Reply: Patient-Reported Satisfaction and Quality of Life in Obese Patients: A Comparison between Microsurgical and Prosthetic Implant Recipients

Kamel, George; Mehta, Karan; Nash, David B.; Jacobson, Joshua; Berk, Robin; Rizzo, Amanda M.; Greige, Nicolas; Benacquista, Teresa; Garfein, Evan S.; Weichman, Katie E.

doi:10.1097/prs.0000000000007287

Cited by 2 publications

(3 citation statements)

References 3 publications

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“…Obesity contributes to chronic medical comorbidities such as hypertension, diabetes, and cardiovascular disease. In the breast reconstruction population, it is associated with increased risk of seroma, wound healing complications, infection, and reconstructive failure (15,26,(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41). In addition to perioperative morbidity, the aesthetics of breast reconstruction are challenged by large breast volume and truncal obesity.…”

Section: Obesementioning

confidence: 99%

“…Two recent publications evaluated patient-reported satisfaction and quality of life in obese patients undergoing autologous and implant-based reconstruction. The authors found that microsurgical breast reconstruction in obese patients yielded higher satisfaction with breasts, overall outcomes, psychosocial well-being, and chest physical wellbeing (37,38). Similarly, Garvey et al analyzed surgical complications in 700 obese patients who underwent alloplastic versus autologous reconstruction (42).…”

Section: Obesementioning

confidence: 99%

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Breast reconstruction in the high-risk population: current review of the literature and practice guidelines

Roubaud¹,

Carey²,

Vartanian³

et al. 2021

Gland Surg

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Breast reconstruction is an important part of the cancer treatment paradigm and the psychosocial benefits are well described in the literature. Notably, breast reconstruction restores both the functional and emotional losses patients experience due to tumor resection. Post-cancer quality of life is an important benchmark of successful treatment; therefore, breast reconstruction is an essential component that should be offered whenever possible. Over time, reconstructive techniques and outcomes have improved dramatically resulting in better patient safety and decreased operative morbidity. When counseling a patient for surgery, the provider must consider all aspects of a patient's health. Ideally, breast cancer patients should be physically, emotionally, and oncologically appropriate candidates for reconstruction. However, in concerted effort to provide opportunities for as many patients as possible, the definition of who is a good candidate for reconstruction has evolved to include higher risk patients. These patients include those with advanced age, nicotine use, obesity, and significant ptosis. With improvements in surgical procedures and perioperative care, this population may also benefit from restorative surgery. However, the exact risk of complications and necessary counseling has gone largely undefined in this population. This article examines particular "highrisk" groups that may be challenging for extirpative and reconstructive surgeons and offers current guidelines for practice.

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Section: Obesementioning

confidence: 99%

Section: Obesementioning

confidence: 99%

Breast reconstruction in the high-risk population: current review of the literature and practice guidelines

Roubaud¹,

Carey²,

Vartanian³

et al. 2021

Gland Surg

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“…The deep inferior epigastric artery perforator (DIEP) flap is the workhorse flap for autologous breast reconstruction and has demonstrated significantly higher patient satisfaction compared to implant‐based techniques (Eltahir et al, 2015; Kamel et al, 2019; Pirro et al, 2017; Toyserkani et al, 2020; Weichman et al, 2015). Through numerous refinements since its first description by Allen and Treece in 1994, surgeons have strove to improve aesthetic outcomes and flap viability while minimizing donor site morbidity (Allen & Treece, 1994; Eom et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Robotic deep inferior epigastric perforator flap harvest in breast reconstruction

et al. 2022

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Introduction Reducing donor site morbidity after deep inferior epigastric artery perforator (DIEP) flap harvest relies mainly upon maintaining integrity of the anterior rectus sheath fascia. The purpose of this study is to describe our minimally‐invasive technique for robotic DIEP flap harvest. Methods A retrospective review of four patients undergoing seven robotic‐assisted DIEP flaps from 2019 to 2020 was conducted. Average patient age and BMI were 52 years (range: 45–60 years) and 26.7 kg/m2 (range: 20.6–32.4 kg/m2), respectively. Average follow‐up was 6.31 months (range: 5.73–7.27 months). Robotic flap harvest was performed with intramuscular perforator dissection in standard fashion, followed by the transabdominal preperitoneal (TAPP) approach to DIEP pedicle harvest using the da Vinci Xi robot. Data was collected on demographic information, perioperative characteristics. Primary outcomes included successful flap harvest as well as donor site morbidity (e.g., abdominal bulge, hernia, bowel obstruction, etc.). Results All four patients underwent bilateral abdominally‐based free flap reconstruction. Three patients received bilateral robotic DIEP flaps, and one patient underwent unilateral robotic DIEP flap reconstruction. The da Vinci Xi robot was used in all cases. Average flap weight and pedicle length were 522 g (range: 110–809 g) and 11.2 cm (range: 10–12 cm), respectively. There were no flap failures, and no patient experienced abdominal wall donor site morbidity on physical exam. Conclusion While further studies are needed to validate its use, this report represents the largest series of robotic DIEP flap harvests to date and is a valuable addition to the literature.

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Reply: Patient-Reported Satisfaction and Quality of Life in Obese Patients: A Comparison between Microsurgical and Prosthetic Implant Recipients

Cited by 2 publications

References 3 publications

Breast reconstruction in the high-risk population: current review of the literature and practice guidelines

Breast reconstruction in the high-risk population: current review of the literature and practice guidelines

Robotic deep inferior epigastric perforator flap harvest in breast reconstruction

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