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Löfstrand J, Paganini A, Grimby-Ekman A, Lidén M, Hansson E. Long-term patient-reported back and shoulder function after delayed breast reconstruction with a latissimus dorsi flap: case-control cohort study. Br J Surg 2024; 111:znad296. [PMID: 37879120 PMCID: PMC10769156 DOI: 10.1093/bjs/znad296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/06/2023] [Accepted: 08/31/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Sacrifice of the latissimus dorsi (LD) muscle might entail donor site morbidity when used in delayed breast reconstruction. Previous studies are small, have short follow-up, and demonstrate diverging results. The aims of this study were to evaluate long-term patient-reported effects on shoulder and back function following LD flap harvest, and to investigate predictors for a worse outcome. METHOD This is a retrospective observational case-control cohort study. Cases were all patients who had undergone an LD flap reconstruction during the years 2007-2017. Controls were patients reconstructed with a deep inferior epigastric perforator (DIEP) flap during the same time period. Participants completed two validated questionnaires; the BREAST-Q reconstruction LD domains and the Western Ontario Shoulder Osteoarthritis Index (WOOS). RESULTS A total of 135 cases (75 per cent) and 118 controls (60 per cent) responded to the questionnaires. The mean follow-up time was 7 years. Patients reconstructed with a LD flap were significantly less satisfied with their back and shoulder function when compared to the DIEP controls, as measured with BREAST-Q and WOOS. Predictors for a poor patient-reported back and shoulder function included axillary surgery and axillary radiotherapy, especially when combined, as well as higher age at reconstruction. CONCLUSION Patients who have undergone LD flap for delayed breast reconstruction had a lower satisfaction with back and shoulder function, when compared to patients who had undergone a DIEP reconstruction. Delayed LD reconstruction should be used with care, especially in patients who have undergone axillary surgery and axillary radiotherapy.
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Affiliation(s)
- Jonas Löfstrand
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Plastic Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Paganini
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Plastic Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Grimby-Ekman
- School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mattias Lidén
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Plastic Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Emma Hansson
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Plastic Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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Sadok N, Krabbe-Timmerman IS, Buisman NH, van Aalst VC, de Bock GH, Werker PMN. Short-Term Quality of Life after Autologous Compared with Alloplastic Breast Reconstruction: A Prospective Study. Plast Reconstr Surg 2023; 152:55S-68S. [PMID: 37036311 PMCID: PMC10521783 DOI: 10.1097/prs.0000000000010496] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 11/09/2022] [Indexed: 04/11/2023]
Abstract
BACKGROUND The aim of this prospective multicenter study was to evaluate whether autologous breast reconstruction (BR) leads to lower short-term quality of life (QoL) compared with alloplastic BR, due to the more physically demanding surgery and increased risk of severe complications of autologous BR. METHODS Changes in QoL after BR were measured in this prospective multicenter study using the BREAST-Q questionnaire, which was administered preoperatively and at 6 weeks and 6 months postoperatively. Characteristics and complications, classified according to Clavien-Dindo, were compared between alloplastic and autologous groups. Profile plots and generalized linear regression models were constructed to analyze the BREAST-Q subscales over time for both BR groups. RESULTS Preoperatively, women undergoing autologous BR scored lower on all BREAST-Q scales compared with women undergoing alloplastic BR, regardless of whether they underwent immediate or delayed BR. Women undergoing autologous BR scored higher at 6 weeks and 6 months postoperatively on the Satisfaction with Breasts ( P = 0.001), Psychosocial Well-Being ( P = 0.024), and Sexual Well-Being ( P = 0.007) subscales. Postoperative Physical Well-Being: Chest score was similar between the groups ( P = 0.533). Clavien-Dindo grade III or higher complications occurred more often among women in the autologous group (27% versus 12%, P = 0.042). Complications were not associated with worse BREAST-Q scores on any of the subscales. CONCLUSIONS In contrast to the authors' expectations, and despite the higher incidence of severe complications and lower preoperative breast satisfaction and QoL scores, women undergoing autologous BR had higher levels of breast satisfaction and psychosocial and sexual well-being, both at 6 weeks and 6 months after BR, compared with women undergoing alloplastic BR. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Tallroth L, Mobargha N, Velander P, Becker M, Klasson S. Expander prosthesis and DIEP flaps in delayed breast reconstruction: Sensibility, patient-reported outcome, and complications in a five-year randomised follow-up study. J Plast Surg Hand Surg 2023; 58:101-109. [PMID: 37747180 DOI: 10.2340/jphs.v58.13477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/17/2023] [Indexed: 09/26/2023]
Abstract
Breast reconstruction is a given choice for many women following mastectomy. There are a multitude of methods available today, and thus, comparative studies are essential to match patients with suitable methods. The aim of this study was to compare 5-year outcomes following delayed breast reconstruction with expander prosthesis (EP) and with deep inferior epigastric perforator (DIEP) flaps. Seventy-three patients, previously randomised to either a permanent EP or a DIEP flap breast reconstruction, were invited for a 5-year follow-up. Assessments included symmetry measurements, breast sensibility with Semmes-Weinstein monofilaments and patient-reported outcome (PRO) with the BREAST-Q. Complications within the first 5 postoperative years were recorded. Additionally, BREAST-Q questionnaires were collected from non-randomised patients with an EP breast reconstruction. Between 2019 and 2022, 65 patients completed the follow-ups. Symmetry and PRO were significantly higher in the DIEP flap group. However, EP-reconstructed breasts were significantly more sensate and demonstrated areas with protective sensibility, unlike the DIEP flap breasts. The overall complication rates were comparable between the two groups (p = 0.27). Regression analysis identified body mass index as a risk factor for reoperation in general anaesthesia and for wound infection. No significant differences were found in a comparison of the randomised and the non-randomised EP groups' BREAST-Q results. This randomised 5-year follow-up study found PRO to be favourable following a DIEP flap reconstruction and sensibility to be better in EP reconstructions. The complication rates were comparable; however, longer follow-ups are warranted to cover the complete lifespans of the two breast reconstruction methods.
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Affiliation(s)
- Linda Tallroth
- Department of Clinical Sciences in Malmö, Lund University.
| | - Nathalie Mobargha
- Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Patrik Velander
- Department of Clinical Sciences in Malmö, Lund University, Sweden; Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
| | - Magnus Becker
- Department of Clinical Sciences in Malmö, Lund University, Sweden; Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
| | - Stina Klasson
- Department of Clinical Sciences in Malmö, Lund University, Sweden; Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
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Kim PJ, Yuan M, Wu J, Gallo L, Uhlman K, Voineskos SH, O’Neill A, Hofer SO. "Spin" in Observational Studies in Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Systematic Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5095. [PMID: 37351115 PMCID: PMC10284325 DOI: 10.1097/gox.0000000000005095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/26/2023] [Indexed: 06/24/2023]
Abstract
The deep inferior epigastric artery perforator (DIEP) flap is widely used in autologous breast reconstruction. However, the technique relies heavily on nonrandomized observational research, which has been found to have high risk of bias. "Spin" can be used to inappropriately present study findings to exaggerate benefits or minimize harms. The primary objective was to assess the prevalence of spin in nonrandomized observational studies on DIEP reconstruction. The secondary objectives were to determine the prevalence of each spin category and strategy. Methods MEDLINE and Embase databases were searched from January 1, 2015, to November 15, 2022. Spin was assessed in abstracts and full-texts of included studies according to criteria proposed by Lazarus et al. Results There were 77 studies included for review. The overall prevalence of spin was 87.0%. Studies used a median of two spin strategies (interquartile range: 1-3). The most common strategies identified were causal language or claims (n = 41/77, 53.2%), inadequate extrapolation to larger population, intervention, or outcome (n = 27/77, 35.1%), inadequate implication for clinical practice (n = 25/77, 32.5%), use of linguistic spin (n = 22/77, 28.6%), and no consideration of the limitations (n = 21/77, 27.3%). There were no significant associations between selected study characteristics and the presence of spin. Conclusions The prevalence of spin is high in nonrandomized observational studies on DIEP reconstruction. Causal language or claims are the most common strategy. Investigators, reviewers, and readers should familiarize themselves with spin strategies to avoid misinterpretation of research in DIEP reconstruction.
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Affiliation(s)
- Patrick J. Kim
- From the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Morgan Yuan
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jeremy Wu
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lucas Gallo
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Kathryn Uhlman
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sophocles H. Voineskos
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Anne O’Neill
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Stefan O.P. Hofer
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Löfstrand J, Paganini A, Lidén M, Hansson E. Donor-Site Satisfaction of DIEP and Latissimus Dorsi Flaps-A Comparative Cohort Study. J Reconstr Microsurg 2022. [PMID: 36379466 DOI: 10.1055/a-1978-9610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Understanding of donor-site morbidity and satisfaction after breast reconstruction is limited. There are few previous studies comparing satisfaction with different donor sites in breast reconstruction. This study aimed to examine the long-term patient-reported satisfaction with the donor site of latissimus dorsi (LD) flaps in comparison to the deep inferior epigastric artery perforator (DIEP) flaps. Further, a systematic review of previously published studies was conducted. METHODS In this retrospective cross-sectional study, all women who underwent breast reconstructions with either LD or DIEP flap following mastectomy and radiotherapy between 2007 and 2017 were included; patient-reported satisfaction was assessed using the BREAST-Q reconstruction module. For the systematic review, studies examining patient-reported abdominal satisfaction and well-being, and meeting the PICO (Population, Intervention, Comparison, and Outcome) criteria were included. RESULTS Eligible and responding participants were divided into the LD (n = 135 patients) and DIEP (n = 118 patients) flap groups. Impairment due to muscular weakness of the donor site was more common in the LD group than that of the DIEP group. Bulging was common in the DIEP group and increased over time. Regarding the esthetic appearance of the donor site, the patients in the DIEP group were less satisfied than the LD group. The systematic review showed that most of the patients were dissatisfied with their abdomen after the operation. CONCLUSION Patients who have undergone DIEP flap for breast reconstruction are less satisfied with the donor-site esthetics than those who have undergone LD flap. Patient-reported abdominal bulging was common in the DIEP group and the number seemed to increase over time. Most patients were not satisfied with their abdominal scarring postoperatively, as per the systematic review. These results may indicate a need for more nuanced preoperative patient information, as well as improvements in the surgical management of the donor site, for DIEP flap reconstructions.
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Affiliation(s)
- Jonas Löfstrand
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Plastic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Paganini
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Plastic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mattias Lidén
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Plastic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Emma Hansson
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Plastic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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Escandón JM, Escandón L, Ahmed A, Weiss AC, Nazerali R, Ciudad P, Langstein HN, Manrique OJ. Breast Reconstruction using the Latissimus Dorsi Flap and Immediate Fat Transfer (LIFT): A Systematic Review and Meta-Analysis. J Plast Reconstr Aesthet Surg 2022; 75:4106-4116. [DOI: 10.1016/j.bjps.2022.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/28/2022] [Accepted: 08/16/2022] [Indexed: 10/31/2022]
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7
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Yuan M, Wu J, Lee J, Cao D, Huynh MNQ, Gallo L, Neill ACO, Hofer SO. The Risk of Bias of Non-Randomized Observational Studies in Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Systematic Review using ROBINS-I. J Plast Reconstr Aesthet Surg 2022; 75:4096-4105. [DOI: 10.1016/j.bjps.2022.06.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/07/2022] [Accepted: 06/21/2022] [Indexed: 10/31/2022]
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8
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The effect of sarcopenic obesity and muscle quality on complications after DIEP-flap breast reconstruction. Heliyon 2022; 8:e09381. [PMID: 35600454 PMCID: PMC9118656 DOI: 10.1016/j.heliyon.2022.e09381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/22/2022] [Accepted: 05/04/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction The aim of this study was to evaluate whether sarcopenic obesity and muscle quality as expressed by skeletal muscle radiodensity (SMD) are associated to postoperative complications in women undergoing DIEP-flap breast reconstruction (BR). Methods All patients who underwent DIEP-flap BR at our tertiary center between 2010 and 2018 were asked to sign informed consent for the use of their electronic medical records and images. By outlining anatomical skeletal muscle contours on the preoperative abdominal CT-scan at lumbar level L3, SMD and skeletal muscle indices (SMI) were measured by two observers independently. Using logistic regression analyses, the association between sarcopenic obesity (BMI >25 & SMI <39), low SMD (<40HU), and Clavien-Dindo (CD) grade ≥ II complications was evaluated. In this way odds ratios (OR) and adjusted odds ratios (ORadjusted) were provided. Results Out of the 103 patients included in this study, 36% had CD grade ≥ II complications within 30 days of surgery. Twenty patients (19%) suffered from sarcopenic obesity of whom eleven patients (55%) had CD grade ≥ II complications (OR = 2.7, p = 0.05). In a multivariate analysis, sarcopenic obesity was not significantly related to a higher complication rate (ORadjusted = 2.2, p = 0.14) but women with SMD below average and those with prior radiotherapy had a higher risk for grade ≥ II complications (ORadjusted = 2.9, p = 0.02 and ORadjusted = 2.7, p = 0.02 respectively). Conclusion Below average SMD (<40HU) was found to be associated with the development of postoperative CD grade ≥ II complications in women undergoing DIEP-flap BR. Future research should evaluate whether improving SMD reduces the complication incidence in this patient group.
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Palve JS, Luukkaala TH, Kääriäinen MT. Autologous reconstructions are associated with greater overall medium-term care costs than implant-based reconstructions in the Finnish healthcare system: A retrospective interim case-control cohort study. J Plast Reconstr Aesthet Surg 2021; 75:85-93. [PMID: 34627717 DOI: 10.1016/j.bjps.2021.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 06/04/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Previous studies have mainly reported the short-term costs of different reconstruction techniques. Revision operations may increase costs in longer follow-up. Authors report medium-term data on different reconstruction methods. We hypothesised that the reconstruction method would affect not only the duration of reconstruction process but also total costs. METHODS The reconstruction database was reviewed from 2008 to 2019. Women with autologous (deep inferior epigastric perforator, transverse musculocutaneous gracilis and latissimus dorsi [LD] without implant) and implant-based (implant and LD with implant) reconstructions were included. Variables evaluated included age, body mass index, smoking, comorbidities, radiotherapy, complications and readmissions. Risk factors for multiple revision surgeries were analysed. Time to definitive reconstruction and related costs were also calculated. RESULTS In total, 591 patients with autologous reconstructions and 202 with implant-based reconstructions were included. The median follow-up time was 73 months. Definitive reconstruction was obtained in 443 days in implant-based reconstructions and in 403 days in autologous reconstructions (P = 0.050). Independent risk factors for multiple surgeries were younger age (P < 0.001) and comorbidity (P = 0.008). No statistically significant difference was observed in the rate of overall surgical procedures (P = 0.098), but implant-based reconstructions were more commonly associated with two or more planned operations (P = 0.008). Autologous reconstructions were associated with greater total cost ($22 052 vs. $18 329, P < 0.001). CONCLUSIONS This review of reconstructions over a 12-year study period revealed that autologous reconstructions are associated with greater overall costs, but there is no statistically significant difference in reconstruction time or rate of surgical procedures. However, a full cost assessment between reconstructive techniques requires a much longer follow-up period.
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Affiliation(s)
- J S Palve
- Department of Plastic Surgery, Tampere University, Faculty of Medicine and Health Technology and Tampere University Hospital Finland.
| | - T H Luukkaala
- Research, Development and Innovation Center, Tampere University Hospital and Health Sciences, Faculty of Social Sciences, Tampere University Finland
| | - M T Kääriäinen
- Department of Plastic Surgery, Tampere University, Faculty of Medicine and Health Technology and Tampere University Hospital Finland
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Laikhter E, Shiah E, Manstein SM, Comer CD, Bustos VP, Lin SJ. Trends and characteristics of neurotization during breast reconstruction: perioperative outcomes using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). J Plast Surg Hand Surg 2021; 56:291-297. [PMID: 34524064 DOI: 10.1080/2000656x.2021.1973484] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study aimed to investigate the impact of performing neurotization during breast reconstruction on total operating time and post-operative morbidity. The 2015 through 2019 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) databases were utilized to identify patients who underwent breast reconstruction with and without neurotization. Baseline demographics, comorbidities, operative characteristics and outcomes were examined for each group. Thirty-day complication and readmission rates were compared using univariable and multivariable logistic regressions. Of 73,507 patients identified who underwent breast reconstruction, 240 had reconstruction with neurotization. Autologous reconstruction was more prevalent for patients with neurotization (90.8% vs. 18.5%, p<.001). Average operating time was longer when neurotization was performed during both autologous (527.1 ± 152.4 vs. 414.8 ± 186.3, p<.001) and alloplastic-only reconstruction (310.9 ± 115.9 vs. 173.0 ± 94.3, p<.001). The likelihood total operating time exceeded 521 min (two standard deviations above average) increased when neurotization was performed (OR 2.464, CI 1.864-3.255, p<.001). Thirty-day complications occurred in 13.8% of patients with neurotization and 6.8% without (p<.001). Similarly, 30-day readmission rates were higher for patients with neurotization (7.5% vs. 4.2%, p<.001). However, when adjusted for comorbidities and operative characteristics, neurotization did not significantly impact 30-day complication rates (OR 0.802, CI 0.548-1.174, p=.256) or 30-day readmission rates (OR 1.352, CI 0.822-2.223, p=.077). Although neurotization during breast reconstruction increases operating time, comorbidities and procedural characteristics play a greater role in post-operative outcomes than neurotization alone.
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Affiliation(s)
- Elizabeth Laikhter
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Eric Shiah
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Samuel M Manstein
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Carly D Comer
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Valeria P Bustos
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Samuel J Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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11
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Starnoni M, Pinelli M, Porzani S, Baccarani A, De Santis G. Standardization and Selection of High-risk Patients for Surgical Wound Infections in Plastic Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3472. [PMID: 33907656 PMCID: PMC8062150 DOI: 10.1097/gox.0000000000003472] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/13/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND The aim of the present study was to show that the Infection Risk Index (IRI), based on only 3 factors (wound classification, American Society of Anesthesiologists score, and duration of surgery), can be used to standardize selection of infection high-risk patients undergoing different surgical procedures in Plastic Surgery. METHODS In our Division of Plastic Surgery at Modena University Hospital, we studied 3 groups of patients: Group A (122 post-bariatric abdominoplasties), Group B (223 bilateral reduction mammoplasties), and Group C (201 tissue losses with first intention healing). For each group, we compared surgical site infection (SSI) rate and ratio between patients with 0 or 1 risk factors (IRI score 0 or 1) and patients with 2 or 3 risk factors (IRI score 2 or 3). RESULTS In group A, patients with IRI score 0-1 showed an SSI Ratio of 2.97%, whereas patients with IRI score 2-3 developed an SSI ratio of 27.27%. In group B, patients with IRI score 0-1 showed an SSI ratio of 2.99%, whereas patients with IRI score 2-3 developed an SSI ratio of 18.18%. In group C, patients with IRI score 0-1 showed an SSI ratio of 7.62%, whereas patients with IRI score 2-3 developed an SSI ratio of 30.77%. CONCLUSIONS Existing infection risk calculators are procedure-specific and time-consuming. IRI score is simple, fast, and unspecific but is able to identify patients at high or low risk of postoperative infections. Our results suggest the utility of IRI score in refining the infection risk stratification profile in Plastic Surgery.
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Affiliation(s)
- Marta Starnoni
- From the Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
- Division of Plastic and Reconstructive Surgery, University Hospital of Modena, Modena, Italy
| | - Massimo Pinelli
- Division of Plastic and Reconstructive Surgery, University Hospital of Modena, Modena, Italy
| | - Silvia Porzani
- Division of Plastic and Reconstructive Surgery, University Hospital of Modena, Modena, Italy
| | - Alessio Baccarani
- Division of Plastic and Reconstructive Surgery, University Hospital of Modena, Modena, Italy
| | - Giorgio De Santis
- Division of Plastic and Reconstructive Surgery, University Hospital of Modena, Modena, Italy
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The Use of Local Perforator Flaps in Delayed or Secondary Breast Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3263. [PMID: 33425582 PMCID: PMC7787289 DOI: 10.1097/gox.0000000000003263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/29/2020] [Indexed: 12/03/2022]
Abstract
Supplemental Digital Content is available in the text. Local perforator flaps are used as immediate volume replacement techniques in breast conserving surgery. Here, we describe a case series of local perforator flaps used in the delayed setting to correct defects following previous breast surgery, including previous breast conservation surgery or mastectomy with reconstruction. All cases were performed in a tertiary referral breast unit between 2014 and 2020. Cases were identified using a prospectively maintained database. Indications, type of perforator flap used, immediate post-operative complications, and longer term outcomes were recorded. Fifteen cases were identified: 8 following previous breast conserving surgery and radiotherapy, 6 following mastectomy and reconstruction, and 1 for developmental breast asymmetry following childhood radiotherapy. Indications included volume deficit, contour defect, asymmetry, and capsular contracture. One patient a major complication requiring return to theater due to implant-related infection. There were no flap losses. Longer term, 2 patients underwent lipomodeling to further augment breast volume as part of a planned, staged revision. One patient subsequently elected to have bilateral breast implant exchange to increase volume. Our series shows the versatility of local perforator flaps in the correction of complex breast defects that can occur following previous breast surgery. Delayed local perforator flaps are associated with low morbidity, and further revision surgery is not commonly required.
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13
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Tallroth L, Velander P, Klasson S. A short-term comparison of expander prosthesis and DIEP flap in breast reconstructions: A prospective randomized study. J Plast Reconstr Aesthet Surg 2020; 74:1193-1202. [PMID: 33436336 DOI: 10.1016/j.bjps.2020.10.104] [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: 10/11/2019] [Revised: 08/25/2020] [Accepted: 10/27/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is yet no clear consensus on which method is preferable in secondary breast reconstructions, prosthesis, or autologous tissue. METHODS In this first prospective randomized study, 29 women underwent reconstruction with expander prosthesis (EP) and 44 with deep inferior epigastric perforator (DIEP) flap. Inclusion started in 2012 and ended in 2018. Demographic data, complications, surgery time, hospital days, and consulting visits were recorded. Patient satisfaction was evaluated pre- and postoperatively using the BREAST-Q questionnaire. Health care costs were calculated based on rates from the financial year 2018. Here, we report the results related to the surgery and the first 30 postoperative days. RESULTS The two groups were comparable regarding demographics and clinical characteristics. Satisfaction with breasts, measured with BREAST-Q, was significantly higher in patients who had undergone reconstruction with DIEP flap compared with EP. Within 30 days after breast reconstruction, significantly fewer women (n = 2) in the EP group suffered complications compared to the DIEP flap group (n = 16; p < 0.01). The health care cost was also significantly higher in the DIEP flap group relative to the EP group (p < 0.01). DISCUSSION This patient cohort will be studied systematically over time, and results concerning the need for complementary surgery, costs, esthetics, and the patient-reported outcome (PRO) will be reported in future work. In this short-term report, EP seems to be preferable in regard to cost and complications, and DIEP flap is to choose from the patient's perspective.
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Affiliation(s)
- Linda Tallroth
- Skåne University Hospital, Department of Plastic and Reconstructive Surgery, Jan Waldenströms gata 18, 20501 Malmö, Sweden
| | - Patrik Velander
- Skåne University Hospital, Department of Plastic and Reconstructive Surgery, Jan Waldenströms gata 18, 20501 Malmö, Sweden
| | - Stina Klasson
- Skåne University Hospital, Department of Plastic and Reconstructive Surgery, Jan Waldenströms gata 18, 20501 Malmö, Sweden.
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Late Bleed after Deep Inferior Epigastric Perforator Flap Breast Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3035. [PMID: 32983790 PMCID: PMC7489612 DOI: 10.1097/gox.0000000000003035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/15/2020] [Indexed: 11/25/2022]
Abstract
Late bleed following deep inferior epigastric perforator (DIEP) flap breast reconstruction is an uncommon event. In this case report, the authors describe a case of late bleed 7 months following the index operation. This occurred in the setting of strenuous exercise. No specific etiology was determined and the condition resolved without treatment.
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Demiri EC, Tsimponis A, Pagkalos A, Georgiadou E, Goula OC, Spyropoulou GA, Dionyssiou D. Fat-Augmented Latissimus Dorsi versus Deep Inferior Epigastric Perforator Flap: Comparative Study in Delayed Autologous Breast Reconstruction. J Reconstr Microsurg 2020; 37:208-215. [PMID: 32892331 DOI: 10.1055/s-0040-1716348] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The use of autologous tissues is considered the mainstay for delayed breast reconstruction. Aside the free abdominal flaps, which are most commonly used, the fat-augmented latissimus-dorsi (FALD) flap has been recently shown a reliable alternative option for pure autologous breast reconstruction. In this retrospective study, we aim to compare outcomes of autologous breast reconstructions using the extended FALD and deep inferior epigastric perforator flap (DIEP) flap, with an emphasis on patients' characteristics, demographic data, complications, and patients' satisfaction after a minimum 12-month follow-up. METHODS Our series consists of 135 women who underwent a delayed postmastectomy unilateral autologous breast reconstruction from 2011 to 2017: 36 patients (Group A) had an extended FALD flap and 99 (Group B) a free DIEP flap performed by the same surgeons. Demographic data, breast volume, medical history, smoking, complications, and patients' satisfaction were recorded and analyzed. Student's t-test for independent variables, Mann-Whitney U-test, and Chi-squared test were used to compare the reported variables. RESULTS Patients' age, body mass index (BMI), and pregnancy history were statistically different between groups (p < 0.001, p = 0.004, p < 0.001, respectively); younger age (35.1 vs. 41.2 years), lower BMI (25.6 vs. 28.4), and fewer pregnancies were recorded in Group A. Breast volume was also found significantly smaller in Group A patients (p = 0.009). Past medical history using the ASA physical status classification score, previous radiation therapy, history of smoking, and incidence of overall complications were similar in both groups. Overall satisfaction scores were found slightly higher, but not statistically significant, in the free-flap group (p = 0.442). CONCLUSION The use of the FALD flap may provide comparable outcome to the DIEP flap in delayed breast reconstruction in terms of complications and patients' satisfaction; it should be considered a good reconstructive option for young and thin nulliparous patients, with small to medium size opposite breast.
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Affiliation(s)
- Efterpi C Demiri
- Department of Plastic Surgery, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou Hospital, Periferiaki Odos Neas Efkarpias, Thessaloniki, Greece
| | - Antonios Tsimponis
- Department of Plastic Surgery, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou Hospital, Periferiaki Odos Neas Efkarpias, Thessaloniki, Greece
| | - Anastasios Pagkalos
- Department of Plastic Surgery, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou Hospital, Periferiaki Odos Neas Efkarpias, Thessaloniki, Greece
| | - Eleni Georgiadou
- Department of Plastic Surgery, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou Hospital, Periferiaki Odos Neas Efkarpias, Thessaloniki, Greece
| | - Olga-Christina Goula
- Department of Plastic Surgery, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou Hospital, Periferiaki Odos Neas Efkarpias, Thessaloniki, Greece
| | - Georgia-Alexandra Spyropoulou
- Department of Plastic Surgery, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou Hospital, Periferiaki Odos Neas Efkarpias, Thessaloniki, Greece
| | - Dimitrios Dionyssiou
- Department of Plastic Surgery, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou Hospital, Periferiaki Odos Neas Efkarpias, Thessaloniki, Greece
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Wang J, Xiu B, Guo R, Zhang Q, Su Y, Li L, Chi W, Shao Z, Wu J. Autologous tissue reconstruction after mastectomy-A cross-sectional survey of 110 hospitals in China. Eur J Surg Oncol 2020; 46:2202-2207. [PMID: 32807619 DOI: 10.1016/j.ejso.2020.07.008] [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: 10/08/2019] [Revised: 06/11/2020] [Accepted: 07/06/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Autologous reconstruction after mastectomy became more and more popular, so this study aimed to obtain up-to-date and comprehensive data on autologous reconstruction in China. METHODS An electronic questionnaire was sent to 110 hospitals, which were chosen depending on geographical distribution and hospital types. The questionnaire investigated the demographics, characteristics, breast cancer treatment and reconstruction situation of these hospitals through different modules. We only focused on the autologous breast reconstruction module data. RESULTS 96 hospitals have performed breast reconstruction surgery. The proportion of the hospital performing latissimus dorsi flap (LDF, N = 91), pedicle transverse rectus abdominis myocutaneous flap (pTRAM, N = 62), free abdominal flap (N = 43) and other kinds of flap decreased in sequence. Of the overall reconstruction cases, only 34.3% were autologous reconstruction and LDF was still the most popular option for autologous reconstruction. Related factors of hospital performing different procedures included years of performing breast reconstruction, breast surgical volume, and establishment of an independent plastic surgery department. Compared with LDF, abdominal breast reconstruction was associated with a higher flap necrosis rate. CONCLUSIONS This cross-sectional survey offers real-life autologous reconstruction information on a large population and covers the national surgical landscape in China. Autologous reconstruction is still an important part of breast reconstruction. Nevertheless, its low proportion and lower proportion of abdominal flap reconstruction in each institution, demonstrates that special training should be developed for breast surgeons and multidisciplinary cooperation would be promoted in the future.
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Affiliation(s)
- Jia Wang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Bingqiu Xiu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Rong Guo
- Department of Breast Surgery, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Qi Zhang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yonghui Su
- Department of Breast Surgery, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Lun Li
- Department of Breast Surgery, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Weiru Chi
- Department of Breast Surgery, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Zhimin Shao
- Department of Breast Surgery, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Jiong Wu
- Department of Breast Surgery, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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Brorson F, Thorarinsson A, Kölby L, Elander A, Hansson E. Early complications in delayed breast reconstruction: A prospective, randomized study comparing different reconstructive methods in radiated and non-radiated patients. Eur J Surg Oncol 2020; 46:2208-2217. [PMID: 32807615 DOI: 10.1016/j.ejso.2020.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/25/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND There is little high-quality scientific evidence identifying the best and safest methods for delayed breast reconstruction, with most previous studies retrospective in nature. The primary aim was to compare early complication rates for two different breast-reconstructive methods in radiated and non-radiated patients, using a validated scale. The secondary aim was to identify predictors for complications. MATERIALS AND METHODS This study represents a clinical, randomized, prospective trial (ClinicalTrials.Gov identifier: NCT03963427), where the patients were divided into two study arms: non-radiated and radiated. In the non-radiated arm, patients were randomized to a one-stage lateral thoracodorsal flap with an implant or two-stage expander reconstruction. In the radiated arm, patients were randomized to a latissimus dorsi reconstruction combined with an implant or deep inferior epigastric artery perforator (DIEP) reconstruction. All adverse events were classified according to Clavien-Dindo and summarization of overall morbidity was performed by calculating the Comprehensive Complication Index score. The study was conducted from 2008 to 2020. RESULTS The complication frequencies were similar for the two surgical methods within each arm. In the non-radiated arm, risk factors for any complication were any comorbidities, and in the radiated arm, factors were a high body mass index and a contralateral operation. CONCLUSIONS The usage of the Clavien-Dindo scale in reconstructive surgery is feasible, but further validation is needed. In non-radiated patients, the frequencies of short-term complications were similar for lateral thoracodorsal flap and expander reconstruction, whereas in radiated patients, they were similar for DIEP and latissimus dorsi. The complication profile of the methods varied.
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Affiliation(s)
- Fredrik Brorson
- Department of Plastic Surgery, University of Gothenburg, The Sahlgrenska Academy, Institute of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Andri Thorarinsson
- Department of Plastic Surgery, University of Gothenburg, The Sahlgrenska Academy, Institute of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Kölby
- Department of Plastic Surgery, University of Gothenburg, The Sahlgrenska Academy, Institute of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Elander
- Department of Plastic Surgery, University of Gothenburg, The Sahlgrenska Academy, Institute of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Emma Hansson
- Department of Plastic Surgery, University of Gothenburg, The Sahlgrenska Academy, Institute of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Nishioka H, Yasunaga Y, Yanagisawa D, Yuzuriha S, Ito KI. Where do you insert a drain tube during breast reconstruction? Surg Today 2020; 50:1626-1632. [PMID: 32507906 DOI: 10.1007/s00595-020-02043-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE A drain tube is commonly inserted during breast reconstruction surgery. This leads to a scar in addition to the scar on the breast. This study was performed to investigate how patients feel about the drain scar and to clarify its ideal location. METHODS A questionnaire survey about the drain scar was distributed to 38 consecutive breast reconstruction patients and a total of 104 female doctors and nurses engaged in breast reconstruction. The drain scars were evaluated using the Japan Scar Workshop (JSW) Scar Scale. RESULTS A total of 32% of the patients expressed some anxiety about the drain scar. Patients who were anxious about the drain scar had higher scores on the JSW Scar Scale than those who were not anxious. Younger doctors and nurses preferred the drain scar to be on the side of the chest, while older doctors and nurses preferred the drain scars to be at the axilla. CONCLUSIONS About a third of the patients had some anxiety associated with their drain scar after breast reconstruction surgery, and this anxiety level was correlated with objective assessment of the scar. Thus, more patient involvement or the provision of more information regarding drain placement is required.
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Affiliation(s)
- Hiroshi Nishioka
- Department of Plastic and Reconstructive Surgery, Kofu Municipal Hospital, 366 Masutsubo Kofu, Yamanashi, 400-0832, Japan.
| | - Yoshichika Yasunaga
- Department of Plastic and Reconstructive Surgery, Ina Central Hospital, 1313-1 Koshirokubo Ina, Nagano, 396-8555, Japan.,Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, 3-1-1 Asahi Matsumoto, Nagano, 390-8621, Japan
| | - Daisuke Yanagisawa
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, 3-1-1 Asahi Matsumoto, Nagano, 390-8621, Japan
| | - Shunsuke Yuzuriha
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, 3-1-1 Asahi Matsumoto, Nagano, 390-8621, Japan
| | - Ken-Ichi Ito
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi Matsumoto, Nagano, 390-8621, Japan
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Predictive risk factors of complications in different breast reconstruction methods. Breast Cancer Res Treat 2020; 182:345-354. [PMID: 32468337 PMCID: PMC7297836 DOI: 10.1007/s10549-020-05705-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/21/2020] [Indexed: 10/26/2022]
Abstract
PURPOSE Women with different BMI, age and comorbidities seek for breast reconstruction. It is critical to understand the risk associated with each technique to ensure the most appropriate method and timing is used. Outcome after reconstructions have been studied, but consensus is lacking regarding predictive risk factors of complications. The authors present their experience of different autologous and alloplastic reconstructions with an emphasis on predictors of complications. METHODS Prospectively maintained reconstruction database from 2008 to 2019 was reviewed. Factors associated with complications were identified using logistic regression, multinomial logistic regression and risk factor score to determine predictors of complications. RESULTS A total of 850 breast reconstructions were performed in 793 women, including 447 DIEP, 283 LD, 12 TMG and 51 implant reconstructions. Complications included minor (n = 231, 29%), re-surgery requiring (n = 142, 18%) and medical complications (n = 7, 1%). Multivariable analysis showed that complications were associated independently with BMI > 30 (OR 1.59; 95% CI 1.05-2.39, p = 0.027), LD technique (OR 4.05; 95% CI 2.10-7.81, p < 0.001), asthma or chronic obstructive pulmonary disease (OR 2.77; 95% CI 1.50-5.12, p = 0.001) and immediate operation (OR 0.69; 95% CI 0.44-1.07, p = 0.099). Each factor contributed 1 point in the creation of a risk-scoring system. The overall complication rate was increased as the risk score increased (35%, 61%, 76% and 100% for 1, 2, 3 and 4 risk scores, respectively, p < 0.001). CONCLUSIONS The rate of complication can be predicted by a risk-scoring system. In increasing trend of patients with medical problems undergoing breast reconstruction, tailoring of preventive measures to patients' risk factors and careful consideration of the best timing of reconstruction is mandatory to prevent complications and costs.
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Wu J, Yan C, Wang L, Yang Y, Ling R, Li N. Oncoplastic technique using a lateral mammary adipofascial flap for the breast-conserving reconstruction. ANNALS OF TRANSLATIONAL MEDICINE 2020; 7:794. [PMID: 32042810 DOI: 10.21037/atm.2019.12.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Achieving satisfactory cosmetic results after breast-conserving surgery (BCS) can be difficult for breast cancer patients with large tumors. To avoid breast asymmetries and deformation, we present a case of breast reconstruction after BCS with a lateral mammary adipofascial flap, which was dissociated along the sentinel lymph node biopsy incision. During the procedure, the pedicled flap was transferred into the residual tumor cavity through a tunnel between them and then matched the residual cavity. The sufficient blood supply of the transferred flap was observed in ultrasound at follow-up. The operative is straightforward to perform and less invasive. No operative complications were observed. The cosmetic results were found to be good with a natural shape, volume, and symmetry, and with which the patient has reported high satisfaction. This procedure offers a new possibility in breast reconstruction and is worth considering as a new option for immediate repair after BCS.
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Affiliation(s)
- Jiang Wu
- Department of Thyroid, Breast, and Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Changjiao Yan
- Department of Thyroid, Breast, and Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Lei Wang
- Department of Thyroid, Breast, and Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Yuqing Yang
- Department of Thyroid, Breast, and Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Rui Ling
- Department of Thyroid, Breast, and Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Nanlin Li
- Department of Thyroid, Breast, and Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
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Thomas AB, Shammas RL, Orr J, Truong T, Kuchibhatla M, Sergesketter AR, Hollenbeck ST. An Assessment of Bleeding Complications Necessitating Blood Transfusion across Inpatient Plastic Surgery Procedures. Plast Reconstr Surg 2019; 143:1109e-1117e. [DOI: 10.1097/prs.0000000000005537] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Prasad K, Zhou R, Zhou R, Schuessler D, Ostrikov KK, Bazaka K. Cosmetic reconstruction in breast cancer patients: Opportunities for nanocomposite materials. Acta Biomater 2019; 86:41-65. [PMID: 30576863 DOI: 10.1016/j.actbio.2018.12.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 12/08/2018] [Accepted: 12/17/2018] [Indexed: 12/23/2022]
Abstract
The most common malignancy in women, breast cancer remains a major medical challenge that affects the life of thousands of patients every year. With recognized benefits to body image and self-esteem, the use of synthetic mammary implants for elective cosmetic augmentation and post-mastectomy reconstruction continues to increase. Higher breast implant use leads to an increased occurrence of implant-related complications associated with implant leakage and rupture, capsular contracture, necrosis and infections, which include delayed healing, pain, poor aesthetic outcomes and the need for revision surgeries. Along with the health status of the implant recipient and the skill of the surgeon, the properties of the implant determine the likelihood of implant-related complications and, in doing so, specific patient outcomes. This paper will review the challenges associated with the use of silicone, saline and "gummy bear" implants in view of their application in patients recovering from breast cancer-related mastectomy, and investigate the opportunities presented by advanced functional nanomaterials in meeting these challenges and potentially opening new dimensions for breast reconstruction. STATEMENT OF SIGNIFICANCE: Breast cancer is a significant cause of morbidity and mortality in women worldwide, which is difficult to prevent or predict, and its treatment carries long-term physiological and psychological consequences. Post-mastectomy breast reconstruction addresses the cosmetic aspect of cancer treatment. Yet, drawbacks of current implants contribute to the development of implant-associated complications, which may lead to prolonged patient care, pain and loss of function. Nanomaterials can help resolve the intrinsic biomechanical mismatch between implant and tissues, enhance mechanical properties of soft implantable materials, and provide an alternative avenue for controlled drug delivery. Here, we explore advances in the use of functionalized nanomaterials to enhance the properties of breast implants, with representative examples that highlight the utility of nanomaterials in addressing key challenges associated with breast reconstruction.
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Affiliation(s)
- Karthika Prasad
- School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; CSIRO-QUT Joint Sustainable Processes and Devices Laboratory, Commonwealth Scientific and Industrial Research Organisation, P.O. Box 218, Lindfield, NSW 2070, Australia
| | - Renwu Zhou
- School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; CSIRO-QUT Joint Sustainable Processes and Devices Laboratory, Commonwealth Scientific and Industrial Research Organisation, P.O. Box 218, Lindfield, NSW 2070, Australia
| | - Rusen Zhou
- School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; CSIRO-QUT Joint Sustainable Processes and Devices Laboratory, Commonwealth Scientific and Industrial Research Organisation, P.O. Box 218, Lindfield, NSW 2070, Australia
| | - David Schuessler
- Product Development, Allergan, 2525 Dupont Drive, Irvine, CA 92612, United States
| | - Kostya Ken Ostrikov
- School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; CSIRO-QUT Joint Sustainable Processes and Devices Laboratory, Commonwealth Scientific and Industrial Research Organisation, P.O. Box 218, Lindfield, NSW 2070, Australia
| | - Kateryna Bazaka
- School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; CSIRO-QUT Joint Sustainable Processes and Devices Laboratory, Commonwealth Scientific and Industrial Research Organisation, P.O. Box 218, Lindfield, NSW 2070, Australia.
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Sadok N, Krabbe-Timmerman IS, de Bock GH, Werker PMN, Jansen L. The Effect of Smoking and Body Mass Index on The Complication Rate of Alloplastic Breast Reconstruction. Scand J Surg 2019; 109:143-150. [PMID: 30712467 DOI: 10.1177/1457496919826711] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS The aim of this study was to evaluate the effect of smoking and body mass index on the occurrence of complications after alloplastic breast reconstruction. MATERIALS AND METHODS A consecutive series of 56 patients treated with immediate or delayed alloplastic breast reconstruction, including six cases combined with latissimus dorsi flap, at three hospitals between 2012 and 2018 were included. Complications were scored and defined according to Clavien-Dindo. To evaluate the impact of smoking, body mass index, and other potential risk factors on the occurrence of any and severe complications, univariate and multivariate logistic regression analyses were applied to estimate odds ratios and 95% confidence intervals. RESULTS In 56 patients, 22 patients had a complication. As much as 46% of smokers had severe complications compared to 18% of non-smokers. Of patients with body mass index ⩾ 25, 40% had severe complications compared to 10% with body mass index < 25. Smokers had eight times more chance of developing severe complications than non-smokers (ORadjusted = 8.0, p = 0.02). Patients with body mass index ⩾ 25 had almost 10 times more severe complications compared to patients with body mass index ⩽ 25 (ORadjusted = 9.9, p = 0.009). No other risk factors were significant. CONCLUSION Smoking and body mass index ⩾ 25 both increased the complication rate to such an extent that patients should be informed about their increased risk for complications following alloplastic breast reconstruction and on these grounds surgeons may delay alloplastic breast reconstruction. It is an ethical dilemma whether one should deny overweight and obese patients and those who smoke an immediate alloplastic breast reconstruction. For both life style interventions, adequate guidance should be made available.
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Affiliation(s)
- N Sadok
- Department of Plastic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - I S Krabbe-Timmerman
- Department of Plastic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
| | - P M N Werker
- Department of Plastic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - L Jansen
- Department of Surgical Oncology, University Medical Center Groningen, Groningen, The Netherlands
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Outcomes of Fat-Augmented Latissimus Dorsi (FALD) Flap Versus Implant-Based Latissimus Dorsi Flap for Delayed Post-radiation Breast Reconstruction. Aesthetic Plast Surg 2018; 42:692-701. [PMID: 29372268 DOI: 10.1007/s00266-018-1081-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/07/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although free abdominal flaps constitute the gold standard in post-radiation delayed breast reconstruction, latissimus dorsi-based methods offer alternative reconstructive options. This retrospective study aims to compare outcomes of delayed breast reconstruction using the fat-augmented latissimus dorsi (FALD) autologous reconstruction and the latissimus dorsi-plus-implant reconstruction in irradiated women. METHODS We reviewed the files of 47 post-mastectomy irradiated patients (aged 29-73 years), who underwent delayed latissimus dorsi-based breast reconstruction between 2010 and 2016. Twenty-three patients (Group A) had an extended FALD flap and twenty-four patients (Group B) an implant-based latissimus dorsi reconstruction. Patients' age, BMI, pregnancies, volume of injected fat, implant size, postoperative complications, and secondary surgical procedures were recorded and analyzed. RESULTS Age, BMI, pregnancies, and donor-site complications were similar in both groups (p > 0.05). Mean fat volume injected initially was 254 cc (ranged 130-380 cc/session); mean implant volume was 323 cc (ranged 225-420 cc). Breast complications were significantly fewer in Group A (one wound dehiscence, two oily cysts) compared to Group B (three cases with wound dehiscence, two extrusions, thirteen severe capsular contractions). Non-statistically significant difference was documented for secondary procedures between groups; although the mean number of additional surgeries/patient was higher in Group A, they referred to secondary lipofilling, whereas in Group B they were revision surgeries for complications. CONCLUSIONS The FALD flap constitutes an alternative method for delayed autologous reconstruction after post-mastectomy irradiation, avoiding implant-related complications. Although additional fat graft sessions might be required, it provides an ideal autogenous reconstructive option for thin nulliparous women, with a small opposite breast and adequate fat donor sites. 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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Thorarinsson A, Fröjd V, Kölby L, Lidén M, Elander A, Mark H. Patient determinants as independent risk factors for postoperative complications of breast reconstruction. Gland Surg 2017; 6:355-367. [PMID: 28861376 DOI: 10.21037/gs.2017.04.04] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Breast reconstruction is an essential component in the treatment of breast cancer. Postoperative complications after breast reconstruction are common and affect patient satisfaction. Determining independent risk factors using patient characteristics could be advantageous for patient assessment and counseling. METHODS We retrospectively enrolled 623 consecutive patients who underwent reconstruction with a deep inferior epigastric perforator flap (DIEP), latissimus dorsi flap (LD), lateral thoracodorsal flap (LTDF), or tissue expander with a secondary implant (EXP) in this study. Information on demographic and perioperative factors was collected, as well as information on all postoperative complications. Logistic regression was used to analyze associations between possible patient-related risk factors and postoperative complications. RESULTS Smoking was associated with the highest number of early overall complications [odds ratio (OR) 2.05, 95% confidence interval (CI) 1.25-3.37, P=0.0005], followed by body mass index (BMI) (OR 1.07, 95% CI 1.01-1.13, P=0.017). High BMI was associated with the highest number of late overall postoperative complications (OR 1.06, 95% CI 1.00-1.11, P=0.042), followed by history of radiotherapy (OR 1.66, 95% CI 1.01-2.74, P=0.046). When the risk factors were combined, the risk for postoperative complications rose exponentially. CONCLUSIONS Our results provide evidence that patients should cease smoking and overweight patients should lose weight before undergoing breast reconstruction. Additionally, if the patient has received radiotherapy, the reconstruction method should be carefully chosen. High BMI, history of radiotherapy, and smoking are independent risk factors for many types of both early and late postoperative complications in breast reconstructive surgery. Combining these risk factors multiplies the risk of postoperative complications.
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Affiliation(s)
- Andri Thorarinsson
- Department of Plastic Surgery, Sahlgrenska University Hospital, Institute for Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Victoria Fröjd
- Department of Plastic Surgery, Sahlgrenska University Hospital, Institute for Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Kölby
- Department of Plastic Surgery, Sahlgrenska University Hospital, Institute for Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mattias Lidén
- Department of Plastic Surgery, Sahlgrenska University Hospital, Institute for Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Elander
- Department of Plastic Surgery, Sahlgrenska University Hospital, Institute for Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hans Mark
- Department of Plastic Surgery, Sahlgrenska University Hospital, Institute for Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Long-Term Health-Related Quality of Life after Breast Reconstruction: Comparing 4 Different Methods of Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1316. [PMID: 28740762 PMCID: PMC5505823 DOI: 10.1097/gox.0000000000001316] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/07/2017] [Indexed: 01/22/2023]
Abstract
Background: Studies have confirmed that breast reconstruction is beneficial to improve health-related quality of life (HR-QoL) in breast cancer patients. Our aim was to compare 4 different methods of breast reconstruction on patient satisfaction and HR-QoL using both general and specific patient-reported outcome instruments. Methods: Retrospectively, 459 patients who underwent breast reconstruction with a deep inferior epigastric artery perforator (DIEP) flap, latissimus dorsi flap, lateral thoracodorsal flap, or expander with secondary implant and who had responded to the questionnaires were enrolled. Questionnaire answers, together with demographic and follow-up data, were statistically analyzed and compared between groups. Short-Form 36 Health Survey (SF-36) results were also compared with those from a sample of 930 age-matched women from the Swedish population. Results: There were slight differences in the SF-36 results but no significant differences in Psychological General Well-Being Index and EuroQoL-5 Dimension Questionnaire results between groups. Analysis of Breast-Q showed that the DIEP group had significantly higher score on the scale satisfaction with breast, significantly higher score in satisfaction with outcome than the lateral thoracodorsal flap (P = 0.014) and EXP groups (P = 0.024). There were no significant differences in most of the domains of the HR-QoL instruments. The higher satisfaction with breasts and outcome in the DIEP group is interesting, considering the higher complication rates associated with this reconstruction method. Conclusions: Patients who underwent breast reconstruction with a DIEP flap were more satisfied with their reconstructed breast and outcome than the other 3 groups. Breast reconstruction centers should make DIEP reconstruction widely available to patients after mastectomy.
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Mani M, Saour S, Ramsey K, Power K, Harris P, James S. Bilateral breast reconstruction with deep inferior epigastric perforator flaps in slim patients. Microsurgery 2017; 38:143-150. [DOI: 10.1002/micr.30173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 02/03/2017] [Accepted: 02/28/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Maria Mani
- Department of Plastic and Reconstructive Surgery; The Royal Marsden Hospital; London United Kingdom
- Department of Surgical Sciences; Section of Plastic and Reconstructive Surgery; Uppsala University, Uppsala Sweden
| | - Samer Saour
- Department of Plastic and Reconstructive Surgery; The Royal Marsden Hospital; London United Kingdom
| | - Kelvin Ramsey
- Department of Plastic and Reconstructive Surgery; The Royal Marsden Hospital; London United Kingdom
| | - Kieran Power
- Department of Plastic and Reconstructive Surgery; The Royal Marsden Hospital; London United Kingdom
| | - Paul Harris
- Department of Plastic and Reconstructive Surgery; The Royal Marsden Hospital; London United Kingdom
| | - Stuart James
- Department of Plastic and Reconstructive Surgery; The Royal Marsden Hospital; London United Kingdom
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Thorarinsson A, Fröjd V, Kölby L, Modin A, Lewin R, Elander A, Mark H. Blood loss and duration of surgery are independent risk factors for complications after breast reconstruction. J Plast Surg Hand Surg 2017; 51:352-357. [PMID: 28122466 DOI: 10.1080/2000656x.2016.1272462] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Complications after breast reconstructive surgery are common, and they can be caused by a wide range of factors. The aim of the present study was to identify independent perioperative risk factors for postoperative complications after breast reconstruction. METHODS A retrospective study was performed of 623 consecutive breast cancer patients who had undergone deep inferior epigastric perforator (DIEP) flap, latissimus dorsi (LD) flap, lateral thoracodorsal flap (LTDF), or tissue expander with secondary implant (EXP). Data on demography, perioperative parameters, and complications were collected. Logistic regression models adjusted to the reconstruction method and to confounding demographic factors were used for statistical analysis. RESULTS Increased blood loss for each 10-ml step increased the risk for overall early complications (p = 0.017), early seroma (p = 0.037), early resurgery (p = 0.010), late local overall complications (p = 0.024), and late fat necrosis (p = 0.031). Longer duration of surgery for each 10-minute step increased the risk of overall early complications (p = 0.019), but, in the univariate model, there was an increased risk for nine different types of complications (p = 0.004-0.029). There was no association between the experience of the surgeon performing the procedure and the frequency of complications. CONCLUSIONS Duration of surgery and blood loss during surgery are independent risk factors for postoperative complications, and should be minimised. Further research is needed to establish the association between the experience of the surgeon and the occurrence of complications.
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Affiliation(s)
- Andri Thorarinsson
- a Sahlgrenska Academy, Department of Plastic Surgery , Institute for Clinical Sciences , Gothenburg , Sweden
| | - Victoria Fröjd
- a Sahlgrenska Academy, Department of Plastic Surgery , Institute for Clinical Sciences , Gothenburg , Sweden
| | - Lars Kölby
- a Sahlgrenska Academy, Department of Plastic Surgery , Institute for Clinical Sciences , Gothenburg , Sweden
| | - Albert Modin
- a Sahlgrenska Academy, Department of Plastic Surgery , Institute for Clinical Sciences , Gothenburg , Sweden
| | - Richard Lewin
- a Sahlgrenska Academy, Department of Plastic Surgery , Institute for Clinical Sciences , Gothenburg , Sweden
| | - Anna Elander
- a Sahlgrenska Academy, Department of Plastic Surgery , Institute for Clinical Sciences , Gothenburg , Sweden
| | - Hans Mark
- a Sahlgrenska Academy, Department of Plastic Surgery , Institute for Clinical Sciences , Gothenburg , Sweden
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Amblee A, Ganesh M. Retroperitoneal Fat Necrosis in a Patient with Extensive Weight Loss After Adrenalectomy for ACTH-Independent Cushing Syndrome: A Case Report and Review of the Literature. AACE Clin Case Rep 2016. [DOI: 10.4158/ep15935.cr] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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