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Minerva Surgery Oct 2022Breast cancer is the second leading cause of death in women. The most recent and successful advancement in implant-assisted breast reconstruction after mastectomy is the... (Observational Study)
Observational Study
BACKGROUND
Breast cancer is the second leading cause of death in women. The most recent and successful advancement in implant-assisted breast reconstruction after mastectomy is the prepectoral approach using an acellular dermal matrix (ADM). Patients with ptotic breasts and macromastia were initially excluded from this type of immediate reconstruction remaining a difficult group to treat. The aim of this paper is to present our experience in performing skin-reducing mastectomy with pre-pectoral implant and complete ADM coverage as a single-stage procedure in patients with large ptotic breasts, evaluating the benefits and complications resulting from the use of this technique.
METHODS
A retrospective analysis of skin-reducing mastectomies and pre-pectoral breast reconstructions using Braxon porcine-derived ADM performed between January 2019 and February 2021 at our Breast Unit.
RESULTS
We treated 20 patients and performed a total of 24 skin-reducing mastectomies with pre-pectoral reconstruction. We observed two cases of partial NAC necrosis (8.3%) and one case of total NAC necrosis (4.2%). The incidence of skin flap necrosis was 8.3% (N.=2) healed by secondary intention. No case of prosthesis removal, infection or seroma was reported. Patients scored very good level of satisfaction with breast based on the results of the BREAST- Q questionnaire.
CONCLUSIONS
Skin-reducing mastectomy and pre-pectoral breast reconstruction can be offered to patients with large and ptotic breasts with good aesthetic and functional results. New prospective observational studies would be desirable to provide an opportunity to evaluate the long-term capabilities and complications of this technique.
Topics: Female; Swine; Animals; Mastectomy; Acellular Dermis; Retrospective Studies; Mammaplasty; Necrosis
PubMed: 34693673
DOI: 10.23736/S2724-5691.21.08941-3 -
The Breast Journal Apr 2020Not all women undergo post-mastectomy breast reconstruction due to medical comorbidities or personal preference. An aesthetically pleasing closure and contour of the...
BACKGROUND
Not all women undergo post-mastectomy breast reconstruction due to medical comorbidities or personal preference. An aesthetically pleasing closure and contour of the chest wall is still desired, though may be technically difficult to achieve in some patients. By combining techniques and lessons learned from breast reductions and female-to-male mastectomies (FTTM), we present a technical approach to aesthetic primary closure post-mastectomy that can be utilized in patients regardless of preoperative breast size.
METHODS
After mastectomy, excess cranial/caudal tissue is determined and the lower flap is de-epithelialized to allow for bulk in the reconstructed breast. Excess tissue in the horizontal plane is assessed, and axillary, nonbreast tissue is medialized. Excess skin in the horizontal plane is removed with a small lateral incision similar to a wise-pattern closure.
RESULTS
We have performed this technique with good aesthetic results and satisfied patients postoperatively.
CONCLUSION
When performing post-mastectomy closure without reconstruction, attention to tissue excess, medialization of axillary tissue and providing bulk with lateral and caudal tissue allows for an easy, reproducible, and aesthetic closure.
Topics: Breast; Breast Neoplasms; Female; Humans; Male; Mammaplasty; Mastectomy; Surgical Flaps
PubMed: 31578792
DOI: 10.1111/tbj.13641 -
Aesthetic Plastic Surgery Jun 2020The applicability of acellular dermal matrix (ADM) for breast reconstruction is a consolidated reality, as skin and nipple sparing techniques became standard mastectomy...
The applicability of acellular dermal matrix (ADM) for breast reconstruction is a consolidated reality, as skin and nipple sparing techniques became standard mastectomy approaches. ADM is a soft connective tissue graft generated via a decellularization process that preserves intact the extracellular skin matrix. ADM not only provides tissue reinforcement, but also better pocket control, and shape without the compressive effects of total sub-muscular coverage. Our preference is using one "Strattice®" ADM in pocket's format to cover the implant's inferior pole, protecting the totality of the implant in its inferior pole by the ADM. This technique besides its versatility is cheaper than other techniques presented. The success of ADM prepectoral breast reconstruction depends on three pillars: careful patient selection, flap perfusion and postoperative management. The challenge in large and/or ptotic breasts under the risk of large badly perfused flaps as well as of nipple, due to the nipple-furcules distance which can be handled with well-selected criteria as mentioned and safe management of nipple ascension as well as the nipple graft. Traditionally, they need to be associated with reducing mammoplasty techniques to achieve the expected aesthetic results in a single stage. Therefore, the plastic surgeon must be prepared for new reconstructive approaches postmastectomy, having the ADM as an excellent option for that.
Topics: Acellular Dermis; Humans; Mammaplasty; Mastectomy; Nipples; Surgical Flaps
PubMed: 32300878
DOI: 10.1007/s00266-020-01709-y -
Journal of Plastic Surgery and Hand... 2023Little is known about the safety and surgical outcomes of mastectomy after breast reduction in the trans male population. Several concerns have been voiced that...
Little is known about the safety and surgical outcomes of mastectomy after breast reduction in the trans male population. Several concerns have been voiced that performing mastectomy with prior breast reduction surgery, increases the risk for complications and revision surgery. All transgender men with a history of breast reduction, who underwent a mastectomy at our center between 01-1990 and 01-2021 were identified from our hospital registry. A retrospective chart study was conducted recording surgical characteristics, surgical complications, revision surgery, and clinical follow-up. A total of 1362 subcutaneous mastectomies were performed between 01-1990 and 01-2021. A total of 36 (2.6%) individuals were included (35 bilateral and 1 unilateral breast reduction). The mean age at mastectomy was 37 ± 10 years, and the median time between breast reduction and mastectomy was 6.3 years (range 1.0-31.1). Most individuals underwent a Wise-pattern breast reduction (91%) and a double incision mastectomy with free nipple grafts (86%). Following mastectomy, one acute reoperation was performed because of hemorrhage (3%). Partial pedicled nipple necrosis was seen in 7% and (partial) non-take of nipple grafts in 4%. Scar revisions were performed in 9%, dogear corrections in 20%, and both nipple corrections, and contour corrections in 6%. When comparing the outcomes in literature for surgical complications, scar revision, contour correction or nipple areolar complex revision, no clear disadvantage seems to be present when performing mastectomy after breast reduction. Mastectomy is a safe procedure in transgender men with a history of breast reduction.
Topics: Humans; Male; Adult; Middle Aged; Mastectomy; Transgender Persons; Retrospective Studies; Breast Neoplasms; Cicatrix; Mammaplasty; Mastectomy, Subcutaneous; Nipples
PubMed: 36621980
DOI: 10.1080/2000656X.2022.2164293 -
Annals of Surgical Oncology Dec 2023Breast oncology generates extensive literature and widespread media attention every year because of the high worldwide burden of this disease and also because of the... (Review)
Review
Breast oncology generates extensive literature and widespread media attention every year because of the high worldwide burden of this disease and also because of the rapid pace at which treatment advances have progressed. The year 2021 was no different, and this review will summarize some of the practice-changing, practice-validating, and practice-challenging publications of that year. These studies cover a broad range of topics including multidisciplinary care with gene expression profiling; breast cancer disparities; breast cancer screening; and prophylactic mastectomy surgery.
Topics: Humans; Female; Breast Neoplasms; Mastectomy; Prophylactic Mastectomy
PubMed: 37798553
DOI: 10.1245/s10434-023-14230-8 -
Plastic and Reconstructive Surgery Oct 2023Coronavirus disease of 2019 and rising health care costs have incentivized shorter hospital stays after mastectomies with immediate prosthetic reconstruction. The...
BACKGROUND
Coronavirus disease of 2019 and rising health care costs have incentivized shorter hospital stays after mastectomies with immediate prosthetic reconstruction. The purpose of this study was to compare postoperative outcomes following same-day and non-same-day mastectomy with immediate prosthetic reconstruction.
METHODS
A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program database from 2007 to 2019 was performed. Patients who underwent mastectomies and immediate reconstruction with tissue expanders or implants were selected and grouped based on length of stay. Univariate analysis and multivariate regression were performed to compare 30-day postoperative outcomes between length-of-stay groups.
RESULTS
A total of 45,451 patients were included: 1508 had same-day surgery (SDS) and 43,942 were admitted for 1 or more night (non-SDS). There was no significant difference in overall 30-day postoperative complications between SDS and non-SDS following immediate prosthetic reconstruction. SDS was not a predictor of complications (OR, 1.1; P = 0.346), whereas tissue expander reconstruction decreased odds of morbidity compared with direct-to-implant reconstruction (OR, 0.77; P < 0.001). Among patients who had SDS, smoking was significantly associated with early complications on multivariate analysis (OR, 1.85; P = 0.010).
CONCLUSIONS
This study provides an up-to-date assessment of the safety of mastectomies with immediate prosthetic breast reconstruction that captures recent advancements. Postoperative complication rates are similar between same-day discharge and at least 1-night stay, suggesting that same-day procedures may be safe for appropriately selected patients.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, III.
Topics: Humans; Female; Mastectomy; Retrospective Studies; Breast Neoplasms; Mammaplasty; Postoperative Complications
PubMed: 36862949
DOI: 10.1097/PRS.0000000000010348 -
Plastic and Reconstructive Surgery Oct 2022No meta-analysis has examined whether contralateral prophylactic mastectomy increases complication risk for unilateral breast cancer patients undergoing unilateral... (Meta-Analysis)
Meta-Analysis
BACKGROUND
No meta-analysis has examined whether contralateral prophylactic mastectomy increases complication risk for unilateral breast cancer patients undergoing unilateral mastectomy.
METHODS
Fifteen studies on complications of unilateral mastectomy plus contralateral prophylactic mastectomy met inclusion criteria. Meta-analyses compared complications of (1) diseased versus contralateral breasts in unilateral plus contralateral prophylactic mastectomy patients and (2) patients undergoing unilateral plus contralateral prophylactic mastectomy versus unilateral alone when grouped by reconstructive method.
RESULTS
For all unilateral plus contralateral prophylactic mastectomy patients, the diseased breast was significantly more prone to complications versus the contralateral breast (relative risk, 1.24; p = 0.03). In studies that stratified by reconstructive method, the complication risk was significantly higher for unilateral plus contralateral prophylactic mastectomy versus unilateral mastectomy alone for patients with no reconstruction (relative risk, 2.03; p = 0.0003), prosthetic-based reconstruction (relative risk,1.42; p = 0.003), and autologous reconstruction (relative risk, 1.32; p = 0.005). The only prospective trial showed similar results, including for more severe complications. Smaller retrospective studies without stratification by reconstructive method showed similar complications for unilateral plus contralateral prophylactic mastectomy versus unilateral mastectomy alone (relative risk, 1.06; p = 0.70). These groups had similar incidences of complication-related delay in adjuvant therapy, as demonstrated by one study.
CONCLUSIONS
After unilateral plus contralateral prophylactic mastectomy, diseased breasts are at higher risk for complications. Stronger evidence supports higher complication risk for unilateral plus contralateral prophylactic mastectomy than unilateral alone. More work is needed to determine the effect of complications on timing of adjuvant therapy.
Topics: Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy; Prophylactic Mastectomy; Prospective Studies; Retrospective Studies
PubMed: 35943952
DOI: 10.1097/PRS.0000000000009493 -
Medicina (Kaunas, Lithuania) Apr 2020: The surgical choice treatment of the breast cancer mostly depends on the stage of the disease. In the last years, breast cancer surgery has moved from being...
: The surgical choice treatment of the breast cancer mostly depends on the stage of the disease. In the last years, breast cancer surgery has moved from being destructive to being more respectful of the anatomical and physiological integrity of the gland. The aim of the breast surgery should be finalized to obtain the best aesthetic and functional results, respecting the principles of oncologic radicality. The present study is a retrospective analysis aimed to evaluate the long-term outcomes of a conservative technique like the nipple-sparing mastectomy. We observed 894 patients with a median age of 47.5 years old, underwent nipple-sparing mastectomy between 2002-2017. The data acquired include population and tumor characteristics, patient reconstructive outcomes, including locoregional, regional, and distant metastases; other variables, among nipple-areola complex necrosis and infection were collected. The complications detected were considered as "early" within 1 month later the nipple-sparing mastectomy or "late" after this time. The overall complications rate (early and late) and the overall survival and the relapses detected by this study were comparable with those reported in the literature. In order to identify factors that correlate with complications, either early or later, it has been processed an evaluation of the univariate analysis showing adjuvant chemotherapy as the only predictive factor for late complications, while we encountered no predictors for early complications. The present study adds to the data already present in literature, demonstrating that the nipple-sparing mastectomy is a safe procedure, providing good oncological and aesthetic results in patients carefully selected.
Topics: Adult; Aged; Breast Neoplasms; Female; Humans; Mastectomy; Middle Aged; Nipples; Retrospective Studies
PubMed: 32276470
DOI: 10.3390/medicina56040166 -
The Journal of Surgical Research Apr 2021The current obesity epidemic is associated with increased health care costs associated with comorbidities such as diabetes and heart disease as well as postoperative...
BACKGROUND
The current obesity epidemic is associated with increased health care costs associated with comorbidities such as diabetes and heart disease as well as postoperative complications. However, the effect of obesity on operating room (OR) utilization, especially in common breast procedures, has not been completely evaluated. Our study is the first to examine the effect of patient obesity on operative time (OPT) for common breast procedures.
METHODS
The American College of Surgeons National Surgical Quality Improvement Project databases for 2010-2018 were searched for this retrospective review. Patients undergoing common breast operations (lumpectomy, lumpectomy with sentinel lymph node biopsy (SLNB) (+/- injection), lumpectomy and axillary lymph node dissection (ALND), simple mastectomy, mastectomy with SLNB (+/- injection), and mastectomy with ALND) were filtered out by Current Procedural Terminology code and divided into three groups based on their body mass index (BMI) and weight. Using the two-sample t-test, OPT for the procedures was compared among the lowest and highest BMI and weight categories. We also used a linear regression t-test to demonstrate that for every unit increase in BMI, there was a corresponding increase in OPT for each procedure.
RESULTS
When the lowest and highest BMI and weight groups were compared, significant differences in OPT (P < 0.0001) were seen for each of the procedures. Numerous factors that could affect the complexity of surgery and thus OR time were identified. The correlation between BMI and weight and OPT remained significant after controlling for these variables. The differences between the highest and lowest BMI groups were most pronounced for higher complexity procedures, such as lumpectomy with ALND and mastectomy with ALND, with average operating times increasing by 18.2 min and 18.6 min, respectively, for patients with a higher BMI.
CONCLUSIONS
Patient BMI and weight significantly affect OPT for common breast procedures. Therefore, patient BMI should be taken into account to improve OR scheduling.
Topics: Adult; Aged; Body Mass Index; Body Weight; Breast Neoplasms; Facilities and Services Utilization; Female; Humans; Linear Models; Lymph Node Excision; Mastectomy; Middle Aged; Obesity; Operating Rooms; Operative Time; Retrospective Studies
PubMed: 33360306
DOI: 10.1016/j.jss.2020.10.012 -
Breast Disease 2021Phyllodes tumors (PTs) are rare fibroepithelial breast tumors with diverse biological behavior. (Review)
Review
BACKGROUND
Phyllodes tumors (PTs) are rare fibroepithelial breast tumors with diverse biological behavior.
OBJECTIVE
This study aimed to analyze the characteristics, management, and outcome of phyllodes tumors.
METHODS
Patients diagnosed with PTs in our institution from January 2013 to December 2017 were identified retrospectively by the ICD-10 code. Data were collected from medical records. The diagnosis of this tumor was based on histopathological results. Variables analyzed included age, tumor site, surgical option, axillary lymph nodes, chemotherapy and radiotherapy, metastases, disease-free survival (DFS), and overall survival (OS) rate.
RESULTS
Sixty-nine cases of PTs were diagnosed during the period, of which 31 were benign, 38 were malignant, and 1 was a case of bilateral metachronous tumors. We did not find any borderline pathologic cases. The patient's ages ranged from 20 to 71 years, with the highest number of cases (28) from the 40-49-year-old age group. The majority of patients (42) had PT on the right side. Simple mastectomy was the most performed treatment, with 53 such cases, including both benign and malignant. The axillary staging was carried out in 16 cases, of which none had nodal metastasis. Ten cases received chemotherapy, and 16 cases of malignant phyllodes received postoperative radiotherapy. We found 4 cases with distant metastases and 5 cases that developed local recurrence. The DFS rate reached 92.75%, and the overall 5-year survival rate was 84.21%.
CONCLUSIONS
The incidence of PTs is highest in women in the 3rd and fourth decades of age. Simple mastectomy and wide excision are the treatments of choice, with a low recurrence rate in both benign and malignant PTs cases.
Topics: Adult; Aged; Breast; Breast Neoplasms; Congresses as Topic; Female; Humans; Incidence; Mastectomy; Middle Aged; Neoplasm Recurrence, Local; Phyllodes Tumor; Retrospective Studies; Survival Rate; Young Adult
PubMed: 34092583
DOI: 10.3233/BD-219009