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Wang J, Ghanouni A, Losken A, Thompson P. Monitoring for Breast Cancer Recurrence Following Goldilocks Breast Reconstruction. Ann Plast Surg 2024; 92:S432-S436. [PMID: 38857009 DOI: 10.1097/sap.0000000000003952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
BACKGROUND The Goldilocks breast reconstruction utilizes redundant mastectomy skin flaps to fashion a breast mound; however, there is concern that imbrication of these skin flaps may predispose to fat necrosis and make detection of local breast cancer recurrence more difficult. Goldilocks patients follow a traditional postmastectomy screening pathway that includes clinical examination for locoregional recurrence, but it is unclear if this is sufficient. We evaluate our Goldilocks reconstruction case series to determine rates of diagnostic imaging, biopsy, and locoregional and distant recurrence. METHODS Sixty-six patients (94 breasts) undergoing Goldilocks breast reconstruction were retrospectively reviewed. Any diagnostic postoperative imaging/biopsies performed and that confirmed local or distant breast cancer recurrence were noted. RESULTS Average time of follow-up was 45 months. Most patients in this cohort had stage 0 (27.3%) or stage I (40.9%) breast cancer. There were a total of 11 (11.7%) concerning breast masses identified. Seven (7.4%) masses were biopsied, of which 5 were benign and 2 were invasive cancer recurrence. Four masses (4.3%) underwent diagnostic imaging only, all with benign findings. Five patients in this series were found to have either distant disease or a second primary cancer in the nonoperative contralateral breast. CONCLUSIONS Rates of local recurrence following Goldilocks are not higher than expected after other types of postmastectomy reconstruction. Clinical monitoring successfully detected local recurrence in all affected patients in this series. More definite guidelines around the routine screening of Goldilocks mastectomy patients may aid in early detection of local breast cancer recurrence.
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Affiliation(s)
- Jennifer Wang
- From the Division of Plastic & Reconstructive Surgery, Emory University School of Medicine, Atlanta, GA
| | - Arian Ghanouni
- Division of Plastic & Reconstructive Surgery, Montefiore Medical Center, Bronx, NY
| | - Albert Losken
- From the Division of Plastic & Reconstructive Surgery, Emory University School of Medicine, Atlanta, GA
| | - Peter Thompson
- From the Division of Plastic & Reconstructive Surgery, Emory University School of Medicine, Atlanta, GA
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Thimmappa ND. MRA for Preoperative Planning and Postoperative Management of Perforator Flap Surgeries: A Review. J Magn Reson Imaging 2024; 59:797-811. [PMID: 37589377 DOI: 10.1002/jmri.28946] [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: 04/18/2023] [Revised: 07/20/2023] [Accepted: 07/20/2023] [Indexed: 08/18/2023] Open
Abstract
Perforator flap magnetic resonance angiography (MRA) has emerged as a widely accepted and preferred modality for perforator flap mapping at several institutions. Autologous perforator flaps are a type of reconstructive microsurgical technique that involves transferring skin and fat from one part of the patient's body to another to replace tissue lost due to trauma, cancer resection, or other reasons. Autologous perforator flaps are based on a specific perforating blood vessel perfusing the transferred tissue. Hence, the surgery relies on the precise identification and mapping of perforating vessels to ensure successful outcomes. With its superior soft tissue contrast and multiplanar imaging capabilities, MRA has shown great potential in providing accurate and detailed visualization of perforator anatomy, size, and course. This review article summarizes the current literature on perforator flap MRA, including its technical considerations, imaging protocols, postprocessing, and reporting, specifically for autologous breast reconstructions. The advantages and limitations of MRA in evaluating perforator flaps are discussed, including its role in preoperative planning, intraoperative guidance, and postoperative assessment. Anatomy, brief surgical technique, specific technical modifications, and reporting of most commonly performed autologous breast flaps are described. Recent advancements in Perforator flap surgery and MRA techniques are discussed. Additionally, we examine the emerging role of artificial intelligence and machine learning in improving the accuracy and efficiency of perforator flap MRA interpretation. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 5.
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Escandón JM, Langstein HN, Christiano JG, Aristizábal A, Gooch JC, Weiss A, Manrique OJ. Latissimus dorsi flap with immediate fat transfer (LIFT) for autologous breast reconstruction: Single institution experience. Am J Surg 2024; 228:185-191. [PMID: 37743213 DOI: 10.1016/j.amjsurg.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/15/2023] [Accepted: 09/13/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Few studies have reported the outcomes of LDF and immediate fat transfer (LIFT) during breast reconstruction. The aim of this study was to compare the perioperative outcomes and complications of LIFT and standard LDF (without immediate fat transfer) for breast reconstruction. METHODS We retrospectively reviewed charts from patients undergoing autologous breast reconstruction after total mastectomy between 2011 and 2021. We compared intraoperative and postoperative outcomes between groups. RESULTS One hundred nineteen reconstructions (61.02%) were performed with LIFT, while seventy-six (38.98%) were performed with standard LDF. The median volume of total fat transferred during LIFT was 125-cc [110-170 cc]. The rates of donor site wound disruption (23.7% versus 12.6%, p = 0.044) were higher using the standard LDF compared to LIFT. Reconstructions performed with LIFT (HR 4.01, p < 0.001) were found to be associated with secondary fat grafting procedures. CONCLUSION LIFT is a safe procedure to enhance the volume of LDF in patients desiring autologous reconstruction without increasing recipient-site morbidity. On a time-to-event analysis, LIFT was associated with the requirement of further revision procedures using secondary fat grafting.
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Affiliation(s)
- Joseph M Escandón
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, NY, USA
| | - Howard N Langstein
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, NY, USA
| | - Jose G Christiano
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, NY, USA
| | - Alejandra Aristizábal
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, NY, USA
| | - Jessica C Gooch
- Division of Surgical Oncology, Department of Surgery, Pluta Cancer Center, Wilmot Cancer Center, University of Rochester Medical Center, NY, USA
| | - Anna Weiss
- Division of Surgical Oncology, Department of Surgery, Pluta Cancer Center, Wilmot Cancer Center, University of Rochester Medical Center, NY, USA
| | - Oscar J Manrique
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, NY, USA.
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Knoedler S, Knoedler L, Patel H, Diatta FH, Camacho JM, Sofo G, Perozzo FAG, Evans B, Mookerjee VG, Ayyala HS, Pomahac B, Kauke-Navarro M. Surgical management of breast fat necrosis: Multi-institutional data analysis of early outcomes and risk factors for complications. J Plast Reconstr Aesthet Surg 2024; 88:292-295. [PMID: 38029475 DOI: 10.1016/j.bjps.2023.11.015] [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: 10/26/2023] [Revised: 11/06/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Breast fat necrosis (BFN) is a non-cancerous condition affecting the adipose tissue. Despite incidence rates of up to 25% after breast surgery, little is known about risk factors and postoperative outcomes following the surgical treatment of BFN. METHODS The National Surgical Quality Improvement Program of the American College of Surgeons (2008-2021) was queried to identify female patients diagnosed with and surgically treated for BFN. Outcomes of interest included 30-day surgical and medical complications, reoperation, and readmission. We performed confounder-adjusted multivariable analyses to determine risk factors. RESULTS The study population included 1179 female patients (mean age: 55.8 ± 13.8 years), of whom 96% (n = 1130) underwent direct excision and 4.2% (n = 49) received debridement of necrotic tissue. The majority of cases were operated on by general surgeons (n = 867; 74%) in the outpatient setting (n = 1107; 94%). Overall, 74 patients (6.3%) experienced postoperative adverse events, most of which were surgical complications (n = 43; 3.7%). Twenty-one (1.8%) women had to return to operating room, while readmission was reported in 18 (1.5%) cases. Adverse events were significantly more likely to occur in patients with chronic heart failure (p = 0.002) and higher wound classes (p = 0.033). CONCLUSION Complication rates following the surgical management of BFN were found to be relatively high and seen to correlate with the setting. We identified chronic heart failure and wound contamination as risk factors for complication occurrence. These evidence-based insights may sensitize surgeons to critically balance patients' eligibility for BFN surgery and refine perioperative algorithms.
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Affiliation(s)
- Samuel Knoedler
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
| | - Leonard Knoedler
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
| | - Heli Patel
- Nova Southeastern University Dr. Kiran C Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA.
| | - Fortunay H Diatta
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
| | | | - Giuseppe Sofo
- Instituto Ivo Pitanguy, Hospital Santa Casa de Misericórdia Rio de Janeiro, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Filippo A G Perozzo
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Brogan Evans
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
| | - Vikram G Mookerjee
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
| | - Haripriya S Ayyala
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
| | - Bohdan Pomahac
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
| | - Martin Kauke-Navarro
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
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Moon J, Park HY, Lee KT, Mun GH. Natural course of fat necrosis after deep inferior epigastric perforator flap-based breast reconstruction: Evaluation based on ultrasound examination. Microsurgery 2023; 43:676-684. [PMID: 36855279 DOI: 10.1002/micr.31027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/07/2023] [Accepted: 02/10/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Fat necrosis, often developing following deep inferior epigastric perforator (DIEP) flap-based breast reconstruction, is not a negligible complication. This study aimed to conduct a longitudinal assessment of the clinical course of fat necrosis in breast reconstruction with DIEP flap. METHODS Among patients undergoing immediate DIEP flap-based breast reconstruction between 2009 and 2017, those who developed fat necrosis on ultrasonographic examination and did not undergo surgical intervention for the lesion were reviewed. Changes in lesion size over time were assessed based on regular ultrasound examinations. RESULTS A total of 37 cases were analyzed, with a mean follow-up of 52.6 months (range, 19-114). Their mean age was 45.8 years, and the mean body mass index was 23.4 kg/m2 . Of these, 21 lesions had disappeared over time. The mean time from detection to the disappearance was 30.4 months. The remaining 16 lesions did not disappear and persisted for a median follow-up of 43.5 months. Compared with the lesions that persisted, those that disappeared were significantly smaller in initial size (p = 0.040) and had a lower inset ratio of the harvested flap (p = 0.006). The optimal cutoff value for the initial size for disappearance was ≤1.97 cm. Among the lesions >1.97 cm in size, 6 (35.3%) of 17 lesions disappeared, whereas in those ≤1.97 cm, 15 (75.0%) of 20 disappeared over time, with a significant difference (p = 0.041). CONCLUSION The natural course of fat necrosis that develops following the DIEP flap may differ according to its initial size.
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Affiliation(s)
- JeeHyun Moon
- Department of Plastic Surgery, Inha University School of Medicine, Incheon, South Korea
| | | | - Kyeong-Tae Lee
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Goo-Hyun Mun
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Kim HB, Han SJ, Kim EK, Eom JS, Han HH. Comparative Study of DIEP and PAP Flaps in Breast Reconstruction: Reconstructive Outcomes and Fat Necrosis. J Reconstr Microsurg 2023; 39:627-632. [PMID: 36809782 DOI: 10.1055/a-2040-1368] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND This study compared the reconstructive outcomes and fat necrosis of the profunda artery perforator (PAP) flap with those of the deep inferior epigastric perforator (DIEP) flap. METHODS Data on all DIEP and PAP flap breast reconstructions performed between 2018 and 2021 at Asan Medical Center were compared. The overall reconstructive outcomes and presence of fat necrosis were analyzed through ultrasound evaluation performed by a board-certified radiologist. RESULTS The PAP (n = 43) and DIEP flaps (n = 99) were used to reconstruct 31 and 99 breasts, respectively. The average age of the patients in the PAP flap group (39.1 ± 7.3 years) was lower than in the DIEP flap group (47.4 ± 7.7 years), and the body mass index (BMI) of patients undergoing PAP flap reconstruction (22.7 ± 2.8 kg/m2) was lower than those undergoing DIEP flap reconstruction (24.3 ± 3.4 kg/m2). There was no total loss of both flaps. Donor site morbidity was higher in the PAP flap group (11.1%) compared with the DIEP flap (1.0%). The rate of fat necrosis was higher in the PAP flaps (40.7%) than in the DIEP flaps (17.8%) during ultrasound. CONCLUSION In our study, we found that PAP flap reconstruction tended to be performed in patients who were younger with lower BMIs compared with the DIEP flap. Successful reconstructive outcomes were observed in both the PAP and DIEP flaps; however, a higher rate of necrosis was observed in the PAP flap compared with the DIEP flap.
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Affiliation(s)
- Hyung Bae Kim
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong John Han
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eon Key Kim
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Sup Eom
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Ho Han
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Gao S, Lu B, Zhou R, Gao W. Research progress of mechanisms of fat necrosis after autologous fat grafting: A review. Medicine (Baltimore) 2023; 102:e33220. [PMID: 36897702 PMCID: PMC9997804 DOI: 10.1097/md.0000000000033220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 02/16/2023] [Indexed: 03/11/2023] Open
Abstract
Currently, autologous fat grafting is the common surgery employed in the department of plastic and cosmetic surgery. Complications after fat grafting (such as fat necrosis, calcification, and fat embolism) are the difficulties and hotspots of the current research. Fat necrosis is one of the most common complications after fat grafting, which directly affects the survival rate and surgical effect. In recent years, researchers in various countries have achieved great results on the mechanism of fat necrosis through further clinical and basic studies. We summarize recent research progress on fat necrosis in order to provide theoretical basis for diminishing it.
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Affiliation(s)
- Shenzhen Gao
- Department of Plastic and Cosmetic Surgery, The Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University, Nanjing, China
| | - Baixue Lu
- Department of Plastic and Cosmetic Surgery, The Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University, Nanjing, China
| | - Rong Zhou
- Department of Plastic and Cosmetic Surgery, The Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University, Nanjing, China
| | - Weicheng Gao
- Department of Plastic and Cosmetic Surgery, The Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University, Nanjing, China
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Optimizing Prepectoral Implant Placement and Concomitant Fat Grafting After Tissue Expansion. Ann Plast Surg 2023:00000637-990000000-00218. [PMID: 36921323 DOI: 10.1097/sap.0000000000003446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
BACKGROUND Prepectoral implant-based breast reconstruction is often supplemented by autologous fat grafting to optimize aesthetic outcomes. This usually entails several rounds of modest fat transfer to minimize risk of necrosis; however, the limits of fat grafting at expander exchange are not known. METHODS A single-institution retrospective review from July 2016 to February 2022 was performed of all patients who underwent (1) mastectomy, (2) prepectoral tissue expander placement, (3) expander exchange for implant, and (4) at least one round of autologous fat transfer. Student t test and χ2 test were used. RESULTS A total of 82 breasts underwent a single round of fat grafting during implant placement (group 1); 75 breasts underwent fat grafting that occurred in multiple rounds and/or in delay to implant placement (group 2). Group 1 received more fat at the time of implant placement (100 mL; interquartile range, 55-140 mL; P < 0.001) and underwent fewer planned operative procedures compared with group 2 (1.0 vs 2.2, P < 0.001). Total fat volume in group 2 did not significantly exceed that of group 1 until after 3 rounds of fat transfer (128.5 mL; interquartile range, 90-130 mL; P < 0.01). There was no difference in the rate of fat necrosis between groups after the first round (15.9% vs 9.3%, P = 0.2) and final round (15.9% vs 12.0%, P = 0.5) of fat grafting. Complication rates were similar between groups (3.7% vs 8.0%, P = 0.2). CONCLUSIONS A 2-stage approach of prepectoral tissue expander placement with single round of larger volume fat transfer at expander exchange reduces overall number of operative procedures without increased risks.
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Fat necrosis in the breast: a multimodality imaging review of its natural course with different aetiologies. Clin Radiol 2023; 78:323-332. [PMID: 36849280 DOI: 10.1016/j.crad.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Abstract
Fat necrosis of the breast is a commonly encountered condition in daily practice. It is a benign pathology, but it can have variable manifestations and patterns that may sometimes mimic malignancy, depending on its stage of evolution and its underlying cause. This review demonstrates the wide spectrum of appearances of fat necrosis on mammography, digital breast tomosynthesis (DBT), ultrasound, magnetic resonance imaging (MRI), computed tomography (CT), and positron-emission tomography (PET). Sequential follow-up images are included in some cases to illustrate the temporal change of the findings. The typical location and distribution of fat necrosis from a comprehensive list of aetiologies are discussed. Improved knowledge of the multimodality imaging features of fat necrosis could enhance diagnostic accuracy and clinical management, thus avoiding unnecessary invasive investigations.
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Janssen TJ, Wigley CH, Adegbie D, Zoller F, Mosahebi A. The treatment of symptomatic fat necrosis: A review and introduction of a new treatment algorithm. J Plast Reconstr Aesthet Surg 2023; 77:87-93. [PMID: 36563639 DOI: 10.1016/j.bjps.2022.11.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 10/11/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Fat necrosis (FN) is a well-known complication in plastic surgery. Excision of symptomatic FN has been the gold standard, but it often results in contour irregularities that require subsequent treatment. Different alternative surgical and nonsurgical management strategies have been described; however, there are currently no guidelines. This literature review aims to provide an overview of available treatment options and current management standards to support clinical decision making. METHOD A literature search in the databases PubMed, Embase (via Ovid), and Web Of Science was carried out to identify eligible articles. The search strategy included combinations of the following terms: "Fat necrosis "AND (treatment OR management OR therapy). Six articles discussing or reporting management strategies of FN in a plastic surgery context were included. RESULTS A variety of techniques were used to manage symptomatic FN. Asymptomatic or small lesions can be treated conservatively. Oil cyst and moderately sized areas of symptomatic FN can effectively be treated by aspiration, ultrasound-assisted liposuction, or needle aeration. Calcified and large areas of FN require excision and debridement of necrotic fat tissue CONCLUSION: At present, there is no consensus on the management of symptomatic FN. The authors propose a new classification system to aid the guidance of management of symptomatic FN.
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Affiliation(s)
- Tim J Janssen
- Department of Plastic Surgery, Royal Free Hospital, University College London, London, United Kingdom.
| | - Catrin H Wigley
- Department of Plastic Surgery, Royal Free Hospital, University College London, London, United Kingdom
| | - Divine Adegbie
- Department of Plastic Surgery, Royal Free Hospital, University College London, London, United Kingdom
| | - Florence Zoller
- Department of Plastic Surgery, Royal Free Hospital, University College London, London, United Kingdom
| | - Afshin Mosahebi
- Department of Plastic Surgery, Royal Free Hospital, University College London, London, United Kingdom
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Zoccali G, Hagiga A, Farhadi J. Use of free flaps in aesthetic breast surgery: a single centre experience and literature review. J Plast Reconstr Aesthet Surg 2023; 77:190-200. [PMID: 36580704 DOI: 10.1016/j.bjps.2022.11.042] [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: 06/10/2022] [Revised: 09/03/2022] [Accepted: 11/17/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Implant-based breast augmentation is one of the most performed procedures in aesthetic surgery, whereas autologous tissue application is confined to fat grafting as adjuvant procedure. The use of free flaps in cosmetic mammoplasties is not popular, but the number of reports in the literature is increasing. We believe that autologous tissue transfer for cosmetic purposes could be a valuable alternative for volume enhancement in selected conditions, especially following weight loss. In this paper, we provide a systematic literature review of the current literature of using autologous free flaps for breast augmentation in non-cancer patients, and we also report our experience on this topic to identify possible indications and criteria for the patients' selection. METHODS PRISMA's guidelines have been followed for the literature review. In order to demonstrate the feasibility, safety and patient satisfaction with breast volume enhancement with autologous tissue, a retrospective single-centre study was conducted on women who underwent breast volume enhancement with autologous tissue. Patient's satisfaction was assessed with a visual analogue scale (VAS) creating an ad-hoc outcome scale, and the data were summarised with a descriptive statistic. RESULTS Twelve patients were enrolled in the study. Weight loss was the main indication for surgery. The average length of procedure was 5.1 h, and the hospitalization was 2.3 days. After 12 month, the patient outcome was excellent in 2 cases, good in 9 cases and moderate in 1 case. CONCLUSIONS Although further research is needed, the literature review and our case series show that the use of free flaps for breast volume enhancement is safe and gives a satisfactory outcome.
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Affiliation(s)
- Giovanni Zoccali
- Plastic and Reconstructive Surgery Department, IRCCS - Regina Elena National Cancer Institute, Rome, IT.
| | - Ahmed Hagiga
- Plastic and Reconstructive Surgery Department, Queen Victoria Hospital, East Grinstead, UK
| | - Jian Farhadi
- Plastic Surgery Group, Zurich - CH, University of Basel, Basel, CH
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Portnow LH, Majid S, Maduram A, Chesebro AL, Karimova EJ, Chung SH, Gombos EC. Breast Malignancies After Mastectomy With Autologous or Implant Reconstruction. JOURNAL OF BREAST IMAGING 2022; 4:649-660. [PMID: 38417000 DOI: 10.1093/jbi/wbac068] [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: 06/30/2022] [Indexed: 03/01/2024]
Abstract
There are multiple indications for mastectomy for breast cancer, including extent of tumor, inability to achieve negative margins after re-excision, patient preference, or prevention in women with a high lifetime risk of breast cancer. Multiple types of autologous or implant reconstruction options are available for cosmesis. Although rare, breast cancers after mastectomy can occur, and it is important for both surgeons and radiologists to be aware of the associated risk factors, common locations, and classic imaging features of these malignancies. This article reviews the types of mastectomies, reconstruction options, and information about the location, presentation, and prognosis of cancers in the reconstructed breast.
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Affiliation(s)
- Leah H Portnow
- Brigham and Women's Hospital, Department of Radiology, Breast Imaging, Boston, MA, USA
| | - Sana Majid
- Brigham and Women's Hospital, Department of Radiology, Breast Imaging, Boston, MA, USA
| | - Amy Maduram
- Brigham and Women's Hospital, Department of Radiology, Breast Imaging, Boston, MA, USA
| | - Allyson L Chesebro
- Brigham and Women's Hospital, Department of Radiology, Breast Imaging, Boston, MA, USA
| | - E Jane Karimova
- Brigham and Women's Hospital, Department of Radiology, Breast Imaging, Boston, MA, USA
| | - Stephanie H Chung
- Brigham and Women's Hospital, Department of Radiology, Breast Imaging, Boston, MA, USA
| | - Eva C Gombos
- Brigham and Women's Hospital, Department of Radiology, Breast Imaging, Boston, MA, USA
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Rakhawy MMME, Soliman N, Elnahas W, Karam R, Abdel-Khalek AM. Prediction of local breast cancer recurrence after surgery: the added value of diffusion tensor imaging. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00831-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
There is considerable overlap between benign postoperative changes and recurrent breast cancer imaging features in patients surgically treated for breast cancer. This study aims to evaluate the value of adding multiple diffusion tensor imaging (DTI) parameters, including mean diffusivity (MD), fractional anisotropy (FA), radial diffusivity (RD), axial diffusivity, (AD), and relative anisotropy (RA) in differentiating breast cancer recurrence from postoperative changes in patients who were surgically treated for breast cancer and to also evaluate the role of these parameters in characterizing the different pathologies seen in the postoperative breast.
Results
This is a prospective study that was performed on female patients who were surgically treated for breast cancer. The study was done on 60 cases having 77 breast lesions. (Sixty-two of them were described as mass lesions and 15 of them were described as non-mass enhancement on MRI.) Among analyzed DTI parameters, MD showed the highest sensitivity (97.1%), specificity (88.1%), and accuracy (92.2%) in predicting recurrent breast cancer. FA, AD, and RD showed sensitivity (77.1%, 85.7%, and 88.6%) and specificity (83.3%, 83.3%, and 73.8%) in predicting recurrent breast cancer, respectively. The median MD values were lower in grade III recurrent breast cancers when compared to its values in recurrent grade II breast cancers and recurrent DCIS (0.6 × 10–3 mm2/s vs. 0.8 × 10–3 mm2/s and 0.9 × 10–3 mm2/s), respectively. FA also showed median values in grade III recurrent breast cancer higher than its values in grade II recurrent breast cancer and recurrent DCIS (0.6 vs. 0.5 and 0.39), respectively. The sensitivity, specificity, PPV, NPV, accuracy, F1 score, and MCC of DCE-MRI alone versus DCE-MRI plus combined DTI parameters were 88.6% versus 100%, 88.1% versus 90.5%, 86.1% versus 89.7%, 90.2% versus 100%, 88.3% versus 94.6%, 87.3% versus 94.6%, and 76.5% versus 90.1%, respectively.
Conclusions
DTI may play an important role as a complementary method to discriminate recurrent breast cancer from postoperative changes in patients surgically treated for previous breast cancer.
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Overview of Oncoplastic Breast Surgery Techniques for the Treatment of Breast Cancer with Review of Normal and Abnormal Postsurgical Imaging Findings. CURRENT RADIOLOGY REPORTS 2022. [DOI: 10.1007/s40134-022-00394-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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A new indication and surgical procedure to reduce fat necrosis after breast-conserving surgery using an inframammary adipofascial flap. Asian J Surg 2022; 45:2268-2272. [PMID: 35000855 DOI: 10.1016/j.asjsur.2021.12.044] [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: 07/27/2021] [Revised: 12/03/2021] [Accepted: 12/10/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There is little information on the risk factors for fat necrosis after breast-conserving surgery using an inframammary adipofascial flap (IAF). METHODS We conducted a retrospective cohort study from a single institution evaluating the risk factors for fat necrosis after breast-conserving surgery using an IAF (n = 41) performed from 2005 to 2020 for newly diagnosed stage 0-2 breast cancer or phyllodes tumor. RESULTS Age (≥50 years of age vs. <50 years of age), mammographic density (fatty vs. other) and operation period (before vs. after revision of surgical procedure and patient indication) were significantly associated with fat necrosis (p = 0.006, p = 0.04 and p = 0.02, respectively). CONCLUSION Our study suggested that the use of an IAF with crescent dermis and selection of appropriate cases for IAF after breast-conserving surgery may be useful for the purpose of reducing fat necrosis. Further study is needed.
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Al-Hilli Z, Wilkerson A. Breast Surgery: Management of Postoperative Complications Following Operations for Breast Cancer. Surg Clin North Am 2021; 101:845-863. [PMID: 34537147 DOI: 10.1016/j.suc.2021.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Breast cancer surgery is associated with low rates of surgical morbidity. Postoperative complications related to breast surgery include seroma, infection, hematoma, mastectomy flap necrosis, wound dehiscence, persistent postsurgical pain, Mondor disease, fat necrosis, reduced tactile sensation after mastectomy, and venous thromboembolism. Postoperative complications related to axillary surgery include seroma, infection, lymphedema, nerve injury, and reduced shoulder/arm mobility. The overall rate of complication related to axilla surgery may be confounded by the type of breast surgery performed. The management of postoperative complications related to oncologic breast and axillary surgery independent of reconstruction is reviewed here.
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Affiliation(s)
- Zahraa Al-Hilli
- Department of General Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue /A80, Cleveland, OH 44195, USA.
| | - Avia Wilkerson
- Department of General Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue /A80, Cleveland, OH 44195, USA
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