Delayed two-stage breast reconstruction: The impact of radiotherapy.

BACKGROUND: Despite a trend towards immediate breast reconstruction in recent years, delayed breast reconstruction using a tissue expander remains a common procedure. Radiotherapy after mastectomy but before reconstruction is a risk factor, although studies examining the effect of this are limited. The aim of this retrospective cohort study is to evaluate the impact of pre-reconstructive radiotherapy (PRT) in patients undergoing breast reconstruction using an expander/implant. MATERIALS AND METHODS: Two hundred twenty-three consecutive patients underwent unilateral mastectomy followed by expander-based reconstruction over a 10-year period (2004-2013). Fifty patients (22%) received radiotherapy before reconstruction (PRT group), and 173 patients (78%) did not (non-PRT group). Descriptive patient data as well as data regarding the operations, hospitalisation and complications were collected. Statistical analyses such as logistic regression, Fisher exact test and multivariate analysis were performed using R-statistics. RESULTS: PRT was a significant predictor of loss of reconstruction, and when adjusted for smoking and body mass index (BMI), it showed an odds ratio (OR) of 17.8 [95% confidence interval (CI): 5.7-70.6; p<0.01] for loss of reconstruction, with 15 (30%) in the PRT group and 7 (4%) in the non-PRT group. We found no difference in short-term reoperations or infections at either stage of reconstruction. CONCLUSION: In patients undergoing delayed breast reconstruction using an expander/implant, radiotherapy is a significant risk factor for loss of reconstruction. It should be considered a relative contraindication for this reconstructive modality, and careful selection and advisement of the patient about the risks of complications and potential need for additional corrective surgery or later autologous breast reconstruction should be discussed.

Efficacy of breast reconstruction with fat grafting: A systematic review and meta-analysis.

BACKGROUND: Breast reconstruction with fat grafting is a new alternative to prosthetic implants and flaps for women with breast cancer. In this study, we investigate the efficacy of fat grafting for breast reconstruction in a meta-analysis. METHODS: The study followed the PRISMA and MOOSE guidelines for systematic reviews and meta-analyses. Studies were included if the patients underwent complete breast reconstruction with fat grafting as the only treatment modality. The number of fat grafting treatments needed to complete a breast reconstruction was modeled in a meta-analysis for five treatment categories: modified radical mastectomy, skin-sparing mastectomy, and breast-conserving surgery; the two mastectomy groups were subdivided into nonirradiated and irradiated. RESULTS: Twenty-one studies were included in the meta-analysis. The studies comprised 1011 breast reconstructions in 834 patients. The estimated numbers of treatments to complete a reconstruction were 2.84-4.66 in the mastectomy groups and 1.72 in the breast-conserving surgery group. The number of fat grafting sessions needed to complete a breast reconstruction was significantly higher for the irradiated patients than for the nonirradiated patients (p < 0.05). There was no significant difference in the number of fat grafting sessions needed to complete a breast reconstruction after a modified radical mastectomy versus a skin-sparing mastectomy. CONCLUSIONS: This study provides an evidence-based foundation for several practical issues related to breast reconstruction with fat grafting. The analysis showed that radiotherapy is the most important factor associated with the number of treatment sessions needed to complete a breast reconstruction and with the rate of complications.

[Fat grafting of the breast].

An increasing amount of evidence supports the benefits of fat grafting for breast augmentation, correction following breast-conserving surgery, breast reconstructions as well as correction of tuberous, hypoplastic and asymmetrical breasts. The aim of fat grafting is to create a breast with an aesthetic, natural appearance. In this review, we describe the most common indications for fat grafting of the breast and give an overview of the techniques in use as well as their associated risks and future perspectives.

Closure Of Thoracic Wall Defect Using Breast Implant Capsule Tissue As A Rotation Flap - A Case Report.

A 70-year old woman underwent thoracic surgery resulting in rupture of a silicone implant. During re-implantation at a later time an iatrogenic thoracic wall defect was discovered. In order to complete re-implantation the defect was closed using a rotation flap constructed from capsular tissue from the previous silicone implant.

Use of autologous fat grafting for the correction of burn scar contracture in the hand: a case report.

Severe burn injuries to the hand represent a topic of great concern due to long-term complications such as hypertrofic burn scar and contracture, which may result in loss of function. We present a case of burn scar contracture in the hand of a child undergoing Z-plasty and lipofilling.

[Hemifacial atrophy treated with lipofilling].

Autologous lipofilling is a relatively new method of reconstructing congenital and acquired soft tissue defects. However, long-term results are unpredictable due to varying survival rate of the fat graft, and additional treatments are often required. We present a case of a 53-year-old woman who had a right hemifacial soft tissue deficit and received lipofilling twice with no complications and satisfactory cosmetic results. We consider conventional lipofilling to be safe and viable for facial soft tissue augmentation.

Treatment of congenital unilateral hypoplastic breast anomalies using autologous fat grafting: A study of 11 consecutive patients.

During the period 2008-2013, 11 women were treated with autologous fat grafting for unilateral congenital breast hypoplasia comprising both tuberous breast and micromastia. No correction of the contralateral breast was done at evaluation. Patients were treated median one time, and they had their inter-breast volume difference reduced from median 175 to 50 ml. Patients showed overall high degree of satisfaction with the treatment, but they were less satisfied when addressing size and shape separately. The median follow-up time was 13 months, and the achieved breast volume sustained throughout the follow-up period.

Autologous fat transplantation for the treatment of linear scleroderma en coup de sabre.

Scleroderma en coup de sabre is a disfiguring disease for which only limited therapeutic options exist. Three cases of facial linear scleroderma treated with autologous fat transplantation with acceptable results are presented. Autologous fat transplantation was preferred to corrective surgery because of the extent of the lesions and absence of any associated facial distortion. Fat as a filler was chosen to reduce the risk of adverse effects. Adipocytes are suggested to have wider biological effects than other fillers and may offer more durable results. At least two transplantations were needed to evoke a significant effect.

Persistent Reduced Pigmentation of Areola after Breast Reconstruction with Brava-assisted Autologeous Fat Grafting.

SUMMARY: A 17-year-old healthy woman treated for unilateral hypoplastic breast anomaly with Brava-assisted fat grafting experienced persistent reduced pigmentation of the areola on the treated breast. The reduced pigmentation was confirmed at 6-month postoperative follow-up and verified by histological examination of comparable biopsies from both areolas.

A prospective study of short- and long-term cosmetic outcome after reduction mammaplasty from three different perspectives: the patient, a department surgeon, and an independent private practitioner in plastic surgery.

BACKGROUND: Numerous studies have examined the outcome of reduction mammaplasty. This study evaluates the cosmetic outcome after reduction mammaplasty from the perspective of the patient, a ward surgeon, and a private practitioner in plastic surgery, and analyzes which factors influence it. METHODS: The material stems from a Danish quality assurance program in the public health care system. Nonparametric statistics and logistic regression were used to compare cosmetic outcomes and possible confounding. RESULTS: Over 80 percent of the patients evaluated the short- and long-term cosmetic outcome as good or very good. The surgeons and especially the private practitioner were more critical. The evaluation of breast features also differs between patients and surgeons. The main issue for patients is symmetry. With time, patients and the private practitioner become more critical about the scars. Surgeons are most concerned about nipple bottoming out. Predictive factors for surgeons were the patient's age, body mass index, and postoperative complications. Evaluation by patients was, in addition to complications, influenced by the preoperative information given, confidence in the treatment, and the overall course on the ward. CONCLUSIONS: Patients evaluate cosmetic outcome significantly more favorably than surgeons and especially the private practitioner. They are also concerned about different breast features. Decreased nipple sensation does not influence the patient's evaluation. Evaluation by the surgeons depends on more objective measures than does evaluation by the patients. One must not underestimate the importance of factors such as preoperative information about the surgery and complications, together with proper and qualified care. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

[Regional nerve block in facial surgery]. / Regional nerveblokade ved ansigtskirurgi.

Regional nerve blocking techniques offer a suitable alternative to local infiltration anaesthesia for facial soft tissue-surgery. Moreover, they present several advantages over general anaesthesia, including smoother recovery, fewer side effects, residual analgesia into the postoperative period, earlier discharge from the recovery room and reduced costs. The branches of the trigeminal nerve and the sensory nerves originating from the upper cervical plexus can be targeted at several anatomical locations. We summarize current knowledge on facial nerve block techniques and recommend ten nerve blocks providing efficient anaesthesia for the entire head and upper-neck region.

Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial.

OBJECTIVE: To investigate the effect of a restricted intravenous fluid regimen versus a standard regimen on complications after colorectal resection. SUMMARY BACKGROUND DATA: Current fluid administration in major surgery causes a weight increase of 3-6 kg. Complications after colorectal surgery are reported in up to 68% of patients. Associations between postoperative weight gain and poor survival as well as fluid overload and complications have been shown. METHODS: We did a randomized observer-blinded multicenter trial. After informed consent was obtained, 172 patients were allocated to either a restricted or a standard intraoperative and postoperative intravenous fluid regimen. The restricted regimen aimed at maintaining preoperative body weight; the standard regimen resembled everyday practice. The primary outcome measures were complications; the secondary measures were death and adverse effects. RESULTS: The restricted intravenous fluid regimen significantly reduced postoperative complications both by intention-to-treat (33% versus 51%, P = 0.013) and per-protocol (30% versus 56%, P = 0.003) analyses. The numbers of both cardiopulmonary (7% versus 24%, P = 0.007) and tissue-healing complications (16% versus 31%, P = 0.04) were significantly reduced. No patients died in the restricted group compared with 4 deaths in the standard group (0% versus 4.7%, P = 0.12). No harmful adverse effects were observed. CONCLUSION: The restricted perioperative intravenous fluid regimen aiming at unchanged body weight reduces complications after elective colorectal resection.