Nipple‐sparing mastectomy with immediate breast reconstruction with a deep inferior epigastric perforator flap without skin paddle using delayed primary retention suture

Francis, Eamon; Dimovska, Eleonora O. F.; Chou, Hsu‐Huan; Lin, Yi‐Ling; Cheng, Ming‐Huei

doi:10.1002/jso.26852

Cited by 3 publications

(3 citation statements)

References 36 publications

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“…1). 15–91 A list of all included studies is available in Supplemental Digital Content 3. ( See table, Supplementary Digital Content 3 , which displays characteristics and references of all included studies.…”

Section: Resultsmentioning

confidence: 99%

“Spin” in Observational Studies in Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Systematic Review

Kim

Yuan

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Breast reconstruction after mastectomy in breast cancer patients is known to provide significant improvements in psychological well-being. 1 Among various techniques available, the deep inferior epigastric perforator (DIEP) flap is considered to be the gold standard for autologous breast reconstruction. 2 Despite the clinical importance and high regard of the DIEP flap technique, most research studies in leading plastic surgery journals are nonrandomized and observational in nature. 3 Nonrandomized observational studies on DIEP flap breast reconstruction have shown high risk of bias in their methodology. 2 Nonrandomized observational studies are generally considered to be of lesser quality evidence compared with randomized controlled trials (RCT) and systematic reviews/meta-analyses of RCTs. Nonetheless, observational studies are commonplace in plastic surgery. The prevalence of observational research, in part, is due to being less resource intensive and easier to conduct. 4 Other Breast Original articleBackground: The deep inferior epigastric artery perforator (DIEP) flap is widely used in autologous breast reconstruction. However, the technique relies heavily on nonrandomized observational research, which has been found to have high risk of bias. "Spin" can be used to inappropriately present study findings to exaggerate benefits or minimize harms. The primary objective was to assess the prevalence of spin in nonrandomized observational studies on DIEP reconstruction. The secondary objectives were to determine the prevalence of each spin category and strategy. Methods: MEDLINE and Embase databases were searched from January 1, 2015, to November 15, 2022. Spin was assessed in abstracts and full-texts of included studies according to criteria proposed by Lazarus et al. Results: There were 77 studies included for review. The overall prevalence of spin was 87.0%. Studies used a median of two spin strategies (interquartile range: 1-3). The most common strategies identified were causal language or claims (n = 41/77, 53.2%), inadequate extrapolation to larger population, intervention, or outcome (n = 27/77, 35.1%), inadequate implication for clinical practice (n = 25/77, 32.5%), use of linguistic spin (n = 22/77, 28.6%), and no consideration of the limitations (n = 21/77, 27.3%). There were no significant associations between selected study characteristics and the presence of spin. Conclusions:The prevalence of spin is high in nonrandomized observational studies on DIEP reconstruction. Causal language or claims are the most common strategy. Investigators, reviewers, and readers should familiarize themselves with spin strategies to avoid misinterpretation of research in DIEP reconstruction.

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Section: Resultsmentioning

confidence: 99%

“Spin” in Observational Studies in Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Systematic Review

Kim

Yuan

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Section: Discussionmentioning

confidence: 99%

“…Nipple-sparing mastectomy has been proven to be oncologically safe in appropriately selected patients for the treatment of invasive breast cancer and breast cancer prophylaxis while also producing superior aesthetic results compared with simple and skin-sparing mastectomies. [2][3][4][6][7][8][15][16][17] Patient selection criteria include peripherally located tumors <3 cm in size and >2 cm from the NAC, negative retroareolar margins, clinically negative axilla, and no skin or chest wall involvement. [2][3][4][5][6]9,16 However, ischemia-related complications due to increased perfusion requirements of the breast skin and NAC remains a significant issue, with the prevalence of ischemic complications ranging from 2% to 30% in the literature.…”

Section: Discussionmentioning

confidence: 99%

Hyperbaric Oxygen Therapy for Threatened Nipple-Sparing Mastectomy Flaps

Nasr¹,

Rifkin²,

Muller³

et al. 2023

Ann Plast Surg

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Background: Nipple-sparing mastectomy (NSM) is emerging as the standard of care for treatment of breast cancer because of its oncologic safety and superior aesthetic outcomes. However, ischemia or necrosis of the skin flap and/or nipple-areola complex remain frequent complications. Hyperbaric oxygen therapy (HBOT) has emerged as a potential adjunct for flap salvage, although it is not currently a widely accepted practice. Here we review our institution's experience using a protocol of HBOT in patients with signs of flap ischemia or necrosis after NSM. Methods: Retrospective review identified all patients treated with HBOT at our institution's hyperbaric and wound care center because of signs of ischemia after NSM. Treatment parameters consisted of 90-minute dives at 2.0 atmosphere once or twice daily. Patients unable to tolerate dives were considered a treatment failure, whereas those lost to follow-up were excluded from analysis. Patient demographics, surgical characteristics, and treatment indications were recorded. Primary outcomes assessed were flap salvage (no operative revision), need for revision procedures, and treatment complications. Results: A total of 17 patients and 25 breasts met the inclusion criteria. The mean ± SD time to initiation of HBOT was 9.47 ± 12.7 days. The mean ± SD age was 46.7 ± 10.4 years, and mean ± SD follow-up time was 36.5 ± 25.6 days. Indications for NSM included invasive cancer (41.2%), carcinoma in situ (29.4%), and breast cancer prophylaxis (29.4%). Initial reconstruction included tissue-expander placement (47.1%), autologous reconstruction with deep inferior epigastric flaps (29.4%), and direct-to-implant reconstruction (23.5%). Hyperbaric oxygen therapy indications included ischemia or venous congestion for 15 breasts (60.0%) and partial thickness necrosis for 10 breasts (40.0%). Flap salvage was achieved in 22 of 25 breasts (88.0%). Reoperation was required for 3 breasts (12.0%). Hyperbaric oxygen therapy-related complications were observed in 4 patients (23.5%), which included 3 patients with mild ear pain and 1 patient with severe sinus pressure leading to treatment abortion. Conclusions: Nipple-sparing mastectomy is an invaluable tool for breast and plastic surgeons to achieve oncologic and cosmetic goals. However, ischemia or necrosis of the nipple-areola complex or mastectomy skin flap remains frequent complications. Hyperbaric oxygen therapy has emerged as a possible intervention for threatened flaps. Our results demonstrate the utility of HBOT in this population to achieve excellent NSM flap salvage rates.

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The Influence of Inset and Shaping of Abdominal-Based Free Flap Breast Reconstruction on Patient-Reported Aesthetic Outcome Scores—A Systematic Review

Zucal,

De Pellegrin,

Parodi

et al. 2024

JCM

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Background: Nowadays, multimodal cancer therapy results in very high survival rates of early-stage breast cancer and microsurgical flap-based breast reconstruction has become safe and reliable, with gradually increasing demand because of its durable and aesthetically pleasing results. This study aimed to explore the impact of different flap shaping and inset techniques on patient-reported outcome measures (PROMs) with regard to the aesthetic result in abdominal flap-based breast reconstruction. Methods: A systematic review was performed screening Pubmed, Cochrane Library and Web of Science for original articles reporting flap inset strategies, concomitantly providing PROMs on the aesthetic result. Results: Of 319 studies identified, six met the inclusion criteria. The studies described different flap rotation options according to the patient’s morphology, different inset planes, and avoidance of the monitoring skin paddle, and suggested that a higher flap-to-mastectomy mass ratio was associated with better aesthetic results. In two comparative studies, according to the PROMs (BREAST-Q, Likert scale) and independent observer judgement, both higher patient satisfaction and superior aesthetic results were observed with the newly described techniques. Conclusions: Emphasis on the aesthetic outcome in terms of breast shape and symmetry, providing an individualized approach of flap inset, considering the contralateral breast’s shape and volume, results in higher satisfaction scores.

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Nipple‐sparing mastectomy with immediate breast reconstruction with a deep inferior epigastric perforator flap without skin paddle using delayed primary retention suture

Cited by 3 publications

References 36 publications

“Spin” in Observational Studies in Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Systematic Review

“Spin” in Observational Studies in Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Systematic Review

Hyperbaric Oxygen Therapy for Threatened Nipple-Sparing Mastectomy Flaps

The Influence of Inset and Shaping of Abdominal-Based Free Flap Breast Reconstruction on Patient-Reported Aesthetic Outcome Scores—A Systematic Review

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