Engineering vascularized soft tissue flaps in an animal model using human adipose-derived stem cells and VEGF+PLGA/PEG microspheres on a collagen-chitosan scaffold with a flow-through vascular pedicle.

Insufficient neovascularization is associated with high levels of resorption and necrosis in autologous and engineered fat grafts. We tested the hypothesis that incorporating angiogenic growth factor into a scaffold-stem cell construct and implanting this construct around a vascular pedicle improves neovascularization and adipogenesis for engineering soft tissue flaps. Poly(lactic-co-glycolic-acid/polyethylene glycol (PLGA/PEG) microspheres containing vascular endothelial growth factor (VEGF) were impregnated into collagen-chitosan scaffolds seeded with human adipose-derived stem cells (hASCs).

Automated calculation of ptosis on lateral clinical photographs.

Rationale, Aims And Objectives: The goal is to fully automate the calculation of a breast ptosis measure from clinical photographs through automatic localization of fiducial points relevant to the measure.

Methods: Sixty-eight women (97 clinical photographs) who underwent or were scheduled for breast reconstruction were included. The photographs were divided into a development set (N = 49) and an evaluation set (N = 48).

Harvesting technique affects adipose-derived stem cell yield.

Background: The success of an autologous fat graft depends in part on its total stromal vascular fraction (SVF) and adipose-derived stem cells (ASCs). However, variations in the yields of ASCs and SVF cells as a result of different harvesting techniques and donor sites are poorly understood.

Objective: To investigate the effects of adipose tissue harvesting technique and donor site on the yield of ASCs and SVF cells.

Combining decellularized human adipose tissue extracellular matrix and adipose-derived stem cells for adipose tissue engineering.

Repair of soft tissue defects resulting from lumpectomy or mastectomy has become an important rehabilitation process for breast cancer patients. This study aimed to provide an adipose tissue engineering platform for soft tissue defect repair by combining decellularized human adipose tissue extracellular matrix (hDAM) and human adipose-derived stem cells (hASCs). To derive hDAM incised human adipose tissues underwent a decellularization process.

Automated Identification of Fiducial Points on 3D Torso Images.

Breast reconstruction is an important part of the breast cancer treatment process for many women. Recently, 2D and 3D images have been used by plastic surgeons for evaluating surgical outcomes. Distances between different fiducial points are frequently used as quantitative measures for characterizing breast morphology.

The advantages of free abdominal-based flaps over implants for breast reconstruction in obese patients.

Background: The authors hypothesized that, for obese patients, delayed abdominal-based free flap (rather than implant-based and immediate) breast reconstruction would result in fewer overall complications and reconstruction losses.

Methods: The authors retrospectively analyzed consecutive implant- and abdominal-based free flap breast reconstructions performed in obese patients between 2005 and 2010 by utilizing the World Health Organization obesity classifications: class I, 30.0 to 34.

A novel quantitative measure of breast curvature based on catenary.

Quantitative, objective measurements of breast curvature computed from clinical photographs could be used to investigate factors that impact reconstruction and facilitate surgical planning. This paper introduces a novel quantitative measure of breast curvature based on catenary. A catenary curve is used to approximate the overall curvature of the breast contour, and the curvature measure is extracted from the catenary curve.

Automated spatial alignment of 3D torso images.

This paper describes an algorithm for automated spatial alignment of three-dimensional (3D) surface images in order to achieve a pre-defined orientation. Surface images of the torso are acquired from breast cancer patients undergoing reconstructive surgery to facilitate objective evaluation of breast morphology pre-operatively (for treatment planning) and/or post-operatively (for outcome assessment). Based on the viewing angle of the multiple cameras used for stereophotography, the orientation of the acquired torso in the images may vary from the normal upright position.

3D Symmetry Measure Invariant to Subject Pose During Image Acquisition.

In this study we evaluate the influence of subject pose during image acquisition on quantitative analysis of breast morphology. Three (3D) and two-dimensional (2D) images of the torso of 12 female subjects in two different poses; (1) hands-on-hip (HH) and (2) hands-down (HD) were obtained. In order to quantify the effect of pose, we introduce a new measure; the 3D pBRA (Percentage Breast Retraction Assessment) index, and validate its use against the 2D pBRA index.

Validation of stereophotogrammetry of the human torso.

The objective of this study was to determine if measurements of breast morphology computed from three-dimensional (3D) stereophotogrammetry are equivalent to traditional anthropometric measurements obtained directly on a subject using a tape measure. 3D torso images of 23 women ranged in age from 36 to 63 who underwent or were scheduled for breast reconstruction surgery were obtained using a 3dMD torso system (3Q Technologies Inc., Atlanta, GA).

Analysis of Breast Contour using Rotated Catenary.

Surgical reconstruction of natural-appearing breasts is a challenging task. Currently, surgical planning is limited to the surgeon's subjective assessment of breast morphology. Therefore, it is useful to develop objective measurements of breast contour.

A pilot study on using eye tracking to understand assessment of surgical outcomes from clinical photography.

Appearance changes resulting from breast cancer treatment impact the quality of life of breast cancer survivors, but current approaches to evaluating breast characteristics are very limited. It is challenging, even for experienced plastic surgeons, to describe how different aspects of breast morphology impact overall assessment of esthetics. Moreover, it is difficult to describe what they are looking for in a manner that facilitates quantification.

Quantifying the aesthetic outcomes of breast cancer treatment: assessment of surgical scars from clinical photographs.

Rationale: Accurate assessment of the degree of scaring that results from surgical intervention for breast cancer would enable more effective pre-operative counselling. The resultant scar that accompanies an open surgical intervention may be characterized by variance in thickness, colour and contour. These factors significantly impact the overall appearance of the breast.

Automated calculation of symmetry measure on clinical photographs.

Rationale, Aims And Objectives: The quality of life of breast cancer survivors is ameliorated by minimizing adverse effects on their physical appearance. Breast reconstruction is important for restoring the survivor's appearance. In breast reconstructive surgery, there is a need to develop technologies for quantifying surgical outcomes and understanding women's perceptions of changes in their appearance.

Animal models for adipose tissue engineering.

There is a critical need for adequate reconstruction of soft tissue defects resulting from tumor resection, trauma, and congenital abnormalities. To be sure, adipose tissue engineering strategies offer promising solutions. However, before clinical translation can occur, efficacy must be proven in animal studies.

Epidermal overgrafting improves coloration in remote flaps and grafts applied to the face for reconstruction.

Background: Flaps and grafts applied to the face from sites below the clavicles are mismatched with regard to their coloration compared with normal facial skin. The color can be improved by removing the epidermis and overgrafting with a thin, split-thickness skin graft of scalp epidermis. This report reviews the authors' clinical experience using this technique.

Coordinated prophylactic surgical management for women with hereditary breast-ovarian cancer syndrome.

Background: Women with BRCA1 or BRCA2 mutations have a substantially increased risk of breast and ovarian cancer compared with the general population. Therefore, prophylactic mastectomy (PM) and bilateral salpingo-oophorectomy (BSO) have been proposed as risk-reduction strategies for BRCA1/2 mutation carriers. We aimed to assess the feasibility of coordinated PM and BSO in hereditary breast-ovarian cancer syndrome.

Assessment of breast aesthetics.

A good aesthetic outcome is an important endpoint of breast cancer treatment. Subjective ratings, direct physical measurements, measurements on photographs, and assessment by three-dimensional imaging are reviewed and future directions in aesthetic outcome measurements are discussed. Qualitative, subjective scales have frequently been used to assess aesthetic outcomes following breast cancer treatment.

A research agenda for appearance changes due to breast cancer treatment.

Breast cancer is one of the most prevalent forms of cancer in the US. It is estimated that more than 180,000 American women will be diagnosed with invasive breast cancer in 2008. Fortunately, the survival rate is relatively high and continually increasing due to improved detection techniques and treatment methods.

The efficacy of bilateral lower abdominal free flaps for unilateral breast reconstruction.

Background: In large-breasted women, those with midline abdominal scars, or those with scant abdominal tissue, a unipedicled lower abdominal flap may be insufficient for breast reconstruction. In these circumstances, bipedicled flaps may best satisfy the reconstructive requirements, but outcomes with bilateral free flaps for unilateral breast reconstruction are generally lacking.

Methods: A retrospective review of patients in whom two vascular pedicles/flaps were used to simultaneously reconstruct a single breast was used to assess operative outcomes.

Revision in autologous breast reconstruction: principles and approach.

As breast reconstruction has an aesthetic endpoint, secondary surgical intervention is an integral part of this process. This article examines revision in autologous breast reconstruction from the perspective of clinical priority. The authors examine challenges they may be faced in autologous breast reconstructions and suggest surgical approaches toward their resolution.

Objective assessment of aesthetic outcomes of breast cancer treatment: measuring ptosis from clinical photographs.

The aesthetic outcome of breast cancer treatment is an important factor in breast cancer survivors' quality of life. We investigated new quantitative, objective measurements of breast ptosis based on ratios of distances between fiducial points manually identified in oblique and lateral clinical photographs. Ptosis refers to the extent to which the nipple is lower than the inframammary fold.