-
Einstein (Sao Paulo, Brazil) 2024This work aims to review the existing use of robotics in plastic surgery. (Review)
Review
OBJECTIVE
This work aims to review the existing use of robotics in plastic surgery.
METHODS
A meticulous selection process identified 22 articles relevant to this scoping review.
RESULTS
The literature on the use of robotics in plastic surgery is sparse. Nonetheless, this review highlights emerging benefits in microsurgery, breast reconstruction, and transoral surgery.
CONCLUSION
This scoping review identifies critical articles reporting the emerging use of robotics in plastic surgery. While the scientific medical community has yet to extensively document its use, the available evidence suggests a promising future for robotics in this field.
Topics: Humans; Robotic Surgical Procedures; Plastic Surgery Procedures; Surgery, Plastic; Microsurgery; Mammaplasty
PubMed: 38747887
DOI: 10.31744/einstein_journal/2024RW0710 -
Annals of the Royal College of Surgeons... May 2024Therapeutic mammaplasty (TM) facilitates large tumour resection while maintaining optimal aesthetic outcome. It carries higher wound complication risks, which may delay...
INTRODUCTION
Therapeutic mammaplasty (TM) facilitates large tumour resection while maintaining optimal aesthetic outcome. It carries higher wound complication risks, which may delay adjuvant therapy initiation. Whether this delay affects oncological outcome requires evaluation.
METHODS
Data were collected for consecutive patients receiving TM at the Leeds breast unit (2009-2017). A prospectively maintained database was used to determine tumour characteristics, wound complication rates, receipt of adjuvant therapy and breast cancer recurrence or death.
RESULTS
In total 112 patients (median age of 54 years) underwent 114 TM procedures. The most common histological subtypes were invasive ductal carcinoma (61.4%), invasive lobular carcinoma (13.2%) and ductal carcinoma in situ (13.2%). Of the patients, 88.2% had oestrogen receptor-positive cancer and 14% had human epidermal growth factor receptor-positive cancer; 26.3% had multifocal cancer. The median tumour size was 30mm. The median Nottingham Prognostic Index was 4.2. The local recurrence rate was 3.5% (median follow-up of 8.6 years). The 5- and 10-year disease-free survival (DFS) was 88.5% and 83.5%, and the equivalent overall survival (OS) rates were 94% and 83.5%. Wound complication rate was 23.6% (=27), the commonest being wound infection (11.4%; =13) and T-junction wound breakdown (10.5%; =12). The median time to adjuvant therapy was 72 days (interquartile range [IQR] 56-90) for patients with wound complications, and 51 days (IQR 42-58) for those without. However, this delay did not affect DFS or OS (log-rank test; =0.58 and =0.94, respectively). This was confirmed on Cox regression analysis.
CONCLUSION
Our study finding demonstrates that although wound complications after TM leads to a modest delay to adjuvant therapy, the long-term oncological outcomes were comparable with those in patients without wound complications.
PubMed: 38746984
DOI: 10.1308/rcsann.2023.0095 -
Archives of Plastic Surgery May 2024Several strategies for the management of venous congestion of the nipple-areola complex (NAC) after reduction mammaplasty have been proposed. Among these, hirudotherapy...
Several strategies for the management of venous congestion of the nipple-areola complex (NAC) after reduction mammaplasty have been proposed. Among these, hirudotherapy represents an ancient but still effective method, even though the risk of infections related to leeches should be considered. We report a peculiar case of breast infection and sepsis after leech therapy in a patient who underwent a reduction mammaplasty. A prompt surgical debridement of the wounds and necrotic tissues associated with targeted antibiotic therapy led to a fast improvement of clinical conditions, and partial preservation of the NAC was obtained. Accurate knowledge of the clinical presentation of soft tissue infections related to leeching allows for an early diagnosis and would serve as a warning for surgeons who approach such breast cosmetic procedures.
PubMed: 38737840
DOI: 10.1055/s-0043-1776696 -
Journal of Plastic, Reconstructive &... Jul 2024
Topics: Humans; Mammaplasty; Microsurgery; Female; Postoperative Complications
PubMed: 38733714
DOI: 10.1016/j.bjps.2024.05.008 -
Journal of Plastic, Reconstructive &... Jun 2024
Topics: Humans; Female; Mammaplasty; Propionibacterium acnes; Surgical Wound Infection; Gram-Positive Bacterial Infections; Breast Implantation; Breast Implants; Preoperative Care
PubMed: 38728900
DOI: 10.1016/j.bjps.2024.04.026 -
Journal of Plastic, Reconstructive &... Jun 2024Augmentation mastopexy has a 20-fold higher complication rate than primary augmentation. Performing augmentation mastopexy in post-bariatric patients poses an additional...
BACKGROUND
Augmentation mastopexy has a 20-fold higher complication rate than primary augmentation. Performing augmentation mastopexy in post-bariatric patients poses an additional challenge owing to the reduced quality of the soft skin tissue. Therefore, it is technically complex and also fraught with complications. Implant dislocation, recurrent ptosis, wound healing problems with exposed implants, and the threat of implant loss are complications that must be prevented.
METHODS
We present a case series study on our technique for stabilizing breast implants using the double inner bra technique (DIB) in which a laterobasal myofascial flap and an inferiorly based dermoglandular flap form a double inner bra for implant stabilization and protection.
RESULTS
Thirty-seven cases were operated on using this technique from December 2020 to June 2023. No hematomas (0%), seromas (0%), infections (0%), and implant losses (0%) were recorded. Moreover, none of the patients had implant malposition (0%). With regard to recurrent ptosis mammae or waterfall deformity, 7 cases (2.6%) showed early ptosis within the first 3 months, and the number of ptosis decreased over time. Furthermore, 5 (1.81%) patients showed ptosis mammae after 6-12 months. Implant defect or rupture has not yet occurred (0%).
CONCLUSION
The DIB is an easy-to-learn and versatile technique. It has low complication rates and can be used to achieve esthetically satisfactory mid- to long-term results.
Topics: Humans; Female; Adult; Middle Aged; Bariatric Surgery; Breast Implantation; Postoperative Complications; Mammaplasty; Surgical Flaps; Breast Implants
PubMed: 38723510
DOI: 10.1016/j.bjps.2024.04.061 -
Aesthetic Plastic Surgery May 2024Macromastia is a physically and psychologically distressing condition for adolescents. While reduction mammaplasty is often the best treatment, risk factors for...
BACKGROUND
Macromastia is a physically and psychologically distressing condition for adolescents. While reduction mammaplasty is often the best treatment, risk factors for adolescent wound complications remain unclear. This study aims to investigate the impact of obesity and other predictors of postoperative wound complications following adolescent reduction mammaplasty using a national database.
METHODS
The 2012-2019 National Surgical Quality Improvement Program Pediatric (NSQIP-P) databases were reviewed to identify primary reduction mammaplasty encounters. World Health Organization Body Mass Index (BMI), alongside patient and case characteristics, were assessed for association for 30-day wound disruption or surgical site complications. Statistical analyses were performed to identify independent predictors for complications and determine a potential BMI cutoff for risk stratification.
RESULTS
There were 1215 patients with an average age of 16.6 years. The average BMI was 30.7 kg/m, and 593 (48.8%) patients were nonobese while 622 (51.2%) were obese. The incidence of complications was 5.27%. Independent predictors of complications included a BMI 35-39.9, BMI > 40, and an American Society of Anesthesiologists (ASA) Classification > 3. A receiver operating characteristic curve determined that a BMI of 34.6 can be a potential cutoff for increased complication risk.
CONCLUSIONS
Higher obesity increases risk of wound complications; however, complication rates remain low. A BMI of 34.6 is a potential screening metric for counseling and monitoring patients. Reduction mammaplasty should remain a viable option as it can significantly improve quality of life.
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 the online Instructions to Authors www.springer.com/00266 .
PubMed: 38720101
DOI: 10.1007/s00266-024-04048-4 -
Annals of Plastic Surgery Jun 2024About 30% to 50% of women with breast cancer undergo mastectomy, and approximately 50% of them will receive adjuvant radiotherapy (ART). This study evaluates the medium-...
BACKGROUND
About 30% to 50% of women with breast cancer undergo mastectomy, and approximately 50% of them will receive adjuvant radiotherapy (ART). This study evaluates the medium- and long-term impact of ART after immediate breast reconstruction (IBR) with latissimus dorsi myocutaneous (LDM) flap and silicone implants.
METHODS
Clinical, surgical, and oncological data were retrospectively collected and analyzed based on the medical records of 176 patients who had undergone IBR with LDM flap and silicone implants.
RESULTS
The data showed that 7.4% of patients had a history of previous radiotherapy, 56.3% received ART, 31.8% developed capsular contracture with a mean follow-up of 58.1 months, and 14.2% of surgeries were categorized as procedures with a prolonged operating time, lasting above 1 SD of the observed mean. Those who experienced prolonged operating time (odds ratio, 4.72; 95% confidence interval, 1.72-12.93; P = 0.003) and those who received ART (odds ratio, 7.38; 95% confidence interval, 3.18-17.10; P < 0.001) were more likely to develop capsular contracture. Thirty-two patients (18%) underwent capsulectomy with implant replacement, and 7 patients (4%) had the implant removed. The mean time between IBR and reoperation was 29.1 months. Patients who received ART were 2.84 times more likely to experience reconstruction failure or undergo implant-related reoperation ( P = 0.002).
CONCLUSIONS
The results indicated that IBR with LDM flap and silicone implant followed by ART is a safe procedure, resulting in low rates of reconstruction failure. However, ART increased the likelihood of capsular contracture development and implant-related reoperation, having a negative effect on reconstructed breasts.
Topics: Humans; Female; Breast Neoplasms; Middle Aged; Radiotherapy, Adjuvant; Retrospective Studies; Mammaplasty; Breast Implants; Adult; Superficial Back Muscles; Myocutaneous Flap; Mastectomy; Treatment Outcome; Aged; Follow-Up Studies; Silicone Gels; Postoperative Complications
PubMed: 38718327
DOI: 10.1097/SAP.0000000000003882 -
Annals of Plastic Surgery Jun 2024The unique dual-lumen and baffle design of the IDEAL IMPLANT Structured Saline breast implant gives it specific advantages over both silicone gel-filled and the original...
The unique dual-lumen and baffle design of the IDEAL IMPLANT Structured Saline breast implant gives it specific advantages over both silicone gel-filled and the original saline-filled implants. This internal baffle structure also gives it an appearance on various radiologic imaging studies that may be misinterpreted as a rupture because of similarities to the well-known radiologic appearance of a ruptured silicone gel implant. Patients may present with various misinterpreted imaging studies, highlighting the need for plastic surgeons and radiologists to be familiar with the normal appearance of the intact IDEAL IMPLANT and be able to distinguish it from a ruptured IDEAL IMPLANT. The radiology findings must be correlated with the clinical findings, or an intact IDEAL IMPLANT misdiagnosed as ruptured, may cause unnecessary patient worry, and may prompt unnecessary surgery for removal or replacement.
Topics: Humans; Breast Implants; Female; Diagnostic Errors; Device Removal; Prosthesis Failure; Unnecessary Procedures; Breast Implantation; Adult; Prosthesis Design; Silicone Gels; Saline Solution; Middle Aged
PubMed: 38717197
DOI: 10.1097/SAP.0000000000003921 -
Annals of Plastic Surgery Jun 2024This study aimed to determine whether there is a difference in free flap failure based on the decision to undergo immediate versus delayed autologous tissue breast...
This study aimed to determine whether there is a difference in free flap failure based on the decision to undergo immediate versus delayed autologous tissue breast reconstruction after mastectomy. The National Surgical Quality Improvement Program database was queried for breast free flap procedures performed between 2015 and 2020. This study demonstrates that the decision to undergo immediate versus delayed autologous tissue breast reconstruction does not have a significant association with free flap failure. This remains true regardless of whether patients undergo unilateral mastectomy with reconstruction or whether patients choose to also undergo contralateral prophylactic mastectomy with reconstruction.
Topics: Humans; Mammaplasty; Free Tissue Flaps; Female; Middle Aged; Mastectomy; Retrospective Studies; Breast Neoplasms; Transplantation, Autologous; Adult; Time Factors; Postoperative Complications
PubMed: 38717156
DOI: 10.1097/SAP.0000000000003900