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Revista Brasileira de Ginecologia E... 2024The purpose of this study was to compare postoperative pain between SF flap and serratus anterior muscle (SM) in direct-to-implant breast reconstruction. (Comparative Study)
Comparative Study
Outcomes after elevation of serratus anterior fascia flap versus serratus muscle flap in direct-to-implant breast reconstruction following mastectomy: a prospective study.
OBJECTIVE
The purpose of this study was to compare postoperative pain between SF flap and serratus anterior muscle (SM) in direct-to-implant breast reconstruction.
METHODS
This is a prospective cohort study that included 53 women diagnosed with breast cancer who underwent mastectomy and one-stage implant-based breast reconstruction from January 2020 to March 2021. Twenty-nine patients (54.7%) had SF elevation, and 24 patients (45.3%) underwent SM elevation. We evaluated patient-reported early postoperative pain on the first day after surgery. Also, it was reported that all surgical complications in the first month and patient reported outcomes (PROs) were measured with the BRECON 23 questionnaire.
RESULTS
The serratus fascia group used implants with larger volumes, 407.6 ± 98.9 cc (p < 0.01). There was no significant difference between the fascial and muscular groups regarding the postoperative pain score reported by the patients (2 versus 3; p = 0.30). Also, there was no difference between the groups regarding early surgical complications and PROs after breast reconstruction.
CONCLUSION
The use of SF seems to cause less morbidity, which makes the technique an alternative to be considered in breast reconstruction. Although there was no statistical difference in postoperative pain scores between the fascia and serratus muscle groups.
Topics: Humans; Female; Prospective Studies; Mastectomy; Middle Aged; Pain, Postoperative; Breast Neoplasms; Surgical Flaps; Mammaplasty; Adult; Fascia; Patient Reported Outcome Measures; Treatment Outcome; Breast Implantation
PubMed: 38765542
DOI: 10.61622/rbgo/2024AO13 -
The Journal of Surgical Research Jul 2024
Letter Regarding: Limited English Proficiency Is Not Associated With Poor Postoperative Outcomes or Follow-Up Rates in Patients Undergoing Breast Reduction Mammoplasty-A Single Institution Retrospective Cohort Study.
Topics: Humans; Mammaplasty; Female; Retrospective Studies; Postoperative Complications; Language; Treatment Outcome; Follow-Up Studies
PubMed: 38763811
DOI: 10.1016/j.jss.2024.04.036 -
Journal of Plastic, Reconstructive &... Jul 2024Dynamic infrared thermography (DIRT) is a quick and non-invasive technique for perforator mapping in free flaps that provides real-time information. After a cold...
BACKGROUND
Dynamic infrared thermography (DIRT) is a quick and non-invasive technique for perforator mapping in free flaps that provides real-time information. After a cold challenge, areas best supplied with blood become visible hotspots on color-coded maps, indicating perforators. This study presents a proof of principle for a new and innovative feature of DIRT, where projected augmented reality is used to directly display thermal images on the patient's abdomen prior to the deep inferior epigastric artery perforator (DIEP) flap breast reconstruction.
METHODS
A self-aligning projection device prototype (Anatomy Projector) equipped with an integrated thermal camera was used to obtain thermal information and project the color-coded map directly on the patient's abdomen before DIEP flap breast reconstruction. Projected DIRT hotspots were verified using a hand-held Doppler, and compared to the vascularity on computed tomography angiography (CTA), and intraoperative perforator measurements following a Cartesian grid.
RESULTS
A total of 514 DIRT hotspots were projected in 50 patients, among them 97.3% could be verified using Doppler. The positive predictive value for CTA was 74.5%. Intraoperative measurements yielded 132 perforators in 71 flaps, among them 75 perforators (56.8%) correlated with projected DIRT hotspots, and half of them (54.7%) appeared within the first 5 emerging hotspots.
CONCLUSION
This study showed that real-time display of thermal data in DIEP flap breast reconstruction is feasible via projected augmented reality. Projection facilitates convenient marking of hotspots, and a high resemblance to Doppler and CTA data was observed. Further research should assess the added value of projecting thermal images intraoperatively and in other fields of plastic surgery.
Topics: Humans; Thermography; Mammaplasty; Perforator Flap; Female; Epigastric Arteries; Augmented Reality; Middle Aged; Computed Tomography Angiography; Infrared Rays; Adult
PubMed: 38763059
DOI: 10.1016/j.bjps.2024.05.001 -
Journal of Plastic, Reconstructive &... Jul 2024High mobile glandular ptotic breasts present the greatest challenge for implant breast augmentation with suboptimal outcomes occurring frequently. Here, we describe and...
BACKGROUND
High mobile glandular ptotic breasts present the greatest challenge for implant breast augmentation with suboptimal outcomes occurring frequently. Here, we describe and evaluate an innovative approach for breast augmentation in this breast type. By widely disrupting and redefining the parenchyma-muscle interface, this technique offers opportunities to restore the takeoff point of the breast and improve the fullness of the upper pole, thus producing a "perkier" breast appearance.
METHODS
A retrospective review was performed, and 68 patients who underwent breast augmentation with either type III dual-plane or the new approach between January 2015 and January 2021 were included. The patients were divided into two groups. The aesthetic outcome and patient satisfaction were evaluated using different 10-point rating forms. Data on demographic information, surgical details, and relative complication rates were recorded and compared.
RESULTS
Upon comparing the aesthetic outcomes and satisfaction, the test group demonstrated better breast shape, nipple-areola position, upper pole contour outcome, and upper pole satisfaction. No post-operative hematoma, seroma, or infection occurred in either groups. No double-bubble deformity occurred in the test group, whereas it occurred in two patients in the control group. The rates of capsular contracture were 1.4% and 1.6%, in the test and control groups, respectively.
CONCLUSIONS
The new approach is a safe surgical method with good aesthetic outcome, high patient satisfaction, and long-lasting result. This approach is a supplement to the dual-plane techniques, to realize the benefits of mastopexy and type III dual-plane breast augmentation.
Topics: Humans; Female; Retrospective Studies; Adult; Patient Satisfaction; Breast; Esthetics; Breast Implantation; Mammaplasty; Breast Implants; Middle Aged; Postoperative Complications
PubMed: 38763057
DOI: 10.1016/j.bjps.2024.05.013 -
Journal of Plastic, Reconstructive &... Jul 2024This study evaluated trends in Medicare reimbursement for commonly performed breast oncologic and reconstructive procedures. Average national relative value units (RVUs)...
This study evaluated trends in Medicare reimbursement for commonly performed breast oncologic and reconstructive procedures. Average national relative value units (RVUs) for physician-based work, facilities, and malpractice were collected along with the corresponding conversion factors for each year. From 2010 to 2021, there was an overall average decrease of 15% in Medicare reimbursement for both breast oncology (-11%) and reconstructive procedures (-16%). Based on these findings, breast and reconstructive surgeons should advocate for reimbursement that better reflects the costs of their practice.
Topics: Humans; United States; Breast Neoplasms; Medicare; Female; Mammaplasty; Insurance, Health, Reimbursement; Reimbursement Mechanisms
PubMed: 38759511
DOI: 10.1016/j.bjps.2024.04.064 -
Journal of Plastic, Reconstructive &... Jul 2024In the existing literature, assessing transgender patients' quality of life after surgery, especially using standardized surveys, is rare. The nipple sensation regarding...
BACKGROUND
In the existing literature, assessing transgender patients' quality of life after surgery, especially using standardized surveys, is rare. The nipple sensation regarding the operating technique has neither been studied in a prospective nor standardized way.
METHODS
For one year, we prospectively assessed transgender patients operated on for a gender-affirming chest surgery in our unit. Each patient answered the BREAST-Q© survey and the BODY-Q© chest module survey before and six months after the surgery. In addition, a measure of nipple sensation was performed using Semmes-Weinstein monofilaments pre-and post-operatively to compare surgical techniques.
RESULTS
Fifty-one patients (102 breasts) were included in our study. The average age was 23.1 years and the average BMI was 24.8 kg/m. Twenty-one patients (45%) had double incision and free nipple graft mastectomy, 14 (27%) patients had double incision and inferior pedicle mastectomy, while the 14 (27%) other patients had a semi-circular technique. Our study shows an improvement in all the scores of the surveys after surgery (p < 0.0001). Patients with double incision and inferior pedicle mastectomies rated a significantly higher satisfaction with nipples (p = 0.013) and significantly better sexual well-being (p = 0.007) than other techniques. In addition, preservation of nipple sensation was shown in patients operated by semi-circular technique (p < 0.001) and inferior pedicle technique (p < 0.0001).
CONCLUSIONS
Our prospective study confirms the significant improvement in the quality of life of transgender patients after chest gender-affirming surgery. Double incision with inferior pedicle seems to provide better satisfaction with nipples, higher sexual well-being, and preservation of nipple sensation.
Topics: Humans; Nipples; Quality of Life; Female; Male; Prospective Studies; Adult; Patient Satisfaction; Young Adult; Sensation; Sex Reassignment Surgery; Transgender Persons; Mammaplasty; Surveys and Questionnaires
PubMed: 38759510
DOI: 10.1016/j.bjps.2024.05.022 -
Breast Disease 2024Fat transfer has been widely used after breast conservative surgery (BCS) where it aims to recover shapes as a simple, inexpensive, biocompatible method but the... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Fat transfer has been widely used after breast conservative surgery (BCS) where it aims to recover shapes as a simple, inexpensive, biocompatible method but the technique is not without complications. Platelet Rich Plasma (PRP) is a promising approach to enhance fat graft survival and subsequently improve the outcome. The aim of this study was to evaluate the effect of enriching fat graft with PRP for delayed correction of deformities after conservative surgery for breast cancer regarding esthetic outcome and incidence of complications.
METHODS
The current study included 50 female patients who were scheduled for delayed lipofilling for correction of deformities after conservative surgery for breast cancer. The studied patients were randomly allocated into 2 groups: Group I (G I) included 25 patients scheduled for PRP enriched lipoinjection and Group II (G II) included 25 patients scheduled for lipoinjection without PRP as a control group.
RESULTS
Number of sessions of lipoinjection was significantly less in G I in comparison to G II (P = 0.024). During the 2nd session; the amounts of fat injected and harvested were significantly less in G I in comparison to G II (P = 0.049 and 0.001 respectively). Recipient site complications were significantly more evident in G II in comparison to G I (P = 0.01). Surgeon and patient satisfactions were significantly more evident in GI in comparison to G II (P = 0.005 and 0.029 respectively).
CONCLUSION
The addition of PRP to fat grafts is a simple, cost-effective and safe method to improve esthetic outcome and decrease complications.
Topics: Humans; Female; Platelet-Rich Plasma; Breast Neoplasms; Middle Aged; Adipose Tissue; Adult; Mammaplasty; Patient Satisfaction; Postoperative Complications; Mastectomy, Segmental
PubMed: 38758987
DOI: 10.3233/BD-230057 -
Minerva Surgery Aug 2024This study presents preliminary results of robot-assisted nipple-sparing immediate breast reconstruction (R-NSMIBR) with gel implant combined with latissimus dorsi...
BACKGROUND
This study presents preliminary results of robot-assisted nipple-sparing immediate breast reconstruction (R-NSMIBR) with gel implant combined with latissimus dorsi muscle flap without island flap and validation of the safety and utility of this novel surgical modality.
METHODS
Records pertinent to R-NSMIBR with gel implants combined with latissimus dorsi muscle flap surgery for breast reconstruction between September 2022 and May 2023 were examined. A total of 13 patients who underwent R-NSMIBR were analyzed, nine of which were performed without skin island.
RESULTS
We divided the patients with and without skin islands into two groups and recorded the operation time and bleeding respectively. The mean total operative time for R-NSMIBR was 436.5±56.88 minutes and 355.75±69.68 minutes. As experience in learning increased, time required to create the operating space and position the robotic arm decreased significantly. Not creating an island of skin also saves a great deal of surgical time. Average total blood loss was 37.5±6.45 mL and 26.25±7.5 mL. No cases of nipple-areolar complex necrosis or perioperative complications or no local recurrences were reported. There were no local recurrences or deaths that occurred during a mean follow-up period of 3±1 months.
CONCLUSIONS
All the patients expressed satisfaction with the aesthetic outcome following surgery. There were no significant differences between two groups. This surgical method shows promise for future promotion in the field.
Topics: Humans; Female; Robotic Surgical Procedures; Mammaplasty; Middle Aged; Superficial Back Muscles; Nipples; Surgical Flaps; Adult; Operative Time; Breast Neoplasms; Retrospective Studies; Blood Loss, Surgical; Breast Implants; Time Factors; Mastectomy, Subcutaneous; Treatment Outcome
PubMed: 38757888
DOI: 10.23736/S2724-5691.24.10244-4 -
Bulletin Du Cancer Jun 2024
Topics: Humans; Female; Mastectomy; Mammaplasty; Patient Participation; Decision Making, Shared; Breast Neoplasms
PubMed: 38755035
DOI: 10.1016/j.bulcan.2024.03.004 -
Journal of Plastic Surgery and Hand... May 2024For preference sensitive treatments, such as breast reconstructions, there are barriers to conducting randomised controlled trials (RCTs). The primary aims of this...
BACKGROUND
For preference sensitive treatments, such as breast reconstructions, there are barriers to conducting randomised controlled trials (RCTs). The primary aims of this systematic review were to investigate what type of research questions are explored by RCTs in breast reconstruction, where have they been performed and where have they been published, and to thematise the research questions and thus create an overview of the state of the research field.
METHODS
Randomised controlled trials investigating any aspect of breast reconstructions were included. The PubMed database was searched with a pre-defined search string. Inclusion and data abstraction was performed in a pre-defined standardised fashion. For the purpose of this study, we defined key issues as comparison of categories of breast reconstruction and comparison of immediate and delayed breast reconstruction, when the thematisation was done.
RESULTS
A total of 419 abstracts were retrieved from the search. Of the 419, 310 were excluded as they were not RCTs concerning some aspect of breast reconstruction, which left us with 110 abstracts to be included in the study. The research questions of the included studies could more or less be divided into seven different themes inclusive of 2 key issues: Other issues - comparison of different categories of breast reconstruction, comparison of immediate and delayed breast reconstruction, surgical details within a category of breast reconstruction, surgical details valid for several categories of breast reconstruction, donor site management, anaesthetics, and non-surgical details. Only five studies compared key issues, and they all illustrate the challenges with RCTs in breast reconstruction.
CONCLUSIONS
A total of 110 publications based on RCTs in breast reconstruction have been published. Seven themes of research questions could be identified. Only five studies have explored the key issues. Better scientific evidence is needed for the key issues in breast reconstruction, for example by implementing a new study design in the field.
Topics: Humans; Mammaplasty; Randomized Controlled Trials as Topic; Female; Research Design
PubMed: 38751090
DOI: 10.2340/jphs.v59.40087