Information requirements of young women with breast cancer treated with mastectomy or breast conserving surgery: A systematic review

Information requirements of young women with breast cancer treated with mastectomy or breast conserving surgery: A systematic review
Recio-Saucedo A, Gerty S et al.
Online Publication (February 2016Volume 25, Pages 1–13)


Young women with breast cancer have poorer prognosis, greater lifetime risk of local recurrence, contralateral recurrence, and distant disease, regardless of surgery received. Here we systematically review published evidence relating to the information requirements and preferences of young women diagnosed with early-stage breast cancer offered a choice between mastectomy and Breast Conservation Surgery (BCS). Findings will inform the development of a surgical decision aid for young women.

The Profunda Artery Perforator Flap: Investigating the Perforasome Using Three-Dimensional Computed Tomographic Angiography

The Profunda Artery Perforator Flap: Investigating the Perforasome Using Three-Dimensional Computed Tomographic Angiography
Wong, C et al
Plastic & Reconstructive Surgery: November 2015 - Volume 136 - Issue 5 - p 915–919


Background: The profunda artery perforator flap has been emerging as an alternative method of autologous breast reconstruction. This flap uses upper posterior thigh tissue. The profunda artery perforator perforasome is investigated using three-dimensional computed tomographic angiography.
Methods: Ten cadaveric thighs were dissected centered over the profunda artery perforator. The perforator was injected with contrast medium and the flap was then subjected to computed tomographic scanning using a GE Lightspeed 16-slice scanner. The three-dimensional images were viewed, and measurements were obtained using Aquarius software, including horizontal and vertical extensions of the flap and areas of perfusion. Clinical examples are presented.
 Results: A profunda artery perforator (occasionally two) was consistently found in the upper medial thigh region, posterior to the gracilis muscle. The area of vascularity shown by the spread of contrast extends inferiorly beyond the usual lower border of the profunda artery perforator flap, which is usually 7 cm wide. In injected cadaveric flaps, the mean horizontal dimension was 16.7 cm and the mean vertical dimension was 16.5 cm. The mean area perfused was 8812 cm2. Conclusions: The profunda artery perforator flap is a vascularly sound flap, and is a good option for autologous breast reconstruction. Advantages include a reliable pedicle, no position changes required, and possibly an improved donor-site contour from a thigh lift. It is an excellent alternative to abdominally based free flaps and can also be used in conjunction with other flaps for further volume enhancement.

Comparison of Allergan, Mentor, and Sientra Contoured Cohesive Gel Breast Implants: A Single Surgeon’s 10-Year Experience

Comparison of Allergan, Mentor, and Sientra Contoured Cohesive Gel Breast Implants: A Single Surgeon’s 10-Year Experience


Plastic & Reconstructive Surgery: November 2015 - Volume 136 - Issue 5 - p 957–966


Doren, Erin L.


Background: Contoured cohesive gel breast implants have been recently approved in the United States. These implants have been available for premarket approval studies for selected surgeons. The purpose of this study was to assess a single surgeon’s outcomes in three specific clinical situations—breast augmentation, secondary augmentation, and breast reconstruction—using implants of all three contoured cohesive gel implant manufacturers (Allergan, Mentor, and Sientra) over a 10-year period.
Methods: The authors performed a prospective study of contoured cohesive silicone gel breast implants. Demographic and outcomes data were recorded. Complication rates were compared among the three implant manufacturers.
Results: From 2001 to 2013, 695 patients were included from U.S. Food and Drug Administration clinical trials......................

Breast Implant–Associated Infections: The Role of the National Surgical Quality Improvement Program and the Local Microbiome

Breast Implant–Associated Infections: The Role of the National Surgical Quality Improvement Program and the Local Microbiome

Plastic & Reconstructive Surgery: November 2015 - Volume 136 - Issue 5 - p 921–929


Cohen, Justin B. et al

Background: The most common cause of surgical readmission after breast implant surgery remains infection. Six causative organisms are principally involved: Staphylococcus epidermidis and S. aureus, Escherichia, Pseudomonas, Propionibacterium, and Corynebacterium. The authors investigated the infection patterns and antibiotic sensitivities to characterize their local microbiome and determine ideal antibiotic selection.
Methods: A retrospective review of 2285 consecutive implant-based breast procedures was performed. Included surgical procedures were immediate and delayed breast reconstruction, tissue expander exchange, and cosmetic augmentation. Patient demographics, chemotherapy and/or irradiation status, implant characteristics, explantation reason, time to infection, microbiological data, and antibiotic sensitivities were reviewed.
Results: Forty-seven patients (2.1 percent) required inpatient admission for antibiotics, operative explantation, or drainage by interventional radiology. The infection rate varied depending on surgical procedure, with the highest rate seen in mastectomy and immediate tissue expander reconstruction (6.1 percent). The mean time to explantation was 41 days. Only 50 percent of infections occurred within 30 days of the indexed National Surgical Quality Improvement Program operation. The most commonly isolated organisms were coagulase-negative Staphylococcus (27 percent), methicillin-sensitive S. aureus (25 percent), methicillin-resistant S. aureus (7 percent), Pseudomonas (7 percent), and Peptostreptococcus (7 percent). All Gram-positive organisms were sensitive to vancomycin, linezolid, tetracycline, and doxycycline; all Gram-negative organisms were sensitive to gentamicin and cefepime.
Conclusions: Empiric antibiotics should be vancomycin (with the possible inclusion of gentamicin) based on their broad effectiveness against the authors’ unique microbiome. Minor infections should be treated with tetracycline or doxycycline as a second-line agent. National Surgical Quality Improvement Program data are adequate for monitoring and comparing breast infections but certainly not comprehensive. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. 

Discussion: Use of Acellular Dermal Matrix in Postmastectomy Breast Reconstruction: Are All Acellular Dermal Matrices Created Equal?

Discussion:  Use of Acellular Dermal Matrix in Postmastectomy Breast Reconstruction: Are All Acellular Dermal Matrices CreatedEqual?



Plastic & Reconstructive Surgery: October 2015 - Volume 136 - Issue 4 - p 654–656


A discussion article about the use of acellular dermal matrix.

A Comparison of Elliptical Mastectomy to Inverted-T Pattern Mastectomy in Two-Stage Prosthetic Breast Reconstruction

A Comparison of Elliptical Mastectomy to Inverted-T Pattern Mastectomy in Two-Stage Prosthetic Breast Reconstruction

Plastic & Reconstructive Surgery: October 2015 - Volume 136 - Issue 4 - p 426e–433e

Kilgo, Matthew S et al.

Background: Patients with large or ptotic breasts undergoing mastectomy followed by tissue expander/implant-based reconstruction may benefit from a Wise (inverted-T) pattern reduction mammaplasty incision compared with the traditional horizontal elliptical incision. The authors compared these two groups of patients with regard to complication rates and outcomes.
Methods: Sixty-nine patients (117 breasts) were identified who underwent Wise pattern mastectomy and two-stage reconstruction. A control group of 89 patients (136 breasts) who underwent reconstruction after horizontal elliptical mastectomy were selected over the same period. Patient demographics, clinical characteristics, and complication rates were recorded and analyzed statistically.
Results: Patient demographics (age, body mass index, diabetes, smoking, and irradiation history) and clinical characteristics (laterality, expander size and fill volume, and time to expansion) were similar, with the exception of body mass index (control, 26.7 kg/m2; inverted-T, 28.7 kg/m2; p = 0.04) and mean intraoperative fill volume (control, 158.7 cc; inverted-T, 196.9 cc; p = 0.02). Of all complications (infection, seroma, flap necrosis, expander loss, and salvage), only the rate of mastectomy flap necrosis was significantly greater (p = 0.002) in patients undergoing inverted-T mastectomy (25.6 percent versus 11.0 percent). This difference did not result in a significantly higher rate of expander loss or need for salvage surgery.
Conclusions: The inverted-T mastectomy approach can be performed safely with acceptable complication rates. When compared with an internal control group, complication rates were similar, with the exception of mastectomy flap necrosis. Despite a higher rate of flap necrosis, 91 percent of inverted-T patients successfully completed the expansion process. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Breast conservative surgery and local recurrence

The Breast Published Online: September 29, 2015

 Mahdi Rezai, Stefan Kraemer, Rainer Kimmig, Peter Kern

Breast conservation is a legacy of Umberto Veronesi who laid the groundwork for the preservation of the body image of women affected by breast cancer (BC) with the Milan I study in the late 70ies of the last millennium. Breast conservative surgery (BCS) has two aspects: oncological safety of tumour resection with free margins and aesthetic preservation of the breast. Determinants of local control used to be T-size, nodal status and receptor status until biologically driven concepts defined risk of recurrence on the basis of molecular portraits. We explored whether these concepts of intrinsic subtypes prove at a large scale in the context of BCS and which surgical techniques procure best oncological and aesthetic outcomes, avoiding re-excision and necessity of conversion to mastectomy.

Optimal surgical management for high-risk populations

The Breast Published Online: September 29, 2015

Tari A. King, Melissa Pilewskie, Monica Morrow

The recognition that breast cancer is a group of genetically distinct diseases with differing responses to treatment and varying patterns of both local and systemic failure has led to many questions regarding optimal therapy for those considered to be high risk. Young patients, patients with triple-negative breast cancer (TNBC), and those who harbor a deleterious mutation in BRCA1 or BRCA2 are frequently considered to be at highest risk of local failure, leading to speculation that more-aggressive surgical treatment is warranted in these patients.

Exploring information provision in reconstructive breast surgery: A qualitative study

The Breast Published Online: September 29, 2015

Shelley Potter, Nicola Mills, Simon Cawthorn, Sherif Wilson, Jane Blazeby

Women considering reconstructive breast surgery (RBS) require adequate information to make informed treatment decisions. This study explored patients' and health professionals' (HPs) perceptions of the adequacy of information provided for decision-making in RBS.

Neoadjuvant chemotherapy is not a contraindication for nipple sparing mastectomy

The Breast, October 2015 Volume 24, Issue 5, Pages 661–666

Stefano Santoro, Andrea Loreti, Francesco Cavaliere, Leopoldo Costarelli, Massimo La Pinta, Elena Manna, Maria Mauri, Paola Scavina, Elena Santini, Ugo De Paula, Vito Toto, Lucio Fortunato

Nipple-sparing mastectomy (NSM) has been recently implemented to improve cosmetic outcome after mastectomy, but it is rarely considered today after neoadjuvant chemotherapy (NCH).

Shifting Autologous Breast Reconstruction into an Ambulatory Setting: Patient-Reported Quality of Recovery

Plastic and Reconstructive Surgery October 2015 - Volume 136 - Issue 4 - p 657–665

Davidge, Kristen et al

As bundled payment models gain popularity, it is imperative that providers use patient outcomes and patient experience to define evidence-based pathways of care. The purpose of this study was to evaluate the quality of recovery experienced by women undergoing early discharge (less than 24 hours) after autologous breast reconstruction with a pedicled flap and determine predictors of postoperative quality of recovery. Methods: A prospective cohort study was performed on all women undergoing autologous breast reconstruction at Women’s College Hospital between September of 2011 and July of 2013 that met study inclusion criteria. 

Use of Acellular Dermal Matrix in Postmastectomy Breast Reconstruction: Are All Acellular Dermal Matrices Created Equal?

Plastic and Reconstructive Surgery October 2015 - Volume 136 - Issue 4 - p 647–653

Ranganathan, Kavitha et al

AlloDerm and FlexHD are two types of acellular dermal matrices commonly used in implant-based reconstruction. Although the use of acellular dermal matrix has revolutionized immediate breast reconstruction in the setting of breast cancer, it remains unclear which type of acellular dermal matrix is best. The purpose of this retrospective cohort study was to compare postoperative complication rates between these two types of acellular dermal matrix. The authors reviewed the records of all patients who underwent implant-based breast reconstruction at their institution between 1998 and 2013. Dependent variables of seroma, hematoma, infection, delayed wound healing, implant exposure, and return to the operating room for management of complications were recorded.

Natrelle410 Extra-Full Projection Silicone Breast Implants: 2-Year Results from Two Prospective Studies

Plastic and Reconstructive Surgery October 2015 - Volume 136 - Issue 4 - p 638–646

Cordeiro, Peter G.; McGuire, Patricia; Murphy, Diane K.  

The safety and effectiveness of the Natrelle Style 410 highly cohesive silicone gel breast implant (Allergan, Inc., Irvine, Calif.) in full or moderate height and projection have been shown in a 10-year study. Extra-full projection implants may be an appropriate option for some women undergoing breast reconstruction. A total of 2795 women received at least one Natrelle 410 extra-full projection implant (X-style) for breast reconstruction in two similarly designed, prospective, multicenter studies…………..

TUGs into VUGs and Friendly BUGs: Transforming the Gracilis Territory into the Best Secondary Breast Reconstructive Option

TUGsinto VUGs and Friendly BUGs: Transforming the Gracilis Territory into the Best Secondary Breast Reconstructive Option

Plastic and Reconstructive Surgery 136(3):447-454, September 2015.

Park, Julie E.; Alkureishi, Lee W. T.; Song, David H.

The best secondary option for autologous breast reconstruction remains controversial. Limitations of the gracilis myocutaneous flap, including volume, skin paddle reliability, and donor morbidity, have been addressed by several modifications, hereby expanding its role in the decision tree for autologous breast reconstruction. This report documents the authors’ experience with gracilis flap breast reconstruction. This is a retrospective case series of a prospectively maintained database of patients undergoing breast reconstruction with the free gracilis myocutaneous flap, including the transverse upper gracilis, vertical upper gracilis, and bilateral stacked vertical upper gracilis.

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........