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The British Journal of Surgery Aug 2015Acellular dermal matrix (ADM) may improve outcomes in implant-based breast reconstruction (IBBR). The aim of this study was critically to appraise and evaluate the... (Review)
Review
BACKGROUND
Acellular dermal matrix (ADM) may improve outcomes in implant-based breast reconstruction (IBBR). The aim of this study was critically to appraise and evaluate the current evidence for ADM-assisted IBBR.
METHODS
Comprehensive electronic searches identified complete papers published in English between January 2000 and August 2013, reporting any outcome of ADM-assisted IBBR. All systematic reviews, randomized clinical trials (RCTs) and non-randomized studies (NRSs) with more than 20 ADM recipients were included. Studies were critically appraised using AMSTAR for systematic reviews, the Cochrane risk-of-bias tool for RCTs and its adaptation for NRSs. Characteristics and results of identified studies were summarized.
RESULTS
A total of 69 papers (8 systematic reviews, 1 RCT, 40 comparative studies and 20 case series) were identified, all of which were considered at high risk of bias, mostly due to patient selection and selective outcome reporting. The median ADM group sample size was 51.0 (i.q.r. 33.0-127.0). Most studies were single-centre (54), and they were often single-surgeon (16). ADM was most commonly used for immediate (40) two-stage IBBR (36) using human ADM (47), with few studies evaluating ADM-assisted single-stage procedures (10). All reported clinical outcomes (for example implant loss) and more than half of the papers (33) assessed process outcomes, but few evaluated cosmesis (16) or patient-reported outcomes (10). Heterogeneity between study design and, especially, outcome measurement precluded meaningful data synthesis.
CONCLUSION
Current evidence for the value of ADMs in IBBR is limited. Use in practice should therefore be considered experimental, and evaluation within registries or well designed and conducted studies, ideally RCTs, is recommended to prevent widespread adoption of a potentially inferior intervention.
Topics: Acellular Dermis; Breast Implantation; Female; Humans; Outcome Assessment, Health Care
PubMed: 26109277
DOI: 10.1002/bjs.9804 -
Annals of Surgical Oncology Aug 2015Although the safety of applying omentum to the female breast for total breast reconstruction is controversial, it has recently been used to treat certain mammary... (Review)
Review
PURPOSE
Although the safety of applying omentum to the female breast for total breast reconstruction is controversial, it has recently been used to treat certain mammary disorders as well. A systematic review was therefore conducted to analyze and establish the suitability and safety of applying omentum to the breast.
METHODS
Covereing the interval from January 1984 to December 2013, we performed searches in MEDLINE, Embase, SciELO, and Google-Scholar for original articles describing the applicability of greater omentum to the breast and its clinical complications.
RESULTS
Sixty observational articles with 985 women were chosen. The main clinical indications were total breast reconstruction after mastectomy due to breast cancer (45 studies), radiation damage (23 studies), and congenital Poland syndrome (4 studies). Altogether, 273 complications were identified among the 985 women treated. The most frequent was flap necrosis (26.74 %). The most serious was injury to the digestive system (1.10 %). There was a 35.48 % incidence of local breast cancer recurrence in eight observational studies on oncological risk. Seven of the eight included only women with advanced cancer. One of these studies reported the incidence and relapse time predominantly according to the primary tumor size.
CONCLUSIONS
Although the oncological risk remains unclear, there was a high volume of complications that affected the digestive system. These findings suggest that omentum has well established applicability, but only for total breast reconstruction of huge defects, where muscular/myocutaneous or perforator flaps may be unsuitable.
Topics: Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy; Neoplasm Recurrence, Local; Observational Studies as Topic; Omentum; Poland Syndrome; Radiation Injuries
PubMed: 25572679
DOI: 10.1245/s10434-014-4328-8 -
BMC Surgery Sep 2021There is no consensus for when publicly funded breast reduction is indicated and recommendations in guidelines vary greatly, indicating a lack of evidence and unequal... (Meta-Analysis)
Meta-Analysis
BACKGROUND
There is no consensus for when publicly funded breast reduction is indicated and recommendations in guidelines vary greatly, indicating a lack of evidence and unequal access. The primary aim of this review was to examine risks and benefits of breast reduction to treat breast hypertrophy. Secondary aims were to examine how the studies defined breast hypertrophy and indications for a breast reduction.
METHODS
A systematic literature search was conducted in PubMed, MEDLINE All, Embase, the Cochrane Library, and PsycInfo. The included articles were critically appraised, and certainty of evidence was assessed using the GRADE approach. Meta-analyses were performed when possible.
RESULTS
Fifteen articles were included; eight reporting findings from four randomised controlled trials, three non-randomised controlled studies, three case series, and one qualitative study. Most studies had serious study limitations and problems with directness. Few of the studies defined breast hypertrophy. The studies showed significantly improved health-related quality of life and sexuality-related outcomes in patients who had undergone breast reduction compared with controls, as well as reduced depressive symptoms, levels of anxiety and pain. Most effect sizes exceeded the reported minimal important difference for the scale. Certainty of evidence for the outcomes above is low (GRADE ⊕ ⊕). Although four studies reported significantly improved physical function, the effect is uncertain (very low certainty of evidence, GRADE ⊕). None of the included studies reported data regarding work ability or sick leave. Three case series reported a 30-day mortality of zero. Reported major complications after breast reduction ranged from 2.4 to 14% and minor complications from 2.4 to 69%.
CONCLUSION
There is a lack of high-quality studies evaluating the results of breast reduction. A breast reduction may have positive psychological and physical effects for women, but it is unclear which women benefit the most and which women should be offered a breast reduction in the public healthcare system. Several priorities for further research have been identified.
PRE-REGISTRATION
The study is based on a Health Technology Assessment report, pre-registered and then published on the website of The Regional HTA Centre of Region Västra Götaland, Sweden.
Topics: Anxiety; Delivery of Health Care; Female; Humans; Mammaplasty; Quality of Life; Risk Assessment
PubMed: 34511096
DOI: 10.1186/s12893-021-01336-7 -
Journal of Clinical Nursing Apr 2023To systematically evaluate the effects of decision aids for women facing breast reconstruction decision on decision conflict, decision regret, knowledge, satisfaction,... (Meta-Analysis)
Meta-Analysis Review
AIMS AND OBJECTIVES
To systematically evaluate the effects of decision aids for women facing breast reconstruction decision on decision conflict, decision regret, knowledge, satisfaction, anxiety and depression.
BACKGROUND
Breast reconstruction decision is not good or bad and should be guided by clinical evidence and patient preferences. Decision aids can increase the patient's decision-making enthusiasm and ability, improve the quality of decision and promote shared decision-making between patients and medical staff.
DESIGN
Systematic review and meta-analysis.
METHODS
Eight databases were conducted from the establishment of the database until October 2021. The PRISMA checklist was selected for analysis in this paper. The meta-analysis was conducted in Review Manager 5.3. The quality of the studies was assessed using the Cochrane risk-of-bias tool. The result is decision conflict, decision regret, knowledge and other secondary outcomes. Sensitivity analysis and subgroup analysis were also conducted.
RESULTS
A total of twelve randomised controlled trials (RCTs) were included in the systematic review and meta-analysis. Meta-analysis revealed that decision aids could significantly reduce decision conflict and decision regret, improve knowledge, satisfaction and depression and had no influence on anxiety.
CONCLUSIONS
The results of the systematic review and meta-analysis reviewed the positive effect of decision aids on the decision-making of women facing postmastectomy breast reconstruction. In the future, more well-designed RCTs are needed to confirm the effects of decision aids on the decision-making of breast reconstruction and nurses should be encouraged to take part in the development of decision aids in accordance with strict standards and apply them to breast cancer patients considering postmastectomy breast reconstruction.
RELEVANCE TO CLINICAL PRACTICE
Our study provides evidence for the effectiveness of decision aids on breast reconstruction and points to the important role of healthcare providers in the use of decision aids and in facilitating shared decision-making.
Topics: Female; Humans; Anxiety; Emotions; Anxiety Disorders; Mammaplasty; Decision Support Techniques; Randomized Controlled Trials as Topic
PubMed: 35460127
DOI: 10.1111/jocn.16328 -
Journal of Plastic, Reconstructive &... Nov 2023Animal-derived acellular dermal matrices (ADMs) are increasingly being used in prepectoral direct-to-implant (DTI) breast reconstruction. However, the indications and... (Review)
Review
BACKGROUND
Animal-derived acellular dermal matrices (ADMs) are increasingly being used in prepectoral direct-to-implant (DTI) breast reconstruction. However, the indications and complication profile associated with this type of reconstruction remain unclear. This study aimed to perform a systematic review of the available literature on the use of animal-derived ADM in prepectoral DTI breast reconstruction.
METHODS
Three different literature databases, namely, PubMed, Web of Sciences, and Embase were screened using the following keywords: "immediate" AND "pre-pectoral" OR "prepectoral" AND "ADM breast reconstruction." Animal-derived ADM used (porcine - Braxon® and non-Braxon® - and bovine - Surgimend®) anthropometric information, clinical data, and complications profile were considered.
RESULTS
A total of 340 articles were initially identified, of which only 45 articles (5089 patients and 6598 reconstructed breasts) satisfied our inclusion criteria. The most widely used ADM was Braxon® in the context of conservative mastectomies. In most studies, a subcutaneous layer > 1 cm and lack of previous radiotherapy were considered prerequisites for this type of reconstruction. An increased risk of complications was found in smokers, patients who underwent radiation treatment, patients with high breast volumes, and patients with cancers requiring axillary dissection. Data related to the role of diabetes, high body mass index, and breast implant size on surgical outcomes were instead inconcludent. Age was not directly proportional to the complications.
CONCLUSION
The complications associated with different animal-derived ADMs are generally comparable. The profile of patients required for eligibility for this type of reconstruction appears to have been identified and is in line with current recommendations.
Topics: Humans; Animals; Cattle; Swine; Female; Mastectomy; Acellular Dermis; Breast Neoplasms; Mammaplasty; Breast Implantation; Breast Implants; Retrospective Studies
PubMed: 37716255
DOI: 10.1016/j.bjps.2023.08.020 -
Journal of Plastic, Reconstructive &... Oct 2023Recent studies have successfully employed perioperative protocols and Enhanced Recovery After Surgery (ERAS) protocols to promote and increase the range of breast... (Review)
Review
INTRODUCTION
Recent studies have successfully employed perioperative protocols and Enhanced Recovery After Surgery (ERAS) protocols to promote and increase the range of breast reconstruction procedures performed in ambulatory settings. This systematic review aims to identify the common perioperative protocol items associated with successful ambulatory breast reconstruction.
METHODS
A systematic review of electronic databases (Ovid Medline, EMBASE, and Cochrane) was conducted. Studies that described the perioperative care protocol for postmastectomy breast reconstruction in ambulatory settings (discharge within 24 h) were included. Two reviewers independently screened the literature and extracted the data. Risk of bias was assessed with the National Heart, Lung, and Blood Institute quality tool. The perioperative protocol details, type of reconstruction, information regarding patient selection criteria, successful discharge rates, and complication rates were extracted.
RESULTS
Twelve studies were included in the systematic review, with 1484 patients undergoing ambulatory breast reconstruction with a well-defined perioperative protocol. Sixteen perioperative items were identified. The most discussed items were preoperative counseling (11/12), preoperative and intraoperative multimodal analgesia (11/12), and postoperative analgesia (10/12). Our recommendation includes two new items and seven modified items compared to previous ERAS guidelines. Overall, the mean number of items was 9.22 in same-day discharge and 6.75 in 24-h discharge (P = 0.169). 78.4% of the patients (1123 of 1433) were successfully discharged within 24 h. No studies identified an increase in readmission or complications with ambulatory discharge.
CONCLUSION
Sixteen core items were defined for a successful perioperative ERAS protocol for 24-h discharge breast reconstruction. Implementing perioperative protocols can facilitate under-24-h discharge for alloplastic and autologous surgery.
Topics: Female; Humans; Breast Neoplasms; Enhanced Recovery After Surgery; Length of Stay; Mammaplasty; Mastectomy; Perioperative Care
PubMed: 37536192
DOI: 10.1016/j.bjps.2023.06.075 -
Aesthetic Surgery Journal Jun 2021There is limited evidence available in the literature with regard to the complication profile of mastectomy and immediate prosthetic reconstruction in augmented patients. (Meta-Analysis)
Meta-Analysis
BACKGROUND
There is limited evidence available in the literature with regard to the complication profile of mastectomy and immediate prosthetic reconstruction in augmented patients.
OBJECTIVES
The aim of this systematic review and meta-analysis was to compare postoperative complications between women with vs without prior augmentation undergoing skin- or nipple-sparing mastectomy and immediate prosthetic reconstruction.
METHODS
A systematic search was conducted in February 2020 for studies comparing women with vs without prior augmentation undergoing skin- or nipple-sparing mastectomy and immediate prosthetic reconstruction with documentation of postoperative complications. Outcomes analyzed included early, late, and overall complications. Pooled odds ratios (ORs) with 95% CIs were obtained through meta-analysis.
RESULTS
Our meta-analysis, which included 6 studies comparing 241 breasts with prior augmentation and 1441 without, demonstrated no significant difference between the 2 groups in rates of early (36.7% vs 24.8%: OR, 1.57; 95% CI, 0.94-2.64; P = 0.09), late (10.1% vs 19.9%: OR, 0.53; 95% CI, 0.06-4.89; P = 0.57), and overall complications (36.5% vs 31.2%: OR, 1.23; 95% CI, 0.76-2.00; P = 0.40). Subgroup analysis showed a significantly higher rate of hematoma formation in the augmented group (3.39% vs 2.15%: OR, 2.68; 95% CI, 1.00-7.16; P = 0.05), but no difference in rates of seroma, infection, mastectomy skin flap necrosis, and prosthesis loss.
CONCLUSIONS
Our meta-analysis suggests that prior augmentation does not significantly increase overall postoperative complications in women undergoing skin- or nipple-sparing mastectomy and immediate prosthetic reconstruction. However, the significantly higher rate of hematoma formation in augmented patients warrants further investigation and preoperative discussion.
Topics: Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy; Mastectomy, Subcutaneous; Nipples; Postoperative Complications; Retrospective Studies; Seroma
PubMed: 33480970
DOI: 10.1093/asj/sjab028 -
Journal of Plastic, Reconstructive &... Dec 2022Breast reduction is one of the most commonly requested and performed plastic surgery procedures, and its psychological, esthetic, and analgesic benefits are well known.... (Review)
Review
Breast reduction is one of the most commonly requested and performed plastic surgery procedures, and its psychological, esthetic, and analgesic benefits are well known. Several studies dealing with the effects of reduction mammoplasty on the physiology of respiration have been published in the past decades. This systematic review aims to assess whether bilateral breast reduction is associated with measurable improvement in lung function in women with macromastia. This review was performed in accordance with the PRISMA guidelines. PubMed, SCOPUS, and Web of Science databases were queried in search of clinical studies that investigated lung function in women undergoing breast reduction for macromastia and reported any type of parameter or outcome measure relevant to pulmonary function. The search yielded 394 articles of which 15 articles met our specific inclusion criteria. The primary outcome measures of the studies and their respective results were tabulated, contrasted, and compared. The 15 studies included in this review cover the period from 1974 to 2018. According to most included studies, reduction mammaplasty produces a change of objective respiratory parameters, such as spirometric tests or arterial blood gas (ABG) measurements; nevertheless, the clinical and functional relevance of the observed changes is debatable.
Topics: Humans; Female; Hypertrophy; Mammaplasty; Breast; Lung
PubMed: 36229312
DOI: 10.1016/j.bjps.2022.08.068 -
European Journal of Cancer (Oxford,... Nov 2014The aim of this review is to investigate the effect of timing of the reconstruction and radiotherapy, with respect to complication rate and cosmetic outcome, with a... (Review)
Review
OBJECTIVE
The aim of this review is to investigate the effect of timing of the reconstruction and radiotherapy, with respect to complication rate and cosmetic outcome, with a special focus on the timing of the placement of the definite implant.
METHODS
PubMed was searched for publications between January 2000 and December 2012. Of 37 eligible studies, timing of reconstruction, type, and incidence of complications were recorded. First, we calculated the weighted mean including confidence intervals for complications and cosmetic outcome overall, and for the following subgroups: (1) Autologous reconstruction after radiotherapy; (2) Definite implant reconstruction after radiotherapy; (3) Autologous reconstruction before radiotherapy; (4) Definite implant reconstruction before radiotherapy. A second analysis was performed using only studies that directly compared group 1 versus 3 and 2 versus 4.
RESULTS
A large variation in complication rates (8.7-70.0%) and in acceptable cosmetic outcome (41.4-93.3%) was reported. The first analysis showed more complications and a higher revision rate if an implant reconstruction was performed after radiotherapy; for autologous reconstruction fibrosis occurred more often if reconstruction was applied first. The second analysis showed no significant differences in total complication rate. Only implant failure occurred more often if applied after radiotherapy (odds ratio (OR) 3.03 [1.59-5.77]). No differences were found in both patient and physician satisfaction.
CONCLUSIONS
A definite implant reconstruction placed before radiotherapy limits the rate of complications. For autologous reconstruction, less fibrosis is seen if reconstruction is performed after radiotherapy, but timing had no significant impact on total complication rate.
Topics: Breast Implants; Combined Modality Therapy; Fibrosis; Humans; Mammaplasty; Mastectomy; Odds Ratio; Postoperative Complications; Radiotherapy; Plastic Surgery Procedures; Time Factors
PubMed: 25168640
DOI: 10.1016/j.ejca.2014.07.023 -
European Journal of Surgical Oncology :... May 2016Oncoplastic surgery consists a new approach for extending breast conserving surgery possibilities This manuscript aimed to systematically review data on the oncological... (Review)
Review
UNLABELLED
Oncoplastic surgery consists a new approach for extending breast conserving surgery possibilities This manuscript aimed to systematically review data on the oncological outcome of oncoplastic breast surgery. Electronic databases were searched with the appropriate search term up to and included April 2013.
INCLUSION CRITERIA
full publications including at least 10 patients and providing evidence on at least one of the following outcomes: margin involvement, local recurrence, metastatic disease, death number. Forty studies including 2830 patients, met inclusion criteria; twenty one studies investigated volume displacement techniques; fifteen studies investigated volume replacement techniques; four studies presented data on various oncoplastic techniques. Study quality was low. The majority of studies were observational studies. The length of follow up was relatively short, with only two studies reporting a median duration longer than 60 months. Only seven studies including more than 100 patients. There was great variation in the frequency of margin involvement ranging between 0% and 36% of patients. Local recurrence was observed in 0-10.8% of patients. Distant metastasis was observed in 0-18.9% of patients. In conclusion, long term oncological outcome of oncoplastic surgery for breast cancer is not adequately investigated. Further research efforts should focus on Level I evidence on oncological outcome of oncoplastic surgery.
Topics: Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy, Segmental; Neoplasm Metastasis; Neoplasm Recurrence, Local
PubMed: 26922045
DOI: 10.1016/j.ejso.2016.02.002