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Mayr-Riedler MS, Topka C, Schneider S, Heidekrueger PI, Machens HG, Broer PN. The Role of Density in Achieving Volume and Weight Symmetry in Breast Reconstruction. J Reconstr Microsurg 2024; 40:619-626. [PMID: 38272059 DOI: 10.1055/a-2253-8442] [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: 01/27/2024]
Abstract
BACKGROUND Knowledge of tissue and implant density is crucial in obtaining both volume and weight symmetry in unilateral breast reconstruction. Therefore, the aim of this study was to determine and compare the density of abdominal and breast tissue specimens as well as of 5th generation breast implants. METHODS Thirty-one breast tissue and 30 abdominal tissue specimens from 61 patients undergoing either mammaplasty or abdominoplasty as well as five different 5th generation breast implants were examined. Density (g/mL) was calculated by applying the water displacement method. RESULTS The mean specimen density was 0.94 ± 0.02 g/mL for breast tissue and 0.94 ± 0.02 g/mL for abdominal tissue, showing no significant difference (p = 0.230). Breast tissue density significantly (p = 0.04) decreased with age, while abdominal tissue did not. A regression equation to calculate the density of breast tissue corrected for age (breast density [g/mL] = 0.975-0.0007 * age) is provided. Breast tissue density was not related to body mass index, past pregnancy, or a history of breastfeeding. The breast implants had a density ranging from 0.76 to 1.03 g/mL which differed significantly from breast tissue density (-0.19 g/mL [-19.8%] to +0.09 g/mL [+9.58%]; p ≤ 0.001). CONCLUSION Our results support the suitability of abdominal-based perforator flaps in achieving both volume and weight symmetry in unilateral autologous breast reconstruction. Abdominal flap volume can be derived one-to-one from mastectomy weight. Further, given significant brand-dependent density differences, the potential to impose weight disbalances when performing unilateral implant-based reconstructions of large breasts should be considered.
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Affiliation(s)
- Michael S Mayr-Riedler
- Department for Plastic, Reconstructive, Hand and Burn Surgery, Munich Clinic Bogenhausen, Munich, Germany
| | - Charlotte Topka
- Department for Plastic, Reconstructive, Hand and Burn Surgery, Munich Clinic Bogenhausen, Munich, Germany
| | - Simon Schneider
- Department for Plastic, Reconstructive, Hand and Burn Surgery, Munich Clinic Bogenhausen, Munich, Germany
- Department for Plastic Surgery and Hand Surgery, Technical University of Munich, Munich, Germany
| | - Paul I Heidekrueger
- Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Regensburg, Germany
| | - Hans-Günther Machens
- Department for Plastic Surgery and Hand Surgery, Technical University of Munich, Munich, Germany
| | - P Niclas Broer
- Department for Plastic, Reconstructive, Hand and Burn Surgery, Munich Clinic Bogenhausen, Munich, Germany
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Mathelin C, Barranger E, Boisserie-Lacroix M, Boutet G, Brousse S, Chabbert-Buffet N, Coutant C, Daraï E, Delpech Y, Duraes M, Espié M, Golfier F, Hamy AS, Kermarrec E, Lavoué V, Lodi M, Luporsi É, Maugard C, Molière S, Seror JY, Taris N, Uzan C, Vaysse C, Fritel X. [Techniques and complications of non-genetic risk reducing mastectomies: Guidelines of the National College of French Gynecologists and Obstetricians (CNGOF)]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:121-129. [PMID: 34922037 DOI: 10.1016/j.gofs.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Based on an updated review of the international literature covering the different surgical techniques and complications of risk reducing mastectomies (RRM) in non-genetic context, the Commission of Senology (CS) of the College National des Gynécologues Obstétriciens Français (CNGOF) aimed to establish recommendations on the techniques to be chosen and their implementation. DESIGN The CNGOF CS, composed of 24 experts, developed these recommendations. A policy of declaration and monitoring of links of interest was applied throughout the process of making the recommendations. Similarly, the development of these recommendations did not benefit from any funding from a company marketing a health product. The CS adhered to and followed the AGREE II (Advancing guideline development, reporting and evaluation in healthcare) criteria and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method to assess the quality of the evidence on which the recommendations were based. The potential drawbacks of making recommendations in the presence of poor quality or insufficient evidence were highlighted. METHODS The CS considered 6 questions in 4 thematic areas, focusing on oncologic safety, risk of complications, aesthetic satisfaction and psychological impact, and preoperative modalities. RESULTS The application of the GRADE method resulted in 7 recommendations, 6 with a high level of evidence (GRADE 1±) and 1 with a low level of evidence (GRADE 2±). CONCLUSION There was significant agreement among the CS members on recommendations for preferred surgical techniques and practical implementation.
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Affiliation(s)
- C Mathelin
- CHRU, avenue Molière, 67200 Strasbourg, France; ICANS, 17, rue Albert-Calmette, 67033 Strasbourg cedex, France.
| | - E Barranger
- Centre Antoine-Lacassagne, 36, avenue de Valombrose, 06189 Nice, France
| | | | - G Boutet
- AGREGA, service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor d'Aquitaine, centre hospitalier universitaire de Bordeaux, groupe hospitalier Pellegrin, place Amélie-Raba-Léon, 33 000 Bordeaux, France
| | - S Brousse
- CHU de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes cedex 9, France
| | | | - C Coutant
- Département d'oncologie chirurgicale, centre Georges-François-Leclerc, 1, rue du Pr Marion, 21079 Dijon cedex, France
| | - E Daraï
- Hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Y Delpech
- Centre Antoine Lacassagne, 33, avenue de Valombrose, 06189 Nice, France
| | - M Duraes
- CHU de Montpellier, 191, avenue du Doyen-Giraud, 34295 Montpellier cedex, France
| | - M Espié
- Hôpital St Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - F Golfier
- Centre hospitalier Lyon Sud, bâtiment 3B, 165, chemin du Grand-Revoyet, 69495 Pierre Benite, France
| | - A S Hamy
- Institut Curie, 26, rue d'Ulm, 75248 Paris, France
| | - E Kermarrec
- Service de radiologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - V Lavoué
- Service de gynécologie, CHU, 16, boulevard de Bulgarie, 35200 Rennes, France
| | - M Lodi
- CHU, avenue Molière, 67200 Strasbourg, France
| | - É Luporsi
- Oncologie médicale et oncogénétique, hôpital de Mercy, CHR Metz-Thionville, 1, allée du Château, 57085 Metz, France
| | - C Maugard
- Service de génétique oncologique clinique et unité de génétique oncologique moléculaire, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg
| | - S Molière
- Imagerie du sein, CHRU, avenue Molière 67200 Strasbourg, France
| | - J-Y Seror
- Cabinet privé, 9 ter boulevard Montparnasse, 75006 Paris, France
| | - N Taris
- Oncogénétique, ICANS, 17, rue Albert Calmette, 67033 Strasbourg, France
| | - C Uzan
- Hôpital Pitié-Salpetrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - C Vaysse
- Service de chirurgie oncologique, CHU de Toulouse, institut universitaire du cancer de Toulouse-Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France
| | - X Fritel
- Centre hospitalo-universitaire de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
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Optimal breast reconstruction type for patients treated with neoadjuvant chemotherapy, mastectomy followed by radiation therapy. Breast Cancer Res Treat 2020; 183:127-136. [PMID: 32607638 DOI: 10.1007/s10549-020-05747-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/13/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE To explore the optimal type of breast reconstruction and the time interval to postmastectomy radiotherapy (PMRT) associated with lower complications in breast cancer patients receiving neoadjuvant chemotherapy. METHODS We reviewed the medical records of 300 patients who received neoadjuvant chemotherapy, mastectomy with breast reconstruction and PMRT at our institution from 2000 to 2017. Reconstruction types included autologous flaps (AR), single-stage-direct-to-implant and two-stages expander/implant (TE/I). The primary endpoint was the rate of reconstruction complications including infection, skin and fat necrosis. Subgroup analysis compared rates of capsular contracture, implant rupture, implant exposure and overall implant failure in single-stage-direct-to-implant to TE/I. The secondary endpoint was identifying the time interval between surgery with immediate implant-based reconstruction and PMRT associated with lower probability of implant failure. Logistic regression models, Kaplan-Meier estimates and Polynomial regression were used to assess endpoints. RESULTS The median follow-up was 43.5 months. 29.3%, 28.3% and 42.4% of the cohort had AR, TE/I and single-stage-direct-to-implant D, respectively. The 5-year cumulative incidence rate of complications was 14.0%, 29.7% and 19.4% for AR, TE/I and single-stage-direct-to-implant, respectively (Log rank p = 0.02). Multivariate analysis showed significant association between TE/I and higher risk of infection (OR 8.1, p = 0.009) compared to AR, while single-stage-direct-to-implant and AR were comparable (OR 3.2, p = 0.2). On subgroup analysis, TE/I was significantly associated with higher rates of implant failure. The mean wait time to deliver PMRT after immediate reconstruction with no adjuvant chemotherapy was 8.4 and 10.7 weeks in single-stage-direct-to-implant and TE/I, respectively (p < 0.005). Delivering PMRT after 8 weeks of surgery yielded 10% probability of reconstruction failure in single-stage-direct-to-implant versus 40% in TE/I. CONCLUSION In comparison to two stages reconstruction, single-stage-direct-to-implant following neoadjuvant chemotherapy has lower complications and offers timely delivery of PMRT.
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Risk-reducing mastectomy: a case series of 124 procedures in Brazilian patients. Breast Cancer Res Treat 2020; 181:69-75. [PMID: 32215763 DOI: 10.1007/s10549-020-05582-w] [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: 12/10/2019] [Accepted: 02/20/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Women with mutations in breast cancer predisposition genes have a significantly higher lifetime risk of developing breast cancer and can opt for risk-reducing mastectomy. Women with positive family history of cancer can also opt for prophylactic surgery as a preventive method in selected cases. Current studies showed reduced risk of developing breast cancer after prophylactic nipple-sparing mastectomy, however, despite the good clinical outcomes, one of the main concerns regarding nipple-sparing mastectomy (NSM) is the oncological safety of nipple-areola complex preservation. In this study, we aimed to evaluate the indications, complication rates, and unfavorable events of 62 Brazilian patients that underwent risk-reducing NSM from 2004 to 2018. METHODS Patient data were reviewed retrospectively and descriptive statistics were utilized to summarize the findings. RESULTS The mean patients age was 43.8 years. The main indication for risk-reducing NSM was the presence of pathogenic mutation (53.3%), followed by atypia or lobular carcinoma in situ (25.8), and family history of breast cancer and/or ovarian cancer (20.9%). There were four (3.2%) incidental diagnosis of ductal carcinoma in situ and one invasive ductal carcinoma (0.8%). From the 124 prophylactic NSM performed, two (1.6%) complications had occurred: one (0.8%) infection and one (0.8%) partial nipple necrosis. In a mean follow-up of 50 months, there was one (1.6%) newly diagnosed breast cancer in the 62 patients undergoing prophylactic NSM. CONCLUSIONS Our findings demonstrated efficacy and safety to perform NSM as prophylactic surgery with good oncological outcomes and low complication rates in a case series of Brazilian patients.
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Margenthaler JA, Gan C, Yan Y, Cyr AE, Tenenbaum M, Hook D, Myckatyn TM. Oncologic Safety and Outcomes in Patients Undergoing Nipple-Sparing Mastectomy. J Am Coll Surg 2020; 230:535-541. [PMID: 32032724 DOI: 10.1016/j.jamcollsurg.2019.12.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 12/16/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Nipple-sparing mastectomy (NSM) is an alternative to skin-sparing mastectomy in appropriately selected patients. The aim of this study was to review our experience with NSM and to evaluate for oncologic safety. STUDY DESIGN Patients who underwent NSM at our institution from September 2008 through August 2017 were identified after IRB approval. Data included patient age, tobacco use, tumor size, hormone receptor status, lymph node status, radiation and chemotherapy use, incision type, and reconstruction type. Statistical analyses were performed using ANOVA and chi-square tests. RESULTS There were 322 patients who underwent 588 NSM (83% bilateral, 17% unilateral), including 399 (68%) for malignancy (Stage 0 [27%], I [44%], II [25%] and III [4%]). The overall rate of wound complication was 18.9%. Tobacco use increased complication (37.5% vs 16.3%, p < 0.001), as did adjuvant radiation therapy (31.4% vs 17.4%, p = 0.014). Patients with lymph node involvement and larger tumor size had a higher rate of complication (31.3% vs 17.2%, p = 0.016). Patients undergoing circumareolar incisions had a higher rate of complication than those undergoing lateral radial, inframammary fold, or curvilinear incisions (43.5% vs 17.4% vs 17.4% vs 14.3%, respectively, p = 0.018). Six (1%) local chest wall recurrences occurred during the follow-up period, none of which involved the nipple-areolar complex. Four patients (1%) suffered a distant recurrence. CONCLUSIONS Most NSM performed at our institution are in patients with malignancy. The oncologic safety is confirmed by the low locoregional recurrence rate. Tobacco use and adjuvant radiation therapy remain the most significant risk factors for complication, highlighting the need for careful patient selection and patient counseling regarding modifiable risk factors and expected outcomes.
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Affiliation(s)
| | - Connie Gan
- Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Yan Yan
- Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Amy E Cyr
- Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Marissa Tenenbaum
- Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Diana Hook
- Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Terence M Myckatyn
- Department of Surgery, Washington University School of Medicine, St Louis, MO
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Putting Together the Pieces: Development and Validation of a Risk-Assessment Model for Nipple-Sparing Mastectomy. Plast Reconstr Surg 2020; 145:273e-283e. [PMID: 31985614 DOI: 10.1097/prs.0000000000006443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Young WA, Degnim AC, Hoskin TL, Jakub JW, Nguyen MD, Tran NV, Harless CA, Manrique OJ, Boughey JC, Hieken TJ. Outcomes of > 1300 Nipple-Sparing Mastectomies with Immediate Reconstruction: The Impact of Expanding Indications on Complications. Ann Surg Oncol 2019; 26:3115-3123. [DOI: 10.1245/s10434-019-07560-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Indexed: 11/18/2022]
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Nahabedian MY. The bioengineered prosthetic breast reconstruction: advancements, evidence, and outcomes. Gland Surg 2019; 8:271-282. [PMID: 31328106 DOI: 10.21037/gs.2018.08.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Recent advancements in prosthetic breast reconstruction have provided the foundation for the bioengineered breast. These advancements include improved mastectomy techniques, autologous fat grafting, acellular dermal matrices (ADMs), and improved devices. Device-based breast reconstruction has evolved from subcutaneous, partial or total subpectoral, and now to prepectoral placement of devices. The evidence demonstrating the safety and efficacy of the bioengineered breast continues to increase. This manuscript will review the fundamental components of the bioengineered breast and provide an update of the current evidence.
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Affiliation(s)
- Maurice Y Nahabedian
- Department of Plastic Surgery, Virginia Commonwealth University, Inova Branch, Falls Church, Virginia, USA.,National Center for Plastic Surgery, McLean, VA, USA
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Shia WC, Yang HJ, Wu HK, Lin SL, Lai HW, Huang YL, Chen DR. Implant volume estimation in direct-to-implant breast reconstruction after nipple-sparing mastectomy. J Surg Res 2018; 231:290-296. [PMID: 30278942 DOI: 10.1016/j.jss.2018.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 03/26/2018] [Accepted: 05/17/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Nipple-sparing mastectomy (NSM) is an increasingly popular alternative to more traditional mastectomy approaches. However, estimating the implant volume during direct-to-implant (DTI) reconstruction following NSM is difficult for surgeons with little-to-moderate experience. We aimed to provide a fast, easy to use, and accurate method to aid in the estimation of implant size for DTI reconstruction using the specimen weight and breast volume. METHODS A retrospective analysis was performed using data from 145 NSM patients with specific implant types. Standard two-dimensional digital mammograms were obtained in 118 of the patients. Breast morphological factors (specimen weight, mammographic breast density and volume, and implant size and type) were recorded. Curve-fitting and linear regression models were used to develop formulas predicting the implant volume, and the prediction performance of the obtained formulas was evaluated using the prospective data set. RESULTS Two formulas to estimate the implant size were obtained, one using the specimen weight and one using the breast volume. The coefficients of correlation (R2) in these formulas were over 0.98 and the root mean squared errors were approximately 13. CONCLUSIONS These implant volume estimate formulas benefit surgeons by providing a preoperative implant volume assessment in DTI reconstruction using the breast volume and an intraoperative assessment using the specimen weight. The implant size estimation formulas obtained in the present study may be applied in a majority of patients.
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Affiliation(s)
- Wei-Chung Shia
- Cancer Research Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Hui-Ju Yang
- Department of Dermatology, Changhua Christian Hospital, Changhua, Taiwan
| | - Hwa-Koon Wu
- Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan
| | - Shih-Lung Lin
- Department of Reconstructive, Plastic & Hand Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Hung-Wen Lai
- Endoscopic and Oncoplastic Breast Surgery Center, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, National Yang Ming University, Taipei, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Yu-Len Huang
- Department of Computer Science, Tunghai University, Taichung, Taiwan
| | - Dar-Ren Chen
- Cancer Research Center, Changhua Christian Hospital, Changhua, Taiwan; Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.
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The Impact of Mastectomy Weight on Reconstructive Trends and Outcomes in Nipple-Sparing Mastectomy. Plast Reconstr Surg 2018; 141:795e-804e. [DOI: 10.1097/prs.0000000000004404] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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