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Aesthetic Plast Surg 2021 Apr 23. Epub 2021 Apr 23.

Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 33 Badachu Road, Shijingshan District, Beijing, 100144, China.

Background: Previous data were not conclusive on the safety of gestation in patients whose abdominal flaps were earlier harvested. We performed a meta-analysis to evaluate the abdominal wall complications and birth mode of pregnancy in post-TRAM or post-DIEP harvested individuals.

Methods: A literature search was performed using the PubMed, Embase, Scopus, and Google scholar database. Read More

Plast Surg (Oakv) 2021 Feb 20;29(1):16-20. Epub 2020 Jul 20.

Department of Plastic Surgery, Ohio State University Wexner Medical Center, Columbus, OH, USA.

Introduction: Abdominal wall morbidity after microsurgical breast reconstruction is an important consideration for patients and surgeons. Previous studies are limited by multiple mesh locations or types. In this study, we evaluate specifically subfascial polypropylene mesh placement to determine a more definitive complication rate and basis for objective comparison. Read More

Plast Reconstr Surg Glob Open 2020 Oct 29;8(10):e3120. Epub 2020 Oct 29.

Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, Md.

Introduction: Transverse rectus abdominis myocutaneous (TRAM) and deep inferior epigastric artery perforator (DIEP) flaps are the most common abdominally based breast reconstruction procedures. Each technique has its advantages and disadvantages; however, how morbidity relates to satisfaction is not well-understood. Our aim was to compare complications and patient-reported outcomes following pedicled TRAM (pTRAM), free TRAM (fTRAM), and DIEP flaps to guide flap selection. Read More

Arch Plast Surg 2020 Sep 15;47(5):428-434. Epub 2020 Sep 15.

Division of Plastic Surgery, Stanford University, Palo Alto, CA, USA.

Background: Three-dimensional (3D) model printing improves visualization of anatomical structures in space compared to two-dimensional (2D) data and creates an exact model of the surgical site that can be used for reference during surgery. There is limited evidence on the effects of using 3D models in microsurgical reconstruction on improving clinical outcomes.

Methods: A retrospective review of patients undergoing reconstructive breast microsurgery procedures from 2017 to 2019 who received computed tomography angiography (CTA) scans only or with 3D models for preoperative surgical planning were performed. Read More

Cureus 2020 Jun 22;12(6):e8776. Epub 2020 Jun 22.

Plastic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, USA.

The free transverse rectus abdominis myocutaneous (fTRAM) flap is a frequently used option for autologous breast reconstruction, typically based on deep inferior epigastric vessels anastomosed to either the axillary or internal mammary systems. The distal portion of the fTRAM flap is routinely discarded prior to anastomosis, due to tenuous blood supply in the vascular territory most distal to the pedicle. This becomes problematic in cases that require use of the entire flap, such as in thin patients with large soft-tissue defects. Read More

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

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

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

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

Eur J Obstet Gynecol Reprod Biol 2020 Sep 30;252:166-173. Epub 2020 May 30.

Gynaecological Oncology Unit, Department of Obstetrics and Gynaecology, Multidisciplinary Breast Clinic, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, B-2650, Antwerp, Belgium.

Objective: Breast reconstructions with perforator flaps from the lower abdomen, commonly known as Deep Inferior Epigastric artery Perforator flap (DIEP-flap), have become the golden standard for autologous breast reconstruction after breast amputation. During this surgical procedure multiple challenging steps are encountered such as the selection of a suitable perforator that provides sufficient blood supply for the flap, surgical dissection of the chosen perforator, determination of perfusion area of the chosen perforator, microsurgical anastomosis, flap inset and shaping the flap into a breast. The current gold standard for perforator mapping is Computed Tomography Angiography (CTA). Read More

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 2020 Dec 8;120(6):375-382. Epub 2019 Jul 8.

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

Background: 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.

Methods: 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

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