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

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

1 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

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

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

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

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

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

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

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

[News] Sarcopenia and adiposity linked to overall survival

1 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

1 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

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.