1
|
De Vita R, Mangialardi ML, Pozzi M, Vietti Michelina V, Nanni J, Zingaretti N, Parodi PC, Zoccali G. A Pericardium Bovine Matrix Pocket in DTI Prepectoral Breast Reconstruction. Clin Breast Cancer 2024; 24:e613-e621. [PMID: 39003171 DOI: 10.1016/j.clbc.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 05/30/2024] [Accepted: 06/08/2024] [Indexed: 07/15/2024]
Abstract
Breast reconstructive surgery has evolved significantly over the years. One of the recent advancements is the use of prepectoral implants in combination with synthetic and biological material as a natural and effective coverage. To date, there is little published data on breast reconstruction using acellular bovine pericardium matrix and most concern submuscular breast reconstruction. This study aimed to describe the multicentric-multisurgeon experience in performing direct to implant (DTI) prepectoral breast reconstructions using acellular bovine pericardium matrix (ABPM) pocket. A retrospective multicentric data collection of the all the immediate prepectoral breast reconstructions using acellular bovine pericardium was carried out by the authors. Surgical data including type of mastectomy, axillary surgery, type and size of implant, size of ABPM, duration of surgery were collected for each patient. Postoperative data including adjuvant treatments, complications, necessity to perform other interventions, patient's satisfaction were collected. Cosmetic results were also evaluated by 7 different observers at minimum 1 year follow-up. A total of 65 breast reconstruction were included in the study. Mean follow up was 21.3 months. Average surgical time was 1,42 hours. Minor complications occurred in 4 breasts; major complications occurred in 2 breasts. After 6 months follow-up, 7 patients underwent fat grafting to correct any rippling and /or wrinkling. Breast aesthetic and patients reported outcomes were satisfactory. Not significant capsular contracture was noted at the follow up control. To date, this is the largest study about prepectoral breast reconstruction with ABPM. On the basis of our results, prepectoral breast reconstruction ABPM assisted is a reliable, safe and suitable option providing good patient satisfaction outcomes.
Collapse
Affiliation(s)
- Roy De Vita
- Plastic and Reconstructive Surgery department, I.R.C.C.S. "Regina Elena" National Cancer Institute, Rome, RM, Italy
| | - Maria Lucia Mangialardi
- Plastic and Reconstructive Surgery department, I.R.C.C.S. "Regina Elena" National Cancer Institute, Rome, RM, Italy.
| | - Marcello Pozzi
- Plastic and Reconstructive Surgery department, I.R.C.C.S. "Regina Elena" National Cancer Institute, Rome, RM, Italy
| | - Veronica Vietti Michelina
- Plastic and Reconstructive Surgery department, I.R.C.C.S. "Regina Elena" National Cancer Institute, Rome, RM, Italy
| | - Jacopo Nanni
- Plastic and Reconstructive Surgery department, I.R.C.C.S. "Regina Elena" National Cancer Institute, Rome, RM, Italy
| | - Nicola Zingaretti
- Department of Medical Area (DAME), Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, University of Udine, Udine, Italy
| | - Pier Camillo Parodi
- Department of Medical Area (DAME), Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, University of Udine, Udine, Italy
| | - Giovanni Zoccali
- Plastic and Reconstructive Surgery department, I.R.C.C.S. "Regina Elena" National Cancer Institute, Rome, RM, Italy
| |
Collapse
|
2
|
Liu P, Song Y, Chen Z, Zhang Z, Li Z. Efficacy of antibiotic prophylaxis for reducing capsular contracture in prosthesis-based breast surgery: a systemic review and meta-analysis. Updates Surg 2024; 76:1183-1194. [PMID: 38396193 DOI: 10.1007/s13304-024-01767-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/22/2024] [Indexed: 02/25/2024]
Abstract
Antibiotics Prophylaxis to prevent capsular contracture in prosthesis-based breast surgery is common in clinical practice. However, there is currently a dearth of high-quality evidence concerning the effectiveness of antibiotic usage in this field. To identify all pertinent studies prior to January 2023, a comprehensive literature search was conducted in the PubMed, Embase, Web of Science, Cochrane Library, and Medline databases. The extracted data was then subjected to meta-analysis. Fourteen studies were retained in the analysis. According to the results, perioperative antibiotic prophylaxis did not reduce the risk of capsular contracture (RR 1.15, 95% CI 0.82-1.59, p = 0.55) or surgical-site infection (RD 0.01, 95% CI - 0.01 to 0.03, p = 0.59) compared to nonantibiotic prophylaxis. There was no statistically significant difference between extended antibiotic prophylaxis and perioperative antibiotic prophylaxis in terms of preventing capsular contracture, whether calculated by patient numbers (RD 0.01, 95% CI - 0.01 to 0.02, p = 0.87) or by total procedures (RD 0.00, 95% CI - 0.00 to 0.01, p = 0.88), or controlling surgical-site infection (RR 1.05, 95% CI 0.77-1.44, p = 0.27). Additionally, topical antibiotic irrigation did not decrease the risk of infection (RR 0.61, 95% CI 0.34-1.08, p = 0.29) and capsular contracture, regardless of patient number (RR 0.41, 95% CI 0.27-0.63, p = 0.18) or total number of procedures (RR 1.29, 95% CI 0.73-2.28, p < 0.01). Current evidence revealed that both systemic and topical antibiotic prophylaxis may not provide benefits in preventing capsular contracture in prosthesis-based breast surgery. When the occurrence of surgical-site infections is minimized to the greatest extent, the administration of additional antibiotics for reducing capsular contracture should be carefully and judiciously considered.
Collapse
Affiliation(s)
- Pengcheng Liu
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Orthopedic Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuting Song
- Department of Orthopedic Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhixing Chen
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhenyu Zhang
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhengyong Li
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| |
Collapse
|
3
|
Bottosso S, Sidoti GB, Vita L, Scian A, Bonat Guarini L, Renzi N, Ramella V, Papa G. A Multi-Center Retrospective Observational Analysis of Three-Year Experience of Our Protocol for Prevention and Monitoring of Surgical Site Infections in Implant-Based Breast Reconstruction. Cancers (Basel) 2024; 16:2439. [PMID: 39001499 PMCID: PMC11240831 DOI: 10.3390/cancers16132439] [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: 04/26/2024] [Revised: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND With the rise in the mastectomy rate, the number of patients who choose to undergo postmastectomy reconstruction has been increasing, and implant-based procedures are the most performed methods for postmastectomy breast reconstruction. Among the possible complications, the most feared is the loss of reconstruction. It can be related to several reasons, but one of the most common is infection of the implant, which can lead to prolonged antibiotic treatment, undesired additional surgical procedures, increased incidence of capsular contracture, and unsatisfactory aesthetics results, with a huge psychological impact on patients. AIMS The primary intent of this study is to analyze the status of infection rates at our institution and evaluate the effectiveness of our prevention protocol since its introduction. Secondly, we compared data of the surgical site infections (SSIs) after implant-based breast reconstruction at Trieste Hospital, where the protocol has been employed since 2020, and in another center, where plastic surgeons of our team are involved, with different prevention procedures. METHODS AND RESULTS We enrolled 396 female patients, who underwent implant-based breast reconstruction, using definitive mammary implants or breast tissue expanders, with or without ADM (acellular dermal matrix), both for breast cancer and risk-reducing surgery in BRCA1/2 patients. Patients treated at the Hospital of Trieste, with the use of the prevention protocol, were considered the experimental group (group 1), while patients treated in Gorizia by the same breast team with standardized best-practice rules, but without the use of the prevention protocol, were considered the control group (group 2). Infected patients were 5 in the first group (1.7%) and 8 in the second one (7.9%), with a global infection rate of 3.2%. CONCLUSION After the introduction of our prevention protocol, we faced a lower incidence of infection after breast surgery with implants or tissue expanders.
Collapse
Affiliation(s)
- Stefano Bottosso
- Plastic Surgery Department, Ospedale di Cattinara, ASUGI, Strada di Fiume, 447, 34149 Trieste, Italy
| | - Giulia Benedetta Sidoti
- Department of Medical, Surgical and Health Sciences, Plastic and Reconstructive Surgery Unit, University of Trieste, 34149 Trieste, Italy
| | - Ludovica Vita
- Department of Medical, Surgical and Health Sciences, Plastic and Reconstructive Surgery Unit, University of Trieste, 34149 Trieste, Italy
| | - Alessandro Scian
- Department of Medical, Surgical and Health Sciences, Plastic and Reconstructive Surgery Unit, University of Trieste, 34149 Trieste, Italy
| | - Luigi Bonat Guarini
- Department of Medical, Surgical and Health Sciences, Plastic and Reconstructive Surgery Unit, University of Trieste, 34149 Trieste, Italy
| | - Nadia Renzi
- Plastic Surgery Department, Ospedale di Cattinara, ASUGI, Strada di Fiume, 447, 34149 Trieste, Italy
| | - Vittorio Ramella
- Plastic Surgery Department, Ospedale di Cattinara, ASUGI, Strada di Fiume, 447, 34149 Trieste, Italy
- Department of Medical, Surgical and Health Sciences, Plastic and Reconstructive Surgery Unit, University of Trieste, 34149 Trieste, Italy
| | - Giovanni Papa
- Plastic Surgery Department, Ospedale di Cattinara, ASUGI, Strada di Fiume, 447, 34149 Trieste, Italy
- Department of Medical, Surgical and Health Sciences, Plastic and Reconstructive Surgery Unit, University of Trieste, 34149 Trieste, Italy
| |
Collapse
|
4
|
Vrolijk JJ, Bargon CA, Becherer BE, Wilschut JA, van Bommel ACM, Hommes JE, Keuter XHA, Young-Afat DA, Verkooijen HM, van der Hulst RRJW, Mureau MAM, Rakhorst HA. Risk Factors for Unplanned Reoperation during the Expansion Phase in Two-Stage Breast Reconstruction in the Dutch Breast Implant Registry. Plast Reconstr Surg 2024; 154:33e-43e. [PMID: 37506354 DOI: 10.1097/prs.0000000000010945] [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: 07/30/2023]
Abstract
BACKGROUND The majority of postmastectomy breast reconstructions (PMBRs) are currently performed in two stages using a tissue expander (TE). However, complications during the expansion phase occur regularly, leading to unplanned reoperations and/or reconstruction failure. This study aimed to identify risk factors for unplanned reoperation after TE placement, assessed the time until unplanned and planned reoperation, and investigated indications for unplanned reoperation. METHODS Patient- and surgery-related characteristics of patients who underwent two-stage PMBR between 2017 and 2021 were collected from the Dutch Breast Implant Registry (DBIR). Unplanned reoperation was defined as TE explantation followed by either no replacement or replacement with the same or a different TE. Covariate-adjusted characteristics associated with unplanned reoperation were determined using backward stepwise selection and multivariable logistic regression analyses. RESULTS In total, 2529 patients (mean age, 50.2 years) were included. Unplanned reoperation occurred in 19.4% of all registered TEs ( n = 3190). Independent factors associated with unplanned reoperation were body mass index (BMI) greater than or equal to 25 kg/m 2 (adjusted OR [aOR], 1.63, 99% CI, 1.20 to 2.57 for BMI of 25 to 29.9 kg/m 2 ; aOR, 2.57, 99% CI, 1.74 to 3.78 for BMI ≥30 kg/m 2 ), low institutional volume (aOR, 1.51; 99% CI, 1.06 to 2.18), no drains (aOR, 2.06; 99% CI, 1.15 to 3.60), subcutaneous TE placement (aOR, 5.71; 99% CI, 3.59 to 9.10), and partial pectoralis major muscle coverage (aOR, 1.35; 99% CI, 1.02 to 1.79). Age younger than 40 years (aOR, 0.49; 99% CI, 0.32 to 0.74) and delayed PMBR (aOR, 0.35; 99% CI, 0.19 to 0.60) reduced the risk of unplanned reoperation. Median time until reoperation was 97 days for unplanned and 213 days for planned reoperation. Deep wound infections were most often registered as indication for unplanned reoperation (34.4%). CONCLUSION This study identified several risk factors for unplanned reoperation that may be used to reduce complications in expander-based PMBR. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
Collapse
Affiliation(s)
- J Juliët Vrolijk
- From the Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center
- Dutch Institute for Clinical Auditing
| | - Claudia A Bargon
- Department of General Surgery, Department of Plastic and Reconstructive Surgery, St. Antonius Hospital, Soestwetering
| | - Babette E Becherer
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam
| | | | | | - Juliëtte E Hommes
- From the Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center
| | - Xavier H A Keuter
- From the Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center
| | - Danny A Young-Afat
- Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam University Medical Centre
| | | | | | - Marc A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam
| | - Hinne A Rakhorst
- Department of Plastic, Reconstructive, and Hand Surgery, Medisch Spectrum Twente
- Department of Plastic Surgery, Ziekenhuis Groep Twente
| |
Collapse
|
5
|
Binici S, Güven M, Özdemir A, İlik ZA, Demirhan B, Uygur S, İliklerden ÜH. Addressing radiotherapy-induced fibrosis: the potential of platelet-rich plasma and infliximab for improved breast cancer management. Histochem Cell Biol 2024:10.1007/s00418-024-02267-z. [PMID: 38282055 DOI: 10.1007/s00418-024-02267-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 01/30/2024]
Abstract
Breast cancer treatment encompasses various therapeutic modalities, including surgery, radiotherapy, and chemotherapy. Breast-conserving surgery has been an integral part of breast cancer management. However, radiotherapy, an important component of breast cancer management, can lead to complications, particularly fibrosis, affecting reconstructive surgery outcomes. We conducted an in vivo study using 48 female Wistar Albino rats, employing segmental mastectomy and radiotherapy to simulate post-mastectomy conditions. The rats were divided into six groups: control, mastectomy, mastectomy + radiotherapy, mastectomy + platelet-rich plasma (PRP) + radiotherapy, mastectomy + infliximab + radiotherapy, and mastectomy + infliximab + PRP + radiotherapy. Edema, hyperemia, inflammation, and fibrosis were assessed as indicators of tissue response. Histopathological analysis revealed that mastectomy + infliximab and mastectomy + infliximab + PRP groups showed significant reductions in fibrosis compared to other groups. Edema, hyperemia, and inflammation were also less severe in these groups compared to the control group. Radiotherapy-induced fibrosis is a major concern in breast reconstruction. Our study suggests that local PRP application and systemic infliximab administration, either alone or in combination, could mitigate the adverse effects of radiotherapy. This approach has the potential to improve reconstructive outcomes in patients undergoing or having the possibility to undergo radiotherapy. This is the first study showing the effectiveness of infliximab and PRP combination on wound healing. The provided experimental rat model might offer guidance for further research. This study provides insights into optimizing outcomes in reconstructive breast surgery, paving the way for further research and clinical studies.
Collapse
Affiliation(s)
- Serhat Binici
- General Surgery Department, Şırnak State Hospital, Şırnak, Turkey.
| | - Mustafa Güven
- Faculty of Medicine, Van Yuzuncu Yıl University, Van, Turkey
| | - Abdulselam Özdemir
- Faculty of Medicine, Department of General Surgery, Van Yuzuncu Yıl University, Van, Turkey
| | - Zehra Akman İlik
- Department of Pathology, Van Education and Research Hospital, Van, Turkey
| | - Birhan Demirhan
- Faculty of Medicine, Department of Radiation Oncology, Van Yuzuncu Yıl University, Van, Turkey
| | - Serhat Uygur
- Faculty of Medicine, Van Yuzuncu Yıl University, Van, Turkey
| | - Ümit Haluk İliklerden
- Faculty of Medicine, Department of General Surgery, Van Yuzuncu Yıl University, Van, Turkey
| |
Collapse
|
6
|
Cho MJ, Farhadi RV, Nash DW, Kaleeny J, Povoski SP, Chao AH. The current use of tissue expanders in breast reconstruction: device design, features, and technical considerations. Expert Rev Med Devices 2024; 21:27-35. [PMID: 38032224 DOI: 10.1080/17434440.2023.2288911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/24/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION The use of tissue expanders (TE) in post-mastectomy breast reconstruction is a widely accepted practice, especially in patients desiring implant-based breast reconstruction. It has become the standard of care to perform a two-staged breast reconstruction using tissue expanders for the past 50 years due to its reliability, safety, cost-effectiveness, and versatility. Due to its popularity, there are numerous types and features of breast tissue expanders and various surgical approaches available for plastic surgeons. AREAS COVERED In this article, we will review the role of tissue expanders in breast reconstruction, the types and features of breast tissue expanders, and technical considerations. EXPERT OPINION The use of tissue expanders in breast reconstruction offers significant advantages of preserving the breast skin envelope and reestablishing the breast mound. With evolving approaches to breast reconstruction, tissue expander design, and application underwent several refinements and modifications. Due to these advances, studies on its long-term efficacy and safety profile typically fall behind and more studies with higher levels of evidence are needed to better evaluate the efficacy and safety profile of tissue expanders. With increased understanding, reconstructive surgeons can minimize complications and maximize reconstructive, aesthetic outcomes with high patient satisfaction.
Collapse
Affiliation(s)
- Min-Jeong Cho
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Rana V Farhadi
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - David W Nash
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Joseph Kaleeny
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Albert H Chao
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| |
Collapse
|
7
|
Pierzchajlo N, Zibitt M, Hinson C, Stokes JA, Neil ZD, Pierzchajlo G, Gendreau J, Buchanan PJ. Enhanced recovery after surgery pathways for deep inferior epigastric perforator flap breast reconstruction: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2023; 87:259-272. [PMID: 37924717 DOI: 10.1016/j.bjps.2023.10.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/29/2023] [Accepted: 10/07/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Deep inferior epigastric perforator (DIEP) surgery is one of the most difficult breast reconstruction techniques available, both in terms of operating complexity and patient recovery. Enhanced recovery after surgery (ERAS) pathways were recently introduced in numerous subspecialties to reduce recovery time, patient pain, and cost by providing multimodal perioperative care. Plastic surgery has yet to widely integrate ERAS with DIEP reconstruction, mostly due to insufficient data on patient outcomes with this combined approach. METHODS Five major medical databases were queried using predetermined search criteria according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Statistical analysis was performed using Cochrane's RevMan (v5.4). RESULTS A total of 466 articles were identified. A total of 14 studies were included in the review with a combined sample of 2102 patients. Eight studies were included in the meta-analysis with a combined sample of 1679 patients. On average, the included studies utilized 11.69 of 18 suggested protocols for ERAS with breast reconstruction. Our primary outcome, length of stay, was reduced by a mean of 1.12 (95% confidence interval [CI] [-1.30, -0.94], n = 1627, p < 0.001) days in the ERAS group. Postoperative oral morphine equivalents (OME) were also reduced in the ERAS group by 104.02 (95% CI [-181.43, -26.61], n = 545, p = 0.008) OME. The ERAS group saw a significant 3.54 (95% CI [-4.43, -2.65], n = 527, p < 0.001) standardized mean difference cost reduction relative to the control groups. The surgery time was reduced by 60.46 (95% CI [-125, 4.29], n = 624, p < 0.07) min, although this was not statistically significant. CONCLUSIONS The ERAS pathway in DIEP breast reconstruction is consistently associated with reduced hospital stay, opioid use, and patient cost. Moreover, there appears to be no evidence of serious adverse outcomes associated with the application of the ERAS protocol.
Collapse
Affiliation(s)
| | | | - Chandler Hinson
- Frederick P. Whiddon College of Medicine, University of South Alabama, Mobile, AL, USA
| | | | | | | | - Julian Gendreau
- Department of Biomedical Engineering, Johns Hopkins, Baltimore, MD, USA
| | - Patrick J Buchanan
- Plastic, Aesthetic, & Hand/Micro Surgeon, The Georgia Institute for Plastic Surgery, Savannah, GA, USA
| |
Collapse
|
8
|
Scarabosio A, Contessi Negrini F, Pisano G, Beorchia Y, Castriotta L, De Francesco F, Riccio M, Parodi PC, Zingaretti N. Prepectoral Direct-To-Implant One-Stage Reconstruction With ADMs: Safety and Outcome in "Thin Patients". Clin Breast Cancer 2023; 23:e507-e514. [PMID: 37735018 DOI: 10.1016/j.clbc.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Prepectoral direct-to-implant reconstruction with acellular dermal matrix (ADM) represents a safe, fast, and successful option in breast reconstruction in a selected cohort of patients. Nowadays, this procedure is considered challenging in thin. Meanwhile, his cohort has not been accurately analyzed yet. METHODS A single institution retrospective cohort study was performed between January 2019 and March 2023 in all women who underwent mastectomy. Biometrical and clinical data were recorded. Also, surgical technique, operating room (OR) time, mastectomy weights, implant choice, and acellular dermal matrix (ADM) types were properly noted. Postoperative complications represented the main topic: these were classified into early and late ones based on onset time. At least 12-month follow-up was required. A comparison between thin and ideal body mass index (BMI) populations was performed. RESULTS Early complications did not seem to differ between the 2 groups with 37.8% and 38.9% of women having at least 1 early complication in thin and ideal-weight women, respectively (P = .919). In univariable regression analysis, compared with women with a BMI of 22.1 to 25.0, women with a BMI ≤ 22.0 were associated with an increased risk of late complications of 2.84 (1.13-7.14). Specifically, thin women appeared to have a 3-fold increased risk (OR = 2.97, 95% CI 1.08-8.18) of ripples/wrinkles compared with women with ideal weight. CONCLUSIONS Prepectoral reconstruction with ADM in thin patients may be considered as safe as in standard BMI patients. Rippling may be more frequent, but, whenever needed, easy to correct with a few sessions of lipo-grafts. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Anna Scarabosio
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Filippo Contessi Negrini
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Gaetano Pisano
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Yvonne Beorchia
- Institute of Hygiene and Evaluative Epidemiology, Friuli Centrale University Health Authority, Udine, Italy
| | - Luigi Castriotta
- Institute of Hygiene and Evaluative Epidemiology, Friuli Centrale University Health Authority, Udine, Italy
| | - Francesco De Francesco
- Department of Reconstructive Surgery and Hand Surgery, AOU "Ospedali Riuniti", Ancona, Italy; Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Jesi, Italy
| | - Michele Riccio
- Department of Reconstructive Surgery and Hand Surgery, AOU "Ospedali Riuniti", Ancona, Italy; Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Jesi, Italy
| | - Pier Camillo Parodi
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine, Udine, Italy; Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Jesi, Italy.
| | - Nicola Zingaretti
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine, Udine, Italy; Accademia del Lipofilling, Research and Training Center in Regenerative Surgery, Jesi, Italy
| |
Collapse
|
9
|
Hassan AM, Biaggi-Ondina A, Asaad M, Morris N, Liu J, Selber JC, Butler CE. Artificial Intelligence Modeling to Predict Periprosthetic Infection and Explantation following Implant-Based Reconstruction. Plast Reconstr Surg 2023; 152:929-938. [PMID: 36862958 DOI: 10.1097/prs.0000000000010345] [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: 03/04/2023]
Abstract
BACKGROUND Despite improvements in prosthesis design and surgical techniques, periprosthetic infection and explantation rates following implant-based reconstruction (IBR) remain relatively high. Artificial intelligence is an extremely powerful predictive tool that involves machine learning (ML) algorithms. We sought to develop, validate, and evaluate the use of ML algorithms to predict complications of IBR. METHODS A comprehensive review of patients who underwent IBR from January of 2018 to December of 2019 was conducted. Nine supervised ML algorithms were developed to predict periprosthetic infection and explantation. Patient data were randomly divided into training (80%) and testing (20%) sets. RESULTS The authors identified 481 patients (694 reconstructions) with a mean ± SD age of 50.0 ± 11.5 years, mean ± SD body mass index of 26.7 ± 4.8 kg/m 2 , and median follow-up time of 16.1 months (range, 11.9 to 3.2 months). Periprosthetic infection developed in 113 of the reconstructions (16.3%), and explantation was required with 82 (11.8%) of them. ML demonstrated good discriminatory performance in predicting periprosthetic infection and explantation (area under the receiver operating characteristic curve, 0.73 and 0.78, respectively), and identified nine and 12 significant predictors of periprosthetic infection and explantation, respectively. CONCLUSIONS ML algorithms trained using readily available perioperative clinical data accurately predict periprosthetic infection and explantation following IBR. The authors' findings support incorporating ML models into perioperative assessment of patients undergoing IBR to provide data-driven, patient-specific risk assessment to aid individualized patient counseling, shared decision-making, and presurgical optimization.
Collapse
Affiliation(s)
- Abbas M Hassan
- From the Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center
| | - Andrea Biaggi-Ondina
- From the Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center
| | - Malke Asaad
- From the Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center
| | - Natalie Morris
- From the Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center
| | - Jun Liu
- From the Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center
| | - Jesse C Selber
- From the Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center
| | - Charles E Butler
- From the Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center
| |
Collapse
|
10
|
Saturno MP, Mejia MR, Wang A, Kwon D, Oleru O, Seyidova N, Henderson PW. Generative artificial intelligence fails to provide sufficiently accurate recommendations when compared to established breast reconstruction surgery guidelines. J Plast Reconstr Aesthet Surg 2023; 86:248-250. [PMID: 37793197 PMCID: PMC10965244 DOI: 10.1016/j.bjps.2023.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/08/2023] [Indexed: 10/06/2023]
Affiliation(s)
- Michael P Saturno
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Mateo Restrepo Mejia
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Anya Wang
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Daniel Kwon
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Olachi Oleru
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Nargiz Seyidova
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Peter W Henderson
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| |
Collapse
|
11
|
Grous A, Mazur S, Winter P, Kozak K, Jagiello-Gruszfeld A, Napierała M, Nowecki Z. Immediate breast reconstruction in breast cancer patients with the use of Serasynth and SeragynBR synthetic meshes. Single-oncological center experience, analysis of complications. POLISH JOURNAL OF SURGERY 2023; 96:11-20. [PMID: 38629281 DOI: 10.5604/01.3001.0016.3172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
<br><b>Introduction:</b> The use of meshes in mastectomies with immediate breast reconstruction (IBR) has become the gold standard.</br> <br><b>Aim:</b> The use of meshes in mastectomies with immediate breast reconstruction (IBR) has become a gold standard. The purpose of the study was to analyze the complications and own experience with the use of Serasynth fully absorbable and SeragynBR partially absorbable synthetic meshes.</br> <br><b>Material and methods:</b> In the period from December 2017 to July 2020, 118 IBR were performed in the Author's Department with the use of SeragynBR and Serasynth meshes in 93 patients operated for breast cancer. 78 Serasynth meshes (Group 1) and 40 SeragynBR meshes (Group 2) were implanted.</br> <br><b>Results:</b> The most common complication was persistent seroma collection, which was reported in 17.9% of cases in Group 1 and 25% in Group 2. Skin inflammation was reported in 7.6% and 17.5%, while infections in 2.5% and 5% of the operated breasts in Group 1 and Group 2. Reoperation was required in 5.1% and 5% of the patients in Group 1 and Group 2. The percentage of complications was lower when Serasynth rather than Seragyn BR meshes were implanted. The frequent incidence of the seroma collection did not contribute in any significant way to serious complications such as removal of mesh/implant or infection. The complications, which developed following the implantation of both mesh types, were similar to those presented in other publications concerning mastectomy with IBR with the use of synthetic meshes. The percentage of implant losses/explanations in the discussed groups was lower than that reported in the literature.</br> <br><b>Conclusion:</b> Despite the complications, both types of meshes can be considered as safe additions to reconstructive breast surgeries.</br> <br><b>Level of Evidence:</b> Level III.</br>.
Collapse
Affiliation(s)
- Aleksander Grous
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska Curie Memorial Cencer Center and Institute of Oncology, Warsaw, Poland
| | - Slawomir Mazur
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska Curie Memorial Cencer Center and Institute of Oncology, Warsaw, Poland
| | - Paweł Winter
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska Curie Memorial Cencer Center and Institute of Oncology, Warsaw, Poland
| | - Krzysztof Kozak
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska Curie Memorial Cencer Center and Institute of Oncology, Warsaw, Poland
| | - Agnieszka Jagiello-Gruszfeld
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska Curie Memorial Cencer Center and Institute of Oncology, Warsaw, Poland
| | - Marcin Napierała
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska Curie Memorial Cencer Center and Institute of Oncology, Warsaw, Poland
| | - Zbigniew Nowecki
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska Curie Memorial Cencer Center and Institute of Oncology, Warsaw, Poland
| |
Collapse
|
12
|
Sattar AK, Masroor T, Martins RS, Zahid N, Shahzad H, Soomro R, Saleem O, Vohra LM, Zeeshan S, Ashfaq MA, Khan I, Nadeem R, Fatima N, Qureshi AA, Amersi FF, Mahmood SF. Impact of Postoperative Antibiotic Prophylaxis on Surgical Site Infections Rates After Mastectomy with Drains but Without Immediate Reconstruction: A Multicenter, Double-Blinded, Randomized Control Superiority Trial. Ann Surg Oncol 2023; 30:5965-5973. [PMID: 37462826 DOI: 10.1245/s10434-023-13887-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/28/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND There is no consensus on the use of postoperative antibiotic prophylaxis (PAP) after mastectomy with indwelling drains. We explored the utility of continued PAP in reducing surgical site infection (SSI) rates after mastectomy without immediate reconstruction and with indwelling drains. PATIENTS AND METHODS A multicenter, two-armed, randomized control superiority trial was conducted in Pakistan. We enrolled all consenting adult patients undergoing mastectomy without immediate reconstruction. All patients received a single preoperative dose of cephalexin within 60 min of incision, and postoperatively were randomized to receive either continued PAP using cephalexin (intervention) or a placebo (control) for the duration of indwelling, closed-suction drains. The primary outcome was the development of SSI within 30 days and 90 days postoperatively. Secondary outcomes included study-drug-associated adverse events. Intention-to-treat analysis was performed using multivariable Cox regression. RESULTS A total of 369 patients, 180 (48.8%) in the intervention group and 189 (51.2%) in the control group, were included in the final analysis. Overall cumulative SSI rates were 3.5% at 30 days and 4.6% at 90 days postoperatively. PAP was not associated with SSI reduction at 30 (hazard ratio, HR 1.666 [95% confidence interval CI 0.515-5.385]) or 90 (1.575 [0.558-4.448]) days postoperatively, or with study-drug-associated adverse effects (0.529 [0.196-1.428]). CONCLUSIONS Continuing antibiotic prophylaxis for the duration of indwelling drains after mastectomy without immediate reconstruction offers no additional benefit in terms of SSI reduction. There is a need to update existing guidelines to provide clearer recommendations regarding use of postoperative antibiotic prophylaxis after mastectomy in the setting of indwelling drains.
Collapse
Affiliation(s)
- Abida K Sattar
- Department of Surgery, Aga Khan University, Karachi, Pakistan.
| | - Taleaa Masroor
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Russell Seth Martins
- Division of Thoracic Surgery, Department of Surgery, JFK University Medical Center, Hackensack Meridian Health, Edison, NJ, USA
| | - Nida Zahid
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Hania Shahzad
- Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Rufina Soomro
- Department of Surgery, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Omema Saleem
- Department of Surgery, Dow University of Health Sciences, Karachi, Pakistan
| | - Lubna M Vohra
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Sana Zeeshan
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | | | - Irum Khan
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Rida Nadeem
- Department of Surgery, Dow University of Health Sciences, Karachi, Pakistan
| | - Nikhat Fatima
- Department of Surgery, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | | | - Farin F Amersi
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | |
Collapse
|
13
|
Aldarragi A, Farah N, Warner CM, Ghasemi AM, Ekakitie OT, Jabr Y, Rahman S. The Duration of Postoperative Antibiotics in Autologous Breast Reconstruction: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e40631. [PMID: 37476125 PMCID: PMC10355167 DOI: 10.7759/cureus.40631] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
Although prophylactic antibiotic use following autologous breast reconstruction post-mastectomy is a common practice, there is no consensus in the literature regarding its duration. Antibiotic stewardship is important to minimise multi-resistant organisms as well as mitigate the associated side effects. Currently, there are no published guidelines regarding the duration of prophylactic antibiotics in autologous breast reconstruction surgery following mastectomy. The authors searched the online literature regarding the administration of antibiotics for autologous breast reconstruction surgery post-mastectomy. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. The primary outcome measure was the incidence of surgical site infections (SSIs). Three studies met the inclusion criteria and included a total of 1,400 patients. Overall, 101 (7.2%) SSIs were observed. There was no significant difference in the rate of SSIs when comparing the use of antibiotics for less than or longer than 24 hours postoperatively (odds ratio = 1.434, p = 0.124). There is no significant difference between SSIs with the use of antibiotics for longer than 24 hours when compared to less than 24 hours. Further studies in the form of randomised controlled trials are required to assess the effects of prophylactic antibiotic duration in autologous breast reconstruction following mastectomy.
Collapse
Affiliation(s)
- Ameer Aldarragi
- Trauma and Orthopaedics, Manchester University NHS Foundation Trust, Manchester, GBR
| | - Nima Farah
- Plastic Surgery, Leeds General Infirmary, Leeds, GBR
| | - Christian M Warner
- Trauma and Orthopaedics, Stepping Hill Hospital, Stockport NHS Foundation Trust, Stockport, GBR
- Trauma and Orthopaedics, Manchester Shoulder and Elbow Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, GBR
| | - Ali M Ghasemi
- Otolaryngology, Doncaster Royal Infirmary, Leeds, GBR
| | | | - Yamen Jabr
- Trauma and Orthopaedics, Countess of Chester Hospital, Chester, GBR
| | - Shafiq Rahman
- Plastic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, GBR
| |
Collapse
|
14
|
Driscoll CR, Grosser JA, Davidson AL, Lloyd KM, Prabhu SS, Katz AJ. The Impact of Postoperative Antibiotic and Duration After Implant-Based Breast Reconstruction on Resistance Among Cultured Species. Ann Plast Surg 2023; 90:S359-S362. [PMID: 37332208 DOI: 10.1097/sap.0000000000003451] [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: 06/20/2023]
Abstract
BACKGROUND There is a growing presence of literature within plastic surgery that establishes best practice for postoperative antibiotics after implant-based breast reconstruction (IBBR), although it has not been widely adopted or translated into clinical practice. This study aims to determine how antibiotic and duration affects patient outcomes. We hypothesize that IBBR patients who receive a longer duration of postoperative antibiotics will demonstrate higher rates of antibiotic resistance as compared with the institutional antibiogram. METHODS A retrospective chart review included patients who underwent IBBR between 2015 and 2020 at a single institution. Variables of interest included patient demographics, comorbidities, surgical techniques, infectious complications, and antibiograms. Groups were classified by antibiotic (cephalexin, clindamycin, or trimethoprim/sulfamethoxazole) and duration (≤7 days, 8-14 days, and >14 days). RESULTS There were a total of 70 patients who experienced infections included in this study. Onset of infection did not differ based on antibiotic during either device implantation (postexpander P = 0.391; postimplant P = 0.234). Antibiotic and duration did not have an established relationship with explantation rate either (P = 0.154). In patients who had Staphylococcus aureus isolated, there was significantly increased resistance to clindamycin when compared with the institutional antibiogram (sensitivities of 43% and 68%, respectively). CONCLUSIONS Neither antibiotic nor duration displayed a difference in overall patient outcomes, including explantation rates. In this cohort, S. aureus strains isolated in association with IBBR infections demonstrated a higher level of resistance to clindamycin compared with strains isolated and tested within the broader institution.
Collapse
Affiliation(s)
- Cassandra R Driscoll
- From the Department of Plastic and Reconstructive Surgery, Atrium Health Wake Forest Baptist
| | | | | | - Kelsey M Lloyd
- From the Department of Plastic and Reconstructive Surgery, Atrium Health Wake Forest Baptist
| | - Shamit S Prabhu
- Department of Plastic and Reconstructive Surgery, Ronald Reagan UCLA Medical Center, Los Angeles, CA
| | - Adam J Katz
- From the Department of Plastic and Reconstructive Surgery, Atrium Health Wake Forest Baptist
| |
Collapse
|
15
|
Beaulieu-Jones BR, Fefferman A, Woods AP, Shewmaker G, Zhang T, Roh DS, Sachs TE, Merrill A, Ko NY, Cassidy MR. Impact of Race, Ethnicity, Primary Language, and Insurance on Reconstruction after Mastectomy for Patients with Breast Cancer at an Urban, Academic Safety-Net Hospital. J Am Coll Surg 2023; 236:1071-1082. [PMID: 36524735 DOI: 10.1097/xcs.0000000000000531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Disparities in breast reconstruction have been observed in national cohorts and single-institution studies based on race, ethnicity, insurance, and language. However, little is known regarding whether safety-net hospitals deliver more or less equitable breast reconstruction care in comparison with national cohorts. STUDY DESIGN We performed a retrospective study of patients with either invasive breast cancer or ductal carcinoma in situ diagnosed and treated at our institution (January 1, 2009, to December 31, 2014). The rate of, timing of, and approach to breast reconstruction were assessed by race, ethnicity, insurance status, and primary language among women who underwent mastectomy. Reasons for not performing reconstruction were also analyzed. RESULTS A total of 756 women with ductal carcinoma in situ or nonmetastatic invasive cancer were identified. The median age was 58.5 years, 56.2% were non-White, 33.1% were non-English-speaking, and 48.9% were Medicaid/uninsured patients. A total of 142 (18.8%) underwent mastectomy during their index operation. A total of 47.9% (n = 68) did not complete reconstruction. Reasons for not performing reconstruction included patient preference (n = 22), contraindication to immediate reconstruction (ie, locoregionally advanced disease prohibiting immediate reconstruction) without follow-up for consideration of delayed reconstruction (n = 12), prohibitive medical risk or contraindication (ie, morbid obesity; n = 8), and progression of disease, prohibiting reconstruction (n = 7). Immediate and delayed reconstruction were completed in 43.7% and 8.5% of patients. The rate of reconstruction was inversely associated with tumor stage (odds ratio 0.52, 95% CI 0.31 to 0.88), but not race, ethnicity, insurance, or language, on multivariate regression. CONCLUSIONS At a safety-net hospital, we observed rates of reconstruction at or greater than national estimates. After adjustment for clinical attributes, rates did not vary by race, ethnicity, insurance or language. Future research is needed to understand the role of reconstruction in breast cancer care and how to advance shared decision-making among diverse patients.
Collapse
Affiliation(s)
- Brendin R Beaulieu-Jones
- Department of Surgery (Beaulieu-Jones), Boston University, Boston, MA
- Boston Medical Center, and School of Medicine (Beaulieu-Jones, Fefferman, Shewmaker, Roh, Sachs, Merrill, Ko, Cassidy), Boston University, Boston, MA
| | - Ann Fefferman
- Boston Medical Center, and School of Medicine (Beaulieu-Jones, Fefferman, Shewmaker, Roh, Sachs, Merrill, Ko, Cassidy), Boston University, Boston, MA
| | - Alison P Woods
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Woods)
| | - Grant Shewmaker
- Boston Medical Center, and School of Medicine (Beaulieu-Jones, Fefferman, Shewmaker, Roh, Sachs, Merrill, Ko, Cassidy), Boston University, Boston, MA
| | - Tina Zhang
- Department of Medicine (Zhang), Boston University, Boston, MA
| | - Daniel S Roh
- Section of Plastic and Reconstructive Surgery (Roh), Boston University, Boston, MA
- Boston Medical Center, and School of Medicine (Beaulieu-Jones, Fefferman, Shewmaker, Roh, Sachs, Merrill, Ko, Cassidy), Boston University, Boston, MA
| | - Teviah E Sachs
- Section of Surgical Oncology (Sachs, Merrill, Cassidy), Boston University, Boston, MA
- Boston Medical Center, and School of Medicine (Beaulieu-Jones, Fefferman, Shewmaker, Roh, Sachs, Merrill, Ko, Cassidy), Boston University, Boston, MA
| | - Andrea Merrill
- Section of Surgical Oncology (Sachs, Merrill, Cassidy), Boston University, Boston, MA
- Boston Medical Center, and School of Medicine (Beaulieu-Jones, Fefferman, Shewmaker, Roh, Sachs, Merrill, Ko, Cassidy), Boston University, Boston, MA
| | - Naomi Y Ko
- Section of Hematology and Oncology (Ko), Boston University, Boston, MA
- Boston Medical Center, and School of Medicine (Beaulieu-Jones, Fefferman, Shewmaker, Roh, Sachs, Merrill, Ko, Cassidy), Boston University, Boston, MA
| | - Michael R Cassidy
- Section of Surgical Oncology (Sachs, Merrill, Cassidy), Boston University, Boston, MA
- Boston Medical Center, and School of Medicine (Beaulieu-Jones, Fefferman, Shewmaker, Roh, Sachs, Merrill, Ko, Cassidy), Boston University, Boston, MA
| |
Collapse
|
16
|
Prophylactic Antibiotics for Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Comparison between Three Different Duration Approaches. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4833. [PMID: 36845865 PMCID: PMC9946379 DOI: 10.1097/gox.0000000000004833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/11/2023] [Indexed: 02/24/2023]
Abstract
There is no consensus on the duration of prophylactic antibiotic use for autologous breast reconstruction after mastectomy. We attempted to standardize the use of prophylactic antibiotics after mastectomy using a deep inferior epigastric perforator flap for the breast reconstruction procedure. Methods This retrospective case series included 108 patients who underwent immediate breast reconstruction with a deep inferior epigastric perforator flap at the Ditmanson Medical Foundation Chia-Yi Christian Hospital between 2012 and 2019. Patients were divided into three groups based on the duration of prophylactic antibiotic administration (1, 3, and >7 days) for patients with drains. Data were analyzed between January and April 2021. Results The prevalence of surgical site infection in the breast was 0.93% (1/108), and in the abdomen it was 0%. The patient groups did not differ by age, body mass index, smoking status, or neoadjuvant chemotherapy. Only one patient experienced surgical site infection in the breast after half-deep necrosis of the inferior epigastric perforator flap. There were no significant differences in surgical site infection based on the duration of prophylactic antibiotic use. The operation time, methods of breast surgery, volume of fluid drainage in the first 3 days of the abdominal and breast drains, and day of removal of the abdominal and breast drains did not affect surgical site infection. Conclusion Based on these data, we do not recommend extending prophylactic antibiotics beyond 24 hours in deep inferior epigastric perforator reconstruction.
Collapse
|
17
|
Mrad MA, Al Qurashi AA, Shah Mardan QNM, Alqarni MD, Alhenaki GA, Alghamdi MS, Fathi AB, Alobaidi HA, Alnamlah AA, Aljehani SK, Daghistani G, Alsharif TH. Predictors of Complications after Breast Reconstruction Surgery: A Systematic Review and Meta-analysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4693. [PMID: 36583164 PMCID: PMC9750533 DOI: 10.1097/gox.0000000000004693] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/06/2022] [Indexed: 12/15/2022]
Abstract
Breast reconstruction (BR) is a unique surgical procedure that provides patients undergoing mastectomy with significant psychosocial and aesthetic benefits and has also become a crucial part of the treatment pathway for women with breast cancer. Due to methodological inadequacies and the absence of substantial risk factor analysis, no conclusion can be drawn about the correlation between risk variables and post-surgical complications in BR surgery. We aim to identify the potential risk factors associated with postoperative complications. Methods We queried MEDLINE and Cochrane CENTRAL from their inception to March 2022, for published randomized controlled trials and observational studies that assessed complications post-reconstruction procedure in breast cancer patients following mastectomy or evaluated at least one of the following outcomes of major or reoperative complications. The results from the studies were presented as odds ratios with 95% confidence intervals and were pooled using a random-effects model. Results Our pooled analysis demonstrated a significant correlation with BR postoperative complications and risk factors such as diabetes, hypertension, and obesity. Diabetes and the development of seroma were found to have a significant relationship. Risk variables such as age, radiotherapy, COPD, and smoking had no significant connection with 0-to-30-day readmission and 30-to-90-day readmission. Conclusion This meta-analysis shows that risk factors like age, smoking history, high blood pressure, and body mass index (BMI) have a big effect on complications after BR, and patients with risk factors have a high rate of developing infection.
Collapse
Affiliation(s)
- Mohamed Amir Mrad
- Plastic and Reconstructive Surgery Section, Department of Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Abdullah A Al Qurashi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | | | - Mohammed D Alqarni
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | | | | | - Abdulaziz B Fathi
- Plastic and Reconstructive Surgery Section, Department of Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Hussain A Alobaidi
- Plastic and Reconstructive Surgery Section, Department of Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Abdulrahman A Alnamlah
- Plastic and Reconstructive Surgery Section, Department of Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Saif K Aljehani
- Plastic and Reconstructive Surgery Section, Department of Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | | |
Collapse
|
18
|
Racial Disparities in Breast Reconstruction at a Comprehensive Cancer Center. J Racial Ethn Health Disparities 2022; 9:2323-2333. [PMID: 34647274 DOI: 10.1007/s40615-021-01169-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Breast reconstruction after a mastectomy is an important component of breast cancer care that improves the quality of life in breast cancer survivors. African American women are less likely to receive breast reconstruction than Caucasian women. The purpose of this study was to further investigate the reconstruction disparities we previously reported at a comprehensive cancer center by assessing breast reconstruction rates, patterns, and predictors by race. METHODS Data were obtained from women treated with definitive mastectomy between 2000 and 2012. Sociodemographic, tumor, and treatment characteristics were compared between African American and Caucasian women, and logistic regression was used to identify significant predictors of reconstruction by race. RESULTS African American women had significantly larger proportions of public insurance, aggressive tumors, unilateral mastectomies, and modified radical mastectomies. African American women had a significantly lower reconstruction rate (35% vs. 49%, p < 0.01) and received a larger proportion of autologous reconstruction (13% vs. 7%, p < 0.01) compared to Caucasian women. The receipt of adjuvant radiation therapy was a significant predictor of breast reconstruction in Caucasian but not African American women. CONCLUSIONS We identified breast reconstruction disparities in rate and type of reconstruction. These disparities may be due to racial differences in sociodemographic, tumor, and treatment characteristics. The predictors of breast reconstruction varied by race, suggesting that the mechanisms underlying breast reconstruction may vary in African American women. Future research should take a target approach to examine the relative contributions of sociodemographic, tumor, and treatment determinants of the breast reconstruction disparities in African American women.
Collapse
|
19
|
Woods AP, Papageorge MV, de Geus SWL, Alonso A, Merrill A, Cassidy MR, Roh DS, Sachs TE, McAneny D, Drake FT. Impact of Patient Primary Language upon Immediate Breast Reconstruction After Mastectomy. Ann Surg Oncol 2022; 29:8610-8618. [PMID: 35933541 DOI: 10.1245/s10434-022-12354-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/12/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Preoperative decision-making in patients who speak a primary language other than English is understudied. We investigated whether patient primary language is associated with differences in immediate breast reconstruction (IBR) after mastectomy. PATIENTS AND METHODS This retrospective observational study analyzed female patients undergoing mastectomy in the New Jersey State Inpatient Database (2009-2014). The primary outcome was the odds of IBR with a prespecified subanalysis of autologous tissue-based IBR. We used multivariable logistic regression and hierarchical generalized linear mixed models to control for patient characteristics and nesting within hospitals. RESULTS Of 13,846 discharges, 12,924 (93.3%) specified English as the patient's primary language, while 922 (6.7%) specified a language other than English. Among English-speaking patients, 6178 (47.8%) underwent IBR, including 2310 (17.9%) autologous reconstructions. Among patients with a primary language other than English, 339 (36.8%) underwent IBR, including 93 (10.1%) autologous reconstructions. Unadjusted results showed reduced odds of IBR overall [odds ratio (OR) 0.64, 95% CI 0.55-0.73], and autologous reconstruction specifically (OR 0.52, 95% CI 0.41-0.64) among patients with a primary language other than English. After adjustment for patient factors, this difference persisted among the autologous subgroup (OR 0.64, 95% CI 0.51-0.80) but not for IBR overall. A hierarchical model incorporating both patient characteristics and hospital-level effects continued to show a difference among the autologous subgroup (OR 0.75, 95% CI 0.58-0.97). CONCLUSIONS Primary language other than English was an independent risk factor for lower odds of autologous IBR after adjustments for patient and hospital effects. Focused efforts should be made to ensure that patients who speak a primary language other than English have access to high-quality shared decision-making for postmastectomy IBR.
Collapse
Affiliation(s)
- Alison P Woods
- Department of Surgery, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA. .,Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Marianna V Papageorge
- Department of Surgery, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Susanna W L de Geus
- Department of Surgery, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Andrea Alonso
- Department of Surgery, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Andrea Merrill
- Department of Surgery, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Michael R Cassidy
- Department of Surgery, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Daniel S Roh
- Department of Surgery, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Teviah E Sachs
- Department of Surgery, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - David McAneny
- Department of Surgery, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Frederick Thurston Drake
- Department of Surgery, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| |
Collapse
|
20
|
Warren DK, Peacock KM, Nickel KB, Fraser VJ, Olsen MA. Postdischarge prophylactic antibiotics following mastectomy with and without breast reconstruction. Infect Control Hosp Epidemiol 2022; 43:1382-1388. [PMID: 34569458 PMCID: PMC8957624 DOI: 10.1017/ice.2021.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Prophylactic antibiotics are commonly prescribed at discharge for mastectomy, despite guidelines recommending against this practice. We investigated factors associated with postdischarge prophylactic antibiotic use after mastectomy with and without immediate reconstruction and the impact on surgical-site infection (SSI). STUDY DESIGN We studied a cohort of women aged 18-64 years undergoing mastectomy between January 1, 2010, and June 30, 2015, using the MarketScan commercial database. Patients with nonsurgical perioperative infections were excluded. Postdischarge oral antibiotics were identified from outpatient drug claims. SSI was defined using International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) diagnosis codes. Generalized linear models were used to determine factors associated with postdischarge prophylactic antibiotic use and SSI. RESULTS The cohort included 38,793 procedures; 24,818 (64%) with immediate reconstruction. Prophylactic antibiotics were prescribed after discharge after 2,688 mastectomy-only procedures (19.2%) and 17,807 mastectomies with immediate reconstruction (71.8%). The 90-day incidence of SSI was 3.5% after mastectomy only and 8.8% after mastectomy with immediate reconstruction. Antibiotics with anti-methicillin-sensitive Staphylococcus aureus (MSSA) activity were associated with decreased SSI risk after mastectomy only (adjusted relative risk [aRR], 0.74; 95% confidence interval [CI], 0.55-0.99) and mastectomy with immediate reconstruction (aRR, 0.80; 95% CI, 0.73-0.88), respectively. The numbers needed to treat to prevent 1 additional SSI were 107 and 48, respectively. CONCLUSIONS Postdischarge prophylactic antibiotics were common after mastectomy. Anti-MSSA antibiotics were associated with decreased risk of SSI for patients who had mastectomy only and those who had mastectomy with immediate reconstruction. The high numbers needed to treat suggest that potential benefits of postdischarge antibiotics should be weighed against potential harms associated with antibiotic overuse.
Collapse
Affiliation(s)
- David K. Warren
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Kate M. Peacock
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Katelin B. Nickel
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Victoria J. Fraser
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Margaret A. Olsen
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | | |
Collapse
|
21
|
Thalji SZ, Cortina CS, Guo MS, Kong AL. Postoperative Complications from Breast and Axillary Surgery. Surg Clin North Am 2022; 103:121-139. [DOI: 10.1016/j.suc.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
22
|
Variation in the use of infection control measures and infection-related revision incidence after breast implant surgery in the Netherlands. JPRAS Open 2022; 34:226-238. [DOI: 10.1016/j.jpra.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/04/2022] [Indexed: 11/07/2022] Open
|
23
|
Guimier E, Carson L, David B, Lambert JM, Heery E, Malcolm RK. Pharmacological Approaches for the Prevention of Breast Implant Capsular Contracture. J Surg Res 2022; 280:129-150. [PMID: 35969932 DOI: 10.1016/j.jss.2022.06.073] [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: 11/02/2021] [Revised: 06/17/2022] [Accepted: 06/29/2022] [Indexed: 11/15/2022]
Abstract
Capsular contracture is a common complication associated with breast implants following reconstructive or aesthetic surgery in which a tight or constricting scar tissue capsule forms around the implant, often distorting the breast shape and resulting in chronic pain. Capsulectomy (involving full removal of the capsule surrounding the implant) and capsulotomy (where the capsule is released and/or partly removed to create more space for the implant) are the most common surgical procedures used to treat capsular contracture. Various structural modifications of the implant device (including use of textured implants, submuscular placement of the implant, and the use of polyurethane-coated implants) and surgical strategies (including pre-operative skin washing and irrigation of the implant pocket with antibiotics) have been and/or are currently used to help reduce the incidence of capsular contracture. In this article, we review the pharmacological approaches-both commonly practiced in the clinic and experimental-reported in the scientific and clinical literature aimed at either preventing or treating capsular contracture, including (i) pre- and post-operative intravenous administration of drug substances, (ii) systemic (usually oral) administration of drugs before and after surgery, (iii) modification of the implant surface with grafted drug substances, (iv) irrigation of the implant or peri-implant tissue with drugs prior to implantation, and (v) incorporation of drugs into the implant shell or filler prior to surgery followed by drug release in situ after implantation.
Collapse
Affiliation(s)
| | - Louise Carson
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Benny David
- NuSil Technology LLC, Carpinteria, California
| | | | | | - R Karl Malcolm
- School of Pharmacy, Queen's University Belfast, Belfast, UK.
| |
Collapse
|
24
|
Guideline Awareness Disparities in Plastic Surgery: A Survey of American Society of Plastic Surgeons. Plast Reconstr Surg Glob Open 2022; 10:e4456. [PMID: 35958166 PMCID: PMC9362863 DOI: 10.1097/gox.0000000000004456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/08/2022] [Indexed: 12/05/2022]
Abstract
The American Society of Plastic Surgeons (ASPS) clinical practice guidelines were constructed to help direct evidence-based surgical management in plastic surgery. Societal member awareness of the recommendations for breast reconstruction has yet to be studied among ASPS members.
Collapse
|
25
|
Sattar AK, Shahzad H, Masroor T, Martins RS, Zahid N, Amersi FF. Practice Patterns of Antibiotic Prophylaxis in Patients Undergoing Mastectomy: A Survey of Members of the American Society of Breast Surgeons. Ann Surg Oncol 2022; 29:6314-6322. [PMID: 35879481 DOI: 10.1245/s10434-022-12223-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/01/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Surgical site infections after breast surgery range from 1 to 16%. Both the American Society of Breast Surgeons (ASBrS) and the American Association of Plastic Surgeons guidelines lack clarity on postoperative antibiotic prophylaxis (AP) after mastectomy. We surveyed the ASBrS membership to understand their practice patterns of AP after mastectomy and familiarity with ASBrS guidelines. METHODS A self-designed, 19-question survey was emailed to all 2934 ASBrS members. Information was obtained on the participants' training, familiarity with ASBrS guidelines, and practices of prescribing perioperative AP after mastectomy with/without reconstruction and with indwelling drains. RESULTS In total, 556 (19%) responses were analyzed. Half were fellowship-trained breast surgeons/surgical oncologists (50.2%), with 55.6% having practiced for > 15 years and 66.9% in community/private practice. Only 53.6% reported familiarity with ASBrS guidelines for perioperative AP. Most (> 90%) surgeons reported "always" placing drains after mastectomy and "always" prescribing preoperative AP. Postoperatively, preference for continuing AP in cases with drains in place varied by procedure: 7.7% when no reconstruction, 29.1% when autologous-only, and 52.5% when implant reconstruction. Academic surgeons were less likely than surgeons in community/private practice to continue postoperative AP, whether for the duration of indwelling drains (5.1% versus 9.4%) or even till 7 days postoperatively (0.6% versus 3.2%) (p < 0.05). CONCLUSIONS Surgeons uniformly adhere to ASBrS guidelines for preoperative AP. However, there is wide variation in AP postoperatively in patients with/without reconstruction and with indwelling drains. Our results highlight the need for high-quality evidence based on which guidelines must be updated, and the need to familiarize surgeons with current guidelines.
Collapse
Affiliation(s)
- Abida K Sattar
- Department of Surgery, Link Building, Aga Khan University, Karachi, Pakistan.
| | - Hania Shahzad
- Department of Surgery, Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | | | | | - Nida Zahid
- Department of Surgery, Link Building, Aga Khan University, Karachi, Pakistan
| | | |
Collapse
|
26
|
Kim WJ, Pyon JK, Mun GH, Bang SI, Jeon BJ, Lee KT. Is Elective Nighttime Operation Associated With Adverse Outcomes? Analysis in Immediate Tissue Expander-Based Breast Reconstruction. J Patient Saf 2022; 18:261-268. [PMID: 35067617 DOI: 10.1097/pts.0000000000000963] [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 Despite the long-standing presumption that nighttime surgery could affect adverse outcomes, its association independent of patient's general condition and disease severity remains unclear. We hypothesized that conducting elective surgery for subjects with good physical status at nighttime was not associated with increased risks of postoperative complications and aimed to examine it in tissue-expander-insertion (TEI) operation for breast reconstruction. METHOD Patients who underwent immediate unilateral TEI-based breast reconstruction between 2014 and 2019 were enrolled. They were categorized into 3 groups based on the starting time of the TEI operation: 8 am to 6 pm (group 1), 6 pm to 8 pm (group 2), and after 8 pm (group 3). The postoperative complication rates were compared among the groups. The independent associations of each variable, including the operation starting time and adverse outcomes, were analyzed. RESULTS In total, 1458 patients were analyzed, including 970 in group 1, 358 in group 2, and 130 in group 3. The groups showed similar baseline characteristics regarding comorbidities and the American Society of Anesthesiologists classification. Compared with group 1, group 3 was associated with significantly increased rates of overall complications including infection, reoperation, and premature removal of the tissue expander. These differences retained influences in the multivariable analyses. Group 3 showed a significantly longer hospitalization period than the other 2 groups. The complication rates did not differ between groups 1 and 2. CONCLUSIONS Conducting TEI operation at nighttime seems to be associated with increased risks of adverse postoperative outcomes compared with conducting it during regular working hours.
Collapse
Affiliation(s)
- Woo-Ju Kim
- From the Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | | | | | | | | |
Collapse
|
27
|
DermACELL Acellular Dermal Matrix in Oncologic Breast Reconstruction: A Cohort Study and Systematic Review. Plast Reconstr Surg Glob Open 2022; 10:e4396. [PMID: 35747252 PMCID: PMC9208874 DOI: 10.1097/gox.0000000000004396] [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: 03/04/2022] [Accepted: 05/06/2022] [Indexed: 11/26/2022]
Abstract
Acellular dermal matrices (ADMs) are commonly used in tissue expander and direct-to-implant reconstruction following mastectomy. Few studies have reported outcomes of DermACELL use or compared DermACELL with AlloDerm ADM. This study sought to compare outcomes of DermACELL and AlloDerm in oncologic breast reconstruction and to review the literature reporting outcomes of patients undergoing reconstruction using DermACELL.
Collapse
|
28
|
Cottler PS, Kang H, Nash V, Salopek L, Bruce AC, Spiller KL, Campbell CA. Immunomodulation of Acellular Dermal Matrix Through Interleukin 4 Enhances Vascular Infiltration. Ann Plast Surg 2022; 88:S466-S472. [PMID: 35502953 PMCID: PMC9289891 DOI: 10.1097/sap.0000000000003163] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Acellular dermal matrix (ADM) supported implant-based reconstruction remains the most commonly performed mode of reconstruction after breast cancer. Acellular dermal matrix clinical usage has reported benefits but requires rapid and efficient vascular and cellular incorporation into the recipient to have the best outcomes. Orderly transition from M1 to M2 macrophage phenotypic profile, coordinated in part by interleukin 4 (IL-4), is an important component of vascular stabilization and remodeling. Using the ADM substrate as a delivery device for immunomodulation of macrophage phenotype holds the potential to improve integration. METHODS Interleukin 4 was adsorbed onto ADM samples and drug elution curves were measured. Next, experimental groups of 8 C57BL/6 mice had 5-mm ADM discs surgically placed in a dorsal window chamber with a vascularized skin flap on one side and a plastic cover slip on the other in a model of implant-based breast reconstruction. Group 1 consisted of IL-4 (5 μg) adsorbed into the ADM preoperatively and group 2 consisted of an untreated ADM control. Serial gross examinations were performed with histology at day 21 for markers of vascularization, mesenchymal cell infiltration, and macrophage lineage. RESULTS Drug elution curves showed sustained IL-4 release for 10 days after adsorption. Serial gross examination showed similar rates of superficial vascular investment of the ADM beginning at the periphery by day 14 and increasing through day 21. Interleukin-4 treatment led to significantly increased CD31 staining of vascular endothelial cells within the ADM over the control group (P < 0.05) at 21 days. Although vimentin staining did not indicate a significant increase in fibroblasts overall, IL-4 did result in a significant increase in expression of α-smooth muscle actin. The expression of macrophage phenotype markers Arginase1 and iNOS present within the ADM were not significantly affected by IL-4 treatment at the day 21 time point. CONCLUSIONS Acellular dermal matrix has the potential to be used for immunomodulatory cytokine delivery during the timeframe of healing. Using implanted ADM as a delivery vehicle to drive IL-4 mediated angiogenesis and vascular remodeling significantly enhanced vascularity within the ADM substrate.
Collapse
Affiliation(s)
- Patrick S. Cottler
- Department of Plastic Surgery, University of Virginia, Charlottesville, VA
| | - Hannah Kang
- Department of Plastic Surgery, University of Virginia, Charlottesville, VA
| | - Victoria Nash
- School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA
| | - Lisa Salopek
- Department of Plastic Surgery, University of Virginia, Charlottesville, VA
| | - Anthony C. Bruce
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA
| | - Kara L. Spiller
- School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA
| | - Chris A. Campbell
- Department of Plastic Surgery, University of Virginia, Charlottesville, VA
| |
Collapse
|
29
|
Liu EH, Tong M, Kim GY, Farrokhyar F, Dal Cin A. Antibiotic Prophylaxis in Alloplastic Breast Reconstruction: Regimens and Outcomes. Plast Surg (Oakv) 2022; 30:25-31. [PMID: 35096689 PMCID: PMC8793750 DOI: 10.1177/2292550321995730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Surgical site infections (SSI) in prosthesis-based breast reconstruction can have a significant impact on patient outcome. Despite current CDC (Centers for Disease Control and Prevention) guidelines recommending 24 hours of postoperative antibiotics, various perioperative antimicrobial regimens are reported in the literature. Consensus on the optimal duration of antibiotics remains unclear. In this study, the aim is to compare the incidence of surgical site infections following different antibiotic durations in alloplastic breast reconstruction. METHODS In this retrospective cohort study, all consecutive patients who underwent expander/implant-based breast reconstruction between January 2009 and December 2014 at a tertiary centre were included. Data on patient demographics, risk factors, operative time, choice and timing of antibiotic used before surgery, and the duration of postoperative antibiotic use were collected. The primary outcome, SSI, is defined according to CDC criteria. RESULTS A total of 507 consecutive expander/implant-based cases were included. Minimum follow-up time was 1 year. The overall infection incidence was 14% (95% CI: 11%-17%), and the rate of subsequent explantation was 8%. Of the infected cases, 80% (45/56) received 1 week of postoperative antibiotic, while 20% (11/56) had a prolonged course of antibiotics (2-3 weeks; P = .003, odds ratio [OR] = 2.9; 95% CI: 1.4-5.8). Most infections were superficial (65%). Prior history of radiation treatment was identified as a risk factor for developing surgical site infection (P = .02). CONCLUSION Overall infection rate and risk factors for infections are in keeping with current literature. Prescribing one week of postoperative antibiotic was found to be associated with a higher incidence of SSI compared to a more prolonged antibiotic regimen.
Collapse
Affiliation(s)
- Edward H. Liu
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Mary Tong
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba
| | - Grace Y. Kim
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Forough Farrokhyar
- Office of Surgical Research Services, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Arianna Dal Cin
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
- Arianna Dal Cin, 504-304 Victoria Ave North, Hamilton, Ontario, Canada L8L 5G4.
| |
Collapse
|
30
|
Munhoz AM, Chala L, Melo GD, Azevedo Marques Neto AD, Tucunduva T. Clinical and MRI Evaluation of Silicone Gel Implants with RFID-M Traceability System: A Prospective Controlled Cohort Study Related to Safety and Image Quality in MRI Follow-Up. Aesthetic Plast Surg 2021; 45:2645-2655. [PMID: 34075463 DOI: 10.1007/s00266-021-02355-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/09/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND SmoothSilk implants (SSI) are the first generation of implants to incorporate a radio-frequency identification device (RFID-M), a non-invasive traceability system. Although the RFID-M is considered compatible with magnetic resonance imaging (MRI), the size of the artifact and its influence on breast tissue vary. This prospective study assessed safety and MRI issues in a cohort of breast reconstruction patients. METHODS Forty-four SSI were used for breast reconstruction in patients undergoing treatment for breast cancer. All patients were evaluated for magnetic field interactions, MRI-related heating and artifacts in a 1.5-T MRI unit using standard T1/T2-weighted sequences utilized in clinical assessment of breast tissue/implants. RESULTS Mean patient age was 41.5 years (27-53ys) and body mass index was 28+-6.44 kg/m2. In 18/22 patients (81.8%), mastectomies were unilateral. No patients reported local heat/discomfort. All implants showed RFID-M-related artifacts with an estimated mean volume in T1 of 42.9cm3 (26.2-63.6cm3; SD±8.6 and 95% CI, 40.37-45.45) and in T2 of 60.5cm3 (35.4-97.2cm3; SD±14.7 and 95% CI, 56.29-65.01). Artifact volume was smaller in T1 than in T2, to a statistically significant degree (p <0.001). There were no statistically significant differences in artifact volume according to surgical indication, breast side or implant volume. There were 4/44 (9%) cases of minor rotation (<45°). In all cases, adequate analysis of the breast tissue was performed. CONCLUSIONS The results demonstrate that SSI with RFID-M technology presented an artifact volume of 42.9cm3 and 60.5cm3 in T1 and T2 images, respectively. Our findings provide detailed information on the quality and location of MRI artifacts in a reconstructed cohort which can help guide clinical decision-making for patients. To our knowledge, this is the first time RFID-M breast implants have been prospectively evaluated for clinical and MRI issues in a cohort of reconstructive 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 .
Collapse
Affiliation(s)
- Alexandre Mendonça Munhoz
- Breast Surgery Group, Plastic Surgery Division, Rua Mato Grosso, 306 cj.1706 Higienópolis ZIP, São Paulo, SP, 01239-040, Brazil.
- Plastic Surgery Department - Hospital Moriah, Hospital Sírio-Libanês, Rua Mato Grosso, 306 cj.1706 Higienópolis ZIP, São Paulo, SP, 01239-040, Brazil.
- Post-Graduation Course Hospital Sírio-Libanês, São Paulo, Brazil.
| | - Luciano Chala
- Department of Breast Radiology, Fleury Imaging Center, São Paulo, Brazil
| | - Giselle de Melo
- Department of Breast Radiology, Fleury Imaging Center, São Paulo, Brazil
| | | | - Tatiana Tucunduva
- Department of Breast Radiology, Fleury Imaging Center, São Paulo, Brazil
| |
Collapse
|
31
|
Leitner HS, Pauzenberger R, Ederer IA, Radtke C, Hacker S. BMI Specific Complications Following Implant-Based Breast Reconstruction after Mastectomy. J Clin Med 2021; 10:jcm10235665. [PMID: 34884366 PMCID: PMC8658513 DOI: 10.3390/jcm10235665] [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: 11/04/2021] [Revised: 11/27/2021] [Accepted: 11/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Breast reconstruction has a positive impact on body image and quality of life for women after experiencing the physically and psychologically demanding process of mastectomy. Previous studies have presented body mass index (BMI) as a predictor for postoperative complications after breast reconstruction, however, study results vary. This retrospective study aimed to investigate the impact of patients’ BMI on postoperative complications following implant-based breast reconstruction. Methods: All implant-based breast reconstructions performed at the Department of Plastic, Reconstructive and Aesthetic Surgery at the Medical University of Vienna from January 2001 to March 2018 were evaluated. A total of 196 reconstructed breasts among 134 patients met eligibility criteria. Demographic data, surgical techniques, as well as major and minor complications within a one-year follow-up period were analyzed. Results: Patients’ BMI did not show a significant impact on complication rates. The overall incidence of postoperative complications was 30.5% (40/131) of which 17.6% required reoperation. Impaired wound healing (18.3%), seroma (6.1%), hematoma (4.6%), capsular contraction (4.6%) and infection (3.8%) were the most common complications. Conclusion: In our study cohort, BMI was not associated with a significantly higher risk of complications. However, postoperative complications significantly increased with a longer operative time and resulted in an extended length of hospital stay.
Collapse
Affiliation(s)
- Helena Sophie Leitner
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria; (H.S.L.); (R.P.); (C.R.)
| | - Reinhard Pauzenberger
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria; (H.S.L.); (R.P.); (C.R.)
- Privatordination Dr. Pauzenberger, 4861 Schörfling am Attersee, Austria
| | - Ines Ana Ederer
- Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, AGAPLESION Markus Hospital, 60431 Frankfurt, Germany;
| | - Christine Radtke
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria; (H.S.L.); (R.P.); (C.R.)
| | - Stefan Hacker
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria; (H.S.L.); (R.P.); (C.R.)
- Department of Plastic, Aesthetic and Reconstructive Surgery, State Hospital Wiener Neustadt, 2700 Wiener Neustadt, Austria
- Correspondence: ; Tel.: +43-2622-9004-23401
| |
Collapse
|
32
|
Stuart SR, Munhoz AM, Chaves CLG, Montag E, Cordeiro TCS, Fuzisaki TT, Marta GN, Carvalho HA. Complications after breast reconstruction with alloplastic material in breast cancer patients submitted or not to post mastectomy radiotherapy. Rep Pract Oncol Radiother 2021; 26:730-739. [PMID: 34760307 DOI: 10.5603/rpor.a2021.0087] [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: 05/19/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022] Open
Abstract
Background and purpose Breast reconstruction following mastectomy is a relevant element of breast cancer treatment. The purpose of this study was to evaluate the influence of radiotherapy (RT) on local complications in patients with breast cancer that had undergone breast reconstruction with alloplastic material. Materials and methods Retrospective study of breast cancer patients submitted to mastectomy and breast reconstruction from 2009 to 2013. Clinical and treatment variables were correlated with early and late complications. Results 251 patients were included; mean age was 49.7 (25 to 78) years. Reconstruction was immediate in 94% of the patients, with 88% performed with a temporary tissue expander. Postoperative radiotherapy (RT) was delivered to 167 patients (66.5%). Early complications were present in 26.3% of the patients. Irradiated patients presented 5.4% incidence of late complications versus 2.4% for non-irradiated patients (p = 0.327). Diabetes (OR = 3.41 95% CI: 1.23-9.45, p = 0.018) and high body mass index (BMI) (OR = 2.65; 95% CI: 1.60-4.37, p < 0.0001) were the main risk factors. The overall incidence of late complications was 4.4%, with predominance of severe capsular contracture (8/11). Arterial hypertension (OR = 4.78; 95% CI: 1.97-11.63, p = 0.001), BMI (OR = 0.170; 95% CI: 0.048-0.607, p = 0.006) and implant placement (OR = 3.55; 95% CI: 1.26-9.99, p = 0.016) were related to late complications. Conclusions The overall rate of complications was low in this population. Radiotherapy delivery translated into a higher but not statistically significant risk of late complications when compared with the non-irradiated patients. Already well-known clinical risk factors for complications after breast reconstruction were identified.
Collapse
Affiliation(s)
- Silvia Radwanski Stuart
- Department of Radiology and Oncology - Radiotherapy, Instituto do Câncer do Estado de São Paulo (ICESP), Brasil.,Instituto de Radiologia (INRAD) - Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brasil
| | - Alexandre Mendonça Munhoz
- Instituto de Radiologia (INRAD) - Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brasil
| | - Cristiane L G Chaves
- Department of Radiology and Oncology - Radiotherapy, Instituto do Câncer do Estado de São Paulo (ICESP), Brasil
| | - Eduardo Montag
- Instituto de Radiologia (INRAD) - Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brasil
| | - Thalita C S Cordeiro
- Department of Radiology and Oncology - Radiotherapy, Instituto do Câncer do Estado de São Paulo (ICESP), Brasil
| | - Tatiana Taba Fuzisaki
- Department of Radiology and Oncology - Radiotherapy, Instituto do Câncer do Estado de São Paulo (ICESP), Brasil
| | - Gustavo N Marta
- Department of Radiology and Oncology - Radiotherapy, Instituto do Câncer do Estado de São Paulo (ICESP), Brasil
| | - Heloisa A Carvalho
- Department of Radiology and Oncology - Radiotherapy, Instituto do Câncer do Estado de São Paulo (ICESP), Brasil.,Instituto de Radiologia (INRAD) - Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brasil
| |
Collapse
|
33
|
Hassan RAM, Urban CDA, Dória MT, Spautz CC, Rabinovich I, Anselmi KF, Schunemann E, Kuroda F, Sobreiro BP, Lima RSD. Exposed Implant after Immediate Breast Reconstruction - Presentation and Analysis of a Clinical Management Protocol. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:690-698. [PMID: 34670304 PMCID: PMC10183878 DOI: 10.1055/s-0041-1735939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Infection and exposure of the implant are some of the most common and concerning complications after implant-based breast reconstruction. Currently, there is no consensus on the management of these complications. The aim of the present study was to review our cases and to present a clinical protocol. METHODS We conducted a retrospective review of consecutive patients submitted to implant-based breast reconstruction between 2014 and 2016. All patients were managed according to a specific and structured protocol. RESULTS Implant exposure occurred in 33 out of 277 (11.9%) implant-based reconstructions. Among these, two patients had history of radiotherapy and had their implant removed; Delayed reconstruction with a myocutaneous flap was performed in both cases. Signs of severe local infection were observed in 12 patients, and another 5 presented with extensive tissue necrosis, and they were all submitted to implant removal; of them, 8 underwent reconstruction with a tissue expander, and 2, with a myocutaneous flap. The remaining 14 patients had no signs of severe infection, previous irradiation or extensive tissue necrosis, and were submitted to primary suture as an attempt to salvage the implant. Of these, 8 cases (57.1%) managed to keep the original implant. CONCLUSION Our clinical protocol is based on three key points: history of radiotherapy, severe infection, and extensive tissue necrosis. It is a practical and potentially-reproducible method of managing one of the most common complications of implant-based breast reconstruction.
Collapse
Affiliation(s)
| | - Cícero de Andrade Urban
- Department of Post-graduation, Universidade Positivo, Curitiba, PR, Brazil.,Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
| | | | | | - Iris Rabinovich
- Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil.,Department of Obstetrics and Gynecology, Universidade Federal do Paraná, Curitiba, Paraná, PR, Brazil
| | | | - Eduardo Schunemann
- Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil.,Department of Obstetrics and Gynecology, Universidade Federal do Paraná, Curitiba, Paraná, PR, Brazil
| | - Flávia Kuroda
- Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
| | | | | |
Collapse
|
34
|
Zucker I, Bouz A, Castro G, Rodriguez de la Vega P, Barengo NC. Smoking as a Risk Factor for Surgical Site Complications in Implant-Based Breast Surgery. Cureus 2021; 13:e18876. [PMID: 34804725 PMCID: PMC8599112 DOI: 10.7759/cureus.18876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 11/05/2022] Open
Abstract
Background Smoking is a cause of many postoperative complications, including delayed wound healing, tissue necrosis, and reconstructive flap loss. However, there is a paucity of evidence-based guidelines for smoking cessation in patients undergoing implant-based breast surgery. Objective The objective of this study was to determine if smoking is associated with wound dehiscence or superficial/deep surgical site infection (SSI) in women undergoing implant-based breast surgery. Methods Using theAmerican College of Surgeons National Surgical Quality Improvement Program, data was obtained of U.S. adult females (n=10,077) between the ages of 18 and 70 who underwent insertion of a breast prosthesis from 2014 to 2016. The patient's preoperative smoking status, demographics, and comorbidities were analyzed to determine association with wound dehiscence, superficial SSI, and deep SSI. Unadjusted and adjusted logistic regression analyses were used to calculate odds ratios (OR) and 95% confidence intervals (95% CI). Results Patients who smoked had a statistically significant higher proportion of wound complications (2.4%) compared to non-smokers (1.3%; p<0.01). Adjusted analysis demonstrated a significantly higher odds of wound complications in smoking patients compared to those who did not smoke (OR 2.0; 95% CI 1.3-3.2). Conclusions Our study suggests that smoking is an independent risk factor for postoperative complications in patients undergoing implant-based breast surgery. These results have significant clinical implications, as increased precautions can be taken in smokers undergoing breast surgery to minimize postoperative wound complications. Future studies may determine the optimal amount of time that patients should abstain from smoking prior to implant-based breast surgery.
Collapse
Affiliation(s)
- Isaac Zucker
- Department of Translational Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Antoun Bouz
- Department of Translational Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Grettel Castro
- Department of Translational Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Pura Rodriguez de la Vega
- Department of Translational Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Noel C Barengo
- Department of Public Health, University of Helsinki, Helsinki, FIN
- Department of Translational Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
- Faculty of Medicine, Riga Stradins University, Riga, LVA
| |
Collapse
|
35
|
Kim MY, Suh YJ, An YY. Imaging surveillance for the detection of ipsilateral local tumor recurrence in patients who underwent oncoplastic breast-conserving surgery with acellular dermal matrix: abbreviated MRI versus conventional mammography and ultrasonography. World J Surg Oncol 2021; 19:290. [PMID: 34579740 PMCID: PMC8477561 DOI: 10.1186/s12957-021-02403-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the usefulness of surveillance-abbreviated magnetic resonance imaging (AB-MRI) for the detection of ipsilateral local tumor recurrence (LTR) in patients who underwent oncoplastic breast-conserving surgery (BCS) with acellular dermal matrix (ADM) by comparing its diagnostic performance with that of mammography (MG) and ultrasonography (US). METHODS The postoperative MG, US, and AB-MRI findings of the ipsilateral breast and pathological results of 324 patients who underwent oncoplastic BCS using ADM were reviewed. The cancer detection rate (CDR), sensitivity, specificity, positive predictive value (PPV) for biopsy, accuracy, and area under the curve (AUC) for each imaging modality were calculated. RESULTS A total of 8 ipsilateral LTRs were diagnosed, and most cancers (87.5%) were stage 0 or 1 (median size of invasive cancer, 1.44 cm; range, 0.7-2 cm). The CDRs of MG, US, MG + US, and AB-MRI were 0.009, 0.012, 0.015, and 0.025 per woman, respectively. Three cancers were detectable on only AB-MRI, and the additional CDR of AB-MRI was 0.010. The sensitivity and specificity of MG, US, MG + US, and AB-MRI were 37.5%, 50%, 62.5%, and 100% and 99.7%, 98.4%, 98.1%, and 97.8%, respectively. The PPVs for biopsy were 75%, 44.4%, 45.5%, and 53.3%, respectively. The AUC was significantly higher for AB-MRI (0.989) than for MG alone (0.686, P = 0.0009), US alone (0.742, P = 0.009), and MG + US (0.803, P = 0.04). A total of 66.7% of cancers visible on only AB-MRI were located at the deep posterior portion of the excision cavity, which might have been missed with MG or MG + US due to masking by the ADM filler. CONCLUSION AB-MRI can improve the detection of ipsilateral LTR despite postoperative changes caused by ADM fillers compared to conventional MG and US. Patients who undergo BCS with ADM can be candidates for AB-MRI surveillance considering improved cancer detection and high sensitivity.
Collapse
Affiliation(s)
- Mi Young Kim
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Young Jin Suh
- Department of Surgery, Division of Breast and Thyroid Surgical Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea
| | - Yeong Yi An
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea.
| |
Collapse
|
36
|
Giunta S, Laidsaar-Powell R, Huang L, Hatcher N, Dhillon H, Muscat DM, Carroll S, McNeil C, Burke L, Howson P, Chan B, Juraskova I. Considering the type and timing of breast reconstruction after mastectomy: Qualitative insights into women's decision-making. Eur J Oncol Nurs 2021; 54:102024. [PMID: 34536790 DOI: 10.1016/j.ejon.2021.102024] [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] [Received: 01/17/2021] [Revised: 05/05/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The information women receive about the type and timing of breast reconstruction (BR) from healthcare providers is crucial to help them make an informed decision, and this is particularly important in complex cases and/or high-risk cases. This study sought to provide qualitative insights into Australian women's BR decision-making experiences. METHOD Twenty-nine women who had received a mastectomy and made decisions about BR, including the type (expander, implant and/or autologous) and timing (immediate, delayed or immediate-delayed), participated in semi-structured telephone interviews. Interviews were analysed thematically using the Framework method. RESULTS Seven themes were identified: 1) information provision and needs; 2) values and preferences; 3) pressure to decide; 4) feasibility (e.g. clinical and/or financial factors); 5) social influence and support; 6) multidisciplinary team and organisational structures; and 7) decision implementation and outcomes. Breast care nurse support, as well as collaboration and communication within multidisciplinary teams were perceived by women as facilitating the BR decision-making process. CONCLUSIONS The identified themes offer an in-depth explanation of how a sample of Australian women make BR decisions. The current findings highlight the often limited clinician-patient information-sharing and demonstrate the overarching influence of the multidisciplinary medical team and organisational structures on BR decision-making. Development of in-consult decision-aids and strategies to improve multidisciplinary care are discussed.
Collapse
Affiliation(s)
- Sarah Giunta
- The University of Sydney, Faculty of Science, School of Psychology, NSW, Australia
| | - Rebekah Laidsaar-Powell
- The University of Sydney, Faculty of Science, School of Psychology, NSW, Australia; Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, NSW, Australia; Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, NSW, Australia
| | - Lorna Huang
- The University of Sydney, Faculty of Science, School of Psychology, NSW, Australia; Department of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW, Australia
| | - Natasha Hatcher
- The University of Sydney, Faculty of Science, School of Psychology, NSW, Australia
| | - Haryana Dhillon
- The University of Sydney, Faculty of Science, School of Psychology, NSW, Australia; Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, NSW, Australia; Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, NSW, Australia
| | - Danielle M Muscat
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Susan Carroll
- The University of Sydney, Faculty of Medicine and Health Sciences, Sydney Medical School, NSW, Australia; Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Catriona McNeil
- The University of Sydney, Faculty of Medicine and Health Sciences, Sydney Medical School, NSW, Australia; Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Lucinda Burke
- The University of Sydney, Faculty of Medicine and Health Sciences, Sydney Medical School, NSW, Australia; Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Pamela Howson
- Strathfield Private Hospital, Strathfield, NSW, Australia
| | - Belinda Chan
- Chris O'Brien Lifehouse, Camperdown, NSW, Australia; Strathfield Private Hospital, Strathfield, NSW, Australia
| | - Ilona Juraskova
- The University of Sydney, Faculty of Science, School of Psychology, NSW, Australia; Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, NSW, Australia; Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, NSW, Australia.
| |
Collapse
|
37
|
Seventy-Fifth Anniversary of Plastic and Reconstructive Surgery: How Evidence-Based Medicine Has Transformed Plastic Surgery. Plast Reconstr Surg 2021; 147:1235-1241. [PMID: 33890912 DOI: 10.1097/prs.0000000000007913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
38
|
Roubaud MS, Carey JN, Vartanian E, Patel KM. Breast reconstruction in the high-risk population: current review of the literature and practice guidelines. Gland Surg 2021; 10:479-486. [PMID: 33634005 DOI: 10.21037/gs-2020-nfbr-09] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Breast reconstruction is an important part of the cancer treatment paradigm and the psychosocial benefits are well described in the literature. Notably, breast reconstruction restores both the functional and emotional losses patients experience due to tumor resection. Post-cancer quality of life is an important benchmark of successful treatment; therefore, breast reconstruction is an essential component that should be offered whenever possible. Over time, reconstructive techniques and outcomes have improved dramatically resulting in better patient safety and decreased operative morbidity. When counseling a patient for surgery, the provider must consider all aspects of a patient's health. Ideally, breast cancer patients should be physically, emotionally, and oncologically appropriate candidates for reconstruction. However, in concerted effort to provide opportunities for as many patients as possible, the definition of who is a good candidate for reconstruction has evolved to include higher risk patients. These patients include those with advanced age, nicotine use, obesity, and significant ptosis. With improvements in surgical procedures and perioperative care, this population may also benefit from restorative surgery. However, the exact risk of complications and necessary counseling has gone largely undefined in this population. This article examines particular "high-risk" groups that may be challenging for extirpative and reconstructive surgeons and offers current guidelines for practice.
Collapse
Affiliation(s)
- Margaret S Roubaud
- Department of Plastic and Reconstructive Surgery, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Joseph N Carey
- Department of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA, USA
| | - Emma Vartanian
- Department of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA, USA
| | - Ketan M Patel
- Department of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
39
|
Arnaout A, Zhang J, Frank S, Momtazi M, Cordeiro E, Roberts A, Ghumman A, Fergusson D, Stober C, Pond G, Jeong A, Vandermeer L, Hutton B, Clemons M. A Randomized Controlled Trial Comparing Alloderm-RTU with DermACELL in Immediate Subpectoral Implant-Based Breast Reconstruction. ACTA ACUST UNITED AC 2020; 28:184-195. [PMID: 33704185 PMCID: PMC7816190 DOI: 10.3390/curroncol28010020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/01/2020] [Accepted: 12/16/2020] [Indexed: 12/15/2022]
Abstract
Background: The effectiveness of different acellular dermal matrices (ADM) used for implant-based reconstruction immediately following mastectomy is an important clinical question. A prospective randomized clinical trial was performed to evaluate the superiority of DermACELL over Alloderm-RTU in reducing drain duration. Methods: Patients undergoing mastectomy with subpectoral immediate and permanent implant-based breast reconstruction were randomized to Alloderm-RTU or DermACELL. The primary outcome was seroma formation, measured by the duration of postoperative drain placement. Secondary outcomes included: post drain removal seroma aspiration, infection, redbreast syndrome, wound dehiscence, loss of the implant, and unplanned return to the operating room. Results: 62 patients were randomized for 81 mastectomies (41 Alloderm-RTU, 40 DermACELL). Baseline characteristics were similar. There was no statistically significant difference in mean drain duration (p = 0.16), with a trend towards longer duration in the Alloderm-RTU group (1.6 days; 95%CI, 0.7 to 3.9). The overall rate of minor and major complications were statistically similar between the two groups; although patients with Alloderm-RTU had 3 times as many infections requiring antibiotics (7.9% vs. 2.5%) with a risk difference of 5.4 (95%CI −4.5 to 15.2), and twice as many unplanned returns to the operating room (15.8% vs. 7.5%) with a risk difference of 8.3 (95% CI −5.9 to 22.5) as DermACELL. Conclusion: This is the first prospective randomized clinical trial comparing the two most commonly used human-derived ADMs. There was no statistically significant difference in drain duration, minor, or major complications between DermACELL over Alloderm-RTU in immediate subpectoral permanent implant-based breast reconstruction post-mastectomy.
Collapse
Affiliation(s)
- Angel Arnaout
- Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON K1Y 4E9, Canada; (A.A.); (J.Z.); (S.F.); (M.M.); (E.C.); (A.R.); (A.G.)
| | - Jing Zhang
- Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON K1Y 4E9, Canada; (A.A.); (J.Z.); (S.F.); (M.M.); (E.C.); (A.R.); (A.G.)
| | - Simon Frank
- Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON K1Y 4E9, Canada; (A.A.); (J.Z.); (S.F.); (M.M.); (E.C.); (A.R.); (A.G.)
| | - Moein Momtazi
- Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON K1Y 4E9, Canada; (A.A.); (J.Z.); (S.F.); (M.M.); (E.C.); (A.R.); (A.G.)
| | - Erin Cordeiro
- Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON K1Y 4E9, Canada; (A.A.); (J.Z.); (S.F.); (M.M.); (E.C.); (A.R.); (A.G.)
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON K1H 8L6, Canada; (D.F.); (C.S.); (A.J.); (L.V.); (B.H.)
| | - Amanda Roberts
- Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON K1Y 4E9, Canada; (A.A.); (J.Z.); (S.F.); (M.M.); (E.C.); (A.R.); (A.G.)
| | - Ammara Ghumman
- Department of Surgery, The Ottawa Hospital and University of Ottawa, Ottawa, ON K1Y 4E9, Canada; (A.A.); (J.Z.); (S.F.); (M.M.); (E.C.); (A.R.); (A.G.)
| | - Dean Fergusson
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON K1H 8L6, Canada; (D.F.); (C.S.); (A.J.); (L.V.); (B.H.)
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
| | - Carol Stober
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON K1H 8L6, Canada; (D.F.); (C.S.); (A.J.); (L.V.); (B.H.)
| | - Gregory Pond
- Juravinski Cancer Center, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Ahwon Jeong
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON K1H 8L6, Canada; (D.F.); (C.S.); (A.J.); (L.V.); (B.H.)
| | - Lisa Vandermeer
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON K1H 8L6, Canada; (D.F.); (C.S.); (A.J.); (L.V.); (B.H.)
| | - Brian Hutton
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON K1H 8L6, Canada; (D.F.); (C.S.); (A.J.); (L.V.); (B.H.)
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
| | - Mark Clemons
- Ottawa Hospital Research Institute and University of Ottawa, Ottawa, ON K1H 8L6, Canada; (D.F.); (C.S.); (A.J.); (L.V.); (B.H.)
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, ON K1H 8L6, Canada
- Correspondence: ; Tel.: +1-613-737-7700 (ext. 70170)
| | | |
Collapse
|
40
|
Management of Expander- and Implant-Associated Infections in Breast Reconstruction. Aesthetic Plast Surg 2020; 44:2075-2082. [PMID: 32840671 DOI: 10.1007/s00266-020-01923-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Periprosthetic infection remains the most common complication after implant-based breast reconstruction. Objectives of the study were to (1) describe our clinical approach and treatment protocol for managing patients with suspected periprosthetic infection, (2) identify the microorganisms causing periprosthetic infections at our institute, and (3) report on outcomes of implant salvage versus explantation. METHODS A retrospective chart review of patients who were treated with parenteral antibiotics for periprosthetic infection was carried out. Patient characteristics, clinical and laboratory findings, outcomes, treatment modalities and complications were extracted from electronic medical records. Data were compared between patients whose implants were salvaged versus explanted. RESULTS Fifty-nine patients with 67 tissue expander (TE)/implants underwent parenteral antibiotic treatment for suspected infection. Thirty-three (49%) of the TE/implants were salvaged. Mean follow-up was 14.3 months. The most commonly cultured organisms were P. aeruginosa followed by S. epidermidis. All suspected infections were treated with broad spectrum parenteral antibiotics with MRSA coverage. The most common combination was daptomycin 6 mg/kg combined with Zosyn 4.5 g. Explantations were significantly more common in patients with history of chemotherapy (p = 0.03), hypertension (p = 0.04) and those who underwent therapeutic mastectomy (p = 0.04). CONCLUSION Risk factors for explantation due to postoperative periprosthetic infections following TE/implant-based breast reconstruction include chemotherapy, hypertension and therapeutic mastectomy. Prompt diagnosis and effective treatment of periprosthetic infection, particularly in these high-risk patients, are imperative to salvage the breast reconstruction. Gram-negative bacteria are increasingly found in breast implant infections and should be covered when employing empiric antibiotherapy. 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 .
Collapse
|
41
|
Surgeon choice in the use of postdischarge antibiotics for prophylaxis following mastectomy with and without breast reconstruction. Infect Control Hosp Epidemiol 2020; 42:467-470. [PMID: 33040748 DOI: 10.1017/ice.2020.462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Multiple guidelines recommend discontinuation of prophylactic antibiotics <24 hours after surgery. In a multicenter, retrospective cohort of 2,954 mastectomy patients ± immediate breast reconstruction, we found that utilization of prophylactic postdischarge antibiotics varied dramatically at the surgeon level among general surgeons and was virtually universal among plastic surgeons.
Collapse
|
42
|
Cao Z, Cao J, Pang X, Du W, Wu P. A comparative study for the rate of adverse outcomes in unilateral and bilateral abdominal flap breast reconstruction: A meta-analysis. Medicine (Baltimore) 2020; 99:e22096. [PMID: 32925752 PMCID: PMC7489626 DOI: 10.1097/md.0000000000022096] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Adverse outcomes after unilateral vs bilateral breast reconstruction involve an unknown level of risk that warrants thorough investigation. METHODS To address this research need, PubMed, Ovid, Medline, EMBASE, and Scopus databases were searched through systematically from January 1, 1990, to January 1, 2019 to retrieve the relevant studies on the risk of postoperative complications after unilateral vs bilateral abdominal flap breast reconstruction. According to the pre-designed inclusion criteria, available data were extracted from the relevant studies, and then analyzed comparatively in order to identify the relative risk (RR) and 95% confidence intervals (CI) applying either a random or a fixed effects model. RESULTS Eventually, 20 studies involving 8122 female subjects met the inclusion criteria. It was found that unilateral reconstruction involved a significantly higher risk of flap loss (RR: 1.56, 95% CI: 1.21-2.00; P < .05) and fat necrosis (RR: 1.60, 95% CI: 1.23-2.09; P < .05) compared to bilateral reconstruction, while bilateral reconstruction involved a greater risk of abdominal hernia/bulge (RR: 1.67, 95% CI: 1.25-2.24; P < .05). The risk was found to be higher following bilateral free transverse rectus abdominis myocutaneous (fTRAM) flaps in comparison with deep inferior epigastric perforator (DIEP) flaps (RR: 2.62, 95% CI: 1.33-5.15; P < .05). CONCLUSION The risk of postoperative flap complications in unilateral breast reconstruction is significantly higher than that in bilateral reconstruction. Contrarily, the abdominal complications were significantly higher in the bilateral group vs the unilateral group. Meanwhile, the risk of abdominal hernia/bulge complication after bilateral breast reconstruction was significantly higher with fTRAM vs DIEP. Therefore, DIEP flaps are recommended in priority for bilateral breast reconstruction, unless specifically contraindicated.
Collapse
Affiliation(s)
- Zheming Cao
- Department of Orthopedics, Xiangya Hospital of Central South University
| | - Jiri Cao
- Xiangya Nursing School of Central South University, Changsha, China
| | - Xiaoyang Pang
- Department of Orthopedics, Xiangya Hospital of Central South University
| | - Wei Du
- Department of Orthopedics, Xiangya Hospital of Central South University
| | - Panfeng Wu
- Department of Orthopedics, Xiangya Hospital of Central South University
| |
Collapse
|
43
|
Chao AH. Safe and Efficient Implant-based Breast Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3134. [PMID: 33133973 PMCID: PMC7544319 DOI: 10.1097/gox.0000000000003134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/29/2020] [Indexed: 11/14/2022]
Abstract
Implant-based breast reconstruction is a safe and effective option associated with high patient satisfaction. Techniques have evolved significantly over the past several decades, characterized mostly by a reduction in the number of stages and time required to complete reconstruction, with maximal preservation of native breast elements. Nevertheless, both old and new techniques of implant-based breast reconstruction have a role depending on the specific clinical scenario, and thus plastic surgeons should be well versed in the full spectrum of options. This article reviews the key considerations underlying decision-making in implant-based breast reconstruction and the most effective techniques, with a focus on optimizing safety and efficiency.
Collapse
Affiliation(s)
- Albert H. Chao
- From the Department of Plastic Surgery, Ohio State University, Columbus, Ohio
| |
Collapse
|
44
|
The use of surgical site drains in breast reconstruction: A systematic review. J Plast Reconstr Aesthet Surg 2019; 73:651-662. [PMID: 31926896 DOI: 10.1016/j.bjps.2019.11.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 10/22/2019] [Accepted: 11/22/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Use of drains has been advocated in order to prevent seroma and hematoma; however, specific recommendations vary widely. The goal is to perform a systematic analysis of published literature on the use of drains for breast reconstruction. METHODS The literature search was performed according to the PRISMA guidelines. The search included the Cochrane Library, Embase, and Pubmed databases using the terms "breast reconstruction" and "breast flap" combined with "drain", "seroma," and "seroma prevention". The references were appraised in two rounds, by two independent reviewers; studies were included/excluded based on relevance of title and subsequently by the content of their abstracts/manuscripts. Outcomes regarding seroma, infection rate, length of stay (LOS), drainage, reconstruction type and complications were analyzed. RESULTS Of 2252 studies identified via search, 64 were relevant and 21 met inclusion criteria. Most of the study designs were case series or retrospective cohort studies (Level of Evidence III or IV), with the exception of one prospective randomized-controlled trial. Seroma rate was given in 18 studies, infection rate in 11, and criteria for drain removal in 19. Reoperation rate was available in 7 and LOS in 18 studies. The majority of studies (13) agreed to remove the drain when the output was less than 30 ml/24 h. Drain output was reported in 11, and 20 reported drain type used. CONCLUSION There is sparse literature available with which to make evidence-based guidelines. A standardized guideline for reporting drain use is crucial to providing a better understanding of complications in breast reconstruction related to surgical drains.
Collapse
|
45
|
Delayed two-stage breast reconstruction: The impact of radiotherapy. J Plast Reconstr Aesthet Surg 2019; 72:1763-1768. [DOI: 10.1016/j.bjps.2019.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 04/24/2019] [Accepted: 06/12/2019] [Indexed: 11/21/2022]
|
46
|
Long-Term Outcomes After Autologous or Tissue Expander/Implant–Based Breast Reconstruction and Postmastectomy Radiation for Breast Cancer. Pract Radiat Oncol 2019; 9:e497-e505. [DOI: 10.1016/j.prro.2019.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/07/2019] [Accepted: 06/11/2019] [Indexed: 01/03/2023]
|
47
|
Two-Staged Implant-Based Breast Reconstruction: A Long-Term Outcome Study in a Young Population. ACTA ACUST UNITED AC 2019; 55:medicina55080481. [PMID: 31416221 PMCID: PMC6723805 DOI: 10.3390/medicina55080481] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/18/2019] [Accepted: 08/12/2019] [Indexed: 11/17/2022]
Abstract
Background and objectives: Differences in patient anatomy and physiology exist between young and older patients undergoing breast reconstruction after mastectomy. Breast cancer has been described as being more aggressive, more likely to receive radiation, contralateral mastectomy, as well as bilateral reconstruction in young patients. Our purpose is to report long-term experience on two-staged implant-based breast reconstruction (IBR) in young females, with complication sub-analysis based on obesity and adjuvant radiation. Materials and Methods: Retrospective chart review of all consecutive young patients who underwent two-staged IBR at our institution, between 2000 and 2016, was performed. Patients between 15 and 40 years old with least 1-year follow-up were included. Univariate logistic regression models and receiver operating characteristic (ROC) curves were created. Results: Overall 594 breasts met our inclusion criteria. The mean age was 34 years, and the median follow-up was 29.6 months. Final IBR was achieved in 98% of breasts. Overall, 12% of breasts had complications, leading to explantations of 5% of the devices. Adjuvant radiation was followed by higher rates of total device explantations (p = 0.003), while obese patients had higher rates of total complications (p < 0.001). For each point increase in BMI, the odds of developing complications increased 8.1% (p < 0.001); the cutoff BMI to predict higher complications was 24.81 kg/m2. Conclusions: This population demonstrates high successful IBR completion and low explantation rates. These data suggest that obese women and those with planned adjuvant radiation deserve special counseling about their higher risk of complications.
Collapse
|
48
|
Begum H, Vishwanath S, Merenda M, Tacey M, Dean N, Elder E, Mureau M, Bezic R, Carter P, Cooter RD, Deva A, Earnest A, Higgs M, Klein H, Magnusson M, Moore C, Rakhorst H, Saunders C, Stark B, Hopper I. Defining Quality Indicators for Breast Device Surgery: Using Registries for Global Benchmarking. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2348. [PMID: 31592377 PMCID: PMC6756659 DOI: 10.1097/gox.0000000000002348] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/29/2019] [Indexed: 11/26/2022]
Abstract
Breast device registries monitor devices encompassing breast implants, tissue expanders and dermal matrices, and the quality of care and patient outcomes for breast device surgery. Defining a standard set of quality indicators and risk adjustment factors will enable consistency and adjustment for case-mix in benchmarking quality of care across breast implant registries. This study aimed to develop a set of quality indicators to enable assessment and reporting of quality of care for breast device surgery which can be applied globally. METHODS A scoping literature review was undertaken, and potential quality indicators were identified. Consensus on the final list of quality indicators was obtained using a modified Delphi approach. This process involved a series of online surveys, and teleconferences over 6 months. The Delphi panel included participants from various countries and representation from surgical specialty groups including breast and general surgeons, plastic and reconstructive surgeons, cosmetic surgeons, a breast-care nurse, a consumer, a devices regulator (Therapeutic Goods Administration), and a biostatistician. A total of 12 candidate indicators were proposed: Intraoperative antibiotic wash, intraoperative antiseptic wash, preoperative antibiotics, nipple shields, surgical plane, volume of implant, funnels, immediate versus delayed reconstruction, time to revision, reoperation due to complications, patient satisfaction, and volume of activity. RESULTS Three of the 12 proposed indicators were endorsed by the panel: preoperative intravenous antibiotics, reoperation due to complication, and patient reported outcome measures. CONCLUSION The 3 endorsed quality indicator measures will enable breast device registries to standardize benchmarking of care internationally for patients undergoing breast device surgery.
Collapse
Affiliation(s)
- Husna Begum
- From the Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Swarna Vishwanath
- From the Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Michelle Merenda
- From the Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Mark Tacey
- From the Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Nicola Dean
- Department of Plastic and Reconstructive Surgery, Flinders Medical Center, Flinders University, South Australia, Australia
| | - Elisabeth Elder
- From the Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
- Westmead Breast Cancer Institute, Westmead Hospital, New South Wales, Australia
| | - Marc Mureau
- Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ron Bezic
- Refine Cosmetic Clinic, New South Wales, Australia
| | - Pamela Carter
- Therapeutic Goods Administration, Australian Capital Territory Australia
| | - Rodney D. Cooter
- From the Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Anand Deva
- Macquarie Plastic & Reconstructive Surgery, Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Australia
| | - Arul Earnest
- From the Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Michael Higgs
- Parkside Cosmetic Surgery, South Australia Australia
| | - Howard Klein
- South Island Plastic Surgery, Christchurch, New Zealand
| | - Mark Magnusson
- School of Medicine, Griffith University, Queensland, Australia; Australasian College of Cosmetic Surgery, New South Wales, Australia
| | - Colin Moore
- Refine Cosmetic Clinic, New South Wales, Australia
| | - Hinne Rakhorst
- Department of Plastic, Reconstructive and Hand surgery, Medisch Spectrum Twente and ZGT Almelo, Enschede, The Netherlands
| | - Christobel Saunders
- School of Medicine, University of Western Australia, Western Australia, Australia
| | - Birgit Stark
- Kliniken för Rekonstruktiv Plastikkirurgi Karolinska Institute, Stockholm, Sweden
| | - Ingrid Hopper
- From the Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| |
Collapse
|
49
|
Greig H, Roller J, Ziaziaris W, Van Laeken N. A retrospective review of breast reconstruction outcomes comparing AlloDerm and DermaCELL. JPRAS Open 2019; 22:19-26. [PMID: 32158893 PMCID: PMC7061595 DOI: 10.1016/j.jpra.2019.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 07/17/2019] [Indexed: 12/22/2022] Open
Abstract
Acellular dermal matrix (ADM) has become an accepted and advantageous adjunct to alloplastic breast reconstruction. The increase in demand has led to an upsurge of dermal-based products, both human and animal derived. There are few direct ADM comparative studies, but it is unclear whether there are any differences in complication rates. Our primary objective was to determine whether there is a difference in outcomes between AlloDerm and DermACELL in immediate alloplastic breast reconstruction. A retrospective chart review of those who underwent immediate alloplastic breast reconstruction from January to December 2016 was performed. This encompassed 64 consecutive patients (95 breasts) with tissue expander or direct-to-implant reconstruction and either AlloDerm or DermACELL ADM. Demographics, particulars of the surgery, additional treatments and complications were all recorded. Differences in seroma, haematoma and infection rates, as well as more serious complications including implant replacement, capsular contracture and failure, were all reviewed. The groups were comparable in terms of age, BMI and relevant comorbidities. Mastectomy weight and resulting implant volume were higher in the DermACELL group, with volume reaching statistical significance (p = 0.001). With an average follow-up of 18 months, there was no difference in capsular contraction or implant replacement. However, in those who developed capsular contracture in the DermACELL group, more breasts had no history of radiation, which was significant (p = 0.042). Overall, there were no significant differences in complication rates of seroma, haematoma, mastectomy flap necrosis and infection.
Collapse
Affiliation(s)
- Heather Greig
- Plastic & Reconstructive Surgery Service, University of British Columbia, #1000-777W. Broadway, Vancouver, BC V5Z4J7, Canada
| | - Janine Roller
- Plastic & Reconstructive Surgery Service, University of British Columbia, #1000-777W. Broadway, Vancouver, BC V5Z4J7, Canada
| | | | - Nancy Van Laeken
- Plastic & Reconstructive Surgery Service, University of British Columbia, #1000-777W. Broadway, Vancouver, BC V5Z4J7, Canada
| |
Collapse
|
50
|
Manyam BV, Shah C, Woody NM, Reddy CA, Weller MA, Juloori A, Naik M, Valente S, Grobmyer S, Durand P, Djohan R, Tendulkar RD. Long-term complications and reconstruction failures in previously radiated breast cancer patients receiving salvage mastectomy with autologous reconstruction or tissue expander/implant-based reconstruction. Breast J 2019; 25:1071-1078. [PMID: 31264293 DOI: 10.1111/tbj.13428] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/26/2018] [Accepted: 12/17/2018] [Indexed: 11/30/2022]
Abstract
Salvage mastectomy (SM) is the standard of care for patients with local recurrence (LR) after breast conservation therapy (BCT), often with immediate reconstruction. Complications of reconstruction are a concern for these patients, and long-term data are limited. We sought to compare rates of complications requiring re-operation (CRR) and reconstruction failure (RF) between autologous reconstruction (AR) and tissue expander/implant reconstruction (TE/I). Patients with locally recurrent breast cancer after BCT, treated with SM and immediate AR or TE/I between 2000 and 2008, were identified. CRR was defined as unplanned return to operating room for wound infection, dehiscence, necrosis (including flap, skin, or fat), hematoma, or hernia (for AR) and extrusion, leak, or capsular contracture (for TE/I). RF was defined as conversion to another reconstruction technique or to flat chest wall. This study included 103 patients with 107 reconstructions. Median follow-up was 6.6 years. CRR and RF were significantly higher with TE/I (n = 34) compared to AR (n = 73) at 5 years (50.9% vs 25.5%; P = 0.02) and (42.1% vs 5.8%; P < 0.001). On univariate analysis (UVA), TE/I (HR = 2.14; P = 0.02) and diabetes (HR = 5.10; P = 0.007) were significant predictors for CRR. On UVA, TE/I (HR = 7.30; P < 0.001) and older age at reconstruction (HR = 1.03; P = 0.003) were significant predictors for RF. In this population of previously irradiated patients, TE/I was associated with significantly higher CRR and RF. Complications continue to occur up to 10 years after TE/I. AR should be considered in appropriately selected patients, though TE/I may remain a reasonable option in patients without high-risk factors for surgical complications.
Collapse
Affiliation(s)
- Bindu V Manyam
- Department of Radiation Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio
| | - Chirag Shah
- Department of Radiation Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio
| | - Neil M Woody
- Department of Radiation Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio
| | - Chandana A Reddy
- Department of Radiation Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio
| | - Michael A Weller
- Department of Radiation Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio
| | - Aditya Juloori
- Department of Radiation Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio
| | - Mihir Naik
- Department of Radiation Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio
| | | | | | - Paul Durand
- Department of Plastic Surgery, Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Risal Djohan
- Department of Plastic Surgery, Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rahul D Tendulkar
- Department of Radiation Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio
| |
Collapse
|