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Plastic and Reconstructive Surgery Nov 2014The safety of single-stage augmentation-mastopexy remains controversial given the dual purpose of increasing breast volume and decreasing the skin envelope. Currently,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The safety of single-stage augmentation-mastopexy remains controversial given the dual purpose of increasing breast volume and decreasing the skin envelope. Currently, the literature is relatively sparse and heterogeneous. This systematic review considered complication profiles and pooled summary estimates in an attempt to guide surgical decision-making.
METHODS
Multiple databases were queried for combined augmentation-mastopexy outcomes. Whenever possible, meta-analysis of complication rates was performed.
RESULTS
Twenty-three studies met inclusion criteria. Average follow-up varied from 16 to 173 weeks, with a majority under 1 year. The pooled total complication rate was 13.1 percent (95 percent CI, 6.7 to 21.3 percent). The most common individual complication was recurrent ptosis, with an incidence of 5.2 percent (95 percent CI, 3.1 to 7.8 percent), followed by poor scarring (3.7 percent; 95 percent CI, 1.9 to 6.1 percent). The pooled incidences of capsular contracture and tissue-related asymmetry were 3.0 percent (95 percent CI, 1.4 to 5.0 percent) and 2.9 percent (95 percent CI, 1.2 to 5.4 percent), respectively. Infection, hematoma, and seroma were rare, with pooled incidences of less than 2 percent each. Three published studies reported data on patient satisfaction. The reoperation rate obtained from 13 studies was 10.7 percent (95 percent CI, 6.7 to 15.4 percent).
CONCLUSIONS
This meta-analysis encompassed 4856 cases of simultaneous augmentation-mastopexy. Study heterogeneity was high because of differences in surgical techniques, outcome definitions, and follow-up durations. This review suggests that with careful patient selection, pooled complication and reoperation rates for single-stage augmentation-mastopexy are acceptably low.
Topics: Adult; Breast Implantation; Breast Implants; Esthetics; Female; Humans; Mammaplasty; Middle Aged; Postoperative Complications; Prosthesis Failure; Reoperation; Risk Assessment; Treatment Outcome; United States; Wound Healing; Young Adult
PubMed: 25347628
DOI: 10.1097/PRS.0000000000000582 -
Aesthetic Plastic Surgery Aug 2021Medical tourism is expanding on a global basis, with patients seeking cosmetic surgery in countries abroad. Little information is known regarding the risks and outcomes... (Review)
Review
INTRODUCTION
Medical tourism is expanding on a global basis, with patients seeking cosmetic surgery in countries abroad. Little information is known regarding the risks and outcomes of cosmetic tourism, in particular, for aesthetic breast surgery. The majority of the literature involves retrospective case series with no defined comparator. We aimed to amalgamate the published data to date to ascertain the risks involved and the outcomes of cosmetic tourism for aesthetic breast surgery on a global basis.
METHODS
A systematic review of PubMed, Google Scholar, EMBASE, the Cochrane library and OVID Medline was conducted using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) guidelines. Keywords such as "medical tourism", "cosmetic tourism", "tourism", "tourist", "surgery", "breast" and "outcomes" were used. Seven hundred and seventy-one titles were screened, and 86 abstracts were reviewed leaving 35 full texts. Twenty-four of these met the inclusion criteria and were used to extract data for this systematic review.
RESULTS
One hundred and seventy-one patients partook in cosmetic tourism for aesthetic breast surgery. Forty-nine percent of patients had an implant-based procedure. Other procedures included: mastopexy (n=4), bilateral breast reduction (n=11) and silicone injections (n=2). Two-hundred and twenty-two complications were recorded, common complications included: wound infection in 39% (n=67), breast abscess/ collection in 12% (n=21), wound dehiscence in 12% (n= 20) and ruptured implant in 8% (n=13). Clavien-Dindo classification of the complications includes 88 (51%) IIIb complications with 103 returns to theatre, 2 class IV complications (ICU stay) and one class V death of a patient. Explantation occurred in 39% (n=32) of implant-based augmentation patients.
CONCLUSIONS
Aesthetic breast surgery tourism is popular within the cosmetic tourism industry. However, with infective complications (39%) and return to theatre rates (51%) significantly higher than expected, it is clear that having these procedures abroad significantly increases the risks involved. The high complication rate not only impacts individual patients, but also the home country healthcare systems. Professional bodies for cosmetic surgery in each country must highlight and educate patients how to lower this risk if they do choose to have cosmetic surgery abroad. In this current era of an intra-pandemic world where health care is already stretched, the burden from cosmetic tourism complications must be minimised.
LEVEL OF EVIDENCE III
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Topics: Breast Neoplasms; Esthetics; Female; Humans; Mammaplasty; Medical Tourism; Retrospective Studies; Surgery, Plastic; Tourism; Treatment Outcome
PubMed: 33876284
DOI: 10.1007/s00266-021-02251-1 -
Plastic and Reconstructive Surgery Jan 2016The main drawback of autologous fat grafting, which is commonly used for soft-tissue augmentation, is the high resorption rate. Cell-assisted lipotransfer has been used... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The main drawback of autologous fat grafting, which is commonly used for soft-tissue augmentation, is the high resorption rate. Cell-assisted lipotransfer has been used to improve fat graft survival; however, evidence for its efficacy and safety is still lacking.
METHODS
The authors searched PubMed, Cochrane Library, EBSCO, and EMBASE for clinical studies on cell-assisted lipotransfer published from 2008 through 2014. A meta-analysis was conducted to pool the estimated fat survival rate. Incidence of complications and incidence of multiple operations were calculated.
RESULTS
Seventeen articles involving 387 cases were included in the systematic review. The pooled fat survival rate was significantly higher in the cell-assisted lipotransfer group than in the nonlipotransfer group (60 percent versus 45 percent, p = 0.0096). Complication incidence was similar in the two groups. Cell-assisted lipotransfer significantly improved fat survival in the face (by 19 percent) and reduced the incidence of multiple operations (by 13.6 percent). In breast fat grafting, however, fat survival was improved by only 9 percent, which was not statistically significant. Meanwhile, lipotransfer in breast cases was associated with a higher complication incidence compared with face cases (p < 0.001).
CONCLUSIONS
This study demonstrates that cell-assisted lipotransfer has better efficacy than conventional fat grafting (non-cell-assisted lipotransfer). It is more applicable to face cases than to breast cases. Until now, there has not been enough evidence of the superiority of cell-assisted lipotransfer over conventional fat grafting for reducing complications.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, III.
Topics: Adipose Tissue; Female; Graft Survival; Humans; Mammaplasty; Tissue Transplantation; Transplantation, Autologous; Treatment Outcome
PubMed: 26710060
DOI: 10.1097/PRS.0000000000001981 -
Annals of Plastic Surgery Jul 2022Improving patient care and safety requires high-quality evidence. The objective of this study was to systematically review the existing evidence for patient safety (PS)...
BACKGROUND
Improving patient care and safety requires high-quality evidence. The objective of this study was to systematically review the existing evidence for patient safety (PS) and quality improvement initiatives in breast reconstruction.
METHODS
A systematic review of the published plastic surgery literature was undertaken using a computerized search and following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Publication descriptors, methodological details, and results were extracted. Articles were assessed for methodological quality and clinical heterogeneity. Descriptive statistics were completed, and a meta-analysis was considered.
RESULTS
Forty-six studies were included. Most studies were retrospective (52.2%) and from the third level of evidence (60.9%). Overall, the scientific quality was moderate, with randomized controlled trials generally being higher quality. Studies investigating approaches to reduce seroma (28.3% of included articles) suggested a potential benefit of quilting sutures. Studies focusing on infection (26.1%) demonstrated potential benefits to prophylactic antibiotics and drain use under 21 days. Enhanced recovery after surgery protocols (10.9%) overall did not compromise PS and was beneficial in reducing opioid use and length of stay. Interventions to increase flap survival (10.9%) demonstrated a potential benefit of nitroglycerin on mastectomy skin flaps.
CONCLUSIONS
Overall, studies were of moderate quality and investigated several worthwhile interventions. More validated, standardized outcome measures are required, and studies focusing on interventions to reduce thromboembolic events and bleeding risk could further improve PS.
Topics: Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy; Patient Safety; Quality Improvement; Retrospective Studies
PubMed: 35749815
DOI: 10.1097/SAP.0000000000003062 -
Journal of Plastic, Reconstructive &... Jul 2022Reconstructive microsurgical free flap techniques are often the treatment of choice for a variety of complex tissue defects across multiple surgical specialties.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Reconstructive microsurgical free flap techniques are often the treatment of choice for a variety of complex tissue defects across multiple surgical specialties. However, the practice is underdeveloped in low- and middle-income countries. The aim of this systematic review was to evaluate the clinical application and outcomes of reconstructive microsurgery performed in Africa.
METHODS
Seven databases (PubMed, Web of Science, MEDLINE, CINAHL, Academic Search Complete, Embase, and Google Scholar) were searched for studies reporting microsurgical procedures performed in Africa. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tools and quality of evidence using the GRADE approach. Meta-analysis was performed using a random effects model to estimate the pooled proportion of events with 95% confidence intervals. The primary outcome was free flap success rate, and the secondary outcomes were the complication and flap salvage rates.
RESULTS
Ninety-two studies were included in the narrative synthesis and nine in the pooled meta-analysis. In total, 1376 free flaps in 1327 patients from 1976 to 2020 were analyzed. Head and neck oncologic reconstruction made up 30% of cases, while breast reconstruction comprised 2%. The pooled flap survival rate was 89% (95% CI: 0.84, 0.93), complication rate 51% (95% CI: 0.36, 0.65), and free flap salvage rate was 45% (95% CI: 0.08, 0.84).
CONCLUSION
This meta-analysis showed that the free flap success rates in Africa are high and comparable to those reported in high-income countries. However, the comparatively higher complication rate and lower salvage rate suggest a need for improved perioperative care.
REVIEW REGISTRATION
Registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 25th September 2020, ID: CRD42020192344.
Topics: Free Tissue Flaps; Head; Humans; Mammaplasty; Microsurgery; Neck; Postoperative Complications; Plastic Surgery Procedures
PubMed: 35643598
DOI: 10.1016/j.bjps.2022.04.028 -
Annals of Plastic Surgery Mar 2023There remains an unclear definition of the term "gigantomastia," with many studies using different parameters and measurements. Currently, the operative management and...
INTRODUCTION
There remains an unclear definition of the term "gigantomastia," with many studies using different parameters and measurements. Currently, the operative management and patient education for gigantomastia are outdated. The historical teaching that a free nipple graft is necessary in elongated pedicles to avoid nipple necrosis may not be factual. The principal goal of our review aims to determine the safety of nipple-sparing breast reductions on large ptotic breasts via complication rate analysis.
METHODS
The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines of conduct for systematic review and meta-analysis. In October 2021, PubMed was used to search the US National Library of Medicine database. Rayyan Intelligent Systematic Review aided in screening studies by title then abstract. If inclusion criteria were met, the entire article was reviewed.
RESULTS
Twenty-two articles satisfied the inclusion and exclusion criteria. The study was composed of 1689 total patients with a mean body mass index of 32.9 (±3.4). Mean midclavicle-to-nipple distance and resection weight per breast was 39 cm (±3.8) and 1423.8 g (±268.9), respectively. A Wise pattern was preferred in 77.3% of the studies, with an inferior (45.5%) and superomedial (45.5%) pedicle used most commonly. Complete nipple areolar complex necrosis (1.7%) was found in 4 studies, whereas partial (5.9%) was observed in 11. More common complications included delayed wound healing (17.4%), surgical site infection (14.3%), seroma (10.5%), scar hypertrophy (9.9%), and wound dehiscence (9.2%).
CONCLUSION
Nipple-sparing breast reduction surgery can be safely performed on hypertrophic and severely ptotic breasts with nipple areolar complications, such as partial or complete nipple areolar complex loss, at a rate less than previously believed.
Topics: Humans; Hypertrophy; Mammaplasty; Necrosis; Nipples; Retrospective Studies; Treatment Outcome
PubMed: 36796050
DOI: 10.1097/SAP.0000000000003415 -
BJS Open Nov 2021Therapeutic mammaplasty (TM) is an oncological procedure which combines tumour resection with breast reduction and mastopexy techniques. Previous systematic reviews have...
BACKGROUND
Therapeutic mammaplasty (TM) is an oncological procedure which combines tumour resection with breast reduction and mastopexy techniques. Previous systematic reviews have demonstrated the oncological safety of TM but reporting of critically important outcomes, such as quality of life, aesthetic and functional outcomes, are limited, piecemeal or inconsistent. This systematic review aimed to identify all outcomes reported in clinical studies of TM to facilitate development of a core outcome set.
METHODS
Medline, EMBASE, CINAHL and Web of Science were searched from inception to 5 August 2020. Included studies reported clinical outcomes following TM for adult women. Two authors screened articles independently for eligibility. Data were extracted regarding the outcome definition and classification type (for example, oncological, quality of life, etc.), time of outcome reporting and measurement tools.
RESULTS
Of 5709 de-duplicated records, 148 were included in the narrative synthesis. The majority of studies (n = 102, 68.9 per cent) reported measures of survival and/or recurrence; approximately three-quarters (n = 75, 73.5 per cent) had less than 5 years follow-up. Aesthetic outcome was reported in half of studies (n = 75, 50.7 per cent) using mainly subjective, non-validated measurement tools. The time point at which aesthetic assessment was conducted was highly variable, and only defined in 48 (64.0 per cent) studies and none included a preoperative baseline for comparison. Few studies reported quality of life (n = 30, 20.3 per cent), functional outcomes (n = 5, 3.4 per cent) or resource use (n = 28, 18.9 per cent).
CONCLUSION
Given the oncological equivalence of TM and mastectomy, treatment decisions are often driven by aesthetic and functional outcomes, which are infrequently and inconsistently reported with non-validated measurement tools.
Topics: Adult; Breast Neoplasms; Esthetics; Female; Humans; Mammaplasty; Mastectomy; Quality of Life
PubMed: 34894122
DOI: 10.1093/bjsopen/zrab126 -
Aesthetic Surgery Journal Mar 2020Reduction mammaplasty remains critical to the treatment of breast hypertrophy. No technique has been shown to be superior; however, comparison between studies is...
BACKGROUND
Reduction mammaplasty remains critical to the treatment of breast hypertrophy. No technique has been shown to be superior; however, comparison between studies is difficult due to variation in outcome reporting.
OBJECTIVES
The authors sought to identify a comprehensive list of outcomes and outcome measures in reduction mammaplasty.
METHODS
A comprehensive computerized search was performed. Included studies were randomized or nonrandomized controlled trials involving at least 100 cases of female breast hypertrophy and patients of all ages who underwent 1 or more defined reduction mammaplasty technique. Outcomes and outcome measures were extracted and tabulated.
RESULTS
A total 106 articles were eligible for inclusion; 57 unique outcomes and 16 outcome measures were identified. Frequency of patient-reported and author-reported outcomes were 44% and 88%, respectively. Postoperative complications were the most frequently reported outcome (82.2%). Quality-of-life outcomes were accounted for in 37.7% of studies. Outcome measures were either condition-specific or generic; frequencies were as low as 1% and as high as 5.6%. Five scales were formally assessed in the breast reduction populations. Clinical measures were defined in 15.1% of studies.
CONCLUSIONS
There is marked heterogeneity in reporting of outcomes and outcome measures in the literature. A standardized outcome set is needed to compare outcomes of various reduction mammaplasty techniques.
Topics: Breast; Female; Humans; Hypertrophy; Mammaplasty; Outcome Assessment, Health Care; Quality of Life
PubMed: 31679031
DOI: 10.1093/asj/sjz308 -
Cancer Oct 2022Oncological safety of different types and timings of PMBR after breast cancer remains controversial. Lack of stratified risk assessment in literature makes current... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Oncological safety of different types and timings of PMBR after breast cancer remains controversial. Lack of stratified risk assessment in literature makes current clinical and shared decision-making complex. This is the first systematic review and meta-analysis to evaluate differences in oncological outcomes after immediate versus delayed postmastectomy breast reconstruction (PMBR) for autologous and implant-based PMBR separately.
METHODS
A systematic literature search was performed in MEDLINE, Cochrane Library, and Embase. The Cochrane Collaboration Handbook and Meta-analysis Of Observational Studies in Epidemiology checklist were followed for data abstraction. Variability in point estimates attributable to heterogeneity was assessed using I -statistic. (Loco)regional breast cancer recurrence rates, distant metastasis rates, and overall breast cancer recurrence rates were pooled in generalized linear mixed models using random effects.
RESULTS
Fifty-five studies, evaluating 14,217 patients, were included. When comparing immediate versus delayed autologous PMBR, weighted average proportions were: 0.03 (95% confidence interval [CI], 0.02-0.03) versus 0.02 (95% CI, 0.01-0.04), respectively, for local recurrences, 0.02 (95% CI, 0.01-0.03) versus 0.02 (95% CI, 0.01-0.03) for regional recurrences, and 0.04 (95% CI, 0.03-0.06) versus 0.01 (95% CI, 0.00-0.03) for locoregional recurrences. No statistically significant differences in weighted average proportions for local, regional and locoregional recurrence rates were observed between immediate and delayed autologous PMBR. Data did not allow comparing weighted average proportions of distant metastases and total breast cancer recurrences after autologous PMBR, and of all outcome measures after implant-based PMBR.
CONCLUSIONS
Delayed autologous PMBR leads to similar (loco)regional breast cancer recurrence rates compared to immediate autologous PMBR. This study highlights the paucity of strong evidence on breast cancer recurrence after specific types and timings of PMBR.
LAY SUMMERY
Oncologic safety of different types and timings of postmastectomy breast reconstruction (PMBR) remains controversial. Lack of stratified risk assessment in literature makes clinical and shared decision-making complex. This meta-analysis showed that delayed autologous PMBR leads to similar (loco)regional recurrence rates as immediate autologous PMBR. Data did not allow comparing weighted average proportions of distant metastases and total breast cancer recurrence after autologous PMBR, and of all outcome measures after implant-based PMBR. Based on current evidence, oncological concerns do not seem a valid reason to withhold patients from certain reconstructive timings or techniques, and patients should equally be offered all reconstructive options they technically qualify for.
Topics: Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy; Neoplasm Recurrence, Local; Transplantation, Autologous
PubMed: 35894936
DOI: 10.1002/cncr.34393 -
Plastic and Reconstructive Surgery Aug 2022Primary cadaveric studies were reviewed to give a contemporary overview of what is known about innervation of the female breast and nipple/nipple-areola complex. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Primary cadaveric studies were reviewed to give a contemporary overview of what is known about innervation of the female breast and nipple/nipple-areola complex.
METHODS
The authors performed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review and meta-analysis. The authors searched four electronic databases for studies investigating which nerve branches supply the female breast and nipple/nipple-areola complex or describing the trajectory and other anatomical features of these nerves. Inclusion criteria for meta-analysis were at least five studies of known sample size and with numerical observed values. Pooled prevalence estimates of nerve branches supplying the nipple/nipple-areola complex were calculated using random-effects meta-analyses; the remaining results were structured using qualitative synthesis. Risk of bias within individual studies was assessed with the Anatomical Quality Assurance checklist.
RESULTS
Of 3653 studies identified, 19 were eligible for qualitative synthesis and seven for meta-analysis. The breast skin is innervated by anterior cutaneous branches and lateral cutaneous branches of the second through sixth and the nipple/nipple-areola complex primarily by anterior cutaneous branches and lateral cutaneous branches of the third through fifth intercostal nerves. The anterior cutaneous branch and lateral cutaneous branch of the fourth intercostal nerve supply the largest surface area of the breast skin and nipple/nipple-areola complex. The lateral cutaneous branch of the fourth intercostal nerve is the most consistent contributory nerve to the nipple/nipple-areola complex (pooled prevalence, 89.0 percent; 95 percent CI, 0.80 to 0.94).
CONCLUSIONS
The anterior cutaneous branch and lateral cutaneous branch of the fourth intercostal nerve are the most important nerves to spare or repair during reconstructive and cosmetic breast surgery. Future studies are required to elicit the course of dominant nerves through the breast tissue.
Topics: Biological Phenomena; Breast; Dissection; Female; Humans; Intercostal Nerves; Mammaplasty; Mastectomy; Nipples
PubMed: 35652898
DOI: 10.1097/PRS.0000000000009306