Prepectoral Implant-Based Breast Reconstruction with Postmastectomy Radiation Therapy.

BACKGROUND: Two-stage subpectoral implant-based breast reconstruction is the most common method for breast reconstruction. Recent advances in surgical techniques and technology have made prepectoral implant-based breast reconstruction feasible. There are limited data on outcomes after prepectoral implant-based breast reconstruction and postmastectomy radiation therapy. METHODS: A retrospective review of consecutive patients undergoing immediate two-stage prepectoral implant-based breast reconstruction with postmastectomy radiation therapy was performed. Outcomes of irradiated breasts were compared with nonirradiated breasts in bilateral cases. RESULTS: Ninety-three cases of prepectoral implant-based breast reconstruction in 54 women who underwent immediate two-stage reconstruction (39 bilateral and 15 unilateral) and unilateral postmastectomy radiation therapy were identified. Mean follow-up was 19 months from mastectomy and tissue expander reconstruction and 9 months from implant placement. Crude complication rates in irradiated versus nonirradiated sides were as follows: surgical-site infection, 18.5 percent versus 7.7 percent; seroma, 5.6 percent versus 5.1 percent; mastectomy skin flap necrosis, 1.9 percent versus 2.6 percent; wound dehiscence, 1.9 percent versus 7.7 percent; capsular contracture, 1.9 percent versus 0 percent; hematoma, 1.9 percent versus 2.6 percent; and extrusion, 1.9 percent versus 0 percent. On univariate analysis, there were no risk factors associated with any complication, including radiation therapy, surgical-site infection, unplanned readmissions, and unplanned return to the operating room. To date, reconstruction has been completed in 96 percent of patients, with successful implant-based breast reconstruction in 81 breasts (45 irradiated breasts and 36 nonirradiated breasts). CONCLUSIONS: Early data of prepectoral implant-based breast reconstruction in patients with postmastectomy radiation therapy show promising results. Postmastectomy radiation therapy should not be an absolute contraindication to prepectoral implant-based breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Robotic paraesophageal hernia repair: a single-center experience and systematic review.

Robotic Surgery is becoming increasingly used in general surgery. The objective of this study is to evaluate the safety, effectiveness and short-term (less than 1 year) outcomes of Robotic Paraesophageal Hernia (RPEH) Surgery using the DaVinci Surgical Robot system (Intuitive Surgical, CA) in a large community hospital. This is a retrospective cohort study of 28 consecutive patients who underwent robotic paraesophageal hernia repair January 2011-March 2013 in this institution. Data and outcomes collected for analysis include patient demographics, operating times, conversion, complications, mortality and recurrence. The mean age of the patients was 68.7 +/- 12.7 years, 82% were females and the mean BMI was 29 +/- 6.3. The mean operative time, including the robot docking time, was 83.6 + 24 min. The average length of hospital stay (LOS) was 2.8 +/- 1.9 days. There were no conversions to open or laparoscopic procedures. Postoperative complications were noted in 3 patients (10.7%), including one mortality (3.4%). One symptomatic recurrence (3.4%) was noted during the 12-month follow-up period. Robotic Paraesophageal repair is a safe (similar rate of complication and mortality to literature for laparoscopic procedure) and an effective (paraeshopageal hernia repaired without high recurrence) procedure with acceptable complication rates even in older patients with high operative risks.

Clinical outcomes and cost-benefit analysis comparing laparoscopic and robotic colorectal surgeries.

BACKGROUND: The introduction of minimally invasive platforms for colorectal surgery-laparoscopy and more recently robotics-allows for smaller incisions, shortened hospital stay, less postoperative pain, and quicker return to normal activity. There exists a lack of evidence-based knowledge comparing the clinical outcomes and cost-benefit analysis of the different types of minimally invasive surgery. The aim of this study was to analyze and compare the short-term clinical outcomes and overall hospital costs between laparoscopic and robotic colorectal surgery. METHODS: After IRB approval, we conducted a retrospective chart review from 131 patients who underwent laparoscopic colorectal surgery and 96 patients who underwent robotic colorectal surgery. Data analyzed included pertinent patient demographics, operative times (OR times), conversion rates, postoperative pathology, complications, length of hospital stay, 90-day readmission rates, 30-day mortality, and overall hospital costs. RESULTS: Two hundred and twenty-seven patients were included-laparoscopic (N = 131) and robotic (N = 96) colorectal surgeries. Mean age of patients in the laparoscopic versus robotic cohort was 70.9 vs 63.6 years, (p < 0.001). Around 62 % were operated on for malignant disease. Mean OR time was 113 min for laparoscopy and 109 min for robotics, p = 0.59. Conversion rates were comparable. Mean length of hospital stay (6.6 vs 5.7 days) and postoperative complications (3.2 vs 7 %) were comparable between the laparoscopic and robotic arms. Overall hospital charges were $114,853 for laparoscopy and $107,220 for robotics, and no significant difference was noted (p = 0.448, NS). CONCLUSION: Robotic colectomies were comparable to laparoscopic colectomies in terms of overall hospital charges and short-term clinical outcomes, including length of stay and conversion rates. Robotic surgery was favored for left-sided colectomy. With shorter learning curves and wider availability, robotic approach offers a safe and economically feasible minimally invasive platform for complex colorectal resections.

A Systematic Review of Smartphone Applications for Plastic Surgery Providers: Target Audience, Uses, and Cost.

BACKGROUND: The growth and acceptance of smartphones among clinicians has been remarkable over the last decade. Over 87% of doctors use a smartphone or tablet capable of running third-party software known as applications (apps). In the field of plastic surgery, apps have been designed for personal practice development, education, clinical tools and guidelines, and entertainment. This study reviews the literature on apps related to plastic surgery and determines the number and types of apps available. METHODS: A systematic review of the literature was performed to find articles written about plastic surgery applications. Queries were run in the Apple iPhone iOS App store and Google Play using the term "plastic surgery." Apps were reviewed for ratings, downloads, and cost. In addition, apps were categorized based on purpose. Categories include practice development, media/literature, clinical tool and guideline apps, or recreation. RESULTS: The literature search yielded 8 articles for review, 2 articles focused on categorizing apps and 6 articles focused on describing useful apps. Searching Apple's iTunes (iOS) store identified 273 and Google Play identified 250 apps related to plastic surgery; since 2013, a 62%, and 580% increase, respectively. The iOS store included practice development (46%), recreation (26%), media/literature (14%), and clinical tool and guideline (11%). Google Play store included recreation apps (44%), practice development (24%), clinical tools and guidelines (11%), and media and literature (9%). CONCLUSIONS: Apps related to the field of plastic surgery are increasing in prevalence. The content of these apps are variable, and the majority are intended for marketing and development of private practices. Apps linking to literature, texts, study materials, and clinical tools and guidelines are developed for both practicing plastic surgeons and surgical trainees. Finding "useful" apps takes time because searches are often complicated by a variety of apps.

Diffuse dermal angiomatosis of the breast: a series of 22 cases from a single institution.

BACKGROUND: Diffuse dermal angiomatosis (DDA) is a rare cutaneous disorder that can affect the breast. A total of nine cases of breast involvement have been described in the literature, but there is currently no consensus in the best therapeutic approach. The objective of this study was to examine patient outcomes with such therapies in women diagnosed with DDA of the breast. METHODS: Consecutive cases of DDA of the breast were retrospectively reviewed including patient demographic variables, diagnostic criteria and type of therapies. A successful outcome was defined as complete healing of chronic open breast wounds and absence of disease recurrence after cessation of therapy. RESULTS: Twenty-two women (mean age, 48.4 years) diagnosed with DDA of the breast were identified between 2004 and 2012. The diagnosis was confirmed with skin biopsy in 12 patients and clinical diagnosis in the remaining ten patients. The majority of patients were obese [68.2% (15/22), average body mass index (BMI), 36.9 kg/m(2)] and at the time of diagnosis, 27.3% of patients were active smokers (6/22). Only two patients (9.1%) received isotretinoin, neither had full recovery and both patients showed recurrence when taken off of therapy. Other medical therapies showed less to no improvement. Two patients underwent successful surgical treatment. One patient had a successful outcome following breast reduction, although her postoperative course was complicated with delayed wound healing. The other patient presented with recurrence of DDA following breast reduction, and was successfully managed with bilateral simple mastectomies. CONCLUSIONS: Our findings suggest that DDA of the breast is associated with macromastia, obesity and tobacco use. Isotretinoin therapy is published as having favorable outcomes to other therapies, but in this series only appears to reduce symptoms rather than eradicate DDA. Our findings indicate that other medical therapies have been attempted with limited success. Surgical management of DDA of the breast may provide definitive treatment.