Thursday, 17 May 2018

Evolution in Monitoring of Free Flap Autologous Breast Reconstruction after Nipple-Sparing Mastectomy: Is There a Best Way?



Plastic and Reconstructive Surgery - Most Popular Articles by Frey, Jordan D.; Stranix, John T.; Chiodo, Michael V.; Alperovich, Michael; Ahn, Christina Y.; Allen, Robert J.; Choi, Mihye; Karp, Nolan S.; Levine, Jamie P.  

Plastic and Reconstructive Surgery: May 2018 - Volume 141 - Issue 5 - p 1086–1093

Background: Free flap monitoring in autologous reconstruction after nipple-sparing mastectomy remains controversial. The authors therefore examined outcomes in nipple-sparing mastectomy with buried free flap reconstruction versus free flap reconstruction incorporating a monitoring skin paddle. Methods: Autologous free flap reconstructions with nipple-sparing mastectomy performed from 2006 to 2015 were identified. Demographics and operative results were analyzed and compared between buried flaps and those with a skin paddle for monitoring. Results: Two hundred twenty-one free flaps for nipple-sparing mastectomy reconstruction were identified: 50 buried flaps and 171 flaps incorporating a skin paddle. The most common flaps used were deep inferior epigastric perforator (64 percent), profunda artery perforator (12.1 percent), and muscle-sparing transverse rectus abdominis myocutaneous flaps (10.4 percent). Patients undergoing autologous reconstructions with a skin paddle had a significantly greater body mass index (p = 0.006). Mastectomy weight (p = 0.017) and flap weight (p < 0.0001) were significantly greater in flaps incorporating a skin paddle. Comparing outcomes, there were no significant differences in flap failure (2.0 percent versus 2.3 percent; p = 1.000) or percentage of flaps requiring return to the operating room (6.0 percent versus 4.7 percent; p = 0.715) between groups. Buried flaps had an absolute greater mean number of revision procedures per nipple-sparing mastectomy (0.82) compared with the skin paddle group (0.44); however, rates of revision procedures per nipple-sparing mastectomy were statistically equivalent between the groups (p = 0.296). Conclusion: Although buried free flap reconstruction in nipple-sparing mastectomy has been shown to be safe and effective, the authors’ technique has evolved to favor incorporating a skin paddle, which allows for clinical monitoring and can be removed at the time of secondary revision. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Dosage-dependent reduction of macular pigment optical density in female breast cancer patients receiving tamoxifen adjuvant therapy



by I-Liang Lim, Angela Voon Pei Loo, Visvaraja Subrayan, Tsung Fei Khang, Mee Hoong See, Adlinda Alip, Nur Aishah Mohd Taib  


The Breast June 2018 Volume 39, Pages 117–122

It is now increasingly common for breast cancer patients to receive adjuvant tamoxifen therapy for a period of up to 10 years. As survival rate increases, managing tamoxifen ocular toxicities is important for patients' quality of life. Macular pigments in photoreceptor cells protect against free radical damage, which can cause macular degeneration. By reducing macular pigment concentration, tamoxifen may increase the risk of macular degeneration. Here, we compared macular pigment optical density (MPOD) and central macular thickness between breast cancer patients on tamoxifen adjuvant therapy (n = 70), and a control group (n = 72).

Prolactin Induced Protein (PIP) is a potential biomarker for early stage and malignant breast cancer



 by Anju Gangadharan, Themba Nyirenda, Kishan Patel, Nydia Jaimes-Delgadillo, Dominique Coletta, Takemi Tanaka, Ayal C. Walland, Zena Jameel, Srinivasa Vedantam, Sittinon Tang, Ciaran Mannion, Grace Y. Lee, Andre Goy, Andrew Pecora, K. Stephen Suh  


The Breast June 2018 Volume 39, Pages 101–109

Breast cancer (BC) is the second leading cause of cancer-related mortality in women. Bioinformatic analysis and expression screening showed that Prolactin Induced Protein (PIP) was differentially expressed in BC. The objective of this investigation was to characterize the expression pattern of PIP, an aspartyl proteinase, in malignant and non-malignant breast tissues.

Incidence of isolated local breast cancer recurrence and contralateral breast cancer: A systematic review



by Inge Spronk, François G. Schellevis, Jako S. Burgers, Geertruida H. de Bock, Joke C. Korevaar  

The Breast: June 2018 Volume 39, Pages 70–79

An increasing number of women is surviving breast cancer and due to that at risk of developing an isolated ipsilateral breast tumor recurrence (IBTR) or a contralateral breast cancer (CBC). Patients' main concern is cancer recurrence. Patient counseling on breast cancer recurrence is challenging. In order to provide healthcare professionals and patients more guidance, a systematic literature review of the incidence of isolated IBTR and CBC in women diagnosed with early invasive breast cancer was performed.

The Evolving Presence of Women in Academic Plastic Surgery: A Study of the Past 40 Years



by Plana, Natalie M.; Khouri, Kimberly S.; Motosko, Catherine C.; Stern, Marleigh J.; Anzai, Lavinia; Poudrier, Grace; Massie, Jonathan P.; Diaz-Siso, J. Rodrigo; Flores, Roberto L.; Hazen, Alexes  

Plastic and Reconstructive Surgery: May 2018 - Volume 141 - Issue 5 - p 1304–1310

Background: Among surgical subspecialties, plastic surgery holds the highest percentage of women, and, the female contingent of board-certified plastic surgeons and trainees has grown steadily. However, their academic impact has been underestimated. We present the academic footprint of female plastic surgeons over the past 40 years. Methods: A list of female plastic surgeons currently active at, and retired from, Accreditation Council for Graduate Medical Education–accredited plastic surgery residency programs was compiled. Each surgeon was searched on PubMed to gather their total number of publications, journals, and topics of research after completion of training. Date of publication and 5-year impact factor for each journal were recorded. Publications were organized into 10-year periods (1976 to 1985, 1986 to 1995, 1996 to 2005, and 2006 to 2016). Results: One hundred fifty-five currently active and 80 retired academic female plastic surgeons were identified, who published 2982 articles in 479 peer-reviewed journals. The average 5-year impact factor was 4.093. The number of publications increased with each decade: 37 (1976 to 1985), 218 (1986 to 1995), 472 (1996 to 2005), and 2255 (2006 to 2016). The most commonly published areas were hand/nerve (22 percent), craniofacial (21 percent), and breast (20 percent). Over time, publications in hand/nerve research decreased (76, 60, 38, and 14 percent, respectively); craniofacial-related publications increased (8, 11, 18, and 23 percent, respectively); and publications in breast research increased (0, 8, 9, and 24 percent, respectively). The 2006 to 2016 period yielded the most even distribution of research topics. Conclusion: The academic contribution of female plastic surgeons has substantially increased in number and has become more evenly distributed across subspecialty topics.


A Prospective Comparison of Short-Term Outcomes of Subpectoral and Prepectoral Strattice-Based Immediate Breast Reconstruction



by Baker, Benjamin G.; Irri, Renu; MacCallum, Vivienne; Chattopadhyay, Rahul; Murphy, John; Harvey, James R.  

Plastic and Reconstructive Surgery: May 2018 - Volume 141 - Issue 5 - p 1077–1084 

Background: Prepectoral acellular dermal matrix–assisted immediate implant-based breast reconstruction is gaining popularity, involving complete implant coverage with acellular dermal matrix. The authors aimed to compare pain, patient-reported outcome measures (including implant rippling), and safety of prepectoral and subpectoral Strattice–assisted implant-based breast reconstruction. Methods: Consecutive patients were recruited prospectively, having either therapeutic or risk-reducing mastectomy. Patients scored their pain three times per day for the first 7 postoperative days on a Likert scale, and completed the BREAST-Q reconstruction module 3 months postoperatively. Clinical records and the authors’ prospective complications database were used to compare the early morbidity of the two procedures. Results: Forty patients were recruited into the study. There was no significant difference in pain scores between the prepectoral group (mean, 1.5) and the subpectoral cohort (mean, 1.5; p = 0.45) during the first 7 days. Thirty-one BREAST-Q questionnaires were returned; mean Q scores were similar for both prepectoral and subpectoral (72 and 71, respectively; p = 0.81) groups. Patients reported significantly more visible implant rippling in the prepectoral group than in the subpectoral group (seven of 13 versus two of 17; p = 0.02). There was no significant difference in length of stay or early morbidity, with implant loss being 4.7 percent in the prepectoral group compared with 0 percent in the subpectoral group. Conclusions: Early postoperative pain and quality of life at 3 months are equivalent between groups. Early experience of prepectoral implant placement with complete acellular dermal matrix coverage suggests this is safe and provides good quality of life for patients. Further studies are required to compare short- and long-term outcomes with the current standard forms of reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Happy and Unhappy Patients: A Quantitative Analysis of Online Plastic Surgeon Reviews for Breast Augmentation


by Dorfman, Robert G.; Purnell, Chad; Qiu, Cecil; Ellis, Marco F.; Basu, C. Bob; Kim, John Y. S.  

Plastic and Reconstructive Surgery: May 2018 - Volume 141 - Issue 5 - p 663e–673e

Background: Online reviews have become modern versions of the word-of-mouth recommendation, and prospective patients are increasingly consulting them before making decisions about their surgical care. The authors’ objectives were to (1) identify trends in the use of online reviews, and (2) important reasons for patient satisfaction and dissatisfaction with aesthetic surgery. The authors selected breast augmentation as the primary procedure of interest. Methods: Reviews of the top 10 to 20 most reviewed plastic surgeons in each of six large metropolitan areas were obtained from Google, Yelp, and RealSelf. Reviews were assessed for predefined dimensions of satisfaction and dissatisfaction. Results: A total of 1077 breast augmentation reviews were obtained. Ratings were distributed bimodally, with peaks at five stars and one star. The majority of reviews were positive (87.5 percent). Relative popularity of Google versus Yelp varied across geographic regions, and average rating varied by platform. Between 2011 and 2016, the number of online reviews for breast augmentation grew at an average rate of 42.6 percent per year. Aesthetic outcome was the most commonly cited dimension (69.8 percent of reviews), whereas cost was mentioned in only 7.8 percent of reviews. A substantial minority of negative Yelp (37 percent) and Google (9.4 percent) reviews were written by patients who did not actually undergo surgery. Free-text analysis of heterogeneous reviews (containing positive and negative attributes) classified dimensions as critical, redeemable, or protective. Conclusion: As the influence of online review platforms continues to grow, understanding drivers of positive and negative reviews may help surgeons improve patient satisfaction.

The Cost of Contralateral Prophylactic Mastectomy in Women with Unilateral Breast Cancer



by Billig, Jessica I.; Duncan, Anthony; Zhong, Lin; Aliu, Oluseyi; Sears, Erika D.; Chung, Kevin C.; Momoh, Adeyiza O.  

Plastic and Reconstructive Surgery: May 2018 - Volume 141 - Issue 5 - p 1094–1102


Background: Contralateral prophylactic mastectomy may be unnecessary from an oncologic perspective; therefore, the debate persists about the value of contralateral prophylactic mastectomy in women with early-stage unilateral breast cancer. Given finite health care resources, this study aims to evaluate the cost of contralateral prophylactic mastectomy and breast reconstruction. Methods: Women with unilateral breast cancer undergoing either unilateral mastectomy or unilateral mastectomy with contralateral prophylactic mastectomy and immediate breast reconstruction were selected from the Truven MarketScan databases between 2009 and 2013. Demographic and treatment data were recorded, and over an 18-month follow-up period, the treatment cost was tallied. A log-transformed linear model was used to compare cost between the groups. Results: A total of 2343 women were identified who met our inclusion criteria, with 1295 undergoing unilateral mastectomy and 1048 undergoing contralateral prophylactic mastectomy. Complication rates within 18 months were similar for women undergoing unilateral mastectomy and contralateral prophylactic mastectomy (39 percent versus 42 percent; p = 0.17). Management with unilateral mastectomy with reconstruction required an adjusted cumulative mean cost of $33,557. Contralateral prophylactic mastectomy with reconstruction was an additional $11,872 in expenditure (p < 0.001). The cost of initial procedures (mean difference, $6467) and secondary procedures (mean difference, $2455) were the greatest contributors to cost. Conclusions: In women with unilateral breast cancer, contralateral prophylactic mastectomy with reconstruction is more costly. The increased monetary cost of contralateral prophylactic mastectomy may be offset by improved quality of life. However, this financial reality is an important consideration when ongoing efforts toward reimbursement reform may not pay for contralateral prophylactic mastectomy if outcomes data are not presented to justify this procedure.

[News] Sarcopenia and adiposity linked to overall survival



The Lancet Oncology by Elizabeth Gourd Published: 12 April 2018

Patients with non-metastatic breast cancer who have sarcopenia or high total adipose tissue at diagnosis might have an increased risk of mortality, a new study suggests.

[News] No impact of English national cancer policies on survival




[News] No impact of English national cancer policies on survival

The Lancet Oncology by Talha Khan Burki  Published: 22 March 2018

A new study has concluded that the 2000 NHS Cancer Plan and subsequent national cancer policy strategies did not reduce socio-economic inequalities in cancer survival or improve cancer survival overall in England.

Antibiotic Prophylaxis after Immediate Breast Reconstruction: The Reality of Its Efficacy



by Ranganathan, Kavitha; Sears, Erika D.; Zhong, Lin; Chung, Ting-Ting; Chung, Kevin C.; Kozlow, Jeffrey H.; Momoh, Adeyiza O.; Waljee, Jennifer F.

Plastic and Reconstructive Surgery: April 2018 - Volume 141 - Issue 4 - p 865–877



Background: Numerous techniques are used to prevent infection after immediate implant-based breast reconstruction. Postoperative antibiotic prophylaxis is commonly prescribed to decrease the risk of reconstructive failure, despite conflicting evidence regarding its effectiveness. The authors studied whether postoperative antibiotic prophylaxis decreases the risk of infection-related explantation in the setting of immediate prosthesis-based breast reconstruction. Methods: Using Truven MarketScan databases, the authors identified all patients who underwent immediate implant reconstruction between January of 2010 and June of 2014 with at least 6 months of follow-up. Postoperative antibiotic prophylaxis was defined as any oral antibiotic course to be taken postoperatively based on prescriptions filled within 14 days preoperatively through 24 hours after discharge. Reconstructive failure, defined as explantation because of infection, was the primary outcome. Secondary outcomes of interest included wound complications, infection, and readmission for infection. Multivariable regression analyses controlled for demographic variables/comorbidities. Results: Of the 7443 patients, 6049 (81 percent) filled prescriptions for postoperative antibiotic prophylaxis. These patients were equally likely to develop a wound complication (OR, 0.93; 95 percent CI, 0.71 to 1.23) or infection (OR, 0.89; 95 percent CI, 0.70 to 1.14), undergo explantation because of infection (OR, 0.82; 95 percent CI, 0.57 to 1.18), or require readmission for infection (OR, 1.21; 95 percent CI, 0.82 to 1.78) compared with those who did not receive antibiotics. There was no significant difference in the risk of infection-related outcomes based on postoperative antibiotic prophylaxis duration. Conclusions: Postoperative antibiotic prophylaxis was not associated with a reduced risk of infection or explantation following prosthesis-based breast reconstruction. Given rising rates of antibiotic resistance, focusing instead on technical considerations and the management of comorbid conditions may more effectively enhance the safety of breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Wednesday, 21 March 2018

Mammographic density and breast cancer risk in breast screening assessment cases and women with a family history of breast cancer.

Mammographic density and breast cancer risk in breast screening assessment cases and women with a family history of breast cancer.

Author(s) Duffy, Stephen W; Morrish, Oliver W E; Allgood, Prue C; Black, Richard; Gillan, Maureen G C; Willsher, Paula; Cooke, Julie; Duncan, Karen A; Michell, Michael J; Dobson, Hilary M; Maroni, Roberta; Lim, Yit Y; Purushothaman, Hema N; Suaris, Tamara; Astley, Susan M; Young, Kenneth C; Tucker, Lorraine; Gilbert, Fiona J
Source European journal of cancer (Oxford, England : 1990); Jan 2018; vol. 88 ; p. 48-56
Publication Date Jan 2018
Place of Publication England
Accession Number 29190506
ISSN 1879-0852
PubMed ID 29190506
Publication Type(s) Journal Article
Database Medline
Abstract
BACKGROUNDMammographic density has been shown to be a strong independent predictor of breast cancer and a causative factor in reducing the sensitivity of mammography. There remain questions as to the use of mammographic density information in the context of screening and risk management, and of the association with cancer in populations known to be at increased risk of breast cancer.AIMTo assess the association of breast density with presence of cancer by measuring mammographic density visually as a percentage, and with two automated volumetric methods, Quantra™ and VolparaDensity™.METHODSThe TOMosynthesis with digital MammographY (TOMMY) study of digital breast tomosynthesis in the Breast Screening Programme of the National Health Service (NHS) of the United Kingdom (UK) included 6020 breast screening assessment cases (of whom 1158 had breast cancer) and 1040 screened women with a family history of breast cancer (of whom two had breast cancer). We assessed the association of each measure with breast cancer risk in these populations at enhanced risk, using logistic regression adjusted for age and total breast volume as a surrogate for body mass index (BMI).RESULTSAll density measures showed a positive association with presence of cancer and all declined with age. The strongest effect was seen with Volpara absolute density, with a significant 3% (95% CI 1-5%) increase in risk per 10 cm3 of dense tissue. The effect of Volpara volumetric density on risk was stronger for large and grade 3 tumours.CONCLUSIONSAutomated absolute breast density is a predictor of breast cancer risk in populations at enhanced risk due to either positive mammographic findings or family history. In the screening context, density could be a trigger for more intensive imaging.

Top ten concerns burdening people with cancer: Perceptions of patients with cancer and the nurses caring for them.

Top ten concerns burdening people with cancer: Perceptions of patients with cancer and the nurses caring for them.
Author(s) Mitchell, Keith S J; Delfont, Sarah; Bracey, Maria Lucinda; Endacott, Ruth

Source European journal of oncology nursing : the official journal of European Oncology Nursing Society; Apr 2018; vol. 33 ; p. 102-106

Publication Date Apr 2018
DOI 10.1016/j.ejon.2018.02.004
ISSN 1532-2122
Database Medline

PURPOSEWe examined the concerns that nurses perceive patients to have, whether these are congruent with patients' concerns and whether they vary according to cancer site. We also examined Distress Thermometer scores according to cancer site.METHODA cross-sectional survey design: (i) secondary analysis of an existing Holistic Needs Assessment (HNA) and Distress Thermometer (DT) dataset was used, (ii) a survey of specialist nurse teams to identify their perceptions of patient concerns. Data collected between January 2015 and June 2016 from the HNA database from one NHS Trust in England (n = 1233 patients). Specialist nurse teams for breast, colorectal, gynaecology, skin and urology cancers identified the concerns that they perceived their patients would report.RESULTSThe HNA showed high internal consistency (Cronbach's alpha 0.86). Across the five cancer sites, nurses identified between 3 and 6 of the top ten concerns (TTC) expressed by patients, with wide variation across cancer sites. Nine of the TTC were significantly associated (p < 0.05) with a specific cancer site. The breast and gynaecological cancer groups both recorded significantly higher median Distress Thermometer scores than the urology, skin and colorectal cancer groups (Kruskall-Wallis χ2 (4, n = 1228) 186.695, p=<.01).CONCLUSIONSOne of the aims of the eHNA is to enable service delivery appropriate to patient needs. Our findings suggest that this will only be achieved if eHNA is examined, and services developed, by individual cancer site. The misconception of patient needs by specialist nurses underscores the importance of review of information provided by patients during consultations.

Tuesday, 20 March 2018

Depression, Antidepressant Use, and Breast Cancer Risk in Pre- and Postmenopausal Women: A Prospective Cohort Study.

Depression, Antidepressant Use, and Breast Cancer Risk in Pre- and Postmenopausal Women: A Prospective Cohort Study.


Author(s) Reeves, Katherine W; Okereke, Olivia I; Qian, Jing; Tamimi, Rulla M; Eliassen, A Heather et al.
Source Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology; Mar 2018; vol. 27 (no. 3); p. 306-314
Publication Date Mar 2018
ISSN 1538-7755
Database Medline

Background: Depression and antidepressant use is highly prevalent among U.S. women and may be related to increased breast cancer risk. However, prior studies are not in agreement regarding an increase in risk.Methods: We conducted a prospective cohort study within the Nurses' Health Study (NHS) and NHSII among females age 25 and older. Over more than 10 years of follow-up in each cohort, 4,014 incident invasive breast cancers were diagnosed. We used Cox proportional hazards regressions with updating of exposures and covariates throughout follow-up to estimate HRs and 95% confidence intervals (CIs) for associations between clinical depression and antidepressant use with invasive breast cancer risk. Analyses were repeated separately for in situ disease, as well as stratified by estrogen receptor (ER) subtype and menopausal status at diagnosis.Results: No statistically significant associations were observed between clinical depression (HR for reporting ≥3 times vs. 0, 1.13; 95% CI, 0.85-1.49) or antidepressant use (HR for reporting ≥3 times vs. 0, 0.92; 95% CI, 0.80-1.05) and invasive breast cancer risk in multivariable analyses. Likewise, we observed no significant associations between clinical depression or antidepressant use and risk of in situ, ER+, ER-, premenopausal, or postmenopausal breast cancer.Conclusions: In the largest prospective study to date, we find no evidence that either depression or antidepressant use increase risk of breast cancer.Impact: The results of this study are reassuring in that neither depression nor antidepressant use appear to be related to subsequent breast cancer risk. Cancer Epidemiol Biomarkers Prev; 27(3); 306-14. ©2017 AACR.

Neoadjuvant chemotherapy for early breast cancer

Title: Neoadjuvant chemotherapy for early breast cancer

Author: Petros Charalampoudis and Andreas Karakatsanis

The pivotal meta-analysis1 by the Early Breast Cancer Trialists' Collaborative Group (EBCTCG) provides high-quality data on the concept of risk-adapted breast-conserving therapy. The investigators showed equivalent survival in patients treated with the same chemotherapy before or after surgery, with a significantly higher frequency of local recurrence in patients receiving neoadjuvant chemotherapy (NACT) compared with the adjuvant group. This difference in local recurrence was not accompanied by a decrease in survival.

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Where Do We Look? Assessing Gaze Patterns in Breast Reconstructive Surgery with Eye-Tracking Technology

Title: Where Do We Look? Assessing Gaze Patterns in Breast Reconstructive Surgery with Eye-Tracking Technology

Author: Cai, Lawrence Z. B.S.; Paro, John A. M. M.D.; Lee, Gordon K. M.D.; Nazerali, Rahim S. M.D.
Publication: Plastic and Reconstructive Surgery: March 2018 - Volume 141 - Issue 3 - p 331e–340e

Abstract: 
Background: Aesthetics plays a large role in determining a successful outcome in plastic and reconstructive surgery. As such, understanding perceptions of favorable aesthetics is crucial for optimizing patient satisfaction. Eye-tracking technology offers an unbiased way of measuring how viewers evaluate breast reconstructions.
Methods: Twenty-nine raters with varied plastic surgery experience were shown 20 images of breast reconstruction at various stages. Breasts were divided into those with nipples and no reconstruction scars, those with nipples and reconstruction scars, and those with reconstruction scars and no nipples. Raters viewed each image for 8 seconds to evaluate aesthetic outcomes. Eye-tracking equipment and software were used to track raters’ gaze and analyze the distribution of attention.
Results: In breasts with reconstruction scars and no nipples, viewers spent 53.9 percent of the view time examining scars, whereas viewers’ attention was divided evenly in breasts with both reconstruction scars and nipples, spending 27.5 percent and 27.7 percent of view time examining the nipples and reconstruction scars, respectively. When examining complete reconstructions, viewers spent more time scanning the entire image before fixating on scars and spent less time on single-site fixation.
Conclusions: Complete reconstructions, which notably include the final nipple-areola complex, appear to play an important role in restoring normal viewing parameters. In essence, completed breast reconstructions with nipple-areola complexes divert attention from extraneous surgical scars and lead viewers to assess the breasts more holistically. Eye-tracking technology provides a powerful link between objective gaze and viewer attention that may potentially be used to predict subjective aesthetic preferences.

Is the Right Research Being Conducted to Advance Knowledge about Breast Reconstruction? An Analysis of the Research Pipeline

Title: Is the Right Research Being Conducted to Advance Knowledge about Breast Reconstruction? An Analysis of the Research Pipeline

Author: Checketts, Jake X. B.S.; Gordon, Joshua D.O.; Crawford, Julia H. M.L.I.S., A.H.I.P.; Adams, Haley D.O.; Duckett, Laurie D.O.; Vassar, Matt Ph.D.
Publication: Plastic and Reconstructive Surgery: March 2018 - Volume 141 - Issue 3 - p 566–577

Abstract:
Background: Capsular contracture around breast implants is a severe and unpredictable complication experienced by up to 50 percent of patients after breast augmentation and reconstruction, and represents a major cause leading to reoperation. Several lines of evidence point to the involvement of subclinical infections and of bacterial biofilm formation.
Methods: To reduce the incidence of capsular contracture following mammaplasty, the authors studied the correlation between contamination by exogenous and endogenous bacterial flora and the capacity to develop bacterial biofilm in mammary implants. The authors performed a microbiological study assessing microbial growth of swabs from breast skin, nipple-areola complex, and mammary gland biopsy specimens. Furthermore, the authors compared the results with the data resulting from cultural experiments from biopsy specimens of periprosthetic capsule, contracted or not, and from the surfaces of the relative prosthesis.
Results: Between July of 2012 and July of 2013, a series of 65 female patients from the area of Naples, Italy, and its province, who underwent breast plastic surgery with the use of implants for aesthetic or reconstructive reasons, were included in the study. The authors noticed that there is a greater tendency for capsular contracture to form in oncologic patients who received radiotherapy, patients with precedent capsular contracture, and patients with cutaneous contamination by biofilm-producing microbes.
Conclusions: Although all of the new technical procedures tend to reduce the amount of bacterial charge that comes into contact with the prosthesis at the time of its introduction, a minimal amount must always be taken for granted. This is the rationale for a preventative personalized antibiotic therapy.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

P2 Importance of breast tumour margins and how to measure them effectively

P2 Importance of breast tumour margins and how to measure them effectively


Medical School, The University of Western Australia, Perth, WA, Australia
Publication: Australasian Society for Breast Disease 11th Scientific Meeting 5-7 October 2017

Abstract: : In Australia, around 70% of women with early breast cancer undergo breast-conserving surgery either as a primary procedure or after neoadjuvant systemic therapy. It is important to ensure that all tumour is removed during surgery, including all microscopic disease. Residual cancer can increase local recurrence risk (1). Therefore, women who have positive surgical margins are generally advised to undergo re-excision or mastectomy. Currently, 2030% of patients undergoing breast-conserving surgery require additional surgery for positive margins, increasing risk of wound infection, delay of adjuvant treatment, increased anxiety and poor cosmetic outcomes (1).

Thursday, 15 February 2018

Germline BRCA mutation and outcome in young-onset breast cancer (POSH): a prospective cohort study

 Germline BRCA mutation and outcome in young-onset breast cancer (POSH): a prospective cohort study

Copson ,E et al
Lancet Oncology Volume 19, No. 2, p169–180, February 2018

Patients with young-onset breast cancer who carry a BRCA mutation have similar survival as non-carriers. However, BRCA mutation carriers with triple-negative breast cancer might have a survival advantage during the first few years after diagnosis compared with non-carriers. Decisions about timing of additional surgery aimed at reducing future second primary-cancer risks should take into account patient prognosis associated with the first malignancy and patient preferences.

The Lateral Thigh Perforator Flap for Autologous Breast Reconstruction: A Prospective Analysis of 138 Flaps

The Lateral Thigh Perforator Flap for Autologous Breast Reconstruction: A Prospective Analysis of 138 Flaps

Tuinder, S et al
Plastic and Reconstructive Surgery: February 2018 - Volume 141 - Issue 2 -  p 257–268

Background: The septocutaneous tensor fasciae latae or lateral thigh perforator flap was previously introduced by the authors’ group as an alternative flap for autologous breast reconstruction when the abdomen is not suitable as a donor site. The authors analyzed their experience with the lateral thigh perforator flap and present the surgical refinements that were introduced. 
Methods: A prospective study was conducted of all lateral thigh perforator flap breast reconstructions performed since September of 2012. Patient demographics, operative details, complications, and flap reexplorations were recorded. Preoperative imaging with magnetic resonance angiography was performed in all patients. Surgical refinements introduced during this study included limitation of the flap width and the use of quilting sutures at the donor site. 
Results: A total of 138 lateral thigh perforator flap breast reconstructions were performed in 86 consecutive patients. Median operative times were 277 minutes (range, 196 to 561 minutes) for unilateral procedures and 451 minutes (range, 335 to 710 minutes) for bilateral. Median flap weight was 348 g (range, 175 to 814 g). Two total flap losses (1.4 percent) were recorded, and 11 flaps (8.0 percent) required reexploration, which resulted in viable flaps. The incidence of donor-site complications was reduced significantly after the surgical refinements were introduced. Wound problems decreased from 40.0 percent to 6.3 percent, seroma decreased from 25.0 percent to 9.5 percent, and infection decreased from 27.5 percent to 9.5 percent. 
Conclusions: The lateral thigh perforator flap is an excellent option for autologous breast reconstruction, with minimal recipient-site complications. The surgical refinements resulted in a significant reduction of donor-site complications. Therefore, the lateral thigh perforator flap is currently the authors’ second choice after the deep inferior epigastric artery perforator flap.