Background Partial breast reconstruction with reduction mammaplasty is an accepted option for women with breast cancer who wish to receive breast conserving therapy. With additional surgery and potential postoperative complications, the impact this approach has on the timely initiation of adjuvant radiation therapy has been raised as a concern. The purpose of this study was to determine if any postoperative complications after oncoplastic reduction (OCR) are associated with a delay in time to radiation. Methods All patients undergoing OCR with postoperative adjuvant radiation at a single institution between 1997 and 2015 were included in the analysis. Women who received adjuvant chemotherapy or experienced delays in radiation therapy due to nonsurgical reasons were excluded from our analysis. Comparisons were made between the time to radiation for patients with surgical complications and those without. Results One hundred eighteen patients were included. Twenty-six (22.0%) experienced a surgical complication. Complications included cellulitis, delayed healing, seroma, wound breakdown, and wound dehiscence. Postoperative complications resulted in a significantly different median time interval for initiation of radiation (74 days vs 54 days, P < 0.001) compared to those without a complication. Among the entire cohort, 5% of patients required a second operative procedure due to complications. (n = 6/118 patients) including hematoma, infection, seroma, open wounds, wound dehiscence, and nipple necrosis. There was no difference in median time to radiation therapy in those with complications who returned to the operating room (73 days) compared to those who did not (74 days, P = 0.692). Conclusion Postoperative complications following OCR procedures were associated with an increased time to initiation of adjuvant radiation therapy regardless of whether or not the complication required reoperation. This needs to be taken into consideration when planning these combined procedures with every attempt made to minimize complications through patient selection and surgical technique.

Incisional hernia following TRAM flap breast reconstruction can be a challenging problem. Attention to surgical technique and the use of mesh minimize the risk of recurrence.

The management of women with breast cancer who wish to preserve their breasts often includes partial reconstruction at the time of tumor resection. This is referred to as the oncoplastic approach and has been shown to improve outcomes. The purpose of this review was to better understand the current surgeon mindset relative to the oncoplastic approach. A survey was designed to understand demographics and opinions on partial breast reconstruction at the time of tumor resection. This was disseminated to the registered members of the American Society of Breast Surgeons as well the American Society of Plastic Surgeons (ASPS) through an online system and comparisons were made. There were 422 responders in the ABS and 214 responders in the ASPS for a response rate of 14.8% and 9.1%, respectively. Most (69.7%) breast surgeons felt that partial breast reconstruction following lumpectomy was not limited in their practice. Fifty percent of plastic surgeons felt that it was limited because they were not getting the referrals. Both groups agreed that complex partial reconstructions were best performed using the team approach. Margin involvement was a major concern in both groups, and the groups agreed that the aesthetic benefits were a major driving force. Future adoption of these techniques will rely on increased training and increased awareness of these procedures. There tends to be general agreement surrounding the concerns and benefits of immediately reconstructing the partial mastectomy defect. Disparity does exist between the two groups in terms of delivery likely due to the system-based inadequacies in the USA. This represents an area for improvement.

No abstract

Mandibular distraction using an implantable device has become a widely accepted and utilized procedure for the treatment of retrognathia. Although excellent results have been reported and observed with distraction osteogenesis, complications such as facial nerve injury have been previously reported. Often, this injury is usually temporary and corrects over the course of time. Frey syndrome has been classically described as an injury or severance of the auricotemporal branch of the trigeminal nerve. It is commonly seen as a complication of parotid surgery and has never been reported in association with mandibular distraction. The authors report a unique case of both facial nerve paralysis and Frey syndrome in a patient following the removal of an internal mandibular distraction device. A review of the literature along with diagnosis and management are discussed.