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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 Apr 28. 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 Mar 18. Epub 2021 Mar 18.

From the Division of Plastic Surgery, Columbia University Irving Medical Center Columbia University Medical School, New York, NY.

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 Mar;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

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 2020 Dec 15;Publish Ahead of Print. Epub 2020 Dec 15.

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

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 2020 Nov 13. 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

Plast Reconstr Surg Glob Open 2020 Oct 11;8(10):e2986. Epub 2020 Apr 11.

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

Background: Patients who had undergone both autologous abdominal tissue (AAT) and tissue expander and implant (TE/I) breast reconstruction reported satisfaction with their reconstruction. While aesthetics and quality of life are important, the cost associated with these procedures must also be considered when choosing one method over the other. The objective of this study was to determine whether AAT-based breast reconstruction is cost-effective compared with 2-stage TE/I reconstruction at a 12-month follow-up. Read More

J Plast Reconstr Aesthet Surg 2021 01 21;74(1):30-40. Epub 2020 Oct 21.

Section of Plastic Surgery, Department of Surgery, University of Michigan, 1500 E. Medical Center Drive, 2130 Taubman Center, SPC 5340, Ann Arbor, MI, United States. Electronic address:

Background: Although acellular dermal matrix (ADM) is widely used in expander-implant-based breast reconstructions, previous analyses have been unable to demonstrate improvements in patient-reported outcomes (PROs) with this approach over non-ADM procedures. This study aims to develop a more selective, evidence-based approach to the use of ADM in expander-implant-based breast reconstruction by identifying patient subgroups in which ADM improved clinical outcomes and PROs.

Study Design: The Mastectomy Reconstruction Outcomes Consortium Study prospectively evaluated immediate expander-implant reconstructions at 11 centers from 2012 to 2015. Read More

Plast Reconstr Surg Glob Open 2020 May 21;8(5):e2864. Epub 2020 May 21.

Breast Surgery Clinic, Tokyo, Japan.

Capsular contracture is a common complication among breast implant reconstruction patients. The aim of this study was to assess the duration of and risk factors associated with capsular contracture by comparing 2 reconstruction methods.

Methods: The medical charts of patients who received a reconstructed breast implant and underwent a capsule revision surgery were retrospectively reviewed. Read More

JAMA Surg 2020 Dec;155(12):1132-1140

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

Importance: The potential association between breast implant-related anaplastic large cell lymphoma (BIA-ALCL) and implant texture has raised concerns about the additional unexpected adverse effects of textured implants, including potentially adverse outcomes for other cancers. In addition to the risk of developing BIA-ALCL, breast cancer survivors may worry about whether the type of implant inserted is associated with recurrence of their original cancer-an issue for which little evidence currently exists.

Objective: To evaluate the oncologic outcomes of breast cancer according to the surface type of implants used for reconstruction and to identify the independent factors associated with breast cancer recurrence and survival, including implant surface type. Read More

Ann Surg Oncol 2021 Apr 24;28(4):2191-2198. Epub 2020 Sep 24.

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

Background: In immediate two-stage implant-based breast reconstruction, adjuvant chemotherapy, when indicated, is usually conducted between the stages, which might influence the outcomes of the second-stage operation.

Objective: The purpose of this study was to evaluate the potential influence of adjuvant chemotherapy on the final outcomes of two-stage implant-based reconstructions.

Methods: Patients who underwent immediate tissue expander/implant breast reconstruction between 2010 and 2016, with completion of both stages, were reviewed. Read More

Plast Reconstr Surg 2020 10;146(4):495e-496e

Plastic Surgery Hospital (Institute), Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.

Breast J 2020 11 26;26(11):2235-2236. Epub 2020 Aug 26.

Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK.

Aesthetic Plast Surg 2020 08 17;44(4):1120-1127. Epub 2013 Jul 17.

Department of Plastic and Reconstructive Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.

Background: Recent evidence suggests that the use of acellular dermal matrices in prosthetic breast reconstruction, revision, or augmentation may be associated with an increased risk of complications. In this article we report our results of a potential alternative, using a new long-term resorbable synthetic matrix in these cases.

Methods: A retrospective study was performed evaluating 11 primary breast reconstructions (19 breasts), 43 secondary reconstructions (77 breasts), 3 augmentation/augmentation mastopexys (6 breasts), and 5 mastopexys (10 breasts) in 62 patients using TIGR Matrix Surgical Mesh. Read More

Clin Breast Cancer 2020 10 23;20(5):402-407. Epub 2020 May 23.

Division of Breast Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong. Electronic address:

Introduction: Immediate breast reconstruction offers cosmetic and psychological advantages post-mastectomy. There are various options of reconstruction, and this study aims to evaluate the associated complications.

Patients And Methods: This is a single-center retrospective study analyzing data from January 1, 2008 to December 31, 2017 for immediate breast reconstruction procedures post-mastectomy performed at an academic breast unit. Read More

Breast Cancer Res Treat 2020 Aug 30;183(1):127-136. Epub 2020 Jun 30.

Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.

Purpose: To explore the optimal type of breast reconstruction and the time interval to postmastectomy radiotherapy (PMRT) associated with lower complications in breast cancer patients receiving neoadjuvant chemotherapy.

Methods: We reviewed the medical records of 300 patients who received neoadjuvant chemotherapy, mastectomy with breast reconstruction and PMRT at our institution from 2000 to 2017. Reconstruction types included autologous flaps (AR), single-stage-direct-to-implant and two-stages expander/implant (TE/I). Read More

J Plast Surg Hand Surg 2020 Oct 26;54(5):317-322. Epub 2020 Jun 26.

Pain Management and Palliative Care Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Chronic pain after breast surgery including breast reconstruction is a major concern for patients. However, the factors associated with chronic pain after breast surgery are uncertain in Japanese population. The aim of this study was to identify patient-specific and medical/surgical factors that predict chronic pain after breast surgery in Japanese patients. Read More

J Plast Reconstr Aesthet Surg 2020 07 22;73(7):1357-1404. Epub 2020 May 22.

Plastic and Reconstructive Surgery Department, Addenbrooke's Hospital Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Anglia Ruskin School of Medicine, Anglia Ruskin University, Cambridge & Chelmsford, UK; Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. Electronic address:

Plast Reconstr Surg 2020 05;145(5):917e-926e

From the Section of Plastic and Reconstructive Surgery, the Center for Statistical Consultation and Research, and the Department of Radiation Oncology, University of Michigan; and Plastic Surgery, Brigham and Women's Hospital.

Background: Whether to irradiate the tissue expander before implant exchange or to defer irradiation until after exchange in immediate, two-stage expander/implant reconstruction remains uncertain. The authors evaluated the effects of irradiation timing on complication rates and patient-reported outcomes in patients undergoing immediate expander/implant reconstruction.

Methods: Immediate expander/implant reconstruction patients undergoing postmastectomy radiation therapy at 11 Mastectomy Reconstruction Outcomes Consortium sites with demographic, clinical, and complication data were analyzed. Read More

Nagoya J Med Sci 2020 Feb;82(1):39-45

Department of Plastic and Reconstructive Surgery, Okayama University Hospital.

The popularity of a sling method using biomaterial sheets for immediate breast reconstruction based on prosthesis has been increasing in western countries. However, acellular dermal matrix, which is representative of the biomaterial sheet, is not available and the sling method also has not been accepted in Japan. We focused on a new bioabsorbable sheet (NEOVEIL sheet) as a substitute for the sling method and report a prospective study protocol to assess the safety and effectiveness of this material. Read More

Ann Plast Surg 2020 07;85(S1 Suppl 1):S63-S67

Division of Plastic and Reconstructive Surgery, Department of Surgery, Stony Brook University Hospital.

Background: Hematomas after tissue expander immediate breast reconstruction (TE-IBR) pose a significant challenge during the recovery period. In this study, we aim to evaluate whether hematoma formation leads to subsequent complications and how management can impact final reconstructive goals.

Methods: A single-institution retrospective review of TE-IBRs from 2001 to 2018 was performed using an established breast reconstruction database. Read More

Plast Reconstr Surg 2020 04;145(4):865-876

From the Section of Plastic Surgery, the School of Public Health, Center for Cancer Biostatistics, the Department of Radiation Oncology, Center for Bioethics and Social Science in Medicine, the Department of Internal Medicine, and the Department of Health Management and Policy, University of Michigan; Ann Arbor U.S. Department of Veterans Affairs Health Services Research and Development; the Department of Surgery, Memorial Sloan Kettering Cancer Center; the Department of Epidemiology, Emory University, Rollins School of Public Health; and the Department of Preventive Medicine, Keck School of Medicine, University of Southern California.

Background: Within the multidisciplinary management of breast cancer, variations exist in the reconstructive options offered and care provided. The authors evaluated plastic surgeon perspectives on important issues related to breast cancer management and reconstruction and provide some insight into factors that influence these perspectives.

Methods: Women diagnosed with early-stage breast cancer (stages 0 to II) between July of 2013 and September of 2014 were identified through the Georgia and Los Angeles Surveillance, Epidemiology, and End Results registries. Read More

Plast Reconstr Surg 2020 06;145(6):1357-1365

From the Department of Plastic Surgery, Loma Linda University Medical Center; DuPage Medical Group/DMG Aesthetics; the Department of Plastic Surgery, Central DuPage Hospital/Northwestern Medicine; Compass Oncology; and Peacehealth Medical Group.

Background: Breast reconstruction in patients with a high body mass index (BMI) (≥30 kg/m) is technically challenging and is associated with increased postoperative complications. The optimal reconstructive approach for these patients remains to be determined. This study compared outcomes of prepectoral and dual-plane reconstruction in high-BMI patients to determine whether there was an association between postoperative complications and the plane of reconstruction. Read More

Arch Plast Surg 2020 Mar 27;47(2):140-145. Epub 2020 Feb 27.

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

Background: Capsular contracture is a common complication of two-stage expander/implant breast reconstruction. To minimize the risk of this complication, capsulectomy is performed using monopolar cautery or ultrasonic surgical instrumentation, the latter of which can be conducted with a Harmonic scalpel. To date, there is disagreement regarding which of the two methods is superior. Read More