Periareolar Skin-Sparing Mastectomy and Latissimus Dorsi Flap with Biodimensional Expander Implant Reconstruction: Surgical Planning, Outcome, and Complications

Munhoz, Alexandre Mendonça; Aldrighi, Claudia; Montag, Eduardo; Arruda, Eduardo; Aldrighi, José Mendes; Filassi, José Roberto; Ferreira, Marcus Castro

doi:10.1097/01.prs.0000246406.68739.e4

Cited by 51 publications

(42 citation statements)

References 28 publications

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“…The percentage of capsular contracture Baker III/IV observed in this study (6.3%) is lower than that in other publications, ranging from 10% to 56% (median, 28% for a follow-up time of approximately 3 years) [13][14][15][23][24][25][26][27][28][29] . Capsular contracture has an increased incidence when the reconstructed breast received radiation therapy after the implantation of AM, even in the presence of a myocutaneous flap cover, as demonstrated in the 3 cases of reconstruction with LD.…”

Section: Discussioncontrasting

confidence: 48%

“…This procedure favors a more rapid return of patients to their daily lifestyle, with enhanced immunity and better prognosis 4,5 . In our study, the percentage of use of expanders, with or without flaps of LD or rectus abdominis, was 31.25%, which corresponds to the results reported in most health-care services for breast reconstruction, in which the incidence ranges from 30% to 43% [11][12][13][14][15] . The TRAM was used for approximately one-fourth of the reconstructions, especially in cases of delayed reconstructions and in patients with radiodermatitis.…”

Section: Discussionmentioning

confidence: 82%

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Complicações em reconstrução mamária total em pacientes mastectomizadas por câncer de mama: análise comparativa de longo prazo quanto a influência de técnica, tempo de cirurgia, momento da reconstrução e tratamento adjuvante

Claro¹,

Costa²,

Pinheiro³

et al. 2013

Rev. Bras. Cir. Plást.

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Introduction: Some techniques for total reconstruction of the breast, regardless of complexity, present specific complications, with varying degrees of morbidity. Therefore, the aim of this study was to identify the most frequent complications of the main techniques used for breast reconstruction, and to compare these complications to the relevant independent variables. Methods: This cross-sectional observational study was conducted by reviewing the medical records of patients who had their breasts completely rebuilt after a mastectomy due to breast cancer from January 2007 to December 2009, with a minimum postoperative follow-up of 3 years. The data collected, such as the timing of the intervention, reconstruction techniques, operative time, and adjuvant treatment, were statistically related to the presence of complications. Results: Of the 48 total breast reconstructions analyzed, the technique in which expanders were used followed by replacement with implants showed the lowest prevalence of complications (16.7%, P < 0.000). Some techniques showed specific complications. The operative time for transplantation of transverse rectus abdominis musculocutaneous flap (363.57 ± 59.91 min) was significantly higher than that required for techniques using alloplastic materials (155.71 ± 38.02 min, P = 0.01), but similar to that for the latissimus dorsi flap (309.69 ± 77.66 min). The operative time, timing of surgical intervention, and type of adjuvant treatment did not correlate with the incidence of complications. Conclusions: Each technique has its indications, contraindications, and complications. The application of each technique should be individualized on the basis of the individual characteristics of the patient to obtain better results, avoiding short-and long-term complications.

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Section: Discussioncontrasting

confidence: 48%

Section: Discussionmentioning

confidence: 82%

Complicações em reconstrução mamária total em pacientes mastectomizadas por câncer de mama: análise comparativa de longo prazo quanto a influência de técnica, tempo de cirurgia, momento da reconstrução e tratamento adjuvante

Claro¹,

Costa²,

Pinheiro³

et al. 2013

Rev. Bras. Cir. Plást.

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“…In the remaining breast cancer patients, almost 75% of tumors measured 2 cm or less (T1) and the majority were stage 0 and I. Similarly as observed by other authors, the present study also included a few stage III breast carcinomas; however in the preoperative period these patients were staged as earlierstage carcinoma [9,58] . Additionally, the authors excluded patients with NAC infiltration, NAC bleeding or with the tumor at less than 5 cm from the NAC.…”

Section: Introductionmentioning

confidence: 48%

“…Simultaneously, the native breast skin envelope and infra-mammary fold are preserved therefore facilitating the reconstruction procedure. Utilizing the breast skin envelope optimizes the contour of the breast, resulting in a satisfactory aesthetic outcome and minimizing scarring and post-mastectomy deformity [6][7][8][9] . Recently, an argumentation has advanced about the opportunity of extending conservation of the skin to include the NAC [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] .…”

Section: Introductionmentioning

confidence: 99%

“…The introduction of biodimensional implant-expander system (BIES) has proved increasingly popular over the last years [9,21,33,[97][98][99][100][101][102] . Designed with the objective of combining the advantages of the silicone gel implant and tissue expander into one system, it may present a superior breast form compared with what might be achieved using unshaped implants or expanders.…”

mentioning

confidence: 99%

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Immediate nipple-areola-sparing mastectomy reconstruction: An update on oncological and reconstruction techniques

Munhoz

Montag

Filassi

et al. 2014

WJCO

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Nipple-sparing mastectomy (NSM) is a safe technique in patients who are candidates for conservation breast surgery. However, there is worry concerning its oncological safety and surgical outcome in terms of postoperative complications. The authors reviewed the literature to evaluate the oncological safety, patient selection, surgical techniques, and also to identify the factors influencing postoperative outcome and complication rates. Patient selection and safety related to NSM are based on oncological and anatomical parameters. Among the main criteria, the oncological aspects include the clinical stage of breast cancer, tumor characteristics and location including small, peripherally located tumors, without multicentricity, or for prophylactic mastectomy. Surgical success depends on coordinated planning with the oncological surgeon and In general, the NSM reconstruction is related to autologous and alloplastic techniques and sometimes include contra-lateral breast surgery. Choice of reconstructive technique following NSM requires accurate consideration of various patient related factors, including: breast volume, degree of ptosis, areola size, clinical factors, and surgeon's experience. In addition, tumor related factors include dimension, location and proximity to the nipple-areola complex. Regardless of the fact that there is no unanimity concerning the appropriate technique, the criteria are determined by the surgeon' s experience and the anatomical aspects of the breast. The positive aspects of the technique utilized should include low interference with the oncological treatment, reproducibility, and long-term results. Selected patients can have safe outcomes and therefore this may be a feasible option for early breast cancer management. However, available data demonstrates that NSM can be safely performed for breast cancer treatment in selected cases. Additional studies and longer follow-up are necessary to define consistent selection criteria for NSM.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Breast reconstruction; Skin-sparing mastectomy; Nipple-sparing mastectomy; Outcome; Complications; Silicone breast implants; Tissue expanders; Oncoplastic surgery Core tip: In selected patients, nipple-sparing mastectomy (NSM) has allowed an adequate oncologic control with satisfactory aesthetic outcome. In addition, utilizing the native breast skin optimizes the aesthetic outcome of the reconstructed breast and minimizes postmastectomy deformity. The satisfactory results are due to a close collaboration with the oncological surgical ed the technique for benign diseases, however he did not report the procedure for oncological objectives or as a risk-reduction alternative [10,11] . Recently, there has been an increase in clinical experience studies of NSM for breast cancer prophylaxis or early cancer treatment, evidencing revived interest in this surgical procedure [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][33][34][35][36][37][38][39][40][41][42][43...

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Adjacent skin rotation flap for large defect in primary breast tumor

Jin

Zha

et al. 2018

Journal of Surgical Oncology

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Backgrounds Surgical resection of large primary breast tumor often results in large chest wall defects. The purpose of this study is to evaluate the feasibility of using adjacent skin rotation (ASR) flap in patients with giant primary breast tumor. Methods A total of 26 giant primary breast tumor patients treated with ASR flap were included in this study. The postoperative conditions, including operating time, blood loss, length of hospital stay, and clinical complications were observed. Meanwhile, the information on 17 breast tumor patients treated with transverse rectus abdominis myocutaneous (TRAM) flap were collected and assigned to a control group. Results The mean defect size after mastectomy was 16.7 × 13.4 cm, while the median follow‐up period was 13 months after surgery. A total of 15.4% patients had developed with local complications, and one of them had more than one complication. When comparing the postoperative outcomes, statistically significant differences were found between the two groups with respect to operating time, blood loss, and length of hospital stay (P < 0.001). Conclusions ASR flap is a reliable technique for immediate reconstruction of massive chest wall defects in patients with giant primary breast tumor.

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Periareolar Skin-Sparing Mastectomy and Latissimus Dorsi Flap with Biodimensional Expander Implant Reconstruction: Surgical Planning, Outcome, and Complications

Cited by 51 publications

References 28 publications

Complicações em reconstrução mamária total em pacientes mastectomizadas por câncer de mama: análise comparativa de longo prazo quanto a influência de técnica, tempo de cirurgia, momento da reconstrução e tratamento adjuvante

Complicações em reconstrução mamária total em pacientes mastectomizadas por câncer de mama: análise comparativa de longo prazo quanto a influência de técnica, tempo de cirurgia, momento da reconstrução e tratamento adjuvante

Immediate nipple-areola-sparing mastectomy reconstruction: An update on oncological and reconstruction techniques

Adjacent skin rotation flap for large defect in primary breast tumor

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