Sensory restoration following breast reconstruction with operative reinnervation: A systematic review and meta-analysis.

Background: There is currently no consensus on the efficacy of operative reinnervation at the time of post-mastectomy reconstruction. This review compares postoperative sensation between innervated and non-innervated flaps in breast reconstruction through systematic review and meta-analysis.

Methods: EMBASE, Ovid, and CENTRAL were searched from inception to December 6, 2023.

Practice Patterns in Primary Breast Augmentation: A 16-Year Review of Continuous Certification Tracer Data from the American Board of Plastic Surgery.

Background: As part of the continuous certification process, the American Board of Plastic Surgery collects case data for specific tracer procedures in aesthetic surgery to assess practice improvement by the diplomates. These case-based data provide valuable information on national trends in clinical practice. The current study was performed to analyze practice patterns in aesthetic primary breast augmentation.

Parental-leave policies and perceptions of pregnancy during surgical residency training in North America: a scoping review.

Background: The number of surgical residents experiencing childbearing during residency training is increasing, and there is an absence of clarity with respect to parental-leave, lactation and return-to-work policies in support of residents. The aim of this review was to examine parental-leave policies during residency training in surgery and the perceptions of these policies by residents, program directors and coresidents, as described in the literature.

Methods: We performed a scoping review of the literature based on the following themes: maternity or parental-leave policies; antepartum work-restriction policies and obstetric complications; accommodations for training absences; support for, and perceptions of, maternity or parental leave during residency training; and challenges upon return to work, namely resident performance and breastfeeding.

Surgeon Gender-Related Differences in Operative Coding in Plastic Surgery.

Background: Numerous studies in the medical and surgical literature have discussed the income gap between male and female physicians, but none has adequately accounted for the disparity.

Methods: This study was performed to determine whether gender-related billing and coding differences may be related to the income gap. A 10 percent minimum difference was set a priori as statistically significant.

Simulating the IMA Recipient Site for DIEP Flap Surgery: A New Model for Dynamic Microsurgery Simulation with Real-Time Respiration and a Pilot Study.

Background:  Breast reconstruction (BR) using autologous free flaps has been shown to have numerous psychosocial and quality-of-life benefits. Unfortunately, the microsurgical learning curve is quite steep due to some unique operative challenges. Currently, there is no realistic simulation model that captures real-life respiratory excursion and the depth of internal mammary vessels within the compact recipient site.

Canadian Expert Opinion on Breast Reconstruction Access: Strategies to Optimize Care during COVID-19.

Background: Breast reconstructive services are medically necessary, time-sensitive procedures with meaningful health-related quality of life benefits for breast cancer survivors. The COVID-19 global pandemic has resulted in unprecedented restrictions in surgical access, including access to breast reconstructive services. A national approach is needed to guide the strategic use of resources during times of fluctuating restrictions on surgical access due to COVID-19 demands on hospital capacity.

The Impact of the COVID-19 Pandemic on Breast Reconstruction: A Canadian Perspective.

Background: The COVID-19 pandemic has led to unprecedented challenges and restrictions in surgical access across Canada, including for breast reconstructive services which are an integral component of comprehensive breast cancer care. We sought to determine how breast reconstructive services are being restricted, and what strategies may be employed to optimize the provision of breast reconstruction through a pan-Canadian evaluation from the providers' perspective.

Methods: This was a cross-sectional survey of Canadian plastic and reconstructive surgeons who perform breast reconstruction.

Breast implant-associated EBV-positive diffuse large B-cell lymphoma: Two case reports and literature review.

Lymphomas associated with breast implants are mostly of the T-cell type. They are predominantly anaplastic lymphoma kinase-negative anaplastic large cell lymphoma (ALK-negative ALCL) characterized by CD30 positivity universally. Whilst the majority of primary breast lymphomas occurring in the absence of breast implants are of B-cell origin, there are few cases of implant-associated B-cell lymphomas reported to date in the literature, a subset of which are diffuse large B-cell lymphoma (DLBCL).

State of Gender Diversity and Equity Policies within Plastic and Reconstructive Surgery in Canada.

Background: Given the growing number of women in plastic and reconstructive surgery (PRS), it is imperative to evaluate the extent of gender diversity and equity policies among Canadian PRS programs to support female trainees and staff surgeons.

Methods: A modified version of the United Nations Women's Empowerment Principles (WEPs) Gender Gap Analysis tool was delivered to Canadian PRS Division Chairs (n = 11) and Residency Program Directors (n = 11). The survey assessed gender discrimination and equity policies, paid parental leave policies, and support for work/life balance.

Breast Reconstruction Following Breast Implant-Associated Anaplastic Large Cell Lymphoma.

Background: Standard of care treatment of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) involves surgical resection with implant removal and complete capsulectomy. We report a case series of BIA-ALCL reconstruction with proposals for timing and technique selection.

Methods: We retrospectively reviewed and prospectively enrolled all BIA-ALCL patients at 2 tertiary care centers and 1 private plastic surgery practice from 1998 to 2017.

A Qualitative Assessment of the Journey to Delayed Breast Reconstruction.

Background: Canada has low immediate breast reconstruction (IBR) rates compared to the United States and Europe. Breast cancer survivors live with mastectomy defects sometimes for years, and this represents an area for improvement in cancer care.

Purpose: This study qualitatively assessed (1) information provided about breast reconstruction at the time of cancer diagnosis among women seeking delayed breast reconstruction (DBR) and (2) referral practices for plastic surgery consultation for DBR.

Patient-Reported Outcomes following Breast Conservation Therapy and Barriers to Referral for Partial Breast Reconstruction.

Background: The purpose of this study was to evaluate the self-reported aesthetic outcome of breast conservation therapy in a generalized sample of patients, and to describe potential barriers to referral for partial breast reconstruction.

Methods: Consecutive breast conservation therapy patients completing radiotherapy over a 1-year period at a regional cancer center were identified. Eligible patients were contacted by means of mail/e-mail and invited to participate.

Surgeon-Reported Needs for Improved Training in Identifying and Managing Free Flap Compromise.

 This study examined the need for improved training in the identification and management of free flap (FF) compromise and assessed a potential role for simulated scenario training.  Online needs assessment surveys were completed by plastic surgeons and a subsample with expertise in microsurgery education participated in focus groups. Data were analyzed using descriptive statistics and mixed qualitative methods.

Impact of Prior Tissue Expander/Implant on Postmastectomy Free Flap Breast Reconstruction.

Background: Implant-based breast reconstructions can result in unsatisfactory results requiring surgical revision or salvage reconstructive surgery with autologous tissue. This study compares the outcomes and complications of salvage (tertiary) flap reconstruction after failed prosthesis placement to those of primary/secondary flap reconstruction.

Methods: All patients undergoing free flap breast reconstruction after failed prosthesis between July 1, 2005, and June 30, 2014, were identified.

Pharmacologic prophylactic treatment for perioperative protection of skeletal muscle from ischemia-reperfusion injury in reconstructive surgery.

Background: In autogenous muscle transplantation, unpredictable complications can cause prolonged ischemia, resulting in ischemia-reperfusion injury. The authors investigated the efficacy and mechanism of nicorandil, a nitrovasodilator and adenosine triphosphate-sensitive potassium channel opener, in inducing perioperative protection of muscle flaps from ischemia-reperfusion injury.

Methods: Pigs (18.

Efficacy and mechanism of hypoxic postconditioning in salvage of ex vivo human rectus abdominis muscle from hypoxia/reoxygenation injury.

In reconstructive surgery, skeletal muscle may endure protracted ischemia before reperfusion, which can lead to significant ischemia/reperfusion injury. Ischemic postconditioning induced by brief cycles of reperfusion/reocclusion at the end of ischemia has been shown to salvage skeletal muscle from ischemia/reperfusion injury in several animal models. However, ischemic postconditioning has not been confirmed in human skeletal muscle.

Comparison of implant-based immediate breast reconstruction with and without acellular dermal matrix.

Background: Acellular dermal matrix is frequently used in implant-based breast reconstruction to cover the inferior aspect of the breast pocket. Its performance profile remains equivocal. The authors studied whether adding it in implant-based immediate breast reconstruction improved outcomes when compared with non-acellular dermal matrix reconstruction.

Intravenous fluid infusion rate in microsurgical breast reconstruction: important lessons learned from 354 free flaps.

Background: The purpose of this study was to determine the role of intravenous fluid infusion rate in the development of in-hospital complications in patients undergoing microsurgical breast reconstruction for breast cancer.

Methods: A retrospective review was performed between 2002 and 2009 at a single institution for all consecutive patients undergoing free flap reconstruction of the breast. The authors examined patient variables (age; body mass index; preoperative hemoglobin, hematocrit, and creatinine levels; American Society of Anesthesiologists classification; and cardiac risk factors), surgical variables (type of reconstruction, timing, laterality, need for blood transfusion, and duration of general anesthesia), and fluid variables (rate of crystalloid and colloid infusion in the first 24 hours standardized by weight).

Immediate placement of implants in breast reconstruction: patient selection and outcomes.

Background: With the advent of skin-sparing mastectomy techniques, it became clear that immediate placement of an implant could be utilized for breast reconstruction in select patients. The authors assessed the safety, patient selection factors, and aesthetic results with this technique.

Methods: Thirty-five consecutive patients (eight unilateral and 27 bilateral) who underwent immediate implant-based breast reconstruction were analyzed.

Versatility of the proximally pedicled anterolateral thigh flap and its use in complex abdominal and pelvic reconstruction.

Background: The anterolateral thigh flap was described by Song et al. in 1984. Although more usually used as a free flap, it also has remarkable versatility as a pedicled flap.

Expansion and characterization of human melanoma tumor-infiltrating lymphocytes (TILs).

Background: Various immunotherapeutic strategies for cancer are aimed at augmenting the T cell response against tumor cells. Adoptive cell therapy (ACT), where T cells are manipulated ex vivo and subsequently re-infused in an autologous manner, has been performed using T cells from various sources. Some of the highest clinical response rates for metastatic melanoma have been reported in trials using tumor-infiltrating lymphocytes (TILs).

Vasorelaxation effect and mechanism of action of vascular endothelial growth factor-165 in isolated perfused human skin flaps.

Background: Experimental evidence is accumulating to indicate that local acute vascular endothelial growth factor-165 (VEGF(165)) therapy is effective in attenuation of skin ischemia and increase in skin viability in rat skin flap surgery and the mechanism involves vasodilation induced by VEGF(165). So far, the vasodilator effect and mechanism of action of VEGF(165) have not been studied in human skin. The objective of this project is to test the hypothesis that VEGF(165) is also a potent vasodilator in human skin vasculature.

Perforator flaps in breast reconstruction.

Patients are well informed and seek autogenous breast reconstruction. The motivating factors include a preference for autologous tissue reconstruction and the complementary improvement in body contour, safety concerns surrounding implants, and implant-related complications in the setting of previous radiation therapy. In this article a variety of perforator flaps from donor sites that include the trunk (thoracodorsal artery perforator and intercostal artery perforator), abdomen (deep inferior epigastric artery perforator and superficial inferior epigastric artery), and buttock (superior gluteal artery perforator and inferior gluteal artery perforator) are described.

Pathogenesis of radiation-induced capsular contracture in tissue expander and implant breast reconstruction.

Background: Capsular contracture is the main complication in postmastectomy tissue expander and implant breast reconstruction in patients requiring radiotherapy. There is evidence that the wingless signaling pathway plays a central role in the pathogenesis of fibroproliferation in fibromatosis and hyperplastic skin wounds, involving multiple linked events leading to up-regulation of target genes and fibroproliferation. Here, the authors tested their hypothesis that the wingless signaling pathway may also regulate radiotherapy-induced fibroproliferation in capsular tissue around expanders/implants in breast reconstruction.

Function and health status outcomes following soft tissue reconstruction for limb preservation in extremity soft tissue sarcoma.

Background: While advances in reconstructive surgery have facilitated limb preservation in extremity soft tissue sarcoma (ESTS), limited information exists as to the functional outcome of patients with these reconstructed extremities. The primary objective of this study is to evaluate the impact of flap reconstruction on postoperative function and health status in patients undergoing limb-salvage surgery for ESTS.

Methods: Clinical and outcome data for eligible patients were extracted from a prospectively maintained database of sarcoma patients.