Revisiting the internal mammaries as recipient vessels in breast reconstruction: considerations in current practice.

Background: The internal mammary artery (IMA) has supplanted the thoracodorsal artery as the primary recipient vessel in autologous breast reconstruction. Additionally, the IMA continues to be the preferred bypass graft choice in patients undergoing coronary artery bypass grafting (CABG). However, practice patterns in breast reconstruction have evolved considerably since the adoption of the IMA for this application.

Bipedicle-Conjoined Deep Inferior Epigastric Perforator Flaps for Unilateral Breast Reconstruction in Overweight and Obese Patients: Do the Benefits Outweigh the Risks?

Background:  Some surgeons have advocated for the use of bipedicle-conjoined deep inferior epigastric perforator (DIEP) flaps in unilateral autologous breast reconstruction in thin patients in whom a hemiabdominal flap is deemed insufficient. There have been no studies to date, however, exploring complication rates for bipedicle-conjoined DIEP flaps for unilateral reconstruction in overweight or obese patients.

Methods:  The authors performed a retrospective review of two senior authors' patients from 2013 until 2018.

Unilateral Autologous Breast Reconstruction with Bi-pedicled, Conjoined Deep Inferior Epigastric Perforator Flaps.

Background:  The abdomen remains the most popular and reliable donor site for autologous breast reconstruction. Some patients, however, lack sufficient tissue to recreate an aesthetic breast mound using a single-pedicle, deep inferior epigastric perforator (DIEP) flap, particularly when matching a contralateral native breast. The amount of abdominal skin and/or soft tissue reliably supplied by one vascular pedicle is frequently insufficient to adequately restore the breast skin envelope and "footprint.

Risk Factors for Postoperative Venous Thromboembolic Complications after Microsurgical Breast Reconstruction.

Background:  Venous thromboembolism (VTE) is a significant cause of postoperative morbidity and a focus of patient safety initiatives. Despite giving appropriate prophylaxis in accordance with the Caprini risk assessment model, we observed a high incidence of VTE in patients undergoing microsurgical breast reconstruction at our institution. To explore factors contributing to these events, we compared patients undergoing microsurgical breast reconstruction who sustained postoperative VTEs to those who did not.

Bipedicle-conjoined perforator flaps in breast reconstruction.

Background: For some patients seeking autologous breast reconstruction, there may be insufficient abdominal skin and soft tissue to reconstruct an adequately sized breast. Perfusion from a single-pedicle deep inferior epigastric perforator artery flap has a high degree of variability across the midline, and this further limits perfusion. We have found that bipedicle-conjoined abdominal perforator flaps are a novel and reliable technique for reconstruction in these women, and this study examines our experience.

Breast reconstruction with deep inferior epigastric artery perforator flap: 3.0-T gadolinium-enhanced MR imaging for preoperative localization of abdominal wall perforators.

Purpose: To prospectively evaluate 3.0-T gadolinium-enhanced magnetic resonance (MR) imaging for localization of inferior epigastric artery (IEA) perforators before reconstructive breast surgery involving a deep inferior epigastric perforator (DIEP) flap.

Materials And Methods: This study was exempt from institutional review board approval, and the requirement for informed patient consent was waived.

Use of irradiated cartilage in rhinoplasty of the non-Caucasian nose.

Background: Aesthetic correction of the non-Caucasian nose may require a high volume of graft material to achieve an aesthetically pleasing shape and contour while maintaining characteristics in keeping with the patient's ethnicity.

Objective: We report our experience with the long-term use of irradiated homograft costal cartilage (IHCC) in 17 non-Caucasian patients.

Methods: Individually packaged specimens of IHCC were obtained from government-approved tissue banks for intraoperative use in the augmentation of the dorsum as an onlay graft and, when necessary, to create maxillary-columellar-tip (MCT) struts and crural and spreader grafts.