Background and objective:Immediate breast reconstruction not only reduces the number of surgeries for patients after mastectomy but also decreases psychological and physical trauma,making it increasingly popular.Howev...Background and objective:Immediate breast reconstruction not only reduces the number of surgeries for patients after mastectomy but also decreases psychological and physical trauma,making it increasingly popular.However,there is currently no consensus on the integration of post-mastectomy radiotherapy(PMRT)with reconstruction techniques.This review evaluates the impact of PMRT on complications following immediate breast reconstruction,providing guidance for clinical treatment decisions.Methods:PubMed,Web of Science,Embase,and other databases were searched for studies published in the past 15 years on outcomes of implant-based breast reconstruction in the context of radiotherapy to identify articles for analysis.RevMan 5.4 software was used to analyze the risks of seroma,infection,wound dehiscence,flap necrosis,implant exposure,capsule contracture,and reconstruction failure.Results:A total of 1l relevant studies were included,comprising 6323 cases of immediate breast reconstruction.It was found that breasts receiving postoperative irradiation had a significantly increased risk of complications,with statistically significant differences in seroma(P=0.004),infection(P<0.00001),wound dehiscence(P=0.04),implant exposure(P<0.00001),capsule contracture(P<0.00001),and reconstruction failure(P<0.00001).There was no statistically significant difference in flap necrosis(P=0.88).Conclusion:The results indicate that postoperative radiotherapy significantly increases the risk of complications for patients undergoing immediate implant-based reconstruction.Preventive measures may be taken in advance with the assistance of healthcare providers if necessary.展开更多
Purpose: For post-mastectomy radiation therapy, skin dose must be accurately estimated to assess skin reactions, such as: erythema, desquamation, and necrosis. Even with advanced algorithms, planning systems do not al...Purpose: For post-mastectomy radiation therapy, skin dose must be accurately estimated to assess skin reactions, such as: erythema, desquamation, and necrosis. Even with advanced algorithms, planning systems do not always provide accurate dosimetry for target volumes distal to skin. Methods and Materials: In this study, a female anthropomorphic (ART) phantom and the newest generation of optically stimulated luminescence dosimeters (OSLD) (nanoDots, Landauer Inc.) were deployed to measure chest wall dose distribution. Since actual dose to patients’ lung and heart cannot be measured using in-vivo dosimetry, film was also used to verify the dose distribution to the left lung and heart. The treatment planning was performed using tolerance limits of 95% to 107% of prescription dose. The ART phantom was irradiated according to 3 three-dimensional (3D) conformal radiotherapy plans for 200 cGy dose per fraction using 6 MV medial and lateral tangential photon beams. The dose distribution provided by treatment planning was studied using nanoDots and film. Results: Results show that the largest surface dose difference between nanoDots measurement and prescribed dose for medial and lateral tangential beams, are 3.8% and 9.8%, respectively. This difference may be due to higher effective point of measurement and angular dependence of the nanoDots. The maximum differences in measured dose compared with prescribed dose, using film for heart and the left lung, were 6.2% and 7.5% respectively. Conclusions: Both nanoDots and film provided reasonable estimation of dose distribution in post-mastectomy radiation therapy.展开更多
Objective: To compare the efficacy and safety of Lidocaine 2% versus Dexamethasone injected locally in mastectomy wound as pain relieving agents. Materials & Methods: A randomized single-blinded study in which 50 ...Objective: To compare the efficacy and safety of Lidocaine 2% versus Dexamethasone injected locally in mastectomy wound as pain relieving agents. Materials & Methods: A randomized single-blinded study in which 50 patients candidate for Mastectomy were included. Participants were equally randomized into two groups;Group A, in which patients received 10 ml Lidocaine 2% and Group B, in which patients received 16 mL Dexamethasone. In both groups, the drugs were given via local infiltration in the subcutaneous layer of the Mastectomy wound immediately after skin closure. Pain control was assessed post-operatively in the first 24 hours using the visual analogue scale (VAS) in addition the need for additional analgesia was recorded. Results: There was a statistically significant lower VAS score in group A (Lidocaine group) when compared to those in group B (Dexamethasone group) 1 h, 6 h, 12 h postoperatively with no significance 24 h postoperatively (36% vs 64% 1 h, 28% vs 64% 6 h, 30% vs 72% 12 h and, 80% vs 60% 24 h). This statistical significance was evident throughout the post-operative hours (1 h, 6 h, 12 h). Though local Lidocaine caused marked improvement of pain in bigger number of patients in group A than group B, yet it showed no statistical significance 24 h post-mastectomy. Furthermore, the number of participants that needed additional doses of analgesia lower in group A (48% vs 56%) in comparison to group B, but still showed no statistical significance. Conclusion: Local injection of Lidocaine 2% in Mastectomy wounds, has an upper hand in reducing the post-operative pain and showed a lesser need for post-operative analgesia when compared to local Dexamethasone injection.展开更多
Autologous fat grafting is an important surgical technique in aesthetic and reconstructive procedures.Fat grafting for breast reconstruction is now an established procedure for adding volume and improving cutaneous pl...Autologous fat grafting is an important surgical technique in aesthetic and reconstructive procedures.Fat grafting for breast reconstruction is now an established procedure for adding volume and improving cutaneous pliability;it can be used independently to replace more invasive flap procedures or implants,or as an adjunct for smaller volume supplementation.The breadth of applications in the breast necessitates diversity in technique and approach,and while there is no universally agreed-upon protocol,basic principles have guided the evolution of some commonly adopted tenets.Broadly,fat grafting outcomes are highly favorable but dependent on patient and procedure factors,requiring learned patient selection and expertise in recipient site assessment.Common complications from fat grafting,such as fat necrosis and the development of nodules,are particularly troublesome for post-oncologic patients,requiring considerable pre-surgical consultation for patient education and managing expectations.In addition to volume and contour augmentation,fat grafting has additional beneficial effects that have recently drawn increased attention including pain reduction from implant capsular contracture or postmastectomy pain syndrome,improved skin quality and reduced fibrosis following radiation,and possible anti-tumorigenic effects.New developments in clinical fat grafting research that are promising include the use of adipose progenitor cells admixed with lipoaspirate for improved volume retention or alternative biologics such as platelet-rich plasma.Preclinically,research towards safe and effective regenerative medicine approaches is actively underway,with the ultimate goal of achieving predictable and increased graft retention,reducing the number of required surgical procedures and enabling on-table results to reflect procedure outcomes.展开更多
文摘Background and objective:Immediate breast reconstruction not only reduces the number of surgeries for patients after mastectomy but also decreases psychological and physical trauma,making it increasingly popular.However,there is currently no consensus on the integration of post-mastectomy radiotherapy(PMRT)with reconstruction techniques.This review evaluates the impact of PMRT on complications following immediate breast reconstruction,providing guidance for clinical treatment decisions.Methods:PubMed,Web of Science,Embase,and other databases were searched for studies published in the past 15 years on outcomes of implant-based breast reconstruction in the context of radiotherapy to identify articles for analysis.RevMan 5.4 software was used to analyze the risks of seroma,infection,wound dehiscence,flap necrosis,implant exposure,capsule contracture,and reconstruction failure.Results:A total of 1l relevant studies were included,comprising 6323 cases of immediate breast reconstruction.It was found that breasts receiving postoperative irradiation had a significantly increased risk of complications,with statistically significant differences in seroma(P=0.004),infection(P<0.00001),wound dehiscence(P=0.04),implant exposure(P<0.00001),capsule contracture(P<0.00001),and reconstruction failure(P<0.00001).There was no statistically significant difference in flap necrosis(P=0.88).Conclusion:The results indicate that postoperative radiotherapy significantly increases the risk of complications for patients undergoing immediate implant-based reconstruction.Preventive measures may be taken in advance with the assistance of healthcare providers if necessary.
文摘Purpose: For post-mastectomy radiation therapy, skin dose must be accurately estimated to assess skin reactions, such as: erythema, desquamation, and necrosis. Even with advanced algorithms, planning systems do not always provide accurate dosimetry for target volumes distal to skin. Methods and Materials: In this study, a female anthropomorphic (ART) phantom and the newest generation of optically stimulated luminescence dosimeters (OSLD) (nanoDots, Landauer Inc.) were deployed to measure chest wall dose distribution. Since actual dose to patients’ lung and heart cannot be measured using in-vivo dosimetry, film was also used to verify the dose distribution to the left lung and heart. The treatment planning was performed using tolerance limits of 95% to 107% of prescription dose. The ART phantom was irradiated according to 3 three-dimensional (3D) conformal radiotherapy plans for 200 cGy dose per fraction using 6 MV medial and lateral tangential photon beams. The dose distribution provided by treatment planning was studied using nanoDots and film. Results: Results show that the largest surface dose difference between nanoDots measurement and prescribed dose for medial and lateral tangential beams, are 3.8% and 9.8%, respectively. This difference may be due to higher effective point of measurement and angular dependence of the nanoDots. The maximum differences in measured dose compared with prescribed dose, using film for heart and the left lung, were 6.2% and 7.5% respectively. Conclusions: Both nanoDots and film provided reasonable estimation of dose distribution in post-mastectomy radiation therapy.
文摘Objective: To compare the efficacy and safety of Lidocaine 2% versus Dexamethasone injected locally in mastectomy wound as pain relieving agents. Materials & Methods: A randomized single-blinded study in which 50 patients candidate for Mastectomy were included. Participants were equally randomized into two groups;Group A, in which patients received 10 ml Lidocaine 2% and Group B, in which patients received 16 mL Dexamethasone. In both groups, the drugs were given via local infiltration in the subcutaneous layer of the Mastectomy wound immediately after skin closure. Pain control was assessed post-operatively in the first 24 hours using the visual analogue scale (VAS) in addition the need for additional analgesia was recorded. Results: There was a statistically significant lower VAS score in group A (Lidocaine group) when compared to those in group B (Dexamethasone group) 1 h, 6 h, 12 h postoperatively with no significance 24 h postoperatively (36% vs 64% 1 h, 28% vs 64% 6 h, 30% vs 72% 12 h and, 80% vs 60% 24 h). This statistical significance was evident throughout the post-operative hours (1 h, 6 h, 12 h). Though local Lidocaine caused marked improvement of pain in bigger number of patients in group A than group B, yet it showed no statistical significance 24 h post-mastectomy. Furthermore, the number of participants that needed additional doses of analgesia lower in group A (48% vs 56%) in comparison to group B, but still showed no statistical significance. Conclusion: Local injection of Lidocaine 2% in Mastectomy wounds, has an upper hand in reducing the post-operative pain and showed a lesser need for post-operative analgesia when compared to local Dexamethasone injection.
文摘Autologous fat grafting is an important surgical technique in aesthetic and reconstructive procedures.Fat grafting for breast reconstruction is now an established procedure for adding volume and improving cutaneous pliability;it can be used independently to replace more invasive flap procedures or implants,or as an adjunct for smaller volume supplementation.The breadth of applications in the breast necessitates diversity in technique and approach,and while there is no universally agreed-upon protocol,basic principles have guided the evolution of some commonly adopted tenets.Broadly,fat grafting outcomes are highly favorable but dependent on patient and procedure factors,requiring learned patient selection and expertise in recipient site assessment.Common complications from fat grafting,such as fat necrosis and the development of nodules,are particularly troublesome for post-oncologic patients,requiring considerable pre-surgical consultation for patient education and managing expectations.In addition to volume and contour augmentation,fat grafting has additional beneficial effects that have recently drawn increased attention including pain reduction from implant capsular contracture or postmastectomy pain syndrome,improved skin quality and reduced fibrosis following radiation,and possible anti-tumorigenic effects.New developments in clinical fat grafting research that are promising include the use of adipose progenitor cells admixed with lipoaspirate for improved volume retention or alternative biologics such as platelet-rich plasma.Preclinically,research towards safe and effective regenerative medicine approaches is actively underway,with the ultimate goal of achieving predictable and increased graft retention,reducing the number of required surgical procedures and enabling on-table results to reflect procedure outcomes.
