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Siqueira HFF, Teixeira JLDA, Lessa Filho RDS, Hora EC, Evangelista MDFA, Lisboa TCWM, de Araújo FV, Luna ICG, Brito ÉDAC, Lima MS, Moura AR, de Almeida PNG, Barreto IDDC, Lima CA. Aesthetic assessment instrument for breasts reconstruction. J Plast Reconstr Aesthet Surg 2024; 95:242-249. [PMID: 38941778 DOI: 10.1016/j.bjps.2024.05.037] [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: 01/22/2024] [Revised: 05/06/2024] [Accepted: 05/17/2024] [Indexed: 06/30/2024]
Abstract
INTRODUCTION Few validated aesthetic assessment instruments in breast reconstruction use discrete scales to facilitate studies with multiple evaluators. OBJECTIVE This research aimed to propose an aesthetic assessment scale for reconstructed breasts. METHODOLOGY A scale was suggested using discrete variables, with responses ranging from 1 to 10, and the responses for each category could be summed to obtain an average that could be used in studies with multiple evaluators. To test the instrument suggested in this study, 5 experienced plastic surgeons assessed 46 patients. For all the analyses, a rejection level for the null hypothesis of 5% (p < 0.05) was adopted. RESULTS The suggested scale obtained valid intraclass correlation coefficients, with 0.9 for the overall aesthetic evaluation of the breast and the lowest being 0.77 for defining the inframammary fold. We observed good diagnostic accuracy in all comparisons, with the area under the curve ranging from 0.85 to 0.97. Regarding convergent validity, we observed correlations of 0.77 (p < 0.001) between breast volume and volume symmetry, 0.66 (p < 0.001) between breast shape and contour naturalness. The test-retest reliability was 0.708, which is considered good. CONCLUSION The results of this study support the effectiveness of the proposed new aesthetic evaluation scale, revealing consistency among different evaluators and over time. Convergent validation strengthens the relationship between the variables of the new scale and those of the Garbay scale. Furthermore, the robust diagnostic accuracy highlights the clinical utility of the new scale in assessing aesthetic outcomes in breast reconstructions.
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Affiliation(s)
- Hianga Fayssa Fernandes Siqueira
- Health Sciences Graduate Program, Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil; Department of Medicine, Federal University of Sergipe (Lagarto Campus), Lagarto, Sergipe, Brazil; Medical Division, Emergency Hospital of Sergipe (Hospital de Urgências de Sergipe), Aracaju, Sergipe, Brazil.
| | - Jorge Luiz de Almeida Teixeira
- Medical Division, Emergency Hospital of Sergipe (Hospital de Urgências de Sergipe), Aracaju, Sergipe, Brazil; University Hospital (Hospital Universitário), Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil
| | - Reginaldo da Silva Lessa Filho
- Medical Division, Emergency Hospital of Sergipe (Hospital de Urgências de Sergipe), Aracaju, Sergipe, Brazil; University Hospital (Hospital Universitário), Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil
| | - Evânia Curvelo Hora
- Health Sciences Graduate Program, Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil; Medical Division, Emergency Hospital of Sergipe (Hospital de Urgências de Sergipe), Aracaju, Sergipe, Brazil; University Hospital (Hospital Universitário), Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil
| | - Maria de Fátima Albuquerque Evangelista
- Medical Division, Emergency Hospital of Sergipe (Hospital de Urgências de Sergipe), Aracaju, Sergipe, Brazil; Department of Medicine, Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju Campus, Aracaju, Sergipe, Brazil
| | | | - Fernando Vicente de Araújo
- Department of Medicine, Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju Campus, Aracaju, Sergipe, Brazil
| | - Igor Chaves Gomes Luna
- Department of Medicine, Federal University of Pernambuco (Universidade Federal de Pernambuco), Recife, Pernambuco, Brazil
| | - Érika de Abreu Costa Brito
- Health Sciences Graduate Program, Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil; University Hospital (Hospital Universitário), Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil
| | - Marcela Sampaio Lima
- Health Sciences Graduate Program, Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil; University Hospital (Hospital Universitário), Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil
| | - Alex Rodrigues Moura
- Health Sciences Graduate Program, Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil; University Hospital (Hospital Universitário), Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil
| | - Phillip Nicolau Guimarães de Almeida
- Medical Division, Emergency Hospital of Sergipe (Hospital de Urgências de Sergipe), Aracaju, Sergipe, Brazil; Department of Medicine, Federal University of Vale do São Francisco (Universidade Federal do Vale do São Francisco), Paulo Afonso Campus, Paulo Afonso, Bahia, Brazil
| | | | - Carlos Anselmo Lima
- Health Sciences Graduate Program, Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil; University Hospital (Hospital Universitário), Federal University of Sergipe (Universidade Federal de Sergipe), Aracaju, Sergipe, Brazil; State Health Department of Sergipe (Secretaria de Saúde do Estado de Sergipe), Aracaju, Sergipe, Brazil.
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Tallroth L, Mobargha N, Velander P, Klasson S, Becker M. Evaluation of an assessment scale for aesthetic outcome in breast reconstructions based on digital photos in both 2D and 3D format. J Plast Surg Hand Surg 2023; 57:427-433. [PMID: 36507728 DOI: 10.1080/2000656x.2022.2152820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The aesthetic outcome is crucial in a breast reconstruction. Our aim was to evaluate the intra- and interrater reliability of an aesthetic outcome assessment scale with digital photos of breast reconstructions in two-dimensional (2D) and three-dimensional (3D) format. Thirty-three women with delayed breast reconstructions, consecutively participating in a five-year follow-up between November 2019 and June 2021, were included in the study. Of these, 14 were reconstructed with an expander prosthesis (EP) and 19 with a deep inferior epigastric perforator (DIEP) flap. Photos of the breasts were assessed in 2D and 3D format by expert, layman and patient panels. Data were analysed with the weighted kappa (wk) statistics. The intrarater agreements were moderate to substantial, with wk between 0.66 and 0.73 for the panels. Within the panels, the interrater agreements were 0.46-0.62. Moderate agreements were found between the matched 2D and 3D format photos (wk 0.62-0.66). The patient panel graded scar appearance worse in 3D compared with 2D format. In all panels, there was a tendency towards DIEP flap reconstructions receiving higher aesthetic outcome grades compared with EP. Thus, the aesthetic outcome assessment scale demonstrated acceptable agreements between the individual panellists and within the panels. Scars captured in 3D format may provide a greater resemblance to the reality compared with 2D. Implications for clinics remain to be further studied.
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Affiliation(s)
- Linda Tallroth
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences in Malmö, Lund University, Sweden
| | - Nathalie Mobargha
- Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Patrik Velander
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences in Malmö, Lund University, Sweden
| | - Stina Klasson
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences in Malmö, Lund University, Sweden
| | - Magnus Becker
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences in Malmö, Lund University, Sweden
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Lee WS, Park SO, Kim IK. Prevention of Abdominal Bulging Using Onlay Dermal Autografts from Discarded Zone IV TRAM Flap Tissue. J Clin Med 2022; 11:jcm11071929. [PMID: 35407538 PMCID: PMC8999363 DOI: 10.3390/jcm11071929] [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: 12/28/2021] [Revised: 03/26/2022] [Accepted: 03/29/2022] [Indexed: 02/04/2023] Open
Abstract
While the transverse rectus abdominis myocutaneous (TRAM) flap is a popular option for abdominal-based breast reconstruction, abdominal wall morbidities such as bulging or hernia remain a concern. Here, we introduced a surgical technique for reinforcing the abdominal wall using an onlay autograft obtained from discarded zone IV tissue following a primary closure. We compared abdominal wall morbidities between patients receiving an onlay graft and those receiving primary closure only. We retrospectively reviewed the medical charts of patients who underwent breast reconstruction using a TRAM flap between December 2018 and May 2021. Additionally, we assessed donor-site morbidities based on physical examination. Of the 79 patients included, 38 had received a dermal graft and 41 had not. Donor-site morbidities occurred in 10 (24.5%) and 1 (2.6%) patients, and bulging occurred in 8 (19.5%) and 1 (2.6%) patients in the primary closure and dermal autograft groups, respectively. A statistically significant difference in the incidence of bulging was observed between the groups (p = 0.030). In conclusion, the introduction of a dermal autograft after primary closure can successfully ameliorate morbidities at the TRAM flap site.
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Affiliation(s)
- Won Seob Lee
- Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu 42415, Korea;
| | - Seong Oh Park
- Department of Plastic and Reconstructive Surgery, Hanyang University College of Medicine, Seoul 04763, Korea
- Correspondence: (I.-K.K.); (S.O.P.); Tel.: +82-53-620-3480 (I.-K.K.); +82-2-2290-8564 (S.O.P.); Fax: +82-53-626-0705 (I.-K.K.); +82-2-2295-7671 (S.O.P.)
| | - Il-Kug Kim
- Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu 42415, Korea;
- Correspondence: (I.-K.K.); (S.O.P.); Tel.: +82-53-620-3480 (I.-K.K.); +82-2-2290-8564 (S.O.P.); Fax: +82-53-626-0705 (I.-K.K.); +82-2-2295-7671 (S.O.P.)
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Augustinho LBZ, Sabino M, Veiga DF, Abla LEF, Juliano Y, Ferreira LM. Patient satisfaction with breast reconstructionusing musculocutaneous flap from latissimus dorsiversus from rectus abdominis: a cross-sectional study. SAO PAULO MED J 2018; 136:551-556. [PMID: 30892486 PMCID: PMC9897135 DOI: 10.1590/1516-3180.2018.032916112018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 11/16/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Breast cancer is the second most frequent type of cancer worldwide and the most common type among women. The treatment for this condition has evolved over recent decades with therapeutic and technological advances. Breast reconstruction techniques using musculocutaneous flaps from the latissimus dorsi and rectus abdominis have aroused interest regarding patients' quality of life. Our goal here was to compare patients' satisfaction scores after they underwent breast reconstruction using musculocutaneous flaps from either the latissimus dorsi or the rectus abdominis. DESIGN AND SETTING Primary, clinical, analytical, observational and cross-sectional study conducted in a federal university and a public hospital. METHODS Demographic and clinical data were collected. The Mini-Mental State Examination was then applied, with testing for specificity and sensitivity. Lastly, a breast evaluation questionnaire was applied to evaluate breast satisfaction among 90 women, who were divided into three groups: mastectomy (control; n = 30); breast reconstruction using flap from the latissimus dorsi (n = 30); and reconstruction using flap from the rectus abdominis (n = 30). RESULTS The groups were homogeneous regarding the main demographic data and the questionnaire responses (P < 0.05). Compared with the control group, the reconstruction groups showed significant improvement in satisfaction (P < 0.0002) after one year. CONCLUSION Within our sample, women who underwent breast reconstruction with flaps from either the latissimus dorsi or the rectus abdominis had similar satisfaction scores.
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Affiliation(s)
| | - Miguel Sabino
- MD, PhD. Physician, Adjunct Professor and Coordinator of the Postgraduate Program on Translational Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Daniela Francescato Veiga
- MD, PhD. Physician and Professor, Postgraduate Program on Translational Surgery, Universidade Federal de São Paulo (UNİFESP), São Paulo; and Pro-Rector of Postgraduate Studies, Universidade do Vale do Sapucaí (UNIVÁS), Pouso Alegre (MG), Brazil.
| | - Luiz Eduardo Felipe Abla
- MD, PhD. Physician and Director, Discipline of Plastic Surgery, Hospital Pérola Byington, São Paulo (SP), Brazil.
| | - Yara Juliano
- PhD. Business Administrator and Full Professor, Discipline of Collective Health, School of Medicine, Universidade de Santo Amaro (UNISA), São Paulo (SP), Brazil.
| | - Lydia Masako Ferreira
- MD, PhD. Physician and Titular Professor, Discipline of Plastic Surgery, Universidade Federal de São Paulo (UNİFESP), São Paulo (SP), Brazil.
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O'Connell RL, Di Micco R, Khabra K, Kirby AM, Harris PA, James SE, Power K, Ramsey KWD, Rusby JE. Comparison of Immediate versus Delayed DIEP Flap Reconstruction in Women Who Require Postmastectomy Radiotherapy. Plast Reconstr Surg 2018; 142:594-605. [PMID: 29927832 PMCID: PMC6112844 DOI: 10.1097/prs.0000000000004676] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 03/16/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND The authors investigated aesthetic outcome and patient satisfaction in women who have undergone deep inferior epigastric artery perforator (DIEP) flap reconstruction in the setting of postmastectomy radiotherapy. Patients who underwent DIEP flap reconstruction without postmastectomy radiotherapy were the control group. METHODS Participants who had undergone DIEP flap reconstruction between September 1, 2009, and September 1, 2014, were recruited, answered the BREAST-Q, and underwent three-dimensional surface-imaging. A panel assessed the aesthetic outcome by reviewing these images. RESULTS One hundred sixty-seven women participated. Eighty women (48 percent) underwent immediate DIEP flap reconstruction and no postmastectomy radiotherapy; 28 (17 percent) underwent immediate DIEP flap reconstruction with postmastectomy radiotherapy; 38 (23 percent) underwent simple mastectomy, postmastectomy radiotherapy, and DIEP flap reconstruction; and 21 (13 percent) underwent mastectomy with temporizing implant, postmastectomy radiotherapy, and DIEP flap reconstruction. Median satisfaction scores were significantly different among the groups (p < 0.05). Post hoc comparison demonstrated that women who had an immediate DIEP flap reconstruction were significantly less satisfied if they had postmastectomy radiotherapy. In women requiring radiotherapy, those undergoing delayed reconstruction after a simple mastectomy were most satisfied, but there was no significant difference between the immediate DIEP flap and temporizing implant groups. Median panel scores differed among groups, being significantly higher if the immediate reconstruction was not subjected to radiotherapy. There was no significant difference in panel assessment among the three groups of women who had received radiotherapy. CONCLUSIONS Patients who avoid having their immediate DIEP flap reconstruction irradiated are more satisfied and have better aesthetic outcome than those who undergo postmastectomy radiotherapy. In women requiring radiotherapy and who wish to have an immediate or "delayed-immediate" reconstruction, there were no significant differences in panel or patient satisfaction. Therefore, immediate DIEP flap reconstruction or mastectomy with temporizing implant then DIEP flap surgery are acceptable treatment pathways in the context of post-mastectomy radiotherapy.
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Affiliation(s)
- Rachel L O'Connell
- From the Departments of Breast Surgery, Statistics, Clinical Oncology, and Plastic Surgery, The Royal Marsden NHS Foundation Trust
| | - Rosa Di Micco
- From the Departments of Breast Surgery, Statistics, Clinical Oncology, and Plastic Surgery, The Royal Marsden NHS Foundation Trust
| | - Komel Khabra
- From the Departments of Breast Surgery, Statistics, Clinical Oncology, and Plastic Surgery, The Royal Marsden NHS Foundation Trust
| | - Anna M Kirby
- From the Departments of Breast Surgery, Statistics, Clinical Oncology, and Plastic Surgery, The Royal Marsden NHS Foundation Trust
| | - Paul A Harris
- From the Departments of Breast Surgery, Statistics, Clinical Oncology, and Plastic Surgery, The Royal Marsden NHS Foundation Trust
| | - Stuart E James
- From the Departments of Breast Surgery, Statistics, Clinical Oncology, and Plastic Surgery, The Royal Marsden NHS Foundation Trust
| | - Kieran Power
- From the Departments of Breast Surgery, Statistics, Clinical Oncology, and Plastic Surgery, The Royal Marsden NHS Foundation Trust
| | - Kelvin W D Ramsey
- From the Departments of Breast Surgery, Statistics, Clinical Oncology, and Plastic Surgery, The Royal Marsden NHS Foundation Trust
| | - Jennifer E Rusby
- From the Departments of Breast Surgery, Statistics, Clinical Oncology, and Plastic Surgery, The Royal Marsden NHS Foundation Trust
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Negenborn VL, Young-Afat DA, Dikmans REG, Smit JM, Winters HAH, Don Griot JPW, Twisk JWR, Ruhé PQ, Mureau MAM, Lapid O, Moerman E, van Turnhout AAWM, Ritt MJPF, Bouman MB, Mullender MG. Quality of life and patient satisfaction after one-stage implant-based breast reconstruction with an acellular dermal matrix versus two-stage breast reconstruction (BRIOS): primary outcome of a randomised, controlled trial. Lancet Oncol 2018; 19:1205-1214. [PMID: 30104147 DOI: 10.1016/s1470-2045(18)30378-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 05/13/2018] [Accepted: 05/15/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND There is increasing interest in the use of acellular dermal matrices (ADMs) in implant-based breast reconstruction (IBBR). Suggested advantages are that ADMs facilitate one-stage IBBR and improve aesthetic outcomes. We compared immediate one-stage ADM-assisted IBBR with two-stage IBBR (current standard of care). Our previously reported secondary endpoint showed that one-stage ADM-assisted IBBR was associated with significantly more adverse outcomes. Here, we present the primary endpoint results aiming to assess whether one-stage IBBR with ADM provides higher patient-reported quality of life (QOL) compared with two-stage IBBR. METHODS This multicentre, open-label, randomised controlled trial (BRIOS study) was done in eight hospitals in the Netherlands. We recruited women aged older than 18 years with breast carcinoma or a genetic predisposition who intended to undergo skin-sparing mastectomy and immediate IBBR. Participants were randomly assigned to undergo one-stage IBBR with ADM (Strattice, LifeCell, Branchburg, NJ, USA) or two-stage IBBR. Randomisation was stratified by centre and indication for surgery (oncological or prophylactic) in blocks of ten participants. The primary endpoint was patient-reported QOL, as measured with the BREAST-Q (ie, health-related QOL scales and satisfaction scales), in the modified intention-to-treat population. The study follow-up is complete. This study is registered with the Netherlands Trial Register, number NTR5446. FINDINGS Between April 14, 2013, and May 29, 2015, we enrolled 142 women, of whom 69 were randomly assigned to receive one-stage ADM-assisted IBBR and 73 to receive two-stage IBBR. After exclusions, the modified intention-to-treat population comprised 60 patients in the one-stage group and 61 patients in the two-stage group. Of these, 48 women (mean follow-up 17·0 months [SD 7·8]) in the one-stage group and 44 women (17·2 months [SD 6·7]) in the two-stage group completed the BREAST-Q at least 1 year after implant placement. We found no significant differences in postoperative patient-reported QOL domains, including physical wellbeing (one-stage mean 78·0 [SD 14·1] vs two-stage 79·3 [12·2], p=0·60), psychosocial wellbeing (72·6 [17·3] vs 72·8 [19·6], p=0·95), and sexual wellbeing (58·0 [17·0] vs 57·1 [19·5], p=0·82), or in the patient-reported satisfaction domains: satisfaction with breasts (63·4 [15·8] vs 60·3 [15·4], p=0·35) and satisfaction with outcome (72·8 [19·1] vs 67·8 [16·3], p=0·19). INTERPRETATION Taken together with our previously published findings, one-stage IBBR with ADM does not yield superior results in terms of patient-reported QOL compared with two-stage IBBR. Risks for adverse outcomes were significantly higher in the one-stage ADM group. Use of ADM for one-stage IBBM should be considered on a case-by-case basis. FUNDING Pink Ribbon, Nuts-Ohra, and LifeCell.
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Affiliation(s)
- Vera Lidwina Negenborn
- Department of Plastic, Reconstructive & Hand Surgery, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands; Research Institute, Amsterdam Public Health, Amsterdam, Netherlands
| | - Danny Aschwin Young-Afat
- Department of Plastic, Reconstructive & Hand Surgery, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands; Imaging Division, University Medical Center, Utrecht, Netherlands
| | - Rieky Elise Gustina Dikmans
- Department of Plastic, Reconstructive & Hand Surgery, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands; Research Institute, Amsterdam Public Health, Amsterdam, Netherlands
| | - Jan Maerten Smit
- Department of Plastic, Reconstructive & Hand Surgery, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands; Alexander Monro Breast Cancer Hospital, Bilthoven, Netherlands
| | - Henri Adolf Hubert Winters
- Department of Plastic, Reconstructive & Hand Surgery, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands; Alexander Monro Breast Cancer Hospital, Bilthoven, Netherlands
| | | | | | - Pieter Quinten Ruhé
- Department of Plastic, Reconstructive & Hand Surgery, Meander Medical Centre, Amersfoort, Netherlands
| | - Marcus Antonius Maria Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Oren Lapid
- Department of Plastic, Reconstructive & Hand Surgery, Amsterdam UMC Academic Medical Center, University of Amsterdam, Netherlands
| | - Esther Moerman
- Department of Plastic, Reconstructive & Hand Surgery, Amsterdam UMC Academic Medical Center, University of Amsterdam, Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Onze Lieve Vrouwe Gasthuis Oost, Amsterdam, Netherlands
| | | | | | - Mark-Bram Bouman
- Department of Plastic, Reconstructive & Hand Surgery, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands; Alexander Monro Breast Cancer Hospital, Bilthoven, Netherlands
| | - Margriet Gezina Mullender
- Department of Plastic, Reconstructive & Hand Surgery, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands; Research Institute, Amsterdam Public Health, Amsterdam, Netherlands.
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Andrade AC, Veiga DF, Aguiar IDC, Juliano Y, Sabino M, Ferreira LM. Outcomes analysis of breast reduction in Brazilian women using the BREAST-Q® questionnaire: a cross-sectional controlled study. Clinics (Sao Paulo) 2018; 73:e313. [PMID: 29924186 PMCID: PMC5996439 DOI: 10.6061/clinics/2018/e313] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 12/11/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to analyse patient-reported outcomes of reduction mammoplasty among Brazilian women. METHODS A total of 100 women were enrolled in this cross-sectional controlled study, 50 with breast hypertrophy (Hypertrophy Group) and 50 who had undergone breast reduction at least six and up to 12 months before (Mammoplasty Group). The Brazilian version of the BREAST-Q® was applied to assess patient-reported outcomes. The module reduction/mastopexy was used, and the preoperative and postoperative versions were applied to the hypertrophy and mammoplasty groups, respectively. RESULTS The mammoplasty group presented higher scores for the subscales satisfaction with breasts, psychosocial well-being, sexual well-being and physical well-being (p=0.0001 for all of these subscales). CONCLUSION These results suggest that patients submitted to reduction mammoplasty are satisfied with the outcomes and present better quality of life scores compared with women with breast hypertrophy.
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Affiliation(s)
- Adriana Corbolan Andrade
- Programa de Pós-graduação em Cirurgia Translacional, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
| | - Daniela Francescato Veiga
- Programa de Pós-graduação em Cirurgia Translacional, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | | | - Yara Juliano
- Departamento de Bioestatistica, Universidade do Vale do Sapucai, Pouso Alegre, MG, BR
| | - Miguel Sabino
- Programa de Pós-graduação em Cirurgia Translacional, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
| | - Lydia Masako Ferreira
- Programa de Pós-graduação em Cirurgia Translacional, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
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Santos G, Urban C, Edelweiss MI, Zucca-Matthes G, de Oliveira VM, Arana GH, Iera M, Rietjens M, de Lima RS, Spautz C, Kuroda F, Anselmi K, Capp E. Long-Term Comparison of Aesthetical Outcomes After Oncoplastic Surgery and Lumpectomy in Breast Cancer Patients. Ann Surg Oncol 2015; 22:2500-2508. [DOI: 10.1245/s10434-014-4301-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Ibrahim AMS, Koolen PGL, Ganor O, Markarian MK, Tobias AM, Lee BT, Lin SJ, Mureau MAM. Does acellular dermal matrix really improve aesthetic outcome in tissue expander/implant-based breast reconstruction? Aesthetic Plast Surg 2015; 39:359-68. [PMID: 25894022 DOI: 10.1007/s00266-015-0484-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 03/26/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The expectation for improved results by women undergoing postmastectomy reconstruction has steadily risen. A majority of these operations are tissue expander/implant-based breast reconstructions. Acellular dermal matrix (ADM) offers numerous advantages in these procedures. Thus far, the evidence to justify improved aesthetic outcome has solely been based on surgeon opinion. The purpose of this study was to assess aesthetic outcome following ADM use in tissue expander/implant-based breast reconstruction by a panel of blinded plastic surgeons. METHODS Mean aesthetic results of patients who underwent tissue expander/implant-based breast reconstruction with (n = 18) or without ADM (n = 20) were assessed with objective grading of preoperative and postoperative photographs by five independent blinded plastic surgeons. Absolute observed agreement as well as weighted Fleiss Kappa (κ) test statistics were calculated to assess inter-rater variability. RESULTS When ADM was incorporated, the overall aesthetic score was improved by an average of 12.1 %. In addition, subscale analyses revealed improvements in breast contour (35.2 %), implant placement (20.7 %), lower pole projection (16.7 %), and inframammary fold definition (13.8 %). Contour (p = 0.039), implant placement (p = 0.021), and overall aesthetic score (p = 0.022) reached statistical significance. Inter-rater reliability showed mostly moderate agreement. CONCLUSIONS Mean aesthetic scores were higher in the ADM-assisted breast reconstruction cohort including the total aesthetic score which was statistically significant. Aesthetic outcome alone may justify the added expense of incorporating biologic mesh. Moreover, ADM has other benefits which may render it cost-effective. Larger prospective studies are needed to provide plastic surgeons with more definitive guidelines for ADM use. 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)
- Ahmed M S Ibrahim
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA,
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Maass SWMC, Bagher S, Hofer SOP, Baxter NN, Zhong T. Systematic Review: Aesthetic Assessment of Breast Reconstruction Outcomes by Healthcare Professionals. Ann Surg Oncol 2015; 22:4305-16. [PMID: 25691279 DOI: 10.1245/s10434-015-4434-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Achieving an aesthetic outcome following postmastectomy breast reconstruction is both an important goal for the patient and plastic surgeon. However, there is currently an absence of a widely accepted, standardized, and validated professional aesthetic assessment scale following postmastectomy breast reconstruction. METHODS A systematic review was performed to identify all articles that provided professional assessment of the aesthetic outcome following postmastectomy, implant- or autologous tissue-based breast reconstruction. A modified version of the Scientific Advisory Committee's Medical Outcomes Trust (MOT) criteria was used to evaluate all professional aesthetic assessment scales identified by our systematic review. The criteria included conceptual framework formation, reliability, validity, responsiveness, interpretability, burden, and correlation with patient-reported outcomes. RESULTS A total of 120 articles were identified: 52 described autologous breast reconstruction, 37 implant-based reconstruction, and 29 both. Of the 12 different professional aesthetic assessment scales that exist in the literature, the most commonly used scale was the four-point professional aesthetic assessment scale. The highest score on the modified MOT criteria was assigned to the ten-point professional aesthetic assessment scale. However, this scale has limited clinical usefulness due to its poor responsiveness to change, lack of interpretability, and wide range of intra- and inter-rater agreements (Veiga et al. in Ann Plast Surg 48(5):515-520, 2002). CONCLUSIONS A "gold standard" professional aesthetic assessment scale needs to be developed to enhance the comparability of breast reconstruction results across techniques, surgeons, and studies to aid with the selection of procedures that produce the best aesthetic results from both the perspectives of the surgeon and patients.
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Affiliation(s)
- Saskia W M C Maass
- Division of Plastic & Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, Toronto, ON, Canada.,Division of Plastic & Reconstructive Surgery, University of Toronto, Toronto, ON, Canada
| | - Shaghayegh Bagher
- Division of Plastic & Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, Toronto, ON, Canada.,Division of Plastic & Reconstructive Surgery, University of Toronto, Toronto, ON, Canada
| | - Stefan O P Hofer
- Division of Plastic & Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, Toronto, ON, Canada.,Division of Plastic & Reconstructive Surgery, University of Toronto, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Nancy N Baxter
- Departments of Surgery and Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.,The Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Toni Zhong
- Division of Plastic & Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, Toronto, ON, Canada. .,Division of Plastic & Reconstructive Surgery, University of Toronto, Toronto, ON, Canada. .,Department of Surgery, University of Toronto, Toronto, ON, Canada.
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12
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Buck D, Rawlani V, Wayne J, Dumanian GA, Mustoe TA, Fine NA, Galiano R, Kim JY. Cosmetic outcomes following head and neck melanoma reconstruction: The patient's perspective. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2013; 20:e10-5. [PMID: 23598768 DOI: 10.1177/229255031202000108] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND While studies have compared aesthetic outcomes following wide local excision of head and neck melanoma, none have evaluated this important outcome from the patient's perspective. Indeed, one could argue that the psychosocial impact of head and neck melanoma excision and reconstruction is more accurately assessed by deriving patient-based as opposed to surgeon-based outcome measures. OBJECTIVE To evaluate aesthetic outcomes following wide local excision of head and neck melanoma from the patient's perspective. METHODS Fifty-one patients who underwent excision of 57 head and neck melanomas followed by immediate closure by primary repair, skin grafting, local flap coverage or free tissue transfer were asked to complete a written survey at least six months after their surgery. A visual analogue scale (VAS) was used to assess the patient's perception of appearance alteration, satisfaction with his or her appearance, and emotional impairment. An ordinal scale was used to evaluate several criteria of the reconstructive outcome (pain, itching, colour, scarring, stiffness, thickness and irregularity). RESULTS Forty-two patients (82.4%) completed the survey. There were significant correlations between VAS scores reported for appearance alteration, satisfaction with outcome and emotional impairment (P=0.001). Patients who received skin grafts reported significantly unfavourable VAS scores compared with other methods of reconstruction (P=0.046). Moreover, skin grafts received significantly worse ordinal scale ratings for itching (P=0.043), colour (P=0.047), scarring (P=0.003) and stiffness (P=0.041) compared with other methods of reconstruction. Both skin grafts and free flaps were reported to have significantly less favourable thickness (P=0.012) and irregularity (P=0.036) than primary closure or local tissue transfer. There was no significant difference between patients undergoing primary closure with local tissue transfer (P>0.413). Other factors related to the patient's VAS scores included location of the melanoma (P=0.033), size of defect (P=0.037) and recurrence of melanoma (P=0.042). CONCLUSION The degree of emotional impairment following reconstruction of head and neck melanoma excision defects was correlated with the patient's perception of appearance alteration. From the patient's perspective, primary closure and local tissue transfer appeared to result in the highest aesthetic satisfaction.
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Affiliation(s)
- Donald Buck
- Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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13
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What is better in TRAM flap survival: LLLT single or multi-irradiation? Lasers Med Sci 2012; 28:755-61. [DOI: 10.1007/s10103-012-1130-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 05/31/2012] [Indexed: 10/28/2022]
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14
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Nishioka MA, Pinfildi CE, Sheliga TR, Arias VE, Gomes HC, Ferreira LM. LED (660 nm) and laser (670 nm) use on skin flap viability: angiogenesis and mast cells on transition line. Lasers Med Sci 2011; 27:1045-50. [PMID: 22207449 DOI: 10.1007/s10103-011-1042-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 12/08/2011] [Indexed: 11/28/2022]
Abstract
Skin flap procedures are commonly used in plastic surgery. Failures can follow, leading to the necrosis of the flap. Therefore, many studies use LLLT to improve flap viability. Currently, the LED has been introduced as an alternative to LLLT. The objective of this study was to evaluate the effect of LLLT and LED on the viability of random skin flaps in rats. Forty-eight rats were divided into four groups, and a random skin flap (10 × 4 cm) was performed in all animals. Group 1 was the sham group; group 2 was submitted to LLLT 660 nm, 0.14 J; group 3 with LED 630 nm, 2.49 J, and group 4 with LLLT 660 nm, with 2.49 J. Irradiation was applied after surgery and repeated on the four subsequent days. On the 7th postoperative day, the percentage of flap necrosis was calculated and skin samples were collected from the viable area and from the transition line of the flap to evaluate blood vessels and mast cells. The percentage of necrosis was significantly lower in groups 3 and 4 compared to groups 1 and 2. Concerning blood vessels and mast cell numbers, only the animals in group 3 showed significant increase compared to group 1 in the skin sample of the transition line. LED and LLLT with the same total energies were effective in increasing viability of random skin flaps. LED was more effective in increasing the number of mast cells and blood vessels in the transition line of random skin flaps.
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Affiliation(s)
- Michele A Nishioka
- Post Graduation Plastic Surgery, Federal University of São Paulo, R. Napoleão de Barros, 715, 4º andar, CEP 04024-900, São Paulo, SP, Brazil
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15
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Kim MS, Rodney WN, Reece GP, Beahm EK, Crosby MA, Markey MK. Quantifying the aesthetic outcomes of breast cancer treatment: assessment of surgical scars from clinical photographs. J Eval Clin Pract 2011; 17:1075-82. [PMID: 20630016 PMCID: PMC2958242 DOI: 10.1111/j.1365-2753.2010.01476.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
RATIONALE Accurate assessment of the degree of scaring that results from surgical intervention for breast cancer would enable more effective pre-operative counselling. The resultant scar that accompanies an open surgical intervention may be characterized by variance in thickness, colour and contour. These factors significantly impact the overall appearance of the breast. A number of studies have addressed the mechanical and pathologic aspects of scarring. The majority of these investigations have focused on the physiologic process of scar formation and means to improve the qualities of a scar. Few studies have focused on quantifying the visual impact of scars. METHODS This manuscript critically reviews current methods used to assess scars in terms of overall satisfaction after surgery. We introduce objective, quantitative measures for assessing linear breast surgical scars using digital photography. These new measurements of breast surgical scars are based on calculations of contrast and area. RESULTS AND CONCLUSIONS We demonstrate, using the intra-class correlation coefficient, that the new measures are robust to observer variability in annotating the scar region on clinical photographs. As an example of the utility of the new measures, we use them to quantify the aesthetic differences of reconstruction following skin-sparing mastectomy vs. conventional mastectomy.
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Affiliation(s)
- Min Soon Kim
- Department of Health Management and Informatics, University of Missouri School of Medicine, Columbia, Missouri, USA
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16
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Veiga DF, Veiga-Filho J, Ribeiro LM, Archangelo-Junior I, Mendes DA, Andrade VO, Caetano LV, Campos FS, Juliano Y, Ferreira LM. Evaluations of aesthetic outcomes of oncoplastic surgery by surgeons of different gender and specialty: A prospective controlled study. Breast 2011; 20:407-12. [DOI: 10.1016/j.breast.2011.04.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 08/25/2010] [Accepted: 04/06/2011] [Indexed: 01/11/2023] Open
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Abstract
BACKGROUND The development of a complication after surgery can be difficult for both patient and surgeon. With a growing body of literature evaluating patient satisfaction after breast reconstruction, few studies directly focus on the impact of surgical complications on satisfaction. This study analyzed the effect of complications on general and aesthetic satisfaction after breast reconstruction. METHODS All women at an academic institution undergoing breast reconstruction between 1999 and 2006 were identified. Patient demographics and history of complications were collected. A questionnaire adapted from the Michigan Breast Reconstruction Outcomes Survey was administered examining general and aesthetic satisfaction. Patients with complications were compared with patients with no complications. RESULTS Overall, 716 women underwent 932 reconstructions; 233 patients had a complication. Patient demographics and response rate were similar between the two groups (overall response rate 75.4 percent). Development of a complication correlated with increased odds of aesthetic dissatisfaction (odds ratio = 1.61, p = 0.047). Other predictors of dissatisfaction were older age, reconstruction with an implant, and a longer time interval between reconstruction and survey, while autologous reconstruction was a predictor of satisfaction. Among patients with a complication, implant reconstruction and mastectomy for prophylaxis were significant predictors of dissatisfaction. CONCLUSIONS Aesthetic satisfaction after breast reconstruction is lower in patients developing a complication, older patients, and those receiving an implant reconstruction. Furthermore, patients with a prophylactic mastectomy are more likely than those with a therapeutic mastectomy to be dissatisfied when complications arise. These relationships are important, as measures to improve quality and decrease complications can directly improve patient satisfaction.
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18
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Rossetto LA, Abla LEF, Vidal R, Garcia EB, Gonzalez RJ, Gebrim LH, Neto MS, Ferreira LM. Factors associated with hernia and bulge formation at the donor site of the pedicled TRAM flap. EUROPEAN JOURNAL OF PLASTIC SURGERY 2010; 33:203-208. [PMID: 20694032 PMCID: PMC2905518 DOI: 10.1007/s00238-010-0418-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 03/02/2010] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to evaluate the correlation between risk factors and hernia or bulge formation at the donor site of the transverse rectus abdominis myocutaneous (TRAM) flap. A retrospective study was conducted between September 2005 and December 2008 in 206 patients who underwent breast reconstruction with pedicled TRAM flap. Eight (3.9%) of these patients had abdominal wall hernia and 26 (12.6%) had abdominal bulging. The incidence of hernia was significantly higher (P < 0.05) among patients with body mass index (BMI) >/= 30 kg/m(2) (hernia incidence, 15.0%) than that among patients with BMI <30 kg/m(2) (hernia incidence, 3.2%), while the incidence of abdominal bulge was significantly lower (P < 0.05) among patients with BMI >/= 30 kg/m(2) (abdominal bulge incidence, 5.0%) than that among patients with BMI >/= 30 kg/m(2) (abdominal bulge incidence, 19.1%). Therefore, obesity was identified as a risk factor for abdominal wall hernia. It was also found that the use of mesh to reinforce the abdominal wall significantly reduced (P < 0.025) the incidence of hernia (use of mesh (hernia incidence, 2.5%) versus non-mesh (hernia incidence, 5.9%)) and abdominal bulge (use of mesh (abdominal bulge incidence, 9.9%) versus non-mesh (abdominal bulge incidence, 17.3%)) among the patients.
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Affiliation(s)
- Luis Antonio Rossetto
- Graduate Program in Plastic Surgery, Federal University of São Paulo School of Medicine (UNIFESP-EPM), São Paulo, Brazil
- Division of Plastic Surgery, UNIFESP/EPM, Rua Napoleão de Barros, 715–4º andar, CEP 04024-002 São Paulo, SP Brazil
| | - Luiz Eduardo Felipe Abla
- Women’s Health Reference Center, Pérola Byington Hospital, São Paulo, Brazil
- Division of Plastic Surgery, UNIFESP/EPM, Rua Napoleão de Barros, 715–4º andar, CEP 04024-002 São Paulo, SP Brazil
| | - Ronaldo Vidal
- Graduate Program in Plastic Surgery, Federal University of São Paulo School of Medicine (UNIFESP-EPM), São Paulo, Brazil
| | - Elvio Bueno Garcia
- Division of Plastic Surgery, UNIFESP/EPM, Rua Napoleão de Barros, 715–4º andar, CEP 04024-002 São Paulo, SP Brazil
| | - Ricardo João Gonzalez
- Division of Plastic Surgery, UNIFESP/EPM, Rua Napoleão de Barros, 715–4º andar, CEP 04024-002 São Paulo, SP Brazil
| | - Luiz Henrique Gebrim
- Women’s Health Reference Center, Pérola Byington Hospital, São Paulo, Brazil
- Division of Senology, Department of Gynecology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Miguel Sabino Neto
- Division of Plastic Surgery, UNIFESP/EPM, Rua Napoleão de Barros, 715–4º andar, CEP 04024-002 São Paulo, SP Brazil
| | - Lydia Masako Ferreira
- Division of Plastic Surgery, UNIFESP/EPM, Rua Napoleão de Barros, 715–4º andar, CEP 04024-002 São Paulo, SP Brazil
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Pinfildi CE, Liebano RE, Hochman BS, Enokihara MM, Lippert R, Gobbato RC, Ferreira LM. Effect of Low-Level Laser Therapy on Mast Cells in Viability of the Transverse Rectus Abdominis Musculocutaneous Flap. Photomed Laser Surg 2009; 27:337-43. [DOI: 10.1089/pho.2008.2295] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Carlos Eduardo Pinfildi
- Department of Plastic Surgery and IMES-FAFICA, São Paulo Federal University (UNIFESP), São Paulo, SP, Brazil
| | - Richard Eloin Liebano
- Department of Plastic Surgery and UNICID, São Paulo Federal University (UNIFESP), São Paulo, SP, Brazil
| | - Bernardo S. Hochman
- Department of Plastic Surgery, São Paulo Federal University (UNIFESP), São Paulo, SP, Brazil
| | | | - Rodrigo Lippert
- Department of Plastic Surgery, São Paulo Federal University (UNIFESP), São Paulo, SP, Brazil
| | - Rafael Corrêa Gobbato
- Department of Plastic Surgery, São Paulo Federal University (UNIFESP), São Paulo, SP, Brazil
| | - Lydia Masako Ferreira
- Plastic Surgery, Division of Surgery Department and Post-Graduate Program in Plastic Surgery, São Paulo Federal University (UNIFESP), São Paulo, SP, Brazil
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20
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Kokuba E, Neto MS, Garcia E, Bastos E, Aihara A, Ferreira L. Functional capacity after pedicled TRAM flap delayed breast reconstruction. J Plast Reconstr Aesthet Surg 2008; 61:1394-6. [DOI: 10.1016/j.bjps.2008.02.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Revised: 02/14/2008] [Accepted: 02/17/2008] [Indexed: 11/30/2022]
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21
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Effects of Radiation Therapy on Pedicled Transverse Rectus Abdominis Myocutaneous Flap Breast Reconstruction. Ann Plast Surg 2008; 60:568-72. [DOI: 10.1097/sap.0b013e31815b6ced] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Abstract
The pedicled transverse rectus abdominis myocutaneous (TRAM) flap remains a viable option in breast reconstruction. This article documents the history of the TRAM flap and puts in context the vascular anatomy through a discussion of the vascular zones. Options for flap delay are discussed and an algorithm is presented for patient selection. Finally, the issue of unipedicle versus bipedicle flap harvest is discussed and complications are examined.
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Affiliation(s)
- Glyn Jones
- Division of Plastic and Reconstructive Surgery, Emory Crawford Long Hospital, Atlanta, GA 30308, USA.
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23
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Dian D, Schwenn K, Mylonas I, Janni W, Jaenicke F, Friese K. Aesthetic result among breast cancer patients undergoing autologous breast reconstruction versus breast conserving therapy. Arch Gynecol Obstet 2006; 275:445-50. [PMID: 17103182 DOI: 10.1007/s00404-006-0270-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Accepted: 10/05/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE Following breast-conserving surgery or mastectomy followed by autologous breast reconstruction, breast cancer patients were studied to discover their satisfaction with the aesthetic results of the two treatment strategies. PATIENTS AND METHODS One hundred and thirty-four breast cancer patients were included in this study. Sixty-four underwent breast-conserving surgery followed by radiotherapy. Mastectomy was performed in 70 patients with immediate or late reconstruction. To evaluate the quality of the aesthetic results in both groups we designed a questionnaire assessing different cosmetic categories. RESULTS Patients in both therapy groups showed a very high satisfaction with their cosmetic results; the patients undergoing breast reconstruction were even more satisfied than the patients who had breast-conserving therapy. CONCLUSION Our study demonstrated that breast reconstruction with autologous tissue offers an opportunity to support patients with advanced breast cancer who were confronted with mastectomy, showing a high degree of satisfaction with the cosmetic results.
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Affiliation(s)
- Darius Dian
- University Hospital Munich, Munich, Germany.
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24
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Cohen M, Evanoff B, George LT, Brandt KE. A subjective rating scale for evaluating the appearance outcome of autologous breast reconstruction. Plast Reconstr Surg 2006; 116:440-9. [PMID: 16079671 DOI: 10.1097/01.prs.0000173214.05854.e4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Subjective evaluations of the appearance outcome of autologous breast reconstruction are usually performed by surgeons and not by patients. Such surgeon-based evaluations are rarely reproducible and show little interobserver agreement. Among existing patient-based subjective scales, none has been tested for reliability, and no study to date has evaluated the reliability when both surgeons and patients use the same scale. METHODS The authors developed a new instrument for assessing the appearance of autologous breast reconstruction. The instrument's use by four plastic surgeons and 36 transverse rectus musculocutaneous flap patients was assessed for test-retest reliability, internal consistency, surgeon-patient and surgeon-surgeon interobserver agreement, and interitem correlation. RESULTS The instrument demonstrated high overall internal consistency when used by patients (Cronbach alpha = 0.92). Test-retest reliability on each aesthetic subitem in the scale was higher among patients than among surgeons (weighted kappa range, 0.57 to 0.88 versus 0.25 to 0.66). Interrater agreement was poor among both patients and surgeons (weighted kappa, 0.0 to 0.39). Poor correlation was found between surgeons' evaluations of aesthetic subitems and patients' overall appearance and overall satisfaction scores. CONCLUSIONS The instrument both demonstrates better internal consistency and is more reliable when used by patients to evaluate their own reconstructions. By contrast, the instrument's use by surgeons is not as internally consistent and reproducible. The poor interobserver agreement among surgeons and the weak correlation between surgeon and patient evaluations suggest that patient input regarding item-specific criteria should be included in evaluations of breast reconstructions.
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Affiliation(s)
- Michael Cohen
- Division of General Medical Sciences and Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO, USA
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25
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Kim MS, Reece GP, Beahm EK, Miller MJ, Atkinson EN, Markey MK. Objective assessment of aesthetic outcomes of breast cancer treatment: measuring ptosis from clinical photographs. Comput Biol Med 2006; 37:49-59. [PMID: 16438948 DOI: 10.1016/j.compbiomed.2005.10.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2004] [Revised: 08/17/2005] [Accepted: 10/10/2005] [Indexed: 11/29/2022]
Abstract
The aesthetic outcome of breast cancer treatment is an important factor in breast cancer survivors' quality of life. We investigated new quantitative, objective measurements of breast ptosis based on ratios of distances between fiducial points manually identified in oblique and lateral clinical photographs. Ptosis refers to the extent to which the nipple is lower than the inframammary fold. The new objective measures were compared to ratings made using an existing subjective scale. The variability in the objective measurements due to intra- and inter-observer variability in marking fiducial points was shown to be equivalent to less than one point on the subjective ptosis scale.
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Affiliation(s)
- Min Soon Kim
- Biomedical Engineering Department, The University of Texas at Austin, Austin, TX 78712, USA
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26
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Song AY, Fernstrom MH, Scott JA, Ren DX, Rubin JP, Shestak KC. Assessment of TRAM Aesthetics: The Importance of Subunit Integration. Plast Reconstr Surg 2006; 117:15-24. [PMID: 16404242 DOI: 10.1097/01.prs.0000194925.35873.ac] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Characterization of optimal aesthetics in transverse rectus abdominis musculocutaneous (TRAM) breast reconstruction is a challenge that even the most experienced breast surgeon faces. Aesthetic assessment in breast surgery has attempted to evaluate the reconstructed breast either as one cohesive entity or as a sum of its parts. The authors propose that the most advantageous assessment involves looking at the reconstructions in terms of aesthetic components, not necessarily in visual subunits. METHODS The authors investigated the responses of five physicians and 12 nonphysician evaluators using various methods of aesthetic assessment, including, most importantly, a visual analogue scale survey. Pearson's correlation and intraclass correlation analyses were performed using SAS software. RESULTS Their analysis determined that while all components of TRAM reconstruction were important, symmetry, contour, and breast positioning were consistently named the most important components of breast reconstruction. When the breast reconstruction was divided into aesthetic subunits, there was a high degree of correlation between the overall score and the subunit scores (r = 0.81: r > 0.6 for good correlation). CONCLUSIONS From these assessments, the authors derived a set of aesthetic rules for TRAM flap reconstruction. They believe that methodical application of these rules on a consistent basis can lead to the production of maximal aesthetic outcomes in TRAM breast reconstruction.
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Affiliation(s)
- Angela Y Song
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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27
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Nano MT, Gill PG, Kollias J, Bochner MA, Malycha P, Winefield HR. Psychological impact and cosmetic outcome of surgical breast cancer strategies. ANZ J Surg 2005; 75:940-7. [PMID: 16336382 DOI: 10.1111/j.1445-2197.2005.03517.x] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Current surgical treatment modalities for breast cancer include breast conserving surgery, mastectomy alone and mastectomy with breast reconstruction. There are recognized benefits of breast conservation and breast reconstruction over mastectomy but there are few studies assessing this area in Australia. The aim of the present study was to compare the various surgical strategies for breast cancer treatment in terms of quality of life, cosmesis and patient satisfaction. METHODS A chart analysis was conducted of all patients who underwent Breast Cancer Reconstruction at the Royal Adelaide Hospital Breast Unit between 1990 and 2002. Patients were then traced and asked to take part in an interview. Mastectomy and breast conservation patients who attended outpatient clinic for follow up were also approached. All three groups were interviewed and self-assessment quality of life questionnaires (Functional Assessment of Cancer Therapy-Breast, body image) were administered. The breast conservation and reconstruction groups also underwent assessment of satisfaction and cosmesis. RESULTS A total of 78 mastectomy, 109 breast conservation and 123 breast reconstruction patients were interviewed. Quality of life assessment was similar between the three groups but the breast conservation and reconstruction patients' body image scores were superior to the mastectomy group. Patient satisfaction was higher in the reconstruction group than the breast conservation group of patients, while cosmesis was similar. CONCLUSION While little difference was seen on quality of life assessment, body image is improved with the use of breast conservation and reconstruction. The high satisfaction and cosmesis scores in the breast reconstruction group are an indication of the superior results that can be achieved with breast reconstruction.
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Affiliation(s)
- Maria Teresa Nano
- Adelaide University, Division of Medicine, Department of Surgery, South Australia, Australia.
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28
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Garcia EB, Ferreira LM, Sabino Neto M, Sallum N. Experimental model of cranially pedicled TRAM flap in rats. Acta Cir Bras 2004. [DOI: 10.1590/s0102-86502004000700011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In a simple, reproducible, and non-expensive experimental model the transverse rectus abdominis muscle (TRAM) flap has been described in male, adult Wistar rats (Rattus norvegicus albinus, Rodentia, Mammalia), weighing approximately 300g, at the central biotery of the Federal University at São Paulo, Paulista Medical School (UNIFESP - EPM). This article describes the use of a cranially based pedicled rectus abdominis muscle flap sling, unilaterally to the right, with the purpose to better understand the pathophysiology of and the research on new treatments to prevent partial or total flap necrosis. This experimental model sponsors quite a number of studies to be conducted to assess the effects of different drugs of physical methods on the feasibility of standard, cranial monopedicled TRAM.As a standard model, it also harbors the comparison among results from different studies.
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Shaikh-Naidu N, Preminger BA, Rogers K, Messina P, Gayle LB. Determinants of aesthetic satisfaction following TRAM and implant breast reconstruction. Ann Plast Surg 2004; 52:465-70; discussion 470. [PMID: 15096928 DOI: 10.1097/01.sap.0000123901.06133.b7] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Several studies have evaluated patient satisfaction following breast reconstruction with the transverse rectus abdominis myocutaneous (TRAM) flap and tissue expander/implant. However, the specific aesthetic determinants of patient satisfaction have not been determined. METHODS Patients who had undergone tissue expander/implant or TRAM flap reconstruction were retrospectively polled on their age, type and timing of reconstruction, mastectomy type, laterality of reconstruction, adjuvant therapy, and symmetrizing and nipple-areolar procedures. Aesthetic satisfaction based on breast shape, symmetry of breast shape, breast size, symmetry of breast size, breast scarring, and breast sensation was assessed using a 5-point scale. RESULTS Two hundred eleven patients with 105 TRAM flaps and 160 expander/implants responded. Unilateral TRAM recipients rated their breast shape, symmetry of breast shape, and symmetry of breast volume significantly higher than did implant patients. When bilateral reconstruction patients were evaluated, no significant differences were seen. The presence of nipple-areolar reconstruction positively influenced every parameter except breast sensation. Immediate reconstruction, skin-sparing mastectomy, and age >60 years at the time of reconstruction were also associated with higher scores, while postoperative radiation therapy resulted in lower satisfaction. Free flap reconstruction produced higher satisfaction in breast shape and breast scarring when compared with pedicle flap reconstruction. CONCLUSIONS Aesthetic satisfaction after breast reconstruction is highly influenced by the presence of nipple-areolar reconstruction and less so by age, timing of reconstruction, adjuvant therapy, or free flap procedures. The type of reconstructive procedure is a significant variable only in unilateral reconstruction.
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Affiliation(s)
- Nina Shaikh-Naidu
- Division of Plastic Surgery, Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA.
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