Donor site grading after six autologous breast reconstructions for one single patient

Speck, Nicole E.; Lardi, Alessia M.; Farhadi, Jian

doi:10.1007/s00238-020-01720-1

Eur J Plast Surg

2020

DOI: 10.1007/s00238-020-01720-1

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Donor site grading after six autologous breast reconstructions for one single patient

Nicole E. Speck¹,

Alessia M. Lardi²,

Jian Farhadi

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Cited by 2 publications

(1 citation statement)

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“…Innovations such as acellular dermal matrices and autologous fat grafting have substantially elevated the aesthetic results of alloplastic reconstruction 3,4 . Autologous reconstruction has also evolved significantly, with free tissue transfer rising in prevalence because of advancements in microsurgery technologies like fluorescence-assisted indocyanine angiography, laser Doppler imaging, and 3-dimensional printing 5,6 . These have revolutionized preoperative planning and intraoperative assessment of flap viability.…”

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confidence: 99%

Impact of Comorbidities on Sensory Return After Breast Reconstruction

Qin,

Black,

Chen

et al. 2024

Ann Plast Surg

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Purpose Breast anesthesia after mastectomy and reconstruction has been an ongoing concern with few improvements made in recent years. At present, there is a lack of studies evaluating the impact of comorbidities on sensation restoration. Identifying risk factors (RF) will be helpful with preoperative counseling. Methods This was a prospective study on patients who underwent mastectomy and immediate implant-based or neurotized deep inferior epigastric perforator (DIEP) flap-based reconstruction. Neurosensory testing was performed at predefined time points using a pressure specified device. Patients were stratified based on reconstruction type and comorbidities, including obesity (≥30 kg/m2), age (>55 years), hypertension, alcohol use, and smoking status. Sensory comparisons among the comorbidity groups were conducted using unpaired 2-sample t tests. Results A total of 239 patients were included in this study with 109 patients in the implant cohort and 131 patients in the DIEP cohort. One patient underwent bilateral reconstruction using both reconstructive modalities. Preoperatively, age older than 55 years was identified as an RF for reduced breast sensation in the implant cohort (difference in threshold, 10.7 g/mm2), whereas obesity was identified as an RF in the DIEP cohort (difference in threshold, 8 g/mm2). During the first 2 years postreconstruction, age older than 55 years and tobacco use history were found to be negatively correlated with breast sensation for both cohorts. With DIEP reconstruction specifically, obesity was identified as an additional RF during the early postoperative period. Of note, none of the comorbidities were found to be long-term RFs for reduced breast sensitivity. All breast sensation levels returned to comparable levels across all comorbidities by 4 years postreconstruction. Conclusions Currently, various comorbidities have been recognized as RFs for several postoperative complications including extended postoperative stay, necrosis, infection, and reoperation. However, our findings suggest that, although age, smoking history, and obesity showed transient associations with reduced breast sensation during the initial years postreconstruction, they play no role in the long-term potential of sensory nerve regeneration.

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confidence: 99%

Impact of Comorbidities on Sensory Return After Breast Reconstruction

Qin,

Black,

Chen

et al. 2024

Ann Plast Surg

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Microsurgical Breast Reconstruction in Patients with Disorders of Hemostasis: Perioperative Risks and Management

Speck

Hellstern

Farhadi

2022

Plastic &Amp; Reconstructive Surgery

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Background: Surgical and technological advances have resulted in the widespread adoption of microsurgical breast reconstruction. Many comorbidities that potentially might impair vasculature and wound healing are no longer considered contraindications for these procedures. However, some uncertainty still prevails regarding the perioperative management of patients with disorders of hemostasis. Methods: The authors combined a literature review with a retrospective chart review of patients with disorders of hemostasis who had undergone microsurgical breast reconstruction at the senior author’s (J.F.) center between 2015 to 2020. Several disorders associated with thrombotic and/or hemorrhagic complications were identified, and a standardized risk assessment and management strategy was developed in cooperation with a hematologist. Results: Overall, 10 studies were identified comprising 29 patients who had a defined disorder of hemostasis and underwent microsurgical breast reconstruction. Seventeen microsurgical breast reconstructions were performed on 11 patients at the senior author’s (J.F.) center. High factor VIII levels, heterozygous factor V Leiden, and heterozygous prothrombin mutation G20210A were the most common genetic or mixed genetic/acquired thrombophilic conditions. As expected, hereditary antithrombin, protein C, or protein S deficiencies were rare. Among hemorrhagic disorders, thrombocytopenia, platelet dysfunction, and von Willebrand disease or low von Willebrand factor levels were those factors most frequently associated with increased perioperative bleeding. Conclusions: Patients should be screened for elevated risk of thrombosis or bleeding before undergoing microsurgical breast reconstruction, and positive screening should prompt a complete hematologic evaluation. Interdisciplinary management of these disorders with a hematologist is essential to minimize risks and to obtain optimal reconstructive results. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, IV.

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Donor site grading after six autologous breast reconstructions for one single patient

Cited by 2 publications

References 18 publications

Impact of Comorbidities on Sensory Return After Breast Reconstruction

Impact of Comorbidities on Sensory Return After Breast Reconstruction

Microsurgical Breast Reconstruction in Patients with Disorders of Hemostasis: Perioperative Risks and Management

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