International Expert Panel Consensus on Fat Grafting of the Breast.

BACKGROUND: Autologous fat grafting has broad applications in reconstructive and aesthetic breast surgery as a natural filler and for its regenerative purposes. Despite the widespread use of fat grafting, there remains no shared consensus on what constitutes the optimal fat grafting technique and its oncological safety. For this reason, the authors of this study have organized a Survey and an International Consensus Conference that was held at the Aesthetic Breast Meeting in Milan (December 15, 2018). METHODS: All studies on fat grafting, both for breast aesthetic and reconstructive purposes, were electronically screened. The literature review led to 17 "key questions" that were used for the Survey. The authors prepared a set of 10 "key statements" that have been discussed in a dedicated face-to-face session during the meeting. RESULTS: The 10 key statements addressed all the most debated topics on fat grafting of the breast. Levels of evidence for the key statements ranged from III to IV with 2 statements (20%) supported by a level of evidence III and 6 statements (60%) by level of evidence IV. Overall consensus was reached for 2 statements (20%) with >75% agreement reached for 7 statements. CONCLUSIONS: The survey demonstrated a diversity of opinion and attitude among the panelists with regard to technique. Clear recommendations for evidence-based clinical practice for fat grafting use both in aesthetic and reconstructive breast surgery could not be defined due to the scarcity of level 1 or 2 studies.

The Use of TIGR Matrix in Breast Aesthetic and Reconstructive Surgery: Is a Resorbable Synthetic Mesh a Viable Alternative to Acellular Dermal Matrices?

The authors document their experience in the use of synthetic 100% bioresorbable surgical mesh (TIGR Matrix, Novus Scientific, Uppsala, Sweden) in breast reconstruction as well as in breast aesthetic surgery. They performed a retrospective review on patients who underwent implant-based breast reconstruction as well as patients who underwent breast reduction mammoplasty procedures with the use of TIGR Matrix Surgical Mesh. When compared with other synthetic but nonresorbable meshes, it appears to show a potentially lower seroma and infection rates, but most importantly, a lower rate of revisional and mesh explantation surgeries.

Polyurethane Implants in 2-Stage Breast Reconstruction: 9-Year Clinical Experience.

BACKGROUND: Capsular contracture (CC) is a major complication of breast surgery with smooth and textured implants. Polyurethane (PU) foam-coated breast implants were developed to decrease the incidence of CC. OBJECTIVES: The authors determined the incidence of CC following 2-stage breast reconstruction using PU foam-covered implants, with and without radiation therapy. METHODS: The records of 92 patients who received 115 PU implants were retrospectively reviewed. The rates of CC over time were compared for irradiated and nonirradiated groups with a Kaplan-Meier analysis and log-rank test. CC rates also were analyzed with respect to age. RESULTS: The median follow-up time for patients was 103.3 months. Nine patients experienced unilateral Baker grade III or IV fibrous CC, including 6 patients from the irradiated group and 3 patients from the nonirradiated group. The overall cumulative incidence of CC at 9 years was 8.1%. In the irradiated and nonirradiated groups, the 9-year cumulative incidence was 10.7% and 5.5%, respectively. CC occurred within 3 years in the irradiated group and within 7 years in the nonirradiated group. The incidence of CC appeared to be higher among younger patients. CONCLUSIONS: Radiation therapy increases the risk of high-grade CC with textured or smooth implants. PU implants are associated with a much lower cumulative incidence of CC following 2-stage breast reconstruction, even when radiotherapy is performed. LEVEL OF EVIDENCE 3.

The Modern Polyurethane-Coated Implant in Breast Augmentation: Long-Term Clinical Experience.

BACKGROUND: First-generation polyurethane foam-coated breast implants were associated with a low risk of capsular contracture (CC), but the risk of CC with modern polyurethane-coated silicone implants has not been established. OBJECTIVES: The authors sought to determine the long-term rates of CC after primary breast augmentation with Microthane, a polyurethane-coated silicone gel implant. METHODS: A total of 131 patients (255 breasts) were evaluated in a retrospective study. Data were compiled from postoperative follow-up sessions at 2 weeks; 1, 3, 6, and 12 months; and annually thereafter. Rates of various complications, including CC, were determined. RESULTS: CC developed in 3 of the 255 implanted breasts (1.2%; Baker grade III or IV), and postoperative hematoma occurred in 2 implanted breasts (0.8%). Spontaneous CC that was not associated with other complications was observed in 1 implanted breast (0.4%). All instances of CC occurred before the 31st postoperative month. CONCLUSIONS: For patients who undergo primary breast augmentation with modern polyurethane-coated implants, the long-term risk of CC is low. LEVEL OF EVIDENCE: 3 Therapeutic.

Reconstruçäo mamária imediata e critérios oncológicos: nossas atuais orientaçoës / Immediated breast reconstruction and oncologic criteria: our current definition

Os autores, através de uma revisäo da literatura, propöem-se a verificar os parâmetros oncológicos para a definiçäo dos casos "candidatáveis" a yna reconstruçäo imediata após mastectomia de Patey. Em relaçäo ao problema das recidivas locais, pelos resultados observados, evidencia-se que a hipótese de uma prótese sob o músculo grande peitoral mascarar essas recidivas näo é estatisticamente quantificável. A reconstrçäo näo interfere também com o carcinoma mamário, seja em termos de sobrevida ou de intervalo livre da doença. Consideramos que o tempo médio de aparecimento da recidiva, também nos casos N+, é de cerca de dois anos; achamos que estas pacientes com linfonodos positivos, se motivadas e candidatas a uma mastectomia modificada, näo devem ser excluídas de um programa reconstrutivo imediato. A baixa morbidade, os custos limitados, as vantagens psicológicas e o rápido início das terapias complementares fazem da reconstruçäo imediata um recurso fundamental. Conseqüentemente, há uma melhora da qualidade de vida também para os casos com limitadas perspectivas de sobrevida

Cranioplastia frontoparietal: aplicaçöes da resina acrílica termicamente ativada / Fronto-parietal cranioplasty: use of acrylic resin activated by heat

Os autores relatam sua experiência de 12 casos de cranioplastia frontoparietal com utilizaçäo de resina acrílica fisicamente ativada. Pela análise retrospectiva dos resultados, observa-se a ausência de infecçöes pós-operatórias, a estabilidade a curto e médio prazo da prótese e o aspecto cosmético da área reconstruida. Säo discutidas as vantagens técnicas do produto por nós utilizado, em relaçäo aos outros materiais aloplásticos