Autologous breast reconstruction using the immediately lipofilled extended latissimus dorsi flap

Johns, Neil; Fairbairn, Neil; Trail, Matthew; Ewing, Ailith; Yong, Li; Raine, Cameron; Dixon, J. Michael

doi:10.1016/j.bjps.2017.10.015

Cited by 29 publications

(22 citation statements)

References 46 publications

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“…This finding differs from a previous study by Thorarinsson et al [8], in which, the highest incidence of overall complications was registered in DIEP reconstructions as well as complications demanding re-surgery. On the other hand, other studies indicate that general complication rates, other than seroma, of LD flaps are comparable to perforator-based free flaps such as DIEP [10]. Differences were also observed in implant reconstructions which, in our study, had equal amount both minor complications and complications requiring surgery, while in earlier studies implant reconstructions had less minor complications than complications requiring re-surgery [8].…”

Section: Discussioncontrasting

confidence: 44%

Predictive risk factors of complications in different breast reconstruction methods

Palve

Luukkaala

Kääriäinen

2020

Breast Cancer Res Treat

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Purpose Women with different BMI, age and comorbidities seek for breast reconstruction. It is critical to understand the risk associated with each technique to ensure the most appropriate method and timing is used. Outcome after reconstructions have been studied, but consensus is lacking regarding predictive risk factors of complications. The authors present their experience of different autologous and alloplastic reconstructions with an emphasis on predictors of complications. Methods Prospectively maintained reconstruction database from 2008 to 2019 was reviewed. Factors associated with complications were identified using logistic regression, multinomial logistic regression and risk factor score to determine predictors of complications. Results A total of 850 breast reconstructions were performed in 793 women, including 447 DIEP, 283 LD, 12 TMG and 51 implant reconstructions. Complications included minor (n = 231, 29%), re-surgery requiring (n = 142, 18%) and medical complications (n = 7, 1%). Multivariable analysis showed that complications were associated independently with BMI > 30 (OR 1.59; 95% CI 1.05-2.39, p = 0.027), LD technique (OR 4.05; 95% CI 2.10-7.81, p < 0.001), asthma or chronic obstructive pulmonary disease (OR 2.77; 95% CI 1.50-5.12, p = 0.001) and immediate operation (OR 0.69; 95% CI 0.44-1.07, p = 0.099). Each factor contributed 1 point in the creation of a risk-scoring system. The overall complication rate was increased as the risk score increased (35%, 61%, 76% and 100% for 1, 2, 3 and 4 risk scores, respectively, p < 0.001). Conclusions The rate of complication can be predicted by a risk-scoring system. In increasing trend of patients with medical problems undergoing breast reconstruction, tailoring of preventive measures to patients' risk factors and careful consideration of the best timing of reconstruction is mandatory to prevent complications and costs.

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Section: Discussioncontrasting

confidence: 44%

Predictive risk factors of complications in different breast reconstruction methods

Palve

Luukkaala

Kääriäinen

2020

Breast Cancer Res Treat

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“…Authors remind that the transferred grease keeps the memory of its place of origin that is if the patient slims down after intervention, she will lose a part of the benefit of intervention where from importance that the patient is in her weight of balance at the time of intervention. 10,21,22 At the beginning, the risk of repetition of breast cancer was a subject of debate on the injection of grease in mammary reconstruction after surgery for breast cancer, especially in correction of the consequences of conservative treatments. 3,10 Towards the end of 1980s, Bricoll and al offered the use of the fatty transfers in the breast, but the publications launched very virulent reactions of opposition because they thought that the injections of grease in the breast could procreate microcalcifications and cysts that can bother the detection of cancers and in 1987, the American ASPRS society declared itself disadvantageous to the use of the fatty transfer in the breast, then studies were led entraining a progressive lifting of debate.…”

Section: Discussionmentioning

confidence: 99%

Mammary lipofiling seen to the hospital complex of Dax

Aimé¹,

Martial

Kamary

et al. 2019

Int J Reprod Contracept Obstet Gynecol

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Background: Taken care therapeutics of breast cancer is in constant evolution. She links, according to the stadium of illness, a specific treatment of the cancer and mammary reconstruction which makes integral part of the treatment of breast cancer today. The lipofilling or lipostructure is one of the techniques used in mammary reconstruction.Methods: A descriptive retrospective study on lipofilling accomplished in Hospital complex of Dax, France from January 1st, 2016 till October 31st, 2017 was accomplished, to assess the rate of aesthetic and psychological satisfaction of the patients on the basis of breast Q, then to assess its effectiveness and its security. The statistical analysis was made with the software Excel of Microsoft Office 2007.Results: Authors could record 52 lipofillings at 40 patients among 1212 gynecological surgical operations is 4.29% surgical activities. 47 cases (90.38%) of lipofilling were accomplished at 35 patients after a surgery for breast cancer accomplishing a frequency of 3.87% of surgical activity. The women from 49 to 54 years old are the most concerned the median age of which was of 52 years (37 and 73 years) and the patients are still sexually active in 26 cases (74.29%). The mastectomy was practiced in 32 cases (91.45%). An immediate reconstruction was accomplished at 29 (82.86%) patients. The back big rag autologous was used in 22 cases (62.85%). In 33 cases (94.27%), the lipofilling was accomplished to supplement the reconstruction among which by the back big rag at 22 patients (62.5%) and by mammary prosthesis at 11 patients (31.42%). One took a sample in 32 cases of a volume from 400 to 700 ml of grease average of which was 456.38 ml (200-800 ml). A volume from 200 to 300 ml was injected at 17 patients (36.17%) with an average of 264.14 ml (100-600 ml). No repetition of the cancer was recorded during this study. A score of more than 60 was recorded in every domain for the valuation of satisfaction in more than 90% cases.Conclusions: With the evolution of the taking care of the cancers of breast, mammary reconstruction by lipofilling is a technology which goes know a big development. It is a new way of natural reconstruction at the mastectomy patients who wish, more and more a less aggressive surgical gesture with good result.

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“…Recently, it was found that lipofilling to augment the shape of an LD flap resulted in seromas and wound dehiscence. However, the fat grafting brought no recurrence to any patient in the study [ 87 ]. These reports are snapshots of a wider sample of work, partly described in the body of this review, which all generally report similar outcomes.…”

Section: Is Breast Reconstruction Post-cancer Safe or Not?mentioning

confidence: 99%

Breast cancer recurrence after reconstruction: know thine enemy

et al. 2018

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Breast reconstruction proceeding cancer treatment carries risk, regardless of the type of surgery. From fat grafting, to flap placement, to implants, there is no guarantee that reconstruction will not stimulate breast cancer recurrence. Research in this field is clearly divided into two parts: scientific interventional studies and clinical retrospective evidence. The reconstructive procedure offers hypoxia, a wound microenvironment, bacterial load, adipose derived stem cells; agents shown experimentally to cause increased cancer cell activity. This is compelling scientific evidence which serves to bring uncertainty and fear to the reconstructive procedure. In the absence of clinical evidence, this laboratory literature landscape is now informing surgical choices. Curiously, clinical studies have not shown a clear link between breast cancer recurrence and reconstructive surgery. Where does that leave us? This review aims to analyze the science and the surgery, thereby understanding the oncological fear which accompanies breast cancer reconstruction.

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Autologous breast reconstruction using the immediately lipofilled extended latissimus dorsi flap

Cited by 29 publications

References 46 publications

Predictive risk factors of complications in different breast reconstruction methods

Predictive risk factors of complications in different breast reconstruction methods

Mammary lipofiling seen to the hospital complex of Dax

Breast cancer recurrence after reconstruction: know thine enemy

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