Outcomes Of Breast Reconstruction Research Articles

Enhancing Aesthetics in Bilateral DIEP Flap Breast Reconstruction: the Role of Tissue Pre-Expansion.

Achieving symmetrical outcomes in bilateral autologous breast reconstruction is challenging, particularly in cases of asymmetrical recipient sites. Tissue pre-expansion is proposed to improve aesthetics by enlarging the skin envelope for refined breast shaping. This study examines its efficacy in bilateral DIEP flap reconstructions. This study systematically evaluated 43 patients that underwent bilateral DIEP flap breast reconstruction between 2004 and 2021. The efficacy of tissue pre-expansion in enhancing aesthetic outcomes, patient demographics, and complications were analysed. Aesthetic outcomes were measured using the aesthetic item score (AIS). Patients had an average age of 48.67 years (range: 29-79) and BMI of 27.08 (range: 23-36). Of these, 65.12% had undergone radiotherapy and 83.72% chemotherapy before reconstruction. Patients predominantly received secondary breast reconstruction (72.02%). Pre-expansion significantly improved breast symmetry and the overall aesthetic result (OAR) in cases of asymmetrical recipient-site conditions (3.76 vs. 3.16, p = 0.006 and 7.08 vs. 6.27, p = 0.03, respectively). There was a non-significant trend towards better breast form and volume, with no effect on scarring. For patients with symmetrical recipient-site conditions, pre-expansion did not significantly impact the aesthetic outcome. No significant differences in complication rates were observed. Tissue pre-expansion significantly enhances aesthetic outcomes of bilateral autologous breast reconstruction, notably breast symmetry and OAR, in patients with asymmetrical recipient-site conditions. However, careful patient selection and preoperative planning are essential for leveraging pre-expansion's benefits, emphasizing the importance of informed decision-making and expectation management.This publication/studyinvestigates the efficacy of tissue pre-expansion in enhancing aesthetic outcomes for bilateral DIEP flap breast reconstructions. Detailed analysis of 43 patients that received bilateral DIEP reconstruction with and without pre-expansion. Finds significant improvements in breast symmetry and overall aesthetic rating (OAR) for patients with asymmetrical recipient-site conditions. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Prepectoral Breast Reconstruction

Learning Objectives: After studying this article, the participant should be able to: 1. Describe indications and patient factors relevant to performing prepectoral breast reconstruction. 2. Understand the effects of different types of implants and implant support in prepectoral breast reconstruction. 3. Describe techniques for surgical revision to improve outcomes in prepectoral breast reconstruction. 4. Understand the current literature surrounding clinical and quality-of-life outcomes in prepectoral breast reconstruction. Summary: This article goes beyond a general review of prepectoral breast reconstruction, providing a working framework and important considerations for any surgeon utilizing prepectoral breast reconstruction techniques. This article also addresses current controversies, provides practice tips and technical pearls, and addresses gaps in knowledge with both opinion and a review of the most current literature.

Maximizing Aesthetic Outcomes in Delayed Breast Reconstruction: the Be.A.U.T-I.F.U.L. DIEP® Step-by-Step Inset Technique.

In microvascular breast reconstruction, the focus has shifted to achieving aesthetically pleasing results. Delayed breast reconstruction poses challenges such as ensuring natural ptosis and avoiding a "patch" effect. The Be.A.U.T-I.F.U.L. deep inferior epigastric perforator (DIEP) flap inset, presented here, offers a systematic and sequential seven-step method to optimize breast reconstruction outcomes. This approach emphasizes safety during flap harvest using the best (Be.) perforator identified via computed tomography angiography to minimize dissection and ensure solid perfusion. The flap is placed obliquely, directing its tail to the axilla (A.), enhancing upper (U.) pole volume and ptosis. The flap base is tucked-in (T-I.) to increase the projection of the breast mound, and its lateral portion is split as a fishtail (F.): the upper (U.) fin is used to define the lateral inframammary fold and prevent lateral displacement of the reconstructed breast, while the lower (L.) fin is turned under the flap to further improve projection. This structured approach, focusing on key breast aesthetics, ensures optimal cosmetic outcomes and can serve for most delayed microsurgical breast reconstruction scenarios. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Long-term surgical and patient reported outcomes of latissimus dorsi flap and acellular dermal matrix breast reconstructions: a comparative observational cohort study, with up to 12 years follow-up

Long-term surgical and patient reported outcomes of latissimus dorsi flap and acellular dermal matrix breast reconstructions: a comparative observational cohort study, with up to 12 years follow-up

Management of Breast Cancer by Skin-Reducing Mastectomy and Immediate Breast Reconstruction by Prepectoral Implant Approach with Polypropylene Mesh for Patients with Large Breasts.

To assess the feasibility and outcomes of immediate breast reconstruction using a dermal sling and polypropylene mesh for fixation after skin-reducing mastectomy with prepectoral prosthesis placement in patients with large breasts who were diagnosed with cancer. This retrospective study included demographic and clinical data from female patients with breast cancer and large breasts, who were candidates for skin-reducing mastectomy and immediate reconstruction. Data regarding operative technique, implant size, operative duration, and intraoperative complications were retrieved. Early and late postoperative complications were recorded. Routine assessment of postoperative patient satisfaction was performed using the Breast Reconstruction Satisfaction Questionnaire. The study included data from 49 female patients with a mean (± SD) age of 40.88 ± 8.03 years; the mean follow-up was 31.5 ± 8.1 months. The operation was successful in 47 (95.9%) patients, whereas reconstruction failed in 2. Capsule contracture occurred in 9 (18.4%) patients, 4 of whom required capsulectomy. Severe wound infections occurred in 2 (4.1%) patients, 1 of whom was treated conservatively. Implant exposure occurred in 2 (4.1%) patients, 1 of which was managed using a skin rotational flap. Five (10.2%) patients experienced mildly impaired range of motion. Forty-four (90.0%) patients reported postoperative satisfaction, with 3 expressing satisfaction only when postoperative complications were treated. The prepectoral approach using a combined synthetic mesh and dermal sling yielded a good solution for patients with large breasts. The technique was associated with minimal complications, yielded good postoperative patient satisfaction, and is affordable. The results of using a synthetic mesh appeared to be equivalent to those of ADM. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The protocol for BROWSE-P (breast reconstruction outcomes with Strattice™ or Artia™ – pre-pectoral): a cohort study to assess long-term outcomes of immediate pre-pectoral implant based breast reconstruction with Strattice™ or Artia™

Introduction: Techniques in implant-based breast reconstruction (IBBR) have evolved over the last 15 years due to the introduction of mesh or acellular dermal matrices (ADMs). Traditionally, total submuscular coverage progressed to upper pole muscle cover with lower pole ADM and now total or anterior ADM cover in the pre-pectoral plane. Data is scarce to support the pre-pectoral technique but, it is suggested to result in less postoperative pain, more natural cosmesis and avoidance of animation deformity. The BROWSE study concluded that subpectoral with Strattice™ IBBR resulted in better cosmesis and lower rates of capsular contracture when compared to the total submuscular technique. The BROWSE-P study aims to assess the safety profile of Artia™ a porcine derived ADM and review the long-term outcomes of pre-pectoral IBBR with Strattice™ and Artia™. Methods and analysis: BROWSE-P is a single center cohort study. Consecutive patients who have undergone immediate pre-pectoral IBBR with Strattice™ or Artia™ from January 2017 to December 2022 will be included. Demographic, operative, oncology, complication, and further surgery data with be collected to assess the rate of revision surgery and safety profile of Artia™. Those who have their implant reconstruction in situ will be invited for clinical assessment to assess for capsular contracture. Participants will also be asked to complete a BREAST-Q post-reconstruction module, to assess patient satisfaction and quality of life, and have medical photographs taken for an assessment of aesthetic outcome by a blinded panel using the 10-point Visser scale. We aim to collect data on 500 reconstructions and complete clinical assessment, patient reported outcomes and aesthetic assessment for 250 patients.

“Comparison of DIEP and PAP free flaps for breast reconstruction in the context of breast cancer: A retrospective study of 677 patients over 10 years”

BackgroundPAP (Profunda Artery Perforator) flap following cancer surgery has emerged as a relevant alternative for breast reconstruction but remains mainly used in cases where the DIEP (Deep Inferior Epigastric Perforator) flap cannot be performed. The aim of this work is to compare PAP and DIEP flaps’ surgical and aesthetics outcomes in breast reconstruction. MethodsWomen who underwent breast reconstruction by DIEP or PAP flap at the Plastic Surgery Department of Georges Pompidou European University Hospital, Paris, France, between January 2012 and December 2020 were included. Patient’s demographic characteristics were recorded as well as type, laterality and timing of reconstruction. Operative times, length of hospital stay, general and surgical complications were compared. The number of late surgical reoperations, their timing relative to the initial reconstructive procedure, and their purpose were also compared. ResultsA total of 677 patients were included, 559 of whom received a DIEP flap and 118 a PAP flap. PAP flap patients were significantly younger, thinner, and had a smaller initial bra cup size than those who received a DIEP (p<0.001) Operative time was similar for both groups (p=0.074). There was no difference in the number of early postoperative reoperations (p>0.554) or of late revisions (p>0.403) between DIEP or PAP. ConclusionProvided that the technical and human resources are available, PAP flap is a valid technique, with no increased risk of surgical complications and reoperations, nor lengthening of operative time. The PAP flap should be considered a primary therapeutic option and not only an alternative to the DIEP flap.

The Impact of Complication Timing on the Outcomes of Implant-based Breast Reconstruction.

The National Surgical Quality Improvement Program (NSQIP) database provides an important resource for determining complication rates and risk factors for surgical procedures. However, NSQIP is limited to 30-day follow-up, and it is unclear whether this is reliable for evaluating prosthetic breast reconstruction outcomes. A single-institution, cross-sectional, retrospective review was performed for patients undergoing mastectomy with immediate, prepectoral tissue expander reconstruction. Timing of complications was stratified as early (within 30 days of operation) versus late (after 30 days). Categorical variables were compared using χ2 (or Fisher exact) tests, and continuous variables were analyzed using Kruskal-Wallis or Wilcoxon rank-sum tests. There were 301 patients (509 reconstructed breasts) included with a median follow-up time of 11 months. Of them, 176 patients (58%) experienced a postoperative complication-140 patients (47%) experienced an early complication and 36 patients (12%) experienced a late complication. Patients with late complications had a significantly higher rate of reconstructive failure compared with the early complication group (17% versus 10%; P = 0.001) and were more likely to require a flap (28% versus 7%; P = 0.001) for final reconstruction. Revision surgery rates after final implant placement were higher in the late complication group (36% versus 64%; P = 0.285). Late complications after prepectoral breast reconstruction have a more prominent impact on reconstructive failure and revisions than early complications. This finding may inform strategies to revise national databases such as NSQIP to include more detailed information and longer capture periods.

Race and Ethnicity Impacts Patient-Reported Outcomes in Implant-Based Breast Reconstruction.

Addressing social determinants of health is critical in achieving health equity, and of the many determinants, race and ethnicity are key contributors in postmastectomy breast reconstruction. The purpose of this study was to investigate the impact of race and ethnicity on patient-reported outcomes (PROs) after implant-based breast reconstruction (IBBR) and to provide reference values for each cohort. We identified all patients who underwent IBBR between January 2017 and August 2022 and completed the BREAST-Q longitudinally. Race and ethnicity were self-categorized as White, Asian, Black, or Hispanic. Reference values were established. Outcomes of interest were BREAST-Q scores preoperatively, and 6months, 1year, and 2years postoperatively. Generalized estimating equation (GEE) modeling was performed to assess race and ethnicity as independent predictors of BREAST-Q scores. Overall, 3281 patients were included, of whom 2479 (75.6%) were White, 296 (9.0%) were Asian, 239 (7.3%) were Black, and 267 (8.1%) were Hispanic. There were significant differences in Physical Well-being of the Chest at all timepoints; Satisfaction with Breasts and Psychosocial Well-being at preoperative, 6months, and 1year; and in Sexual Well-being at 1year. GEE modeling showed that relative to White patients, Asian subjects scored significantly lower on all BREAST-Q domains, while Black and Hispanic patients scored significantly lower on the Physical Well-being of the Chest domain. Racial and ethnic disparities persist within IBBR, with minority patients scoring lower on the BREAST-Q than White patients. This study suggests that more work is needed to understand and improve these PROs in minority patient populations. Individualized reference values may prove beneficial in assessing outcomes over time.

Prophylactic Local Antibiotics for Tissue Expansion (PLATE) Improve Breast Reconstruction Outcomes.

Infection following tissue expander (TE) breast reconstruction is frequent and impactful. Preliminary reports demonstrate value of local antibiotic delivery for implant salvage and prophylactic potential. Herein is a multi-institutional retrospective study employing surgeon-crafted tobramycin-vancomycin PMMA plates (PLATE) during TE implantation for infection prophylaxis. The authors hypothesized the intervention would be associated with fewer infections compared to historical practice. In 2021, surgeons at three institutions began independently offering PLATE for primary TE breast reconstructions. After independent IRB approvals, data were retrospectively collected for PLATE subjects and pre-intervention cohorts of equivalent sizes. Subjects were followed for seven months, or to second stage removal. The primary outcome, complication requiring readmission/reoperation, was compared between aggregated cohorts. Analysis included logistic modeling and Kaplan-Meyer survival. The aggregate sample included 183 intervention subjects (292 breasts) and 183 controls (301 breasts), each with 5+/-2-month follow-up. Overall, complications were significantly less frequent with PLATE (13.1% vs 21.9%, p<0.01*). This was driven by significantly fewer infections (4.8% vs 12.6%, p<0.01*) with no difference in rates of tissue necrosis, seroma, or other complications (p>0.05). In multivariable regression, the intervention was associated with significantly reduced odds of any complication (OR=0.53, 95%CI: [0.3-0.93]) and infection (OR=0.22, 95%CI: [0.08-0.50]). Kaplan-Meyer curves demonstrated significant longitudinal reduction in complication and infection (p<0.01*) without notable rebound throughout dissipation of the antibiotic eluent. Prophylactic employment of intraoperatively-crafted PLATE during TE implantation was associated with significant infection reduction without increase in local or systemic complications. This reproducible tool may be highly valuable in alloplastic breast reconstruction.

Outcomes of ADM-Assisted Implant-based Breast Reconstructions According to Division Types of the Pectoralis Major Muscle.

In implant-based breast reconstruction (IBR), several surgical techniques are based on the implant insertion planes. Ideal location for breast implants has become a popular topic in IBRs because each technique has advantages and disadvantages. Herein, we report the outcomes of three different division types of the pectoralis muscle and suggest an algorithm for selecting the division types. Charts of patients who underwent IBRs between October 2017 and December 2020 were retrospectively reviewed. The patients were classified into three groups (prepectoral, high subpectoral, and subpectoral) according to the division types of the pectoralis muscle. Aesthetic outcomes were assessed in terms of animation deformity, rippling deformity, and visibility of the upper implant border. Total 104 cases were included. 25, 38, and 41 were in the prepectoral, high-subpectoral, subpectoral IBR groups, respectively. Animation deformities frequently appeared in the subpectoral group. Nipple displacement was most prominent in the subpectoral group. Skin rippling at rest was mostly detected in the prepectoral group, whereas ripping during contraction was commonly observed in the subpectoral group. Visibility of upper border was more prominent in the prepectoral group than the other groups. We propose an algorithm for selecting the division types of the pectoralis muscle. If the pectoralis muscle is thick, prepectoral plane is most preferred to avoid the animation deformity. In cases with thin pectoralis muscle, thickness of the mastectomy flap is considered next. If it is thicker than 1cm, prepectoral plane is better than the subpectoral plane; otherwise, high-subpectoral plane is preferable for better aesthetic outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Intraoperative Hypothermia Versus Normothermia in Breast Reconstruction: A Systematic Review and Meta-Analysis.

Despite advancements in breast reconstruction, the precise impact of intraoperative hypothermia on postoperative complications remains unclear. Recent literature suggests that intraoperative hypothermia is a risk factor for impaired wound healing and increases the incidence of surgical site infections. This study examines the effect of intraoperative hypothermia on postoperative outcomes in breast reconstruction. We searched PubMed, Embase, and Cochrane Library for studies comparing hypothermia with normothermia in breast reconstruction. A meta-analytical method was employed to estimate the risk of postoperative complications among patients undergoing breast reconstruction. Data synthesis employed the random-effects models, presenting the results as risk ratio (RR) with corresponding 95% confidence intervals (CIs). Statistical analysis was performed using Review Manager 5.4 (Cochrane Collaboration), and heterogeneity was assessed using I2 statistics. Four studies meeting our inclusion criteria were included in the meta-analysis, comprising 871 participants. The average age and body mass index were 52.98 years and 27.76 kg/m2, with a follow-up duration of 3-6 months. In our analysis, intraoperative hypothermia was associated with an increase in the incidence of wound healing complications in breast reconstruction (RR 1.68; 95% CI 1.24 to 2.27; p = 0.0008). Despite lower incidence of infection, hematoma, seroma, and necrosis in the hypothermia group, no significant differences were observed. Our meta-analysis assessing intraoperative hypothermia in breast reconstruction indicates that hypothermia is a significant risk factor for wound healing complications.

The Statistical Fragility of Outcomes on Breast Reconstruction with Acellular Dermal Matrix: A Systematic Review of Randomized Controlled Trials.

Acellular dermal matrix (ADM) is pivotal in breast surgery, yet the statistical robustness of surgical outcomes remains underexplored. This study employs the fragility index (FI), reverse fragility index (rFI), and fragility quotient (FQ) to investigate the statistical fragility of ADM breast reconstruction outcomes. Randomized controlled trials (RCTs) (2013-present) with dichotomous outcomes were sourced from PubMed, Embase, SCOPUS, Medline, and Cochrane databases. FI and rFI-event reversals needed to alter outcome significance-and FQ-standardized fragility across trials-were computed and reported as median (IQR). Subgroup analysis focused on intervention types. Out of 33 studies screened, 19 RCTs comprising 204 outcomes were included, with a median FI of 4 (3 - 5) and FQ of 0.039 (0.029 - 0.070). Twenty-six outcomes achieved statistical significance, with a median FI of 3.5 (1 - 5) and FQ of 0.033 (0.010 - 0.073). The remaining 178 outcomes were nonsignificant, exhibiting a median FI of 4 (3 - 5) and FQ of 0.040 (0.030 - 0.070). Of the 204 outcomes, 18% had a number of patients lost to follow up equal to or surpassing the FI. By intervention type, the median FIs were similar in value but remained low. ADM-related breast reconstruction outcomes are statistically fragile, so reversal of a few outcomes or maintaining follow-up with patients may alter the significance of findings. Future researchers are thus recommended to report FI and FQ metrics with P-values to accurately portray reconstructive surgery outcomes.

Hug Flap and Hamdi Hammock: Two Innovative Techniques for Enhancing Aesthetic Outcomes in Deep Inferior Epigastric Artery Perforator Breast Reconstruction.

Achieving optimal aesthetic outcomes in deep inferior epigastric artery perforator (DIEP) flap breast reconstruction remains a challenge, often necessitating additional procedures for refinement. This study presents two innovative techniques (the hug flap and Hamdi hammock) aimed at enhancing breast projection and inframammary fold (IMF) definition in DIEP flap reconstruction. The hug flap technique uses de-epithelialized caudal mastectomy skin to augment breast projection, whereas the Hamdi hammock uses a percutaneous purse-string suture to define the IMF. A retrospective review of 782 patients who underwent DIEP flap breast reconstruction between 2007 and 2023 was conducted. The hug flap group required significantly less additional fat grafting compared to other techniques (11% versus 27% and 22%). No total flap losses occurred in the hug flap group, and fat necrosis rates were low. The Hamdi hammock was used in 405 patients with a mean of two lipofilling sessions. Complications were minor and no stitches required removal. The hug flap and Hamdi hammock techniques offer effective and safe methods for enhancing breast projection and IMF definition in DIEP flap reconstruction. These techniques may reduce the need for additional procedures and improve aesthetic outcomes.

National Trends and In-Hospital Outcomes for Immediate Implant-Based Versus Autologous-Based Breast Reconstruction: A Propensity Score-Matched Analysis.

Breast reconstruction consists primarily of two methods: autologous breast reconstruction (ABR) and implant-based breast reconstruction (IBR). Each of these methods has its advantages and disadvantages. The current study used the National Inpatient Sample (NIS), the largest inpatient database in the United States, to explore the trends, complications, and disparities in the use of IBR and ABR. The current study used the NIS database from 2016 to 2020, including the International Classification of Diseases, 10th version (ICD-10) codes. A propensity score-matching (1:1) analysis was used to match the IBR and ABR groups. The percentage of breast reconstruction increased from 58.8% in 2016 to 63.4% by 2020. The trend of ABR was upward, and the trend of IBR was downward. In addition, the ABR group had significantly higher rates of cardiovascular complications (odds ratio [OR], 1.29), respiratory complications (OR, 4.26), vascular complications requiring surgery (OR, 7.82), blood transfusions (OR, 3.44), vasopressor need (OR, 1.409), and acute kidney injury (OR, 1.68). However, the ABR group had significantly lower rates of wound infection (OR, 0.430), wound dehiscence (OR, 0.213), wound seroma (OR, 0.602), and sepsis (OR, 0.252). A significant disparity was found in using ABR for different subgroups based on age, hospital teaching status, racial background, socioeconomic status, and hospital bed size. The current study showed an upward trend in the utilization of ABR and a downward trend for IBR. Although ABR had a higher rate of pulmonary, cardiovascular, vascular, and bleeding complications, it had a lower rate of wound-related complications.

Outcomes of free flap breast reconstruction in patients aged 70 years and over: A single-centre experience

BackgroundChronological age is an important factor in determining whether a patient is offered reconstruction following breast cancer surgery. Free flap breast reconstruction is considered by many as the gold standard but is seldom offered to older patients, as the risks are considered too high. This study aims to examine the outcomes of free flap breast reconstruction in patients aged 70 and above treated in our unit. MethodsWe conducted a retrospective review examining the outcomes of consecutive patients aged 70 and above undergoing autologous free flap breast reconstruction at a single centre between January 2015 and December 2023. Logistic regression was used to determine the relationship between increasing age and comorbidities, and four primary outcome variables – all complications, readmission, return to theatre, and length of stay. ResultsWe identified 71 patients with a mean age of 72.3 years (70-78). 63.4% had one or more comorbidities, with the most common being hypertension and hypercholesterolaemia. Most patients were ASA grade 1 or 2 (91.5%). The overall complication rate was 36%, the majority of which were minor wound healing complications (22.5%). There were no episodes of flap loss, either partial or complete. The rates of severe complications (14%), readmission (8.4%) and return to theatre (7%) were low and comparable to those previously published for our general patient cohort. There was no relationship between increasing age beyond 70 years and any of the four primary adverse outcome measures. ConclusionsFree flap breast reconstruction in patients aged 70 and above can be very successful and safe and should be considered as an option in all fit, surgically optimised patients, independently of age.

Evaluation of prepectoral reconstruction surgical outcomes: Main operating room vs ambulatory surgery center

IntroductionDuring the height of the recent Coronavirus (COVID-19) pandemic, many surgeries were transitioned to ambulatory surgery centers to reserve inpatient resources and reduce transmission risks. Our study evaluated surgical outcomes of patients who underwent prepectoral breast reconstruction in the operating rooms of two full-service main hospitals versus their associated surgery centers. MethodsA retrospective chart review was conducted of patients who underwent immediate prepectoral breast reconstruction at a single hospital between 2018 and 2022. Eligible patients had at least 3 months of post-expander follow-up, with the majority also having 3 months of post-implant follow-up. Patient demographics, reconstructive characteristics, post-expander outcomes, and post-implant outcomes were evaluated between the surgery center and main operating room with Chi-square (or Fisher’s exact) and Wilcoxon rank-sum tests. ResultsThis study included 301 patients, outcomes of 509 post-expander breasts, and outcomes of 410 post-implant breasts. The patient characteristics were similar with the only significant difference being the hospital length of stay (increased stay at the main hospital). There were no statistically significant differences in any of the surgical outcomes between the two groups in the post-expander or post-implant period. ConclusionThe COVID-19 pandemic disrupted elective procedures, prompting a shift towards outpatient surgery to optimize hospital resources and reduce inpatient exposure risks. While breast reconstruction is elective, delays can pose risks for cancer patients. Our results show that surgical outcomes for prepectoral prosthetic breast reconstruction remain consistent whether performed in outpatient surgical centers or main hospitals.

Direct-to-implant and tissue expander-based immediate breast reconstruction in Chinese women: A comparison of surgical complications and patient-reported outcomes

BackgroundDirect-to-implant (DTI) breast reconstruction restores the patient's body image immediately after the mastectomy but may increase postoperative complications compared to tissue expander (TE)-based breast reconstruction. There are very few studies that compared the surgical complications and patient-reported outcomes of DTI and TE breast reconstructions in Asian women. MethodThe study compares postoperative complications and patient-reported outcomes (PROs) between DTI and TE breast reconstruction in Chinese women and explores the risk factors of postoperative complications and influencing factors of PROs. Retrospective chart review of patients undergoing immediate breast reconstruction between 2008 and 2022 was conducted and BREAST-Q questionnaires of the breast reconstruction module were distributed to eligible patients. Multivariate regression models were used to explore risk factors for postoperative complications and factors that influence BREAST-Q scores. ResultsDTI was associated with lower rates of major complication and implant loss but has no significant influence on patients’ satisfaction or quality of life. Age and axillary lymph node dissection are important complication risk factors for both DTI and TE. The application of ADM significantly increased the risk of seroma or hematoma. In the DTI group, capsular contracture significantly reduced patients’ satisfaction with breast scores. ConclusionDTI dual-plane breast reconstruction does not increase complication rates in appropriately selected Chinese patients. In DTI patients, the management of capsular contracture is crucial for improving patient satisfaction.

Microsurgical breast reconstruction in the United States: a narrative review of the current state.

Breast reconstruction with microsurgical techniques allows for autologous reconstruction after mastectomy without the complications associated with alloplastic reconstruction. Autologous reconstruction has undergone significant improvement and now offers patients a variety of options depending on patient specific factors and aesthetic outcomes. This review aims to focus on the history of autologous reconstruction, operative considerations, general surgical techniques for flaps, and indications for choosing the ideal free tissue transfer for all medical specialties and not only plastic surgeons. A comprehensive review of the literature was performed using PubMed and Embase databases. Manuscripts that provided objective data with respect to history of microsurgical options, surgical techniques, patient considerations, and contraindications were utilized for this review with the objective to simplify data for all non-plastic surgeon readers. In this study, we find that patient selection is critical in successful outcomes for microsurgical breast reconstruction. We find that abdominal free flaps are now considered gold standard for autologous reconstruction. However, reliable alternatives exist for patients who are not considered ideal candidates for this reconstruction. These include thigh-based flaps such as gracilis myocutaneous flaps, profunda artery perforator flaps, lateral thigh perforator flaps and trunk-based flaps such as lumbar artery perforator flap. Postoperative considerations involve clinical monitoring and enhanced recovery after surgery. The rate of reconstructive success and flap viability is greater that 95%, even in high-risk populations, and therefore risk stratification should be performed based on an individual basis. While there are no absolute contraindications to autologous reconstruction, relative contraindications do exist including obesity and elderly populations due to the increased surgical and medical complications. While implant-based reconstruction remains the predominant method of breast reconstruction in the United States, there have been many exciting advancements in autologous reconstruction that offers high aesthetic outcomes and patient satisfaction.

Early post-operative outcome of pre-pectoral implant-based immediate total breast reconstruction with Polyglactin 910 (Vicryl™) mesh – low cost solution for a low-middle income country

BackgroundThe incidence of breast cancer in Pakistan has been rising with approximately one third of these patients requiring mastectomy. Among breast reconstruction treatment options, the use of Acellular Dermal Matrix (ADM) for pre-pectoral breast implant surgery has proven effective with improved cosmetic outcome. However, due to high cost it cannot be regularly implemented in a developing country like Pakistan. An alternative to ADM, Polyglactin 910 (Vicryl™, Ethicon) mesh has been introduced in pre-pectoral breast reconstructive surgery which has shown to be almost 10 times lower in cost. We set out to determine the frequency of early postoperative complications when using Polyglactin 910 mesh for pre-pectoral implant-based breast reconstruction surgery.MethodsA single centre, retrospective, chart review was conducted, and a total 28 women were included in the study. Thirty-two pre-pectoral implant-based mastectomies with Polyglactin 910 mesh were performed. Early post-operative outcomes (within 12 months of procedure) including duration of antibiotic use, post-operative infection, implant displacement, flap necrosis, seroma formation, wound dehiscence, hematoma formation, capsular contracture and reconstruction failure, were recorded.ResultsOnly 4 (12.5%) women experienced early post-operative morbidity. One patient developed a wound dehiscence, which eventually led to reconstruction failure and removal of the implant. Another patient had seroma formation and flap necrosis. None of the patients developed postoperative implant displacement, hematoma formation or capsular contracture in the early post-operative period.ConclusionThis study reveals that early post-operative outcomes with Polyglactin 910 mesh in breast reconstructive surgery are few, thus making it a cost effective, reliable, and safe treatment option, especially in developing countries like Pakistan.