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European Journal of Surgical Oncology :... Apr 2024In the developmental stage of minimal-accessed nipple-sparing mastectomy (MA-NSM), selecting patients with small to medium-sized breasts was common for better cosmetic...
BACKGROUND
In the developmental stage of minimal-accessed nipple-sparing mastectomy (MA-NSM), selecting patients with small to medium-sized breasts was common for better cosmetic outcomes and oncological safety. However, the suitability of MA-NSM for large, ptotic breasts remained uncertain. This retrospective study aim to assess MA-NSM outcomes in patients with large breasts.
MATERIALS AND METHODS
This retrospective study included patients receiving conventional NSM (C-NSM) and MA-NSM from January 2011 to September 2022, at a single institution. We analyzed perioperative parameters and clinical outcomes based on breast specimen size, classified as small (≤300 g), medium (>300-450 g), large (>450-600 g), and very large (>600 g).
RESULTS
A total of 728 patients was enrolled. C-NSM was performed in 51% (371/728) of cases, while MA-NSM was done in 49% (357/728). The overall complication rate of MA-NSM was comparable to C-NSM (p = 0.573), but severe complications (Clavien-Dindo, CD III) was significantly reported more following C-NSM, regardless of breast size. During a median follow-up of 52 months, no significant difference in oncological outcomes was observed. Comparing MA-NSM and C-NSM outcomes in large-very large breasts (>450 g), MA-NSM demonstrated significantly less blood loss (p = 0.036) and lower incidence of severe complications (CD ≥ III) compared to C-NSM (p = 0.002).
CONCLUSION
MA-NSM is feasible for large breasts and offers benefits by reducing blood loss and decreasing the incidence of severe complications (CD ≥ III) in this patient group.
Topics: Humans; Female; Mastectomy; Mammaplasty; Retrospective Studies; Nipples; Robotic Surgical Procedures; Breast Neoplasms
PubMed: 38402736
DOI: 10.1016/j.ejso.2024.108030 -
Breast (Edinburgh, Scotland) Apr 2024Sensory nerve coaptation has great potential to restore sensation after autologous breast reconstruction. However, blinded and randomized studies are lacking. We... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Sensory nerve coaptation has great potential to restore sensation after autologous breast reconstruction. However, blinded and randomized studies are lacking. We therefore present the preliminary results of our ongoing double-blinded randomized controlled trial that compares sensory recovery of innervated versus non-innervated DIEP flaps.
METHODS
Patients who underwent DIEP flap breast reconstruction between July 2019 and February 2022 were included and randomized. The anterior cutaneous branch of the second or third intercostal nerve was coapted. Pre- and postoperative sensory testing was performed with Semmes-Weinstein Monofilaments, Pressure Specified Sensory Device, and a thermostimulator, for tactile and temperature thresholds.
RESULTS
This interim analysis comprised 41 patients contributing 29 innervated and 38 non-innervated breasts. At 24 months of follow-up, the mean monofilament value of the flap skin was lower in innervated than in non-innervated flaps (4.48 vs. 5.20, p = 0.003). Touch thresholds were lower the center of the innervated flaps (47.8 vs. 71.2 g/mm, p = 0.036), and heat pain was more often imperceptible in non-innervated flaps (42.1% vs. 10.3%, p = 0.004). No adverse events were associated with sensory nerve coaptation.
CONCLUSIONS
These preliminary results indicate superior sensibility and recovery of protective sensation in innervated compared with non-innervated DIEP flaps. Although the results of the completed trial must be awaited to establish the full clinical impact, including highly anticipated quality of life outcomes, we encourage continuation of scientific and clinical efforts in this promising technique.
Topics: Female; Humans; Breast; Breast Neoplasms; Mammaplasty; Quality of Life; Touch; Double-Blind Method
PubMed: 38401421
DOI: 10.1016/j.breast.2024.103691 -
Journal of Plastic, Reconstructive &... Mar 2024Flap neurotisation is a promising solution to restore the diminished or complete loss of sensation following mastectomy. This systematic review compared sensory outcomes... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Flap neurotisation is a promising solution to restore the diminished or complete loss of sensation following mastectomy. This systematic review compared sensory outcomes in neurotised versus non-neurotised abdominal-based autologous breast reconstructions to establish its benefit in routine clinical practice.
METHODS
A literature search was performed according to the PRISMA guidelines. Medline, PubMed, EMBASE, and Cochrane databases were queried for relevant studies. Pressure sensitivity, measured using Semmes-Weinstein monofilaments (SWM) or the pressure-specified sensory device (PSSD), was the primary outcome measure.
RESULTS
A total of 12 studies comprising 367 neurotised and 295 non-neurotised flap reconstructions were included, with 8 studies included in the meta-analysis. Neurotised flaps demonstrated superior sensory outcomes over non-neurotised flaps, with significant differences in SWM scores (mean difference [MD], -1.552 95% CI, -2.351 to -0.7535; p = 0.0001) and PSSD (MD -13.36; 95% CI, -26.41 to -0.3117; p = 0.0448) at follow-up (range 8 to 77 months). The differences in total skin sensation (native and flap skin combined) were statistically significant in the SWM group (p = 0.0010) but not in the PSSD group (p = 0.0649). Investigation on the factors impacting sensation recovery in neurotised flaps yielded inconclusive outcomes.
CONCLUSIONS
Neurotised flaps consistently demonstrated superior sensation outcomes compared with non-neurotised flaps, irrespective of flap type or neurotisation technique. However, further research is essential to elucidate the factors that impact sensory recovery and standardise neurotisation practices for more optimal post-mastectomy reconstruction outcomes.
Topics: Humans; Female; Mastectomy; Breast Neoplasms; Mammaplasty; Sensation; Surgical Flaps
PubMed: 38401199
DOI: 10.1016/j.bjps.2024.01.045 -
The Breast Journal 2024Mammoplasty is a surgery commonly used for macromastia. Many mammoplasty techniques are described, all with their specific pros and cons. However, the concern to avoid...
Mammoplasty is a surgery commonly used for macromastia. Many mammoplasty techniques are described, all with their specific pros and cons. However, the concern to avoid serious complications sometimes takes precedence, and the ideal result cannot be. For macromastia and severely ptotic breasts, usually the free nipple-areolar complex (NAC) mammoplasty technique is implemented. The results, however, may only be completely satisfactory regarding cosmetics. Loss of NAC, poor appearance, flabbiness, flattening, and ptosis are among the disadvantages of this technique. This study aimed to present the results of mammoplasty employing the superomedial pedicle technique without interrupting a macromastia central base with a pedicle length of 8 to 18 cm. According to the literature, many plastic surgeons recommend the free NAC rather than the pedicle technique because of the high complication rates in mammoplasties planned for highly ptotic breasts and macromastia. On the other hand, many free NAC techniques and their modifications with pedicle mammoplasty are described. The general conviction is that a standard method, protocol, or technique good for all patients does not exist. Our results are more acceptable both cosmetically and physiologically. Therefore, the superomedial pedicle technique can be modified to achieve ideal results where free NAC mammoplasty is considered for severe macromastia and ptotic patients. This combined method contributes to the viability of NAC by increasing blood supply to breast tissue and providing an ideal breast appearance.
Topics: Humans; Female; Treatment Outcome; Breast Neoplasms; Breast; Mammaplasty; Nipples; Retrospective Studies; Hypertrophy
PubMed: 38389976
DOI: 10.1155/2024/7635485 -
Life Science Alliance May 2024Breast implants are extensively employed for both reconstructive and esthetic purposes. However, the safety of breast implants with textured surfaces has been...
Breast implants are extensively employed for both reconstructive and esthetic purposes. However, the safety of breast implants with textured surfaces has been questioned, owing to a potential correlation with anaplastic large-cell lymphoma and the recurrence of breast cancer. This study investigates the immune response elicited by different prosthetic surfaces, focusing on the comparison between macrotextured and microtextured breast implants. Through the analysis of intraoperatively harvested periprosthetic fluids and cell culture experiments on surface replicas, we demonstrate that macrotextured surfaces elicit a more pronounced chronic-like activation of leucocytes and an increased release of inflammatory cytokines, in contrast to microtextured surfaces. In addition, in vitro fluorescent imaging of leucocytes revealed an accumulation of lymphocytes within the cavities of the macrotextured surfaces, indicating that the physical entrapment of these cells may contribute to their activation. These findings suggest that the topography of implant surfaces plays a significant role in promoting a chronic-like inflammatory environment, which could be a contributing factor in the development of lymphomas associated with a wide range of implantable devices.
Topics: Humans; Female; Breast Implants; Breast Implantation; Breast Neoplasms; Lymphoma, Large-Cell, Anaplastic
PubMed: 38383454
DOI: 10.26508/lsa.202302132 -
Plastic and Reconstructive Surgery.... Feb 2024Superior pedicle breast reduction is a very popular technique among plastic surgeons. This technique has had many variations looking for fewer complications and better...
BACKGROUND
Superior pedicle breast reduction is a very popular technique among plastic surgeons. This technique has had many variations looking for fewer complications and better long-lasting results. The aim of this article is to present a novel technique of breast reduction, making variations in the design of the periareolar incision, using a superior pedicle with a constant vertical incision of 5 cm and a shortened horizontal incision.
METHODS
The superior pedicle inverted T-mammoplasty with a shortened horizontal scar technique was performed in 1200 patients who underwent surgery between 2010 and 2023; follow-up examination was carried out for an average of 1 year (3 months to 3 years). A patient satisfaction survey was conducted.
RESULTS
Patient satisfaction rate was 99%. There were no cases of total necrosis of the areola-nipple complex, 2.7% of the patients presented partial necrosis of the areola-nipple complex, 1.4% of the patients presented local infection, 1.7% presented dehiscence at some point of the vertical or horizontal suture, 4% of the patients presented a widened scar, 8% of the patients presented alteration in the sensibility of the areola-nipple complex, and 0.6% of the patients presented hematoma. With this technique, a rise of the areola-nipple complex of up to 22cm was achieved.
CONCLUSIONS
The superior pedicle inverted T-mammaplasty with shortened horizontal scar technique showed a lower number of surgical complications compared with other techniques previously used for breast reduction, even when applied in gigantomasty. It provides lasting results and a high rate of patient satisfaction.
PubMed: 38379778
DOI: 10.1097/GOX.0000000000005625 -
Breast (Edinburgh, Scotland) Apr 2024We retrospectively identified 295 women undergoing outpatient implant breast reconstruction (IBR) who received standardized ERAS care pre-pandemic (PP; April 2018-March...
We retrospectively identified 295 women undergoing outpatient implant breast reconstruction (IBR) who received standardized ERAS care pre-pandemic (PP; April 2018-March 2020) and during the pandemic (DP; April 2020-March 2022). The majority of IBR was completed as outpatient surgeries DP versus PP (73% versus 38%, p < 0.001). Immediate IBR increased DP versus PP (p < 0.001). Preoperative ERAS© order sets were used 54% of the time. Lack of ERAS© order set use was associated with unplanned admissions (55.3% versus 44.7%, p = 0.02). COVID-19 changed health care and nudged IBR to outpatient procedures. With ERAS© recommendations, IBR can be safely and effectively transitioned to outpatient settings.
Topics: Female; Humans; Pandemics; Retrospective Studies; Enhanced Recovery After Surgery; Outpatients; COVID-19; Breast Neoplasms; Mammaplasty
PubMed: 38368765
DOI: 10.1016/j.breast.2024.103689 -
BMC Surgery Feb 2024Breast cancer surgeries involving MS-TRAM/DIEP breast reconstruction has traditionally been collaborative efforts between breast surgeons and plastic surgeons. However,...
BACKGROUND
Breast cancer surgeries involving MS-TRAM/DIEP breast reconstruction has traditionally been collaborative efforts between breast surgeons and plastic surgeons. However, in our institution, this procedure is performed by dual-trained breast surgeons who are proficient in both breast surgery and MS-TRAM/DIEP breast reconstruction. This study aims to provide insights into the learning curve associated with this surgical approach.
MATERIALS AND METHODS
We included eligible breast cancer patients who underwent MS-TRAM/DIEP breast reconstruction by dual-trained breast surgeons between 2015 and 2020 at our institution. We present the learning curve of this surgical approach, with a focus on determining factors affecting flap harvesting time, surgery time, and ischemic time. Additionally, we assessed the surgical complication rates.
RESULTS
A total of 147 eligible patients were enrolled in this study. Notably, after 30 cases, a statistically significant reduction of 1.7 h in surgery time and 21 min in ischemic time was achieved, signifying the attainment of a plateau in the learning curve. And the major and minor complications were comparable between the early and after 30 cases.
CONCLUSION
This study explores the learning curve and feasibility experienced by dual-trained breast surgeons in performing MS-TRAM/DIEP breast reconstruction.
TRIAL REGISTRATION
NCT05560633.
Topics: Humans; Female; Learning Curve; Postoperative Complications; Mammaplasty; Breast Neoplasms; Surgeons; Retrospective Studies
PubMed: 38355459
DOI: 10.1186/s12893-024-02344-z -
Asian Journal of Surgery May 2024Reconstruction of breast following mastectomy is important in terms of rehabilitating patients of breast cancer. Numerous approaches have been used in the reconstruction...
BACKGROUND
Reconstruction of breast following mastectomy is important in terms of rehabilitating patients of breast cancer. Numerous approaches have been used in the reconstruction process. A procedure that has gained interest of the patients is reconstruction of breast using the autologous form. Main objective of this study is to determine the outcomes of modified fleur-de-lis latissimus dorsi flap in patients undergoing breast reconstruction.
METHODOLOGY
This is a retrospective case series which was conducted at the Department of Plastic Surgery, SIMS/Services Hospital, Lahore, from January 2020 till December 2022. 184 patients age 25-60 years and Females with a history of mastectomy, who had to undergo creation of breast shape using a tissue flap from another part of the body at the site of breast following mastectomy were included. All patients were subjected to standard procedure of breast reconstruction with latissimus dorsi flap using modified fleur-de-lis technique and postoperatively weekly assessment in the first month and then monthly until 3 months was carried out and outcome of the study was analysed.
RESULTS
The mean age and VAS score of the patients was 49.7 ± 9.17 and 6 ± 2.21, respectively. 57.1 % patients have DCIS, benign in 38 % patients and other tumours were present in 4.9 % patients. Immediate versus delayed reconstruction was done in 63.6 % versus 36.4 % patients respectively. Good aesthetic outcome was achieved in 80.3 % patients CONCLUSION: Modified fleur-de-lis latissimus dorsi flap in patients undergoing breast reconstruction yielded a good aesthetic outcome in the majority of the patients.
Topics: Humans; Mammaplasty; Female; Middle Aged; Adult; Retrospective Studies; Superficial Back Muscles; Mastectomy; Breast Neoplasms; Treatment Outcome; Myocutaneous Flap
PubMed: 38350776
DOI: 10.1016/j.asjsur.2024.01.125 -
International Journal of Surgery... Apr 2024Due to the short operation time and no need for special instruments, reverse-sequence endoscopic nipple-sparing mastectomy (R-E-NSM) with direct-to-implant breast...
A novel technique of reverse-sequence endoscopic nipple-sparing mastectomy with direct-to-implant breast reconstruction: medium-term oncological safety outcomes and feasibility of 24-h discharge for breast cancer patients.
BACKGROUND
Due to the short operation time and no need for special instruments, reverse-sequence endoscopic nipple-sparing mastectomy (R-E-NSM) with direct-to-implant breast reconstruction (DIBR) has been rapidly becoming popular in the last three years. However, there has yet to be an evaluation of its oncologic safety or the feasibility of discharging patients within 24 h.
MATERIALS AND METHODS
In this single-centre retrospective cohort study, individuals diagnosed with stage 0-III breast cancer between May 2020 and April 2022 who underwent traditional open mastectomy or R-E-NSM with DIBR were included. Follow-up started on the date of surgery and ended in December 2023. Data, including demographics, tumour characteristics, medium-term oncological outcomes, and postoperative complications, were collected and analyzed. Propensity score matching (PSM) was performed to minimize selection bias.
RESULTS
This study included 1679 patients [median (IQR) age, 50 [44-57) years]. Of these, 344 patients underwent R-E-NSM with DIBR (RE-R group), and 1335 patients underwent traditional open mastectomy (TOM group). The median [IQR] follow-up time was 30 [24-36] months [29 (23-33) months in the RE-R group and 30([24-36) months in the TOM group]. Regarding before or after PSM, the P value of local recurrence-free survival (LRFS, 0.910 and 0.450), regional recurrence-free survival (RRFS, 0.780 and 0.620), distant metastasis-free survival (DMFS, 0.061 and 0.130), overall survival (OS, 0.260 and 0.620), disease-free survival (DFS, 0.120 and 0.330) were not significantly different between the RE-R group and the TOM group. The 3y-LRFS and 3y-DFS rates were 99.0% and 97.1% for the RE-R group and 99.5% and 95.3% for the TOM group, respectively. The rates of any complications and major complications were not significantly different between the RE-R patients who were discharged within 24 h and the RE-R patients who were not discharged within 24 h ( P =0.290, P =0.665, respectively) or the TOM patients who were discharged within 24 h ( P =0.133, P =0.136, respectively).
CONCLUSIONS
R-E-NSM with DIBR is an innovative oncologic surgical procedure that not only improves cosmetic outcomes but also ensures reliable oncologic safety and fewer complications, enabling patients to be safely discharged within 24 h. A long-term prospective multicenter assessment will be supporting.
Topics: Humans; Female; Middle Aged; Breast Neoplasms; Retrospective Studies; Adult; Nipples; Endoscopy; Feasibility Studies; Patient Discharge; Mastectomy; Mammaplasty; Postoperative Complications; Treatment Outcome
PubMed: 38348883
DOI: 10.1097/JS9.0000000000001134