Background Matrices are now commonly used in breast reconstruction, but the scientific evidence is still scares. The main aim was to compare complications and the need for corrections in immediate breast reconstruction with the porcine-derived Surgisis ® with the traditional muscle-covered technique. The secondary aim was to compare long-term quality of life and satisfaction. Methods All consecutive patients who had their breast reconstructed with a Surgisis ® or muscle-covered tissue expander/implant were included. Patients were followed clinically and with BREAST-Q. Results During the study period, 116 reconstructions (71 patients) were operated in the Surgisis ® group and 132 reconstructions (90 patients) in the control group. The median follow-up time was 74 months (min 43-max 162). The total early complication rate was 37% in the Surgisis ® group and 27% in the control group. There were no differences in implant loss (p = 0.68) or total number of complications (p = 0.24) between the two groups. Risk factors for complications were mainly patient characteristics and the use of a tissue expander. There was a slightly higher capsular contracture frequency in the Surgisis ® patients (4.2% vs. 2.5%). The need for corrections and patient satisfaction and quality of life were similar in the two groups. Conclusions The use of Surgisis ® in implant-based reconstruction seems to result in an acceptable total early complication rate. The rate might be higher in tissue expander-based reconstruction. Risk factors are mainly patient characteristics. The capsular contracture rate and need for corrections, as well as patient satisfaction and quality of life, are similar in the Surgisis ® patients and muscle-covered controls. Level of evidence: III

Background There is no consensus for when publicly funded breast reduction is indicated and recommendations in guidelines vary greatly, indicating a lack of evidence and unequal access. The primary aim of this review was to examine risks and benefits of breast reduction to treat breast hypertrophy. Secondary aims were to examine how the studies defined breast hypertrophy and indications for a breast reduction. Methods A systematic literature search was conducted in PubMed, MEDLINE All, Embase, the Cochrane Library, and PsycInfo. The included articles were critically appraised, and certainty of evidence was assessed using the GRADE approach. Meta-analyses were performed when possible. Results Fifteen articles were included; eight reporting findings from four randomised controlled trials, three non-randomised controlled studies, three case series, and one qualitative study. Most studies had serious study limitations and problems with directness. Few of the studies defined breast hypertrophy. The studies showed significantly improved health-related quality of life and sexuality-related outcomes in patients who had undergone breast reduction compared with controls, as well as reduced depressive symptoms, levels of anxiety and pain. Most effect sizes exceeded the reported minimal important difference for the scale. Certainty of evidence for the outcomes above is low (GRADE ⊕ ⊕). Although four studies reported significantly improved physical function, the effect is uncertain (very low certainty of evidence, GRADE ⊕). None of the included studies reported data regarding work ability or sick leave. Three case series reported a 30-day mortality of zero. Reported major complications after breast reduction ranged from 2.4 to 14% and minor complications from 2.4 to 69%. Conclusion There is a lack of high-quality studies evaluating the results of breast reduction. A breast reduction may have positive psychological and physical effects for women, but it is unclear which women benefit the most and which women should be offered a breast reduction in the public healthcare system. Several priorities for further research have been identified. Pre-registration The study is based on a Health Technology Assessment report, pre-registered and then published on the website of The Regional HTA Centre of Region Västra Götaland, Sweden.

Throughout different eras and cultures what is considered the cosmetically ideal breast has varied greatly. There is no broadly accepted standardised method that objectively evaluates aesthetic outcome after breast reduction mammoplasty. The primary aim of this study was to evaluate the result of breast reduction regarding nipple position, comparing it to an objective previously described standard. Secondary aims were to determine symmetry and examine predictors for achieving an aesthetically pleasing breast. The position of the nipple was measured in postoperative pictures and compared to a previously described standard. Three-hundred and thirty-six breast were included in the study. Compared with the previously described standard, 26% (89/336) of the nipples were within the optimal position in mediolateral direction, and 44% (147/336) in craniocaudal direction. The majority of women had the nipple in the same position in the two breasts. Age at surgery seems to significantly influence the possibility of achieving an optimal nipple position. No other predictors were found. Improvements can be made in placement of the nipple during reduction mammoplasty. Further studies are needed on how knowledge of the ideal nipple position can be used to optimize surgical planning and technique, and reduce variability in outcomes, in breast reduction mammoplasties.