301 results match your criteria Breast Reconstruction Expander-Implant


Immediate and Long-term Complications of Direct-to-implant Breast Reconstruction after Nipple- or Skin-sparing Mastectomy.

Plast Reconstr Surg Glob Open 2018 Nov 5;6(11):e1977. Epub 2018 Nov 5.

Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.

Background: Traditionally, breast reconstruction options after mastectomy comprise an autologous flap or staged expander/implant reconstruction, or a combination of both. Recent introduction of skin or nipple-sparing mastectomies have led to much interest in direct-to-implant immediate breast reconstructions. We performed a retrospective review of our initial experience. Read More

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http://dx.doi.org/10.1097/GOX.0000000000001977DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6414105PMC
November 2018

Prepectoral breast reconstruction and radiotherapy-a closer look.

Authors:
Steven Sigalove

Gland Surg 2019 Feb;8(1):67-74

Scottsdale Center for Plastic Surgery, Scottsdale, AZ, USA.

Background: Prosthetic breast reconstruction in the setting of post-mastectomy radiation therapy (PMRT) has historically been plagued by complications and poor outcomes. We study the effects of PMRT in the setting of prepectoral prosthetic breast reconstruction in an attempt to ascertain the value of this muscle sparing technique as it relates to complications and outcomes.

Methods: A retrospective analysis was performed on patients who underwent immediate, prepectoral, direct-to-implant or two-staged expander/implant breast reconstruction following skin-sparing mastectomy (SSM) or nipple-sparing mastectomy (NSM) and had postmastectomy radiotherapy. Read More

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http://dx.doi.org/10.21037/gs.2019.01.01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6378256PMC
February 2019

Short-term cost-effectiveness of one-stage implant-based breast reconstruction with an acellular dermal matrix versus two-stage expander-implant reconstruction from a multicentre randomized clinical trial.

Br J Surg 2019 Mar 5. Epub 2019 Mar 5.

Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, the Netherlands.

Background: Implant-based breast reconstruction (IBBR) is the most commonly performed reconstructive procedure and its economic impact is significant. This study aimed to analyse whether a direct one-stage IBBR with use of an acellular dermal matrix (ADM) is more cost-effective than two-stage (expander-implant) breast reconstruction.

Methods: The BRIOS (Breast Reconstruction In One Stage) study was an open-label multicentre RCT in which women scheduled for skin-sparing mastectomy and immediate IBBR were randomized between one-stage IBBR with ADM or two-stage IBBR. Read More

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http://dx.doi.org/10.1002/bjs.11102DOI Listing

Comparative Study of Nipple-Areola Complex Position and Patient Satisfaction After Unilateral Mastectomy and Immediate Expander-Implant Reconstruction Nipple-Sparing Mastectomy Versus Skin-Sparing Mastectomy.

Aesthetic Plast Surg 2019 Apr 11;43(2):313-327. Epub 2019 Feb 11.

Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.

Background: Major surgical concerns associated with nipple-sparing mastectomy (NSM) are partial or total nipple-areola complex (NAC) loss, decreased sensation, and nipple malposition. Patient satisfaction and NAC outcomes including malposition in patients who have undergone unilateral expander-implant reconstruction after NSM as compared with skin-sparing mastectomy (SSM) remain unclear. Therefore, the aim of this study was to assess patient satisfaction and NAC outcomes of breast cancer patients who underwent spared or reconstructed NAC after unilateral NSM as compared with unilateral SSM. Read More

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http://dx.doi.org/10.1007/s00266-018-1217-8DOI Listing
April 2019
1 Read

Managing Postoperative Infection following Breast Reconstruction with the Sientra AlloX2 Tissue Expander.

Authors:
Arash Momeni

Plast Reconstr Surg Glob Open 2018 Dec 17;6(12):e2046. Epub 2018 Dec 17.

Division of Plastic and Reconstructive Surgery, Stanford University Medical Center Palo Alto, Calif.

Background: Implant-based breast reconstruction is the most common reconstructive modality in the United States. Significant advances in surgical technique and technology have resulted in improvement of clinical outcomes. A recent innovation has been the introduction of a tissue expander with an integral drain that permits access to the periprosthetic space. Read More

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http://dx.doi.org/10.1097/GOX.0000000000002046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326611PMC
December 2018
11 Reads

[Patients' satisfaction after immediate breast reconstruction: Comparison between five surgical techniques].

Ann Chir Plast Esthet 2018 Dec 28. Epub 2018 Dec 28.

Service de chirurgie plastique, hôpital Civil Strasbourg, 1, place de l'hôpital, 67091 Strasbourg, France.

Introduction: The purpose of this study is to evaluate patients' satisfaction after immediate breast reconstruction (IBR) according to the surgical technique.

Methods: Included patients had an IBR between 2012 and 2017 and finished their reconstruction since a year. Patients were contacted by phone and their satisfaction was evaluated with the Breast Q questionnaire. Read More

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http://dx.doi.org/10.1016/j.anplas.2018.12.002DOI Listing
December 2018
1 Read

Bacterial profile of suction drains and the relationship thereof to surgical-site infections in prosthetic breast reconstruction.

Arch Plast Surg 2018 Nov 15;45(6):542-549. Epub 2018 Nov 15.

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

Background: Despite the increasing popularity of prosthetic breast reconstruction, scant data exist on the microbiological profile of drainage fluid from closed-suction drains and the relationship thereof to surgical-site infections (SSIs) in breast reconstruction surgery. This study aimed to determine whether bacteria isolated from drainage fluid were associated with the development of SSIs, and whether the bacterial profile of drainage fluid could be a clinically useful predictor of SSIs.

Methods: We performed a retrospective chart review of 61 women who underwent tissue expander/implant or direct-to-implant reconstructions. Read More

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http://dx.doi.org/10.5999/aps.2018.00437DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6258990PMC
November 2018
16 Reads

Effect of breast reconstruction modality on the development of postmastectomy shoulder morbidity.

J Plast Reconstr Aesthet Surg 2018 Dec 6;71(12):1761-1767. Epub 2018 Aug 6.

Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, Korea. Electronic address:

Background: The aim of this study was to evaluate the impact of breast reconstruction modality on the incidence of shoulder morbidity.

Methods: Breast cancer patients who underwent immediate reconstructions using three modalities, namely, tissue expander-implant, latissimus dorsi (LD) pedicled flap, and deep inferior epigastric artery perforator (DIEP) flap, from 2008 to 2013 were examined. The cumulative incidence of shoulder morbidity was compared among the reconstruction modalities, and risk factor analysis was performed using multivariable analysis. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S17486815183027
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http://dx.doi.org/10.1016/j.bjps.2018.07.033DOI Listing
December 2018
10 Reads

Breast Reconstruction and Radiation Therapy.

Cancer Control 2018 Jan-Dec;25(1):1073274818795489

2 Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.

Purpose: The optimal approach to the integration of postmastectomy reconstruction and radiation therapy is not well-established. This review will summarize current literature pertaining to the most common types of reconstruction in the setting of postmastectomy radiation therapy (PMRT).

Data Sources: Literature from PubMed was reviewed from 2000 to 2016. Read More

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http://dx.doi.org/10.1177/1073274818795489DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6108018PMC
December 2018
5 Reads

Human acellular dermis increases surgical site infection and overall complication profile when compared with submuscular breast reconstruction: An updated meta-analysis incorporating new products.

J Plast Reconstr Aesthet Surg 2018 Nov 6;71(11):1547-1556. Epub 2018 Jul 6.

Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine. 601 N. Caroline St. Baltimore, MD USA. Electronic address:

Background: Human acellular dermal matrix (HADM) is an increasingly used adjunct to breast reconstruction. Previous meta-analyses demonstrate increased risks of complications, but these studies largely represent one product. The purpose of this study is to stratify outcomes on the basis of a meta-analysis of complications incorporating all new studies after 2012 and their associated new human-based products. Read More

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http://dx.doi.org/10.1016/j.bjps.2018.06.012DOI Listing
November 2018
4 Reads

A Comparison of Patient-Reported Outcomes After Nipple-Sparing Mastectomy and Conventional Mastectomy with Reconstruction.

Ann Surg Oncol 2018 Oct 2;25(10):2909-2916. Epub 2018 Jul 2.

Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Introduction: Nipple-sparing mastectomy (NSM) is increasingly used for breast cancer risk reduction and treatment. Prior small studies with variable control for baseline characteristics suggest superior satisfaction with NSM. The purpose of this study was to compare patient satisfaction following NSM and total mastectomy (TM) utilizing the BREAST-Q patient-reported outcome measure in a well-characterized patient population. Read More

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http://dx.doi.org/10.1245/s10434-018-6585-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6205203PMC
October 2018
21 Reads

Acellular Dermal Matrix in Immediate Expander/Implant Breast Reconstruction: A Multicenter Assessment of Risks and Benefits.

Plast Reconstr Surg 2018 09;142(3):414e

Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China.

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http://dx.doi.org/10.1097/PRS.0000000000004656DOI Listing
September 2018

Direct-to-Implant versus Two-Stage Tissue Expander/Implant Reconstruction: 2-Year Risks and Patient-Reported Outcomes from a Prospective, Multicenter Study.

Plast Reconstr Surg 2018 07;142(1):89e-91e

Plastic and Reconstructive Surgery Unit Plastic and Reconstructive Surgery Unit, Department of Senology Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy.

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http://dx.doi.org/10.1097/PRS.0000000000004520DOI Listing

Comparison of 2-Year Complication Rates Among Common Techniques for Postmastectomy Breast Reconstruction.

JAMA Surg 2018 Oct;153(10):901-908

Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor.

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. Read More

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http://dx.doi.org/10.1001/jamasurg.2018.1687DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6233788PMC
October 2018
9 Reads

AlloDerm RTU Integration and Clinical Outcomes When Used for Reconstructive Breast Surgery.

Plast Reconstr Surg Glob Open 2018 May 18;6(5):e1744. Epub 2018 May 18.

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

Background: AlloDerm Ready To Use (RTU) is a sterile version of AlloDerm regenerative tissue matrix, developed in response to concerns regarding the potential risk of infectious complications with the latter aseptic matrix. Clinical data on AlloDerm RTU use is, however, limited, particularly with respect to histologic evidence of graft integration and clinical outcomes.

Methods: Consecutive patients who underwent tissue-expander/implant reconstruction with the use of AlloDerm RTU from March 2011 to September 2012 were included in this analysis. Read More

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http://Insights.ovid.com/crossref?an=01720096-201805000-0000
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http://dx.doi.org/10.1097/GOX.0000000000001744DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5999421PMC
May 2018
2 Reads

Quantitative analysis of shoulder function and strength after breast reconstruction: A retrospective cohort study.

Medicine (Baltimore) 2018 Jun;97(24):e10979

Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.

Immediate breast reconstruction (IBR) after mastectomy has been proven to affect patient quality of life, psychological well-being, and functional capacities. In the present study, we aimed to investigate the effect of breast reconstruction on postoperative shoulder function and muscle performance by evaluating isokinetic muscle performance tests.A retrospective chart review to collect data on shoulder function analysis with isokinetic muscle performance testing was performed among patients who received mastectomy with IBR from July 2013 to March 2015. Read More

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http://dx.doi.org/10.1097/MD.0000000000010979DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6023658PMC
June 2018
6 Reads

Prepectoral Breast Reconstruction with Fenestrated Acellular Dermal Matrix: A Novel Design.

Plast Reconstr Surg Glob Open 2018 Apr 4;6(4):e1712. Epub 2018 Apr 4.

Department of Plastic Surgery, University of California, Irvine, Orange, Calif.

Fenestrated acellular dermal matrix (ADM) has improved patient outcomes in both direct-to-implant and 2-stage tissue expander/implant breast reconstruction. This technical alteration utilizes optimal fenestration overlap to enhance the breast reconstruction experience. We present a novel, surgeon-designed shaped fenestrated ADM, placed in the recently repopularized prepectoral pocket for anterior coverage of implants in direct-to-implant and 2-stage breast reconstruction. Read More

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http://dx.doi.org/10.1097/GOX.0000000000001712DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977957PMC
April 2018
6 Reads

Inhibition Mechanism of Acellular Dermal Matrix on Capsule Formation in Expander-Implant Breast Reconstruction After Postmastectomy Radiotherapy.

Ann Surg Oncol 2018 Aug 31;25(8):2279-2287. Epub 2018 May 31.

Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea.

Background: Capsular contracture is one of the most common complications of expander-implant breast reconstruction. Recently, clinical reports have shown that use of an acellular dermal matrix (ADM) to cover breast implants decreases incidence of capsular contracture, but the underlying mechanism is unclear. Here, we examine how ADM reduces capsular formation in expander-implant breast reconstruction and identify cellular and molecular mechanisms of ADM-mediated reduction of capsular contracture in nonirradiated and irradiated patients. Read More

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http://dx.doi.org/10.1245/s10434-018-6549-8DOI Listing

Direct-to-Implant versus Two-Stage Tissue Expander/Implant Reconstruction: 2-Year Risks and Patient-Reported Outcomes from a Prospective, Multicenter Study.

Plast Reconstr Surg 2018 07;142(1):91e

Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China.

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http://dx.doi.org/10.1097/PRS.0000000000004479DOI Listing
July 2018
3 Reads

Predictors of complications after direct-to-implant breast reconstruction with an acellular dermal matrix from a multicentre randomized clinical trial.

Br J Surg 2018 09 16;105(10):1305-1312. Epub 2018 Apr 16.

Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.

Background: In the multicentre randomized trial BRIOS (Breast Reconstruction In One Stage), direct-to-implant (DTI) breast reconstruction with an acellular dermal matrix (ADM) was associated with a markedly higher postoperative complication rate compared with two-stage tissue expander/implant breast reconstruction. This study aimed to identify factors that contribute to the occurrence of complications after DTI ADM-assisted breast reconstruction.

Methods: Data were obtained from the BRIOS study, including all patients treated with DTI ADM-assisted breast reconstruction. Read More

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http://doi.wiley.com/10.1002/bjs.10865
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http://dx.doi.org/10.1002/bjs.10865DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6099293PMC
September 2018
6 Reads

Analysis of clinical management of infected breast implants and of factors associated to successful breast pocket salvage in infections occurring after breast reconstruction.

Int J Infect Dis 2018 Jun 13;71:67-72. Epub 2018 Apr 13.

Clinica Malattie Infettive, Programma Infettivologia dell'Ospite Immunocompromesso Policlinico San Martino, Largo Rosanna Benzi 10, Genoa 16132, Italy; Department of Health Sciences, University of Genova, 16132 Genova, Italy. Electronic address:

Objectives: Considerable efforts have been devoted so far to improve salvage procedures of infected breast implants in absence of defined guidelines or validated clinical protocols. Within a cohort of prospectively recruited patients who underwent breast reconstruction, we performed a retrospective review of proven implant infections in order to describe factors contributing to management success.

Methods: We collected data in 1293 consecutive patients who underwent two stage (expander+prosthesis) breast reconstruction with at least 12 months of follow-up. Read More

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http://dx.doi.org/10.1016/j.ijid.2018.03.019DOI Listing
June 2018
4 Reads

A Histological Comparison of Two Human Acellular Dermal Matrix Products in Prosthetic-Based Breast Reconstruction.

Plast Reconstr Surg Glob Open 2017 Dec 27;5(12):e1576. Epub 2017 Dec 27.

Emory University, Division of Plastic and Reconstructive Surgery, Atlanta, Ga.; Atlanta Plastic Surgery, Atlanta, Ga.

Background: Acellular dermal matrices (ADMs) are an integral component of breast reconstruction. The ideal matrix would be relatively immuno-inert, allow rapid vascularization, and be affordable. The purpose of this study was to histologically compare 2 commonly used ADM products. Read More

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http://dx.doi.org/10.1097/GOX.0000000000001576DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5889434PMC
December 2017
1 Read

Postmastectomy Breast Reconstruction With the Totally Autologous Latissimus Dorsi Flap in the Thin, Small-Breasted Woman: Give It More Thought!

Eplasty 2018 26;18:e13. Epub 2018 Feb 26.

Department of Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.

Thin women have fewer autologous tissue breast reconstructive options than their higher body mass index counterparts-due to a lack of adequate donor sites. They are therefore usually offered expander/implant techniques. The total autologous latissimus dorsi flap is generally used in "well-padded" individuals, as they have enough fat on their back on which a completely autologous reconstruction could be based. Read More

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5838613PMC
February 2018
8 Reads

Complications After Two-Stage Expander Implant Breast Reconstruction Requiring Reoperation: A Critical Analysis of Outcomes.

Ann Plast Surg 2018 May;80(5S Suppl 5):S292-S294

From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford Health Care, Stanford, CA.

Background: Two-stage expander implant breast reconstruction is commonly performed after mastectomy. Salvage and long-term outcomes after development of complications have not been well described. We examined a single surgeon's experience to study the rate of reoperation secondary to complications after first-stage expander placement and to evaluate their outcomes. Read More

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http://dx.doi.org/10.1097/SAP.0000000000001382DOI Listing
May 2018
6 Reads

Mastectomy Skin Necrosis After Breast Reconstruction: A Comparative Analysis Between Autologous Reconstruction and Implant-Based Reconstruction.

Ann Plast Surg 2018 May;80(5S Suppl 5):S285-S287

From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford Health Care, Stanford, CA.

Background: Mastectomy skin necrosis is a significant problem after breast reconstruction. We sought to perform a comparative analysis on this complication between patients undergoing autologous breast reconstruction and patients undergoing 2-stage expander implant breast reconstruction.

Methods: A retrospective review was performed on consecutive patients undergoing autologous breast reconstruction or 2-stage expander implant breast reconstruction by the senior author from 2006 through 2015. Read More

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http://dx.doi.org/10.1097/SAP.0000000000001379DOI Listing
May 2018
2 Reads

Intraoperative Nerve Blocks Fail to Improve Quality of Recovery after Tissue Expander Breast Reconstruction: A Prospective, Double-Blinded, Randomized, Placebo-Controlled Clinical Trial.

Plast Reconstr Surg 2018 03;141(3):590-597

Chicago, Ill. From the Division of Plastic Surgery and the Department of Anesthesiology, Northwestern University Feinberg School of Medicine.

Background: The authors' study represents the first level I evidence to assess whether intraoperative nerve blocks improve the quality of recovery from immediate tissue expander/implant breast reconstruction.

Methods: A prospective, randomized, double-blinded, placebo-controlled clinical trial was conducted in which patients undergoing immediate tissue expander/implant breast reconstruction were randomized to either (1) intraoperative intercostal and pectoral nerve blocks with 0.25% bupivacaine with 1:200,000 epinephrine and 4 mg of dexamethasone or (2) sham nerve blocks with normal saline. Read More

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http://Insights.ovid.com/crossref?an=00006534-201803000-0000
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http://dx.doi.org/10.1097/PRS.0000000000004104DOI Listing
March 2018
13 Reads

Single-Stage Breast Reconstruction Using an All-In-One Adjustable Expander/Implant.

Plast Reconstr Surg Glob Open 2018 Jan 11;6(1):e1609. Epub 2018 Jan 11.

Division of Plastic and Reconstructive Surgery, McGill University, Montreal, QC, Canada.

Background: When tissue expansion is necessary in breast reconstruction, a single-stage approach is possible using adjustable expander/implants, with or without the use of acellular dermal matrix. We aimed to present the senior author's single-stage experience over a period of 12 years using combined expander/implants in breast reconstruction.

Methods: This is a Single-institution, retrospective review of breast reconstruction with combined expander/implants from 2002 to 2014. Read More

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http://dx.doi.org/10.1097/GOX.0000000000001609DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5811285PMC
January 2018
1 Read

Does 2-Stage Implant-Based Breast Reconstruction Allow for a Larger Volume of the Definite Implant Compared With 1-Stage Reconstruction?

Ann Plast Surg 2018 May;80(5):481-486

Introduction: Breast reconstruction using implants is still the main breast reconstruction technique worldwide. Current debate within implant-based breast reconstruction is whether to perform a 1-stage (direct implant) or 2-stage (tissue expander/implant) reconstruction. Volume differences between a woman's native breast and changes in volume after breast reconstruction might be an important factor for a patient's choice between these types of reconstruction. Read More

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http://Insights.ovid.com/crossref?an=00000637-900000000-9750
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http://dx.doi.org/10.1097/SAP.0000000000001352DOI Listing
May 2018
2 Reads

Secondary Mastopexy After Nipple-Sparing Mastectomy and Staged Subcutaneous Expander/Implant Reconstruction.

Ann Plast Surg 2018 May;80(5):475-480

Background: The acceptance of nipple-sparing mastectomy for the treatment of breast cancer in selected patients has introduced ancillary procedures to improve breast shape, correct ptosis, and enhance breast symmetry. Mastopexy before or at the time of nipple-sparing mastectomy has been performed to correct ptosis, but there have been no reports on secondary Wise pattern mastopexy after completion of staged subcutaneous expander/implant reconstruction.

Methods: Between 2005 and 2015, 155 patients (255 breasts) underwent staged subcutaneous implant/expander-based reconstruction after inframammary nipple-sparing mastectomy. Read More

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http://dx.doi.org/10.1097/SAP.0000000000001337DOI Listing
May 2018
8 Reads

Direct-to-Implant Breast Reconstruction in Women Older than 65 Years: A Retrospective Analysis of Complication Rate and Overall Outcomes.

Plast Reconstr Surg 2018 02;141(2):251-256

MetroHealth, Cleveland, Ohio From the Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation.

Background: Half of all cancers occur in women older than 65 years, yet only 4 to 14 percent of these women undergo reconstruction. Most studies on reconstruction in the elderly have focused on tissue expander/implant or autologous reconstruction. A direct-to-implant approach theoretically reduces the number of operations and postoperative visits, but has yet to be investigated in the elderly. Read More

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http://dx.doi.org/10.1097/PRS.0000000000004015DOI Listing
February 2018
5 Reads

Salvage of Implant-Based Breast Reconstruction in Nipple-Sparing Mastectomies With Autologous Flaps.

Aesthet Surg J 2018 Jun;38(7):734-741

Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO.

Background: Implant-based breast reconstruction (IBR) after nipple-sparing mastectomies (NSM) can have complications that require explantation of a tissue expander or permanent prosthesis. When complications occur, preservation of the nipple-areola complex (NAC) remains critical to ensure aesthetic breast reconstruction. To date, there are minimal data on outcomes for patients experiencing unplanned explantations in IBR after NSM. Read More

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https://academic.oup.com/asj/article/38/7/734/4816911
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http://dx.doi.org/10.1093/asj/sjx247DOI Listing
June 2018
18 Reads

Outcomes in Deep Inferior Epigastric Perforator Flap and Implant-Based Reconstruction: Does Age Really Matter?

Cancer Control 2018 Jan-Mar;25(1):1073274817744603

4 Department of Surgery, Division of Plastic Surgery, University of South Florida, Morsani College of Medicine, Tampa, FL, USA.

Despite the growing elderly population, there is limited research specific to this demographic concerning breast reconstruction (BR). Lack of evidence-based BR recommendations in older populations may contribute to misconceptions and subsequent underutilization of BR, especially autologous BR. Patients who received either deep inferior epigastric perforator (DIEP) flap BR or tissue expander/implant (TE/I) BR by a single surgeon between July 2011 and July 2015 were surveyed postoperatively by using the psychometrically validated BREAST-Q questionnaire to determine patient satisfaction. Read More

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http://journals.sagepub.com/doi/10.1177/1073274817744603
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http://dx.doi.org/10.1177/1073274817744603DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5933585PMC
August 2018
10 Reads

Expander/Implant Removal After Breast Reconstruction: Analysis of Risk Factors and Timeline.

Aesthetic Plast Surg 2018 Feb 21;42(1):64-72. Epub 2017 Dec 21.

Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH, USA.

Introduction: Removal of tissue expanders (TE) or implants is a dire consequence of breast reconstruction, and has the potential to halt the reconstructive efforts. Our goals were to characterize a cohort of patients with TE/implant removal, to perform a time-based analysis, and to review the bacteriology associated with explanted devices.

Materials And Methods: Review of a prospectively maintained database was performed to identify patients who underwent TE/implant removal. Read More

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http://link.springer.com/10.1007/s00266-017-1031-8
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http://dx.doi.org/10.1007/s00266-017-1031-8DOI Listing
February 2018
22 Reads

The Effect of Implant Type on Nipple Position Geometry and Aesthetics Following Tissue Expander Reconstruction After Nipple Sparing Mastectomy.

Aesthet Surg J 2018 May;38(6):605-613

Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.

Background: While recent studies have reported modest to no difference in breast aesthetics for shaped and round implant types in breast augmentations, the anatomy and biomechanics in the setting of breast reconstruction is different.

Objectives: Accordingly, we endeavored to evaluate whether two implant types impacted nipple position and aesthetic features in prosthetic breast reconstruction.

Methods: A retrospective chart review was carried out on patients who underwent nipple-sparing mastectomy (NSM) with immediate tissue expander breast reconstruction. Read More

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http://dx.doi.org/10.1093/asj/sjx210DOI Listing
May 2018
11 Reads

Radiotherapy in the setting of breast reconstruction: types, techniques, and timing.

Lancet Oncol 2017 12;18(12):e742-e753

Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA.

As the use of breast reconstruction and postmastectomy radiotherapy (PMRT) has increased over the past decade, the typical approach to integrating radiotherapy with breast reconstruction has provoked intense controversy in the management of breast cancer. PMRT can lead to an increased frequency of complications in the reconstructed breast. Conversely, the reconstructed breast can increase the complexity of radiotherapy delivery. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S14702045173061
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http://dx.doi.org/10.1016/S1470-2045(17)30617-4DOI Listing
December 2017
12 Reads

Prepectoral Immediate Direct-to-Implant Breast Reconstruction with Anterior AlloDerm Coverage.

Plast Reconstr Surg 2017 Dec;140(6S Prepectoral Breast Reconstruction):31S-38S

Peoria, Ill.; and Boston, Mass. From the University of Illinois College of Medicine; University of Massachusetts; and Illinois Plastic Surgery.

Background: Staged subpectoral expander-implant breast reconstruction is widely performed. Disruption of the pectoralis major origin and the frequent occurrence of animation deformity and functional discomfort associated with subpectoral reconstruction remain ongoing concerns. Prepectoral single-stage direct-to-implant reconstruction resolves many of these issues. Read More

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http://Insights.ovid.com/crossref?an=00006534-201712001-0000
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http://dx.doi.org/10.1097/PRS.0000000000004048DOI Listing
December 2017
27 Reads

Salvage of Infected Breast Implants.

Arch Plast Surg 2017 Nov 27;44(6):516-522. Epub 2017 Oct 27.

Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Background: Implant-based breast reconstruction is being performed more frequently, and implants are associated with an increased risk of infection. We reviewed the clinical features of cases of implant infection and investigated the risk factors for breast device salvage failure.

Methods: We retrospectively analyzed 771 patients who underwent implant-based breast reconstruction between January 2010 and December 2016. Read More

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http://dx.doi.org/10.5999/aps.2017.01025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5801791PMC
November 2017
13 Reads

Direct-to-Implant versus Two-Stage Tissue Expander/Implant Reconstruction: 2-Year Risks and Patient-Reported Outcomes from a Prospective, Multicenter Study.

Plast Reconstr Surg 2017 Nov;140(5):869-877

Ann Arbor, Mich.; Houston, Texas; and New York, N.Y. From the Section of Plastic Surgery and the Department of Biostatistics, University of Michigan; the Department of Plastic Surgery, M. D. Anderson Cancer Center; and the Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center.

Background: Direct-to-implant breast reconstruction offers time-saving advantages over two-stage techniques. However, use of direct-to-implant reconstruction remains limited, in part, because of concerns over complication rates., The authors' aim was to compare 2-year complications and patient-reported outcomes for direct-to-implant versus tissue expander/implant reconstruction. Read More

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http://dx.doi.org/10.1097/PRS.0000000000003748DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5902733PMC
November 2017
15 Reads
2.993 Impact Factor

Nipple-Sparing Mastectomy and Direct-to-Implant Breast Reconstruction.

Plast Reconstr Surg 2017 Nov;140(5S Advances in Breast Reconstruction):44S-50S

Boston, Mass. From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School.

Breast reconstruction following mastectomy has evolved to preserve the native skin and nipple of the breast and create a natural-appearing reconstruction in 1 or 2 surgeries. Nipple-sparing procedures appear to be oncologically safe with low risks of cancer recurrence. In our series of 2,182 nipple-sparing mastectomies, there was no development or recurrence of cancer in the nipple. Read More

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http://dx.doi.org/10.1097/PRS.0000000000003949DOI Listing
November 2017
12 Reads

Optimizing Nipple Position following Nipple-Sparing Mastectomy.

Plast Reconstr Surg Glob Open 2017 Sep 13;5(9):e1490. Epub 2017 Sep 13.

Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.; The John Wayne Cancer Institute, Santa Monica, Calif.; and Renaissance Medical Center for Aesthetic Surgery, Los Angeles, Calif.

Background: The best treatment for nipple malposition following nipple-sparing mastectomy is prevention. This article reviews basic elements for success in nipple-sparing mastectomy and offers an option to patients with grade 2-3 breast ptosis who strongly desire to preserve the nipple.

Methods: Retrospective review identified patients undergoing nipple-sparing mastectomy and immediate reconstruction. Read More

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http://dx.doi.org/10.1097/GOX.0000000000001490DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5640362PMC
September 2017
19 Reads

Surgeon-Controlled Comparison of Direct-to-Implant and 2-Stage Tissue Expander-Implant Immediate Breast Reconstruction Outcomes.

Ann Plast Surg 2018 Mar;80(3):212-216

From the Plastic and Reconstructive Surgery, Summa Health System, Akron, OH.

Background: Current literature comparing outcomes of immediate breast reconstruction using direct-to-implant (DTI) single-stage and 2-stage tissue expanders (TEs) is conflicting. This study compared overall outcomes and determined predictive patient factors associated with higher complication rates.

Methods: After institutional review board approval, a retrospective cohort study of consecutive patients who underwent immediate breast reconstruction from 2010 to 2014 at a single hospital was performed. Read More

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http://dx.doi.org/10.1097/SAP.0000000000001220DOI Listing
March 2018
11 Reads

In the Age of Breast Augmentation, Breast Reconstruction Provides an Opportunity to Augment the Breast.

Cancer Control 2017 Oct-Dec;24(4):1073274817729064

1 Division of Plastic Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA.

Background: Augmentation mammoplasty remains the most common cosmetic surgery procedure performed. The objective of this article is to evaluate the impact of augmented volume of the reconstructed breast in patients that undergo nipple-sparing mastectomy and patients previously augmented who undergo mastectomy with tissue expander/implant-based reconstruction.

Methods: Patients undergoing skin-sparing mastectomy, nipple-sparing mastectomy, and mastectomy after previous augmentation followed by tissue expander/implant-based reconstruction between June 2011 and April 2015 by 2 surgeons at the same institution were included. Read More

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http://dx.doi.org/10.1177/1073274817729064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937240PMC
May 2018
10 Reads

A 3D Mammometric Comparison of Implant-Based Breast Reconstruction With and Without Acellular Dermal Matrix (ADM).

Aesthetic Plast Surg 2018 Feb 15;42(1):49-58. Epub 2017 Sep 15.

Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, PO Box 208041, New Haven, CT, 06520-8041, USA.

This retrospective study utilizes 3D imaging and mammometrics to compare implant-based breast reconstruction with and without the use of ADM. Previous studies have suggested improved aesthetic outcomes with the use of ADM, but none have been able to quantify this difference. Images were obtained at early and late time points following the expander-implant exchange procedure. Read More

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http://link.springer.com/10.1007/s00266-017-0967-z
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http://dx.doi.org/10.1007/s00266-017-0967-zDOI Listing
February 2018
2 Reads

Changes in shoulder muscle activity pattern on surface electromyography after breast cancer surgery.

J Surg Oncol 2018 Feb 22;117(2):116-123. Epub 2017 Aug 22.

Division of Business Administration, Sookmyung Women's University, Seoul, Korea.

Background And Objectives: Alterations in muscle activation and restricted shoulder mobility, which are common in breast cancer patients, have been found to affect upper limb function. The purpose of this study was to determine muscle activity patterns, and to compare the prevalence of abnormal patterns among the type of breast surgery.

Methods: In total, 274 breast cancer patients were recruited after surgery. Read More

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http://dx.doi.org/10.1002/jso.24800DOI Listing
February 2018
27 Reads

Acellular Dermal Matrix in Immediate Expander/Implant Breast Reconstruction: A Multicenter Assessment of Risks and Benefits.

Plast Reconstr Surg 2017 Dec;140(6):1091-1100

Ann Arbor, Mich.; and New York, N.Y. From the Section of Plastic Surgery, Department of Surgery, and the Center for Statistical Consultation and Research, Department of Biostatistics, University of Michigan; and Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center.

Background: Acellular dermal matrix has gained widespread acceptance in immediate expander/implant reconstruction because of perceived benefits, including improved expansion dynamics and superior aesthetic results. Although previous investigators have evaluated its risks, few studies have assessed the impact of acellular dermal matrix on other outcomes, including patient-reported measures.

Methods: The Mastectomy Reconstruction Outcomes Consortium Study used a prospective cohort design to evaluate patients undergoing postmastectomy reconstruction from 10 centers and 58 participating surgeons between 2012 and 2015. Read More

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http://dx.doi.org/10.1097/PRS.0000000000003842DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5705287PMC
December 2017
17 Reads
2 Citations
2.993 Impact Factor

Acellular Dermal Matrix Versus Inferior Deepithelialized Flap Breast Reconstruction: Equivalent Outcomes, with Increased Cost.

Plast Reconstr Surg Glob Open 2017 Jun 28;5(6):e1382. Epub 2017 Jun 28.

Department of Surgery, Section of Plastic Surgery, The Research Institute, St. Luke's University Health Network, Bethlehem, Pa.; and Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, Pa.

Background: Approximately 250,000 new cases of breast cancer are diagnosed yearly in the U.S. resulting in more postmastectomy breast reconstructions (PMBRs). Read More

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http://dx.doi.org/10.1097/GOX.0000000000001382DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5505849PMC
June 2017
7 Reads

Paravertebral Blocks Reduce Narcotic Use Without Affecting Perfusion in Patients Undergoing Autologous Breast Reconstruction.

Ann Surg Oncol 2017 Oct 17;24(11):3180-3187. Epub 2017 Jul 17.

Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO, USA.

Background: Autologous breast reconstruction offers excellent long term outcomes after mastectomy. However, maintaining adequate postoperative analgesia remains challenging. Use of paravertebral blocks (PVBs) reduces postoperative narcotic use and length of stay, and enhanced recovery protocols with mixed analgesia methods are gaining popularity, but few studies have explored the intraoperative effects of these interventions. Read More

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http://dx.doi.org/10.1245/s10434-017-6007-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6136427PMC
October 2017
3 Reads

Factors Associated with Acute Postoperative Pain Following Breast Reconstruction.

JPRAS Open 2017 Mar 15;11:1-13. Epub 2016 Sep 15.

University of Michigan Healthcare Systems, Ann Arbor, MI.

Introduction: Post-mastectomy breast reconstruction has become an increasingly important component of breast cancer treatment. Unfortunately, some patients experience severe postoperative pain, placing them at risk for increased clinical morbidity and the development of disabling chronic pain. In an attempt to identify at-risk patients, we prospectively evaluated patient characteristics and medical/surgical variables associated with more severe acute post-reconstruction pain. Read More

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http://dx.doi.org/10.1016/j.jpra.2016.08.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5507622PMC
March 2017
14 Reads
4 Citations

One-stage muscle-sparing breast reconstruction in elderly patients: A new tool for retaining excellent quality of life.

Breast J 2018 03 13;24(2):180-183. Epub 2017 Jul 13.

Department of Plastic and Reconstructive Surgery, Sapienza University, Rome, Italy.

More than 50% of breast cancer care occurs in elderly but women aged 65 and over generally have lower breast reconstruction (BR) rates. In medical literature, few papers focused on BR in elderly patients and usually the reported techniques are multisteps such as expander-implant reconstruction, local, and free flaps. We present a one-stage reconstruction technique employed in elderly patients: muscle-sparing immediate BR with subcutaneous implant and Braxon acellular dermal matrix. Read More

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http://dx.doi.org/10.1111/tbj.12860DOI Listing
March 2018
4 Reads

Complications After Total Skin-Sparing Mastectomy and Expander-Implant Reconstruction: Effects of Radiation Therapy on the Stages of Reconstruction.

Ann Plast Surg 2018 Jan;80(1):10-13

Background: Many patients undergoing total-skin sparing mastectomy (TSSM) and 2-staged expander-implant (TE-I) reconstruction require postmastectomy radiation therapy (PMRT). Additionally, many patients undergoing TSSM for recurrent cancer have a history of lumpectomy and radiation therapy (XRT). Few studies have looked at the impact of XRT on the stages of TE-I reconstruction. Read More

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http://dx.doi.org/10.1097/SAP.0000000000001186DOI Listing
January 2018
7 Reads