Enlarged Breast Size (Macromastia) and Associated Neurologic Risks: A Scoping Review.

Background And Objectives: Symptomatic macromastia (enlarged breasts) is a syndrome of persistent headache, neck and shoulder pain, thoracic kyphosis, painful shoulder grooving from bra straps, inframammary rash, backache, and upper extremity paresthesias. Up to 89% of the 100,000 US women undergoing breast reduction surgery (reduction mammoplasty) annually report headache preoperatively with many endorsing postoperative headache improvement. Headache is one insurance indication to cover surgical reduction, and peak prevalence of migraine matches the average age of women with macromastia at time of surgery.

Patient-Reported Abdominal Morbidity Following Abdomen-Based Breast Reconstruction.

Background:  Abdominal wall morbidity occurs with increased frequency following flap harvest in the obese abdomen. Its impact on patient-reported outcomes (PROs) in breast reconstruction has been poorly characterized.

Methods:  A retrospective review of obese patients undergoing abdominal-based free autologous breast reconstruction was conducted over 15 years.

Outcomes of Nipple-Sparing Mastectomy in the Ptotic and Non-Ptotic Breast with Staged-Immediate Reconstruction Timing and Pre-Pectoral, Direct-to-Implant Technique.

Background and objectives Proven to be oncologically safe, nipple-sparing mastectomy (NSM) preserves the entire breast skin envelope and is associated with higher patient satisfaction. However, breast ptosis is a relative contraindication to NSM, limiting who it is offered to. Direct-to-implant (DTI) breast reconstruction eliminates tissue expansion and shortens the reconstructive process but may be associated with mastectomy skin flap compromise after the placement of full-volume implants.

Assessment of Flap Viability for Complex Transmetatarsal Amputation Using Indocyanine Green Fluorescent Angiography: A Case Study.

Despite advancements in the treatment of diabetic patients with "at-risk" limbs, minor and major amputations remain commonplace. The diabetic population is especially prone to surgical complications from lower extremity amputation because of comorbidities such as renal disease, hypertension, hyperlipidemia, microvascular and macrovascular disease, and peripheral neuropathy. Complication occurrence may result in increases in hospital stay duration, unplanned readmission rate, mortality rate, number of operations, and incidence of infection.

Post-breast Reduction Pyoderma Gangrenosum Managed With Gender-Affirming Top Surgery.

Pyoderma gangrenosum (PG) is a rare skin condition characterized by ulcerative lesions and most often associated with inflammatory bowel diseases (IBDs), ulcerative colitis, or Chron's disease. Postsurgical pyoderma gangrenosum (PSPG) of the breast is exceptionally rare and can occur in the absence of IBD. We report on a patient with pyoderma gangrenosum following elective breast reduction and subsequent reconstruction with gender-affirming top surgery.

Breast Reconstruction and Nipple-Sparing Mastectomy: Technical Modifications and Their Outcomes Over Time at an Academic Breast Center.

Background: Superior aesthetic outcomes can be achieved with mastectomy techniques that maximize breast envelope preservation and maintain the nipple-areolar complex. This is the impetus for the popularization of the nipple-sparing mastectomy (NSM). Nipple-sparing mastectomy is a challenging procedure due to potential ischemia of the mastectomy flap (which includes the nipple-areolar complex) and the risk of incomplete oncologic resection.

Breast Reconstruction Completion in the Obese: Does Reconstruction Technique Make a Difference in Its Achievement?

Background:  Breast mound and nipple creation are the goals of the reconstructive process. Unlike in normal body mass index (BMI) women, breast reconstruction in the obese is associated with increased risk of perioperative complications. Our aim was to determine if reconstruction technique and the incidence of perioperative complications affect the achievement of reconstruction completion in the obese female.

Dermal Regeneration Template and Staged Skin Grafting for Extirpative Scalp Wound Reconstruction: A 14-Year Experience.

Objective: Dermal regeneration template and staged split-thickness skin grafting may mitigate the need for flap coverage of postoncologic scalp defects. This technique has been studied previously in small case series. We examine the effect of risk factors, surgical technique, irradiation, and dressing modalities on reconstructive outcomes in a highly comorbid patient cohort.

Degloving Soft Tissue Injuries of the Extremity: Characterization, Categorization, Outcomes, and Management.

Unlabelled: We aimed to identify degloving soft tissue injury (DSTI) patient characteristics, injury and reconstruction patterns, and factors affecting outcomes of DSTI injuries to propose a reconstructive protocol for these injuries.

Methods: A retrospective analysis of consecutive patients with DSTIs of an extremity over a 22-year period has been done.

Results: 188 patients with 201 extremity DSTIs were included.

The Lateral Breast Flap Sling: A Novel Technique for the Revision of Autologous Breast Reconstructions.

Introduction A wide breast footprint is a common complaint expressed by breast reconstruction patients following abdominally-based autologous breast reconstruction. Our aim is to describe the lateral autologous breast sling, a novel technique, which modifies the lateral flap inset to address this common patient complaint. Methods A review of consecutive women who underwent the lateral autologous breast flap sling procedure over a four-year period was completed.

Patient-Guided Breast Reconstruction Education.

Background Breast reconstructive surgeons must discuss large amounts of information in an expedient manner to a growing group of women. Our aim is to identify the breast reconstruction resources women prefer and how they desire information to be conveyed in order to develop patient-guided reconstruction education. Methods A preoperative and postoperative breast reconstruction survey was given to women planning to undergo breast reconstruction or who have already undergone reconstruction.

Operative risk stratification in the obese female undergoing implant-based breast reconstruction.

The prevalence of obesity is growing, and breast reconstruction in the obese patient is becoming the norm rather than the exception. Our aim was to evaluate implant reconstruction outcomes in the obese female in the presence of coincident surgical risk factors and identify potential risk-reducing interventions. A review of consecutive obese women (BMI ≥ 30) who underwent mastectomy and implant breast reconstruction was performed.

Use of Incisional Negative Pressure Wound Therapy in Skin-Containing Free Tissue Transfer.

Background:  Negative pressure wound therapy (NPWT) was initially introduced for wound management, but its benefits have stimulated the investigation of its use in new clinical scenarios. Most recently, incisional NPWT has been shown to be a benefit. Incisional NPWT applied to skin-containing free tissue transfer has not been well defined.

An Analysis of Complication Risk Factors in 641 Nipple Reconstructions.

Nipple-areola reconstruction represents the completion of the breast restorative process and is associated with significant positive psychological implications. While factors such as medical comorbidities, smoking status, and radiation therapy have been shown to be associated with an increase in complications following breast reconstruction, their impact on nipple reconstruction remains largely unaddressed in the literature. An IRB-approved, retrospective review of 472 patients who underwent nipple reconstruction at Wake Forest University over a 15-year period was completed.

Correlation between abdominal perforator vessels identified with preoperative CT angiography and intraoperative fluorescent angiography in the microsurgical breast reconstruction patient.

Background: CT angiography (CTA) has become a reliable method of perforator vessel identification. Indocyanine green fluorescent angiography (ICGLA) produces a real-time image of large- and small-caliber blood vessels. The aim of this prospective study was to compare ICGLA with CTA to evaluate its reliability of vessel identification and correlation to perforator vessel size and number determined preoperatively by CTA.

Impact of intraoperative vasopressor use in free tissue transfer for head, neck, and extremity reconstruction.

General anesthesia induces hypotension and this is commonly treated intraoperatively with administering vasopressors. Microsurgeons are hesitant to use vasopressors due to the potential risk of inducing vasoconstriction and flap necrosis. The aim of this study was to determine the frequency of intraoperative vasopressor utilization in patients undergoing free tissue transfer reconstruction and to determine its impact on patient outcomes.

The effect of reusable versus disposable draping material on infection rates in implant-based breast reconstruction: a prospective randomized trial.

Background: Clinical infection remains a significant problem in implant-based breast reconstruction and is a physical and emotional strain to the breast reconstruction patient. Bacterial strikethrough of draping and gown material is a likely source of infection. Strategies to reduce infection in implant-based breast reconstruction are essential to improve patient outcomes.

"Supersize" panniculectomy: indications, technique, and results.

Background: Obesity remains a significant health problem associated with considerable morbidity and mortality. Panniculectomy in the obese patient population aims at treating complications related to excess abdominal skin in an attempt to improve quality of life, increase mobility, and potentially prepare the patient for subsequent bariatric surgery or enrollment in a weight-loss program. We describe the indications and outcomes of "supersize" panniculectomy in the extreme obesity patient population.

Factors affecting complications in radiated breast reconstruction.

Introduction: Breast irradiation in combination with breast reconstruction is associated with increased complications. Because of the diminishing threshold for radiotherapy, breast reconstruction irradiation is rising. Our aim was to evaluate factors affecting outcomes in irradiated breast reconstructions.

Changes in dermal histomorphology following surgical weight loss versus diet-induced weight loss in the morbidly obese patient.

Introduction: Patients with postgastric bypass and diet-induced weight loss present to the plastic surgeon for various body contouring procedures. Gross differences in skin dermal elasticity may exist between these populations; however, studies evaluating histologic differences are lacking. This prospective study aims to evaluate histomorphologic differences in morbidly obese patients following surgical versus diet-induced (nonsurgical) weight loss.

Complex abdominal wall hernias: a new classification system and approach to management based on review of 133 consecutive patients.

Background: Plastic surgeons are increasingly involved in the repair of complex ventral hernias. Although this typically involves recurrent incisional hernias, operative strategies can be applied to most abdominal wall defects, including chronic wounds with or without exposed mesh, enterocutaneous fistulas, or hernias associated with significant pannus formation.

Methods: This is a retrospective review of a single institution/single surgeon experience of complex ventral hernia repair performed over a 5-year period.