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Handchir Mikrochir Plast Chir 2020 Apr 7;52(2):83-87. Epub 2020 Apr 7.

Agaplesion Diakonie-Klinikum Hamburg gGmbH Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie.

Introduction: In recent decades, the internet has become one of the most important sources of information for patients. How substantial are the possibilities to find out about breast reconstruction on the homepages of university hospitals in Germany? Is there information about plastic surgery with its spectrum of modern reconstructive possibilities?

Methods: A total of 35 homepages of university breast centres in Germany was analysed for the indication of cooperation with a plastic surgeon or a department for plastic surgery and their links, with information on reconstructive possibilities such as implant reconstruction, autologous soft tissue reconstruction with pedicled and free flaps as well as lipofilling.

Results: A plastic surgeon or a cooperating department is mentioned on 49 % of the homepages. Read More

Front Oncol 2020 5;10:177. Epub 2020 Mar 5.

Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen-Nuernberg, Erlangen, Germany.

Breast cancer is the most common malignancy in women. The interdisciplinary treatment is based on the histological tumor type, the TNM classification, and the patient's wishes. Following tumor resection and (neo-) adjuvant therapy strategies, breast reconstruction represents the final step in the individual interdisciplinary treatment plan. Read More

J Plast Reconstr Aesthet Surg 2019 Dec 7;72(12):1923-1929. Epub 2019 Sep 7.

Division of Plastic and Reconstructive Surgery, Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, 770 Welch Road, Suite 400, Stanford, Palo Alto, CA 94304, United States. Electronic address:

Over the past several decades, technical advances in breast reconstruction have resulted in the development of flaps that are aimed at progressively decreasing abdominal wall morbidity. There is, however, ongoing controversy related to the superiority of deep inferior epigastric perforator (DIEP) flaps over muscle-sparing TRAM (MS-TRAM) flaps. Hence, the question remains unanswered as to which approach should be considered the standard of care, and more importantly, whether the rate of DIEP flap utilization should be considered a quality metric in breast reconstruction. Read More

Cardiovasc Diagn Ther 2019 Aug;9(Suppl 1):S131-S142

Department of Radiology, UT Health Science Center, San Antonio, TX, USA.

Perforator flap-based breast reconstruction in a post mastectomy patient requires dissection of the artery-vein bundle (perforators) responsible for perfusion of the subcutaneous fat and skin of the flap. Traditionally, these reconstructions were performed with the transverse rectus abdominis myocutaneous (TRAM) flap, but autologous breast reconstruction using muscle sparing free flaps has become steadily more popular in recent years. Preoperative imaging to locate and evaluate candidate perforators has become an essential step before patients undergo the microsurgical procedure. Read More

Ann Plast Surg 2020 03;84(3):293-299

From the Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan.

Background: Despite improvements in the early detection of breast cancer, locally advanced breast cancer (LABC) involving the chest wall exists in developing countries. Surgical resection remains a controversial management option. This study aims to demonstrate the value of chest wall reconstructive techniques for large LABC defects and report long-term outcomes. Read More

Gland Surg 2019 Jun;8(3):242-248

St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Chelmsford, UK.

Background: The plasmakinetic cautery is a surgical dissection instrument that combines scalpel-like cutting precision with electrocautery-like haemostasis properties, and operates at lower temperatures (40-170 °C) than conventional electrocautery (200-350 °C). The aim of this study is to evaluate the clinical benefits of using plasmakinetic cautery in abdominal free flap dissection for breast reconstruction.

Methods: Forty women undergoing abdominal-based microsurgical breast reconstruction (DIEP/MS-TRAM) were randomized to plasmakinetic cautery (n=20) or conventional electrocautery (n=20) for dissection of the abdominal free flap. Read More

Acta Chir Belg 2019 Jul 8:1-8. Epub 2019 Jul 8.

b Department of Plastic Surgery , Gatot Soebroto Army Central Hospital , Jakarta , Indonesia.

Breast reconstruction can ease the psychological burden in breast cancer patients that have undergone mastectomy. The aim of our study is to collect the latest evidences to summarize whether pedicled TRAM (pTRAM) is non-inferior in terms of patient satisfaction and complications to free TRAM (fTRAM) so that it may be used in region with limited resources. We performed a comprehensive search on studies that compared pTRAM and fTRAM flap from several databases. Read More

Ann Plast Surg 2019 12;83(6):e59-e67

From the Department of Plastic and Reconstructive Surgery, School of Medicine, Fukuoka University, Fukuoka, Japan.

Background: We compare the vascular territory of free muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flaps, deep inferior epigastric perforator (DIEP) flaps, and crossover anastomosis (CA) flaps using intraoperative ex vivo angiography. We also use ex vivo angiography to analyze the vascular architecture of the MS-TRAM flap.

Methods: Our study includes 84 lower abdominal free flaps: MS-TRAM, DIEP-1 (1 perforator), DIEP-2 (2 perforators), and CA. Read More

Breast J 2019 09 2;25(5):898-902. Epub 2019 Jun 2.

Division of Plastic Surgery, University of Pennsylvania Health Systems, Philadelphia, Pennsylvania.

The benefits of breast reconstruction via free tissue transfer with simultaneous implant placement, that is, hybrid breast reconstruction, in select patients are well-known. Challenges exist, however, and are related to proper implant selection as well as postoperative mastectomy skin necrosis. Here, the authors present an approach that increases reconstructive precision while minimizing postoperative mastectomy skin necrosis. Read More

J Reconstr Microsurg 2019 Oct 10;35(8):594-601. Epub 2019 May 10.

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

Background:  Bilateral mastectomy rates are increasing in the United States. The abdomen is the most common harvest site for autologous reconstruction. Nationwide data were examined to determine differences in hospital charges, length of stay (LOS), and early postoperative complications following immediate bilateral pedicled transverse rectus abdominis myocutaneous (pTRAM), free TRAM (fTRAM), deep inferior epigastric perforator (DIEP), and superficial inferior epigastric artery (SIEA) perforator flaps and were compared with unilateral reconstruction. Read More

Arch Plast Surg 2019 Mar 31;46(2):140-146. Epub 2019 Mar 31.

Department of Plastic Surgery, Korea University College of Medicine, Seoul, Korea.

Background: Thoracodorsal vessels (TDVs) and internal mammary vessels (IMVs) have both been widely employed as recipient vessels for use in free muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flaps. However, whether TDVs or IMVs are preferable as recipient vessels for autologous breast reconstruction with a free MS-TRAM flap remains controversial. The purpose of this study was to compare the clinical outcomes when TDVs were used as recipient vessels to those obtained when IMVs were used as recipient vessels for autologous breast reconstruction with a free MS-TRAM flap. Read More

Ann Plast Surg 2019 05;82(5S Suppl 4):S325-S331

Division of Plastic Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA.

Background: Google Trends (GT) is a free, open-source tool that permits customizable analysis of search term volumes entered into the Google search engine. Google Trends data may offer useful and actionable insight to plastic surgeons pertaining to worldwide, national, and regional evolution of patient interest for breast procedures and other common surgeries.

Methods: Search terms were generated using the "related queries" feature of GT. Read More

Microsurgery 2020 Jan 22;40(1):38-43. Epub 2019 Feb 22.

Department of Plastic Surgery, Korea University Anam Hospital, Seoul, South Korea.

Background: Identification and understanding of predictors for complications and aesthetic outcomes in free muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flap are essential for successful breast reconstruction. The purpose of this study was to investigate predictors for complications and aesthetic outcomes in patients who underwent autologous breast reconstruction with free MS-TRAM flaps.

Patients And Methods: Between March 2003 and September 2017, a total of 214 patients who underwent breast reconstruction with MS-TRAM flaps were included in this study. Read More

Microsurgery 2020 Jan 28;40(1):74-78. Epub 2019 Jan 28.

Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany.

Abdominal free flaps such as the muscle sparing transverse rectus abdominis myocutaneous (ms-TRAM) or deep inferior epigastric artery perforator (DIEP) flap represent the gold standard in autologous breast reconstruction. We describe a salvage procedure during bilateral free flap breast reconstruction due to insufficient venous drainage using a venous cross-over bypass. A 54-year-old woman with a thrombosis of the left subclavian port-system in the medical history was elected for simultaneous bilateral breast reconstruction with ms-TRAM and DIEP flaps. Read More

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2019 01;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 2019 03;143(3):667-677

Detroit, Mich.; Tampa, Fla.; Durham, N.C.; and New York, N.Y. From the Division of Plastic Surgery, Department of Surgery, Henry Ford Health System; the Division of Plastic Surgery, Department of Surgery, Morsani College of Medicine, University of South Florida; the Department of Biostatistics, Department of Surgery, Duke University; and Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center.

Background: This study aimed to identify differences in patient-reported abdominal well-being, satisfaction, and quality of life in women with muscle-preserving free abdominal versus pedicle transverse rectus abdominis musculocutaneous (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. Descriptive statistics and regression analyses were used to compare abdominal physical well-being, breast satisfaction, chest physical, psychosocial well-being, and sexual well-being in women undergoing free versus pedicle TRAM flaps. Read More

J Surg Oncol 2019 Mar 18;119(3):388-396. 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 Dec 24;52(6):325-332. 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 09 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 09 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 11;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 06 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 02;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