1,447 results match your criteria Breast Reconstruction Perforator Flap


An anatomical study of the lymph-collecting vessels of the medial thigh and clinical applications of lymphatic vessels preserving profunda femoris artery perforator (LpPAP) flap using pre- and intraoperative indocyanine green (ICG) lymphography.

J Plast Reconstr Aesthet Surg 2020 May 19. Epub 2020 May 19.

Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550 Japan.

Background And Objectives: The profunda femoris artery perforator (PAP) flap is gaining popularity in microsurgical reconstruction. The complications that can occur after the PAP flap harvest include donor-site lymphedema, seroma, or cellulitis. The aim of this study was to evaluate and establish a safer technique for the elevation of lymphatic vessels preserving profunda femoris artery perforator (LpPAP) flap using pre- and intraoperative ICG lymphography. Read More

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http://dx.doi.org/10.1016/j.bjps.2020.03.023DOI Listing

Laparoscopic Assisted DIEP Flap Harvest Minimizes Fascial Incision in Autologous Breast Reconstruction.

Plast Reconstr Surg 2020 May 21. Epub 2020 May 21.

Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA 19104.

Introduction: Total extra-peritoneal laparoscopic-assisted (TEP-lap-assisted) harvest of the deep inferior epigastric (DIE) vessels permits a decrease in myofascial dissection in DIEP flap breast reconstruction. We present a reliable technique that further decreases donor site morbidity in autologous breast reconstruction.

Methods: The authors conducted a retrospective cohort study of female subjects presenting to the senior surgeon from March 2018 to March 2019 for autologous breast reconstruction after a newly diagnosed breast cancer. Read More

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http://dx.doi.org/10.1097/PRS.0000000000007048DOI Listing

Fat Necrosis After DIEP Flap Breast Reconstruction: A Review of Perfusion-Related Causes.

Aesthetic Plast Surg 2020 May 22. Epub 2020 May 22.

Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, 2 Hastings Road, Frankston, VIC, 3199, Australia.

Introduction: Fat necrosis is a common complication for the deep inferior epigastric perforator (DIEP) flap. A thorough understanding of the factors associated with fat necrosis will aid operative planning for reconstructive surgeons.

Methods: A systematic review of the literature was performed between January 1989 and April 2019. Read More

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http://dx.doi.org/10.1007/s00266-020-01784-1DOI Listing

The Reconstruction after a Giant Phyllodes Tumor Resection Using a DIEP Flap.

Plast Reconstr Surg Glob Open 2020 Apr 27;8(4):e2760. Epub 2020 Apr 27.

Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.

A phyllodes tumor of the breast is a rare neoplasm, accounting for 0.3%-1% of all breast cancers. The size is 4-5 cm on average but sometimes the tumor grows more and involves the entire breast. Read More

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http://dx.doi.org/10.1097/GOX.0000000000002760DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7209875PMC

Consecutive 265 Profunda Artery Perforator Flaps: Refinements, Satisfaction, and Functional Outcomes.

Plast Reconstr Surg Glob Open 2020 Apr 7;8(4):e2682. Epub 2020 Apr 7.

Department of Plastic Surgery at the University of Texas Southwestern Medical Center, Dallas, Tex.

Introduction: The ideal form of breast reconstruction provides total permanent restoration of the breast mound. When a deep inferior epigastric (DIEP) flap is not an option or does not provide significant volume, a secondary source must be considered. In our practice, the profunda artery perforator (PAP flap) from the thigh has emerged as a second choice. Read More

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http://dx.doi.org/10.1097/GOX.0000000000002682DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7209884PMC

An Individualized Patient-centric Approach and Evolution towards Total Autologous Free Flap Breast Reconstruction in an Academic Setting.

Plast Reconstr Surg Glob Open 2020 Apr 7;8(4):e2681. Epub 2020 Apr 7.

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.

Advances with newer perforator flaps and complex microsurgical techniques have enabled creative solutions in autologous breast reconstruction. For patients seeking total autologous breast reconstruction without the use of implants, body regions other than the abdomen have emerged to provide a substitute or additional donor tissue. In cases where abdominal perforator flaps are not possible (as with prior abdominoplasty), flaps taken from the lower back or thigh can be used. Read More

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http://dx.doi.org/10.1097/GOX.0000000000002681DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7209872PMC

Combined microvascular breast and lymphatic reconstruction with deep inferior epigastric perforator flap and gastroepiploic vascularized lymph node transfer for postmastectomy lymphedema patients.

Gland Surg 2020 Apr;9(2):512-520

Division of Plastic and Reconstructive Surgery, Mayo Clinic, Jacksonville, FL, USA.

Background: The combination of microvascular breast reconstruction (MBR) and vascularized lymph node transfer (VLNT) in a single-stage procedure is a surgical option for women who desire breast reconstruction and postmastectomy lymphedema surgery. In this study, we present a series of patients who underwent simultaneous lymphatic and MBR with the gastroepiploic VLNT (GE-VLNT) and the deep inferior epigastric perforator (DIEP) flap respectively.

Methods: Between 2018 and 2019, all consecutive patients diagnosed with lymphedema stage IIb-III International Society of Lymphology who opted to pursue simultaneous MBR with DIEP flap and GE-VLNT were included in this study. Read More

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http://dx.doi.org/10.21037/gs.2020.01.14DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7225469PMC

Unilateral autologous breast reconstruction with unipedicled and bipedicled deep inferior epigastric artery perforator flap: A review of 168 cases over 3 years.

Microsurgery 2020 May 8. Epub 2020 May 8.

Department of Plastic and Reconstructive Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, South Korea.

Background: Harvesting a DIEP flap based on bipedicled perforators can enhance vascular perfusion, which can reduce complication rates, minimize fat necrosis, and flap failure. This study summarizes our experience with using unipedicled and bipedicled DIEP flaps for breast reconstruction.

Patients And Methods: A total of 168 consecutive patients undergoing unilateral breast reconstruction with DIEP flaps over a 3-year period were retrospectively reviewed. Read More

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http://dx.doi.org/10.1002/micr.30601DOI Listing

Multidisciplinary approach to chest wall reconstruction in primary breast angiosarcoma resection.

BMJ Case Rep 2020 May 6;13(5). Epub 2020 May 6.

Department of Surgery, Galway University Hospitals, Galway, Ireland.

Angiosarcomas account for less than 1% of primary breast cancers. Typically, they occur in young women with a low-risk personal or family history. Diagnosis, resection and reconstruction require a multidisciplinary team of breast surgeons, oncologists and plastic reconstructive surgeons. Read More

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http://dx.doi.org/10.1136/bcr-2019-233156DOI Listing

Breast sensibility in bilateral autologous breast reconstruction with unilateral sensory nerve coaptation.

Breast Cancer Res Treat 2020 Jun 28;181(3):599-610. Epub 2020 Apr 28.

Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands.

Background: Patient satisfaction after breast reconstruction is dependent on both esthetics and functional outcomes. In an attempt to improve breast sensibility, a sensory nerve coaptation can be performed. The aim of this study was to objectify the sensory recovery in patients who, by chance, underwent bilateral autologous breast reconstruction with one innervated and one non-innervated flap. Read More

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http://dx.doi.org/10.1007/s10549-020-05645-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7220889PMC

[Effects of pedicled rectus abdominis myocutaneous flap combined with free deep inferior epigastric artery perforator flap carrying inguinal lymphatic flap in breast reconstruction and upper limb lymphedema treatment post radical mastectomy].

Zhonghua Shao Shang Za Zhi 2020 Apr;36(4):297-303

Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha 410008, China.

To explore the effects of pedicled rectus abdominis myocutaneous (PRAM)flap combined with free deep inferior epigastric artery perforator (DIEAP) flap carrying inguinal lymphatic flap in breast reconstruction and upper limb lymphedema treatment post radical mastectomy. From October 2014 to September 2016, 9 patients with upper limb lymphedema after mastectomy were treated with PRAM flap combined with free DIEAP flap carrying inguinal lymphatic flap for breast reconstruction and upper limb lymphedema treatment in Hunan Province Cancer Hospital. The patients were all females, aged 34-66 (44±7) years. Read More

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http://dx.doi.org/10.3760/cma.j.cn501120-20190117-00011DOI Listing

Current Status and Factors Influencing Surgical Options for Breast Cancer in China: A Nationwide Cross-Sectional Survey of 110 Hospitals.

Oncologist 2020 Apr 25. Epub 2020 Apr 25.

Department of Breast Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.

Background: There are limited nationwide data regarding breast cancer surgery in China. The Chinese Anti-Cancer Association's Committee of Breast Cancer Society and the Chinese Society of Breast Surgeons conducted a nationwide survey to examine the use of and barriers associated with surgical options among patients with breast cancer.

Methods: Surveys were sent via e-mail to the directors of 110 centers that performed at least 200 breast cancer operations in 2017. Read More

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http://dx.doi.org/10.1634/theoncologist.2020-0001DOI Listing

Does Pregnancy Predict Incisional Hernia Repair after Abdominally Based Autologous Breast Reconstruction? A Retrospective Review of 890 Free Flaps.

Plast Reconstr Surg 2020 May;145(5):909e-916e

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

Background: The abdomen is a common donor site in autologous breast reconstruction. The authors aimed to determine whether pregnancy following autologous breast reconstruction increases the risk of incisional hernia repair.

Methods: All women younger than 50 years who underwent abdominally based autologous breast reconstruction between 2005 and 2016 were identified. Read More

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http://dx.doi.org/10.1097/PRS.0000000000006723DOI Listing

Immediate unilateral breast reconstruction and contralateral breast augmentation with bilateral free deep inferior epigastric perforator flaps.

Ann R Coll Surg Engl 2020 Apr 24:e1-e3. Epub 2020 Apr 24.

Norfolk and Norwich University Hospitals, NHS Foundation Trust, Norwich, UK.

A 42-year-old woman was referred for consideration of left-sided mastectomy and immediate reconstruction. She previously had a bilateral breast augmentation using silicone implants. She desired to maintain her breast size and natural appearance. Read More

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http://dx.doi.org/10.1308/rcsann.2019.0186DOI Listing

Absent Internal Mammary Recipient Vein in Autologous Breast Reconstruction.

Plast Reconstr Surg Glob Open 2020 Feb 25;8(2):e2660. Epub 2020 Feb 25.

Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama, Kanagawa, Japan.

The internal mammary vessels (IMA/Vs) have been used as the first-choice recipient vessels for microsurgical anastomosis and flap inset in autologous breast reconstruction owing to their ease of access and use compared with the thoracodorsal vessels (TDA/Vs). Herein, we report two cases of deep inferior epigastric perforator flap breast reconstructions in which the recipient internal mammary vein (IMV) was lacking. In the first case, a 50-year-old patient underwent delayed two-stage reconstruction, and in the second, a 45-year-old patient underwent delayed reconstruction because of capsular contracture following breast implant reconstruction. Read More

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http://dx.doi.org/10.1097/GOX.0000000000002660DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7159964PMC
February 2020

No-drain Technique in Abdominal Closure for Breast Reconstruction: Lower Complication Rate, Shorter Hospitalization Stay.

Plast Reconstr Surg Glob Open 2020 Feb 6;8(2):e2637. Epub 2020 Feb 6.

Department of Plastic, Reconstructive and Aesthetic Surgery, KK Women's and Children's Hospital, Singapore 229899, Singapore.

Background: Progressive tension suture (PTS) technique in cosmetic abdominoplasty is safe in terms of seroma rates. This was extrapolated to deep inferior epigastric perforator (DIEP) flap donor site closure. No study to our knowledge has analyzed the PTS technique alone without drains in transverse rectus abdominis musculocutaneous (TRAM) flap donor sites. Read More

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http://dx.doi.org/10.1097/GOX.0000000000002637DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7159947PMC
February 2020

Anatomical Study of Lumbar Artery Perforators in Male Subjects.

Plast Reconstr Surg Glob Open 2020 Feb 10;8(2):e2628. Epub 2020 Feb 10.

Plastic, Reconstructive, and Aesthetic Surgery Department, Erasmus Hospital, Brussels, Belgium.

Introduction: The lumbar artery perforator (LAP) flap takes an important place in lumbosacral reconstruction and in breast reconstruction. Although studies on the location of lumbar perforators in women are common, no anatomical study has focused solely on male subjects. Our objective is to facilitate the surgical approach to the LAP flap in male subjects by precisely ascertaining the characteristics of the perforators. Read More

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http://dx.doi.org/10.1097/GOX.0000000000002628DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7159950PMC
February 2020

Definition of Tumor Bed Boost in Oncoplastic Breast Surgery: An Understanding and Approach.

Clin Breast Cancer 2020 Mar 20. Epub 2020 Mar 20.

Breast Surgery, Cambridge University Hospitals, Cambridge, UK. Electronic address:

Introduction: Definition of the tumor bed (TB) is currently guided by intraoperatively placed metal clips. However, this traditional planning method may not be sufficient for tumor cavity defect refilled with modern oncoplastic breast surgery. We explored the impact of a close cooperation between surgeon and oncologist on the accuracy of TB contouring after partial breast reconstruction with chest wall perforator flaps (CWPF). Read More

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http://dx.doi.org/10.1016/j.clbc.2020.03.003DOI Listing

Deconstructing the Reconstruction: Evaluation of Process and Efficiency in Deep Inferior Epigastric Perforator Flaps.

Plast Reconstr Surg 2020 Apr;145(4):717e-724e

Dallas, Texas From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.

Background: With advances in technology and technique, the goal of microvascular breast reconstruction has transitioned from flap success to minimizing complications and maximizing aesthetic outcome and efficiency. In an effort to evaluate efficiency, the authors implemented a rigorous process analysis in their practice to evaluate deep inferior epigastric perforator (DIEP) flap breast reconstruction.

Methods: A prospective implementation of process analysis was instituted on 147 DIEP flaps. Read More

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http://dx.doi.org/10.1097/PRS.0000000000006630DOI Listing

Lumbar Flap versus the Gold Standard: Comparison to the DIEP Flap.

Plast Reconstr Surg 2020 Apr;145(4):706e-714e

Gent, Belgium From the Department of Plastic and Reconstructive Surgery, University of Gent.

Background: The lumbar artery perforator flap is an excellent free flap for breast reconstruction whenever the deep inferior epigastric perforator (DIEP) flap is not an option. The main indication is a lack of abdominal bulk, often seen in young BRCA-positive women seeking prophylactic amputation and immediate reconstruction.

Methods: Between October of 2010 and July of 2016, a total of 661 free flap breast reconstructions were performed. Read More

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http://dx.doi.org/10.1097/PRS.0000000000006681DOI Listing

Estimation of Contralateral Perfusion in the DIEP Flap by Scoring the Midline-Crossing Vessels in Computed Tomographic Angiography.

Plast Reconstr Surg 2020 Apr;145(4):697e-705e

Seoul, Korea From the Departments of Plastic Surgery and Radiology and the Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine.

Background: In deep inferior epigastric perforator flap surgery, the amount of perfusion achievable in the contralateral side over a midline is unclear. Predicting contralateral perfusion preoperatively using computed tomographic angiography will allow efficient breast reconstruction with decreased complications. The authors used computed tomographic angiography to determine whether contralateral perfusion is related to blood vessel status across the midline. Read More

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http://dx.doi.org/10.1097/PRS.0000000000006684DOI Listing

Revisiting Anastomosis to the Retrograde Internal Mammary System in Stacked Free Flap Breast Reconstruction: An Algorithmic Approach to Recipient-Site Selection.

Plast Reconstr Surg 2020 Apr;145(4):880-887

Dallas, Texas From the Department of Plastic Surgery, University of Texas Southwestern.

Background: The authors present their stacked flap breast reconstruction experience to facilitate selection of either caudal internal mammary vessels or intraflap vessels for the second recipient anastomosis.

Methods: A retrospective review was conducted of multiflap breast reconstructions (double-pedicled deep inferior epigastric perforator, stacked profunda artery perforator, and stacked profunda artery perforator/deep inferior epigastric perforator) performed at the authors' institution from 2011 to 2018. Data collected included demographics, recipient vessels used, and intraoperative/postoperative flap complications. Read More

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http://dx.doi.org/10.1097/PRS.0000000000006712DOI Listing

Optimizing Quality of Life for Patients with Breast Cancer-Related Lymphedema: A Prospective Study Combining DIEP Flap Breast Reconstruction and Lymphedema Surgery.

Plast Reconstr Surg 2020 Apr;145(4):676e-685e

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

Background: Patients with breast cancer-related lymphedema can be treated with a simultaneous deep inferior epigastric perforator (DIEP) flap, vascularized inguinal lymph node transfer, and lymphovenous anastomosis for aesthetic breast reconstruction and lymphedema in one operation.

Methods: The authors performed a comparison of prospectively followed patients who underwent free flap breast reconstruction with vascularized inguinal lymph node transfer and anastomosis to a retrospective cohort of patients who underwent free flap breast reconstruction with vascularized inguinal lymph node transfer alone.

Results: Thirty-three patients underwent DIEP flap reconstruction with vascularized inguinal lymph node transfer and lymphovenous anastomosis, and 21 received a free flap with lymph node transfer alone. Read More

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http://dx.doi.org/10.1097/PRS.0000000000006634DOI Listing
April 2020
2.993 Impact Factor

Incidence of Complications in Delayed Abdominal-Based Flap Breast Reconstruction Using a Drainless Recipient Site: A Case Series.

Ann Plast Surg 2020 Mar 19. Epub 2020 Mar 19.

Plastic and Reconstructive Surgery, MedStar Franklin Square Medical Center, Baltimore, MD.

Background: Seroma is a common complication after breast surgery such as mastectomy and immediate reconstruction. However, there is a lack of evidence for the utility of drains in the recipient site in delayed autologous breast reconstruction. We reviewed our experience with delayed abdominal-based flap breast reconstruction with a drainless recipient site. Read More

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http://dx.doi.org/10.1097/SAP.0000000000002328DOI Listing

Chest wall perforator flaps for partial breast reconstruction: Surgical outcomes from a multicenter study.

Arch Plast Surg 2020 Mar 15;47(2):153-159. Epub 2020 Mar 15.

Department of Breast and General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.

Background: Perforator artery flaps based on the branches of intercostal arteries and lateral thoracic artery can be used for reconstruction after breast-conserving surgery (BCS). Although described more than a decade ago, these have not been adopted widely in clinical practice. We report on short-term and long-term surgical outcomes of partial breast reconstruction using chest wall perforator flaps from a prospective multicenter audit. Read More

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http://dx.doi.org/10.5999/aps.2019.01186DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7093273PMC

Current status of and trends in post-mastectomy breast reconstruction in Korea.

Arch Plast Surg 2020 Mar 15;47(2):118-125. Epub 2020 Mar 15.

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

Since April 2015, post-mastectomy breast reconstruction has been covered by the Korean National Health Insurance Service (NHIS). The frequency of these procedures has increased very rapidly. We analyzed data obtained from the Big Data Hub of the Health Insurance Review and Assessment Service (HIRA) and determined annual changes in the number of breast reconstruction procedures and related trends in Korea. Read More

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http://dx.doi.org/10.5999/aps.2019.01676DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7093270PMC

Interdisciplinary Treatment of Breast Cancer After Mastectomy With Autologous Breast Reconstruction Using Abdominal Free Flaps in a University Teaching Hospital-A Standardized and Safe Procedure.

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

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http://dx.doi.org/10.3389/fonc.2020.00177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7066123PMC

Use of infrared thermography for the assessment of free flap perforators in autologous breast reconstruction: A systematic review.

JPRAS Open 2020 Mar 3;23:60-70. Epub 2019 Dec 3.

Department of Plastic Surgery, Galway University Hospital, Galway, Ireland.

Perforator-based flaps have in recent years become the mainstay of autologous breast reconstruction practice. Imaging modalities ranging from Doppler ultrasound to CT angiography demonstrate varying utility in the preoperative identification and localisation of perforators. Despite these available radiological investigations, finding and quantitatively assessing perforators remain a time-consuming and tedious process that is often complicated by a number of factors including variable anatomy prior surgery and body habitus. Read More

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http://dx.doi.org/10.1016/j.jpra.2019.11.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7061583PMC

Cook-Swartz Doppler Probe Surveillance for Free Flaps-Defining Pros and Cons.

Surg J (N Y) 2020 Jan 3;6(1):e42-e46. Epub 2020 Mar 3.

Department of Plastic, Aesthetic, Reconstructive and Hand Surgery, Agaplesion Diakonieklinikum Rotenburg, Rotenburg (Wümme), Germany.

 The main postoperative complication of free flaps is perfusion compromise. Urgent intervention is critical to increase the chances of flap survival. Invasive flap perfusion monitoring with direct blood flow feedback through the Cook-Swartz Doppler probe could enable earlier detection of perfusion complications. Read More

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http://dx.doi.org/10.1055/s-0040-1702922DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7054061PMC
January 2020

"Three-dimensional evaluation of breast volume changes following autologous free flap breast reconstruction over six months".

Breast 2020 Apr 10;50:85-94. Epub 2020 Feb 10.

Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.

Objectives: To date, little is known about postoperative changes in breast volume after autologous breast reconstruction. The purpose of this retrospective study was to investigate breast volume changes following autologous free flap reconstruction and the factors affecting flap volume.

Materials And Methods: Patients who underwent deep inferior epigastric perforator, superficial inferior epigastric artery and profunda artery perforator flaps between December 2016 and January 2019 were included. Read More

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http://dx.doi.org/10.1016/j.breast.2020.02.005DOI Listing

Long-Term Outcomes of Immediate Autologous Breast Reconstruction for Breast Cancer Patients.

J Surg Res 2020 Jul 26;251:78-84. Epub 2020 Feb 26.

Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Kanazawa, Yokohama, Kanagawa, Japan.

Background: There is limited information on the oncological outcomes of immediate autologous breast reconstruction in the Asian population. This study aimed to evaluate the oncological outcomes of immediate one-stage autologous breast reconstruction using a free perforator flap for breast cancer patients at a single institution in Japan.

Methods: We retrospectively reviewed 239 patients who underwent immediate one-stage autologous breast reconstruction using a free perforator flap after skin- or nipple-sparing mastectomy. Read More

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http://dx.doi.org/10.1016/j.jss.2020.01.010DOI Listing

Robotic-Assisted DIEP Flap Harvest for Autologous Breast Reconstruction: A Comparative Feasibility Study on a Cadaveric Model.

J Reconstr Microsurg 2020 Jun 27;36(5):362-368. Epub 2020 Feb 27.

Department of Cardiovascular Medicine, Center for Regenerative Medicine, Mayo Clinic, Rochester, Minnesota.

Background:  The deep inferior epigastric perforator (DIEP) flap is the most common perforator flap for microsurgical breast reconstruction. Contrary to the conventional open approach, robotic-assisted DIEP flap harvest intends to preserve ARS integrity, thereby reducing the morbidity. We assessed the feasibility and compared performance outcomes of a robotic, cadaveric training model for DIEP flap harvest using two approaches: transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP). Read More

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http://dx.doi.org/10.1055/s-0040-1701666DOI Listing
June 2020
1.006 Impact Factor

Revisiting the Relationship Between Hospital Case Volume and Outcomes in Abdominally Based Free Flap Breast Reconstruction.

Ann Plast Surg 2020 Feb 25. Epub 2020 Feb 25.

Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

Background: Increased operative volume has been associated with benefits in patient outcomes for a variety of surgical procedures. In autologous abdominally based breast reconstruction, however, there are few studies assessing the association between procedure volume and patient outcomes. The objectives of this study are to evaluate the associations between abdominal-based free flap breast reconstruction and patient outcomes. Read More

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http://dx.doi.org/10.1097/SAP.0000000000002308DOI Listing
February 2020

Intraoperative Laser-Assisted Indocyanine Green Imaging Can Reduce the Rate of Fat Necrosis in Microsurgical Breast Reconstruction.

Plast Reconstr Surg 2020 Mar;145(3):507e-513e

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

Background: Fat necrosis following microsurgical breast reconstruction is common and problematic for patients and surgeons alike. Indocyanine green angiography provides a means of evaluating flap perfusion at the time of surgery to inform judicious excision of hypoperfused tissue. The authors hypothesized that incorporation of protocolized indocyanine green-informed flap débridement at the time of surgery would decrease the incidence of fat necrosis. Read More

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http://dx.doi.org/10.1097/PRS.0000000000006547DOI Listing

Robotic Surgery: A Novel Approach for Breast Surgery and Reconstruction.

Plast Reconstr Surg Glob Open 2020 Jan 29;8(1):e2578. Epub 2020 Jan 29.

Division of Surgery and Interventional Science, University College London, Royal Free Hospital, London, UK.

Breast cancer is the most prevalent cancer and second leading cause of cancer-related deaths in both the US and UK female population, a prominent cause of morbidity and cost to both health services. All surgically fit patients are offered breast reconstruction following the initial surgery, and this is traditionally an open approach: either implant-based or an autologous tissue flap. Both lead to scarring that is difficult to conceal. Read More

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http://dx.doi.org/10.1097/GOX.0000000000002578DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7015621PMC
January 2020

Intraoperative Laser Speckle Contrast Imaging in DIEP Breast Reconstruction: A Prospective Case Series Study.

Plast Reconstr Surg Glob Open 2020 Jan 20;8(1):e2529. Epub 2020 Jan 20.

Department of Medical Radiation Physics, Linköping University, Linköping, Sweden.

Laser speckle contrast imaging (LSCI) is a laser-based perfusion imaging technique that recently has been shown to predict ischemic necrosis in an experimental flap model and predicting healing time of scald burns. The aims were to investigate perfusion in relation to the selected perforator during deep inferior epigastric artery perforator (DIEP) flap surgery, and to evaluate LSCI in assisting of prediction of postoperative complications.

Methods: Twenty-three patients who underwent DIEP-procedures for breast reconstruction at 2 centers were included. Read More

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http://dx.doi.org/10.1097/GOX.0000000000002529DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7015619PMC
January 2020

Postoperative Free Flap Breast Protocol Optimizing Resources and Patient Safety.

J Reconstr Microsurg 2020 Jun 23;36(5):379-385. Epub 2020 Feb 23.

Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.

Background:  As deep inferior epigastric artery perforator (DIEP) flaps have gained popularity in breast reconstruction, the postoperative care of these patients, including the appropriate hospital length-of-stay and the need for intensive care unit (ICU) admission, has become a topic of debate. At our institution, we have adopted a pathway that aims for discharge on postoperative day 3, utilizing continuous tissue oximetry without ICU admission. This study aims to evaluate outcomes with this pathway to assess its safety and feasibility in clinical practice. Read More

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http://dx.doi.org/10.1055/s-0040-1701698DOI Listing

The perforator flap from the contralateral large healthy breast as an alternative for breast reconstruction or combined breast and thoracic reconstruction.

Microsurgery 2020 Feb 18. Epub 2020 Feb 18.

Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, PR China.

Background: It has been demonstrated that contralateral breast tissue can be used for delayed breast reconstruction. The current report presented the clinical outcomes of the perforator flap from the contralateral lower breast as a pedicled flap for immediate or delayed breast reconstruction and as a free flap for delayed breast reconstruction or simultaneous breast and thoracic reconstruction in patients with macromastia.

Methods: From June 2014 to August 2018, a total of 15 female patients with a mastectomy defect on one side and a large healthy breast on the other side were collected in our department. Read More

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http://dx.doi.org/10.1002/micr.30570DOI Listing
February 2020
2.421 Impact Factor

Nipple-sparing mastectomy through periareolar incision with immediate reconstruction.

Ann Surg Treat Res 2020 Feb 31;98(2):57-61. Epub 2020 Jan 31.

Department of Surgery, College of Medicine, Ewha Womans University, Seoul, Korea.

Purpose: Nipple-sparing mastectomy (NSM) has become increasingly popular due to improved cosmesis without compromising oncologic safety. Radial and inframammary incisions are usually used to achieve NSM, with periareolar incisions usually being avoided because of the risk to nipple-areola complex viability. In an attempt to maximize esthetic effects, we performed NSM through periareolar incision with immediate reconstruction. Read More

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http://dx.doi.org/10.4174/astr.2020.98.2.57DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7002881PMC
February 2020

Dynamic infrared thermography (DIRT) in Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction: standardization of the measurement set-up.

Gland Surg 2019 Dec;8(6):799-805

Gynaecological Oncology Unit, Department of Obstetrics and Gynaecology, Multidisciplinary Breast Clinic, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium.

Breast reconstruction with an autologous free Deep Inferior Epigastric Perforator (DIEP) flap is one of the preferred options following mastectomy. A challenging step in this procedure is the selection of a suitable perforator that provides sufficient blood supply for the flap. The current golden standard for perforator mapping is computed tomography angiography (CTA). Read More

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http://dx.doi.org/10.21037/gs.2019.12.09DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6989904PMC
December 2019

The Feasibility of a Sensate Profunda Artery Perforator Flap in Autologous Breast Reconstruction: An Anatomic Study for Clinical Application.

Ann Plast Surg 2020 Jun;84(6S Suppl 5):S451-S454

Division of Plastic Surgery.

Background: The profunda artery perforator (PAP) flap has been demonstrated to be an effective method of autologous breast reconstruction, particularly when the abdominal donor site is contraindicated. However, there are no current reports regarding the use of a sensate PAP flap in this type of reconstruction. The objective of this study is to describe the feasibility and anatomic location of the sensory nerves supplying the PAP flap in relation to surface landmarks for use in autologous breast reconstruction. Read More

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http://dx.doi.org/10.1097/SAP.0000000000002275DOI Listing

Bipedicle-Conjoined Deep Inferior Epigastric Perforator Flaps for Unilateral Breast Reconstruction in Overweight and Obese Patients: Do the Benefits Outweigh the Risks?

J Reconstr Microsurg 2020 Jun 3;36(5):346-352. Epub 2020 Feb 3.

Department of Plastic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.

Background:  Some surgeons have advocated for the use of bipedicle-conjoined deep inferior epigastric perforator (DIEP) flaps in unilateral autologous breast reconstruction in thin patients in whom a hemiabdominal flap is deemed insufficient. There have been no studies to date, however, exploring complication rates for bipedicle-conjoined DIEP flaps for unilateral reconstruction in overweight or obese patients.

Methods:  The authors performed a retrospective review of two senior authors' patients from 2013 until 2018. Read More

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http://dx.doi.org/10.1055/s-0040-1701209DOI Listing

The Butterly iQ: An ultra-simplified color Doppler ultrasound for bedside pre-operative perforator mapping in DIEP flap breast reconstruction.

J Plast Reconstr Aesthet Surg 2020 May 18;73(5):983-1007. Epub 2020 Jan 18.

Department of Plastic Surgery, St Thomas Hospital, Guy's and St. Thomas' NHS Trust, London, UK.

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http://dx.doi.org/10.1016/j.bjps.2020.01.002DOI Listing

Geisinger MyCode detects BRCA2 mutation prior to abdominal panniculectomy allowing for DIEP flap breast reconstruction.

Case Reports Plast Surg Hand Surg 2019 6;6(1):145-147. Epub 2019 Nov 6.

Department of Plastic Surgery, Geisinger Medical Center, Danville, PA, USA.

This case report presents a 38-year-old female who was scheduled for abdominal panniculectomy and tested positive for BRCA2 mutation through Geisinger MyCode. She canceled her panniculectomy and elected to proceed with bilateral mastectomies, utilizing her abdominal tissue for deep inferior epigastric perforator flap reconstruction. Read More

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http://dx.doi.org/10.1080/23320885.2019.1684824DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6968680PMC
November 2019

Application of Three-Dimensional Printed Vascular Modeling as a Perioperative Guide to Perforator Mapping and Pedicle Dissection during Abdominal Flap Harvest for Breast Reconstruction.

J Reconstr Microsurg 2020 Jun 30;36(5):325-338. Epub 2020 Jan 30.

Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.

Background:  Advancements in three-dimensional (3D) printing have enabled production of patient-specific guides to aid perforator mapping and pedicle dissection during abdominal flap harvest. We present our early experience using this tool to navigate deep inferior epigastric artery (DIEA) topography and evaluate its impact on operative efficiency and clinical outcomes.

Patients And Methods:  Between January 2013 and December 2018, a total of 50 women underwent computed tomographic angiography (CTA)-guided perforator mapping prior to abdominal flap breast reconstruction, with ( = 9) and without ( = 41) 3D-printed vascular modeling (3DVM). Read More

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http://dx.doi.org/10.1055/s-0039-1700991DOI Listing
June 2020
1.006 Impact Factor

Umbilical Ablation During Deep Inferior Epigastric Perforator Flap Harvest Decreases Donor Site Complications.

Ann Plast Surg 2020 Jan 30. Epub 2020 Jan 30.

Breast Reconstruction Associates, Great Neck.

Background: Donor site complications are a significant source of morbidity for patients undergoing abdominal-based free flap breast reconstruction, but there is a paucity of data regarding minimizing these postoperative complications. We hypothesize that selective ablation of the umbilicus at the time of deep inferior epigastric perforator (DIEP) harvest decreases the incidence of umbilical and abdominal wall complications in high-risk patients.

Methods: A retrospective review was performed of all patients (n = 117) who underwent DIEP harvest with concomitant umbilical ablation from 2010 to 2015. Read More

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http://dx.doi.org/10.1097/SAP.0000000000002191DOI Listing
January 2020

Breast reconstruction with superior epigastric artery perforator (SEAP) free flap: Report of two cases.

Microsurgery 2020 Jan 30. Epub 2020 Jan 30.

Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham, North Carolina.

The deep inferior epigastric artery perforator (DIEP) flap is the gold standard for autologous breast reconstruction. When the DIEP pedicle is damaged, alternative perforator flaps are harvested from sites with less donor tissue, such as the thigh. Pedicled superior epigastric artery perforator (SEAP) flaps have been recently described for reconstruction of inferior partial breast defects. Read More

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http://dx.doi.org/10.1002/micr.30563DOI Listing
January 2020

Role of CTA in Women with Abdominal Scars Undergoing DIEP Breast Reconstruction: Review of 1,187 Flaps.

J Reconstr Microsurg 2020 May 28;36(4):294-300. Epub 2020 Jan 28.

Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Background:  This study examines the effect of prior abdominal surgery on flap, donor-site, and overall complications in women undergoing deep inferior epigastric artery perforator (DIEP) flap breast reconstruction and assesses whether preoperative computed tomography angiography (CTA) affects outcomes.

Methods:  All DIEP flaps performed at our institution between 2004 and 2015 were identified retrospectively. Patients were stratified based on a history of prior abdominal surgery and whether or not they underwent a preoperative CTA. Read More

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http://dx.doi.org/10.1055/s-0039-1701040DOI Listing

The Robotic DIEP Flap.

Authors:
Jesse C Selber

Plast Reconstr Surg 2020 Feb;145(2):340-343

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

The history of autologous breast reconstruction has been characterized by the desire for progressively increasing reliability with decreasing donor-site morbidity. The robotic deep inferior epigastric artery perforator flap permits the longest possible pedicle harvest through the smallest possible fascial incision and, for this reason, may be the next stage in the evolution of minimally invasive, autologous breast reconstruction. Read More

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http://dx.doi.org/10.1097/PRS.0000000000006529DOI Listing
February 2020

Automatic detection of perforators for microsurgical reconstruction.

Breast 2020 Apr 12;50:19-24. Epub 2020 Jan 12.

Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal; Faculdade de Medicina da Universidade Nova de Lisboa, Nova Medical School, Lisbon, Portugal.

The deep inferior epigastric perforator (DIEP) is the most commonly used free flap in mastectomy reconstruction. Preoperative imaging techniques are routinely used to detect location, diameter and course of perforators, with direct intervention from the imaging team, who subsequently draw a chart that will help surgeons choosing the best vascular support for the reconstruction. In this work, the feasibility of using a computer software to support the preoperative planning of 40 patients proposed for breast reconstruction with a DIEP flap is evaluated for the first time. Read More

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http://dx.doi.org/10.1016/j.breast.2020.01.001DOI Listing