Breast Volume Replacement Research Articles

Oncoplastic breast volume replacement with the use of lateral intercostal artery perforator flap

Breast cancer is very common, and there has been a lot of progress in terms of diagnosing and treating it. Surgical intervention, which is tailored to the patient's particular needs and numerous clinical concerns, is one of the management methods used. Some indicators that can be used are, for instance, the size and the stage. Smaller and earlier stage malignancies can be treated with a wide excision. However, getting a proper excision margin around the tumor and not removing too much tissue is problematic. Several studies have shown that when 20% of the breast volume is removed, there is a significant risk of deformity. Currently, oncoplastic surgery is the gold standard for breast reconstruction to minimize such a risk, and one of the techniques is volume replacement, which includes reconstruction of the breast with the transposition of tissue from elsewhere. Numerous volume replacement procedures were performed in the reported patients. The thoracodorsal artery perforator (TDAP) and lateral intercostal artery perforator (LICAP) flaps showed good outcomes in terms of cosmetic and oncological aspects, yet LICAP was found to be an excellent choice for the lateral breast defect and the aesthetic result was satisfactory. We present the case of a 19-year-old woman who had a borderline phyllodes tumor and 49-year-old woman with invasive breast cancer ductal carcinoma in situ (DCIS) that was treated with a wide excision and volume replacement with a LICAP. Following the success of the LICAP treatment, the defect appears symmetrical with the contralateral breast a few weeks following surgery. In conclusion, LICAP and TDAP flaps oncoplastic surgery offer advantages that should be considered to increase satisfactory of the patients after breast construction surgery in Indonesia.

A single centre experience of local perforator flaps in oncoplastic breast surgery; a cross-sectional study.

Various oncoplastic techniques have emerged over the years to preserve breast cosmesis and symmetry without compromising the principles of tumor excision. One of the newer techniques for breast volume replacement to achieve symmetry and cosmesis is the use of fasciocutaneous pedicled chest wall perforator flaps or local perforator flaps (LPF). The objectives of this study were to document the details of the surgical procedure as well as patient-reported satisfaction and well-being following the procedure using a validated BREAST-Q tool among Pakistani women. This cross-sectional study was conducted from March 2019 to February 2021 enrolling 25 female patients who underwent breast conservative surgery using LPF for breast tumors at The Aga Khan University Hospital, Karachi. Data related to the procedure was collected on a pre-designed proforma. Cosmetic outcomes and patient satisfaction were evaluated using 2 scales from BREAST-Q BCT domain version 2.0. The questionnaire was self-administered by the patients during their routine follow-up in the clinic. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 23. Mean (SD)/median (IQR) were computed for quantitative variables and frequency and percentages were calculated for qualitative variables. 2 sample t-test was applied. P-value ≤0.05 was considered significant. 25 patients underwent LPF with a mean age of 47±13.1 years. 8 LICAP, 7 AICAP, and 10 LTAP flaps were performed. Two postoperative complications of wound site erythema were encountered. 23 women were eligible for the BREAST-Q survey. Median (IQR) postoperative satisfaction with breasts and physical well-being chest (equivalent Rasch transformed score) was 100 (41) and 76 [18] respectively. We found high satisfaction with breasts and comparable physical well-being among Pakistani women after LPF surgeries. Local perforator flaps in oncoplastic breast-conserving surgery are a good option showing high satisfaction with breasts and physical well-being in Pakistani women.

Oncoplastic breast-conserving surgery for women with primary breast cancer.

Oncoplastic breast-conserving surgery for women with primary breast cancer.

Displacement of Surgical Clips in Patients with Human Acellular Dermal Matrix in the Excision Cavity during Whole Breast Irradiation Following Breast-Conserving Surgery.

PurposeThe purpose of this study was to investigate the displacement of surgical clips in the excision cavity during whole breast irradiation following breast-conserving surgery (BCS) with or without acellular dermal matrix (ADM) insertion, and to analyze clinicopathologic factors associated with the displacement of surgical clips.Materials and MethodsFrom 2016 to 2017, 100 consecutive breast cancer patients who underwent BCS with the placement of surgical clips (superior, inferior, medial, lateral, and deep sides) in the tumor bed were included in this study. All patients took first planning computed tomography (CT) scan (CT 1) before whole breast irradiation and second CT scan (CT 2) before boost irradiation. Between two sets of planning CT, the displacement of surgical clips was calculated from the ΔX (lateral–medial), ΔY (anterior–posterior), ΔZ (superior–inferior), and three-dimensional (3D) directions. Patients were divided into two groups according to the breast volume replacement with ADM: group A with ADM and group B without ADM.ResultsThe means and 1 standard deviations of 3D displacement for superior, inferior, medial, lateral and deep clips were 5.2±2.9, 5.2±3.2, 5.6±4.5, 5.6±4.3, and 4.9±4.9 mm in entire cohort (n=100); 5.6±2.6, 6.0±3.5, 6.7±5.8, 6.7±5.7, and 6.1±7.4 mm in group A (n=38); 4.9±3.1, 4.8±3.0, 5.0±3.5, 5.0±2.9, and 4.3±2.8 mm in group B (n=62), respectively. The 3D displacements of group A were longer than those of group B, but only significant difference was observed in lateral clip (p=0.047).ConclusionThis study demonstrated displacement of surgical clips during whole breast irradiation in patients with ADM insertion. For patients who had breast volume replacement using ADM, adaptive boost planning should be considered.

Total breast reconstruction with fat graft after serial expander deflation: a case series

Fat graft popularity has increased over the last few decades, finding a widespread pattern of application in oncological reconstruction, wound therapy and cosmetic surgery. Recently, the fat graft has been used for breast volume replacement after skin modelling by conventional tissue expanders positioned during mastectomy or after forced removal of prostheses due to complications. Our purpose was to assess fat grafting feasibility and safety, indicating its low rate of complications. We retrospectively analysed 7 patients treated with autologous fat grafts after oncological surgery for breast cancer. Patients not eligible for implant reconstruction and patients who refused implants were included. We analysed age, BMI (Body Mass Index), expansion rate and grafting data (session numbers, injected volume in each session and complication rates). Clinical examinations were performed every 6 months for 1 year after complete reconstruction to evaluate adipose tissue reabsorption and, eventually, further required fat grafting sessions. The aesthetic outcomes were excellent in all of the patients in our series. According to patient surveys, the satisfaction rate was very high. The filled expanders’ final volumes varied from 270 to 630 mL (average: 420 mL). The number of fat grafting sessions ranged between 2 and 3 (average 2.43), and the injected grafting volume during each session varied from 35 to 300 ml (average 175.43 ml). Expander deflation during each surgery session varied from 50 to 270 ml (average 100.63). No complications were reported. Our technique is useful and innovative and leads to good aesthetic results with shorter hospital recovery and low complications rates, compared to major reconstructive surgery. Moreover, the oncological safety appears to be uncompromised. Therapeutic, IV.

Oncoplastic Breast Volume Replacement with the Use of Lateral Intercostal Artery Perforator Flaps

Oncoplastic surgery after conservative breast cancer treatment, in appropriately selected patients, is considered the gold standard in breast reconstruction.1,2 Among the reconstructive options available, a key role is played by loco-regional perforator flaps and particularly by the lateral intercostal artery perforator (LICAP) flap3,4 with regard to breast defects after quadrantectomy localized in the external quadrants (volume replacement) or after mastectomy in patients with small breasts (in thin patients with mammary volume < 100 cc).

Erratum to immediate breast volume replacement using a free dermal fat graft after breast cancer surgery: multi-institutional joint research of short-term outcomes in 262 Japanese patients.

[This corrects the article on p. 179 in vol. 4, PMID: 26005649.].

Total Breast Reconstruction With Fat Grafting After Internal Expansion and Expander Removal.

The development of fat grafting techniques both in cosmetic and reconstructive breast surgery has highlighted the need to recreate a breast mound using similar tissues and without visible scarring. Our technique combines skin expansion by conventional expanders and breast volume replacement by serial fat grafting and final expander removal. Fat grafting had been performed both by Coleman technique and Bodyjet system. We report a series of 12 cases enrolled between 2008 and 2013. Each case has been presented in this article, focusing on received treatment, observed complications, and results. Satisfactory results were observed 6 months after the last session in most of the concluded reconstructions with a low complication rate.

Contemporary issues and prospects of skin-sparing mastectomy performance in patients with breast cancer

For breast reconstructive surgery oncological requirements are imposed, which include the principle of radicality, ablastics, antiblastics and minimal impact on the general and disease-free survival rate, as well as aesthetical requirements - excised breast volume replacement, recovery of tactile sensitivity and shape most closely resembling the natural one. The mastectomy technique determines the breast reconstruction aesthetic results. In 1991 skin-sparing mastectomy combined with the one-stage breast reconstruction, which allows to preserve the organ skin, was described by B.A. Toth and P. Lappert. In 1997, G. Carlson proposed the classification of incisions for skin-sparing mastectomy, which considers both aesthetic and oncological aspects of the surgery, thereby it is successfully used to the present day. In 2003, R.M. Simmons published his incision classification in skin-sparing mastectomy, which differs from the G. Carlson classification only by type III incision. Determinant factors for skin-sparing mastectomy type choice are the presence of scars from previous biopsies, tumor topographic and anatomical parameters and planned reconstruction method. Selection of the appropriate incision type for skin-sparing mastectomy depends on the location and the tumor invasion depth in the breast tissue, the distance of the tumor from the nipple-areola complex and aesthetically favorable zones, as well as biometric data (the areola diameter, breast hypertrophy and ptosis) and the patient desires. Thus skin-sparing mastectomy is aimed to the closest possible to the preoperative level result achievement.

Immediate breast volume replacement using a free dermal fat graft after breast cancer surgery: multi-institutional joint research of short-term outcomes in 262 Japanese patients.

Immediate volume replacement using a free dermal fat graft (FDFG) has been proven safe with early postoperative benefits. The aims of the present study were to clarify adequate indications and risk factors associated with operative morbidity. A multi-institutional analysis of partial mastectomy with immediate volume replacement with FDFG was undertaken in 14 hospitals specializing in breast cancer treatment. Clinical and oncological variables were analyzed to identify factors associated with postoperative complications. A total of 262 cases were analyzed. Considering the observation period and overlap of patients, 13 (5.4%) out of 242 patients had complications within 1 month of surgery while 7 (4.6%) out of 151 patients developed complications 1-12 months after surgery. Two hundred and eleven out of 242 patients were statistically examined using a multivariate analysis, which revealed that the weight of resected breast tissue, size of implanted FDFG (cranio-caudal length), and weight of implanted FDFG were associated with a higher likelihood of postoperative complications. Immediate breast volume replacement using a FDFG after breast cancer surgery should be done for selected patients with breast cancer to avoid postoperative complications. The prospective and larger investigations are warranted for the establishment of appropriate guidelines.

Long-term results of breast volume replacement using an inframammary adipofascial flap after breast-conserving surgery

We have used an inframammary adipofascial flap for breast-conserving reconstruction in the inferior portion of the breast since 2005. The aim herein is to report this oncoplastic procedure in detail, including the long-term results. The surgical procedure was as follows: A skin incision is made at the inframammary line. After partial resection of the breast, a tongue-shaped flap of the fat and the anterior sheath of the rectus abdominis muscle are pulled up in the inframammary area. The flap is then inserted into the breast area where the tumor was removed, and it is secured with absorbable sutures to the surrounding breast tissue. When making the flap, it is very important to preserve several intercostal perforators around the inframammary line. Cosmetic results at more than 5years after the operation in the 5 patients were assessed using photographs. The results were found to be good in 4 cases (80%) and poor in 1 case. The poor outcome was a case with 100% fat necrosis of the flap. This surgical procedure is easy to perform, and the long-term cosmetic outcomes were good, without complications. We consider this procedure to be useful for breast-conserving reconstruction after breast cancer occurring in the inferior portion of the breast.

Usefulness of breast-volume replacement using an inframammary adipofascial flap after breast-conservation therapy

In breast-conservative therapy (BCT), it is difficult to repair defects in the inferior portion of the breast. We performed an immediate reconstruction using an inframammary adipofascial flap after breast conservation in 4 patients with breast cancer in the inferior portion of their breasts and evaluated the usefulness of the procedure. A skin incision is made at the inframammary line. Immediately following BCT, a tongue-shaped flap of the fat and the anterior sheath of the rectus abdominis muscle are pulled up and inserted to reconstruct the breast mound. The cosmetic outcomes of all patients were good, and this surgical procedure can be easily performed by general surgeons without the need of assistance by plastic surgeons. We believe this to be a useful surgical modality for the reconstruction of BCT in the inferior portion breast cancer.

The Outcome of Patients with Breast Cancer Who Underwent Breast Conserving Treatment with or without Immediate Volume Replacement with Autogenous Tissue.

BACKGROUND: Breast conserving treatment (BCT) is accepted as an appropriate therapy for most patients with stage I and stage II breast cancer. However, BCT is associated with a relatively high incidence of local recurrence, and aesthetically unacceptable results occur in some patients. A novel method of immediate volume replacement using autogenous tissue has been developed to strike a balance between adequate excision and cosmesis. We determined the oncological outcome inpatients with breast cancer treated with wide excision, immediate volume replacement with autogenous tissue, and axillary dissection followed by radiotherapy. METHODS: One hundred fifty-three patients with TIS, stage I, II, or III breast cancer underwent wide excision and axillary dissection. The surgical margin ofexcised breast tissue was examined histologically during surgery. If involved, the breast tissue adjacent to the primary site was excised. When the margin of re-excision was positive, patients underwent modified radical mastectomy with or without breast reconstruction. After wide excision, immediate volume replacementwith autogenous tissue was perform-ed, unless the deformity was corrected by undermining and conization of the residual breast tissue. Postoperatively, all patients received breast irradiation. RESULTS: Eighteen patients underwent modified radical mastectomy. The surgical margin was negative in 132 of the 135 patients who underwent BCT. The crude local recurrence rate was 0.7% (1/135). Estimated overall and disease-free 5-year survival rates were 96% and 94%, respectively. CONCLUSION: Wide excision with tumor-free margins and axillary dissection followed by breast irradiation provides adequate local control in many patients with breast cancer. Immediate breast volume replacement with autogenous tissue mayavoid some unpleasant cosmetic results associated with extensive local resection. Our technique eliminates the need for mastectomy in selected patients.

Breast volume replacement using the de-epithialized latissimus dorsi myocutaneous flap

The de-epithelialized latissimus dorsi myocutaneous flap can be used for volume replacement of the subcutaneous mastectomy or unilateral hypoplasia, or for the replacement of the contracted prosthetic implant. Acceptable aesthetic results should be expected, and the permanence of the procedure is an improvement over the conventional silicone implant method of breast volume replacement. The procedure is applicable to both obese and thin patients, and should be considered as a reasonable alternative to the other methods of autologous replacement of lost breast tissue.