Evaluating Postoperative Narcotic Use in Prepectoral Versus Dual-plane Breast Reconstruction Following Mastectomy.

Background: The majority of postmastectomy breast reconstruction performed in the United States is device-based. Typically, a tissue expander or implant is placed in the dual-plane (ie, subpectoral). Prepectoral breast reconstruction with acellular dermal matrices following mastectomy is a relatively new technique that has favorable outcomes with minimal complications and satisfactory aesthetic results.

SPY Elite's Ability to Predict Nipple Necrosis in Nipple-Sparing Mastectomy and Immediate Tissue Expander Reconstruction.

Background: Nipple-sparing techniques have improved the aesthetics of reconstruction following mastectomy, but nipple necrosis complicates up to 37% of procedures, distressing patients, delaying adjuvant therapy, and compromising outcomes. No method reliably detects nipple necrosis better than clinical assessment of tissue perfusion. We prospectively assessed the accuracy of intraoperative indocyanine green laser angiography to predict nipple necrosis.

Hyperbaric Oxygen following Bilateral Skin-sparing Mastectomies: A Case Report.

We describe a case in which hyperbaric oxygen therapy was used to salvage ischemic skin flaps after nipple-sparing mastectomy.

Evaluating sterile human acellular dermal matrix in immediate expander-based breast reconstruction: a multicenter, prospective, cohort study.

Background: Human acellular dermal matrices have gained increasing use in immediate expander-based breast reconstruction. However, some studies suggest that these grafts may be associated with a higher incidence of infection and seroma. To evaluate complication rates after matrix-based breast reconstruction, the authors conducted a prospective, multicenter, cohort study to evaluate a sterile human acellular dermal matrix in immediate expander-based breast reconstruction, specifically, to determine whether it offered a more favorable risk profile with respect to infection and seroma.

Nipple areola reconstruction.

Nipple areola reconstruction is often considered the "finishing touch" in the process of breast reconstruction after surgery for breast cancer. Attention to detail with respect to patient selection, timing of reconstruction and surgical technique must therefore be paid to avoid an unsatisfactory result that may taint an otherwise successful reconstructive sequence. There are many surgical techniques available to recreate the nipple areola complex, but each of the various techniques is designed to accomplish similar goals.

Breast reconstruction with prosthetic implants.

For patients who undergo mastectomy for the treatment of breast cancer, the restoration of a normal breast form through breast reconstruction is important to body image and quality of life. Implant-based reconstruction has the capability of producing excellent results in the well selected patient. In addition, compared with autogenous tissue reconstruction, implant reconstruction offers a shorter operative procedure with a quicker convalescence and no donor site morbidity.

Vascularized calvarial bone flaps and midface reconstruction.

Learning Objectives: After studying this article, the participant should be able to: 1. Identify the fascial layers of the temporalis region. 2.

The role of peripheral nerve surgery in the treatment of chronic pain associated with amputation stumps.

Background: Debilitating pain following amputation surgery can seriously affect the long-term success of the operation and the patient's quality of life. Often, such patients are unable to ambulate because of pain when using a prosthesis; become grouped in the chronic pain category; and are treated with high-dose narcotics, antidepressants, or other methods to treat symptoms that may provide little or no relief. Little attention has been given to the role of peripheral nerve surgery as an early treatment option.

The versatility of the superomedial pedicle with various skin reduction patterns.

Background: The inferior pedicle technique remains one of the most commonly used techniques in breast reduction surgery, despite lengthy operating times, poor nipple sensation, and bottoming-out over time. The superomedial pedicle in reduction mammaplasty has previously been described using limited incision patterns. This study evaluated the safety and reliability of the superomedial pedicle with various skin reduction patterns and compared the surgical time with the inferior pedicle technique.

Implant-based reconstruction.

Prosthetic reconstruction of the breast, either with standard or adjustable implants or as a staged procedure with tissue expanders followed by implants, has evolved into a reliable method for breast reconstruction. Advances in implant technology and biomaterials allow for low complication rates, good aesthetic outcomes, and consistent results. Potential advantages over other reconstructive techniques include the relative simplicity of the procedures, the use of adjacent tissue without significant donor site morbidity, reduced operative time, and quicker patient recovery.

Mechanisms and clinical applications of the vacuum-assisted closure (VAC) Device: a review.

The use of sub-atmospheric pressure dressings, available commercially as the vacuum-assisted closure (VAC) device, has been shown to be an effective way to accelerate healing of various wounds. The optimal sub-atmospheric pressure for wound healing appears to be approximately 125 mm Hg utilizing an alternating pressure cycle of 5 minutes of suction followed by 2 minutes off suction. Animal studies have demonstrated that this technique optimizes blood flow, decreases local tissue edema, and removes excessive fluid from the wound bed.