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Song D, Tang Y, Li Z, Zhou X, Zhang Y, Feng G, Zhou B, Lü C, Yi L, Luo Z, Wang Z. [Effect of free deep inferior epigastric artery perforator flap transplantation in breast shaping of two-staged breast reconstruction with vertical scar]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1323-1327. [PMID: 34651488 DOI: 10.7507/1002-1892.202105016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarize the difficulties and key points of free deep inferior epigastric artery perforator flap (DIEP) transplantation in breast shaping of two-staged breast reconstruction with vertical scar. Methods The clinical data of 32 postoperative breast cancer patients after mastectomy who underwent free DIEP transplantation for breast reconstruction between October 2015 and October 2019, whose original surgical incisions were all vertical and longitudinal, were retrospectively analysed. All the patients were female, aged from 31 to 42 years, with an average of 34.6 years. The disease duration of breast cancer ranged from 9 to 48 months (mean, 22.8 months). Free DIEP pedicled with contralateral vessels were used in all cases, and the recipient vessels were intrathoracic vessels. Among them, 17 flaps were placed longitudinally, 15 flaps were placed obliquely; Z-shaped flaps were used in 18 cases to adjust the chest wall skin contracture, and contralateral breast reduction and mastopexy were accomplished at the same time in 23 cases. Results All DIEP survived completely, and all donor and recipient sites healed by first intention. Internal thoracic lymph node metastasis was found in 1 case and treated with radiotherapy. All 32 cases were followed up 9-48 months, with an average of 19.4 months. The appearance and texture of all flaps were satisfactory, and only linear scar was left in donor site. Eleven patients underwent further autologous fat transplantation and nipple reconstruction. All patients had no effect on abdominal wall activity, and no local recurrence and metastasis was found. Conclusion It is difficult to use free DIEP for two-staged breast reconstruction in patients received mastectomy with vertical longitudinal scar left. Combined with different breast shaping techniques, the outcomes can significantly improve.
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Affiliation(s)
- Dajiang Song
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Yuanyuan Tang
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Zan Li
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Xiao Zhou
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Yixin Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200000, P.R.China
| | - Guang Feng
- Department of Burn and Plastic Reconstructive Surgery, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, P.R.China
| | - Bo Zhou
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Chunliu Lü
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Liang Yi
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Zhenhua Luo
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Zhiyuan Wang
- Ultrasound Diagnosis Center, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China
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Wagner RD, Hamilton KL, Doval AF, Spiegel AJ. How to Maximize Aesthetics in Autologous Breast Reconstruction. Aesthet Surg J 2020; 40:S45-S54. [PMID: 33202010 DOI: 10.1093/asj/sjaa223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
With continuous technical and functional advances in the field of breast reconstruction, there is now a greater focus on the artistry and aesthetic aspects of autologous reconstruction. Whereas once surgeons were most concerned with flap survival and vessel patency, they are now dedicated to reconstructing a similarly or even more aesthetically pleasing breast than before tumor resection. We discuss the approach to shaping the breast through the footprint, conus, and skin envelope. We then discuss how donor site aesthetics can be optimized through flap design, scar management, and umbilical positioning. Each patient has a different perception of their ideal breast appearance, and through conversation and counseling, realistic goals can be set to reach optimal aesthetic outcomes in breast reconstruction.
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Affiliation(s)
- Ryan D Wagner
- Residents, Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, TX
| | - Kristy L Hamilton
- Residents, Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, TX
| | | | - Aldona J Spiegel
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX
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An Aesthetic Factor Priority List of the Female Breast in Scandinavian Subjects. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3173. [PMID: 33173686 PMCID: PMC7647653 DOI: 10.1097/gox.0000000000003173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 08/14/2020] [Indexed: 11/26/2022]
Abstract
There is little consensus about the relative determinative value of each individual factor in female breast aesthetics. When performing breast surgery with an aesthetic goal, certain factors will be more important than others. The purpose of this study was to make an aesthetic factor rank list to determine the relative contributions to overall breast aesthetics.
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The Modified Lateral Intercostal Artery Perforator Flap. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2066. [PMID: 30881825 PMCID: PMC6416140 DOI: 10.1097/gox.0000000000002066] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/10/2018] [Indexed: 11/26/2022]
Abstract
Background The main surgical options for treatment of breast cancer are breast-conserving surgery and mastectomy. BCS aims to achieve complete excision of the tumor while achieving a pleasing cosmetic result. Excision of tumors in the lateral aspect of the breast has been associated with issues such as contour deformities and asymmetry. Development of volume replacement techniques such as the lateral intercostal artery perforator flap (LICAP) aimed to address these issues. Our modification of the traditional LICAP offers a less visible scar, good access to the axilla, and no need to reposition the patient. Methods All patients undergoing a modified LICAP were identified from our database. The lateral intercostal artery perforators were marked with ultrasound and 2 "lazy S" lines were drawn to mark the flap. The wide local excision (with or without axillary surgery) was performed and the flap mobilized to fill the defect. Results Twenty-two patients underwent modified LICAP in 14 months. The mean specimen weight was 86 g. Four patients (18%) had a re-excision for positive margins. Nineteen patients had axillary surgery performed at the time of their modified LICAP flap. No patients had a scar that extended posterior to the posterior axillary line; no patients required a separate incision for axillary surgery; and no patients needed to be repositioned intraoperatively. Conclusions Our early experience with this innovative procedure has been favorable. The perioperative complication rate is low. Due to the relatively short follow-up, longer term outcomes such as postradiotherapy appearance are yet to be determined.
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An international comparison of reimbursement for DIEAP flap breast reconstruction. J Plast Reconstr Aesthet Surg 2015; 68:1529-35. [DOI: 10.1016/j.bjps.2015.06.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 06/09/2015] [Accepted: 06/21/2015] [Indexed: 11/22/2022]
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Nahabedian MY. Achieving ideal breast aesthetics with autologous reconstruction. Gland Surg 2015; 4:134-44. [PMID: 26005645 DOI: 10.3978/j.issn.2227-684x.2015.03.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/05/2015] [Indexed: 11/14/2022]
Abstract
Achieving ideal breast aesthetic has become a top priority for women considering breast reconstruction following mastectomy. The use of autologous tissue is generally regarded as providing the most natural results because donor tissues quality and consistency is similar to that of the native breast. There are several donor sites that are particularly useful for autologous reconstruction that include the abdomen, gluteal region, posterior thorax, and the thigh. Traditional and microsurgical techniques can be used. Shaping is a critical component and involves a basic understanding of the footprint, conus, and skin envelope. This manuscript will review many aspects of breast shaping in-order to achieve aesthetically pleasing results in a predictable manner.
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Affiliation(s)
- Maurice Y Nahabedian
- Department of Plastic Surgery, Georgetown University Hospital, Washington DC 20007, USA
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Blondeel P, Athanasiadou M, Tromaropoulos A. Breast reconstruction. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Guan D, Lin H, Lv Z, Xin Y, Meng K, Song X. The oncoplastic breast surgery with pedicled omental flap harvested by laparoscopy: initial experiences from China. World J Surg Oncol 2015; 13:95. [PMID: 25884817 PMCID: PMC4358712 DOI: 10.1186/s12957-015-0514-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/14/2015] [Indexed: 11/18/2022] Open
Abstract
Background A new technique of oncoplastic breast surgery (OBS) using laparoscopically harvested pedicled omental flap has been developed in the past 10 years. This study aimed to evaluate the feasibility of this technique. Methods Twenty-five patients underwent OBS using laparoscopically harvested omental flap. Operative time, blood loss, complications, recurrence, and cosmetic outcomes were prospectively analyzed. Results Between June 2010 and March 2014, 25 patients were recruited in our study. The surgery was performed successfully in 24 patients. All these patients recovered uneventfully after the surgery. Mean operative time was 310 min, ranging from 205 to 410 min. Mean blood loss was 70 ml, ranging from 20 to 150 ml. Patients were followed up for 32 months on average, ranging from 6 to 51 months. Four patients complained of mild epigastric discomfort. One patient had local recurrence and distant bone and liver metastasis and died 11 months after the surgery. One patient was diagnosed with metastases in the lung, bone, and liver without local recurrence 2 years after surgery. The cosmetic satisfaction rate was 91.7% and 95.8% by surgeon and patients, respectively. Conclusion OBS with laparoscopically harvested omental flap might be a feasible technique with a good cosmetic outcome.
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Affiliation(s)
- Dandan Guan
- Department of Breast and Thyroid Surgery, Zhejiang Provincial People's Hospital, 158 Shang Tang Road, Hangzhou, 310014, Zhejiang Province, China.
| | - Hui Lin
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qing Chun Road, Hangzhou, 310016, Zhejiang Province, China.
| | - Zhenye Lv
- Department of Breast and Thyroid Surgery, Zhejiang Provincial People's Hospital, 158 Shang Tang Road, Hangzhou, 310014, Zhejiang Province, China.
| | - Ying Xin
- Department of Breast and Thyroid Surgery, Zhejiang Provincial People's Hospital, 158 Shang Tang Road, Hangzhou, 310014, Zhejiang Province, China.
| | - Kexin Meng
- Department of Breast and Thyroid Surgery, Zhejiang Provincial People's Hospital, 158 Shang Tang Road, Hangzhou, 310014, Zhejiang Province, China.
| | - Xiangyang Song
- Department of Breast and Thyroid Surgery, Zhejiang Provincial People's Hospital, 158 Shang Tang Road, Hangzhou, 310014, Zhejiang Province, China.
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Munhoz AM, Montag E, Gemperli R. Current aspects of therapeutic reduction mammaplasty for immediate early breast cancer management: An update. World J Clin Oncol 2014; 5:1-18. [PMID: 24527398 PMCID: PMC3920176 DOI: 10.5306/wjco.v5.i1.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 11/02/2013] [Accepted: 11/16/2013] [Indexed: 02/06/2023] Open
Abstract
Breast-conservation surgery (BCS) is established as a safe surgical treatment for most patients with early breast cancer. Recently, advances in oncoplastic techniques are capable of preserving the breast form and quality of life. Although most BCS defects can be managed with primary closure, the aesthetic outcome may be unpredictable. Among technical options, therapeutic reduction mammaplasty (TRM) remains a useful procedure since the BCS defect can be repaired and the preoperative appearance can be improved, resulting in more proportional breasts. As a consequence of rich breast tissue vascularization, the greater part of reduction techniques have based their planning on preserving the pedicle of the nipple-areola complex after tumor removal. Reliable circulation and improvement of a conical shape to the breast are commonly described in TRM reconstructions. With an immediate approach, the surgical process is smooth since both procedures can be carried out in one operative setting. Additionally, it permits wider excision of the tumor, with a superior mean volume of the specimen and potentially reduces the incidence of margin involvement. Regardless of the fact that there is no consensus concerning the best TRM technique, the criteria is determined by the surgeon’s experience, the extent/location of glandular tissue resection and the size of the defect in relation to the size of the remaining breast. The main advantages of the technique utilized should include reproducibility, low interference with the oncological treatment and long-term results. The success of the procedure depends on patient selection, coordinated planning and careful intra-operative management.
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Semprini G, Cattin F, Vaienti L, Brizzolari M, Cedolini C, Parodi P. Oncoplastic surgery and cancer relapses: Cosmetic and oncological results in 489 patients. Breast 2013; 22:946-51. [DOI: 10.1016/j.breast.2013.05.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 11/18/2012] [Accepted: 05/05/2013] [Indexed: 12/22/2022] Open
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Current trends in breast reconstruction: survey of American Society of Plastic Surgeons 2010. Ann Plast Surg 2013; 70:103-10. [PMID: 21862916 DOI: 10.1097/sap.0b013e31822ed5ce] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND We conducted a retrospective survey of American Society of Plastic Surgeons to ascertain the current trends in breast reconstruction (BR). METHODS Surveys were sent to 2250 active American Society of Plastic Surgeons members by e-mail with a cover letter including the link using Survey Monkey for the year 2010. In all, 489 surveys (a response rate of 21.7%) were returned. Three hundred fifty-eight surveys from respondents performing BR in their practices were included in the study. The survey included questions on surgeon demographics, practice characteristics, BR after mastectomy, number of BR per year, type and timing of BR, use of acellular dermal matrix, reconstructive choices in the setting of previous irradiation and in patients requiring postmastectomy radiation therapy, timing of contralateral breast surgery, fat grafting, techniques used for nipple-areola reconstruction, the complications, and physician satisfaction and physician reported patient satisfaction. Returned responses were tabulated and assessed. RESULTS After prophylactic mastectomy, 16% of BRs were performed. In all, 81.2% of plastic surgeons predominantly performed immediate BR. In patients requiring postmastectomy radiation therapy, 81% did not perform immediate BR. Regardless of practice setting and laterality of reconstruction, 82.7% of respondents predominantly performed implant-based BR. Half of the plastic surgeons performing prosthetic BR used acellular dermal matrix. Only 14% of plastic surgeons predominantly performed autologous BR. Surgeons in solo, plastic surgery group practices, and multispecialty group practices preferred implant-based BR for both unilateral and bilateral cases more frequently than those in academic practices (P < 0.05). Overall, plastic surgeons in academic settings preferred autologous BR more frequently than those in other practice locations (P < 0.05). Of total respondents, 64.8% did not perform microsurgical BR at all; 28% reported performing deep inferior epigastric perforator flap BR. Pedicled transverse rectus abdominis myocutaneous flap was the most often used option for unilateral autologous reconstruction, whereas deep inferior epigastric perforator flap was the most commonly used technique for bilateral BR. The overall complication rate reported by respondents was 11%. CONCLUSION The survey provides an insight to the current trends in BR practice with respect to surgeon and practice setting characteristics. Although not necessarily the correct best practices, the survey does demonstrate a likely portrayal of what is being practiced in the United States in the area of BR.
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Abstract
BACKGROUND Ionizing radiation is known to have deleterious chronic effects on skin, including fibrosis and poor wound healing, hypothesized as mediated by ischemia and hypoxia. Past studies have been unable to simultaneously investigate changes in perfusion and oxygenation as separate parameters. Hyperspectral imaging has emerged as a tool with which to concurrently measure skin perfusion and oxygenation. The authors investigated the use of hyperspectral imaging in a novel murine model of chronic radiation injury. METHODS Areas of flank skin (n = 20) on hairless mice were exposed to a 50-Gy dose of beta-radiation. Hyperspectral imaging acquisition was performed at select points through 8 weeks. Immunohistochemical staining and gene expression analysis were performed to evaluate cutaneous vascular density, epidermal cell hypoxia, and angiogenic factors. RESULTS All irradiated areas developed a chronic-phase wound by day 28. Hyperspectral imaging demonstrated a 21 percent decline in perfusion on day 56 (p < 0.001), whereas oxygenation levels were unchanged. A 1.7-fold reduction in blood vessel density was measured in irradiated skin compared with control tissue (p < 0.001), but no difference in epidermal cell hypoxia was observed. Vascular endothelial growth factor and related receptor expression were significantly lower in irradiated tissue. CONCLUSIONS The authors' analysis does not support the presence of hypoxia in chronic-phase irradiated skin but suggests that hypoperfusion may be a predominant characteristic. The concurrent states of hypoperfusion and normoxia may be explained by the lower metabolic demands of fibrosed tissue.
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Serra-Renom JM, Cabero G, Serra-Mestre JM, D'Andrea F, Marco V, Mayo W. Transplant of an autologous platelet gel prosthesis to fill defects after tumor excision. Ann Plast Surg 2012; 72:381-7. [PMID: 23241784 DOI: 10.1097/sap.0b013e3182610b4d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tumor excision causes disfigurement in the breast. We present our technique for filling the defect with activated platelet gel, thus avoiding the deformity. METHODS Between 2006 and 2011, 23 patients (age range, 45-72 years) underwent tumorectomy for breast cancer. After estimating and extracting the volume of blood required, we centrifuged the blood at 1800 rpm for 8 minutes. Later, the middle and lower thirds of the plasma) were separated and activated with CaCl₂ at a ratio of 1/20, forming a gel, which was used to fill the tumorectomy cavity. RESULTS Imaging tests (ultrasound, mammography, and magnetic resonance imaging) performed 12 months after surgery revealed scar tissue in the area where the autoprosthesis had been inserted. Magnetic resonance imaging showed no retraction or deformity in the skin silhouette. Histology study after 1 year demonstrated that the platelet gel had been replaced by fibrous scar tissue with dense collagen and the presence of small capillary vessels. Patients recorded high rates of satisfaction. CONCLUSIONS This technique maintains the shape and volume of the breast, avoiding deformities and retractions of the nipple areola complex by filling the defect with an autoprosthesis. After 12 months, the autoprosthesis had been replaced by fibrous tissue and dense collagen. Postoperative control was good, and the effectiveness of adjuvant radiotherapy or chemotherapy was not altered. No cases of tumor relapse were recorded. On palpation, consistency and softness were similar to that of breast tissue. The aesthetic results were highly satisfactory.
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Affiliation(s)
- Jose M Serra-Renom
- From the *Aesthetic, Plastic and Reconstructive Surgery Department, Hospital Quirón Barcelona, Universitat Internacional de Catalunya; †Obstetrics and Gynecology Department, Hospital Quirón Barcelona; ‡Aesthetic, Plastic and Reconstructive Surgery Department, Seconda Università degli Studi di Napoli; §Pathology Department, Hospital Quirón Barcelona; and ∥Radiology Department, Hospital Quirón Barcelona, Spain
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Mallucci P, Branford O. Concepts in aesthetic breast dimensions: Analysis of the ideal breast. J Plast Reconstr Aesthet Surg 2012; 65:8-16. [DOI: 10.1016/j.bjps.2011.08.006] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 07/27/2011] [Accepted: 08/02/2011] [Indexed: 11/15/2022]
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Sajid M, Betal D, Akhter N, Rapisarda I, Bonomi R. Prevention of Postoperative Seroma-Related Morbidity by Quilting of Latissimus Dorsi Flap Donor Site: A Systematic Review. Clin Breast Cancer 2011; 11:357-63. [DOI: 10.1016/j.clbc.2011.04.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 04/09/2011] [Accepted: 04/15/2011] [Indexed: 10/18/2022]
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Three-dimensional evaluation of breast contour and volume changes following subpectoral augmentation mammaplasty over 6 months. J Plast Reconstr Aesthet Surg 2011; 64:1152-60. [DOI: 10.1016/j.bjps.2011.03.037] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 03/16/2011] [Accepted: 03/27/2011] [Indexed: 11/17/2022]
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The Use of a Barbed Self-Retaining Suture System in the Positioning and Manipulation of the Breast Mound during Reconstructive and Aesthetic Breast Surgery. Plast Reconstr Surg 2011; 128:90e-91e. [DOI: 10.1097/prs.0b013e31821ef343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Aesthetic subunit of the breast: an analysis of women's preference and clinical implications. Ann Plast Surg 2011; 68:240-5. [PMID: 21629084 DOI: 10.1097/sap.0b013e318216b563] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Patient satisfaction in breast surgery is dependent on achieving a balance among all aesthetic subunits. The purpose of this study is to identify which subunit of the breast women consider important and correlate this clinically to improve patient satisfaction following breast surgery. A total of 313 subjects (ages, 20-80) were surveyed using a 25-point survey instrument collected via a telemedicine form. The data was analyzed to determine clinical significance. Of the subjects, 63% selected the upper inner quadrant as the most important subunit. Furthermore, 66% of the subjects indicated defects located in this region would lead them to seek operative intervention and this was consistent for all subgroups. Based on these results, defects in the upper inner quadrant of the breast are more likely to cause patient dissatisfaction. Patient outcomes following surgery can be enhanced by restoring volume and minimizing scars in this upper medial subunit of the breast.
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Berry MG, Cucchiara V, Davies DM. Breast augmentation: Part III--preoperative considerations and planning. J Plast Reconstr Aesthet Surg 2011; 64:1401-9. [PMID: 21524951 DOI: 10.1016/j.bjps.2011.03.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 01/15/2011] [Accepted: 03/21/2011] [Indexed: 11/29/2022]
Abstract
The past four decades since the introduction of silicone mammary prostheses have seen significant improvements in their quality and durability. Advances in our understanding of the aetiopathology and prevention of adverse capsular contracture (ACC) have occurred such that surgical technique itself has now probably become the single most important determinant of both immediate and long-term outcome. Considered a simple, and in some quarters mindless, procedure it has evolved such that high-quality short- and stable long-term results are now expected. Whilst the fundamentals of breast augmentation (BA) remain, evolutionary philosophies confront today's surgeon with a wealth of options. Of fundamental importance has been the paradigm shift from a purely, or predominantly, volumetric, through biodimensional to a tissue-based approach. With BA, more than any other aesthetic procedure, possessing more variables, choice and influential external factors a thorough understanding of the myriad options available is essential. This review seeks to cover the key elements in obtaining an optimal primary result. It provides a rational basis for the selection of an option tailored to both the patient and the individual tissue characteristics in addition to the pertinent medico-legal issues.
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Affiliation(s)
- M G Berry
- Institute of Cosmetic and Reconstructive Surgery, Welbeck Hospital, London W1G 8EN, UK.
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Discussion. Shaping the breast in aesthetic and reconstructive breast surgery: an easy three-step principle. Part III--reconstruction following breast conservative treatment. Plast Reconstr Surg 2009; 124:39-40. [PMID: 19568042 DOI: 10.1097/prs.0b013e3181aa0ff1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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