Expander Breast Reconstruction Research Articles

Effect of internal port on dose distribution in post-mastectomy radiotherapy for breast cancer patients after expander breast reconstruction.

In patients with expander-based reconstruction a few dosimetric analyses detected radiation therapy dose perturbation due to the internal port of an expander, potentially leading to toxicity or loss of local control. This study aimed at adding data on this field. A dosimetric analysis was conducted in 30 chest wall treatment planning without and with correction for port artifact. In plans with artifact correction density was overwritten as 1 g/cm3. Medium, minimum and maximum chest wall doses were compared in the two plans. Both plans, with and without correction, were compared on an anthropomorphic phantom with a tissue expander on the chest covered by a bolus simulating the skin. Ex vivo dosimetry was carried out on the phantom and in vivo dosimetry in three patients by using film strips during one treatment fraction. Estimated doses and measured film doses were compared. No significant differences emerged in the minimum, medium and maximum doses in the two plans, without and with correction for port artifacts. Ex vivo and in vivo analyses showed a good correspondence between detected and calculated doses without and with correction. The port did not significantly affect dose distribution in patients who will receive post-mastectomy radiation therapy.

Impact of skeletal muscle mass on complications following expander breast reconstruction

Sarcopenia is characterized by skeletal muscle mass (SMM) depletion and decreased muscle power. In two-stage breast reconstruction using a tissue expander, obesity is the main risk factor for postoperative complications. Obese patients with breast cancer and sarcopenia have a hidden lower SMM with a larger body mass index (BMI). This study aimed to investigate the impact of decreased SMM on complications after tissue expander surgery. In this nonrandomized, retrospective cohort study, 157 patients underwent 169 expander indwelling surgeries. Cross-sectional areas (cm2) of skeletal muscles at the third lumbar vertebra were measured on computed tomography (CT) and normalized for height (cm2/m2) to determine the skeletal muscle index (SMI). Subcutaneous and visceral adipose tissue areas were measured in the same slice and normalized for height (cm2/m2) to determine the total adipose tissue index (TATI). The SMI/TATI ratio was calculated as an index of sarcopenic obesity. Postoperative complications occurred in 40 cases (23.7%). In multivariate analysis, a lower SMI/TATI ratio was identified as a significant independent risk factor for complications (P < 0.001, adjusted odds ratio (OR) = 2.28 per 10% decrease). Delayed wound healing was significantly associated with lower SMI/TATI ratio (P = 0.003, OR = 6.33 per 10% decrease) and diabetes (P = 0.044, OR = 7.36). Seroma was significantly associated with high BMI (P < 0.001, OR = 8.00 per 5-kg/m2 increase) and blood loss (P = 0.003, OR = 1.18 per 10 g increase). These results show that patients with a large adipose tissue volume and lower SMM (sarcopenic obesity) have more complications after expander surgery than those with high BMI, or TATI alone.

Postmastectomy radiation therapy using VMAT technique for breast cancer patients with expander reconstruction.

Postmastectomy radiotherapy (PMRT) following immediate breast reconstruction is increasingly adopted in the management of breast cancer patients. We retrospectively evaluate the complication rates of PMRT using VMAT technique to immediate tissue expander-based reconstructions and the possible impact of tissue expander volume on radiotherapy planning. We reviewed the data of patients who underwent immediate expander breast reconstruction and received PMRT with VMAT (50Gy in 25 fractions) on the reconstructed breast and axillary levels III-IV. Neoadjuvant or adjuvant systemic therapy was administered in most of the patients. Autologous fat grafting was routinely performed at the time of second-stage reconstruction. Between 2015 and 2017, PMRT was delivered to 46 consecutive patients (median age 50years) with expander reconstruction. Median follow-up was 27months (range 10-41). Two patients (4.3%) had a reconstruction failure, as expander rupture and infection, following the first- and the second-stage reconstruction, respectively. In most cases expanders were completely inflated before PMRT (65.2%). Median expander volume before PMRT was 425cm3 (range 150-700cm3). The amount of expander inflation did not significantly affect dosimetry, except for skin dose, with a surface receiving more than 30Gy of 36.6 ± 0.9cm2 and 47.0 ± 2.5cm2 for a volume expander below or above the median, respectively. However, this variable was not predictor for complications. Disease progression was recorded in 15.2% of patients. PMRT using VMAT technique for breast cancer patients with expander reconstruction is associated with a very low complication rate. The expander volume before PMRT does not significantly compromise radiotherapy dose distribution.

P306 - Complications and patient satisfaction following unilateral immediate expander breast reconstruction after nipple sparing subcutaneous mastectomy

P306 - Complications and patient satisfaction following unilateral immediate expander breast reconstruction after nipple sparing subcutaneous mastectomy

Use of Acellular Dermal Matrix is Comparable to Expander Based Breast Reconstructions for Post Operative Physiotherapy Requirements

Currently all suitable women who require mastectomy for Breast Cancer should be offered breast reconstruction either as an immediate or delayed procedure. Various forms of breast reconstruction are available but since the introduction of Acellular Dermal Matrixes (ADMs), implant based reconstruction has become more popular. Implant based reconstruction has the advantages of being a relatively short operation with minimal morbidity compared to myocutaneous flap based reconstructions. ADMs are thought to improve the cosmetic outcomes of implant based reconstructions by allowing a more natural breast mound to be created. They also provide a one stage procedure as opposed to expander based reconstructions that require several inflations in clinic and a second operation to exchange the expander to a silicone implant. Most studies on the use of ADMs have been focused on cosmesis and financial or logistical benefits. To date there have been no studies on whether the use of ADM has an effect on post operative physiotherapy requirements. This study assessed the number of physiotherapy sessions required for women, who had undergone expander or ADM assisted breast reconstruction, to regain full shoulder mobility. There was no significant difference between the two procedures for physiotherapy requirements, with greater significance on the type of concomitant axillary surgery performed.

The use of the Deaver retractor for port insertion in expander breast reconstruction

The use of the Deaver retractor for port insertion in expander breast reconstruction