Role In Breast Reconstruction Research Articles

Surface Topography, Microbial Adhesion, and Immune Responses in Silicone Mammary Implant-Associated Capsular Fibrosis.

Breast cancer is the most common cancer in women globally, often necessitating mastectomy and subsequent breast reconstruction. Silicone mammary implants (SMIs) play a pivotal role in breast reconstruction, yet their interaction with the host immune system and microbiome remains poorly understood. This study investigates the impact of SMI surface topography on host antimicrobial responses, wound proteome dynamics, and microbial colonization. Biological samples were collected from ten human patients undergoing breast reconstruction with SMIs. Mass spectrometry profiles were analyzed for acute and chronic wound proteomes, revealing a nuanced interplay between topography and antimicrobial response proteins. 16S rRNA sequencing assessed microbiome dynamics, unveiling topography-specific variations in microbial composition. Surface topography alterations influenced wound proteome composition. Microbiome analysis revealed heightened diversity around rougher SMIs, emphasizing topography-dependent microbial invasion. In vitro experiments confirmed staphylococcal adhesion, growth, and biofilm formation on SMI surfaces, with increased texture correlating positively with bacterial colonization. This comprehensive investigation highlights the intricate interplay between SMI topography, wound proteome dynamics, and microbial transmission. The findings contribute to understanding host-microbe interactions on SMI surfaces, essential for optimizing clinical applications and minimizing complications in breast reconstruction.

Multistage Latissimus Dorsi Flap with Implant for Complex Post-Mastectomy Reconstruction: An Old but Still Current Technique

Introduction: The latissimus dorsi (LD) flap has been used for reconstructing mastectomy defects since the early 1900s. Although its popularity has declined over the last decades, it still retains an important role in breast reconstruction. We present our recent experience with the multistage LD flap and implant for extremely complex post-mastectomy defects. Patients and Methods: Between 2011 and 2020, 42 consecutive patients underwent post-mastectomy LD reconstruction with an expander (STAGE 1). Some of them received prior fat-grafting of the mammary region (STAGE 0). All patients were scheduled for an expander-definitive implant change (STAGE 2). Some of them completed the program with fat-grafting, nipple and areola reconstruction, and other refinements (STAGE 3 or 4). Results: Two patients underwent fat-grafting at STAGE 0. Mean age at STAGE 1 was 46.7 years, mean BMI was 23.6, 14.4% of the patients were smokers, and 21.4% had comorbidities. Immediate reconstructions were performed in 35.7% and delayed in 64.3%. Mean surgical time at STAGE 1 was 194.7 min for delayed reconstructions and 242.3 min for immediate ones. Mean hospital stay for STAGE 1 procedures was 3.8 days; all other STAGES were performed as ambulatory surgery. No flap necrosis was observed and only 1 patient required a surgical revision for bleeding. Dorsal seroma occurred in 45.2% of cases. Conclusions: The multistage LD flap with implant is a useful and safe tool within the reconstructive armamentarium for post-mastectomy defects. It combines multiple simple procedures and does not require specific skills and surgical training (level of evidence 4).

Versatility of the Pedicled Thoracodorsal Artery Perforator Flap (TDAP) Anatomic Basis and Clinical Application in breast reconstruction

Background: the thoracodorsal artery perforator (TDAP) flap is relatively new member of perforator flap family in reconstructive surgery. TDAP flap used as pedicled flap in breast reconstruction. Advantages of the TDAP flap include homogenous flap thickness, minimal donor-site morbidity, and constant vascular anatomy with a long pedicle. Aim: to study versatility of the pedicled thoracodorsal artery perforator flap and evaluate its role in breast reconstruction. Methods: This prospective cohort study was conducted in Zagazig university Hospitals during the period from January 2018 till January 2019 on 20 patients with breast cancer who have been subjected to breast surgery and immediate breast reconstruction. Results: the mean time taken for flap elevation was 266 ± 18 minutes, flap elevated with single perforator in 85 % of the cases and with double perforators in the remaining 15%. The mean skin paddle diameters were 15.6 ± 3.3 cm in length and 7.2 ± 2.1 cm width. The donor side was closed by primary closure in 90% while two cases (10%) needed grafting for closure. Objective and subjective assessment for the post procedure satisfaction showed that around 90% of the population was satisfied by the result. Conclusion: The TDAP has several advantages that make it a work horse for many soft tissue reconstructions in appropriately selected patients. The drawback of the TDAP can be manipulated by some technical modification.

Defining the Role of Free Flaps in Partial Breast Reconstruction.

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

Fat Grafting: Its Role in Breast Reconstruction

Purpose of Review Fat grafting is a useful adjunct to both implant and autologous reconstruction, in both immediate and delayed settings. More recently it has also been used as a standalone method of breast reconstruction. Herein we discuss the recent literature and experience with autologous fat grafting for breast reconstruction.

Latissimus Dorsi Mini-Flap as a Volume Replacement Technique after Partial Mastectomy for Breast Cancer in the Upper and Central Breast Quadrants: A Single Center Experience

Background: The latissimus dorsi (LD) muscle flap plays an essential role in breast reconstruction after partial mastectomy for cancer because of its stability and versatility. We evaluated both oncologic and aesthetic outcomes in addition to the related complications of this flap as an adjunct to breast conserving surgery in the management of breast cancer patients. Methods: All patients underwent a one-stage procedure with immediate reconstruction through two-steps operation; wider local excision utilizing oncoplastic principles and mini flap harvest & volume replacement. Results: The study included 34 cases with early breast cancer; 30 patients had partial breast resection and defect refilling by LD mini-flap, three patients underwent mastectomy and one patient underwent extended LDF. The mean defect volume was (212.63 cm3 ± 59.57) cm3, while the mean flap volume was (218.27 cm3 ± 53.64 cm3). Patient self-evaluation of the cosmetic outcome was excellent in 20%, good in 60% and satisfactory in 20% of patients. Panel evaluation according to Harvard scale showed excellent in 36.7%, good in 36.7%, fair in 26.7% of patients. The median hospital stay was 4 days. The postoperative complications included wound gap in 4 patients (13.3%), postoperative donor site seroma in 16 patients (53.3%). No flap loss or necrosis, no affection on arm or shoulder mobility occurred. Lastly, no tumor recurrence till now. Conclusion: Latissimus dorsi mini-flap can achieve adequate cosmetic and oncologic outcomes with a low incidence of complications in patients with early stage (I/II) breast cancer and small to medium sized breasts.

Bilateral Mastectomy versus Breast-Conserving Surgery for Early-Stage Breast Cancer: The Role of Breast Reconstruction

Bilateral Mastectomy versus Breast-Conserving Surgery for Early-Stage Breast Cancer: The Role of Breast Reconstruction

Prophylactic venous cannulation of the pedicled TRAM flap in breast reconstruction

Since its inception nearly 30 years ago, the pedicled TRAM flap has remained a reliable technique of breast reconstruction. However, venous congestion of the flap in the early postoperative period is well recognised and may lead to partial or total flap loss. This study describes a simple technique routinely employed by the senior author over 15 years involving intraoperative cannulation of the deep inferior epigastric vein and externalisation into an ileostomy bag, in order to facilitate drainage and reduce the likelihood of venous congestion. In addition to its role in breast reconstruction, this technique may be a useful adjunct to any form of free or pedicled tissue transfer.

The angel flap for nipple reconstruction

Creation of an aesthetically pleasing nipple plays a significant role in breast reconstruction as a determining factor in patient satisfaction. The goals for nipple reconstruction include minimal donor site morbidity and appropriate, long-lasting projection. Currently, the most popular techniques used are associated with a significant loss of projection postoperatively. Accordingly, the authors introduce the angel flap, which is designed to achieve nipple projection with lasting results. The lateral edges of the flap and the area surrounding the top of the nipple are de-epithelialized and the flaps are wrapped to create a nipple mound composed primarily of dermis. Decreasing the amount of fat within core of the nipple and enhancing dermal content promotes long-lasting projection. Furthermore, the incision pattern fits within a desired areolar size, preventing unnecessary superfluous extension of the incisions. Thus, the technique described herein achieves the goals of nipple reconstruction, including adequate and long-lasting projection, without extension of the lateral limb scars.

Predicting results of DIEP flap reconstruction: The flap viability index

Worldwide experience with the DIEP flap has established its pre-eminent role in breast reconstruction after mastectomy. CT angiographic vascular imaging has enhanced the planning of reconstruction, allowing mapping of perforator patterns to increase the predictability of surgery. This study extends the role of perforator mapping, using measurement of perforator lumen diameters and flap weights to calculate an index that reliably predicts the amount of tissue which will survive. We call this the Flap Viability Index.

Does Veritas® play a role in breast reconstruction? a case report

To reduce operative times and surgical complications in implant-based breast reconstruction, many authors advocate the use of exogenous material (modified xenograft) to support tissue regeneration. In this article, a case is presented in which a bovine collagen patch (Veritas® Collagen Matrix; Synovis Surgical Innovations, St Paul, MN) was used in the immediate breast reconstruction with an implant. The good results obtained in this case confirm Veritas® as a viable alternative to AlloDerm® Regenerative Tissue Matrix (LifeCell Corporation, Branchburg, NJ) and further support its ability to sustain and stimulate recovery of the surrounding tissues.

A Prospective Randomized Trial of the Efficacy of Marginal Quilting Sutures and Fibrin Sealant in Reducing the Incidence of Seromas in the Extended Latissimus Dorsi Donor Site

The extended latissimus dorsi is a workhorse flap and plays an important role in breast reconstruction. Unfortunately, seromas at the flap donor site are a frustrating problem complicating many procedures. The purpose of this study was to evaluate the efficacy of a combination of fibrin sealant (Quixil; Johnson & Johnson, Langhorne, Pa.) and limited quilting sutures at reducing seroma formation. This was a prospective, double-blinded, clinical trial under a single surgeon. Twenty-six patients were enrolled in the study, and all were followed up for a period of 6 months. The patients were randomized to receive either quilting sutures only (group 1) or a combination of Quixil sealant and marginal quilting sutures (group 2). The incidence of seroma was 23.1 percent in group 1 and 7.7 percent in group 2 (odds ratio, 0.28; relative risk, 0.33). The mean total volume aspirated was significantly higher in group 1 (196.7 ml compared with 30 ml, p = 0.01). The average number of aspirations was 2.7 in group 1 compared with one in group 2. There was a significant reduction in inpatient stay for group 2 by 2 days (p = 0.01). Operative time was shortened by an average of 25 minutes. The combination of fibrin sealant and marginal quilting sutures significantly reduces total drainage, hospital stay, and seroma formation. In the authors' opinion, the benefits of seroma prevention outweigh the extra costs associated with this product. The potential, albeit small, risk of virus transmission and allergic reaction, however, needs to be taken into consideration, as with any blood transfusion product.

Preservation of the lateral thoracic vein in axillary dissection – Its role in breast reconstruction using the DIEP flap

Axillary clearance is still an integral part of the surgical treatment of breast cancer. Despite evolution in surgical technique, some accessory axillary structures such as the lateral throacic vein, may be sacrificied in order to achieve and adequate oncological clearance. Recent years have seen rapid advances in onco-plastic surgery and its involvement in breast cancer patients. As many onco-plastic procedures necessitate an adequate blood supply, structures which were thought to be expendable such as the lateral thoracic vein, are now viewed as useful vessels for success. We describe the use of the lateral thoracic vein as a salvage option in the Deep Inferior Epigastric Perforator (DIEP) flap and encourage surgeons to preserve this vessels when appropriate and safe to do so.

Der Stellenwert der s-GAP-Lappenplastik in der Brustrekonstruktion – Ein Erfahrungsbericht

In breast reconstruction with autologous tissue the DIEP flap has become the gold standard in recent years. The superior gluteal artery perforator (s-GAP) flap is an alternative harvested from the buttock. We present our experience with the s-GAP flap and discuss its role in breast reconstruction. All s-GAP flaps performed for breast reconstruction in the Department of Plastic and Hand Surgery, Behandlungszentrum Vogtareuth from June 2002 until February 2007 were retrospectively analysed. Out of 59 flaps 4 flaps failed, the success rate was 94 %. Partial or fat necrosis occurred in 2 cases. The s-GAP flap served as a safe reconstructive alternative to the DIEP flap. Advantages of the s-GAP flap are reliable perforators, the safe vascular supply and the firm fat structure which facilitates the breast reconstruction. The donor site morbidity is minimal, the gluteal muscles stay intact and the scar is easy to hide in the underwear. Disadvantages are a demanding preparation with a prolonged operating time compared to the DIEP flap. The s-GAP flap is a reliable and safe option for autologeous breast reconstruction. It is the method of choice for staged bilateral breast reconstruction or if the DIEP flap is not available, particularly in the thin patient.

The Infected Breast Prosthesis after Mastectomy Reconstruction: Successful Salvage of Nine Implants in Eight Consecutive Patients

The use of tissue expanders and permanent implants has an established role in breast reconstruction after mastectomy. Periprosthetic infection, however, represents a known complication. The most conservative approach to severe or recalcitrant prosthetic infection remains removal of the device. However, removal makes subsequent reinsertion and reexpansion more difficult, with less predictable cosmetic results. The authors believe that timely surgical intervention directed toward salvage of infected breast prostheses can be successful, without demonstrating increased capsular contracture. The authors present nine consecutive cases of infected breast implants (nine implants in eight patients). All patients had previously undergone mastectomy for malignancy and immediate expander/implant reconstruction. Six patients had localized infections that failed to respond to oral antibiotics and two women initially presented with systemic infection. All patients were placed on intravenous antibiotics followed by drainage of fluid, manual debridement and curettage of the infected pocket, device exchange, and postoperative antibiotics. All nine infected breast prostheses responded to this approach and currently remain intact and without recurrent infection. Mean time to follow-up for all patients was 14.6 months (range, 10 to 25 months). In patients with severely infected breast prostheses, timely operative intervention can salvage the previously "unsalvageable" implant; in addition, the surgically replaced implants did not develop severe capsular contractures. Surgical salvage of severely infected breast prostheses after mastectomy is a treatment option that should be considered when dealing with severe or recalcitrant infection in a suitable patient.

After mastectomy: the nurse's counselling role in breast reconstruction

After mastectomy: the nurse's counselling role in breast reconstruction