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Tellarini A, Bascialla E, Paganini F, Fasoli V, Buttarelli F, Marra EP, Tamborini F, Corno M, Di Giovanna D, Baraziol R, Flocchini M, Curic LM, Tuttolomondo A, Calabrese S, Valdatta L. Breast reconstruction with TiLOOP® Bra: Another arrow in plastic surgeons' quiver? J Plast Reconstr Aesthet Surg 2024; 97:89-114. [PMID: 39151289 DOI: 10.1016/j.bjps.2024.07.060] [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: 12/30/2023] [Revised: 06/25/2024] [Accepted: 07/22/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND The use of lower-pole sling products has made immediate breast reconstruction a feasible option in women undergoing skin-nipple sparing and skin-reducing mastectomies. To date, available data on the comparative efficacy of biological and synthetic meshes regarding postoperative complications are scattered and limited. METHODS A systematic literature search was performed to screen three different databases (PubMed, Web of Sciences, and Embase) using the following keywords: "breast reconstruction" AND "TiLOOP®" OR "Titanium-Coated Polypropylene Mesh" OR "TCPM". The perioperative and demographic characteristics of patients, complications profiles, and patient-reported outcomes were considered. RESULTS We initially identified 234 articles, of which only 41, including 3923 patients and 5042 reconstructed breasts, fully satisfied the inclusion criteria. CONCLUSION TiLOOP® Bra could be considered a safe and aesthetically valid alternative to Acellular Dermal Matrices (ADMs) in non-smokers patients undergoing skin-nipple sparing and skin-reducing mastectomies and immediate reconstruction. In such populations, complications are more likely to develop in patients with extreme body mass index values. The incidence of seroma with TiLOOP® Bra is comparable to that of ADMs as it is the beneficial effect in radiated patients, where TiLOOP® Bra seems superior to implant alone reconstruction. It has a good bio-integration with host tissues and resistance to infections in patients with a weakened immune system as a consequence of oncologic perioperative treatments.
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Affiliation(s)
- Annachiara Tellarini
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy.
| | - Elisa Bascialla
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Ferruccio Paganini
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Veronica Fasoli
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Francesco Buttarelli
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Eduardo Paolo Marra
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Federico Tamborini
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy; Microsurgery and Hand Surgery Unit, ASST Settelaghi Varese, Varese, Italy
| | - Martina Corno
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Danilo Di Giovanna
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Roberto Baraziol
- Department of Plastic Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Maria Flocchini
- Department of Plastic Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Laura Maria Curic
- Department of Plastic Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
| | | | - Sarah Calabrese
- Department of Plastic Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Luigi Valdatta
- Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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Clark RC, Reese MD, Attalla P, Camacho JM, Hirpara MM, Delong MR, Reid CM. A Systematic Review and Meta-Analysis of Synthetic Mesh Outcomes in Alloplastic Breast Reconstruction. Aesthet Surg J Open Forum 2024; 6:ojae066. [PMID: 39346802 PMCID: PMC11427907 DOI: 10.1093/asjof/ojae066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2024] Open
Abstract
Background Mesh implants are frequently employed in alloplastic breast reconstruction. Notably, no mesh to date has FDA approval for this indication. Several synthetic meshes have been introduced with heterogeneous properties and outcomes. Objectives This study aims to systematically review synthetic mesh use in alloplastic breast reconstruction, describe rates of short-term complications, and analyze these outcomes in reports comparing synthetic and biologic meshes. The authors hypothesized data from comparative and noncomparative studies would show no significant differences between synthetic and biological meshes. Methods The authors conducted a systematic literature review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Thirty-one studies reporting the use of synthetic mesh and clinical outcomes were included. Eight studies directly comparing synthetic mesh and biological mesh were meta-analyzed for relative risk (RR). Nineteen noncomparative studies were analyzed for meta-rates. Outcomes, including seroma, infection, reoperation, and explant, were assessed on a per-breast basis. Resultant models were challenged for sensitivity and bias. Results Meta-analysis of comparative studies demonstrated no difference in the risk of infection with synthetic mesh (RR = 0.53; 95% CI [0.26-1.10]), but a reduced risk of reoperation (RR = 0.54; 95% CI [0.33-0.89]) or explant (RR = 0.43; 95% CI [0.21-0.87]). Meta-analysis of noncomparative studies demonstrated rates of seroma = 3%; 95% CI [1%-6%], infection = 4%; 95% CI [3%-6%], reoperation = 10%; 95% CI [7%-13%], and explant = 3%; 95% CI [2%-5%]). Conclusions Studies comparing synthetic and biologic meshes demonstrated noninferiority of synthetic in all outcomes assessed. Noncomparative studies demonstrated rates of seroma, infection, reoperation, and explant similar to literature values for biological mesh. Level of Evidence 2 Risk
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Affiliation(s)
| | | | | | | | | | | | - Chris M Reid
- Corresponding Author: Dr Chris Reid, 200 West Arbor Drive MC 8890, San Diego, CA 92103-8890, USA. E-mail:
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Catanuto G, Virzì D, Latino M, Musmeci N, Fichera D, Balafa K, Cannata I, Rocco N, Marino M, Castiglione G, Caruso F. One-Stage Implant-Based Breast Reconstruction With Polyurethane-Coated Device: Standardized Assessment of Outcomes. Aesthet Surg J 2024; 44:491-498. [PMID: 37738139 DOI: 10.1093/asj/sjad301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/06/2023] [Accepted: 09/19/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Nipple-sparing mastectomies (NSMs) and implant-based breast reconstructions have evolved from 2-stage reconstructions with tissue expansion and implant exchange to direct-to-implant procedures. In this study, we tested safety and efficacy of polyurethane-based implants according to standard assessment tools. OBJECTIVES This study aimed to test safety and feasibility of polyurethane-coated implants with standardized assessment employing internationally acknowledged evaluation criteria. METHODS Cases of NSMs followed by breast reconstruction in 1 stage with immediate prepectoral polyurethane-coated implant placement were retrospectively reviewed. Preoperative characteristics of the population have been collected. Adherence to quality assurance criteria of the Association of Breast Surgery-British Association of Plastic Reconstructive and Aesthetic Surgeons was verified. Complications were assessed with the Clavien Dindo classification, modified for the breast. Rippling, implant rotation, and malposition were also evaluated. RESULTS Sixty-three consecutive patients underwent 74 NSMs and immediate breast reconstruction with micro polyurethane foam-coated anatomic implants. In 5 cases we had unplanned readmissions with return to the operating room under general anesthesia (6.7%) and implant loss within 3 months from breast reconstruction (5 implants, 6.7%). Postoperative complications according to Clavien Dindo were grade 1 in 6 cases (8.1%), grade 2 in 3 cases (4%), and 3b in 5 cases (6.7%). CONCLUSIONS Polyurethane-coated implants may prevent rotation and malposition and capsular contracture in the short term. Unplanned readmission rates and implant loss rates in the short term may be slightly higher.See the abstract translated into Hindi, Portuguese, Korean, German, Italian, Arabic, Chinese, and Taiwanese online here: https://doi.org/10.1093/asj/sjad301. LEVEL OF EVIDENCE: 4
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4
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Bruno E, Borea G, Valeriani R, De Luca A, Lo Torto F, Loreti A, Ribuffo D. Evaluating the Quality of Online Patient Information for Prepectoral Breast Reconstruction Using Polyurethane-Coated Breast Implants. JPRAS Open 2024; 39:11-17. [PMID: 38107035 PMCID: PMC10724489 DOI: 10.1016/j.jpra.2023.10.015] [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: 09/19/2023] [Accepted: 10/29/2023] [Indexed: 12/19/2023] Open
Abstract
Background An increasing number of patients are using online information regarding medical issues; however, the Internet is not subject to content ratings or filters. Unreliable information found on the web can heavily influence patients to the extent that it can lead to wrong decisions in the choice of treatment. In our daily experience we meet more informed patients and given the increasing use of polyurethane-coated implants in breast reconstruction in Europe, we wondered about the level of information available online. Our study aims to assess the quality of information available online on breast reconstruction with polyurethane-coated implants. Materials and Methods Assuming that the most used search engines are Google and Yahoo, we used a search strategy to identify online information regarding prepectoral breast reconstruction with polyurethane-coated implants. The selected websites were divided into 5 groups (practitioners, hospitals, healthcare portals, professional societies, and encyclopedias), and the quality of information was assessed by using an expanded version of the Ensuring Quality Information for Patients (EQIP) tool, which is a checklist applicable to all existing types of information. Results Fifty-six websites were selected and were categorized into 5 groups: 17 practitioners, 9 hospitals, 13 healthcare portals, 7 professional societies, 10 encyclopedias. The average score was 17 points (range: 12 - 25). We found 13 reliable websites with a score higher than 20 using the expanded version of the EQIP tool, whereas 43 were deemed unreliable, as they scored lower. Conclusion Proper communication between surgeon and patient is crucial in the therapeutic choice, as the available online information presently is scarce and can lead to wrong decisions if not properly verified.
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Affiliation(s)
- Edoardo Bruno
- Department of Plastic and Reconstructive Surgery, Sapienza Università di Roma, 00161, Rome, Italy
| | - Gianluca Borea
- Department of Plastic and Reconstructive Surgery, Sapienza Università di Roma, 00161, Rome, Italy
| | - Roberto Valeriani
- Department of Plastic and Reconstructive Surgery, Sapienza Università di Roma, 00161, Rome, Italy
- School of Applied Medical-Surgical Sciences, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy
| | - Alessandro De Luca
- Department of Surgical Sciences, Sapienza Università di Roma, 00161, Rome, Italy
| | - Federico Lo Torto
- Department of Plastic and Reconstructive Surgery, Sapienza Università di Roma, 00161, Rome, Italy
| | - Andrea Loreti
- Department of Plastic and Reconstructive Surgery, Azienda Ospedaliera San Giovanni-Addolorata, Via Dell'Amba Aradam 8, 00161, Rome, Italy
| | - Diego Ribuffo
- Department of Plastic and Reconstructive Surgery, Sapienza Università di Roma, 00161, Rome, Italy
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Morgan O, Belda R, Schnur J, Montgomery G, Parmar S, Chirivella I, Cano A. Prophylactic mastectomy and bilateral salpingo-oophorectomy in patients with breast cancer: a systematic review of postsurgical sexual function and menopausal hormone therapy symptom mitigation. Sex Med Rev 2023; 12:3-13. [PMID: 37183167 DOI: 10.1093/sxmrev/qead020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/07/2023] [Accepted: 04/09/2023] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Preventative surgical procedures for patients who are breast cancer (BRCA) positive-namely, bilateral salpingo-oophorectomy and mastectomy-have been linked to changes in sexual function, including surgically induced menopause. A patient's decision to undergo preventive surgery as opposed to high-risk screening is heavily reliant on advice received from one's health care provider. Quality of life should be considered when shared decision making is conducted with patients. OBJECTIVES To assemble and analyze findings related to patient-reported sexual function after these surgical procedures, to see if and how either procedure affects sexual function from patient baseline, and to determine whether the effects can be mitigated with menopausal hormone therapy. METHODS A literature review based on the PubMed, Embase, and MEDLINE databases was conducted from inception through January 25, 2022. To be included, studies had to meet an a priori list of Medical Subject Headings: "BRCA" AND "sexual dysfunction" OR "dyspareunia." GRADE criteria were used to determine the quality of studies relating to menopause hormone therapy. RESULTS The search yielded 14 results, and 11 reported sufficient data for systematic review. Sexual function was measured via validated and investigator-generated surveys. All studies, no matter the survey metric, found significant reduction in sexual function with bilateral salpingo-oophorectomy; no studies revealed sexual function changes associated with mastectomy postsurgery. Few studies indicated that menopause hormone therapy resulted in significant improvement in sexual function, and all studies reported that postoperative sexual function could not reach baseline levels with therapy. No studies were high quality by GRADE metrics. CONCLUSION Prophylactic mastectomies and bilateral salpingo-oophorectomies among patients who are BRCA positive cause SF changes postprocedure. Menopausal hormone therapy offers little help in mediating symptoms. Significantly more research is needed to explore potential changes in sexual function, as it is an important aspect of quality of life for patients with BRCA positivity.
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Affiliation(s)
- Orly Morgan
- Department of Medical Education, Miller School of Medicine, University of Miami, Miami, FL 33101, United States
| | - Rocio Belda
- Department of Paediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, 46003, Spain
| | - Julie Schnur
- Department of Population Health Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Guy Montgomery
- Department of Population Health Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Shivangi Parmar
- Department of Medical Education, Miller School of Medicine, University of Miami, Miami, FL 33101, United States
| | - Isabel Chirivella
- Department of Paediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, 46003, Spain
| | - Antonio Cano
- Department of Paediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, 46003, Spain
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Frasson AL, Falcone AB, Barbosa F, Anton de Souza AB, Malhone C, Miranda I, Vollbrecht B, Rodriguez Martinez Frasson MA, Kobe L, Lichtenfels M. Low rate of complications in nipple-sparing mastectomy for patients with BRCA1 and BRCA2 mutation. Per Med 2023; 20:493-501. [PMID: 37909344 DOI: 10.2217/pme-2023-0084] [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] [Indexed: 11/03/2023]
Abstract
Background: To describe the indications and outcomes of BRCA mutation carriers undergoing nipple-sparing mastectomy (NSM). Methods: In this retrospective study, 76 BRCA mutation carriers with no cancer who opted to undergo risk reduction NSM or diagnosed with breast cancer (BC) who opted to undergo therapeutic NSM were included. Results: Indications for NSM: cancer treatment (n = 33), bilateral risk reduction (n = 39) and contralateral prophylactic NSM (n = 4). In a mean follow-up of 45 months (median: 30 months), one patient (2.5%) undergoing risk-reducing NSM developed a new BC. One (3%) local, one (3%) ipsilateral axillary and one (3%) distant recurrence were observed in BC patients. No partial or total nipple necrosis occurred. Conclusion: NSM is safe for reducing the risk of BC development in BRCA mutation carriers and for treating cancer.
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Affiliation(s)
- Antônio Luiz Frasson
- Breast Cancer Group, Albert Einstein Hospital, Albert Einstein Avenue 627, 05652-900, São Paulo, Brazil
- Breast Cancer Center, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Ipiranga 6690, 90610-000, Porto Alegre, Brazil
| | - Ana Beatriz Falcone
- Breast Cancer Group, Albert Einstein Hospital, Albert Einstein Avenue 627, 05652-900, São Paulo, Brazil
| | - Fernanda Barbosa
- Breast Cancer Group, Albert Einstein Hospital, Albert Einstein Avenue 627, 05652-900, São Paulo, Brazil
| | - Alessandra Borba Anton de Souza
- Breast Cancer Center, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Ipiranga 6690, 90610-000, Porto Alegre, Brazil
| | - Carolina Malhone
- Breast Cancer Group, Albert Einstein Hospital, Albert Einstein Avenue 627, 05652-900, São Paulo, Brazil
| | - Isabela Miranda
- Breast Cancer Center, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Ipiranga 6690, 90610-000, Porto Alegre, Brazil
| | - Betina Vollbrecht
- Breast Cancer Center, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Ipiranga 6690, 90610-000, Porto Alegre, Brazil
| | - Monica Adriana Rodriguez Martinez Frasson
- Breast Cancer Group, Albert Einstein Hospital, Albert Einstein Avenue 627, 05652-900, São Paulo, Brazil
- Breast Cancer Center, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Ipiranga 6690, 90610-000, Porto Alegre, Brazil
| | - Luiza Kobe
- Breast Cancer Group, Albert Einstein Hospital, Albert Einstein Avenue 627, 05652-900, São Paulo, Brazil
| | - Martina Lichtenfels
- Breast Cancer Group, Albert Einstein Hospital, Albert Einstein Avenue 627, 05652-900, São Paulo, Brazil
- Breast Cancer Center, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Ipiranga 6690, 90610-000, Porto Alegre, Brazil
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Loreti A, Fanelli B, Abate O, Spallone D, Arelli F, Bruno E, Marcasciano M, La Pinta M, Meli EZ, Fortunato L. Surgical Delay of Nipple Areola Complex: A Powerful Technique to Extend the Indication of Nipple-Sparing Mastectomy. Clin Breast Cancer 2023; 23:255-264. [PMID: 36681577 DOI: 10.1016/j.clbc.2023.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND Surgical delay (SD) techniques, performed before the nipple sparing mastectomy (NSM), are procedures conceived to improve the blood supply to the nipple-areola complex (NAC) in order to overcome the ischemic risk. The aim of the study is reporting our experience with SD of the NAC in the setting of NSM, identify the rate of nipple and skin necrosis and other complications and to evaluate patient satisfaction with cosmetic outcome. PATIENTS AND METHODS A retrospective review of female patients, who underwent NSM and breast reconstruction between the July 2014 and the July 2019, was performed at the Breast Unit of San Giovanni-Addolorata Hospital in Rome. Eighty-nine NSM after SD procedure were performed in 66 patients. In all cases immediate breast reconstruction was performed with a direct to implant technique and polyurethane implants in prepectoral plan were used in all reconstructions. RESULTS We registered only 1 case of total NAC necrosis and 3 skin flap necrosis. Furthermore, patient satisfaction with breast reconstruction resulted excellent or good in 23 cases and good in 36 cases; the external plastic surgeon considered the breast reconstruction excellent or good in 63 cases. CONCLUSION We support the thesis that SD techniques may expand indications for NAC sparing mastectomy and immediate breast reconstruction in women with known risk factors for local complications. Microabstract This is the largest single center series on surgical delay of nipple areola complex providing interesting data on follow-up and complication rates and we support the thesis that surgical delay techniques may expand indications for nipple-areola complex sparing mastectomy and immediate breast reconstruction in women with known risk factors for local complications.
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Affiliation(s)
- Andrea Loreti
- Plastic and Reconstructive Surgery Division, Azienda Ospedaliera San Giovanni-Addolorata, Rome, Italy.
| | - Benedetta Fanelli
- Department of Surgery ''P.Valdoni'', Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Ornella Abate
- Plastic and Reconstructive Surgery Division, Azienda Ospedaliera San Giovanni-Addolorata, Rome, Italy
| | - Diana Spallone
- Plastic and Reconstructive Surgery Division, Azienda Ospedaliera San Giovanni-Addolorata, Rome, Italy
| | - Floriana Arelli
- Plastic and Reconstructive Surgery Division, Azienda Ospedaliera San Giovanni-Addolorata, Rome, Italy
| | - Edoardo Bruno
- Department of Surgery ''P.Valdoni'', Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Marco Marcasciano
- Division of Plastic and Reconstructive Surgery, Magna Grecia University of Catanzaro, Viale Europa, Catanzaro, Italy
| | - Massimo La Pinta
- Breast Unit, Azienda Ospedaliera San Giovanni-Addolorata, Rome, Italy
| | | | - Lucio Fortunato
- Breast Unit, Azienda Ospedaliera San Giovanni-Addolorata, Rome, Italy
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Quality of Life 9 to 13 Years after Autologous or Alloplastic Breast Reconstruction: Which Breast Remains Best? Plast Reconstr Surg 2023; 151:467-476. [PMID: 36730486 PMCID: PMC9944754 DOI: 10.1097/prs.0000000000009899] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the long-term patient satisfaction and quality of life 9 to 13 years after autologous versus alloplastic breast reconstruction and compare the data to those of an earlier study. METHODS This is a 9-year follow-up study of 92 women who underwent breast reconstruction (47 autologous and 45 alloplastic) between 2006 and 2010 and filled out the BREAST-Q questionnaire in 2010. Changes in BREAST-Q scores were analyzed by using a change score from baseline (2010) to follow-up (2019), which was presented by a mean change score with 95% confidence intervals. Linear regression analyses were performed to test which patient characteristics were related to the BREAST-Q change scores. RESULTS The response rate at follow-up was 60% (25 autologous and 30 alloplastic). Responders at follow-up had a lower body mass index and had less frequently undergone unilateral breast reconstruction compared to the nonresponders. Women undergoing both autologous and alloplastic breast reconstruction had significantly decreased satisfaction with breasts (-4 points), satisfaction with outcome (-8 points), and satisfaction with nipples (-20 points) over time. None of the patient characteristics, including reconstruction technique, were related to the BREAST-Q change scores. CONCLUSIONS Satisfaction with breasts, satisfaction with outcome, and satisfaction with nipples decreased slightly over time for women undergoing alloplastic and autologous breast reconstruction. Women undergoing autologous breast reconstruction seemed to remain more satisfied with their breasts 9 to 13 years after breast reconstruction compared to women undergoing alloplastic breast reconstruction. Because of the small sample size, conclusions should be carefully drawn. However, the results were in line with the expectations based on previous literature.
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Di Taranto G, Coleman GJ, Hardwicke J, Wallis KL, Skillman J. A comparative study between deep inferior epigastric artery perforator flap breast reconstruction and DIEP flap breast reconstruction coupled with vascularized lymph node transfer: Improving the quality of life of patients with breast cancer related lymphedema without affecting donor site outcomes. Microsurgery 2023; 43:213-221. [PMID: 35635124 DOI: 10.1002/micr.30924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/15/2022] [Accepted: 05/06/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Despite simultaneous microvascular breast reconstruction (MBR) and vascularized lymph node transfer (VLNT) gaining wide popularity as a potential treatment for breast cancer related lymphedema (BCRL), there is a lack of evidence supporting the procedure. There are few reports in the literature, and no study has compared simple deep inferior epigastric artery perforator (DIEP) to simultaneous DIEP flap and VLNT. PATIENTS AND METHODS A retrospective analysis of our series of DIEP flaps was conducted. Patients presenting with BCRL who had delayed MBR and simultaneous VLNT were selected. Thirty-two patients were included and compared with a control group of delayed MBR with DIEP flap alone. Clinical evaluation, circumference reduction rate, and LYMQOL questionnaire were used to compare preoperative and postoperative findings in the study group. A digital version of BREAST Q questionnaire was administered to all patients. RESULTS Thirty-two patients were enrolled in the study group, with a mean follow-up of 42.5 ± 25.7 months and mean age of 54.1 ± 7.8 years. The mean circumference reduction rate was 46.1 ± 52.3, 39 ± 42.3, 47.5 ± 53.5, 39.2 ± 52.4, 33.6 ± 50.1 at the deltoid insertion, above the elbow, below the elbow, at the mid-forearm and wrist respectively. Postoperative LYMQOL scores significantly improved (function 1.21, appearance 1.15, symptoms 1.34, mood 1.33, overall QOLscore 8.6) from preoperative baseline (p < .001). There was no significant difference in term of outcomes and complications rate of the donor site between the study and control groups. CONCLUSIONS Simultaneous DIEPandVLNT improves the HRQOL of patients with lymphedema. Coupling VLNT with abdominal flap does not increase the morbidity of donor site.
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Affiliation(s)
- Giuseppe Di Taranto
- Department of Plastic Surgery, University Hospitals of Coventry and Warwickshire, Coventry, UK.,Department of Surgery "P Valdoni", Sapienza University, Rome, Italy
| | - Grant J Coleman
- Department of Plastic Surgery, University Hospitals of Coventry and Warwickshire, Coventry, UK
| | - Joseph Hardwicke
- Department of Plastic Surgery, University Hospitals of Coventry and Warwickshire, Coventry, UK.,Honorary Professor, Warwick Medical School, University of Warwick, Coventry, UK
| | - Katy L Wallis
- Department of Plastic Surgery, University Hospitals of Coventry and Warwickshire, Coventry, UK
| | - Joanna Skillman
- Department of Plastic Surgery, University Hospitals of Coventry and Warwickshire, Coventry, UK
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10
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Toyokuni S, Kong Y, Motooka Y, Akatsuka S. Environmental impact on carcinogenesis under BRCA1 haploinsufficiency. Genes Environ 2023; 45:2. [PMID: 36639692 PMCID: PMC9837898 DOI: 10.1186/s41021-023-00258-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
Cancer is the primary cause of human mortality in Japan since 1981. Although numerous novel therapies have been developed and applied in clinics, the number of deaths from cancer is still increasing worldwide. It is time to consider the strategy of cancer prevention more seriously. Here we propose a hypothesis that cancer can be side effects of long time-use of iron and oxygen and that carcinogenesis is an evolution-like cellular events to obtain "iron addiction with ferroptosis-resistance" where genes and environment interact each other. Among the recognized genetic risk factors for carcinogenesis, we here focus on BRCA1 tumor suppressor gene and how environmental factors, including daily life exposure and diets, may impact toward carcinogenesis under BRCA1 haploinsufficiency. Although mice models of BRCA1 mutants have not been successful for decades in generating phenotype mimicking the human counterparts, a rat model of BRCA1 mutant was recently established that reasonably mimics the human phenotype. Two distinct categories of oxidative stress, one by radiation and one by iron-catalyzed Fenton reaction, promoted carcinogenesis in Brca1 rat mutants. Furthermore, mitochondrial damage followed by alteration of iron metabolism finally resulted in ferroptosis-resistance of target cells in carcinogenesis. These suggest a possibility that cancer prevention by active pharmacological intervention may be possible for BRCA1 mutants to increase the quality of their life rather than preventive mastectomy and/or oophorectomy.
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Affiliation(s)
- Shinya Toyokuni
- grid.27476.300000 0001 0943 978XDepartment of Pathology and Biological Responses, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan ,grid.27476.300000 0001 0943 978XCenter for Low-Temperature Plasma Sciences, Nagoya University, Furo-Cho, Chikusa-Ku, Nagoya, 464-8603 Japan
| | - Yingyi Kong
- grid.27476.300000 0001 0943 978XDepartment of Pathology and Biological Responses, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan
| | - Yashiro Motooka
- grid.27476.300000 0001 0943 978XDepartment of Pathology and Biological Responses, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan
| | - Shinya Akatsuka
- grid.27476.300000 0001 0943 978XDepartment of Pathology and Biological Responses, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550 Japan
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“Hook Shape” Nipple-Sparing Mastectomy and Prepectoral Implant Reconstruction: Technique, Results and Outcomes from a Preliminary Case Series. Aesthetic Plast Surg 2022; 47:546-556. [PMID: 36280606 DOI: 10.1007/s00266-022-03115-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/11/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Nipple-sparing mastectomy (NSM) is a surgical procedure increasingly performed for breast cancer or risk reduction surgeries. The site of skin incision seems to affect not only cosmesis but also technical ease in operating and vascular viability of the nipple. We present a series of patients who underwent a modified vertical surgical approach for NSM, which resulted to be safe, reliable, and with good esthetic results. MATERIALS AND METHODS From December 2016 to February 2019, 27 "Hook Shape" incision NSMs were performed. All patients underwent an immediate subcutaneous muscle-sparing reconstruction with tissue expander covered by a titanium-coated polypropylene mesh, followed by a second surgical step with expander substitution and lipofilling on the definitive implant when indicated. Preoperative and postoperative BREAST-Q patient-reported outcomes measure was performed in all cases. RESULTS Postoperative morbidity was evaluated: One patient developed seroma and another presented a systemic infection that resolved with intravenous infusion of antibiotics. One patient experienced vertical wound dehiscence, recovered after conservative treatment and without implant exposure. No implant loss was observed. Nipple-areola complex necrosis or ischemia rate was 0%. The BREAST-Q outcomes reported significant increases in the overall satisfaction with breast (p < 0.05), psychosocial well-being (p < 0.05), and sexual well-being (p < 0.05) sections. Scores in the physical impact of surgery section appeared to decline from preoperative to postoperative evaluations, with no statistically significant results. CONCLUSION The mastectomy incision pattern can burden the surgical challenge, impact vascular viability of the nipple and significantly affect the aesthetic outcomes in breast reconstruction. We report our experience with an alternative approach for NSM, which appears a safe, practical, and reproducible method for patients with small- to medium-sized breasts and little/medium ptosis (grade I or II). 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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Acea-Nebril B, García-Novoa A, García Jiménez L. The PreQ-20 TRIAL: A prospective cohort study of the oncologic safety, quality of life and cosmetic outcomes of patients undergoing prepectoral breast reconstruction. PLoS One 2022; 17:e0269426. [PMID: 35834508 PMCID: PMC9282436 DOI: 10.1371/journal.pone.0269426] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 05/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Mastectomy currently constitutes a necessary surgical procedure in the oncologic setting and in the context of high risk. Prepectoral breast reconstruction (PBR) has been proposed as a surgical alternative to retropectoral techniques by providing less postoperative morbidity and a better cosmetic result. However, there is a lack of prospective studies that have evaluated its safety and patient-reported satisfaction.
Methods
We conducted a prospective cohort study to assess the safety, quality of life and cosmetic sequelae of PBR in women with breast cancer and high risk. The study’s main objective is to assess the safety of PBR in terms of postsurgical complications and the feasibility of reconstruction (loss of implants). The secondary objectives are to evaluate oncologic safety (local relapses, residual glandular tissue) and to identify factors related to quality of life and cosmetic sequelae. The evaluation of residual tissue will be conducted by MRI 12 to 18 months after the surgery, and the quality-of-life assessment will be performed using the Breast-Q questionnaire. An initial patient evaluation will be conducted 12–18 months after the surgery, and a second evaluation will be performed at 5 years. The estimated sample size is 81 patients.
Discussion
The PreQ-20 study will analyze the impact of PBR on 3 separate measures: safety, quality of life and cosmetic sequelae. Unlike other studies that analyzed these three measures jointly for women with breast cancer and high risk, this study will individualize the results for these 2 patient groups. This differentiation is necessary from the methodological point of view, given that the 2 patient groups have separate clinical and emotional implications. The assessment of these groups will focus on the following aspects: postoperative complications, local relapses, evaluation of residual glandular tissue and incidence rate of primary tumors in the same, the cosmetic sequelae and the satisfaction and the quality-of-life assessment by the patients.
Trial registration
ClinicalTrials.gov: NCT04642508.
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Affiliation(s)
- Benigno Acea-Nebril
- Breast Unit, Department of Surgery, University Hospital Complex A Coruña, A Coruña, Spain
| | - Alejandra García-Novoa
- Breast Unit, Department of Surgery, University Hospital Complex A Coruña, A Coruña, Spain
- * E-mail:
| | - Lourdes García Jiménez
- Breast Unit, Department of Surgery, University Hospital Complex A Coruña, A Coruña, Spain
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13
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Klifto KM, Tecce MG, Serletti JM, Kovach SJ. Comparison of nine methods of immediate breast reconstruction after resection of localized breast cancer: A cost-effectiveness Markov decision analysis of prospective studies. Microsurgery 2022; 42:401-427. [PMID: 35355320 DOI: 10.1002/micr.30882] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 01/08/2022] [Accepted: 03/10/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Women undergoing immediate breast reconstruction without radiation therapy have reconstruction methods available with uncertain long-term costs associated with complications requiring surgery and revisions. We evaluated cost-effectiveness of nine methods of immediate breast reconstruction for women with localized breast cancer. METHODS Markov modeling was performed over 10-years for unilateral/bilateral breast reconstructions from healthcare/societal perspectives. PubMed, Embase, Cochrane, Scopus, and CINAHL were searched to derive data from 13,744 patients in 79 prospective studies. Complications requiring surgery (mastectomy necrosis, total/partial flap necrosis, seroma, hematoma, infection, wound dehiscence, abdominal hernia, implant removal/explantation) and revisions (fat necrosis, capsular contracture, asymmetry, scars/redundant tissue, implant rupture/removal, fat grafting) were evaluated over yearly cycles. Reconstructions included: direct-to-implant (DTI), tissue expander-to-implant (TEI), latissimus dorsi flap-to-implant (LDI), latissimus dorsi (LD), pedicled transverse rectus abdominis myocutaneous (TRAM), free TRAM, deep inferior epigastric perforator/superficial inferior epigastric artery (DIEP/SIEA), thigh-based, or gluteal based flaps. Outcomes were incremental cost-effectiveness ratios (ICER) and net monetary benefits (NMB). Willingness-to-pay thresholds were $50,000 and $100,000. RESULTS From a healthcare perspective for unilateral reconstruction, compared to LD, the ICER for DTI was -$42,109.35/quality-adjusted life-years (QALY), LDI was -$25,300.83/QALY, TEI was -$22,036.02/QALY, DIEP/SIEA was $8307.65/QALY, free TRAM was $8677.26/QALY, pedicled TRAM was $13,021.44/QALY, gluteal-based was $17,698.99/QALY, and thigh-based was $23,447.82/QALY. NMB of DIEP/SIEA was $404,523.47, free TRAM was $403,821.40, gluteal-based was $392,478.64, thigh-based was $387,691.70, pedicled TRAM was $376,901.83, LD was $370,646.93, DTI was $339,668.77, LDI was $334,350.30, and TEI was $329,265.84. CONCLUSIONS All nine methods of immediate breast reconstruction were considered cost-effective from healthcare/societal perspectives. LD provided the lowest costs, while DIEP/SIEA provided the greatest effectiveness and NMB.
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Affiliation(s)
- Kevin M Klifto
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA.,Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Michael G Tecce
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Joseph M Serletti
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Stephen J Kovach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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14
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Early Clinical Outcomes of Polydioxanone Mesh for Prepectoral Prosthetic Breast Reconstruction. Plast Reconstr Surg Glob Open 2022; 10:e4082. [PMID: 35186635 PMCID: PMC8849407 DOI: 10.1097/gox.0000000000004082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 11/29/2021] [Indexed: 11/26/2022]
Abstract
Many biologic matrices and synthetic meshes are available as adjuncts for prosthetic and autologous breast reconstructions to help control implant position and to reinforce abdominal flap donor sites. Absorbable synthetic meshes may have advantages over biologic matrices and permanent meshes, such as lower cost and better long-term biocompatibility. We present a prospective case series of patients undergoing two-stage, prepectoral breast reconstruction with polydioxanone (PDO) mesh.
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15
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Seth I, Seth N, Bulloch G, Rozen WM, Hunter-Smith DJ. Systematic Review of Breast-Q: A Tool to Evaluate Post-Mastectomy Breast Reconstruction. BREAST CANCER (DOVE MEDICAL PRESS) 2021; 13:711-724. [PMID: 34938118 PMCID: PMC8687446 DOI: 10.2147/bctt.s256393] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 11/29/2021] [Indexed: 12/12/2022]
Abstract
Purpose The aim of this systematic review is to update and synthesize new evidence on BREAST-Q questionnaire’s ability to reflect patient-reported outcomes in women who have undergone breast reconstruction surgery (BRS) following mastectomy. Methods PubMed, Science Direct, Google Scholar, Cochrane CENTRAL, and Clincaltrial.gov were searched for relevant studies from January 2009 to September 2021. Any interventional or observational studies that used BREAST-Q to assess patient-reported outcomes in the assessment of BRS following mastectomy were included. Results A total of 42 studies were eligible for inclusion in the review. Three were randomized controlled trials and 39 were observational studies. Compared with pre-operative scores, there was an improvement in all BREAST-Q outcome domains following BRS including ‘satisfaction with breasts’, “satisfaction with outcome” “psychosocial”, “physical”, and “sexual wellbeing”. Sexual well-being had the lowest BREAST-Q score both pre-and post-operatively (37.8–80.0 and 39.0–78.0, respectively). Autologous BRS reports higher satisfaction and overall wellbeing compared to implant-based BRS. BREAST-Q has a higher and narrow internal consistency of 0.81 to 0.96 compared with other patient-reported outcome measures (PROMs; EORTC-QLQ, FACT-B, BR-23, BCTOS). The BREAST-Q questionnaire is the only PROM which allows patients to reflect on their care, surgical outcomes, and satisfaction collectively. Conclusion This review highlights the fact that BREAST-Q can effectively and reliably measure satisfaction and wellbeing of breast cancer patients after BRS. Comparatively, sexual wellbeing shows poorer outcomes following BRS and more longitudinal studies are necessary to understand the basis for these findings. Compared to other PROMs, BREAST-Q is reliable and specific to breast cancer surgery. Overall, BREAST-Q can help clinicians improve their quality of service, understand patient experiences, and may be used as an auditing tool for surgical outcomes.
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Affiliation(s)
- Ishith Seth
- Department of Surgery, Bendigo Health, Bendigo, Victoria, 3550, Australia
| | - Nimish Seth
- Department of Surgery, The Alfred Hospital, Melbourne, Victoria, 3004, Australia
| | - Gabriella Bulloch
- Faculty of Science, Medicine and Health, University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - Warren M Rozen
- Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, 3004, Australia
| | - David J Hunter-Smith
- Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, 3004, Australia
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Zhou Z, Li J, Wang H, Luan Z, Li Y, Peng X. Upper limb rehabilitation system based on virtual reality for breast cancer patients: Development and usability study. PLoS One 2021; 16:e0261220. [PMID: 34910786 PMCID: PMC8673600 DOI: 10.1371/journal.pone.0261220] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/27/2021] [Indexed: 01/13/2023] Open
Abstract
Background Functional exercise is crucial for breast cancer patients after surgery, and the use of virtual reality technology to assist patients with postoperative upper limb functional rehabilitation has gradually attracted the attention of researchers. However, the usability of the developed rehabilitation system is still unknown to a large extent. The purpose of this study was to develop a virtual reality upper limb rehabilitation system for patients after breast cancer surgery and to explore its usability. Methods We built a multidisciplinary team based on virtual reality and human-computer interaction technology and designed and developed an upper limb function rehabilitation system for breast cancer patients after surgery. Breast cancer patients were recruited from a grade III-a general hospital in Changchun city for the experiment. We used the System Usability Scale to evaluate the system availability, the Presence Questionnaire scale to measure the immersive virtual reality scene, and the Simulator Sickness Questionnaire subjective measurement scale for simulator sickness symptoms. Results This upper limb rehabilitation system hardware consisted of Head-mounted Display, a control handle and notebook computers. The software consisted of rehabilitation exercises and game modules. A total of 15 patients were tested on this system, all of whom were female. The mean age was 54.73±7.78 years, and no patients were excluded from the experiment because of adverse reactions such as dizziness and vomiting. The System Usability Scale score was 90.50±5.69, the Presence Questionnaire score was 113.40±9.58, the Simulator Sickness Questionnaire-nausea score was 0.93±1.16, the Simulator Sickness Questionnaire-oculomotor score was 0.80±1.27, the Simulator Sickness Questionnaire-disorientation score was 0.80±1.27, and the Simulator Sickness Questionnaire total score was 2.53±3.40. Conclusions This study fills in the blanks regarding the upper limb rehabilitation of breast cancer patients based on virtual reality technology system usability research. As the starting point of research in the future, we will improve the system’s function and design strictly randomized controlled trials, using larger samples in the promotion, to evaluate its application in breast cancer patients with upper limbs and other physiological functions and the feasibility and effects of rehabilitation.
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Affiliation(s)
- Zijun Zhou
- Breast Surgery, Jilin Province Tumor Hospital, Jilin, China
| | - Jiaxin Li
- School of Nursing, Jilin University, Jilin, China
| | - He Wang
- Breast Surgery, Jilin Province Tumor Hospital, Jilin, China
| | - Ze Luan
- School of Nursing, Jilin University, Jilin, China
| | - Yuan Li
- School of Nursing, Jilin University, Jilin, China
| | - Xin Peng
- School of Nursing, Jilin University, Jilin, China
- * E-mail:
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17
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Athamnah M, Rabai NA, Shkoukani ZW, Al Azzam HS, Abu-Shanab A. Nipple-Sparing Mastectomy: Initial Experience Evaluating Patients Satisfaction and Oncological Safety in a Tertiary Care Centre in Jordan. Cureus 2021; 13:e19238. [PMID: 34877215 PMCID: PMC8642139 DOI: 10.7759/cureus.19238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Nipple-sparing mastectomy (NSM), a procedure involving careful dissection of the breast tissue whilst keeping the nipple-areola complex (NAC) intact, is now increasingly practiced amongst surgeons in the treatment of certain situations of breast cancer. Given the importance of breasts to the female body image, this type of conservative breast surgery takes into account patient satisfaction and overall cosmesis, whilst ensuring appropriate oncological safety. Methods and results Four nipple-sparing mastectomy procedures were performed in our tertiary care centre, Princess Basma Teaching Hospital, in Jordan between June and September 2019. Indications for these procedures included invasive ductal carcinoma, malignant phyllodes, and high-grade ductal carcinoma in-situ. Patients were carefully assessed prior to surgical intervention using radiological imaging, ensuring a distance from NAC of >2 cm in all cases. Procedures were performed successfully with minimal intraoperative and no post-operative complications. Follow-up was carried out at 24 months, with no cases of local or distant post-operative recurrence, and patient satisfaction was qualitatively measured with the use of a BREAST-Q questionnaire. The questionnaire demonstrated improved overall physical well-being and satisfaction with an average overall post-operative physical well-being of 97%. Conclusion Following nipple-sparing mastectomy and immediate submuscular reconstruction with silicone implants,patients demonstrated high levels of satisfaction and quality of life (QoL) as measured by BREAST-Q survey. Two years of follow-up confirmed high patient satisfaction with increased scores from the preoperative baseline level.
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Affiliation(s)
- Mohammad Athamnah
- Department of General Surgery, Princess Basma Teaching Hospital, Irbid, JOR
| | - Nimah A Rabai
- Department of General Surgery, Princess Basma Teaching Hospital, Irbid, JOR
| | | | - Hussein S Al Azzam
- Department of General Surgery, Princess Basma Teaching Hospital, Irbid, JOR
| | - Amer Abu-Shanab
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, JOR
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Michno V, Malter W, Paepke S, Thill M, Kelling K, Meiré A, Tofall S, Nolte E, Christ H, Eichler C. Impact of demographic and perioperative risk factors on complication rates in skin-sparing/nipple-sparing mastectomy with implant-based reconstruction using titanized polypropylene mesh (TiLOOP® Bra). Surg Oncol 2021; 40:101675. [PMID: 34871867 DOI: 10.1016/j.suronc.2021.101675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/11/2021] [Accepted: 11/14/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Skin/nipple-sparing mastectomies (SSM/NSSM) have been reported to have acceptable complication rates and good aesthetic outcomes with high patient satisfaction. However, in this relatively young and rapidly expanding field of reconstructive plastic surgery, differences in perioperative management are noted between breast centers. Prospective studies of complication rates using a titanized polypropylene mesh (TiLOOP® Bra) are currently lacking. METHODS A prospective subgroup analysis was performed based on the data set of the prospective, single-arm, multicenter observational study (PRO-BRA). Early complication rates after skin/nipple-sparing mastectomy with implant-based immediate or secondary reconstruction using a titanized polypropylene mesh (TiLOOP® Bra) subpectorally were investigated in relation to demographic factors, as well as intra-and postoperative management. The subgroup consists of 258 patients. Complications were categorised into necrosis, infection, postoperative bleeding or hematoma, seroma, wound healing delays and R1-situations. RESULTS Early complication rates of SSM/NSSM using titanium-based meshes are comparable to complication-rates using ADM's. Logistic regression shows significantly higher risk for wound healing delays, necrosis and seroma with increasing BMI, abladat- and implant-weight (OR 1,17 -1,66, p-value < 0,001). Smokers have significantly higher necrosis rates (20.7%) compared to non-smokers (5.5%) (p-value = 0.002). Discharge with drainage results in a trend toward higher rates of wound healing complications. CONCLUSION The use of TiLOOP® Bra meshes was shown to have acceptable complication rates. Complication rates depend on certain demographic and intraoperative risk factors and should be considered in indications and information of patients.
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Affiliation(s)
- Viktoria Michno
- Clinic for Gynecology and Obstetrics, Center of Breast Disease, University of Cologne, Cologne, Germany.
| | - Wolfram Malter
- Clinic for Gynecology and Obstetrics, Center of Breast Disease, University of Cologne, Cologne, Germany
| | - Stefan Paepke
- Department of Obstetrics and Gynecology, Technical University of Munich, Munich, Germany
| | - Marc Thill
- Department of Gynecology and Gynecologic Oncology, Agaplesion Markus Hospital, Frankfurt Am Main, Germany
| | - Katharina Kelling
- Department of Gynecology and Gynecologic Oncology, Agaplesion Markus Hospital, Frankfurt Am Main, Germany
| | - Anette Meiré
- Center of Breast Disease,St. Elisabeth Hospital, Cologne, Germany
| | | | | | - Hildegard Christ
- Clinic for Gynecology and Obstetrics, Center of Breast Disease, University of Cologne, Cologne, Germany
| | - Christian Eichler
- Breast Cancer Center, St.- Franziskus Hospital Münster, Germany and Clinic for Gynecology and Obstetrics, Center of Breast Disease, University of Cologne, Cologne, Germany
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Breast Reconstruction after Mastectomy with the Use of an Implant and Serratus Anterior Fascia Flap-Initial Clinical Evaluation. J Pers Med 2021; 11:jpm11111142. [PMID: 34834494 PMCID: PMC8623064 DOI: 10.3390/jpm11111142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 11/17/2022] Open
Abstract
Prosthesis-based techniques are the predominant form of breast reconstruction worldwide. The most performed surgical technique involves the placement of the expander in a partial submuscular plane. The coverage of the implant remains a difficult management problem that can lead to complications and poor outcomes. The use of the serratus fascia flap may be the best choice to create a subpectoral pocket for the placement of a tissue expander, with excellent results in terms of morbidity and cost-effectiveness. A total of 20 breast reconstructions with the inferolateral coverage with the serratus fascia were performed. Patients demonstrated a low overall complication rate (9.5%), such as seroma and infection, with complete resolution during the follow-up and no major complications. The US examination of the soft tissues over the implant reported thickness measurements that demonstrated a good coverage over the inferolateral area. Our study shows that using the serratus fascia flap to create a pocket with the pectoralis major for the placement of the tissue expander is an effective technique during two-stage breast reconstruction. The resulting low rate of morbidity and the US findings collected reveal the safety of this procedure. Its success relies on appropriate patient selection and specific intraoperative technique principles.
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Assessing Postsurgical Outcomes with Prepectoral Breast Reconstruction: A Literature Review and Meta-analysis Update. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3825. [PMID: 34712539 PMCID: PMC8547925 DOI: 10.1097/gox.0000000000003825] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/19/2021] [Indexed: 12/29/2022]
Abstract
Background: Prepectoral implant-based breast reconstruction is an alternative to subpectoral/dual-plane reconstruction. Methods: This study examined outcomes of prepectoral reconstruction using a meta-analysis of data pooled with data from our previous review. Thirty studies were included. Results: Explantation, seroma, and infection were the most common complications with no animation deformity reported. Significantly lower odds of infection were observed with prepectoral compared with dual-plane reconstruction. Conclusions: Current literature suggests that prepectoral reconstruction may be associated with lower rates of postsurgical infections.
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Prepectoral implant-based breast reconstruction with TiLOOP® Bra Pocket - a single-centre retrospective study. J Plast Reconstr Aesthet Surg 2021; 75:104-111. [PMID: 34635454 DOI: 10.1016/j.bjps.2021.08.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 06/14/2021] [Accepted: 08/26/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Prepectoral implant-based reconstruction using synthetic meshes is feasible with good outcomes. We present our data using TiLOOP® Bra Pocket, a novel ready-to-use mesh pocket which acts as an internal bra and prevents the implant from dislocating or twisting. MATERIALS AND METHODS A single-centre retrospective cohort study was performed to assess short-term complication rates and cosmetic outcomes in patients with prepectoral implant-based reconstruction using the TiLOOP® Bra Pocket. The primary endpoint was complication rates during the first 6 months. The secondary endpoint was the cosmetic outcome after 6 to 12 months, which was judged by two breast surgeons using the Harvard score. RESULTS A total of 63 breasts (43 patients) were reconstructed using the TiLOOP® Bra Pocket between 2018 and 2020, 57 were immediate reconstructions. The overall complication rate was 30,2% (n = 19/63). Major complications occurred in seven breasts (n = 7/63; 11,1%) and minor complications occurred in 12 breasts (12/63; 19,0%). The unplanned revision rate was 12,7%. The cosmetic outcome was good (Harvard score: mean 3, range 1-4; SD 0,75). Seventeen cosmetic complications were observed (17/63; 27,0%) and six cosmetic revision surgeries were performed (6/63; 9,5%). CONCLUSION The use of the TiLOOP® Bra Pocket is convenient and standardized because the pocket is preformed and does not require to be sewn first. Cosmetic outcome is good; however, the surgical morbidity needs to be addressed in future reconstructions. Careful patient selection and preparation techniques are vital in order to achieve acceptable complication rates and satisfying cosmetic results.
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Luque Suárez S, Olivares Crespo ME, Brenes Sánchez JM, Herrera de la Muela M. Psychological implications of risk-reducing mastectomies in BRCA1/2 mutation carriers. Cir Esp 2021; 100:7-17. [PMID: 34217636 DOI: 10.1016/j.cireng.2021.06.014] [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: 03/08/2021] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
Risk-reducing surgeries decrease the risk of developing breast cancer by 95%. But this type of surgery can be life-changing. This systematic review analyzed anxiety/depressive symptomatology, body image and quality of life on BRCA1/2 mutation carriers with or without a previous oncological history who have undergone risk-reducing mastectomy. PRISMA method was used to conduct this review. The initial search identified 234 studies. However, only 7 achieved the inclusion criteria. No statistically significant differences were found in terms of anxious symptomatology. One study found that depressive symptomatology had increased significantly in women without previous oncological history at the long-term follow-up measure. Women who underwent bilateral risk-reducing mastectomy and implant-based breast reconstruction tended to be satisfied with their body image/cosmetic outcome. No differences were reported at long-term follow-ups, independently of the surgery performed.
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Luque Suárez S, Olivares Crespo ME, Brenes Sánchez JM, Herrera de la Muela M. Psychological implications of risk-reducing mastectomies in BRCA1/2 mutation carriers. Cir Esp 2021; 100:S0009-739X(21)00180-9. [PMID: 34140136 DOI: 10.1016/j.ciresp.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 12/21/2022]
Abstract
Risk-reducing surgeries decrease the risk of developing breast cancer by 95%. But this type of surgery can be life-changing. This systematic review analyzed anxiety/depressive symptomatology, body image and quality of life on BRCA1/2 mutation carriers with or without a previous oncological history who have undergone risk-reducing mastectomy. PRISMA method was used to conduct this review. The initial search identified 234 studies. However, only 7 achieved the inclusion criteria. No statistically significant differences were found in terms of anxious symptomatology. One study found that depressive symptomatology had increased significantly in women without previous oncological history at the long-term follow-up measure. Women who underwent bilateral risk-reducing mastectomy and implant-based breast reconstruction tended to be satisfied with their body image/cosmetic outcome. No differences were reported at long-term follow-ups, independently of the surgery performed.
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Filipe MD, de Bock E, Postma EL, Bastian OW, Schellekens PPA, Vriens MR, Witkamp AJ, Richir MC. Robotic nipple-sparing mastectomy complication rate compared to traditional nipple-sparing mastectomy: a systematic review and meta-analysis. J Robot Surg 2021; 16:265-272. [PMID: 34128142 PMCID: PMC8960562 DOI: 10.1007/s11701-021-01265-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 06/09/2021] [Indexed: 12/03/2022]
Abstract
Breast cancer is worldwide the most common cause of cancer in women and causes the second most common cancer-related death. Nipple-sparing mastectomy (NSM) is commonly used in therapeutic and prophylactic settings. Furthermore, (preventive) mastectomies are, besides complications, also associated with psychological and cosmetic consequences. Robotic NSM (RNSM) allows for better visualization of the planes and reducing the invasiveness. The aim of this study was to compare the postoperative complication rate of RNSM to NSM. A systematic search was performed on all (R)NSM articles. The primary outcome was determining the overall postoperative complication rate of traditional NSM and RNSM. Secondary outcomes were comparing the specific postoperative complication rates: implant loss, hematoma, (flap)necrosis, infection, and seroma. Forty-nine studies containing 13,886 cases of (R)NSM were included. No statistically significant differences were found regarding postoperative complications (RNSM 3.9%, NSM 7.0%, p = 0.070), postoperative implant loss (RNSM 4.1%, NSM 3.2%, p = 0.523), hematomas (RNSM 4.3%, NSM 2.0%, p = 0.059), necrosis (RNSM 4.3%, NSM 7.4%, p = 0.230), infection (RNSM 8.3%, NSM 4.0%, p = 0.054) or seromas (RNSM 3.0%, NSM 2.0%, p = 0.421). Overall, there are no statistically significant differences in complication rates between NSM and RNSM.
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Affiliation(s)
- M. D. Filipe
- Department of Surgery, Cancer Centre, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - E. de Bock
- Department of Surgery, Cancer Centre, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - E. L. Postma
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - O. W. Bastian
- Department of Surgery, Cancer Centre, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - P. P. A. Schellekens
- Department of Plastic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M. R. Vriens
- Department of Surgery, Cancer Centre, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - A. J. Witkamp
- Department of Surgery, Cancer Centre, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - M. C. Richir
- Department of Surgery, Cancer Centre, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
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Le NK, Soni SE, Smith PD, Kumar A, Dayicioglu D. Preservation of the Implant in Nipple-Sparing Mastectomies: A Retrospective Cohort Study. Ann Plast Surg 2021; 86:S491-S494. [PMID: 33538504 DOI: 10.1097/sap.0000000000002696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mastectomies are an integral part of breast cancer treatment for many patients.1 Of those patients, a significant number have previously undergone breast augmentation before being diagnosed with breast cancer. Therefore, we developed the novel technique of performing nipple- and implant-sparing mastectomies (NISMs) for women with prior breast augmentations. This study will assess the plausibility of using NISMs versus nipple-sparing mastectomies (NSMs) in this subgroup of patients by comparing the complication rates. METHODS Data were collected on age, tumor size, tumor grade, receptors, and the interval between mastectomy and implant exchange for both groups. Descriptive statistics were used to summarize patient characteristics. Independent samples t tests, χ2 tests, and Fisher exact tests were used to compare the NISM and NSM cohorts. Logistic regression was used to assess the association between complications and mastectomy type and was summarized as an odds ratio with a 95% confidence interval. RESULTS Fifteen patients underwent an NISM and 35 patients underwent an NSM. The overall rate of complications was less in NISM cases than in NSM cases (20% vs 27%). However, this difference was not statistically significant (odds ratio, 0.54; 95% confidence interval, 0.18-1.64; P = 0.278). CONCLUSIONS The overall complication rate was lower with NISMs compared with NSMs. Nipple- and implant-sparing mastectomy is a novel, viable, and safe option for patients with breast cancer and a history of submuscular breast augmentation.
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Affiliation(s)
| | - Sara E Soni
- From the Department of Plastic Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL
| | | | - Ambuj Kumar
- Department of Health Outcomes and Behavior, University of South Florida, Morsani College of Medicine, Tampa, FL
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"To Pre or Not to Pre": Introduction of a Prepectoral Breast Reconstruction Assessment Score to Help Surgeons Solving the Decision-Making Dilemma. Retrospective Results of a Multicenter Experience. Plast Reconstr Surg 2021; 147:1278-1286. [PMID: 33973934 DOI: 10.1097/prs.0000000000008120] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Implant-based reconstruction is the most performed breast reconstruction, and both subpectoral and prepectoral approaches can lead to excellent results. Choosing the best procedure requires a thorough understanding of every single technique, and proper patient selection is critical to achieve surgical success, in particular when dealing with prepectoral breast reconstruction. METHODS Between January of 2014 and December of 2018, patients undergoing mastectomy and eligible for immediate prepectoral breast reconstruction with tissue expander or definitive implant, were selected. The Prepectoral Breast Reconstruction Assessment score was applied to evaluate patient-related preoperative and intraoperative risk factors that could influence the success of prepectoral breast reconstruction. All patients were scored retrospectively, and the results obtained through this assessment tool were compared to the records of the surgical procedures actually performed. RESULTS Three hundred fifty-two patients were included; 112 of them underwent direct-to-implant immediate reconstruction, and 240 underwent the two-stage procedure with temporary tissue expander. According to the Prepectoral Breast Reconstruction Assessment score, direct-to-implant reconstruction should have been performed 6.2 percent times less, leading to an increase of 1.4 percent in two-stage reconstruction and 4.8 percent in submuscular implant placement. CONCLUSIONS To date, there is no validated system to guide surgeons in identifying the ideal patient for subcutaneous or retropectoral breast reconstruction and eventually whether she is a good candidate for direct-to-implant or two-stage reconstruction. The authors processed a simple risk-assessment score to objectively evaluate the patient's risk factors, to standardize the decision-making process, and to identify the safest and most reliable breast reconstructive procedure. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Casella D, Lo Torto F, Marcasciano M, Barellini L, Frattaroli JM, Turriziani G, Ribuffo D. Breast Animation Deformity: A Retrospective Study on Long-Term and Patient-Reported Breast-Q Outcomes. Ann Plast Surg 2021; 86:512-516. [PMID: 32826435 DOI: 10.1097/sap.0000000000002522] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND We evaluated the aesthetic outcomes and quality of life of patients who underwent neurotomy of the lateral and medial branch of the pectoralis nerve for animation deformity after breast reconstruction. MATERIAL AND METHODS Health-related quality of life questionnaire and cosmetic outcome evaluation were conducted using the preoperative and the postoperative BREAST-Q modules for reconstructive surgery. An external author also assessed the general aesthetic outcome before and after surgery. RESULTS Sixty-two patients with animation deformity after breast reconstruction were enrolled: 43 in group 1 (second-stage breast reconstruction), 10 in group 2 (permanent breast prosthesis), and 9 in group 3 (Baker III-IV capsular contraction). Patients scored high level of satisfaction with outcome concerning all aspects of the survey. Overall satisfaction with breast was significantly increased after surgery in all the 3 groups, whereas physical well-being was improved in group 1 and group 3 and psychosocial well-being was improved in group 1. General outcome evaluation by an external author, compared with the preoperative condition, also showed significant improvement. CONCLUSIONS Section of the lateral and medial branches of the pectoralis nerve represents an easy and reproducible technique, associated with low morbidity and very good results in terms of patient satisfaction, comfort, and hospitalization.
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Affiliation(s)
- Donato Casella
- From the Department of Oncologic and Reconstructive Breast Surgery, "Breast Unit Integrata di Livorno, Cecina, Piombino, Elba, Azienda USL Toscana nord ovest," Pisa
| | - Federico Lo Torto
- Plastic Surgery Unit, Department of Surgery "P. Valdoni", Sapienza University, Rome, Italy
| | - Marco Marcasciano
- Plastic Surgery Unit, Department of Surgery "P. Valdoni", Sapienza University, Rome, Italy
| | - Leonardo Barellini
- From the Department of Oncologic and Reconstructive Breast Surgery, "Breast Unit Integrata di Livorno, Cecina, Piombino, Elba, Azienda USL Toscana nord ovest," Pisa
| | | | - Gianmarco Turriziani
- Plastic Surgery Unit, Department of Surgery "P. Valdoni", Sapienza University, Rome, Italy
| | - Diego Ribuffo
- Plastic Surgery Unit, Department of Surgery "P. Valdoni", Sapienza University, Rome, Italy
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Riis M. Management of patients with BRCA mutation from the point of view of a breast surgeon. Ann Med Surg (Lond) 2021; 65:102311. [PMID: 33996049 PMCID: PMC8091883 DOI: 10.1016/j.amsu.2021.102311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 12/24/2022] Open
Abstract
Germ-line mutation in BRCA (BReast CAncer gene) 1 or BRCA2 are found in 3–4% of all women with breast cancer. These patients have a significant increased risk of breast and ovarian cancer. They are often younger when diagnosed with the mutation, and the possible breast cancer they get is often aggressive with inferior outcome. There are risk reducing strategies, and the most powerful strategy is risk reducing surgery, both risk reducing bilateral mastectomy (RRM) and risk reducing bilateral salpino-oophorectomy (PBSO). This review is meant to address breast surgery in patients with germline BRCA mutation. The guidelines and techniques applied is under continuous change and it is important for the clinicians to be well informed to provide the patient with the information needed for them to make an informed decision on what risk strategy to choose. Patients with germ-line mutation in BRCA1 or BRCA2 have a significant increased risk of breast and ovarian cancer. There are different risk reducing strategies and the most powerful strategy is risk-reducing surgery, both risk reducing bilateral mastectomy and risk reducing bilateral salpingo-oophorectomy. Guidelines and techniques for the risk reducing surgery of the breast are under continuous change and improvement. Breast conserving therapy is not associated with worse survival and is a good option for a BRCA mutation carrier diagnosed with breast cancer. Risk-reducing mastectomy can be performed in a later setting. The management of BRCA mutation carriers, both affected and unaffected, should be performed in a multidisciplinary team. Physicians need to be systematically educated and updated on the most recent literature.
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Casella D, Nanni J, Lo Torto F, Barellini L, Redi U, Kaciulyte J, Cassetti D, Ribuffo D, Marcasciano M. Extended Latissimus Dorsi Kite Flap (ELD-K Flap): Revisiting an Old Place for a Total Autologous Breast Reconstruction in Patients with Medium to Large Breasts. Aesthetic Plast Surg 2021; 45:390-401. [PMID: 33057755 DOI: 10.1007/s00266-020-01990-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/19/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The latissimus dorsi (LD) flap represents one of the most reliable methods for autologous breast reconstruction. However, in many patients, the exclusive use of this technique may not guarantee the restoration of an adequate volume and projection. We report our experience with the extended latissimus dorsi kite flap (ELD-K flap), an alternative surgical approach to maximize the volume of the fleur-de-lis pattern LD flap, for total autologous breast reconstruction. METHODS Between 2016 and 2018, 23 patients were subjected to mastectomy and immediate autologous reconstruction with "extended latissimus dorsi kite flap" (ELD-K flap), technique that employs an extended version of the LD musculocutaneous flap, based on the skeletonized thoracodorsal pedicle and a trilobate skin incision with an inferiorly based vertical branch. The BREAST-Q questionnaire was administered preoperatively, and one year after surgery to evaluate the quality of life results of the patients. BREAST-Q latissimus dorsi module was also provided. RESULTS Average body mass index was 29.7 kg/m2 (range 25-40 kg/m2). Mild complications occurred in only six cases, and eight patients underwent treatment to improve the donor site scar outcome. Patients indicated high scores in quality of life measures with an increase in all BREAST domains from the preoperative to the postoperative period. A statistically significant increase (p < 0.05) was noted in: "overall satisfaction with breasts" (p < 0.05), "psychosocial well-being" (p < 0.05), "physical impact of the surgery" (p < 0.05). Within the LD module, participants reported a mean score of, respectively, 73.8 and 67.9 for "satisfaction with back" and "satisfaction with shoulder and back function" domains. CONCLUSIONS The extended incision allows the recruitment of additional tissue to provide enough volume to complete the reconstruction without implants. The isolation of the vascular pedicle allows for extreme freedom and mobilization of the flap, ensuring adequate filling of the breast. ELD-K flap may expand the indications for a total autologous LD immediate breast reconstruction, representing an additional and reliable alternative in selected cohorts 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)
- Donato Casella
- UOC Chirurgia Oncologica Della Mammella, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Jacopo Nanni
- Department of Surgery, "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Federico Lo Torto
- Department of Surgery, "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Leonardo Barellini
- Unità Di Oncologia Chirurgica Ricostruttiva Della Mammella, "Spedali Riuniti" Di Livorno, "Breast Unit" Integrata Di Livorno Cecina, Piombino Elba, Azienda USL Toscana Nord Ovest, Livorno, Italy
| | - Ugo Redi
- Department of Surgery, "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Juste Kaciulyte
- Department of Surgery, "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Dario Cassetti
- UOC Chirurgia Oncologica Della Mammella, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Diego Ribuffo
- Department of Surgery, "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Marco Marcasciano
- Department of Surgery, "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
- Unità Di Oncologia Chirurgica Ricostruttiva Della Mammella, "Spedali Riuniti" Di Livorno, "Breast Unit" Integrata Di Livorno Cecina, Piombino Elba, Azienda USL Toscana Nord Ovest, Livorno, Italy.
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Quality of life after autologous fat transfer additional to prosthetic breast reconstruction in women after breast surgery: A systematic review. Eur J Surg Oncol 2020; 47:772-777. [PMID: 33243607 DOI: 10.1016/j.ejso.2020.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/13/2020] [Accepted: 10/18/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Breast cancer is the most frequent form of cancer among women worldwide. Reconstructive surgery may improve the quality of life (QoL), after mastectomy. Various techniques are used to reconstruct the female breast; however, few is known about its specific post-surgery influence represented in patient-reported outcomes. OBJECTIVE This systematic review assesses the difference in patient-reported QoL between prosthetic reconstruction alone, and prosthetic reconstruction with additional autologous fat transfer (AFT). DATA SOURCES A literature search was performed in PubMed, Embase, Cochrane and CINAHL online databases from inception to February 11th, 2020. STUDY SELECTION Inclusion and exclusion criteria were used to assess the eligibility of the retrieved articles. The only eligible studies were cohort studies. DATA COLLECTION AND ANALYSIS Relevant data for the research question was extracted from the articles and systematically documented. Results not contributing to answering the objective were intentionally left out. No meta-analysis was realized. RESULTS This systematic review resulted in the inclusion of only six relevant studies, all cohort studies, consisting of 1437 unique patients. These studies evaluated the quality of life of patients by means of the validated BREAST-Q questionnaire. Outcomes varied for which reason no definite answer could be provided to whether additional AFT results in a higher QoL. CONCLUSIONS It is unclear whether additional AFT after prosthetic surgery leads to a higher QoL when compared to sole prosthetic reconstruction or not. Additional studies, assessing the QoL of patients who received additional AFT, are required to draw solid conclusions. LEVEL OF EVIDENCE Level III; systematic literature review of cohort studies.
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Lanthaler M, Spinelli R, Tasch C, Sieb M, Harfmann M, Nitto A, Pierer G, Bauer T. Influence of Incision Site on Postoperative Outcome in Skin-/Nipple-Sparing Mastectomy: Is There a Difference between Radial and Inframammary Incision? Breast Care (Basel) 2020; 15:265-271. [PMID: 32774221 DOI: 10.1159/000502408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/29/2019] [Indexed: 11/19/2022] Open
Abstract
Background The aim of this study was to determine whether there is a difference in results between the radial and the inframammary approach in nipple-/skin-sparing mastectomy and immediate reconstruction. Methods The patients were divided into two groups (group 1: radial incision; group 2: inframammary fold incision [IMF]), each consisting of two subgroups for direct-to-implant reconstruction (1a, 2a) and expander reconstruction (1b, 2b). The patients were operated on between March 2012 and May 2017. Preoperative tumor parameters, reconstruction parameters, postoperative tumor parameters, and immediate and late complications were assessed. Postoperative photographs were evaluated by the patients and 8 plastic surgeons by means of grading (1-5) and the visual analog scale (VAS; 1-10). Results Enrolled in this study were 28 patients, namely, 7 patients in each subgroup. The median age was 46 years, and the median follow-up period was 40 months. No immediate complications occurred. Three patients had late complications, but there was no case of evident capsular fibrosis. Twenty-seven patients (96.42%) evaluated the postoperative result as excellent/good. The postoperative evaluation by the plastic surgeons was excellent/good for a median of 18 patients (64.28%). Group 1 showed a median VAS score of 7.63 (expander group: 7.50; direct-to-implant group: 7.75); the median VAS score for group 2 was 8.25 (expander group: 8.75; direct-to-implant group: 7.50). Conclusions Our study shows good results for implant breast reconstruction in both groups, with minimally better results for the IMF group. In the direct-to-implant subgroups, the radial group showed slightly better results.
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Affiliation(s)
- Monika Lanthaler
- Department of Plastic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Rossella Spinelli
- Department of Plastic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Tasch
- Department of Plastic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Sieb
- Department of Mechatronics - Medical Engineering, Management Center Innsbruck, Innsbruck, Austria
| | - Manuel Harfmann
- Department of Plastic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Agnese Nitto
- Department of Plastic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerhard Pierer
- Department of Plastic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Bauer
- Department of Plastic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Weber WP, Morrow M, Boniface JD, Pusic A, Montagna G, Kappos EA, Ritter M, Haug M, Kurzeder C, Saccilotto R, Schulz A, Benson J, Fitzal F, Matrai Z, Shaw J, Peeters MJV, Potter S, Heil J, González E, Elzayat M, Koller R, Gnant M, Brenelli F, Paulinelli RR, Zobel V, Joukainen S, Karhunen-Enckell U, Kauhanen S, Piat JM, Bjelic-Radisic V, Faridi A, Heitmann C, Hoffmann J, Kneser U, Kümmel S, Kühn T, Kontos M, Tampaki EC, Barry M, Allweis TM, Carmon M, Hadar T, Catanuto G, Garcia-Etienne CA, Gentilini OD, Knox S, Klein B, Koppert L, Gouveia PF, Svensjö T, Bucher HC, Ess S, Ganz-Blättler U, Günthert A, Hauser N, Hynes N, Knauer M, Pfeiffer M, Rochlitz C, Tausch C, Harder Y, Zimmermann F, Schwab FD, D'Amico V, Soysal SD, Castrezana Lopez L, Fulco I, Hemkens LG, Lohsiriwat V, Gulluoglu BM, Karadeniz G, Karanlik H, Sezer A, Gulcelik MA, Emiroglu M, Kovacs T, Rattay T, Romics L, Vidya R, Wyld L, El-Tamer M, Sacchini V. Knowledge gaps in oncoplastic breast surgery. Lancet Oncol 2020; 21:e375-e385. [DOI: 10.1016/s1470-2045(20)30084-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 12/26/2022]
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Leser C, Deutschmann C, Dorffner G, Gschwantler-Kaulich D, Castillo DM, Abayev S, Stübler M, Reitsamer R, Singer C. Complication rates among women undergoing preventive mastectomy: An Austrian registry. Breast J 2020; 26:1639-1644. [PMID: 32452097 DOI: 10.1111/tbj.13877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 03/24/2020] [Accepted: 04/23/2020] [Indexed: 11/27/2022]
Abstract
Germline variations in the BRCA-1 and BRCA-2 genes are associated with an increased risk of breast cancer. These variants are found in 5% of all breast cancer cases. Prophylactic mastectomy is the most effective risk-reducing method and shows high rates of patient satisfaction and acceptance. We established a registry of Austrian BRCA-1 and BRCA-2 mutation carriers who had undergone mastectomy for oncologic or prophylactic reasons. Data were collected on the type of operation, complications, and type of reconstructive surgery for patients between 2014 and 2017. The complication rate in patients with nipple-sparing mastectomy was significantly lower (23.1%) than in those with other types of mastectomies (60.7%; P = .005). In patients with implant-based breast reconstruction, subpectoral placement was associated with a significantly higher rate of complications than prepectoral placement (P = .025). Median implant volume was 350 cc (range: 155-650 cc), and a 100-cc increase was associated with doubling of the odds of a complication (regression coefficient = 0.007); based on this finding, some surgeons may decide on using smaller implants. In summary, we identified significant associations between the risk of complications and surgical characteristics, and found host factors like diabetes, BMI, and smoking among Austrian patients with BRCA-1 and BRCA-2 variants.
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Affiliation(s)
- Carmen Leser
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Christine Deutschmann
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Georg Dorffner
- Institute for Artificial Intelligence and Decision Support, Medical University of Vienna, Vienna, Austria
| | - Daphne Gschwantler-Kaulich
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | | | - Sara Abayev
- Department of Plastic and Reconstructive Surgery, Wilhelminen Hospital, Vienna, Austria
| | - Madeleine Stübler
- Department of Surgery, Kepler University Hospital Linz, Linz, Austria
| | - Roland Reitsamer
- Department of Obstetrics and Gynaecology, University Hospital Salzburg, Salzburg, Austria
| | - Christian Singer
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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ADM-assisted prepectoral breast reconstruction and skin reduction mastectomy: Expanding the indications for subcutaneous reconstruction. J Plast Reconstr Aesthet Surg 2020; 73:673-680. [DOI: 10.1016/j.bjps.2019.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 08/07/2019] [Accepted: 11/22/2019] [Indexed: 12/12/2022]
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Body Mass Index Can Predict Outcomes in Direct-to-Implant Prepectoral Breast Reconstruction. Plast Reconstr Surg 2020; 145:867e-868e. [DOI: 10.1097/prs.0000000000006703] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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36
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Klapdor R, Weiß C, Kuehnle E, Kohls F, von Ehr J, Philippeit A, Hille-Betz U. Quality of Life after Bilateral and Contralateral Prophylactic Mastectomy with Implant Reconstruction. Breast Care (Basel) 2020; 15:519-526. [PMID: 33223996 DOI: 10.1159/000505449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/16/2019] [Indexed: 01/23/2023] Open
Abstract
Background Prophylactic mastectomy is an effective approach to breast cancer risk reduction in patients at high risk. Further studies using standardized measures for quality of life are needed to better understand the effect of prophylactic mastectomy on individual patients and, thereby, allow for better patient counseling and selection. Methods In this prospective study patients undergoing bilateral mastectomy were asked to complete the BREAST-Q questionnaire before and 1 year after surgery. All patients underwent bilateral mastectomy with implant-based breast reconstruction. Patient- and surgery-related information was collected in a database. Results In total, 48 patients underwent bilateral skin-sparing mastectomy. Of these, 29 (60.4%) suffered from breast cancer. A 2-stage reconstruction with intermediate expander implantation was conducted in 19 (39.6%) patients. All patients completed the BREAST-Q questionnaire. The domain "psychosocial well-being" was significantly improved from a mean score of 74.98 preoperatively to a postoperative score of 81.56 (p = 0.021). In contrast, the domain "physical well-being" dropped -8.38 points on average to a postoperative score of 74.96 (p < 0.001). Interestingly, patients with the lowest preoperative score in the domain "satisfaction with breast" showed the greatest increase after surgery (50.31 vs. 67.25, p < 0.001). On the contrary, patients with the highest preoperative values experienced the strongest decrease in satisfaction (91.60 vs. 75.27, p = 0.012). Conclusion Implant-based prophylactic mastectomy leads to good quality-of-life results in patients at high risk for breast cancer. Especially, patients with a low preoperative satisfaction with their breasts have a significantly higher chance of experiencing substantial improvements in their quality of life.
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Affiliation(s)
- Rüdiger Klapdor
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Christina Weiß
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Elna Kuehnle
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Fabian Kohls
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Julia von Ehr
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Anja Philippeit
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Ursula Hille-Betz
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
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37
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Rathat G, Herlin C, Bonnel C, Captier G, Duraes M. Endoscopic Nipple-Sparing Mastectomy with Immediate Prepectoral Implant-Based Reconstruction: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1812-1816. [PMID: 31801936 PMCID: PMC6913238 DOI: 10.12659/ajcr.919669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Patient: Female, 45-year-old Final Diagnosis: Prophylactic mastectomy Symptoms: — Medication: — Clinical Procedure: — Specialty: Obstetrics and Gynecology
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Affiliation(s)
- Gauthier Rathat
- Department of Oncological Breast Surgery, Montpellier University Hospital, Montpellier, France
| | - Christian Herlin
- Department of Plastic Surgery, Montpellier University Hospital, Montpellier, France
| | - Christophe Bonnel
- Innovation Extractor Department, Montpellier Hospital, University of Montpellier, Montpellier, France
| | - Guillaume Captier
- Laboratory of Anatomy, University of Montpellier, Montpellier, France
| | - Martha Duraes
- Department of Oncological Breast Surgery, Montpellier University Hospital, Montpellier, France
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Reitsamer R, Peintinger F, Klaassen-Federspiel F, Sir A. Prepectoral direct-to-implant breast reconstruction with complete ADM or synthetic mesh coverage – 36-Months follow-up in 200 reconstructed breasts. Breast 2019; 48:32-37. [DOI: 10.1016/j.breast.2019.08.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/21/2019] [Accepted: 08/19/2019] [Indexed: 12/18/2022] Open
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Salibian AA, Bekisz JM, Frey JD, Miller B, Choi M, Karp NS. Prophylactic nipple-sparing mastectomy in young previvors: Examining decision-making, reconstructive outcomes, and patient satisfaction in BRCA+ patients under 30. Breast J 2019; 26:971-975. [PMID: 31736224 DOI: 10.1111/tbj.13692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 10/29/2019] [Accepted: 10/31/2019] [Indexed: 11/27/2022]
Abstract
Bilateral prophylactic mastectomies (BPM) in young previvors with high-risk mutations are rising; however, little data on management, therapy timing, and outcomes exist. BRCA+ patients under 30 undergoing BPM from 2006 to 2018 were reviewed. Twenty-two patients aged 23-29 underwent mastectomy 4.2 years after genetic diagnosis. Twelve patients completed surveys, most often citing personal decisions (50%) for undergoing mastectomy and plastic surgeons' recommendations (83.3%) for reconstruction. About 73% of patients completely understood risks/benefits of mastectomy and 63.6% of reconstruction. Patients reported high BREAST-Q Satisfaction and Well-Being scores. Continued educational resource development will optimize shared decision-making in the reconstructive process.
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Affiliation(s)
- Ara A Salibian
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
| | - Jonathan M Bekisz
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
| | - Jordan D Frey
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
| | - Brooke Miller
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
| | - Mihye Choi
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
| | - Nolan S Karp
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
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40
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Casella D, Di Taranto G, Onesti M, Greco M, Ribuffo D. A retrospective comparative analysis of risk factors and outcomes in direct-to-implant and two-stages prepectoral breast reconstruction: BMI and radiotherapy as new selection criteria of patients. Eur J Surg Oncol 2019; 45:1357-1363. [DOI: 10.1016/j.ejso.2019.02.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/24/2019] [Accepted: 02/06/2019] [Indexed: 11/30/2022] Open
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41
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The New Trend of Pre-pectoral Breast Reconstruction: An Objective Evaluation of the Quality of Online Information for Patients Undergoing Breast Reconstruction. Aesthetic Plast Surg 2019; 43:593-599. [PMID: 30710175 DOI: 10.1007/s00266-019-01311-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 01/13/2019] [Indexed: 01/09/2023]
Abstract
The Web has increasingly become the major source of information about health care, and patients who need to undergo breast reconstruction often use the internet to acquire an initial knowledge on the subject. We would like to present our study that investigates the quality of published information on pre-pectoral breast reconstruction. We searched the term "Pre-pectoral breast reconstruction" on Google® and Yahoo®. Forty-two web sites were selected and underwent qualitative and quantitative assessment using the expanded EQIP tool. The analysis of document contents showed a critical lack of information about qualitative risks and side-effects descriptions, treatment of potential complications, alert signs for the patient and precautions that the patient may take. Health professionals should inform patients about the potential difficulties of identifying reliable informational web sites about pre-pectoral breast reconstruction. The quality of available information should be improved, especially the important topics included in the content data section of the modified EQIP tool.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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Casella D, Di Taranto G, Marcasciano M, Lo Torto F, Barellini L, Sordi S, Gaggelli I, Roncella M, Calabrese C, Ribuffo D. Subcutaneous expanders and synthetic mesh for breast reconstruction: Long-term and patient-reported BREAST-Q outcomes of a single-center prospective study. J Plast Reconstr Aesthet Surg 2019; 72:805-812. [DOI: 10.1016/j.bjps.2018.12.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/24/2018] [Accepted: 12/10/2018] [Indexed: 02/06/2023]
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Breast Reconstruction Actualized in Nipple-sparing Mastectomy and Direct-to-implant, Prepectoral Polyurethane Positioning: Early Experience and Preliminary Results. Clin Breast Cancer 2018; 19:e358-e363. [PMID: 30691930 DOI: 10.1016/j.clbc.2018.12.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/17/2018] [Accepted: 12/17/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Implant-based breast reconstruction after nipple-sparing mastectomy has been the most common breast reconstruction procedure performed, for both breast cancer treatment and prophylactically. Subpectoral implant placement with partial detachment of the pectoralis major muscle has been the procedure of choice for staged reconstruction and direct-to-implantation. Prepectoral implant placement has recently increased in popularity among plastic surgeons owing to the high rates of animation deformity, loss of muscle function, and chronic pain observed with submuscular implant placement. Acellular dermal matrices or synthetic meshes have been used for implant coverage and support to avoid capsular contracture and implant visibility. In the present study, we have introduced breast reconstruction actualized in nipple-sparing mastectomy and direct-to-implant with prepectoral polyurethane positioning (BRAND4P). PATIENTS AND METHODS A total of 34 nipple-sparing mastectomies and immediate direct-to-implant breast reconstructions with prepectoral polyurethane-coated implant placement were performed in 21 patients (13 bilateral and 8 unilateral). The implant was placed subcutaneously in the exact place of the excised breast parenchyma with no further coverage. RESULTS After a mean follow-up of 4 months, no major complications had been observed. No patient presented with animation deformity or grade III-IV capsular contracture. Patient satisfaction, assessed using the BREAST-Q, was excellent. CONCLUSIONS The BRAND4P method represents a novel prepectoral approach and a feasible alternative to subpectoral implant placement among the available implant-based breast reconstruction techniques.
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44
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Skin-reduction breast reconstructions with prepectoral implant covered by a combined dermal flap and titanium-coated polypropylene mesh. J Plast Reconstr Aesthet Surg 2018; 71:1123-1128. [DOI: 10.1016/j.bjps.2018.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 05/27/2018] [Indexed: 11/15/2022]
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