Comparison of Complications Following Implant-Based Breast Reconstruction Using Triple Antibiotic Solution versus Low Concentration Chlorhexidine Gluconate Solution

Background: Prevention of infection and capsular contracture remains a primary goal of implant-based breast reconstruction (IBBR). Previous studies have demonstrated improved outcomes with the use of triple-antibiotic solution (TAS) for breast pocket irrigation, but ready-to-use products have recently gained popularity. The purpose of this study is to compare outcomes following IBBR between TAS and low-concentration chlorhexidine gluconate (CHG) solutions. Methods: This is a retrospective analysis of 690 consecutive patients undergoing IBBR from 2008-2017. The TAS (n = 346) irrigation solution was composed of 1 g cefazolin, 80 mg gentamicin and 50,000 U bacitracin diluted in 500 mL of normal saline;the CHG (n = 344) irrigation solution was the commercially-available product Irrisept?(0.05% chlorhexidine gluconate in sterile water, Irrimax Corporation, Lawrenceville, GA). Comparisons were made between demographic and clinical variables. Complications were recorded and statistical analysis, including multivariate regression analysis, was performed. Results: The TAS group underwent significantly more skin-sparing mastectomies, adjuvant chemotherapy/radiation and less direct-to-implant reconstruction than the CHG group. The CHG group experienced a significantly lower incidence of total complications (22.4% vs. 31.8%, p = 0.006), minor complications (8.7% vs. 16.5%, p = 0.003), infection (6.4% vs. 12.7%, p = 0.006) and seroma (2.6% vs. 6.9%, p = 0.011). There was a significantly increased rate of delayed wound healing in the CHG group. Multivariate analysis showed that the use of CHG solution significantly decreased the odds of any complication by 1.6-fold (OR 0.637, 95% CI 0.414 - 0.977) and the odds of infection by 2.4-fold (OR 0.420, 95% CI 0.218 - 0.809). There were no statistically significant differences in rates of capsular contracture or other complications. Conclusions: The use of CHG as a pocket irrigant in post-mastectomy breast reconstruction is a reasonable alternative to other solutions, in efforts to minimize prosthetic based complications.

Progress in Implant-Based Breast Reconstruction:What Do We Know?

Breast cancer is the most common malignancy and the most frequently diagnosed cancer in women worldwide.In China,the incidence rate of breast cancer among women has been showing an upward trend and is higher in urban areas.Decades of clinical research have made considerable progress,which is attributable to improved mastectomy and maintenance of a well-perfused skin flap after mastectomy.An in-depth insight into the nature of breast cancer will contribute to reduced overall mortality and prolonged survival.In China,there is an increasing awareness of the importance of breast reconstruction in improving quality of life(QoL)and life expectancy.There has been progress in breast reconstruction surgical procedures due to demand from women.Clinicians should be aware that breast reconstruction is not only a medical problem but also a surgical problem.In the following sections,we present the epitome of advances in implant-based breast reconstruction.

Expanding the Use of Nipple-Sparing Mastectomies in Obese Patients Undergoing Staged Implant-Based Reconstruction

Background: Advantages of various mastectomy techniques include skin reduction and favorable aesthetics in Wise-pattern closures, and less visible scars in nipple-sparing mastectomies (NSM). This study compares postoperative complication profiles between Wise-pattern and nipple-sparing mastectomies in the obese population. Methods: A retrospective chart review of obese patients (BMI ≥ 30) who underwent staged breast reconstruction following Wise-pattern and nipple-sparing mastectomies at our institution between February 2016 and January 2020 was conducted. Complications between cohorts were analyzed using the independent samples t-test (2-sided) and the χ2 test. Results: A total of 232 breasts (163 Wise-pattern, 69 NSM) were re-constructed in 123 obese female patients (85 Wise-pattern, 38 NSM). Complication rates in both the Wise-pattern and NSM patient cohorts were similar following stage 1 (Wise-pattern: 30.7%, NSM: 39.1%, p = 0.212) and stage 2 (Wise-pattern: 16.6%, NSM: 15.9%, p = 0.907) of reconstruction. No statistically significant differences in rates of infection, dehiscence, seroma, hematoma or malposition of tissue expander (TE)/implant following stage 1 or stage 2 were found between cohorts. Conclusions: There were no significant differences in postoperative complication rates between the Wise-pattern and NSM cohorts of obese patients. NSM can be a viable surgical option in carefully selected obese patients and offer the advantage of concealed scarring.

Poland Syndrome: Breast Reconstruction Outcomes in 10 Years (2013-2023)

Summary: Poland syndrome is a rare congenital anomaly characterized by the partial or complete absence of the pectoralis major muscle and a wide spectrum of thoracic anomalies, predominantly on the ipsilateral side. These anomalies include hypoplasia or aplasia of the breast and its components, hypotrophy of subcutaneous fat, and absence of axillary hair, as well as hand deformities that can range from syndactyly to ectrodactyly. The aim of this study was to gather information about patients diagnosed with Poland syndrome at the Central South High Specialty Hospital of Petróleos Mexicanos over a period of 10 years and to identify their reconstructive algorithm. Materials and Methods: A retrospective, observational, and descriptive study was conducted to identify the population diagnosed with Poland syndrome at the “Central South High Specialty Hospital of Petróleos Mexicanos” during the period from 2013 to 2023. Results: The database of patients with Poland syndrome from 2013 to 2023 was analyzed, identifying a total of 8 patients with this diagnosis. Of these, 7 were women (90%) and 1 was a man (10%). The left side was more frequently affected (80%) compared to the right side (20%). The average reconstructive process required two surgical stages, mainly consisting of breast expander reconstruction (first stage) and replacement of the expander with an implant (second stage). Conclusions: Despite being a rare congenital condition, the volume of patients treated at the Central South High Specialty Hospital allows for improved diagnosis and contributes to their reconstructive process. The lack of diagnosis in the male population is notable, likely due to the absence of adequate screening.

Study on the Impact of Post-Mastectomy Radiotherapy on Immediate Breast Reconstruction and Complications: A Meta-Analysis

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.

Breast reconstruction:Review of current autologous and implantbased techniques and long-term oncologic outcome

Implant-based reconstruction is the most common method of breast reconstruction.Autologous breast reconstruction is an indispensable option for breast reconstruction demanding keen microsurgical skills and robust anatomical understanding.The reconstructive choice is made by the patient after a discussion with the plastic surgeon covering all the available options.Advantages and disadvantages of each technique along with long-term oncologic outcome are reviewed.

Rapid printing of 3D porous scaffolds for breast reconstruction

Prosthesis implantation and fat transplantation are common breast reconstructionmethods.In general,prosthesis implantation alone does not achieve a realistic enough appearance,and fat transplantation alone is difficult to achieve in the correct capacity.To date,no reports have focused on methods of combining fat with implanted prostheses for breast reconstruction.Using a newly designed bionic ink(i.e.,polyether F127 diacrylate(F127DA)&poly(ethylene glycol)diacrylate(PEGDA))and projection-based three-dimensional bioprinting(PBP),we report the development of a new method for printing porous prostheses.PEGDA was used to improve the printing precision of the prosthesis by increasing the gel point of F127DA and reducing the impact of external temperature.The compression modulus of the printed prosthesis was very close to that of prostheses currently used in clinical practice and to that of natural breasts.Finally,stromal vascular fraction gel(SVF-gel),a human fat extract,was injected into the pores of the synthesized prostheses to prepare a prosthesis mixed with adipose tissue.These were implanted subcutaneously in nude mice to observe their biological performance.After 14 and 28 days of observation,the prosthesis showed good biocompatibility,and adipose tissues grew well in and around the prosthesis.This result shows that a porous prosthesis containing pre-placed adipose tissues is a promising breast reconstruction material.

Surgical Complications in Breast Reconstruction: Assessment and Associations

Introduction: Breast cancer represents a pathology that generates catastrophic impact and has recently increased its incidence and survival due to timely diagnosis and treatment. Therefore, improving the quality of life of cancer survivors has become a priority, offering reconstructive procedures that reduce complications, costs, hospital stay, and optimize resources. Material and methods: 264 patients reconstructed with autologous tissue (TRAM flap and latissimus dorsi) and alloplastic (breast tissue expander—breast implant and direct breast implant) were included. Variables such as demographic, anthropometric, and histologic type were collected. Results: 62% were reconstructed through the use of alloplastics and 38% with autologous tissue. The risk factors related to a greater probability of immediate postoperative complications (surgical site infection, surgical wound dehiscence and reconstruction failure) were obesity (OR: 2.1, CI: 1.5 - 2.7), preoperative radiation (OR: 1.89, CI: 1.75 - 1.92), arterial hypertension (OR: 1.2), Diabetes Mellitus (OR: 1.78) and smoking (OR: 1.31). Conclusions: The reconstructive process is complex and influenced by patient factors, surgeon experience and the hospital center. However, when choosing the reconstructive strategy, risk factors present in each patient must be considered, since radiation and obesity present a greater probability of postoperative complications.

Surgical Outcomes Following Partial Breast Reconstruction with Chest Wall Perforator Flaps

Introduction: In the last two decades, chest wall perforator flaps (CWPF) have become a versatile tissue replacement technique for partial breast reconstruction following breast-conserving surgery (BCS) in well-selected cases. We present the surgical outcome of 81 patients with chest wall perforator flaps used for breast-conserving surgery. Methods: We recorded the outcomes of three oncoplastic breast surgeons who performed partial breast reconstruction with chest wall perforator flaps from 1st January 2018 to 30th June 2022 at Sherwood Forest Hospitals NHS Foundation Trust. Data were collected on patient demographics, including age, BMI, smoking status, bra size, previous treatments, type of CWPF procedure, tumor size (measured clinically, via imaging and histologically), biopsy results, specimen weight, margins involvement, re-operation rate, surgical site infection (SSI), flap loss, flap shrinkage, hematoma, and seroma rates. Results: A total of 81 patients were included in this study, with an average age of 55.7 years and a body mass index (BMI) of 26.7 kg/m2. The bra size varied between A to FF with A (7.4%), B (28.3%), C (38.2%), D (13.6%), DD (11.1%), and FF (1.2%). 14.8% of the patients had neoadjuvant chemotherapy (NACT). For 45 patients, LICAP (lateral intercostal artery perforator), 16 AICAP (anterior intercostal artery perforator), 13 MICAP (medial intercostal artery perforator), and for seven patients, LTAP (lateral thoracic artery perforator) flaps were used. The average tumor was measured at 15.75 mm clinically, 19.1 mm via imaging, and 19.6 mm histologically. Biopsy showed that 16% of the tumors were ductal carcinoma in situ (DCIS), and 84% were invasive. 16% of patients had involved margins, and re-excision was required in 10 patients, and completion mastectomy was performed in 2 patients. A thirty-day SSI rate was 6.2%, with flap-related complications, including flap loss and shrinkage, at 3.7% and 4.9%, respectively. In addition, 3.7% had a hematoma, and 17.3% had other complications. Conclusion: Partial breast reconstruction with perforator flaps is an excellent volume replacement technique in breast-conserving surgery with acceptable complications in well-selected cases.

Recent advances in microvascular autologous breast reconstruction after ablative tumor surgery

Breast cancer is a ubiquitous disease and one of the leading causes of death in women in western societies. With overall increasing survival rates, the number of patients who need post-mastectomy reconstruction is on the rise. Especially since its psychological benefits have been broadly recognized, breast reconstruction has become a key component of breast cancer treatment. Evolving from the early beginnings of breast reconstruction with synthetic implants in the 1960 s, microsurgical tissue transfer is on the way to become the gold standard for post oncology restoration of the breast. Particularly since the advent of perforator based free flap surgery, free tissue transfer has become as safe option for breast reconstruction with low morbidity. The lower abdominal skin and subcutaneous fat tissue typically offer enough volume to create an aesthetically satisfying breast mound. Nowadays, the most commonly used flap from this donor site is the deep inferior epigastric artery perforator flap. If the lower abdomen is not available as a donor site, the gluteal area and thigh provide a number of flaps suitable for breast recon-struction. If the required breast volume is small, and there is enough tissue available on the upper medial thigh, then a transverse upper gracilis flap may be a practicable method to reconstruct the breast. In case of a higher amount of required volume, a gluteal artery perforator flap is the best choice. However, what is crucial in addition to selecting the best flap option for the individual patient is the timing of the operation. In patients with confirmed post-mastectomy radiation therapy, it is advisable to perform microvascular breast reconstruction only in a delayed fashion.

Multi-center investigation of breast reconstruction after mastectomy from Chinese Society of Breast Surgery:A survey based on 31 tertiary hospitals(CSBrS-004)

Objective:Multi-center data on the current status and trends of breast reconstruction after mastectomy in China are lacking.Herein,we conducted a cross-sectional survey to investigate the current clinical practice pattern of postmastectomy breast reconstruction among Chinese female patients with breast cancer.Methods:A standardized questionnaire used to collect information on breast reconstruction among females diagnosed with breast cancer was distributed by 31 members of the Chinese Society of Breast Surgery between January 1,2018 and December 31,2018.Information was collected on tumor characteristics,treatment,mesh application,nipple-areola complex(NAC)preservation,postoperative complications,bilateral reconstruction,patient satisfaction and local recurrence.The overall rate of breast reconstruction was assessed,and the characteristics were compared across patient groups with different reconstruction approaches.Results:A total of 1,554 patients underwent breast reconstruction after total mastectomy,with a reconstruction rate of 9.6%.Among them,1,190 were implant-based,and 262 underwent autologous reconstructions,while 102 cases underwent a combination of both.Patients who underwent implant-based reconstruction were younger than those who received autologous reconstruction(40.1±4.6 vs.45.0±5.9,P=0.004).Compared to patients with autologous reconstruction,mesh application(25.5%vs.6.5%),NAC preservation(51.8%vs.40.5%)and reconstruction failure(1.8%vs.0)were more frequently reported among those with implant-based reconstruction.There was no significant difference in general satisfaction across three reconstruction approaches,though patients with autologous reconstruction reported the highest aesthetic satisfaction among the three groups(P=0.044).Conclusions:Implant-based breast reconstruction remains the dominant choice among patients,while autologous reconstruction was associated with higher aesthetic satisfaction.Our multi-center investigation based on the findings of the tertiary hospitals of Chinese Society of Breast Surgery may guide a future series of clinical studies on breast reconstruction in China.

Sensory reinnervation of free flaps in reconstruction of the breast and the upper and lower extremities

There is long-standing debate about sensate versus non-sensate free microvascular flaps among microsurgeons. The principle of connecting not only the vascular supply, but also sensitive nerves, in free tissue transfer is attractive. However, increased operating time and partial spontaneous innervation led to the common decision to restrict microsurgical tissue transfer to the vascular anastomosis and to leave the nerves ＂untreated＂. Nevertheless, in special cases such as breast reconstruction or extremity reconstruction, the question about sensory nerve coaptation of the flaps remains open. We present our experience with free microvascular tissue transfer for breast and extremity reconstruction and compare the data with previous literature and conclude that most free flap surgeries do not benefit from nerve coaptation.

Nipple-Areola Sparing Mastectomy Followed by Immediate Breast Reconstruction in 126 Patients

This study is to explore the indications, procedures, effectiveness, and feasibility of nipple-areola sparing mastectomy followed by immediate breast reconstruction. The nipple-areola sparing mastectomy followed by immediate breast reconstruction was performed in 126 patients with breast cancer from June 2005 to October 2011. The cosmetic outcomes of the reconstructed breasts were evaluated according to objective and subjective criteria. Meanwhile, the postoperative complications were observed and the therapeutic efficacies were followed up. All the operations were successful. Six patients experienced mild complications early after surgery and were resolved after symptomatic treatment. Both the subjective and objective evaluation for the aesthetic outcomes yielded a satisfactory rate of 97.62% during the 6-80-month follow-up. No recurrence or metastasis was found in 118 cases. Nipple-areola sparing mastectomy followed by immediate breast reconstruction is a simple and effective option for significantly improving the cosmetic outcomes and quality of life of patients, without serious complications or impact on the comprehensive treatment and long-term effect against breast cancer.

Male papillary breast cancer treated by wide resection and latissimus dorsi flap reconstruction: A case report and review of the literature

Breast cancer(BC) in men represents between 0.5% and 1% of all BC diagnosed each year. We report a case of advanced BC in a 62-year-old male treated at our interdisciplinary Breast Cancer Center. The patient presented with a newly diagnosed large, symptomatic mass in his left breast. Clinical examination showed a not movable mass of 16 cm diameter, deforming the whole breast; the overlying skin was livid and hypervascularized. Enlarged lymph nodes were palpable in the axillary pit. He had no concomitant diseases at time of presentation. He denied any first- or second degree family medical history of cancer of any type and he never received radiotherapy. Ultrasound guided minimal-invasive 14-gauge core biopsy revealed a moderately differentiated encapsulated papillary carcinoma with high expression of estrogen and progesterone receptors(both > 80%, IRS 12) and HER2-negative. Because of the tumor size a mastectomy with axillary dissection and chest wall reconstruction using a latissimus dorsi flap was performed. Histological analysis showed invasive growth besides typical(non-invasive) papillary carcinoma and was classified as invasive solid papillary carcinoma; p T3(10 cm), p N0(0/15), M0,R0; Oncotype DX Recurrence Score indicated low risk(RS: 2). After discussion in the interdisciplinary tumor board meeting, radiation therapy and tamoxifen were recommended. The patient had an uneventful recovery and is disease-free after two years of follow-up. Male BC is typically diagnosed at an advanced stage, most likely due to a lack of awareness that men can develop BC. Therefore, in case of a large tumor, a flap-based thoracic reconstruction may be required.

Breast Reconstruction: Does It Worth to Start If the Patient Is Not Sure to Take All the Process Along?

Introduction: Breast cancer is the most common cancer in women worldwide, representing a major public health problem. There is still little information comparing the satisfaction of the patients who finished their process against the ones who start it but did not finish it. The aim of our retrospective study was to analyze the results in terms of satisfaction after one year of undergoing to complete breast reconstruction (CBR) vs incomplete breast reconstruction (IBR). Materials and Methods: Retrospective study of patients that underwent breast reconstruction (BR) surgery after mastectomy for breast cancer treatment. Performed at Hospital Central Sur de Alta Especialidad PEMEX in Mexico City, including patients from January 1, 2015 to January 01, 2020. Demographic baseline variables were included. BREAST-Q satisfaction questionnaires one year after the last reconstructive procedure were analyzed. Results: A total of 44 patients fulfilled the inclusion criteria. Of these 44 patients, 11 were included in the IBR group, and 33 patients in the CBR group. There were no statistically significant differences between the two groups in terms of age (IBR 56.09 vs CBR 53.06 years, p = 0.321);BMI (IBR 27.94 vs CBR 26.40, p = 0.253), time from mastectomy to first reconstructive procedure (IBR 22.8 vs CBR 31 months, p = 0.957), history of chemotherapy (IBR 27.3% vs CBR 33.3%, p = 0.709) and radiotherapy (IBR 54.5% vs CBR 42.4%, p = 0.484), additionally type of reconstruction, affected side or complication rate were not significantly different. Regarding postoperative satisfaction, only the second module of satisfaction with breasts displayed statistically significant differences, with a higher score in the CBR group (46.27 vs 52.27, p = 0.019). Other items explored didn’t show significant differences. Discussion: The data reported in this study suggest that regardless of whether the last stage of a BR is reached, the results in these settings can be very similar in terms of psychosocial well-being, sexual well-being, physical well-being regarding the chest area, with some degree of better perception of her breasts. Conclusion: This study suggests that the results in terms of satisfaction in BR after mastectomy for breast cancer are quite similar for patients who decide to take only the first reconstructive stage, compared with those that finished all the process along, this may be a valuable tool for decision making.

Patient Satisfaction Index and Quality of Life Measurement with Breast-Q after Breast Reconstruction in a Plastic Surgery Center in Mexico

Introduction: Cancer is one of the most devastating pathologies to affect the breast. Mastectomy stigmas are associated with depression, body image dysmorphia, and decreasing quality of life. BREAST-Q is a PROM (Patient Reported Outcome Measures) that has proven useful in measuring satisfaction with breast reconstruction results from the patient’s point of view. Objectives: To measure the satisfaction index and improvement in quality of life after breast reconstruction for breast cancer sequelae in our hospital in the last 5 years. Materials and Methods: Descriptive Study that includes patients with Breast cancer diagnosis that underwent mastectomy and breast reconstruction (prosthesis or autologous tissue) in “Hospital Central Sur de Petroleos Mexicanos” (January 2015 to January 2020), whose satisfaction index was measured with BREAST-Q one year after reconstruction. Results: 153 patients were included in the analysis. Mean global satisfaction was 74 points. We observed a tendency towards higher psychosocial, sexual and appearance satisfaction in patients who underwent reconstruction with autologous tissue. The mean satisfaction with provided information was 64 points and with the medical team > 90 points. Conclusion: Breast reconstruction is associated to a high satisfaction index and quality of life improvement regardless of the technique. BREAST-Q proved to be useful in evaluating patient experience and it helped us identify areas of opportunity to improve our care.

Comparison of Different Reconstruction Algorithms for Decreasing the Exposure Dose during Digital Breast Tomosynthesis: A Phantom Study

We compared reconstruction algorithms [filtered back projection (FBP), maximum likelihood expectation maximization (MLEM), and the simultaneous iterative reconstruction technique (SIRT)] in terms of the radiation dose and image quality, for exploring the possibility of decreasing the radiation dose during digital breast tomosynthesis (DBT). The three algorithms were implemented using a DBT system and experimentally evaluated using measurements, such as signal difference-to-noise ratio (SDNR) and intensity profile, on a BR3D phantom (infocus plane image). The possible radiation dose reduction, contrast improvement, and artifact reduction in DBT were evaluated using different exposure levels and the three reconstruction techniques. We performed statistical analysis (one-way analysis of variance) of the SDNR data. The effectiveness of each technique for enhancing the visibility of the BR3D phantom was quantified with regard to SDNR (FBP versus MLEM, P < 0.05;FBP vs. SIRT, P < 0.05;MLEM vs. SIRT, P = 0.945);the artifact reduction was quantified with regard to the intensity profile. MLEM and SIRT produced reconstructed images with SDNR values indicative of low-contrast visibility. The SDNR value for the half-radiation dose MLEM and SIRT images was close to that of the FBP reference radiation dose image. Artifacts were decreased in the MLEM and SIRT images (in the infocus plane) according to the intensity profiles that we obtained. With MLEM and SIRT, the radiation dose may be decreased to half comparison with FBP.

A Comparison of Reconstruction Algorithms Regarding Exposure Dose Reductions during Digital Breast Tomosynthesis

This study compared reconstruction algorithms [filtered back projection (FBP) and simultaneous iterative reconstruction technique (SIRT)] with respect to radiation doses and image quality and suggested the possibility of decreasing the exposure dose in digital breast tomosynthesis (DBT). These two existing algorithms were implemented using a DBT system and experimentally evaluated using contrast-detail (CD) phantom measurements, such as contrast-to-noise ratio (CNR), root mean square error (RMSE), intensity profile, and artifact spread function (ASF), and the results obtained with FBP and SIRT were compared. The potential dose reduction, contrast improvement, quantum noise reduction, and artifact reduction in DBT were evaluated using different exposures and the two reconstruction techniques. The effectiveness of each technique for enhancing the visibility of a CD phantom was quantified with respect to CNR and RMSE, and artifact reduction was quantified with respect to the intensity profile and ASF. SIRT produced reconstructed images with CNR values indicative of high-contrast detection. Image error was smaller in the in-focus plane SIRT images, and artifacts were decreased in these images according to the determined intensity profiles and ASF. These results suggest that when using SIRT, the exposure dose could possibly be decreased to half.

Skin-Sparing Mastectomy and Breast Reconstruction: An Update for Clinical Practice

Aim: To provide an up-to-date review of the literature on skin-sparing mastectomy (SSM) for breast cancer (BC). The article also reviews the oncological safety, effects of radiotherapy (RT) on immediate breast reconstruction (IBR), the indications for preserving the nipple-areola complex (NAC) and the emerging role of allogenic grafts as adjuncts to implant in IBR. Methods: Review of the English literature from 1965 to 2013 was carried out using Medline and PubMed research engines. Results: SSM is oncologically safe in appropriately selected cases of invasive breast cancer (IBC) and ductal carcinoma in-situ (DCIS) including IBC 5 cm, multi-centric tumours, DCIS and for risk-reduction surgery. Inflammatory breast cancer and tumours with extensive skin involvement represent contra-indications to SSM due to an unacceptable risk of local recurrence. Prior breast irradiation or the need for post-mastectomy radiotherapy (PMRT) do not preclude SSM with IBR, however the aesthetic outcome may be compromised by radiation. Preservation of the nipple-areola complex (NAC) has aesthetic and psychological benefits and is safe for peripherally located node negative unifocal tumours. An intraoperative frozen section protocol for the retro-areolar tissue should be performed when NAC preservation is considered. The advent of acellular dermal matrix has enhanced the scope of implant-based immediate reconstruction following SSM. Cell-assisted fat transfer is emerging as a promising technique to optimise the aesthetics outcome. There is no sufficient evidence to support the role of endoscopic mastectomy in clinical practice. Conclusion: Numerous retrospective and prospective studies show that SSM is oncolgically safe in appropriately selected cases and is aesthetically superior to non-SSM mastectomy. New tech-niques such as the use of acellular dermal matrix (ADM) and cell-assisted fat transfer have increased the use of implants for volume replacement following SSM. In the absence of randomized clinical trials, an updated systematic meta-analysis of published studies is required in order to consolidate the evidence.

Lessons Learned from Three Different Acellular Dermal Matrices in Direct-to-Implant Breast Reconstruction

The aim of the study was to show significant differences regarding postoperative complications and outcomes using three different Acellular Dermal Matrices (ADM), namely Epiflex®, Strattice® and Braxon®, in immediate implant-based subpectoral breast reconstruction cases. Background: The use of Acellular Dermal Matrices for implant-based breast reconstruction cases continues to evolve. There is a wide variety of products which differ significantly in their biological features. It remains unclear if and how these differences manifest in clinical practice. Methods: 82 cases of primary breast reconstruction in the Department of Plastic and Aesthetic Surgery of HELIOS Clinics Schwerin, Germany between 2010 and 2018 were analyzed. 25 patients received Strattice® acellular dermal matrix (SADM), 22 cases Epiflex® acellular dermal matrix (EADM) and the remaining 35 cases Braxon® acellular dermal matrix (BADM). The mean follow-up was 1.8 years. Cases were analyzed regarding minor or major complications and rate of capsular contracture grade III or IV (Baker Classification). Results: The overall complication rate was 34.1% for all groups (SADM = 40%, EADM = 50%, BADM = 20%, p-value = 0.051). Of all cases, 6 patients underwent implant exchange or secondary autologous reconstruction due to capsular contracture (7.3%). The mean time between revision due to capsular contracture and reconstruction was 35.8 ± 14.4 months. 50% of patients, who developed capsular contracture, received postoperative radiation. Mean hospitalization time was 8.2 ± 3 days (SADM = 8 ± 3.2 days, EADM = 10 ± 2.8 days, BADM = 6 ± 1.3 days). There were no significant differences between all three groups for demographics, overall complication rate or capsular contracture. However, patients receiving Braxon® matrix showed significantly fewer minor complications (p-value = 0.01). Moreover, patients receiving Braxon® ADM showed a significantly lower time of hospitalization (p < 0.001). Conclusion: No significant differences regarding the overall complication rate were found between the three groups. Different biological features of ADM showed a weak influence on overall results. However, patients receiving Braxon® ADM showed significantly lower minor complication rates and hospitalization time. In addition, these matrices showed a trend towards lower capsular contracture rates. The low rate of capsular contracture hints at possible advantages of ADM-use in direct-to-implant cases.