Simultaneous Mastopexy Explantation With a Vertical Bipedicle and Novel Open Pattern Marking Technique.

There are limited studies in the plastic surgery literature that detail technical considerations in simultaneous breast implant removal and mastopexy procedures. These procedures are difficult, with significant potential for complications and poor cosmesis. The current plastic surgery literature describes a limited number of techniques that address these concerns, virtually all of which are variants of superior or superior medial pedicle vertical pattern mastopexy.

Outcomes After Elevation of Serratus Anterior Fascia During Prosthetic Breast Reconstruction.

Background: Achieving optimal inferolateral coverage is critical to successful prosthetic breast reconstruction. Serratus anterior fascia (SF) elevation, a promising alternative to muscle flaps and acellular dermis (ADM), has not been rigorously studied. This study evaluates complication rates after mastectomy and immediate tissue expander (TE) coverage using SF, relative to other existing methods of reconstruction.

Analysis of risk factors for complications in expander/implant breast reconstruction by stage of reconstruction.

Background: Expander/implant breast reconstruction is a common approach to breast reconstruction. Although several studies evaluate risk factors for complications during the overall reconstructive process, no studies currently evaluate risk factors by stage of reconstruction. This information is important, as it can help guide physician and patient decision making.

A Pilot Assessment of Ethnic Differences in Cosmetic Outcomes following Breast Conservation Therapy.

Background: One of the primary benefits of breast conserving therapy (BCT) is the potential ability to preserve the aesthetic appearance of the breast. However, current literature and clinical experience suggest that the aesthetic benefits of BCT may not be equally shared among ethnic groups. This is a pilot study that uses novel techniques to evaluate the cosmetic outcomes of African American and white women following BCT.

Comparison of Delayed and Immediate Tissue Expander Breast Reconstruction in the Setting of Postmastectomy Radiation Therapy.

Background: Despite the continued demand for immediate prosthetic breast reconstruction, some suggest that delayed reconstruction may reduce complications. However, with limited comparative data available, the extent of this benefit is unclear, particularly in the setting of postmastectomy radiation therapy (PMRT). This study evaluates outcomes after mastectomy and delayed tissue expander reconstruction (DTER) or immediate tissue expander reconstruction (ITER).

Body mass index as a continuous predictor of outcomes after expander-implant breast reconstruction.

Background: Studies show that obesity is a risk factor for complications after expander/implant breast reconstructions. However, reports vary on the precise threshold of body mass index (BMI) as a predictor of heightened risk. We endeavored to link BMI as a continuous variable to overall complications in a single-surgeon series of expander-implant reconstructions.

Reconstruction of the inframammary fold using barbed suture.

Achieving accurate inframammary fold (IMF) position and definition during breast reconstruction is a critical step toward obtaining optimal aesthetic outcomes. This article presents a simple technique for IMF reconstruction after implant-based breast reconstruction with an internal running, barbed suture. The results of this technique are retrospectively reviewed in 45 patients, with only 2 patients requiring additional procedures to adjust IMF position for a total revision rate of 4.

Outcomes of immediate tissue expander breast reconstruction followed by reconstruction of choice in the setting of postmastectomy radiation therapy.

A common sequence for performing staged tissue expander breast reconstruction is to immediately insert a tissue expander, complete expansion before radiotherapy, and then perform the definitive reconstruction after radiotherapy is complete. This study evaluates the outcomes of this treatment regimen in 237 patients over a 10-year period at Northwestern Memorial Hospital. Overall, 62% of the patients successfully completed tissue expander/implant reconstruction, 22.

The differential effect of BMI on prosthetic versus autogenous breast reconstruction: a multivariate analysis of 12,986 patients.

Background: The comparative safety of breast reconstruction in obese patients remains to be clearly defined. This study utilized multi-institutional data to characterize the effect of body mass index (BMI) on breast reconstruction outcomes.

Methods: Utilizing Current Procedural Terminology (CPT) codes, patients undergoing tissue expander, pedicled transverse rectus abdominis myocutaneous (TRAM) flap, latissimus dorsi flap, and free flap breast reconstruction were identified in the National Surgical Quality Improvement Program (NSQIP) database.

Two surgeons, one patient: the impact of surgeon-surgeon familiarity on patient outcomes following mastectomy with immediate reconstruction.

Background: Mastectomy with immediate reconstruction requires the coordination and expertise of two distinct surgeons. This often results in several different combinations of mastectomy and reconstructive surgeons, but with an unknown impact on patient outcomes. We evaluate the effect of different surgical teams on complication rates following mastectomy and immediate reconstruction.

A multi-institutional perspective of complication rates for elective nonreconstructive breast surgery: an analysis of NSQIP data from 2006 to 2010.

Background: As elective nonreconstructive breast surgery increases in popularity, there is greater demand for accurate multi-institutional data on minor and major postoperative complications.

Objective: The authors utilized a multi-institutional database to compare 30-day morbidities and reoperation rates among the different types of elective nonreconstructive breast surgery.

Methods: Patients in the National Surgical Quality Improvement Program (NSQIP) participant use file who underwent elective nonreconstructive breast surgery between 2006 and 2010 were identified.

Use of the tabbed expander in latissimus dorsi breast reconstruction.

Latissimus dorsi (LD) myocutaneous flap breast reconstruction with a tissue expander/implant is a post-mastectomy option often used as a salvage procedure for a failed tissue expander (TE). The patient is traditionally placed in the lateral decubitus position for flap dissection and is re-prepped and re-draped in the supine position for placement of the tissue expander. A new generation of anatomically-shaped, tabbed tissue expanders are increasingly being used in place of traditional untabbed expanders.

Utility of acellular dermis-assisted breast reconstruction in the setting of radiation: a comparative analysis.

Background: The role of acellular dermis in immediate prosthetic breast reconstruction remains unclear, particularly within a radiated field. The authors evaluated and compare outcomes following reconstruction with and without acellular dermis, and analyzed patients exposed to radiation therapy.

Methods: Retrospective review of 417 consecutive patients (592 breasts) treated from January of 2006 to October of 2008 at one institution was performed.

Hematoma after mastectomy with immediate reconstruction: an analysis of risk factors in 883 patients.

Background: Mastectomy followed by breast reconstruction presents unique circumstances, such as 2 operating teams, that may affect the likelihood of postoperative bleeding. This study evaluates risk factors for hematoma formation in patients undergoing mastectomy with immediate implant reconstruction.

Methods: The charts of 883 patients (1199 breasts) who underwent mastectomy and immediate tissue expander reconstruction between April 1998 and August 2008 at a single institution were retrospectively reviewed.

Long-term outcomes following fat grafting in prosthetic breast reconstruction: a comparative analysis.

Background: Autologous fat grafting has become a common technique for optimizing aesthetic outcomes following breast reconstruction. Its long-term oncologic implications, however, remain unclear. The authors evaluated long-term outcomes following tissue expander breast reconstruction with and without fat grafting.

Ascending necrotizing fasciitis of the face following odontogenic infection.

Necrotizing fasciitis (NF) of the face is a rare but extremely dangerous complication of dental infection associated with a nearly 30% mortality rate. This infection spreads rapidly along the superficial fascial planes of the head and neck and can lead to severe disfigurement. Reports in the literature of cases of NF of the face caused by dental infection are few.

Outcomes of tissue expander/implant breast reconstruction in the setting of prereconstruction radiation.

Background: Although the effects of postoperative radiation on tissue expander breast reconstruction are well documented, few data exist regarding the effects of prereconstruction radiation. This study evaluates the outcomes of tissue expander breast reconstruction in women with prereconstruction radiation.

Methods: This study retrospectively evaluated two treatments: (1) mastectomy without reconstruction followed by postoperative radiation and delayed reconstruction (10 patients) and (2) failed breast-conserving therapy (lumpectomy plus radiotherapy) necessitating mastectomy and immediate reconstruction (66 patients).

Additive risk of tumescent technique in patients undergoing mastectomy with immediate reconstruction.

Background: The potential advantages of tumescent mastectomy technique have been increasingly discussed within the literature. However, there is concern that tumescent solution may also affect postoperative complication rates. This study evaluates patient outcomes following tumescent mastectomy and immediate implant reconstruction.

A prospective study of 708 form-stable silicone gel breast implants.

Background: Form-stable silicone gel breast implants represent the fifth generation of silicone gel augmentation devices. Additional crosslinking between the silicone molecules allows these implants to retain their shape, especially in the vertical position.

Objective: The authors evaluate the efficacy of Silimed form-stable silicone gel breast implants.