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Handchir Mikrochir Plast Chir 2022 Jun 21. Epub 2022 Jun 21.

Plastische und Ästhetische Chirurgie, Sana Krankenhaus Gerresheim, Düsseldorf, Germany.

Introduction: The ideal technical and chronological approach of breast reconstruction in case of planned radiotherapy after mastectomy (post-mastectomy radiotherapy, PMRT) continues to be controversially discussed.

Methods: The authors analysed the MEDLINE Database PubMed for relevant studies concerning PMRT and breast reconstruction. The main theses from these publications were extracted and summarised. Read More

Front Oncol 2022 23;12:815498. Epub 2022 May 23.

Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Background: Breast reconstruction is a promising surgical technique to improve health-related quality of life (HRQoL) in patients with breast cancer. However, the long-term risk factors associated with HRQoL after breast surgery are still unclear. Our aim was to evaluate breast satisfaction and HRQoL following breast reconstruction to identify clinical factors associated with each domain of BREAST-Q in the long-term. Read More

Plast Reconstr Surg Glob Open 2022 Apr 13;10(4):e4261. Epub 2022 Apr 13.

Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, Calif.

Prosthetic breast reconstruction via the subpectoral approach in morbidly obese patients (body mass index: ≥40 kg/m) has been reported to be associated with an increased risk of perioperative complications and poor outcomes. Further, immediate reconstruction appears to carry a higher risk of poor outcomes than delayed reconstruction in this population. The impact of morbid obesity on outcomes after prepectoral breast reconstruction has not yet been evaluated, and such was the purpose of this study. Read More

Gland Surg 2022 Jan;11(1):1-11

Department of Surgery, Ajou University School of Medicine, Suwon, Korea.

Background: Numerous risk factors for the complications of two-stage, immediate implant-based breast reconstruction have been identified, although few studies have directly examined the impact of breast size and expansion protocols on the surgical outcomes of breast reconstruction. This study aimed to evaluate the impact of breast size, expansion velocity, and volume-related variables on postoperative complications of breast reconstruction.

Methods: The cohort involved patients who underwent immediate breast expander reconstruction at a single center between 2017 and 2019. Read More

Plast Surg (Oakv) 2022 Feb 19;30(1):25-31. Epub 2021 May 19.

Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada.

Purpose: Surgical site infections (SSI) in prosthesis-based breast reconstruction can have a significant impact on patient outcome. Despite current guidelines recommending 24 hours of postoperative antibiotics, various perioperative antimicrobial regimens are reported in the literature. Consensus on the optimal duration of antibiotics remains unclear. Read More

Contemp Oncol (Pozn) 2021 5;25(4):291-294. Epub 2022 Jan 5.

Clinic of Surgical Oncology, Poznan University of Medical Sciences, Poznań, Poland.

Introduction: Infection is one of the most common complications of breast reconstruction. The presence of bacterial biofilm on the implant surface does not always manifest itself clinically as an infection. Still little is known about the factors that trigger the transition from a normal to a pathological state. Read More

Clin Hemorheol Microcirc 2022 ;80(4):389-397

University Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg andCaritas Hospital St. Josef, Regensburg, Germany.

Background: Autologous fat grafting (AFG) has been established over the past two decades as an additive technique during and after breast reconstruction. Complete reconstruction of the breast mound with AFG alone represents an exceptional technique that has been published mostly in case reports or in studies with limited cases.The purpose of this study is to investigate the influence of three different techniques for breast reconstruction on the recovery of skin sensitivity at the reconstructed breast. Read More

Breast Cancer 2022 Mar 14;29(2):302-313. Epub 2021 Nov 14.

Breast Surgery, Breast Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, University of Florence, L.go Brambilla 3, 50134, Florence, Italy.

We re-evaluated acute and early-late toxicity-related factors among pre-pectoral immediate tissue expander/implant (TE/I) breast reconstruction (BR) unselected, first-era, cases, including previous breast radiation treatment and post-mastectomy radiation therapy (PMRT). A retrospective analysis of 146 (117 therapeutic and 29 prophylactic) pre-pectoral reconstructions, between 2012 and 2016, considered patient-related (age, body mass index [BMI], smoke-history, comorbidity, BRCA mutation), and treatment-related characteristics (previous irradiation, axillary surgery, PMRT, pre- and postoperative chemotherapy, endocrine therapy, and target-therapy). Safety was evaluated as acute and early-late complications, and TE/I failures. Read More

Plast Reconstr Surg 2022 Jan;149(1):1e-12e

From the Departments of Radiation Oncology, Plastic Surgery, and Surgery and the Biostatistics Center, Massachusetts General Hospital, Harvard Medical School; and Department of Clinical Oncology, Alexandria University.

Background: The purpose of this study was to create a nomogram using machine learning models predicting risk of breast reconstruction complications with or without postmastectomy radiation therapy.

Methods: Between 1997 and 2017, 1617 breast cancer patients undergoing mastectomy and breast reconstruction were analyzed. Those with autologous, tissue expander/implant, and single-stage direct-to-implant reconstruction were included. Read More

Ann Surg Oncol 2022 Feb 30;29(2):1100-1108. Epub 2021 Sep 30.

Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Background: Two-stage tissue expander/implant-based method has been used predominantly for breast reconstruction. Implant rupture is one of the bothersome complications, inducing additional morbidity including reoperation. The present study aimed to identify the independent factors associated with development of implant rupture. Read More

Ann Plast Surg 2021 10;87(4):396-401

From the Department of Head, Neck, Plastic and Reconstructive Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY.

Background: Despite best practices, infection remains the most common complication after breast reconstruction with expanders and implants, ranging from 2% to 29%. Empiric broad-spectrum antibiotics are frequently used in nonsurgical treatment of implant-associated infections in an effort to salvage the reconstruction. Pitfalls of antibiotherapy include adverse events, vascular access site complications, and drug resistance. Read More

Plast Reconstr Surg 2021 10;148(4):703-716

From the Divisions of Plastic and Reconstructive Surgery and Departments of Surgery, Mayo Clinic Rochester, Jacksonville, and Scottsdale; and Mayo Clinic Alix School of Medicine.

Background: Obesity is a risk factor for complications in breast reconstruction. Thus, implant-based immediate breast reconstruction in obese women may be controversial. The authors analyzed obese patients who underwent skin-sparing mastectomy using Wise-pattern incisions (Goldilocks procedure) and compared outcomes between two groups: Goldilocks with immediate breast reconstruction and Goldilocks only. Read More

ANZ J Surg 2021 09 10;91(9):1751-1758. Epub 2021 Aug 10.

Breast and Endocrine Surgery Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.

Background: Breast reconstruction (BR) often forms part of a patient's breast cancer journey. Revision surgery may be required to maintain the integrity of a BR, although this is not commonly reported in the literature. Different reconstructive methods may have differing requirements for revision. Read More

Aesthetic Plast Surg 2021 12 4;45(6):2581-2590. Epub 2021 Aug 4.

Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.

Background: Biological matrix-assisted one-stage implant-based breast reconstruction (IBBR) could improve the inframammary fold to achieve good esthetic results. However, whether biological matrix-assisted one-stage IBBR yields better postoperative outcomes compared with two-stage IBBR remains unclear. We aimed to compare and analyze surgical complications and patient-reported outcomes (PROs) based on the BREAST-Q version 2. Read More

Acta Biomed 2021 07 1;92(3):e2021228. Epub 2021 Jul 1.

Plastic and Reconstructive Microsurgery - Careggi University Hospital - Florence.

Background The aim of this retrospective study is to evaluate the patient-reported outcome after immediate ADM-assisted implant- based breast reconstruction. Material and Methods Patients underwent breast reconstruction from 2015 to 2019 have been retrospectively divided into group A (partial subpectoral implant and ADM and group B (expander/implant). For each patient we evaluated retrospectively postoperative complications and patients' satisfaction. Read More

Am Surg 2021 Jun 27:31348211029866. Epub 2021 Jun 27.

Division of Plastic and Reconstructive Surgery, Department of Surgery, 1867Tufts Medical Center, Boston, MA, USA.

Introduction: Following breast cancer surgery, patients often require adjuvant radiation and chemotherapy for locoregional and systemic disease control. These procedures may result in postoperative complications, which may delay adjuvant therapy. To potentially decrease these complications, hemostatic agents may be used. Read More

BMC Cancer 2021 May 8;21(1):522. Epub 2021 May 8.

Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Hsing Street, Kweishan, Taoyuan, 33305, Taiwan.

Background: Neoadjuvant chemotherapy (NACT) was initially applied to locally advanced breast cancer to convert advanced lesions to an operable status. Currently, its application has been expanded to enhance overall oncological results, especially in patients with triple-negative or HER-2-positive breast cancer. With more NACT being applied, the role and impact of this approach on breast reconstruction needs to be determined. Read More

Chirurgia (Bucur) 2021 Mar-Apr;116(2):224-231

Background And Objectives: Nowadays, breast cancer treatment spans from simple lesion excision to complex management including surgery (mastectomy with or without axillary lym-phadenectomy) and adjuvant treatment (chemotherapy, radiotherapy, hormonal therapy and im-munotherapy). Lately, breast reconstruction has become part of the breast cancer approach, but, while its physical and emotional benefits are undisputed, it comes with its own set of risks and complications, especially when delayed breast reconstruction after radiotherapy is performed. This paper aims to present our experience on the effects of radiotherapy in conjunction with de-layed alloplastic breast reconstruction. Read More

Aesthetic Plast Surg 2021 12 28;45(6):3090-3091. Epub 2021 Apr 28.

Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy.

Breast surgeons seem to agree on the fact that a same-day surgery (mastectomy and breast reconstruction) protocol provides appropriate cancer treatment during times of unprecedented resource limitations, such as in the COVID era. In this scenario, pre-pectoral implant-based breast reconstruction can be definitively considered a sustainable technique. Nevertheless, the authors focus on the management of patients who had already undergone a same day procedure with two-stage breast reconstruction, implanting a breast tissue expander during the last two-year period and have been progressively delayed according to a surgical care based on priority. Read More

Ann Plast Surg 2021 07;87(1s Suppl 1):S2-S6

From the Division of Plastic Surgery, Columbia University Irving Medical Center.

Background: An increasing number of women are choosing to undergo contralateral prophylactic mastectomy with immediate bilateral breast reconstruction. Operating on the contralateral noncancer side is not without its own set of risks. We sought to compare complication rates between the cancerous and contralateral prophylactic breasts. Read More

Anticancer Res 2021 Apr;41(4):1903-1908

Department of Plastic Surgery, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, U.S.A.

Background/aim: We employed a survey to the American Society of Plastic Surgeons (ASPS) to investigate the management of breast reconstruction across the US during the COVID-19 pandemic.

Patients And Methods: An electronic survey on breast reconstruction practice demographics, COVID-19-related restrictions on breast reconstruction, and pertinent dates of restrictions was employed.

Results: A total of 228 responses were obtained. Read More

Plast Reconstr Surg 2021 04;147(4):579e-586e

From the Department of Plastic Surgery, Memorial Sloan Kettering Cancer Center.

Background: In the United States, approximately 57,000 tissue expander/implant-based breast reconstructions are performed each year. Complete submuscular tissue expander coverage affords the best protection against implant exposure but can restrict lower pole expansion. The benefits of using acellular dermal matrix are enticing, but questions remain as to whether or not its presence increases reconstructive failures. Read More

Plast Reconstr Surg 2021 03;147(3):545-555

From the Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine.

Background: In two-stage prosthetic breast reconstruction, two types of tissue expanders are used for the first stage: microtextured Siltex and macrotextured Biocell. Despite emerging concerns regarding the safety of macrotextured prostheses, the association between the use of macrotextured expanders and adverse outcomes remains unknown clinically. This study aimed to evaluate potential impacts of the type of tissue expander on the long-term outcomes of implant-based breast reconstruction. Read More

Aesthet Surg J 2021 10;41(11):1252-1262

Background: Biofilm-associated bacteria have been observed in both breast implant revision and tissue expander-implant exchange surgeries. The utilization of antimicrobial solutions in breast surgery, especially those containing triple antibiotics (TAB) and/or 10% povidone-iodine (PI), may help reduce existing biofilm-associated bacteria, which is particularly important in a mature breast pocket that may contain residual bacteria from a previously colonized implant surface or, theoretically, bacteria that may arrive postoperatively through hematogenous spread.

Objectives: A series of in vitro assessments was performed to evaluate the antimicrobial utility of TAB and PI, either alone or in combination, against preformed biofilm-associated bacteria. Read More

J Plast Surg Hand Surg 2021 Feb 20;55(1):6-12. Epub 2021 Jan 20.

Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Seoul, Korea.

Although an anatomical implant is no longer recommended in practice, frequent use of the implants in the past decade left apprehension to surgeons, and malrotation is one of the concerns. However, a limited amount of literature has focused on malrotation to date, especially in breast reconstruction, and there also exists a lack of consensus regarding the correction of malrotation. Given that implant-based reconstruction has increased in frequency and there remain many potential patients who have used earlier models of anatomical implants, this study sought to analyze predisposing risk factors and approaches to correct implant malrotation. Read More

Ann Plast Surg 2021 11;87(5):501-505

From the Department of Plastic Surgery, Asan Medical Center, University of Ulsan, School of Medicine, Seoul, Republic of Korea.

Background And Objectives: Despite expander-based breast reconstruction being used as a reliable reconstruction method, implant removal due to wound dehiscence and infection still occurs in 0.5% to 15% of cases. This study aimed to compare the outcomes of the new inframammary fold (IMF) incision approach with previous incision in second-stage operation of expander-based 2-stage breast reconstruction. Read More

Aesthet Surg J 2022 01;42(2):171-180

From the Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.

Background: Concerns about the safety of silicone breast implants (SBIs) have existed for years, but a causal relation between systemic complaints and SBIs has not been proven. Nevertheless, some women are worried and even request explantation.

Objectives: This study aimed to review the explantation procedures performed, focusing on patient-reported symptoms preoperatively, the effect of explantation, and the effect of breast reconstruction on these symptoms. Read More

Gland Surg 2020 Oct;9(5):1182-1192

Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Background: Contralateral augmentation mammoplasty in implant-based reconstruction could potentially lead to deterioration of the thickness of the mastectomy skin flap and increase postoperative complications of the reconstructed breast. We compared the complication rates of the reconstructed breast in the augmentation and no-augmentation groups among patients undergoing tissue expander/implant breast reconstruction.

Methods: Patients who underwent mastectomy followed by tissue expander/implant breast reconstruction between February 2010 and April 2018 were retrospectively reviewed. Read More

Surg Today 2021 Jun 13;51(6):862-871. Epub 2020 Nov 13.

Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Japan.

Advances in multi-modality treatments incorporating systemic chemotherapy, endocrine therapy, and radiotherapy for the management of breast cancer have resulted in a surgical-management paradigm change toward less-aggressive surgery that combines the use of breast-conserving or -reconstruction therapy as a new standard of care with a higher emphasis on cosmesis. The implementation of skin-sparing and nipple-sparing mastectomies (SSM, NSM) has been shown to be oncologically safe, and breast reconstructive surgery is being performed increasingly for patients with breast cancer. NSM and breast reconstruction can also be performed as prophylactic or risk-reduction surgery for women with BRCA gene mutations. Read More

Plast Reconstr Surg Glob Open 2020 Oct 11;8(10):e3179. Epub 2020 Apr 11.

Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Ontario.

Background: To determine the superiority of autologous abdominal tissue (AAT) or tissue-expander implant (TE/I) reconstruction, a robust comparative cohort study is required. This study sought to determine the feasibility of a future large pragmatic cohort study comparing clinical and cost-effectiveness of AAT and TE/I at 12 months postoperative.

Methods: Potential participants were screened during consultation with their surgeon. Read More