Staged breast reconstruction utilizing primary nipple repositioning surgery prior to nipple-sparing mastectomy.

Staged nipple-sparing mastectomy (NSM) following mastopexy or breast reduction has become increasingly utilized in patients with large or ptotic breasts. The safety and efficacy of this approach has been demonstrated in recent years. However, the optimal timing between stages has not been established.

Strategic Approaches to Intraflap Anastomosis: Navigating Conjoined DIEP Flap Reconstruction-A Comprehensive Roadmap.

Background: For patients desiring autologous breast reconstruction without adequate abdominal tissue volume, the deep inferior epigastric perforator (DIEP) flap may be stacked or combined with other flaps for bilateral reconstruction. Various combinations of anastomoses have been described in the literature. We sought to describe a framework for intraflap anastomoses.

Modern Approaches to Breast Neurotization.

Absent or diminished breast sensation is a persistent problem for many postmastectomy patients. Breast neurotization is an opportunity to improve sensory outcomes, which are poor and unpredictable if left to chance. Several techniques for autologous and implant reconstruction have been described with successful clinical and patient-reported outcomes.

Pyoderma gangrenosum after deep inferior epigastric perforator flap: How prompt diagnosis and treatment can avoid surgical debridement and further morbidity.

Pyoderma gangrenosum (PG) is a skin disorder characterized by painful, enlarging necrotic ulcers with bluish borders surrounded by advancing zones of erythema. The key histologic feature is neutrophilic infiltration of the superficial and deep layers of the dermis and the absence of microorganisms. Although rare and associated with autoimmune diseases such as rheumatoid arthritis, ulcerative colitis and Crohn's disease, the diagnosis is commonly missed at presentation and patients are often treated for infection with antibiotics and surgical debridement.

Antitumor Immunity from Abdominal Flap-Embedded Therapeutic Cancer Vaccine.

Background: Abdominal flaps are routinely performed in clinic after primary mastectomy of breast cancer. However, cancer patients can still develop cancer recurrence and metastasis after surgery. In this study, we evaluated the feasibility of concurrent abdominal flap reconstruction and vaccine inoculation in the tissue for prevention and treatment of HER2-positive breast cancer.

Refining the Rib-sparing Approach in Microsurgical Breast Reconstruction: Keys to Success.

Background:  Free tissue transfer using microsurgical techniques is a popular option for breast reconstruction, and the internal mammary vessels remain the most popular recipient vessels for the anastomosis. Traditionally, ribs were resected for better access to these vessels in the intercostal space. However, rib resection has the potential for complications and adds a surgical step.

Safety of Routine Pedicle Division during Delayed Breast Augmentation following Free Flap Breast Reconstruction.

Background: Autologous free flap breast reconstruction is a common reconstructive procedure, with the ability to produce a natural breast shape and a long history of success. Despite its benefits, there are special situations in which patients lack sufficient donor-site tissue to achieve adequate breast size and projection. With this study, the authors describe their institutional experience of delayed implant augmentation after autologous breast reconstruction with a particular focus on pedicle division as a technique to improve aesthetic results.

Efficacy of Closed Incision Negative Pressure Wound Therapy on Abdominal Donor Site After Free Flap Breast Reconstruction.

Introduction: Negative pressure wound therapy (NPWT) has been used to treat acute and chronic wounds in a variety of scenarios. Specifically, in autologous breast reconstruction, studies investigating the use of closed incision NPWT (ciNPWT) in breast surgery are lacking.

Objective: The aim of this study was to analyze the use of ciNPWT at the abdominal donor site following deep inferior epigastric perforator (DIEP) flap breast reconstruction.

How to Maximize Aesthetics in Autologous Breast Reconstruction.

With continuous technical and functional advances in the field of breast reconstruction, there is now a greater focus on the artistry and aesthetic aspects of autologous reconstruction. Whereas once surgeons were most concerned with flap survival and vessel patency, they are now dedicated to reconstructing a similarly or even more aesthetically pleasing breast than before tumor resection. We discuss the approach to shaping the breast through the footprint, conus, and skin envelope.

Incidental Findings in CT and MR Angiography for Preoperative Planning in DIEP Flap Breast Reconstruction.

Background: Autologous breast reconstruction with deep inferior epigastric perforator flaps is considered a standard of care in the treatment after mastectomy, yet vascular anatomy is highly variable and perforator selection remains challenging. The use of preoperative imaging can influence surgical planning and assist intraoperative decision-making. However, this imaging can inevitably uncover incidental findings.

2020 special issue: Twenty years of breast reconstruction: Past, present, and future.

Breast reconstruction has evolved in the last 25 years to provide women with better autologous and implant-based options. The general trends of breast reconstruction have shifted to skin and nipple-areolar complex preservation, resulting in improved aesthetics and patient satisfaction. Autologous reconstruction has made a dramatic movement toward microsurgical reconstruction by free tissue transfer and has addressed lymphedema and breast sensation.

Sensory Recovery of the Breast following Innervated and Noninnervated DIEP Flap Breast Reconstruction.

Background: The sensory recovery of the breast remains an undervalued aspect of autologous breast reconstruction. The aim of this study was to evaluate the effect of nerve coaptation on the sensory recovery of the breast following DIEP flap breast reconstruction and to assess the associations of length of follow-up and timing of the reconstruction.

Methods: A prospective comparative study was conducted of all patients who underwent either innervated or noninnervated DIEP flap breast reconstruction and returned for follow-up between September of 2015 and July of 2017.

Management of Microsurgical Patients using Intraoperative Unfractionated Heparin and Thromboelastography.

Background:  Maintaining optimal coagulation is vital for successful microvascular tissue transfer. The viscoelastic thromboelastography (TEG) is a modern and dynamic method to assess a patient's coagulation status. The aim of this study was to evaluate its diagnostic capabilities of identifying microvascular complications.

Two successful cases of DIEP flaps for breast reconstruction in patients with Factor V Leiden.

Factor V Leiden (FVL) is the most common inherited hypercoagulable condition. It is a genetic disorder caused by a missense mutation that prevents inactivation of Factor V in the clotting cascade, leading to overproduction of thrombin and excess clotting. This pathophysiological process is especially unfavorable in patients undergoing free tissue transfer.

Nipple viability after nipple-sparing mastectomy in patients with prior circum-areolar incisions.

Nipple-areola-sparing mastectomy (NSM) is becoming more commonplace as it offers a more esthetic breast appearance while still appropriately treating malignancy. However, patients with prior circum-areolar incisions are often considered at risk for nipple viability. The authors present a case series of all patients undergoing NSM at their institution between 2012 and 2016.

Implications of Internal Mammary Lymph Node Sampling During Microsurgical Breast Reconstruction.

Introduction: Internal mammary lymph node (IMN) chain assessment for breast cancer is controversial; however, current oncologic data have shed new light on its importance. Metastatic involvement of the IMN chain has implications for staging, prognosis, treatment, and survival. Here, we analyzed our data gathered during sampling of the IMN and the oncologic treatment changes that resulted from our findings.

Algorithmic Approach for Intraoperative Salvage of Venous Congestion in DIEP Flaps.

Background:  Flap congestion is a frequently described intraoperative complication during autologous breast reconstruction with abdominal perforator flaps, which, if not addressed, can lead to detrimental results such as flap failure. Here, we describe our institution's algorithm of intraoperative salvage of congested flaps and present their outcomes.

Patients And Methods:  All patient charts from 2002 to 2016 of a single plastic surgeon were reviewed for patients who underwent deep inferior epigastric perforator flap breast reconstruction resulting in 602 patients and 831 flaps.

Risk-Reducing Mastectomy and Breast Reconstruction: Indications and Evidence for Current Management Strategies.

Breast cancer affects nearly every woman either personally or through a family member or friend. Awareness of associated familial and genetic risks has been steadily increasing over the last decade. Bilateral risk-reduction mastectomy seeks to decrease the incidence and mortality of breast cancer in women without abnormality but with elevated risk of developing cancer.

Sensation of the autologous reconstructed breast improves quality of life: a pilot study.

Purpose: The number of breast cancer survivors continues to grow. Due to refinements in operating techniques, autologous breast reconstruction has become part of standard care. Impaired sensation remains a debilitating side effect with a significant impact on the quality of life.