Breast Surgery Bulletin: Plastic and Reconstructive Surgery [journal]

Blondeel, Phillip N. M.D., Ph.D.; Hijjawi, John M.D.; Depypere, Herman M.D., Ph.D.; Roche, Nathalie M.D.; Van Landuyt, Koenraad M.D., Ph.D.;
Shaping the Breast in Aesthetic and Reconstructive Breast Surgery: An Easy Three-Step Principle
Plastic & Reconstructive Surgery. 123(2):455-462, February 2009.
Abstract
Creating or recreating an aesthetically pleasing breast shape in reconstructive and aesthetic breast surgery is an act that most experienced "breast" surgeons will find self-evident. We propose a simple three-step philosophical and hands-on approach that will make it easier for young and unexperienced plastic surgeons to not only analyze the problematic breast but also come up with an easy surgical strategy to create reproducible results.This is Part I of four parts describing the three-step principle being applied in reconstructive and aesthetic breast surgery. Part I explains how to analyze a problematic breast by understanding the three main anatomical features of a breast and how they interact: the footprint, the conus of the breast, and the skin envelope. Part II deals with reconstructions after complete mastectomy and Part III covers reconstruction after breast conservation surgery. Finally, Part IV applies the same principles in the field of aesthetic breast surgery. Throughout these four parts, the three-step principle will be the red line to fall back on to define the problem and to propose a solution.(C)2009American Society of Plastic Surgeons

Selective Breast Reduction: A Personal Approach with a Central-Superior Pedicle.
Giacomo Datta, M.D.; Salvatore Carlucci, M.D.
SUPPLEMENTAL DIGITAL CONTENT IS AVAILABLE IN THE TEXT.

Septum-Based Mammaplasty: A Surgical Technique Based on Wuringer's Septum for Breast Reduction.
Moustapha Hamdi, M.D., Ph.D.; Koenraad Van Landuyt, M.D., Ph.D.; Patrick Tonnard, M.D.; Alex Verpaele, M.D.; Stan Monstrey, M.D., Ph.D.
SUPPLEMENTAL DIGITAL CONTENT IS AVAILABLE IN THE TEXT.

Friday, 22 August 2008

Plastic and reconstructive surgery Jun and Jul 2008

An innovative three-dimensional approach to defining the anatomical changes occurring after short scar-medial pedicle reduction mammaplasty.
Plastic and reconstructive surgery, Jun 2008, vol. 121, no. 6
p. 1875-85
Tepper-Oren-M, Choi-Mihye, Small-Kevin, Unger-Jacob et al
Abstract
BACKGROUND: Three-dimensional photography of the breast offers new opportunities to advance the fields of aesthetic and reconstructive breast surgery. The following study investigates the use of three- dimensional imaging to assess changes in breast surface anatomy, volume, tissue distribution, and projection following medial pedicle reduction mammaplasty. METHODS: Preoperative and postoperative three- dimensional scans were obtained from patients undergoing short-scar medial pedicle breast reduction. Three-dimensional models were analyzed by topographical color maps, changes in the lowest point of the breast, surface measurements, and the point of maximal projection. Total breast volume and percentage volumetric tissue distribution in the upper and lower poles were also determined. RESULTS: Thirty patients underwent reduction mammaplasty (mean postoperative scan, 80 +/- 5 days). Color maps highlighted the majority of spatial changes in the central, upper poles. Reduction mammaplasty resulted in a significant decrease in the anteroposterior projection of the breast (6.3 +/- 0.2 postoperatively compared with 8.1 +/- 0.2 cm preoperatively; p <>

Internal mammary perforator recipient vessels for breast reconstruction using free TRAM, DIEP, and SIEA flaps.
Plastic and reconstructive surgery, Jul 2008, vol. 122, no. 1
p. 315-6
Munhoz-Alexandre-Mendonca.
Comment, Letter.
Comment on: Plast Reconstr Surg. 2007 Dec; 120(7):1769-73.

Salvage of a congested DIEP flap: a new technique.
Plastic and reconstructive surgery Jul 2008, vol. 122, no. 1
p. 41e-42e
Shamsian-Negin, Sassoon-Elaine, Haywood-Richard.

Utility and anatomical examination of the DIEP flap's three- dimensional image with multidetector computed tomography.
Plastic and reconstructive surgery, Jul 2008, vol. 122, no. 1
p. 40e-41e
Mihara-Makoto, Nakanishi-Misa, Nakashima-Miho, Narushima-Mitunaga, Koshima-Isao.

A local anesthetic pump reduces postoperative pain and narcotic and antiemetic use in breast reconstruction surgery: a randomized controlled trial.
Plastic and reconstructive surgery, Jul 2008, vol. 122, no. 1
p. 39-52
Rawlani-Vinay, Kryger-Zol-B, Lu-Leonard, Fine-Neil-A.
Abstract
BACKGROUND: The purpose of this study was to conduct a double-blind, randomized, prospective trial evaluating the efficacy of a local anesthetic pain pump in reducing postoperative pain, narcotic use, and the incidence of postoperative nausea and vomiting in breast reduction surgery. METHODS: Thirty-one patients undergoing bilateral breast reduction using a single technique (inferior pedicle, Wise pattern with supplemental liposuction) were enrolled. The patients were randomized to receive either 0.25% bupivacaine (n = 16) or 0.9% saline (n = 15) delivered over a period of 48 to 55 hours. All patients were monitored postoperatively and completed a written survey and telephone interview. Parameters measured over a period of 48 hours included subjective pain, episodes of postoperative nausea and vomiting, and the amount of narcotics and antiemetics used. RESULTS: There were no statistically significant differences between the two groups regarding patient age, body mass index, weight of the breast reduction, complication rate, and standardized subjective pain perception. Patients randomized to bupivacaine reported significantly lower pain scores on the day of surgery and on the first and second postoperative days when compared with patients receiving placebo (p <>

A new preoperative imaging modality for free flaps in breast reconstruction: computed tomographic angiography.
Plastic and reconstructive surgery, Jul 2008, vol. 122, no. 1

p. 38e-40e,
Rozen-Warren-M, Phillips-Timoth-J, Ashton-Mark-W, Stella-Damien-L, Taylor-G-Ian.

Sonographic assessment on breast augmentation after autologous fat graft.
Plastic and reconstructive surgery, Jul 2008, vol. 122, no. 1, p. 36e-38e
Wang-Hongyan, Jiang-Yuxin, Meng-Hua, Yu-Yuan, Qi-Keming.

Use of patient body mass index as a rationing tool in breast reduction surgery.
Plastic and reconstructive surgery, Jul 2008, vol. 122, no. 1, p. 35e-36e
Tadiparthi-Sujatha, Liew-S-H.

The transverse musculocutaneous gracilis flap for breast reconstruction: guidelines for flap and patient selection.
Plastic and reconstructive surgery, Jul 2008, vol. 122, no. 1

p. 29-38
Schoeller-Thomas, Huemer-Georg-M, Wechselberger-Gottfried.
Abstract
BACKGROUND: The transverse musculocutaneous gracilis (TMG) flap has received little attention in the literature as a valuable alternative source of donor tissue in the setting of breast reconstruction. The authors give an in-depth review of their experience with breast reconstruction using the TMG flap. METHODS: A retrospective review of 111 patients treated with a TMG flap for breast reconstruction in an immediate or a delayed setting between August of 2002 and July of 2007 was undertaken. Of these, 26 patients underwent bilateral reconstruction and 68 underwent unilateral reconstruction, and 17 patients underwent reconstruction unilaterally with a double TMG flap. Patient age ranged between 24 and 65 years (mean, 37 years). RESULTS: Twelve patients had to be taken back to the operating room because of flap-related problems and nine patients underwent successful revision microsurgically, resulting in three complete flap losses in a series of 111 patients with 154 transplanted TMG flaps. Partial flap loss was encountered in two patients, whereas fat tissue necrosis was managed conservatively in six patients. Donor-site morbidity was an advantage of this flap, with a concealed scar and minimal contour irregularities of the thigh, even in unilateral harvest. Complications included delayed wound healing (n = 10), hematoma (n = 5), and transient sensory deficit over the posterior thigh (n = 49). CONCLUSIONS: The TMG flap is more than an alternative to the deep inferior epigastric perforator (DIEP) flap in microsurgical breast reconstruction in selected patients. In certain indications, such as bilateral reconstructions, it possibly surpasses the DIEP flap because of a better concealed donor scar and easier harvest.

True incidence of all complications following immediate and delayed breast reconstruction.
Plastic and reconstructive surgery, Jul 2008, vol. 122, no. 1

p. 19-28
Sullivan-Stephen-R, Fletcher-Derek-R-D, Isom-Casey-D, Isik-F-Frank.
Abstract
BACKGROUND: Improved self-image and psychological well-being after breast reconstruction are well documented. To determine methods that optimized results with minimal morbidity, the authors examined their results and complications based on reconstruction method and timing. METHODS: The authors reviewed all breast reconstructions after mastectomy for breast cancer performed under the supervision of a single surgeon over a 6-year period at a tertiary referral center. Reconstruction method and timing, patient characteristics, and complication rates were reviewed. RESULTS: Reconstruction was performed on 240 consecutive women (94 bilateral and 146 unilateral; 334 total reconstructions). Reconstruction timing was evenly split between immediate (n = 167) and delayed (n = 167). Autologous tissue (n = 192) was more common than tissue expander/implant reconstruction (n = 142), and the free deep inferior epigastric perforator was the most common free flap (n = 124). The authors found no difference in the complication incidence with autologous reconstruction, whether performed immediately or delayed. However, there was a significantly higher complication rate following immediate placement of a tissue expander when compared with delayed reconstruction (p = 0.008). Capsular contracture was a significantly more common late complication following immediate (40.4 percent) versus delayed (17.0 percent) reconstruction

Use of 2-Octyl-Cyanoacrylate Skin Adhesive (Dermabond) for Wound Closure following Reduction Mammaplasty: A Prospective, Randomized Intervention
Plastic and reconstructive surgery, Jul 2008, vol. 122, no. 1

p. 10-8
Nipshagen-Martine-D, Hage-J-Joris, Beekman-Werner-H.
Abstract
BACKGROUND: 2-Octyl-cyanoacrylate skin adhesive may be used for surgical wound closure. However, its use in plastic surgery has not been properly assessed. METHODS: The authors conducted a prospective, randomized, controlled clinical intervention study in which the scar characteristics after use of skin adhesive were compared with those after suture closure. Bilateral reduction mammaplasty was performed in 50 patients. The method of closure (sutures versus skin adhesive) applied to each breast was determined randomly, using each patient as her own control. Scars were assessed by the patient and by a blinded panel, at 1 week, 6 weeks, and 6 months after surgery, using a visual analogue scale, the modified Hollander Wound Evaluation Scale, and the Patient and Observer Scar Assessment Scale. RESULTS: Both patients and panelists expressed an overall preference for the adhesive side as of 1 week after surgery. Patients' visual analogue scale scores for scar comfort and scar appearance and panelists' visual analogue scale scores for aesthetic outcome were significantly better for the adhesive side after 6 weeks and 6 months

Prophylactic Mastectomy and Reconstruction: Clinical Outcomes and Patient Satisfaction
Plastic and reconstructive surgery, Jul 2008, vol. 122, no. 1

p. 1-9
Spear-Scott-L, Schwarz-Karl-A, Venturi-Mark-L, Barbosa-Todd, Al- Attar-Ali.
Abstract
BACKGROUND: The purpose of this study was to evaluate both clinical outcomes and satisfaction in patients who have undergone prophylactic mastectomy and breast reconstruction. METHODS: A 5-year retrospective analysis of the senior author's (S.L.S.) experience with breast reconstruction following prophylactic mastectomy was performed. Timing, type of mastectomy and reconstruction, complications, and cancer occurrence/recurrence were examined. Patients reported their level of satisfaction and willingness to undergo the procedure again. Aesthetic outcomes were graded by an independent and blinded group of surgeons. RESULTS: There were 101 breast reconstructions performed in 74 patients following prophylactic mastectomy. With a mean follow-up of 31 months, there were three breast-site complications in this group (3 percent). Forty-seven patients in the study had a unilateral prophylactic mastectomy; on the contralateral side with cancer, there were five breast-site complications in reconstructions following therapeutic mastectomy (10 percent). Aesthetic outcome ratings by surgeons were higher in the bilateral prophylactic mastectomy and reconstruction patients compared with the cancer patients who had undergone a therapeutic mastectomy and reconstruction along with a contralateral prophylactic mastectomy; however, this difference did not reach statistical significance. Patient satisfaction was higher in the bilateral prophylactic group, with all of the patients completing the survey stating they would undergo the procedure again. CONCLUSIONS: Breast reconstruction following prophylactic mastectomy was as safe as or more safe than that following therapeutic mastectomy, which has been shown in other studies to result in a high percentage of patient satisfaction. Although not statistically significant, the results from reconstruction after prophylactic mastectomy trended toward improved aesthetic outcome with a lower complication rate compared with reconstruction after therapeutic mastectomy.

Skin banking in autologous breast reconstruction.
Plastic and reconstructive surgery, Jun 2008, vol. 121, no. 6

p. 2177-8; author reply 2178
Kovach-Stephen-J.
Comment, Letter.
Comment on: Plast Reconstr Surg. 2007 Oct; 120(5):1133-6.

The impact of obesity on patient satisfaction with breast reconstruction.
Plastic and reconstructive surgery, Jun 2008, vol. 121, no. 6

p. 1893-9
Atisha-Dunya-M, Alderman-Amy-K, Kuhn-Latoya-E, Wilkins-Edwin-G.
Abstract
BACKGROUND: As the U.S. population becomes increasingly overweight, a growing number of patients with body mass indexes greater than 30 are seeking mastectomy reconstruction. The authors' purpose was to prospectively evaluate the effect of body mass index on patient satisfaction with breast reconstruction. METHODS: Women undergoing first-time breast reconstruction at one of 12 centers in the United States and Canada were surveyed preoperatively and at postoperative year 1. Satisfaction was evaluated with two scales assessing general and aesthetic satisfaction. Using Centers for Disease Control and Prevention criteria, patients were classified as normal weight, overweight, or obese. Logistic regressions evaluated the effects of body mass index on patient satisfaction with expander/implant, pedicled transverse rectus abdominis musculocutaneous (TRAM) flap, and free TRAM flap techniques while controlling for patient age and timing of reconstruction. RESULTS: Data were available for a total of 262 patients. Patient body mass index had a significant effect on aesthetic satisfaction, particularly among patients undergoing expander/implant procedures. Compared with normal weight individuals, obese patients with expander/implants were significantly less satisfied aesthetically (odds ratio, 0.14, p = 0.02). However, there was no significant difference between obese and normal weight patients in aesthetic satisfaction with TRAM flap reconstruction. Finally, body mass index had no significant effects on general satisfaction for either expander/implant or TRAM flap technique. CONCLUSION: Although previous investigators have reported relatively high complication rates and modest aesthetic results for breast reconstruction in overweight and obese women, the authors' study suggests that patient satisfaction with reconstruction is surprisingly high in this population, particularly in cases of autogenous tissue reconstruction.

Predicting complications following expander/implant breast reconstruction: an outcomes analysis based on preoperative clinical risk.
Plastic and reconstructive surgery, Jun 2008, vol. 121, no. 6

p. 1886-92
McCarthy-Colleen-M, Mehrara-Babak-J, Riedel-Elyn et al
Abstract
BACKGROUND: Complications following postmastectomy reconstruction can cause significant morbidity. The compound effect of individual risk factors on the development of complications following expander /implant reconstruction has not, however, been well delineated. This study evaluated the impact of clinical risk factors to predict complications following postmastectomy expander/implant reconstruction. METHODS: From 2003 through 2004, 1170 expander /implant reconstructions were performed at a single center. A prospectively maintained database was reviewed. Variables including age, smoking status, body mass index, history of diabetes, hypertension, chemotherapy and/or radiation, as well as timing and laterality of reconstruction were evaluated. The primary endpoint was the development of a complication; the secondary endpoint was failure of reconstruction. RESULTS: Over the 2 year study period, 1170 expander/implant reconstructions were performed in 884 patients. The odds of developing complications was 2.2 times greater in smokers

An Innovative Three-Dimensional Approach to Defining the Anatomical Changes Occurring after Short Scar-Medial Pedicle Reduction Mammaplasty.

Plastic and reconstructive surgery, Jun 2008, vol. 121, no. 6

p. 1875-85
Tepper-Oren-M, Choi-Mihye, Small-Kevin, Unger-Jacob et al
Abstract
BACKGROUND: Three-dimensional photography of the breast offers new opportunities to advance the fields of aesthetic and reconstructive breast surgery. The following study investigates the use of three- dimensional imaging to assess changes in breast surface anatomy, volume, tissue distribution, and projection following medial pedicle reduction mammaplasty. METHODS: Preoperative and postoperative three- dimensional scans were obtained from patients undergoing short-scar medial pedicle breast reduction. Three-dimensional models were analyzed by topographical color maps, changes in the lowest point of the breast, surface measurements, and the point of maximal projection. Total breast volume and percentage volumetric tissue distribution in the upper and lower poles were also determined. RESULTS: Thirty patients underwent reduction mammaplasty (mean postoperative scan, 80 +/- 5 days). Color maps highlighted the majority of spatial changes in the central, upper poles. Reduction mammaplasty resulted in a significant decrease in the anteroposterior projection of the breast (6.3 +/- 0.2 postoperatively compared with 8.1 +/- 0.2 cm preoperatively

Breast Surgery Bulletin

Wednesday, 9 March 2011

Plastic and Reconstructive Surgery Vol 127 Iss 3 March 2011

Tuesday, 8 February 2011

Plastic and Reconstructive Surgery Vol 127 Iss 2 February 2011

Monday, 10 January 2011

Plastic and Reconstructive Surgery Vol 127 Iss 1 January 2011

Wednesday, 8 December 2010

Plastic and Reconstructive Surgery Vol 126 Iss 6 December 2010

Monday, 15 November 2010

Plastic and Reconstructive Surgery Vol 126 Iss 5 November 2010

Wednesday, 6 October 2010

Plastic and Reconstructive Surgery Vol 126 Iss 4 October 2010

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Plastic and Reconstructive Surgery Vol 126 Iss 3 September 2010

Monday, 23 August 2010

Plastic and Reconstructive Surgery Vol 126 Iss 2 August 2010

Monday, 5 July 2010

Plastic and Reconstructive Surgery Vol 126 Issue 1 July 2010

Tuesday, 15 June 2010

Plastic and Reconstructive Surgery Vol 125 Iss 6 June 2010

Tuesday, 4 May 2010

Plastic and Reconstructive Surgery Vol 125 Iss 5 May 2010

Monday, 19 April 2010

Plastic & Reconstructive Surgery Vol 125 Iss 4 April 2010

Friday, 6 March 2009

Plastic & Reconstructive Surgery Vol 123 No 2 2009

Friday, 22 August 2008

Plastic and reconstructive surgery Jun and Jul 2008

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