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These findings suggest that early changes in deoxygenated hemoglobin seen with hyperspectral imaging may predict the region and extent of flap necrosis. Further clinical studies are needed to determine whether hyperspectral imaging is applicable to the clinical setting.

It is generally claimed that short-scar mammaplasty is limited to small-to-medium reductions. Its use in patients with severe macromastia has been associated with a high rate of complications. This report presents our experience of reduction mammaplasty greater than 1000 g per breast using a short-scar technique. The procedure is based on the following: a) modified breast marking method with conservative placement of the nipple-areola complex, determined not only by the level of the inframammary fold but also degree of upper pole volume loss; b) use of liposuction for contouring the inferior pole; c) vertical design dermoglandular resection; d) superomedial pedicle; and e) skin closure without undermining or gathering. A total of 69 patients were identified (n = 138 breasts). Mean age was 38.0 years with average BMI of 36.4 kg/m. Mean weight of breast removed was 1333.8 g (range, 1002-3275). New nipple position was determined to be inferior to the inframammary fold at a mean distance of 4.6 cm, as predicted by the degree of flatness of upper pole. Complications included delayed healing (7.2%), fat necrosis (10.1%), infection (5.8%), hematoma (2.9%), and seroma (1.5%). There were no instances of nipple-areola complex necrosis. Revision of dog-ears was necessary in 7 patients (10.1%). The authors conclude that in using a modified short-scar mammaplasty approach in cases of severe macromastia, the outcomes can be improved with reduced scar burden, pleasing breast shape, and a low complication rate.

Background: Prior studies have examined the relationship between obesity and adverse outcomes after reduction mammaplasty, suggesting a correlation between increasing body mass index (BMI) and postoperative complications. However, there is little data published regarding such correlation with respect to short-scar technique. Methods: A total of 236 patients underwent short-scar mammaplasty with a superomedial pedicle from 2008 to 2014. The procedure was performed by a single surgeon at an academic medical center. Adverse outcomes included delayed healing, major wounds, nipple necrosis, fat necrosis, seroma, hematoma, infection, revision, and dog ear deformities. Univariate and multivariate logistic regression analyses were used to calculate crude and adjusted odds ratios for the association of BMI category with the development of any adverse outcome. Results: Patients were grouped by the following BMI categories: <25 kg/m 2 (n ¼ 27), 25 to <30 kg/m 2 (n ¼ 71), 30 to <35 kg/ m 2 (n ¼ 73), 35 to <40 kg/m 2 (n ¼ 45), and >40 kg/m 2 (n ¼ 20). The mean follow-up period was 260 days. The total complication rate in each group was 22.2%, 23.9%, 27.4%, 33.3%, and 45.0%, respectively. Although the proportion of patients experiencing at least 1 adverse outcome increased across the ascending BMI categories (P trend ¼ .145), there was no statistically significant difference between the groups. Conclusion: This study of 236 patients who underwent short-scar reduction mammaplasty found a positive trend in the incidence of adverse outcomes as BMI increased. However, this was not statistically significant. Résumé Historique : Desétudes antérieures ont porté sur le lien entre l'obésité et lesévénements indésirables après une mammoplastie de réduction, laissant supposer un lien entre l'augmentation de l'indice de masse corporelle (IMC) et les complications postopératoires. Cependant, peu de données sont publiées sur cette corrélation et la technique à petite cicatrice. Méthodologie : Entre 2008 et 2014, un total de 236 patientes a subi une mammoplastie avec petite cicatrice à l'aide d'un pédicule supériomédian. Un seul chirurgien a effectué l'intervention dans un centre hospitalier universitaire. Lesévénements indésirables incluaient le retard de la cicatrisation, les plaies majeures, la nécrose du mamelon, la nécrose des graisses, le sérome, l'hématome, l'infection, la révision et les déformations cornées. Les chercheurs ont utilisé l'analyse par régression logistique univariée et multivariée pour calculer le rapport de cotes (RC) brut et rajusté etétablir l'association entre la catégorie d'IMC et l'apparition d'événements indésirables. Résultats : Les patientesétaient regroupées selon les catégories d'IMC suivantes : moins de 25 kg/m 2 (n ¼ 27), 25 à moins de 30 kg/m 2 (n ¼ 71), 30 à moins de 35 kg/m 2 (n ¼ 73), 35 à moins de 40 kg/m 2 (n ¼ 45) et plus de de 40 kg/m 2 (n ¼ 20).

From discussing the etiologies of post-mastectomy pain syndrome and potential methods of prevention, the next step is to create specific methods of prevention and to identify ways to measure their effects. With the increase in breast cancer related surgeries and increased survival after breast cancer patients, efforts must be made to prevent chronic pain and improve quality of life for these patients after surgery. The plastic surgeon, skilled in breast reconstruction and peripheral nerve reconstruction, may play a significant role in eliminating chronic pain after breast cancer related surgery.

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Summary Background Post-mastectomy pain syndrome (PMPS) is a known debilitating surgical complication. While research on prevention, risk factors, and treatments have been conducted, there remains no cohesive treatment paradigm. The aim of our study is to synthesize the existing evidence on PMPS treatment, which may facilitate the implementation of standardized, effective management strategies. Methods Using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a comprehensive search was developed and translated for MEDLINE, Cochrane Library, EMBASE, CINAHL, PsycINFO, Web of Science, and ClinicalTrials.gov. The databases were searched using a combination of free terms, phrase searching, and database-specific controlled vocabulary related to PMPS. All unique records were by two independent reviewers. Publications on chronic (>3 months duration) pain after breast cancer-related surgery were included. Limited case series, case reports, and editorials were not included. Results A total of 3402 articles from the years 1946–2019 resulted from the literature search after deduplication. Twenty-seven articles met final inclusion criteria for analysis, which revealed 10 major treatment modalities: fat grafting, neuroma surgery, lymphedema surgery, nerve blocks and neurolysis, laser, antidepressants, neuromodulators, physical therapy, mindfulness-based cognitive therapy, and capsaicin. Conclusions In this review, we present a comprehensive assessment of the treatments available for PMPS that may help guide breast surgeons and reconstructive surgeons to employ the most effective treatment strategies for these patients. This review supports the importance of multimodal, multidisciplinary care in improving the management of PMPS.