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Plastic and Reconstructive Surgery Mar 2012Reduction mammaplasty is commonly described with regard to its qualitative benefits. The authors sought to perform a systematic review of the literature focusing on... (Review)
Review
BACKGROUND
Reduction mammaplasty is commonly described with regard to its qualitative benefits. The authors sought to perform a systematic review of the literature focusing on functional outcomes after reduction mammaplasty with regard to physical and psychological symptom improvement, including weight-related effects, exercise, and eating behaviors, in addition to aesthetic outcomes.
METHODS
A systematic review of the English literature was performed using the PubMed database to evaluate outcomes following reduction mammaplasty from 1977 to 2010. Studies were chosen that addressed the physical and psychological benefits of reduction mammaplasty using a validated questionnaire.
RESULTS
Women who undergo reduction mammaplasty have a functional improvement in musculoskeletal pain, headaches, sleep, and breathing. Psychological benefits are vast and include improved self-esteem, sexual function, and quality of life, in addition to less anxiety and depression. After reduction mammaplasty, women appear to exercise more and have a reduction in eating disorders.
CONCLUSION
The authors present a comprehensive review of the literature with regard to the physical and emotional concerns women with macromastia experience and the broad benefits reduction mammaplasty could have for their daily functions and quality of life postoperatively.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, III.
Topics: Female; Health Status; Humans; Mammaplasty; Patient Satisfaction; Quality of Life; Treatment Outcome
PubMed: 22090252
DOI: 10.1097/PRS.0b013e31824129ee -
Plastic and Reconstructive Surgery Jul 2021Reduction mammaplasty for macromastia is one of the most common operations performed by plastic surgeons. There remains hesitancy in operating on adolescents, as there... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Reduction mammaplasty for macromastia is one of the most common operations performed by plastic surgeons. There remains hesitancy in operating on adolescents, as there is ongoing debate about breast regrowth and potential impact on breastfeeding. The goal of this study was to analyze these concerns by reviewing the current literature.
METHODS
A systematic review of MEDLINE, Scopus, and Google Scholar was conducted using the following terms: "breast reduction" or "mammaplasty" or "breast reconstruction" and "adolescent" or "youth" or "pediatric" or "child" or "teen." Primary outcomes were success of breastfeeding after the procedure and procedure-related complications.
RESULTS
Twenty-three studies (87 percent retrospective), consisting of 2926 patients with preoperative cup sizes of C to KK (mean, DDD), met inclusion criteria. Mean age at the time of surgery ranged from 16 to 21 years, with the youngest patient being 12 years old. The overall complication rate was 27.3 percent (95 percent CI, 14.4 to 42.5 percent). Minor complications (22.8 percent; 95 percent CI, 10.2 to 38.5 percent) were more common than major (4.2 percent; 95 percent CI, 1.6 to 7.9 percent). Eighteen percent of patients (95 percent CI, 2.2 to 43.8 percent) reported regrowth of their breast tissue postoperatively, with 2.7 percent (95 percent CI, 0.9 to 5.5 percent) undergoing a second revision mammaplasty. Fifty-three percent of patients (95 percent CI, 36.0 to 69.3 percent) did not attempt breastfeeding. Of those who attempted, 55.1 percent (95 percent CI, 34.4 to 74.9 percent) were successful.
CONCLUSIONS
Prospective data are lacking. Patient counseling should focus on encouraging a trial of breastfeeding, despite surgical history. One-fifth of adolescent patients may notice breast regrowth postoperatively; however, the amount of regrowth is likely small and unlikely to reexacerbate symptoms, as the rate of revision surgery is small.
Topics: Adolescent; Age Factors; Breast; Breast Feeding; Child; Counseling; Female; Humans; Hypertrophy; Mammaplasty; Patient Education as Topic; Postoperative Complications; Practice Guidelines as Topic; Reoperation; Retrospective Studies; Symptom Flare Up; Time-to-Treatment; Treatment Outcome; Young Adult
PubMed: 34181602
DOI: 10.1097/PRS.0000000000008102 -
Plastic and Reconstructive Surgery Jan 2016The main drawback of autologous fat grafting, which is commonly used for soft-tissue augmentation, is the high resorption rate. Cell-assisted lipotransfer has been used... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The main drawback of autologous fat grafting, which is commonly used for soft-tissue augmentation, is the high resorption rate. Cell-assisted lipotransfer has been used to improve fat graft survival; however, evidence for its efficacy and safety is still lacking.
METHODS
The authors searched PubMed, Cochrane Library, EBSCO, and EMBASE for clinical studies on cell-assisted lipotransfer published from 2008 through 2014. A meta-analysis was conducted to pool the estimated fat survival rate. Incidence of complications and incidence of multiple operations were calculated.
RESULTS
Seventeen articles involving 387 cases were included in the systematic review. The pooled fat survival rate was significantly higher in the cell-assisted lipotransfer group than in the nonlipotransfer group (60 percent versus 45 percent, p = 0.0096). Complication incidence was similar in the two groups. Cell-assisted lipotransfer significantly improved fat survival in the face (by 19 percent) and reduced the incidence of multiple operations (by 13.6 percent). In breast fat grafting, however, fat survival was improved by only 9 percent, which was not statistically significant. Meanwhile, lipotransfer in breast cases was associated with a higher complication incidence compared with face cases (p < 0.001).
CONCLUSIONS
This study demonstrates that cell-assisted lipotransfer has better efficacy than conventional fat grafting (non-cell-assisted lipotransfer). It is more applicable to face cases than to breast cases. Until now, there has not been enough evidence of the superiority of cell-assisted lipotransfer over conventional fat grafting for reducing complications.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, III.
Topics: Adipose Tissue; Female; Graft Survival; Humans; Mammaplasty; Tissue Transplantation; Transplantation, Autologous; Treatment Outcome
PubMed: 26710060
DOI: 10.1097/PRS.0000000000001981 -
BJS Open Nov 2021Therapeutic mammaplasty (TM) is an oncological procedure which combines tumour resection with breast reduction and mastopexy techniques. Previous systematic reviews have...
BACKGROUND
Therapeutic mammaplasty (TM) is an oncological procedure which combines tumour resection with breast reduction and mastopexy techniques. Previous systematic reviews have demonstrated the oncological safety of TM but reporting of critically important outcomes, such as quality of life, aesthetic and functional outcomes, are limited, piecemeal or inconsistent. This systematic review aimed to identify all outcomes reported in clinical studies of TM to facilitate development of a core outcome set.
METHODS
Medline, EMBASE, CINAHL and Web of Science were searched from inception to 5 August 2020. Included studies reported clinical outcomes following TM for adult women. Two authors screened articles independently for eligibility. Data were extracted regarding the outcome definition and classification type (for example, oncological, quality of life, etc.), time of outcome reporting and measurement tools.
RESULTS
Of 5709 de-duplicated records, 148 were included in the narrative synthesis. The majority of studies (n = 102, 68.9 per cent) reported measures of survival and/or recurrence; approximately three-quarters (n = 75, 73.5 per cent) had less than 5 years follow-up. Aesthetic outcome was reported in half of studies (n = 75, 50.7 per cent) using mainly subjective, non-validated measurement tools. The time point at which aesthetic assessment was conducted was highly variable, and only defined in 48 (64.0 per cent) studies and none included a preoperative baseline for comparison. Few studies reported quality of life (n = 30, 20.3 per cent), functional outcomes (n = 5, 3.4 per cent) or resource use (n = 28, 18.9 per cent).
CONCLUSION
Given the oncological equivalence of TM and mastectomy, treatment decisions are often driven by aesthetic and functional outcomes, which are infrequently and inconsistently reported with non-validated measurement tools.
Topics: Adult; Breast Neoplasms; Esthetics; Female; Humans; Mammaplasty; Mastectomy; Quality of Life
PubMed: 34894122
DOI: 10.1093/bjsopen/zrab126 -
Journal of Plastic, Reconstructive &... Jul 2022Reconstructive microsurgical free flap techniques are often the treatment of choice for a variety of complex tissue defects across multiple surgical specialties.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Reconstructive microsurgical free flap techniques are often the treatment of choice for a variety of complex tissue defects across multiple surgical specialties. However, the practice is underdeveloped in low- and middle-income countries. The aim of this systematic review was to evaluate the clinical application and outcomes of reconstructive microsurgery performed in Africa.
METHODS
Seven databases (PubMed, Web of Science, MEDLINE, CINAHL, Academic Search Complete, Embase, and Google Scholar) were searched for studies reporting microsurgical procedures performed in Africa. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tools and quality of evidence using the GRADE approach. Meta-analysis was performed using a random effects model to estimate the pooled proportion of events with 95% confidence intervals. The primary outcome was free flap success rate, and the secondary outcomes were the complication and flap salvage rates.
RESULTS
Ninety-two studies were included in the narrative synthesis and nine in the pooled meta-analysis. In total, 1376 free flaps in 1327 patients from 1976 to 2020 were analyzed. Head and neck oncologic reconstruction made up 30% of cases, while breast reconstruction comprised 2%. The pooled flap survival rate was 89% (95% CI: 0.84, 0.93), complication rate 51% (95% CI: 0.36, 0.65), and free flap salvage rate was 45% (95% CI: 0.08, 0.84).
CONCLUSION
This meta-analysis showed that the free flap success rates in Africa are high and comparable to those reported in high-income countries. However, the comparatively higher complication rate and lower salvage rate suggest a need for improved perioperative care.
REVIEW REGISTRATION
Registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 25th September 2020, ID: CRD42020192344.
Topics: Free Tissue Flaps; Head; Humans; Mammaplasty; Microsurgery; Neck; Postoperative Complications; Plastic Surgery Procedures
PubMed: 35643598
DOI: 10.1016/j.bjps.2022.04.028 -
European Journal of Surgical Oncology :... Mar 2012Therapeutic mammaplasty (TM) is suggested to have a number of advantages by comparison to conventional breast conserving surgery (BCS), but there is a paucity of... (Review)
Review
INTRODUCTION
Therapeutic mammaplasty (TM) is suggested to have a number of advantages by comparison to conventional breast conserving surgery (BCS), but there is a paucity of published data on TM which evaluates oncologic and aesthetic end-points, and outcomes remain uncertain.
METHODS
Online databases were searched to identify studies regarding TM. Identified studies were scrutinised and key data relating to oncologic and aesthetic outcome, patient reported outcome measures (PROMs) and study design were recorded.
RESULTS
Most identified studies were retrospective, and no randomised controlled trials were found. Mean tumour size was reported in nine of 20 studies, with only four of 20 reporting on mean surgical margins obtained at TM. Management of a positive surgical margin following TM varied considerably between studies. With a median follow-up of between 13 and 68 months, rates of local recurrence, metastasis and death were comparable to BCS. Aesthetic assessment was complete in only three of 15 studies. PROMs and aesthetic outcomes were evaluated using non-validated tools. All studies evaluating aesthetic outcome contained evaluation by clinicians, but included patient views in only 10/15 studies. Complication rates ranged between 10% (6/63) and 91% (28/31), but delayed adjuvant treatment in only 6% of cases.
CONCLUSION
Identified studies fail to clarify indications or confirm the suggested improved outcomes from TM over BCS, although oncological outcomes appear comparable. High complication rates impact little on delivery of adjuvant therapies. Prospective data registration is required to define indications and quality assurances, and support development of specific assessment tools for this technique in the future.
Topics: Breast Neoplasms; Esthetics; Female; Humans; Mammaplasty; Outcome Assessment, Health Care; Patient Satisfaction; Postoperative Complications
PubMed: 22206704
DOI: 10.1016/j.ejso.2011.12.004 -
Aesthetic Plastic Surgery Aug 2021Women with macromastia experienced constitutional and psychosocial symptoms which could be improved by vertical scar or Inverted-T scar reduction mammaplasty. The... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Women with macromastia experienced constitutional and psychosocial symptoms which could be improved by vertical scar or Inverted-T scar reduction mammaplasty. The authors conducted the first systematic review and meta-analysis in an attempt to declare the differences of the vertical scar versus the Inverted-T scar reduction technique by comparing the postoperative complications and aesthetic effects.
METHODS
PubMed, EMBASE, Web of Science, Scopus and Cochrane Central Register of Controlled Trials databases for clinical studies were searched through June 30, 2019. Cumulative analysis was conducted using the Review Manager Version 5.3 software. The summary odds ratio (OR) was estimated using random effect models at 95% confidence intervals (CIs), statistical heterogeneity was tested using the Chi-square test and risk of bias was assessed using the Cochrane Handbook 5.1.0 and the Newcastle-Ottawa scale (NOS).
RESULTS
Two randomized controlled trials (RCT) and nine observational comparative studies were included. The vertical scar method was significantly lower than the Inverted-T scar method in overall incidence of complications (OR: 2.06; 95%CI, 1.15 to 3.70; P: 0.002) and wound dehiscence (OR: 4.62; 95%CI, 2.33 to 9.16; P<0.00001). No significant differences in seroma, hematoma, nipple necrosis, fat necrosis and reoperation were noted.
CONCLUSIONS
Both two breast reduction techniques are equally safe, while the vertical scar approach resulted in a statistically lower rate of overall complications and wound dehiscence.
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 Table of Contents or online Instructions to Authors www.springer.com/00266 .
Topics: Cicatrix; Esthetics; Female; Follow-Up Studies; Humans; Hypertrophy; Mammaplasty; Retrospective Studies; Seroma; Treatment Outcome
PubMed: 33649925
DOI: 10.1007/s00266-021-02167-w -
Aesthetic Plastic Surgery Feb 2023Gestational gigantomastia (GG) is an uncommon pregnancy condition, and the underlying cause of GG has yet to be determined. Medical management and surgery are two... (Review)
Review
BACKGROUND
Gestational gigantomastia (GG) is an uncommon pregnancy condition, and the underlying cause of GG has yet to be determined. Medical management and surgery are two treatment options for GG, and breast reduction or mastectomy with delayed reconstruction is the only available surgical option. We have conducted this systematic review to summarize and critically analyze all the GG data in the literature.
METHODS
The preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines were adhered to in reporting this article. A systematic search was conducted in February 2022 for published case reports and case series on GG using the PubMed, MEDLINE, and Cochrane databases. The following keywords were used: macromastia, gestational gigantomastia, and gestational.
RESULTS
A total of 639 articles were searched, and only 66 case reports published between 1962 and 2022 were included. The mean patient's age at presentation was 28.79 years old. The majority of the patients were in their first trimester (n = 23, 47%). The main complaint was rapid bilateral breast enlargement (n = 54, 80.59%). Bromocriptine was the most common medical management used (n = 19/35, 54.28%). Bilateral breast reduction was the most common surgery (n = 24/48, 50%). Most patients had uneventful recovery (n = 40/54, 74.07%).
CONCLUSION
Gigantomastia is a difficult condition, in terms of its management. We have found that surgery is the gold-standard among all the cases reported; while Bromocriptine was the most commonly administered medical therapy. This systematic review provides a guideline for plastic surgeons to better facilitate their care of these patients.
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; Pregnancy; Humans; Adult; Mastectomy; Bromocriptine; Breast Neoplasms; Treatment Outcome; Mammaplasty
PubMed: 35941388
DOI: 10.1007/s00266-022-03003-5 -
Journal of Plastic, Reconstructive &... Nov 2023Acellular dermal matrices (ADMs) are commonly used in prepectoral breast reconstruction. However, ADM is associated with high cost and potentially infection and seroma.... (Meta-Analysis)
Meta-Analysis Review
Acellular dermal matrices (ADMs) are commonly used in prepectoral breast reconstruction. However, ADM is associated with high cost and potentially infection and seroma. Comparative studies on prepectoral reconstruction with and without ADM are limited to small, single-institution series. The purpose of this study was to perform a meta-analysis of prepectoral reconstruction with and without ADM. A systematic literature review was performed to identify studies comparing prepectoral reconstruction with and without ADM using PubMed, EMBASE, and Cochrane databases. Pooled rates of patient demographics and outcomes were analyzed. Meta-analytic effect size estimates were calculated for reconstructive complications in studies comparing reconstruction with and without ADM. In total, 515 reconstructions from four studies were included. Most cases were nipple-sparing mastectomies and utilized tissue-expander reconstructions. Meta-analysis demonstrated no significant difference in the rate of complications between cohorts with and without ADM. Short-term complications included reconstructive failure (1.2% in ADM cohort and 2.8% in no-ADM), seroma (1.2% and 8.3%, respectively), hematoma (1.2% and 2.1%), infection (4.7% and 4.2%), and mastectomy flap ischemia and/or necrosis (2.4% and 5.2%). Long-term complications included rippling (3.3% in ADM and 5.1% in no-ADM cohorts) and capsular contracture (6.8% and 3.4%, respectively). This meta-analysis demonstrated no difference in the rate of complications between cases with and without ADM. However, the outcomes data from no-ADM reconstruction mostly reflect robust mastectomy flaps. Surgeon discretion as informed by specific clinical scenarios should guide decisions regarding the use of ADM in prepectoral breast reconstruction.
Topics: Humans; Female; Mastectomy; Acellular Dermis; Breast Implantation; Seroma; Breast Neoplasms; Mammaplasty; Breast Implants; Retrospective Studies
PubMed: 37793198
DOI: 10.1016/j.bjps.2023.09.042 -
Plastic and Reconstructive Surgery Oct 2012Evidence of the benefit of dilute epinephrine infiltration before reduction mammaplasty is provided by several controlled trials. Despite variation in operative... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Evidence of the benefit of dilute epinephrine infiltration before reduction mammaplasty is provided by several controlled trials. Despite variation in operative technique and data collection, a reduction in intraoperative blood loss has been shown. The aim of this review of the literature is to weigh the available evidence with respect to reducing blood loss during surgery and other outcome measures such as postoperative drainage.
METHODS
Two researchers independently selected articles for review, and data were extracted from each primary article and used for statistical and descriptive comparisons.
RESULTS
A meta-analysis of operative blood loss showed a highly significant drop in operative blood loss in breasts infiltrated with epinephrine and a reduction in the need for blood transfusion. Operative time, postoperative drainage, and complications were not significantly affected by epinephrine infiltration.
CONCLUSION
The authors' recommendation would be for the use of dilute epinephrine infiltration before reduction mammaplasty.
Topics: Adult; Aged; Blood Loss, Surgical; Dose-Response Relationship, Drug; Epinephrine; Female; Follow-Up Studies; Humans; Instillation, Drug; Intraoperative Care; Mammaplasty; Middle Aged; Randomized Controlled Trials as Topic; Risk Assessment; Treatment Outcome; United Kingdom; Vasoconstrictor Agents
PubMed: 23018690
DOI: 10.1097/PRS.0b013e318262f085