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Breast (Edinburgh, Scotland) Jun 2023Simple breast conservation surgery (sBCS) has technically advanced onto oncoplastic breast procedures (OBP) to avoid mastectomy and improve breast cancer patients'... (Review)
Review
Simple breast conservation surgery (sBCS) has technically advanced onto oncoplastic breast procedures (OBP) to avoid mastectomy and improve breast cancer patients' psychosocial well-being and cosmetic outcome. Although OBP are time-consuming and expensive, we are witnessing an increase in their use, even for cases that could be managed with sBCS. The choice between keeping it simple or opting for more complex oncoplastic procedures is difficult. This review proposes a pragmatic approach in assisting this decision. Medical literature suggests that OBP and sBCS might be similar regarding local recurrence and overall survival, and patients seem to have higher satisfaction levels with the aesthetic outcome of OBP when compared to sBCS. However, the lack of comprehensive high-quality research assessing their safety, efficacy, and patient-reported outcomes hinders these supposed conclusions. Postoperative complications after OBP may delay the initiation of adjuvant RT. In addition, precise displacement of the breast volume is not effectively recorded despite surgical clips placement, making accurate dose delivery tricky for radiation oncologists, and WBRT preferable to APBI in complex OBP cases. With a critical eye on financial toxicity, patient satisfaction, and oncological outcomes, OBP must be carefully integrated into clinical practice. The thoughtful provision of informed consent is essential for decision-making between sBCS and OBP. As we look into the future, machine learning and artificial intelligence can potentially help patients and doctors avoid postoperative regrets by setting realistic aesthetic expectations.
Topics: Humans; Female; Breast Neoplasms; Mastectomy; Mastectomy, Segmental; Artificial Intelligence; Breast; Mammaplasty
PubMed: 36924556
DOI: 10.1016/j.breast.2023.03.006 -
World Journal of Surgical Oncology Apr 2016Mesh use in surgical breast reconstruction is becoming increasingly common; however, there is still no consensus on whether synthetic matrices or biological matrices... (Review)
Review
Mesh use in surgical breast reconstruction is becoming increasingly common; however, there is still no consensus on whether synthetic matrices or biological matrices produce the best outcomes. This review analyses these outcomes, namely the differences in aesthetic outcomes, cost, and the rates of the most commonly reported complications.The results indicate that breast reconstruction with a synthetic matrix produces comparable aesthetic outcomes to a biological matrix, with lower costs and complication rates. The individual results for complication rates show that biological matrixes are associated with lower infection rates and slightly lower capsular contracture, but higher haematoma rates, and slightly higher rates of skin necrosis and explantation--although many had post-op radiotherapy.The majority of the studies evaluated used biological matrices, and there are no randomised controlled trials directly comparing the two types of meshes; definite conclusions cannot be drawn from the available evidence. The authors suggest that a randomised controlled trial comparing these outcomes in synthetic and biological matrix use is needed.
Topics: Breast Neoplasms; Female; Humans; Mammaplasty; Surgical Mesh
PubMed: 27102580
DOI: 10.1186/s12957-016-0874-9 -
Annals of Plastic Surgery Jun 2022Autologous fat grafting is a popular technique for volume replacement in the breast and face. The efficacy, safety, and complication rate of this technique at the... (Review)
Review
BACKGROUND
Autologous fat grafting is a popular technique for volume replacement in the breast and face. The efficacy, safety, and complication rate of this technique at the division of plastic surgery at the University of Alabama at Birmingham will be described in this review.
METHODS
An institutional review board-approved retrospective review of patients undergoing fat grafting procedures from January 2015 to July 2018 was performed. Records were reviewed for fat graft recipient site, donor site, amount grafted, and complications. Continuous variables were compared using either a t test or one-way analysis of variance test. Categorical data were compared using χ2 test. A P value of 0.05 or less was considered statistically significant for all comparisons.
RESULTS
A total of 396 patients who underwent fat grafting procedures of the face and body from January 2015 through July 2018 met inclusion criteria. Average amount of fat grafted for all grafts was 124.4 +/- 6.74 grams. Two hundred fifty of the grafts (62.7%) involved the bilateral breasts with an average of 140.6 +/- 93.97 g used, 70 per side. Of the 396 patients, 110 (27.8%) experienced complications. Forty three of the complications (10.9%) were considered to be major, which included hematomas/seromas, fat necrosis, dermatitis/cellulitis, and infection. No statistical differences were seen among recipient site complication rate. Types of minor complications were statistically significant per recipient sites with bilateral breasts more likely to experience asymmetry than the other recipient sites (20% for bilateral breasts vs 16% overall, P < 0.05). Fifty nine of the 110 patients (53.6%) had the complications reported to be resolved.
CONCLUSIONS
Fat grafting is a reliable method for volumization of the breasts and face. Minor complications were not infrequent in this case series; however, no life-threatening complications were observed. Continued work needs to be done to use fat grafting beyond traditional measures.
Topics: Adipose Tissue; Humans; Mammaplasty; Retrospective Studies; Transplantation, Autologous; Treatment Outcome
PubMed: 35690941
DOI: 10.1097/SAP.0000000000003234 -
Annals of Surgical Oncology Jan 2022
Topics: Breast Neoplasms; Female; Financial Stress; Humans; Mammaplasty; Mastectomy; Outcome Assessment, Health Care; Retrospective Studies; Treatment Outcome
PubMed: 34528178
DOI: 10.1245/s10434-021-10792-7 -
Aesthetic Plastic Surgery Jun 2023Mounting evidence suggests that breast reduction surgery displays higher rates of surgical site infections (SSI) than initially presumed. Objective of this network... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Mounting evidence suggests that breast reduction surgery displays higher rates of surgical site infections (SSI) than initially presumed. Objective of this network meta-analysis is to evaluate the effectiveness of different antibiotic regimens in the prophylaxis from surgical site infections and delayed wound healing (DWH) following breast reduction.
METHODS
A network meta-analysis was conducted using a predetermined protocol after searching the electronic databases MEDLINE, Scopus, the Cochrane Library and US National Institutes of Health Ongoing Trials Register from inception to July 2022. The included studies had to examine breast reduction in females with at least 1-month follow-up, receiving antibiotics in an intervention arm compared to a control arm. The quality of studies was assessed using the Cochrane risk of bias tool. A frequentist Mantel-Haenszel approach was adopted for the reported SSI rates while an inverse variance random effects model was used for the DWH rates.
RESULTS
A total of 10 studies was included in the analysis involving 1331 patients. All but one study controlled for major risk factors, and no differences were observed in patients' baseline characteristics. Antibiotic administration significantly reduced the SSI rate after breast reduction, with the prolonged antibiotic regimen being the most efficacious (odds ratio [OR]: 0.36 [95%CI: 0.15-0.85]). No statistically significant reduction in delayed wound healing rate was revealed among the regimens.
CONCLUSIONS
Antibiotics mitigate the SSI rate after breast reduction. This meta-analysis provides an evidence-based strategy to optimize antibiotic administration. Further research is needed though to examine antibiotic prophylaxis on delayed wound healing.
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: Female; Humans; Surgical Wound Infection; Antibiotic Prophylaxis; Network Meta-Analysis; Anti-Bacterial Agents; Mammaplasty
PubMed: 36928312
DOI: 10.1007/s00266-023-03313-2 -
In Vivo (Athens, Greece) 2023Silicone implants or tissue expanders placed under the pectoralis major (PM) muscle are often used for breast reconstruction. However, the disruption of PM insertions,... (Review)
Review
Silicone implants or tissue expanders placed under the pectoralis major (PM) muscle are often used for breast reconstruction. However, the disruption of PM insertions, which is often an inevitable part of the surgical procedure, is known to cause PM morbidity and, subsequently, problems with the use of the ipsilateral arm. In this systematic review, we present current knowledge regarding the effect of submuscular silicone-based breast reconstruction on the function of PM and the ipsilateral arm. A search of the relevant English literature was performed through PubMed and ten eligible studies were identified. Articles reporting breast augmentation were accepted as the techniques of implant insertion are similar to reconstruction. Questionnaires reporting the status of the arm, analysis of the range of motion of the shoulder with 3-D video, isometric or isokinetic dynamometry, ultrasound shear-wave elastography, volumetric MRI, electromyography and light and electron microscopy of the PM fibers were used for the assessment of PM and arm status. The insertion of implants under the PM, especially when combined with dissection of some of its insertions, seems to be associated with measurable abnormal microscopic, imaging, and dynamometric findings. However, the intact part of the muscle and possibly other nearby muscular structures are able to compensate for the lost part of PM. Thus, the insertion of implants fully or partially under the PM seems to have no or little effect on the function of the ipsilateral upper limb in daily life.
Topics: Pectoralis Muscles; Silicones; Mammaplasty; Prostheses and Implants; Magnetic Resonance Imaging; Breast Implants
PubMed: 37652471
DOI: 10.21873/invivo.13289 -
Annals of the Royal College of Surgeons... Feb 2017
Topics: Female; Humans; Mammaplasty; Nipples; Surgical Flaps
PubMed: 27659355
DOI: 10.1308/rcsann.2016.0307 -
Editorial Comment on: One-Year Experience of Same-Day Mastectomy and Breast Reconstruction Protocol.Annals of Surgical Oncology Sep 2022
Topics: Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy; Postoperative Complications; Retrospective Studies
PubMed: 35834143
DOI: 10.1245/s10434-022-12021-1 -
Advances in Clinical and Experimental... 2015Breast cancer remains the most common tumor in women, and new techniques for post- surgical breast reconstruction have been recently introduced. These new procedures... (Review)
Review
Breast cancer remains the most common tumor in women, and new techniques for post- surgical breast reconstruction have been recently introduced. These new procedures include autologous fat grafting with or without the enrichment with autologous stromal vascular fraction (SVF), platelet-derived growth factors and insulin. The reported improvement of fat graft viability with these techniques likely depends on the presence in the SVF of multipotent resident adipose derived-stem cells (ASCs). The clinical advantage derives from the plasticity of ASCs and their ability to generate new functional adipose tissue and vessels. However, there is an ongoing debate regarding the possible interplay between breast tumor cells and resident or transplanted ASCs for their capacity to locally secrete growth factors. Most of the data in the literature concerning ASCs is derived from in vitro models, whereas the knowledge of ASC behavior in vivo remains scarce. Recent reports concerning SVF/ASC enrichment of fat graft did not describe any significant worsening of prognosis for patients undergoing those procedures. However, further studies and longer follow-ups are needed to specifically define technical procedures and to confirm the safety of procedures of SVF/ASC enrichment during post-surgical breast reconstruction.
Topics: Adipose Tissue; Animals; Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy; Regenerative Medicine; Risk Factors; Stem Cell Transplantation; Treatment Outcome
PubMed: 26467147
DOI: 10.17219/acem/31673 -
Medicine Mar 2023Currently, autologous fat grafting is the common surgery employed in the department of plastic and cosmetic surgery. Complications after fat grafting (such as fat... (Review)
Review
Currently, autologous fat grafting is the common surgery employed in the department of plastic and cosmetic surgery. Complications after fat grafting (such as fat necrosis, calcification, and fat embolism) are the difficulties and hotspots of the current research. Fat necrosis is one of the most common complications after fat grafting, which directly affects the survival rate and surgical effect. In recent years, researchers in various countries have achieved great results on the mechanism of fat necrosis through further clinical and basic studies. We summarize recent research progress on fat necrosis in order to provide theoretical basis for diminishing it.
Topics: Humans; Fat Necrosis; Adipose Tissue; Mammaplasty; Autografts; Transplantation, Autologous
PubMed: 36897702
DOI: 10.1097/MD.0000000000033220