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World Journal of Surgical Oncology Apr 2023Cell-assisted lipotransfer (CAL), a technique of autologous adipose transplantation enriched with adipose-derived stem cells (ADSCs), has the potential to improve... (Review)
Review
BACKGROUND
Cell-assisted lipotransfer (CAL), a technique of autologous adipose transplantation enriched with adipose-derived stem cells (ADSCs), has the potential to improve cosmetic outcomes at irradiated sites. However, many concerns have been raised about the possibility of ADSCs increasing oncological risk in cancer patients. With the increasing demand for CAL reconstruction, there is an urgent need to determine whether CAL treatment could compromise oncological safety after radiotherapy, as well as to evaluate its efficacy in guiding clinical decisions.
METHODS
A PRISMA-compliant systematic review of the safety and efficacy of CAL in breast cancer patients after radiotherapy was conducted. The PubMed, Ovid, Cochrane Library, and ClinicalTrials.gov databases were comprehensively searched from inception to 31 December 2021.
RESULTS
The search initially yielded 1185 unique studies. Ultimately, seven studies were eligible. Based on the limited outcome evidence, CAL did not increase recurrence risk in breast cancer patients but presented aesthetic improvement and higher volumetric persistence in a long-term follow-up. Although breast reconstruction with CAL also had oncological safety after radiotherapy, these patients needed more adipose tissue and had relatively lower fat graft retention than the non-irradiated patients (P < 0.05).
CONCLUSIONS
CAL has oncological safety and does not increase recurrence risk in irradiated patients. Since CAL doubles the amount of adipose required without significantly improving volumetric persistence, clinical decisions for irradiated patients should be made more cautiously to account for the potential costs and aesthetic outcomes. There is limited evidence at present; thus, higher-quality, evidence-based studies are required to establish a consensus on breast reconstruction with CAL after radiotherapy.
Topics: Humans; Female; Breast Neoplasms; Neoplasm Recurrence, Local; Adipose Tissue; Adipocytes; Mammaplasty
PubMed: 37069583
DOI: 10.1186/s12957-023-03010-z -
BJS Open May 2022Following therapeutic mammoplasty (TM), the contralateral breast may require a later balancing procedure to optimize shape and symmetry. The alternative is to offer... (Observational Study)
Observational Study
BACKGROUND
Following therapeutic mammoplasty (TM), the contralateral breast may require a later balancing procedure to optimize shape and symmetry. The alternative is to offer patients simultaneous TM with immediate contralateral symmetrization via a dual-surgeon approach, with the goal of reducing costs and minimizing the number of subsequent hospital appointments in an era of COVID-19 surges. The aim of this cost-consequence analysis is to characterize the cost-benefit of immediate bilateral symmetrization dual-operator mammoplasty versus staged unilateral single operator for breast cancer surgery.
METHOD
A prospective single-centre observational study was conducted at an academic teaching centre for breast cancer surgery in the UK. Pseudonymized data for clinicopathological variables and procedural care information, including the type of initial breast-conserving surgery and subsequent reoperation(s), were extracted from the electronic patient record. Financial data were retrieved using the Patient-Level Information and Costing Systems.
RESULTS
Between April 2014 and March 2020, 232 women received either immediate bilateral (n = 44), staged unilateral (n = 57) for breast cancer, or unilateral mammoplasty alone (n = 131). The median (interquartile range (i.q.r.)) additional cost of unilateral mammoplasty with staged versus immediate bilateral mammoplasty was €5500 (€4330 to €6570) per patient (P < 0.001), which represents a total supplementary financial burden of €313 462 to the study institution. There was no significant difference between groups in age, Charlson comorbidity index, operating minutes, time to adjuvant radiotherapy in months, or duration of hospital stay.
CONCLUSION
Synchronous dual-surgeon immediate bilateral TM can deliver safe immediate symmetrization and is financially beneficial, without delay to receipt of adjuvant therapy, or additional postoperative morbidity.
Topics: Breast Neoplasms; COVID-19; Female; Humans; Mammaplasty; Mastectomy, Segmental; Prospective Studies; Treatment Outcome
PubMed: 35674701
DOI: 10.1093/bjsopen/zrac073 -
JAMA Pediatrics May 2018Transmasculine youth, who are assigned female at birth but have a gender identity along the masculine spectrum, often report considerable distress after breast...
IMPORTANCE
Transmasculine youth, who are assigned female at birth but have a gender identity along the masculine spectrum, often report considerable distress after breast development (chest dysphoria). Professional guidelines lack clarity regarding referring minors (defined as people younger than 18 years) for chest surgery because there are no data documenting the effect of chest surgery on minors.
OBJECTIVE
To examine the amount of chest dysphoria in transmasculine youth who had had chest reconstruction surgery compared with those who had not undergone this surgery.
DESIGN, SETTING, AND PARTICIPANTS
Using a novel measure of chest dysphoria, this cohort study at a large, urban, hospital-affiliated ambulatory clinic specializing in transgender youth care collected survey data about testosterone use and chest distress among transmasculine youth and young adults. Additional information about regret and adverse effects was collected from those who had undergone surgery. Eligible youth were 13 to 25 years old, had been assigned female at birth, and had an identified gender as something other than female. Recruitment occurred during clinical visits and via telephone between June 2016 and December 2016. Surveys were collected from participants who had undergone chest surgery at the time of survey collection and an equal number of youth who had not undergone surgery.
MAIN OUTCOMES AND MEASURES
Outcomes were chest dysphoria composite score (range 0-51, with higher scores indicating greater distress) in all participants; desire for chest surgery in patients who had not had surgery; and regret about surgery and complications of surgery in patients who were postsurgical.
RESULTS
Of 136 completed surveys, 68 (50.0%) were from postsurgical participants, and 68 (50.0%) were from nonsurgical participants. At the time of the survey, the mean (SD) age was 19 (2.5) years for postsurgical participants and 17 (2.5) years for nonsurgical participants. Chest dysphoria composite score mean (SD) was 29.6 (10.0) for participants who had not undergone chest reconstruction, which was significantly higher than mean (SD) scores in those who had undergone this procedure (3.3 [3.8]; P < .001). Among the nonsurgical cohort, 64 (94%) perceived chest surgery as very important, and chest dysphoria increased by 0.33 points each month that passed between a youth initiating testosterone therapy and undergoing surgery. Among the postsurgical cohort, the most common complication of surgery was loss of nipple sensation, whether temporary (59%) or permanent (41%). Serious complications were rare and included postoperative hematoma (10%) and complications of anesthesia (7%). Self-reported regret was near 0.
CONCLUSIONS AND RELEVANCE
Chest dysphoria was high among presurgical transmasculine youth, and surgical intervention positively affected both minors and young adults. Given these findings, professional guidelines and clinical practice should consider patients for chest surgery based on individual need rather than chronologic age.
Topics: Adolescent; Adult; Age Factors; Attitude to Health; Cohort Studies; Female; Gender Dysphoria; Gender Identity; Humans; Male; Mammaplasty; Patient Satisfaction; Postoperative Complications; Psychiatric Status Rating Scales; Self Report; Thoracic Wall; Transgender Persons; Treatment Outcome; Young Adult
PubMed: 29507933
DOI: 10.1001/jamapediatrics.2017.5440 -
Genes Feb 2021Growing numbers of asymptomatic women who become aware of carrying a breast cancer gene mutation (BRCA) mutation are choosing to undergo risk-reducing bilateral... (Review)
Review
Growing numbers of asymptomatic women who become aware of carrying a breast cancer gene mutation (BRCA) mutation are choosing to undergo risk-reducing bilateral mastectomies with immediate breast reconstruction. We reviewed the literature with the aim of assessing the oncological safety of nipple-sparing mastectomy (NSM) as a risk-reduction procedure in BRCA-mutated patients. Nine studies reporting on the incidence of primary breast cancer post NSM in asymptomatic BRCA mutated patients undergoing risk-reducing bilateral procedures met the inclusion criteria. NSM appears to be a safe option for BRCA mutation carriers from an oncological point of view, with low reported rates of new breast cancers, low rates of postoperative complications, and high levels of satisfaction and postoperative quality of life. However, larger multi-institutional studies with longer follow-up are needed to establish this procedure as the best surgical option in this setting.
Topics: Adult; Asymptomatic Diseases; BRCA1 Protein; BRCA2 Protein; Breast Neoplasms; Clinical Decision-Making; Female; Follow-Up Studies; Gene Expression; Humans; Mammaplasty; Mastectomy; Middle Aged; Mutation; Nipples; Quality of Life; Risk Assessment
PubMed: 33578759
DOI: 10.3390/genes12020253 -
Ugeskrift For Laeger Aug 2015Breast reconstruction using autologous tissue is commonly used in breast cancer patients who have received radiation therapy. The use of a latissimus dorsi flap is a... (Review)
Review
Breast reconstruction using autologous tissue is commonly used in breast cancer patients who have received radiation therapy. The use of a latissimus dorsi flap is a safe and viable alternative to the use of an abdominal flap. The cosmetic results are excellent but there is need for a better understanding of the donor-site morbidity in regard to potential loss of shoulder function. We believe that it is possible to improve the procedure through optimized surgical technique in combination with the implementation and the benefits of fast-track surgery.
Topics: Breast Neoplasms; Female; Humans; Mammaplasty; Myocutaneous Flap; Superficial Back Muscles; Time Factors
PubMed: 26320590
DOI: No ID Found -
Annals of Transplantation Sep 2015Over the last decade autologous fat from subcutaneous tissue has been used by plastic surgeons for face volumization. It has also been used with growing frequency for... (Review)
Review
Over the last decade autologous fat from subcutaneous tissue has been used by plastic surgeons for face volumization. It has also been used with growing frequency for aesthetic breast enhancement. Currently, experts in this field are becoming increasingly aware of the potential of fat for breast reconstruction. However, the safety of fat transfers to post-mastectomy defects has been called into question in recent debates due to the, albeit rare, observations of their possible influence on local cancer recurrence. The majority of concerned opinions are based on the safety of fat supplementation with additional amounts of adipose mesenchymal and stem cells. In experimental conditions, these cells were shown to create pathophysiological microenvironments and promote neoplastic transitions. This raises the question as to whether breast reconstruction with enriched fat is sufficiently safe to be performed without scientific justification and whether the present legal regulations are sufficient to guarantee patient safety in small facilities. In a number of circumstances, patients who have undergone treatment in profit-oriented offices, outside the system of oncological or surgical centers, might have been left without any long-term cancer surveillance. Valid opinions have also been expressed on the grounds of the ethical doubts concerning the advertising used by cosmetic practitioners who, on occasion, tend to overemphasize the putative benefits of stem cell applications despite the scant support in evidence-based medicine. Real progress in this field is possible only in scientific research that relies on bioethical evaluation, properly planned clinical trials, and the judgment of peers.
Topics: Adipose Tissue; Breast Neoplasms; Female; Humans; Mammaplasty; Neoplasm Recurrence, Local; Stem Cell Transplantation
PubMed: 26346742
DOI: 10.12659/AOT.894134 -
Aesthetic Surgery Journal Nov 2023Soft tissue and cutaneous tension is an important contributor to complicated wound healing and poor scar cosmesis after surgery and its mitigation is a key consideration... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Soft tissue and cutaneous tension is an important contributor to complicated wound healing and poor scar cosmesis after surgery and its mitigation is a key consideration in aesthetic and reconstructive procedures.
OBJECTIVES
The study objective was to assess the efficacy of the force modulating tissue bridge (FMTB) ("Brijjit", Brijjit Medical Inc., Atlanta, GA) in reducing mechanical tension on postoperative wounds.
METHODS
A prospective, single-center, randomized, within-subject clinical trial was conducted to evaluate wound healing and nascent scar formation after 8 weeks of postoperative wound support with the FMTB. Patients received standard of care (SOC) subcuticular closure on the vertical incision of 1 breast and experimental closure with the FMTB on the contralateral incision after Wise-pattern reduction mammaplasty. Three-dimensional wound analysis and rates of T-junction dehiscence were evaluated by clinical assessment at 2, 4, 6, and 8 weeks postsurgery.
RESULTS
Thirty-four patients (n = 68 breasts) completed 8 weeks of postoperative FMTB application. There was a reduced rate of T-junction wound dehiscence in FMTB breasts (n = 1) vs SOC breasts (n = 11) (P < .01). The mean vertical incision wound area during the intervention period was significantly decreased in the FMTB breast (1.5 cm2) vs the SOC breast (2.1 cm2) (P < .01) and was significantly lower at 2-, 4-, and 8-week follow-up (P < .01). Only the closure method was significantly associated with variations in Week 8 wound area (P < .01) after linear regression modeling.
CONCLUSIONS
FMTBs decrease nascent scar dimensions and reduce the occurrence of wound dehiscence. This study provides evidence that the use of continuous mechanomodulation significantly reduces postoperative wound complications after skin closure.
Topics: Female; Humans; Cicatrix; Mammaplasty; Plastic Surgery Procedures; Prospective Studies; Wound Healing; Postoperative Care; Surgical Wound Dehiscence
PubMed: 37606245
DOI: 10.1093/asj/sjad269 -
Medicina (Kaunas, Lithuania) May 2020: Breast cancer treatment has deeply changed in the last fifty years. Acellular dermal matrices (ADMs) were introduced for breast reconstruction, with encouraging... (Review)
Review
: Breast cancer treatment has deeply changed in the last fifty years. Acellular dermal matrices (ADMs) were introduced for breast reconstruction, with encouraging results, but with conflicting reports too. The present paper aims to summarize the current data on breast reconstruction using acellular dermal matrices. : We reviewed the literature regarding the use of ADM-assisted implant-based breast reconstruction. s: The main techniques were analyzed and described. : Several authors have recently reported positive results. Nevertheless, an increased complications' rate has been reported by other authors. Higher cost compared to not-ADM-assisted breast reconstruction is another concern.
Topics: Acellular Dermis; Adult; Breast Neoplasms; Female; Humans; Mammaplasty; Pectoralis Muscles; Postoperative Complications
PubMed: 32466619
DOI: 10.3390/medicina56060256 -
Acta Clinica Croatica Sep 2022Aesthetic breast surgery is the most common body surgery at Bagatin Polyclinic. During 2020 and 2021, altogether 274 cosmetic surgeries were performed on the breasts....
Aesthetic breast surgery is the most common body surgery at Bagatin Polyclinic. During 2020 and 2021, altogether 274 cosmetic surgeries were performed on the breasts. This included breast augmentation, breast augmentation and lifting operations, in a ratio of 2 to 1.According to statistics from the American Association of Plastic Surgeons (ASPS), in 2020 breast augmentation with implants was ranked fifth of all cosmetic surgeries performedand the second largest body surgery immediately after liposuction, with 193,073 procedures done. In addition to these procedures, breast augmentation (87,051) and breast reduction (33,574) procedures were also popular. Due to the increased interestin these procedures and their high daily percentage of operating programs, adequate analgesia and recovery of patients, who undergo these cosmetic breast corrections, areimportant. Today, it is no longer enough for an operation to go well and the patients to have good results. It is also important that the procedure itself, from induction of anesthesia to early and late recovery, allows for a quick return to daily activities and work.
Topics: Humans; United States; Female; Ambulatory Surgical Procedures; Mammaplasty; Mastectomy; Analgesia; Breast Neoplasms
PubMed: 36824637
DOI: 10.20471/acc.2022.61.s2.06 -
Journal of Plastic, Reconstructive &... Jan 2022Previous studies have mainly reported the short-term costs of different reconstruction techniques. Revision operations may increase costs in longer follow-up. Authors... (Review)
Review
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.
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.
Topics: Breast Implantation; Breast Neoplasms; Case-Control Studies; Delivery of Health Care; Female; Finland; Humans; Mammaplasty; Postoperative Complications; Retrospective Studies
PubMed: 34627717
DOI: 10.1016/j.bjps.2021.08.020