Post-Mastectomy Implant Complications in the Hispanic Breast Cancer Patient Population.

BACKGROUND/AIM: The purpose was to analyze the impact of post-mastectomy radiation therapy (PMRT) on implant-based breast reconstruction (IBR) in self-identified Hispanic patients compared to non-Hispanic counterparts. PATIENTS AND METHODS: We retrospectively reviewed patients who underwent IBR between January 1, 2017 and December 31, 2019 at a single hospital system. Patients were cisgender women, assigned female at birth, 18 years or older, and underwent mastectomy with immediate IBR +/- PMRT. We compared characteristics between Hispanic and non-Hispanic patients, assessing capsular contracture and implant loss rates. Multivariable analysis was performed to identify factors associated with complications. RESULTS: A total of 317 patients underwent mastectomy and reconstruction. Of these patients, 302 underwent a total of 467 mastectomies with IBR, and these 467 procedures were included in the analysis of complications. Complications occurred in 175 breasts (37.5%), regardless of PMRT. Seventy-two of the 302 patients (24%) received PMRT to one breast. The overall rates of capsular contracture, implant loss, and overall complications did not vary significantly between Hispanic and non-Hispanic patients (p=0.866, 0.974, and 0.761, respectively). When comparing only irradiated patients, there was a trend towards increased implant loss and overall complication rates in Hispanic versus non-Hispanic patients (p=0.107 and 0.113, respectively). Following PMRT the rate of any complication was 71% in Hispanic women and 53% in non-Hispanic women. CONCLUSION: Our study illuminates a trend towards higher complication rates after PMRT in Hispanic versus non-Hispanic patients. Further studies are needed to understand why Hispanic patients may have more side effects from radiation therapy.

Comparison of Immediate Breast Reconstruction Outcomes in Patients With and Without Prior Cosmetic Breast Surgery.

BACKGROUND: Skin-sparing (SSM) and nipple-sparing mastectomy (NSM) with immediate breast reconstruction (IBR) have significantly increased. There is limited information on complications of IBR in patients with prior cosmetic breast surgery (CBS). We compare IBR outcomes in patients undergoing SSM and/or NSM with and without prior CBS. MATERIALS AND METHODS: Patients undergoing mastectomy from January 1, 2017 to December 31, 2019 were selected. Patient characteristics, surgical approach, and complications were compared between mastectomy and IBR cases for breasts with and without prior CBS. Binary logistic regression analysis was performed to identify predictors of complications and reconstruction loss. RESULTS: 956 mastectomies were performed in 697 patients, with IBR performed for 545 mastectomies in 356 patients. Median age was 51 (range 19-83), 45.8% of patients were age < 50, 62.6% of mastectomies were performed for breast cancer. 95 mastectomies (17.4%) were performed in breasts with prior CBS and 450 (82.6%) without. NSM was more frequently utilized for breasts with prior CBS (P < .001). Complications occurred in 80 mastectomies (14.7%); reconstruction loss in 30 (5.5%). On multivariable analysis, age ≥ 50 (OR 1.76, 95%CI 1.01-3.09, P = .047) and NSM (OR 2.11, 95%CI 1.17-3.79, P = .013) were associated with an increased risk of any complication. Prior CBS was not associated with an increased risk of complications (OR 1.11, 95%CI 0.58-2.14, P = .743) or reconstruction loss (OR 1.32, 95%CI 0.51-3.38, P = .567). CONCLUSION: In this analysis of mastectomy and IBR, prior CBS was not associated with an increased risk of complications or reconstruction loss. In patients with prior CBS undergoing mastectomy, IBR may be safely performed.

Stricter ioPTH criterion for successful parathyroidectomy in stage III CKD patients with primary hyperparathyroidism.

BACKGROUND: The effects of underlying renal insufficiency on intraoperative parathormone monitoring during parathyroidectomy (PTX) for primary hyperparathyroidism remain unclear. This study evaluates operative outcomes in patients undergoing parathyroidectomy using classic or stricter >50% intraoperative parathormone decrease criterion for primary hyperparathyroidism with mild or moderate renal insufficiency. METHODS: A retrospective review of prospectively collected data in 577 patients undergoing parathyroidectomy guided by intraoperative parathormone monitoring for primary hyperparathyroidism was performed. Patients were stratified by stages I to III of chronic kidney disease; those with overt secondary hyperparathyroidism (chronic kidney disease stages IV and V) were excluded. Patients were further subdivided into subgroups based on the classic criterion of a >50% intraoperative parathormone decrease and a stricter criterion of a >50% intraoperative parathormone decrease e to a normal range (<65 pg/mL). Long-term operative outcomes were compared across the 3 chronic kidney disease groups. RESULTS: Of 577 patients, 38% (221) had normal renal function or stage I chronic kidney disease, 44% (251) had stage II chronic kidney disease, and 18% (105) had stage III chronic kidney disease. In stages I and II chronic kidney disease patients, there were no differences in operative success, failure, recurrence, bilateral neck exploration, and multiglandular disease between classic and stricter criterion groups. In contrast, in stage III chronic kidney disease patients, operative success was greater using the stricter intraoperative parathormone criterion than the classic intraoperative parathormone criterion (100% vs 92%, respectively, P < .05). No other outcome differences were identified between classic and stricter intraoperative parathormone criterion subgroups in stage III chronic kidney disease patients. CONCLUSION: In patients with primary hyperparathyroidism and concurrent stage III chronic kidney disease, a stricter criterion of a >50% intraoperative parathormone decrease to a normal range should be used for successful parathyroidectomy.

Healing refractory venous ulcers: new treatments offer hope.

Non-healing wounds are associated with an inflammatory and proteolytic wound environment, and recent therapeutic strategies have been focused on reversing these changes. Connexins, as members of gap junctions, are important in intercellular signaling and wound repair. Connexin 43 (Cx43) downregulation is associated with normal wound healing, and it has been found to be upregulated in non-healing venous leg ulcers (VLUs). Ghatnekar et al. (2014) report findings of a small phase II trial performed in Indian patients with chronic VLUs, reporting that ACT1, a mimetic peptide of Cx43, accelerates healing in the treatment group. Despite standard care with compression therapy and adjuvant therapy for refractory wounds, at present in clinical practice a significant number of patients remain unhealed. The potential for ACT1 exists to help heal refractory VLUs, but it faces additional regulatory hurdles.