Search Our Scientific Publications & Authors

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2019 Jan;33(1):70-74

Department of Plastic and Reconstructive Surgery, Peking University People's Hospital, Beijing, 100044, P.R.China.

Objective: To explore the effectiveness of dual-pedicle abdominal flap for unilateral breast reconstruction.

Methods: Between March 2014 and March 2018, a clinical data of 19 female patients underwent dual-pedicle abdominal flap reconstruction because of unilateral mastectomy defect was reviewed retrospectively. The median age was 45 years (range, 32-51 years), including 3 immediate breast reconstruction and 16 delayed breast reconstruction, and left side in 7 cases and right side in 12 cases. Read More

Ann Surg Treat Res 2019 Jan 26;96(1):8-13. Epub 2018 Dec 26.

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

Purpose: The creation of the nipple-areola complex is the final stage in breast reconstruction and highly affects patient satisfaction. The neo-nipple is well known to shrink over time, particularly in the nipple projection. Currently, no reconstruction technique is clearly superior in terms of nipple size maintenance. Read More

Plast Reconstr Surg 2018 Dec 24. Epub 2018 Dec 24.

Department of Surgery, Duke University, Durham, NC.

Background: The purpose of this study was to identify differences in patient reported abdominal well-being, satisfaction, and quality of life in women with muscle-preserving free abdominal versus pedicle TRAM flap for breast reconstruction.

Background: The purpose of this study was to identify differences in patient reported abdominal well-being, satisfaction, and quality of life in women with muscle-preserving free abdominal versus pedicle TRAM flap for breast reconstruction.

Methods: Women with a history of breast cancer surgery were recruited from the Army of Women foundation to take the BREAST-Q© and a background questionnaire. Read More

J Surg Oncol 2018 Dec 18. Epub 2018 Dec 18.

Division of Plastic and Reconstructive Surgery, University Health Network, Toronto, Ontario, Canada.

Background And Objectives: The deep inferior epigastric perforator (DIEP) flap may be associated with less long-term donor-site morbidity compared with free muscle-sparing transverse rectus abdominis myocutaneous flap (MS-TRAM) flap. However, DIEP flaps may have longer operative time and higher rates of acute postoperative complications. We performed a cost-effectiveness analysis (CEA) that compared the long-term costs and patient-reported outcomes between the two flaps. Read More

Handchir Mikrochir Plast Chir 2018 08 8;50(4):E1. Epub 2018 Oct 8.

BG Unfallklinik Ludwigshafen, Klinik für Hand, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum.

Arch Plast Surg 2018 Sep 15;45(5):441-448. Epub 2018 Sep 15.

Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu, Korea.

Background: Previously, surveys have been used to investigate breast reconstruction statistics. Since 2015, breast reconstruction surgery after mastectomy has been covered by the National Health Insurance Service in Korea, and data from breast reconstruction patients are now available from the Health Insurance Review and Assessment Service (HIRA). We investigated statistics in breast reconstruction in Korea through statistics provided by the HIRA Big Data Hub. Read More

Surg Oncol 2018 Sep 26;27(3):513. Epub 2018 Jun 26.

Department of Plastic and Hand Surgery, University Hospital of Erlangen, Erlangen, Germany; Interdisciplinary Breast Center, University Hospital of Erlangen, Erlangen, Germany.

Introduction: Breast reconstruction is an important element in the successful therapy of breast cancer [1]. Thereby, autologous microvascular breast reconstruction has been shown to be a reliable technique. The use of a deep inferior epigastric perforator (DIEP) flap or a muscle-sparing (MS) free transverse rectus abdominis musculocutaneous (TRAM) flap is recognized in many centres as gold standard for reconstructive options [2-4]. Read More

Ann Chir Plast Esthet 2018 Nov 7;63(5-6):457-472. Epub 2018 Sep 7.

Université Paris Descartes, 15, rue de l'École-de-Médecine, 75005 Paris, France.

Perforator free flaps allow breast reconstructions « like with like » with skin and fat, excluding mammary gland, with a low morbidity. Those autologous reconstructions prevent material associated infections, capsular contracture and implant replacements, associated to breast reconstructions including implants. DIEP flap was described in 1994 to reduce the morbidity faced with TRAM flaps harvest. Read More

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

Handchir Mikrochir Plast Chir 2018 08 21;50(4):248-255. Epub 2018 Aug 21.

BG Unfallklinik Ludwigshafen, Klinik für Hand, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum.

The most common donor-site for autologous breast reconstruction is the abdomen. Over the past several decades technical advances have resulted in the development of flaps that have been associated with a progressive decrease in abdominal wall morbidity. However, controversy exists related to the differences between muscle-sparing (MS)-TRAM and deep inferior epigastric perforator (DIEP) flaps. Read More

J Reconstr Microsurg 2019 Jan 29;35(1):74-82. Epub 2018 Jul 29.

Division of Plastic and Reconstructive Surgery, University of Utah, School of Medicine, Salt Lake City, Utah.

Background:  The abdomen is the most common area from which tissue is harvested for autologous breast reconstruction. We sought to examine national data to determine the differences in total hospital charges, length of stay (LOS), and early postoperative complications following pedicled transverse rectus abdominis myocutaneous flap (pTRAM), free TRAM (fTRAM), deep-inferior epigastric perforator (DIEP), and superficial inferior epigastric artery perforator (SIEA) flaps.

Methods:  The 2009-2013 Nationwide Inpatient Sample Database was used to identify patients who underwent a unilateral mastectomy and only one type of abdominally based autologous flap (pTRAM, fTRAM, DIEP, and SIEA) during the same hospital admission. Read More

J Plast Surg Hand Surg 2018 Jul 24:1-8. Epub 2018 Jul 24.

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

Transverse rectus abdominis myocutaneous flap is one of the most commonly used reconstruction tools after oncological mastectomy. However, post-operative donor-site morbidities remain an issue to be addressed. In this study, we retrospectively reviewed patients with either immediate or delayed breast reconstruction using a free muscle-sparing type I transverse rectus abdominis myocutaneous flap only, performed by a single surgeon, regarding the donor-site morbidity. Read More

Arch Plast Surg 2018 Jul 15;45(4):333-339. Epub 2018 Jul 15.

Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan.

Background: Flap volume is an important factor for obtaining satisfactory symmetry in breast reconstruction with a transverse rectus abdominis myocutaneous (TRAM) free flap. We aimed to develop an easy and simple method to estimate flap volume.

Methods: We performed a preoperative estimation of the TRAM flap volume in five patients with breast cancer who underwent 2-stage breast reconstruction following an immediate tissue expander operation after a simple mastectomy. Read More

J Plast Reconstr Aesthet Surg 2018 Sep 28;71(9):1301-1309. Epub 2018 Jun 28.

Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden.

Background: Abdominal-based free flap has increasingly become the gold standard for breast reconstruction, however long-term evidence of the aesthetic outcome and quality of life is lacking. The present study aims to gain an overview of patients with abdominal-based free flap breast reconstructions in a long-term perspective.

Methods: Seventy-five patients who received abdominal-based free flap breast reconstructions between 2000-2007 in Uppsala, Sweden were invited back for photographs, 3D imaging and questionnaires. Read More

J Plast Reconstr Aesthet Surg 2018 Sep 9;71(9):1295-1300. Epub 2018 Jun 9.

Division of Plastic & Reconstructive Surgery, Stanford University Medical Center, 770 Welch Road, Suite 400, Palo Alto, CA 94304, USA. Electronic address:

Background: Autologous breast reconstruction is considered by many to be the gold standard reconstructive modality following mastectomy. Despite the advantages of autologous reconstruction, however, surgeons have been cautious in recommending this approach to patients who desire to become pregnant postoperatively because of concerns related to abdominal wall morbidity. While intuitive, this approach does not appear to be based on robust data. Read More

Ann Plast Surg 2018 Nov;81(5):584-590

Department of Plastic and Reconstructive Surgery, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea.

Introduction: In extensive radionecrosis following radiotherapy for breast cancer (BC) treatment, the defect after excision can be reconstructed with a transverse rectus abdominis myocutaneous (TRAM) flap. In this study, we report outcome of free TRAM flap using contralateral internal mammary artery (IMA) as a recipient in comparison with pedicled TRAM.

Methods: We reviewed cases of chest wall radionecrosis following BC treatment during the past 8 years. Read More

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

Plast Reconstr Surg 2018 08;142(2):120e-125e

Houston, Texas From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center.

Background: Obesity has been viewed as a relative contraindication against autologous free flap breast reconstruction because of increased risks of complications, including flap loss.

Methods: The authors conducted a prospective analysis of obese patients undergoing autologous breast reconstruction.

Results: Overall, 72 patients (average age, 48. Read More

Medicine (Baltimore) 2018 May;97(18):e0680

Division of Breast and Endocrine Surgery, Department of Surgery.

To evaluate the oncological outcomes of patients with breast cancer after nipple-sparing mastectomy (NSM)/skin-sparing mastectomy (SSM), followed by immediate reconstruction, as compared to conventional mastectomy (CM).SSM/NSM has been increasingly used to treat women with breast cancer who wish to preserve the overlying breast skin, but concern exist regarding its oncological safety due to the potential for residual breast tissue. We report our experience performing SSM/NSM for breast cancer treatment compared to CM with a long follow-up period. Read More

Plast Reconstr Surg 2018 07;142(1):92e-94e

Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, N.Y.

J Plast Reconstr Aesthet Surg 2018 Jun 2;71(6):819-826. Epub 2018 Mar 2.

Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA. Electronic address:

Background: Enhanced recovery after surgery (ERAS) pathways have been shown in multiple surgical specialties to decrease hospital length of stay (LOS) after surgery. ERAS in breast reconstruction has been found to decrease hospital LOS and inpatient opioid use. ERAS protocols can facilitate a patient's recovery and can potentially increase the quality of care while decreasing costs. Read More

Breast 2018 Apr 8;38:45-51. Epub 2017 Dec 8.

Department of Plastic and Reconstructive Surgery, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, South Korea.

Objectives: The transverse rectus abdominis musculocutaneous (TRAM) flap is an important option for breast reconstruction. Several studies have recently evaluated whether a greater number of complications result from the use of pedicled TRAM (pTRAM) flaps versus either free TRAM (fTRAM) flaps or deep inferior epigastric artery perforator (DIEP) flaps. To clarify the evidence regarding this issue, we performed an objective meta-analysis of published studies. Read More

Plast Reconstr Surg 2018 02;141(2):271-281

Boston, Mass.; Ann Arbor, Mich.; and New York, N.Y. From the Division of Plastic Surgery, Brigham and Women's Hospital; the Section of Plastic Surgery and the Department of Biostatistics, University of Michigan Medical School; and Memorial Sloan Kettering Cancer Center.

Background: Abdominal flap reconstruction is the most popular form of autologous breast reconstruction. The current study compared complications and patient-reported outcomes after pedicled transverse rectus abdominis myocutaneous (TRAM), free TRAM, deep inferior epigastric perforator (DIEP), and superficial inferior epigastric artery (SIEA) flaps.

Methods: Patients undergoing abdominally based breast reconstruction at 11 centers were prospectively evaluated for abdominal donor-site and breast complications. Read More

J Plast Reconstr Aesthet Surg 2017 Nov 20;70(11):1543-1546. Epub 2017 Jun 20.

Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.

Background: A key component of modern analgesics is the use of multimodal opioid-sparing analgesia (MOSA). In the past, our analgesic regime after autologous breast reconstruction (ABR) included either NSAID or a selective cyclooxygenase-2 (COX-2) inhibitor. COX-2 inhibitors are superior to NSAIDs because of the well-known side effects of NSAID treatment (bleeding/gastrointestinal ulcers). Read More

Plast Reconstr Surg 2017 Dec;140(6):1101-1109

Tochigi, Japan From the Department of Plastic Surgery, Jichi Medical University.

Background: The deep inferior epigastric perforator (DIEP) flap, which is a modification of the muscle-sparing free transverse rectus abdominis musculocutaneous (TRAM) flap, is being more frequently used in an effort to reduce postoperative abdominal morbidity. However, there is no consensus as to which of these flaps is superior. The authors aimed to compare quantitative measurements of abdominal function obtained with an isokinetic dynamometer after DIEP and muscle-sparing free TRAM flap elevation. Read More

J Surg Res 2017 07 20;215:257-263. Epub 2017 Apr 20.

Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Electronic address:

Background: Umbilical stalk necrosis represents a rare, yet important complication after abdominal-based microsurgical breast reconstruction, which is both underrecognized and understudied in the literature. Once identified, umbilical reconstruction can be an extremely challenging problem.

Methods: All consecutive breast free flaps at a single institution from February 2004 to February 2016 were reviewed, excluding non-abdominal-based flaps. Read More

Clin Breast Cancer 2017 10 29;17(6):471-485. Epub 2017 Apr 29.

Department of Clinical Neurophysiology, Turku University Hospital, Turku, Finland.

Background: We evaluated clinical against psychophysical (tactile and thermal quantitative sensory test [QST]), neurophysiologic (somatosensory evoked potential [SEP]), and epithelial nerve fiber density (ENFD) examinations in detection and follow-up of sensory alterations after breast reconstruction done with or without nerve anastomoses.

Patients And Methods: In a prospective 2-year follow-up design, 56 breast cancer patients underwent innervated and 20 patients noninnervated free rectus abdominis muscle-sparing flap (ms-TRAM) breast reconstruction. Healthy contralateral breasts (36 patients) and 20 healthy volunteer women served as control participants. Read More

Plast Reconstr Surg 2017 09;140(3):518e-519e

Department of Plastic Surgery, Ohio State University, Columbus, Ohio.

Microsurgery 2017 Oct 24;37(7):800-807. Epub 2017 May 24.

Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas.

Background: The goal of this study was to determine the impact of resident involvement on various methods of breast reconstruction via an American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) retrospective analysis.

Methods: We performed a retrospective analysis of the ACS NSQIP database to identify patients undergoing breast reconstruction by free flap, implant, latissimus dorsi (LD), and transverse rectus abdominis myocutaneous (TRAM) flap reconstruction modalities. Primary outcomes measured include major and wound complications. Read More

Plast Reconstr Surg Glob Open 2017 Mar 13;5(3):e1266. Epub 2017 Mar 13.

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

In breast reconstruction using a free transverse rectus abdominis myocutaneous or deep inferior epigastric perforator flap, the trimming process for the flap area, which is usually the upper portion of the reconstructed breast, is critical to creating a natural-looking breast. In this study, we investigated which subcutaneous fat layer of the abdominal flap benefited most from a well-maintained blood supply during the trimming process using intraoperative fluorescent angiography system in a cross-sectional view of the elevated abdominal flap. We concluded that, for cosmetic purposes, the deep subcutaneous fat layer (beneath Scarpa's fascia) should be trimmed first to minimize fat necrosis due to fat ischemia. Read More

Ann Surg Oncol 2017 Jul 22;24(7):1881-1888. Epub 2017 Mar 22.

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

Background: This study was designed to explore the clinicopathological factors associated with internal mammary lymph node (IMN) metastasis in radiologically IMN-negative breast malignancies and to discuss the clinical value of opportunistic biopsy during immediate breast reconstruction using free flaps, where the internal mammary vessels are the recipient.

Methods: We retrospectively reviewed patients who received curative total mastectomy for breast malignancy followed by immediate reconstruction using transverse rectus abdominis myocutaneous (TRAM) free flap. Suspicious lymph nodes encountered during dissection of the third intercostal space for the recipient vessels were biopsied. Read More

Med J Malaysia 2017 Feb;72(1):85-87

University College Dublin, School of Medicine & Medical Science, Dublin, Ireland.

Breast reconstructive surgery has evolved tremendously since its inception. Following tumour clearance surgery, physical restoration with breast reconstruction is an important aspect of physical and emotional rehabilitation. Various methods have been described to suit patients demand for the best aesthetic outcome. Read More

Sci Rep 2017 03 6;7(1):80. Epub 2017 Mar 6.

The 2nd Department of Breast Surgery, Breast Cancer Center of the Third Affiliated Hospital of Kunming Medical University, Yunnan province, China.

Breast cancer-related lymphoedema (BCRL) is a common and intractable complication. To evaluate the possible complications of using lymphatic transverse rectus abdominis myocutaneous/deep inferior epigastric perforator (TRAM/DIEP) flaps for breast reconstruction and BCRL treatment, 20 patients with moderate or severe BCRL were retrospectively enrolled between November 2012 and October 2014. 10 patients had undergone lymphatic TRAM/DIEP flap surgery were assigned to the surgery group. Read More

Gland Surg 2017 Feb;6(1):89-92

Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA.

Desmoid tumors are fibroblastic connective tissue tumors that most commonly develop within the anterior abdominal wall. The etiology of desmoid tumors has not been well defined; however, hereditary, hormonal, traumatic, and surgery-related causes have been implicated. Desmoid tumors are believed to arise from musculoaponeurotic structures. Read More

J Plast Surg Hand Surg 2017 Oct 13;51(5):323-328. Epub 2017 Jan 13.

a Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine , Kagawa University , Takamatsu , Japan.

Objective: The present study elucidates whether or not preserving fat tissues deeper than the Scarpa's fascia in zone 3 and zone 4 reduces postoperative fluid collection after harvesting the transverse rectus-abdominis muscle (TRAM) flap.

Methods: Thirty-one patients for whom breast reconstruction with free TRAM flaps had been performed were included in the study. Fat tissues deeper than the Scarpa's fascia in zone 3 and zone 4 were addressed in two ways. Read More

Ann Plast Surg 2017 Jun;78(6):717-722

From the *Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; †T. Marciniak Lower Silesian Specialist Hospital, Wroclaw, Poland; ‡Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, LA; §Department of Plastic and Reconstructive Surgery, VU Medical Center, Amsterdam, the Netherlands; and ∥Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

Background: The incidence of breast cancer (BC) cases has increased significantly. The number of breast reconstruction (BR) procedures performed has mirrored this trend. Although implant-only procedures remain the most commonly used type of immediate BR, autologous techniques involving donor sites account for approximately 20%. Read More

Ann Plast Surg 2017 May;78(5):516-520

From the Division of Plastic, Aesthetic, & Reconstructive Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard Miller School of Medicine, Miami, FL.

Introduction: Abdominal based breast reconstruction exists in a continuum from pedicled transverse rectus abdominis myocutaneous (TRAM) flap to deep inferior epigastric perforator (DIEP) free flap. DIEP flap has the advantage of complete rectus abdominis sparing during harvest, thus decreasing donor site morbidity. Aim of this study is to determine whether the surgical advantages of the DIEP flap impact postoperative outcomes versus the free TRAM flap (fTRAM). Read More

Aesthetic Plast Surg 2017 Feb 28;41(1):19-25. Epub 2016 Dec 28.

Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.

Background: Tissue transfer, such as use of the transverse rectus abdominis myocutaneous (TRAM) or deep inferior epigastric artery perforator (DIEP) free flaps, is considered a standard method. However, outcomes may vary among inset methods. Here we compared the aesthetic outcomes of breast reconstructions using vertical and horizontal flap inset methods. Read More

Ann Surg 2018 Jan;267(1):164-170

Division of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.

Objective: In postmastectomy reconstruction, procedure choice is heavily influenced by the relative risks of the various options. This study sought to evaluate complications in a large, multicenter patient population.

Summary Of Background Data: Previous studies have reported widely varying complication rates, but have been limited by their single center designs and inadequate controlling for confounders in their analyses. Read More

J Reconstr Microsurg 2017 Feb 31;33(2):130-136. Epub 2016 Oct 31.

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

 To evaluate whether the timing of surgery after radiation in autologous breast reconstruction affects major complications.  We performed a retrospective review of 454 free flaps (331 patients) for breast reconstruction at a single institution from 2003 to 2014. Charts were reviewed for age, BMI, laterality, flap type (TRAM, msTRAM, DIEP), surgeon, donor vessels (IMA, TD), chemotherapy, smoking, diabetes, hypertension, DVT, venous anastomoses, vein size, and time from radiation (none, < 12 months, or ≥ 12 months). Read More

Aesthetic Plast Surg 2016 Dec 14;40(6):869-876. Epub 2016 Oct 14.

Division of Plastic, Aesthetic & Reconstructive Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Clinical Research Building, 1120 N.W. 14th Street, 4th Floor, Miami, FL, 33136, USA.

Introduction: Conventionally, free transverse rectus abdominis myocutaneous (fTRAM) flap breast reconstruction has been associated with decreased donor site morbidity and improved flap inset. However, clinical success depends upon more sophisticated technical expertise and facilities. This study aims to characterize postoperative outcomes undergoing free versus pedicled TRAM (pTRAM) flap breast reconstruction. Read More

J Plast Reconstr Aesthet Surg 2016 Oct 3;69(10):1382-8. Epub 2016 Aug 3.

Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Krankenhausstraße 12, 91054 Erlangen, Germany. Electronic address:

The aim of this prospective study was to assess the correlation of flap perfusion analysis based on laser-assisted Indocyanine Green (ICG) angiography with combined laser Doppler spectrophotometry in autologous breast reconstruction using free DIEP/ms-TRAM flaps. Between February 2014 and July 2015, 35 free DIEP/ms-TRAM flaps were included in this study. Besides the clinical evaluation of flaps, intraoperative perfusion dynamics were assessed by means of laser-assisted ICG angiography and post-capillary oxygen saturation and relative haemoglobin content (rHb) using combined laser Doppler spectrophotometry. Read More

J Plast Surg Hand Surg 2016 Oct 28;50(5):302-6. Epub 2016 Apr 28.

a Department of Plastic Surgery, Asan Medical Center , University of Ulsan, College of Medicine , Seoul , South Korea ;

Background: The purpose of this study was to determine the risk factors associated with mastectomy skin flap necrosis during immediate reconstruction with TRAM or DIEP flaps.

Methods: This study reviewed 1116 cases of immediate breast reconstruction over 10 years. Patients ranged in age from 29-76 years (average = 45. Read More

Plast Reconstr Surg 2016 May;137(5):1372-80

Houston, Texas From the Department of Plastic and Reconstructive Surgery, The University of Texas M. D. Anderson Cancer Center.

Background: In thin patients or when a significant amount of skin is needed, use of the entire abdomen to reconstruct a single breast may be necessary. In this article, the authors present their 15-year experience in dual-pedicle flap evolution and optimization of flap design.

Methods: A retrospective review was conducted of all bipedicle flaps performed from 2000 to 2015. Read More

Microsurgery 2017 Jan 21;37(1):21-28. Epub 2016 Apr 21.

University of Helsinki, Finland.

Background: We describe a new dual neurorrhaphy method for a free abdominal-based flap and compare sensory recovery with this novel technique to that with conventional neurorrhaphy technique for breast reconstruction.

Methods: 70 breast cancer patients underwent muscle sparing innervated transversal rectus abdominis myocutaneous flap (neuro ms-TRAM) breast reconstruction with either a novel dual neurorrhaphy technique (N = 41) or single (N = 29) neurorrhaphy only. Dual neurorrhaphy was performed on both sides and single neurorrhaphy on one side of the flap, using the end-to-end or end-to-side technique. Read More

Aesthetic Plast Surg 2016 Jun 8;40(3):372-9. Epub 2016 Apr 8.

Institute for Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY, 10016, USA.

Background: The aim of this study was to perform an updated systematic review of the literature over the last 10 years, analyzing and comparing the many published techniques with the hope of providing plastic surgeons with a new standard in creating the perfect umbilicus in the setting of both abdominoplasty and abdominally based free-flap breast reconstruction.

Methods: An initial search using the PubMed online database with the keyword "umbilicoplasty" was performed. These results were filtered to only include articles published within the last 10 years. Read More

J Plast Reconstr Aesthet Surg 2016 May 25;69(5):598-603. Epub 2015 Nov 25.

Plastic and Reconstructive Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. Electronic address:

Background: Currently, autologous breast reconstruction with a free tissue transfer from the lower abdomen is considered to be a safe method that provides a stable long-term solution. The DIEP-flap and the ms-2-TRAM-flap reconstructions have helped reduce donor site morbidity. In order to assess the potential differences between these techniques, we carried out myosonographic evaluations that assessed the muscle dynamics pre- and post-operatively. Read More

Plast Reconstr Surg 2016 Mar;137(3):758-71

Vancouver, British Columbia, and Toronto, Ontario, Canada; and New York, N.Y. From the Department of Surgery, Division of Plastic and Reconstructive Surgery, the Department of Psychology, University of British Columbia; the Division of Plastic and Reconstructive Surgery, University Health Network, University of Toronto; the Department of Surgery, Division of Plastic and Reconstructive Surgery Montefiore Medical Center; New York Medical Center, New York University; and the Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center.

Background: Approximately 20 percent of women select autologous tissue for postmastectomy breast reconstruction, and most commonly choose the abdomen as the donor site. An increasing proportion of women are seeking muscle-sparing procedures, but the benefit remains controversial. It is therefore important to determine whether better outcomes are associated with these techniques, thereby justifying longer operative times and increased costs. Read More

Plast Reconstr Surg 2016 Mar;137(3):749-57

Philadelphia, Pa. From the Division of Plastic Surgery, University of Pennsylvania Health System.

Background: Donor-site hernia is one of the most feared complications following abdominally based autologous breast reconstruction. The authors aim to assess the incidence of surgically repaired abdominal hernia across different types of abdominally based breast reconstruction, identify predictive perioperative factors, and estimate the health care charges associated with this morbidity.

Methods: Using inpatient and ambulatory surgery data from four states in the United States, the authors identified adult women who underwent pedicled transverse rectus abdominis muscle (TRAM), free TRAM, or deep inferior epigastric perforator (DIEP) flap breast reconstruction between 2008 and 2012. Read More

PLoS One 2016 10;11(2):e0148318. Epub 2016 Feb 10.

Division of Radiation Oncology, Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.

Purpose: To compare the long-term clinical outcomes of postmastectomy radiotherapy (PMRT) between breast cancer patients with and without immediate transverse rectus abdominis myocutaneous (TRAM) flap reconstruction.

Methods: The study included 492 patients with stage II or III breast cancer who underwent modified radical mastectomy (MRM) and chemotherapy followed by PMRT between 1997 and 2011. Cox regression model and Kaplan-Meier curves were calculated, and the log-rank test was used to evaluate the differences between overall and disease-free survival rates in the 2 groups. Read More