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Aesthetic Plastic Surgery Jun 2024Vertical mammoplasty techniques have been widely used for breast reduction. The authors present the combination of superior pedicle vertical mammoplasty with liposuction...
BACKGROUND
Vertical mammoplasty techniques have been widely used for breast reduction. The authors present the combination of superior pedicle vertical mammoplasty with liposuction in different regions in the treatment of severe breast hypertrophy in obese patients. We also propose some innovative methods in terms of surgical approach, breast parenchymal anatomy pattern and liposuction.
METHODS
A retrospective study of 50 female patients with severe hypertrophic breasts and obesity who underwent breast reduction in our department from February 2019 to February 2022 was performed. Pre- and postoperative photographs, breast parenchyma distribution and postoperative patient satisfaction were recorded.
RESULTS
Fifty patients underwent breast reduction. Through clinical examination, patient photo evaluation and satisfaction survey results. Good breast shape and projection, full upper pole of the breast, and high satisfaction results were obtained. There were no serious complications.
CONCLUSION
This technique is acceptable and reproducible. It is suitable for patients with varying degrees of breast hypertrophy, especially those with severe hypertrophic breasts and obesity. There are fewer associated complications and a lower rate of re-repair.
LEVEL OF EVIDENCE V
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 .
PubMed: 38834717
DOI: 10.1007/s00266-024-04135-6 -
Annals of Plastic Surgery Jun 2024Machine learning (ML) is a form of artificial intelligence that has been used to create better predictive models in medicine. Using ML algorithms, we sought to create a...
BACKGROUND
Machine learning (ML) is a form of artificial intelligence that has been used to create better predictive models in medicine. Using ML algorithms, we sought to create a predictive model for breast resection weight based on anthropometric measurements.
METHODS
We analyzed 237 patients (474 individual breasts) who underwent reduction mammoplasty at our institution. Anthropometric variables included body surface area (BSA), body mass index, sternal notch-to-nipple (SN-N), and nipple-to-inframammary fold values. Four different ML algorithms (linear regression, ridge regression, support vector regression, and random forest regression) either including or excluding the Schnur Scale prediction for the same data were trained and tested on their ability to recognize the relationship between the anthropometric variables and total resection weights. Resection weight prediction accuracy for each model and the Schnur scale alone were evaluated based on using mean absolute error (MAE).
RESULTS
In our cohort, mean age was 40.36 years. Most patients (71.61%) were African American. Mean BSA was 2.0 m2, mean body mass index was 33.045 kg/m2, mean SN-N was 35.0 cm, and mean nipple-to-inframammary fold was 16.0 cm. Mean SN-N was found to have the greatest variable importance. All 4 models made resection weight predictions with MAE lower than that of the Schnur Scale alone in both the training and testing datasets. Overall, the random forest regression model without Schnur scale weight had the lowest MAE at 186.20.
CONCLUSION
Our ML resection weight prediction model represents an accurate and promising alternative to the Schnur Scale in the setting of reduction mammaplasty consultations.
PubMed: 38833662
DOI: 10.1097/SAP.0000000000004016 -
BJS Open May 2024Health-related quality of life and patient-related outcome measures for patients with cancer have gained increased interest over the last decade. However, few...
BACKGROUND
Health-related quality of life and patient-related outcome measures for patients with cancer have gained increased interest over the last decade. However, few prospective studies with longitudinal data evaluated health-related quality of life in patients with breast cancer. This study aimed to investigate how health-related quality of life changed from the time of diagnosis to 1 year after breast cancer surgery for the main surgical techniques.
METHODS
This prospective longitudinal single-centre study included patients with primary breast cancer diagnosed in 2019-2020 who underwent surgery. Patients completed a health-related quality of life questionnaire (Breast-Q) at baseline. One year after surgery, they completed the Breast-Q a second time, the EORTC (European Organization for Research and Treatment of Cancer) quality of life questionnaire-C30 and the quality of life questionnaire-BR23. Analysis of variance and Kruskal-Wallis tests were used to evaluate the differences in health-related quality of life between surgical groups. Analysis of covariance with robust standard errors was used to adjust for confounders.
RESULTS
In total, 340 patients were included in the study; 160 patients received oncoplastic partial mastectomy, 112 received partial mastectomy, 42 received mastectomy and 26 had mastectomy with immediate reconstruction. Patients that had partial mastectomy or oncoplastic partial mastectomy were more satisfied with their breasts (P < 0.001), had a better body image (P = 0.006) and higher sexual functioning scores (P = 0.027) than patients who had a mastectomy with/without reconstruction. The oncoplastic and mastectomy with reconstruction groups had more breast symptoms than other groups (P < 0.001), and the mastectomy group had the least symptoms from the chest area.
CONCLUSION
Partial mastectomy and oncoplastic partial mastectomy have the best outcomes in terms of breast satisfaction, body image and sexual functioning. This highlights the importance of preserving the breast when feasible and underscores that breast reconstruction is not equal to breast conservation. Registration number: NCT04227613 (http://www.clinicaltrials.gov).
Topics: Humans; Female; Breast Neoplasms; Quality of Life; Middle Aged; Prospective Studies; Longitudinal Studies; Mastectomy; Mammaplasty; Aged; Surveys and Questionnaires; Adult; Mastectomy, Segmental
PubMed: 38829692
DOI: 10.1093/bjsopen/zrae042 -
Journal of Visualized Experiments : JoVE May 2024Oncoplastic breast surgery, with its focus on improving cosmetic outcomes while maintaining oncological safety, has fundamentally transformed the landscape of breast...
Oncoplastic breast surgery, with its focus on improving cosmetic outcomes while maintaining oncological safety, has fundamentally transformed the landscape of breast cancer surgical treatment, giving rise to an array of techniques for breast reconstruction. Nipple-sparing mastectomy (NSM) with immediate implant-based breast reconstruction (IBBR) has emerged as a cornerstone in managing early breast cancer. Aligned with the principles of minimally invasive surgery, recent years have witnessed the widespread integration of endoscopic approaches in breast surgery, encompassing procedures like endoscopic breast-conserving surgery (E-BCS) and endoscopic nipple-sparing mastectomy (E-NSM), among others. Capitalizing on the advantages of inconspicuous and shorter incisions, improved visibility, and the avoidance of radiation therapy, the popularity of E-NSM with IBBR is on the rise. However, conventional E-NSM with IBBR often requires two or more incisions, which can result in suboptimal cosmetic outcomes and even prosthesis loss.This paper presents a comprehensive account of the intricate surgical procedures involved in endoscopic bilateral nipple-sparing mastectomy with immediate pre-pectoral implant-based breast reconstruction. The insights shared are drawn from the collective experience of our institution. Notable benefits associated with the described surgical approach encompass enhanced cosmetic outcomes, improved postoperative quality of life, and enhanced physiological functions attributable to the application of pre-pectoral implant-based breast reconstruction through a single incision.
Topics: Humans; Female; Endoscopy; Breast Neoplasms; Nipples; Mammaplasty; Mastectomy; Axilla; Breast Implants
PubMed: 38829141
DOI: 10.3791/65392 -
Aesthetic Plastic Surgery May 2024
PubMed: 38816656
DOI: 10.1007/s00266-024-04153-4 -
Journal of Plastic, Reconstructive &... Jul 2024SARS-CoV-2 (COVID-19) infection has been described as a cause of systemic hypercoagulability and a risk factor for the development of venous thromboembolism (VTE)....
INTRODUCTION
SARS-CoV-2 (COVID-19) infection has been described as a cause of systemic hypercoagulability and a risk factor for the development of venous thromboembolism (VTE). Whereas some multispecialty studies have proposed a link between COVID-19 and postoperative thrombosis, other single-specialty studies have found no such association. We utilized a large national database to determine whether prior COVID-19 infection was associated with the incidence of VTE following common plastic surgery operations.
METHODS
The Merative™ MarketScan® Research Databases were used to identify female patients who underwent index abdominal panniculectomy, breast reduction, autologous breast reconstruction, or implant-based breast reconstruction procedures between 2020 and 2021. International Classification of Disease, tenth edition (ICD-10) codes were used to identify patients diagnosed with COVID-19 preoperatively and those who experienced a VTE in the 90 days postoperatively. Propensity score matching and multivariable logistic regression were used to determine any independent association between COVID-19 and postoperative VTE.
RESULTS
Twenty-four thousand two hundred and twenty-eight patients met inclusion criteria. Mean age at time of surgery was 44 years. Six percent carried a preoperative COVID-19 diagnosis, and postoperative VTE occurred in 1.3%. In a propensity-score-matched analysis of 2754 patients, COVID-19 did not significantly correlate with incidence of postoperative VTE (P = 0.463). Compared with a matched prepandemic cohort (14,151 patients), the incidence of VTE did not increase following any of the four studied procedures during the COVID-19 pandemic.
CONCLUSION
This analysis of a national insurance claims database provides evidence against a link between resolved COVID-19 infection and VTE within 90 days of four common plastic surgery operations.
Topics: Humans; COVID-19; Female; Venous Thromboembolism; Postoperative Complications; Adult; Middle Aged; Plastic Surgery Procedures; Mammaplasty; Incidence; Risk Factors; SARS-CoV-2; Abdominoplasty; Retrospective Studies; Databases, Factual
PubMed: 38810360
DOI: 10.1016/j.bjps.2024.04.013 -
Journal of Plastic, Reconstructive &... Jul 2024Breast hypertrophy may cause significant suffering, such as back- and breast pain, painful shoulder groves, and eczemas. Furthermore, women with breast hypertrophy may...
BACKGROUND
Breast hypertrophy may cause significant suffering, such as back- and breast pain, painful shoulder groves, and eczemas. Furthermore, women with breast hypertrophy may have lower quality of life than women without breast hypertrophy. Although 50% of the women undergoing breast reduction in the US have body mass index (BMI) >30 kg/m, the current standard of normality is based on studies focusing on women <40 years of age and BMIs <25 kg/m. This study aimed to present reference values for breast measurements for women with obesity and to investigate the relationship between BMI loss and each breast measurement.
MATERIALS AND METHODS
One hundred and six women underwent laparoscopic Roux-en-Y gastric bypass in Gothenburg, Sweden. The participants' breast anthropometrics were measured before and after bariatric surgery and their perception of the skin on their breasts was measured using the Sahlgrenska Excess Skin Questionnaire.
RESULTS
Breast volume, sternal notch to nipple (SNN) distance, and ptosis increased significantly with increasing BMI. For instance, women with BMIs between 30-34.9 kg/m have a mean breast volume of approximately 770 ml, those with BMIs of 40-44.9 kg/m have approximately 1150 ml, and those with BMIs above 50 kg/m have approximately 1400 ml. Furthermore, the percent change in the respective breast measurements relative to percent BMI change can be predicted, for instance, with a 20% reduction in BMI, the breast volume, SNN-distance, and ptosis decrease by 25%, 4%, and 20% respectively.
CONCLUSIONS
This article presents the first standard of normality for breast anthropometrics in women with obesity and a model for predicting the change in breast anthropometrics relative to BMI.
CLINICAL TRIAL REGISTRATION
This is a longitudinal observation study, registered https://fou.nu/is/gsb/ansokan/49651, No: VGFOUGSB-49651. Trial registry name: "Överskottshud efter överviktskirurgi - dess utveckling samt behov och effekt av plastikkirurgi" ("Excess skin after bariatric surgery - its development and the need and effect of plastic surgery").
Topics: Humans; Female; Breast; Weight Loss; Adult; Body Mass Index; Reference Values; Middle Aged; Obesity; Mammaplasty; Gastric Bypass; Hypertrophy; Sweden
PubMed: 38810359
DOI: 10.1016/j.bjps.2024.05.021 -
Plastic and Reconstructive Surgery Jun 2024
Meta-Analysis
Topics: Humans; Female; Postoperative Complications; Breast Implantation; Breast Implants; Mammaplasty; Transgender Persons
PubMed: 38810155
DOI: 10.1097/PRS.0000000000010922 -
Ugeskrift For Laeger May 2024Around 2,500 women receive a breast augmentation with silicone-based implants yearly in Denmark. A number of these women report various uncharacteristic systemic... (Review)
Review
Around 2,500 women receive a breast augmentation with silicone-based implants yearly in Denmark. A number of these women report various uncharacteristic systemic symptoms, which they attribute to the breast implants, including impaired cognition, joint pain, etc. This condition has been termed "breast implant illness" and is currently not a recognised diagnosis. The correlation between the patient's self-reported symptoms and breast implants has not been established and there is limited evidence that surgery has any effect. In this review, the current literature on the topic has been reviewed.
Topics: Humans; Breast Implants; Female; Self Report; Arthralgia; Silicone Gels; Denmark; Breast Implantation
PubMed: 38808767
DOI: 10.61409/V12230801 -
Journal of Medical Internet Research May 2024Web-based decision aids have been shown to have a positive effect when used to improve the quality of decision-making for women facing postmastectomy breast... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Web-based decision aids have been shown to have a positive effect when used to improve the quality of decision-making for women facing postmastectomy breast reconstruction (PMBR). However, the existing findings regarding these interventions are still incongruent, and the overall effect is unclear.
OBJECTIVE
We aimed to assess the content of web-based decision aids and its impact on decision-related outcomes (ie, decision conflict, decision regret, informed choice, and knowledge), psychological-related outcomes (ie, satisfaction and anxiety), and surgical decision-making in women facing PMBR.
METHODS
This systematic review and meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 6 databases, PubMed, Embase, Cochrane Library, CINAHL, PsycINFO, and Web of Science Core Collection, were searched starting at the time of establishment of the databases to May 2023, and an updated search was conducted on April 1, 2024. MeSH (Medical Subject Headings) terms and text words were used. The Cochrane Risk of Bias Tool for randomized controlled trials was used to assess the risk of bias. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach.
RESULTS
In total, 7 studies included 579 women and were published between 2008 and 2023, and the sample size in each study ranged from 26 to 222. The results showed that web-based decision aids used audio and video to present the pros and cons of PMBR versus no PMBR, implants versus flaps, and immediate versus delayed PMBR and the appearance and feel of the PMBR results and the expected recovery time with photographs of actual patients. Web-based decision aids help improve PMBR knowledge, decisional conflict (mean difference [MD]=-5.43, 95% CI -8.87 to -1.99; P=.002), and satisfaction (standardized MD=0.48, 95% CI 0.00 to 0.95; P=.05) but have no effect on informed choice (MD=-2.80, 95% CI -8.54 to 2.94; P=.34), decision regret (MD=-1.55, 95% CI -6.00 to 2.90 P=.49), or anxiety (standardized MD=0.04, 95% CI -0.50 to 0.58; P=.88). The overall Grading of Recommendations, Assessment, Development, and Evaluation quality of the evidence was low.
CONCLUSIONS
The findings suggest that the web-based decision aids provide a modern, low-cost, and high dissemination rate effective method to promote the improved quality of decision-making in women undergoing PMBR.
TRIAL REGISTRATION
PROSPERO CRD42023450496; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=450496.
Topics: Female; Humans; Decision Making; Decision Support Techniques; Internet; Mammaplasty; Mastectomy; Randomized Controlled Trials as Topic
PubMed: 38801766
DOI: 10.2196/53872