A Propensity-Matched Analysis of the Influence of Breast Reconstruction on Subsequent Development of Lymphedema

A Propensity-Matched Analysis of the Influence of Breast Reconstruction on Subsequent Development of Lymphedema
Plastic & Reconstructive Surgery:
August 2015 - Volume 136 - Issue 2 - p 134e–143e

Basta M et al

Background: Recent literature demonstrates a lower incidence of lymphedema with breast reconstruction. This study compared the incidence of lymphedema after axillary dissection in a propensity-matched cohort of patients with and without immediate breast reconstruction. 
Methods: A review of patients undergoing axillary lymphadenectomy with or without immediate breast reconstruction from January 1, 2000, to July 1, 2013, was conducted. Comorbidities, cancer treatment, operative characteristics, and pathologic findings were reviewed. The primary outcome was postoperative lymphedema. Univariate analysis identified baseline differences between the patient groups. Cohorts were propensity-matched by age, body mass index greater than 30 kg/m2, adjuvant radiation therapy, cardiovascular disease, and hypertension. Subsequent multivariate regression was performed to identify independent predictors of lymphedema among matched patients. Results: A total of 4647 patients underwent breast cancer resection, with 1955 having axillary lymphadenectomy (no reconstruction, n = 1200; autologous, n = 563; implant-based, n = 192). Matching yielded a cohort of 239 reconstruction and 239 no-reconstruction patients demonstrating no differences in age, body mass index, hypertension, adjuvant radiation therapy, or axillary dissection extent. With 55.9 months’ follow-up, postoperative lymphedema was diagnosed in 94 patients (19.7 percent). Reconstruction patients developed lymphedema in 19.2 percent of cases versus 20.1 percent for no- reconstruction patients (p = 0.82). Regression identified two independent predictors of lymphedema: postoperative radiation therapy (OR, 2.90; p < 0.001) and obesity (OR, 2.36; p < 0.001). 
Conclusions: This study demonstrates a 19.7 percent incidence of lymphedema following axillary lymphadenectomy. Reconstruction does not appear to alter lymphedema risk, whereas postoperative radiation therapy, obesity, and extensive axillary dissection greatly increase risk.

Conservative surgery for multifocal/multicentric breast cancer

Conservative surgery for multifocal/multicentric breast cancer
The Breast Published Online: August 23, 2015


Matthijs V, et al


Multifocal (MF) and multicentric (MC) breast cancer is regularly considered a relative contraindication for breast-conserving therapy (BCT). There are two reasons for this wide spread notion:However, we concur that if optimal ‘cytoreductive surgery’ is achieved this will result in good local control....................

Prognostic significance of nodal involvement region in clinical stage IIIc breast cancer patients who received primary systemic treatment, surgery, and radiotherapy

Prognostic significance of nodal involvement region in clinical stage IIIc breast cancer patients who received primary systemic treatment, surgery, and radiotherapy
The Breast  Article in press
  
Jae Myoung Noh, et al

To evaluate the prognostic influence of involvement of both internal mammary nodes (IMNs) and supraclavicular nodes (SCNs) in clinical stage IIIc breast cancer patients who underwent primary systemic treatment, surgery, and radiotherapy (RT).

The locoregional recurrence post-mastectomy for ductal carcinoma in situ: Incidence and risk factors

The locoregional recurrence post-mastectomy for ductal carcinoma in situ: Incidence and risk factors
The Breast. In Press. Accepted: June 7, 2015; Published Online: August 12



The objective of this retrospective study was to determine the incidence of recurrence of breast cancer after mastectomy for ductal carcinoma in situ (DCIS) in our institution, and to evaluate the associated risk factors while comparing them to those proposed in the literature.

C-Y Trilobed Flap for Improved Nipple-Areola Complex Reconstruction

C-Y Trilobed Flap for Improved Nipple-Areola Complex Reconstruction
Plastic & Reconstructive Surgery:August 2015 - Volume 136 - Issue 2 - p 234–237

Butz, D, et al

Summary: Nipple-areola complex reconstruction has been shown to improve breast reconstruction patients’ overall satisfaction. Trilobed flap variations are some of the more commonly used flaps for nipple-areola complex reconstruction. The donor-site scar frequently extends outside the width of an ideal areolar tattoo diameter. There have been many modifications to the original flap design, but none of them addresses the length of the donor-site scar. The technique described uses a triangular stitch in the donor site to limit the length of the scar. This also creates tiny dog-ears within the future areola zone that give a natural wrinkled appearance when tattooed.

Patient-Reported Satisfaction and Quality of Life following Breast Reconstruction in Thin Patients: A Comparison between Microsurgical and Prosthetic Implant Recipients

Patient-Reported Satisfaction and Quality of Life following Breast Reconstruction in Thin Patients: A Comparison between Microsurgical and Prosthetic Implant Recipients
Plastic & Reconstructive Surgery: August 2015 - Volume 136 - Issue 2 - p 213–220

Weichman, K et al

Background: Patients undergoing autologous breast reconstruction have higher long-term satisfaction rates compared with those undergoing prosthetic reconstruction. Regardless, most patients still undergo prosthetic reconstruction. The authors compared outcomes of microsurgical reconstruction to those of prosthetic reconstruction in thin patients and evaluated the effect of reconstructive type on quality of life. Methods: After institutional review board approval was obtained, the authors reviewed all patients undergoing breast reconstruction at a single institution from November of 2007 to May of 2012. Thin patients were included for analysis and divided into two cohorts: microsurgical reconstruction and tissue expander/implant reconstruction........