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Kim J, Han MW, Hong KY. Prospective Clinical Trial for Predicting Mastectomy Skin Flap Necrosis with Indocyanine Green Angiography in Implant-Based Prepectoral Breast Reconstruction. Aesthetic Plast Surg 2024:10.1007/s00266-024-04106-x. [PMID: 38740624 DOI: 10.1007/s00266-024-04106-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/25/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Indocyanine green angiography (ICG-A) is a useful tool for evaluating mastectomy skin flap (MSF) perfusion during breast reconstruction. However, a standardized protocol for interpreting and applying MSF perfusion after mastectomy has not been established yet. The purpose of this study is to establish criteria for assessing MSF perfusion in immediate implant-based prepectoral breast reconstruction while correlating ICG-A findings with postoperative outcomes METHODS: This prospective observational study was conducted at a single institution and involved patients with breast cancer who underwent mastectomy and immediate implant-based prepectoral breast reconstruction between August 2021 and August 2023. The terms "hypoperfused flap" and "hypoperfused area" were defined according to ICG-A perfusion. MSF exhibited < 30% perfusion, excluding the nipple and the corresponding region, respectively. Data on the hypoperfused flap, hypoperfused area, and MSF necrosis were collected. RESULTS Fifty-three breast cases were analyzed. Eight patients developed MSF necrosis (15.1%, 8/53). Of these, two patients underwent surgical debridement and revision within 3 months (3.8%, 2/53). There were nine cases of a hypoperfused flap, eight of which developed MSF necrosis. The hypoperfused flap was a significant predictor of the occurrence of MSF necrosis (p < 0.001). There was a tendency for increased full-thickness necrosis with a wider hypoperfused area. CONCLUSIONS The hypoperfused flap enabled the prediction of MSF necrosis with high sensitivity, specificity, positive predictive value, and negative predictive value. Considering the presumed correlation between the extent of the hypoperfused area and the need for revision surgery, caution should be exercised when making intraoperative decisions regarding the reconstruction method. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Jaewoo Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Plastic and Reconstructive Surgery, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Man Wong Han
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Ki Yong Hong
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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Chen Y, Yang C, Yang S, Chen X, Huang L. Serratus Anterior Fascia for Immediate Implant-Based Breast Reconstruction: A Case Series of 65 Patients With Breast Cancer. Ann Plast Surg 2024; 92:169-173. [PMID: 38157477 DOI: 10.1097/sap.0000000000003769] [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: 01/03/2024]
Abstract
OBJECTIVE After immediate implant-based breast reconstruction (IIBR) after mastectomy, implant exposure or capsular contracture can occur. This study aimed to evaluate IIBR using serratus anterior fascia in patients with breast cancer. METHODS This retrospective case series study enrolled patients with breast cancer underwent IIBR using the serratus anterior fascia after mastectomy in the Department of Breast Surgery of Fujian Cancer Hospital between January 2021 and December 2022. RESULTS Sixty-five cases with breast cancer underwent IIBR using serratus anterior fascia were enrolled, with a median age of 39 years (range, 24-57 years) and body mass index of 21.32 kg/m 2 (range, 19-25 kg/m 2 ). The aesthetic outcomes of the reconstructed breasts showed good in 53 cases (81.6%), moderate in 11 cases (16.9%), and poor in 1 case (1.5%) due to offset position. Two cases showed poor wound healing, which improved after repeat suturing and 5 cases developed partial ischemic necrosis of the nipple, which scabbed and healed spontaneously. CONCLUSIONS Implant-based breast reconstruction using serratus anterior fascia may provide good aesthetic outcomes with few complications.
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Affiliation(s)
- Ying Chen
- From the Department of Breast Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian, China
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3
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Tramm T, Kaidar-Person O. Optimising post-operative radiation therapy after oncoplastic and reconstructive procedures. Breast 2023; 69:366-374. [PMID: 37023565 PMCID: PMC10119683 DOI: 10.1016/j.breast.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/16/2023] [Accepted: 03/25/2023] [Indexed: 03/30/2023] Open
Abstract
Surgical techniques for breast cancer have been refined over the past decades to deliver an aesthetic outcome as close as possible to the contralateral intact breast. Current surgery further allows excellent aesthetic outcome even in case of mastectomy, by performing skin sparing or nipple sparing mastectomy in combination with breast reconstruction. In this review we discuss how to optimise post-operative radiation therapy after oncoplastic and breast reconstructive procedures, including dose, fractionation, volumes, surgical margins, and boost application.
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Kayahan M. Can Skin Sparing Mastectomy and Immediate Submuscular Implant-Based Reconstruction Be a Better Choice in Treatment of Early-Stage Breast Cancer? Eur J Breast Health 2022; 18:55-62. [DOI: 10.4274/ejbh.galenos.2021.2021-6-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/05/2021] [Indexed: 12/01/2022]
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Useful Reduction Mammoplasty Technique in Oncoplastic Breast Surgery and Reconstruction. Breast J 2022; 2022:2952322. [PMID: 36340218 PMCID: PMC9616674 DOI: 10.1155/2022/2952322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/25/2022] [Accepted: 10/05/2022] [Indexed: 11/27/2022]
Abstract
Background A combination of the reduction mammoplasty technique and breast reconstruction allows surgeons to lift ptotic breasts through local flaps and skin reduction during surgery for breast cancer. This study presents a reliable course for the combination of partial and skin or nipple-sparing mastectomy with reduction-reconstruction surgery. Methods Fifty-seven patients underwent a partial mastectomy before reduction mammoplasty of both breasts during the same time period between 2014 and 2021 at our institution and thirteen patients underwent skin or nipple-sparing mastectomy, breast reconstruction with an extended latissimus dorsi flap or silicone implant, and aesthetic reduction mammoplasty of the contralateral breast during the same time period. Additional photos were obtained preoperatively, immediately after the operation, and at one, three, six, and twelve months postoperatively. Patient satisfaction was evaluated preoperatively and postoperatively and postoperative complications were noted. Results Among the patients who underwent a partial mastectomy, the mean age was 45.18 ± 11.05 years, the mean body mass index (BMI) was 26.74 ± 3.53 kg/m2, and the mean preoperative right and left breast volumes were 663.85 (±28.12) cc and 664.34 (±37.13) cc, respectively, and the mean excised mass weight was 177.74 (±213.93) g. Among the patients who underwent a skin-sparing mastectomy, the mean age was 51.62 ± 8.96 years, the mean BMI was 26.91 ± 4.34 kg/m2, and the mean preoperative right and left breast volumes were 624.17 (±98.52) cc and 562.31 (±80.81) cc, respectively, and the mean excised mass weight was 618.05 (±338.17) g. Four patients (5.3%) in the partial mastectomy group had fat necrosis. The mean patient satisfaction score was higher postoperatively in both groups. Conclusion Patients with breast cancer and large and/or ptotic breasts can successfully undergo reduction mammoplasty for both breasts immediately following partial mastectomy and nipple or skin-sparing mastectomy.
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Nair AG, Giannakeas V, Semple JL, Narod SA, Lim DW. Contemporary Trends in Breast Reconstruction Use and Impact on Survival Among Women with Inflammatory Breast Cancer. Ann Surg Oncol 2022; 29:8072-8082. [PMID: 36074200 DOI: 10.1245/s10434-022-12408-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/04/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Breast reconstruction is generally discouraged in women with inflammatory breast cancer (IBC). Nevertheless, reconstruction rates are increasing in this population. OBJECTIVE We aimed to determine contemporary trends and predictors of breast reconstruction use and its impact on mortality among IBC patients. METHODS Demographic, clinicopathologic, and follow-up data for women with non-metastatic IBC having mastectomy between 2004 and 2015 were collected from the Surveillance, Epidemiology, and End Results (SEER) 18 registries database. Rates and predictors of immediate breast reconstruction, along with survival outcomes between the breast reconstruction and no reconstruction groups were calculated. To account for selection bias, a propensity score analysis matching one reconstruction patient to three no reconstruction patients was performed. RESULTS A total of 4076 women with non-metastatic IBC who underwent mastectomy (388 [9.5%] with breast reconstruction and 3688 [90.5%] without) were included. The proportion of women undergoing breast reconstruction and contralateral prophylactic mastectomy increased from 6.2 to 15.3% and 12.9 to 29.6%, respectively, between 2004 and 2015. Younger age, higher annual income, metropolitan residence, and bilateral mastectomy predicted breast reconstruction use. The 10-year breast cancer-specific survival was 62.9% for women having breast reconstruction and 47.6% for women not having breast reconstruction. After propensity-matched analysis, 10-year cancer-specific survival was similar between the reconstruction (56.6%) and no reconstruction (62.2%) groups (adjusted hazard ratio 0.96, 95% confidence interval 0.79-1.16; p = 0.65). CONCLUSIONS Breast reconstruction rates continue to rise among IBC patients, particularly young women and women with access to reconstruction. Breast reconstruction is not associated with inferior breast cancer-specific survival and can be an option for select patients.
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Affiliation(s)
| | - Vasily Giannakeas
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - John L Semple
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Department of Surgery, Women's College Hospital, Toronto, ON, Canada.,Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Steven A Narod
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - David W Lim
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada. .,Department of Surgery, Women's College Hospital, Toronto, ON, Canada.
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Letsiou E, Tsakatikas S, Vakis G, Tsapakidis K, Charalampakis N, Diamantis A, Poultsidi A, Michelakis D, de Bree E, Mauri D, Tsoukalas N, Antoniades C, Tolia M. Radiotherapy and Breast Reconstruction: What Is the Ideal Timing? A Narrative Review. Rev Recent Clin Trials 2022; 17:73-85. [PMID: 35289255 DOI: 10.2174/1574887117666220314161609] [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: 09/22/2021] [Revised: 11/13/2021] [Accepted: 12/24/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Women undergoing mastectomy choose to pursue breast reconstruction (BR) in order to reduce their body image distress.Adjuvant chest wall irradiation is associated with a negative cosmetic outcome. The aim of our review was to identify the optimal timing of BR relating to radiotherapy delivery. MATERIALS AND METHODS Using Cochrane Library, Embase, PubMed, Springer, Wanfang and CNKI, we performed a non-systematic review of articles published up to August 2021. RESULTS There is no hard evidence in favor of immediate, delayed or 2-stage BR when post-mastectomy radiation is indicated. Immediate and 2-stage BR seem to be valid alternatives to delayed BR. CONCLUSIONS Further research is essential in order to assess clinician and patient reported aesthetic outcomes and determine the optimal timing of BR in view of post-mastectomy radiotherapy, in breast cancer survivors.
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Affiliation(s)
| | - Sergios Tsakatikas
- Department of Medical Oncology, Metaxa Cancer Hospital, 185 37 Athens, Greece
| | - George Vakis
- Plastic Surgery Clinic, Evangelismos General Hospital, Ipsilantou 45-47, 106 76, Athens, Greece
| | - Konstantinos Tsapakidis
- Department of Oncology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41500, Larisa, Greece
| | | | - Alexandros Diamantis
- Department of Surgery, Medical School, University of Thessaly, 415 00 Larissa, Greece
| | - Antigoni Poultsidi
- Department of Surgery, Medical School, University of Thessaly, 415 00 Larissa, Greece
| | - Dimosthenis Michelakis
- Department of Surgical Oncology, Medical School of Crete University Hospital, 711 10 Heraklion, Greece
| | - Eelco de Bree
- Department of Surgical Oncology, Medical School of Crete University Hospital, 711 10 Heraklion, Greece
| | - Davide Mauri
- Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.,Department of Medical, Oncology, Greece Society for Study of Clonal Heterogeneity of Neoplasia (EMEKEN), University Hospital of Ioannina, Ioannina, Greece
| | - Nikolaos Tsoukalas
- Department of Oncology, 401 General Military Hospital of Athens, 115 25, Athens, Greece
| | - Chrysostomos Antoniades
- Department of Radiotherapy, School of Medicine, University of Crete, 711 10, Heraklion, Greece
| | - Maria Tolia
- Department of Radiotherapy, School of Medicine, University of Crete, 711 10, Heraklion, Greece
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Otani N, Tomita K, Taminato M, Kuroda K, Yano K, Kubo T. Sensory Reinnervation With Subcutaneously Embedded Innervated Flaps: An Experimental Study in Rats. Ann Plast Surg 2022; 88:e1-e8. [PMID: 34387580 DOI: 10.1097/sap.0000000000002973] [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: 11/26/2022]
Abstract
BACKGROUND In breast reconstruction, both aesthetic outcomes and sensory function are important for postoperative quality of life. Innervated flaps are useful in reconstruction after conventional mastectomy (CM), which leaves a large portion of the skin paddle exposed on the body surface. However, whether they are also useful in skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) remains unclear. This study aimed to examine the usefulness of innervated flaps in restoring sensation after SSM and NSM using a rat model. METHODS Dorsal cutaneous nerves of rats were entirely eliminated except for the medial branch of the dorsal cutaneous nerve of thoracic segment 13, resulting in an innervated field surrounded by a denervated field. The innervated field was elevated as an innervated island flap and then subcutaneously embedded, with the skin paddle deepithelialized entirely (NSM group, n = 5) or except at the center (SSM group, n = 6). In the control model (CM group, n = 5), the flap was sutured back into its original position. Postoperative changes in the mechanonociceptive field were evaluated using the cutaneous trunci muscle reflex test. Immunohistochemical evaluation of regenerated nerves in the new mechanonociceptive field was performed at postoperative week 12. RESULTS In the SSM and CM groups, the mechanonociceptive field expanded around the skin paddle. In the NSM group, a new mechanonociceptive field appeared at postoperative week 4 and expanded thereafter. Areas of the mechanonociceptive field at postoperative week 12 did not differ significantly between the SSM and NSM groups, but were significantly smaller compared with the CM group and comparable to original flap areas. Histologically, S100- and PGP9.5-positive nerve fibers were observed in the dermis of the new mechanonociceptive field and subcutaneous flap tissue. CONCLUSIONS Subcutaneously embedded innervated island flaps induced nerve regeneration and sensory reinnervation of the denervated skin, suggesting that innervated flaps may also be useful in reconstruction post-SSM/NSM.
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Affiliation(s)
- Naoya Otani
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University
| | - Koichi Tomita
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University
| | - Mifue Taminato
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University
| | - Kazuya Kuroda
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University
| | | | - Tateki Kubo
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University
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Laustsen-Kiel CM, Lauritzen E, Langhans L, Engberg Damsgaard T. Study protocol for a 10-year prospective observational study, examining lymphoedema and patient-reported outcome after breast reconstruction. BMJ Open 2021; 11:e052676. [PMID: 34873005 PMCID: PMC8650483 DOI: 10.1136/bmjopen-2021-052676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Over the last decades, treatment of breast cancer has become increasingly more effective. Consequently, an increasing number of women are living with late effects of breast cancer treatment, including disfiguring scars, deformity or asymmetry of the breast, secondary lymphoedema and other physical and psychosocial late effects. Data from this study will provide knowledge on how to guide breast reconstruction in the future towards outcomes with fewer complications, higher long-term quality of life (QoL) and satisfaction with the aesthetic outcome. The development of secondary lymphoedema, for which the effect of breast reconstruction has yet to be established, will be thoroughly examined. METHODS AND ANALYSIS Women receiving breast reconstruction (autologous and implant based) at the Department of Plastic Surgery and Burns Treatment, Rigshospitalet, will be invited to participate. The patients will be followed for 10 years postoperatively. Demographic, health-related, oncological characteristics and treatment data will be registered. Validated assessment tools, such as the BREAST-Q and Beck Depression Inventory, will be used to measure an extensive range of clinical outcomes, including QoL, life and aesthetic satisfaction and depression. Arm range of motion will be measured with a goniometer and lymphoedema by bioimpedance spectroscopy, compared with circular arm measurements. ETHICS AND DISSEMINATION This study will be conducted according to the 5th version of the Helsinki Declaration. The regional ethical committee for Capital Region Denmark did not find the study notifiable, according to the law of the committee § 1, part 4. All data will be anonymised before its publication. This study will be conducted according to the Danish data protection regulation and is catalogued and approved by the Capital Region Head of Knowledge Centre. According to the Danish health law § 46, part 2, this study does not need the Danish Patient Safety Authority's approval. The findings of this study will be submitted to international peer-reviewed journals.
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Affiliation(s)
| | - Elisabeth Lauritzen
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
| | - Linnea Langhans
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
| | - Tine Engberg Damsgaard
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
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Ośmiałowska E, Misiąg W, Chabowski M, Jankowska-Polańska B. Coping Strategies, Pain, and Quality of Life in Patients with Breast Cancer. J Clin Med 2021; 10:jcm10194469. [PMID: 34640484 PMCID: PMC8509228 DOI: 10.3390/jcm10194469] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/19/2021] [Accepted: 09/23/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction: Each year, around 16,500 women in Poland are diagnosed with breast cancer, the second most common cause of death in women. In Poland, nearly 70,000 women live with breast cancer diagnosed within the last 5 years. Quality of life (QoL) research is particularly important in cancer patients, as it provides knowledge on their psychological and physical health, as well as the environment in which the patients function, all of which is essential to implementing multidisciplinary care involving the best use of the appropriate methods. Carrying the burden of cancer is a major challenge for patients. The strategy that patients use to cope with breast cancer significantly affects their quality of life. The purpose of the study is to assess the impact of coping strategies on the QoL in breast cancer patients. Material and Methods: The prospective study included a group of 202 women who had undergone surgical treatment for breast cancer at the Lower Silesian Cancer Center and who reported for follow-up appointments at the Oncology Clinic and the Surgical Oncology Clinic. For the study, we used the: EORTC QLQ-C30 cancer questionnaire, EORTC QLQ-BR23 module, Mental Adjustment to Cancer (Mini-MAC) scale, visual analog scale (VAS) for pain intensity, as well as the patients’ medical records, hospital records, and our own survey form. Results: The mean patient age was 53 years. Most patients had been diagnosed with cancer between one and two years before. In the women studied, there was a negative association between QoL and the choice of a destructive strategy for coping with cancer, and a positive one between QoL and a constructive coping strategy. Severe pain caused by the disease and its treatment significantly decreased the patients’ QoL in multiple domains. Conclusions: Patients choosing constructive strategies obtained higher QoL scores, while greater reliance on destructive coping strategies was associated with significantly worse QoL. In all functioning domains, higher levels of pain were associated with poorer QoL and more severe symptoms associated with the disease and its treatment.
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Affiliation(s)
- Edyta Ośmiałowska
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 51-618 Wroclaw, Poland
| | - Weronika Misiąg
- Student Research Group No 180, Faculty of Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Mariusz Chabowski
- Department of Clinical Nursing, Division of Oncology and Palliative Care, Faculty of Health Science, Wroclaw Medical University, 51-618 Wroclaw, Poland
- Department of Surgery, 4th Military Teaching Hospital, 50-981 Wroclaw, Poland
| | - Beata Jankowska-Polańska
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 51-618 Wroclaw, Poland
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11
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Lauritzen E, Damsgaard TE. Use of Indocyanine Green Angiography decreases the risk of complications in autologous- and implant-based breast reconstruction: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2021; 74:1703-1717. [PMID: 33931326 DOI: 10.1016/j.bjps.2021.03.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 03/08/2021] [Accepted: 03/13/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Indocyanine Green Angiography (ICG-A) is an imaging technique used to visualize tissue perfusion in real time. The aim of this systematic review and meta-analysis is to evaluate all published papers on breast reconstruction using ICG-A, which provides information on complication rates and to investigate whether the use of this peroperative method decreases the risk of complications. MATERIALS AND METHODS MEDLINE/PubMed, EMBASE, Cochrane, and UpToDate were searched using relevant terms. The literature was assessed using the PRISMA guidelines. Inclusion criteria were: original articles written in English assessing ICG-angiography in breast reconstruction. The individual studies were evaluated according to Cochrane guidelines. RESULTS The search yielded 243 papers on ICG-A and breast reconstruction. Twenty-six of these were included for analysis. The risk of overall major complications ([OR] = 0.53, 95% confidence interval (CI) = 0.43-0.66, p = 0.00001) and overall loss of reconstruction ([OR] = 0.58, 95% CI = 0.37-0.92, and p = 0.020) was significantly lower when peroperative ICG-A was used. When using ICG-A to evaluate mastectomy flaps, a statistically lower risk of major complications ([OR] = 0.56 and p = 0.0001) and the loss of reconstruction was found ([OR] = 0.46, p = 0.006). ICG-A used in autologous breast reconstruction significantly reduced the risk of minor ([OR] = 0.62 and p = 0.001) and major complications ([OR] = 0.53 and p = 0.0028). CONCLUSIONS This is the first systematic review to analyze the use of ICG-A on both mastectomy flaps and autologous reconstruction. The results obtained in the current study indicate that the use of ICG-A in breast reconstructive procedures reduces the complications as well as the loss of reconstruction.
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Affiliation(s)
- Elisabeth Lauritzen
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Denmark.
| | - Tine Engberg Damsgaard
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Denmark
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12
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Ranieri J, Fiasca F, Guerra F, Perilli E, Mattei A, Di Giacomo D. Examining the Post-operative Well-Being of Women Who Underwent Mammoplasty: A Cross-Sectional Study. Front Psychiatry 2021; 12:645102. [PMID: 33854453 PMCID: PMC8039438 DOI: 10.3389/fpsyt.2021.645102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/04/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Mammoplasty is the most common surgery used for breast augmentation (aesthetic plastic) and breast reconstruction (disease-related plastic) in women who have been diagnosed with and surgically treated for regional breast cancer with modified radical mastectomy. This study aims to examine the long-term effects of mammoplasty on the psychological well-being of women. Methods: Participants were 44 women aged 30-50 years (mean = 40.4 ± 5.9). They were divided into two groups based on the purpose of the breast surgery they underwent [augmentation surgery (AS) vs. reconstruction surgery (RS)] and the time that had elapsed since their surgery (≤3 vs. >3 years). Results: Our findings suggest that women who underwent AS reported a decline in their psychological well-being over time. The women who had undergone AS ≤3 and >3 years did not show any differences in emotional functioning, with the exception of the BREAST-Q scores on the satisfaction with breasts subscale. We examined the impact of mammoplasty on the satisfaction levels and well-being of women who had undergone RS (after MRM). They were less satisfied with their breasts than those who belonged to the AS group, confirming our hypothesis. However, this was true only among those who had undergone surgery ≤3 years earlier. Conclusions: In conclusion, our findings underscore the need to provide psychological support to those who have undergone breast AS and RS. Additionally, this study implies the need for personalized psychological interventions to improve the emotional adaptation process and enhance women's mental well-being.
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Affiliation(s)
| | | | | | | | | | - Dina Di Giacomo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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Brunbjerg ME, Jensen TB, Overgaard J, Christiansen P, Damsgaard TE. Comparison of one-stage direct-to-implant with acellular dermal matrix and two-stage immediate implant-based breast reconstruction-a cohort study. Gland Surg 2021; 10:207-218. [PMID: 33633977 DOI: 10.21037/gs-20-581] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The use of acellular dermal matrix (ADM) in one-stage immediate implant-based breast reconstruction (BR) may offer advantages over the two-stage expander-to-implant technique, but literature shows conflicting results. The aim of the present study was to compare these two techniques for immediate implant-based BR regarding postoperative complications, aesthetic correction procedures and aesthetic outcome. Methods The study was designed as an observational cohort study with 44 participants admitted for immediate implant-based BR at Department of Plastic Surgery, Aarhus University Hospital, Denmark. 21 patients underwent BR with a one-stage direct-to-implant technique using ADM and 23 patients underwent BR with a two-stage expander-to-implant technique. Follow-up time was 2 years. Results The risk of implant loss was equal between groups; one-stage group 16% and two-stage group 17% whereas the risk of implant exchange (but not loss of BR) was 13% in the one-stage group compared to 7% in the two-stage group. The risk of at least one major complication were equal between groups; 28% and 24% but the risk of at least one minor complication was significantly higher in the two-stage group (41%) compared to the one-stage group (3%). Number of aesthetic corrections were equally frequent in the two treatment groups (one-stage group 1.8, two-stage group 1.5). Patient and investigator assessed aesthetic outcome was very high in both groups as well as the degree of symmetry between breasts. No capsular contracture Baker grade 3 or 4 was observed. Conclusions The present study design sets limitations for drawing wide conclusions. This study did not reveal any significant differences between the two breast reconstructive techniques besides a higher risk of minor complications in the two-stage group, that did, however, not lead to a higher risk of implant loss. With equally high satisfaction with the aesthetic result and no significant difference in number of aesthetic corrections between the two groups we suggest, that the one-stage approach using ADM may be feasible and allows the patient to achieve an implant-based BR with a minimum of surgeries and outpatient visits. The study was registered in ClinicalTrials.gov (NCT04209010).
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Affiliation(s)
- Mette Eline Brunbjerg
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Thomas Bo Jensen
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Peer Christiansen
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
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14
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Hong SE, Kim JH. The relationship of human acellular dermal matrix thickness on complication rate and patient-reported outcomes in implant-based immediate breast reconstruction. Gland Surg 2021; 10:90-100. [PMID: 33633966 DOI: 10.21037/gs-20-534] [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] [Indexed: 11/06/2022]
Abstract
Background As it can be said that prosthetic breast reconstruction has been increased by the use of acellular dermal matrices (ADMs), ADMs are widely used in implant reconstruction. A large variety types of ADMs are now produced, but there is a paucity of data comparing the ADM products directly. We evaluated the effects of ADM thickness on complication rates and patient satisfaction after dual-plane subpectoral ADM-assisted implant breast reconstruction. Methods A retrospective study of patients who underwent immediate implant breast reconstruction using ADM was performed. We compared clinical course and postoperative outcomes for two ADM groups with different thicknesses [thin ADMs, 0.6-1.5 mm (group 1) vs. thick ADMs, 1.5-3.0 mm (group 2)] based on the incidence of complications and the duration of drainage. Patient satisfaction was also evaluated using the Breast Questionnaire (BREAST-Q), 6 months after surgery. Results A total of 51 patients were included in the study (group 1, n=21; group 2, n=30). Patient demographics were similar between the two groups, and no difference in postoperative complication rate (P>0.05) and Jackson-Pratt (JP) drainage durations (P>0.05). On regression analysis, ADM thickness was not an independent factor for any complication subtype. There were also no significant differences in BREAST-Q results, across all metrics, between the study groups. Conclusions In dual plane subpectoral implant placement breast reconstruction with an inferior ADM-sling, the thickness of ADM was not a factor in determining postoperative complications and patient satisfaction. Therefore, it is possible to select the thickness according to the surgeon's preference.
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Affiliation(s)
- Seung Eun Hong
- Department of Plastic and Reconstructive Surgery, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Jung-Hoon Kim
- Department of Plastic and Reconstructive Surgery, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, Korea
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15
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Cuomo R. Submuscular and Pre-Pectoral ADM Assisted Immediate Breast Reconstruction: A Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E256. [PMID: 32466619 PMCID: PMC7353845 DOI: 10.3390/medicina56060256] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/22/2020] [Accepted: 05/23/2020] [Indexed: 12/13/2022]
Abstract
Background and objectives: Breast cancer treatment has deeply changed in the last fifty years. Acellular dermal matrices (ADMs) were introduced for breast reconstruction, with encouraging results, but with conflicting reports too. The present paper aims to summarize the current data on breast reconstruction using acellular dermal matrices. Materials and Methods: We reviewed the literature regarding the use of ADM-assisted implant-based breast reconstruction. Results: The main techniques were analyzed and described. Conclusions: Several authors have recently reported positive results. Nevertheless, an increased complications' rate has been reported by other authors. Higher cost compared to not-ADM-assisted breast reconstruction is another concern.
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Affiliation(s)
- Roberto Cuomo
- Santa Maria Alle Scotte Hospital, Plastic and Reconstructive Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Mario Bracci Street, 53100 Siena, Italy
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16
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Patient satisfaction with breast reconstruction: how much do timing and surgical technique matter? EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-020-01663-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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17
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Livingston-Rosanoff D, Trentham-Dietz A, Hampton JM, Newcomb PA, Wilke LG. Evaluation of Long-Term Satisfaction with Breast Surgery in Patients Treated for Ductal Carcinoma In Situ: A Population-Based Longitudinal Cohort Study. Ann Surg Oncol 2020; 27:2628-2636. [PMID: 32095924 DOI: 10.1245/s10434-020-08216-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Breast-conserving surgery (BCS) and mastectomy have equivalent survival for ductal carcinoma in situ (DCIS), allowing patients to participate in selecting a personalized surgical option; however, this decision-making role can increase patient anxiety. Data evaluating patient satisfaction with their decision to undergo BCS versus mastectomy for the treatment of DCIS are limited. METHODS Women with DCIS were enrolled in a population-based, state-wide cohort from 1997 to 2006. Participants were surveyed about their satisfaction with their surgical and reconstruction decisions. Quality-of-life (QoL) evaluations were performed with biennial follow-up surveys though 2016. Multivariable logistic regression modeling examined the relationship between type of surgery and reconstruction with patient satisfaction. RESULTS Overall, 1537 women were surveyed, on average, 2.9 years following DCIS diagnosis. Over 90% reported satisfaction with their treatment decision regardless of surgery type. Women who underwent mastectomy with reconstruction were more likely to report lower levels of satisfaction than women who underwent BCS (odds ratio [OR] 2.98, 95% confidence interval [CI] 1.18-7.51, p < 0.01). However, over 80% of women who underwent mastectomies reported satisfaction with their reconstruction decision. Women without reconstruction had the highest levels of satisfaction, while women with implants were more likely to be dissatisfied (implant + autologous: OR 2.77, 95% CI 1.24-6.24; implant alone: OR 4.02, 95% CI 1.947-8.34, p ≤ 0.01). QoL scores were not associated with differences in surgical or reconstruction satisfaction at 5, 10, and 15 years following DCIS diagnosis. CONCLUSIONS Women undergoing surgery for DCIS express satisfaction with their treatment decisions. Following mastectomy, most women are satisfied with their reconstruction decision, including women who did not undergo reconstruction.
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Affiliation(s)
| | - Amy Trentham-Dietz
- Department of Population Health Sciences and Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - John M Hampton
- Department of Population Health Sciences and Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | | | - Lee G Wilke
- Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, WI, USA
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18
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Patient Reported Quality of Life and Aesthetic Satisfaction with Latissimus Dorsi Flap in Immediate Partial and Delayed Total Breast Reconstruction. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2018; 53:42-45. [PMID: 33536825 PMCID: PMC7847730 DOI: 10.14744/semb.2018.04820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 09/18/2018] [Indexed: 11/20/2022]
Abstract
Objectives: Latissimus dorsi (LD) muscle flap can be used as an alternative to abdominal flaps for autologous breast reconstruction. The aim of the present study was to present the results of the quality of life and aesthetic satisfaction of breast reconstruction surgeries with LD flap and implants. Methods: Sixteen patients who had undergone LD flap breast reconstruction were included in the study. Patients were surveyed on the quality of life and aesthetic satisfaction 12 months following breast reconstruction. Results: There were no major complications observed following surgeries. All of the patients included in the study were highly satisfied with the final aesthetic results. There was no difference in satisfaction rate between partial versus total reconstructions and between reconstruction with or without implant. Conclusion: LD flaps can be a good alternative to abdominal flaps for autologous breast reconstruction for both partial and total breast reconstruction and can achieve similar aesthetic results.
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19
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Barone M, Cogliandro A, Signoretti M, Persichetti P. Analysis of Symmetry Stability Following Implant-Based Breast Reconstruction and Contralateral Management in 582 Patients with Long-Term Outcomes. Aesthetic Plast Surg 2018; 42:936-940. [PMID: 29359234 DOI: 10.1007/s00266-018-1082-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/07/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This study aimed to analyse the long-term outcomes following breast reconstruction and contralateral management to evaluate the stability of breast symmetry and patient satisfaction. MATERIALS AND METHODS The study population consisted of women who had undergone implant-based monolateral breast reconstruction and contralateral management. Patients answered the BREAST-Q reconstruction module. Two reviewers analysed the post-operative outcomes of the patients included and compiled the Kroll Scale. Patients were divided into three groups: implant-based contralateral management, breast reduction and mastopexy. The Fisher's exact test was applied to the results. RESULTS From the BREAST-Q analysis, the group of patients undergoing contralateral breast augmentation achieved significantly better results regarding the ability to wear clothing (p ≪ 0.001), symmetry (p ≪ 0.001), psychosocial well-being (p ≪ 0.001) and physical well-being (p ≪ 0.001). From the analysis of the Kroll Scale, the group of implant-based contralateral management received the highest score for symmetry (p ≪ 0.001), shape (p ≪ 0.001) and aesthetic result overall (p ≪ 0.001). CONCLUSIONS This study was the first to use BREAST-Q to analyse the stability of breast symmetry following breast reconstruction with long-term results. The implant-based contralateral management was the most effective procedure for achieving a stable and lasting result to obtain the high satisfaction 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)
- M Barone
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
| | - A Cogliandro
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy.
| | - M Signoretti
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
| | - P Persichetti
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy
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20
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Alstrup T, Christensen BO, Damsgaard TE. ICG angiography in immediate and delayed autologous breast reconstructions: peroperative evaluation and postoperative outcomes. J Plast Surg Hand Surg 2018; 52:307-311. [PMID: 30039727 DOI: 10.1080/2000656x.2018.1486320] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Postoperative complications in patients undergoing autologous breast reconstruction should be kept at the lowest possible level. Optimization of autologous breast reconstruction, especially techniques that can identify tissue perfusion and ischemia, will greatly benefit the patients and consequently society. Hence, the aim of this study was to evaluate the complication rates for autologous pedicle flap breast reconstructions, with and without the use of ICG-angiography. A single-institution retrospective review of mastectomy patients was performed. A total of 230 cases who underwent immediate or delayed, unilateral or bilateral pedicle autologous flap breast reconstruction between January 2013 and September 2016 was reviewed. Complication rates in the ICG-angiography and clinical assessment group were evaluated and compared. A total of 191 cases were identified of which 77 were evaluated with ICG-angiography, and 114 were evaluated clinically. There was no significant difference in overall complication rates between the two groups (ICG-angiography, 36.4%; Clinical assessment, 37.7%; p = .88). No significant difference was observed when stratifying for major or minor complications. However, when stratifying for the timing of the reconstruction, the rate of major complications was significantly lower in the ICG-angiography group (ICG-angiography, 0%; Clinical assessment 23.3%; p = .039). BMI was significantly associated with increased risk of minor complications (p = .018), whereas there was no correlation to age, prior smoking, chemotherapy, radiation, diabetes, or hypertension. Our study found that use of ICG-angiography was associated with a significant decrease in the rate of major complications for immediate autologous reconstructions.
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Affiliation(s)
- Toke Alstrup
- a Plastic Surgery Research Unit, Department of Plastic and Breast Surgery , Aarhus University Hospital , Aarhus , Denmark
| | - Bekka O Christensen
- a Plastic Surgery Research Unit, Department of Plastic and Breast Surgery , Aarhus University Hospital , Aarhus , Denmark
| | - Tine Engberg Damsgaard
- a Plastic Surgery Research Unit, Department of Plastic and Breast Surgery , Aarhus University Hospital , Aarhus , Denmark
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21
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Adam H, Docherty Skogh AC, Edsander Nord Å, Schultz I, Gahm J, Hall P, Frisell J, Halle M, de Boniface J. Risk of recurrence and death in patients with breast cancer after delayed deep inferior epigastric perforator flap reconstruction. Br J Surg 2018; 105:1435-1445. [PMID: 29683203 PMCID: PMC6174948 DOI: 10.1002/bjs.10866] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 02/22/2018] [Indexed: 12/14/2022]
Abstract
Background Postmastectomy reconstruction using a deep inferior epigastric perforator (DIEP) flap is increasingly being performed in patients with breast cancer. The procedure induces extensive tissue trauma, and it has been hypothesized that the release of growth factors, angiogenic agonists and immunomodulating factors may reactivate dormant micrometastasis. The aim of the present study was to estimate the risk of breast cancer recurrence in patients undergoing DIEP flap reconstruction compared with that in patients treated with mastectomy alone. Methods Each patient who underwent delayed DIEP flap reconstruction at Karolinska University Hospital, Sweden, between 1999 and 2013, was compared with up to four controls with breast cancer who did not receive a DIEP flap. The control patients were selected using incidence density matching with respect to age, tumour and nodal status, neoadjuvant therapy and year of mastectomy. The primary endpoint was breast cancer‐specific survival. Survival analysis was carried out using Kaplan–Meier survival estimates and Cox proportional hazard regression analysis. Results The analysis included 250 patients who had 254 DIEP flap reconstructions and 729 control patients. Median follow‐up was 89 and 75 months respectively (P = 0·053). Breast cancer recurrence developed in 50 patients (19·7 per cent) in the DIEP group and 174 (23·9 per cent) in the control group (P = 0·171). The 5‐year breast cancer‐specific survival rate was 92·0 per cent for patients with a DIEP flap and 87·9 per cent in controls (P = 0·032). Corresponding values for 5‐year overall survival were 91·6 and 84·7 per cent (P < 0·001). After adjustment for tumour and patient characteristics and treatment, patients without DIEP flap reconstruction had significantly lower overall but not breast cancer‐specific survival. Conclusion The present findings do not support the hypothesis that patients with breast cancer undergoing DIEP flap reconstruction have a higher rate of breast cancer recurrence than those who have mastectomy alone. Deep inferior epigastric perforator is safe
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Affiliation(s)
- H Adam
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - A C Docherty Skogh
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Å Edsander Nord
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - I Schultz
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - J Gahm
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - P Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Oncology, South General Hospital, Stockholm, Sweden
| | - J Frisell
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Breast and Endocrine Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - M Halle
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - J de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Breast Unit, Capio St Göran's Hospital, Stockholm, Sweden
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22
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Herrera de la Muela M, García López E, Frías Aldeguer L, Gómez-Campelo P. Protocol for the BRECAR study: a prospective cohort follow-up on the impact of breast reconstruction timing on health-related quality of life in women with breast cancer. BMJ Open 2017; 7:e018108. [PMID: 29259059 PMCID: PMC5778343 DOI: 10.1136/bmjopen-2017-018108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION The completion of postmastectomy breast reconstruction (BR) in women with breast cancer can last from months to years, and to our knowledge, there is a lack of studies that analyse how the different types and times of reconstruction impact on the patient's quality of life and psychosocial adjustment.The primary aim of the BREast Cancer Reconstruction (BRECAR Study) is twofold. First, to describe health-related quality of life (HRQoL), overall satisfaction with surgery and psychological impact (body image, self-esteem, depression and anxiety) on women who will have undergone a mastectomy with planned BR, considering the varied timing of BR procedures (immediate BR (iBR), delayed BR (dBR) and two-stage BR (2sBR)). To measure the impact on surgical outcomes, we will obtain data prior to and after surgery (6-9 and at 18 months of follow-up). Second, to analyse sociodemographic, clinical and psychosocial factors associated with HRQoL, satisfaction with surgery and psychological impact. METHODS AND ANALYSIS A prospective, observational, clinical cohort study of women diagnosed with breast cancer who have an indication for mastectomy treated at La Paz University Hospital (Madrid, Spain).Patients will be classified into one of three groups under conditions of routine clinical practice, based on the type of BR planned: the iBR group, the dBR group and the 2sBR group.Under typical clinical practice conditions, we will perform three visits: baseline visit (presurgery), V1 (6-9 months after diagnosis) and V2 (18 months after diagnosis). A sample size of 210 patients is estimated. ETHICS AND DISSEMINATION The study protocol and informed consent form have been reviewed and approved by the Institutional Review Board of La Paz Hospital (no. PI-2036). Dissemination of results will be via journal articles and conference presentations.
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Affiliation(s)
- Maria Herrera de la Muela
- Breast Pathology Unit, Department of Gynecology, Hospital Universitario La Paz, Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital, Madrid, Spain
| | - Enrique García López
- Breast Pathology Unit, Department of Gynecology, Hospital Universitario La Paz, Madrid, Spain
| | - Laura Frías Aldeguer
- Breast Pathology Unit, Department of Gynecology, Hospital Universitario La Paz, Madrid, Spain
| | - Paloma Gómez-Campelo
- Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital, Madrid, Spain
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23
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Barone M, Cogliandro A, Tambone V, Persichetti P. Analysis of outcomes and patient’s satisfaction following monolateral and bilateral mastectomy using BREAST-Q. EUROPEAN JOURNAL OF PLASTIC SURGERY 2017. [DOI: 10.1007/s00238-017-1376-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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24
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Bertozzi N, Pesce M, Santi P, Raposio E. One-Stage Immediate Breast Reconstruction: A Concise Review. BIOMED RESEARCH INTERNATIONAL 2017; 2017:6486859. [PMID: 29098159 PMCID: PMC5643043 DOI: 10.1155/2017/6486859] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 08/24/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND One-stage direct-to-implant immediate breast reconstruction (IBR) is performed simultaneously with breast cancer resection. We explored indications, techniques, and outcomes of IBR to determine its feasibility, safety, and effectiveness. MATERIAL AND METHODS We reviewed the available literature on one-stage direct-to-implant IBR, with or without acellular dermal matrix (ADM), synthetic mesh, or autologous fat grafting. We analyzed the indications, preoperative work-up, surgical technique, postoperative care, outcomes, and complications. RESULTS IBR is indicated for small-to-medium nonptotic breasts and contraindicated in patients who require or have undergone radiotherapy, due to unacceptably high complications rates. Only patients with thick, well-vascularized mastectomy flaps are IBR candidates. Expandable implants should be used for ptotic breasts, while anatomical shaped implants should be used to reconstruct small-to-medium nonptotic breasts. ADMs can be used to cover the implant during IBR and avoid muscle elevation, thereby minimizing postoperative pain. Flap necrosis, reoperation, and implant loss are more common with IBR than conventional two-staged reconstruction, but IBR has advantages such as lack of secondary surgery, faster recovery, and better quality of life. CONCLUSIONS IBR has good outcomes and patient-satisfaction rates. With ADM use, a shift from conventional reconstruction to IBR has occurred. Drawbacks of IBR can be overcome by careful patient selection.
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Affiliation(s)
- Nicolò Bertozzi
- Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma, Italy
- Cutaneous, Mini-Invasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Marianna Pesce
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
- Plastic Surgery Department, IRCCS San Martino University Hospital, National Institute for Cancer Research Genoa, Genoa, Italy
| | - Pierluigi Santi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
- Plastic Surgery Department, IRCCS San Martino University Hospital, National Institute for Cancer Research Genoa, Genoa, Italy
| | - Edoardo Raposio
- Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma, Italy
- Cutaneous, Mini-Invasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
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25
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Cogliandro A, Brunetti B, Barone M, Favia G, Persichetti P. Management of contralateral breast following mastectomy and breast reconstruction using a mirror adjustment with crescent mastopexy technique. Breast Cancer 2017; 25:94-99. [PMID: 28819836 DOI: 10.1007/s12282-017-0796-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/04/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Heterologous breast reconstruction after mastectomy sometimes requires the management of the contralateral breast to achieve symmetric long lasting aesthetic results. Some techniques could be used for the symmetrization of contralateral breast with or without implants as breast augmentation, reduction mammoplasty, mastopexy, with T inverted, J, vertical, periareolar, semi-circular, or axillary scars. The aim of this study is to present the use of crescent mastopexy technique with implants in contralateral adjustment following monolateral breast reconstruction compared with a control group in which patients underwent other contralateral procedures. We used BREAST-Q to evaluate breast perception and patient's satisfaction and surgeon-rated aesthetic outcomes were measured using the Kroll evaluation (a global and itemized aesthetic tool). MATERIALS AND METHODS A retrospective study was designed. We enrolled in the study 55 patients who had undergone breast reconstruction with implants and contralateral breast symmetrization procedure at our hospital between 2010 and 2016, and they answered to BREAST-Q postoperative module after almost 1 year from breast reconstruction. The study population consisted of 2 groups of women: patient underwent contralateral adjustment with crescent mastopexy and augmentation and patients underwent other contralateral procedures. Statistical analysis was performed using descriptive and summary statistics to identify a central tendency between the two groups, we applied Fisher's exact test to the results to obtain answers 1 year after the last procedure for the two groups. RESULTS This cross-sectional study compared two cohorts in which 55 women underwent monolateral mastectomy and breast reconstruction with contralateral adjustment, 15 of these underwent contralateral crescent mastopexy with augmentation, and 40 (control group) underwent contralateral breast adjustment with other mastopexy and augmentation technique (27 patients underwent T inverted mastopexy, 2 J mastopexy, 6 vertical scar mastopexy, 5 periareolar mastopexy). Nineteen patients suffered of co-morbidities (smoking, autoimmune disease, cardiological, neurological, and dismetabolic). All patients answered the postoperative BREAST-Q reconstruction module almost 1 year from last surgical procedure. CONCLUSIONS In patients with a pseudoptosis or mild ptosis of the contralateral breast, crescent mastopexy could be a valid procedure with minimal scars, better symmetry, and global cosmetic results than other procedures. This is the first study which compares crescent mastopexy with augmentation with other mastopexy procedures. Level III: evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group. LEVEL (III) Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.
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Affiliation(s)
- A Cogliandro
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy
| | - B Brunetti
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy
| | - Mauro Barone
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy.
| | - G Favia
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy
| | - P Persichetti
- Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Via Alvaro Del Portillo 200, Rome, Italy
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Affiliation(s)
- Christoffer Johansen
- Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
- Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark
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