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Nigerian Journal of Clinical Practice Jun 2022Breast reduction is a common and safe procedure with predicted cosmetic outcomes. Many techniques have evolved over the recent decades.
BACKGROUND
Breast reduction is a common and safe procedure with predicted cosmetic outcomes. Many techniques have evolved over the recent decades.
AIMS
The aim of this study is to determine what type of breast reduction techniques are currently preferred among board certificated Saudi plastic surgeons and assess the surgeons' satisfaction, surgeon-reported patient satisfaction, and complication rates post breast reduction with the preferred techniques.
MATERIALS AND METHODS
This is a cross-sectional questionnaire-based study. The questionnaire was adapted from previously published studies and distributed to a small group before full-scale distribution to Saudi plastic surgeons by email and communication groups.
RESULTS
The mean age of the participants was 45.4 (± 8.9). Most participants were males (82%), and the majority held a Saudi board (44%), and 20% held a Canadian board. Significant differences between different board certifications, held fellowship, and years of experience emerged in terms of surgical preferences. The two most common complications reported by surgeons were suture splitting (34%) and excess scarring (24%).
CONCLUSIONS
In Saudi Arabia, inverted T resection patterns with superior or superomedial pedicle designs are the standard techniques used in breast reduction, with higher satisfaction rates and fewer complications. Surgical preferences were significantly different between surgeons based on their training and held fellowships.
Topics: Canada; Certification; Cross-Sectional Studies; Female; Humans; Male; Mammaplasty; Surgeons; Surgery, Plastic; Surveys and Questionnaires
PubMed: 35708433
DOI: 10.4103/njcp.njcp_1943_21 -
Journal of Korean Medical Science Apr 2020Korea is no longer safe from the risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL); the first reported case was a Korean woman in her 40s who...
BACKGROUND
Korea is no longer safe from the risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL); the first reported case was a Korean woman in her 40s who had a 7-year-history of receiving an implant-based augmentation mammaplasty using a textured implant. We conducted this study to discuss the emerging crisis of stakeholders in implant-based augmentation mammaplasty and to propose a multi-disciplinary approach to early detection of its complications.
METHODS
We analyzed medical examination data that was collected from patients who visited us between August 12 and September 27, 2019. We evaluated a total of 114 women (n = 114) in the current study. They were evaluated for whether they were in healthy condition. Moreover, their baseline characteristics were also examined; these included age, gender, height (cm), weight (kg), duration since surgery (years), possession of a breast implant card, the site of surgical incision, side of symptoms and reasons for outpatient visit. Furthermore, the patients were also evaluated for their subjective awareness of the manufacturer, surface and shape of the breast implant. Potential complications include malrotation, folding, seroma, capsule thickening, upside-down rotation, rupture, capsule mass and breast mass.
RESULTS
A majority of the patients had a past history of receiving textured implants. The corresponding percentage was 78.95% (90/114) and 85.09% (97/114) based on their subjective awareness of a breast implant and sonographic findings, respectively. That is, it was slightly increased with the use of a breast ultrasound.
CONCLUSION
Here, we propose the following approaches. First, patient data should be prospectively collected. By tracking outcomes and complications of an implant-based augmentation mammaplasty, both high-quality care and patient safety can be ensured. Second, stakeholders in implant-based augmentation mammaplasty should collaborate with customers and regulatory authorities. Third, surgeons should consider applying imaging modalities for early detection of postoperative complications.
Topics: Adult; Breast; Female; Humans; Lymphoma, Large-Cell, Anaplastic; Mammaplasty; Middle Aged; Republic of Korea; Ultrasonography; Young Adult
PubMed: 32301294
DOI: 10.3346/jkms.2020.35.e103 -
Medicine Dec 2016Cosmetic breast surgery is the only therapeutic alternative for psychological and physical complications associated with micromasty, breast ptosis, and macromasty. We... (Comparative Study)
Comparative Study Observational Study
Cosmetic breast surgery is the only therapeutic alternative for psychological and physical complications associated with micromasty, breast ptosis, and macromasty. We analyzed the effects of 2 variables, time, and type of cosmetic breast surgery, on anxiety symptomatology and quality of life.Following a mixed 3 × 4 design, 3 groups of women with breast augmentation (n = 63), mastopexy (n = 42), and breast reduction (n = 30) were selected and evaluated using the State-Trait Anxiety Inventory and the 12-Item Short-Form Health Survey at 4 different times, the preoperative stage, and at 1, 6, and 12 months postoperative. Pearson's chi square, Welch's U, Games-Howell tests, mixed analysis of variance, and Cohen's d and w for effect size were calculated.Results relating to anxiety (state and trait) showed that the time factor was significant (P < 0.001) with differences between the preoperative stage (higher anxiety levels) and the 3 postoperative stages: at 1 month (P < 0.001), 6 months (P < 0.001), and 12 months (P < 0.001). In quality of life, type of surgery and time factors were found to have interactive effects on vitality (P = 0.044) and role-emotional (P = 0.023) dimensions. Compared to the other 2 groups, women who had undergone mastopexy felt worse (vitality) at 1 month since surgery than in the other stages, and better at 6 months since surgery (role-emotional). In the rest of the dimensions, and focusing on the most relevant effect sizes, the type of surgery made a difference in the physical functioning (P = 0.005) and role-physical (P = 0.020) dimensions, where women who had had breast reduction felt worse than those who had had augmentation. Time also resulted in differences in the physical functioning (P < 0.001), role-physical (P < 0.001), and bodily pain (P < 0.001) dimensions, where women felt worse at 1 month since surgery than during the rest of the stages, as well as in the social functioning dimension (P < 0.001) at 1 month, compared to 6 months postoperative.We conclude that in the long term, women who have cosmetic breast surgery recover their physical and psychological well-being.
Topics: Adult; Anxiety Disorders; Female; Humans; Mammaplasty; Mental Disorders; Middle Aged; Postoperative Complications; Psychometrics; Quality of Life; Retrospective Studies; Risk Assessment; Self Report; Severity of Illness Index; Socioeconomic Factors; Spain; Surveys and Questionnaires
PubMed: 27930592
DOI: 10.1097/MD.0000000000005620 -
Journal of Reconstructive Microsurgery Jul 2023This study compared the ergonomics of surgeons during deep inferior epigastric perforator (DIEP) flap surgery using either baseline equipment (loupes, headlights, and...
BACKGROUND
This study compared the ergonomics of surgeons during deep inferior epigastric perforator (DIEP) flap surgery using either baseline equipment (loupes, headlights, and an operating microscope) or an exoscope. Plastic surgeons may be at high risk of musculoskeletal problems. Recent studies indicate that adopting an exoscope may significantly improve surgeon postures and ergonomics.
METHODS
Postural exposures, using inertial measurement units at the neck, torso, and shoulders, were calculated in addition to the surgeons' subjective physical and cognitive workload. An ergonomic risk score on a scale of 1 (lowest) to 4 (highest) was calculated for each of the postures observed. Data from 23 bilateral DIEP flap surgeries (10 baseline and 13 exoscope) were collected.
RESULTS
The neck and torso risk scores decreased significantly during abdominal flap harvest and chest dissection, while right shoulder risk scores increased during the abdominal flap harvest for exoscope DIEP flap procedures compared with. Exoscope anastomoses demonstrated higher neck, right shoulder, and left shoulder risk scores. The results from the survey for the "surgeon at abdomen" showed that the usage of exoscopes was associated with decreased performance and increased mental demand, temporal demand, and effort. However, the results from the "surgeon at chest" showed that the usage of exoscopes was associated with lower physical demand and fatigue, potentially due to differences in surgeon preference.
CONCLUSION
Our study revealed some objective evidence for the ergonomic benefits of exoscope; however, this is dependent on the tasks the surgeon is performing. Additionally, personal preferences may be an important factor to be considered in the ergonomic evaluation of the exoscope.
Topics: Mammaplasty; Perforator Flap; Ergonomics; Abdomen; Neck; Epigastric Arteries
PubMed: 36509101
DOI: 10.1055/s-0042-1758188 -
Breast Cancer (Tokyo, Japan) Nov 2023The application of immediate breast reconstruction (IBR) for post-neoadjuvant therapy (NAT) patients was controversial. The aim of this study was to investigate the...
OBJECTIVE
The application of immediate breast reconstruction (IBR) for post-neoadjuvant therapy (NAT) patients was controversial. The aim of this study was to investigate the long-term survival outcomes of IBR for these patients.
METHODS
Data between January 2010 and November 2017 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was performed to reduce the influence of confounding factors between the mastectomy alone group (MA) and the mastectomy with IBR group (IBR). The rates of 5 year breast cancer-specific survival (BCSS) were compared by Kaplan-Meier curves with log-rank test.
RESULTS
The IBR was associated with improved 5-year BCSS in the IBR group before PSM (88.5 vs. 79.1%, P < 0.001). The proportion of IBR increased from 21.5% in 2010 to 28.2% in 2017. After PSM, a total of 9,610 patients were enrolled for survival analysis (4,805 in each group). In the complete response (CR) group, the 5-year BCSS rates did not differ (93.4 vs. 95.6%, P = 0.16). In the non-CR group, the 5-year BCSS rate was higher in patients who received IBR (82.5% 79.4%, P = 0.034).
CONCLUSION
In general, the application of IBR among post-NAT patients has steadily increased from 2010 to 2017. In the CR group, survival outcomes of post-NAT patients who received IBR were similar to those who received mastectomy alone. In the non-CR group, IBR was associated with potential survival benefits. More studies are expected to validate our findings.
Topics: Humans; Female; Breast Neoplasms; Mastectomy; Neoadjuvant Therapy; Mammaplasty; Prognosis; Retrospective Studies
PubMed: 37505442
DOI: 10.1007/s12282-023-01489-8 -
British Journal of Hospital Medicine... Mar 2020Breast cancer is the most commonly diagnosed female cancer in the UK, with one in eight women receiving a cancer diagnosis during their lifetime. Forty per cent of women... (Review)
Review
Breast cancer is the most commonly diagnosed female cancer in the UK, with one in eight women receiving a cancer diagnosis during their lifetime. Forty per cent of women diagnosed with breast cancer undergo mastectomy as their primary therapeutic procedure. While a full range of choices is offered, breast reconstruction using implants is the patient-preferred method of reconstruction following mastectomy. This review discusses the evolution of implant-based reconstruction, focusing on the recent trend towards prepectoral breast reconstruction. Key quality indicators in the current literature are considered, including oncological outcomes, aesthetics and patient-related outcome measures, as are the health-care economics of this emerging surgical technique.
Topics: Acellular Dermis; Breast Implantation; Breast Neoplasms; Cost-Benefit Analysis; Female; Humans; Mammaplasty; Mastectomy; Patient Satisfaction; Postoperative Complications; Quality Indicators, Health Care; United Kingdom
PubMed: 32240004
DOI: 10.12968/hmed.2018.0428a -
European Review For Medical and... Nov 2021The aim of this study is to demonstrate that for patients undergoing mastectomy the use of the proprioceptive memory represents a valid method to identify the perfect...
OBJECTIVE
The aim of this study is to demonstrate that for patients undergoing mastectomy the use of the proprioceptive memory represents a valid method to identify the perfect position of the nipple, which will be reconstructed on an operated breast.
PATIENTS AND METHODS
Fifty-one patients undergoing breast reconstruction after unilateral Modified Radical Mastectomy or unilateral Skin Sparing Mastectomy were included in the study. All patients were asked to identify, while keeping their eyes closed, the mammary segment where they perceived their nipples, both on the reconstructed breast mound and on the contralateral breast. Sternal Notch-to-nipple distance (SN), Nipple-to-inframammary Fold distance (NF), Midclavicular line-to-nipple distance (CN), the distance from the nipple to the chest Midline (NM), Anterior Axillary line-to-nipple distance (ZN) were measured on both breasts. The ideal position of the nipple to be reconstructed was evaluated using a geometric method based on the Pythagorean Theorem.
RESULTS
A statistically significant correlation emerges between the distances measured from the anatomical landmarks of the chest to the point coinciding with the patient's perception of the nipple on the reconstructed breast, and the distances measured from the same chest landmarks to the nipple on the contralateral native breast and to the nipple placed in the ideal position assessed with the geometric method.
CONCLUSIONS
The patient's proprioceptive memory of the nipple position can be useful to identify the exact place to reconstruct the nipple in breast reconstruction.
Topics: Adult; Aged; Female; Humans; Mammaplasty; Mastectomy; Middle Aged; Nipples; Proprioception
PubMed: 34859858
DOI: 10.26355/eurrev_202111_27245 -
Asian Journal of Surgery Jan 2023Autologous lipotransfer is an essential component of soft tissue reconstruction. However, it is not widely applied or accepted by surgeons due to its unstable survival... (Meta-Analysis)
Meta-Analysis Review
Autologous lipotransfer is an essential component of soft tissue reconstruction. However, it is not widely applied or accepted by surgeons due to its unstable survival rate and uncertain efficacy. The cell-assisted fat transfer (CAL) is a promising technique that increases the fat survival rate. However, it is controversial based on various clinical studies. Here, we assessed the fat survival and complication rates of CAL, compared to the conventional autologous lipotransfer. To conduct our research, two reviewers independently screened related articles published in Medicine (via PubMed), EMBASE, Cochrane Library, and Web of Science. The combined effect estimates for efficacy evaluation was performed by the Review Manager software (RevMan 5.4.1). In total, 14 articles were included in our analysis (n = 722). Based on our analysis, the survival rate of the fat graft in CAL was significantly higher than the conventional fat grafting group (non-CAL group) (SMD = 2.81, 95%CI [1.54, 4.08], P < 0.01). In the subgroup, the fat retention of CAL in the facial filling was higher than the conventional one (SMD = 3.01, 95%CI [1.68, 4.33], P < 0.01). After breast augmentation, however, the difference between the experimental and control group was not statistically significant (SMD = 1.80, 95%CI [-0.31, 3.91], P = 0.09). Moreover, the CAL group exhibited comparable complications as the non-CAL group. Based on our analysis, the CAL group was significantly better than the conventional lipotransfer in terms of fat survival, particularly, during facial filling. However, it failed to reduce the complication rate, compared to the non-CAL group.
Topics: Humans; Mammaplasty; Face
PubMed: 35504778
DOI: 10.1016/j.asjsur.2022.04.031 -
Journal of Plastic, Reconstructive &... Nov 2020The coronavirus disease-2019 pandemic has had a significant impact on the delivery of surgical services, particularly reconstructive surgery. This article examines the... (Review)
Review
The coronavirus disease-2019 pandemic has had a significant impact on the delivery of surgical services, particularly reconstructive surgery. This article examines the current evidence to assess the feasibility of recommencing immediate breast reconstruction services during the pandemic and highlights considerations required to ensure patient safety.
Topics: Betacoronavirus; Breast Neoplasms; COVID-19; Clinical Protocols; Coronavirus Infections; Cross Infection; Feasibility Studies; Female; Humans; Mammaplasty; Mastectomy; Pandemics; Patient Selection; Pneumonia, Viral; Postoperative Complications; Risk Assessment; SARS-CoV-2; Time Factors
PubMed: 32948493
DOI: 10.1016/j.bjps.2020.08.044 -
World Journal of Surgery Apr 2022Analysing the results of breast reconstruction is important both in terms of oncological safety and health-related quality of life (HRQoL). Immediate breast...
BACKGROUND
Analysing the results of breast reconstruction is important both in terms of oncological safety and health-related quality of life (HRQoL). Immediate breast reconstruction (IBR) is thought to be prone to complications and heavy for patients with no time to adapt to having cancer. Delayed reconstruction (DR) is an option after primary surgery and oncological treatments, but requires patients to go through two recovery periods after surgery.
METHODS
A prospective study of 1065 breast cancer patients with repeated measurement of HRQoL with both generic (15D) and disease specific (EORTC QLQ C-30 BR23) measuring tools included 51 IBR patients and 41 DR patients. These patients' HRQoL and reconstruction methods were studied in more detail alongside with clinical data to determine HRQoL levels for patients with IBR and those with mastectomy and DR during a 24-month follow-up. Measuring points were baseline, 3, 6, 12 and 24 months.
RESULTS
Most frequent techniques used were abdominal flaps (IBR n = 16, DR n = 14), latissimus dorsi flaps (LD) (IBR n = 19, DR n = 10), implants (IBR n = 12) and fat grafting (DR n = 6). Smaller groups were excluded from group comparisons. Approximately one third of the patients encountered complications. Symptom scores did not differ between reconstruction methods. DR patients had better overall HRQoL at 12 months, but at 24 months the situation had changed in favour of IBR. Both approaches of reconstructive surgery produced good HRQoL with no significant differences between the approaches studied.
Topics: Breast Neoplasms; Female; Follow-Up Studies; Humans; Mammaplasty; Mastectomy; Prospective Studies; Quality of Life
PubMed: 35001140
DOI: 10.1007/s00268-021-06426-4