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BioMed Research International 2017One-stage direct-to-implant immediate breast reconstruction (IBR) is performed simultaneously with breast cancer resection. We explored indications, techniques, and... (Review)
Review
BACKGROUND
One-stage direct-to-implant immediate breast reconstruction (IBR) is performed simultaneously with breast cancer resection. We explored indications, techniques, and outcomes of IBR to determine its feasibility, safety, and effectiveness.
MATERIAL AND METHODS
We reviewed the available literature on one-stage direct-to-implant IBR, with or without acellular dermal matrix (ADM), synthetic mesh, or autologous fat grafting. We analyzed the indications, preoperative work-up, surgical technique, postoperative care, outcomes, and complications.
RESULTS
IBR is indicated for small-to-medium nonptotic breasts and contraindicated in patients who require or have undergone radiotherapy, due to unacceptably high complications rates. Only patients with thick, well-vascularized mastectomy flaps are IBR candidates. Expandable implants should be used for ptotic breasts, while anatomical shaped implants should be used to reconstruct small-to-medium nonptotic breasts. ADMs can be used to cover the implant during IBR and avoid muscle elevation, thereby minimizing postoperative pain. Flap necrosis, reoperation, and implant loss are more common with IBR than conventional two-staged reconstruction, but IBR has advantages such as lack of secondary surgery, faster recovery, and better quality of life.
CONCLUSIONS
IBR has good outcomes and patient-satisfaction rates. With ADM use, a shift from conventional reconstruction to IBR has occurred. Drawbacks of IBR can be overcome by careful patient selection.
Topics: Breast; Breast Implants; Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy; Quality of Life; Surgical Flaps
PubMed: 29098159
DOI: 10.1155/2017/6486859 -
Cleveland Clinic Journal of Medicine Feb 2019Women receive breast implants for both aesthetic and reconstructive reasons. This brief review discusses the evolution of and complications related to breast implants,... (Review)
Review
Women receive breast implants for both aesthetic and reconstructive reasons. This brief review discusses the evolution of and complications related to breast implants, as well as key considerations with regard to aesthetic and reconstructive surgery of the breast.
Topics: Breast Implants; Clinical Decision-Making; Esthetics; Female; Humans; Implant Capsular Contracture; Lymphoma, Large-Cell, Anaplastic; Mammaplasty; Patient Selection; Postoperative Complications; Risk Factors; Silicone Gels
PubMed: 30742581
DOI: 10.3949/ccjm.86a.18017 -
Annals of Surgical Oncology Apr 2023There is a lack of consensus detailing the optimal approach to free-flap breast reconstruction when considering immediate, delayed, or staged techniques. This study...
BACKGROUND
There is a lack of consensus detailing the optimal approach to free-flap breast reconstruction when considering immediate, delayed, or staged techniques. This study compared costs, complications, and healthcare resource utilization (HCRU) across staged, delayed, and immediate free-flap breast reconstruction.
PATIENTS AND METHODS
Retrospective study using MarketScan databases to identify women who underwent mastectomies and free-flap reconstructions between 2014 and 2018. Complications, costs, and HCRU [readmission, reoperation, emergency department (ED) visits] occurring 90 days after mastectomy and 90 days after free flap were compared across immediate, delayed, and staged reconstruction.
RESULTS
Of 3310 women identified, 69.8% underwent immediate, 11.7% underwent delayed, and 18.5% underwent staged free-flap reconstruction. Staged reconstruction was associated with the highest rate (57.8% staged, 42.3% delayed, 32.0% immediate; p < 0.001) and adjusted relative risk [67% higher than immediate (95% CI: 49-87%; p < 0.001)] of surgical complications. Staged displayed the highest HCRU (staged 47.9%, delayed, 38.4%, immediate 25.2%; p < 0.001), with 16.5%, 30.7%, and 26.5% of staged patients experiencing readmission, reoperation, or ED visit, respectively. The adjusted probability of HCRU was 206% higher (95% CI: 156-266%; p < 0.001) for staged compared with immediate. Staged had the highest mean total cost (staged $106,443, delayed $80,667, immediate $76,756; p < 0.001) with regression demonstrating the adjusted mean cost for staged is 31% higher (95% CI: 23-39%; p < 0.001) when compared with immediate.
CONCLUSIONS
Staged free-flap reconstruction is associated with increased complications, costs, and HCRU, while immediate demonstrated the lowest. The potential esthetic benefits of a staged approach should be balanced with the increased risk for adverse events after surgery.
Topics: Female; Humans; Mastectomy; Mammaplasty; Retrospective Studies; Breast Neoplasms; Free Tissue Flaps; Patient Acceptance of Health Care; Postoperative Complications
PubMed: 36474094
DOI: 10.1245/s10434-022-12896-0 -
Breast (Edinburgh, Scotland) Jun 2010Autologous fat transplantation has been used to correct cosmetic deformities in almost all areas of the body. In recent years, there has been a resurgence of interest in... (Review)
Review
BACKGROUND
Autologous fat transplantation has been used to correct cosmetic deformities in almost all areas of the body. In recent years, there has been a resurgence of interest in the use of fatty tissue to fill defects resulting from breast conserving surgery (BCS) and asymmetries after reconstructive breast surgery.
METHODS
A Medline database search was performed, and the published evidence was reviewed.
RESULTS & CONCLUSION
We describe and discuss the technique and indications, advantages, disadvantages and future direction of fat transfer to the breast. SEARCH METHODOLOGY: A Medline database search was used to retrieve relevant literature. Key search words used were: breast fat transfer, fat auto-transplantation, adipose tissue injection and lipomodelling. As a number of original articles are in French these were translated and used in addition to the English publications.
Topics: Adipose Tissue; Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy
PubMed: 20347309
DOI: 10.1016/j.breast.2010.02.009 -
Ugeskrift For Laeger Jul 2018An increasing amount of evidence supports the benefits of fat grafting for breast augmentation, correction following breast-conserving surgery, breast reconstructions as... (Review)
Review
An increasing amount of evidence supports the benefits of fat grafting for breast augmentation, correction following breast-conserving surgery, breast reconstructions as well as correction of tuberous, hypoplastic and asymmetrical breasts. The aim of fat grafting is to create a breast with an aesthetic, natural appearance. In this review, we describe the most common indications for fat grafting of the breast and give an overview of the techniques in use as well as their associated risks and future perspectives.
Topics: Adipose Tissue; Breast; Breast Neoplasms; Female; Humans; Lipectomy; Lipodystrophy; Mammaplasty; Risk Factors; Stem Cell Transplantation; Tissue Expansion; Transplantation, Autologous
PubMed: 30064621
DOI: No ID Found -
Cleveland Clinic Journal of Medicine Mar 2008Breast reconstruction can help to address the disfigurement and sense of loss that often follow mastectomy. The decision whether to pursue reconstruction and the choice... (Review)
Review
Breast reconstruction can help to address the disfigurement and sense of loss that often follow mastectomy. The decision whether to pursue reconstruction and the choice of reconstructive strategy are individualized decisions that must take into account the patient's body characteristics, overall health, breast cancer treatment plan, and personal preferences. Options for reconstruction broadly include placement of breast implants or use of the patient's own tissue (autologous reconstruction). Both saline-filled and silicone gel-filled implants are safe and effective options for implant-based reconstruction. Autologous reconstruction usually involves transfer of tissue from the abdomen, with recent advances allowing preservation of the abdominal muscles. Both implant-based and autologous procedures have advantages and drawbacks, and both types of reconstruction may be compromised by subsequent radiation therapy. For this and other reasons, consultation with a plastic surgeon early in treatment planning is important for women considering postmastectomy reconstruction.
Topics: Breast Implants; Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy; Postoperative Complications; Surgical Flaps
PubMed: 18457193
DOI: 10.3949/ccjm.75.suppl_1.s17 -
Breast Cancer Research and Treatment Jun 2019Reconstructive breast surgeons, like all procedural care providers, face a transition from volume reimbursement (i.e., per unit of service) to value-based care. Value... (Review)
Review
PURPOSE
Reconstructive breast surgeons, like all procedural care providers, face a transition from volume reimbursement (i.e., per unit of service) to value-based care. Value can be defined as the relationship between outcomes and costs, or more specifically healthcare outcomes per unit cost. Although the definition of a meaningful outcome for a particular treatment can vary, some weighted average of survival, function, complications, process measures, and patient-reported outcomes (PROs) comprise the numerator, while the total cost of a complete care cycle is the denominator. We aim to construct a value-based care framework for reconstructive surgery using post-mastectomy reconstruction as an organizing element.
METHODS
A preexisting value framework was applied to breast reconstruction using expert opinion and literature review. Domains and associated realization strategies were constructed based on established health economic principles.
RESULTS
Seven domains were identified including: implementing an inclusive and transparent process for stakeholder engagement, practicing clear and explicit treatment goals, anchoring care delivery to the patient perspective, maximizing value across the entire continuum of care, optimizing operation efficiency, and scaling best practices with implementation science.
CONCLUSIONS
In the near future, reconstructive plastic surgeons may be asked to solve clinical problems for fixed reimbursement (i.e. bundled payments). Considering breast reconstruction through a value lens provides surgeons with an opportunity to adapt and thrive in an evolving healthcare landscape. Lastly, we hope this document helps promote value assessment within the specialty.
Topics: Breast Neoplasms; Continuity of Patient Care; Female; Health Policy; Humans; Mammaplasty; Mastectomy; Patient Reported Outcome Measures; Patient Satisfaction; Practice Guidelines as Topic
PubMed: 30937659
DOI: 10.1007/s10549-019-05212-0 -
Ugeskrift For Laeger Jan 2017Tuberous breast deformity is a relatively rare breast anomaly, manifesting during puberty. Patients usually complain of small breasts, asymmetry or dissatisfaction with... (Review)
Review
Tuberous breast deformity is a relatively rare breast anomaly, manifesting during puberty. Patients usually complain of small breasts, asymmetry or dissatisfaction with the shape of the breast. Objectively, patients present with reduced breast base, displaced inframammary fold, hypoplasia, asymmetry, ptosis and areola herniation. The surgical options are multiple, and either one- or two-stage procedures can be planned, using expanders, implants, "unfurling", lipografting or a combination of these. Surgical treatment leads to a high degree of patient satisfaction and low complication rates.
Topics: Breast; Female; Humans; Mammaplasty; Patient Satisfaction
PubMed: 28115051
DOI: No ID Found -
Revue Medicale de Liege Jul 2022The autologous fat injection technique, called lipofilling or lipomodeling, is used in both aesthetic and reconstruction procedures. Lipofilling is rarely accompanied by...
The autologous fat injection technique, called lipofilling or lipomodeling, is used in both aesthetic and reconstruction procedures. Lipofilling is rarely accompanied by complications. We report the case of a young female patient who had undergone breast lipofilling before and who developed significant recurrent but self-limiting inflammatory mastitis in the previously injected breast during two successive pregnancies. To our knowledge, no case of post-lipofilling inflammatory mastitis induced by pregnancy has been described to date. This case suggests an interaction between autologous fat injected into the breast and hormonal impregnation linked to pregnancy. This interaction would create a local environment conducive to the occurrence of an inflammatory reaction, according to a pathophysiological mechanism yet to be defined.
Topics: Adipose Tissue; Breast Neoplasms; Female; Humans; Mammaplasty; Mastitis; Pregnancy
PubMed: 35924505
DOI: No ID Found -
Medicina (Kaunas, Lithuania) Mar 2024Implant-based breast reconstruction (IBBR) is the most frequently performed procedure for breast reconstruction following mastectomy, which involves the surgical... (Review)
Review
Implant-based breast reconstruction (IBBR) is the most frequently performed procedure for breast reconstruction following mastectomy, which involves the surgical placement of breast implants. The approach to breast reconstruction can be divided into two main categories, namely prepectoral breast reconstruction (PPBR) and subpectoral breast reconstruction (SPBR), based on the implant plan and placement technique. In recent years, there has been a significant surge in the popularity of prepectoral implant-based breast reconstruction, where the implants are positioned above the chest muscle, as opposed to beneath it in the subpectoral approach. However, despite this growing preference, there is a lack of comprehensive data regarding the national trends in the utilization of this technique, thus necessitating further investigation. This narrative review aims to ascertain the current global patterns linked to prepectoral breast reconstruction and elucidate the considerations surrounding patient and implant selection, reconstructive techniques, the utilization of meshes in prepectoral reconstruction, the ensuing outcomes and complications, the ramifications of radiotherapy, and the potential advantages of integrating fat infiltration into the implementation of this technique in breast reconstruction with a focus on published papers in last five years. Conclusion: Prepectoral breast reconstruction has emerged as an appropriate surgical option for individuals seeking breast reconstruction. This development can be attributed to the recent progress made in implant technology, which has significantly enhanced the outcomes of this procedure. Additionally, advancements in mastectomy techniques, autologous fat grafting, and the use of acellular dermal matrices (ADMs) have also played a vital role in improving the aesthetic results of prepectoral breast reconstruction. As a result, the significance and effectiveness of this technique in the field of breast reconstruction have been firmly established, making it an essential component of the overall armamentarium available to plastic surgeons for breast reconstruction purposes.
Topics: Humans; Female; Mastectomy; Breast Neoplasms; Pectoralis Muscles; Mammaplasty; Breast Implantation; Retrospective Studies
PubMed: 38541157
DOI: 10.3390/medicina60030431