Optimizing perioperative strategies to maximize success with prepectoral breast reconstruction

Srinivasa, Dhivya; Holland, Michael; Sbitany, Hani

doi:10.21037/gs.2018.09.10

Cited by 12 publications

(7 citation statements)

References 26 publications

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“…If the mastectomy skin flap was thin or viability judged to be suboptimal clinically, a tissue expander was placed in the subpectoral plane. Tumor size or oncologic characteristics did not influence the decision to perform pre-pectoral versus subpectoral reconstruction, the determinant of implant placement location and single versus staged approach is determined by mastectomy skin flap viability, which is supported by the literature [16,17]. Anesthetic was administered using a strict total intravenous anesthesia (TIVA) protocol along with administration of at least two anti-emetics in order to maximize patient comfort and avoid postoperative nausea and vomiting.…”

Section: Day Of Surgerymentioning

confidence: 99%

High-Efficiency Same-Day Approach to Breast Reconstruction During the COVID-19 Crisis

Specht

Sobti

Rosado

et al. 2020

Breast Cancer Res Treat

114

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Purpose As our hospitals conserve and re-allocate resources during the COVID-19 crisis, there is urgent need to determine how best to continue caring for breast cancer patients. During the time window before the COVID-19 critical peak and particularly thereafter, as hospitals are able to resume cancer operations, we anticipate that there will be great need to maximize efficiency to treat breast cancer. The goal of this study is to present a same-day protocol that minimizes resource utilization to enable hospitals to increase inpatient capacity, while providing care for breast cancer patients undergoing mastectomy and immediate breast reconstruction during the COVID-19 crisis. Methods IRB exempt patient quality improvement initiative was conducted to detail the operationalization of a novel same-day breast reconstruction protocol. Consecutive patients having undergone immediate breast reconstruction were prospectively enrolled between February and March of 2020 at Massachusetts General Hospital during the COVID-19 crisis. Peri-operative results and postoperative complications were summarized. Results Time interval from surgical closure to patient discharge was 5.02 ± 1.29 h. All patients were discharged home, with no re-admissions or emergency department visits. No postoperative complications were observed. Conclusion This report provides an instruction manual to operationalize a same-day breast reconstruction protocol, to meet demands of providing appropriate cancer treatment during times of unprecedented resource limitations. Pre-pectoral implantbased breast reconstruction can be the definitive procedure or be used as a bridge to autologous reconstruction. Importantly, we hope this work will be helpful to our patients and community as we emerge from the COVID-19 pandemic.

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Section: Day Of Surgerymentioning

confidence: 99%

High-Efficiency Same-Day Approach to Breast Reconstruction During the COVID-19 Crisis

Specht

Sobti

Rosado

et al. 2020

Breast Cancer Res Treat

114

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“…The assessment of skin flaps in the present study was performed by means of visual inspection and evaluation of perfusion based on clinical judgement (warmth, colour, capillary refill). Although we did not use peri-operative assessment of vascular flow to the mastectomy flaps, the use of such techniques in case of concern may provide useful information to guide the surgical plan (18). The implant loss rate in the present study was 4.5%.…”

Section: Discussionmentioning

confidence: 75%

Pre-pectoral one-stage breast reconstruction with anterior biological acellular dermal matrix coverage

Khan¹,

Tasoulis²,

Teoh³

et al. 2021

Gland Surg

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Background: Pre-pectoral implant breast reconstruction (IBR) is gaining popularity. Several techniques using different types of meshes and methods of placement have been described, but no method is currently considered standard. The aim of this study was to evaluate the outcomes of pre-pectoral IBR using acellular dermal matrix (ADM) for anterior implant cover. Methods: Retrospective cohort study of consecutive patients who underwent pre-pectoral IBR between November 2016 to August 2018. Data on demographics, adjuvant therapies and operative technique was collected. Postoperative complications, length of hospital stay and secondary cosmetic procedures were recorded. Statistical analysis was performed using descriptive statistics, non-parametric tests and logistic regression. Results: One hundred and eleven pre-pectoral IBR were performed in 65 patients. Median age was 41 [interquartile range (IQR), 35-51.5] years, and BMI 22 (IQR, 20.4-24.4) kg/m 2 . Therapeutic mastectomy was performed in 33 procedures with nipples preservation in 78 cases. The median mastectomy weight and implant volume was 360 (IQR, 220-533) gr, and 445 (IQR, 400-475) cc respectively. At a median followup of 18 (IQR, 12-22.5) months, 37 mastectomies had at least 1 complication, but only 12 required surgery.The implant loss rate was 4.5% (5 cases). Lipofilling as secondary procedure was performed in 10.8% of cases. Factors associated with post-operative complications on univariate analysis were nipple preservation (P=0.028), BMI (P=0.01) and implant volume (P=0.027) but these did not remain significant on multivariate analysis.Conclusions: Pre-pectoral IBR using ADM for anterior implant cover is associated with low complication and reconstructive failure rate. Patient selection and meticulous surgical technique are important for successful outcome.

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“… 54 By facilitating an optimal breast pocket, ADMs help to obtain symmetrical coverage, enhance the aesthetic outcome, decrease pain from pectoralis muscle mobilisation and reduce scarring. 57 , 62 Limited capsule contracture and scarring may also be attributed to the decreased inflammatory response associated with ADMs. 63 , 64 Additionally, it is more difficult for scar tissue or capsules to develop on the ADM surface.…”

Section: Resultsmentioning

confidence: 99%

Clinical applications of acellular dermal matrices: A review

Petrie

Cox

Becker

2022

Scars, Burns & Healing

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Introduction The extracellular matrix (ECM) plays an integral role in wound healing. It provides both structure and growth factors that allow for the organised cell proliferation. Large or complex tissue defects may compromise host ECM, creating an environment that is unfavourable for the recovery of anatomical function and appearance. Acellular dermal matrices (ADMs) have been developed from a variety of sources, including human (HADM), porcine (PADM) and bovine (BADM), with multiple different processing protocols. The objective of this report is to provide an overview of current literature assessing the clinical utility of ADMs across a broad spectrum of applications. Methods PubMed, MEDLINE, EMBASE, Scopus, Cochrane and Web of Science were searched using keywords ‘acellular dermal matrix’, ‘acellular dermal matrices’ and brand names for commercially available ADMs. Our search was limited to English language articles published from 1999 to 2020 and focused on clinical data. Results A total of 2443 records underwent screening. After removing non-clinical studies and correspondence, 222 were assessed for eligibility. Of these, 170 were included in our synthesis of the literature. While the earliest ADMs were used in severe burn injuries, usage has expanded to a number of surgical subspecialties and procedures, including orthopaedic surgery (e.g. tendon and ligament reconstructions), otolaryngology, oral surgery (e.g. treating gingival recession), abdominal wall surgery (e.g. hernia repair), plastic surgery (e.g. breast reconstruction and penile augmentation), and chronic wounds (e.g. diabetic ulcers). Conclusion Our understanding of ADM’s clinical utility continues to evolve. More research is needed to determine which ADM has the best outcomes for each clinical scenario. Lay Summary Large or complex wounds present unique reconstructive and healing challenges. In normal healing, the extracellular matrix (ECM) provides both structural and growth factors that allow tissue to regenerate in an organised fashion to close the wound. In difficult or large soft-tissue defects, however, the ECM is often compromised. Acellular dermal matrix (ADM) products have been developed to mimic the benefits of host ECM, allowing for improved outcomes in a variety of clinical scenarios. This review summarises the current clinical evidence regarding commercially available ADMs in a wide variety of clinical contexts.

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Optimizing perioperative strategies to maximize success with prepectoral breast reconstruction

Cited by 12 publications

References 26 publications

High-Efficiency Same-Day Approach to Breast Reconstruction During the COVID-19 Crisis

High-Efficiency Same-Day Approach to Breast Reconstruction During the COVID-19 Crisis

Pre-pectoral one-stage breast reconstruction with anterior biological acellular dermal matrix coverage

Clinical applications of acellular dermal matrices: A review

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