Modern surgical treatments for lymphedema.

Lymphedema occurs when the lymphatic system is malformed, leaking or is damaged by infection or cancer treatment. Enlarged extremities due to extensive fluid retention and adipose tissue deposition, recurrent cellulitis, and the requirement for hard-to-wear compression garments lead to impaired limb function and decreased quality of life. This narrative review aims to elucidate classification, diagnostic tools, and conservative management strategies leading the path to patient selection for microsurgical reconstructive procedures or volume reduction procedures.

Phase II study shows potential benefit of adenoviral vascular endothelial growth factor C (VEGF-C) and lymph node transfer in lymphedema.

Background: Breast cancer-related lymphedema (BCRL) is a common complication lacking medical treatment. Lymfactin® is an adenovirus type 5-based gene therapy and prolymphangiogenic growth factor vector that induces vascular endothelial growth factor C (VEGF-C) expression. Our aim was to evaluate the therapeutic effect of Lymfactin® with vascularized lymph node transfer (VLNT).

Long-term results of the tuberous breast: What to expect after the primary correction process?

Background And Aims: Tuberous breast is a rare anomaly affecting the development of mainly the female breast. It presents with varying degrees of hypoplasia in the breast base and skin. In some cases, herniation and widening of the areola is observed.

Immediate versus delayed breast reconstruction: Long-term follow-up on health-related quality of life and satisfaction with breasts.

Introduction: Health-related quality of life (HRQL) can be improved by breast reconstruction following mastectomy. The optimal timing of the reconstruction remains unclear.

Methods: A cross-sectional study on 338 women who had undergone immediate or delayed breast reconstruction between 08/2017 and 07/2019 was performed.

Antibiotic prophylaxis in clean and clean-contaminated plastic surgery: A critical review.

Antibiotic prophylaxis is frequently used in plastic surgery procedures, despite the generally low rates of infection and few guidelines on the practice. The increasing prevalence of bacterial resistance to antibiotics calls for a reduction in unnecessary antibiotic use. The aim of this review was to create an updated summary of the available data on the effectiveness of antibiotic prophylaxis in reducing the postoperative infection in clean and clean-contaminated plastic surgery.

Topical tranexamic acid reduces postoperative hematomas in reduction mammaplasties.

Background: Postoperative bleeding requiring reoperation is an untoward event in breast surgery. Topical tranexamic acid (TXA) has been routinely used to reduce the risk of postoperative bleeding in some surgical fields. In breast surgery, it is not routinely used owing to scarce information.

Total Breast Reconstruction with Lipofilling after Traditional Mastectomy without the Use of Tissue Expanders.

Background: Lipofilling can be used to reconstruct a breast without additional implants or autologous composite grafts. However, methods to maximize retention of the transferred fat remain under debate. Here, the authors present their experience of breast reconstruction with lipofilling without concomitant use of tissue expanders.

Health-Related Quality of Life After Breast Reconstruction: Comparing Outcomes Between Reconstruction Techniques Using the BREAST-Q.

Background: Reconstruction of the breast following mastectomy can improve patients' health-related quality of life (HRQL). We aimed to assess HRQL in women after mastectomy and breast reconstruction and to identify differences in HRQL related to the reconstruction method used.

Methods: A cross-sectional study was performed on patients who had undergone breast reconstruction in Helsinki University Hospital between 08/2017 and 7/2019.

Oncoplastic breast consortium recommendations for mastectomy and whole breast reconstruction in the setting of post-mastectomy radiation therapy.

Aim: Demand for nipple- and skin- sparing mastectomy (NSM/SSM) with immediate breast reconstruction (BR) has increased at the same time as indications for post-mastectomy radiation therapy (PMRT) have broadened. The aim of the Oncoplastic Breast Consortium initiative was to address relevant questions arising with this clinically challenging scenario.

Methods: A large global panel of oncologic, oncoplastic and reconstructive breast surgeons, patient advocates and radiation oncologists developed recommendations for clinical practice in an iterative process based on the principles of Delphi methodology.

Beyond the 21-cm Notch-to-nipple Myth: Golden Proportions in Breast Aesthetics.

Background: The 21-cm notch-to-nipple distance has been accepted without academic scrutiny as a key measure in breast aesthetics. The Fibonacci sequence and phi ratio occur frequently in nature. They have previously been used to assess aesthetics of the face, but not the breast.

An Aesthetic Factor Priority List of the Female Breast in Scandinavian Subjects.

Background: There is little consensus about the relative determinative value of each individual factor in female breast aesthetics. When performing breast surgery with an aesthetic goal, certain factors will be more important than others. The purpose of this study was to make an aesthetic factor rank list to determine the relative contributions to overall breast aesthetics.

Full breast reconstruction with fat and how to recycle the "dog-ear".

Mastectomy without immediate reconstruction leaves us with a population of women who may need a new breast in a delayed fashion. These women are often elderly, not fit for major flap surgery or reluctant to have long scars or implants. Free fat grafting has mainly been used as an adjunct to other reconstructive methods.

Fat Grafting Can Induce Browning of White Adipose Tissue.

Background: Fat grafting is commonly used when treating soft-tissue defects. However, much of the basic biology behind fat transfer is still uncovered. Adipocytes can be divided into energy storing white and energy burning brown adipose cells.

Reduction mammaplasty in patients with history of breast cancer: The incidence of occult cancer and high-risk lesions.

Introduction: Contralateral reduction mammaplasty is regularly included in the treatment of breast cancer patients. We analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammaplasty specimens of women with previous breast cancer. We also analyzed if timing of reduction mammaplasty in relation to oncological treatment influenced the incidence of abnormal findings, and compared if patients with abnormal contralateral histopathology differed from the study population in terms of demographics.

Breast Cancer Detection by Preoperative Imaging in Reduction Mammaplasty Patients: A Single Center Study of 918 Patients.

Background: The role of preoperative imaging and the usability of different imaging modalities is highly variable and controversial in reduction mammaplasty patients. Our study describes the imaging process in a single center in regard to modality selection, age and timing, and of the association between imaging and histopathological findings in reduction mammaplasty specimens.

Methods: Nine hundred eighteen women, who underwent reduction mammaplasty during 1.

Should we routinely analyze reduction mammaplasty specimens?

Background: Reduction mammaplasty is one of the most common plastic surgery procedures. Preoperative imaging and histopathology protocols vary among countries and institutions. We aimed to analyze the incidence of occult breast cancer and high-risk lesions in reduction mammaplasty specimens.

No need to cut the nerve in LD reconstruction to avoid jumping of the breast: a prospective randomized study.

Background And Aim: It has been shown that the myocutaneous latissimus dorsi flap volume and consistency remain mainly the same regardless the nerve is cut or not in breast reconstruction. It is controversial how big an impact the flap innervation has on the muscle activity of the flap. The aim of the study was to prospectively evaluate the influence of latissimus dorsi flap innervation on the functional and aesthetic outcome of delayed breast reconstruction.

Breast reconstruction de novo by water-jet assisted autologous fat grafting--a retrospective study.

Background: Autologous fat grafting has become a frequent, simple, reproducible and low-risk technique for revisional or partial breast reconstruction. The presented European multicenter study describes an optimized treatment and follow-up protocol for the de novo breast reconstruction after total mastectomy by lipotransfer alone.

Methods: A retrospective European multicenter trial included 135 procedures on 28 (35 breasts) postmastectomy patients (mean 52.

[Free fat transfer--a versatile tool in reconstructive surgery].

Free fat transfer or lipofilling is a procedure quickly increasing in popularity. Free fat transfer offers treatment for soft tissue defects caused by trauma or cancer, congenital anomalies, painful scars, irradiation injuries and aesthetic indications. The advantages compared to, e.

Skeletal muscle injury and repair: the effect of disuse and denervation on muscle and clinical relevance in pedicled and free muscle flaps.

Skeletal muscle is prone to injury upon trauma or nerve damage. In reconstructive surgery, it is an interesting spare part. Fortunately, skeletal muscle is capable of extensive regeneration.

The significance of latissimus dorsi flap innervation in delayed breast reconstruction: a prospective randomized study-magnetic resonance imaging and histologic findings.

Background: It is controversial whether surgical denervation of the thoracodorsal nerve should be performed in breast reconstruction with a myocutaneous latissimus dorsi flap. Denervation may prevent discomforting symptoms caused by muscle contraction, but the flap may also lose significant volume. The authors prospectively evaluated the influence of latissimus dorsi flap innervation on the latissimus dorsi muscle structure in delayed breast reconstruction.

Vascular endothelial growth factor and its receptors are expressed in human nerve grafts.

Vascularization and angiogenicity of human nonvascularized nerve grafts in the second stage of facial reanimation were studied. Immunohistochemistry for endothelial markers (CD-31) and vascular endothelial growth factor (VEGF) and its receptors Flt-1 and Flk-1 was performed on distal end biopsies from 35 cross-facial nerve grafts. In grafted nonvascularized nerve, density of vascular structures (also clearly immunopositive for VEGF and both receptors) showed a mean of 166 vessels (range 78 to 267) per unit area, corresponding to control values.