Tuesday, 28 April 2015

Parasternal infiltration composite breast augmentation

Parasternal infiltration composite breast augmentation. Plastic and Reconstructive Surgery, April 2015, Vol. 135(4), p.1010-18.

Bravo, F.G.


Background: The simultaneous combination of both fat grafting to the breast and mammary implants has been recently proposed as a useful technique in breast augmentation surgery. The purpose of this study was to evaluate the aesthetic benefits of selective parasternal fat grafting at the time of primary implant breast augmentation.
Methods: Fifty-nine consecutive primary breast augmentation patients were studied retrospectively. Patients were divided into two groups: group 1 patients (n = 38) were treated only with breast implants, whereas group 2 patients (n = 21) received breast implants and parasternal fat grafting of 60 to 140 cc of adipose tissue. The length between the medial border of each breast, defined as the parasternal vertical aesthetic line, was measured preoperatively and postoperatively for both groups and compared through statistical analysis.
Results: The mean length between the parasternal vertical aesthetic lines in group 1 postoperatively was significantly higher, 2.26 ± 1.24 cm (p < 0.0001); whereas this length for group 2 was significantly lower after surgery, 0.60 ± 0.32 cm (p < 0.0001). No cysts or fat necroses were observed in group 2, presumably because of the low volume of fat used.
Conclusions: Parasternal fat grafting performed simultaneously with breast augmentation is a safe procedure, and seems to provide a valuable cosmetic advantage by improving the medial transition zone of the breast implant with the presternal area. It prevents a “separated-breasts” deformity, which may produce unnatural results in implant-based breast augmentations, especially in thin patients.

Tamoxifen and Aromatase inhibitors as potential perioperative thrombotic risk factors in free flap breast reconstruction

Tamoxifen and Aromatase inhibitors as potential perioperative thrombotic risk factors in free flap breast reconstruction. Plastic and Reconstructive Surgery, April 2015 Vol. 135(4), p.670(e)-79(e).

Mirzabiegi, M.N., et al.


Selective estrogen-receptor modulators and aromatase inhibitors have become ubiquitous in the treatment of breast cancer. However, hormone therapy is a well-established thromboembolic risk factor. The purpose of this study is two-fold: (1) to further evaluate tamoxifen as a potential thrombotic risk factor and (2) to evaluate use of aromatase inhibitors as a potential novel risk factor.
Results: One thousand three hundred forty-seven flaps were performed on 858 patients. There were no statistically significant differences in thrombotic complications or flap failure in comparing those that did not receive preoperative hormone therapy versus those that did receive preoperative hormone therapy, nor were there significant differences specific to those receiving tamoxifen or aromatase inhibitors. A post hoc power analysis was performed with the supposition that hormone therapy exposure results in a two-fold increase in complication rate. The study power was found to be 0.863.
Conclusions: Tamoxifen may have been previously overestimated as a microvascular thrombotic risk factor. At a minimum, these data suggest that withholding tamoxifen for 2 weeks before surgery can mitigate thrombotic risk.

Breast reconstruction outcomes after nipple-sparing mastectomy and radiation therapy

Breast reconstruction outcomes after nipple-sparing mastectomy and radiation therapy. Plastic and Reconstructive Surgery, April 2015, Vol. 135(4), p.959-66.

Reish, R.G., et al.


Few studies in the literature examine outcomes of immediate breast reconstruction after mastectomy with nipple preservation and radiation therapy. Nipple-sparing mastectomy and immediate reconstruction in patients who had or will receive radiation therapy is associated with a higher incidence of complications and operative revisions compared with patients without radiation. However, most patients have successful reconstructions with nipple retention and no recurrences.

The impact of postoperative expansion initiation timing on breast expander capsular characteristics

The impact of postoperative expansion initiation timing on breast expander capsular characteristics: A prospective combined clinical and scanning electron microscopy study. Plastic and Reconstructive Surgery, April 2015, Vol. 135(4), p.967-974.

Paek, L.S., et al.


 In the first stage of expander-to-implant breast reconstruction, postoperative expansion is classically initiated at 10 to 14 days (conventional approach). The authors hypothesized that it may be beneficial to wait 6 weeks postoperatively before initiating serial expansion (delayed approach). Clinical and ultrastructural periprosthetic capsule analysis is first required before determining whether a delayed approach ultimately improves capsular tissue adherence and expansion process predictability.

Breast density legislation

Breast density legislation - practical considerations. NEJM 2015, 372: 593-5

Slanetz, P.J., et al.


Ever since Nancy Cappello, a Connecticut woman who hadn't been told that her mammograms showed dense breast tissue, was diagnosed with stage 3 breast cancer in 2004 and advocated for a new state law, there's been a growing movement to educate women about breast density and the potential role of supplemental screening in early cancer detection. Cappello's state was the first to pass a law requiring physicians to offer supplemental whole-breast ultrasonography to women with dense breasts — defined as containing more than 50% fibroglandular tissue — and mandating that insurers cover the additional screening.
Since then, the number of breast-density laws in the United States has grown rapidly: as of January 2015, a total of 21 states had adopted such legislation. Laws vary considerably among states, with some requiring only that physicians notify women with dense breasts of their status and others stipulating that supplemental screening be offered to such women. Most state laws, however, do not mandate insurance coverage of additional screening, though the lack of such coverage could increase income-based health disparities.

Pertuzumab, Trastuzumab, and Docetaxel in HER2-Positive metastatic breast cancer

Pertuzumab, Trastuzumab and Docetaxel in HER2-Positive metastatic breast cancer. NEJM 2015, 372: 724-34

Swain, S.M., et al.


In patients with metastatic breast cancer that is positive for human epidermal growth factor receptor 2 (HER2), progression-free survival was significantly improved after first-line therapy with pertuzumab, trastuzumab, and docetaxel, as compared with placebo, trastuzumab, and docetaxel. Overall survival was significantly improved with pertuzumab in an interim analysis without the median being reached. We report final prespecified overall survival results with a median follow-up of 50 months.