Nomogram-based Approach for Predicting Complication Risks Following Prepectoral Direct-to-Implant Breast Reconstruction.

Background: Despite the recent steep rise in the use of prepectoral direct-to-implant (DTI) breast reconstruction, concerns remain regarding the potentially risk of complications, resulting in the selective application of the technique; however, the selection process was empirically based on the operator's decision. Using patient and operation-related factors, this study aimed to develop a nomogram for predicting postoperative complications following prepectoral DTI reconstruction.

Methods: Between August 2019 and March 2023, immediate prepectoral DTI was performed for all patients deemed suitable for one-stage implant-based reconstruction.

Association of Weight-Bearing Activity and Prognosis of Plantar Melanoma: An Unanticipated Perspective.

Background: In the development of plantar melanoma, it is suspected that mechanical stress caused by weight-bearing activities, such as walking, rather than ultraviolet exposure, may play a significant role, showing a concentrated prevalence in areas of the foot where weight-bearing actions are prevalent. However, research investigating whether such mechanical stress influences disease prognosis has been limited. This study was designed to investigate the association between weight-bearing activity and the oncologic outcomes of patients with plantar melanoma.

Optimizing Intraflap Anastomosis of Conjoined Bilateral DIEP Flap for Breast Reconstruction: Planning, Execution and Outcomes in 201 patients.

Background: Conjoined bilateral deep inferior epigastric perforator (DIEP) flap with intraflap anastomosis is an efficient approach for breast reconstruction, enabling the use of almost the entire abdominal tissue. Variations in bilateral DIEA anatomy may make it challenging to apply this technique consistently. This study aimed to derive optimal strategies for achieving reliable conjoined bilateral DIEP flap with intraflap anastomosis universally.

Learning curve for robot-assisted nipple-sparing mastectomy: A single institution experience.

Background: Robot-assisted nipple sparing mastectomy (RANSM) is emerging because it offers hidden incisions and ergonomic movements. In this study, we report the learning curve and feasibility of RANSM.

Methods: A retrospective study was conducted among women who underwent RANSM with immediate breast reconstruction from July 2019 to June 2022.

Safety of performing multiple free flap surgeries by a single surgeon in a single day.

Background: With the growing popularity of the use of free flaps, surgeons may frequently encounter situations necessitating the performance of multiple free flap surgeries in a single day. Given its prolonged duration and technical complexity, concerns remain regarding their safety. This study investigated whether a single surgeon conducting multiple free flap surgeries in a day heightens the risk of complications.

Risk Factors for Step-Off Deformity of the Donor Site following Abdominal Flap-Based Breast Reconstruction.

Background: Step-off deformity is a suboptimal aesthetic outcome at the donor site following abdominal flap harvesting for breast reconstruction. This study assessed the prevalence of step-off deformities after autologous breast reconstruction and explored the associated risk factors.

Methods: This retrospective study evaluated step-off deformities among consecutive patients who had undergone autologous abdominal flap-based breast reconstruction between January of 2019 and December of 2022.

Shifting toward total drainless approach in DIEP flap-based breast reconstruction: Evaluation of safety.

With increasing interest in swift postoperative recovery, there has been a trend toward omitting drains in deep inferior epigastric perforator (DIEP) flap-based breast reconstruction, ideally aiming to avoid drains in the breasts and abdomen. This study evaluated our transition toward total drainless reconstruction, focusing specifically on the safety of omitting drains in the breasts. Patients who underwent breast reconstruction with DIEP flap from 2018 to 2023 were reviewed.

Association of Neoadjuvant Chemotherapy With Postoperative Outcomes in Immediate Prepectoral Prosthetic Breast Reconstruction.

Purpose: Neoadjuvant chemotherapy (NACT) followed by total mastectomy and immediate reconstruction has become an important strategy in the treatment of breast cancer. Although the safety of subpectoral implant-based breast reconstruction with NACT has been extensively evaluated, the safety in prepectoral reconstruction has not been clearly elucidated. We aimed to evaluate the association of NACT with immediate prepectoral breast reconstruction outcomes.

Efficacy of the enhanced recovery after surgery protocol on reducing surgical disparities related to overweight/obesity in deep inferior epigastric perforator flap breast reconstruction.

Background: When choosing a method of deep inferior epigastric perforator (DIEP) flap for breast reconstruction, concerns regarding the potentially detrimental effects of obesity on postoperative recovery remain. Enhanced recovery after surgery (ERAS) is known to facilitate rapid postoperative recovery. This study aimed to examine the effect of the ERAS protocol on the disparity between normal/underweight and overweight/obese patients after DIEP flap breast reconstruction.

Identification of optimal flap types for color matching in free flap-based facial reconstruction in Asian population.

Large soft tissue defects of the face often require free flap-based reconstruction. To avoid a conspicuous patch-like appearance, choosing flaps with a color similar to that of the adjacent facial skin is crucial. This study aimed to identify the flap types that show the best color match via objective color evaluation.

Oncologic Outcomes of Immediate Breast Reconstruction in the Setting of Neoadjuvant Chemotherapy: A Long-term Follow-up Study of a Matched Cohort.

Purpose: Despite the increasing use of immediate breast reconstruction (IBR), its oncologic safety in the setting of neoadjuvant chemotherapy (NACT) needs to be comprehensively clarified in breast cancer management. The objective of the present study was to analyze the oncologic safety of IBR following NACT.

Methods: In total, 587 patients with breast cancer who underwent a total mastectomy (TM) with IBR after NACT between 2008 and 2017 at a single institution were retrospectively reviewed.

The early postoperative effects of rinsing the breast pocket with tranexamic acid in prepectoral prosthetic breast reconstruction.

Background: The efficacy of tranexamic acid (TXA) has been reported in breast surgery; however, its application and duration have varied across studies. This study aimed to assess the early postoperative outcomes of rinsing the breast pocket with TXA during prepectoral prosthetic breast reconstruction using an acellular dermal matrix (ADM).

Methods: A retrospective chart review was conducted in consecutive patients who underwent immediate prosthetic prepectoral reconstruction between August 2021 and December 2022.

Impact of Initial Filling Medium on Outcomes of Subpectoral, Two-Stage, Implant-Based Breast Reconstruction: Air versus Saline.

Background: In two-stage expander-based breast reconstruction, the use of air as the initial filling medium has been suggested to confer clinical advantages over conventional saline, but this has not been demonstrated in a large series. This study aimed to evaluate the association between material type (air versus saline) for initial expander filling and postoperative outcomes.

Methods: This retrospective study included patients who underwent immediate, subpectoral, tissue expander-based breast reconstruction between January of 2018 and March of 2021.

Safety of Drainless Donor Closure in DIEP Flap-Based Breast Reconstruction: A Prospective Analysis Using Ultrasound.

Background:  Although drainless donor closure with progressive tension suture (PTS) technique has been attempted to further reduce donor morbidity in deep inferior epigastric perforator (DIEP) flap-based breast reconstruction, its clinical safety has not yet been fully elucidated. This study prospectively investigated donor morbidity after DIEP flap elevation and drain-free donor closure.

Methods:  A prospective cohort study was performed on 125 patients who underwent DIEP flap-based breast reconstruction and drainless donor closure.

Association of the breast reconstruction modality with the development of postmastectomy lymphedema: A long-term follow-up study.

Background: Whether the breast reconstruction modality could influence the long-term development of post-mastectomy lymphedema has been little investigated. The present study aimed to evaluate the potential association of the breast reconstruction method with the incidence of lymphedema over an extended follow-up period.

Methods: Patients with breast cancer who underwent immediate reconstruction from 2008 to 2014 were reviewed.

Usefulness of Free Tissue Transfer for the Reconstruction of Extensive Thigh Defects.

Background:  Despite the increasing popularity of free tissue transfer, thigh defects have been alienated from their potential indication, owing to the abundance of regional reconstruction options. However, some challenging situations where locoregional modalities may lead to suboptimal outcomes often require free flap. Due to lacking studies regarding microvascular reconstruction of thigh defects, this study aimed to investigate the versatility of free tissue transfer for reconstruction of thigh defects.

Longitudinal analysis of long-term outcomes of abdominal flap-based microsurgical reconstruction and two-stage prosthetic reconstruction.

Two-stage tissue expander/implant (TE/I) and deep inferior epigastric perforator (DIEP) flaps are the two main pillars of breast reconstruction. This study aimed to conduct a longitudinal analysis of long-term outcomes after immediate DIEP- and TE/I-based reconstruction. This retrospective cohort study included patients with breast cancer who underwent immediate DIEP- or TE/I-based reconstruction between 2012 and 2017.

Short Fasciotomy-Deep Inferior Epigastric Perforator Flap Harvest for Breast Reconstruction.

Background: Despite several technical modifications to further reduce donor invasiveness in harvesting deep inferior epigastric perforator (DIEP) flaps, techniques with general applicability and demonstrating clinical benefits are scarce. The present study aimed to introduce a short-fasciotomy technique and evaluate its reliability, efficacy, and applicability by comparison with those of conventional methods.

Methods: A retrospective study was conducted with 304 consecutive patients who underwent DIEP flap-based breast reconstruction.

Natural course of fat necrosis after deep inferior epigastric perforator flap-based breast reconstruction: Evaluation based on ultrasound examination.

Background: Fat necrosis, often developing following deep inferior epigastric perforator (DIEP) flap-based breast reconstruction, is not a negligible complication. This study aimed to conduct a longitudinal assessment of the clinical course of fat necrosis in breast reconstruction with DIEP flap.

Methods: Among patients undergoing immediate DIEP flap-based breast reconstruction between 2009 and 2017, those who developed fat necrosis on ultrasonographic examination and did not undergo surgical intervention for the lesion were reviewed.

Comparison of Outcomes of Smile Reanimation Between Dual- Versus Single-Innervation Technique in Single-Stage Latissimus Dorsi Neuromuscular Transfer in Facial Paralysis Patients.

Although a dual-innervation technique has emerged in single-stage functional latissimus dorsi (LD) muscle transfer for smile reanimation, its benefits over conventional techniques have not been elucidated. To compare outcomes of dual-innervation technique with those of single-innervation. Patients with facial palsy treated with single-stage functional LD muscle transfer were identified, and categorized into two groups: single and dual innervation.

Association of Fat Graft with Breast Cancer Recurrence in Implant-Based Reconstruction: Does the Timing Matter?

Purpose: In two-stage prosthetic breast reconstruction, autologous fat graft (AFG) is often conducted simultaneously with the second-stage operation, which is usually performed shortly after mastectomy. There is a paucity of studies evaluating whether conducting AFG early, with a relatively short interval from the primary operation, is oncologically safe. This study aimed to evaluate potential associations of AFG with breast cancer prognosis, focusing on its timing.

Suggestion for the omission of post-mastectomy chest wall radiation therapy in patients who underwent skin-sparing/nipple-sparing mastectomy.

Aim: Both skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) have been widely adopted. Although postmastectomy radiation therapy (PMRT) can improve clinical outcomes, it can worsen cosmesis following reconstruction. Therefore, identifying risk factors of ipsilateral breast tumor recurrence (IBTR) could help de-escalate PMRT after NSM/SSM in patients with pT1-2 disease.

Three-dimensional Volume Changes of the Reconstructed Breast Following DIEP Flap Breast Reconstruction.

Background:  This study aimed to assess whether the reconstructed breast volume changed postoperatively following a deep inferior epigastric artery perforator (DIEP) flap.

Methods:  Patients were included if they had undergone unilateral breast reconstruction with a DIEP flap at the two selected centers between April 2017 and September 2019. Serial 3-D surface imaging of both breasts was taken at 1, 3, 6, and 12 months postoperatively.

Association of Unilateral Latissimus Dorsi Muscle Harvest for Breast Reconstruction with Postoperative Spinal Posture.

Background: The latissimus dorsi muscle originates from the lower thoracic spine with broad attachment and plays a subsidiary role in spinal postural stability. The authors investigated whether harvesting unilateral latissimus dorsi muscle for breast reconstruction could influence spinal posture in the long term.

Methods: Patients who underwent immediate unilateral breast reconstruction between 2002 and 2010 were reviewed.

Association of Preoperative Sarcopenia with Adverse Outcomes of Breast Reconstruction Using Deep Inferior Epigastric Artery Perforator Flap.

Background: Sarcopenia, defined as a significant loss of skeletal muscle mass and function, is suggested to be associated with an increased risk of complications after various surgical interventions. However, evidence regarding sarcopenia in microsurgical breast reconstruction has been lacking. The present study was designed to evaluate the association between preoperative sarcopenia and adverse outcomes in deep inferior epigastric perforator (DIEP) flap-based breast reconstruction.