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Journal of Plastic, Reconstructive &... Feb 2022Lipomodelling has become increasingly popular for reconstructive, aesthetic and therapeutic indications. The guidelines summarise available evidence for indications,... (Review)
Review
Lipomodelling has become increasingly popular for reconstructive, aesthetic and therapeutic indications. The guidelines summarise available evidence for indications, training, technique, audit and outcomes in lipomodelling and also highlight areas for further research.
Topics: Adipose Tissue; Breast Neoplasms; Female; Humans; Mammaplasty; Plastics; Surgery, Plastic; United Kingdom
PubMed: 34895855
DOI: 10.1016/j.bjps.2021.09.033 -
The impact of breast reduction surgery on breastfeeding: Systematic review of observational studies.PloS One 2017Almost half a million breast reduction surgeries are performed internationally each year, yet it is unclear how this type of surgery impacts breastfeeding. This is... (Review)
Review
BACKGROUND
Almost half a million breast reduction surgeries are performed internationally each year, yet it is unclear how this type of surgery impacts breastfeeding. This is particularly important given the benefits of breastfeeding.
OBJECTIVES
To determine if breast reduction surgery impacts breastfeeding success and whether different surgical techniques differentially impact breast feeding success.
METHODS
Databases were searched up to September 5, 2017. Studies were included if they reported the number of women successful at breastfeeding or lactation after breast reduction surgery, and if they reported either the total number of women who had children following breast reduction surgery, or the total number of women who attempted to breastfeed following surgery.
RESULTS
Of 1,212 studies, 51 studies met the inclusion criteria; they were located worldwide and had 31 distinct breast reduction techniques. The percentage of breastfeeding success among studies was highly variable. However, when analyzed by the preservation of the column of parenchyma from the nipple areola complex to the chest wall (subareolar parenchyma), a clear pattern emerged. The median breastfeeding success was 4% (interquartile range (IQR) 0-38%) for techniques with no preservation, compared to 75% (IQR 37-100%) for techniques with partial preservation and 100% (IQR 75-100%) for techniques with full preservation.
CONCLUSIONS
Techniques that preserve the column of subareolar parenchyma appear to have a greater likelihood of successful breastfeeding. The preservation of the column of subareolar parenchyma should be disclosed to women prior to surgery. Guidelines on the best breast reduction techniques to be used in women of child bearing years may be advantageous to ensure women have the greatest potential for successful breastfeeding after breast reduction surgery.
Topics: Breast Feeding; Female; Humans; Mammaplasty
PubMed: 29049351
DOI: 10.1371/journal.pone.0186591 -
JAMA Surgery Oct 2018In breast reconstruction, it is critical for patients and surgeons to have comprehensive information on the relative risks of the available options. However, previous... (Comparative Study)
Comparative Study
IMPORTANCE
In breast reconstruction, it is critical for patients and surgeons to have comprehensive information on the relative risks of the available options. However, previous studies that evaluated complications were limited by single-center designs, inadequate follow-up, and confounding.
OBJECTIVE
To assess 2-year complication rates across common techniques for postmastectomy reconstruction in a multicenter patient population.
DESIGN, SETTING, AND PARTICIPANTS
This longitudinal, multicenter, prospective cohort study conducted from February 1, 2012, through July 31, 2015, took place at the 11 study sites associated with the Mastectomy Reconstruction Outcomes Consortium study. Eligible patients included women 18 years and older presenting for first-time breast reconstruction with at least 2 years of follow-up. Procedures evaluated included direct-to-implant (DTI) technique, expander-implant (EI) technique, latissimus dorsi (LD) flap, pedicled transverse rectus abdominis myocutaneous (pTRAM) flap, free transverse rectus abdominis myocutaneous (fTRAM) flap, deep inferior epigastric perforator (DIEP) flap, and superficial inferior epigastric artery (SIEA) flap.
INTERVENTIONS
Postmastectomy breast reconstruction.
MAIN OUTCOMES AND MEASURES
Development of complications, reoperative complications, and wound infections during 2-year follow-up. Mixed-effects logistic regression analysis controlled for variability among centers and for demographic and clinical variables.
RESULTS
A total of 2343 patients (mean [SD] age, 49.5 [10.1] years; mean [SD] body mass index, 26.6 [5.7]) met the inclusion criteria. A total of 1525 patients (65.1%) underwent EI reconstruction, with 112 (4.8%) receiving DTI reconstruction, 85 (3.6%) pTRAM flaps, 95 (4.1%) fTRAM flaps, 390 (16.6%) DIEP flaps, 71 (3.0%) LD flaps, and 65 (2.8%) SIEA flaps. Overall, complications were noted in 771 (32.9%), with reoperative complications in 453 (19.3%) and wound infections in 230 (9.8%). Two years postoperatively, patients undergoing any autologous reconstruction type had significantly higher odds of developing any complication compared with those undergoing EI reconstruction (pTRAM flap: odds ratio [OR], 1.91; 95% CI, 1.10-3.31; P = .02; fTRAM flap: OR, 2.05; 95% CI, 1.24-3.40; P = .005; DIEP flap: OR, 1.97; 95% CI, 1.41-2.76; P < .001; LD flaps: OR, 1.87; 95% CI, 1.03-3.40; P = .04; SIEA flap: OR, 4.71; 95% CI, 2.32-9.54; P < .001). With the exception of LD flap reconstructions, all flap procedures were associated with higher odds of reoperative complications (pTRAM flap: OR, 2.48; 95% CI, 1.33-4.64; P = .005; fTRAM flap: OR, 3.02; 95% CI, 1.73-5.29; P < .001; DIEP flap: OR, 2.76; 95% CI, 1.87-4.07; P < .001; SIEA flap: OR, 2.62; 95% CI, 1.24-5.53; P = .01) compared with EI techniques. Of the autologous reconstructions, only patients undergoing DIEP flaps had significantly lower odds of infection compared with those undergoing EI procedures (OR, 0.45; 95% CI, 0.25-0.29; P = .006). However, DTI and EI procedures had higher failure rates (EI and DTI techniques, 7.1%; pTRAM flap, 1.2%; fTRAM flap, 2.1%; DIEP flap, 1.3%; LD flap, 2.8%; and SIEA flap, 0%; P < .001).
CONCLUSIONS AND RELEVANCE
Significant differences were noted across reconstructive procedure types for overall and reoperative complications, which is critically important information for women and surgeons making breast reconstruction decisions.
Topics: Adult; Breast Implants; Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy; Postoperative Care; Postoperative Complications; Prospective Studies; Regression Analysis; Surgical Flaps; Transplantation, Autologous
PubMed: 29926077
DOI: 10.1001/jamasurg.2018.1687 -
Journal of UOEH 2023Few studies have examined the effect of immediate breast reconstruction (IBR) on the overall progression of breast cancer therapy. This study examins the effect of IBR...
Few studies have examined the effect of immediate breast reconstruction (IBR) on the overall progression of breast cancer therapy. This study examins the effect of IBR on the breast cancer therapy. 142 patients underwent mastectomy in our department (With IBR group, n = 17; Without IBR group, n = 125). We examined the number of days from diagnosis to surgery, operation time, length of postoperative stay, number of days from surgery to postoperative therapy, and complications in patients with or without breast reconstruction and by type of reconstruction. In the IBR group, the operation time was longer (P < 0.001), postoperative hospital stay was longer when adjusted for multivariate analysis (P = 0.008), and complications were significantly more common (P < 0.001), but there was no significant difference when limited to grade ≥3 complications. There was no difference until the start of postoperative treatment. The results reveal that IBR requires coordination between the surgical and operating room staff, and does not affect the transition to postoperative treatment but does affect an increased incidence of minor complications and length of postoperative stay.
Topics: Humans; Female; Breast Neoplasms; Mastectomy; Mammaplasty; Chemotherapy, Adjuvant; Retrospective Studies; Postoperative Complications
PubMed: 38057108
DOI: 10.7888/juoeh.45.199 -
Aesthetic Plastic Surgery Dec 2023Capsular contracture (CC) is one of the most common complications of implant-based breast reconstruction or augmentation surgery. Common risk factors of CC include... (Review)
Review
Capsular contracture (CC) is one of the most common complications of implant-based breast reconstruction or augmentation surgery. Common risk factors of CC include biofilm, surgical site infections, history of prior CC or fibrosis, history of radiation therapy, and implant characteristics. Though bacterial contamination of breast protheses is associated with adverse sequelae, there are not universally accepted guidelines and limited best practice recommendations for antimicrobial breast pocket irrigation. Despite advanced molecular biology, the exact mechanism of this complication is not fully understood. Interventions that decrease the rate of CC include antibiotic prophylaxis or irrigation, acellular dermal matrix, leukotriene inhibitors, surgical techniques, and others. However, there is inconsistent evidence supporting these risk factors, and the current data was based on broad heterogeneous studies. The objective of this review was to provide a summary of the current data of contributing risk factors as well as preventative and treatment measures for CC.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 the Table of Contents or the online Instructions to Authors http://www.springer.com/00266.
Topics: Humans; Breast Implants; Breast Implantation; Incidence; Mammaplasty; Anti-Infective Agents; Contracture; Implant Capsular Contracture; Retrospective Studies; Treatment Outcome; Follow-Up Studies
PubMed: 37410129
DOI: 10.1007/s00266-023-03453-5 -
Journal of Plastic Surgery and Hand... 2023The challenge in the operative therapy for enlargement of the male breast is to deal with the skin excess. Shape and scars are the major parameters after which patients... (Review)
Review
OBJECTIVES
The challenge in the operative therapy for enlargement of the male breast is to deal with the skin excess. Shape and scars are the major parameters after which patients assess their operative result. Therefore, we assessed the satisfaction rate among patients undergoing subcutaneous mastectomy at our institution with special regard to scar tissue formation and the postoperative appearance of the chest wall in dependence of the surgical approach (periarolar versus inframammary fold).
METHODS
The study includes = 36 male patients who underwent subcutaneous mastectomy at AGAPLESION Markus Hospital Frankfurt/Main. Patient's satisfaction dependent with the appearance of the chest wall and scar formation was evaluated by a modified BREAST Q® questionnaire plus two male-based additional questions.
RESULTS
There is no statistically significant difference in satisfaction with the operative result depending on the pattern of incision (periareolar versus submammary periareolar; 81.9% versus 75.5%) with the operative result. Evaluation of additional questions of the modified BREAST Q® questionnaire showed that 86% of the patients ( = 31) would rather have more scars and a flatter chest wall. A BMI >25 kg/m is accompanied by a higher risk for complications ( = 0.04).
CONCLUSIONS
Periareolar incision is still the method of choice, if promising an aesthetic appealing result. When reaching its limits though, we showed that a flat and male-shaped appearance of the chest wall is priority for the patients and should therefore be for the surgeon as well.
Topics: Humans; Male; Cicatrix; Gynecomastia; Breast Neoplasms; Mastectomy; Retrospective Studies; Patient Reported Outcome Measures; Patient Satisfaction; Mammaplasty
PubMed: 34591727
DOI: 10.1080/2000656X.2021.1981349 -
Archives of Gynecology and Obstetrics Jun 2022To achieve long-term improvement in health care of transgender women, it is necessary to analyze all aspects of gender-confirming surgery, especially the relation of...
BACKGROUND
To achieve long-term improvement in health care of transgender women, it is necessary to analyze all aspects of gender-confirming surgery, especially the relation of risks and benefits occurring in these procedures. While there are many studies presenting data on the urologic part of the surgery, there are just few data about complications and satisfaction with breast augmentation.
METHODS
This is a retrospective study using parts of the BREAST-Q Augmentation Questionnaire and additional questions for symptoms of capsular contracture and re-operations and analyzing archived patient records of all transwomen which were operated at University Hospital Essen from 2007 to 2020.
RESULTS
99 of these 159 patients (62%) completed the questionnaire after a median time of 4 years after surgery. Breast augmentation led to re-operations due to complications in 5%. The rate of capsular contracture (Baker Grad III-IV) in this population was 3%. Most patients (75%) rated high scores of satisfaction with outcome (more than 70 points) and denied to have restrictions due to their implants in their everyday life. All patients reported an improvement in their quality of life owing to breast augmentation.
CONCLUSION
Breast augmentation by inserting silicon implants is a safe surgical procedure which takes an important part in reducing gender dysphoria.
Topics: Breast Implantation; Breast Implants; Contracture; Female; Follow-Up Studies; Humans; Mammaplasty; Patient Satisfaction; Personal Satisfaction; Quality of Life; Retrospective Studies
PubMed: 35597817
DOI: 10.1007/s00404-022-06603-3 -
Plastic and Reconstructive Surgery Dec 2020Implementation of payment reform for breast reconstruction following mastectomy demands a comprehensive understanding of costs related to the complex process of...
BACKGROUND
Implementation of payment reform for breast reconstruction following mastectomy demands a comprehensive understanding of costs related to the complex process of reconstruction. Bundled payments for services to women with breast cancer may profoundly impact reimbursement and access to breast reconstruction. The authors' objectives were to determine the contribution of cancer therapies, comorbidities, revisions, and complications to costs following immediate reconstruction and the optimal duration of episodes to incentivize cost containment for bundled payment models.
METHODS
The cohort was composed of women who underwent immediate breast reconstruction between 2009 and 2016 from the MarketScan Commercial Claims and Encounters database. Continuous enrollment for 3 months before and 24 months after reconstruction was required. Total costs were calculated within predefined episodes (30 days, 90 days, 1 year, and 2 years). Multivariable models assessed predictors of costs.
RESULTS
Among 15,377 women in the analytic cohort, 11,592 (75 percent) underwent tissue expander, 1279 (8 percent) underwent direct-to-implant, and 2506 (16 percent) underwent autologous reconstruction. Adjuvant therapies increased costs at 1 year [tissue expander, $39,978 (p < 0.001); direct-to-implant, $34,365 (p < 0.001); and autologous, $29,226 (p < 0.001)]. At 1 year, most patients had undergone tissue expander exchange (76 percent) and revisions (81 percent), and a majority of complications had occurred (87 percent). Comorbidities, revisions, and complications increased costs for all episode scenarios.
CONCLUSIONS
Episode-based bundling should consider separate bundles for medical and surgical care with adjustment for procedure type, cancer therapies, and comorbidities to limit the adverse impact on access to reconstruction. The authors' findings suggest that a 1-year time horizon may optimally capture reconstruction events and complications.
Topics: Administrative Claims, Healthcare; Adult; Breast Implants; Breast Neoplasms; Cohort Studies; Female; Health Care Costs; Health Care Reform; Health Services Accessibility; Humans; Income; Insurance, Health; Mammaplasty; Mastectomy; Middle Aged; Surgical Flaps; Tissue Expansion Devices; Transplantation, Autologous; United States
PubMed: 33234949
DOI: 10.1097/PRS.0000000000007329 -
International Journal of Surgery... 2011With the rise in childhood obesity, an increase in the number of patients seeking adolescent breast reduction has been appreciated. This study examines our experience...
INTRODUCTION
With the rise in childhood obesity, an increase in the number of patients seeking adolescent breast reduction has been appreciated. This study examines our experience with presenting symptoms, techniques, and both surgical and pathologic outcomes for reduction mammaplasty in the adolescent population.
METHODS
Medical records of 76 consecutive patients under 18 years of age who underwent reduction mammaplasty over a 10 year period were identified and reviewed for BMI, symptoms, comorbidities, cancer history, surgical technique, resection weight, pathologic findings, and complications. Pathology costs were determined from billing records.
RESULTS
Operative indications included neck, back, and/or shoulder pain (75%), intertrigo (8%), shoulder grooving (17%), difficulty finding bras (8%) and participating in sports (9%), and social distress (24%). Average BMI was 31 kg/m(2) and 65% of children were obese (BMI > 30). Surgical techniques included Wise pattern (93%) and superior pedicle (7%). Complications occurred in 8 patients (10.5%). Pathologic examination yielded no cancers with 80% normal or mildly fibrotic and 20% benign histology. Per breast reduction specimen, pathology internal costs and external costs by Medicare data averaged $65 and $118, respectively.
CONCLUSIONS
Adolescent mammaplasty patients present symptoms mirroring those of the adult population but also exhibit greater obesity, physical strain, social distress, and comorbid psychiatric disorders. Literature reports similar complication rates for adults as we found in our adolescent population. We recommend that surgeons strongly consider reduction mammaplasty in the carefully selected adolescent with macromastia, with realistic expectations and complications in this burgeoning group. Routine pathologic examination, however, is not a cost effective goal.
Topics: Adolescent; Breast; Female; Humans; Hypertrophy; Mammaplasty; Obesity
PubMed: 21146642
DOI: 10.1016/j.ijsu.2010.12.001 -
World Journal of Surgical Oncology Feb 2022Lateral excess tissue after mastectomy is a frequent problem, which should be included into preoperative planning. Women with lateral tissue abundance are frequently...
BACKGROUND
Lateral excess tissue after mastectomy is a frequent problem, which should be included into preoperative planning. Women with lateral tissue abundance are frequently impaired cosmetically and functionally. We suggest a novel oncoplastic mastectomy technique to eliminate the above mentioned.
METHODS
Surgical technique Two small horizontal lines are drawn, one line above and one line below the Nipple Areola Complex. These lines should represent the possible skin excision and allow tight skin closure. Consecutively, two ending points of the incision are planned, one close to the xyphoid area and the other one in the anterior axillary line. These points are then interconnected in an s-shaped manner to form a double s-shaped skin excision.
RESULTS
The double S-shaped technique is an easy reproducible technique which not only allows good access to the lateral side of the mastectomy, but also and mainly the reduction of lateral fat and skin.
CONCLUSION
The double S mastectomy allows for simultaneous removal of access in the axillary region, eliminating skin, and fat as needed and preventing the lateral dog ear.
Topics: Breast Neoplasms; Esthetics; Female; Humans; Mammaplasty; Mastectomy; Nipples
PubMed: 35189907
DOI: 10.1186/s12957-022-02515-3