% compared with 6.9%, p = 0.40), or major medical complications (1.8% compared with 1.6%, p = 0.57). Both immediate one-stage, direct-to-implant, and two-stage tissue expander reconstructions result in low rates of morbidity. One-stage reconstruction suggests a slightly higher complication rate related to prosthesis failure.

  5. Breast Reconstruction after a Bilateral Mastectomy Using the BRAVA Expansion System and Fat Grafting

    Directory of Open Access Journals (Sweden)

    Ondrej Mestak, MD

    2013-11-01

    Full Text Available Summary: Fat graft breast reconstruction following a mastectomy is always limited by the size of the skin envelope, which affects the amount of graft that can be injected in 1 session. Because the fat graft naturally resorbs in all patients, several sessions of fat grafting are necessary. BRAVA’s negative pressure causes a “reverse” expansion of the skin envelope, thus permitting more space for the fat graft. This allows decreasing number of required procedures for an adequate breast reconstruction. We operated on a 38-year-old patient 4 years after bilateral mastectomy without irradiation for breast cancer. Before the procedure, the patient was instructed to wear the BRAVA system for 12 hours daily for 2 months before the first session, at all times between the sessions and for 1 month following the last fat grafting session. We performed 3 fat grafting sessions, as planned. Altogether, we injected 840 cm3 of fat on the right side and 790 cm3 of fat on the left side. Four months after the last operation, the patient was very satisfied with her new breasts. The breasts were soft, with good sensation and a natural feel. Using the BRAVA external expansion system for the enhancement of fat grafting is a suitable technique for breast reconstruction after a mastectomy. This technique produces soft and natural feeling breasts in fewer operative sessions, with a minimal risk of complications. Patient compliance, however, is greatly needed to achieve the desired results.

  6. A case report of total breast reconstruction using an inframammary adipofascial flap with an implant.

    Science.gov (United States)

    Ogawa, Tomoko; Yamakawa, Tomomi

    2016-01-01

    Prosthetic-based breast reconstruction can be used in combination with autologous flaps such as a latissimus dorsi (LD) flap or a thoracodorsal artery perforator (TDAP) flap to achieve symmetry. However, the LD and TDAP flaps require a different skin incision from that which is used for the mastectomy. As a new autologous flap for use in combination with prosthetic-based breast reconstruction after nipple-sparing mastectomy (NSM), we used an inframammary adipofascial flap. The patient was a 27-year-old female with moderate ptotic breasts, who had ductal carcinoma in situ in the lower outer quadrant of her left breast. After NSM through the inframammary fold (IMF) incision, the subcutaneous fat of the intended inframammary area was undermined, and the tongue shaped adipofascial flap was pulled up in the intended area. After inserting a tissue expander under the major pectoral muscle, this adipofascial flap was reflected back to the inferior portion of the breast area. After modeling the breast mound with this flap, the inframammary skin incision was sutured. Eleven months later, the patient underwent surgery to replace the expander with a permanent implant. Eight months after the replacement with an implant, the cosmetic result is good. This procedure can be performed through the same skin incision on the IMF as NSM. Total breast reconstruction using the inframammary adipofascial flap with an implant can be an alternative approach to achieving symmetry in some patients. This method is useful for breast reconstruction after NSM for young patients with moderate-ptotic breasts. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  7. Breast volume estimation from systematic series of CT scans using the Cavalieri principle and 3D reconstruction.

    Science.gov (United States)

    Erić, Mirela; Anderla, Andraš; Stefanović, Darko; Drapšin, Miodrag

    2014-01-01

    Preoperative breast volume estimation is very important for the success of the breast surgery. In the present study, two different breast volume determination methods, Cavalieri principle and 3D reconstruction were compared. Consecutive sections were taken in slice thickness of 5 mm. Every 2nd breast section in a set of consecutive sections was selected. We marked breast tissue with blue line on each selected section, and so prepared CT scans used for breast volume estimation. The volumes of the 60 breasts were estimated using the Cavalieri principle and 3D reconstruction. The mean breast volume value was established to be 467.79 ± 188.90 cm(3) with Cavalieri method and 465.91 ± 191.41 cm(3) with 3D reconstruction. The mean CE for the estimates in this study was calculated as 0.25%. Skin-sparing volume was about 91.64% of the whole breast volume. Both methods are very accurate and have a strong linear association. Our results suggest that the calculation of breast volume or its part in vivo from systematic series of CT scans using the Cavalieri principle or 3D breast reconstruction is accurate enough to have a significant clinical benefit in planning reconstructive breast surgery. These methods can help the surgeon guide the choice of the most appropriate implant or/and flap preoperatively. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  8. IMMEDIATE BREAST RECONSTRUCTION WITH LATISSIMUS DORSI MUSCULOCUTANEOUS FLAP: A SUITABLE OPTION FOR CHINESE WOMEN AFTER MASTECTOMY

    Institute of Scientific and Technical Information of China (English)

    DI Gen-hong; YU Ke-da; WU Jiong; QI Fa-zhi; LU Jin-song; SHEN Zhen-zhou; SHAO Zhi-min

    2006-01-01

    Objective: To discuss the suitable immediate breast reconstruction modalities for Chinese patients by comparing thepedicled transverse rectus abdominis myocytaneous flap (TRAM) reconstruction with latissimus dorsi myocytaneous flap (LTD) reconstruction plus implants or not after mastectomy due to breast cancer. Methods: From Jan. 2000 to Jul. 2005, 74staged 0-Ⅱ patients (mean age 39) were performed immediate breast reconstruction with autologous tissue either using LTD flaps or pedicled TRAM flaps with supplemental implants when necessary after mastectomy due to breast cancer and the charts were reviewed. Results: The age, marriage and menses status did not affect the selection of modalities and the need of implants. In 74 patients, 62 cases (83.8%) were performed LTD reconstruction with 13 implants and 12 cases received TRAM with 1 implant. The difference in need of implants or not between the two modalities had no statistical significance (P=0.442,Fisher' exact test). Aesthetic results judged as good or fair were in 88% patients and the cosmetic effects between LTD and TRAM groups or implant and non-implant groups had no differences. All reconstructions were successful, with 4.1%cumulative locoregional recurrence and 100% overall survival by following up to 66 months (median 9 months). The DFS and RFS between the two modalities had no significant differences by log rank test. Conclusion: Immediate autologous tissue reconstruction makes it possible to regain the natural and symmetric contour of breast without increased local recurrence. The LTD flap reconstruction is a suitable option for most Chinese women as well as the pedicled TRAM flap.

  9. Skin-sparing mastectomy and immediate autologous breast reconstruction in locally advanced breast cancer patients: a UBC perspective.

    Science.gov (United States)

    Ho, Adelyn L; Tyldesley, Scott; Macadam, Sheina A; Lennox, Peter A

    2012-03-01

    To describe the clinical outcomes of patients with locally advanced breast cancer (LABC) receiving neoadjuvant chemotherapy and preoperative radiotherapy, followed by skin-sparing mastectomy (SSM) and immediate autologous breast reconstruction (IABR). A retrospective review of 30 LABC patients who underwent SSM and IABR between 1997 to 2007 was performed. Data were drawn from patient records and the University of British Columbia (UBC) Breast Reconstruction and British Columbia Cancer Agency databases. All 30 patients received neoadjuvant chemotherapy, preoperative radiotherapy, SSM, and IABR. Fifteen patients (50%) had stage IIIA disease, 13 (43%) stage IIIB, and 2 (6.7%) stage IIIC. Reconstruction types included the pedicled transverse rectus myocutaneous flap (n = 24), the latissimus dorsi flap (n = 5), and a combination of transverse rectus myocutaneous and latissimus dorsi flap (n = 1). The median follow-up was 3.51 years (range 1-9.4 years). Local complications included mastectomy flap necrosis (n = 3), partial flap necrosis (n = 1), fat necrosis (n = 1), seroma (n = 3), infection (n = 2), and flap fibrosis (n = 1). The incidence of donor site complications was 20%. Overall 5-year actuarial locoregional relapse-free, distant relapse-free, and disease-specific survival rates were 80, 65, and 68%, respectively. Excellent or good physician-rated aesthetic results were achieved in 66% of patients. The UBC protocol avoids irradiation of the autologous breast reconstruction. Outcomes compare with findings from similar studies with respect to local recurrence, distant relapse, overall survival, and surgical complication rates. Neoadjuvant chemotherapy and preoperative radiotherapy in LABC patients desiring autologous breast reconstruction can be considered a safe option.

  10. Clinical outcomes of percutaneous drainage of breast fluid collections after mastectomy with expander-based breast reconstruction.

    Science.gov (United States)

    Tong, Ricky T; Kohi, Maureen; Fidelman, Nicholas; Kuo, Yuo-Chen; Foster, Robert; Peled, Anne; Kolli, K Pallav; Taylor, Andrew G; LaBerge, Jeanne M; Kerlan, Robert K

    2013-09-01

    To determine clinical outcomes of patients who underwent imaging-guided percutaneous drainage of breast fluid collections after mastectomy and breast reconstruction. A retrospective review was performed including all consecutive patients who underwent percutaneous drainage of fluid collections after mastectomy with tissue expander-based reconstruction between January 2007 and September 2012. During this period, 879 mastectomies (563 patients) with expander-based breast reconstruction were performed. Fluid collections developed in 28 patients (5%), which led to 30 imaging-guided percutaneous drainage procedures. The median follow-up time was 533 days. Patient characteristics, surgical technique, microbiology analysis, and clinical outcomes were reviewed. The mean age of patients was 51.5 years (range, 30.9-69.4 y), and the median time between breast reconstruction and drainage was 35 days (range, 4-235 d). Erythema and swelling were the most common presenting symptoms. The median volume of fluid evacuated at the time of drain placement was 70 mL. Drains were left in place for a median 14 days (range, 6-34 d). Microorganisms were detected in the fluid in 12 of 30 drainage procedures, with Staphylococcus aureus being the most common microorganism. No further intervention was needed in 21 of 30 drainage procedures (70%). However, surgical intervention (removal of expanders) was needed after 6 (20%) drainage procedures, and additional percutaneous drainage procedures were performed after 3 (10%) drainage procedures. Percutaneous drainage is an effective means of treating postoperative fluid collections after expander-based breast reconstruction and can obviate the need for repeat surgery in most cases. Copyright © 2013 SIR. Published by Elsevier Inc. All rights reserved.

  11. A Prospective Analysis of Dynamic Loss of Breast Projection in Tissue Expander-Implant Reconstruction

    Directory of Open Access Journals (Sweden)

    Lauren M Mioton

    2015-05-01

    Full Text Available BackgroundBreast projection is a critical element of breast reconstruction aesthetics, but little has been published regarding breast projection as the firm expander is changed to a softer implant. Quantitative data representing this loss in projection may enhance patient education and improve our management of patient expectations.MethodsFemale patients who were undergoing immediate tissue-expander breast reconstruction with the senior author were enrolled in this prospective study. Three-dimensional camera software was used for all patient photographs and data analysis. Projection was calculated as the distance between the chest wall and the point of maximal projection of the breast form. Values were calculated for final tissue expander expansion and at varying intervals 3, 6, and 12 months after implant placement.ResultsFourteen breasts from 12 patients were included in the final analysis. Twelve of the 14 breasts had a loss of projection at three months following the implant placement or beyond. The percentage of projection lost in these 12 breasts ranged from 6.30% to 43.4%, with an average loss of projection of 21.05%.ConclusionsThis study is the first prospective quantitative analysis of temporal changes in breast projection after expander-implant reconstruction. By prospectively capturing projection data with three-dimensional photographic software, we reveal a loss of projection in this population by three months post-implant exchange. These findings will not only aid in managing patient expectations, but our methodology provides a foundation for future objective studies of the breast form.

  12. Tradeoffs Associated With Contralateral Prophylactic Mastectomy in Women Choosing Breast Reconstruction: Results of a Prospective Multicenter Cohort.

    Science.gov (United States)

    Momoh, Adeyiza O; Cohen, Wess A; Kidwell, Kelley M; Hamill, Jennifer B; Qi, Ji; Pusic, Andrea L; Wilkins, Edwin G; Matros, Evan

    2017-07-01

    Assess postoperative morbidity and patient-reported outcomes after unilateral and bilateral breast reconstruction in patients with unilateral breast cancer. Relatively little is known about the morbidity associated with and changes in quality of life experienced by patients who undergo contralateral prophylactic mastectomy (CPM) and breast reconstruction. This information would be valuable for decision making in patients with unilateral breast cancer. Women undergoing mastectomy and breast reconstruction for unilateral breast cancer were recruited for this prospective observational study. Postoperative complications after implant and autologous breast reconstruction in patients undergoing unilateral or bilateral mastectomy were recorded. Preoperative and 1 year patient-reported outcomes were measured. Univariate tests and logistic regression analyses were performed, studying the effects of reconstructive method, laterality, and risk factors on surgical complication rates, patient satisfaction, and anxiety. We identified 1144 women who underwent either unilateral (47.2%) or bilateral (52.8%) mastectomies with reconstruction. Bilateral autologous (odds ratio 1.73, 95% confidence interval 1.07-2.81) and implant reconstructions (odds ratio 1.73, 95% confidence interval 1.22-2.47) were associated with a higher risk of complications compared with unilateral reconstructions. Baseline anxiety was greater in women who chose bilateral compared with unilateral implant reconstructions (P = 0.001). There was no difference in anxiety levels between groups postoperatively. Postoperatively, women who chose CPM with implant reconstructions were more satisfied with their breasts than women with unilateral reconstructions (P = 0.034). Although higher postoperative complications were observed after CPM and reconstruction, these procedures were associated with decreased anxiety levels and improved satisfaction with breasts for women who underwent implant reconstructions.

  13. Quality of life after immediate breast reconstruction and skin-sparing mastectomy - a comparison with patients undergoing breast conserving surgery.

    Science.gov (United States)

    Heneghan, H M; Prichard, R S; Lyons, R; Regan, P J; Kelly, J L; Malone, C; McLaughlin, R; Sweeney, K J; Kerin, M J

    2011-11-01

    Historically breast cancer surgery was associated with significant psychosocial morbidity and suboptimal cosmetic outcome. Recent emphasis on women's quality of life following breast cancer treatment has drawn attention to the importance of aesthetic outcome and potential benefits of immediate breast reconstruction (IBR). Our primary aim was to assess patient's quality of life after IBR, compared to a matched group undergoing breast conservation. We also investigated the oncological safety and morbidity associated with immediate reconstruction. A prospectively collected database of all breast cancer patients who underwent IBR at a tertiary referral breast unit was reviewed. Patients were reviewed clinically, and administered two validated quality of life questionnaires, at least one year after completing their treatment. 255 patients underwent IBR following mastectomy over a 55 month period. Reconstruction with ipsilateral latissimus dorsi flap was most commonly performed (88%). After mean follow-up of 36 months, IBR patients' quality of life was comparable to a group of age-matched women (n = 160) who underwent breast conserving surgery (p = 0.89). No patient experienced local recurrence (0%), distant metastases developed in 4.8% and disease related mortality was 2.2%. Post-operative morbidities included wound infection (11.8%), chronic pain (2.0%), capsular contracture (11%; 36% of whom had radiotherapy) and fat necrosis (14.1%). No patient experienced flap loss. IBR is a highly acceptable form of treatment for women requiring mastectomy. With high rates of patient satisfaction, low associated morbidity, and proven oncological safety, it is an appropriate recommendation for all women requiring mastectomy. Copyright © 2011 Elsevier Ltd. All rights reserved.

  14. Subcutaneous Implant-based Breast Reconstruction with Acellular Dermal Matrix/Mesh: A Systematic Review.

    Science.gov (United States)

    Salibian, Ara A; Frey, Jordan D; Choi, Mihye; Karp, Nolan S

    2016-11-01

    The availability of acellular dermal matrix (ADM) and synthetic mesh products has prompted plastic surgeons to revisit subcutaneous implant-based breast reconstruction. The literature is limited, however, with regards to evidence on patient selection, techniques, and outcomes. A systematic review of the Medline and Cochrane databases was performed for original studies reporting breast reconstruction with ADM or mesh, and subcutaneous implant placement. Studies were analyzed for level of evidence, inclusion/exclusion criteria for subcutaneous reconstruction, reconstruction characteristics, and outcomes. Six studies (186 reconstructions) were identified for review. The majority of studies (66.7%) were level IV evidence case series. Eighty percent of studies had contraindications for subcutaneous reconstruction, most commonly preoperative radiation, high body mass index, and active smoking. Forty percent of studies commenting on patient selection assessed mastectomy flap perfusion for subcutaneous reconstruction. Forty-five percent of reconstructions were direct-to-implant, 33.3% 2-stage, and 21.5% single-stage adjustable implant, with ADM utilized in 60.2% of reconstructions versus mesh. Pooled complication rates included: major infection 1.2%, seroma 2.9%, hematoma 2.3%, full nipple-areola complex necrosis 1.1%, partial nipple-areola complex necrosis 4.5%, major flap necrosis 1.8%, wound healing complication 2.3%, explantation 4.1%, and grade III/IV capsular contracture 1.2%. Pooled short-term complication rates in subcutaneous alloplastic breast reconstruction with ADM or mesh are low in preliminary studies with selective patient populations, though techniques and outcomes are variable across studies. Larger comparative studies and better-defined selection criteria and outcomes reporting are needed to develop appropriate indications for performing subcutaneous implant-based reconstruction.

  15. Utilization of Inferiorly Based Dermofat Flap in Breast Reconstruction after Simple Mastectomy due to Gigantomastia.

    Science.gov (United States)

    Bogdanov-Berezovsky, A; Krieger, Y; Shoham, Y; Silberstein, E

    2013-01-01

    Gigantomastia (GM) is a rare disabling condition characterized by excessive breast tissue growth. To date, there is no universal classification and definition of GM. At present, GM is determined as weight over 1.5 kg per breast (Dancey et al., 2008) or 3% or more of the patient's total body weight (Dafydd et al., 2011). The lack of generally acknowledged approach regarding GM is expressed by the different methods of its treatment ranging from hormonal prescription to mastectomy and subsequent complex breast reconstruction (Shoma et al., 2011). We describe a treatment approach, including simple mastectomy and immediate breast reconstruction by an inferiorly based dermofat flap with silicone implants and nipple grafting.

  16. Breast reconstruction de novo by water-jet assisted autologous fat grafting – a retrospective study

    Directory of Open Access Journals (Sweden)

    Hoppe, Delia Letizia

    2013-12-01

    Full Text Available [english] Background: Autologous fat grafting has become a frequent, simple, reproducible and low-risk technique for revisional or partial breast reconstruction. The presented European multicenter study describes an optimized treatment and follow-up protocol for the de novo breast reconstruction after total mastectomy by lipotransfer alone.Methods: A retrospective European multicenter trial included 135 procedures on 28 (35 breasts postmastectomy patients (mean 52.4 years. All women were treated with the water-jet assisted fat grafting method (BEAULI™ combined with additional procedures (NAC reconstruction, contralateral mastoplasty and evaluated with at least 6 months follow-up (mean 2.6 years. Sonography or mammography, clinical examination, patient questionnaire (10-point Likert scale and digital photographs were carried out.Results: On average the patients received 4 to 6 procedures each with a single volume of 159 ml (±61 ml over 21 months (range 9 months to 2.5 years. In total 1,020 ml (±515 ml fat were grafted till a complete breast reconstruction was achieved. Irradiated patients needed a significantly higher volume than non-irradiated (p<0.041. Main treatment complications were liponecrosis (2.59%, infection (0.74% and granuloma (0.74%. Patient satisfaction was overall high to very high (96% and confirmed the good aesthetic results (68% and the natural softness, contour and shape of the reconstructed breast.Conclusions: A complete breast reconstruction with large volume fat grafting is alternatively possible to standard techniques in selected cases. It takes at least 4 to 6 lipotransfers in the course of 2 years. Patients with prior radiotherapy may require even up to 8 sessions over nearly 3 years of treatment.

  17. Nipple-Areola Complex Necrosis after Nipple-Sparing Mastectomy with Immediate Autologous Breast Reconstruction

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    Jin-Woo Cho

    2015-09-01

    Full Text Available BackgroundAutologous or implant-based breast reconstruction after nipple-sparing mastectomy is increasingly preferred worldwide as a breast cancer treatment option. However, postoperative nipple-areola complex (NAC necrosis is the most significant complication of nipple-sparing mastectomy. The purpose of our study was to identify the risk factors for NAC necrosis, and to describe the use of our skin-banking technique as a solution.MethodsWe reviewed cases of immediate autologous breast reconstruction after nipple-sparing mastectomy at our institution between June 2005 and January 2014. The patients' data were reviewed and the risk of NAC necrosis was analyzed based on correlations between patient variables and NAC necrosis. Moreover, data pertaining to five high-risk patients who underwent the donor skin-banking procedure were included in the analysis.ResultsEighty-five patients underwent immediate autologous breast reconstruction after nipple-sparing mastectomy during the study period. Partial or total NAC necrosis occurred in 36 patients (43.4%. Univariate analysis and binary regression modeling found that body mass index, smoking history, radiation therapy, and mastectomy volume were significantly associated with NAC necrosis. Of the 36 cases of NAC necrosis, 31 were resolved with dressing changes, debridement, or skin grafting. The other five high-risk patients underwent our prophylactic skin-banking technique during breast reconstruction surgery.ConclusionsNAC necrosis is common in patients with multiple risk factors. The use of the skin-banking technique in immediate autologous breast reconstruction is an attractive option for high-risk patients. Banked skin can be used in such cases without requiring additional donor tissue, with good results in terms of aesthetic and reconstructive outcomes.

  18. Assessment of patient factors, surgeons, and surgeon teams in immediate implant-based breast reconstruction outcomes.

    Science.gov (United States)

    Gfrerer, Lisa; Mattos, David; Mastroianni, Melissa; Weng, Qing Y; Ricci, Joseph A; Heath, Martha P; Lin, Alex; Specht, Michelle C; Haynes, Alex B; Austen, William G; Liao, Eric C

    2015-02-01

    Outcome studies of immediate implant-based breast reconstruction have focused largely on patient factors, whereas the relative impact of the surgeon as a contributing variable is not known. As the procedure requires collaboration of both a surgical oncologist and a plastic surgeon, the effect of the surgeon team interaction can have a significant impact on outcome. This study examines outcomes in implant-based breast reconstruction and the association with patient characteristics, surgeon, and surgeon team familiarity. A retrospective review of 3142 consecutive implant-based breast reconstruction mastectomy procedures at one institution was performed. Infection and skin necrosis rates were measured. Predictors of outcomes were identified by unadjusted logistic regression followed by multivariate logistic regression. Surgeon teams were grouped according to number of cases performed together. Patient characteristics remain the most important predictors for outcomes in implant-based breast reconstruction, with odds ratios above those of surgeon variables. The authors observed significant differences in the rate of skin necrosis between surgical oncologists with an approximately two-fold difference between surgeons with the highest and lowest rates. Surgeon teams that worked together on fewer than 150 procedures had higher rates of infection. Patient characteristics are the most important predictors for surgical outcomes in implant-based breast reconstruction, but surgeons and surgeon teams are also important variables. High-volume surgeon teams achieve lower rates of infection. This study highlights the need to examine modifiable risk factors associated with optimum implant-based breast reconstruction outcomes, which include patient and provider characteristics and the surgical team treating the patient. Risk, III.

  19. Is tamoxifen associated with an increased risk for thromboembolic complications in patients undergoing microvascular breast reconstruction? [Ist die Einnahme von Tamoxifen zum Zeitpunkt der mikrovaskulären Brustrekonstruktion mit einer erhöhten Rate an thrombembolischen Komplikationen assoziiert?

    Directory of Open Access Journals (Sweden)

    Krämer, Robert

    2013-02-01

    Full Text Available [english] Introduction: Tamoxifen is associated with a twofold increased risk of thromboembolic events. Third generation aromatase inhibitors (AIs, such as letrozole, anastrozole, and exemestane have therefore replaced tamoxifen in the adjuvant therapy of hormone receptor-positive breast cancer. A retrospective review was performed in patients who underwent delayed microvascular breast reconstruction and received tamoxifen at the time of surgery in order to assess the risk of both minor and major flap complications including thromboembolic events.Patients and methods: Twenty-nine patients who underwent delayed microsurgical breast reconstruction with autologous tissue between 2006 and 2012 were included in the study. The overall complication rates were compared between patients who did versus those who did not receive tamoxifen at the time of microsurgical breast reconstruction. Results: Breast reconstruction was performed with a DIEP flap in and with a TRAM flap in 4 patients. Overall, the complication rate was 37.9% (n=11 consisting of 5 major (including one total flap loss and 6 minor complications. In patients receiving tamoxifen (n=5, we observed one minor complication and one major complication with a total flap loss due to thrombus formation at the anastomosis site. In one patient pulmonary embolism occurred without association to tamoxifen. The number of thromboembolic events was equivalent in both groups (p=0.642. No increase of major (p=0.858 or minor (p=0.967 complications in the tamoxifen group could be observed. Taking the overall complication rate into account there was no statistically difference between the two groups (p=0.917.Conclusion: In our study we could not observe an increased risk for thromobembolic events in patients receiving tamoxifen while undergoing autologous microvascular breast reconstruction.[german] Aromatasehemmer der dritten Generation haben mittlerweile Tamoxifen in der neoadjuvanten und adjuvanten Therapie

  20. Breast Microcalcification Detection Using Super-Resolution Ultrasound Image Reconstruction

    Science.gov (United States)

    2010-09-01

    Gotzsche, P. C. and Olsen, O., “Is screening for breast cancer with mammography justifiable?,” The Lancet 355, 129–134 (2000). [6] Olsen, O. and Gotzsche...P. C., “Cochrane review on screening for breast cancer with mammography,” The Lancet 358, 1340–1342 (2001). [7] Skaane, P. and Skjennald, A., “Screen

  1. Shaped versus Round Implants for Breast Reconstruction: Indications and Outcomes

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    Maurice Y. Nahabedian, MD

    2014-03-01

    Conclusions: Both shaped and round silicone gel devices can result in natural aesthetic outcomes. Shaped devices are preferred for contouring the upper pole and for optimizing breast projection. Round devices are preferred when the upper pole is not deficient and the patient desires softer breasts. Longer follow-up studies will be necessary.

  2. Small refinements in breast reconstruction: a technique for inframammary fold creation.

    Science.gov (United States)

    Ismagilov, Arthur; Vanesyan, Anna; Kamaletdinov, Ilnur

    2017-04-01

    In breast reconstructive surgery, the inframammary fold (IMF) is an essential component of breast identity. The lack of the IMF following previous mastectomy requires restoration. We have developed a new IMF reconstruction technique using the posterior sheet (PS) of the expander capsule. This article presents our 10-year experience of performing this original technique during two-stage breast reconstruction. Preoperatively, the midline, lateral, and medial borders (MBs) of the implant pocket and the new IMF line were marked. After extracting the expander, the anterior sheet of the expander capsule was removed with the exception of its lowest 2-cm portion. Two needles were placed at the intersection of the new IMF line with the lateral border (LB) of the implant pocket and its MB. Within the pocket, horizontal dissection of the PS of the capsule was performed from one needle to another, after which the sheet was mobilized downward. The mobilized free border of the PS was pulled upward until the inframammary crease was at the new marked location, and then fixed with non-absorbable interrupted sutures to the underlying tissues. An implant was placed over this layer. The covering tissues were then closed. A total of 321 patients were included. The median age was 38 years (range, 18-58 years). No serious wound complications were observed. Breast-thoracic angle decreased in 21 patients (6.5%), and the distance from the IMF to the lower border of breast segment III was greater than that of the contralateral breast in 14 patients (4.4%). This technique provides a well-defined IMF without indentations or retraction. The results are stable on long-term follow-up and provide a sharp breast-thoracic angle, which is crucial in creating natural-looking ptosis of the reconstructed breast.

  3. Body Posture After Mastectomy: Comparison Between Immediate Breast Reconstruction Versus Mastectomy Alone.

    Science.gov (United States)

    Atanes Mendes Peres, Ana Carolina; Dias de Oliveira Latorre, Maria do Rosário; Yugo Maesaka, Jonathan; Filassi, José Roberto; Chada Baracat, Edmund; Alves Gonçalves Ferreira, Elizabeth

    2017-01-01

    Immediate breast reconstruction has been increasingly incorporated as part of breast cancer treatment, especially for the psychological benefits. Currently, there are many options for breast reconstruction surgery, but the impact of the different techniques on body posture has not been widely studied. One study demonstrated that immediate breast reconstruction with a Beker-25 prosthesis could help to preserve body posture after mastectomy; however, there is no evidence regarding the effect of surgery on the body posture of women after breast reconstruction when using autologous tissue. The purpose of this paper is to compare the body postures of women who underwent immediate breast reconstruction using an abdominal flap with those of women who underwent mastectomy alone. This is a cross-sectional study. Seventy-six women diagnosed with breast cancer underwent mastectomy, between 1 and 5 years after the diagnosis, are the participants of the study. Two groups were defined: women who underwent mastectomy and immediate breast reconstruction (n = 38) and women who underwent mastectomy alone (n = 38). To assess body posture, specific anatomical points for obtaining photographs were located and marked in anterior, posterior and right-side and left-side views. The photographs were analysed using Postural Analysis Software/Software de Análise Postural (PAS/SAPO). In the left lateral view, there was a significant difference in the vertical alignment of the trunk (4.2 vs 3.1; p = 0.05). There were no significant differences between the two groups for the variables in the anterior, posterior or right-side views. Women who underwent mastectomy alone, compared with women who underwent immediate breast reconstruction with abdominal flaps, showed differences in the vertical alignment of the trunk, with greater asymmetry between the acromion and greater trochanter, which can mean trunk rotation. No significant differences were found between the two groups in the

  4. Improvement of Upper Extremity Lymphedema after Delayed Breast Reconstruction with an Extended Latissimus Dorsi Myocutaneous Flap

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    Kyeong Tae Lee

    2012-03-01

    Full Text Available Lymphedema is a common complication after mastectomy in breast cancer patients. Manytreatment options are available, but no treatment results in a complete cure. We report acase of lymphedema that occurred after modified radical mastectomy in a breast cancerpatient who showed objective improvement after delayed breast reconstruction with anlatissimus dorsi myocutaneous flap. A 41-year-old female patient with left breast cancer hadundergone modified radical mastectomy with axillary lymph node dissection and postoperativeradiotherapy 12 years previously. Four years after surgery, lymphedema developed andincreased in aggravation despite conservative treatment. Eight years after the first operation,the patient underwent delayed breast reconstruction using the extended latissimus dorsimyocutaneous flap method. After reconstruction, the patient’s lymphedema symptomsshowed dramatic improvement by subjective measures including tissue softness and feeling oflightness, and by objective measures of about 7 mL per a week, resulting in near normal rangesof volume. At a postoperative follow-up after 3 years, no recurrence was observed. Delayedbreast reconstruction with extended latissimus dorsi myocutaneous flaps may be helpful topatients with lymphedema after mastectomy. This may be a good option for patients who areworried about the possibility of the occurrence or aggravation of secondary lymphedema.

  5. Iterative reconstruction using a Monte Carlo based system transfer matrix for dedicated breast positron emission tomography.

    Science.gov (United States)

    Saha, Krishnendu; Straus, Kenneth J; Chen, Yu; Glick, Stephen J

    2014-08-28

    To maximize sensitivity, it is desirable that ring Positron Emission Tomography (PET) systems dedicated for imaging the breast have a small bore. Unfortunately, due to parallax error this causes substantial degradation in spatial resolution for objects near the periphery of the breast. In this work, a framework for computing and incorporating an accurate system matrix into iterative reconstruction is presented in an effort to reduce spatial resolution degradation towards the periphery of the breast. The GATE Monte Carlo Simulation software was utilized to accurately model the system matrix for a breast PET system. A strategy for increasing the count statistics in the system matrix computation and for reducing the system element storage space was used by calculating only a subset of matrix elements and then estimating the rest of the elements by using the geometric symmetry of the cylindrical scanner. To implement this strategy, polar voxel basis functions were used to represent the object, resulting in a block-circulant system matrix. Simulation studies using a breast PET scanner model with ring geometry demonstrated improved contrast at 45% reduced noise level and 1.5 to 3 times resolution performance improvement when compared to MLEM reconstruction using a simple line-integral model. The GATE based system matrix reconstruction technique promises to improve resolution and noise performance and reduce image distortion at FOV periphery compared to line-integral based system matrix reconstruction.

  6. Iterative reconstruction using a Monte Carlo based system transfer matrix for dedicated breast positron emission tomography

    Energy Technology Data Exchange (ETDEWEB)

    Saha, Krishnendu [Ohio Medical Physics Consulting, Dublin, Ohio 43017 (United States); Straus, Kenneth J.; Glick, Stephen J. [Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts 01655 (United States); Chen, Yu. [Department of Radiation Oncology, Columbia University, New York, New York 10032 (United States)

    2014-08-28

    To maximize sensitivity, it is desirable that ring Positron Emission Tomography (PET) systems dedicated for imaging the breast have a small bore. Unfortunately, due to parallax error this causes substantial degradation in spatial resolution for objects near the periphery of the breast. In this work, a framework for computing and incorporating an accurate system matrix into iterative reconstruction is presented in an effort to reduce spatial resolution degradation towards the periphery of the breast. The GATE Monte Carlo Simulation software was utilized to accurately model the system matrix for a breast PET system. A strategy for increasing the count statistics in the system matrix computation and for reducing the system element storage space was used by calculating only a subset of matrix elements and then estimating the rest of the elements by using the geometric symmetry of the cylindrical scanner. To implement this strategy, polar voxel basis functions were used to represent the object, resulting in a block-circulant system matrix. Simulation studies using a breast PET scanner model with ring geometry demonstrated improved contrast at 45% reduced noise level and 1.5 to 3 times resolution performance improvement when compared to MLEM reconstruction using a simple line-integral model. The GATE based system matrix reconstruction technique promises to improve resolution and noise performance and reduce image distortion at FOV periphery compared to line-integral based system matrix reconstruction.

  7. Meshed acellular dermal matrix:technique and application in implant based breast reconstruction

    Institute of Scientific and Technical Information of China (English)

    Dino Zammit; Jonathan Kanevsky; Fan-Yi Meng; Tassos Dionisopoulos

    2016-01-01

    Alloderm was the first acellular dermal matrix used and remains a popular choice among plastic surgeons. However, while the overall surgical outcome of breast reconstruction using alloderm has been a success, the economic burden on the health care system makes it a subject of frequent re-evaluations in cost-effectiveness. Prompted by the high price of $3,700 USD for a 6 cm × 16 cm area, our group proposes the meshing of AlloDerm to decrease the total amount needed for breast reconstruction, while achieving comparable surgical outcomes as using unmeshed alloderm.

  8. Magnetic resonance imaging (MRI) evaluation of residual breast tissue following mastectomy and reconstruction with silicone implants.

    Science.gov (United States)

    Zippel, Douglas; Tsehmaister-Abitbol, Vered; Rundstein, Arie; Shalmon, Anat; Zbar, Andrew; Nardini, Gil; Novikov, Ilya; Sklair-Levy, Miri

    2015-01-01

    We present our use of magnetic resonance (MR) measurement to determine the amount of residual breast tissue (RBT) following total mastectomy with reconstruction. Breast MR images of 45 women who underwent surgery between January and November 2011 were reviewed. The cohort included therapeutic and prophylactic mastectomies. RBT was evaluated at four points with a digital caliper assessing T2-weighted and T1-weighted images. Patients undergoing mastectomy for carcinoma tended to have less RBT than in prophylactic surgery. Greater age and recent surgery both correlated with larger RBT. Variable thickness of RBT is demonstrable following mastectomy and implant reconstruction using MR imaging. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Breast reconstruction following prophylactic or therapeutic mastectomy for breast cancer: Recommendations from an evidence-based provincial guideline

    Science.gov (United States)

    Shea-Budgell, Melissa; Quan, May Lynn; Mehling, Blair; Temple-Oberle, Claire

    2014-01-01

    The side effects of mastectomy can be significant. Breast reconstruction may alleviate some distress; however, there are currently no provincial recommendations regarding the integration of reconstruction with breast cancer therapy. The purpose of the present article is to provide evidence-based strategies for the management of patients who are candidates for reconstruction. A systematic review of meta-analyses, guidelines, clinical trials and comparative studies published between 1980 and 2013 was conducted using the PubMed and EMBASE databases. Reference lists of publications were manually searched for additional literature. The National Guidelines Clearinghouse and SAGE directory, as well as guideline developers’ websites, were also searched. Recommendations were developed based on the available evidence. Reconstruction consultation should be made available for patients undergoing mastectomy. Tumour characteristics, cancer therapy, patient comorbidities, body habitus and smoking history may affect reconstruction outcomes. Although immediate reconstruction should be considered whenever possible, delayed reconstruction is acceptable when immediate is not available or appropriate. The integration of reconstruction and postmastectomy radiotherapy should be addressed in a multidisciplinary setting. The decision as to which type of procedure to perform (autologous or alloplastic with or without acellular dermal matrices) should be left to the discretion of the surgeons and the patient after providing counselling. Skin-sparing mastectomy is safe and appropriate. Nipple-sparing is generally not recommended for patients with malignancy, but could be considered for carefully selected patients. Immediate reconstruction requires resources to coordinate operating room time between the general and plastic surgeons, to provide supplies including acellular dermal matrices, and to develop the infrastructure needed to facilitate multidisciplinary discussions. PMID:25114623

  10. Patient-Reported Outcomes Following Breast Reconstruction Surgery and Therapeutic Mammoplasty: Prospective Evaluation 1 Year Post-Surgery with BREAST-Q Questionnaire.

    Science.gov (United States)

    Shekhawat, Laxmi; Busheri, Laleh; Dixit, Santosh; Patel, Chaula; Dhar, Upendra; Koppiker, Chaitanyanand

    2015-12-01

    Breast Cancer (BC) treatment leads to mutilation and destruction of breast shape with negative effects on body image and self-esteem.One of the main goals of reconstructive and oncoplastic breast surgery is to satisfy patients and improve their quality of life (QoL).Therefore, it is important to assess the patient experience post-surgery by means of patient-reported outcome measures (PROMs) that focus on the patient's perception of the surgery and surgical care, as well as psychosocial well-being and physical functioning. The objective of the current study was to identify predictors of patient satisfaction such as breast appearance including implant type in a selective sample of women who underwent breast reconstruction surgery using implants. Participants in this prospective study were women, (age 26-75 years) that were newly diagnosed with breast carcinoma. All consecutive patients who underwent breast reconstruction between January 2013 and October 2014 were asked to complete the BREAST-Q questionnaire 1 year after surgery. 120 patients underwent unilateral breast reconstruction using implant. While 38 patients underwent reconstruction with opposite breast reduction symmertization, 27 patients underwent therapeutic mammoplasty. The response rate for BREAST-Q questionnaire completion was 98 % with 147 out of 150 study participants completed the questionnaire. From the data collected from 147 patients, the responses could be distributed into 4 distinct groups based on the reconstruction outcomes namely "very much satisfied" (93 %) or "definitely and mostly satisfied" (94 %) or "satisfied" with the outcome (88 %) or "definitely agree on having reconstruction rather than the alternative of having no breast "(91 %).The results showed significant improvement in all four areas that were evaluated after surgery namely satisfaction with the appearance of the breasts, psychosocial, sexual and physical well-being. While the reconstruction surgery had an overall

  11. Patient-reported Quality of Life and Satisfaction With Cosmetic Outcomes After Breast Conservation and Mastectomy With and Without Reconstruction: Results of a Survey of Breast Cancer Survivors.

    Science.gov (United States)

    Jagsi, Reshma; Li, Yun; Morrow, Monica; Janz, Nancy; Alderman, Amy; Graff, John; Hamilton, Ann; Katz, Steven; Hawley, Sarah

    2015-06-01

    Although breast conservation is therapeutically equivalent to mastectomy for most patients with early-stage breast cancer, an increasing number of patients are pursuing mastectomy, which may be followed by breast reconstruction. We sought to evaluate long-term quality of life and cosmetic outcomes after different locoregional management approaches, as perceived by patients themselves. We surveyed women with a diagnosis of nonmetastatic breast cancer from 2005 to 2007, as reported to the Los Angeles and Detroit population-based Surveillance, Epidemiology, and End Results registries. We received responses from 2290 women approximately 9 months after diagnosis (73% response rate) and from 1536 of these 4 years later. We evaluated quality of life and patterns and correlates of satisfaction with cosmetic outcomes overall and, more specifically, within the subgroup undergoing mastectomy with reconstruction, using multivariable linear regression. Of the 1450 patients who responded to both surveys and experienced no recurrence, 963 underwent breast-conserving surgery, 263 mastectomy without reconstruction, and 222 mastectomy with reconstruction. Cosmetic satisfaction was similar between those receiving breast conservation therapy and those receiving mastectomy with reconstruction. Among patients receiving mastectomy with reconstruction, reconstruction type and radiation receipt were associated with satisfaction (P mastectomy with reconstruction. In patients undergoing postmastectomy radiation, the use of autologous reconstruction may mitigate the deleterious impact of radiation on cosmetic outcomes.

  12. Feeling like me again: a grounded theory of the role of breast reconstruction surgery in self-image.

    Science.gov (United States)

    McKean, L N; Newman, E F; Adair, P

    2013-07-01

    The present study aimed to develop a theoretical understanding of the role of breast reconstruction in women's self-image. Semi-structured interviews were conducted with 10 women from breast cancer support groups who had undergone breast reconstruction surgery. A grounded theory methodology was used to explore their experiences. The study generated a model of 'breast cancer, breast reconstruction and self-image', with a core category entitled 'feeling like me again' and two principal categories of 'normal appearance' and 'normal life'. A further two main categories, 'moving on' and 'image of sick person' were generated. The results indicated a role of breast reconstruction in several aspects of self-image including the restoration of pre-surgery persona, which further promoted adjustment.

  13. Comparing five alternative methods of breast reconstruction surgery: a cost-effectiveness analysis.

    Science.gov (United States)

    Grover, Ritwik; Padula, William V; Van Vliet, Michael; Ridgway, Emily B

    2013-11-01

    The purpose of this study was to assess the cost-effectiveness of five standardized procedures for breast reconstruction to delineate the best reconstructive approach in postmastectomy patients in the settings of nonirradiated and irradiated chest walls. A decision tree was used to model five breast reconstruction procedures from the provider perspective to evaluate cost-effectiveness. Procedures included autologous flaps with pedicled tissue, autologous flaps with free tissue, latissimus dorsi flaps with breast implants, expanders with implant exchange, and immediate implant placement. All methods were compared with a "do-nothing" alternative. Data for model parameters were collected through a systematic review, and patient health utilities were calculated from an ad hoc survey of reconstructive surgeons. Results were measured in cost (2011 U.S. dollars) per quality-adjusted life-year. Univariate sensitivity analyses and Bayesian multivariate probabilistic sensitivity analysis were conducted. Pedicled autologous tissue and free autologous tissue reconstruction were cost-effective compared with the do-nothing alternative. Pedicled autologous tissue was the slightly more cost-effective of the two. The other procedures were not found to be cost-effective. The results were robust to a number of sensitivity analyses, although the margin between pedicled and free autologous tissue reconstruction is small and affected by some parameter values. Autologous pedicled tissue was slightly more cost-effective than free tissue reconstruction in irradiated and nonirradiated patients. Implant-based techniques were not cost-effective. This is in agreement with the growing trend at academic institutions to encourage autologous tissue reconstruction because of its natural recreation of the breast contour, suppleness, and resiliency in the setting of irradiated recipient beds.

  14. A systematic review of complications of implant-based breast reconstruction with prereconstruction and postreconstruction radiotherapy.

    Science.gov (United States)

    Momoh, Adeyiza O; Ahmed, Raouf; Kelley, Brian P; Aliu, Oluseyi; Kidwell, Kelley M; Kozlow, Jeffrey H; Chung, Kevin C

    2014-01-01

    To conduct a systematic review of the literature to assess outcomes data on complications associated with implant-based breast reconstruction performed before or after chest wall radiation to assist in guiding the decision-making process for reconstruction of the irradiated breast. Studies from a PubMed search that met predetermined inclusion criteria were identified and included. Complications of interest were low- and high-grade capsular contractures, minor and major complications, reconstruction failure rates, and reconstruction completion rates. Pooled complication rates were calculated. A total of 26 articles were included in the study after screening 1,006 publications, with 14 studies presenting data on prereconstruction radiation and 23 studies presenting data on postreconstruction radiation. Complication rates evaluated in patients exposed to radiation before or after implant reconstruction were not significantly different. Reconstruction failure rates were similar at 19 and 20 % for pre- and postreconstruction radiation patients, respectively. Completion rates were similar at 83 and 80 % for pre- and postreconstruction radiation patients, respectively. Review of the current literature suggests similar overall success and failure rates with radiotherapy provided both before and after reconstruction. Failure rates in both groups of patients are clinically significant when considering implant reconstruction in the setting of radiation.

  15. Optimization of digital breast tomosynthesis (DBT) acquisition parameters for human observers: effect of reconstruction algorithms

    Science.gov (United States)

    Zeng, Rongping; Badano, Aldo; Myers, Kyle J.

    2017-04-01

    We showed in our earlier work that the choice of reconstruction methods does not affect the optimization of DBT acquisition parameters (angular span and number of views) using simulated breast phantom images in detecting lesions with a channelized Hotelling observer (CHO). In this work we investigate whether the model-observer based conclusion is valid when using humans to interpret images. We used previously generated DBT breast phantom images and recruited human readers to find the optimal geometry settings associated with two reconstruction algorithms, filtered back projection (FBP) and simultaneous algebraic reconstruction technique (SART). The human reader results show that image quality trends as a function of the acquisition parameters are consistent between FBP and SART reconstructions. The consistent trends confirm that the optimization of DBT system geometry is insensitive to the choice of reconstruction algorithm. The results also show that humans perform better in SART reconstructed images than in FBP reconstructed images. In addition, we applied CHOs with three commonly used channel models, Laguerre-Gauss (LG) channels, square (SQR) channels and sparse difference-of-Gaussian (sDOG) channels. We found that LG channels predict human performance trends better than SQR and sDOG channel models for the task of detecting lesions in tomosynthesis backgrounds. Overall, this work confirms that the choice of reconstruction algorithm is not critical for optimizing DBT system acquisition parameters.

  16. Should Immediate Autologous Breast Reconstruction Be Considered in Women Who Require Postmastectomy Radiation Therapy? A Prospective Analysis of Outcomes.

    Science.gov (United States)

    Billig, Jessica; Jagsi, Reshma; Qi, Ji; Hamill, Jennifer B; Kim, Hyungjin M; Pusic, Andrea L; Buchel, Edward; Wilkins, Edwin G; Momoh, Adeyiza O

    2017-06-01

    In women who require postmastectomy radiation therapy, immediate autologous breast reconstruction is often discouraged. The authors prospectively evaluated postoperative morbidity and satisfaction reported by women undergoing delayed or immediate autologous breast reconstruction in the setting of postmastectomy radiation therapy. Patients enrolled in the Mastectomy Reconstruction Outcomes Consortium study, who received postmastectomy radiotherapy and underwent immediate or delayed free abdominally based autologous breast reconstruction, were identified. Postoperative complications at 1 and 2 years after reconstruction were assessed. Patient-reported outcomes were evaluated using the BREAST-Q questionnaire preoperatively and at 1 and 2 years postoperatively. Bivariate analyses and mixed-effects regression models were used to compare outcomes. A total of 175 patients met the authors' inclusion criteria. Immediate reconstructions were performed in 108 patients and delayed reconstructions in 67 patients; 93.5 percent of immediate reconstructions were performed at a single center. Overall complication rates were similar based on reconstructive timing (25.9 percent immediate and 26.9 percent delayed at 1 year; p = 0.54). Patients with delayed reconstruction reported significantly lower prereconstruction scores (p Breasts and Psychosocial and Sexual Well-being than did patients with immediate reconstruction. At 1 and 2 years postoperatively, both groups reported comparable levels of satisfaction in assessed BREAST-Q domains. From this prospective cohort, immediate autologous breast reconstruction in the setting of postmastectomy radiation therapy appears to be a safe option that may be considered in select patients and centers. Breast aesthetics and quality of life, evaluated from the patient's perspective, were not compromised by flap exposure to radiation therapy. Therapeutic, III.

  17. Fewer Revisions in Abdominal-based Free Flaps than Latissimus Dorsi Breast Reconstruction after Radiation

    Science.gov (United States)

    Smith, Benjamin D.; Liu, Jun; Robb, Geoffrey L.; Kronowitz, Steven J.; Garvey, Patrick B.

    2016-01-01

    Background: The most commonly chosen flaps for delayed breast reconstruction after postmastectomy radiation therapy (PMRT) are abdominal-based free flaps (ABFFs) and pedicled latissimus dorsi (LD) musculocutaneous flaps. The short-and long-term advantages and disadvantages of delayed ABFFs versus LD flaps after PMRT remain unclear. We hypothesized that after PMRT, ABFFs would result in fewer postoperative complications and a lower incidence of revision surgery than LD flaps. Methods: We retrospectively reviewed a prospectively maintained database of consecutive patients who underwent unilateral, delayed breast reconstruction after PMRT using ABFFs or pedicled LD flaps with implants at the MD Anderson Cancer Center between January 1, 2001, and December 31, 2011. We compared outcomes and additional surgeries required between the 2 groups. Univariate and multivariate logistic regression modeling analyzed the relationships between patient and reconstruction characteristics and postoperative outcomes. Results: A total of 139 consecutive patients’ breast reconstructions were evaluated: 101 ABFFs (72.7%) versus 38 LDs (27.3%). Average follow-up was similar for ABFF and LD reconstructions. Although ABFF and LD reconstructions experienced similar rates of overall (30.7% vs 23.7%, respectively; P = 0.53), donor-site (8.91% vs 5.13%, respectively; P = 0.48), and flap (20.7% vs 17.9%, respectively; P = 0.37) complications, the LD reconstructions required more additional surgeries (92.1% vs 67.3%; P surgeries more than 1 year after reconstruction (37.1% vs 14.7%; P = 0.02). Conclusion: Although early complication rates were similar for both types of reconstructions, ABFFs seem to have the advantage of providing a more durable result that required fewer revision surgeries in the long term.

  18. Patient-subjective cosmetic outcomes following the varying stages of tissue expander breast reconstruction: the importance of completion.

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    Buck, Donald W; Shenaq, Deana; Heyer, Kamaldeep; Kato, Caroline; Kim, John Y S

    2010-12-01

    Tissue expander breast reconstruction consists of three major surgical steps: placement of the expander after mastectomy, exchange of the expander for an implant, and nipple-areola complex reconstruction. The evolution of patient satisfaction throughout this process has not been evaluated. Here we performed a stratified analysis of patient-subjective cosmetic outcomes during the stages of breast reconstruction. Twenty-eight consecutive tissue expander-implant reconstructions were performed by the senior author using human acellular dermis. Cosmetic outcomes were assessed after each reconstructive stage using a validated Breast Evaluation Questionnaire consisting of questions related to breast size, shape and firmness in three separate contexts: intimate or sexual activities, leisure or social activities, and professional or job-related activities. Eighteen patients underwent unilateral reconstruction, while 10 underwent bilateral reconstruction. Satisfaction scores were statistically higher following Stage I and II procedures for bilateral reconstructions. For unilateral reconstructions, there was a statistically significant elevation in scores following Stage II. The addition of nipple-areola reconstruction resulted in the highest scores for both unilateral and bilateral reconstructions. These score elevations were significant (p reconstructions and as such, the significant differences in scores between unilateral and bilateral cohorts after stages I and II were nearly eliminated after completion of the entire reconstructive process. Satisfaction with tissue expander reconstruction is significantly affected by the patients' stage during the reconstructive process. Completion of all three stages, including nipple-areolar complex reconstruction, achieves maximal patient satisfaction. For unilateral reconstructions, completion of the entire reconstructive process, including contralateral symmetry procedures and nipple-areolar complex reconstruction, results in

  19. Age-dependent Characteristics in Women with Breast Cancer: Mastectomy and Reconstructive Trends at an Urban Academic Institution.

    Science.gov (United States)

    Rodby, Katherine A; Robinson, Emilie; Danielson, Kirstie K; Quinn, Karina P; Antony, Anuja K

    2016-03-01

    Breast reconstruction is an important aspect of treatment after breast cancer. Postmastectomy reconstruction bears a significant impact on a woman's postsurgical confidence, sexuality, and overall well-being. Previous studies have inferred that women under age 40 years have unique characteristics that distinguish them from an older cohort. Identifying age-dependent trends will assist with counseling women on mastectomy and reconstruction. To identify age-dependent trends, 100 consecutive women were sampled from a prospectively maintained breast reconstruction database at an urban academic institution from June 2010 through June 2013. Women were placed into two cohorts breast cancer. Younger women typically present with more aggressive features requiring oncologic treatment including chemotherapy and radiation. Mastectomy and reconstructive choices also demonstrate age-dependent characteristics. Women in younger age groups are more likely to pursue risk-reduction procedures and implant-based strategies, whereas older women had a higher propensity for abdominal-based autologous reconstruction. In addition, preferential reconstructive strategies correlate with age-dependent archetypical features of the breast (higher profile implants in younger patients; autologous reconstruction on affected side mimicking natural ptosis, and contralateral mastopexy in older patients). These trends seem to be consistent with each increasing year of age. Age-related preferences and expectations, age-dependent body habitus and breast shape, and lifetime risk play a role in the choices pursued for mastectomy and reconstruction.

  20. Breast reconstruction after mastectomy among Department of Defense beneficiaries by race

    Science.gov (United States)

    Enewold, Lindsey; McGlynn, Katherine A.; Zahm, Shelia H.; Poudrier, Jill; Anderson, William; Shriver, Craig D.; Zhu, Kangmin

    2014-01-01

    Background Post-mastectomy breast reconstruction increased approximately 20% between 1998 and 2008 in the United States and has been found to improve body image, self-esteem and quality of life. These procedures, however, tend to be less common among minority women, which may be due to variations in healthcare access. The Department of Defense (DoD) provides equal healthcare access, thereby affording an exceptional environment to assess whether racial variations persist when access to care is equal. Methods Linked DoD cancer registry and medical claims data were used. The receipt of reconstruction was compared between white (n=2,974) and black women (n=708) who underwent mastectomies to treat incident, histologically-confirmed, breast cancer diagnosed from 1998 to 2007. Results During the study period, post-mastectomy reconstruction increased among both black (27.3% to 40.0%) and white (21.8% to 40.6%) female breast cancer patients. Receipt of reconstruction did not vary significantly by race (odds ratio: 0.93; 95% confidence interval 0.76-1.15). Reconstruction decreased significantly with increasing age, tumor stage and receipt of radiotherapy and was significantly more common in more recent years, among active servicewomen, Tricare Prime (HMO) beneficiaries and women whose sponsor was an officer. Conclusion The receipt of reconstruction did not vary by race within this equal access health system, indicating that the racial disparities reported in previous studies may have partially been due to variations in healthcare access. Additional research to determine why a large proportion of breast cancer patients do not undergo reconstruction might be beneficial, particularly because these procedures have been associated with non-cosmetic benefits. PMID:24965236

  1. Dynamic relaxation in algebraic reconstruction technique (ART) for breast tomosynthesis imaging.

    Science.gov (United States)

    Oliveira, N; Mota, A M; Matela, N; Janeiro, L; Almeida, P

    2016-08-01

    A major challenge in Digital Breast Tomosynthesis (DBT) is handling image noise since the 3D reconstructed images are obtained from low dose projections and limited angular range. The use of the iterative reconstruction algorithm Algebraic Reconstruction Technique (ART) in clinical context depends on two key factors: the number of iterations needed (time consuming) and the image noise after iterations. Both factors depend highly on a relaxation coefficient (λ), which may give rise to slow or noisy reconstructions, when a single λ value is considered for the entire iterative process. The aim of this work is to present a new implementation for the ART that takes into account a dynamic mode to calculate λ in DBT image reconstruction. A set of initial reconstructions of real phantom data was done using constant λ values. The results were used to choose, for each iteration, the suitable λ value, taking into account the image noise level and the convergence speed. A methodology to optimize λ automatically during the image reconstruction was proposed. Results showed we can dynamically choose λ values in such a way that the time needed to reconstruct the images can be significantly reduced (up to 70%) while achieving similar image quality. These results were confirmed with one clinical dataset. With simple methodology we were able to dynamically choose λ in DBT image reconstruction with ART, allowing a shorter image reconstruction time without increasing image noise. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  2. Obesity-related Risk Factors in Implant-based Breast Reconstruction Using AlloDerm

    Science.gov (United States)

    Coleman, Cathryn A.; Erickson, Stephen W.

    2017-01-01

    With a population in which 70% of the patients were overweight or obese, we reviewed retrospectively 135 breasts of 70 consecutive patients who underwent implant-based immediate breast reconstruction using freeze-dried AlloDerm as the acellular dermal matrix. Several obesity-related parameters were evaluated to determine their possible correlation to early postoperative complications. We found that breast width and surface area of AlloDerm usage correlated with the development of infection and mastectomy skin flap necrosis. Increased breast width and size of AlloDerm matrix implanted were correlated with higher rates of both minor and significant skin necrosis and of cellulitis. Body mass index was correlated with the development of cellulitis and minor and major skin necrosis but not with seroma or reconstruction failure. Preexisting breast cup size correlated with the development of seroma but not the other complications. We observed no statistically significant association between reconstruction failure and any of the parameters reviewed, but this is likely due to the small number of failures in our data set (n = 10). PMID:28280672

  3. Immediate Partial Breast Reconstruction with Endoscopic Latissimus Dorsi Muscle Flap Harvest

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    Chae Eun Yang

    2014-09-01

    Full Text Available BackgroundCurrently, breast conservation therapy is commonly performed for the treatment of early breast cancer. Depending on the volume excised, patients may require volume replacement, even in cases of partial mastectomy. The use of the latissimus dorsi muscle is the standard method, but this procedure leaves an unfavorable scar on the donor site. We used an endoscope for latissimus dorsi harvesting to minimize the incision, thus reducing postoperative scars.MethodsTen patients who underwent partial mastectomy and immediate partial breast reconstruction with endoscopic latissimus dorsi muscle flap harvest were reviewed retrospectively. The total operation time, hospital stay, and complications were reviewed. Postoperative scarring, overall shape of the reconstructed breast, and donor site deformity were assessed using a 10-point scale.ResultsIn the mean follow-up of 11 weeks, no tumor recurrence was reported. The mean operation time was 294.5 (±38.2 minutes. The postoperative hospital stay was 11.4 days. Donor site seroma was reported in four cases and managed by office aspiration and compressive dressing. Postoperative scarring, donor site deformity, and the overall shape of the neobreast were acceptable, scoring above 7.ConclusionsReplacement of 20% to 40% of breast volume in the upper and the lower outer quadrants with a latissimus dorsi muscle flap by using endoscopic harvesting is a good alternative reconstruction technique after partial mastectomy. Short incision benefits from a very acceptable postoperative scar, less pain, and early upper extremity movement.

  4. Increased Flap Weight and Decreased Perforator Number Predict Fat Necrosis in DIEP Breast Reconstruction

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    Carolyn L. Mulvey, BS

    2013-05-01

    Conclusions: Flaps with increasing weight have increased risk of fat necrosis. These data suggest that inclusion of more than 1 perforator may decrease odds of fat necrosis in large flaps. Perforator flap breast reconstruction can be performed safely; however, considerations concerning race, body mass index, staging with tissue expanders, perforator number, and flap weight may optimize outcomes.

  5. An Algorithmic Approach to Total Breast Reconstruction with Free Tissue Transfer

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    Seong Cheol Yu

    2013-05-01

    Full Text Available As microvascular techniques continue to improve, perforator flap free tissue transfer is now the gold standard for autologous breast reconstruction. Various options are available for breast reconstruction with autologous tissue. These include the free transverse rectus abdominis myocutaneous (TRAM flap, deep inferior epigastric perforator flap, superficial inferior epigastric artery flap, superior gluteal artery perforator flap, and transverse/vertical upper gracilis flap. In addition, pedicled flaps can be very successful in the right hands and the right patient, such as the pedicled TRAM flap, latissimus dorsi flap, and thoracodorsal artery perforator. Each flap comes with its own advantages and disadvantages related to tissue properties and donor-site morbidity. Currently, the problem is how to determine the most appropriate flap for a particular patient among those potential candidates. Based on a thorough review of the literature and accumulated experiences in the author’s institution, this article provides a logical approach to autologous breast reconstruction. The algorithms presented here can be helpful to customize breast reconstruction to individual patient needs.

  6. The use of 3D laser imaging and a new breast replica cast as a method to optimize autologous breast reconstruction after mastectomy.

    Science.gov (United States)

    Ahcan, Uros; Bracun, Drago; Zivec, Katarina; Pavlic, Rok; Butala, Peter

    2012-04-01

    Aesthetically pleasing and symmetrical breasts are the goal of reconstructive breast surgery. Sometimes, however, multiple procedures are needed to improve a reconstructed breast's symmetry and appearance. In order to avoid additional corrective procedures, we have developed a new method that uses a reverse engineering technique to produce what we call a new breast replica cast (NBRC). The NBRC is a mould of the contralateral healthy breast, designed according to preoperative laser 3D images. During surgery, the mould is used to help shape the new breast. With this method, we are able to achieve breast symmetry in terms of volume, projection, contour, and position on the chest wall more accurately, more quickly, and more safely than before. Copyright © 2011 Elsevier Ltd. All rights reserved.

  7. The differential effect of BMI on prosthetic versus autogenous breast reconstruction: a multivariate analysis of 12,986 patients.

    Science.gov (United States)

    Hanwright, Philip J; Davila, Armando A; Hirsch, Elliot M; Khan, Seema A; Fine, Neil A; Bilimoria, Karl Y; Kim, John Y S

    2013-10-01

    The comparative safety of breast reconstruction in obese patients remains to be clearly defined. This study utilized multi-institutional data to characterize the effect of body mass index (BMI) on breast reconstruction outcomes. Utilizing Current Procedural Terminology (CPT) codes, patients undergoing tissue expander, pedicled transverse rectus abdominis myocutaneous (TRAM) flap, latissimus dorsi flap, and free flap breast reconstruction were identified in the National Surgical Quality Improvement Program (NSQIP) database. Patients were stratified as obese (BMI ≥ 30) and non-obese (BMI breast reconstruction, 3636 (28.0%) were obese. Overall morbidity was significantly elevated in obese patients across all forms of reconstruction (p reconstructions (OR = 1.09, OR = 1.05, OR = 1.10, respectively; p reconstructions (p = 0.001 and p reconstruction patients. Compared with obese tissue expander recipients, obese patients reconstructed using autologous tissue had higher rates of reoperations (12.8% versus 9.1%), overall morbidity (18.0% versus 9.5%), surgical (12.7% versus 8.3%), and medical complications (9.0% versus 2.2%). The NSQIP database allows for evaluation and comparison of reconstructive outcomes in the obese population. Increased BMI was associated with higher morbidity in autologous reconstruction than tissue expander reconstruction. Among autologous procedures, latissimus flaps experienced the lowest captured 30 day morbidity. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. Impact of Evolving Radiation Therapy Techniques on Implant-Based Breast Reconstruction.

    Science.gov (United States)

    Muresan, Horatiu; Lam, Gretl; Cooper, Benjamin T; Perez, Carmen A; Hazen, Alexes; Levine, Jamie P; Saadeh, Pierre B; Choi, Mihye; Karp, Nolan S; Ceradini, Daniel J

    2017-06-01

    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. Retrospective chart review identified all implant-based reconstructions performed at a single institution from November of 2010 to November of 2013. These data were cross-referenced with a registry of patients undergoing breast irradiation. Patient demographics, treatment characteristics, and outcomes were analyzed. Three hundred twenty-six patients (533 reconstructions) were not irradiated, whereas 83 patients (125 reconstructions) received radiation therapy; mean follow-up was 24.7 months versus 26.0 months (p = 0.49). Overall complication rates were higher in the irradiated group (35.2 percent versus 14.4 percent; p heart and lung dosing, to optimize reconstructive outcomes. Prone positioning significantly decreases the maximum skin dose and trends toward significance in reducing reconstructive complications. With continued study, this may become clinically important. Interdepartmental studies such as this one ensure quality of care. Therapeutic, III.

  9. Preferred use of the ipsilateral pedicled TRAM flap for immediate breast reconstruction: an illustrated approach.

    Science.gov (United States)

    Tan, Bien-Keem; Joethy, Janna; Ong, Yee-Siang; Ho, Gay-Hui; Pribaz, Julian J

    2012-02-01

    Recent experience with the ipsilateral TRAM flap has shown that it has the advantage of a longer functional pedicle length, which allows tension-free inset of well-vascularized tissue into the breast pocket. This leads to better positioning and shaping of the reconstructed breast with minimal disruption of the inframammary fold. The purpose of this article was to provide an illustrated approach to the ipsilateral TRAM flap and to clarify the technique when applied in the context of immediate breast reconstruction following cancer extirpation. A prospective evaluation of 89 patients who underwent immediate breast reconstruction following skin-sparing mastectomy for breast cancer was performed. All patients underwent ipsilateral TRAM reconstruction. The innate insetting advantage of the ipsilateral TRAM flap is illustrated in the article. The key steps of the technique were as follows: (1) The ipsilateral corner of the flap was used as the axillary tail, leaving the more bulky part to form the main body of the breast; (2) To avoid undesirable twists, a right TRAM was rotated clockwise so that its apex points superiorly; (3) This flap was subsequently tunneled into the breast pocket while preserving the inframammary fold. The opposite maneuvers were done for the left side; (4) If the flap was congested, venous augmentation was performed where the tributary of the axillary vein or the thoracodorsal vein was anastomosed with the inferior epigastric vein from the flap with an interposed vein graft (17% of cases). All flaps survived and flap-related complications included partial necrosis of tissue across the midline (2.2%), palpable fat necrosis (22%), and hematoma requiring drainage (2.2%). All flaps were raised concurrent with the resection, and the combined operative time ranged from 3.5 to 6 h, with a mean hospital stay of 7 days. The ipsilateral TRAM flap was a reliable flap with low complication rates and short surgery time. It was our preferred choice for

  10. Incidental Internal Mammary Nodes during Recipient Vessel Dissection in Breast Reconstruction: Are They Significant?

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    Aaron L. Grant, MD, FRCSC

    2014-12-01

    Full Text Available Summary: Internal mammary (IM lymph nodes may be exposed during recipient vessel preparation in free-flap breast reconstruction, and in rare cases, positivity of these nodes may affect treatment in patients with breast cancer. This systematic review examines the incidence and significance of IM nodes identified by plastic surgeons. Eligibility criteria included free-flap breast reconstruction with concurrent IM node biopsy. Data were analyzed for incidence of IM node biopsy and nodal positivity. Ten studies met inclusion criteria, with a total of 2055 patients and 717 nodes submitted to pathology. Incidence of IM positivity ranged approximately from 1% to 11%, for a calculated gross overall incidence of 2.9%. Of 59 patients with a positive IM node, 50 patients received additional adjuvant therapy, with insufficient data to determine the effect of treatment on survival.

  11. Indications for the use of MemoryShape breast implants in aesthetic and reconstructive breast surgery: long-term clinical outcomes of shaped versus round silicone breast implants.

    Science.gov (United States)

    Caplin, David A

    2014-09-01

    The availability of different styles of silicone gel implants-including traditional round devices and shaped, form-stable implants-offers a variety of choices for women undergoing breast augmentation and reconstruction. The purpose of this analysis was to characterize clinical outcomes associated with the Mentor MemoryGel (round) MemoryShape/Contour Profile Gel (shaped) devices through 9 years of use in women undergoing breast augmentation or reconstruction. The Mentor Core studies are nonrandomized, open-label clinical trials designed to assess the long-term safety and efficacy of silicone gel breast implants. The cumulative incidence of selected complications and reoperations was estimated using the Kaplan-Meier method. Patient satisfaction was assessed by asking the patient if she would decide to have breast implant surgery again. Shaped implants were associated with lower cumulative incidence rates of Baker Grade III/IV capsular contracture compared with round implants (3.4% vs 11.3%, respectively, in primary augmentation, P < 0.0001; 15.6% vs 24.4% in revision-augmentation, P < 0.05). Reoperation, explantation, and infection rates were comparable between devices across cohorts, except for lower incidence of infection with shaped than round implants in primary reconstruction (1.6% vs 6.2%, P < 0.05). Rupture rates were lower with shaped implants, with significance reached in primary augmentation patients at 8 years (3.1% vs 10.3%, P < 0.05). High levels of patient satisfaction (exceeding 94%) with both devices were reported at 9 years across cohorts. Prospective data through 9 years support comparable safety of round and shaped breast implants, and high levels of patient satisfaction, in patients undergoing primary and revision breast augmentation and reconstruction.

  12. Reconstrucción mamaria con el colgajo musculocutáneo recto abdominal transverso (TRAM Breast reconstruction with the transverse rectus abdominis musculocutaneous (TRAM flap

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    J. A. Lozano

    2005-01-01

    Full Text Available El colgajo musculocutáneo de recto abdominal transverso ha sido la técnica quirúrgica más utilizada en reconstrucción mamaria autógena. Proporciona una nueva mama con volumen adecuado, ptosis, aspecto natural y no requiere la implantación de prótesis, obteniéndose una buena simetría con la mama contralateral, que perdura en el tiempo. El inconveniente de esta técnica es la morbilidad de la pared abdominal. Este colgajo sacrifica el músculo y la vaina anterior del recto que puede tener consecuencias como hernias y eventraciones. Para minimizar este problema se desarrolló el colgajo de recto abdominal microquirúrgico, que sólo sacrifica una porción muscular, disminuyendo significativamente el número de secuelas. Como inconveniente presenta la dificultad de la técnica quirúrgica, requiriendo dominio de la microcirugía vasculonerviosa. En conclusión, se puede devolver a la mujer mastectomizada una nueva mama de forma completamente autógena, con volumen, forma y textura similares al lado sano que ayude, en definitiva, a recuperar la autoestima perdida.The transverse rectus abdominis musculocutaneous (TRAM flap has been the most employed technique in autogenous breast reconstruction. It provides a new breast of adequate volume, ptosis and natural appearance, and does not require the implantation of prosthesis; a good symmetry with the contralateral breast is obtained, which lasts over time. The drawback of this technique is the morbidity of the abdominal wall. This flap sacrifices the muscle and the anterior rectus sheath which can result in consequences such as hernias and eventrations. To minimise this problem the microsurgical TRAM flap was developed, which only sacrifices a portion of muscle, significantly reducing the number of sequels. A drawback is the difficulty of the surgical technique, which requires mastery of vascular-nervous microsurgery. In conclusion, a new breast can be returned to the mastectomised woman in a

  13. Metal artifact reduction using a patch-based reconstruction for digital breast tomosynthesis

    Science.gov (United States)

    Borges, Lucas R.; Bakic, Predrag R.; Maidment, Andrew D. A.; Vieira, Marcelo A. C.

    2017-03-01

    Digital breast tomosynthesis (DBT) is rapidly emerging as the main clinical tool for breast cancer screening. Although several reconstruction methods for DBT are described by the literature, one common issue is the interplane artifacts caused by out-of-focus features. For breasts containing highly attenuating features, such as surgical clips and large calcifications, the artifacts are even more apparent and can limit the detection and characterization of lesions by the radiologist. In this work, we propose a novel method of combining backprojected data into tomographic slices using a patch-based approach, commonly used in denoising. Preliminary tests were performed on a geometry phantom and on an anthropomorphic phantom containing metal inserts. The reconstructed images were compared to a commercial reconstruction solution. Qualitative assessment of the reconstructed images provides evidence that the proposed method reduces artifacts while maintaining low noise levels. Objective assessment supports the visual findings. The artifact spread function shows that the proposed method is capable of suppressing artifacts generated by highly attenuating features. The signal difference to noise ratio shows that the noise levels of the proposed and commercial methods are comparable, even though the commercial method applies post-processing filtering steps, which were not implemented on the proposed method. Thus, the proposed method can produce tomosynthesis reconstructions with reduced artifacts and low noise levels.

  14. Pyoderma Gangrenosum after Deep Inferior Epigastric Perforator Breast Reconstruction: Systematic Review and Case Report.

    Science.gov (United States)

    Zelones, Justin T; Nigriny, John F

    2017-04-01

    Pyoderma gangrenosum (PG) is a rare skin disorder of the neutrophilic dermatoses spectrum that can mimic wound infections in surgical patients. PG after breast surgery has been reported but in limited amounts in autologous breast reconstruction patients. We present the first case of PG after a delayed bilateral deep inferior epigastric perforator flap breast reconstruction in the setting of systemic disease along with a systematic review. PubMed, Ovid, and Web of Science were systematically searched to obtain cases of PG after autologous breast reconstruction. Sixty articles were identified but only 16 were relevant to this study. Systemic disease was present in 2 patients (13%). Wound onset occurred typically 5 days after surgery. Fever and/or leukocytosis was observed in 10 patients (63%). Wound cultures were positive in 2 patients (13%). Donor-site wounds were present in 9 patients (56%). Bilateral breast wounds were present in 67% of bilateral cases. Debridement was performed in 10 cases (63%). Skin graft or substitute was performed in 6 cases (38%). Resection of autologous flap was performed in 3 cases (19%). All patients were treated with systemic steroids (81%) and/or immunosuppressive medications (50%). Complete wound healing occurred by 4 months on average. If early ulcerative wounds develop at multiple sites after autologous breast reconstruction with worsening after debridement and antibiotic therapy, then PG should be considered. It is imperative that an early diagnosis and subsequent treatment with steroids and/or immunosuppressive medications be initiated so further surgical procedures, flap loss, and scarring can be minimized.

  15. Outcomes of Take-Back Operations in Breast Reconstruction with Free Lower Abdominal Flaps

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    Ji Hong Yim

    2015-11-01

    Full Text Available BackgroundMicrovascular complications after free-flap breast reconstructions are potentially devastating problems that can increase patient morbidity and lead to flap loss. To date, no comprehensive study has examined the rates of salvage and the methods of microvascular revision in breast reconstruction. We reviewed the treatment of microvascular complications of free-flap breast reconstruction procedures over a seven-year period.MethodsA retrospective review of all patients who underwent microvascular breast reconstruction at our institution between April 2006 and December 2013 was conducted. Based on their surgical records, all patients who required emergency re-exploration were identified, the rate of flap salvage was determined, the factors associated with flap salvage were evaluated, and the causes and methods of revision were reviewed.ResultsDuring the review period, 605 breast reconstruction procedures with a free lower abdominal flap were performed. Seventeen of these flaps were compromised by microvascular complications, and three flaps were lost. The overall salvage rate was 82.35%. No significant differences between the salvaged group and the failed group were observed with regard to age, BMI, axillary dissection, number of anastomotic arteries and veins, recipient vessel types, or use of the superficial inferior epigastric vein in the revision operation. Successful salvage of the flap was associated with a shorter time period between recognizing the signs of flap compromise and the take-back operation.ConclusionsThe salvage rate of compromised lower abdominal flaps was high enough to warrant attempting re-exploration. Immediate intervention after the onset of flap compromise signs is as important as vigilant postoperative monitoring.

  16. Two-Stage Latissimus Dorsi Flap with Implant for Unilateral Breast Reconstruction: Getting the Size Right

    Directory of Open Access Journals (Sweden)

    Jiajun Feng

    2016-03-01

    Full Text Available BackgroundThe aim of unilateral breast reconstruction after mastectomy is to craft a natural-looking breast with symmetry. The latissimus dorsi (LD flap with implant is an established technique for this purpose. However, it is challenging to obtain adequate volume and satisfactory aesthetic results using a one-stage operation when considering factors such as muscle atrophy, wound dehiscence and excessive scarring. The two-stage reconstruction addresses these difficulties by using a tissue expander to gradually enlarge the skin pocket which eventually holds an appropriately sized implant.MethodsWe analyzed nine patients who underwent unilateral two-stage LD reconstruction. In the first stage, an expander was placed along with the LD flap to reconstruct the mastectomy defect, followed by gradual tissue expansion to achieve overexpansion of the skin pocket. The final implant volume was determined by measuring the residual expander volume after aspirating the excess saline. Finally, the expander was replaced with the chosen implant.ResultsThe average volume of tissue expansion was 460 mL. The resultant expansion allowed an implant ranging in volume from 255 to 420 mL to be placed alongside the LD muscle. Seven patients scored less than six on the relative breast retraction assessment formula for breast symmetry, indicating excellent breast symmetry. The remaining two patients scored between six and eight, indicating good symmetry.ConclusionsThis approach allows the size of the eventual implant to be estimated after the skin pocket has healed completely and the LD muscle has undergone natural atrophy. Optimal reconstruction results were achieved using this approach.

  17. Preoperative implant selection for unilateral breast reconstruction using 3D imaging with the Microsoft Kinect sensor.

    Science.gov (United States)

    Pöhlmann, Stefanie T L; Harkness, Elaine; Taylor, Christopher J; Gandhi, Ashu; Astley, Susan M

    2017-08-01

    This study aimed to investigate whether breast volume measured preoperatively using a Kinect 3D sensor could be used to determine the most appropriate implant size for reconstruction. Ten patients underwent 3D imaging before and after unilateral implant-based reconstruction. Imaging used seven configurations, varying patient pose and Kinect location, which were compared regarding suitability for volume measurement. Four methods of defining the breast boundary for automated volume calculation were compared, and repeatability assessed over five repetitions. The most repeatable breast boundary annotation used an ellipse to track the inframammary fold and a plane describing the chest wall (coefficient of repeatability: 70 ml). The most reproducible imaging position comparing pre- and postoperative volume measurement of the healthy breast was achieved for the sitting patient with elevated arms and Kinect centrally positioned (coefficient of repeatability: 141 ml). Optimal implant volume was calculated by correcting used implant volume by the observed postoperative asymmetry. It was possible to predict implant size using a linear model derived from preoperative volume measurement of the healthy breast (coefficient of determination R(2) = 0.78, standard error of prediction 120 ml). Mastectomy specimen weight and experienced surgeons' choice showed similar predictive ability (both: R(2) = 0.74, standard error: 141/142 ml). A leave one-out validation showed that in 61% of cases, 3D imaging could predict implant volume to within 10%; however for 17% of cases it was >30%. This technology has the potential to facilitate reconstruction surgery planning and implant procurement to maximise symmetry after unilateral reconstruction. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  18. Semi-automated segmentation and classification of digital breast tomosynthesis reconstructed images.

    Science.gov (United States)

    Vedantham, Srinivasan; Shi, Linxi; Karellas, Andrew; Michaelsen, Kelly E; Krishnaswamy, Venkataramanan; Pogue, Brian W; Paulsen, Keith D

    2011-01-01

    Digital breast tomosynthesis (DBT) is a limited-angle tomographic x-ray imaging technique that reduces the effect of tissue superposition observed in planar mammography. An integrated imaging platform that combines DBT with near infrared spectroscopy (NIRS) to provide co-registered anatomical and functional imaging is under development. Incorporation of anatomic priors can benefit NIRS reconstruction. In this work, we provide a segmentation and classification method to extract potential lesions, as well as adipose, fibroglandular, muscle and skin tissue in reconstructed DBT images that serve as anatomic priors during NIRS reconstruction. The method may also be adaptable for estimating tumor volume, breast glandular content, and for extracting lesion features for potential application to computer aided detection and diagnosis.

  19. Protocol for the prevention and management of complications related to ADM implant-based breast reconstructions

    Directory of Open Access Journals (Sweden)

    Citron, Isabelle

    2016-01-01

    Full Text Available Acellular dermal matrix (ADM implant-based reconstructions have transformed direct-to-implant breast reconstruction (DTI. But like all surgery, it is not deplete of complications such as seroma, infections and wound healing problems. These are cited with varying frequencies in the literature. With increased experience and through a series of measures instituted to minimize complications, we have been able to improve outcomes for our patients. We report our technical refinements for prevention of ADM reconstruction associated complications including patient selection, implant selection, drains, dressing and our post operative antibiotic regime. We also outline our protocol for the management of ADM associated complications including seroma, simple and complex infection and red breast syndrome, such that the sequelae of complications are minimized and patients achieve a better long-term outcome.

  20. Neurectomy for breast reconstruction-related spasms of the pectoralis major muscle.

    Science.gov (United States)

    Adkinson, Joshua M; Miller, Nathan F; Murphy, Robert X

    2014-02-01

    Tissue expander-based breast reconstruction is the most commonly utilized technique in the U.S. This modality, however, may be associated with significant pain related to pectoralis myospasms. Spasms of the pectoralis major likely result from trauma to the pectoral nerves during muscle elevation. In a subset of patients, Botox(®) therapy may be inadequate for long-term relief. We describe a patient with intractable pectoralis myospasms after breast reconstruction. Upon failing Botox(®) therapy, medial and lateral pectoral neurectomies were performed. Nine months after the procedure, the patient noted dramatic improvement in both symptoms and cosmesis with no musculoskeletal sequelae. We recommend medial and lateral pectoral neurectomy as an alternative in patients with intractable pectoral myospasms after tissue expander reconstruction.

  1. Oncological safety of immediate rectus abdominis myocutaneous breast reconstruction in patients with locally advanced disease (stage IIb and III

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    Mushtaq Mir

    2013-01-01

    Full Text Available Background: The management of locally advanced (Stage IIb and III breast cancer is challenging. It often includes multimodal treatment with systemic therapy and/or radiation therapy and surgery. Immediate breast reconstruction has not traditionally been performed in these patients. We review the results of immediate rectus abdominis musculo-cutaneous (TRAM/VRAM flap in 60 patients treated for Stage IIb and III breast cancer. Materials and Methods: Data were collected prospectively on 60 patients diagnosed with Stage IIb (32 patients and Stage III (28 patients breast cancer between May 2008 and May 2012. All patients had mastectomy and immediate rectus abdominis myocutaneous reconstruction (TRAM in 40 patients and VRAM in 20 patients. All patients received primary systemic therapy, and all patients received postoperative radiotherapy to the operative site. Results: Mean age was 40.13 (range 28-53 years, mean hospital stay was 8.86 days and mean follow-up for the group was 28 months. Neither of them developed local disease recurrence in the operative site till the last follow-up. Eight (13.3% patients had some delay in chemo-radiation therapy due to flap-related complications. Flap-related complications were present in eight patients (partial flap failure in four and superficial skin necrosis in four. There was no adverse effect of chemo-radiation therapy on reconstructed breast. Conclusion: Immediate TRAM/VRAM breast reconstruction for locally advanced breast cancer is not associated with a significant delay in adjuvant therapy or an increased risk of local relapse. Radiation therapy can be delivered to the reconstructed breast when indicated without difficulty. Breast reconstruction facilitates surgical resection of locally advanced breast cancer with primary closure and should be considered if the patient desires immediate breast reconstruction.

  2. Mastectomy scars following breast reconstruction: should routine histologic analysis be performed?

    Science.gov (United States)

    Warner, Robert M; Wallace, David L; Ferran, Nicholas A; Erel, Ertan; Park, Alan J; Prinsloo, Daniel J; Waters, Ruth

    2009-04-01

    There is some debate in the recent literature regarding the routine submission of mastectomy scars for histologic analysis when performing delayed breast reconstructions. The aim of this study was to review the relevant publications and evaluate the practice of routine histologic examination of mastectomy scars. The authors conducted a retrospective review, across three regional plastic and reconstructive surgery units, of 433 patients who had 455 scars routinely sent for histologic examination following delayed breast reconstruction between January of 2000 and December of 2006. Patients with clinical evidence of recurrent carcinoma were excluded. Data from 433 patients revealed an average age at reconstruction of 49.9 years (range, 25 to 77 years). The mean interval from primary breast surgery to reconstruction was 3.9 years (range, 2 months to 32 years), and the average length of patient follow-up, from primary surgery, was 6.4 years (range, 1 to 40 years). The majority of the initial operations were carried out for invasive carcinoma (89 percent). Four mastectomy scars in three patients were positive for carcinoma recurrence. The publications related to the practice of routine histologic analysis of mastectomy scars provide conflicting conclusions. As a proportion of patients may benefit from the early detection and treatment of locoregional recurrence, the authors suggest that the routine submission of mastectomy scars will allow for the earlier detection of soft-tissue recurrences that may affect long-term outcome. In keeping with cancer surgery principles, the authors recommend routine histologic examination of mastectomy scars following delayed breast reconstruction.

  3. Impact of Postoperative Antibiotic Prophylaxis Duration on Surgical Site Infections in Autologous Breast Reconstruction.

    Science.gov (United States)

    Drury, Kerry E; Lanier, Steven T; Khavanin, Nima; Hume, Keith M; Gutowski, Karol A; Thornton, Brian P; Hansen, Nora M; Murphy, Robert X; Fine, Neil A; Kim, John Y S

    2016-02-01

    Although some surgeons prescribe prolonged postoperative antibiotics after autologous breast reconstruction, evidence is lacking to support this practice. We used the Tracking Operations and Outcomes for Plastic Surgeons database to evaluate the association between postoperative antibiotic duration and the rate of surgical site infection (SSI) in autologous breast reconstruction. The intervention of interest for this study was postoperative duration of antibiotic prophylaxis: either discontinued 24 hours after surgery or continued beyond 24 hours. The primary outcome variable of interest for this study was the presence of SSI within 30 days of autologous breast reconstruction. Cohort characteristics and 30-day outcomes were compared using χ² and Fischer exact tests for categorical variables and Student t tests for continuous variables. Multivariate logistic regression was used to control for confounders. A total of 1036 patients met inclusion criteria for our study. Six hundred fifty-nine patients (63.6%) received antibiotics for 24 hours postoperatively, and 377 patients (36.4%) received antibiotics for greater than 24 hours. The rate of SSI did not differ significantly between patients given antibiotics for only 24 hours and those continued on antibiotics beyond the 24-hour postoperative time period (5.01% vs 2.92%, P = 0.109). Furthermore, antibiotic duration was not predictive of SSI in multivariate regression modeling. We did not find a statistically significant difference in the rate of SSI in patients who received 24 hours of postoperative antibiotics compared to those that received antibiotics for greater than 24 hours. These findings held for both purely autologous reconstruction as well as latissimus dorsi reconstruction in conjunction with an implant. Thus, our study does not support continuation of postoperative antibiotics beyond 24 hours after autologous breast reconstruction.

  4. Predictive risk factors of free flap thrombosis in breast reconstruction surgery.

    Science.gov (United States)

    Masoomi, Hossein; Clark, Emily G; Paydar, Keyianoosh Z; Evans, Gregory R D; Nguyen, Audrey; Kobayashi, Mark R; Wirth, Garrett A

    2014-11-01

    Vascular thrombosis is one of the major postoperative complications of free flap microvascular breast reconstruction operations. It is associated with higher morbidity, higher cost, increased length of hospital stay, and potentially flap loss. Our purpose is to evaluate the rate of this complication and whether patient characteristics play a role. Using the Nationwide Inpatient Sample (NIS) database, we examined the clinical data of patients who underwent free flap breast reconstruction between 2009 and 2010 in the United States. Multivariate and univariate regression analyses were performed to identify independent risk factors of flap thrombosis. A total of 15,211 patients underwent free flap breast reconstruction surgery (immediate reconstruction: 43%). The most common flap was the free deep inferior epigastric perforator (DIEP) flap (53.6%), followed by free transverse rectus abdominis myocutaneous (TRAM) flap (43.1%), free superficial inferior epigastric artery (SIEA) flap (2%), and free gluteal artery perforator (GAP) flap (1.3%). The overall rate of flap thrombosis was 2.4 %, with the highest rate seen in the SIEA group (11.4%) and the lowest in the TRAM group (1.7%). Peripheral vascular disease (adjusted odds ration [AOR] 10.61), SIEA flap (AOR, 4.76) and delayed reconstruction (AOR, 1.42) were found to be statistically significant risk factors for flap thrombosis. Other comorbidities were not linked. While the overall rate of flap thrombosis in free flap breast reconstruction was relatively low (2.4%), Plastic Surgeons should be aware that patients with peripheral vascular disease and those undergoing free SIEA flap are at higher risk of flap thrombosis and they should closely monitor flaps to increase the chance for early salvage.

  5. Goldilocks Mastectomy: A Safe Bridge to Implant-Based Breast Reconstruction in the Morbidly Obese.

    Science.gov (United States)

    Schwartz, Jean-Claude

    2017-06-01

    Reconstructive surgeons are encountering an increasing number of obese women requiring postmastectomy reconstruction. These patients are poor candidates for autologous and prosthetic-based reconstructions as they have a high rate of reconstructive failure, surgical complications, and poor aesthetic outcomes. We demonstrate here the utility of the previously described Goldilocks mastectomy with free nipple grafts as a safe bridge to second stage implant-based breast reconstruction. Ten consecutive morbidly (BMI > 40) or super obese (BMI>50) women underwent bilateral Goldilocks mastectomy with free nipple grafts followed by second stage subpectoral implant placement at least three months postoperatively. Patients were assessed for implant-related complications including malposition, capsular contracture, dehiscence, and extrusion. Ten postmastectomy reconstructions in patients with BMIs ranging from 37 to 50 with a mean BMI of 45 underwent bilateral Goldilocks mastectomy with free nipple grafts. Two patients had wound healing complications after Goldilocks mastectomy but were completely healed within 8 weeks. There were no instances of delayed wound healing or reconstructive failure after prosthetic placement. With at least 9 months of follow-up on all patients, no patient has had a capsular contracture, significant malposition, or other complication requiring reoperation. The obese patient poses a significant reconstructive challenge for which no reproducible approach has been described. Here, we present a 2-stage strategy: the previously described Goldilocks mastectomy with free nipple grafts followed by second stage subpectoral definitive implant placement. This is the first proposed description of a reliable strategy for postmastectomy reconstruction in the morbidly and super obese.

  6. Technical, Psychological, and Economic Aspects of DIEP Flap Breast Reconstruction

    NARCIS (Netherlands)

    T.H.C. Damen (Tim)

    2011-01-01

    textabstractIn the Western world the incidence of breast cancer (BC) is high. In the Netherlands the lifetime risk for women to develop BC is around 13%, making it the most common form of cancer among women with approximately 12.000 women being diagnosed annually. Also, increasing numbers of women a

  7. Technical, Psychological, and Economic Aspects of DIEP Flap Breast Reconstruction

    NARCIS (Netherlands)

    T.H.C. Damen (Tim)

    2011-01-01

    textabstractIn the Western world the incidence of breast cancer (BC) is high. In the Netherlands the lifetime risk for women to develop BC is around 13%, making it the most common form of cancer among women with approximately 12.000 women being diagnosed annually. Also, increasing numbers of women

  8. Autologous breast reconstruction with endoscopic latissimus dorsi musculosubcutaneous flaps in patients choosing breast-conserving therapy: mammographic appearance.

    Science.gov (United States)

    Monticciolo, D L; Ross, D; Bostwick, J; Eaves, F; Styblo, T

    1996-08-01

    The objective of this study was to define and evaluate mammographic changes in patients treated with breast-conserving therapy and a new reconstructive technique that uses autologous tissue from a latissimus dorsi musculosubcutaneous flap. Of 20 patients who underwent either immediate or delayed endoscopic latissimus dorsi muscle flap reconstruction after lumpectomy, 13 also had postsurgery mammograms available for review. Radiographic findings assessed included skin thickening, density or radiolucency at the reconstruction site, density around the flap, fat necrosis, calcifications, and the presence of surgical clips. Mammograms for three patients (23%) revealed thickening that we believed was attributable to radiation therapy. No patient had increased density in the flap itself; all flaps were relatively radiolucent centrally (13/13; 100%). Mammograms revealed density around the rim of the flap in four patients (31%). This density was most likely secondary to latissimus dorsi muscle fibers and did not limit radiographic evaluation. One patient had calcifications, probably secondary to fat necrosis. No oil cysts were seen. In the majority of patients (11/13; 85%), surgical clips were visible. Endoscopic latissimus dorsi muscle flap reconstruction, previously used only for mastectomy patients, is now being used for improved esthetic outcome in selected patients who desire breast conservation. Our results indicate that the mammographic findings are predictable. The most common findings are relative radiolucency centrally, with or without density from muscle fibers around the edges of the area of tissue transfer. The transplanted musculosubcutaneous flap does not interfere with mammographic evaluation.

  9. Early Results Show Reduced Infection Rate Using No-touch Technique for Expander/ADM Breast Reconstruction

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    Henry B. Wilson, MD, FACS

    2015-03-01

    Full Text Available Summary: Infection is a common complication of immediate breast reconstruction that often leads to device removal, a result emotionally devastating to the patient and frustrating for her surgeon. “No-touch” techniques have been used in other surgical disciplines and plastic surgery, but they have not been reported for breast reconstruction with tissue expanders or implants and acellular dermis. We report a novel technique of tissue expander and acellular dermis placement using no-touch principles with a self-retaining retractor system that holds promise to decrease infectious complications of breast reconstruction.

  10. Contralateral Breast Symmetrisation in Immediate Prosthetic Breast Reconstruction after Unilateral Nipple-Sparing Mastectomy: The Tailored Reduction/Augmentation Mammaplasty

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    Marzia Salgarello

    2015-05-01

    Full Text Available BackgroundIn the literature on nipple-sparing mastectomy (NSM with one-stage immediate implant reconstruction, contralateral symmetrisation has drawn little attention, with many surgeons still performing standard cosmetic mammaplasty procedures. However, standard implant-based mammaplasty usually does not result in proper symmetry with the mastectomy side, especially regarding breast projection, overall shape, and volume distribution.MethodsWe retrospectively reviewed 19 consecutive patients undergoing unilateral NSM with immediate prosthetic reconstruction and contralateral simultaneous symmetrisation by using the tailored reduction/augmentation mammaplasty technique between June 2012 and August 2013.ResultsThe average follow-up time was 13 months (range, 10-24 months. No major complications, such as infection, haematoma, and nipple-areola complex necrosis, were experienced.ConclusionsOur experience suggests that simultaneous contralateral symmetrisation with tailored reduction/augmentation mammaplasty after unilateral immediate implant reconstruction after NSM facilitates durable and pleasant symmetric outcomes.

  11. Clinical Applications of the Transverse Musculocutaneous Gracilis Flap for Secondary Breast Reconstruction after Simple Mastectomy.

    Science.gov (United States)

    Wechselberger, Gottfried; Traintinger, Heike; Larcher, Lorenz; Russe, Elisabeth; Edelbauer, Monika; Ensat, Florian

    2016-01-01

    In secondary autologous breast reconstruction, the current standard is a flap derived from the lower abdomen or the back. If these donor sites are not available because of lack of tissue, prior operations, or simply the patient's desire to avoid these donor sites, the authors use the transverse musculocutaneous gracilis flap if feasible. The authors retrospectively evaluated only patients where secondary autologous breast reconstruction was performed with a transverse musculocutaneous gracilis flap because of the prior mentioned reasons. Indications, limitations, advantages, and technique are discussed by sharing the authors' experience in 23 patients using 26 transverse musculocutaneous gracilis flaps. No flap loss could be observed in this series. In four patients, minimal lateral skin necrosis could easily be managed by débridement and primary wound closure. In 12 cases, subsequent lipofilling was performed for a better breast shape. On average, patient satisfaction was high. Secondary reconstruction after simple mastectomy using the transverse musculocutaneous gracilis flap requires a little more experience than after skin-sparing mastectomy but, especially combined with later lipofilling, can lead to an optimally shaped breast in selected patients with substantial skin laxity and fat distribution at the inner thigh. Therapeutic, IV.

  12. Women's Experiences With Flap Failure After Autologous Breast Reconstruction: A Qualitative Analysis.

    Science.gov (United States)

    Higgins, Kristen S; Gillis, Joshua; Williams, Jason G; LeBlanc, Martin; Bezuhly, Michael; Chorney, Jill M

    2016-10-06

    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. Interpretive phenomenological analysis, a type of qualitative analysis that provides an in-depth account of participant's experiences and their meanings, was used to analyze the interview data. From these data, patient-derived recommendations were developed for surgeons caring for women who have experienced flap failure. Three main themes (6 subthemes) emerged: coming to terms with flap failure (coping with emotions, body dissatisfaction); making meaning of flap failure experience (questioning, relationship with surgeon); and care providers acknowledging the emotional experience of flap failure (experience of being treated "mechanically," suggestions for improvement). In conclusion, flap failure in breast reconstruction is an emotionally difficult experience for women. Although there are similarities to other populations of patients experiencing suboptimal outcomes from medical procedures, there are also unique aspects of the flap failure experience. A better understanding of women's experiences with flap failure will assist in providing more appropriate supports.

  13. Reliance on double pedicle TRAM flap technique in breast reconstruction based on mammographic evidence

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    Yüksel Fuat

    2004-01-01

    Full Text Available Breast reconstruction is now a part of the overall treatment of breast cancer. Its main drawback is rather the suspicion to conceal any probable recurrence. Fat necrosis is a particularly important finding because it can be mistaken for a local recurrence. Alternatively, local recurrences may be dismissed as areas of fat necrosis. Fat necrosis is a relatively minor complication of TRAM flap breast reconstruction but one that can induce anxiety, expense, and inconvenience for patients and concerns about tumor recurrence. The techniques selected for reconstruction must carry the least risks for these awful complications. 15 breast cancer cases were treated in our center by using Bostwick′s principles. These include double-pedicle technique in cases with one or two risk factors and added vascular delay two weeks prior to this procedure in cases with more risk factors. During the follow up period, neither the patients nor her physicians experienced any nodules in their treatment sites clinically. One case is the only exception that she felt hardness but it softened. Mammographically, no images of fat necrosis were observed in any of the cases. In contrary to other studies reporting no advantages of double pedicle technique to lessen the risk for fat necrosis, we observed fat necrosis only in one of 15 cases. This may be because both sides of the flap are supplied axially and delay procedures are added in high risk patients.

  14. Chest wall resection and reconstruction for locally advanced primary breast cancer.

    Science.gov (United States)

    Hille, Ursula; Soergel, Philipp; Zardo, Patrick; Pertschy, Stefanie; Busch, Kai; Fischer, Stefan

    2013-06-01

    We sought to evaluate clinical and oncologic outcomes of selected patients with locally advanced breast cancer undergoing full thickness chest wall resection (FTCWR) and reconstruction in a multidisciplinary setting. Between 2008 and 2010, five women underwent FTCWR followed by chest wall repair for locally advanced primary breast cancer. In all cases, chest wall repair was performed with a Peri-Guard Repair Patch (Synovis, St. Paul, MN, USA). At follow-up (7-12 months) quality of life, respiratory function and oncologic status were assessed. Successful chest wall resection and repair were achieved in all patients. Plastic reconstruction of post-mastectomy tissue defects was necessary in one case. One patient was treated by breast conserving therapy. Chest ultrasound imaging confirmed absence of adhesions, haematoma or seroma and normal expansion and respiratory movement of the underlying lung in all patients. On follow-up all patients reported good quality of life. Multidisciplinary surgical approaches to chest wall resection and reconstruction in selected patients with locally advanced primary breast cancer are feasible, safe, associated with short operation time and hospital stay and negligible morbidity.

  15. A prospective study comparing endoscopic subcutaneous mastectomy plus immediate reconstruction with implants and breast conserving surgery for breast cancer

    Institute of Scientific and Technical Information of China (English)

    FAN Lin-jun; JIANG Jun; YANG Xin-hua; ZHANG Yi; LI Xing-gang; CHEN Xian-chun; ZHONG Ling

    2009-01-01

    Background Breast conserving surgery (BCS) has been the standard surgical procedure for the treatment of early breast cancer. Endoscopic subcutaneous mastectomy (ESM) plus immediate reconstruction with implants is an emerging procedure. The objective of this prospective study was to evaluate the clinical outcomes of these two surgical procedures in our clinical setting.Methods From March 2004 to October 2007, 43 patients with breast cancer underwent ESM plus axillary lymph node dissection and immediate reconstruction with implants, while 54 patients underwent BCS. The clinical and pathological characteristics, surgical safety, and therapeutic effects were compared between the two groups. Results There were no significant differences in the age, clinical stage, histopathologic type of tumor, operative blood loss, postoperative drainage time, and postoperative complications between the two groups (P>0.05).The postoperative complications were partial necrosis of the nipple and superficial skin flap in the ESM patients, and hydrops in the axilla and residual cavity in the BCS patients. There was no significant difference in the rate of satisfactory postoperative cosmetic outcomes between the ESM (88.4%, 38/43) and BCS (92.6%, 50/54) patients (P>0.05). During follow-up of 6 months to 4 years, all patients treated with ESM were disease-free, but 3 patients who underwent BCS had metastasis or recurrence-one of these patients died of multiple organ metastasis.Conclusions After considering the wide Indications for use, high surgical safety, and favorable cosmetic outcomes, we conclude that ESM plus axillary lymph node dissection and immediate reconstruction with implants-the new surgery of choice for breast cancer-warrants serious consideration as the prospective next standard surgical procedure.

  16. A prospective study comparing endoscopic subcutaneous mastectomy plus immediate reconstruction with implants and breast conserving surgery for breast cancer.

    Science.gov (United States)

    Fan, Lin-Jun; Jiang, Jun; Yang, Xin-Hua; Zhang, Yi; Li, Xing-Gang; Chen, Xian-Chun; Zhong, Ling

    2009-12-20

    Breast conserving surgery (BCS) has been the standard surgical procedure for the treatment of early breast cancer. Endoscopic subcutaneous mastectomy (ESM) plus immediate reconstruction with implants is an emerging procedure. The objective of this prospective study was to evaluate the clinical outcomes of these two surgical procedures in our clinical setting. From March 2004 to October 2007, 43 patients with breast cancer underwent ESM plus axillary lymph node dissection and immediate reconstruction with implants, while 54 patients underwent BCS. The clinical and pathological characteristics, surgical safety, and therapeutic effects were compared between the two groups. There were no significant differences in the age, clinical stage, histopathologic type of tumor, operative blood loss, postoperative drainage time, and postoperative complications between the two groups (P > 0.05). The postoperative complications were partial necrosis of the nipple and superficial skin flap in the ESM patients, and hydrops in the axilla and residual cavity in the BCS patients. There was no significant difference in the rate of satisfactory postoperative cosmetic outcomes between the ESM (88.4%, 38/43) and BCS (92.6%, 50/54) patients (P > 0.05). During follow-up of 6 months to 4 years, all patients treated with ESM were disease-free, but 3 patients who underwent BCS had metastasis or recurrence -one of these patients died of multiple organ metastasis. After considering the wide indications for use, high surgical safety, and favorable cosmetic outcomes, we conclude that ESM plus axillary lymph node dissection and immediate reconstruction with implants - the new surgery of choice for breast cancer - warrants serious consideration as the prospective next standard surgical procedure.

  17. Differences in the Reporting of Racial and Socioeconomic Disparities among Three Large National Databases for Breast Reconstruction.

    Science.gov (United States)

    Kamali, Parisa; Zettervall, Sara L; Wu, Winona; Ibrahim, Ahmed M S; Medin, Caroline; Rakhorst, Hinne A; Schermerhorn, Marc L; Lee, Bernard T; Lin, Samuel J

    2017-04-01

    Research derived from large-volume databases plays an increasing role in the development of clinical guidelines and health policy. In breast cancer research, the Surveillance, Epidemiology and End Results, National Surgical Quality Improvement Program, and Nationwide Inpatient Sample databases are widely used. This study aims to compare the trends in immediate breast reconstruction and identify the drawbacks and benefits of each database. Patients with invasive breast cancer and ductal carcinoma in situ were identified from each database (2005-2012). Trends of immediate breast reconstruction over time were evaluated. Patient demographics and comorbidities were compared. Subgroup analysis of immediate breast reconstruction use per race was conducted. Within the three databases, 1.2 million patients were studied. Immediate breast reconstruction in invasive breast cancer patients increased significantly over time in all databases. A similar significant upward trend was seen in ductal carcinoma in situ patients. Significant differences in immediate breast reconstruction rates were seen among races; and the disparity differed among the three databases. Rates of comorbidities were similar among the three databases. There has been a significant increase in immediate breast reconstruction; however, the extent of the reporting of overall immediate breast reconstruction rates and of racial disparities differs significantly among databases. The Nationwide Inpatient Sample and the National Surgical Quality Improvement Program report similar findings, with the Surveillance, Epidemiology and End Results database reporting results significantly lower in several categories. These findings suggest that use of the Surveillance, Epidemiology and End Results database may not be universally generalizable to the entire U.S.

  18. Daily Serum Collection after Acellular Dermal Matrix-Assisted Breast Reconstruction

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    Glenda Giorgia Caputo

    2015-05-01

    Full Text Available BackgroundThe acellular dermal matrix (ADM-assisted breast reconstruction technique is widely known, but discouraging results due to early postoperative complications have been reported. As the literature identifies seroma as the most common issue after breast surgery without identifying its pathogenesis, we aimed to report the trend of postoperative daily serum collection after ADM-assisted breast reconstruction and compare it with data in the literature in order to discover more about this little-known topic.MethodsA retrospective study on 28 consecutive patients who received ADM-assisted breast reconstruction between February 2013 and February 2014 was performed. In order to reduce the number of variables that could affect serum production, only one brand of ADM was used and all tissues were handled gently and precisely. The daily drainage volume was recorded per patient during the first four days of hospitalization. Likewise, postoperative complications were noted during routine follow-up.ResultsIn total, five (17.9% bilateral and 23 (82.1% unilateral ADM-assisted breast reconstructions (33 implants were performed. The mean age, body mass index, and length of hospital stay were 53.6 years, 21.3 kg/m2, and 4.5 days, respectively. One major complication led to implant loss (3.0%, and nine minor complications were successfully treated with ambulatory surgery (27.3%. Serum collection linearly decreased after 24 hours postoperatively.ConclusionsDaily drainage decreased following the theoretical decline of acute inflammation. In concordance with the literature, daily serum production may not be related to the use of ADM.

  19. REMODELING CHARACTERISTICS AND COLLAGEN DISTRIBUTIONS OF BIOLOGIC SCAFFOLD MATERIALS BIOPSIED FROM POSTMASTECTOMY BREAST RECONSTRUCTION SITES

    Science.gov (United States)

    Cavallo, Jaime A.; Gangopadhyay, Noopur; Dudas, Jason; Roma, Andres A.; Jasielec, Mateusz S.; Baty, Jack; Baalman, Sara; Frisella, Margaret M.; Tenenbaum, Marissa M.; Myckatyn, Terence M.; Matthews, Brent D.; Deeken, Corey R.

    2015-01-01

    OBJECTIVE The study purpose was to evaluate the associations between patient characteristics and the histologic remodeling scores of acellular dermal matrices (ADMs) biopsied from breast reconstruction sites in the first attempt to generate a multivariable risk prediction model of non-constructive remodeling. It was hypothesized that host characteristics and surgical site assessments predict the degree of graft remodeling for ADMs used during breast reconstruction. METHODS ADMs were biopsied from the breast reconstruction sites of n=62 patients during a subsequent breast procedure, stained with Hematoxylin and Eosin, and evaluated according to a semi-quantitative scoring system for remodeling characteristics [cell types (CT), cell infiltration (CI), extracellular matrix (ECM) deposition, scaffold degradation (SD), fibrous encapsulation (FE), and neovascularization (NEO)] and a mean composite score (CR). Biopsies were stained with Sirius Red and Fast Green, and analyzed to determine the collagen I:III ratio. Based on univariate analyses between subject clinical characteristics and the histologic remodeling scores, cohort variables were selected for multivariable regression models using a p ≤0.20. RESULTS The CR score model yielded 3 variables: pack-year history, corticosteroid use, and radiation timing (r2pseudo=0.81). The model for collagen I yielded 2 variables: corticosteroid use and reason for reoperation (r2pseudo=0.78). The model for collagen III yielded 1 variable: reason for reoperation (r2pseudo=0.35). CONCLUSION These preliminary results constitute the first steps in generating a risk prediction model that predicts the patients and clinical circumstances most likely to experience non-constructive remodeling of biologic grafts used to reconstruct the breast. PMID:25910026

  20. [PRIMARY STUDY ON IMPLANT COVERAGE WITH LOCAL SOFT TISSUE IN IMMEDIATE IMPLANT-BASED BREAST RECONSTRUCTION].

    Science.gov (United States)

    Li, Guangxue; Mu, Lan; Liu, Yan; Yang, Kai; Peng, Zhe; Bi, Ye

    2016-03-01

    To explore the method of implant coverage with local soft tissue in immediate implant-based breast reconstruction and to evaluate the early effectiveness. Between April 2014 and August 2015, 11 patients with breast cancer underwent immediate breast reconstruction with implants after mastectomy, and the clinical data were reviewed retrospectively. The age ranged 29-48 years (mean, 36 years). The disease duration was from 7 days to 12 months (median, 3 months). According to tumor staging, 3 cases were rated as T(is)N0M0, 4 cases as T1N0M0, and 4 cases as T2N0M0. The implants were covered with local soft tissue according to the volume of mastectomy and contralateral breast size, including pectoralis major myocutaneous flaps with inframammary adipofasical flaps (3 cases), with serratus anterior fascial flap (5 cases), with rectus sheath fascial flap (1 case), and with serratus anterior fascial flap and rectus sheath fascial flap (2 cases). The size of pectoralis major myocutaneous flaps ranged from 15 cm x 9 cm to 20 cm x 15 cm, and the serratus anterior fascial flaps from 10 cm x 8 cm to 15 cm x 10 cm, and the rectus sheath fascial flap from 8 cm x 6 cm to 10 cm x 8 cm. One patient had partial nipple necrosis postoperatively and was cured, and no other postoperative complications of hematoma, infection, or implant exposure was found. The patients were followed up 4-13 months (median, 8 months). The reconstructive outcomes were excellent in 10 cases and good in 1 case, with an excellent and good rate of 100%. During follow-up, no rupture or exposure of the implant was observed; capsular contracture (Baker grade II) occurred in 1 case. Adequate coverage of implants with different local soft tissue flaps can achieve satisfactory early effectiveness in immediate implant-based breast reconstruction after mastectomy.

  1. Internal mammary vessels as recipients for free TRAM breast reconstruction: aesthetic and functional considerations.

    Science.gov (United States)

    Majumder, S; Batchelor, A G

    1999-06-01

    The utilisation of the internal mammary vessels (IMVs) as recipient vessels for free TRAM reconstruction of the breast is well established. To gain adequate access to the IMVs, a medial segment of the ipsilateral third costal cartilage is usually excised. Concern has been expressed regarding potential complications specific to use of this site, including pneumothorax, intercostal neuralgia, chest wall herniae and contour defects. We present a retrospective study of our experience with free TRAM breast reconstruction, using the IMVs as recipient vessels, to ascertain the incidence of such complications. Twenty-five consecutive cases were studied. The clinical notes were analysed for information regarding immediate and late complications. All the patients were recalled and underwent assessment and examination by the authors. There were no cases of haemo- or pneumothorax on the side of the reconstruction. There were no complaints of chest pain suggestive of intercostal neuralgia. No discernible contour defects at the site of rib excision were found and no thoracic herniae were demonstrated. We suggest that internal mammary vessels can safely be used as recipients for free TRAM reconstruction of the breasts with no added aesthetic or functional morbidity.

  2. Pyoderma gangrenosum with pathergy: A potentially significant complication following breast reconstruction.

    Science.gov (United States)

    Patel, D K; Locke, M; Jarrett, P

    2017-07-01

    The failure of postoperative surgical site infection to resolve after appropriate antibiotic therapy should alert the clinician to other diagnoses. Pyoderma gangrenosum (PG) is an inflammatory neutrophilic dermatosis that is typically characterized by necrotizing ulceration. PG can be exacerbated by minor trauma leading to exaggerated skin injury, a condition known as pathergy. We present a case series of PG arising after immediate reconstruction for breast oncological surgery from 1st January 2006 to 1st September 2014. 395 immediate breast reconstructions were performed in 335 patients. Three cases of post-surgical PG were identified (0.9%), all in the setting of mastectomy for breast cancer. Two cases underwent immediate reconstruction with pedicled transverse rectus abdominus myocutaneous flaps, and one underwent submuscular expander insertion. A mean delay of 6.3 days was observed from first presentation of symptoms to diagnosis of PG. Immunosuppressants commonly used included methylprednisolone, prednisone, and ciclosporin, with good success at halting disease progress. Significant scarring affected all three women. Once the disease was deemed quiescent, intravenous immunoglobulin used in the perioperative period for further surgical procedures provided favorable results. A diagnostic algorithm is suggested to guide surgeons in investigations and management when post-surgical PG is suspected. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  3. Anterior chest wall resection and reconstruction for locally advanced breast cancer.

    Science.gov (United States)

    Wee, Hide Elfrida; Akbar, Fazuludeen Ali; Rajapaksha, Keerthi; Aneez, Dokev Basheer Ahmed

    2015-01-01

    With breast cancer awareness, the incidence of large invasive tumours is rare. We present a video of locally advanced breast cancer invading the anterior chest wall requiring en bloc resection that resulted in a large chest wall defect with exposed pleural and pericardial surface. Skeletal reconstruction and provision of adequate soft tissue coverage in order to avoid respiratory failure was challenging. A 58-year-old female presented with a 3-year history of locally invasive breast carcinoma with contiguous spread to sternum, clavicles, sternoclavicular joints and bilateral second to fifth ribs. She underwent total sternectomy, bilateral second to fifth ribs and chest wall resection resulting in a 21 × 18 cm chest wall defect. Reconstruction of her sternum was with methyl-methacrylate cement prosthesis. Ribs were reconstructed with titanium plates. Soft tissue coverage was achieved with left vertical rectus abdominis pedicle flap, right external oblique transposition flap and a right latissimus dorsi free flap. Flap failure necessitated a right vastus lateralis free flap. She was discharged ambulant without respiratory compromise. Resection and reconstruction of large chest wall defects is possible due to new bioprosthetic materials and is possible with acceptable morbidity and mortality. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  4. Late Surgical-Site Infection in Immediate Implant-Based Breast Reconstruction.

    Science.gov (United States)

    Sinha, Indranil; Pusic, Andrea L; Wilkins, Edwin G; Hamill, Jennifer B; Chen, Xiaoxue; Kim, Hyungjin M; Guldbrandsen, Gretchen; Chun, Yoon S

    2017-01-01

    Surgical-site infection causes devastating reconstructive failure in implant-based breast reconstructions. Large national database studies offer insights into complication rates, but only capture outcomes within 30 days postoperatively. This study evaluates both early and late surgical-site infection in immediate implant-based reconstruction and identifies predictors. As part of the Mastectomy Reconstruction Outcomes Consortium Study, 1662 implant-based breast reconstructions in 1024 patients were evaluated for early versus late surgical-site infection. Early surgical-site infection was defined as infection occurring within 30 days postoperatively; late surgical-site infection was defined as infection occurring 31 days to 1 year postoperatively. Minor infection required oral antibiotics only, and major infection required hospitalization and/or surgical treatment. Direct-to-implant patients had 1-year follow-up, and tissue expander patients had 1-year post-exchange follow-up. Among 1491 tissue expander and 171 direct-to-implant reconstructions, overall surgical-site infection rate for tissue expander was 5.7 percent (85 of 1491) after first-stage, 2.5 percent (31 of 1266) after second-stage, and 9.9 percent (17 of 171) for direct-to-implant reconstruction. Over 47 to 71 percent of surgical-site infection complications were late surgical-site infection. Multivariate analysis identified radiotherapy and increasing body mass index as significant predictors of late surgical-site infection. No significant difference between the direct-to-implant and tissue expander groups in the occurrence of early, late, or overall surgical-site infection was found. The majority of surgical-site infection complications in immediate implant-based breast reconstructions occur more than 30 days after both first-stage and second-stage procedures. Radiotherapy and obesity are significantly associated with late-onset surgical-site infection. Current studies limited to early complications do

  5. A Multi-institutional Analysis of Insurance Status as a Predictor of Morbidity Following Breast Reconstruction

    Science.gov (United States)

    Vieira, Brittany L.; Lanier, Steven T.; Mlodinow, Alexei S.; Bethke, Kevin P.; Murphy, Robert X.; Hume, Keith M.; Gutowski, Karol A.; Fine, Neil A.

    2014-01-01

    Background: Although recent literature suggests that patients with Medicaid and Medicare are more likely than those with private insurance to experience complications following a variety of procedures, there has been limited evaluation of insurance-based disparities in reconstructive surgery outcomes. Using a large, multi-institutional database, we sought to evaluate the potential impact of insurance status on complications following breast reconstruction. Methods: We identified all breast reconstructive cases in the 2008 to 2011 Tracking Operations and Outcomes for Plastic Surgeons clinical registry. Propensity scores were calculated for each case, and insurance cohorts were matched with regard to demographic and clinical characteristics. Outcomes of interest included 15 medical and 13 surgical complications. Results: Propensity-score matching yielded 493 matched patients for evaluation of Medicaid and 670 matched patients for evaluation of Medicare. Overall complication rates did not significantly differ between patients with Medicaid or Medicare and those with private insurance (P = 0.167 and P = 0.861, respectively). Risk-adjusted multivariate regressions corroborated this finding, demonstrating that Medicaid and Medicare insurance status does not independently predict surgical site infection, seroma, hematoma, explantation, or wound dehiscence (all P > 0.05). Medicaid insurance status significantly predicted flap failure (odds ratio = 3.315, P = 0.027). Conclusions: This study is the first to investigate the differential effects of payer status on outcomes following breast reconstruction. Our results suggest that Medicaid and Medicare insurance status does not independently predict increased overall complication rates following breast reconstruction. This finding underscores the commitment of the plastic surgery community to providing consistent care for patients, irrespective of insurance status. PMID:25506538

  6. Embrace the Change: Incorporating Single-Stage Implant Breast Reconstruction into Your Practice.

    Science.gov (United States)

    Rodriguez-Feliz, Jose; Codner, Mark A

    2015-08-01

    Multiple studies have reported on the safety of nipple-sparing mastectomy and low complication rates associated with single-stage implant breast reconstruction. Yet many plastic surgeons continue to be resistant to change. This article presents the senior author's (M.A.C.) experience during his transition period from the latissimus dorsi flap with adjustable implants to a "one-and-done" approach using shaped implants and fetal bovine acellular dermal matrix. A literature review was performed selecting articles discussing single-stage implant reconstruction, indications, outcomes, technique, and complications. Additional articles were selected after review of the references of identified articles. Clinical pearls discussed include patient selection, implant selection, and mastectomy incision choices, with a detailed description of the senior author's operative technique. Twenty-seven single-stage implant reconstructions were performed. Average mastectomy weight was 343.82 g. The average implant volume was 367 cc. Shaped implants were most commonly used. Acellular dermal matrix was used in all breasts. Complications included erythema requiring intravenous antibiotics (three patients), skin ischemia caused by methylene blue (one patient), seroma (one patient), unilateral partial nipple necrosis (one patient), mastectomy skin necrosis (one patient), and exposed/infected implants that were salvaged using a sequential irrigation protocol described by Sforza et al. in 2014 (two patients). Breast reconstruction after mastectomy has evolved toward less invasive, single-stage procedures. Aesthetic refinements include nipple-sparing mastectomy, use of acellular dermal matrix, shaped implants, and fat grafting. Selected patients will benefit from a one-and-done breast implant reconstruction with no additional oncologic risk. Surgeons must embrace the change and provide their patients with a procedure that will offer the best aesthetic outcomes. Therapeutic, IV.

  7. Circumareolar Mastopexy with Multiple Glandular Plications for Symmetry of the Contra-Lateral Breast, in Patients Undergoing Breast Reconstruction with Prosthesis. Experience on 50 Cases

    Directory of Open Access Journals (Sweden)

    M. P. Serra

    2008-01-01

    Full Text Available 4 years experience on 50 cases using the Elliott’s technique for symmetrization of the contra-lateral breast in patients undergoing breast reconstruction with an anatomical prosthesis is presented in this paper. The Elliott’s technique with its double superior and horizontal plication is a suitable and long-lasting procedure for patients with small-moderate ptotic breast and elastic skin, who wish to have a simple procedure and an immediate result with minimal scars.

  8. [Extraordinary case of malignant phylloid tumor of the breast: surgical reconstruction treatment].

    Science.gov (United States)

    Norat, Federica; Dreant, Nicolas; Riah, Younes; Lebreton, Elisa

    2009-01-01

    Phyllode tumors of the breast are fibroepithelial tumors similar to fibroadenomas but with a predominant conjunctive tissue component. They are rare with an incidence of less than 1% of all breast neoplasms. They can be divided in three categories: benign, borderline, malignant. The Authors report the case of a 53 years old woman who presented an exceptional 6.5 kg phylloid tumor of the left mamma. The diagnostic strategies, the surgical total mastectomy procedure with anterior thoracic parietectomy and the surgical reconstructive treatment are described.

  9. Estudio preoperatorio de vasos receptores en reconstrucción mamaria con colgajo DIEP Preoperative planning of receiver vessels in breast reconstruction with DIEP flap

    Directory of Open Access Journals (Sweden)

    C. Tejerina Botella

    2011-09-01

    Full Text Available El estudio preoperatorio vascular de cualquier colgajo microquirúrgico es esencial para el buen desarrollo del mismo. En el colgajo DIEP (colgajo de perforante de arteria epigástrica inferior profunda aplicado a la reconstrucción mamaria, se han establecido durante los últimos años diferentes técnicas para la planificación preoperatoria de la anatomía de los vasos perforantes de la arteria epigástrica inferior. Sin embargo, pensamos, que también es muy importante la planificación anatómica preoperatoria de los vasos receptores, que en la mayoría de los casos son la arteria y vena mamarias internas. Estos vasos sufren en ocasiones variaciones anatómicas, llegando incluso a no existir en algunos pacientes. El conocimiento exacto de la localización, permeabilidad y calibre de estos vasos receptores hará que la intervención sea mas rápida y sencilla.An accurate preoperative vascular evaluation of microsurgical flaps is essential for a good procedure. In DIEP (deep inferior epigastric perforator flap, in breast reconstruction, have been described different preoperative techniques to study the anatomy of the deep inferior epigastric perforators. We think that preoperative planning of the receiver vessels, (internal mammary artery and vein, in most of cases is very important too. These vessels have anatomic changes in some patients. To know the exact location, permeability, and calibre of these vessels will help us to have a more easy and quick operation.

  10. Failure rate and cosmesis of immediate tissue expander/implant breast reconstruction after postmastectomy irradiation.

    Science.gov (United States)

    Baschnagel, Andrew M; Shah, Chirag; Wilkinson, J Ben; Dekhne, Nayana; Arthur, Douglas W; Vicini, Frank A

    2012-12-01

    This study reports the rate of breast reconstruction failure and cosmetic outcomes after postmastectomy radiation therapy (PMRT) with temporary tissue expanders (TEs) or implants in place. Ninety-four patients underwent mastectomy (93 unilateral, 1 bilateral; 95 cases total) and immediate TE reconstruction followed by PMRT. Ninety TEs and 5 permanent implants were irradiated. All patients received a dose of 5400 cGy given in 180-cGy fractions to the reconstructed breast. Twenty-one patients (22%) received tangents alone and 74 patients (78%) were treated with tangents and a supraclavicular field using a monoisocentric technique. Bolus was used in 91 patients (96%). Eighty-eight patients (93%) received chemotherapy and 78 patients (82%) received endocrine therapy. With a median follow-up of 24.1 months, 19 patients (20%) experienced failure of reconstruction. The 1-, 2-, and 3-year actuarial rate of reconstruction failure was 9.7%, 19.3%, and 25.5%, respectively. Infection was the most common cause of failure. Of the 19 failures, 8 patients underwent salvage procedures with flap reconstruction. Univariate analysis was performed examining age, chemotherapy use, hormone therapy use, use of a supraclavicular field, smoking status, diabetes, hypertension, and menopausal status. No risk factors were found to be associated with reconstruction failure. In patients who did not experience reconstruction failure, good/excellent cosmesis was observed in 75% of patients. In the current series of women with a high risk of locoregional recurrence, PMRT with a TE/implant in place provides good cosmesis in the majority of women, with an acceptable risk of expander or implant loss. Copyright © 2012 Elsevier Inc. All rights reserved.

  11. Adaptive diffusion regularization for enhancement of microcalcifications in digital breast tomosynthesis (DBT) reconstruction

    Science.gov (United States)

    Lu, Yao; Chan, Heang-Ping; Fessler, Jeffrey A.; Hadjiiski, Lubomir; Wei, Jun; Goodsitt, Mitchell M.

    2011-03-01

    Digital breast tomosynthesis (DBT) has been shown to increase mass detection. Detection of microcalcifications in DBT is challenging because of the small, subtle signals to be searched in the large breast volume and the noise in the reconstructed volume. We developed an adaptive diffusion (AD) regularization method that can differentially regularize noise and potential signal regions during reconstruction based on local contrast-to-noise ratio (CNR) information. This method adaptively applies different degrees of regularity to signal and noise regions, as guided by a CNR map for each DBT slice within the image volume, such that potential signals will be preserved while noise is suppressed. DBT scans of an American College of Radiology phantom and the breast of a subject with biopsy-proven calcifications were acquired with a GE prototype DBT system at 21 angles in 3° increments over a +/-30° range. Simultaneous algebraic reconstruction technique (SART) was used for DBT reconstruction. The AD regularization method was compared to the non-convex total p-variation (TpV) method and SART with no regularization (NR) in terms of the CNR and the full width at half maximum (FWHM) of the central gray-level line profile in the focal plane of a calcification. The results demonstrated that the SART regularized by the AD method enhanced the CNR and preserved the sharpness of microcalcifications compared to reconstruction without regularization. The AD regularization was superior to the TpV method for subtle microcalcifications in terms of the CNR while the FWHM was comparable. The AD regularized reconstruction has the potential to improve the CNR of microcalcifications in DBT for human or machine detection.

  12. Quality of life of patients who undergo breast reconstruction after mastectomy: effects of personality characteristics.

    Science.gov (United States)

    Bellino, Silvio; Fenocchio, Marina; Zizza, Monica; Rocca, Giuseppe; Bogetti, Paolo; Bogetto, Filippo

    2011-01-01

    Reconstruction after mastectomy has become an integral part of breast cancer treatment. The effects of psychological factors on quality of life after reconstruction have been poorly investigated. The authors examined clinical and personality characteristics related to quality of life in patients receiving reconstructive surgery. All patients received immediate reconstruction and were evaluated in the week before tissue expander implantation (T0) with a semistructured interview for demographic and clinical characteristics, the Temperament and Character Inventory, the Inventory of Interpersonal Problems, the Short Form Health Survey, the Severity Item of the Clinical Global Impression, the Hamilton Depression Rating Scale, and the Hamilton Anxiety Rating Scale. Assessment with the Short Form was repeated 3 months after expander placement (T1). Statistics were calculated with univariate regression and analysis of variance. Significant variables were included in a multiple regression analysis to identify factors related to the change T1-T0 of the mean of the Short Form-transformed scores. Results were significant when p was less than or equal to 0.05. Fifty-seven women were enrolled. Results of multiple regression analysis showed that the Temperament and Character Inventory personality dimension harm avoidance and the Inventory of Interpersonal Problems domain vindictive/self-centered were significantly and independently related to the change in Short Form mean score. Personality dimensions and patterns of interpersonal functioning produce significant effects on patients' quality of life during breast reconstruction. Patients with high harm avoidance are apprehensive and doubtful. Restoration of body image could help them to reduce social anxiety and insecurity. Vindictive/self-centered patients are resentful and aggressive. Breast reconstruction could symbolize the conclusion of a reparative process and fulfill the desire of revenge on cancer.

  13. Primary anaplastic large cell lymphoma of the breast arising in reconstruction mammoplasty capsule of saline filled breast implant after radical mastectomy for breast cancer: an unusual case presentation

    Directory of Open Access Journals (Sweden)

    Sur Monalisa

    2009-04-01

    Full Text Available Abstract Background Primary non-Hodgkin lymphoma (NHL of the breast represents 0.04–0.5% of malignant lesions of the breast and accounts for 1.7–2.2% of extra-nodal NHL. Most primary cases are of B-cell phenotype and only rare cases are of T-cell phenotype. Anaplastic large cell lymphoma (ALCL is a rare T-cell lymphoma typically seen in children and young adults with the breast being one of the least common locations. There are a total of eleven cases of primary ALCL of the breast described in the literature. Eight of these cases occurred in proximity to breast implants, four in relation to silicone breast implant and three in relation to saline filled breast implant with three out of the eight implant related cases having previous history of breast cancer treated surgically. Adjuvant postoperative chemotherapy is given in only one case. Secondary hematological malignancies after breast cancer chemotherapy have been reported in literature. However in contrast to acute myeloid leukemia (AML, the association between lymphoma and administration of chemotherapy has never been clearly demonstrated. Case Presentation In this report we present a case of primary ALCL of the breast arising in reconstruction mamoplasty capsule of saline filled breast implant after radical mastectomy for infiltrating ductal carcinoma followed by postoperative chemotherapy twelve years ago. Conclusion Primary ALK negative ALCL arising at the site of saline filled breast implant is rare. It is still unclear whether chemotherapy and breast implantation increases risk of secondary hematological malignancies significantly. However, it is important to be aware of these complications and need for careful pathologic examination of tissue removed for implant related complications to make the correct diagnosis for further patient management and treatment. It is important to be aware of this entity at this site as it can be easily misdiagnosed on histologic grounds and to exclude

  14. Early Results Show Reduced Infection Rate Using No-touch Technique for Expander/ADM Breast Reconstruction

    OpenAIRE

    Henry B. Wilson, MD, FACS

    2015-01-01

    Summary: Infection is a common complication of immediate breast reconstruction that often leads to device removal, a result emotionally devastating to the patient and frustrating for her surgeon. “No-touch” techniques have been used in other surgical disciplines and plastic surgery, but they have not been reported for breast reconstruction with tissue expanders or implants and acellular dermis. We report a novel technique of tissue expander and acellular dermis placement using no-touch princi...

  15. The quality-of-life benefits of breast reconstruction do not diminish with age.

    Science.gov (United States)

    Sisco, Mark; Johnson, Donald B; Wang, Chihsiung; Rasinski, Kenneth; Rundell, Veronica L; Yao, Katharine A

    2015-05-01

    Older women rarely receive post-mastectomy breast reconstruction (PMBR). While there is a perception that PMBR is less beneficial in this age group, quality-of-life (QOL) data related to PMBR in older women remain scarce. Women with AJCC stage 0-III breast cancer who underwent a mastectomy were surveyed. Respondents included 215 older women (≥ 65 years), of whom 36.0% received PMBR, and a control group of 101 younger women (women with and without PMBR revealed no significant differences in physical health, anxiety, or depression scores; however, PMBR was associated with greater breast satisfaction (P = 0.002) and greater breast-related psychosocial well-being (P = 0.02) than mastectomy alone. Among those who received PMBR, there was no correlation between age and breast satisfaction, psychosocial well-being, nor satisfaction with the outcome (P = 0.11, 0.21, and 0.56). Older women who undergo PMBR have better breast-related QOL outcomes than those who do not. Moreover, the outcomes of PMBR in older women are similar to those seen in younger women. When appropriate, older women should be encouraged to consider PMBR. © 2015 Wiley Periodicals, Inc.

  16. Unilateral breast reconstruction after mastectomy - patient satisfaction, aesthetic outcome and quality of life

    DEFF Research Database (Denmark)

    Juhl, Alexander A.; Christensen, Søren; Zachariae, Robert;

    2017-01-01

    BACKGROUND: An increasing number of women undergo a breast reconstruction (BR) after treatment for breast cancer. The aim of the present study was to evaluate patient-reported esthetic satisfaction, quality of life (QoL), and the association between these, following different types of BR. MATERIALS......-reported esthetic satisfaction scale. Additionally, patients were asked if they experienced a change in QoL owing to the BR. Based on reconstructive method and timing, participants were divided into four groups, three delayed: an abdominal flap group, a latissimus dorsi flap group, an implant ± thoracodorsal flap...... AND METHODS: All women who underwent unilateral BR in Central Denmark Region between January 2005 and July 2011 were included. Participants were sent a questionnaire package, which included the Body Image Scale, The Beck Depression Inventory, the Impact of Event Scale, and a study-specific patient...

  17. Waveform Inversion with Source Encoding for Breast Sound Speed Reconstruction in Ultrasound Computed Tomography

    CERN Document Server

    Wang, Kun; Anis, Fatima; Li, Cuiping; Duric, Neb; Anastasio, Mark A

    2015-01-01

    Ultrasound computed tomography (USCT) holds great promise for improving the detection and management of breast cancer. Because they are based on the acoustic wave equation, waveform inversion-based reconstruction methods can produce images that possess improved spatial resolution properties over those produced by ray-based methods. However, waveform inversion methods are computationally demanding and have not been applied widely in USCT breast imaging. In this work, source encoding concepts are employed to develop an accelerated USCT reconstruction method that circumvents the large computational burden of conventional waveform inversion methods. This method, referred to as the waveform inversion with source encoding (WISE) method, encodes the measurement data using a random encoding vector and determines an estimate of the sound speed distribution by solving a stochastic optimization problem by use of a stochastic gradient descent algorithm. Both computer-simulation and experimental phantom studies are conduc...

  18. Immediate Breast Reconstruction with Abdominal Free Flap and Adjuvant Radiotherapy: Evaluation of Quality of Life and Outcomes.

    Science.gov (United States)

    Pont, Luis Parra; Marcelli, Stefano; Robustillo, Manuel; Song, Dajiang; Grandes, Daniel; Martin, Marcos; Iglesias, Israel; Aso, Jorge; Laloumet, Iñaki; Díaz, Antonio J

    2017-10-01

    The effects of postoperative radiotherapy on free flap-based breast reconstruction are still controversial. Poor outcomes, breast distortion, and fat necrosis have been traditionally documented. The aim of this study was to evaluate whether adjuvant radiotherapy affects the quality of life, satisfaction, and cosmetic result in patients undergoing immediate breast reconstruction with autologous free flap. Between January of 2013 and December of 2016, 230 patients underwent mastectomy with immediate free flap reconstruction at the authors' institution. Patients were divided into two groups depending on whether they received postmastectomy radiotherapy. Quality of life measured with the BREAST-Q questionnaire, self-reported aesthetic outcomes, and general satisfaction were assessed and compared. Fat necrosis of the flap and its severity were also analyzed as the main surgical outcomes. Mean follow-up time after reconstruction was 23 months (range, 6 to 48 months). No significant difference in quality of life or satisfaction scores were found between patients that underwent postmastectomy radiotherapy and patients who did not receive adjuvant radiotherapy. There were no significant differences in rates of fat necrosis between the groups (11.1 percent versus 13.76 percent; p = 0.75). Postmastectomy radiotherapy in patients undergoing immediate breast reconstruction with free flaps does not seem to affect quality of life, satisfaction with the outcome, or the cosmetic result as perceived by the patients. The potential need for postoperative radiotherapy should not hinder women from the benefits of autologous immediate breast reconstruction. Therapeutic, III.

  19. Displaying inguinal lymph nodes before transplantation in a deep inferior epigastric perforator flap breast reconstruction using an innovative projection method

    NARCIS (Netherlands)

    Hummelink, S.L.; Schultze Kool, L.J.; Ulrich, D.J.

    2016-01-01

    INTRODUCTION: Lymphedema of the arm is a common postoperative complication as a result of breast cancer surgery. One of the surgical treatments comprises modification of a deep inferior epigastric perforator (DIEP) flap breast reconstruction to facilitate additional lymph node transplantation from t

  20. Update on Breast Reconstruction Using Free TRAM, DIEP, and SIEA Flaps

    OpenAIRE

    Chevray, Pierre M.

    2004-01-01

    Breast reconstruction using autologous tissue is commonly accomplished using the transverse rectus abdominis myocutaneous (TRAM) flap. The establishment of microvascular surgery led to the development of the free TRAM flap because of its increased vascularity and decreased rectus abdominis sacrifice. The muscle-sparing free TRAM, DIEP, and SIEA flap techniques followed in an effort to decrease abdominal donor site morbidity by decreasing injury to the rectus abdominis muscle and fascia. Data ...

  1. The Matrix Rib Plating System: improving aesthetic outcomes in microvascular breast reconstruction.

    Science.gov (United States)

    Ahdoot, Michael A; Echo, Anthony; Otake, Leo R; Son, Ji; Zeidler, Kamakshi R; Saadian, Isaac; Lee, Gordon K

    2013-04-01

    During microvascular breast reconstruction, exposure of internal mammary vessels (IMVs) is facilitated by the removal of a portion of the rib resulting in occasional chest contour deformity (CCD). The use of rib plating may reduce CCD and reduce postoperative pain. All patients underwent microvascular breast reconstruction using IMVs. In the retrospective arm, photographs were assessed by a blinded reviewer for CCDs. In the prospective cohort, patients were randomized to rib plating with the Synthes Matrix Rib Plating System or no rib plating. Postoperatively, patients were assessed for CCD and pain. In the retrospective arm, 11 of 98 (11.2%) patients representing 12 of 130 (9.2%) breast reconstructions had a noticeable contour deformity. The average body mass index (BMI) of patients with CCDs was 26.6 kg/m. In the prospective arm, there was 16% (3 of 19) rate of visible and palpable CCDs among controls, compared to 0% rate of palpable and visible contour deformity in the rib plating group. Pain was decreased in the rib plating group on all postoperative days. The pain reduction was statistically significant at rest by postoperative day 30. The majority of patients (9 of 11) with compromised aesthetic outcomes had a BMI less than 30 kg/m, suggesting a paucity of overlying soft tissue contributed to visibility of these bony defects. Rib plating prevented chest contour deformity, reduced postoperative pain, and added limited additional morbidity. We believe that rib plating is a safe, useful adjunct to microvascular breast reconstruction using IMVs, as it may improve aesthetic outcomes and reduce postoperative pain.

  2. Plastic Surgeon Expertise in Predicting Breast Reconstruction Outcomes for Patient Decision Analysis

    Directory of Open Access Journals (Sweden)

    Clement S. Sun, MS

    2013-11-01

    Conclusions: The use of individual plastic surgeon–elicited probability information is not encouraged unless the individual’s prediction skill has been evaluated. In the absence of this information, a group consensus on the probability of outcomes is preferred. Without a large evidence base for calculating probabilities, estimates assessed from a group of plastic surgeons may be acceptable for purposes of breast reconstruction decision analysis.

  3. Minimizing incisional dehiscence following 2-stage prosthetic breast reconstruction in the setting of radiation therapy

    OpenAIRE

    Nahabedian, Maurice Y.

    2013-01-01

    Incisional dehiscence is a potential complication following prosthetic breast reconstruction. This is exacerbated in the setting of previous radiation therapy (RT) at the time of exchange of the tissue expander to a permanent implant. A technical modification is described that has successfully minimized this adverse event. Twenty-nine patients that had tissue expanders and RT underwent exchange of the device through a laterally based incision along the inframammary fold (IMF) rather than thro...

  4. Complete tissue expander coverage by musculo-fascial flaps in immediate breast mound reconstruction after mastectomy.

    Science.gov (United States)

    Alani, Harith A; Balalaa, Nahed

    2013-10-01

    Immediate breast reconstruction with tissue expander has become an increasingly popular procedure. Complete coverage of the expander by a musculofascial layer provides an additional well-vascularised layer, reducing the rate of possible complications of skin necrosis, prosthesis displacement, and the late capsular contracture. Complete expander coverage can be achieved by a combination of pectoralis major muscle and adjacent thoracic fascia in selected patients. Seventy-five breast mounds in 59 patients were reconstructed, in the first stage a temporary tissue expander inserted immediately after mastectomy and a musculofascial layer composed of the pectoralis major muscle, the serratus anterior fascia, and the superficial pectoral fascia were created to cover the expander. The first stage was followed months later by implant insertion. Minor and major complications were reported in a period of follow-up ranging from 24-42 months (mean 31 months). Complete musculofascial coverage of the tissue expander was a simple and easy to learn technique providing that the patient has a well-formed and intact superficial pectoral and serratus anterior fascia. From a total of 75 breast mounds reconstructed, major complications rate was 4% (overall rate of 19.8%), including major seroma (n = 4), haematoma (n = 1), partial skin loss (n = 3), wound dehiscence (n = 1), major infection (n = 2), severe capsule contracture (n = 1), and expander displacement (n = 3). The serratus anterior fascia and the superficial pectoral fascia flaps can be effectively used as an autologous tissue layer to cover the lower and the lateral aspect of tissue expanders in immediate breast reconstruction after mastectomy.

  5. Oncological outcome and patient satisfaction with skin-sparing mastectomy and immediate breast reconstruction: a prospective observational study

    OpenAIRE

    Burgoyne Gwyne; Anderson Anne; Patani Neill; Reefy Sara; Osman Hisham; Mokbel Kefah

    2010-01-01

    Abstract Background The management of early breast cancer (BC) with skin-sparing mastectomy (SSM) and immediate breast reconstruction (IBR) is not based on level-1 evidence. In this study, the oncological outcome, post-operative morbidity and patients' satisfaction with SSM and IBR using the latissimus dorsi (LD) myocutaneous flap and/or breast prosthesis is evaluated. Methods 137 SSMs with IBR (10 bilateral) were undertaken in 127 consecutive women, using the LD flap plus implant (n = 85), L...

  6. Body image issues after bilateral prophylactic mastectomy with breast reconstruction in healthy women at risk for hereditary breast cancer.

    Science.gov (United States)

    Gopie, Jessica P; Mureau, Marc A M; Seynaeve, Caroline; Ter Kuile, Moniek M; Menke-Pluymers, Marian B E; Timman, Reinier; Tibben, Aad

    2013-09-01

    The outcome of bilateral prophylactic mastectomy with breast reconstruction (BPM-IBR) in healthy BRCA1/2 mutation carriers can be potentially burdensome for body image and the intimate relationship. Therefore, in the current analysis the impact on body image, sexual and partner relationship satisfaction was prospectively investigated in women opting for BPM-IBR as well as cancer distress and general quality of life. Healthy women undergoing BPM-IBR completed questionnaires preoperatively (T0, n = 48), at 6 months (T1, n = 44) and after finishing breast reconstruction (median 21 months, range 12-35) (T2, n = 36). With multi-level regression analyses the course of outcome variables was investigated and a statistically significant change in body image and/or sexual and partner relationship satisfaction was predicted by baseline covariates. Body image significantly decreased at T1. At T2 sexual relationship satisfaction and body image tended to be lower compared to baseline. The overall partner relationship satisfaction did not significantly change. At T2, 37 % of the women reported that their breasts felt unpleasantly, 29 % was not satisfied with their breast appearance and 21 % felt embarrassed for their naked body. Most body image issues remained unchanged in 30 % of the women. A negative body image was predicted by high preoperative cancer distress. BPM-IBR was associated with adverse impact on body image in a substantial subgroup, but satisfaction with the overall sexual and partner relationship did not significantly change in time. The psychosocial impact of BPM-IBR in unaffected women should not be underestimated. Psychological support should ideally be integrated both before and after BPM-IBR.

  7. Review of three-dimensional (3D) surface imaging for oncoplastic, reconstructive and aesthetic breast surgery.

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    O'Connell, Rachel L; Stevens, Roger J G; Harris, Paul A; Rusby, Jennifer E

    2015-08-01

    Three-dimensional surface imaging (3D-SI) is being marketed as a tool in aesthetic breast surgery. It has recently also been studied in the objective evaluation of cosmetic outcome of oncological procedures. The aim of this review is to summarise the use of 3D-SI in oncoplastic, reconstructive and aesthetic breast surgery. An extensive literature review was undertaken to identify published studies. Two reviewers independently screened all abstracts and selected relevant articles using specific inclusion criteria. Seventy two articles relating to 3D-SI for breast surgery were identified. These covered endpoints such as image acquisition, calculations and data obtainable, comparison of 3D and 2D imaging and clinical research applications of 3D-SI. The literature provides a favourable view of 3D-SI. However, evidence of its superiority over current methods of clinical decision making, surgical planning, communication and evaluation of outcome is required before it can be accepted into mainstream practice.

  8. Comparative Study of Prepectoral and Subpectoral Expander-Based Breast Reconstruction and Clavien IIIb Score Outcomes

    Directory of Open Access Journals (Sweden)

    Lynne N. Bettinger, MD

    2017-07-01

    Full Text Available Background:. Prepectoral breast reconstruction is increasingly popular. This study compares complications between 2 subpectoral and 1 prepectoral breast reconstruction technique. Methods:. Between 2008 and 2015, 294 two-staged expander breast reconstructions in 213 patients were performed with 1 of 3 surgical techniques: (1 Prepectoral, (2 subpectoral with acellular dermal matrix (ADM sling (“Classic”, or (3 subpectoral/subserratus expander placement without ADM (“No ADM”. Demographics, comorbidities, radiation therapy, and chemotherapy were assessed for correlation with Clavien IIIb score outcomes. Follow-up was a minimum of 6 months. Results:. Surgical cohorts (n = 165 Prepectoral; n = 77 Classic; n = 52 No ADM had comparable demographics except Classic had more cardiac disease (P = 0.03, No ADM had higher body mass index (BMI (P = 0.01, and the Prepectoral group had more nipple-sparing mastectomies (P 40, stage 4 cancer, and contralateral prophylactic mastectomy were associated with adverse expander outcomes and a prior history of radiation therapy adversely impacted implant outcomes. Ninety-day follow-up for expander and implant complications may be a better National Surgical Quality Improvement Program measure.

  9. Cost analysis of near-infrared spectroscopy tissue oximetry for monitoring autologous free tissue breast reconstruction.

    Science.gov (United States)

    Pelletier, Aaron; Tseng, Charles; Agarwal, Shailesh; Park, Julie; Song, David

    2011-10-01

    Free flap monitoring typically requires specialized nursing that can increase medical costs. This study uses near-infrared spectroscopy (NIRS) tissue oximetry to monitor free tissue breast reconstruction. We hypothesize this practice will reduce medical costs by eliminating the need for specialized nursing. From August 2006 to January 2010, women undergoing unilateral free tissue breast reconstruction were enrolled and admitted postoperatively to either the surgical intensive care unit (ICU) or floor. Each underwent continuous monitoring using NIRS tissue oximetry and intermittent clinical examination with surface Doppler ultrasonography. Patient demographics, comorbidities, perioperative details, and financial data were recorded. There were 50 patients studied, all with abdominal-based flaps (25 per group). There were no statistically significant differences in patient demographics, comorbidities, mean flap weight, ischemia time, or length of stay between the ICU and floor groups. Four flaps had vascular complications, all detected by NIRS tissue oximetry. Comparison of hospital costs showed an average reduction of $1937 per patient when monitored on the surgical floor (P = 0.036). NIRS tissue oximetry is a sensitive and reliable monitoring tool, eliminating the need for specialized nursing care. The effect is decreased cost structure and increased hospital contribution margin for autologous free tissue breast reconstruction.

  10. Breast augmentation and reconstructive surgery: MR imaging of implant rupture and malignancy

    Energy Technology Data Exchange (ETDEWEB)

    Herborn, Christoph U. [Institute of Diagnostic Radiology, University Hospital, Zuerich (Switzerland); Department of Diagnostic and Interventional Radiology, University Hospital Essen, Hufelandstrasse 55, 45128 Essen (Germany); Marincek, Borut; Erfmann, Daniel; Kubik-Huch, Rahel A. [Institute of Diagnostic Radiology, University Hospital, Zuerich (Switzerland); Meuli-Simmen, Claudia; Wedler, Volker [Department of Surgery, Clinic for Reconstructive Surgery, University Hospital, Zurich (Switzerland); Bode-Lesniewska, Beate [Department of Pathology, University Hospital, Zurich (Switzerland)

    2002-09-01

    The purpose of this study was to assess the diagnostic accuracy of MRI in detecting prosthesis integrity and malignancy after breast augmentation and reconstruction. Forty-one implants in 25 patients were analyzed by MRI before surgical removal. Imaging results were compared with ex vivo findings. Magnetic resonance imaging of the breast was performed on a 1.5-T system using a dedicated surface breast coil. Axial and sagittal T2-weighted fast spin-echo as well as dynamic contrast-enhanced T1-weighted gradient-recalled-echo sequences were acquired. The linguine sign indicating collapse of the silicone shell or siliconomas indicating free silicone proved implant rupture, whereas early focal contrast enhancement of a lesion was suspicious for malignancy. The sensitivity for detection of implant rupture was 86.7% with a specificity of 88.5%. The positive and negative predictive values were 81.3 and 92.0%, respectively. The linguine sign as a predictor of intracapsular implant rupture had a sensitivity of 80% with a specificity of 96.2%. Magnetic resonance imaging revealed two lesions with suspicious contrast enhancement (one carcinoma, one extra-abdominal fibromatosis). Magnetic resonance imaging is a reliable and reproducible technique for diagnosing both implant rupture and malignant lesions in women after breast augmentation and reconstruction. (orig.)

  11. Previous Multiple Abdominal Surgeries: A Valid Contraindication to Abdominal Free Flap Breast Reconstruction?

    Science.gov (United States)

    Di Candia, Michele; Asfoor, Ahmed Al; Jessop, Zita M.; Kumiponjera, Devor; Hsieh, Frank; Malata, Charles M.

    2012-01-01

    Presented in part at the following Academic Meetings: 57th Meeting of the Italian Society of Plastic, Reconstructive and Aesthetic Surgery, September 24-27, 2008, Naples, Italy.45th Congress of the European Society for Surgical Research (ESSR), June 9-12, 2010, Geneva, Switzerland.British Association of Plastic Reconstructive and Aesthetic Surgeons Summer Scientific Meeting, June 30-July 2, 2010, Sheffield Hallam University, Sheffield, UK. Background: Patients with previous multiple abdominal surgeries are often denied abdominal free flap breast reconstruction because of concerns about flap viability and abdominal wall integrity. We therefore studied their flap and donor site outcomes and compared them to patients with no previous abdominal surgery to find out whether this is a valid contraindication to the use of abdominal tissue. Patients and Methods: Twenty patients with multiple previous abdominal operations who underwent abdominal free flap breast reconstruction by a single surgeon (C.M.M., 2000-2009) were identified and retrospectively compared with a cohort of similar patients without previous abdominal surgery (sequential allocation control group, n = 20). Results: The index and control groups were comparable in age, body mass index, comorbidities, previous chemotherapy, and RT exposure. The index patients had a mean age of 54 years (r, 42-63) and an average body mass index of 27.5 kg/m2 (r, 22-38). The main previous surgeries were Caesarean sections (19), hysterectomies (8), and cholecystectomies (6). They underwent immediate (n = 9) or delayed (n = 11) reconstructions either unilaterally (n = 18) or bilaterally (n = 2) and comprising 9 muscle-sparing free transverse rectus abdominis muscle and 13 deep inferior epigastric perforator flaps. All flaps were successful, and there were no significant differences in flap and donor site outcomes between the 2 groups after an average follow up of 26 months (r, 10-36). Conclusion: Multiple previous abdominal

  12. Effects of nitroglycerin ointment on mastectomy flap necrosis in immediate breast reconstruction: a randomized controlled trial.

    Science.gov (United States)

    Gdalevitch, Perry; Van Laeken, Nancy; Bahng, Seokjae; Ho, Adelyn; Bovill, Esta; Lennox, Peter; Brasher, Penelope; Macadam, Sheina

    2015-06-01

    Mastectomy flap necrosis is a common complication of immediate breast reconstruction that impacts recovery time and reconstructive success. Nitroglycerin ointment is a topical vasodilator that has been shown to improve skin flap survival in an animal model. The objective of this study was to evaluate whether the application of nitroglycerin ointment to the breast skin after mastectomy and immediate reconstruction causes a decrease in the rate of mastectomy flap necrosis compared with placebo. This study was conducted as a randomized controlled trial and included patients aged 21 to 69 years undergoing mastectomy and immediate breast reconstruction at the University of British Columbia-affiliated hospitals (Vancouver, British Columbia, Canada). Patients with a medical history that precluded the administration of nitroglycerin were excluded from the study. The target sample size was 400 patients. Nitroglycerin ointment (45 mg) or a placebo was applied to the mastectomy skin at the time of surgical dressing. The trial was stopped at the first interim analysis after 165 patients had been randomized (85 to the treatment group and 80 to the placebo group). Mastectomy flap necrosis developed in 27 patients (33.8 percent) receiving placebo and in 13 patients (15.3 percent) receiving nitroglycerin ointment; the between-group difference was 18.5 percent (p = 0.006; 95 percent CI, 5.3 to 31.0 percent). Postoperative complications were similar in both groups [nitroglycerin, 22.4 percent (19 of 85); placebo, 28.8 percent (23 of 80)]. In patients undergoing mastectomy and immediate reconstruction, there was a marked reduction in mastectomy flap necrosis in patients who received nitroglycerin ointment. Nitroglycerin ointment application is a simple, safe, and effective way to help prevent mastectomy flap necrosis. Therapeutic, I.

  13. An Innovative Risk-Reducing Approach to Postmastectomy Radiation Delivery after Autologous Breast Reconstruction

    Science.gov (United States)

    Piper, Merisa L.; Evangelista, Maristella; Amara, Dominic; Daar, David; Foster, Robert D.; Fowble, Barbara

    2017-01-01

    Introduction: Postmastectomy radiation therapy (PMRT) has known deleterious side effects in immediate autologous breast reconstruction. However, plastic surgeons are rarely involved in PMRT planning. Our institution has adopted a custom bolus approach for all patients receiving PMRT. This offers uniform distribution of standard radiation doses, thereby minimizing radiation-induced changes while maintaining oncologic safety. We present our 8-year experience with the custom bolus approach for PMRT delivery in immediate autologous breast reconstruction. Methods: All immediate autologous breast reconstruction patients requiring PMRT after 2006 were treated with the custom bolus approach. Retrospective chart review was performed to compare the postirradiation complications, reconstruction outcomes, and oncologic outcomes of these patients with those of previous patients at our institution who underwent standard bolus, and to historical controls from peer-reviewed literature. Results: Over the past 10 years, of the 29 patients who received PMRT, 10 were treated with custom bolus. Custom bolus resulted in fewer radiation-induced skin changes and less skin tethering/fibrosis than standard bolus (0% vs 10% and 20% vs 35%, respectively), and less volume loss and contour deformities compared with historical controls (10% vs 22.8% and 10% vs 30.7%, respectively). Conclusions: Custom bolus PMRT minimizes radiation delivery to the internal mammary vessels, anastomoses, and skin; uniformly doses the surgical incision; and provides the necessary radiation dose to prevent recurrence. Because custom bolus PMRT may reduce the deleterious effects of radiation on reconstructive outcomes while maintaining safe oncologic results, we encourage all plastic surgeons to collaborate with radiation oncologists to consider this technique. PMID:28507844

  14. Late results following flap reconstruction for chest wall recurrent breast cancer.

    Science.gov (United States)

    Lindford, A J; Jahkola, T A; Tukiainen, E

    2013-02-01

    Locally extensive recurrent breast cancer usually portends a poor prognosis but certain cases can be treated surgically by wide soft-tissue resection as well as full-thickness chest wall resection (FTCWR). The resulting defect usually necessitates immediate flap coverage. The aim of this study was to assess local control, morbidity, choice of flap reconstruction, patient selection and overall long-term survival following surgical salvage of patients with chest wall recurrent breast cancer. Forty patients were treated with wide soft-tissue resection and immediate flap reconstruction from 1984 to 2011 in a single institution. Demographic, treatment and mortality data were obtained from patients' files. Mean age at surgery was 54 years. FTCWR was performed in 19 cases including three extended forequarter amputations. Chest wall stabilisation involved a synthetic mesh in 12 patients, fascia lata in two patients, free rib grafts in one patient and synthetic mesh and free rib graft in one patient. Soft-tissue reconstruction consisted of microvascular free flaps in seven patients and pedicled flaps in 33 patients. In-hospital mortality was 0%, 30-day mortality was 5%; there were two re-operations, six minor wound complications and one pulmonary embolism. There were no flap losses. In patients operated on with curative intent (n=31) median disease-free interval was 31 months and median survival was 52 months. In selected cases wide resections for extensive chest wall recurrent breast cancer can result in reasonable local control and survival. Several flap options exist for soft-tissue reconstruction. Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  15. Three-dimensional imaging provides valuable clinical data to aid in unilateral tissue expander-implant breast reconstruction.

    Science.gov (United States)

    Tepper, Oren M; Karp, Nolan S; Small, Kevin; Unger, Jacob; Rudolph, Lauren; Pritchard, Ashley; Choi, Mihye

    2008-01-01

    The current approach to breast reconstruction remains largely subjective and is based on physical examination and visual-estimates of breast size. Thus, the overall success of breast reconstruction is limited by the inability of plastic surgeons to objectively assess breast volume and shape, which may result in suboptimal outcomes. A potential solution to this obstacle may be three-dimensional (3D) imaging, which can provide unique clinical data that was previously unattainable to plastic surgeons. The following study represents a prospective analysis of patient volunteers undergoing unilateral tissue expander (TE)-implant reconstruction by one of the two senior authors (MC, NSK). All patients underwent unilateral mastectomy with immediate or delayed insertion of a TE, followed by an exchange for a permanent silicone or saline implant. 3D scans were obtained during routine pre- and postoperative office visits. The 3D breast-volume calculations served as a guide for surgical management. Twelve patients have completed 3D-assisted unilateral breast reconstruction to date. These patients represent a wide range of body habitus and breast size/shape; 3D volume range from 136 to 518 cm(3). The mean baseline breast asymmetry in this group was 12.0 +/- 10.8%. Contralateral symmetry procedures were performed in eleven patients, consisting of the following: mastopexy (n = 6), augmentation (n = 1), mastopexy/augmentation (n = 2), and reduction mammoplasty (n = 2). Reconstruction was completed in a total number of 2 (n = 10) or 3 (n = 2) operations. Overall breast symmetry improved at the completion of reconstruction in the majority of patients, with an average postoperative symmetry of 95.1 +/- 4.4% (relative to 88% preoperatively). 3D imaging serves a valuable adjunct to TE-implant breast reconstruction. This technology provides volumetric data that can help guide breast reconstruction, such as in choosing the initial TE size, total volume of expansion, and final implant size

  16. Lipofilling as a method of reconstructive treatment of breast cancer patients (а review of literature

    Directory of Open Access Journals (Sweden)

    R. V. Lyubota

    2014-01-01

    Full Text Available Lipofilling is one of the most promising directions in reconstructive surgery in patients with breast cancer (ВС. Although, the first transplantation of autologous adipose tissue was performed in the late nineteenth century, widely used techniques associated with the introduction of liposuction (1980s years, which greatly simplified the fence autologous adipose tissue for subsequent transplantation. In clinical studies were proved efficacy and safety lipofilling for reconstruction in patients with ВС. In this paper presents the current data on the efficacy and safety of lipofilling as the primary or secondary method of reconstructive treatment of patients with ВС.

  17. Effects of detector blur and correlated noise on digital breast tomosynthesis reconstruction

    Science.gov (United States)

    Zheng, Jiabei; Fessler, Jeffrey A.; Chan, Heang-Ping

    2017-03-01

    To improve digital breast tomosynthesis (DBT) image quality, we are developing model-based iterative reconstruction methods. We developed the SQS-DBCN algorithm, which incorporated detector blur into the system model and correlation into the noise model under some simplifying assumptions. In this paper, we further improved the regularization in the SQS-DBCN method by incorporating neighbors along the diagonal directions. To further understand the role of the different components in the system model of the SQS-DBCN method, we reconstructed DBT images without modeling either the detector blur or noise correlation for comparison. Visual comparison of the reconstructed images showed that regularizing with diagonal directions reduced artifacts and the noise level. The SQS-DBCN reconstructed images had better image quality than reconstructions without models for detector blur or correlated noise, as indicated by the contrast-to-noise ratios (CNR) of MCs and textural artifacts. These results indicated that regularized DBT reconstruction with detector blur and correlated noise modeling, even with simplifying assumptions, can improve DBT image quality compared to that without system modeling.

  18. Local recurrence following mastectomy and autologous breast reconstruction: incidence, risk factors, and management

    Directory of Open Access Journals (Sweden)

    Wu S

    2016-11-01

    Full Text Available Siyu Wu,1,2 Miao Mo,3 Yujie Wang,1,2 Na Zhang,1,2 Jianwei Li,1,2 Genhong Di,1,2 Zhimin Shao,1,2 Jiong Wu,1,2 Guangyu Liu1,2 1Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, 2Department of Oncology, Shanghai Medical College, Fudan University, 3Clinical Statistics Center, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China Background: Breast reconstruction (BR, including autologous breast reconstruction (ABR after mastectomy (MST, has been gaining popularity all around the world, especially in the People’s Republic of China during the past decade. However, there is a small proportion, but a significant number, of patients who develop local recurrence (LR of breast cancer postoperatively. The purpose of this study is to examine the incidence of LR, discuss risk factors associated with LR, and management of LR following MST and ABR. Methods: A total of 397 patients who underwent MST and ABR after diagnosis of breast cancer were included in this retrospective study. Data were analyzed by the Kaplan–Meier method, the log-rank statistical test, and Cox proportional hazards model. Results: From January 1999 to December 2011, 400 ABRs were performed in 397 patients in Fudan University Shanghai Cancer Center. The median follow-up time in the study was 3.6 years. LR occurred in 11 of 397 patients, with a median time to LR of 2.9 years. In univariate and multivariate analyses, tumor stage, hormonal therapy (yes or no, and tumor type (multifocal or nonmultifocal were significantly associated with LR after ABR following MST. Conclusion: ABR is an oncologically safe surgical procedure with an acceptable LR rate of 2.8%. Risk factors associated with high rate of LR were higher tumor stage, absence of hormonal therapy, and multifocal tumor type. Keywords: local recurrence, autologous breast reconstruction, incidence, risk factors, management

  19. The use of a pedunculated, extended latissimus dorsi flap in primary and secondary breast reconstruction procedures--case report.

    Science.gov (United States)

    Maciejewski, Adam; Ulczok, Rafał; Dobrut, Mirosław; Szumniak, Ryszard; Półtorak, Stanisław

    2012-07-01

    The extended latissimus dorsi flap (LD) is used in breast reconstruction since the 70's. LD flap is often used in corrective surgery in cases of unsatisfactory cosmetic results after breast-conserving therapy. In our department LD flap has several uses. In addition to free microvascular flaps - which applies in breast reconstructive surgery is routine, there are clinical situations where the use of pedicled LD flap is justified. The main indications for its use are: the inability to apply microvascular flap, the general condition (diabetes, advanced atherosclerosis), smoking, previous surgery of abdominal wall, abdominal obesity, patient preferences. Approximately 30% of patients after breast reconstruction require corrective procedures. Group which uses extended LD flap account for 24 patients. In 16 cases it was used for elective breast reconstruction. In the remaining eight cases it was used in the corrective procedures symmetry and shape of the previously reconstructed breast. Based on our own experience it can be concluded that the LD flap with an alternative to microvascular techniques. Complication rate when using the LD flap is relatively low and includes: seroma and slight motor disability of the shoulder girdle.

  20. Investigation of optimal parameters for penalized maximum-likelihood reconstruction applied to iodinated contrast-enhanced breast CT

    Science.gov (United States)

    Makeev, Andrey; Ikejimba, Lynda; Lo, Joseph Y.; Glick, Stephen J.

    2016-03-01

    Although digital mammography has reduced breast cancer mortality by approximately 30%, sensitivity and specificity are still far from perfect. In particular, the performance of mammography is especially limited for women with dense breast tissue. Two out of every three biopsies performed in the U.S. are unnecessary, thereby resulting in increased patient anxiety, pain, and possible complications. One promising tomographic breast imaging method that has recently been approved by the FDA is dedicated breast computed tomography (BCT). However, visualizing lesions with BCT can still be challenging for women with dense breast tissue due to the minimal contrast for lesions surrounded by fibroglandular tissue. In recent years there has been renewed interest in improving lesion conspicuity in x-ray breast imaging by administration of an iodinated contrast agent. Due to the fully 3-D imaging nature of BCT, as well as sub-optimal contrast enhancement while the breast is under compression with mammography and breast tomosynthesis, dedicated BCT of the uncompressed breast is likely to offer the best solution for injected contrast-enhanced x-ray breast imaging. It is well known that use of statistically-based iterative reconstruction in CT results in improved image quality at lower radiation dose. Here we investigate possible improvements in image reconstruction for BCT, by optimizing free regularization parameter in method of maximum likelihood and comparing its performance with clinical cone-beam filtered backprojection (FBP) algorithm.

  1. Significance of the inframammary crease for reconstruction of the breast and methods for its restoration (a review of literature

    Directory of Open Access Journals (Sweden)

    I. F. Kamaletdinov

    2015-01-01

    Full Text Available The use of tissue expanders thanks to its simplicity and efficacy is the most common method of breast reconstruction today. However,the common problem during this procedure is lack of the inframammary crease (IMC that is disrupted during radical treatment for cancer, which prevents the achievement of symmetry with the contralateral breast. IMC is an important component of the attractive aesthetically normal appearance of the breast, since it plays a considerable role in the formation and maintenance of its shape; it is one of the most important elements of the natural manifestation of breast ptosis and ensures the lower support for subpectorally located endoprostheses, which keeps them from malposition. If the IMC is slightly pronounced, asymmetrically located, or displaced in the postoperative period, it virtually negatively affects all other contours, including the shape of the upper and lower poles, the position of the breast on the chest, and the degree of symmetry with the contralateral breast. Thus, the development and mastering of the surgical techniques, which reconstruct properly and hold the position of this structure, is an urgent component of successful reconstructive surgery. This paper analyzes the significance of IMC for reconstruction of the breast and also reviews current methods for its restoration.

  2. Central Breast Excision With Immediate Autologous Reconstruction for Recurrent Periductal Sepsis: An Application of Oncoplastic Surgical Techniques

    Science.gov (United States)

    Gore, Sinclair M.; Wishart, Gordon C.; Malata, Charles M.

    2012-01-01

    Objective: The aim of this procedure was to definitively treat periductal mastitis and periareolar sepsis which was previously resistant to multiple surgical procedures and nonoperative treatment of chronic nipple sepsis. Methods: We employed a multidisciplinary approach to the treatment of end-stage periductal mastitis using a combination of central breast excision and immediate autologous latissimus dorsi flap reconstruction. Results: Clearance of periductal mastitis and infection has been achieved with no recurrence at 3 years. Good symmetry of breast shape and volume has been achieved using this technique. Conclusions: This method of partial breast reconstruction, commonly used for reconstruction of breast cancer ablative defects, may also provide good outcomes in nonmalignant disease. PMID:22893784

  3. Experiences with microsurgical tissue transfers in elderly patients.

    Science.gov (United States)

    Ozkan, Omer; Ozgentas, H Ege; Islamoglu, Kemal; Boztug, Neval; Bigat, Zekiye; Dikici, M Bahadir

    2005-01-01

    The combination of advances in microsurgery and the improvement of anesthetic management with increased understanding of the physiology of preoperative and postoperative care has significantly raised the upper age limit for free-flap transfer in elderly patients. Despite pessimistic opinions regarding elderly patients who have poor recovery potential and decreased physiological reserves, the unique feature of free-tissue transfer is that it allows the transfer of well-vascularized tissue to defects in a single-stage procedure, and leads to improved quality of life. In this report, a retrospective analysis of 55 patients aged 50 and older who underwent microsurgical tissue transfer is presented. Hospital and our own records were used to review various parameters. The preoperative medical status of each patient was assessed using the American Society of Anesthesiologists (ASA) Classification of Physical Status. Each patient's preoperative medical records, age, sex, transferred tissue type, and length of operation were outlined. Postoperative recorded parameters were the fate of flaps and the short-term postoperative outcome, including surgical complications, medical morbidity, and death within 30 days of surgery. Fifty-eight microvascular tissue transfers were performed in 55 consecutive patients. The study comprised 38 male and 17 female patients, with a mean age of 64.8 years. ASA classification status was class 1 for 15 patients, class 2 for 26 patients, and class 3 for 14 patients. Twenty-five flaps were used for lower extremity reconstruction, 32 flaps were used for head and neck reconstruction, and 1 was used for breast reconstruction. The average operative time was 5.7 h, ranging between 2-13 h. There were 14 major medical complications, resulting in an overall medical complication rate of 25%. There were 3 deaths within 30 days postoperatively. Thus, the overall surgical mortality rate was 5.4%. The longer operation times were associated with the development

  4. Surgical complications of skin sparing mastectomy and immediate prosthetic reconstruction after neoadjuvant chemotherapy for invasive breast cancer.

    Science.gov (United States)

    Donker, M; Hage, J J; Woerdeman, L A E; Rutgers, E J Th; Sonke, G S; Vrancken Peeters, M-J T F D

    2012-01-01

    Neoadjuvant chemotherapy is gaining acceptance as an option for breast cancer treatment, particularly in young women. These women may seek immediate breast reconstruction after mastectomy even though it is not known whether such preoperative chemotherapy may be detrimental to post-reconstruction wound healing. Therefore, we set out to assess the influence of neoadjuvant chemotherapy for invasive breast cancer on the short-term complications after skin sparing mastectomy and immediate prosthetic reconstruction. The short-term surgical outcome of 48 immediate breast reconstructions in 37 women treated with neoadjuvant chemotherapy from 2006 through 2009 was prospectively compared to that of 215 immediate reconstructions in 176 women who were operated in the same period without neoadjuvant chemotherapy. The overall rate of short-term postoperative complications was significantly less among neoadjuvantly treated women (15% vs. 29%; p = 0.042) but this did not result in a reduction of loss of prostheses (8% vs. 11%; p = 0.566). Because neoadjuvant chemotherapy is not associated with an increase in short-term complications after skin sparing mastectomy and immediate prosthetic reconstruction in patients with invasive breast cancer, such combined surgical therapy may be offered as treatment option for this particular group of patients also. Copyright © 2011 Elsevier Ltd. All rights reserved.

  5. Breast augmentation surgery

    Science.gov (United States)

    ... on the underside of your breast, in the natural skin fold. The surgeon places the implant through this ... lift Breast pain Breast reconstruction - implants Breast reconstruction - natural tissue Breast ... wound care - open Review Date 2/10/2015 Updated by: ...

  6. Rib-sparing internal mammary vessel harvest for microvascular breast reconstruction in 100 consecutive cases.

    Science.gov (United States)

    Sacks, Justin M; Chang, David W

    2009-05-01

    Using the internal mammary vessels as recipient vessels in free-flap autologous breast reconstruction has become a common practice. However, these vessels are typically accessed by removing a costochondral segment. The purpose of this study was to describe the authors' rib-sparing technique for accessing the internal mammary vessels that is efficient and reliable and limits chest wall morbidity. The authors analyzed 100 consecutive free-tissue transfers for breast reconstruction in which the internal mammary vessels were accessed using a rib-sparing technique. The data were obtained from a prospectively maintained database and medical records. Of the 100 free-flap reconstructions, 47 used deep inferior epigastric perforator flaps, 45 used muscle-sparing transverse rectus abdominis myocutaneous flaps, six used superficial inferior epigastric artery flaps, and two used superior gluteal artery perforator flaps. No rib cartilage was removed in 66, but a segment of rib cartilage was removed in 34 procedures to optimize the exposure and facilitate anastomosis. After the initial learning curve, however, the internal mammary vessels were used in approximately 90 percent of cases without removal of any rib cartilage. The third intercostal space was used to access the internal mammary vessels two-thirds of the time, and the second intercostal space was used one-third of the time. There were no incidences of complications or morbidity associated with the rib-sparing approach to internal mammary vessel harvest. For most patients, the rib-sparing technique is an efficient and safe approach for exposing the internal mammary vasculature for microvascular breast reconstruction while minimizing chest wall morbidity.

  7. Patterns and outcomes of breast reconstruction in older women - A systematic review of the literature.

    Science.gov (United States)

    Oh, D D; Flitcroft, K; Brennan, M E; Spillane, A J

    2016-05-01

    Older age is associated with lower rates of breast reconstruction (BR) for women requiring mastectomy. The purpose was to assess the available evidence on uptake, outcome and quality of life (QoL) after BR in older women. A systematic literature review was performed via Medline, Embase and Cochrane databases using the search terms breast reconstruction, breast cancer, and mastectomy. Eligible studies reported rates of BR, rates of different reconstructive techniques, complication rates, and/or patient reported outcome measures (PROMs) of BR in women aged 60 years or older undergoing mastectomy for ductal carcinoma in situ or invasive carcinoma. A total of 42 eligible studies were included, with 32 of these reporting BR rates, 10 reporting rates of different reconstructive techniques, 10 reporting rates of complications, and four reporting PROMs. The studies reported 24,746 cases of BR in 407,570 mastectomy patients aged 60 years or older from 1987 to 2012. Implant based BR was more common than autologous techniques. Mostly, complication rates were not higher in older women, and QoL outcomes were similar to younger women. This review confirms that BR rates are lower in older women despite recent studies demonstrating its efficacy. The perception among some surgeons and women requiring mastectomy that the potential risks of BR in older women outweigh the benefits needs to be revisited. Education of consumers and surgeons along with public advocacy for offering BR to all clinically eligible women are the most promising means of changing practice. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Increased Flap Weight and Decreased Perforator Number Predict Fat Necrosis in DIEP Breast Reconstruction.

    Science.gov (United States)

    Mulvey, Carolyn L; Cooney, Carisa M; Daily, Francis F; Colantuoni, Elizabeth; Ogbuago, Onyebuchi U; Cooney, Damon S; Rad, Ariel N; Manahan, Michele A; Rosson, Gedge D; Sacks, Justin M

    2013-05-01

    Compromised perfusion in autologous breast reconstruction results in fat necrosis and flap loss. Increased flap weight with fewer perforator vessels may exacerbate imbalances in flap perfusion. We studied deep inferior epigastric perforator (DIEP) and muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flaps to assess this concept. Data from patients who underwent reconstruction with DIEP and/or MS-TRAM flaps between January 1, 2010 and December 31, 2011 (n = 123) were retrospectively reviewed. Patient demographics, comorbidities, intraoperative parameters, and postoperative outcomes were collected, including flap fat necrosis and donor/recipient site complications. Logistic regression analysis was used to examine effects of flap weight and perforator number on breast flap fat necrosis. One hundred twenty-three patients who underwent 179 total flap reconstructions (166 DIEP, 13 MS-TRAM) were included. Mean flap weight was 658 ± 289 g; 132 (73.7%) were single perforator flaps. Thirteen flaps (7.5%) developed fat necrosis. African American patients had increased odds of fat necrosis (odds ratio, 11.58; P fat necrosis significantly increased with flap weight (odds ratio, 1.5 per 100 g increase; P fat necrosis, compared to 14.3% of large multiple perforator flaps. Flaps with increasing weight have increased risk of fat necrosis. These data suggest that inclusion of more than 1 perforator may decrease odds of fat necrosis in large flaps. Perforator flap breast reconstruction can be performed safely; however, considerations concerning race, body mass index, staging with tissue expanders, perforator number, and flap weight may optimize outcomes.

  9. Fibrotic changes after postmastectomy radiotherapy and reconstructive surgery in breast cancer. A retrospective analysis in 109 patients

    Energy Technology Data Exchange (ETDEWEB)

    Classen, Johannes [Tuebingen Univ. (Germany). Dept. of Radiation Oncology; St. Vincentius-Kliniken, Karlsruhe (Germany). Dept. of Radiation Oncology; Nitzsche, Sibille [St. Vincentius-Kliniken, Karlsruhe (Germany). Dept. of Radiation Oncology; Wallwiener, Diethelm; Brucker, Sara [Tuebingen Univ. (Germany). Dept. of Gynecology; Kristen, Peter [Kreiskliniken Reutlingen (Germany). Dept. of Gynecology; Souchon, Rainer; Bamberg, Michael [Tuebingen Univ. (Germany). Dept. of Radiation Oncology

    2010-11-15

    The purpose of this study was to analyze the probability and time course of fibrotic changes in breast reconstruction before or after postmastectomy radiotherapy (PMRT). Between 1995 and 2004, 109 patients were treated with PMRT at Tuebingen University and underwent heterologous (HL) or autologous (AL) breast reconstruction prior or subsequent to radiation therapy. Fibrosis of the reconstructed breast after radiotherapy was assessed using the Baker score for HL reconstructions and the Common Terminology Criteria for Adverse Events (CTCAE) for all patients. Actuarial rates of fibrosis were calculated for the maximum degree acquired during follow- up and at the last follow-up visit documented. Median time to follow-up was 34 months (3-227 months). Radiotherapy was applied with a median total dose of 50.4 Gy. A total of 44 patients (40.4%) received a boost treatment with a median dose of 10 Gy. Breast reconstruction was performed with AL, HL, or combined techniques in 20, 82, and 7 patients, respectively. The 3-year incidence of {>=} grade III maximum fibrosis was 20% and 43% for Baker and CTCAE scores, respectively. The corresponding figures for fibrosis at last follow-up visit were 18% and 2%. The 3-year rate of surgical correction of the contralateral breast was 30%. Initially unplanned surgery of the reconstructed breast was performed in 39 patients (35.8%). Boost treatment and type of cosmetic surgery (HL vs. AL) were not significantly associated with the incidence of fibrosis. We found severe fibrosis to be a frequent complication after PMRT radiotherapy and breast reconstruction. However, surgical intervention can ameliorate the majority of high grade fibrotic events leading to acceptable long-term results. No treatment parameters associated with the rate of fibrosis could be identified. (orig.)

  10. Quality of life after mastectomy with or without immediate breast reconstruction.

    Science.gov (United States)

    Dauplat, J; Kwiatkowski, F; Rouanet, P; Delay, E; Clough, K; Verhaeghe, J L; Raoust, I; Houvenaeghel, G; Lemasurier, P; Thivat, E; Pomel, C

    2017-08-01

    Mastectomy with immediate breast reconstruction (IBR) is a surgical strategy in breast cancer when breast-conserving surgery is not an option. There is a lack of evidence showing an advantage of mastectomy plus IBR over mastectomy alone on health-related quality of life (QoL). A large prospective multicentre survey, STIC-RMI (support of innovative and expensive techniques - immediate breast reconstruction), was undertaken to study the changes in QoL in patients treated by mastectomy with or without IBR. Patients were recruited between 2007 and 2009. European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-BR23 instruments were used to assess QoL before operation, and at 6 and 12 months after surgery. A propensity score was used to compare QoL between mastectomy alone and mastectomy plus IBR, with limited bias. A total of 595 patients were included from 22 French academic hospitals, of whom 407 (68·4 per cent) underwent IBR. One-year data were available for 71·1 per cent of patients. Factors associated with IBR were age, histological tumour type, palpable nodes and an attempt at breast-conserving surgery. At inclusion, QoL was significantly better in the IBR group (P mastectomy alone (P = 0·037). Satisfaction with the cosmetic outcome strongly influenced QoL, especially in upper quartiles (P mastectomy. The QoL benefit provided by IBR depends on patients' life status at inclusion; young active women with an in situ tumour are more likely to preserve their QoL after IBR. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

  11. Bilateral Breast Reconstruction with Abdominal Free Flaps: A Single Centre, Single Surgeon Retrospective Review of 55 Consecutive Patients

    Directory of Open Access Journals (Sweden)

    Peter McAllister

    2016-01-01

    Full Text Available Breast reconstruction using free tissue transfer is an increasingly utilised oncoplastic procedure. The aim was to review all bilateral breast reconstructions using abdominal free flaps by a single surgeon over an 11-year period (2003–2014. A retrospective review was performed on all patients who underwent bilateral breast reconstruction using abdominal free flaps between 2003 and 2014 by the senior author (DAM. Data analysed included patient demographics, indication for reconstruction, surgical details, and complications. Fifty-five female patients (mean 48.6 years [24–71 years] had bilateral breast reconstruction. The majority (41, 74.5% underwent immediate reconstruction and DIEP flaps were utilised on 41 (74.5% occasions. Major surgical complications occurred in 6 (10.9% patients, all of which were postoperative vascular compromise of the flap. Failure to salvage the reconstruction occurred on 3 (5.5% occasions resulting in a total flap failure rate of 2.7%. Obesity (>30 kg/m2 and age > 60 years were shown to have a statistically increased risk of developing postoperative complications (P60 years were associated with higher complication rates.

  12. Quality of life and affective distress in women seeking immediate versus delayed breast reconstruction after mastectomy for breast cancer.

    Science.gov (United States)

    Roth, Randy S; Lowery, Julie C; Davis, Jennifer; Wilkins, Edwin G

    2005-09-15

    This study compared the presurgical psychosocial and functional status of 238 women seeking breast reconstruction, either at the time of their mastectomy (immediate) (n = 151) or after prior mastectomy (delayed) (n = 87). Delayed subjects were further categorized in groups of time-since-mastectomy to examine the effects of time on postmastectomy psychosocial adjustment. Presurgical measures of quality of life, psychological distress, and somatic anxiety were obtained. The results revealed relative impairment of quality of life and psychosocial functioning for immediate compared with delayed subjects. Immediate subjects reported greater disturbance in general mental health functioning, more severe impairment in emotional well being related to their cancer diagnosis, and higher levels of anxiety. Immediate subjects also reported a trend toward greater disturbance in work and daily activities, more frequent interference in social activities, and less vitality. Similarly, it was noted that the immediate group reported greater impairment in physical and functional well being related to their cancer adjustment. On psychological assessment, immediate subjects were more likely to report higher levels of affective distress, depressive symptoms, and obsessive-compulsive traits. For the delayed group, no statistically significant differences in the dependent measures were obtained when comparing subjects at 1 year, 2 years, and more than 2 years after mastectomy. Women seeking immediate reconstruction at the time of mastectomy show a relatively higher incidence of psychosocial impairment and functional disability. Women who undergo mastectomy demonstrate early restoration of psychosocial health within the first year after surgery. Patient preoperative psychosocial distress may have important implications for clinical decision-making and surgical outcome for women seeking combined mastectomy and breast reconstruction.

  13. Low-cost surface reconstruction for aesthetic results assessment and prediction in breast cancer surgery.

    Science.gov (United States)

    Lacher, Rene M; Hipwell, John H; Williams, Norman R; Keshtgar, Mohammed R S; Hawkes, David J; Stoyanov, Danail

    2015-08-01

    The high incidence and low mortality of breast cancer surgery has led to an increasing emphasis on the cosmetic outcome of surgical treatment. Advances in aesthetic evaluation, as well as surgical planning and outcome prediction, have been investigated by using geometrically precise 3D modelling of the breast surface prior to surgery and after the procedure. However, existing solutions are based on expensive site specific setups and remain weakly validated. In this paper, we explore the possibility of using low-cost RGBD cameras as an affordable and mobile system for breast surface reconstruction. The methodology relies on sensor calibration, uncertainty-driven point filtering, dense reconstruction and subsequent multi-view joint optimization to diffuse residual pose errors. Results from a phantom study, with ground truth obtained through commercially available scanners, indicate that the approach is promising with RMS errors in order of 2 mm. A clinical study shows the practical applicability of our method and compares favourably to high-end scanning solutions.

  14. Once is Rarely Enough: A Population-Based Study of Reoperations after Postmastectomy Breast Reconstruction.

    Science.gov (United States)

    Roberts, Amanda; Baxter, Nancy; Camacho, Ximena; Lau, Cindy; Zhong, Toni

    2015-10-01

    Postmastectomy breast reconstruction (PMBR) aims to surgically restore a breast mound following mastectomy. However, additional surgical procedures after PMBR can lead to increased postsurgical morbidity and healthcare utilization. The primary purpose of our study was to determine the overall population-based reoperation rates following PMBR in Ontario, Canada. We conducted a population-based retrospective cohort study that included women aged 18-65 years who underwent a prophylactic or therapeutic mastectomy with immediate or delayed PMBR between April 1, 2002 and March 31, 2008. Reoperations to the breast or donor site used for reconstruction were identified using the Ontario Health Insurance Plan billing codes submitted by general or plastic surgeons. Reoperations were categorized as anticipated, unanticipated major, unanticipated minor, or oncologic. Patients were followed from the date of their PMBR to March 31, 2013, or death. Overall, 3972 women underwent PMBR between April 1, 2002 and March 31, 2008. Among them, 3504 (88%) underwent at least one reoperation during an average follow-up of 5.1 years. The median number of procedures per patient was two (mean 2.4, range 0-26). One of ten patients had three or more unanticipated major reoperations during the follow-up period. Our results provide the first long-term population-level data on the current state of PMBR reoperation rates. The results from this study will inform patient-physician surgical decision-making and provide quantitative expectations of morbidity related to PMBR.

  15. [Tattooing of the nipple-areola complex in breast reconstruction: Technical note].

    Science.gov (United States)

    Riot, S; Devinck, F; Aljudaibi, N; Duquennoy-Martinot, V; Guerreschi, P

    2016-04-01

    The reconstruction of the nipple-areola complex is an essential step in breast reconstruction. It announces the end of the reconstruction process, which is often long and sometimes difficult to live for the patient and will significantly improve the perception of body image. Concerning the reconstruction of the areola, tattooing is one of the preferred techniques. It's a simple, quick and safe procedure with a high satisfaction rate. This technique is still perfectible in our opinion, because the random lifetime of pigmentation is a recognized disadvantage of this procedure. We propose a modification of the conventional technique for improving the quality of dermopigmentation while reducing its completion time. Our method is to perform a dermabrasion before starting the tattoo. Indeed, dermabrasion allows better penetration of the pigments inside the dermis and thus offers two advantages: a more durable result over time and reduced operation time by reducing the number of passing of the machine tattoo. Finally, our tattooing technique seems relevant and totally appropriate: its realization is simple, reproducible, does not increase the overall cost of reconstruction, provides timesavings and gives a better long-term result.

  16. Statistical iterative reconstruction to improve image quality for digital breast tomosynthesis

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Shiyu, E-mail: shiyu.xu@gmail.com; Chen, Ying, E-mail: adachen@siu.edu [Department of Electrical and Computer Engineering, Southern Illinois University Carbondale, Carbondale, Illinois 62901 (United States); Lu, Jianping; Zhou, Otto [Department of Physics and Astronomy and Curriculum in Applied Sciences and Engineering, University of North Carolina Chapel Hill, Chapel Hill, North Carolina 27599 (United States)

    2015-09-15

    Purpose: Digital breast tomosynthesis (DBT) is a novel modality with the potential to improve early detection of breast cancer by providing three-dimensional (3D) imaging with a low radiation dose. 3D image reconstruction presents some challenges: cone-beam and flat-panel geometry, and highly incomplete sampling. A promising means to overcome these challenges is statistical iterative reconstruction (IR), since it provides the flexibility of accurate physics modeling and a general description of system geometry. The authors’ goal was to develop techniques for applying statistical IR to tomosynthesis imaging data. Methods: These techniques include the following: a physics model with a local voxel-pair based prior with flexible parameters to fine-tune image quality; a precomputed parameter λ in the prior, to remove data dependence and to achieve a uniform resolution property; an effective ray-driven technique to compute the forward and backprojection; and an oversampled, ray-driven method to perform high resolution reconstruction with a practical region-of-interest technique. To assess the performance of these techniques, the authors acquired phantom data on the stationary DBT prototype system. To solve the estimation problem, the authors proposed an optimization-transfer based algorithm framework that potentially allows fewer iterations to achieve an acceptably converged reconstruction. Results: IR improved the detectability of low-contrast and small microcalcifications, reduced cross-plane artifacts, improved spatial resolution, and lowered noise in reconstructed images. Conclusions: Although the computational load remains a significant challenge for practical development, the superior image quality provided by statistical IR, combined with advancing computational techniques, may bring benefits to screening, diagnostics, and intraoperative imaging in clinical applications.

  17. Skin/nipple sparing mastectomies and implant-based breast reconstruction in patients with large and ptotic breast: oncological and reconstructive results.

    Science.gov (United States)

    Nava, Maurizio B; Ottolenghi, Joseph; Pennati, Angela; Spano, Andrea; Bruno, Novella; Catanuto, Giuseppe; Boliglowa, Dominik; Visintini, Valentina; Santoro, Stefano; Folli, Secondo

    2012-06-01

    In this study we performed 77 procedures on 65 patients fulfilling the oncological criteria for skin-sparing mastectomy and presenting with large or medium size breasts. All the operations were performed as a single-stage procedure with an anatomical prosthesis allocated into a compound pouch, made up of the pectoralis major, serratus anterior fascia, and a lower dermal adipose flap. The medium size of the anatomical implants employed was 444.3 cc. The implant removal rate was 14.2%. At a median follow-up of 36 months we reported a 0.5% local recurrence rate per year. The overall specific survival rate was 98.2%. This study confirms the safety and effectiveness of this technical variation of skin and nipple-sparing mastectomies. All breast, irrespective of mammary shape and size, can be reconstructed with medium size implants and, if required, contralateral adjustments. The overall complication rate is in keeping with previous studies. Copyright © 2011 Elsevier Ltd. All rights reserved.

  18. Comparison of aesthetic breast reconstruction after skin-sparing or conventional mastectomy in patients receiving preoperative radiation therapy.

    Science.gov (United States)

    Chang, Eric I; Ly, Daphne P; Wey, Philip D

    2007-07-01

    Many options exist for the surgical treatment of breast cancer in terms of tumor extirpation and reconstruction. Skin-sparing mastectomy (SSM) with immediate reconstruction offers patients a superior result, but this can be jeopardized by preoperative radiotherapy. We compared the outcomes of reconstruction after SSM or conventional mastectomy (CM) in the previously irradiated breast. We evaluated 41 patients over an 8-year period, who were divided into 3 categories: preoperative radiotherapy prior to SSM (n = 8), CM after preoperative radiation therapy (n = 9), and no chest wall irradiation prior to SSM (n = 20). The first group demonstrated significantly higher frequency of native flap compromise and capsular contracture formation than the other 2 groups.SSM with TRAM or latissimus with implant reconstruction is an esthetically optimal option for the treatment of patients without previous radiotherapy. However, for patients with preoperative chest wall radiation, TRAM flap reconstruction was superior to latissimus flap with implant after SSM.

  19. Ensuring convergence in total-variation-based reconstruction for accurate microcalcification imaging in breast X-ray CT

    DEFF Research Database (Denmark)

    Jørgensen, Jakob Heide; Sidky, Emil Y.; Pan, Xiaochuan

    2011-01-01

    , shows potential for reconstruction from sparse-view data. For iterative methods it is important to ensure convergence to an accurate solution, since important diagnostic image features, such as presence of microcalcifications indicating breast cancer, may not be visible in a non-converged reconstruction......, and this can have clinical significance. To prevent excessively long computational times, which is a practical concern for the large image arrays in CT, it is desirable to keep the number of iterations low, while still ensuring a sufficiently accurate reconstruction for the specific imaging task....... This motivates the study of accurate convergence criteria for iterative image reconstruction. In simulation studies with a realistic breast phantom with microcalcifications we investigate the issue of ensuring sufficiently converged solution for reliable reconstruction. Our results show that it can...

  20. Ensuring convergence in total-variation-based reconstruction for accurate microcalcification imaging in breast X-ray CT

    CERN Document Server

    Jørgensen, Jakob H; Pan, Xiaochuan

    2011-01-01

    Breast X-ray CT imaging is being considered in screening as an extension to mammography. As a large fraction of the population will be exposed to radiation, low-dose imaging is essential. Iterative image reconstruction based on solving an optimization problem, such as Total-Variation minimization, shows potential for reconstruction from sparse-view data. For iterative methods it is important to ensure convergence to an accurate solution, since important image features, such as presence of microcalcifications indicating breast cancer, may not be visible in a non-converged reconstruction, and this can have clinical significance. To prevent excessively long computational times, which is a practical concern for the large image arrays in CT, it is desirable to keep the number of iterations low, while still ensuring a sufficiently accurate reconstruction for the specific imaging task. This motivates the study of accurate convergence criteria for iterative image reconstruction. In simulation studies with a realistic...

  1. Image reconstruction for a Positron Emission Tomograph optimized for breast cancer imaging

    Energy Technology Data Exchange (ETDEWEB)

    Virador, Patrick R.G.

    2000-04-01

    The author performs image reconstruction for a novel Positron Emission Tomography camera that is optimized for breast cancer imaging. This work addresses for the first time, the problem of fully-3D, tomographic reconstruction using a septa-less, stationary, (i.e. no rotation or linear motion), and rectangular camera whose Field of View (FOV) encompasses the entire volume enclosed by detector modules capable of measuring Depth of Interaction (DOI) information. The camera is rectangular in shape in order to accommodate breasts of varying sizes while allowing for soft compression of the breast during the scan. This non-standard geometry of the camera exacerbates two problems: (a) radial elongation due to crystal penetration and (b) reconstructing images from irregularly sampled data. Packing considerations also give rise to regions in projection space that are not sampled which lead to missing information. The author presents new Fourier Methods based image reconstruction algorithms that incorporate DOI information and accommodate the irregular sampling of the camera in a consistent manner by defining lines of responses (LORs) between the measured interaction points instead of rebinning the events into predefined crystal face LORs which is the only other method to handle DOI information proposed thus far. The new procedures maximize the use of the increased sampling provided by the DOI while minimizing interpolation in the data. The new algorithms use fixed-width evenly spaced radial bins in order to take advantage of the speed of the Fast Fourier Transform (FFT), which necessitates the use of irregular angular sampling in order to minimize the number of unnormalizable Zero-Efficiency Bins (ZEBs). In order to address the persisting ZEBs and the issue of missing information originating from packing considerations, the algorithms (a) perform nearest neighbor smoothing in 2D in the radial bins (b) employ a semi-iterative procedure in order to estimate the unsampled data

  2. Image reconstruction for a Positron Emission Tomograph optimized for breast cancer imaging

    Energy Technology Data Exchange (ETDEWEB)

    Virador, Patrick R.G. [Univ. of California, Berkeley, CA (United States)

    2000-04-01

    The author performs image reconstruction for a novel Positron Emission Tomography camera that is optimized for breast cancer imaging. This work addresses for the first time, the problem of fully-3D, tomographic reconstruction using a septa-less, stationary, (i.e. no rotation or linear motion), and rectangular camera whose Field of View (FOV) encompasses the entire volume enclosed by detector modules capable of measuring Depth of Interaction (DOI) information. The camera is rectangular in shape in order to accommodate breasts of varying sizes while allowing for soft compression of the breast during the scan. This non-standard geometry of the camera exacerbates two problems: (a) radial elongation due to crystal penetration and (b) reconstructing images from irregularly sampled data. Packing considerations also give rise to regions in projection space that are not sampled which lead to missing information. The author presents new Fourier Methods based image reconstruction algorithms that incorporate DOI information and accommodate the irregular sampling of the camera in a consistent manner by defining lines of responses (LORs) between the measured interaction points instead of rebinning the events into predefined crystal face LORs which is the only other method to handle DOI information proposed thus far. The new procedures maximize the use of the increased sampling provided by the DOI while minimizing interpolation in the data. The new algorithms use fixed-width evenly spaced radial bins in order to take advantage of the speed of the Fast Fourier Transform (FFT), which necessitates the use of irregular angular sampling in order to minimize the number of unnormalizable Zero-Efficiency Bins (ZEBs). In order to address the persisting ZEBs and the issue of missing information originating from packing considerations, the algorithms (a) perform nearest neighbor smoothing in 2D in the radial bins (b) employ a semi-iterative procedure in order to estimate the unsampled data

  3. Clinical data related to breast reconstruction; looking back on the 21th century and forward to the next steps

    Directory of Open Access Journals (Sweden)

    Jecan Cristian Radu

    2015-04-01

    Full Text Available Breast reconstruction after breast cancer surgery represents a positive step in restoring a women’s idea of self by reestablishing her feminine features and confidence, thus improving essential aesthetic and emotional aspects. Regarded as the cornerstone in breast cancer management, the surgical treatment has come a long way since 1884 when W.S. Halsted performed the first radical mastectomy- a disfiguring procedure which was conducted until the late 70s when owing to contemporary advancements it was surpassed by modified radical mastectomies and other far less invasive approaches. Either performed in an immediate or a delayed fashion breast reconstruction can be achieved not only through alloplastic procedures using expander/ implant prosthesis but also through autologous tissue transfers wisely harvested from different parts of the body or through methods that combine the two. When planning a breast reconstruction, after the oncologist formally rules out any form of residual cancer, one must take into consideration several critical factors that will eventually condition the technique election process for example the possible local or systemic adjuvant therapy. Although a “one size fits all” breast reconstruction procedure has yet to prevail, the extensive volume of published literature regarding this matter enables a well-experienced plastic surgeon to proceed with careful procedural selection allowing for the best possible results.

  4. Failed pneumoperitoneum for laparoscopic surgery following autologous Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction: a case report.

    Science.gov (United States)

    Balkin, Daniel M; Duh, Quan-Yang; Kind, Gabriel M; Chang, David S; McGrath, Mary H

    2016-04-27

    Laparoscopic abdominal surgery may prove difficult in patients who have undergone previous abdominal procedures. No reports in the medical literature have presented an aborted laparoscopic procedure for failed pneumoperitoneum following autologous flap-based breast reconstruction. A 55-year-old woman presented with recurrent invasive lobular carcinoma of the right breast as well as a history of ductal carcinoma in situ of the left breast. The patient desired to proceed with bilateral skin- and nipple-sparing mastectomies with right axillary lymph node biopsy, followed by immediate bilateral autologous deep inferior epigastric perforator (DIEP) flap-based breast reconstruction. Preoperatively, a computerized tomography angiogram was obtained for reconstructive preparation, which revealed a left adrenal mass. Ensuing work-up diagnosed a pheochromocytoma. Given the concern for breast cancer progression, the patient elected to proceed first with breast cancer surgery and reconstruction prior to addressing the adrenal tumor. Subsequently, 3 months later the patient was brought to the operating room for a laparoscopic left adrenalectomy for the pheochromocytoma. With complete pharmacologic abdominal relaxation, the abdomen proved too tight to accommodate sufficient pneumoperitoneum and the laparoscopy was aborted. The patient was evaluated in the outpatient setting for assessment of abdominal wall compliance at regular intervals. Five months later, the patient was taken back to the operating room where pneumoperitoneum was established without difficulty and the laparoscopic left adrenalectomy was performed without complications. Pneumoperitoneum for laparoscopic surgery subsequent to autologous DIEP flap-based breast reconstruction may prove difficult as a result of loss of abdominal wall compliance. Prior to performing laparoscopy in such patients, surgeons should consider the details of the patient's previous reconstructive procedure and assess potential risk factors

  5. Comparison of Outcomes with Tissue Expander, Immediate Implant, and Autologous Breast Reconstruction in Greater Than 1000 Nipple-Sparing Mastectomies.

    Science.gov (United States)

    Frey, Jordan D; Choi, Mihye; Salibian, Ara A; Karp, Nolan S

    2017-06-01

    Nipple-sparing mastectomy permits complete preservation of the nipple-areola complex with excellent aesthetic results and with oncologic safety similar to that associated with traditional mastectomy techniques. However, outcomes have not been directly compared for tissue expander-, immediate implant-, and autologous tissue-based breast reconstruction after nipple-sparing mastectomy. All patients undergoing nipple-sparing mastectomy from 2006 to June of 2016 were identified at a single institution. Demographics and outcomes were analyzed and compared among different types of breast reconstruction. A total of 1028 nipple-sparing mastectomies were performed. Of these, 533 (51.8 percent) were tissue expander-based, 263 (25.6 percent) were autologous tissue-based, and 232 (22.6 percent) were immediate implant-based reconstructions. Tissue expander-based reconstructions had significantly more minor cellulitis (p = 0.0002) but less complete nipple necrosis (p = 0.0126) and major mastectomy flap necrosis (p < 0.0001) compared with autologous tissue-based reconstructions. Compared to immediate implant-based reconstruction, tissue expander-based reconstructions had significantly more minor cellulitis (p = 0.0006) but less complete nipple necrosis (p = 0.0005) and major (p < 0.0001) and minor (p = 0.0028) mastectomy flap necrosis (p = 0.0059). Immediate implant-based reconstructions had significantly more minor cellulitis (p = 0.0051), minor mastectomy flap necrosis (p = 0.0425), and partial nipple necrosis (p = 0.0437) compared with autologous tissue-based reconstructions. Outcomes were otherwise equivalent among the three groups. Tissue expander, immediate implant, and autologous tissue breast reconstruction techniques may all be safely offered with nipple-sparing mastectomy. However, reconstructive complications appear to be greater with immediate implant- and autologous tissue-based techniques compared with tissue expander-based reconstruction. Therapeutic, III.

  6. Comparison of Wound Complications After Immediate, Delayed, and Secondary Breast Reconstruction Procedures.

    Science.gov (United States)

    Olsen, Margaret A; Nickel, Katelin B; Fox, Ida K; Margenthaler, Julie A; Wallace, Anna E; Fraser, Victoria J

    2017-09-20

    Few data are available concerning surgical site infection (SSI) and noninfectious wound complications (NIWCs) after delayed (DR) and secondary reconstruction (SR) compared with immediate reconstruction (IR) procedures in the breast. To compare the incidence of SSI and NIWCs after implant and autologous IR, DR, and SR breast procedures after mastectomy. This retrospective cohort study included women aged 18 to 64 years undergoing mastectomy from January 1, 2004, through December 31, 2011. Data were abstracted from a commercial insurer claims database in 12 states and analyzed from January 1, 2015, through February 7, 2017. Reconstruction within 7 days of mastectomy was considered immediate. Reconstruction more than 7 days after mastectomy was considered delayed if the mastectomy did not include IR or secondary if the mastectomy included IR. International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for SSI and NIWCs. Mastectomy was performed in 17 293 women (mean [SD] age, 50.4 [8.5] years); 61.4% of women had IR or DR. Among patients undergoing implant reconstruction, the incidence of SSI was 8.9% (685 of 7655 women) for IR, 5.7% (21 of 369) for DR, and 3.2% (167 of 5150) for SR. Similar results were found for NIWCs. In contrast, the incidence of SSI was similar after autologous IR (9.8% [177 of 1799]), DR (13.9% [19 of 137]), and SR (11.6% [11 of 95]) procedures. Compared with women without an SSI after implant IR, women with an SSI after implant IR were significantly more likely to have another SSI (47 of 412 [11.4%] vs 131 of 4791 [2.7%]) and an NIWC (24 of 412 [5.8%] vs 120 of 4791 [2.5%]) after SR. The incidence of SSI (24 of 379 [6.3%] vs 152 of 5286 [2.9%]) and NIWC (22 of 379 [5.8%] vs 129 of 5286 [2.4%]) after implant SR was higher in women who had received adjuvant radiotherapy. Wound complications after IR were associated with significantly more breast surgical procedures (mean of 1.92 procedures [range, 0-9] after

  7. Individualized Risk of Surgical Complications: An Application of the Breast Reconstruction Risk Assessment Score

    Science.gov (United States)

    Mlodinow, Alexei S.; Khavanin, Nima; Hume, Keith M.; Simmons, Christopher J.; Weiss, Michael J.; Murphy, Robert X.; Gutowski, Karol A.

    2015-01-01

    Background: Risk discussion is a central tenet of the dialogue between surgeon and patient. Risk calculators have recently offered a new way to integrate evidence-based practice into the discussion of individualized patient risk and expectation management. Focusing on the comprehensive Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database, we endeavored to add plastic surgical outcomes to the previously developed Breast Reconstruction Risk Assessment (BRA) score. Methods: The TOPS database from 2008 to 2011 was queried for patients undergoing breast reconstruction. Regression models were constructed for the following complications: seroma, dehiscence, surgical site infection (SSI), explantation, flap failure, reoperation, and overall complications. Results: Of 11,992 cases, 4439 met inclusion criteria. Overall complication rate was 15.9%, with rates of 3.4% for seroma, 4.0% for SSI, 6.1% for dehiscence, 3.7% for explantation, 7.0% for flap loss, and 6.4% for reoperation. Individualized risk models were developed with acceptable goodness of fit, accuracy, and internal validity. Distribution of overall complication risk was broad and asymmetric, meaning that the average risk was often a poor estimate of the risk for any given patient. These models were added to the previously developed open-access version of the risk calculator, available at http://www.BRAscore.org. Conclusions: Population-based measures of risk may not accurately reflect risk for many individual patients. In this era of increasing emphasis on evidence-based medicine, we have developed a breast reconstruction risk assessment calculator from the robust TOPS database. The BRA Score tool can aid in individualizing—and quantifying—risk to better inform surgical decision making and better manage patient expectations. PMID:26090295

  8. Mastectomy Weight and Tissue Expander Volume Predict Necrosis and Increased Costs Associated with Breast Reconstruction

    Science.gov (United States)

    Yalanis, Georgia C.; Nag, Shayoni; Georgek, Jakob R.; Cooney, Carisa M.; Manahan, Michele A.; Rosson, Gedge D.

    2015-01-01

    Introduction: Impaired vascular perfusion in tissue expander (TE) breast reconstruction leads to mastectomy skin necrosis. We investigated factors and costs associated with skin necrosis in postmastectomy breast reconstruction. Methods: Retrospective review of 169 women with immediate TE placement following mastectomy between May 1, 2009 and May 31, 2013 was performed. Patient demographics, comorbidities, intraoperative, and postoperative outcomes were collected. Logistic regression analysis on individual variables was performed to determine the effects of tissue expander fill volume and mastectomy specimen weight on skin necrosis. Billing data was obtained to determine the financial burden associated with necrosis. Results: This study included 253 breast reconstructions with immediate TE placement from 169 women. Skin necrosis occurred in 20 flaps for 15 patients (8.9%). Patients with hypertension had 8 times higher odds of skin necrosis [odd ratio (OR), 8.10, P 300 cm3 had 10 times higher odds of skin necrosis (OR, 10.66, P =0.010). Volumes >400 cm3 had 15 times higher odds of skin necrosis (OR, 15.56, P = 0.002). Mastectomy specimen weight was correlated with skin necrosis. Specimens >500 g had 10 times higher odds of necrosis and specimens >1000 g had 18 times higher odds of necrosis (OR, 10.03 and OR, 18.43; P =0.003 and P Mastectomy skin necrosis was associated with a 50% increased inpatient charge. Conclusion: Mastectomy flap necrosis is associated with HTN, larger TE volumes and mastectomy specimen weights, resulting in increased inpatient charges. Conservative TE volumes should be considered for patients with hypertension and larger mastectomy specimens. PMID:26301139

  9. Autologous breast reconstruction: preoperative magnetic resonance angiography for perforator flap vessel mapping.

    Science.gov (United States)

    Agrawal, Mukta D; Thimmappa, Nanda Deepa; Vasile, Julie V; Levine, Joshua L; Allen, Robert J; Greenspun, David T; Ahn, Christina Y; Chen, Constance M; Hedgire, Sandeep S; Prince, Martin R

    2015-01-01

    Selection of a vascular pedicle for autologous breast reconstruction is time consuming and depends on visual evaluation during the surgery. Preoperative imaging of donor site for mapping the perforator artery anatomy greatly improves the efficiency of perforator selection and significantly reduces the operative time. In this article, we present our experience with magnetic resonance angiography (MRA) for perforator vessel mapping including MRA technique and interpretation. We have performed over 400 MRA examinations from August 2008 to August 2013 at our institution for preoperative imaging of donor site for mapping the perforator vessel anatomy. Using our optimized imaging protocol with blood pool magnetic resonance imaging contrast agents, multiple donor sites can be imaged in a single MRA examination. Following imaging using the postprocessing and reporting tool, we estimated incidence of commonly used perforators for autologous breast reconstruction. In our practice, anterior abdominal wall tissue is the most commonly used donor site for perforator flap breast reconstruction and deep inferior epigastric artery perforators are the most commonly used vascular pedicle. A thigh flap, based on the profunda femoral artery perforator has become the second most used flap at our institution. In addition, MRA imaging also showed evidence of metastatic disease in 4% of our patient subset. Our MRA technique allows the surgeons to confidently assess multiple donor sites for the best perforator and flap design. In conclusion, a well-performed MRA with specific postprocessing provides an accurate method for mapping perforator vessel, at the same time avoiding ionizing radiation. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  10. Expander/implant breast reconstruction before radiotherapy. Outcomes in a single-institute cohort

    Energy Technology Data Exchange (ETDEWEB)

    Aristei, C.; Palumbo, I. [Perugia Univ. (Italy). Radiation Oncology Section; Santa Maria della Misericordia Hospital, Perugia (Italy); Falcinelli, L.; Petitto, R.P.; Perrucci, E. [Santa Maria della Misericordia Hospital, Perugia (Italy). Radiation Oncology Div.; Bini, V. [Perugia Univ. (Italy). Dept. of Internal Medicine; Farneti, A. [Perugia Univ. (Italy). Radiation Oncology Section; Gori, S. [Santa Maria della Misericordia Hospital, Perugia (Italy). Medical Oncology Div.

    2012-12-15

    Background and purpose: Radiotherapy (RT) of reconstructed breasts was associated with major complications and poor cosmetic outcome. The present study assessed complication rates, the link between risk factors and prosthesis removal, as well as cosmetic outcomes. Patients and methods: From 1997 to 2009, 101 consecutive patients received RT after breast reconstruction because of risk factors for relapse (92) or because relapse had occurred (9). At RT, 90 patients had temporary tissue expanders and 11 had permanent implants. Twelve patients underwent neo-adjuvant chemotherapy; all patients received adjuvant chemo- and/or hormone therapy. Results: At a median follow-up of 50 months, late toxicities occurred in 28 patients: pain in 7, lymphedema in 6, G1 cutaneous toxicity in 5, and subcutaneous toxicity in 19 (2G1, 9G2, 7G3, 1G4), with more than one side effect in 12. In 8 patients the prosthesis ruptured (3), was displaced (3), was displaced and ruptured (1), or lost shape (1). Capsular contracture was classified in 89 patients as IA in 14, IB in 47, II in 10, III in 11, and IV in 7. Twelve prostheses (11.9%) were removed. The only significant factor for prosthesis removal was age (p = 0.007). Judgments of cosmetic results were available from 81 physicians and 84 patients. Outcome was excellent/good in 58/81 physician judgments and in 57/84 patient evaluations. Overall inter-rater agreement on outcome was good ({kappa}-value 0.64; 95% CI: 0.48-0.79). Conclusion: RT to reconstructed breasts was associated with low rates of late toxicity and prosthesis removal. Cosmetic outcomes were, on the whole, good to excellent. (orig.)

  11. Immediate reconstruction using free medial circumflex femoral artery perforator flaps after breast-conserving surgery.

    Science.gov (United States)

    Izumi, Ken; Fujikawa, Masakazu; Tashima, Hiroki; Saito, Takuya; Sotsuka, Yohei; Tomita, Koichi; Hosokawa, Ko

    2013-11-01

    Recent advances in perforator flap surgical techniques have allowed for safe and reliable autologous tissue transfer with minimal donor-site morbidity. Between April 2012 and January 2013, we performed immediate breast reconstruction using free medial circumflex femoral artery perforator (MCFAP) flaps in 15 patients after breast-conserving surgery. The flaps were harvested from patients in the lithotomy position, while a second surgical team simultaneously conducted tumour resection. Of the 15 procedures performed, three flaps were dissected as true perforator flaps, while 12 flaps were dissected as muscle-sparing perforator flaps. The mean flap weight was 138.5 g (range, 77-230 g) and the mean pedicle length was 5.7 cm (range, 3.0-9.0 cm). Recipient vessels for anastomosis were serratus branches in 10 patients, internal mammary vessels in three patients and thoracodorsal vessels in two patients. The mean duration of surgery was 6.74 h (range, 5.65-9.45 h). There were no major complications requiring surgical intervention. Researchers observed partial flap necrosis, which manifested as small firm lesions in two patients, as well as local wound infection and dehiscence in one patient, which resolved spontaneously. There were no instances of donor-site seroma formation or lymphoedema in any of the patients. An objective assessment of postoperative photographs showed that cosmetic results were mostly satisfactory. Donor-site scars along the medial groin crease were inconspicuous and readily concealed by clothing. Given its reliable vascularity and minimal donor-site morbidity, the free MCFAP flap can be a good alternative for partial breast reconstruction after breast-conserving surgery.

  12. The effect of immediate breast reconstruction on the timing of adjuvant chemotherapy: a systematic review.

    Science.gov (United States)

    Xavier Harmeling, J; Kouwenberg, Casimir A E; Bijlard, Eveline; Burger, Koert N J; Jager, Agnes; Mureau, Marc A M

    2015-09-01

    Adjuvant chemotherapy is often needed to achieve adequate breast cancer control. The increasing popularity of immediate breast reconstruction (IBR) raises concerns that this procedure may delay the time to adjuvant chemotherapy (TTC), which may negatively impact oncological outcome. The current systematic review aims to investigate this effect. During October 2014, a systematic search for clinical studies was performed in six databases with keywords related to breast reconstruction and chemotherapy. Eligible studies met the following inclusion criteria: (1) research population consisted of women receiving therapeutic mastectomy, (2) comparison of IBR with mastectomy only groups, (3) TTC was clearly presented and mentioned as outcome measure, and (4) original studies only (e.g., cohort study, randomized controlled trial, case-control). Fourteen studies were included, representing 5270 patients who had received adjuvant chemotherapy, of whom 1942 had undergone IBR and 3328 mastectomy only. One study found a significantly shorter mean TTC of 12.6 days after IBR, four studies found a significant delay after IBR averaging 6.6-16.8 days, seven studies found no significant difference in TTC between IBR and mastectomy only, and two studies did not perform statistical analyses for comparison. In studies that measured TTC from surgery, mean TTC varied from 29 to 61 days for IBR and from 21 to 60 days for mastectomy only. This systematic review of the current literature showed that IBR does not necessarily delay the start of adjuvant chemotherapy to a clinically relevant extent, suggesting that in general IBR is a valid option for non-metastatic breast cancer patients.

  13. Evaluation of immediate breast reconstruction and radiotherapy: Factors associated with complications; Reconstruction mammaire immediate apres mastectomie suivie de radiotherapie: facteurs de risque de complications

    Energy Technology Data Exchange (ETDEWEB)

    Gross, E.; Cowen, D. [Departement de radiotherapie, hopital de la Timone, 13 - Marseille (France); Hannoun-Levi, J.M. [Departement de radiotherapie, centre Antoine-Lacassagne, 06 - Nice (France); Rouanet, P. [Departement de chirurgie, centre Val-d' Aurelle-Paul-Lamarque, 34 - Montpellier (France); Houvenaeghel, G. [Departement de chirurgie, institut Paoli-Calmettes, 13 - Marseille (France); Teissier, E. [Centre azureen de cancerologie, 06 - Mougins (France); Ellis, S. [Centre catalan d' oncologie, 66 - Perpignan (France); Resbeut, M. [Centre de radiotherapie Saint-Louis, 83 - Toulon (France); Tallet, A. [Departement de radiotherapie, institut Paoli-Calmettes, 13 - Marseille (France); Vaini Cowen, V. [Departement de chirurgie gynecologique, polyclinique du Parc-Rambot, 13 - Aix-en-Provence (France); Azria, D. [Departement de radiotherapie, centre Val-d' Aurelle-Paul-Lamarque, 34 - Montpellier (France)

    2010-12-15

    Objectives: To determine prospectively the factors associated with reconstruction failure (i.e. requiring expander removal) and capsular contracture in patients undergoing mastectomy and immediate two-stage breast reconstruction with a tissue expander and implant, and radiotherapy for breast cancer. This is a multi-institutional prospective non-randomized trial. Patients and Methods: Between 2/1998 and 9/2006, we prospectively evaluated 141 consecutive patients who received 141 implants after mastectomy and underwent chest wall radiotherapy (46 to 50 Gy in 23 to 25 fractions). Patients were evaluated after 24 to 36 months by two senior physicians (radiation oncologist and surgeon). Results: Medical follow-up was 37 months. Baker 1 and 2 capsular contracture was observed in 67.5% of patients, Baker 3 and 4 in 32.5%. There were 32 reconstruction failures. In a univariate analysis, the following factors were associated with Baker 3 and 4 capsular contracture: surgeon, use of hormonotherapy and smoking, of which only one remained in the multivariate analysis: surgeon. In a univariate analysis, the following factors were associated with reconstruction failure: tumor size T3 or T4, smoking, pN+ axilla. Three factors remained associated with reconstruction failure in a multiple logistic regression: large tumors T3/T4, smoking and pN+ axilla. Conclusions: Mastectomy, radiotherapy and immediate breast reconstruction with a tissue expander and implant should be considered when breast conserving surgery has been denied. Adequate patients can be easily selected by using three factors of favourable outcome. (authors)

  14. Successful microsurgical replantation of an amputated penis

    Directory of Open Access Journals (Sweden)

    Sanchit Garg

    2016-01-01

    Full Text Available Penile amputation is an uncommon injury for which immediate surgical replantation is warranted. Microsurgical replantation is the “standard” method for penile replantation. Early replantation yields a high success and low complication rate. We report a case of a 34-year-old male who presented with amputation at the proximal penile shaft which was successfully replanted using microsurgical techniques. Minor skin necrosis was noted post-operatively which was debrided and covered with skin graft. Follow-up at 6 months showed satisfactory cosmetic appearance, normal voiding, return of sensations and erectile function. The level of evidence was V.

  15. Neoadjuvant radiotherapy followed by mastectomy and immediate breast reconstruction. An alternative treatment option for locally advanced breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Pazos, Montserrat; Corradini, Stefanie; Schoenecker, Stephan; Scheithauer, Heike; Belka, Claus [LMU Munich, Department of Radiation Oncology, Munich (Germany); Dian, Darius [Mednord Munich Clinic, Munich (Germany); Bodungen, Vera von; Ditsch, Nina; Wuerstlein, Rachel; Harbeck, Nadia [LMU Munich, Breast Center, Department of Obstetrics and Gynecology, Munich (Germany)

    2017-04-15

    The optimal sequence of mastectomy with immediate breast reconstruction (IBR) and radiotherapy (RT) for the treatment of locally advanced breast cancer (LABC) is still under debate. Increased rates of postoperative complications are described following postmastectomy RT. Neoadjuvant RT aims to improve the aesthetic results and simplify the reconstructive pathway. A total of 22 patients diagnosed with LABC and treated with neoadjuvant RT followed by mastectomy and IBR between 04/2012 and 03/2015 were retrospectively analyzed. RT consisted of external beam RT to the breast and the regional lymphatics, if indicated. Both implant-based and autologous tissue-transfer reconstruction techniques were used. At the time of RT, 10 patients had no prior surgery and 12 patients had previously undergone breast-conserving surgery (BCS) with positive resection margins without the possibility to perform a second BCS. Additional neoadjuvant chemotherapy was administered in 18 patients prior to RT. A complete pathological response was achieved in 55.0% of patients. The 2-year overall survival rate was 89.3%, the 2-year disease-free-survival 79.8% and the local-recurrence-free survival was 95.2%. The cosmetic result was excellent or good in 66% of the patients treated with upfront mastectomy and 37% of the patients who had previously undergone BCS. Among patients who received implant-based IBR, 4 patients developed serious wound-healing problems with implant loss. The most satisfactory results were achieved with autologous tissue reconstruction. A sequential neoadjuvant chemo-/radiotherapy to allow IBR following mastectomy in selected cases of LABC seems feasible and can be safely attempted. Careful patient selection, close monitoring, and continuous patient support is mandatory to ensure compliance in this treatment strategy. (orig.) [German] Die optimale Therapiesequenz von Mastektomie mit sofortiger Brustrekonstruktion (IBR) und Radiotherapie (RT) beim lokal fortgeschrittenen

  16. Impact of Breast Cancer Subtype Defined by Immunohistochemistry Hormone Receptor and HER2 Status on the Incidence of Immediate Postmastectomy Reconstruction.

    Science.gov (United States)

    Wu, Wei; Cheng, Shi; Deng, Heran; Wu, Jiannan; Mao, Kai; Cao, Minghui

    2016-01-01

    Immediate postmastectomy reconstruction has become an increasingly popular choice for breast cancer patients recently. However, whether molecular subtype of cancer impacts the incidence of breast reconstruction is unclear. We aimed to investigate the association between breast cancer subtype defined by immunohistochemistry hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status and recent rates of immediate postmastectomy reconstruction in the United States.The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database was used to evaluate stage I-III breast cancer patients with different subtypes who underwent either mastectomy alone or mastectomy plus reconstruction between 2010 and 2012. Univariate and multivariate analyses were conducted to identify factors influencing the incidence of immediate reconstruction.Of 47,123 women included, 33.1% (10,712/32,376) of HR+/HER2-, 33.1% (1912/5768) of HR+/HER2+, 29.6% (850/2875) of HR-/HER2+, and 27.7% (1689/6104) of triple negative breast cancer patients received immediate breast reconstruction (chi-square test, P breast cancer patients received significantly less breast reconstruction. After adjusting for demographic, socioeconomic, geographic, or clinicopathologic factors, HER2-overexpressing (OR 0.896, 95% CI 0.817-0.984) and triple negative (OR 0.806, 95% CI 0.751-0.866) breast cancer patients remained less likely to undergo immediate postmastectomy reconstruction compared with HR+/HER2- or HR+/HER2+ patients. No significant difference was found in the type of reconstruction among different subtypes. Subgroup analysis showed that the difference of breast reconstruction rates among distinct subtypes varied with different grade and stage groups, and the association between breast cancer subtype and the reconstruction rate was not significant in low grade and early stage patients.This population-based study determined that breast cancer subtype was an independent

  17. Quality of life in women following various surgeries of body manipulation: organ transplantation, mastectomy, and breast reconstruction.

    Science.gov (United States)

    Pérez-San-Gregorio, M Angeles; Fernández-Jiménez, Eduardo; Martín-Rodríguez, Agustín; Borda-Más, Mercedes; Rincón-Fernández, M Esther

    2013-09-01

    This study aimed to determine biopsychosocial differences (anxious-depressive symptomatology and quality of life) among three groups of patients who underwent surgical interventions related to body manipulation, as well as to assess the clinical significance of these results versus reference values. Four groups were compared: women who underwent organ transplant (n = 26), mastectomy for breast cancer (n = 36), breast reconstruction (n = 36), and general population (n = 608). The Hospital Anxiety and Depression Scale and the EORTC QLQ-C30 were used. Women who underwent mastectomy showed the highest anxious-depressive symptomatology and quality-of-life impairment in comparison to the remaining groups, and they also displayed the most clinically significant deterioration in the majority of dimensions (large effect sizes). In contrast, the group with implantation of a healthy organ (transplantation) only showed higher biopsychosocial impairment than the group with reconstruction of an organ (breast reconstruction) in gastrointestinal dysfunctions and in the global self-perception of health.

  18. Body image investment in breast cancer patients undergoing reconstruction: taking a closer look at the Appearance Schemas Inventory-Revised.

    Science.gov (United States)

    Chua, Alicia S; DeSantis, Stacia M; Teo, Irene; Fingeret, Michelle Cororve

    2015-03-01

    Breast cancer and its treatment can significantly affect a woman's body image. As such, it would be useful to understand the importance or value these patients place on their appearance. We evaluated the factor structure of the Appearance Schemas Inventory-Revised (ASI-R), a measure of body image investment, with a sample of 356 breast cancer patients undergoing mastectomy and breast reconstruction. Using confirmatory and exploratory factor analyses, we found that a three-factor model demonstrated an improvement in fit over the original two-factor structure of the ASI-R. These factors were named Appearance Self-Evaluation, Appearance Power/Control, and Appearance Standards and Behavior. The three aforementioned factors demonstrated acceptable internal consistency reliabilities. Our findings have implications for the use of the ASI-R in an oncology setting, specifically for breast cancer patients undergoing reconstruction. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. A systematic review of morbidity associated with autologous breast reconstruction before and after exposure to radiotherapy: are current practices ideal?

    Science.gov (United States)

    Kelley, Brian P; Ahmed, Raouf; Kidwell, Kelley M; Kozlow, Jeffrey H; Chung, Kevin C; Momoh, Adeyiza O

    2014-05-01

    The specific aim of this study was to conduct a systematic review of the literature to assess outcomes data on complications and aesthetic results associated with autologous tissue-based breast reconstruction performed before or after chest wall irradiation. Studies from a PubMed search that met predetermined inclusion criteria were identified. Complications of interest included partial or total flap loss, fat necrosis, thrombosis, infection, seroma, hematoma, delayed wound healing, and flap fibrosis/contracture. Pooled complication rates were calculated. A total of 20 articles were included in the study for autologous reconstruction. These primary articles were selected after screening 897 publications, with six studies presenting data on pre-reconstruction radiation, nine studies presenting data on post-reconstruction radiation, and five studies presenting data on both patient groups. Comparison of pooled complication rates between flaps irradiated before or after reconstruction were statistically similar, including total flap loss (1 vs. 4 %), wound healing complications (10 vs. 14 %), infection (4 vs. 6 %), hematoma (2 vs. 1 %), seroma (4 vs. 4 %), and fat necrosis (10 vs. 13 %). The pooled rate of flap contracture and fibrosis was 27 % in flap reconstructions exposed to radiotherapy. Statistical evaluation of aesthetic outcomes was impossible as a result of variability in assessment and reporting methods. Review of the current literature suggests similar rates of complications and success rates in autologous breast reconstruction patients exposed to pre- or post-reconstruction radiation. Immediate autologous reconstruction should be considered as a viable option even in patients who are likely to require postmastectomy radiotherapy.

  20. 乳腺癌术后乳房重建的策略%Method of breast reconstruction after surgery

    Institute of Scientific and Technical Information of China (English)

    尹健

    2015-01-01

    乳房重建已成为乳腺癌综合治疗的重要组成部分。成功的乳房重建通常不是一次手术就可以完成,而需要进行一系列手术。在临床工作中需要注意以下几方面问题:选择适当的乳房重建时机和方式,对重建乳房及健侧乳房进行必要的修整,并最终完成乳头乳晕重建和纹色。为此,需要手术医生全面熟练掌握肿瘤外科和整形外科的原则和技术,将医学和美学完美结合。%Breast reconstruction has been an integral part of the treatment of breast cancer. It is better viewed as a process rather than a single surgical procedure. The following issues need attention:choosing proper timing and methods of breast reconstruction, improving symmetry between a reconstructed breast and the opposite breast, followed by nipple-areolar complex reconstruction and tattooing. Surgeons should master the principal and techniques of both oncologic surgery and plastic surgery, so that science and art are combined perfectly.

  1. Immediate breast reconstruction with a saline implant and AlloDerm, following removal of a Phyllodes tumor

    Directory of Open Access Journals (Sweden)

    Roller Michael D

    2011-03-01

    Full Text Available Abstract Background Phyllodes tumors are uncommon tumors of the breast that exhibit aggressive growth. While surgical management of the tumor has been reported, a single surgical approach with immediate breast reconstruction using AlloDerm has not been reported. Case presentation A 22-year-old woman presented with a 4 cm mass in the left breast upon initial examination. Although the initial needle biopsy report indicated a fibroadenoma, the final pathologic report revealed a 6.5 cm × 6.4 cm × 6.4 cm benign phyllodes tumor ex vivo. Treatment was a simple nipple-sparing mastectomy coupled with immediate breast reconstruction. After the mastectomy, a subpectoral pocket was created for a saline implant and AlloDerm was stitched to the pectoralis and serratus muscle in the lower-pole of the breast. Conclusions Saline implant with AlloDerm can be used for immediate breast reconstruction post-mastectomy for treatment of a phyllodes tumor.

  2. Treatment of breast animation deformity in implant-based reconstruction with pocket change to the subcutaneous position.

    Science.gov (United States)

    Hammond, Dennis C; Schmitt, William P; O'Connor, Elizabeth A

    2015-06-01

    Breast animation may be an unfortunate result of subpectoral implant-based reconstruction following mastectomy. This article reviews a novel approach to the treatment of animation deformity in cases of reconstruction, whereby the pectoralis major muscle is sutured down to the chest wall and the implant is transferred to the subcutaneous plane. A retrospective review was performed on 19 breasts undergoing pocket change. In selected cases, fat grafting was added to augment the soft-tissue framework around the implant. Demographics, operative details, outcomes, and complications were recorded. All 19 breasts had complete resolution of their animation deformity. Complications were seen in five breasts (26.3 percent). Four breasts (21.1 percent) developed Baker grade III or IV capsular contracture requiring capsulectomy that was curative. One seroma (5.3 percent) required in-office drainage. There were no visible implant deformities, infections, or implant removals. In appropriately selected patients, pocket change to a subcutaneous plane is a safe and effective technique for correction of severe animation deformity following implant-based breast reconstruction. Therapeutic, IV.

  3. Preoperative TRAM free flap volume estimation for breast reconstruction in lean patients.

    Science.gov (United States)

    Minn, Kyung Won; Hong, Ki Yong; Lee, Sang Woo

    2010-04-01

    To obtain pleasing symmetry in breast reconstruction with transverse rectus abdominis myocutaneous (TRAM) free flap, a large amount of abdominal flap is elevated and remnant tissue is trimmed in most cases. However, elevation of abundant abdominal flap can cause excessive tension in donor site closure and increase the possibility of hypertrophic scarring especially in lean patients. The TRAM flap was divided into 4 zones in routine manner; the depth and dimension of the 4 zones were obtained using ultrasound and AutoCAD (Autodesk Inc., San Rafael, CA), respectively. The acquired numbers were then multiplied to obtain an estimate of volume of each zone and the each zone volume was added. To confirm the relation between the estimated volume and the actual volume, authors compared intraoperative actual TRAM flap volumes with preoperative estimated volumes in 30 consecutive TRAM free flap breast reconstructions. The estimated volumes and the actual elevated volumes of flap were found to be correlated by regression analysis (r = 0.9258, P AutoCAD (Autodesk Inc.) allow the authors to attain the precise volume desired for elevation. This method provides advantages in terms of minimal flap trimming, easier closure of donor sites, reduced scar widening and symmetry, especially in lean patients.

  4. Waveform Inversion with Source Encoding for Breast Sound Speed Reconstruction in Ultrasound Computed Tomography

    Science.gov (United States)

    Wang, Kun; Matthews, Thomas; Anis, Fatima; Li, Cuiping; Duric, Neb; Anastasio, Mark A.

    2016-01-01

    Ultrasound computed tomography (USCT) holds great promise for improving the detection and management of breast cancer. Because they are based on the acoustic wave equation, waveform inversion-based reconstruction methods can produce images that possess improved spatial resolution properties over those produced by ray-based methods. However, wa