Journal articles: 'Breast reconstructions'

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Chen, C. M., C. Ahn, and J. Levine. "Perforator flap breast reconstruction in thin patients." Journal of Clinical Oncology 29, no. 27_suppl (September 20, 2011): 242. http://dx.doi.org/10.1200/jco.2011.29.27_suppl.242.

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242 Background: Perforator flap breast reconstruction has strong appeal for many women seeking breast reconstruction, but the procedure requires adequate donor site tissue to produce realistic breasts. Thin women requesting perforator flaps are often advised that they lack sufficient donor site tissue for autologous tissue breast reconstruction, and that implants are their only option. We have expanded the reconstructive options for thin women who seek an alternative to implants with innovative new techniques. Methods: A retrospective review was done of 223 patients who underwent 293 consecutive perforator flap breast reconstructions from April 2007-May 2011. Preoperative imaging allowed visualization of the microvascular anatomy and subcutaneous tissue. Donor sites evaluated included the abdomen, medial thigh, buttocks, and back. Complications included flap loss, hematoma, seroma, takeback, and fat necrosis. No patients were turned away for perforator flap breast reconstruction due to insufficient donor site tissue. Results: Out of 293 perforator flap breast reconstructions, 45 perforator flap breast reconstructions (15.4%) were reported in 26 thin women with a BMI < 23 (mean BMI 20.7, range BMI 18.2-22.7). Out of 45 perforator flap breast reconstructions in thin women, donor sites included 35 hemi-abdominal flaps (77.8%), 4 medial thigh flaps (8.9%), 7 buttock flaps (15.6%), and 2 back flaps (4.4%). Of the 35 hemi-abdominal flaps, 8 hemi-abdominal flaps were combined to create 4 stacked DIEP flaps (22.9%) while the remaining 27 hemi-abdominal flaps were regular DIEP flaps (77.1%). There was one seroma (2.2%) and one takeback for postoperative pain (2.2%); there were no flap losses. Conclusions: Even in thin women, perforator flap breast reconstruction is a safe, reliable, and consistent technique for recreating new breasts. While implant-based breast reconstruction may be acceptable to many women, there is a growing subgroup of patients who prefer autologous tissue breast reconstruction. By challenging common conceptions about the amount of donor site tissue required, we have been able to expand reconstructive options in thin women by using perforator flaps to construct natural, aesthetic breasts.

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Kozak, Krzysztof, Rafal Wojcik, Maciej Czerwonka, Slawomir Mandziuk, and Barbara Madej-Czerwonka. "Oncoplastic breast surgery techniques - a new look at surgical treatment of breast cancer." Current Issues in Pharmacy and Medical Sciences 31, no. 3 (September 1, 2018): 131–34. http://dx.doi.org/10.1515/cipms-2018-0025.

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Abstract Breast cancer is the most common cancer among Polish women [1], thus, the problem of surgical treatment of breasts, especially with regard to conserving and/or reconstruction surgery, is extensively discussed. Currently, in Poland, efforts are made to increase the number of oncologic and reconstructive breast centers which offer specialized treatment of this cancer, the so-called ‘Breast Units’ [1]. This paper analyzes methods of reconstructions, discusses the techniques used in particular types of surgeries and additionally informs the reader of the oncological aspects of the procedures. Based on literature, statistical data of breast reconstructions from Poland and the world are presented. Moreover, complications and psychological aspects of mammary gland surgery are dealt with, and the aesthetic effects of breast reconstructions are discussed. To support of our findings, we also present selected clinical cases from the oncological and reconstructive point of view.

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Aboushi, Renee, W. Kurtis Childe, Christopher S. Hollenbeak, Harold Yang, and Brynn Wolff. "Reoperation and Postoperative Outcomes for Single-Stage versus Two-Stage Breast Reconstruction Following Mastectomy: A Meta-Analysis." Clinical Surgery Journal 1, no. 1 (December 30, 2018): 6–17. http://dx.doi.org/10.46619/csj.2018.1-1002.

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Introduction Implant based breast reconstructions has become widely accepted as an appropriate reconstruction method following mastectomy for breast cancer. The two most common techniques include immediate reconstruction and implantation (single-stage procedure) or the use of a tissue expander with delayed insertion of implant and reconstruction (two-stage procedure). Using existing studies and available data, a meta-analysis was performed analyzing reoperation rates and postoperative complications between these two methods based upon available literature. Methods A literature search was performed by two individual investigators using the databases PubMed, Cochrane, and Medline. All articles comparing implant based single and two stage breast reconstructions outcomes between 2006 and 2016 were utilized. The primary endpoint of interest was reoperation rates. Secondary endpoints included postoperative complications such as infection, seroma, hematoma, and necrosis. Results A total of five studies met the inclusion criteria, for a total of 12,357 breast reconstructions. 2,281 breast reconstructions were singlestage and 10,076 were two-staged. The primary endpoint of reoperation was increased reoperation rate in the single-stage breast reconstruction (OR=0.78, CI 0.67-0.91; p<0.05). Secondary endpoints demonstrated no statistical significance in infections (OR 1.06, CI 0.84-1.34; p=0.40), hematoma (OR=1.66, CI 0.91-3.05; p=0.09) and necrosis (OR=1.13, CI 0.76-1.68; p=0.29). However, there was an increased incidence of seroma formation in two-stage reconstruction (OR=1.86, CI 1.05-3.28; p<0.005). Conclusions Single and two-staged implant breast reconstructions had similar infection, hematoma, and necrosis rates. Single-stage reconstructions resulted in a significant increase in reoperation/revision rates.

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Edwards, Kyle, Daniel Donato, Eric Tatro, Yizhe Xu, Angela Presson, Jayant Agarwal, and Alvin Kwok. "Operative Time and Flap Failure in Unilateral and Bilateral Free Flap Breast Reconstruction." Journal of Reconstructive Microsurgery 34, no. 06 (February 16, 2018): 428–35. http://dx.doi.org/10.1055/s-0038-1627445.

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Background There is an increasing trend toward bilateral breast reconstruction. Using the National Surgical Quality Improvement Program (NSQIP) database, we sought to understand the association between unilateral and bilateral free flap breast reconstruction and operative time and flap failure. Methods We selected a cohort of patients undergoing free flap breast reconstruction using the 2005 to 2010 NSQIP database. Cases were divided into unilateral and bilateral reconstruction. Subgroup analyses were performed dividing cases into delayed and immediate reconstruction. The effect of patient characteristics including age, body mass index (BMI), history of diabetes, and the American Society of Anesthesiologists' classification on operative time and flap failure was examined using univariable and multivariable regression models. Rates and odds ratios (OR) were reported using the multivariable gamma and logistic regression models, respectively. Results There were 691 free flap breast reconstructions performed in the cohort and 29.1% were bilateral cases. There was a 78-minute increase in the median operative time when comparing unilateral and bilateral reconstruction (p = 0.005). Patients undergoing bilateral reconstructions were generally younger and had fewer comorbidities compared with unilateral reconstructions. There was no significant association between bilateral reconstruction and flap failure. Immediate bilateral reconstructions had a significant increase in median operative time compared with immediate unilateral reconstructions (563 versus 480 minutes, p = 0.002) but no significant increase in operative time was noted when comparing delayed unilateral and delayed bilateral reconstructions. Prolonged operative time was associated with flap failure after adjusting for age and BMI (OR 1.17, p < 0.001). Conclusions Bilateral free flap breast reconstruction can be performed safely despite an increase in operative time when compared with unilateral reconstruction.

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Wilkinson, Tolbert S. "IMPLANT-BASED BREAST RECONSTRUCTIONS VERSUS TRAM FLAP BREAST RECONSTRUCTION." Plastic and Reconstructive Surgery 114, no. 3 (September 2004): 820–22. http://dx.doi.org/10.1097/01.prs.0000136535.45017.c4.

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Song, Woo Jin, Sang Gue Kang, Eun Key Kim, Seung Yong Song, Joon Seok Lee, Jung Ho Lee, and Ung Sik Jin. "Current status of and trends in post-mastectomy breast reconstruction in Korea." Archives of Plastic Surgery 47, no. 2 (March 15, 2020): 118–25. http://dx.doi.org/10.5999/aps.2019.01676.

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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. We evaluated the numbers of mastectomy and breast reconstruction procedures performed between April 2015 and December 2018 using data from the HIRA Big Data Hub. We determined annual changes in the numbers of total, autologous, and implant breast reconstructions after NHIS coverage commenced. Data were analyzed using Microsoft Excel. The post-mastectomy breast reconstruction rate increased from 19.4% in 2015 to 53.4% in 2018. In 2015, implant reconstruction was performed in 1,366 cases and autologous reconstruction in 905 (60.1% and 39.8%, respectively); these figures increased to 3,703 and 1,570 (70.2% and 29.7%, respectively) in 2018. Free tissue transfer and deep inferior epigastric perforator flap creation were the most common autologous reconstruction procedures. For implant-based reconstructions, the rates of directto-implant and tissue-expander breast reconstructions (first stage) were similar in 2018. This study summarizes breast reconstruction trends in Korea after NHIS coverage was expanded in 2015. A significant increase over time in the post-mastectomy breast reconstruction rate was evident, with a trend toward implant-based reconstruction. Analysis of data from the HIRA Big Data Hub can be used to predict breast reconstruction trends and convey precise information to patients and physicians.

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Rusby, Jennifer E., Ruth A. Waters, Peter G. Nightingale, and David W. England. "Immediate breast reconstruction after mastectomy: what are the long-term prospects?" Annals of The Royal College of Surgeons of England 92, no. 3 (April 2010): 193–97. http://dx.doi.org/10.1308/003588410x12628812458770.

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INTRODUCTION Immediate breast reconstruction after mastectomy has known psychological and financial advantages but it is difficult to compare the outcome of various methods of reconstruction. Re-operation rates are an objective measure of surgical intervention required to attain and maintain acceptable cosmesis. PATIENTS AND METHODS A series of 95 patients (110 immediate reconstructions) was analysed for number of re-operations required within 5 years of initial surgery, magnitude of procedures, ‘survival’ of the reconstruction and effect of radiotherapy. RESULTS Although more intervention was seen in patients with implant-based reconstruction and the time-course over which autologous and implant-based reconstructions fail is different these did not reach statistical significance. Radiotherapy has a significant effect on failure of implant-based reconstruction. CONCLUSIONS Long-term, large studies of immediate reconstruction are required to assess adequately the impact of type of reconstruction on re-operation rates. The National Mastectomy and Breast Reconstruction Audit is ideally placed to provide answers to remaining questions about longevity of immediate breast reconstruction and the effect that late failure has on patient satisfaction.

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Rose, Jessica F., Sarosh N. Zafar, and Warren A. Ellsworth IV. "Does Acellular Dermal Matrix Thickness Affect Complication Rate in Tissue Expander Based Breast Reconstruction?" Plastic Surgery International 2016 (April 12, 2016): 1–6. http://dx.doi.org/10.1155/2016/2867097.

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Background. While the benefits of using acellular dermal matrices (ADMs) in breast reconstruction are well described, their use has been associated with additional complications. The purpose of this study was to determine if ADM thickness affects complications in breast reconstruction. Methods. A retrospective chart review was performed including all tissue expander based breast reconstructions with AlloDerm (LifeCell, Branchburg, NJ) over 4 years. We evaluated preoperative characteristics and assessed postoperative complications including seroma, hematoma, infection, skin necrosis, and need for reintervention. We reviewed ADM thickness and time to Jackson-Pratt (JP) drain removal. Results. Fifty-five patients underwent 77 ADM-associated tissue expander based breast reconstructions, with average age of 48.1 years and average BMI of 25.9. Average ADM thickness was 1.21 mm. We found higher complication rates in the thick ADM group. Significant associations were found between smokers and skin necrosis (p<0.0001) and seroma and prolonged JP drainage (p=0.0004); radiated reconstructed breasts were more likely to suffer infections (p=0.0085), and elevated BMI is a significant predictor for increased infection rate (p=0.0037). Conclusion. We found a trend toward increased complication rates with thicker ADMs. In the future, larger prospective studies evaluating thickness may provide more information.

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Bartlett, Erica, Agnieszka Kołacińska, and Aldona J. Spiegel. "Flap-based breast reconstructions." Nowotwory. Journal of Oncology 66, no. 6 (June 12, 2017): 463–69. http://dx.doi.org/10.5603/njo.2016.0083.

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Liu, Xingzi, and Jing Han. "Research progress on the safety of cell-assisted lipotransfer in breast repairs after breast conserving therapy." Advances in Modern Oncology Research 2, no. 2 (June 16, 2016): 70. http://dx.doi.org/10.18282/amor.v2.i2.74.

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<p>With the development of medical technology, more breast cancer patients have the opportunity of receiving breast conserving therapy. Post-operation breast reconstructions have gained more attention nowadays. As a new and important method of breast reconstruction after breast surgery, cell-assisted lipotransfer is being carried out in some clinical works. This paper briefly reviewed the current research progress of adipose-derived stem cell-assisted lipotransfer and the recurrence of breast cancers.</p>

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Head, Linden K., Anne Lui, Erin Cordeiro, and Kirsty U. Boyd. "National Multidisciplinary Survey of Regional Anesthesia Preferences in Breast Reconstruction." Plastic Surgery 28, no. 2 (May 2020): 105–11. http://dx.doi.org/10.1177/2292550320925551.

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Background: The purpose of this work was to determine the regional anesthesia preferences of plastic surgeons (PS) and anesthesiologists (A) involved in breast reconstruction in Canada. Methods: Online surveys were sent to members of the Canadian Society of Plastic Surgeons (CSPS) and the Canadian Anesthesiologists Society (CAS). The primary outcome was regional anesthesia preferences in breast reconstruction (delayed, immediate, alloplastic, autologous). Secondary outcomes included the availability and the influence of specialty and academic status on preferences. Statistical analysis used descriptive statistics and Pearson χ2 test. Results: Responses from CSPS and CAS totaled 141 (response rate = 30%) and 217 (response rate = 14%), respectively. Compared with non-academic centres (NAC), academic centres (AC) had significantly greater access to (AC = 60%, NAC = 39%, P = .001) and preferred to use regional anesthesia more often (AC = 36%, NAC = 10%, P < .001). The following proportions of physicians preferred to use regional anesthesia: 40% (PS = 32%, A = 44%, P = .081) for immediate alloplastic reconstruction, 23% (PS = 24%, A = 22%, P = .821) for delayed alloplastic reconstruction, 34% (PS = 18%, A = 41%, P < .001) for immediate autologous reconstruction, and 19% (PS = 13%, A = 21%, P = .195) for delayed autologous reconstruction. Regional anesthesia preferences were significantly different between plastic surgeons and anesthesiologists ( P < .001)—anesthesiologists favoured paravertebral blocks for all reconstructions, while plastic surgeons favoured pectoral nerve blocks for immediate alloplastic reconstruction and intercostal nerve blocks for all other reconstructions. Conclusions: Plastic surgeons and anesthesiologists prefer not to use regional anesthesia in the majority breast reconstructions. Among those who deploy regional anesthesia, plastic surgeons and anesthesiologist have divergent preferences with respect to modality. There is a need for a prospective study comparing paravertebral blocks and intercostal nerve blocks.

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Spinelli, Rossella, Monika Lanthaler, Christoph Tasch, Agnese Nitto, Gerhard Pierer, and Thomas Bauer. "Breast reconstruction with the omentum flap: a case report with unsatisfactory outcome and review of the literature." European Surgery 52, no. 3 (December 11, 2019): 105–9. http://dx.doi.org/10.1007/s10353-019-00621-3.

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Summary Background Recently, breast reconstruction with the greater omentum flap has gained more attention, although it has been only rarely reported in the literature. An unpleasant case presented by us here prompted us to perform a literature search on breast reconstruction with the omentum flap concerning postoperative results and complication rates. Case presentation We here present the case of a 46-year-old woman who presented with severe infection 3 months after omentum flap reconstruction in a distant local hospital. Intraoperative revision showed an inflammatory, completely necrotic flap that had to be removed. Conclusion The literature review shows that the omentum flap can be reasonably used only in one-sided reconstructions of very small breasts. Due to the limited indications, unpredictable flap volume, and our negative experience, we recommend that this type of reconstruction be used with restraint.

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Okada, Alberto, Diego Pereira, Eduardo Montag, Marcelo Portocarrero, Carlos Felício, Eduardo Arruda, Alexandre Fonseca, Rolf Gemperli, and Alexandre Munhoz. "Optimizing Outcomes in Free Flap Breast Reconstruction in the Community Hospital Setting: A Stepwise Approach to DIEP/SIEA Flap Procedures with Banking a Hemiabdominal Flap." Journal of Reconstructive Microsurgery 33, no. 07 (April 20, 2017): 474–82. http://dx.doi.org/10.1055/s-0037-1602588.

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Background Free flap breast reconstruction is a conventional procedure in many countries; however, microvascular compromise remains a devastating outcome. Given the morbidity of total necrosis, optimizing free flap salvage stands out as an important area for research, especially among surgeons to overcome the learning curve period and in resource constrained scenario such as community hospitals. To ensure free deep inferior epigastric perforator (DIEP)/superficial inferior epigastric artery (SIEA) flap breast reconstruction, the authors present a technique involving raising a hemiabdominal flap as a free flap, and banking the remaining flap to be utilized if needed in a subsequent procedure. Methods A retrospective review was performed on all free flap breast reconstructions. In this period, 84 patients (mean age: 50.1 ± 8 years) were included. Results In this study, 65.5% patients underwent immediate reconstruction, and 51.2% received DIEP reconstruction; 9.52% patients were returned to the operating room, and salvage reconstruction using the banked flap was performed in all patients. No differences were observed regarding early complications and age, body mass index, American Society of Anesthesiologists status, diabetes, smoking history, chemotherapy, radiotherapy, and type of flap used (p > 0.05). Hypertension was significantly associated with early complications (p < 0.05). Donor-site complications were associated with RT (p < 0.05). Conclusion The banked flap is a reliable method for ensuring DIEP/SIEA flap survival and should be considered in higher risk reconstructions and community hospitals. We believe that the present technique can be a good addition to the arsenal of plastic surgeons dealing with free flap breast reconstructions in selected patients.

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Kolacinska, Agnieszka, Diana Hodorowicz-Zaniewska, Artur Bocian, Dariusz Michalik, Rafal Matkowski, Andrzej Kurylcio, Pawel Pyka, Michal Charytonowicz, and Maciej Berkan. "Landscape of oncoplastic breast surgery across Poland." Polish Journal of Surgery 89, no. 6 (December 30, 2017): 14–19. http://dx.doi.org/10.5604/01.3001.0010.6735.

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Oncoplastic and reconstructive techniques are essential tools in the armamentarium of contemporary breast surgeons. The aim of the study was to identify oncoplastic reconstructive patterns in breast cancer centers across Poland. A questionnaire of 18 questions was sent by email to the members of the Polish Society of Surgical Oncology and the Polish Society of Plastic, Reconstructive and Esthetic Surgery via their dedicated websites. The numbers of breast cancer patients operated on in each center ranged from 120 to 904 per year. Breast-conserving surgery (BCS) predominated in all but one center (range 50-70%). Immediate breast reconstructions (IBR) accounted for 6-42% of procedures, The most frequent type of IBR was either a two-stage expander followed by a permanent implant or one-stage implant- based with or without synthetic mesh. The most frequent type of delayed breast reconstruction (DBR) was a two-stage expander followed by implant-based reconstruction. None of the surveyed cancer centers performed free flap reconstruction. Deep inferior epigastric perforator (DIEP) flaps were performed in the plastic surgery department. Reconstructions based on pedicled flaps were performed in cancer centers. Acellular dermal matrices (ADM) and fat transfer were used in selected centers. In the clinical scenario of adjuvant radiotherapy, delayed breast reconstruction was favored. The full range of oncoplastic BCS was performed. Patient-reported outcome measures (PROM) and complications were assessed. Our findings can act as a platform for further improvement in skills, certification, data collection and audit, including patient reported expectation measures. There is also an urgent need to address pan-European inconsistencies in procedural reimbursement.

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Molina, Bianca, Erez Dayan, Eric Jablonka, Michelle Okwali, Julie Kim, Joseph Dayan, and Mark Smith. "Defining the Role of Free Flaps in Partial Breast Reconstruction." Journal of Reconstructive Microsurgery 34, no. 03 (November 12, 2017): 185–92. http://dx.doi.org/10.1055/s-0037-1607363.

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Background Free flaps have a well-established role in breast reconstruction after mastectomy; however, their role in partial breast reconstruction remains poorly defined. We reviewed our experience with partial breast reconstruction to better understand indications for free tissue transfer. Methods A retrospective review was performed of all patients undergoing partial breast reconstruction at our center between February 2009 and October 2015. We evaluated the characteristics of patients who underwent volume displacement procedures versus volume replacement procedures and free versus pedicled flap reconstruction. Results There were 78 partial breast reconstructions, with 52 reductions/tissue rearrangements (displacement group) and 26 flaps (replacement group). Bra cup size and body mass index (BMI) were significantly smaller in the replacement group. Fifteen pedicled and 11 free flaps were performed. Most pedicled flaps (80.0%) were used for lateral or upper pole defects. Most free flaps (72.7%) were used for medial and inferior defects or when there was inadequate donor tissue for a pedicled flap. Complications included hematoma, cellulitis, and one aborted pedicled flap. Conclusion Free and pedicled flaps are useful for partial breast reconstruction, particularly in breast cancer patients with small breasts undergoing breast-conserving treatment (BCT). Flap selection depends on defect size, location, and donor tissue availability. Medial defects are difficult to reconstruct using pedicled flaps due to arc of rotation and intervening breast tissue. Free tissue transfer can overcome these obstacles. Confirming negative margins before flap reconstruction ensures harvest of adequate volume and avoids later re-operation. Judicious use of free flaps for oncoplastic reconstruction expands the possibility for breast conservation.

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In, Seok Kyung, Yoon Soo Kim, Ho Sung Kim, Jin Hyung Park, Hong Il Kim, Hyung Suk Yi, Jea Chun Park, et al. "Retrospective review of 108 breast reconstructions using the round block technique after breast-conserving surgery: Indications, complications, and outcomes." Archives of Plastic Surgery 47, no. 6 (November 15, 2020): 574–82. http://dx.doi.org/10.5999/aps.2020.00325.

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Background Several oncoplastic approaches have been implemented in recent years to enhance cosmetic results and to reduce complications. The round block technique is a volume displacement technique for breast reconstruction after breast-conserving surgery (BCS). However, its indications are currently limited according to tumor location, and its cosmetic results and complications have not been clearly established. We hypothesized that the round block technique could produce favorable cosmetic results without major complications regardless of tumor location or nipple-tumor distance, below a certain resected tumor volume and tumor-breast volume ratio.Methods All breast reconstructions using the round block technique after BCS were included in this analysis. Patients’ data were reviewed retrospectively to investigate complications during follow-up, and clinical photos were used to evaluate cosmetic results. The relationships of tumor location, nipple-tumor distance, tumor volume, and the tumor-breast volume ratio with cosmetic results were investigated.Results In total, 108 breasts were reconstructed. The mean resected tumor volume was 30.2±15.0 mL. The cosmetic score was 4.5±0.6 out of 5. Tumor location, nipple-tumor distance, tumor volume, tumor-breast volume ratio, radiotherapy, and chemotherapy had no significant effects on cosmetic results or complications. There were no major complications requiring reoperation.Conclusions Breast reconstruction using the round block technique after BCS can lead to good cosmetic results without major complications regardless of the tumor location, nipple-tumor distance, radiotherapy, or chemotherapy. Below the maximum tumor volume (79.2 mL) and the maximum tumor-breast volume ratio (14%), favorable results were consistently obtained.

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Mátrai, Zoltán, Csaba Kunos, Dávid Pukancsik, Ákos Sávolt, Gusztáv Gulyás, and Miklós Kásler. "Modern breast reconstruction with endoscopically assisted latissimus dorsi flap harvesting." Orvosi Hetilap 155, no. 3 (January 2014): 106–13. http://dx.doi.org/10.1556/oh.2014.29782.

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Skin- and nipple-sparing mastectomies made immediate breast reconstruction possible on a systemic level within breast cancer surgery. Mass reconstruction needs brought by the most common malignancy in women can only be met by the use of implant-based techniques, providing excellent cosmetic results and high patient satisfaction. For these postmastectomy reconstructions the replacement of the skin is no longer a challenge, but the well vascularized, good quality soft tissue coverage of the implant. Oncoplastic breast surgery today is able to conduct oncologically radical complete removal of the glandular tissue through an incision of 6-10 cm made in the armpit, with the nearly scarless retention of the natural skin envelope of the breast, and in the same time adequate axillary staging (sentinel node biopsy/axillary lymphadenectomy) is performed, then using the same incision, the implementation of one-step or multi-step breast reconstruction is possible. During these complex interventions, the latissimus dorsi flap formed by endoscopic technique (leaving no scar on the back), rotated to the anterior chest wall can be used for total autologous reconstruction of low-volume breasts as complete coverage of implants placed under the spared skin-envelope or for revitalization of thin or radiation damaged breast skin. This paper presents 4 cases of breast reconstruction with endoscopically assisted latissimus dorsi muscle flap, and the authors demonstrate the surgical technique in detail and conduct a literature review, for the first time in Hungarian. Orv. Hetil., 2014, 155(3), 106–113.

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Krammer, Julia, Sergei Zolotarev, Inge Hillman, Konstantinos Karalis, Dzmitry Stsepankou, Valeriy Vengrinovich, Jürgen Hesser, and Tony M. Svahn. "Evaluation of a new image reconstruction method for digital breast tomosynthesis: effects on the visibility of breast lesions and breast density." British Journal of Radiology 92, no. 1103 (November 2019): 20190345. http://dx.doi.org/10.1259/bjr.20190345.

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Objective: To compare image quality and breast density of two reconstruction methods, the widely-used filtered-back projection (FBP) reconstruction and the iterative heuristic Bayesian inference reconstruction (Bayesian inference reconstruction plus the method of total variation applied, HBI). Methods: Thirty-two clinical DBT data sets with malignant and benign findings, n = 27 and 17, respectively, were reconstructed using FBP and HBI. Three experienced radiologists evaluated the images independently using a 5-point visual grading scale and classified breast density according to the American College of Radiology Breast Imaging-Reporting And Data System Atlas, fifth edition. Image quality metrics included lesion conspicuity, clarity of lesion borders and spicules, noise level, artifacts surrounding the lesion, visibility of parenchyma and breast density. Results: For masses, the image quality of HBI reconstructions was superior to that of FBP in terms of conspicuity,clarity of lesion borders and spicules (p < 0.01). HBI and FBP were not significantly different in calcification conspicuity. Overall, HBI reduced noise and supressed artifacts surrounding the lesions better (p < 0.01). The visibility of fibroglandular parenchyma increased using the HBI method (p < 0.01). On average, five cases per radiologist were downgraded from BI-RADS breast density category C/D to A/B. Conclusion: HBI significantly improves lesion visibility compared to FBP. HBI-visibility of breast parenchyma increased, leading to a lower breast density rating. Applying the HBIR algorithm should improve the diagnostic performance of DBT and decrease the need for additional imaging in patients with dense breasts. Advances in knowledge: Iterative heuristic Bayesian inference (HBI) image reconstruction substantially improves the image quality of breast tomosynthesis leading to a better visibility of breast carcinomas and reduction of the perceived breast density compared to the widely-used filtered-back projection (FPB) reconstruction. Applying HBI should improve the accuracy of breast tomosynthesis and reduce the number of unnecessary breast biopsies. It may also reduce the radiation dose for the patients, which is especially important in the screening context.

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Balakrishnan, C., and R. Papini. "BREAST RECONSTRUCTIONS WITH THE EXPANDER." Plastic and Reconstructive Surgery 88, no. 2 (August 1991): 372. http://dx.doi.org/10.1097/00006534-199108000-00049.

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Slavin, Sumner A. "BREAST RECONSTRUCTIONS WITH THE EXPANDER." Plastic and Reconstructive Surgery 88, no. 2 (August 1991): 372. http://dx.doi.org/10.1097/00006534-199108000-00050.

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Fischer, John P., Jonas A. Nelson, Brady Sieber, Carrie Stransky, Stephen J. Kovach, Joseph M. Serletti, and Liza C. Wu. "Transfusions in Autologous Breast Reconstructions." Annals of Plastic Surgery 72, no. 5 (May 2014): 566–71. http://dx.doi.org/10.1097/sap.0b013e318268a803.

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Gelati, Chiara, Luca Negosanti, Erich Fabbri, and Riccardo Cipriani. "Aesthetical outcome after breast reconstruction using deep inferior epigastric perforator flap: Personal techniques." Indian Journal of Plastic Surgery 46, no. 03 (September 2013): 513–17. http://dx.doi.org/10.4103/0970-0358.121997.

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ABSTRACT Background: Now-a-days, deep inferior epigastric perforator (DIEP) flap breast reconstruction is widespread throughout the world. The aesthetical result is very important in breast reconstruction and its improvement is mandatory for plastic surgeons. Materials and Methods: The most frequent problems, we have observed in breast reconstruction with DIEP flap are breast asymmetry in terms of volume and shape, the bulkiness of the inferior lateral quadrant of the new breast, the loss of volume of the upper pole and the lack of projection of the inferior pole. We proposed our personal techniques to improve the aesthetical result in DIEP flap breast reconstruction. Our experience consists of more than 220 DIEP flap breast reconstructions. Results: The methods mentioned for improving the aesthetics of the reconstructed breast reported good results in all cases. Conclusion: The aim of our work is to describe our personal techniques in order to correct the mentioned problems and improve the final aesthetical outcome in DIEP flap breast reconstruction.

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Pukancsik, Dávid, Péter Kelemen, Ákos Sávolt, Mihály Újhelyi, Eszter Kovács, Zoltán Zaka, Miklós Kásler, and Zoltán Mátrai. "Azonnali, postmastectomiás emlőrekonstrukciókkal szerzett tapasztalatok. Száz eset klinikopatológiai utánkövetése és a kozmetikai eredmények felmérése." Orvosi Hetilap 157, no. 46 (November 2016): 1830–38. http://dx.doi.org/10.1556/650.2016.30569.

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Introduction: Immediate breast reconstruction provides oncological safety, requires longer operation time. It does not influence the initiation of adjuvant therapy and radiological control, and results in favourable cosmetic outcome. Aim: Assessing the Hungarian data of immediate postmastectomy breast reconstructions, and comparing them to international findings. Method: Between May, 2011 and September, 2014 121 therapeutic and prophylactic, postmastectomy immediate breast reconstructions were performed in 100 patients. The clinico-pathological findings were assessed retrospectively, and surgical, oncological and cosmetic outcomes were evaluated statistically. Results: The mean age of patients was 42.6 years, the follow up time was 29.4 months, and the duration of operation was 132 minutes. Skin-sparing mastectomy was performed most commonly (64%) with submuscular tissue expander placement (70%). Early postoperative complication was identified in 18 patients, and loco-regional recurrence in 1 patient. Most patients (89%) were satisfied with the cosmetic outcome. The average initiation time of adjuvant therapy was 4.8 weeks. Conclusions: Immediate breast reconstruction is a safe and effective option in line with international findings. Orv. Hetil., 2016, 157(46), 1830–1838.

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Cubitt, J., Z. Barber, AA Khan, and M. Tyler. "Breast reconstruction with deep inferior epigastric perforator flaps." Annals of The Royal College of Surgeons of England 94, no. 8 (November 2012): 552–58. http://dx.doi.org/10.1308/003588412x13373405386457.

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INTRODUCTION Approximately 45,000 women are diagnosed with breast cancer in the UK each year. The success of screening and the introduction of adjuvant therapies have meant that prognosis is improving and an increasing number of patients are seeking reconstruction following mastectomy. The purpose of this study was to evaluate the deep inferior epigastric perforator (DIEP) flap reconstructions performed in Stoke Mandeville Hospital and, through analysis of complications, detail the evolution of the current care pathway. METHODS A retrospective analysis was performed of all the DIEP flap reconstructions performed by the senior author (MT) between July 2003 and December 2010. RESULTS Overall, 159 flaps were performed on 141 patients (including 36 bilateral flaps). The average patient age was 49 years (range: 28–70 years) and 13% of flaps were risk reducing for BRCA1/2. Twenty-six per cent of patients suffered one or more complication post-operatively, including systemic complications (pulmonary embolism 2%) and flap specific complications (partial flap necrosis 9%, reanastomosis 3%, fat necrosis 9%). Seventy-four per cent had further elective operations including nipple reconstruction (72%), contralateral breast reduction (36%) and scar revision (21%). CONCLUSIONS DIEP flaps are a safe and reliable option for breast reconstructions. This series illustrates the significant leaning curve, with complications, operative time and ischaemic time reducing through the series and post-operative haemoglobin increasing. The complications experienced in this series of 159 flaps with no total flap loss provide the framework for the evolution of the current care pathway including pre-operative imaging, peri-operative deep vein thrombosis prophylaxis and analgesia.

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Reish, Richard G., Branimir Damjanovic, William G. Austen, Jonathan Winograd, Eric C. Liao, Curtis L. Cetrulo, Daniel M. Balkin, and Amy S. Colwell. "Infection following Implant-Based Reconstruction in 1952 Consecutive Breast Reconstructions." Plastic and Reconstructive Surgery 131, no. 6 (June 2013): 1223–30. http://dx.doi.org/10.1097/prs.0b013e31828bd377.

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Heidekrueger, Paul I., Nicholas Moellhoff, Raymund E. Horch, Jörn A. Lohmeyer, Mario Marx, Christoph Heitmann, Hisham Fansa, et al. "Overall Complication Rates of DIEP Flap Breast Reconstructions in Germany—A Multi-Center Analysis Based on the DGPRÄC Prospective National Online Registry for Microsurgical Breast Reconstructions." Journal of Clinical Medicine 10, no. 5 (March 2, 2021): 1016. http://dx.doi.org/10.3390/jcm10051016.

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While autologous breast reconstruction has gained momentum over recent years, there is limited data on the structure and quality of care of microsurgical breast reconstruction in Germany. Using the breast reconstruction database established by the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC), the presented study investigated the overall outcomes of deep inferior epigastric perforator (DIEP) flap reconstructions in Germany. Data of 3926 patients and 4577 DIEP flaps performed by 22 centers were included in this study. Demographics, patient characteristics, perioperative details and postoperative outcomes were accounted for. Centers performing < Ø 40 (low-volume (LV)) vs. ≥ Ø 40 (high-volume (HV)) annual DIEP flaps were analyzed separately. Overall, total and partial flap loss rates were as low as 2.0% and 1.1% respectively, and emergent vascular revision surgery was performed in 4.3% of cases. Revision surgery due to wound complications was conducted in 8.3% of all cases. Mean operative time and length of hospital stay was significantly shorter in the HV group (LV: 385.82 min vs. HV: 287.14 min; LV: 9.04 (18.87) days vs. HV: 8.21 (5.04) days; both p < 0.05). The outcome and complication rates deduced from the national registry underline the high standard of microsurgical breast reconstruction on a national level in Germany.

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Munder, Beatrix, Christoph Andree, Christian Witzel, Sonia Fertsch, Peter Stambera, Tino Schulz, Olaf Fleischer, et al. "The DIEP Flap as Well-established Method of Choice for Autologous Breast Reconstruction with a Low Complication Rate – Retrospective Single-centre 10-Year Experience." Geburtshilfe und Frauenheilkunde 80, no. 06 (April 16, 2020): 628–38. http://dx.doi.org/10.1055/a-1116-2102.

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Abstract Background Breast cancer is the most common cancer affecting women in Germany. Despite breast-conserving therapy (BCT) being carried out in almost 70% of cases, a high number of women still require complete mastectomy. Prophylactic mastectomy is also indicated for women with a BRCA 1/2 gene mutation. In addition to implant-based heterologous breast reconstruction, autologous breast reconstruction using a DIEP flap has been found to be beneficial, particularly for patients who had prior radiotherapy. This study aims to show that DIEP flap reconstruction surgery is the method of choice for autologous breast reconstruction with a low rate of complications. Patients and Methods Autologous breast reconstruction using a DIEP flap was performed in 1124 patients between July 2004 and December 2014. Retrospective study criteria included potential risk factors such as age, BMI, smoking, chemotherapy and/or radiotherapy, and comorbidities as well as outcome parameters such as postoperative complications. Outcomes were evaluated with a mean follow-up of 24 months. Results A total of 1124 patients underwent 1274 free DIEP flap breast reconstructions, of which 150 were bilateral reconstructions. The primary indication was previous mastectomy in 785 cases, followed by prior implant-based reconstruction in 265 cases. The total flap loss rate was 0.6%. Postoperative surgical revision for abdominal wall hernia was required in 0.2% of cases. The group with a higher BMI and the group of smokers had significantly higher complication rates. Elderly patients (> 65 years), patients who had undergone chemo-/radiotherapy and patients with diabetes did not have higher complication rates. Conclusion DIEP flap surgery is an excellent option for autologous breast reconstruction, with a low rate of donor site morbidity and low complication rates. DIEP flap surgery carried out in a specialised interdisciplinary breast centre in a standardised clinical setting after prior careful patient selection to take account of risk factors such as high BMI and smoking is a reliable method with a low complication rate and satisfactory long-term reconstruction results.

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Khoshdel, Vahab, Ahmed Ashraf, and Joe LoVetri. "Enhancement of Multimodal Microwave-Ultrasound Breast Imaging Using a Deep-Learning Technique." Sensors 19, no. 18 (September 19, 2019): 4050. http://dx.doi.org/10.3390/s19184050.

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We present a deep learning method used in conjunction with dual-modal microwave-ultrasound imaging to produce tomographic reconstructions of the complex-valued permittivity of numerical breast phantoms. We also assess tumor segmentation performance using the reconstructed permittivity as a feature. The contrast source inversion (CSI) technique is used to create the complex-permittivity images of the breast with ultrasound-derived tissue regions utilized as prior information. However, imaging artifacts make the detection of tumors difficult. To overcome this issue we train a convolutional neural network (CNN) that takes in, as input, the dual-modal CSI reconstruction and attempts to produce the true image of the complex tissue permittivity. The neural network consists of successive convolutional and downsampling layers, followed by successive deconvolutional and upsampling layers based on the U-Net architecture. To train the neural network, the input-output pairs consist of CSI’s dual-modal reconstructions, along with the true numerical phantom images from which the microwave scattered field was synthetically generated. The reconstructed permittivity images produced by the CNN show that the network is not only able to remove the artifacts that are typical of CSI reconstructions, but can also improve the detectability of tumors. The performance of the CNN is assessed using a four-fold cross-validation on our dataset that shows improvement over CSI both in terms of reconstruction error and tumor segmentation performance.

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Park, Eun Young, Myungsun Yi, Hye Sook Kim, and Haejin Kim. "A Decision Tree Model for Breast Reconstruction of Women with Breast Cancer: A Mixed Method Approach." International Journal of Environmental Research and Public Health 18, no. 7 (March 30, 2021): 3579. http://dx.doi.org/10.3390/ijerph18073579.

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The number of breast reconstructions following mastectomy has increased significantly during the last decades, but women are experiencing a number of conflicts with breast reconstruction decisions. The aim of this study was to develop a decision tree model of breast reconstruction and to examine its predictability. Mixed method design using ethnographic decision tree modeling was used. In the qualitative stage, data were collected using individual and focus group interviews and analyzed to construct a decision tree model. In the quantitative stage, the questionnaire was developed questions based on the criteria identified in the qualitative stage. A total of 61 women with breast cancer participated in 2017. Five major criteria: recovery of body image; impact on recurrence; recommendations from others; financial resources; and confirmation by physicians. The model also included nine predictive pathways. It turns out that the model predicted 90% of decisions concerning whether or not to have breast reconstruction. The findings indicate that the five criteria play a key role in decision-making about whether or not to have breast reconstruction. Thus, more comprehensive issues, including these five criteria, need to be integrated into an intervention for women with breast cancer to make their best decision on breast reconstruction.

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Vashi, Christopher. "Clinical Outcomes for Breast Cancer Patients Undergoing Mastectomy and Reconstruction with Use of DermACELL, a Sterile, Room Temperature Acellular Dermal Matrix." Plastic Surgery International 2014 (March 11, 2014): 1–7. http://dx.doi.org/10.1155/2014/704323.

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Background. Decellularized human skin has been used in a variety of medical applications, primarily involving soft tissue reconstruction, wound healing, and tendon augmentation. Theoretically, decellularization removes potentially immunogenic material and provides a clean scaffold for cellular and vascular in growth. The use of acellular dermal matrix in two-stage postmastectomy breast reconstruction is described. Methods. Ten consecutive breast cancer patients were treated with mastectomies and immediate reconstruction from August to November 2011. There were 8 bilateral and 1 unilateral mastectomies for a total of 17 breasts, with one exclusion for chronic tobacco use. Reconstruction included the use of a new 6 × 16 cm sterile, room temperature acellular dermal matrix patch (DermACELL) soaked in a cefazolin bath. Results. Of the 17 breasts, 15 reconstructions were completed; 14 of them with expander to implant sequence and acellular dermal matrix. Histological analysis of biopsies obtained during trimming of the matrix at the second stage appeared nonremarkable with evidence of normal healing, cellularity, and vascular infiltration. Conclusion. Postoperative observations showed that this cellular dermal matrix appears to be an appropriate adjunct to reconstruction with expanders. This acellular dermal matrix appeared to work well with all patients, even those receiving postoperative chemotherapy, postoperative radiation, prednisone, or warfarin sodium.

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Vidya, Raghavan, and Simon J. Cawthorn. "Muscle-Sparing ADM-Assisted Breast Reconstruction Technique Using Complete Breast Implant Coverage: A Dual-Institute UK-Based Experience." Breast Care 12, no. 4 (2017): 251–54. http://dx.doi.org/10.1159/000464401.

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Background: We report our early experience of a novel muscle-sparing breast (prepectoral) reconstruction technique using a pre-shaped Braxon® mesh (acellular dermal matrix) which completely wraps around the breast implant. Methods: All patients who underwent prepectoral implant-based breast reconstruction between April 2014 and September 2015 were included in the analysis. The dermal matrix Braxon® used is a pre-shaped matrix which forms a complete implant mesh wrap. The new breast created is placed over the chest wall without disturbing the pectoralis musculature. Results: A total of 51 (42 unilateral and 9 bilateral) muscle-sparing breast reconstructions were carried out. Complications included implant loss (n = 1; 1.7%) secondary to wound infection, seroma (n = 4; 6.7%), and superficial wound dehiscence (n = 1; 1.7%) which was re-sutured without further complication. The median follow-up period was 16.4 (range 8-25) months. Conclusion: The early experience appears highly satisfactory with good clinical outcome. The novel prepectoral implant-based breast reconstruction using the mesh wrap provides an effective alternative to the more traditional submuscular implant-based technique.

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Lhuaire, Martin, Kevin Haddad, Francesco-Saverio Wirz, Samah Abedalthaqafi, Déborah Obadia, Mohamed Derder, Alexandre Marchac, et al. "Medium- and Large-Sized Autologous Breast Reconstruction using a Fleur-de-lys Profunda Femoris Artery Perforator Flap Design: A Report Comparing Results with the Horizontal Profunda Femoris Artery Perforator Flap." Journal of Reconstructive Microsurgery 35, no. 01 (June 2, 2018): 008–14. http://dx.doi.org/10.1055/s-0038-1649508.

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Background The volume of the profunda femoris artery perforator (PAP) flap limits its indications to small- and medium-sized breast reconstructions after modified radical mastectomy for cancer. We report a modified PAP flap design, including not only a vertical extension that increases its volume but also the skin surface, which suits larger breasts requiring immediate or delayed breast reconstructions and compare the results with our horizontal skin paddle PAP flap experience. Patients and Methods In our center between November 2014 and November 2016, 51 consecutive patients underwent a PAP flap breast reconstruction following breast cancer. A retrospective analysis on the collected data was performed to compare 34 patients with a bra cup smaller than C who underwent 41 horizontal PAP flap procedures, with those (n = 17) of a bra cup greater than or equal to C who underwent 21 fleur-de-lys PAP flap procedures. Demographic, anthropometric, flap and surgical characteristics, postoperative complication rates, and hospital stay were compared between the two groups. Results The average flap weight was 480 g (range: 340–735 g) for the fleur-de-lys PAP flap group compared with 222 g (range: 187–325 g) for the horizontal PAP flap procedure (p < 0.001). The mean flap dimensions were 25 × 18 cm for the fleur-de-lys PAP flap group compared with 25 × 7 cm in the horizontal PAP flap group. No flap failure was observed in the fleur-de-lys PAP flap group compared with two flap failures secondary to venous thrombosis in the horizontal PAP flap group (NS). Three patients (14%) experienced delayed healing at the donor site compared with four patients (10%) in the horizontal PAP flap group (NS). Conclusion The fleur-de-lys skin paddle design not only allows an increase of the horizontal PAP flap volume, but also increases the skin surface, with an acceptable donor site morbidity. For medium- or large-sized breasts, the fleur-de-lys PAP flap seems to be ideal when a DIEP flap-based reconstruction is contraindicated.

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Paprottka, Felix J., Nicco Krezdorn, Heiko Sorg, Sören Könneker, Stiliano Bontikous, Ian Robertson, Christopher L. Schlett, Nils-Kristian Dohse, and Detlev Hebebrand. "Evaluation of Complication Rates after Breast Surgery Using Acellular Dermal Matrix: Median Follow-Up of Three Years." Plastic Surgery International 2017 (June 12, 2017): 1–9. http://dx.doi.org/10.1155/2017/1283735.

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Introduction. Acellular dermal matrices (ADMs) are now commonly used for breast reconstruction surgery. There are various products available: ADMs derived from human (HADM), porcine (PADM), or bovine (BADM) sources. Detailed long-term follow-up studies are necessary to detect differences in complication rates between these products. Material and Methods. From 2010 to 2015, forty-one patients underwent 52 ADM-breast reconstructions in our clinic, including oncologic breast reconstructions and breast augmentation revisions (n=52). 15x HADMs (Epiflex®/DIZG), 21x PADMs (Strattice®/LifeCell), and 16x BADMs (Tutomesh®/RTI Surgical) were implanted. Retrospective data collection with median follow-up of 36 months (range: 12–54 months) was performed. Results. Overall complication rate was 17% after ADM implantation (HADM: 7%; PADM: 14%; BADM: 31%). In a composite endpoint of complications and Red Breast Syndrome, a lower event probability was observed between BADMs, PADMs, and HADMs (44%, 19%, and 7%, resp.; p=0.01 for the trend). Furthermore, capsular contracture occurred in 6%, more frequently as compared to the current literature. Conclusions. When ADM-based reconstruction is indicated, the authors suggest primarily the use of HADMs and secondary the use of PADMs. It is shown that BADMs have the highest complication probability within our patient cohort; nevertheless, BADMs convey physical advantages in terms of flexibility and better aesthetic outcomes. The indication for the use of ADMs should be filled for each case individually.

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Hoffman, Saul. "HOW GOOD ARE OUR BREAST RECONSTRUCTIONS?" Plastic and Reconstructive Surgery 87, no. 4 (April 1991): 804. http://dx.doi.org/10.1097/00006534-199104000-00037.

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Goldwyn, Robert M. "How Good Are Our Breast Reconstructions?" Plastic and Reconstructive Surgery 86, no. 3 (September 1990): 548–49. http://dx.doi.org/10.1097/00006534-199009000-00027.

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Fisher, Jack, and Lauren Greenberg. "Secondary Revision of Unsatisfactory Breast Reconstructions." Perspectives in Plastic Surgery Volume 14, Number 2 (2000): 0083–104. http://dx.doi.org/10.1055/s-2000-8428.

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Xue, Amy, Katarzyna Kania, Rodger Brown, Jamal Bullocks, Larry Hollier, and Shayan Izaddoost. "Salvage of Infected Prosthetic Breast Reconstructions." Seminars in Plastic Surgery 30, no. 02 (May 4, 2016): 055–59. http://dx.doi.org/10.1055/s-0036-1580729.

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Goldwyn, Robert M. "How Good Are Our Breast Reconstructions?" Plastic and Reconstructive Surgery 114, Supplement (October 2004): 41–42. http://dx.doi.org/10.1097/00006534-200410001-00030.

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Dean, N. R., T. Neild, J. Haynes, C. Goddard, and R. D. Cooter. "Fading of nipple–areolar reconstructions: the last hurdle in breast reconstruction?" British Journal of Plastic Surgery 55, no. 7 (October 2002): 574–81. http://dx.doi.org/10.1054/bjps.2002.3920.

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Visnjic, Milan, Predrag Kovacevic, Ljiljana Paunkovic, Goran Djordjevic, Dragana Budjevac, and Aleksandar Visnjic. "Breast reconstruction following amputation for cancer." Vojnosanitetski pregled 66, no. 6 (2009): 427–33. http://dx.doi.org/10.2298/vsp0906427v.

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Background/Aim. Today, breast reconstruction is a widely accepted method in the treatment of breast cancer after modified radical mastectomy. Reconstruction methods are associated with an acceptable number of complications and reconstruction favorably impacts quality of life. The aim of the study was to present our experience in breast reconstruction. Methods. We presented here a four-year experience with 84 patients with breast reconstruction after modified radical mastectomy. Results. Implant reconstructions were most common, 44 (52.3%), with primary reconstruction in 31(70.4%) and secondary in 13 (29.5%) women. Lattisimus dorsi flap (LDF) and implant were utilized in 32 (38%) of the patients, with primary reconstruction in 24 (75%) and secondary in 8 (25%) women. Transversal rectus abdominis myocutaneous (TRAM) flap was rarely used - just in 8 (9.5%) patients and only for secondary breast reconstruction. Postoperatively, some early complications such as hematoma, seroma, infections and partial flap necrosis were observed in 10 (11.9%) patients. Late complications, such as implant rejection, hypertrophic scarring and hernias at the flap elevation site, were noted in 10 (11.9%) cases. Implant loss occurred in 5 (5.9%) cases. All the complications were successfully managed, and patients rated their reconstruction as follows: excellent, 49 (59%) cases; very good, 20 (24%), and good, 14 (16.8%). In one case, disease progression was observed 6 months after the primary breast reconstruction. Conclusion. Breast reconstruction is an acceptable method in the treatment of breast cancer in patients in the need for or with already performed mastectomy. The choice of reconstruction approach depends on the breast volume, patient's wish and experience of surgical team. Our results suggest the advantage of breast reconstruction with LDF with implant, since the technique is safe, complications relatively rare and easily manageable, and the results are excellent or very good in each woman.

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Soumian, Soni, Rishikesh Parmeshwar, Mihir Chandarana, Sekhar Marla, Sankaran Narayanan, and Geeta Shetty. "Chest wall perforator flaps for partial breast reconstruction: Surgical outcomes from a multicenter study." Archives of Plastic Surgery 47, no. 2 (March 15, 2020): 153–59. http://dx.doi.org/10.5999/aps.2019.01186.

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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.Methods All patients operated for BCS and partial breast reconstruction using intercostal artery perforator or lateral thoracic artery perforator flaps from January 2015 to October 2018 were included in the analysis. Oncoplastic breast surgeons with appropriate level of training performed all tumor excisions and reconstructions as a single-stage procedure. Patient characteristics, treatment details and surgical outcomes were noted. Specific outcomes recorded were margin re-excision and complication rates.Results One hundred and twelve patients underwent the procedure in the given study period. The median age was 54 years. Median specimen weight was 62.5 g and median volume of excision was 121.4 mL. Fifteen patients (13.39%) underwent a margin re-excision for close or positive margins without additional morbidity. One patient required a completion mastectomy. Eight patients (7.14%) had an early complication. None of the patients required a contralateral symmetrization procedure. The results were comparable across the participating centers.Conclusions Chest wall artery perforator-based flaps are an excellent option for lateral and inferior quadrant partial breast reconstructions. The short and long-term surgical outcomes are comparable across sites and can be performed with minimal morbidity. Patient-reported outcome measures need to be studied.

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Schwaiger, Karl, Laurenz Weitgasser, Maximilian Mahrhofer, Kathrin Bachleitner, Selim Abed, Julia Wimbauer, Elisabeth Russe, Thomas Schoeller, and Gottfried Wechselberger. "Age and Overweight Are Not Contraindications for a Breast Reconstruction with a TMG-Flap—A Risk and Complication Analysis of a Retrospective Double Center Study Including 300 Patients." Journal of Clinical Medicine 10, no. 5 (March 1, 2021): 926. http://dx.doi.org/10.3390/jcm10050926.

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Introduction: The transverse myocutaneous gracilis (TMG) flap has become a popular and reliable alternative for autologous breast reconstruction. Initially described as a valuable tissue source for women with low body-mass index, indications nowadays have widely expanded. The Western civilization demographic development with its aging population and the steady growing average BMI has led to increasing breast reconstructions with TMG flaps in overweight and aged individuals. Patients and Methods: A total of 300 TMG free flaps for unilateral autologous breast reconstruction were evaluated in the form of a retrospective double center cohort study. Data extraction, study group formation and statistical analysis (One-way analysis of variance (ANOVA), Pearson’s chi-squared statistical analysis and relative risk calculation) were done specifically to evaluate age and BMI as risk factors for postoperative complications and outcome. Results: No significant differences in patients’ age and BMI in the complication groups compared to the no-complication group could be found. No significant difference regarding the occurrence of complications could be found in any of the formed risk-groups. No significant increase of minor-, major- or overall complications, flap loss or revision surgeries were found in the elderly patient groups or for patients with overweight. Conclusion: Age and overweight do not significantly increase the risk for postoperative complications after breast reconstructions with free TMG flaps. The findings of this study support the fact that microsurgical breast reconstruction with a free TMG flap should not solely be reserved for younger patients and females with a lower BMI.

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Weitgasser, Laurenz, Karl Schwaiger, Fabian Medved, Felix Hamler, Gottfried Wechselberger, and Thomas Schoeller. "Bilateral Simultaneous Breast Reconstruction with DIEP- and TMG Flaps: Head to Head Comparison, Risk and Complication Analysis." Journal of Clinical Medicine 9, no. 7 (June 28, 2020): 2031. http://dx.doi.org/10.3390/jcm9072031.

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Background: A two center retrospective cohort study of simultaneous bilateral breast reconstructions using double deep inferior epigastric perforator (DIEP) flaps and double transverse myocutaneous/upper gracilis (TMG) flaps was conducted. The aim of this study was to compare surgical procedures, complications, and overall outcome. Patients and Methods: Two study groups, either receiving a simultaneous bilateral breast reconstruction, with double DIEP flaps (n = 152) in group 1, or double TMG flaps (n = 86) in group 2, were compared. A detailed risk and complication analysis was performed. Patient characteristics, operative time and the need for further operations were evaluated. Results: Double DIEP patients had donor site complications in 23.7% and double TMG patients in 16.3% (p = 0.9075, RR 1.45). Flap loss rates of 3.5% (double TMG) and 2.6% (double DIEP) were recorded (p = 0.7071, RR 1.33). The need for postoperative lipofilling was significantly higher in double TMG patients (65.1% vs. 38.2 %, p = 0.0047, RR 1.71). Conclusion: Complication analysis favors the double DIEP procedure. Donor site morbidity was lower and less severe in the double TMG group. Later fat grafting was more frequently needed after double TMG reconstructions. Further studies, preferably of prospective nature, are needed to evaluate the benefit of bilateral simultaneous breast reconstructions.

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Neubauer, Jakob, Claudia Neubauer, Julia Wicklein, Thomas Mertelmeier, Marisa Windfuhr-Blum, and Mathias Langer. "Multiple Angulated Mammography Reconstructions in Digital Breast Tomosynthesis for the Diagnosis of Microcalcifications – Added Value to Standard Stack Reconstructions and Synthesized Mammography." RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren 190, no. 05 (February 1, 2018): 433–40. http://dx.doi.org/10.1055/s-0044-100726.

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Purpose To compare ratings regarding the depiction, diagnostic accuracy and lesion characterization of conventional synthesized mammography (SM), multiple angulated mammography reconstructions (INSIGHT3D), and standard stack reconstructions in digital breast tomosynthesis for microcalcifications. Materials and Methods This is a retrospective, multicase, multireader study. We included patients with digital breast tomosynthesis (DBT), microcalcifications and histology over a period of four months in our institution and the same number of normal cases. Three radiologists, who were blinded to patient data, independently rated the depiction, distribution, morphology and BI-RADS score of microcalcifications in SM, INSIGHT3D and standard stack reconstructions. Deidentified images were presented in random order. Reading time was measured. Friedman and post hoc Nemenyi tests, Cochrane’s Q and post hoc Wilcoxon signed rank tests, Fleiss’ kappa and receiver operating characteristics were used for statistical analysis. Results We included 41 histopathologically proven and 41 normal cases. Depiction of microcalcifications was rated better in INSIGHT3D than in SM and better in stack reconstructions than in INSIGHT3D and SM (P < 0.001). The reading time was lower in SM and INSIGHT3D compared to stack reconstructions (P < 0.001). The diagnostic accuracy and inter-rater correlation were comparable between all tested modes of reconstruction. Conclusions INSIGHT3D has higher ratings regarding the depiction of microcalcifications compared to SM while maintaining a short reading time. Our preliminary assessment suggests that INSIGHT3D provides added value to SM. Key points Citation Format

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Chu, Michael, Fares Samra, Suhail Kanchwala, and Arash Momeni. "Treatment Options for Bilateral Autologous Breast Reconstruction in Patients with Inadequate Donor-Site Volume." Journal of Reconstructive Microsurgery 33, no. 05 (February 24, 2017): 305–11. http://dx.doi.org/10.1055/s-0037-1599074.

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AbstractMore than 250,000 women will be diagnosed with invasive breast cancer in the United States in 2017 alone. A large number of these patients will undergo mastectomy and will be candidates for immediate breast reconstruction. The most common reconstructive options are either implant-based or autologous tissue reconstruction, with the latter having been reported to have higher rates of long-term patient satisfaction, lower cost, and less postoperative pain. A subset of patients, however, may not be ideal candidates for autologous microsurgical reconstruction, for example, due to inadequate abdominal tissues, yet they may desire this reconstructive modality. This is particularly challenging in patients requiring bilateral reconstructions. In this article, the authors discuss the various reconstructive modalities that can be considered in patients who desire bilateral breast reconstruction, are not ideal candidates for autologous reconstruction, yet do not wish to rely solely on implant-based modalities.

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Prantl, Lukas, Nicholas Moellhoff, Uwe V. Fritschen, Guenter Germann, Riccardo E. Giunta, Florian Zeman, Andreas Kehrer, et al. "Impact of Smoking Status in Free Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction: A Multicenter Study." Journal of Reconstructive Microsurgery 36, no. 09 (July 29, 2020): 694–702. http://dx.doi.org/10.1055/s-0040-1714426.

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Abstract Background Several patient-related factors have been identified with regard to the safety and efficacy of breast reconstructions. Using the largest database available in Europe, the presented study investigated the impact of cigarette smoking on deep inferior epigastric artery perforator (DIEP) free-flap breast reconstructions. Methods In total, 3,926 female patients underwent 4,577 free DIEP-flap breast reconstructions after malignancies in 22 different German breast cancer centers. The cases were divided into two groups: nonsmokers (NS) and smokers (S). Impact of smoking on surgical complications, controlled for covariates, and cluster effects within the cancer centers were analyzed by using generalized linear mixed models. Results Overall, there was no significant difference between the groups of patients regarding the rate of total flap loss. However, the rate of partial flap loss (0.9 vs. 3.2%, p < 0.001) and wound-healing disturbances requiring revision surgery (donor site: 1.5 vs. 4.0; recipient site: 1.3 vs. 3.6%, both p < 0.001) was significantly higher in smokers. Multivariable analysis identified smoking to be an independent risk factor for revision surgery (p = 0.001) and partial flap loss (p < 0.0001). Conclusion Our findings suggest that successful free tissue transfer can be achieved in smokers despite higher rates of partial flap losses and wound-healing disturbances. However, patients with a history of smoking requiring DIEP flap reconstruction should be critically evaluated preoperatively, informed in detail about the higher risk of complications and encouraged to quit smoking prior to surgery.

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Giordano, Salvatore, Sofia Harkkila, Carlo M. Oranges, Pietro G. di Summa, and Ilkka Koskivuo. "Immediate versus Delayed Contralateral Breast Symmetrisation in Breast Reconstruction with Latissimus dorsi Flap: A Comparative Study." Breast Care 14, no. 5 (2019): 272–77. http://dx.doi.org/10.1159/000502769.

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To achieve symmetry in unilateral free flap breast reconstruction often requires a contralateral procedure. There is no evidence in the literature to support the benefit of immediate contralateral breast symmetrisation concomitant to breast reconstruction. We hypothesized that performing a simultaneous contralateral balancing operation at the time as the initial reconstruction might provide immediate symmetry and minimize the frequency of secondary procedures. Thus, we performed a comparative study on this issue. A comparative retrospective study was conducted on 78 consecutive patients who underwent unilateral breast reconstruction surgery with latissimus dorsi (LD) flap and contralateral breast symmetrisation from January 2014 to June 2016 at Turku University Hospital. Exclusion criteria included other breast reconstruction techniques and no contralateral symmetrisation at follow-up. The patients were divided according to the timing of contralateral breast balancing operation into an immediate versus a delayed group. Postoperative complications, outcomes, and re-operations were compared. Baseline characteristics were well balanced between the groups except for comorbidity, which was significantly higher in the immediate group. Mastectomy weights (735.6 vs. 390.7 g, p = 0.015), contralateral breast reduction weights (268.3 vs. 105.8 g, p = 0.014), and implant size (218.9 vs. 138.9 g, p = 0.001) were significantly larger in the immediate group. No significant differences in any kind of complications were detected. Similarly, the rates of re-operations were similar among the groups (24.0 vs. 43.3%, p = 0.134). Performing immediate symmetrisation at the time of breast reconstruction is safe and feasible in autologous LD breast reconstructions, where 76% did not require a second operation for symmetry. There were no differences in the rate of any re-operation and, therefore, performance of simultaneous contralateral reduction is a reasonable option.

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Su, Chun-Lin, Jia-Ruei Yang, Wen-Ling Kuo, Shin-Cheh Chen, David Chon-Fok Cheong, and Jung-Ju Huang. "Direct-to-implant breast reconstruction following nipple-sparing mastectomy: predictive factors of adverse surgical outcomes in Asian patients." Archives of Plastic Surgery 48, no. 5 (September 15, 2021): 483–93. http://dx.doi.org/10.5999/aps.2021.00374.

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Background Direct-to-implant (DTI) breast reconstruction after nipple-sparing mastectomy (NSM) with the use of acellular dermal matrix (ADM) provides reliable outcomes; however, the use of ADM is associated with a higher risk of complications. We analyzed our experiences of post-NSM DTI without ADM and identified the predictive factors of adverse surgical outcomes.Methods Patients who underwent NSM and immediate DTI or two-stage tissue expander (TE) breast reconstruction from 2009 to 2020 were enrolled. Predictors of adverse endpoints were analyzed.Results There were 100 DTI and 29 TE reconstructions. The TE group had a higher rate of postmastectomy radiotherapy (31% vs. 11%; P=0.009), larger specimens (317.37±176.42 g vs. 272.08±126.33 g; P=0.047), larger implants (360.84±85.19 g vs. 298.83±81.13 g; P=0.004) and a higher implant/TE exposure ratio (10.3% vs. 1%; P=0.035). In DTI reconstruction, age over 50 years (odds ratio [OR], 5.43; 95% confidence interval [CI], 1.50–19.74; P=0.010) and a larger mastectomy weight (OR, 1.65; 95% CI, 1.08–2.51; P=0.021) were associated with a higher risk of acute complications. Intraoperative radiotherapy for the nipple-areolar complex increased the risk of acute complications (OR, 4.05; 95% CI, 1.07–15.27; P=0.039) and the likelihood of revision surgery (OR, 5.57; 95% CI, 1.25–24.93; P=0.025).Conclusions Immediate DTI breast reconstruction following NSM is feasible in Asian patients with smaller breasts.

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Reimer, Tyson, Mario Solis-Nepote, and Stephen Pistorius. "The Application of an Iterative Structure to the Delay-and-Sum and the Delay-Multiply-and-Sum Beamformers in Breast Microwave Imaging." Diagnostics 10, no. 6 (June 17, 2020): 411. http://dx.doi.org/10.3390/diagnostics10060411.

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Breast microwave imaging (BMI) is a potential breast cancer screening method. This manuscript presents a novel iterative delay-and-sum (DAS) based reconstruction algorithm for BMI. This iterative-DAS (itDAS) algorithm uses a forward radar model to iteratively update an image estimate. A variation of the itDAS reconstruction algorithm that uses the delay-multiply-and-sum (DMAS) beamformer was also implemented (the itDMAS algorithm). Both algorithms were used to reconstruct images from experimental scans of an array of 3D-printed MRI-based breast phantoms performed with a clinical BMI system. The signal-to-clutter ratio (SCR) and signal-to-mean ratio (SMR) were used to compare the performance of the itDAS and itDMAS methods to the DAS and DMAS beamformers. While no significant difference between the itDAS and itDMAS methods was observed in most images, the itDAS algorithm produced reconstructions that had significantly higher SMR than the non-iterative methods, increasing contrast by as much as 19 dB over DAS and 13 dB over DMAS. The itDAS algorithm also increased the SCR of reconstructions by up to 5 dB over DAS and 4 dB over DMAS, indicating that both high-intensity and background clutter are reduced in images reconstructed by the itDAS algorithm.

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McAllister, Peter, Isabel Teo, Kuen Chin, Boikanyo Makubate, and David Alexander Munnoch. "Bilateral Breast Reconstruction with Abdominal Free Flaps: A Single Centre, Single Surgeon Retrospective Review of 55 Consecutive Patients." Plastic Surgery International 2016 (July 18, 2016): 1–9. http://dx.doi.org/10.1155/2016/6085624.

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Breast reconstruction using free tissue transfer is an increasingly utilised oncoplastic procedure. The aim was to review all bilateral breast reconstructions using abdominal free flaps by a single surgeon over an 11-year period (2003–2014). A retrospective review was performed on all patients who underwent bilateral breast reconstruction using abdominal free flaps between 2003 and 2014 by the senior author (DAM). Data analysed included patient demographics, indication for reconstruction, surgical details, and complications. Fifty-five female patients (mean 48.6 years [24–71 years]) had bilateral breast reconstruction. The majority (41, 74.5%) underwent immediate reconstruction and DIEP flaps were utilised on 41 (74.5%) occasions. Major surgical complications occurred in 6 (10.9%) patients, all of which were postoperative vascular compromise of the flap. Failure to salvage the reconstruction occurred on 3 (5.5%) occasions resulting in a total flap failure rate of 2.7%. Obesity (>30 kg/m2) and age > 60 years were shown to have a statistically increased risk of developing postoperative complications (P<0.05). Our experience demonstrates that abdominal free flaps for bilateral breast reconstruction fares well, with a flap failure rate of 2.7%. Increased body mass index and patient age (>60 years) were associated with higher complication rates.

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Journal articles on the topic 'Breast reconstructions'

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