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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 -
Journal of Breast Imaging May 2024
Topics: Humans; Breast Implants; Female; Breast Neoplasms; Breast Implantation; Mammography
PubMed: 38801373
DOI: 10.1093/jbi/wbae029 -
Case Reports in Plastic Surgery & Hand... 2024Symmastia is a rare complication of augmentation mammaplasty that occurs when a breast implant crosses the midline and connects with the contralateral implant pocket. We...
Symmastia is a rare complication of augmentation mammaplasty that occurs when a breast implant crosses the midline and connects with the contralateral implant pocket. We present a case of implant rupture, migration to the contralateral breast, and ultimate symmastia following a traumatic fall in a patient with prior breast augmentation.
PubMed: 38799174
DOI: 10.1080/23320885.2024.2357121 -
Medicina (Kaunas, Lithuania) Apr 2024: The correction of breast hypertrophy and ptosis with implant placement has always posed a challenge for plastic surgeons. Various methods have been devised, yielding...
: The correction of breast hypertrophy and ptosis with implant placement has always posed a challenge for plastic surgeons. Various methods have been devised, yielding conflicting results. The purpose of this study is to describe our surgical technique of breast reduction with silicone implants, present the safety profile of the procedure, and report patient-reported outcomes. : A retrospective review was performed on our case series of cosmetic breast surgery performed by the senior author between October 2020 and November 2023. Only patients who had over 300 g of breast tissue removed were included. The surgery and demographic characteristics were recorded. Patients were asked to complete a questionnaire about satisfaction with their breasts pre-operatively and after the surgery. : Over 745 cases were performed, and 25 were included in the analysis. In total, 78.3% of the patients presented with a Grade 3 ptosis. The mean implant size was 352.39 cc (range 300-455 cc). The breast tissue removed ranged from 312 to 657 g. The mean follow-up was 14.17 months. Only one case required revision surgery after developing capsular contracture and a waterfall deformity. Patients reported a statistically significant improvement across all domains of the questionnaire ( < 0.001). : Breast reduction plus implants is a safe and effective alternative for patients with large ptotic breasts who wish to attain a full upper pole. It carries a similar risk profile to augmentation mastopexy and maintains its functional benefits in alleviating back, neck, and shoulder pain.
Topics: Humans; Retrospective Studies; Female; Breast Implants; Patient Reported Outcome Measures; Adult; Middle Aged; Mammaplasty; Patient Satisfaction; Surveys and Questionnaires; Breast Implantation; Cohort Studies; Breast
PubMed: 38792926
DOI: 10.3390/medicina60050743