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Schneider J, Lim ST, Yi An Y, Suh YJ. Eosinophilic Dermatoses: Cause of Non-Infectious Erythema after Volume Replacement with Diced Acellular Dermal Matrix in Breast Cancer? Life (Basel) 2024; 14:608. [PMID: 38792629 PMCID: PMC11122398 DOI: 10.3390/life14050608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/21/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION Non-infectious erythema, or Red Breast Syndrome (RBS), has been observed on the skin where acellular dermal matrix was implanted, although the exact cause is yet to be determined. PATIENTS AND METHODS A total of 214 female patients underwent breast-conserving surgery (BCS) and volume replacement using diced acellular dermal matrix (dADM) for breast cancer between December 2017 and December 2018. After collecting and evaluating relevant clinical data, inflammation markers, along with NK cell status presented by IFN-γ secretion assay, were measured using ELISA. RESULTS Nineteen patients (8.88%) presented with RBS after BCS and dADM use. A significant increase of platelet-to-lymphocyte ratio was noted in the non-RBS group (p = 0.02). Compared to the RBS group (p = 0.042), the WBC level of the non-RBS group showed significant decrease over time. Eosinophil counts increased significantly at follow-up but went up higher in the RBS group. Multivariate analysis showed preoperative chemotherapy significantly increased the hazard of RBS (OR 3.274, p = 0.047 and OR 17.098, p < 0.001, respectively). DISCUSSION Though no causal relationship between RBS and immune status was proven, the results suggest an association between preoperative chemotherapy and RBS in addition to the possible role of eosinophilia in leading to eosinophilic dermatoses, which warrants further exploration and elucidation.
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Affiliation(s)
- Jean Schneider
- School of Medicine, Texas Tech University Health Science Center, Lubbock, TX 79430, USA;
| | - Seung Taek Lim
- Division of Breast and Thyroid Surgical Oncology, Department of Surgery, The Catholic University of Korea St. Vincent’s Hospital, Suwon 16247, Republic of Korea;
| | - Yeong Yi An
- Department of Radiology, The Catholic University of Korea St. Vincent’s Hospital, Suwon 16247, Republic of Korea;
| | - Young Jin Suh
- Division of Breast and Thyroid Surgical Oncology, Department of Surgery, The Catholic University of Korea St. Vincent’s Hospital, Suwon 16247, Republic of Korea;
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Ng TP, Loo BYK, Yong N, Chia CLK, Lohsiriwat V. Review: Implant-Based Breast Reconstruction After Mastectomy for Breast Cancer: A Meta-analysis of Randomized Controlled Trials and Prospective Studies Comparing Use of Acellular Dermal Matrix (ADM) Versus Without ADM. Ann Surg Oncol 2024; 31:3366-3376. [PMID: 38285304 DOI: 10.1245/s10434-024-14943-4] [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: 09/15/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Breast cancer is the world's most prevalent cancer, and many breast cancer patients undergo mastectomy as the choice of treatment, often with post-mastectomy breast reconstruction. Acellular dermal matrix (ADM) use has become a method to improve outcomes of reconstruction for these patients. We aimed to compare postoperative complications and patient-reported outcomes, which are still poorly characterized, between groups utilizing acellular dermal matrix during reconstruction and those without. MATERIALS AND METHODS We searched electronic databases from inception to 16 June 2022 for randomized controlled trials and prospective cohort studies comparing the outcomes of patients who have and have not received acellular dermal matrix in implant-based breast reconstruction. The results were quantitatively combined and analyzed using random-effects models. RESULTS A total of nine studies were included, representing 3161 breasts. There was no significant difference in postoperative outcomes, such as seroma formation (p = 0.51), hematomas (p = 0.20), infections (p = 0.21), wound dehiscence (p = 0.09), reoperations (p = 0.70), implant loss (p = 0.27), or skin necrosis (p = 0.21). Only two of the studies included evaluated patient-reported outcomes between the use and non-use of ADM in implant-based breast reconstruction using BREAST-Q questionnaire, as well as self-reported pain. There was no reported significant difference in BREAST-Q or pain scores. CONCLUSIONS This meta-analysis shows comparable short- and long-term outcomes between ADM and non-ADM breast reconstruction, suggesting that the use of ADM may not be necessary in all cases given their additional cost. However, there is a paucity of data for patient-reported outcomes, and further research is required to determine whether ADM use affects patient-reported outcomes.
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Affiliation(s)
- Trina Priscilla Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Breast Surgery Service, Department of Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Brandon Yong Kiat Loo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Breast Surgery Service, Department of Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Nicole Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Breast Surgery Service, Department of Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Clement Luck Khng Chia
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Breast Surgery Service, Department of Surgery, Khoo Teck Puat Hospital, Singapore, Singapore.
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Visnu Lohsiriwat
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Mohan AS, Sullivan J, Tenenbaum MM, Broderick KB, Myckatyn TM. Toward a Consensus Aproach for Assessing Capsular Contracture Severity and Progression: A Systematic Review. Plast Reconstr Surg 2024; 153:7-22. [PMID: 37075286 PMCID: PMC10729898 DOI: 10.1097/prs.0000000000010573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/11/2022] [Indexed: 04/21/2023]
Abstract
BACKGROUND Breast implants are the most commonly used medical devices in plastic surgery, and capsular contracture (CC) is one of the most common complications. However, our assessment of CC is based largely on Baker grade, which is problematically subjective and affords only four possible values. METHODS The authors performed a systematic review concluding in September of 2021 in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. It identified 19 articles that propose approaches to measuring CC. RESULTS In addition to Baker grade, the authors identified several modalities reported to measure CC. These included magnetic resonance imaging, ultrasonography, sonoelastography, mammacompliance measuring devices, applanation tonometry, histologic evaluation, and serology. Capsule thickness and other measures of CC inconsistently correlated with Baker grade, whereas the presence of synovial metaplasia was consistently associated with Baker grade I and II, but not III and IV capsules. CONCLUSIONS There remains no particular method to reliably and specifically measure the contracture of capsules that form around breast implants. As such, we would recommend that research investigators use more than one modality to measure CC. Other variables that can impact breast implant stiffness and associated discomfort beyond CC need to be considered when evaluating patient outcomes. Given the value placed on CC outcomes in assessing breast implant safety, and the prevalence of breast implants overall, the need for a more reliable approach to measuring this outcome persists.
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Affiliation(s)
- Abee S. Mohan
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine
| | - Janessa Sullivan
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine
| | - Marissa M. Tenenbaum
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine
| | - Kristen B. Broderick
- From the Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine
| | - Terence M. Myckatyn
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine
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Han WY, Han SJ, Eom JS, Kim EK, Han HH. A Comparative Study of Wraparound versus Anterior Coverage Placement of Acellular Dermal Matrix in Prepectoral Breast Reconstruction. Plast Reconstr Surg 2023; 152:716-724. [PMID: 36862962 DOI: 10.1097/prs.0000000000010347] [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 Prepectoral direct-to-implant insertion (DTI) with acellular dermal matrix (ADM) is the currently preferred operation for breast reconstruction. There are different placements of ADM, which are largely classified as wraparound placement or anterior coverage placement. Because there are limited data comparing these two placements, this study aimed to compare the outcomes of these two methods. METHODS This was a retrospective study of immediate prepectoral DTI breast reconstructions performed by a single surgeon between 2018 and 2020. Patients were classified depending on the ADM placement type used. Surgical outcomes and breast shape changes using nipple position during follow-up were compared. RESULTS A total of 159 patients were included in the study, with 87 in the wraparound group and 72 in the anterior coverage group. Demographics were similar between the two groups, excluding ADM amount used (154.1 cm 2 versus 137.8 cm 2 ; P = 0.01). There were no significant differences in the overall rate of complications between the two groups, including seroma (6.90% versus 5.56%; P = 1.0), total drainage amount (762.1 mL versus 805.9 mL; P = 0.45), and capsular contracture (4.6% versus 1.39%; P = 0.38). The wraparound group had a significantly longer distance change than that of the anterior coverage group in the sternal notch-to-nipple distance (4.44% versus 2.08%; P = 0.03) and midclavicle-to-nipple distance (4.94% versus 2.64%; P = 0.04). CONCLUSIONS Wraparound and anterior coverage placement of ADM in prepectoral DTI breast reconstruction showed similar complication rates, including seroma, drainage amount, and capsular contracture. However, wraparound placement can make the breast more ptotic in shape compared with anterior coverage placement. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Woo Yeon Han
- From the Department of Plastic and Reconstructive Surgery, Yongin Severance Hospital, Yonsei University College of Medicine
| | - Seong John Han
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Jin Sup Eom
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Eun Key Kim
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Hyun Ho Han
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine
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Walker JN, Hanson BM, Hunter T, Simar SR, Duran Ramirez JM, Obernuefemann CLP, Parikh RP, Tenenbaum MM, Margenthaler JA, Hultgren SJ, Myckatyn TM. A prospective randomized clinical trial to assess antibiotic pocket irrigation on tissue expander breast reconstruction. Microbiol Spectr 2023; 11:e0143023. [PMID: 37754546 PMCID: PMC10581127 DOI: 10.1128/spectrum.01430-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/31/2023] [Indexed: 09/28/2023] Open
Abstract
Bacterial infection is the most common complication following staged post-mastectomy breast reconstruction initiated with a tissue expander (TE). To limit bacterial infection, antibiotic irrigation of the surgical site is commonly performed despite little high-quality data to support this practice. We performed a prospective randomized control trial to compare the impact of saline irrigation alone to a triple antibiotic irrigation regimen (1 g cefazolin, 80 mg gentamicin, and 50,000 units of bacitracin in 500 mL of saline) for breast implant surgery. The microbiome in breasts with cancer (n = 16) was compared to those without (n = 16), as all patients (n = 16) had unilateral cancers but bilateral mastectomies (n = 32). Biologic and prosthetic specimens procured both at the time of mastectomy and during TE removal months later were analyzed for longitudinal comparison. Outcomes included clinical infection, bacterial abundance, and relative microbiome composition. No patient in either group suffered a reconstructive failure or developed an infection. Triple antibiotic irrigation administered at the time of immediate TE reconstruction did not reduce bacterial abundance or impact microbial diversity relative to saline irrigation at the time of planned exchange. Implanted prosthetic material adopted the microbial composition of the surrounding host tissue. In cancer-naïve breasts, relative to saline, antibiotic irrigation increased bacterial abundance on periprosthetic capsules (P = 0.03) and acellular dermal matrices (P = 0.04) and altered the microbiota on both. These data show that, relative to saline only, the use of triple antibiotic irrigation in TE breast reconstruction does impact the bacterial abundance and diversity of certain biomaterials from cancer-naïve breasts. IMPORTANCE The lifetime risk of breast cancer is ~13% in women and is treated with a mastectomy in ~50% of cases. The majority are reconstructed, usually starting with a tissue expander to help restore the volume for a subsequent permanent breast implant or the women's own tissues. The biopsychosocial benefits of breast reconstruction, though, can be tempered by a high complication rate of at least 7% but over 30% in some women. Bacterial infection is the most common complication, and can lead to treatment delays, patient physical and emotional distress and escalating health care cost. To limit this risk, plastic surgeons have tried a variety of strategies to limit bacterial infection including irrigating the pocket created after removing the breast implant with antibiotic solutions, but good-quality data are scarce. Herein, we study the value of antibiotics in pocket irrigation using a robust randomized clinical trial design and molecular microbiology approaches.
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Affiliation(s)
- Jennifer N. Walker
- Department of Microbiology and Molecular Genetics, McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas, USA
- Department of Epidemiology, Human Genetics & Environmental Sciences, Center for Infectious Diseases, School of Public Health, University of Texas Health Sciences Center, Houston, Texas, USA
| | - Blake M. Hanson
- Department of Epidemiology, Human Genetics & Environmental Sciences, Center for Infectious Diseases, School of Public Health, University of Texas Health Sciences Center, Houston, Texas, USA
- Division of Infectious Disease, Department of Pediatrics, McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas, USA
- Center for Antimicrobial Resistance and Microbial Genomics, McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas, USA
| | - Tayler Hunter
- Department of Microbiology and Molecular Genetics, McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas, USA
| | - Shelby R. Simar
- Department of Epidemiology, Human Genetics & Environmental Sciences, Center for Infectious Diseases, School of Public Health, University of Texas Health Sciences Center, Houston, Texas, USA
- Division of Infectious Disease, Department of Pediatrics, McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas, USA
- Center for Antimicrobial Resistance and Microbial Genomics, McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas, USA
| | - Jesus M. Duran Ramirez
- Department of Microbiology and Molecular Genetics, McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas, USA
| | - Chloe L. P. Obernuefemann
- Department of Molecular Microbiology, Washington University School of Medicine, Saint Louis, Missouri, USA
- Center for Women’s Infectious Disease Research, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Rajiv P. Parikh
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Marissa M. Tenenbaum
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Julie A. Margenthaler
- Division of Surgical Oncology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Scott J. Hultgren
- Department of Molecular Microbiology, Washington University School of Medicine, Saint Louis, Missouri, USA
- Center for Women’s Infectious Disease Research, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Terence M. Myckatyn
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
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Lee ZH, Diep GK, Brydges HT, Berman ZP, Alfonso AR, Ramly EP, Chaya BF, Thanik VD. Do Corporate Payments Influence Research Related to the Use of Acellular Dermal Matrices in Breast Surgery? Plast Reconstr Surg 2023; 152:376e-384e. [PMID: 36827475 DOI: 10.1097/prs.0000000000010320] [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: 02/26/2023]
Abstract
BACKGROUND No study has assessed the impact of financial conflicts of interests (COIs) on the reporting of breast reconstruction outcomes with acellular dermal matrix (ADM) in peer-reviewed publications. The authors hypothesized that there is (1) an association between financial COIs and likelihood of studies reporting benefits in using ADM, and (2) inconsistent reporting of financial COIs. METHODS The PubMed database was used to identify articles that reported on the use of ADM in breast surgery in four leading plastic surgery journals from January of 2014 to December of 2019. Financial COIs for authors were determined using the open payments database. RESULTS Fifty-five articles were included. Twenty-four articles (43.6%) supported use of ADM, 12 (21.8%) did not promote ADM use, and 19 (34.5%) were neutral. Fifty-one studies (92.7%) had either a first or senior author with a COI, and authors with a COI more commonly reported positive outcomes ( P = 0.02). Studies with positive outcomes featured first authors who received significantly larger financial payments ($95,955 versus $15,642; P = 0.029) compared with studies with negative or neutral outcomes. Receiver operating characteristic curve demonstrated that studies with first authors receiving over $376.28 were more likely to report positive results. Eight senior authors and three first authors received greater than $500 from ADM producers yet did not report any financial disclosure. CONCLUSIONS Financial COI is associated with higher likelihood of studies reporting benefit of using ADM in breast surgery. There remains inconsistent reporting of COIs, and better oversight is needed to ensure unbiased publication on the use of ADM in breast surgery.
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Affiliation(s)
- Z-Hye Lee
- From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center
| | - Gustave K Diep
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Hilliard T Brydges
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Zoe P Berman
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Allyson R Alfonso
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Elie P Ramly
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Bachar F Chaya
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Vishal D Thanik
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
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Impact of Chemotherapy and Radiation Therapy on Inflammatory Response, Neovascularization, and Capsule Formation of Acellular Dermal Matrix in Breast Reconstruction: Analysis of the BREASTrial Biopsy Specimens. Plast Reconstr Surg 2022; 149:378e-385e. [PMID: 35196668 DOI: 10.1097/prs.0000000000008824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Breast Reconstruction Evaluation of Acellular Dermal Matrix as a Sling Trial is a single-center, blinded, prospective, randomized, controlled trial established to compare outcomes using two popular types of acellular dermal matrices, AlloDerm and DermaMatrix, in tissue expander breast reconstruction. This study used the acellular dermal matrix biopsy specimens from the trial to evaluate how adjuvant therapy influences inflammation, neovascularization, and capsule formation of the acellular dermal matrix. METHODS Punch biopsy specimens were taken at the time of expander exchange and were analyzed by a blinded pathologist. The inflammatory response was quantified by the number of fibroblasts, giant cells, and lymphocytes. Neovascularization and capsule formation were similarly quantified by the number of new capillaries and capsule presence and thickness, respectively. RESULTS Histology specimens were collected from 109 patients (170 breasts). In the absence of adjuvant therapy, there was no significant difference between AlloDerm and DermaMatrix in terms of inflammation, neovascularization, or capsule thickness. Both acellular dermal matrices showed a significant decrease in inflammation and neovascularization with adjuvant therapy. When chemotherapy and radiation therapy were used, the decrease in inflammation was greatest for the group reconstructed with DermaMatrix (p < 0.039). CONCLUSIONS Adjuvant therapy influences the inflammatory response, neovascularization, and capsule formation in both acellular dermal matrices. Adjuvant therapy has a protective effect on the inflammatory response toward both acellular dermal matrices in breast reconstruction. In the setting of chemotherapy and radiation therapy, DermaMatrix produced the greatest reduction in inflammation. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Kim JY, Yang KM, Youn JH, Park H, Hahn HM, Lee IJ. In Vitro Analysis of Histology, Mechanics, and Safety of Radiation-free Pre-hydrated Human Acellular Dermal Matrix. J Breast Cancer 2020; 23:635-646. [PMID: 33408889 PMCID: PMC7779726 DOI: 10.4048/jbc.2020.23.e64] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/28/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose Acellular dermal matrix (ADM) supports tissue expanders or implants in implant-based breast reconstruction. The characteristics of ADM tissue are defined by the manufacturing procedure, such as decellularization, preservation, and sterilization, and are directly related to clinical outcomes. This study aimed to compare the properties of a new pre-hydrated-ADM (H-ADM-low) obtained using a decellularization reagent reduction process with a low concentration of detergent with those of radiation-sterilized H-ADM and freeze-dried ADM (FD-ADM). Methods ADMs were evaluated in terms of structure, mechanical quality, and cytotoxicity using histochemical staining, tensile strength testing, and in vitro cell viability analysis. Results The tissue structure of H-ADM-low (CGDERM ONE-STEP) was similar to that of native skin despite complete decellularization. By contrast, in FD-ADM, the tissue structure was damaged by the freeze-drying process, and radiation-sterilized H-ADM showed a compact fibrillar arrangement. Furthermore, matrix components such as collagen and elastin were preserved in H-ADM-low, whereas a loss of elastin fibers with fragmented distribution was observed in radiation-sterilized H-ADMs. H-ADM-low's tensile strength (58.84 MPa) was significantly greater than that of FD-ADM (38.60 MPa) and comparable with that of radiation-sterilized H-ADMs. The residual detergent content in H-ADM-low (47.45 mg/L) was 2.67-fold lower than that of H-ADM decellularized with a conventional detergent concentration (126.99 mg/mL), and this finding was consistent with the cell viability results (90.7% and 70.7%, respectively), indicating that H-ADM-low has very low cytotoxicity. Conclusions H-ADM-low produced through aseptic processes retains the original tissue structure, demonstrates excellent mechanical properties, and does not affect cell viability. Therefore, this newer H-ADM is suitable for use in implant-based breast reconstruction.
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Affiliation(s)
- Ji Young Kim
- Department of Surgery, Ajou University Hospital, Suwon, Korea
| | - Kyung Min Yang
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Korea
| | | | | | - Hyung Min Hahn
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Il Jae Lee
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Korea
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Bloom JA, Asban A, Tian T, Sekigami Y, Losken A, Chatterjee A. A Cost-Utility Analysis Comparing Immediate Oncoplastic Surgery with Delayed Oncoplastic Surgery in Smoking Breast Cancer Patients. Ann Surg Oncol 2020; 28:2579-2588. [PMID: 33051741 DOI: 10.1245/s10434-020-09220-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/18/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Oncoplastic reduction mammoplasty for smoking breast cancer patients committed to smoking cessation may be performed immediately (increasing smoking-related risk) or in a delayed fashion (increasing radiation-related risk). OBJECTIVE Our aim was to examine the cost utility of immediate versus delayed oncoplastic reconstruction when operating on a smoking patient with breast cancer and macromastia with a long-term commitment to smoking cessation. METHODS A literature review determined the probabilities and outcomes for the treatment of unilateral breast cancer with immediate or delayed oncoplastic surgery. Reported utility scores were used to estimate quality-adjusted life-years (QALYs) for varying health states. A decision analysis tree was constructed with rollback analysis to highlight the more cost-effective strategy, and an incremental cost-utility ratio (ICUR) was calculated. Sensitivity analyses were performed to validate the robustness of the results. RESULTS Immediate oncoplastic surgery is associated with a higher clinical effectiveness (QALY) of 33.3 compared with delayed oncoplastic surgery (33.26), with a higher increment of clinical effectiveness of 0.07 and relative cost reduction of $3458.11. This resulted in a negative ICUR of -50,194, which favored immediate reconstruction, indicating a dominant strategy. In one-way sensitivity analyses, delayed reconstruction was the more cost-effective strategy if the probability of successful immediate reconstruction falls below 29% or its cost exceeds $29,611. Monte-Carlo analysis showed a confidence of 99% that immediate oncoplastic surgery is more cost effective. CONCLUSIONS Despite the risk of postoperative complications associated with smoking, immediate oncoplastic surgery is more cost effective compared with delayed oncoplastic surgery in which reconstructive surgery would occur after radiation.
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Affiliation(s)
- Joshua A Bloom
- Department of Surgery, Tufts Medical Center, Boston, MA, USA. .,, Melrose, MA, USA.
| | - Ammar Asban
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tina Tian
- Department of Surgery, Tufts Medical Center, Boston, MA, USA
| | - Yurie Sekigami
- Department of Surgery, Tufts Medical Center, Boston, MA, USA
| | - Albert Losken
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Atlanta, GA, USA
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10
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Stein MJ, Chung A, Arnaout A, Ghaedi B, Ghumman A, Zhang T, Zhang J. Complication rates of acellular dermal matrix in immediate breast reconstruction with radiation: A single-institution retrospective comparison study. J Plast Reconstr Aesthet Surg 2020; 73:2156-2163. [PMID: 32561384 DOI: 10.1016/j.bjps.2020.05.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 03/23/2020] [Accepted: 05/15/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The use of acellular dermal matrix (ADM) in immediate breast reconstruction (IBR) continues to rise despite ongoing concerns with respect to increased complication rates. While the indications for radiation continue to broaden, it is essential to critically evaluate ADM's performance in its context. The purpose of this study was to review complication rates between patients reconstructed with and without ADM, who underwent IBR and radiation. METHODS A retrospective review was performed for patients undergoing IBR and radiation from 2010 to 2019. Postoperative outcomes were compared between patients with and without ADM. RESULTS Over a 9-year period, 130 patients underwent IBR and radiation (42% preoperatively and 59% postoperatively). For patients with preoperative radiation (36 ADM and 18 non-ADM), the average follow-up was 312 and 296 days, respectively. In this group, there was no difference in minor complications (25% ADM, 22% non-ADM, and p = 1.00) or major complications (31% ADM, 22% Non-ADM, and p = 0.52). For patients with postoperative radiation (53 ADM and 23 non-ADM), the average follow-up was 544 and 748 days, respectively. There was no difference in minor complications (21% ADM, 26% non-ADM, and p = 0.11) or major complications (21% ADM, 26% non-ADM, and p = 0.61). Multivariable logistic regression analyses showed no difference between ADM and non-ADM groups (OR 0.83, 95% CI 0.22-3.08, and p = 0.78). CONCLUSION Despite increasing literature supporting the use of ADM in breast reconstruction, postoperative outcomes following radiation remain poorly understood. In the present study, we report no difference in overall complication rates between breasts reconstructed with and without ADM in an irradiated field. Nevertheless, the complication rate remains high, and future studies will be required to determine whether ADM-associated complications in an irradiated field outweigh the purported benefits.
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Affiliation(s)
- Michael J Stein
- Division of Plastic and Reconstructive Surgery, University of Ottawa, Ottawa, Ontario, Canada.
| | - Amy Chung
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Angel Arnaout
- Division of General Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Bahareh Ghaedi
- Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ammara Ghumman
- Division of Plastic and Reconstructive Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Tinghua Zhang
- Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jing Zhang
- Division of Plastic and Reconstructive Surgery, University of Ottawa, Ottawa, Ontario, Canada.
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Polotto S, Bergamini ML, Pedrazzi G, Arcuri MF, Gussago F, Cattelani L. One-step prepectoral breast reconstruction with porcine dermal matrix-covered implant: a protective technique improving the outcome in post-mastectomy radiation therapy setting. Gland Surg 2020; 9:219-228. [PMID: 32420245 DOI: 10.21037/gs.2020.01.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Post-mastectomy radiotherapy (PMRT) applied on implant-assisted immediate breast reconstruction (IBR) involves a marked increase in complication rate. The recent opportunity of performing an ADM-assisted prepectoral breast reconstruction (PPBR) raised the hypotesis of a protective interaction between ADM and periprosthetic tissues under PMRT. Methods We performed a retrospective monocentric analysis of a cohort of consecutively treated patients undergone one-step PPBR between January 2015 and September 2018. The aim is to examine complication rate and aesthetic satisfaction of patients, in order to evaluate if this reconstructive technique could be recommendable in PMRT setting. Group 1 comprised 158 patients not submitted to PMRT and Group 2 twenty-eight patients undergone PMRT. Results All post-operative complications were not statistically different between the two groups, except for capsular contracture (P=0.011). We obtained very high percentages in all BREAST-Q categories in Group 2 patients: satisfaction with breasts 86.8±13.9, satisfaction with implants 6.5±3.0, high satisfaction for no adverse effects of radiation 15.7±6.8. According to multivariate analysis no risk factor was significantly associated with complications. Conclusions We may conclude that one-step PPBR with porcine ADM followed by PMRT is well tolerated, with no significant risk of adverse outcomes, at least in the short-term follow-up. These promising outcomes warrant further studies to examine the existence of a protective effect due to ADM integration with subcutaneous tissue.
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Affiliation(s)
- Susanna Polotto
- Breast Surgical Unit, University Hospital of Parma, Parma (PR), Italy
| | | | - Giuseppe Pedrazzi
- Neuroscience Unit, Department of Medicine and Surgery, University of Parma, Parma (PR), Italy
| | - Maria F Arcuri
- Breast Surgical Unit, University Hospital of Parma, Parma (PR), Italy
| | - Francesca Gussago
- Breast Surgical Unit, University Hospital of Parma, Parma (PR), Italy
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Gwak H, Jeon YW, Lim ST, Park SY, Suh YJ. Volume replacement with diced acellular dermal matrix in oncoplastic breast-conserving surgery: a prospective single-center experience. World J Surg Oncol 2020; 18:60. [PMID: 32209100 PMCID: PMC7093974 DOI: 10.1186/s12957-020-01835-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 03/17/2020] [Indexed: 01/13/2023] Open
Abstract
Background Several studies have reported the use of acellular dermal matrix in breast reconstruction. However, the primary role of acellular dermal matrix in these studies was to support the implant; there are no reports on the use of acellular dermal matrix exclusively as volume replacement. Thus, we aimed to evaluate the safety and effectiveness of filling of the defect with acellular dermal matrix in oncoplastic breast-conserving surgery. Methods We prospectively recruited 120 adult breast cancer patients who were scheduled to undergo oncoplastic breast-conserving surgery with acellular dermal matrix filling from 2017 to 2018. Intraoperatively, diced human acellular dermal matrix measuring 3–5 mm was used on each side to fill in the excisional defect immediately. After 6 months, satisfaction of the patients and surgeons with overall and cosmetic outcomes was evaluated with a survey using a 10-point scale. Postoperative complications were assessed at 2 weeks and 6 months postoperatively. Results Of the 117 patients who were evaluated for their satisfaction, 94.0% were strongly satisfied with the cosmetic outcomes and 90.4% were strongly satisfied overall. Patient overall satisfaction scores were higher than surgeon satisfaction scores (p < 0.001). Of the 117 patients who underwent evaluation of complications 6 months postoperatively, six (5.1%) had hematoma and seven (6.0%) had seroma. The overall reoperation rate due to complications was 8.5%. Only two patients needed acellular dermal matrix removal due to hematoma and inflammation. Conclusion Oncoplastic breast-conserving surgery with acellular dermal matrix filling of defects can be performed safely with high cosmetic satisfaction. Trial registration ICTRP, KCT0003886; retrospectively registered May 3, 2019, http://apps.who.int/trialsearch/Trial2.aspx?TrialID=KCT0003886
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Affiliation(s)
- Hongki Gwak
- Division of Breast and Thyroid Surgical Oncology, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Seoul, Suwon, 16247, Republic of Korea
| | - Ye-Won Jeon
- Division of Breast and Thyroid Surgical Oncology, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Seoul, Suwon, 16247, Republic of Korea
| | - Seung-Taek Lim
- Division of Breast and Thyroid Surgical Oncology, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Seoul, Suwon, 16247, Republic of Korea
| | - Seon-Young Park
- Division of Breast and Thyroid Surgical Oncology, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Seoul, Suwon, 16247, Republic of Korea
| | - Young-Jin Suh
- Division of Breast and Thyroid Surgical Oncology, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Seoul, Suwon, 16247, Republic of Korea.
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13
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Chung AM, Stein MJ, Ghumman A, Zhang J. The effect of post mastectomy radiation therapy on breast reconstruction with and without acellular dermal matrix: a systematic review and meta-analysis protocol. Syst Rev 2019; 8:58. [PMID: 30791946 PMCID: PMC6383242 DOI: 10.1186/s13643-019-0958-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 01/22/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The widespread implementation of acellular dermal matrix (ADM) has broadened the reconstructive repertoire for alloplastic breast reconstruction. ADM's role in the context of postoperative radiation therapy remains unclear. The present review will evaluate whether ADM reduces complication rates in patients undergoing post-mastectomy radiation therapy (PMRT). METHODS A healthcare librarian assisted in performing a search strategy of electronic databases MEDLINE (via Ovid), EMBASE, and CENTRAL. A combination of the keywords and Medical Subject Headings (MESH) to describe the various commercially available ADMs and terms for radiation therapy will be used. The search strategy will identify patients undergoing postoperative radiation following implant-based breast reconstruction and compare outcomes between those with and without ADM. Extracted data will include patient demographics, intraoperative data, and postoperative complications. Data on patient satisfaction and resource utilization will also be extracted if available. The references of selected works will be reviewed for additional studies meeting study criteria. Only peer-reviewed papers written in English will be included. The study data will be assessed for risk of bias and heterogeneity. Providing that sufficient studies can be identified, a meta-analysis will be performed. This review has been registered with PROSPERO (CRD42017056495). CONCLUSIONS To date, the short- and long-term performance of ADM in the context of postoperative radiation remains unclear. The objective of the present review will be to critically evaluate the literature with the intention of improving postoperative outcomes in the context of mastectomy and radiation.
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Affiliation(s)
- Amy M Chung
- Faculty of Medicine, University of Ottawa, Ottawa, Canada.
| | - Michael J Stein
- Division of Plastic and Reconstructive Surgery, Univeristy of Ottawa, Ottawa, Ontario, Canada
| | - Ammara Ghumman
- Division of Plastic and Reconstructive Surgery, Univeristy of Ottawa, Ottawa, Ontario, Canada
| | - Jing Zhang
- Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Division of Plastic and Reconstructive Surgery, Univeristy of Ottawa, Ottawa, Ontario, Canada.,Department of Surgery, The Ottawa Hospital - Civic Campus, 1053 Carling Avenue Box 213, Ottawa, ON, K1Y 4E9, Canada
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Wilsher MJ. Unexpected histological appearance of breast implant associated fibrous pseudocapsules. Pathology 2018; 50:782-785. [PMID: 30314643 DOI: 10.1016/j.pathol.2018.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/20/2018] [Accepted: 05/25/2018] [Indexed: 10/28/2022]
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Lee SH, Chun YS, Park HK, Kim YW, Cheon YW. Dual Coverage of the Inferior Pole with Conjoined Fascial Flap and Acellular Dermal Matrix for Immediate One-Stage Breast Reconstruction with a Prosthetic Implant. Aesthetic Plast Surg 2018; 42:1213-1219. [PMID: 29666911 DOI: 10.1007/s00266-018-1138-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/10/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Elevation of a conjoined fascial flap composed of the pectoralis major, serratus anterior, and external oblique fascia is a type of surgical technique using autologous tissue to cover the lower pole after immediate one-stage direct-to-implant (DTI) breast reconstruction. However, volumetric breast implants hinder use of this technique alone. For better structural stability and more aesthetically favorable breast contour in large breasts, we have devised a technique involving dual coverage of the lower pole by a conjoined fascial flap and acellular dermal matrix (ADM). METHODS Twenty Asian patients underwent DTI breast reconstruction from March 2013 to May 2014. ADM was used to cover the inferomedial quadrant of the breast, and a conjoined fascial flap was elevated to cover the remaining inferolateral quadrant. Both patient- and plastic surgeon-reported outcome measures were assessed using questionnaires. RESULT For every domain of the patient- and plastic surgeon-reported questionnaires, the mean scores were between satisfied and very satisfied. Two patients developed a seroma and one patient developed partial skin flap necrosis. Both seromas resolved after a series of aspirations. The necrotic skin flap was revised under local anesthesia 3 weeks after the reconstructive surgery. CONCLUSION The use of dual coverage of the inferior pole with a conjoined fascial flap and ADM for immediate DTI among patients with large breasts is supported by high scores in both patient- and plastic surgeon-reported outcome measures, as well as low complication rates. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Seo H Lee
- Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon, 405-760, Republic of Korea
| | - Yong S Chun
- Department of General Surgery, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Heung K Park
- Department of General Surgery, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Yang W Kim
- Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon, 405-760, Republic of Korea
| | - Young W Cheon
- Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon, 405-760, Republic of Korea.
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Comment on "Evaluation of Complication Rates after Breast Surgery Using Acellular Dermal Matrix: Median Follow-Up of Three Years". PLASTIC SURGERY INTERNATIONAL 2018; 2018:5231565. [PMID: 30009054 PMCID: PMC6020532 DOI: 10.1155/2018/5231565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 03/26/2018] [Indexed: 12/03/2022]
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A New Human-Derived Acellular Dermal Matrix for Breast Reconstruction Available for the European Market: Preliminary Results. Aesthetic Plast Surg 2018; 42:434-441. [PMID: 29302735 DOI: 10.1007/s00266-017-1069-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/20/2017] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The introduction of acellular dermal matrices (ADMs) contributed to the growing diffusion of direct-to-implant breast reconstruction (DTI-BR) following mastectomy for breast cancer. According to specific legislations, European specialists could not benefit from the use of human-derived ADMs, even though most evidence in the literature are available for this kind of device, showed optimal outcomes in breast reconstruction. The Skin Bank of the Bufalini Hospital (Cesena, Italy) obtained in 2009 the approval for the production and distribution of a new human cadaver-donor-derived ADM (named with the Italian acronym, MODA, for matrice omologa dermica acellulata) from the Italian National Transplant Center and National Health Institute. We report preliminary results of MODA application in direct-to-implant breast reconstruction following nipple-areola complex (NAC)-sparing mastectomy for breast cancer treatment. MATERIALS AND METHODS We prospectively enrolled all women undergoing NAC-sparing mastectomy for breast cancer and DTI-BR in our breast surgical unit from June 2015 to January 2017. We enrolled a selected population without previous chest wall irradiation, not being heavy tobacco smokers or diabetic, with a BMI < 30 kg/m2 and requiring less than 550 cc silicone implants. We assessed short-term outcomes, defined as postoperative complications presenting in the first 30 postoperative days and long-term outcomes at 6 and 12 months. RESULTS From June 2015 to January 2017, we treated 56 breasts. At a mean follow-up of 14 months, we observed only two minor complications described as limited wound dehiscences, conservatively managed with complete resolution without implant exposure or re-intervention. CONCLUSIONS Our preliminary results show very good performance of MODA in direct-to-implant breast reconstruction following NAC-sparing mastectomy for breast cancer treatment. This is particularly relevant for the European market, where no other human-derived devices are available for breast reconstruction due to regulatory restrictions. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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What’s New in Acellular Dermal Matrix and Soft-Tissue Support for Prosthetic Breast Reconstruction. Plast Reconstr Surg 2017; 140:30S-43S. [DOI: 10.1097/prs.0000000000003950] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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See MSF, Farhadi J. Radiation Therapy and Immediate Breast Reconstruction: Novel Approaches and Evidence Base for Radiation Effects on the Reconstructed Breast. Clin Plast Surg 2017; 45:13-24. [PMID: 29080655 DOI: 10.1016/j.cps.2017.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Patients who undergo breast reconstruction experience higher complication rates if they have had a history of radiotherapy. However, implant-based reconstruction confers significantly higher complication and reconstruction failure rates compared with autologous reconstruction. This article analyses the factors that contribute to the complications of the different breast reconstruction modalities and the strategies described to mitigate these problems.
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Affiliation(s)
- Marlene Sue-Fen See
- Department of Plastic Surgery, St. Thomas' Hospital, Guy's and St. Thomas' Hospitals NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK.
| | - Jian Farhadi
- Department of Plastic Surgery, St. Thomas' Hospital, Guy's and St. Thomas' Hospitals NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK; Reconstructive and Aesthetic Surgery, University of Basel, Petersplatz 1, 4001 Basel, Switzerland; Centre for Plastic Surgery, Klinik Pyramide am See, Bellerivestrasse 34, 8034 Zürich, Switzerland
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20
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Onesti MG, Maruccia M, Di Taranto G, Albano A, Soda G, Ballesio L, Scuderi N. Clinical, histological, and ultrasound follow-up of breast reconstruction with one-stage muscle-sparing "wrap" technique: A single-center experience. J Plast Reconstr Aesthet Surg 2017; 70:1527-1536. [PMID: 28736191 DOI: 10.1016/j.bjps.2017.06.023] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 05/02/2017] [Accepted: 06/12/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Prepectoral implant placement and complete coverage with porcine acellular matrix after mastectomy is a new concept in breast surgery presented in few cases in the literature. This paper aimed to present our single-center experience in one-stage breast reconstruction muscle-sparing "wrap" technique by evaluating clinical and aesthetic outcomes, ultrasound and histological examination, and patient quality of life. METHODS From January 2014 to January 2017, 52 patients (40 unilateral, 12 bilateral) underwent one-stage muscle-sparing breast reconstructions with Braxon® acellular dermal matrix and implant. In 3 patients, a surgical biopsy and histological examination with immunohistochemical analysis of the periprosthetic tissue were performed. All patients underwent breast ultrasound examination, and the occurrence of capsular contracture was assessed through the Baker classification and by measuring the mammary compliance scores with the Antoon Paar Mammary compliance system. Breast appearance was evaluated using a visual analogue scale (VAS) and in terms of quality of life using the EOCRT QLQ C-30 and QLQ BR-23 questionnaires. RESULTS Early and late postoperative complications are reported. Histological and ultrasound evaluation showed a complete integration of the matrix. According to the VAS scale, the EOCRT QLQ C-30, and QLQ BR-23, patients' satisfaction resulted in a high score in terms of quality of life and aesthetic outcomes. CONCLUSION The results of this new surgical technique in selected cases are promising in terms of effectiveness and low rate of postoperative complications, but further long-terms evaluations are required.
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Affiliation(s)
- Maria Giuseppina Onesti
- Department Surgery "P.Valdoni", Unit of Plastic and Reconstructive Surgery, Sapienza University, Rome, Italy
| | - Michele Maruccia
- Department Surgery "P.Valdoni", Unit of Plastic and Reconstructive Surgery, Sapienza University, Rome, Italy.
| | - Giuseppe Di Taranto
- Department Surgery "P.Valdoni", Unit of Plastic and Reconstructive Surgery, Sapienza University, Rome, Italy
| | - Antonio Albano
- Department Surgery "P.Valdoni", Unit of Plastic and Reconstructive Surgery, Sapienza University, Rome, Italy
| | - Giuseppe Soda
- Department of Molecular medicine, Sapienza University of Rome, Rome, Italy
| | - Laura Ballesio
- Department of Radiological, Oncological, Anatomo-pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Nicolò Scuderi
- Department Surgery "P.Valdoni", Unit of Plastic and Reconstructive Surgery, Sapienza University, Rome, Italy
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Zenn M, Venturi M, Pittman T, Spear S, Gurtner G, Robb G, Mesbahi A, Dayan J. Optimizing Outcomes of Postmastectomy Breast Reconstruction With Acellular Dermal Matrix: A Review of Recent Clinical Data. EPLASTY 2017; 17:e18. [PMID: 28663773 PMCID: PMC5475305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background: This article reports on the current use of acellular dermal matrix in breast reconstruction. Methods: A literature review of articles on acellular dermal matrix in breast reconstruction from January 1, 2010, through December 20, 2016, was performed and analyzed for trends in acellular dermal matrix use and differences between commonly used acellular dermal matrixes. Findings: Clinical findings varied but include improved cosmesis and more 1-stage reconstructions using acellular dermal matrix. Superiority of sterile versus aseptic acellular dermal matrixes was noted, and the increased incidence of red breast syndrome with AlloDerm was significant. The cost-effectiveness of acellular dermal matrix use despite increased upfront costs was also highlighted. Finally, the article emphasizes the importance of well-vascularized mastectomy flaps and the use of indocyanine green angiography as an adjunct in immediate reconstruction with acellular dermal matrix.
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Affiliation(s)
| | - Mark Venturi
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Troy Pittman
- Plastic and Reconstructive Surgery, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Scott Spear
- Private Practice Plastic Surgery, Chevy Chase, MD
| | - Geoffrey Gurtner
- Department of Plastic Surgery, Stanford University, Palo Alto, Calif
| | - Geoffrey Robb
- Department of Plastic Surgery, MD Anderson Cancer Center, Houston, Tex
| | - Alex Mesbahi
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Joseph Dayan
- Department of Plastic Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
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Evaluation of Complication Rates after Breast Surgery Using Acellular Dermal Matrix: Median Follow-Up of Three Years. PLASTIC SURGERY INTERNATIONAL 2017; 2017:1283735. [PMID: 28695010 PMCID: PMC5485347 DOI: 10.1155/2017/1283735] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 05/11/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Acellular dermal matrices (ADMs) are now commonly used for breast reconstruction surgery. There are various products available: ADMs derived from human (HADM), porcine (PADM), or bovine (BADM) sources. Detailed long-term follow-up studies are necessary to detect differences in complication rates between these products. MATERIAL AND METHODS From 2010 to 2015, forty-one patients underwent 52 ADM-breast reconstructions in our clinic, including oncologic breast reconstructions and breast augmentation revisions (n = 52). 15x HADMs (Epiflex®/DIZG), 21x PADMs (Strattice®/LifeCell), and 16x BADMs (Tutomesh®/RTI Surgical) were implanted. Retrospective data collection with median follow-up of 36 months (range: 12-54 months) was performed. RESULTS Overall complication rate was 17% after ADM implantation (HADM: 7%; PADM: 14%; BADM: 31%). In a composite endpoint of complications and Red Breast Syndrome, a lower event probability was observed between BADMs, PADMs, and HADMs (44%, 19%, and 7%, resp.; p = 0.01 for the trend). Furthermore, capsular contracture occurred in 6%, more frequently as compared to the current literature. CONCLUSIONS When ADM-based reconstruction is indicated, the authors suggest primarily the use of HADMs and secondary the use of PADMs. It is shown that BADMs have the highest complication probability within our patient cohort; nevertheless, BADMs convey physical advantages in terms of flexibility and better aesthetic outcomes. The indication for the use of ADMs should be filled for each case individually.
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The Impact of Expander Inflation/Deflation Status During Adjuvant Radiotherapy on the Complications of Immediate Two-Stage Breast Reconstruction. Aesthetic Plast Surg 2017; 41:551-559. [PMID: 28374300 DOI: 10.1007/s00266-017-0864-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 03/19/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The question of whether expander inflation/deflation status has any bearing on surgical complications in the setting of adjuvant radiation (XRT) has not been addressed. The objective of this study is to investigate whether the inflation/deflation status of the expander at the time of XRT is associated with complications in immediate two-stage expander-implant breast reconstruction. METHODS A retrospective review of 49 consecutive patients who underwent immediate two-stage expander-implant breast reconstruction and received post-mastectomy XRT was conducted. Full deflation of the expanders was performed in the deflation group (20 patients), while the expanders remained inflated in the inflation group at the time of XRT (29 patients). XRT-related complications of each stage of reconstructions were compared between the two groups, and multivariable regression analysis was performed to identify risk factors for XRT-related complications. RESULTS Overall XRT-related complications (65.0 vs. 6.9%, p < 0.001) and reconstruction failures (35.0 vs. 6.9%, p = 0.022) of the first-stage reconstructions were significantly higher in the deflation group. The most common cause of reconstruction failure in the deflation group was failure to re-expand due to skin fibrosis and contracture. In multivariable analysis, deflation of expanders was a significant risk factor for overall complications (odds = 94.4, p = 0.001) and reconstruction failures (odds = 9.09, p = 0.022) of the first-stage reconstructions. CONCLUSIONS Maximal inflation without deflation before XRT can be an option to minimize XRT-related complications and reconstruction failure of the first-stage reconstructions. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Assessment and planning for oncoplastic and reconstructive breast surgery: a review and a proposed chart. EUROPEAN JOURNAL OF PLASTIC SURGERY 2016. [DOI: 10.1007/s00238-016-1221-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Schrenk P. Immediate implant-based breast reconstruction using the TIGR® Matrix mesh. BREAST CANCER MANAGEMENT 2016. [DOI: 10.2217/bmt-2016-0003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Different types of acellular dermal, synthetic and biological matrices have been used in connection with immediate implant-based breast reconstruction. Patients & methods: A new long-term absorbable surgical matrix, TIGR® Matrix mesh was used in a total of 29 patients undergoing a total of 37 mastectomies and immediate reconstruction. Results: Early postoperative results showed no adverse reactions to the mesh and a good integration into the tissue. Conclusion: It may therefore constitute an alternative to acellular, dermal or other synthetic matrices currently available.
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Affiliation(s)
- Peter Schrenk
- Breast Cancer Center, Kepler University Clinic, Linz, Austria
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Remodeling Characteristics and Collagen Distributions of Biologic Scaffold Materials Biopsied From Postmastectomy Breast Reconstruction Sites. Ann Plast Surg 2016; 75:74-83. [PMID: 25910026 DOI: 10.1097/sap.0000000000000538] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The study purpose was to evaluate the associations between patient characteristics and the histologic remodeling scores of acellular dermal matrices (ADMs) biopsied from breast reconstruction sites in the first attempt to generate a multivariable risk prediction model of nonconstructive remodeling. It was hypothesized that host characteristics and surgical site assessments predict the degree of graft remodeling for ADMs used during breast reconstruction. METHODS The ADMs were biopsied from the breast reconstruction sites of n = 62 patients during a subsequent breast procedure, stained with hematoxylin-eosin, and evaluated according to a semi-quantitative scoring system for remodeling characteristics (cell types, cell infiltration, extracellular matrix deposition, scaffold degradation, fibrous encapsulation, and neovascularization) and a mean composite score. Biopsies were stained with Sirius Red and Fast Green, and analyzed to determine the collagen I:III ratio. Based on univariate analyses between subject clinical characteristics and the histologic remodeling scores, cohort variables were selected for multivariable regression models using a P value of 0.20 or less. RESULTS The composite score model yielded 3 variables: pack-year history, corticosteroid use, and radiation timing (r pseudo = 0.81). The model for collagen I yielded 2 variables: corticosteroid use and reason for reoperation (r pseudo = 0.78). The model for collagen III yielded 1 variable: reason for reoperation (r pseudo = 0.35). CONCLUSIONS These preliminary results constitute the first steps in generating a risk prediction model that predicts the patients and clinical circumstances most likely to experience nonconstructive remodeling of biologic grafts used to reconstruct the breast.
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Dolen UC, Schmidt AC, Um GT, Sharma K, Naughton M, Zoberi I, Margenthaler JM, Myckatyn TM. Impact of Neoadjuvant and Adjuvant Chemotherapy on Immediate Tissue Expander Breast Reconstruction. Ann Surg Oncol 2016; 23:2357-66. [PMID: 26942453 DOI: 10.1245/s10434-016-5162-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Delayed wound healing or infection leads to premature tissue expander (TE) explantation after immediate postmastectomy breast reconstruction. A large study with sufficient duration of follow-up focusing on the impact of chemotherapy (CT) on premature TE removal after immediate breast reconstruction is lacking. METHODS A retrospective review of patients undergoing immediate TE reconstruction was conducted. Multivariate analyses identified factors contributing to premature removal of TEs including neoadjuvant and adjuvant CT, specific chemotherapeutic regimens, and other factors like cancer stage, body mass index, smoking, radiation, and age. Kaplan-Meier curves were plotted to study the timing of premature TE removal. RESULTS Of 899 patients with TEs, 256 received no, 295 neoadjuvant, and 348 adjuvant CT. Premature removal occurred more frequently in the neoadjuvant (17.3 %) and adjuvant (19.9 %) cohorts than the no-CT (12.5 %) cohort (p = 0.056). Premature TE removal occurred earlier (p = 0.005) in patients who received no CT than those with adjuvant CT. Radiation in patients receiving neoadjuvant CT prolonged the mean time to premature removal (p = 0.003). In the absence of radiation, premature removal occurred significantly sooner with neoadjuvant than adjuvant CT (p = 0.035). DISCUSSION Premature removal of a TE occurs more commonly in patients treated with neoadjuvant or adjuvant CT and is most commonly observed 2-3 months after placement-well after the follow-up period recorded by the American College of Surgeons National Surgery Quality Improvement Program (NSQIP) database. These findings can be used to aid preoperative counseling and guide the timing of follow-up for these patients.
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Affiliation(s)
- Utku C Dolen
- Division of Plastic and Reconstructive Surgery, Alvin J Siteman Cancer Center , Washington University School of Medicine, St. Louis, MO, USA
| | - Alexandra C Schmidt
- Division of Plastic and Reconstructive Surgery, Alvin J Siteman Cancer Center , Washington University School of Medicine, St. Louis, MO, USA
| | - Grace T Um
- Division of Plastic and Reconstructive Surgery, Alvin J Siteman Cancer Center , Washington University School of Medicine, St. Louis, MO, USA
| | - Ketan Sharma
- Division of Plastic and Reconstructive Surgery, Alvin J Siteman Cancer Center , Washington University School of Medicine, St. Louis, MO, USA
| | - Michael Naughton
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Imran Zoberi
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Julie M Margenthaler
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Terence M Myckatyn
- Division of Plastic and Reconstructive Surgery, Alvin J Siteman Cancer Center , Washington University School of Medicine, St. Louis, MO, USA.
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Nahabedian MY. Implant-based breast reconstruction: Strategies to achieve optimal outcomes and minimize complications. J Surg Oncol 2016; 113:895-905. [DOI: 10.1002/jso.24210] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 02/09/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Maurice Y. Nahabedian
- Department of Plastic Surgery; Georgetown University; Washington District of Columbia
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Poppler L, Cohen J, Dolen UC, Schriefer AE, Tenenbaum MM, Deeken C, Chole RA, Myckatyn TM. Histologic, Molecular, and Clinical Evaluation of Explanted Breast Prostheses, Capsules, and Acellular Dermal Matrices for Bacteria. Aesthet Surg J 2015; 35:653-68. [PMID: 26229126 PMCID: PMC4649701 DOI: 10.1093/asj/sjv017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Subclinical infections, manifest as biofilms, are considered an important cause of capsular contracture. Acellular dermal matrices (ADMs) are frequently used in revision surgery to prevent recurrent capsular contractures. OBJECTIVE We sought to identify an association between capsular contracture and biofilm formation on breast prostheses, capsules, and ADMs in a tissue expander/implant (TE/I) exchange clinical paradigm. METHODS Biopsies of the prosthesis, capsule, and ADM from patients (N = 26) undergoing TE/I exchange for permanent breast implant were evaluated for subclinical infection. Capsular contracture was quantified with Baker Grade and intramammary pressure. Biofilm formation was evaluated with specialized cultures, rtPCR, bacterial taxonomy, live:dead staining, and scanning electron microscopy (SEM). Collagen distribution, capsular histology, and ADM remodeling were quantified following fluorescent and light microscopy. RESULTS Prosthetic devices were implanted from 91 to 1115 days. Intramammary pressure increased with Baker Grade. Of 26 patients evaluated, one patient had a positive culture and one patient demonstrated convincing evidence of biofilm morphology on SEM. Following PCR amplification 5 samples randomly selected for 16S rRNA gene sequencing demonstrated an abundance of suborder Micrococcineae, consistent with contamination. CONCLUSIONS Our data suggest that bacterial biofilms likely contribute to a proportion, but not all diagnosed capsular contractures. Biofilm formation does not appear to differ significantly between ADMs or capsules. While capsular contracture remains an incompletely understood but common problem in breast implant surgery, advances in imaging, diagnostic, and molecular techniques can now provide more sophisticated insights into the pathophysiology of capsular contracture. LEVEL OF EVIDENCE 4 Therapeutic.
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Affiliation(s)
- Louis Poppler
- Drs Poppler and Dr Cohen are Residents, Dr Dolen is a Breast Fellow, Dr Tenenbaum is Residency Program Director and Assistant Professor, and Dr Myckatyn is Breast Fellowship Director and Associate Professor, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO. Mr. Schriefer is a Physicist, Genome Technology Access Center, Department of Genetics, Washington University School of Medicine, Saint Louis, MO. Dr Deeken is Director of Biomedical Engineering and Biomaterials Laboratory, Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, MO. and Dr Chole is Lindburg Professor and Chairman, Department of Otolaryngology, and Director of the Biofilm Core Facility, Washington University School of Medicine, Saint Louis, MO
| | - Justin Cohen
- Drs Poppler and Dr Cohen are Residents, Dr Dolen is a Breast Fellow, Dr Tenenbaum is Residency Program Director and Assistant Professor, and Dr Myckatyn is Breast Fellowship Director and Associate Professor, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO. Mr. Schriefer is a Physicist, Genome Technology Access Center, Department of Genetics, Washington University School of Medicine, Saint Louis, MO. Dr Deeken is Director of Biomedical Engineering and Biomaterials Laboratory, Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, MO. and Dr Chole is Lindburg Professor and Chairman, Department of Otolaryngology, and Director of the Biofilm Core Facility, Washington University School of Medicine, Saint Louis, MO
| | - Utku Can Dolen
- Drs Poppler and Dr Cohen are Residents, Dr Dolen is a Breast Fellow, Dr Tenenbaum is Residency Program Director and Assistant Professor, and Dr Myckatyn is Breast Fellowship Director and Associate Professor, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO. Mr. Schriefer is a Physicist, Genome Technology Access Center, Department of Genetics, Washington University School of Medicine, Saint Louis, MO. Dr Deeken is Director of Biomedical Engineering and Biomaterials Laboratory, Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, MO. and Dr Chole is Lindburg Professor and Chairman, Department of Otolaryngology, and Director of the Biofilm Core Facility, Washington University School of Medicine, Saint Louis, MO
| | - Andrew E Schriefer
- Drs Poppler and Dr Cohen are Residents, Dr Dolen is a Breast Fellow, Dr Tenenbaum is Residency Program Director and Assistant Professor, and Dr Myckatyn is Breast Fellowship Director and Associate Professor, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO. Mr. Schriefer is a Physicist, Genome Technology Access Center, Department of Genetics, Washington University School of Medicine, Saint Louis, MO. Dr Deeken is Director of Biomedical Engineering and Biomaterials Laboratory, Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, MO. and Dr Chole is Lindburg Professor and Chairman, Department of Otolaryngology, and Director of the Biofilm Core Facility, Washington University School of Medicine, Saint Louis, MO
| | - Marissa M Tenenbaum
- Drs Poppler and Dr Cohen are Residents, Dr Dolen is a Breast Fellow, Dr Tenenbaum is Residency Program Director and Assistant Professor, and Dr Myckatyn is Breast Fellowship Director and Associate Professor, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO. Mr. Schriefer is a Physicist, Genome Technology Access Center, Department of Genetics, Washington University School of Medicine, Saint Louis, MO. Dr Deeken is Director of Biomedical Engineering and Biomaterials Laboratory, Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, MO. and Dr Chole is Lindburg Professor and Chairman, Department of Otolaryngology, and Director of the Biofilm Core Facility, Washington University School of Medicine, Saint Louis, MO
| | - Corey Deeken
- Drs Poppler and Dr Cohen are Residents, Dr Dolen is a Breast Fellow, Dr Tenenbaum is Residency Program Director and Assistant Professor, and Dr Myckatyn is Breast Fellowship Director and Associate Professor, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO. Mr. Schriefer is a Physicist, Genome Technology Access Center, Department of Genetics, Washington University School of Medicine, Saint Louis, MO. Dr Deeken is Director of Biomedical Engineering and Biomaterials Laboratory, Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, MO. and Dr Chole is Lindburg Professor and Chairman, Department of Otolaryngology, and Director of the Biofilm Core Facility, Washington University School of Medicine, Saint Louis, MO
| | - Richard A Chole
- Drs Poppler and Dr Cohen are Residents, Dr Dolen is a Breast Fellow, Dr Tenenbaum is Residency Program Director and Assistant Professor, and Dr Myckatyn is Breast Fellowship Director and Associate Professor, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO. Mr. Schriefer is a Physicist, Genome Technology Access Center, Department of Genetics, Washington University School of Medicine, Saint Louis, MO. Dr Deeken is Director of Biomedical Engineering and Biomaterials Laboratory, Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, MO. and Dr Chole is Lindburg Professor and Chairman, Department of Otolaryngology, and Director of the Biofilm Core Facility, Washington University School of Medicine, Saint Louis, MO
| | - Terence M Myckatyn
- Drs Poppler and Dr Cohen are Residents, Dr Dolen is a Breast Fellow, Dr Tenenbaum is Residency Program Director and Assistant Professor, and Dr Myckatyn is Breast Fellowship Director and Associate Professor, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO. Mr. Schriefer is a Physicist, Genome Technology Access Center, Department of Genetics, Washington University School of Medicine, Saint Louis, MO. Dr Deeken is Director of Biomedical Engineering and Biomaterials Laboratory, Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, Saint Louis, MO. and Dr Chole is Lindburg Professor and Chairman, Department of Otolaryngology, and Director of the Biofilm Core Facility, Washington University School of Medicine, Saint Louis, MO
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Clemens MW, Kronowitz SJ. Current perspectives on radiation therapy in autologous and prosthetic breast reconstruction. Gland Surg 2015; 4:222-31. [PMID: 26161307 PMCID: PMC4461707 DOI: 10.3978/j.issn.2227-684x.2015.04.03] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 03/20/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Postmastectomy radiation therapy (PMRT) has a well-established deleterious effect on both prosthetic and autologous breast reconstruction. The purpose of this study was to perform a literature review of the effects of PMRT on breast reconstruction and to determine predictive or protective factors for complications. METHODS The MEDLINE and EMBASE databases were reviewed for articles published between January 2008 and January 2015 including the keywords "breast reconstruction" and "radiation therapy" to identify manuscripts focused on the effects of radiation on both prosthetic and autologous breast reconstruction. This subgroup of articles was reviewed in detail. RESULTS Three hundred and twenty articles were identified and 43 papers underwent full text review. The 16 papers provided level III evidence; 10 manuscripts provided level I or II evidence. Seventeen case series provided level IV evidence and were included because they presented novel perspectives. The majority of studies focused on the injurious effects of radiation therapy and increased complications and concomitant lower patient satisfaction. CONCLUSIONS Prosthetic based breast reconstruction and immediate autologous reconstruction are associated with lower patient satisfaction in the setting of radiation therapy. Autologous reconstructions can improve patient satisfaction as well as lower revision surgery and long term complications when performed in a delayed fashion after PMRT.
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Affiliation(s)
- Mark W Clemens
- Department of Plastic Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Steven J Kronowitz
- Department of Plastic Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
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