Differences in complications and asymmetry in patients who did not receive a balancing procedure in two-stage and direct-to-implant breast reconstruction

Background@#Implant-based immediate breast reconstruction surgery with nipple-sparing mastectomy has recently been favored by patients. However, in patients who do not wish to undergo balancing procedures, it is difficult to select the appropriate implant size, making it challenging to achieve a symmetrical breast shape. Therefore, this study investigated the differences in breast asymmetry and other complications in patients who underwent a two-stage procedure or direct-to-implant (DTI) breast reconstruction to determine whether the two-stage procedure can produce more favorable outcomes. @*Methods@#The participants of this study were patients who underwent immediate two-stage breast reconstruction or DTI breast reconstruction from May 2018 to April 2022, did not receive postoperative radiotherapy, and did not wish to undergo any balancing procedures. An acellular dermal matrix was used for breast reconstruction in all patients, and a single reconstructive surgeon performed all the operations. Statistical significance was set at P<0.05. @*Results@#No significant differences in complications were found between the patients who underwent DTI breast reconstruction and those who underwent two-stage breast reconstruction. In the two-stage breast reconstruction group, breast volume asymmetry was observed in 18.4% (seven patients), which was significantly lower than the percentage of 44.7% (17 patients) observed in the DTI group. @*Conclusions@#Breast asymmetry was observed in a significant proportion of the patients in both groups. However, because breast volume asymmetry was more common in the DTI group than in the two-stage breast reconstruction group, two-stage breast reconstruction may be a favorable method for patients who do not wish to undergo balancing procedures.

Reconstruction of temporal hollowing deformities using silicone implants made using a toy-clay model: a report of three cases

Severe temporal hollowing deformities can occur in patients who undergo craniectomy after intracranial hemorrhage. Reconstruction surgery for cosmetic purposes using silicone implants in patients with temporal hollowing deformities after craniectomy is advantageous because the procedure is simple and rapid, with a short recovery time, resulting in lower overall treatment costs. Of paramount importance, this option yields highly satisfactory results for patients. The authors present three cases of simple and fast surgery using silicone implants where highly satisfactory outcomes were obtained.

Frequency of reoperation in patients who underwent breast reconstruction using Allergan implants after an interview about breast implant-associated anaplastic large cell lymphoma

Background@#In recent years, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has emerged as an important concern. At our institution, patients who received breast reconstruction using Allergan implants were informed individually about BIA-ALCL. The present study analyzed correlations between patients’ level of satisfaction with their breast shape and whether they chose to undergo reoperation (implant removal or replacement). @*Methods@#Breast reconstruction with Allergan implants was performed between December 2014 and April 2018. In total, 107 patients were interviewed, excluding those who had died, were unreachable, or had already undergone reoperation. The mean follow-up period was 53 months (range, 26–73 months). @*Results@#After the interviews, 68 patients postponed reoperation, 29 had their implant replaced, and 10 had their implant removed. Nearly one-fifth (18.9%) of patients who were satisfied with their breast shape (13 out of 69) underwent reoperation due to anxiety over ALCL. Meanwhile, 68.4% of patients who were not satisfied due to capsular contracture or scar contracture (26 out of 38) underwent reoperation. Sixteen of the 30 patients who received postoperative radiotherapy (53.3%) chose to undergo reoperation. @*Conclusions@#Satisfaction with the cosmetic outcomes of implant placement played a meaningful role in patients’ decisions to undergo reoperation. This tendency may be linked to postoperative radiotherapy, which is a major contributor to complications such as contracture. Nonetheless, a substantial proportion of patients who were satisfied with the outcomes chose to undergo reoperation due to concerns regarding ALCL.

Volumetric change of the latissimus dorsi muscle after postoperative chemotherapy and radiotherapy in immediate breast reconstruction with an extended latissimus dorsi musculocutaneous flap: final results from serial studies

Background@#Breast reconstruction using an extended latissimus dorsi (eLD) flap can supplement more volume than reconstruction using various local flaps after partial mastectomy, and it is a valuable surgical method since the reconstruction area is not limited. However, when performing reconstruction, the surgeon should consider latissimus dorsi (LD) volume reduction due to postoperative chemotherapy (POCTx) and postoperative radiotherapy (PORTx). To evaluate the effect of POCTx and PORTx on LD volume reduction, the effects of each therapy—both separately and jointly—need to be demonstrated. The present study quantified LD volume reduction in patients who underwent POCTx and PORTx after receiving breast-conserving surgery (BCS) with an eLD flap. @*Methods@#This study included 48 patients who received immediate breast reconstruction using an eLD flap from January 2013 to March 2017, had chest computed tomography (CT) 7–10 days after surgery and 10–14 months after radiotherapy completion, and were observed for more than 3 years postoperatively. One surgeon performed the breast reconstruction procedures, and measurements of breast volume were obtained from axial CT views, using a picture archiving and communication system. A P-value <0.05 was the threshold for statistical significance. @*Results@#The average volume reduction of LD at 10–14 months after completing POCTx and PORTx was 64.5% (range, 42.8%–81.4%) in comparison to the volume measured 7–10 days after surgery. This change was statistically significant (P<0.05). @*Conclusions@#Based on the findings of this study, when harvesting an eLD flap, surgeons should anticipate an average LD volume reduction of 64.5% if chemotherapy and radiotherapy are scheduled after BCS with an eLD flap.

Long-term results of unilateral cleft lip repair with multiple infantile hemangiomas including one involving the cleft side of the upper lip

Infantile hemangiomas have a growth phase and an involution phase. For this reason, serial observation has generally been recommended as the treatment for uncomplicated infantile hemangiomas. Recently, however, individualized approaches have been emphasized. Although cleft lip and infantile hemangioma are common congenital diseases, infantile hemangiomas on the cleft side (i.e., in the operative field of the cleft lip) are extremely rare, and no clear guidelines have been established for their treatment. We experienced a case in which a patient with a cleft lip had an infantile hemangioma on the cleft side. In accordance with general treatment guidelines, cleft repair was performed 3 months after birth. The Millard rotation-advancement technique, which involves the use of a lower small triangular flap, was used for the repair. No intraoperative complications, such as massive bleeding, or postoperative complications were noted. The patient has received regular follow-up for the past 18 years, and other than a reddish scar on the lower lip, he currently has no related issues. Therefore, this case demonstrates that cleft lip repair performed according to cleft lip treatment guidelines produces good outcomes, even in cases involving a hemangioma on the cleft side.

Adequacy of sentinel lymph node biopsy in malignant melanoma of the trunk and extremities: Clinical observations regarding prognosis

Background@#Methods for identifying local lymph node metastasis in malignant melanoma include sentinel lymph node biopsy (SLNB) and lymph node dissection (LND). In particular, SLNB has been widely used in recent years. This study aimed to retrospectively confirm the adequacy of the current indication criteria for SLNB by applying those criteria to a mixed group of patients who previously received SLNB and LND. @*Methods@#This study included 77 patients with malignant melanoma of the extremities and trunk who were monitored for >24 months. The patients were classified according to whether the current indication criteria for SLNB were applicable. The sentinel lymph nodes were evaluated for each group. Patients for whom the indication criteria for SLNB and LND were applicable were analyzed according to whether SLNB or LND was performed. Finally, the outpatient records of these patients were reviewed to evaluate recurrence, metastasis, and prognosis. @*Results@#Of the 77 patients, SLNB was indicated according to the current criteria in 60 cases. Among the 60 patients for whom SLNB was indicated, 35 survived the follow-up period disease-free, 21 died during the follow-up period, and four experienced metastasis. The 17 patients for whom SLNB was not indicated had no recurrence or metastasis. @*Conclusions@#Patients for whom SLNB was not indicated had no recurrence or metastasis. In cases where SLNB is indicated, the possibility of metastasis and recurrence may be high even if SLNB is negative or LND is performed, so more aggressive treatment and careful follow-up are crucial.

A novel technique for placing titanium mesh with porous polyethylene via the endoscopic transnasal approach into the orbit for medial orbital wall fractures

BACKGROUND: The endoscopic transnasal approach is widely used for reconstructing the medial orbital wall by filling it with a silicone sheet or Merocel, but this technique has the disadvantage of retaining the packing for a long time. To overcome this drawback, a method of positioning an absorbable plate in the orbit has been introduced, but there is a risk of defect recurrence after the plate is absorbed. Here, the authors report the results of a novel surgical technique of placing a nonabsorbable titanium mesh with porous polyethylene into the orbit through the endoscopic transnasal approach. METHODS: Fourteen patients underwent surgery using the endoscopic transnasal approach. Preoperative computed tomography (CT) was used to calculate the size of the bone defect due to the fracture, and the titanium mesh was designed to be shorter than the anteroposterior length of the defect and longer than its height. The titanium mesh was inserted into the orbit under an endoscopic view. The authors then confirmed that the titanium mesh supported the orbital contents by pressing the eyeball and finished the operation. Immediately after surgery, CT results were evaluated. RESULTS: Postoperative CT scans confirmed that the titanium mesh was well-inserted and in the correct position. All patients were discharged without any complications. CONCLUSIONS: We obtained satisfactory results by inserting a titanium mesh with porous polyethylene into the orbit via the transnasal approach endoscopically.

A case of malignant melanoma after repeated recurrent dysplastic nevi

Dysplastic nevus is common and affects about 10% of the northern European-descendent population. Studies over the past several decades have identified dysplastic nevi as a risk factor for malignant melanoma. Furthermore, in rare cases, they confirmed that dysplastic nevi have progressed to melanoma. Cases in which dysplastic nevi progressed to malignant melanoma in multiple studies are not uncommon. A 35-year-old woman presented with the major symptom of multiple itchy brown nodules (2.0 cm× 1.3 cm) in the left cheek that had first appeared 20 years earlier. Complete excision was performed at the first visit; subsequent biopsy confirmed that they were dysplastic nevi. They recurred three times over 3 years at the same site, all of which were histologically diagnosed as dysplastic nevi. Five years after the final excision, a brownish nodule developed in the left cheek, with others at the left temporal region, right retroauricular region, and left shoulder at the same time. These lesions were histologically diagnosed as malignant melanoma. We experienced a case of malignant melanoma that occurred at the same site after three recurrences of dysplastic nevi. Although rare, the possibility of malignant melanoma should be considered in follow-ups in cases involving repeatedly recurrent dysplastic nevi.