Postmastectomy Breast Reconstruction in the Irradiated Breast

Lindegren, Anna; Halle, Martin; Skogh, Ann-Charlott Docherty; Edsander-Nord, Åsa

doi:10.1097/prs.0b013e3182547aaf

Cited by 42 publications

(21 citation statements)

References 20 publications

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“…Not surprisingly, this indicates that those surveyed preferred the minimal amount of scarring possible. The DIEP is often considered the gold standard for breast reconstruction by many surgeons [ 5 ] for its aesthetic result and natural ptosis. However, it has been reported that surgeons may overestimate the result of a technically more advanced reconstruction [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…Body image has been shown to be a key factor in determining differences in quality of life when comparing mastectomy and breast conserving therapy [ 4 ]. Regardless of the reconstructive technique, the overall patient satisfaction rates are typically high post breast reconstruction [ 5 6 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…The issue of patient preference in breast cancer surgery is relatively underrepresented in the literature and often the decision-making process is led by the surgeon. Interestingly, Lindegren et al [ 5 ] reported that there is a difference between patients' and plastic surgeons' opinions regarding breast reconstruction in the irradiated breast. In their study, surgeons favoured the deep inferior epigastric artery perforator (DIEP) flap whereas the patients were more satisfied with the latissimus dorsi flap reconstruction.…”

Section: Introductionmentioning

confidence: 99%

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Scar Wars: Preferences in Breast Surgery

et al. 2015

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BackgroundThe uptake of breast reconstruction is ever increasing with procedures ranging from implant-based reconstructions to complex free tissue transfer. Little emphasis is placed on scarring when counseling patients yet they remain a significant source of morbidity and litigation. The aim of this study was to examine the scarring preferences of men and women in breast oncoplastic and reconstructive surgery.MethodsFive hundred men and women were asked to fill out a four-page questionnaire in two large Irish centres. They were asked about their opinions on scarring post breast surgery and were also asked to rank the common scarring patterns in wide local excisions, oncoplastic procedures, breast reconstructions as well as donor sites.ResultsFifty-eight percent of those surveyed did not feel scars were important post breast cancer surgery. 61% said that their partners' opinion of scars were important. The most preferred wide local excision scar was the lower lateral quadrant scar whilst the scars from the deep inferior epigastric artery perforator (DIEP) flap were most favoured. The superior gluteal artery perforator flap had the most preferred donor site while surprisingly, the DIEP had the least favourite donor site.ConclusionsScars are often overlooked when planning breast surgery yet the extent and position of the scar needs to be outlined to patients and it should play an important role in selecting a breast reconstruction option. This study highlights the need for further evaluation of patients' opinions regarding scar patterns.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Scar Wars: Preferences in Breast Surgery

et al. 2015

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“…For this reason, reconstruction of the lost breast is generally performed. Methods of breast reconstruction are classified into two genres: reconstruction by the transfer of autologous tissues [ 2 , 3 ] and reconstruction with artificial materials [ 4 – 6 ]. The latter genre is less invasive than the former.…”

Section: Introductionmentioning

confidence: 99%

Nummular Eczema of Breast: A Potential Dermatologic Complication after Mastectomy and Subsequent Breast Reconstruction

Iwahira

Nagasao

Shimizu

et al. 2015

Plastic Surgery International

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Purposes. The present paper reports clinical cases where nummular eczema developed during the course of breast reconstruction by means of implantation and evaluates the occurrence patterns and ratios of this complication. Methods. 1662 patients undergoing breast reconstruction were reviewed. Patients who developed nummular eczema during the treatment were selected, and a survey was conducted on these patients regarding three items: (1) the stage of the treatment at which nummular eczema developed; (2) time required for the lesion to heal; (3) location of the lesion on the reconstructed breast(s). Furthermore, histopathological examination was conducted to elucidate the etiology of the lesion. Results. 48 patients (2.89%) developed nummular eczema. The timing of onset varied among these patients, with lesions developing after the placement of tissue expanders for 22 patients (45.8%); after the tissue expanders were replaced with silicone implants for 12 patients (25%); and after nipple-areola complex reconstruction for 14 patients (29.2%). Nummular eczema developed both in periwound regions (20 cases: 41.7%) and in nonperiwound regions (32 cases: 66.7%). Histopathological examination showed epidermal acanthosis, psoriasiform patterns, and reduction of sebaceous glands. Conclusions. Surgeons should recognize that nummular eczema is a potential complication of breast reconstruction with tissue expanders and silicone implants.

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“…The principal drawback from the patient’s perspective of the use of the latissimus flap as an option for breast reconstruction is the incisional scar. Although ultimate patient satisfaction with latissimus reconstruction is quite high, 14 design and placement of the skin island may have a favorable impact on the appearance of the scar and the patient’s perception of the same. The original design by Bostwick et al 1 was a vertical oblique orientation and subsequently a transverse and superiorly oriented location of the flap on the back, with the latter an attempt to conceal the scar beneath the brassiere.…”

Section: Discussionmentioning

confidence: 99%

Tissue Expander versus Tissue Expander and Latissimus Flap in Morbidly Obese Breast Reconstruction Patients

Luce

Adams

Chandler

et al. 2015

Plastic and Reconstructive Surgery - Global Open

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Background:Immediate postmastectomy breast reconstruction in morbidly obese patients represents a challenge because neither prosthetic nor abdominal-based options may be suitable.Methods:This study compared a previously published cohort of immediate prosthetic reconstruction of 346 patients (511 breasts) of whom 49 patients (67 breasts) were morbidly obese (defined as a body mass index > 35) with a morbidly obese patient population whose breasts were reconstructed immediately following postmastectomy with latissimus flap and tissue expander (21 patients and 22 breasts) in the same time period. The preoperative risk factors of mastectomy such as tobacco use, diabetes, and prior radiation and the postoperative complications of mastectomy such as skin necrosis, seroma, and prosthesis loss were examined. The explantation of the tissue expander provided a defined endpoint of reconstruction failure.Results:The average body mass index in the tissue expander/implant group and in the latissimus flap plus tissue expander/implant group was 40.9 and 40.1, respectively. The risk profile of diabetes and tobacco use was similar in both groups. Fifteen of the 67 breasts (22.3%) of the tissue expander/implant group and 15 of the 23 breasts (65.2%) of the latissimus flap group had received prior radiation. The prosthesis loss was 13 of 67 breasts (19.4%) that had tissue-expander–alone reconstruction and 1 of 22 (4.8%) in the latissimus group that had tissue expander reconstruction. Modification of donor-site incision and skin-island location in the latissimus group of patients can minimize scar deformity.Conclusion:The loss rate in immediate postmastectomy reconstruction in morbidly obese patients with latissimus flap plus tissue expander was substantially lower than the loss rate in those with breast reconstructed with tissue expander alone.

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Postmastectomy Breast Reconstruction in the Irradiated Breast

Abstract: Therapeutic, III.

Cited by 42 publications

References 20 publications

Scar Wars: Preferences in Breast Surgery

Scar Wars: Preferences in Breast Surgery

Nummular Eczema of Breast: A Potential Dermatologic Complication after Mastectomy and Subsequent Breast Reconstruction

Tissue Expander versus Tissue Expander and Latissimus Flap in Morbidly Obese Breast Reconstruction Patients

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