Mastectomy Weight Research Articles

Assessing the Accuracy of a 3-Dimensional Surface Imaging System in Breast Volume Estimation.

Preoperative prediction of breast volume can guide patient expectations and aid surgical planning in breast reconstruction. Here, we evaluate the accuracy of a portable surface imager (Crisalix S.A., Lausanne, Switzerland) in predicting breast volume compared with anthropomorphic estimates and intraoperative specimen weights. Twenty-five patients (41 breasts) undergoing mastectomy were scanned preoperatively with the Crisalix surface imager, and 1 of 3 attending plastic surgeons provided an anthropomorphic volume estimate. Intraoperative mastectomy weights were used as the gold standard. Volume conversions were performed assuming a density of 0.958 g/cm. The Pearson correlation coefficient between imager estimates and intraoperative volumes was 0.812. The corresponding value for anthropomorphic estimates and intraoperative volumes was 0.848. The mean difference between imager and intraoperative volumes was -233.5 cm, whereas the mean difference between anthropomorphic estimates and intraoperative volumes was -102.7 cm. Stratifying by breast volume, both surface imager and anthropomorphic estimates closely matched intraoperative volumes for breast volumes 600 cm and less, but the 2 techniques tended to underestimate true volumes for breasts larger than 600 cm. Stratification by plastic surgeon providing the estimate and breast surgeon performing the mastectomy did not eliminate this underestimation at larger breast volumes. For breast volumes 600 cm and less, the accuracy of the Crisalix surface imager closely matches anthropomorphic estimates given by experienced plastic surgeons and true volumes as measured from intraoperative specimen weights. Surface imaging may potentially be useful as an adjunct in surgical planning and guiding patient expectations for patients with smaller breast sizes.

Early experience with lightweight breast implants in breast reconstruction and massive weight loss patients

The B-Lite® lightweight breast implant (LWBI) weighs ~ 30% less than traditional silicone implants for a given volume. Since weight is a persistent and unrelenting stress on the soft breast tissues, a lightweight implant is expected to reduce complications, particularly in challenging cases where there is very thin or ‘at risk’ breast tissue. The study determined the clinical outcomes of women who underwent B-Lite implantation surgery following mastectomy or massive weight loss (MWL) after bariatric surgery. Retrospective review of all cases from January 2017 to June 2018. Candidates underwent standard surgical procedures with the LWBI, either one-stage implantation DTI or two-stage implantation, with surgical mesh or fat grafting. Eleven women (8 following mastectomy and 3 following MWL) aged 47.5 ± 9.1 years with a BMI of 20 ± 1.4 underwent the procedures with a total of 15 implants. At one-month follow-up, complications were rare with no adverse events including no cases of infection, hematoma, seroma or red breast syndrome. The only complications involved two cases who developed necrosis that was clearly related to the mastectomy. The necrosis was consequently, conservatively treated with local debridement. The current follow-up duration is 26 ± 7 months (21–31) with no further complications noted and excellent clinical outcomes. The cosmetic result is exceptional with minimal scarring from the vertical incision. The B-Lite results are preliminary but suggest a safety profile similar or better than traditional implants with a promising benefit in challenging cases. Level of evidence: Level IV, therapeutic study.

Abstract P1-20-12: Robotic versus conventional or endoscopic-assisted nipple sparing mastectomy with immediate prosthesis breast reconstruction in the management of breast cancer- A case control comparison study with analysis of clinical outcomes, patient-reported aesthetic results, and medical cost

Abstract Background: Nipple-sparing mastectomy (NSM), which preserved the nipple areolar complex (NAC) and skin flap during mastectomy, was increasingly performed in breast cancer patients due to better cosmetic outcome, higher patient satisfaction, and maintained oncologic safety. Minimal invasive surgery had become the main stream of operations, and new surgical innovations of NSM, like endoscopic nipple sparing mastectomy (E-NSM) or robotic nipple sparing mastectomy (R-NSM), were emerging and applied in the surgical treatment of breast cancer. However, evidence comparing R-NSM to conventional NSM (C-NSM) or E-NSM was lacking. A case control comparison study was conducted for patients with breast cancer underwent C-NSM, E-NSM, or R-NSM with IPBR at a single institution to compare the clinical outcomes, patient-reported cosmetic results and medical cost. Methods: To compare the efficacy and benefit between R-NSM, C-NSM and E-NSM, a case control comparison study was conducted. Patients with primary operable breast cancer who underwent NSM from January 2011 to May 2019 were retrieved from a prospectively maintained breast cancer database at Changhua Christian Hospital (CCH), a tertiary medical center in Taiwan. To reduce sampling bias from surgical technique or related factors, only patients operated by HWL were enrolled for this comparison analysis. In addition, in order to reduce the possible variations in cosmetic outcomes derived from different types of breast reconstruction, only patients who received immediate cohesive gel implant breast reconstructions were retrieved. Patients who had received previous breast conserving surgery or previous radiation to chest wall were excluded. Results: Altogether, there were a total of 57 patients in the R-NSM with IPBR group, 65 C-NSM and IPBR, and 100 patients in E-NSM with IPBR group in this case control comparison study. The three groups were comparable in terms of age, location of tumor, pathologic tumor size, grade, resected mastectomy weight, and stage of disease. Compared with C-NSM, R-NSM was associated with less blood loss (mean 35 ± 32 versus 104 ± 71 ml, P<0.01) and higher overall satisfaction (96.4% excellent and 3.6% good versus 75.6% excellent and 24.4% good, P=0.02) in patients’ reported cosmetic results. There is a trend (though statistically not significant) of lesser complication rate, and NAC ischemia/necrosis rate of R-NSM if compared with C-NSM. However, longer operation time (mean 247 ± 61 versus 197 ± 80 minutes, P<0.01), and higher over medical cost (10,877 ± 796 versus 5,702 ± 661 US Dollars, P<0.01) was observed in R-NSM group. The surgical margin involvement rate in both R-NSM (1.8%) and E-NSM (4%) procedures were relatively low (P=0.52). R-NSM group was associated with higher satisfaction rates in terms of scar appearance, scar length, and surgical wound position if compared with E-NSM group. Compared with E-NSM, R-NSM took longer operation time (241 ± 61 versus 215 ± 70 mins, P=0.01), less blood loss (32 ± 29 versus 79 ± 62 ml, P<0.01), and higher medical cost (10,587 ± 554 versus 6,855 ± 936 US Dollars, P<0.01). There was no statistically significant difference in nipple ischemia/necrosis or overall complication between R-NSM and E-NSM. Conclusion: R-NSM compared favorably to C-NSM with comparable clinical outcomes, minimal blood loss and higher patients’ satisfaction but at the expense of higher cost and longer operation time. R-NSM was associated with higher would related satisfaction and lesser blood loss if compared with E-NSM, however, at the price of longer operation time and higher medical cost. Citation Format: Hung-Wen Lai, Shou-Tung Chen, Dar-Ren Chen. Robotic versus conventional or endoscopic-assisted nipple sparing mastectomy with immediate prosthesis breast reconstruction in the management of breast cancer- A case control comparison study with analysis of clinical outcomes, patient-reported aesthetic results, and medical cost [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-20-12.

Predicting Ischemic Complications in the Inframammary Approach to Nipple-Sparing Mastectomy: The Midclavicular-to-Inframammary Fold Measurement.

The authors refine their anatomical patient selection criteria with a novel midclavicular-to-inframammary fold measurement for nipple-sparing mastectomy performed through an inframammary approach. Retrospective review was performed of all nipple-sparing mastectomies performed through an inframammary approach. Exclusion criteria included other mastectomy incisions, staged mastectomy, previous breast operation, and autologous reconstruction. Preoperative anatomical measurements for each breast, clinical course, and specimen weight were obtained. One hundred forty breasts in 79 patients were analyzed. Mastectomy weight, but not sternal notch-to-nipple distance, was strongly correlated with midclavicular-to-inframammary fold measurement on linear regression (R = 0.651; p < 0.001). Mastectomy weight was not correlated with ptosis. Twenty-five breasts (17.8 percent) had ischemic complications: 16 (11.4 percent) were nonoperative and nine (6.4 percent) were operative. Those with mastectomy weights of 500 g or greater were nine times more likely to have operative ischemic complications than those with mastectomy weights less than 500 g (p = 0.0048). Those with a midclavicular-to-inframammary fold measurement of 30 cm or greater had a 3.8 times increased incidence of any ischemic complication (p = 0.00547) and a 9.2 times increased incidence of operative ischemic complications (p = 0.00376) compared with those whose midclavicular-to-inframammary fold measurement was less than 30 cm. Breasts undergoing nipple-sparing mastectomy by means of an inframammary approach with midclavicular-to-inframammary fold measurement greater than or equal to 30 cm are at higher risk for having ischemic complications, warranting consideration for a staged approach or other incision. The midclavicular-to-inframammary fold measurement is useful for assessing the entire breast and predicting the likelihood of ischemic complications in inframammary nipple-sparing mastectomies. Risk, III.

The influence of contralateral breast augmentation on the development of complications in direct-to-implant breast reconstruction

Simultaneous contralateral augmentation in direct-to-implant (DTI) breast reconstruction may increase the risk of skin flap necrosis on the reconstruction side due to increased tension on the skin flap when implants are larger than the original breast size. The purpose of this study was to evaluate whether the contralateral augmentation procedure affects complications in unilateral DTI breast reconstruction. Patients who underwent immediate unilateral DTI breast reconstruction from January 2013 to July 2017 were included in this study. Data were collected through retrospective review of individual medical records. The primary outcome variable was the development of perioperative complications including skin flap necrosis. Univariable and multivariable logistic regression analyses were performed to identify risk factors for complications. A total of 121 patients who underwent unilateral immediate DTI breast reconstruction were included in this study. Twenty-one patients (17.4%) underwent simultaneous contralateral augmentation mammoplasty and 100 patients (82.6%) underwent DTI without contralateral augmentation. Overall complications were not different between the contralateral augmentation and no-augmentation groups (23.8% vs. 31%, respectively, p = 0.512). The frequency of skin flap necrosis in the augmentation group (14.3%) was not significantly different from that in the no-augmentation group (18.0%, p > 0.999). In multivariable analysis, mastectomy weight was the only predictor for complications (p = 0.053) and contralateral augmentation was not associated with development of complications. Contralateral breast augmentation in DTI breast reconstruction is not a risk factor for complications and can be safely performed in selected patients.

Single-Stage Direct-to-Implant Breast Reconstruction: A Comparison Between Subpectoral Versus Prepectoral Implant Placement.

Single-stage direct-to-implant (DTI) breast reconstruction can offer several potential benefits. Subpectoral DTI reconstruction can present with animation deformity and pectoralis muscle spasm. To potentially avoid these complications, surgeons have attempted prepectoral placement for DTI; however, the benefits of this approach are mostly unknown. We evaluated the outcomes of DTI between prepectoral and subpectoral placement. This was a retrospective review of patients who underwent immediate DTI breast reconstruction (prepectoral vs subpectoral) between 2011 and 2018. Demographics, clinical characteristics, complications, and patient-reported outcomes (BREAST-Q) were compared. Thirty-three patients (55 breasts) underwent prepectoral DTI, and 42 patients (69 breasts) underwent subpectoral DTI. Demographics were similar among groups. The number of breasts with preoperative ptosis lower than grade 2 was not significantly different between groups (29.1% vs 26.1%; P = 0.699). Median follow-up was 20.3 and 21 months in the prepectoral and subpectoral groups, respectively. Average mastectomy weight was 300 g (180-425 g) and 355 g (203-500 g). Average implant size was 410 cc (330-465 cc) and 425 cc (315-534 cc) in the prepectoral and subpectoral groups, respectively. Alloderm was used in all reconstructions. Total numbers of complications were 4 (7.2%) and 8 (11.6%) in the prepectoral and subpectoral groups, respectively (P = 0.227). BREAST-Q demonstrated mean patient satisfaction was high and similar among groups (75 and 73.9, P = 0.211). Based on these results, we believe prepectoral DTI is safe, reliable, and a promising reconstructive option for selected patients, with equivalent results to other reconstructive options. Our present treatment recommendations are for patients who wish to maintain the same breast size and have minimal or no breast ptosis.

Skin sparing mastectomy and robotic latissimus dorsi-flap reconstruction through a single incision

BackgroundRobotic latissimus dorsi-flap reconstruction (RLDFR) after skin-sparing mastectomy (SSM) for breast cancer (BC) has been performed through a single nipple incision. We report results of SSM with RLDFR, mainly with analysis of feasibility, morbidity, indications, and technique standardization.MethodsWe determined characteristics of patients, previous treatment of BC, and type of reconstruction. Surgical technique, duration of surgery, and complication rate were reported according to three successive periods: P1–3.ResultsForty RLDFR, with breast implant for 16 patients, with previous breast radiotherapy in 30% had been performed. In logistic regression, factors significantly associated with duration of surgery ≥ 300 min were P2 (OR 0.024, p = 0.004) and P3 (OR 0.012, p = 0.004) versus P1. The median mastectomy weight was 330 g and 460 g for BMI < and ≥ 23.5 (p = 0.025). Length of hospitalization was 4 days. Total complication rate was 20% (8/40): seven breast complications (four re-operations) and one RLDF complication with re-operation. Periods were significantly predictive of complications (p = 0.045).ConclusionSSM with RLDFR is feasible, safe, and reproducible. We reported a decrease of duration of surgery, length of post-operative hospitalization, and complication rate.

Does Staged Breast Reduction before Nipple-Sparing Mastectomy Decrease Complications? A Matched Cohort Study between Staged and Nonstaged Techniques.

Nipple-sparing mastectomy in patients with large, ptotic breasts is a reconstructive challenge. Staged breast reduction before prophylactic nipple-sparing mastectomy has been shown to decrease complications; however, a direct comparison of outcomes between staged and nonstaged techniques is lacking. A retrospective review of all patients that underwent staged breast reduction before nipple-sparing mastectomy was conducted. Staged cases were matched to nonstaged nipple-sparing mastectomy cases according to known risk factors for complications. Individual staged cases with appropriate matches in all these categories were then each paired to two nonstaged cases according to the nearest higher and lower mastectomy weight. Staged and nonstaged cohorts were compared with regard to demographics, operative characteristics, and reconstructive outcomes. Eighteen staged breast reductions were identified, performed at an average of 5.0 months before nipple-sparing mastectomy. Staged reductions were matched to 36 prophylactic nonstaged reductions. Average combined mastectomy weight (breast reduction and mastectomy weight) in the staged group was significantly higher than in the nonstaged group (992.6 g versus 640 g; p = 0.0004), although isolated mastectomy weights were comparable (607.1 g versus 640.0 g, respectively; p = 0.6311). Major mastectomy flap necrosis rates were significantly lower in the staged cohort than in the nonstaged cohort (0 percent versus 22.2 percent, respectively; p = 0.0415). Rates of minor mastectomy flap necrosis, partial nipple necrosis, and explantation trended lower in the staged cohort. In patients with large breast size, staged breast reduction before nipple-sparing mastectomy had significantly lower rates of major flap necrosis compared with nonstaged cases after controlling for other known risk factors for complications. Therapeutic, III.

Acellular dermal matrices as an adjunct to implant breast reconstruction: Analysis of outcomes and complications

PurposeAcellular dermal matrices (ADM) are increasingly used in implant-based breast reconstruction (IBR). Uncertainty remains with regard to their efficacy and complications. The aim of this study was to evaluate the outcomes and complication rates associated with the use of ADMs in IBR. MethodsRetrospective cohort study of patients undergoing ADM-assisted IBR between 2008 and 2013. Cases were identified from a prospectively collected database. Simple descriptive statistics and logistic regression analysis were performed. ResultsA total of 110 patients (175 mastectomies) were included in the analysis. The median age was 46 (19–75) years and the median BMI was 22.2 (16.2–41.5). Seventy nine mastectomies were performed for therapeutic purposes. The median mastectomy weight was 244 (185–335) gr. The majority of reconstructions were performed with fixed volume (n = 115, 66%) or permanent expandable implants (n = 53, 30%) as one-stage procedures. Forty mastectomies were associated with at least one complication. The infection rate was 2.3% (n = 4). Post-operative haematoma developed in 5 cases (2.9%), but only 2 required surgical interventions. Three mastectomies were complicated by nipple necrosis (3.6%), 3 with skin necrosis (1.7%) and 9 with wound dehiscence (5.1%). The capsule formation rate was 2.3% (n = 4). Reconstruction failure with implant loss occurred in 3 cases (1.7%). ConclusionsThe complication rates following ADM-assisted IBR can be very low with appropriate patient selection and meticulous surgical technique. This supports the safety of using ADM in carefully selected patients. Further research is warranted to assess the health economics of ADM use in IBR.

Immediate versus Delayed Contralateral Breast Symmetrisation in Breast Reconstruction with Latissimus dorsi Flap: A Comparative Study

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.

A retrospective review of breast reconstruction outcomes comparing AlloDerm and DermaCELL

Acellular dermal matrix (ADM) has become an accepted and advantageous adjunct to alloplastic breast reconstruction. The increase in demand has led to an upsurge of dermal-based products, both human and animal derived. There are few direct ADM comparative studies, but it is unclear whether there are any differences in complication rates. Our primary objective was to determine whether there is a difference in outcomes between AlloDerm and DermACELL in immediate alloplastic breast reconstruction.A retrospective chart review of those who underwent immediate alloplastic breast reconstruction from January to December 2016 was performed. This encompassed 64 consecutive patients (95 breasts) with tissue expander or direct-to-implant reconstruction and either AlloDerm or DermACELL ADM. Demographics, particulars of the surgery, additional treatments and complications were all recorded. Differences in seroma, haematoma and infection rates, as well as more serious complications including implant replacement, capsular contracture and failure, were all reviewed.The groups were comparable in terms of age, BMI and relevant comorbidities. Mastectomy weight and resulting implant volume were higher in the DermACELL group, with volume reaching statistical significance (p = 0.001). With an average follow-up of 18 months, there was no difference in capsular contraction or implant replacement. However, in those who developed capsular contracture in the DermACELL group, more breasts had no history of radiation, which was significant (p = 0.042). Overall, there were no significant differences in complication rates of seroma, haematoma, mastectomy flap necrosis and infection.

Mastectomy Without Drains Reduces Cost with No Detriment to Patient Outcome

Introduction Use of drains after mastectomy remains highly variable. This study aimed to establish whether simple mastectomy managed without a drain would cost less than the same procedure managed with a drain and whether there would be any difference in complications.Methods Prospective data were collected on all patients undergoing simple mastectomy ± sentinel lymph node biopsy over sixteen months. Surgeons decided intra-operatively whether to place a drain. Data included operative details, mastectomy weight, length of stay and postoperative complications. Costing data were identified by combining hospital finance costs for admission and follow-up appointments along with the cost of consumables.Results One hundred and thirty mastectomies were performed on 119 patients. There was a significant difference in mastectomy weight between drain group patients (n=80, median: 730g) and no drain group patients (n=50, median: 424g) (p=<0.001). The mean cost for drain group patients was £639.77 whilst for the no drain group was £365.46, indicating a potential unit saving of £21944.93 over sixteen months. Length of stay was shorter in the no drain group (range: 1-2 days) than the drain group (range: 1-4 days). The presence or absence of drains did not influence complication rates, with no change in seroma interventions (p=0.803).Conclusions Managing simple mastectomy patients without a drain resulted in no increase in complications or subsequent interventions for seroma. Significant cost savings to both the hospital and to the patient can be achieved by omitting drain use. Routine use of drains in patients undergoing simple mastectomy ± SNB may be unnecessary and costly.

Optimizing Outcomes in Nipple-sparing Mastectomy: Mastectomy Flap Thickness Is Not One Size Fits All

Summary:Nipple-sparing mastectomy (NSM) places greater stress on the breast-skin envelope compared with traditional mastectomy techniques. Precise mastectomy flap dissection is critical to optimize breast skin flap thickness and minimize complication risk. This study evaluated patient-specific factors associated with mastectomy flap quality to improve technical success in NSM. Ideal NSM flap thickness was determined for all NSMs from 2006 to 2016 with available preoperative breast magnetic resonance imaging (MRIs). Demographic, operative variables, and flap thickness were compared for NSMs as stratified by body mass index (BMI) and mastectomy weight. Of the 1,037 NSMs, 420 cases (40.5%; 243 patients) had MRI data available, which included 379 (36.5%) preoperative breast MRIs. Average BMI was 24.08 kg/m2, whereas average mastectomy weight was 442.28 g. NSMs were classified according to BMI <25 kg/m2, 25–30 kg/m2, and >30 kg/m2. Average ideal overall NSM flap thicknesses in these groups were 10.43, 12.54, and 14.91 mm, respectively. Each incremental increase in average overall NSM flap thickness per BMI category was statistically significant (P < 0.0001; P < 0.0001; P = 0.0002). NSMs were also classified into mastectomy weight categories: <400 g, 400–799 g, and ≥800 g. Average overall NSM flap thicknesses in these groups were 9.97, 12.21, and 14.50 mm, respectively. Each incremental increase in average overall NSM flap thickness per mastectomy weight category was similarly statistically significant (P < 0.0001; P < 0.0001; P < 0.0001). NSM flap thickness and quality is related to BMI and breast size. Characterizing these anatomic variations preoperatively will help surgeons optimize mastectomy flap dissections and minimize ischemic complications in breast reconstruction after NSM.

The learning curve of robotic nipple sparing mastectomy for breast cancer: An analysis of consecutive 39 procedures with cumulative sum plot

BackgroundThe preliminary experience and learning curve of robotic nipple sparing mastectomy (R-NSM) in the management of breast cancer were analyzed and reported. MethodsThe medical records of patients who underwent R-NSM for breast cancer during the period of March 2017 to June 2018 were collected from the same surgeon in a single institute. Data on clinicopathologic characteristics, type of surgery, method of breast reconstruction, and operation time were prospective collected. Learning curve of R-NSM was evaluated and analyzed by the cumulative sum (CUSUM) plot method. ResultsA total of 39 consecutive R-NSM procedures from 35 patients were analyzed. The time needed for “docking”, “R-NSM”, and “R-NSM and immediate prosthesis breast reconstruction (IPBR)” decreased after cases experience accumulated, and in mature phase procedures could finished within 10 min, 100mins, and 240 min, separately. In CUSUM plots analysis of learning curve, the cases needed to decrease operation time for “docking”, “R-NSM”, and “total time for R-NSM and IPBR” were 13th, 13th, and 12th procedures separately. Mastectomy weight and lymph node metastasis were factors related to operation time. The rate of total nipple areolar complex necrosis for R-NSM was 0%. One (2.9%, 1/35) R-NSM procedure was found to have positive margin involved in the final pathologic check-up. No implant loss, or local recurrence was observed during a mean follow-up of 8.6 ± 4.5 (1.3–16.7) months. ConclusionFrom our preliminary experience, R-NSM and IPBR (or R-NSM alone) is a safe procedure, and the operation time needed significantly decrease after cases experience accumulated.

Digital breastvolumeestimation (DBVE)-A new technique.

There are several limitations with current methods of breast volume measurement; principally relating to assumption of fixed shape forms. This study, utilizing computer aided volume estimates, developed a new method using the digital mapping of breast area and compares results to existing techniques of breast volume measurement and actual breast volume. 50 consecutive breast cancer patients had breast volume calculated from mammograms [craniocaudal (CC) and mediolateral oblique views]; using breast height, width, radius, area and compression thickness. Area was recorded using cursor measurement tool for AGFA® Impax™6 software. The new volumetric estimation is based on the basic formula for the volume of a solid. The technique was compared with three known breast volume estimation techniques. Subsequently,15 patients undergoing mastectomy had pre-op breast volume calculated using this new method and 3 existing techniques; values were compared to fresh mastectomy weights/volumes. 50 patients, mean age 63.2 ± 14.4 (range 38-88) had breast volume estimation. The CC view appears to provide the best correlation with existing techniques. Scatterplots show a significant correlation of all the methods with the digital breast volume estimation method. Mastectomy volume compared with fourbreast volume techniques in n = 15, confined to the CC, shows good correlation between the digital technique and real volume. Scatterplots show significant correlation between digital breast volume estimation and mastectomy weight. This study provided a novel simple tool to estimate breast volume in patients. This may aid in planning cosmetic outcome and oncoplastic approaches in breast cancer and breast reduction surgery.

Relationship between Abdominal Free Flap Weight and Mastectomy Weight in Immediate Breast Reconstruction and its Resultant Aesthetic Outcomes – A Single Centre Series

Relationship between Abdominal Free Flap Weight and Mastectomy Weight in Immediate Breast Reconstruction and its Resultant Aesthetic Outcomes – A Single Centre Series

The Impact of Mastectomy Weight on Reconstructive Trends and Outcomes in Nipple-Sparing Mastectomy: Progressively Greater Complications with Larger Breast Size.

Reconstructive trends and outcomes for nipple-sparing mastectomy continue to be defined. The graduated impact of breast size and mastectomy weight remains incompletely evaluated. All patients undergoing nipple-sparing mastectomy from 2006 to June of 2016 were identified. Demographics and outcomes were analyzed and stratified by mastectomy weight of 800 g or higher (large group), between 799 and 400 g (intermediate group), and less than 400 g (small group). Of 809 nipple-sparing mastectomies, 66 (8.2 percent) had mastectomy weights of 800 g or higher, 328 (40.5 percent) had mastectomy weights between 799 and 400 g, and 415 nipple-sparing mastectomies (51.3 percent) had mastectomy weights less than 400 g. Nipple-sparing mastectomies in the large group were significantly more likely to be associated with major mastectomy flap necrosis (p = 0.0005), complete nipple-areola complex necrosis (p < 0.0001), explantation (p < 0.0001), cellulitis treated with oral (p = 0.0008) and intravenous (p = 0.0126) antibiotics, abscess (p = 0.0254), and seroma (p = 0.0126) compared with those in the intermediate group. Compared with small nipple-sparing mastectomies, patients in the large group had greater major mastectomy flap necrosis (p < 0.0001), complete (p < 0.0001) and partial (p = 0.0409) nipple-areola complex necrosis, explantation (p < 0.0001), cellulitis treated with oral (p < 0.0001) and intravenous (p < 0.0001) antibiotics, abscess (p = 0.0119), and seroma (p < 0.0001). Patients in the intermediate group were more likely to experience major (p < 0.0001) and minor (p < 0.0001) mastectomy flap necrosis, complete (p = 0.0015) and partial (p < 0.0001) nipple-areola complex necrosis, cellulitis treated with oral antibiotics (p = 0.0062), and seroma (p = 0.0248) compared with those undergoing small nipple-sparing mastectomies. Larger mastectomy weights were significant predictors of complications on logistic regression analysis. Reconstructive and ischemic complications in nipple-sparing mastectomy are progressively greater as mastectomy weight and breast size increase. Risk, II.

The relationship between VolparaDensity™ breast volume measurements and mastectomy specimen weight– a new pre-operative tool to guide implant selection

Introduction: VolparaDensity™ is a fully automated breast density assessment software that estimates the percentage volume of fibroglandular tissue from digital mammograms. Previous studies have shown a strong association between volumetric breast density as assessed by Volpara and breast cancer risk. This current study assesses the utility of Volpara in guiding implant selection. Current approaches to implant selection are imprecise. Mastectomy weight is often used as the final guide. Improved outcomes both aesthetically and financially could be achieved if more precise pre-operative methods of implant selection are developed.

Weight analysis of mastectomy specimens and abdominal flaps used for breast reconstruction in Koreans.

BackgroundSlim patients or those with large breasts may be ineligible for breast reconstruction with an abdominal flap, as the volume of the flap may be insufficient. This study aimed to establish that abdominal tissue–based breast reconstruction can be well suited for Korean patients, despite their thin body habitus.MethodsA total of 252 patients who underwent postmastectomy breast reconstruction with an abdominal flap from October 2006 to May 2013 were retrospectively reviewed. The patients’ age and body mass index were analyzed, and a correlation analysis was performed between the weight of the mastectomy specimen and that of the initial abdominal flap.ResultsThe average weights of the mastectomy specimen and initial abdominal flap were 451.03 g and 644.95 g, respectively. The ratio of the weight of the mastectomy specimen to that of the initial flap was 0.71±0.23. There was a strong positive linear relationship between the weight of the mastectomy specimen and that of the initial flap (Pearson correlation coefficient, 0.728). Thirty nulliparous patients had a final-to-initial flap weight ratio of 0.66±0.11. The 25 patients who underwent a contralateral procedure had a ratio of 0.96±0.30. The adjusted ratio of the final flap weight to the initial flap weight was 0.66±0.12.ConclusionsBreast weight had a strong positive relationship with abdominal flap weight in Koreans. Abdominal flaps provided sufficient soft tissue for breast reconstruction in most Korean patients, including nulliparous patients. However, when the mastectomy weight is estimated to be >700 g, a contralateral reduction procedure may be considered.

Predictors of complications after direct-to-implant breast reconstruction with an acellular dermal matrix from a multicentre randomized clinical trial.

BackgroundIn the multicentre randomized trial BRIOS (Breast Reconstruction In One Stage), direct‐to‐implant (DTI) breast reconstruction with an acellular dermal matrix (ADM) was associated with a markedly higher postoperative complication rate compared with two‐stage tissue expander/implant breast reconstruction. This study aimed to identify factors that contribute to the occurrence of complications after DTI ADM‐assisted breast reconstruction.MethodsData were obtained from the BRIOS study, including all patients treated with DTI ADM‐assisted breast reconstruction. Logistic regression analyses were performed to identify factors predictive of postoperative complications.ResultsFifty‐nine patients (91 breasts) were included, of whom 27 (35 breasts) developed a surgical complication. Reoperations were performed in 29 breasts (32 per cent), with prosthesis removal in 22 (24 per cent). In multivariable analyses, mastectomy weight was associated with complications (odds ratio (OR) 1·94, 95 per cent c.i. 1·33 to 2·83), reoperations (OR 1·70, 1·12 to 2·59) and removal of the implant (OR 1·55, 1·11 to 2·17). Younger patients (OR 1·07, 1·01 to 1·13) and those who received adjuvant chemotherapy (OR 4·83, 1·15 to 20·24) more frequently required reoperation. In univariable analyses, adjuvant radiotherapy showed a trend towards more complications (OR 7·23, 0·75 to 69·95) and removal of the implant (OR 5·12, 0·76 to 34·44), without reaching statistical significance.ConclusionBreast size appeared to be the most significant predictor of complications in DTI ADM‐assisted breast reconstruction. The technique should preferably be performed in patients with small to moderate sized breasts. Registration number: NTR5446 ( http://www.trialregister.nl).