Surgical and Patient-Reported Outcomes After Mastectomy and Implant-Based Prepectoral Reconstruction Using TIGR® Synthetic Mesh.

Background Single-stage direct-to-implant (DTI) breast reconstruction after mastectomy has gained popularity over the last decade, thanks to the wide use of biological matrices and synthetic meshes. Despite their high cost, there is no evidence of superior outcome from the biological matrices compared to the synthetic meshes. In this study, we aimed to evaluate our experience with TIGR, a synthetic, long-term absorbable mesh, in mastectomy and immediate breast reconstruction (MIBR) with a focus on patient-reported outcomes (PROMs). Methods This was a single-trust prospective quality improvement study conducted between 2017 and 2019. The main objectives were complication rates including infection, implant loss, and other surgical complications in patients undergoing TIGR mesh-assisted MIBR in the prepectoral plane for either cancer or risk reduction. PROMs were measured using the validated European Organisation for Research and Treatment of Cancer (EORTC) breast questionnaire module. Clinical evaluations were conducted at one week, three weeks, and 12 months postoperatively. All patients provided written consent, and the audit was registered with the Quality Improvement Department of the organization. Results One hundred and twelve meshes were used in 93 patients with a mean age of 49 (24-75) years and a body mass index (BMI) of 23.4 (19.1-29.6). During the follow-up period, complications occurred in 26 patients (28%), including infection in four (4.3%), complete skin flap necrosis in one (1%), partial flap necrosis in three (3.2%), and implant loss in four (4.3%) patients. PROM data from 41 individuals indicated a moderate overall quality of life (82.7%), with high functional domain scores with relatively lower emotional functioning scores. Symptom domains generally scored poorly except for body image and sexual functioning. Conclusion Mastectomy and immediate prepectoral breast reconstruction using TIGR mesh is safe with low major complication rates. It is associated with high functional and quality of life scores but low scores in symptom domains which could be multifactorial. However, limitations due to study type and follow-up duration suggest caution in generalizing findings.

Latissimus Dorsi Flap Revisited: Coverage of Large Chest Wall Defects Following Mastectomy for Locally Advanced Breast Carcinoma and Angiosarcoma.

BACKGROUND:  The latissimus dorsi myocutaneous flap (LDMF) remains a significant tool in the armamentarium of the oncoplastic breast surgeon. Despite declining popularity for reconstruction, owing to the increasing use of implants and free flaps, it still has an important role in certain salvage situations and as a flap to cover large defects. We report our experience with the use of LDMF for immediate coverage of large mastectomy defects when options are limited. METHODS:  Retrospective series of prospectively collected patient records. Patient and tumour characteristics, length of stay, and post-operative and oncologic outcomes are reported. Patients with angiosarcoma were discussed at tertiary sarcoma centres as per national guidelines. Operations were carried out by oncoplastic breast surgeons. The case series was approved by the institutional information governance department in line with institutional requirements for patient data sharing. All patients provided written consent for photography. Descriptive statistics were used to report findings. Median (IQR) was used for continuous variables. RESULTS:  Six women were included, with a median age of 62.5 years, from December 2019 to October 2022. Follow-up ranged from 15 to 49 months. Median tumour size was 72.5 (16.25) mm. Four patients had locally advanced breast carcinoma (LABC), and two had breast angiosarcoma. The donor site and chest wall defects were closed primarily in all cases. Median length of stay was three nights. All mastectomy wounds healed without issues and any delay to their adjuvant treatment. One patient had a minor latissimus dorsi (LD) donor site wound breakdown managed conservatively. Three patients had adjuvant radiotherapy after surgery. Four patients, one after high-grade angiosarcoma and three after aggressive breast carcinoma, had a locoregional recurrence or distant metastases and succumbed within 20 months of surgery. CONCLUSION:  The LDMF can be a reliable option for the primary closure of large post-mastectomy wounds. Its use can lead to timely wound healing, allowing patients to undergo adjuvant treatment without delay. However, the overall oncologic outcomes in patients with LABC and angiosarcoma are poor due to the underlying aggressive tumour biology. Long-term outcomes are to be interpreted with caution due to the small number of patients with diverse pathologic features.

Patient Satisfaction and Quality of Recovery With Ambulatory Serratus Plane Catheter After Mastectomy: A Service Evaluation.

Background Acute moderate to severe pain after mastectomy is common and impedes patient recovery. Ambulatory serratus plane catheter with infusion pump (ASPIP) is a novel method to provide continuous delivery of local anaesthetic agents in the immediate postoperative period for extended analgesia, early mobility, and return to function after mastectomy. The aim of this project was to evaluate the introduction of ASPIP service and its effect on postoperative pain, opioid use, hospital stay, and recovery. Methods This was a service evaluation project. Eligible mastectomy patients were included over six months. All patients provided consent for intraoperative catheter insertion and ASPIP use. The numerical rating scale (NRS) and the Quality of Recovery-15 (QoR-15) tool were used to assess postoperative pain and the quality of recovery, respectively. Overall satisfaction, sleep quality, and recommendations for the catheter were collected. Day-case rates of mastectomy with or without reconstruction were also measured. Data were presented using descriptive statistics. Mean (SD) and median (quartiles) were used for the continuous variables with percentages to report rates. Approval of the institution's Audit & Quality Improvement Department was obtained. Results Thirty-two consecutive mastectomy patients were included over six months. The mean age was 60 years and the mean BMI was 25.8. Mean pain NRS (10 maximum) at rest and on movement were 1.88 vs. 2.56, 2.03 vs. 2.84, and 1.85 vs. 2.3 out of 10 on postoperative day (POD) one, two, and three, respectively. Six patients required opioids on POD one, four patients on POD two, and none on the third day. Sleep disturbance was observed in three, five, and three patients in the first three days, respectively. The mean overall satisfaction was 9.25/10 (SD: 1.18). All patients recommended ASPIP to other patients. QoR-15 scores reported as median (quartiles) were 143 (136, 147) preoperatively and 135 (126.5, 143) postoperatively, with a median difference of -3 (95% CI: -6 to 0). The day-case rate for mastectomy +/- reconstruction was 66% and 39%, respectively. There were no major complications from the catheter with minor issues in four patients. Conclusion The ASPIP is an effective and safe method of managing postoperative pain after mastectomy with positive patient experience and reduced opioid requirement. As part of an enhanced recovery pathway, it can also increase mastectomy day-case rates, including immediate implant reconstruction.

Non-invasive real-time characterization of hollow-core photonic crystal fibers using whispering gallery mode spectroscopy.

Single-ring hollow-core photonic crystal fibers, consisting of a ring of one or two thin-walled glass capillaries surrounding a central hollow core, hold great promise for use in optical communications and beam delivery, and are already being successfully exploited for extreme pulse compression and efficient wavelength conversion in gases. However, achieving low loss over long (km) lengths requires highly accurate maintenance of the microstructure-a major fabrication challenge. In certain applications, for example adiabatic mode transformers, it is advantageous to taper the fibers, but no technique exists for measuring the delicate and complex microstructure without first cleaving the taper at several positions along its length. In this Letter, we present a simple non-destructive optical method for measuring the diameter of individual capillaries. Based on recording the spectrum scattered from whispering gallery modes excited in the capillary walls, the technique is highly robust, allowing real-time measurement of fiber structure during the draw with sub-micron accuracy.

Generation of broadband circularly polarized supercontinuum light in twisted photonic crystal fibers.

We compare the properties of the broadband supercontinuum (SC) generated in twisted and untwisted solid-core photonic crystal fibers when pumped by circularly polarized 40 picosecond laser pulses at 1064 nm. In the helically twisted fiber, fabricated by spinning the preform during the draw, the SC is robustly circularly polarized across its entire spectrum whereas, in the straight fiber, axial fluctuations in linear birefringence and polarization-dependent nonlinear effects cause the polarization state to vary randomly with the wavelength. Theoretical modelling confirms the experimental results. Helically twisted photonic crystal fibers permit the generation of pure circularly polarized SC light with excellent polarization stability against fluctuations in input power and environmental perturbations.

Pump-probe multi-species CARS in a hollow-core PCF with a 20 ppm detection limit under ambient conditions.

We report coherent anti-Stokes Raman spectroscopy (CARS) in a gas-filled single-ring hollow-core photonic crystal fiber (SR-PCF) using a pump-probe configuration. The long collinear path length offered by an SR-PCF strongly enhances the efficiency of the Raman interactions. Pressure tuning the zero-dispersion wavelength (ZDW) of the SR-PCF allows the Raman coherence prepared by seeded pumping at 515 nm to be used in the visible for phase-matched generation of an anti-Stokes signal from a probe in the ultraviolet. The unique dispersion profile in the vicinity of the ZDW enables simultaneous phase matching of all known Raman transitions. We demonstrate that simultaneous multi-species CARS with a detection limit of 20 ppm is possible with only 20 kW of peak pump power delivered by a single laser source.

Broadband robustly single-mode hollow-core PCF by resonant filtering of higher-order modes.

We report a hollow-core photonic crystal fiber that is engineered so as to strongly suppress higher-order modes, i.e., to provide robust LP01 single-mode guidance in all the wavelength ranges where the fiber guides with low loss. Encircling the core is a single ring of nontouching glass elements whose modes are tailored to ensure resonant phase-matched coupling to higher-order core modes. We show that the resulting modal filtering effect depends on only one dimensionless shape parameter, akin to the well-known d/Λ parameter for endlessly single-mode solid-core PCF. Fabricated fibers show higher-order mode losses some ∼100 higher than for the LP01 mode, with LP01 losses <0.2 dB/m in the near-infrared and a spectral flatness ∼1 dB over a >110 THz bandwidth.

High-resolution wavefront shaping with a photonic crystal fiber for multimode fiber imaging.

We demonstrate that a high-numerical-aperture photonic crystal fiber allows lensless focusing at an unparalleled resolution by complex wavefront shaping. This paves the way toward high-resolution imaging exceeding the capabilities of imaging with multi-core single-mode optical fibers. We analyze the beam waist and power in the focal spot on the fiber output using different types of fibers and different wavefront shaping approaches. We show that the complex wavefront shaping technique, together with a properly designed multimode photonic crystal fiber, enables us to create a tightly focused spot on the desired position on the fiber output facet with a subwavelength beam waist.