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Renom M, Feuvrier D, Rolin G, Lihoreau T, Fageot J, Andreoletti JB, Pluvy I. Breast reconstruction through exclusive lipomodeling or in addition to a flap: Current status in Franche-Comté. ANN CHIR PLAST ESTH 2024; 69:410-418. [PMID: 39003225 DOI: 10.1016/j.anplas.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 06/17/2024] [Indexed: 07/15/2024]
Abstract
INTRODUCTION Breast reconstruction after cancer surgery through lipomodeling can be performed alone or in combination with a flap. Our objective is to describe the proportion of techniques used on patients who underwent autologous reconstructive surgery after tumorectomy or mastectomy in Franche-Comté. MATERIALS AND METHODS A bicentric retrospective observational study was conducted between October 2017 and December 2021 (NCT06101732), including three groups: those who underwent exclusive lipomodeling reconstruction after mastectomy (1) or in addition to a flap (2), and those who underwent exclusive lipomodeling reconstruction after tumorectomy (3). Socio-demographic, medical, and surgical data were collected and recorded in a specially designed software. RESULTS Two hundred and fifty-one lipomodeling procedures were performed on 91 patients. In group 1, the average transferred volume was 1191mL with an average number of sessions of 4.4 spreads over 19.4months. In group 2, the average transferred volume was 676mL with an average operative time of 2.5 spread over 16.1months. In group 3, the average transferred volume was 223mL with an average number of sessions of 1.5 spreads over 6.2months. Regarding postoperative complications, 11% had cysts of fat necrosis, 4.4% had infections, and 2.2% had hematomas. CONCLUSION Lipomodeling is a technique that has clearly established itself in the field of breast reconstructive surgery. It results in a few complications and improves the final aesthetic outcome whether used exclusively or in addition to a flap.
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Affiliation(s)
- M Renom
- Department of Orthopaedic Surgery, Traumatology, Plastic Surgery and Hand Assistance, Besançon University Hospital, 3, boulevard Alexandre-Fleming, 25000 Besançon, France.
| | - D Feuvrier
- Department of Orthopaedic Surgery, Traumatology, Plastic Surgery and Hand Assistance, Besançon University Hospital, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - G Rolin
- University of Franche-Comté, Besançon University Hospital, INSERM CIC-1431, 25000 Besançon, France
| | - T Lihoreau
- University of Franche-Comté, Besançon University Hospital, INSERM CIC-1431, 25000 Besançon, France
| | - J Fageot
- Department of Orthopaedic Surgery, Traumatology, Plastic Surgery and Hand Assistance, Besançon University Hospital, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - J B Andreoletti
- Department of Plastic, Reconstructive and Aesthetic Surgery, North Franche-Comté Hospital, 90400 Trévenans, France
| | - I Pluvy
- Department of Orthopaedic Surgery, Traumatology, Plastic Surgery and Hand Assistance, Besançon University Hospital, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
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2
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Biermann N, Eigenberger A, Felthaus O, Brébant V, Heine N, Brix E, Spoerl S, Prantl L, Gurtner G, Anker AM. Breast Lipofilling: Is the Bra Really Full? Clinical Bra Pressure Measurement and In Vitro Testing of Processed and Unprocessed Fat Cells. Aesthetic Plast Surg 2024:10.1007/s00266-024-04116-9. [PMID: 38814346 DOI: 10.1007/s00266-024-04116-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/25/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Breast lipofilling, a popular cosmetic and reconstructive procedure, involves the transplantation of autologous fat to enhance breast volume and contour. Despite its widespread use, cell processing and the aftertreatment remain controversial. This study investigates the pressure applied by a compression bra and reports in vitro stress tests of processed and unprocessed fat cells. METHODS Clinical bra pressure measurements were conducted on a cohort of 45 patients following lipofilling, reduction mammoplasties and DIEP flaps. Laboratory analysis included cell vitality testing using Resazurin assays of processed and unprocessed fat cells after exposure to mechanical or hyperbaric pressure. RESULTS Our findings show a mean overall pressure value of the compression bra for all patients of 6.7 ± 5.7 mmHg (range 0-35). Cell processing is superior to sedimentation only regarding fat cell vitality. However, neither mechanical pressure within the specified range nor hyperbaric oxygen exposure significantly affected fat graft survival as measured by Resazurin assays. CONCLUSION The in vitro measurements showed that it was impossible to harm fat cells with external pressure during lipofilling procedures, regardless of their processing. In the clinical context, the compression bra applied pressure values deceeding the perfusion pressure and may therefore not diminish oxygen supply nor harm the transplanted cells. Therefore, we recommend the use of a compression bra for all lipofilling procedures around the breast. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Niklas Biermann
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany.
| | - Andreas Eigenberger
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
- Medical Device Lab, Regensburg Center of Biomedical Engineering (RCBE), Faculty of Mechanical Engineering, Ostbayerische Technische Hochschule Regensburg, Galgenbergstraße 30, 93053, Regensburg, Germany
| | - Oliver Felthaus
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
| | - Vanessa Brébant
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
| | - Norbert Heine
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
| | - Eva Brix
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
| | - Steffen Spoerl
- Clinic and Polyclinic for Oral and Maxillofacial Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
| | - Lukas Prantl
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
| | - Geoffrey Gurtner
- Department of Plastic and Reconstructive Surgery, Stanford University School Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Alexandra M Anker
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany
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Al Qurashi AA, Shah Mardan QNM, Alzahrani IA, AlAlwan AQ, Bafail A, Alaa Adeen AM, Albahrani A, Aledwani BN, Halawani IR, AlBattal NZ, Mrad MA. Efficacy of Exclusive Fat Grafting for Breast Reconstruction: An Updated Systematic Review and Meta-analysis. Aesthetic Plast Surg 2024:10.1007/s00266-024-03978-3. [PMID: 38772941 DOI: 10.1007/s00266-024-03978-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/29/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Exclusive fat grafting is an alternative method to implant- or flap- based reconstruction techniques following mastectomies or breast conservation therapies. Its efficacy has been explored before but new data has come to light, resulting in previous results becoming outdated. Concerns have also been raised about the oncological safety of this procedure which must be evaluated alongside the efficacy to gain a comprehensive understanding of the merits of this alternative technique. METHODS We queried the PubMed electronic database from its inception until August 2023 for studies evaluating the efficacy and oncological safety of exclusive fat grafting breast reconstruction following cancer-related mastectomy or breast conservation therapy. Results of the analysis were pooled and presented as means or valid proportions. Results of the analysis were pooled using a random-effects model and presented with 95% confidence intervals (95% CIs) where appropriate. RESULTS 41 studies were included in our analysis. Pooled results show that on average, 1.7 sessions of exclusive fat grafting were required to complete reconstruction in Breast Conservation Therapy (BCT) patients, with an average volume of 114.2 ml being injected. For mastectomy patients with irradiated breasts, 4.7 sessions were needed on average with 556.8 ml being required to complete reconstruction, compared to their non-irradiated Counterparts requiring only 2.6 sessions and 207.2 ml to complete reconstruction. Oncological recurrence events were found in 29/583 non-irradiated mastectomy patients (p = 0.014) and in 41/517 BCT patients (p = 0.301) CONCLUSION: Exclusive fat grafting is an oncologically safe and reasonably efficacious alternative to more common methods of breast reconstruction. More data is needed to fully characterize the oncological safety of this procedure in irradiated and non-irradiated mastectomy patients. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Abdullah A Al Qurashi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Qutaiba N M Shah Mardan
- Plastic and Reconstructive Surgery Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Abdullah Q AlAlwan
- Department of Plastic and Reconstructive Surgery, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Anas Bafail
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Abdulqader Murad Alaa Adeen
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Abdulaziz Albahrani
- Department of Plastic and Reconstructive Surgery, King Fahad Hospital, Al Hofuf, Saudi Arabia
| | - Batoul Najeeb Aledwani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | | | - Nouf Z AlBattal
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohamed Amir Mrad
- Plastic and Reconstructive Surgery Section, Department of Surgery, King Faisal Specialist Hospital & Research Centre, P.O. Box 3354, 11211, Riyadh, Saudi Arabia.
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Lucattelli E, Cattin F, Cipriani F, Dellachiesa L, Fogacci T, Frisoni G, Samorani D, Semprini G, Fabiocchi L. Invited Response on: Comment on "Reverse Expansion Following Nipple Sparing Mastectomy: A Natural, Safe and Effective Autologous Technique for Breast Reconstruction". Aesthetic Plast Surg 2023; 47:51-52. [PMID: 35641689 DOI: 10.1007/s00266-022-02936-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Elena Lucattelli
- General and Breast Surgery Department, "A. Franchini" Hospital, AUSL Romagna, Via Pedrignone, 3, 47822, Santarcangelo di Romagna, Italy.
| | - Federico Cattin
- General and Breast Surgery Department, "A. Franchini" Hospital, AUSL Romagna, Via Pedrignone, 3, 47822, Santarcangelo di Romagna, Italy
| | - Federico Cipriani
- General and Breast Surgery Department, "A. Franchini" Hospital, AUSL Romagna, Via Pedrignone, 3, 47822, Santarcangelo di Romagna, Italy
| | - Laura Dellachiesa
- General and Breast Surgery Department, "A. Franchini" Hospital, AUSL Romagna, Via Pedrignone, 3, 47822, Santarcangelo di Romagna, Italy
| | - Tommaso Fogacci
- General and Breast Surgery Department, "A. Franchini" Hospital, AUSL Romagna, Via Pedrignone, 3, 47822, Santarcangelo di Romagna, Italy
| | - Gianluca Frisoni
- General and Breast Surgery Department, "A. Franchini" Hospital, AUSL Romagna, Via Pedrignone, 3, 47822, Santarcangelo di Romagna, Italy
| | - Domenico Samorani
- General and Breast Surgery Department, "A. Franchini" Hospital, AUSL Romagna, Via Pedrignone, 3, 47822, Santarcangelo di Romagna, Italy
| | - Gloria Semprini
- General and Breast Surgery Department, "A. Franchini" Hospital, AUSL Romagna, Via Pedrignone, 3, 47822, Santarcangelo di Romagna, Italy
| | - Luca Fabiocchi
- General and Breast Surgery Department, "A. Franchini" Hospital, AUSL Romagna, Via Pedrignone, 3, 47822, Santarcangelo di Romagna, Italy
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Fabiocchi L, Lucattelli E, Cattin F, Cipriani F, Dellachiesa L, Fogacci T, Frisoni G, Semprini G, Samorani D. Reverse Expansion for Breast Reconstruction after Skin-sparing and Nipple-sparing Mastectomy: Our First 100 Cases. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4915. [PMID: 37020986 PMCID: PMC10069859 DOI: 10.1097/gox.0000000000004915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/02/2023] [Indexed: 04/05/2023]
Abstract
Patients with breast cancer have experienced advancements both in oncological treatment and in aesthetics as a result of developments in reconstructive techniques. We aimed to present our experience with the reverse expansion technique, summarizing the results of our first 100 cases of reconstruction after skin-sparing mastectomy and nipple-sparing mastectomy. Methods From January 2010 to September 2018, 253 breast reconstruction procedures were performed on 100 patients. The reverse expansion technique consists of autologous fat tissue transplantation requiring the combined use of a skin expander and of multiple lipofilling sessions. At the beginning of every session the breast expander was deflated by removing a saline volume similar to that of the fat to be injected. Results Overall, 56 breast reconstructions after skin-sparing mastectomy and 44 after nipple-sparing mastectomy were performed. An average of 661.5 cm3 of fat per session was harvested and an average of 305.3 cm3 per breast was injected. The average number of sessions to achieve breast reconstruction was 2.53. Only four complications after 253 procedures (1.5%) were reported: one donor site hemorrhage due to genetic lack of coagulation factors, and three surgical site infections. Conclusions Considering the large number of positive factors such as a fast postoperative recovery, an easy learning curve, a lack of need of a specialized surgical team, a natural look of the breast shape, and the soft consistency of the grafted tissue, we believe this technique could be the first choice for autologous reconstruction after skin-sparing mastectomy and nipple-sparing mastectomy.
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Affiliation(s)
- Luca Fabiocchi
- General and Breast Surgery Department, "A. Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Elena Lucattelli
- General and Breast Surgery Department, "A. Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Federico Cattin
- General and Breast Surgery Department, "A. Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Federico Cipriani
- General and Breast Surgery Department, "A. Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Laura Dellachiesa
- General and Breast Surgery Department, "A. Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Tommaso Fogacci
- General and Breast Surgery Department, "A. Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Gianluca Frisoni
- General and Breast Surgery Department, "A. Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Gloria Semprini
- General and Breast Surgery Department, "A. Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Domenico Samorani
- General and Breast Surgery Department, "A. Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
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Stefura T, Rusinek J, Wątor J, Zagórski A, Zając M, Libondi G, Wysocki WM, Koziej M. Implant vs. autologous tissue-based breast reconstruction: A systematic review and meta-analysis of the studies comparing surgical approaches in 55,455 patients. J Plast Reconstr Aesthet Surg 2023; 77:346-358. [PMID: 36621238 DOI: 10.1016/j.bjps.2022.11.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 10/13/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The choice of reconstruction type is of utmost importance in treating breast cancer. There are two major reconstructive pathways in this group of patients: autologous breast reconstruction (ABR) and implant-based breast reconstruction (IBR). The aim of this systematic review and meta-analysis was to assess and compare IBR vs. ABR. METHODS A review of studies reporting the differences between the procedures was performed. The MEDLINE/PubMed, ScienceDirect, EMBASE, BIOSIS, SciELO, Scopus, and Web of Science databases were thoroughly searched in September 2021. The data concerning group characteristics, BREAST-Q scores, complication rates, length of stay (LOS), and costs were extracted. The Cochrane risk-of-bias tool was used for randomized studies, while Newcastle-Ottawa Quality Assessment for Cohort Studies was used for other types of research. RESULTS Our meta-analysis included 32 studies (n = 55,455). We observed significantly better outcomes following ABR when it comes to esthetic satisfaction (mean difference [MD] -8.51; 95% confidence interval [CI] -10.70, -6.33; p<0.001) and satisfaction with the entire reconstructive treatment (MD -6.56; 95% CI -9.97, -3.14; p<0.001). Both methods appeared to be comparable in terms of safety, while the complication rates varied insignificantly between the groups (odds ratio [OR] 1.06; 95% CI 0.71, 1.59; p = 0.76). ABR seems to be correlated with significantly higher costs (standard mean difference [SMD] -0.69; 95% CI -1.21, -0.17; p = 0.010). CONCLUSIONS The results obtained from this evidence-based study will improve the understanding of the different clinical pathways that patients can be assigned to. The study emphasized the advantages and disadvantages of both methods.
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Affiliation(s)
| | - Jakub Rusinek
- Jagiellonian University Medical College, Cracow, Poland
| | - Julia Wątor
- Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | | | - Maciej Zając
- Jagiellonian University Medical College, Cracow, Poland
| | - Guido Libondi
- Department of General, Oncological and Vascular Surgery, 5th Military Clinical Hospital in Cracow, Poland
| | - Wojciech M Wysocki
- Department of General, Oncological and Vascular Surgery, 5th Military Clinical Hospital in Cracow, Poland; Chair of Surgery, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Cracow University, Cracow, Poland
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.
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7
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Lucattelli E, Cattin F, Cipriani F, Dellachiesa L, Fogacci T, Frisoni G, Samorani D, Semprini G, Fabiocchi L. Reverse Expansion Following Nipple Sparing Mastectomy: A Natural, Safe and Effective Autologous Technique for Breast Reconstruction. Aesthetic Plast Surg 2022; 46:1602-1608. [PMID: 35064338 DOI: 10.1007/s00266-021-02720-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/06/2021] [Indexed: 11/01/2022]
Abstract
The majority of surgeons choose an implant-based breast reconstruction after mastectomy. Nevertheless, lipofilling is a constantly growing technique allowing a complete breast reconstruction without prosthesis. We introduce our experience using reverse expansion for breast reconstruction following a nipple-sparing mastectomy (NSM) with a subpectoral skin expander. In the period January 2010-August 2021, 106 breast reconstruction procedures were performed on 50 patients after a NSM. We harvested an amount of fat tissue using a 2.5 mm liposuction cannula, we centrifuged it 3 min at 4000 rpm and injected in the recipient site using 3 ml syringes and Coleman cannulas. At the beginning of every session, the breast expander was deflated of a saline volume similar to the one of the fat to be injected. We harvested an average of 679.2 ccs of fat per session and injected an average of 319.3 ccs per breast. The mean number of sessions has been 2.4 per breast. The average number of sessions in a radiotreated patients' subgroup has been slightly higher than a control group. The mean follow-up time was 63.5 months and we observed no complications in 105 over 106 procedures. Lipofilling has proven to be a safe and effective technique for complete breast reconstruction. Our procedure considers the use of a breast expander as a device to prepare the recipient site. Reverse expansion after a NSM allows a like-with-like reconstruction and it might be the first reconstructive choice in a selected group of patients.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Elena Lucattelli
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, AOU Careggi, Largo Piero Palagi 1, 50139, Florence, FI, Italy.
| | - Federico Cattin
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Federico Cipriani
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Laura Dellachiesa
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Tommaso Fogacci
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Gianluca Frisoni
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Domenico Samorani
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Gloria Semprini
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Luca Fabiocchi
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
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8
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Weinzierl A, Schmauss D, Harder Y. [The Value of Synthetic and Biologic Meshes in Implant-Based Breast Reconstruction]. HANDCHIR MIKROCHIR P 2022; 54:269-278. [PMID: 35944534 DOI: 10.1055/a-1830-8217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Implant based breast reconstruction (IBBR) keeps evolving and has been influenced heavily by the use of synthetic and biologic meshes in the last years. In both, subpectoral as well as prepectoral approaches the use of synthetic and biologic meshes has made it possible to place implants precisely according to the breast's footprint and strengthen soft-tissue coverage, particularly in the lower pole of the breast with lower complication rates and better cosmesis. Various mesh options that differ in material, processing, size and cost are currently in clinical use. This review aims to define the role of biologic and synthetic meshes in IBBR regarding the advantages and disadvantages of their use.
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Affiliation(s)
- Andrea Weinzierl
- Institut für Klinisch-Experimentelle Chirurgie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - Daniel Schmauss
- Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Ospedale Regionale di Lugano (ORL), Ente Ospedaliero Cantonale (EOC), Lugano, Schweiz.,Fakultät der Biomedizinischen Wissenschaften, Università della Svizzera Italiana, Lugano, Schweiz
| | - Yves Harder
- Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Ospedale Regionale di Lugano (ORL), Ente Ospedaliero Cantonale (EOC), Lugano, Schweiz.,Fakultät der Biomedizinischen Wissenschaften, Università della Svizzera Italiana, Lugano, Schweiz
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9
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Adipose tissue grafts survival and bioactivity in relation to space and internal pressure of the recipient site: a transversal topic in plastic surgery. Plast Reconstr Surg 2022; 150:700e-701e. [PMID: 35819985 DOI: 10.1097/prs.0000000000009414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Reply: Adipose tissue grafts survival and bioactivity in relation to space and internal pressure of the recipient site: a transversal topic in plastic surgery. Plast Reconstr Surg 2022; 150:701e-702e. [PMID: 35816079 DOI: 10.1097/prs.0000000000009415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zhang G, Ci H, Ma C, Li Z, Jiang W, Chen L, Wang Z, Zhou M, Sun J. Additive manufactured macroporous chambers facilitate large volume soft tissue regeneration from adipose-derived extracellular matrix. Acta Biomater 2022; 148:90-105. [PMID: 35671873 DOI: 10.1016/j.actbio.2022.05.053] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/12/2022] [Accepted: 05/31/2022] [Indexed: 12/12/2022]
Abstract
Breast tissue engineering is a promising alternative intervention for breast reconstruction. Due to their low immunogenicity and well-preserved adipogenic microenvironment, decellularized adipose tissue (DAT) can potentially regenerate adipose tissue in vivo. However, the volume of adipose tissue regenerated from DAT can hardly satisfy the demand for breast reconstruction. Tissue engineering chamber (TEC) is an effective technique for generation of large adipose tissue volumes. However, TEC applications necessitate reoperation to remove non-degradable plastic chambers and harvest autologous tissue flaps, which prolongs the operation time and causes potential damage to donor sites. We improved the TEC strategy by combining bioresorbable polycaprolactone (PCL) chambers and decellularized adipose tissues (DAT). A miniaturized porous PCL chamber was fabricated based on scaling differences between human and rabbit chests, and basic fibroblast growth factor (bFGF)-loaded DAT successfully prepared. In rabbit models, a highly vascularized adipose tissue that nearly filled up the PCL chamber (5 mL) was generated de novo from 0.5 mL bFGF-loaded DAT. The newly formed tissue had significantly high expressions of adipogenic genes, compared to the endogenous adipose tissue. The concept described here can be exploited for breast tissue engineering. STATEMENT OF SIGNIFICANCE: Decellularized adipose tissue (DAT), which provides infiltrated cells adipogenic microenvironment, can potentially regenerate adipose tissue in vivo. Nevertheless, the volume of regenerated adipose tissue is insufficient to repair large sized tissue defect. Tissue engineering chamber (TEC) could provide a protective space for in situ regeneration of large volume tissue. Herein, a new strategy by combining biodegradable polycaprolactone chambers and basic fibroblast growth factor-loaded decellularized adipose tissue is proposed. In rabbit model, newly formed adipose tissue regenerated from DAT successfully filled the dome shaped chamber with ten folds higher volume than DAT, which is proportionally similar to women breast. This work highlighted the importance of adipogenic microenvironment and protective space for adipose tissue regeneration.
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Affiliation(s)
- Guo Zhang
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Wuhan Clinical Research Center for Superficial Organ Reconstruction, Wuhan 430022, China
| | - Hai Ci
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Wuhan Clinical Research Center for Superficial Organ Reconstruction, Wuhan 430022, China; Department of Burn and Plastic Surgery, the First Affiliated Hospital of Medical College of Shihezi University, Shihezi, Xinjiang 832008, China
| | - Chenggong Ma
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Zhipeng Li
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Wuhan Clinical Research Center for Superficial Organ Reconstruction, Wuhan 430022, China
| | - Wenbin Jiang
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Wuhan Clinical Research Center for Superficial Organ Reconstruction, Wuhan 430022, China
| | - Lifeng Chen
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Wuhan Clinical Research Center for Superficial Organ Reconstruction, Wuhan 430022, China
| | - Zhenxing Wang
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Wuhan Clinical Research Center for Superficial Organ Reconstruction, Wuhan 430022, China
| | - Muran Zhou
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Wuhan Clinical Research Center for Superficial Organ Reconstruction, Wuhan 430022, China.
| | - Jiaming Sun
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Wuhan Clinical Research Center for Superficial Organ Reconstruction, Wuhan 430022, China.
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Lucattelli E, Cattin F, Cipriani F, Dellachiesa L, Fogacci T, Frisoni G, Samorani D, Semprini G, Fabiocchi L. Invited Response on: "Reverse Expansion and Tissue-Engineering for Breast Reconstruction". Aesthetic Plast Surg 2022; 46:44-45. [PMID: 35286411 DOI: 10.1007/s00266-022-02847-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/17/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Elena Lucattelli
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, AOU Careggi Largo Piero Palagi 1, 50139, Florence, Italy.
| | - Federico Cattin
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Federico Cipriani
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Laura Dellachiesa
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Tommaso Fogacci
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Gianluca Frisoni
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Domenico Samorani
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Gloria Semprini
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Luca Fabiocchi
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
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Atiyeh B, Oneisi A. Letter-to-the-Editor: Reverse Expansion and Tissue-Engineering for Breast Reconstruction. Aesthetic Plast Surg 2022; 46:41-43. [PMID: 35237882 DOI: 10.1007/s00266-022-02806-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 12/27/2022]
Affiliation(s)
- Bishara Atiyeh
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ahmad Oneisi
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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Breast Reconstruction by Exclusive Lipofilling after Total Mastectomy for Breast Cancer: Description of the Technique and Evaluation of Quality of Life. J Pers Med 2022; 12:jpm12020153. [PMID: 35207642 PMCID: PMC8876120 DOI: 10.3390/jpm12020153] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/14/2021] [Accepted: 12/29/2021] [Indexed: 02/04/2023] Open
Abstract
Background: The objective of this work was to describe the technique of exclusive lipofilling in breast reconstruction after total mastectomy, to evaluate the satisfaction and quality of life of the patients, and to explore current literature on the subject. Methods: We conducted a retrospective observational multicentric study from January 2013 to April 2020. The modalities of surgery, esthetic result, and patient satisfaction were evaluated with the breast reconstruction module of BREAST-Q. Results: Complete data were available for 37 patients. The mean number of sessions was 2.2 (standard deviation 1.1), spread over an average of 6.8 months (SD 6.9). The average total volume of fat transferred was 566.4 mL. The complication rate was 18.9%. No severe complication was observed (Clavien–Dindo 3/4). Two patients were diagnosed with recurrence, in a metastatic mode (5.4%). The average satisfaction rate was 68.4% (SD 24.8) for psychosocial well-being and 64.5% (SD 24.1) for sexual well-being. The satisfaction rate was 60.2% (SD 20.9) for the image of the reconstructed breast and 82.7% (SD 21.9) for locoregional comfort. Conclusions: Breast reconstruction by exclusive lipofilling after total mastectomy provides satisfactory quality of life scores. The simplicity of the surgical technique and equipment required, and the high satisfaction rate confirm that lipofilling should be included in the panel of choice of breast reconstruction techniques.
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Piccotti F, Rybinska I, Scoccia E, Morasso C, Ricciardi A, Signati L, Triulzi T, Corsi F, Truffi M. Lipofilling in Breast Oncological Surgery: A Safe Opportunity or Risk for Cancer Recurrence? Int J Mol Sci 2021; 22:ijms22073737. [PMID: 33916703 PMCID: PMC8038405 DOI: 10.3390/ijms22073737] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 02/08/2023] Open
Abstract
Lipofilling (LF) is a largely employed technique in reconstructive and esthetic breast surgery. Over the years, it has demonstrated to be extremely useful for treatment of soft tissue defects after demolitive or conservative breast cancer surgery and different procedures have been developed to improve the survival of transplanted fat graft. The regenerative potential of LF is attributed to the multipotent stem cells found in large quantity in adipose tissue. However, a growing body of pre-clinical evidence shows that adipocytes and adipose-derived stromal cells may have pro-tumorigenic potential. Despite no clear indication from clinical studies has demonstrated an increased risk of cancer recurrence upon LF, these observations challenge the oncologic safety of the procedure. This review aims to provide an updated overview of both the clinical and the pre-clinical indications to the suitability and safety of LF in breast oncological surgery. Cellular and molecular players in the crosstalk between adipose tissue and cancer are described, and heterogeneous contradictory results are discussed, highlighting that important issues still remain to be solved to get a clear understanding of LF safety in breast cancer patients.
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Affiliation(s)
- Francesca Piccotti
- Laboratorio di Nanomedicina ed Imaging Molecolare, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy; (F.P.); (C.M.); (A.R.)
| | - Ilona Rybinska
- Molecular Targeting Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (I.R.); (T.T.)
| | - Elisabetta Scoccia
- Breast Unit, Surgery Department, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy; (E.S.); (F.C.)
| | - Carlo Morasso
- Laboratorio di Nanomedicina ed Imaging Molecolare, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy; (F.P.); (C.M.); (A.R.)
| | - Alessandra Ricciardi
- Laboratorio di Nanomedicina ed Imaging Molecolare, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy; (F.P.); (C.M.); (A.R.)
| | - Lorena Signati
- Dipartimento di Scienze Biomediche e Cliniche “L. Sacco”, Università Degli Studi di Milano, 20157 Milano, Italy;
| | - Tiziana Triulzi
- Molecular Targeting Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (I.R.); (T.T.)
| | - Fabio Corsi
- Breast Unit, Surgery Department, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy; (E.S.); (F.C.)
- Dipartimento di Scienze Biomediche e Cliniche “L. Sacco”, Università Degli Studi di Milano, 20157 Milano, Italy;
| | - Marta Truffi
- Laboratorio di Nanomedicina ed Imaging Molecolare, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy; (F.P.); (C.M.); (A.R.)
- Correspondence: ; Tel.: +39-0382-592219
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Chen X, Lu F, Yuan Y. The Application and Mechanism of Action of External Volume Expansion in Soft Tissue Regeneration. TISSUE ENGINEERING PART B-REVIEWS 2021; 27:181-197. [PMID: 32821009 DOI: 10.1089/ten.teb.2020.0137] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Xihang Chen
- Department of Plastic and Cosmetic Surgery, Southern Medical University, Nanfang Hospital, Guangzhou, China
| | - Feng Lu
- Department of Plastic and Cosmetic Surgery, Southern Medical University, Nanfang Hospital, Guangzhou, China
| | - Yi Yuan
- Department of Plastic and Cosmetic Surgery, Southern Medical University, Nanfang Hospital, Guangzhou, China
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Ueberreiter CS, Ueberreiter K, Mohrmann C, Herm J, Herold C. [Long-term evaluation after autologous fat transplantation for breast augmentation]. HANDCHIR MIKROCHIR P 2020; 53:149-158. [PMID: 32777824 DOI: 10.1055/a-1183-4338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background The transplantation of autologous fat is an increasingly common but not standardized procedure in aesthetic and reconstructive surgery. Until now only studies about the short-term results after transplantation with autologous fat have been published. In this publication we present our results of a long-term study after fat transplantation.Patients/Material and Methods 14 patients underwent an MRI investigation which was done before and 5-9 years (mean 6 years) years after aesthetic breast lipofilling according to BEAULI-protocol. The difference in volume was calculated with the open source software OsiriX. Two groups were analyzed separately to calculate the influence of body weight changes in final volume gain. In the first group patients with a stable BMI (increase of less than 1 kg/m2) were included. The second group includes patients with a BMI gain exceeding more than 1 kg/m2. The mean increase in BMI was 1,6 kg/m2 (minimum 0 - maximum 3,9). None of the patients lost weight.Results Depending on the desired amount of breast augmentation the patients underwent between one to four operations. An average of 176 ml fat was transplanted per breast and surgery. In the first group a mean volume survival of 74 % (IQR 58 % - 92 %) was observed. In the second group an increase of 135 % (IQR 105 % - 318 %) of the volume of transplanted fat was observed. After an intermediate weight loss one of the patients regained her initial weight.Conclusion In this study the transplantation of autologous fat renders good long-term results. There is a significant correlation between change of weight and fat transplant volume survival over the years. This also explains the very high increase in breast volume in some patients. Autologous fat transplantation seems to be a safe and efficient method for breast augmentation. For further statements studies with larger number of cases are necessary.
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Affiliation(s)
| | | | - Chris Mohrmann
- Klinikum Oldenburg AöR Anästhesiologie/Intensiv-/Notfallmedizin/Schmerztherapie
| | - Juliane Herm
- Charite Universitatsmedizin Berlin Center for Stroke Research Berlin
| | - Christian Herold
- DIAKO Bremen, Chirurgische Klinik, Sektion Plastische und Ästhetische Chirurgie
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Zhou M, Hou J, Zhang G, Luo C, Zeng Y, Mou S, Xiao P, Zhong A, Yuan Q, Yang J, Wang Z, Sun J. Tuning the mechanics of 3D-printed scaffolds by crystal lattice-like structural design for breast tissue engineering. Biofabrication 2019; 12:015023. [DOI: 10.1088/1758-5090/ab52ea] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Calabrese S, Zingaretti N, De Francesco F, Riccio M, De Biasio F, Massarut S, Almesberger D, Parodi PC. Long-term impact of lipofilling in hybrid breast reconstruction: retrospective analysis of two cohorts. EUROPEAN JOURNAL OF PLASTIC SURGERY 2019. [DOI: 10.1007/s00238-019-01577-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AbstractLipofilling has recently gained popularity as a tool in primary treatment of breast cancer, and its association with two-stage implant breast reconstruction is considered as standard treatment in many centers. However, no data are available about the long-term results of the association of lipofilling in combination with expander-implant reconstruction. A retrospective analysis was conducted on patients treated between January 2010 and December 2014. Two groups were compared. Group 1 had a standard expander-implant two-stage reconstruction. Group 2 underwent hybrid breast reconstruction (HBR). Patient characteristics, hospitalization, outcomes, reoperation details, outpatient visits, and evaluation questionnaires were taken into consideration. Intergroup comparison was performed using Wilcoxon Mann-Whitney U test and Pearson’s chi-square test or Fisher’s exact test for categorical variables. Two hundred fourteen patients were evaluated: 130 patients in group 1 and 84 patients in group 2. Group 2 showed significant benefits over group 1 in terms of capsular contracture rate, breast pain, and displacement/rotation of the implant (p = 0.005). The HBR protocol is associated with lower rate of capsular contracture, less breast pain at long follow-up times, and lower overall rates of revision surgery compared to standard expander-implant reconstruction. A specific cost analysis will help further clarify the advantages of this protocol over a standard procedure.Level of Evidence: Level III, risk/prognostic, therapeutic study.
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The Use of Autologous Tissue for Chest Feminization in Gender-Affirming Surgery. Plast Reconstr Surg 2019; 145:228e-229e. [PMID: 31651693 DOI: 10.1097/prs.0000000000006363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Efficacy of breast reconstruction with fat grafting: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2018; 71:1740-1750. [PMID: 30245019 DOI: 10.1016/j.bjps.2018.08.024] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/10/2018] [Accepted: 08/29/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Breast reconstruction with fat grafting is a new alternative to prosthetic implants and flaps for women with breast cancer. In this study, we investigate the efficacy of fat grafting for breast reconstruction in a meta-analysis. METHODS The study followed the PRISMA and MOOSE guidelines for systematic reviews and meta-analyses. Studies were included if the patients underwent complete breast reconstruction with fat grafting as the only treatment modality. The number of fat grafting treatments needed to complete a breast reconstruction was modeled in a meta-analysis for five treatment categories: modified radical mastectomy, skin-sparing mastectomy, and breast-conserving surgery; the two mastectomy groups were subdivided into nonirradiated and irradiated. RESULTS Twenty-one studies were included in the meta-analysis. The studies comprised 1011 breast reconstructions in 834 patients. The estimated numbers of treatments to complete a reconstruction were 2.84-4.66 in the mastectomy groups and 1.72 in the breast-conserving surgery group. The number of fat grafting sessions needed to complete a breast reconstruction was significantly higher for the irradiated patients than for the nonirradiated patients (p < 0.05). There was no significant difference in the number of fat grafting sessions needed to complete a breast reconstruction after a modified radical mastectomy versus a skin-sparing mastectomy. CONCLUSIONS This study provides an evidence-based foundation for several practical issues related to breast reconstruction with fat grafting. The analysis showed that radiotherapy is the most important factor associated with the number of treatment sessions needed to complete a breast reconstruction and with the rate of complications.
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