Premastectomy Radiotherapy and Immediate Breast Reconstruction: A Randomized Clinical Trial.

Importance: Premastectomy radiotherapy (PreMRT) is a new treatment sequence to avoid the adverse effects of radiotherapy on the final breast reconstruction while achieving the benefits of immediate breast reconstruction (IMBR).

Objective: To evaluate outcomes among patients who received PreMRT and regional nodal irradiation (RNI) followed by mastectomy and IMBR.

Design, Setting, And Participants: This was a phase 2 single-center randomized clinical trial conducted between August 3, 2018, and August 2, 2022, evaluating the feasibility and safety of PreMRT and RNI (including internal mammary lymph nodes).

Microvascular Breast Reconstruction in the Era of Value-Based Care: Use of a Cosurgeon Is Associated with Reduced Costs, Improved Outcomes, and Added Value.

Background: Reducing complications while controlling costs is a central tenet of value-based health care. Bilateral microvascular breast reconstruction is a long operation with a relatively high complication rate. Using a two-surgeon team has been shown to improve safety in bilateral microvascular breast reconstruction; however, its impact on cost and efficiency has not been robustly studied.

Understanding the Relationship between Breast Reconstruction Subtype and Risk of Financial Toxicity: A Single-Institution Pilot Study.

Background: The impact of breast reconstruction on financial toxicity remains poorly understood despite growing awareness. The authors sought to illustrate the relationship between breast reconstruction subtypes and the risk of financial toxicity.

Methods: The authors conducted a single-institution cross-sectional survey of all female breast cancer patients undergoing any form of breast reconstruction between January of 2018 and June of 2019.

Complications of Wise-Pattern Compared With Vertical Scar Mastopexy/Breast Reduction in Oncoplastic Breast-Conserving Surgery.

Background: Oncoplastic breast-conserving surgery (OBCS) is most commonly performed using established or modified mastopexy/breast reduction techniques. Although the comparative complication profiles of Wise-pattern mastopexy/breast reduction techniques compared with vertical scar techniques are well understood, outcomes in the setting of OBCS are unknown.

Methods: A retrospective study was conducted of all patients that underwent OBCS using mastopexy/breast reduction techniques at a single center over a 6-year period.

Variability in Current Procedural Terminology Codes for Craniomaxillofacial Trauma Reconstruction: A National Survey.

Background: Current Procedural Terminology (CPT) codes are an important part of surgical documentation and billing for services provided within the United States. This limited coding language presents a challenge in the heterogenous and rapidly evolving field of craniofacial surgery. The authors aimed to survey members of the American Society of Maxillofacial Surgery (ASMS) to characterize the variability in coding practices in the surgical management of craniofacial trauma.

Evaluation of Current Perioperative Antimicrobial Regimens for the Prevention of Surgical Site Infections in Breast Implant-based Reconstructive Surgeries.

Unlabelled: Several steps to reduce the rate of postoperative surgical site infections (SSIs) have been implemented. The use of prophylactic antimicrobials targeting patient's microbial flora has been associated with a decrease in postoperative infections. We evaluated the relationship between perioperative antimicrobials, baseline microbial flora, and occurrence of SSIs.

The Latissimus Dorsi Myocutaneous Flap Is a Safe and Effective Method of Partial Breast Reconstruction in the Setting of Breast-Conserving Therapy.

Background: Reconstruction of partial breast defects in low-volume, nonptotic breasts can be challenging. The authors hypothesized that use of the latissimus dorsi flap in partial breast reconstruction is safe and associated with low complication and high patient satisfaction rates.

Methods: All patients who underwent breast-conserving therapy and latissimus dorsi flap reconstruction from January 1, 2006, to December 31, 2016, were identified in a prospectively maintained database.

The External Jugular Vein Used as Recipient Vessel in Head and Neck Free Flap Reconstruction: Outcomes Compared to the Internal Jugular Vein.

Background: Contradictory data exists on the success rates of employing the external jugular (EJ) vein as a recipient vessel for venous outflow in free flap head and neck reconstruction compared with the internal jugular (IJ) vein. The authors hereby present a retrospective study of prospectively collected data over a 14-year period.

Methods: Five hundred seventy-eight patients underwent 639 free flap head and neck over 14 years.

Using a Second Free Fibula Osteocutaneous Flap after Repeated Mandibulectomy Is Associated with a Low Complication Rate and Acceptable Functional Outcomes.

Background: A significant percentage of patients who undergo segmental mandibulectomy for head and neck cancer will develop a new or recurrent cancer or osteoradionecrosis, necessitating a second mandibulectomy and reconstruction. In this scenario, many surgeons are reluctant to perform a reconstruction with an osseous flap because of the presumed increased morbidity and complexity. The purpose of this study was to evaluate the safety and efficacy of performing a second free fibula flap reconstruction after repeated segmental mandibulectomy.

Salvaging the Infected Breast Tissue Expander: A Standardized Multidisciplinary Approach.

Background: Infections of breast tissue expander (TE) are complex, often requiring TE removal and hospitalization, which can delay further adjuvant therapy and add to the overall costs of breast reconstruction. Therefore, to reduce the rate of TE removal, hospitalization, and costs, we created a standardized same-day multidisciplinary outpatient quality improvement protocol for diagnosing and treating patients with early signs of TE infection.

Methods: We prospectively evaluated 26 consecutive patients who developed a surgical site infection between February 2013 and April 2014.

Obese Women Experience Fewer Complications after Oncoplastic Breast Repair following Partial Mastectomy Than after Immediate Total Breast Reconstruction.

Background: The authors hypothesized that obese patients would experience fewer complications after oncoplastic breast reconstruction following partial mastectomy than after immediate breast reconstruction following total mastectomy.

Methods: Complication rates were compared for oncoplastic breast reconstruction versus immediate breast reconstruction (with either implants or autologous tissue) in consecutive obese patients (body mass index ≥ 30 kg/m(2)) treated at a single center between January of 2005 and April of 2013. Logistic regression was used to analyze the associations between patient and surgical characteristics and postoperative outcomes.

Plastic Surgeon Expertise in Predicting Breast Reconstruction Outcomes for Patient Decision Analysis.

Background: Decision analysis offers a framework that may help breast cancer patients make good breast reconstruction decisions. A requirement for this type of analysis is information about the possibility of outcomes occurring in the form of probabilities. The purpose of this study was to determine if plastic surgeons are good sources of probability information, both individually and as a group, when data are limited.

The advantages of free abdominal-based flaps over implants for breast reconstruction in obese patients.

Background: The authors hypothesized that, for obese patients, delayed abdominal-based free flap (rather than implant-based and immediate) breast reconstruction would result in fewer overall complications and reconstruction losses.

Methods: The authors retrospectively analyzed consecutive implant- and abdominal-based free flap breast reconstructions performed in obese patients between 2005 and 2010 by utilizing the World Health Organization obesity classifications: class I, 30.0 to 34.

Reconstructive outcomes in patients undergoing contralateral prophylactic mastectomy.

Background: As the rate of contralateral prophylactic mastectomy in breast cancer patients increases, more women are seeking immediate bilateral breast reconstruction. The authors evaluated complication rates in the index and prophylactic breasts in patients undergoing bilateral immediate reconstruction.

Methods: The authors retrospectively reviewed the outcomes of all consecutive patients undergoing immediate postmastectomy bilateral reconstruction for an index breast cancer combined with a contralateral prophylactic mastectomy between 2005 and 2010.

Optimal timing of delayed free lower abdominal flap breast reconstruction after postmastectomy radiation therapy.

Background: The purpose of this study was to determine the optimal timing of delayed abdominal free flap breast reconstruction following postmastectomy radiation therapy. The authors evaluated the association between timing of delayed abdominal free flap breast reconstruction following postmastectomy radiation therapy and postoperative complications.

Methods: The authors reviewed a prospectively maintained database of delayed abdominal free flap breast reconstruction performed between July of 2005 and December of 2009.

Extended vertical rectus abdominis myocutaneous flap for pelvic reconstruction: three-dimensional and four-dimensional computed tomography angiographic perfusion study and clinical outcome analysis.

Background: The extended vertical rectus abdominis myocutaneous (eVRAM) flap includes skin and subcutaneous fat extending from the costal margin to the anterior axillary line. The reliability and vascularity of this distal extension have been questioned. The authors hypothesized that the eVRAM flap would have adequate perfusion throughout the extended portion and be reliable for pelvic reconstruction.

Muscle and omental flaps for chest wall reconstruction.

Reconstruction of the chest wall represents an important part of a patient's treatment following resection of various thoracic tumors. Many different types of flaps, including both pedicled and free flaps, have been described for use in chest wall reconstruction. These reconstructions are most effectively managed with a multidisciplinary approach involving plastic and cardiothoracic surgery.

Reconstructive outcomes in patients with sarcoma of the breast.

Background: Primary soft-tissue sarcomas account for less than 1 percent of all breast malignancies. Many of these are associated with prior radiation therapy. Few studies have evaluated this patient population.

Barbed sutures: a review of the literature.

Background: Despite substantial mention in the popular press, there is little in the plastic surgery or dermatology literature regarding the safety, efficacy, longevity, or complications of barbed suture suspension procedures. The authors review the literature to estimate several clinical parameters pertaining to barbed thread suspensions.

Methods: The authors performed a MEDLINE search using the keywords "barbed and suture," "thread and suspension," "Aptos," "Featherlift," and "Contour Thread.

Breaking strength of barbed polypropylene sutures: rater-blinded, controlled comparison with nonbarbed sutures of various calibers.

Objectives: To assess the strength of 2.0 barbed polypropylene suture, and, specifically, to determine the load required to break this suture, and to compare this with the strength of nonbarbed polypropylene suture.

Design: Rater-blinded, controlled trial.

Pyoderma gangrenosum related to a new granulocyte colony-stimulating factor.

A 23-year-old Caucasian man diagnosed with stage IVB Hodgkin's disease was referred to a university oncology section after completing 1.5 cycles of chemotherapy. His chemotherapy consisted of doxorubicin HCL, bleomycin, dacarbazine, and vinblastine, with prophylactic administration of a granulocyte colony stimulating factor.