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Aesthetic Surgery Journal Aug 2014The risk of nerve injuries in aesthetic breast surgery has not been well explored. (Review)
Review
BACKGROUND
The risk of nerve injuries in aesthetic breast surgery has not been well explored.
OBJECTIVES
The authors conducted a systematic review to provide evidence-based information on the incidence and treatment of nerve injuries resulting from aesthetic breast surgery.
METHODS
A broad literature search of Medline, Embase, and the Cochrane Database of Systematic Reviews was undertaken to identify studies in which nerve injury occurred after breast augmentation or mastopexy. Specific inclusion and exclusion criteria were established before the search was performed.
RESULTS
The initial 4806 citations were narrowed by topic, title, and abstract to 53 articles. After full-text review, 36 studies were included. The risk of any nerve injury after breast augmentation ranged from 13.57% to 15.44%. Specific nerve injury rates were calculated for the intercostal cutaneous nerves, branches to the nipple-areola complex, intercostobrachial nerve, long thoracic nerve, and brachial plexus. Also calculated were the total estimated risks of chronic pain, hyperesthesia, hypoesthesia, and numbness. The meta-analysis showed no associations between the rates of breast nerve injury or sensation change and implant size, incision type, or implant position in patients who underwent breast augmentation. The data were insufficient to determine rates of nerve injury in mastopexy.
CONCLUSIONS
The possibility of nerve injury, sensation change, or chronic pain with breast augmentation is real, and estimating the incidences of these conditions is useful to both patients and surgeons. Optimizing patient outcomes requires timely treatment by a multidisciplinary team and may include peripheral nerve surgery.
LEVEL OF EVIDENCE
3.
Topics: Adult; Breast Implantation; Chronic Pain; Female; Humans; Mammaplasty; Neurologic Examination; Pain, Postoperative; Peripheral Nerve Injuries; Risk Assessment; Risk Factors; Sensory Thresholds; Treatment Outcome; Young Adult
PubMed: 24951626
DOI: 10.1177/1090820X14536726 -
La Radiologia Medica Mar 2017To perform a meta-analysis to determine the effect of radiotherapy (RT) on nipple-areolar complex (NAC) and skin flap necrosis, and local recurrence in women who undergo... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To perform a meta-analysis to determine the effect of radiotherapy (RT) on nipple-areolar complex (NAC) and skin flap necrosis, and local recurrence in women who undergo nipple-sparing mastectomy (NSM) and immediate breast reconstruction.
METHODS
Medline, PubMed, Cochrane, and Google Scholar databases were searched until October 16, 2015. Randomized-controlled-trials, prospective, retrospective, and cohort studies were included. The primary outcome was the NAC necrosis rate, and the secondary outcomes were the skin flap necrosis and local recurrence rates.
RESULTS
Of 186 studies identified, 2 prospective and 5 retrospective studies including a total of 3692 patients were included in the meta-analysis. Five, 3, and 2 studies reported data of NAC necrosis (3461 breasts), skin flap necrosis (2490 breasts), and local recurrence (988 breasts), respectively. Pooled results showed no difference in the odds of NAC necrosis [odds ratio (OR) = 1.250, 95% confidence interval (CI) 0.481-3.247, P = 0.647], or local recurrence (OR = 0.564, 95% CI 0.056-5.710, P = 0.627) between patients who received and did not receive RT. Patients treated with RT had a higher likelihood of skin flap necrosis (OR = 2.534, 95% CI 1.720-3.735, P < 0.001). Significant heterogeneity, however, was noted in the analysis of NAC and local recurrence.
CONCLUSIONS
Because of the limitations of the small number of studies and heterogeneity in the analysis, this study does not allow drawing any definitive conclusions and highlights the need of well-controlled trials to determine the effect of RT in patients undergoing NSM.
Topics: Adult; Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy; Middle Aged; Necrosis; Neoplasm Recurrence, Local; Nipples; Odds Ratio; Organ Sparing Treatments; Outcome Assessment, Health Care; Radiation Injuries; Radiotherapy; Sensitivity and Specificity; Surgical Flaps
PubMed: 28000160
DOI: 10.1007/s11547-016-0702-x -
Plastic and Reconstructive Surgery Jan 2013The literature reports overall complication rates in breast reconstruction to be as high as 60 percent. Infection rates can exceed 20 percent, much higher than... (Review)
Review
BACKGROUND
The literature reports overall complication rates in breast reconstruction to be as high as 60 percent. Infection rates can exceed 20 percent, much higher than anticipated in clean elective surgery. There is no consensus among surgeons regarding the necessary duration of antibiotic prophylaxis, although the Centers for Disease Control and Prevention guidelines suggest only 24 hours. This systematic review examines antibiotic regimens and associated infection rates in breast reconstruction.
METHODS
Systematic electronic searches were performed in the PubMed, Ovid, and Cochrane databases using Medical Subject Headings terms for studies reporting antibiotic use and infection in all forms of breast reconstruction. Studies between 1970 and 2011 were reviewed. Included publications were required to report an antibiotic protocol and infection rate.
RESULTS
A total of 834 abstracts were identified, 81 of which met inclusion criteria and were included in the review. The overall reported infection rates in the included studies varied between 0 and 29 percent (average, 5.8 percent). When comparing combined patient cohorts receiving no antibiotics, less than 24 hours, and greater than 24 hours, the average infection rates were 14.4, 5.8, and 5.8 percent, respectively.
CONCLUSIONS
There is no consensus on the necessary duration of antibiotic prophylaxis following breast reconstruction. No benefit was found in patients who received more than 24 hours of postoperative antibiotics. Standardized definitions for antibiotic regimens, unit of analysis reporting, and a new breast reconstruction surgical-site infection grading system are offered to improve standardized outcome documentation. Randomized controlled trials are warranted to best determine an optimal antibiotic regimen.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, III.
Topics: Antibiotic Prophylaxis; Breast Implants; Clinical Protocols; Drug Administration Schedule; Female; Humans; Mammaplasty; Preoperative Care; Prosthesis-Related Infections; Surgical Wound Infection; United States
PubMed: 22965239
DOI: 10.1097/PRS.0b013e3182729c39 -
Journal of Plastic, Reconstructive &... Sep 2023We conducted a systematic review and meta-analysis to evaluate the predictive value of frailty for predicting postsurgical complications in patients undergoing breast... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
We conducted a systematic review and meta-analysis to evaluate the predictive value of frailty for predicting postsurgical complications in patients undergoing breast reconstruction surgery.
METHODS
MEDLINE (PubMed), Scopus, Web of Science, and Embase were searched for relevant studies up to September 13, 2022. A systematic review and meta-analysis of studies were performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement criteria.
RESULTS
Nine studies were included in this research. The rates of overall complications (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.17-1.97, I2 = 76%; p = 0.002), wound complications (OR 1.87, 95% CI 1.56-2.26, I2 = 16%; p < 0.0001), readmissions (OR 1.94, 95% CI 1.61-2.34, I2 = 15%; p < 0.0001), and reoperations (OR 1.41, 95% CI 1.12-1.77, I2 = 39%; p = 0.003) were significantly greater in frail patients than in nonfrail undergoing breast reconstruction surgery. Furthermore, compared with nonfrail patients, this difference remained significantly higher among prefrail individuals (overall complications: OR 1.27, 95% CI 1.13-1.41, I2 = 67%; p < 0.001, wound complications: OR 1.48, 95% CI 1.33-1.66, I2 = 24%; p < 0.0001, readmission: OR 1.47, 95% CI 1.34-1.61, I2 = 0%; p < 0.0001, reoperation: OR 1.32, 95% CI 1.23-1.42, I2 = 0%; p < 0.0001). We found that frail patients undergoing immediate autologous reconstruction surgery are the most vulnerable to experiencing overall postoperative complications.
CONCLUSION
Frailty is a strong predictor of postsurgical complications after breast reconstruction surgery in frail and prefrail patients. The most frailty index utilized was the modified five-item frailty index (mFI-5). More research is needed on this topic to assess the utility of frailty in practice, especially in countries other than the United States.
Topics: Humans; United States; Frailty; Reoperation; Postoperative Complications; Time; Mammaplasty; Risk Factors; Retrospective Studies
PubMed: 37422955
DOI: 10.1016/j.bjps.2023.06.040 -
Aesthetic Surgery Journal Nov 2023Tuberous breast is a complex congenital breast anomaly that can be challenging to correct surgically.
BACKGROUND
Tuberous breast is a complex congenital breast anomaly that can be challenging to correct surgically.
OBJECTIVES
The authors conducted a systematic review with pooled analysis of data, with the aim of determining the effectiveness and complications related to operative management of the deformity.
METHODS
Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were adopted in performing this systematic review. A simplified classification system for tuberous breast deformity was developed to accurately compare data and guide analysis.
RESULTS
The review identified 38 studies, reporting a total of 897 patients undergoing tuberous breast surgery. The mean age of patients was 24 years (range 13-53 years). Mean follow-up was 39 months. A combination of tissue rearrangement and implant augmentation was the most common technique (73% of patients) followed by fat transfer alone (9%). Breast implants were employed in 83% of patients. The mean implanted volume per breast was 263 cc. Fat grafting was performed in 13% of patients and mean volume of fat grafted per breast was 185 cc. An overall complication rate of 20% was reported. Subjective assessment of patient satisfaction was 99%, and the mean score on BREAST-Q for satisfaction with clinical outcome was 86.7. Future studies should focus on robust study designs including randomized and cohort studies, use of patient-reported outcome measures, and long-term follow-up.
CONCLUSIONS
The surgical techniques to correct tuberous breast deformity are safe, effective, and have a high satisfaction rate. Fat transfer has the capacity to provide promising results in treating tuberous breast deformity.
Topics: Humans; Adolescent; Young Adult; Adult; Middle Aged; Female; Mammaplasty; Treatment Outcome; Adipose Tissue; Breast; Breast Diseases; Breast Neoplasms; Retrospective Studies
PubMed: 37439225
DOI: 10.1093/asj/sjad229 -
Breast (Edinburgh, Scotland) Feb 2021The impact of neoadjuvant chemotherapy (NACT) on surgical outcomes following immediate breast reconstruction (IBR) remains unclear. While it is generally considered safe... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The impact of neoadjuvant chemotherapy (NACT) on surgical outcomes following immediate breast reconstruction (IBR) remains unclear. While it is generally considered safe practice to perform an IBR post NACT, reported complication rates in published data are highly variable with the majority of studies including fewer than 50 patients in the NACT and IBR arm. To evaluate this further, we conducted a systematic review and meta-analysis on the effect of NACT on autologous and implant based immediate breast reconstructions. We aimed to assess for differences in the post-operative course following IBR between patients who received NACT with those who did not.
METHODS
PubMed, EMBASE, and Cochrane Library were searched from 1995 to Sept 2, 2020 to identify articles that assessed the impact of NACT on IBR. All included studies assessed outcomes following IBR. Only studies comparing reconstructed patients receiving NACT to a control group of women who did not receive NACT were included. Unadjusted relative risk of outcomes between patients who received or did not receive NACT were synthesized using a fixed-effect meta-analysis. The evidence was assessed using the Newcastle Ottawa Scale scores and GRADE. Primary effect measures were risk ratios (RRs) with 95% confidence intervals.
RESULTS
A total 17 studies comprising 3249 patients were included in the meta-analyses. Overall, NACT did not increase the risk of complications after immediate breast reconstructions (risk ratio [RR]: 0.91, 95% CI 0.74 to 1.11, p = 0.34). There was a moderate, but not significant, increase in flap loss following NACT compared with controls (RR: 1.23, 95% CI 0.70 to 2.18, p = 0.47; I = 0%). Most notably, there was a statistically significant increase in implant/expander loss after NACT (RR: 1.54, 95% CI 1.04 to 2.29, p = 0.03; I = 34%). NACT was not shown to significantly increase the incidence of hematomas, seromas or wound complications, or result in a significant delay to commencing adjuvant therapy (RR: 1.59, 95% CI 0.66 to 3.87, p = 0.30).
CONCLUSION
Immediate breast reconstruction after NACT is a safe procedure with an acceptable post-operative complication profile. It may result in a slight increase in implant loss rates, but it does not delay commencing adjuvant therapy.
Topics: Breast Neoplasms; Chemotherapy, Adjuvant; Combined Modality Therapy; Female; Humans; Mammaplasty; Neoadjuvant Therapy; Postoperative Complications
PubMed: 33341706
DOI: 10.1016/j.breast.2020.11.023 -
European Journal of Surgical Oncology :... May 2016Oncoplastic surgery consists a new approach for extending breast conserving surgery possibilities This manuscript aimed to systematically review data on the oncological... (Review)
Review
UNLABELLED
Oncoplastic surgery consists a new approach for extending breast conserving surgery possibilities This manuscript aimed to systematically review data on the oncological outcome of oncoplastic breast surgery. Electronic databases were searched with the appropriate search term up to and included April 2013.
INCLUSION CRITERIA
full publications including at least 10 patients and providing evidence on at least one of the following outcomes: margin involvement, local recurrence, metastatic disease, death number. Forty studies including 2830 patients, met inclusion criteria; twenty one studies investigated volume displacement techniques; fifteen studies investigated volume replacement techniques; four studies presented data on various oncoplastic techniques. Study quality was low. The majority of studies were observational studies. The length of follow up was relatively short, with only two studies reporting a median duration longer than 60 months. Only seven studies including more than 100 patients. There was great variation in the frequency of margin involvement ranging between 0% and 36% of patients. Local recurrence was observed in 0-10.8% of patients. Distant metastasis was observed in 0-18.9% of patients. In conclusion, long term oncological outcome of oncoplastic surgery for breast cancer is not adequately investigated. Further research efforts should focus on Level I evidence on oncological outcome of oncoplastic surgery.
Topics: Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy, Segmental; Neoplasm Metastasis; Neoplasm Recurrence, Local
PubMed: 26922045
DOI: 10.1016/j.ejso.2016.02.002 -
Journal of Plastic, Reconstructive &... Sep 2022Significant improvements in sensory recovery after innervated breast reconstruction have been reported. However, surgical approaches and sensory testing methods have... (Review)
Review
BACKGROUND
Significant improvements in sensory recovery after innervated breast reconstruction have been reported. However, surgical approaches and sensory testing methods have been widely variable. This systematic review aimed to synthesize neurotization techniques and outcomes in breast reconstruction surgery.
METHODS
A comprehensive literature search of the MEDLINE, Embase, Web of Science, and Cochrane databases was conducted to identify all studies reporting outcomes of neurotization in innervated breast reconstruction. Data extracted from each study included neurotization techniques, operative times, sensory methods and outcomes, and patient-reported outcomes.
RESULTS
A total of 1,350 articles were identified, and 23 articles were included for analysis. Nerve coaptation was performed in 536 breasts and 419 patients, with techniques consisting of direct coaptation (65.1% of flaps), coaptation with nerve conduit (26.3%), and coaptation with nerve allograft (8.6%). The neural component of operating time ranged from 8 to 38 min, and the pooled neurotization success rate among nine studies that reported this outcome was 90.6% (95% CI: 83.6%-96.0%). Overall, innervated breasts achieved earlier and superior sensory recovery that was more uniformly distributed throughout the flap compared to non-innervated breasts. Despite high heterogeneity between studies, all included studies supported neurotized breast reconstruction to improve the rate, quality, and magnitude of sensory recovery.
CONCLUSIONS
Neurotization during breast reconstruction may be worth the investment of additional operating time to increase the prospect of high-quality sensory recovery. Further investigation with standardized sensory testing methods and patient-reported outcome tools is needed to definitively support neurotization as a standard of care in breast reconstruction surgery.
Topics: Breast; Humans; Mammaplasty; Nerve Regeneration; Nerve Transfer; Surgical Flaps
PubMed: 35872020
DOI: 10.1016/j.bjps.2022.06.006 -
Annals of Plastic Surgery Sep 2023The administration of antibiotic prophylaxis for implant-based breast augmentation (IBBA) is commonplace among many plastic surgeons. However, the current literature... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The administration of antibiotic prophylaxis for implant-based breast augmentation (IBBA) is commonplace among many plastic surgeons. However, the current literature lacks evidence-based recommendations to support this practice. Although few studies have demonstrated a reduction in surgical site infection (SSI) and capsular contracture (CC) with antibiotics, these studies were underpowered and poorly designed. The aim of this study was to provide an updated comprehensive analysis of the literature to revisit the benefit of antibiotic prophylaxis.
METHODS
A comprehensive literature search of PubMed, Embase, Web of Science, and Cochrane was performed from January 1989 to January 2022. Observational studies and randomized controlled trials (RCTs) involving primary and secondary IBBA and use of antibiotic prophylaxis were included. Primary outcomes included SSI and CC. Study quality and risk of bias were evaluated using standardized tools. A meta-analysis was performed for eligible studies. Trial Sequential Analysis was used to assess the need for future RCTs.
RESULTS
A total of 5 studies (3 observational and 2 RCTs) with 2383 patients were included in this study. Rates of SSI ranged from 0% to 2.3%, whereas CC ranged from 0% to 53%. Antibiotic prophylaxis showed no benefit for both SSI (odds ratio, 1.77; 95% confidence interval, 0.76-4.13) and CC (odds ratio, 0.46; 95% confidence interval, 0.00-45.72). Trial Sequential Analysis demonstrated that further high-quality RCTs are needed.
CONCLUSIONS
Antibiotic prophylaxis for IBBA failed to demonstrate improvements in SSI and CC in this comprehensive review. Current evidence was shown to be of low quality because of heterogeneity and high risk for bias. Further high-quality multicentered RCTs are warranted to fully evaluate the role of antibiotic prophylaxis for IBBA.
Topics: Female; Humans; Anti-Bacterial Agents; Antibiotic Prophylaxis; Mammaplasty; Observational Studies as Topic; Plastic Surgery Procedures; Surgical Wound Infection
PubMed: 37566823
DOI: 10.1097/SAP.0000000000003622 -
Annals of Plastic Surgery Apr 2012Multiple outcome studies have been published on the use of acellular dermal matrix (ADM) in breast reconstruction with disparate results. The purpose of this study was... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Multiple outcome studies have been published on the use of acellular dermal matrix (ADM) in breast reconstruction with disparate results. The purpose of this study was to conduct a systematic review and meta-analysis to determine an aggregate estimate of risks associated with ADM-assisted breast reconstruction.
METHODS
The MEDLINE, Web of Science, and Cochrane Library databases were queried, and relevant articles published up to September 2010 were analyzed based on specific inclusion criteria. Seven complications were studied including seroma, cellulitis, infection, hematoma, skin flap necrosis, capsular contracture, and reconstructive failure. A pooled random effects estimate for each complication and 95% confidence intervals (CI) were derived. For comparisons of ADM and non-ADM, the pooled random effects odds ratio (OR) and 95% CI were derived. Heterogeneity was measured using the I2 statistic.
RESULTS
Sixteen studies met the inclusion criteria. The pooled complication rates were seroma (6.9%; 95% CI, 5.3%-8.8%), cellulitis (2.0%; 95% CI, 1.2%-3.1%), infection (5.7%; 95% CI, 4.3%-7.3%), skin flap necrosis (10.9%; 95% CI, 8.7%-13.5%), hematoma (1.3%; 95% CI, 0.6%-2.4%), capsular contracture (0.6%; 95% CI, 0.1%-1.7%), and reconstructive failure (5.1%; 95% CI, 3.8%-6.7%). Five studies reported findings for both the ADM and non-ADM patients and were used in the meta-analysis to calculate pooled OR. ADM-assisted breast reconstructions had a higher likelihood of seroma (pooled OR, 3.9; 95% CI, 2.4-6.2), infection (pooled OR, 2.7; 95% CI, 1.1-6.4), and reconstructive failure (pooled OR, 3.0; 95% CI, 1.3-6.8) than breast reconstructions without the use of ADM. The relation of ADM use to hematoma (pooled OR, 2.0; 95% CI, 0.8-5.2), cellulitis (pooled OR, 2.0; 95% CI, 0.9-4.3), and skin flap necrosis (pooled OR, 1.9; 95% CI, 0.6-5.4) was inconclusive.
CONCLUSIONS
In the studies evaluated, ADM-assisted breast reconstructions exhibited a higher likelihood of seroma, infection, and reconstructive failure than prosthetic-based breast reconstructions using traditional musculofascial flaps. ADM is associated with a lower rate of capsular contracture. A careful risk/benefit analysis should be performed when choosing to use ADM in implant-based breast reconstruction.
Topics: Adult; Aged; Breast Implants; Cellulitis; Contracture; Female; Graft Rejection; Hematoma; Humans; Incidence; Mammaplasty; Middle Aged; Postoperative Complications; Prognosis; Risk Assessment; Seroma; Skin Transplantation; Skin, Artificial; Surgical Wound Infection; Tissue Expansion; United States
PubMed: 22421476
DOI: 10.1097/SAP.0b013e31823f3cd9