Breast reconstruction following prophylactic or therapeutic mastectomy for breast cancer: Recommendations from an evidence-based provincial guideline

Budgell, Melissa Shea; Quan, May Lynn; Mehling, Blair; Oberle, Claire Temple

doi:10.4172/plastic-surgery.1000858

Cited by 4 publications

(7 citation statements)

References 81 publications

(91 reference statements)

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“…16,[19][20][21][22] Notably, several authors have suggested that autologous tissue reconstruction is preferable to implant-based reconstruction in the setting of radiation. 15,[23][24][25][26][27] Given that the safety profile and optimal timing of radiation in the setting of breast reconstruction remains controversial, 8,11,[28][29][30] should radiation patterns change, the rates of complications with implant-based reconstruction in the setting of radiation may also change.…”

Section: Discussionmentioning

confidence: 99%

“…Although studies have shown that increased body mass index (BMI), smoking, and radiation are associated with more complications in implant-based reconstruction, characterization of breast implant failures and subsequent tissue salvages have been limited due to the small sample sizes in these studies. [8][9][10][11][12][13][14] When implant-based reconstruction fails, one option is to remove the implant and perform tissue flap reconstruction as a salvage procedure. It is unknown how frequently this occurs or if it is associated with success rates similar to primary flap reconstruction.…”

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confidence: 99%

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A Multicenter Analysis Examining Patients Undergoing Conversion of Implant-based Breast Reconstruction to Abdominally based Free Tissue Transfer

Zhao

Tran

Doval

et al. 2018

J reconstr Microsurg

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Background Breast implant placement is the most common method for postmastectomy reconstruction. For patients who develop complications associated with implant-based reconstruction, additional surgeries may be challenging. This study examined implant-based reconstruction failure in patients undergoing salvage with abdominal free tissue transfer. Methods We conducted an Institutional Review Board approved, multicenter retrospective study of patients with implant-based primary breast reconstruction followed by implant removal and subsequent abdominal free tissue transfer between 2006 and 2016. Patient demographics, treatment details, and complications were evaluated. Severity of implant failure was graded as either (1) not severe (delayed salvage reconstruction) or (2) severe (immediate salvage reconstruction). Results Between 2006 and 2016, 115 patients with 180 mastectomy defects underwent primary implant-based reconstruction with subsequent implant removal and abdominally based free tissue reconstruction. Of these, 68 were delayed and 47 were immediate salvage reconstruction. Factors leading to elective removal were capsular contracture, asymmetry, and implant malposition. Factors leading to obligatory removal were infection, delayed wound healing, and implant extrusion. Postmastectomy radiation was significantly associated with immediate salvage reconstruction (p < 0.001, odds ratio = 3.9) as were large volume implants (p = 0.06). Deep inferior epigastric perforator flaps comprised 78.3% of all abdominally based free tissue reconstructions, while muscle-sparing transverse rectus abdominus myocutaneous flaps comprised 18.3%. Overall flap failure rate was 2.6% (2.94% delayed and 2.13% immediate salvage reconstruction; p = 1.0). Conclusion Our findings suggest that abdominal free tissue transfer remains a safe and effective salvage modality for implant-based breast reconstruction failure. Patients with severe implant failure were more likely to have received radiation. Surgeons should remain cognizant of this during care of patients.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

A Multicenter Analysis Examining Patients Undergoing Conversion of Implant-based Breast Reconstruction to Abdominally based Free Tissue Transfer

Zhao

Tran

Doval

et al. 2018

J reconstr Microsurg

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“…Soft‐tissue defects can be found in various pathologic cases . Fat grafting or lipotransfer, has become an integral part of a plastic surgeon's armamentarium for resolving both aesthetic and reconstructive problems.…”

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confidence: 99%

Self‐synthesized extracellular matrix contributes to mature adipose tissue regeneration in a tissue engineering chamber

Zhan

Chang

Xiao

et al. 2015

Wound Repair Regeneration

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The development of an engineered adipose tissue substitute capable of supporting reliable, predictable, and complete fat tissue regeneration would be of value in plastic and reconstructive surgery. For adipogenesis, a tissue engineering chamber provides an optimized microenvironment that is both efficacious and reproducible; however, for reasons that remain unclear, tissues regenerated in a tissue engineering chamber consist mostly of connective rather than adipose tissue. Here, we describe a chamber-based system for improving the yield of mature adipose tissue and discuss the potential mechanism of adipogenesis in tissue-chamber models. Adipose tissue flaps with independent vascular pedicles placed in chambers were implanted into rabbits. Adipose volume increased significantly during the observation period (week 1, 2, 3, 4, 16). Histomorphometry revealed mature adipose tissue with signs of adipose tissue remolding. The induced engineered constructs showed high-level expression of adipogenic (peroxisome proliferator-activated receptor γ), chemotactic (stromal cell-derived factor 1a), and inflammatory (interleukin 1 and 6) genes. In our system, the extracellular matrix may have served as a scaffold for cell migration and proliferation, allowing mature adipose tissue to be obtained in a chamber microenvironment without the need for an exogenous scaffold. Our results provide new insights into key elements involved in the early development of adipose tissue regeneration.

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“…More importantly, these patients are significantly more likely to receive IBR 15,19,31 compared with patients with invasive cancer, and often are considered to be appropriate candidates for IBR. With regard to our examination of the receipt of IBR across Medicaid hospital status, we mitigated any aforementioned confounding (lack of cancer stage information in the NIS data set) by calculating the IBR rates only for patients with an increased risk of breast cancer and/or in situ disease (ie, prophylactic IBR and IBR for noninvasive cancer, respectively).…”

Section: Outcomes Of Interestmentioning

confidence: 99%

“…In other words, do Medicaid beneficiaries endure IBR disparities because they pursue treatment, or "cluster," at HMHs? 19 Reasons include concerns regarding delaying the onset of adjuvant therapy due to IBR-related complications and a higher likelihood of needing postoperative radiotherapy, which might compromise esthetic outcomes 20 and increase complication rates. 15 However, these results are highly susceptible to confounding from the lack of clinical cancer stage information in the National Inpatient Sample (NIS) database and the fact that Medicaid patients have more locally advanced cancers at the time of their initial presentation.…”

Section: Introductionmentioning

confidence: 99%

The site of care matters: An examination of the relationship between high Medicaid burden hospitals and the use, cost, and complications of immediate breast reconstruction after mastectomy

Muldoon

Gani

Canner

et al. 2017

Cancer

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Breast reconstruction following prophylactic or therapeutic mastectomy for breast cancer: Recommendations from an evidence-based provincial guideline

Cited by 4 publications

References 81 publications

A Multicenter Analysis Examining Patients Undergoing Conversion of Implant-based Breast Reconstruction to Abdominally based Free Tissue Transfer

A Multicenter Analysis Examining Patients Undergoing Conversion of Implant-based Breast Reconstruction to Abdominally based Free Tissue Transfer

Self‐synthesized extracellular matrix contributes to mature adipose tissue regeneration in a tissue engineering chamber

The site of care matters: An examination of the relationship between high Medicaid burden hospitals and the use, cost, and complications of immediate breast reconstruction after mastectomy

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