Rafal Iskanderian, Mohamad H Masri, Naghma Nawaz, S. Grobmyer
: Acellular dermal matrix (ADM) has been used as a soft tissue replacement since its introduction in 1994. There is an emerging practice of filling the defects during breast conservation surgery (BCS) exclusively with diced ADM. A 57-year-old female with no family history of malignancies presented to our institution after undergoing left breast lumpectomy and sentinel lymph node biopsy for early stage left breast cancer at another facility in December 2019. Final histopathology revealed a low grade Invasive Ductal Carcinoma of the left breast of TNM stage pT1cN0M0, Estrogen/Progesterone receptors were positive, HER-2/neu was negative and the resection margins were negative for malignancy or atypia. Genetic profiling revealed high risk of recurrence and accordingly she received adjuvant chemotherapy and radiotherapy and was maintained on hormonal therapy. Six months after surgery, a surveillance chest computed tomography (CT) showed a 5.7 cm × 3.5 cm × 2.7 cm mass with a lobulated margin in the vicinity of the resected tumor in left breast and residual disease or recurrence could not be ruled out. Clinical examination did not reveal any suspicious ipsilateral breast mass, or pathological skin/nipple changes. Focused left breast Ultrasound (US) at the same time showed a 7.7 cm × 2 cm × 4.4 cm artificial appearing mass with a smoothly marginated border and swirling debris at the site of the previously resected malignancy. We contacted her surgeon and learned that in fact the patient had undergone the new procedure of lumpectomy cavity volume replacement with diced ADM. The literature on imaging features of ADM remains limited and imaging diagnosis of ADM remains largely based on clinical history and short-term follow-up. Therefore, ADM has increasingly become a differential consideration in diagnostic imaging, following reconstructive breast surgeries. This case describes the radiological features 6 months after using diced ADM in immediate reconstruction after BCS. These findings remain diagnostically challenging for radiologists and surgeons. Definitive diagnosis relies on clinical correlation.
脱细胞真皮基质(ADM)自1994年问世以来一直被用作软组织替代物。在保乳手术(BCS)中，有一种新兴的做法是专门用adm丁填充缺陷。2019年12月，一名57岁女性，无恶性家族史，在另一家医院接受了早期左乳腺癌的左乳房肿瘤切除术和前哨淋巴结活检。最终病理组织学为左乳浸润性导管癌，TNM期pT1cN0M0，雌激素/孕激素受体阳性，HER-2/neu阴性，切除缘恶性或异型阴性。遗传分析显示复发风险高，因此她接受了辅助化疗和放疗，并维持激素治疗。术后6个月胸部CT监测显示左乳切除肿瘤附近有一个5.7 cm × 3.5 cm × 2.7 cm的肿块，边缘呈分叶状，不排除残留病变或复发。临床检查未发现任何可疑的同侧乳房肿块，或病理性皮肤/乳头改变。左乳超声同时聚焦显示，在先前切除的恶性肿瘤部位出现7.7 cm × 2 cm × 4.4 cm的人工肿块，边缘平滑，漩涡状碎片。我们联系了她的外科医生，了解到患者实际上接受了乳房肿瘤切除空腔容量置换和ADM切块的新手术。关于ADM的影像学特征的文献仍然有限，ADM的影像学诊断主要基于临床病史和短期随访。因此，在乳房重建手术后，ADM越来越多地成为诊断影像学的不同考虑因素。本病例描述了在BCS术后立即重建使用ADM切片6个月后的影像学特征。这些发现对放射科医生和外科医生的诊断仍然具有挑战性。明确诊断依赖于临床相关性。
{"title":"Acellular dermal matrix used for lumpectomy cavity volume replacement mimicking as breast cancer recurrence: a case report","authors":"Rafal Iskanderian, Mohamad H Masri, Naghma Nawaz, S. Grobmyer","doi":"10.21037/ABS-20-93","DOIUrl":"https://doi.org/10.21037/ABS-20-93","url":null,"abstract":": Acellular dermal matrix (ADM) has been used as a soft tissue replacement since its introduction in 1994. There is an emerging practice of filling the defects during breast conservation surgery (BCS) exclusively with diced ADM. A 57-year-old female with no family history of malignancies presented to our institution after undergoing left breast lumpectomy and sentinel lymph node biopsy for early stage left breast cancer at another facility in December 2019. Final histopathology revealed a low grade Invasive Ductal Carcinoma of the left breast of TNM stage pT1cN0M0, Estrogen/Progesterone receptors were positive, HER-2/neu was negative and the resection margins were negative for malignancy or atypia. Genetic profiling revealed high risk of recurrence and accordingly she received adjuvant chemotherapy and radiotherapy and was maintained on hormonal therapy. Six months after surgery, a surveillance chest computed tomography (CT) showed a 5.7 cm × 3.5 cm × 2.7 cm mass with a lobulated margin in the vicinity of the resected tumor in left breast and residual disease or recurrence could not be ruled out. Clinical examination did not reveal any suspicious ipsilateral breast mass, or pathological skin/nipple changes. Focused left breast Ultrasound (US) at the same time showed a 7.7 cm × 2 cm × 4.4 cm artificial appearing mass with a smoothly marginated border and swirling debris at the site of the previously resected malignancy. We contacted her surgeon and learned that in fact the patient had undergone the new procedure of lumpectomy cavity volume replacement with diced ADM. The literature on imaging features of ADM remains limited and imaging diagnosis of ADM remains largely based on clinical history and short-term follow-up. Therefore, ADM has increasingly become a differential consideration in diagnostic imaging, following reconstructive breast surgeries. This case describes the radiological features 6 months after using diced ADM in immediate reconstruction after BCS. These findings remain diagnostically challenging for radiologists and surgeons. Definitive diagnosis relies on clinical correlation.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43523985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: Various patterns of abdominal scarring are considered relative or absolute contraindications for deep inferior epigastric perforator (DIEP) flap harvest. There are implications for the vascular supply to and within the flap and also to the abdominoplasty flap used for donor site closure. In recent years, several authors have advocated techniques of safe flap harvest and donor site closure in the scarred abdomen. We present the first reported case of successful delayed DIEP breast reconstruction in a patient who was 1 year post adjuvant chemo and radiotherapy with a previous ileostomy (right abdominal wall), midline laparotomy and active colostomy (left abdominal wall). Pre-operative workup included joint plastic and colorectal consultations, routine bloods and computed tomography angiography (CTA). A joint procedure was carried out during which the active colostomy was isolated on the abdominal wall musculature and a hemi-DIEP was raised from the contralateral side with good intraflap flow despite a previous ileostomy on the flap side. The colostomy was resited in the abdominoplasty flap and the delayed breast reconstruction was successful performed. The flap, donor site and new colostomy site healed well with an uneventful postoperative course and a high level of patient satisfaction and a subjective improvement in abdominal contour for the patient. As the field of abdominal wall reconstruction grows and reliability of microsurgical breast reconstruction improves, increasingly challenging abdomens can be considered as safe donor sites for autologous breast reconstruction. Careful imaging, counselling and collaboration between plastic surgeons and colorectal surgeons can aid in appropriate management of these complex patients.
{"title":"A case report of the scarred abdomen and DIEP surgery— contraindication or opportunity for combined abdominal wall reconstruction?","authors":"J. Barnes, S. Bennett, M. Chadwick, R. Taghizadeh","doi":"10.21037/ABS-20-105","DOIUrl":"https://doi.org/10.21037/ABS-20-105","url":null,"abstract":": Various patterns of abdominal scarring are considered relative or absolute contraindications for deep inferior epigastric perforator (DIEP) flap harvest. There are implications for the vascular supply to and within the flap and also to the abdominoplasty flap used for donor site closure. In recent years, several authors have advocated techniques of safe flap harvest and donor site closure in the scarred abdomen. We present the first reported case of successful delayed DIEP breast reconstruction in a patient who was 1 year post adjuvant chemo and radiotherapy with a previous ileostomy (right abdominal wall), midline laparotomy and active colostomy (left abdominal wall). Pre-operative workup included joint plastic and colorectal consultations, routine bloods and computed tomography angiography (CTA). A joint procedure was carried out during which the active colostomy was isolated on the abdominal wall musculature and a hemi-DIEP was raised from the contralateral side with good intraflap flow despite a previous ileostomy on the flap side. The colostomy was resited in the abdominoplasty flap and the delayed breast reconstruction was successful performed. The flap, donor site and new colostomy site healed well with an uneventful postoperative course and a high level of patient satisfaction and a subjective improvement in abdominal contour for the patient. As the field of abdominal wall reconstruction grows and reliability of microsurgical breast reconstruction improves, increasingly challenging abdomens can be considered as safe donor sites for autologous breast reconstruction. Careful imaging, counselling and collaboration between plastic surgeons and colorectal surgeons can aid in appropriate management of these complex patients.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49627297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: We aimed to determine if tranexamic acid (TXA) is safe to use in breast surgery and does it reduce haematoma and seroma formation. Methods: Only high-quality randomized control trials (RCT’s) were included for the meta-analysis. Databases searched included Embase, Medline, the Cochrane Central Register of Controlled Trials, Mednar and google scholar. RCT’s study quality was assessed using the Cochrane risk of bias tool. Results: Ten studies were identified, 5 RCT’s and 5 non-RCT’s. Overall the risk of thromboembolic events was not significantly greater after TXA administration (P=0.35) in 2,283 patients from 8 studies. 4 RCT’s were included in the meta-analysis. For mastectomy patients with or without axillary surgery combined with mammoplasty procedures the rate of haematoma was unaffected [odds ratio (OR) =0.42, 95% confidence interval (CI): 0.19 to 0.76, P=0.30]. A small reduction in drainage volumes first 24 hours was observed [mean difference (MD) =−12 mL, 95% CI: −20.7 to −3.7, P=0.005], but no effect on late seroma formation (OR =1.04, 95% CI: 0.37 to 2.91, P=0.94). Conclusions: The overall quantity and quality of evidence for TXA use in breast surgery is extremely limited. The current study suggests there is likely to be minimal benefit, at least for mastectomy and mammoplasty patients, with a still undefined risk of thromboembolic events. No RCT’s were identified examining TXA use in breast reconstruction. then compared to
{"title":"Tranexamic acid use in breast surgery: a systematic review and meta-analysis","authors":"Alec A. Winder, P. McQuillan, B. Dijkstra","doi":"10.21037/ABS-20-126","DOIUrl":"https://doi.org/10.21037/ABS-20-126","url":null,"abstract":"Background: We aimed to determine if tranexamic acid (TXA) is safe to use in breast surgery and does it reduce haematoma and seroma formation. Methods: Only high-quality randomized control trials (RCT’s) were included for the meta-analysis. Databases searched included Embase, Medline, the Cochrane Central Register of Controlled Trials, Mednar and google scholar. RCT’s study quality was assessed using the Cochrane risk of bias tool. Results: Ten studies were identified, 5 RCT’s and 5 non-RCT’s. Overall the risk of thromboembolic events was not significantly greater after TXA administration (P=0.35) in 2,283 patients from 8 studies. 4 RCT’s were included in the meta-analysis. For mastectomy patients with or without axillary surgery combined with mammoplasty procedures the rate of haematoma was unaffected [odds ratio (OR) =0.42, 95% confidence interval (CI): 0.19 to 0.76, P=0.30]. A small reduction in drainage volumes first 24 hours was observed [mean difference (MD) =−12 mL, 95% CI: −20.7 to −3.7, P=0.005], but no effect on late seroma formation (OR =1.04, 95% CI: 0.37 to 2.91, P=0.94). Conclusions: The overall quantity and quality of evidence for TXA use in breast surgery is extremely limited. The current study suggests there is likely to be minimal benefit, at least for mastectomy and mammoplasty patients, with a still undefined risk of thromboembolic events. No RCT’s were identified examining TXA use in breast reconstruction. then compared to","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49647434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Harminder Sandhu, Olivia C. Means, E. Komorowska‐Timek
A seroma is a common complication of any surgical procedure that creates dead space allowing for fluid collection. The etiology of seroma formation is not uniform and has been attributed to fibrosis, a subclinical infection, aberrant behavior of lining cells, or lymphatic leak. Contribution of lymphatic flow as the main cause of a persistent seroma seems particularly relevant if the surgery involved damage to adjacent lymphatic structures. We describe a case of a 61-year-old female who presented with a chronic breast seroma despite 13 months of intermittent drainage and attempts at sclerotherapy. Previously, the patient underwent right breast reconstruction with a tissue expander and latissimus dorsi flap following a modified radical mastectomy and failed right sided reconstruction with a deep inferior epigastric perforator flap for breast cancer. To address the chronic seroma, reverse axillary lymphatic mapping was performed prior to seroma excision to visualize a suspected lymphatic contribution. A single lymphatic collector connecting to the seroma cavity was visualized. After ligation of the lymphatic vessel and replacement of the latissimus dorsi and tissue expander, the seroma was finally cured. With this report, we would like to emphasize that identification and elimination of contributing lymphatic vessels appears to be the key component in management of persistent seromas in the basin of major lymphatic drainage.
{"title":"Lymphatic contribution in a chronic breast seroma: a case report","authors":"Harminder Sandhu, Olivia C. Means, E. Komorowska‐Timek","doi":"10.21037/ABS-20-135","DOIUrl":"https://doi.org/10.21037/ABS-20-135","url":null,"abstract":"A seroma is a common complication of any surgical procedure that creates dead space allowing for fluid collection. The etiology of seroma formation is not uniform and has been attributed to fibrosis, a subclinical infection, aberrant behavior of lining cells, or lymphatic leak. Contribution of lymphatic flow as the main cause of a persistent seroma seems particularly relevant if the surgery involved damage to adjacent lymphatic structures. We describe a case of a 61-year-old female who presented with a chronic breast seroma despite 13 months of intermittent drainage and attempts at sclerotherapy. Previously, the patient underwent right breast reconstruction with a tissue expander and latissimus dorsi flap following a modified radical mastectomy and failed right sided reconstruction with a deep inferior epigastric perforator flap for breast cancer. To address the chronic seroma, reverse axillary lymphatic mapping was performed prior to seroma excision to visualize a suspected lymphatic contribution. A single lymphatic collector connecting to the seroma cavity was visualized. After ligation of the lymphatic vessel and replacement of the latissimus dorsi and tissue expander, the seroma was finally cured. With this report, we would like to emphasize that identification and elimination of contributing lymphatic vessels appears to be the key component in management of persistent seromas in the basin of major lymphatic drainage.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47183053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Supermicrosurgical lymphaticovenicular anastomosis (LVA) and vascularized lymph node transplant (VLNT) are established surgical procedures for fluid-predominant extremity lymphedema. LVA is most effective for early disease, while VLNT is effective for more advanced lymphatic injury. However, the devastating complication of donor-site lymphedema has been reported following VLNT. Contour deformity caused by the bulky VLNT flaps further decreases the appeal of this procedure. Vascularized lymph vessel transplant (VLVT) has emerged as a promising new alternative to VLNT. This novel technique has challenged the accepted belief that incorporation of lymph nodes (LNs) into a flap is necessary for the physiologic treatment of advanced lymphedema. First described with the first dorsal metatarsal artery (FDMA) flap, the superficial circumflex iliac artery perforator (SCIP) and thoracodorsal artery perforator (TDAP) flaps were later on described as additional options for VLVT. Outcomes of VLVT have been found to be mostly equivalent to those of VLNT in alleviating symptoms and improving quality of life (QoL). By not sacrificing LNs, it theoretically reduces donor site morbidity. To date, donor-site lymphedema as a sequela of VLVT harvest has not been reported. As with other modalities for the treatment of lymphedema, an understanding of the progression of this disease and careful patient selection is imperative for the successful implementation of VLVT. A review of the literature, combined with the senior author’s experience with these novel techniques, was utilized to generate an updated algorithm for the surgical treatment of extremity
{"title":"Vascularized lymph vessel transplant (VLVT): our experience and lymphedema treatment algorithm","authors":"Lynn M Orfahli, Vahe Fahradyan, Wei F. Chen","doi":"10.21037/ABS-20-139","DOIUrl":"https://doi.org/10.21037/ABS-20-139","url":null,"abstract":"Supermicrosurgical lymphaticovenicular anastomosis (LVA) and vascularized lymph node transplant (VLNT) are established surgical procedures for fluid-predominant extremity lymphedema. LVA is most effective for early disease, while VLNT is effective for more advanced lymphatic injury. However, the devastating complication of donor-site lymphedema has been reported following VLNT. Contour deformity caused by the bulky VLNT flaps further decreases the appeal of this procedure. Vascularized lymph vessel transplant (VLVT) has emerged as a promising new alternative to VLNT. This novel technique has challenged the accepted belief that incorporation of lymph nodes (LNs) into a flap is necessary for the physiologic treatment of advanced lymphedema. First described with the first dorsal metatarsal artery (FDMA) flap, the superficial circumflex iliac artery perforator (SCIP) and thoracodorsal artery perforator (TDAP) flaps were later on described as additional options for VLVT. Outcomes of VLVT have been found to be mostly equivalent to those of VLNT in alleviating symptoms and improving quality of life (QoL). By not sacrificing LNs, it theoretically reduces donor site morbidity. To date, donor-site lymphedema as a sequela of VLVT harvest has not been reported. As with other modalities for the treatment of lymphedema, an understanding of the progression of this disease and careful patient selection is imperative for the successful implementation of VLVT. A review of the literature, combined with the senior author’s experience with these novel techniques, was utilized to generate an updated algorithm for the surgical treatment of extremity","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49161500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Breast reconstruction after mastectomy is commonly undertaken in patients inappropriate for breast conserving surgery, women who are at high genetic risk for breast cancer or otherwise based on patient preference. Current breast reconstruction techniques are diverse and may involve the use of an autologous tissue flap, tissue expanders or definitive implants. Regardless of the technique used, the use of acellular dermal matrices (ADMs) has become increasingly prevalent. The increased uptake of ADMs has led to a paradigm shift in breast reconstruction. This has led to a proliferation of new products and materially contributed to increased rates of pre-pectoral reconstruction. Single-stage and two-stage breast reconstruction remain a contentious issue with increasing evidence justifying direct-to-implant reconstruction in well selected patients with ADMs. ADMs are able to provide solutions to a multitude of issues surrounding inadequate tissue coverage and support, such as implant rippling, implant migration and capsular contracture. This review outlines an overview of the history of ADMs, commonly used ADMs and addresses the evidence with respect to known complications of ADMs. A number of product alternatives to ADMs are explored and an analysis of materials and characteristics are also provided. Notwithstanding cheaper costs of manufacturing these products may offer comparable outcomes. Ultimately this narrative review provides an institutional insight into breast reconstruction in a high volume Australian centre routinely employing ADMs. Important adjuncts such as indocyanine green angiography (ICGA) and negative pressure wound therapy (NPWT) have enhanced outcomes in our practice facilitating the identification of patients likely to benefit from staged expander based reconstruction.
{"title":"Acellular dermal matrices in breast reconstruction: a narrative review and institutional perspective","authors":"Shanshan He, Jian Yin","doi":"10.21037/ABS-20-68","DOIUrl":"https://doi.org/10.21037/ABS-20-68","url":null,"abstract":"Breast reconstruction after mastectomy is commonly undertaken in patients inappropriate for breast conserving surgery, women who are at high genetic risk for breast cancer or otherwise based on patient preference. Current breast reconstruction techniques are diverse and may involve the use of an autologous tissue flap, tissue expanders or definitive implants. Regardless of the technique used, the use of acellular dermal matrices (ADMs) has become increasingly prevalent. The increased uptake of ADMs has led to a paradigm shift in breast reconstruction. This has led to a proliferation of new products and materially contributed to increased rates of pre-pectoral reconstruction. Single-stage and two-stage breast reconstruction remain a contentious issue with increasing evidence justifying direct-to-implant reconstruction in well selected patients with ADMs. ADMs are able to provide solutions to a multitude of issues surrounding inadequate tissue coverage and support, such as implant rippling, implant migration and capsular contracture. This review outlines an overview of the history of ADMs, commonly used ADMs and addresses the evidence with respect to known complications of ADMs. A number of product alternatives to ADMs are explored and an analysis of materials and characteristics are also provided. Notwithstanding cheaper costs of manufacturing these products may offer comparable outcomes. Ultimately this narrative review provides an institutional insight into breast reconstruction in a high volume Australian centre routinely employing ADMs. Important adjuncts such as indocyanine green angiography (ICGA) and negative pressure wound therapy (NPWT) have enhanced outcomes in our practice facilitating the identification of patients likely to benefit from staged expander based reconstruction.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68292247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The rates of breast reconstruction after mastectomy are rising each year. Autologous breast reconstruction using free tissue transfer is considered the gold standard reconstruction, especially with recent controversy surrounding breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). During free tissue transfer, the flap vessels must be anastomosed to recipient vessels on the chest wall. There are multiple options of recipient vessels during microvascular breast reconstruction. Most commonly, the thoracodorsal vessels or the internal thoracic vessels [also known as the internal mammary (IM) vessels] are used as the recipient vessels for microvascular anastomosis of the free tissue transfer. Other second-line options include the thoracoacromial axis and the lateral thoracic vessels. The use of perforators of the internal thoracic vessels for free flap anastomosis during autologous breast reconstruction has been in use for almost twenty years. They are generally favoured over use of thoracodorsal vessels as they result in medialisation of the flap. In recent years, the use of perforators of the internal thoracic vessels has become popular. Great debate surrounds whether or not they should be used as recipient vessels as opposed to the conventional main vessels. In this article, we discuss the advantages and disadvantages of both techniques to guide the choice of reconstructive microsurgeons.
{"title":"Advantages and disadvantages of using the internal thoracic artery perforators as recipient vessels in autologous breast reconstruction—a narrative review","authors":"S. Beecher","doi":"10.21037/ABS-20-50","DOIUrl":"https://doi.org/10.21037/ABS-20-50","url":null,"abstract":"The rates of breast reconstruction after mastectomy are rising each year. Autologous breast reconstruction using free tissue transfer is considered the gold standard reconstruction, especially with recent controversy surrounding breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). During free tissue transfer, the flap vessels must be anastomosed to recipient vessels on the chest wall. There are multiple options of recipient vessels during microvascular breast reconstruction. Most commonly, the thoracodorsal vessels or the internal thoracic vessels [also known as the internal mammary (IM) vessels] are used as the recipient vessels for microvascular anastomosis of the free tissue transfer. Other second-line options include the thoracoacromial axis and the lateral thoracic vessels. The use of perforators of the internal thoracic vessels for free flap anastomosis during autologous breast reconstruction has been in use for almost twenty years. They are generally favoured over use of thoracodorsal vessels as they result in medialisation of the flap. In recent years, the use of perforators of the internal thoracic vessels has become popular. Great debate surrounds whether or not they should be used as recipient vessels as opposed to the conventional main vessels. In this article, we discuss the advantages and disadvantages of both techniques to guide the choice of reconstructive microsurgeons.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46303005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Breast Consultant Surgeon, Nottingham University Trust, Nottingham Breast Institute, Nottingham, UK; Clinical Director of Cellular Pathology, Consultant Histopathologist, Manchester University Foundation Trust, Manchester, UK Contributions: (I) Conception and design: R Pardo-Garcia; (II) Administrative support: R Pardo-Garcia; (III) Provision of study materials or patients: R Pardo-Garcia; (IV) Collection and assembly of data: Both authors; (V) Data analysis and interpretation: Both authors; (VI) Manuscript writing: Both authors; (VII) Final approval of manuscript: Both authors. Correspondence to: Ricardo Pardo-Garcia. Nottingham University Hospitals NHS Trust, City Hospital Campus, Breast Institute, Hucknall Rd., Nottingham NG5 1PB, UK. Email: rpardo133@yahoo.es.
{"title":"The interface between breast conserving surgery with oncoplastic techniques and mastectomy: when to perform one or the other—a narrative review","authors":"R. Pardo-García, M. Montero-Fernández","doi":"10.21037/abs-21-35","DOIUrl":"https://doi.org/10.21037/abs-21-35","url":null,"abstract":"Breast Consultant Surgeon, Nottingham University Trust, Nottingham Breast Institute, Nottingham, UK; Clinical Director of Cellular Pathology, Consultant Histopathologist, Manchester University Foundation Trust, Manchester, UK Contributions: (I) Conception and design: R Pardo-Garcia; (II) Administrative support: R Pardo-Garcia; (III) Provision of study materials or patients: R Pardo-Garcia; (IV) Collection and assembly of data: Both authors; (V) Data analysis and interpretation: Both authors; (VI) Manuscript writing: Both authors; (VII) Final approval of manuscript: Both authors. Correspondence to: Ricardo Pardo-Garcia. Nottingham University Hospitals NHS Trust, City Hospital Campus, Breast Institute, Hucknall Rd., Nottingham NG5 1PB, UK. Email: rpardo133@yahoo.es.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48366342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Goltsman, S. Warrier, C. Mak, A. Spillane, J. Ascherman
Chris O’Brien Lifehouse Camperdown, New South Wales, Australia; Royal Prince Alfred Institute of Academic Surgery, The University of Sydney, Camperdown, New South Wales, Australia; Breast and Surgical Oncology at the Poche Centre, The Mater Hospital, North Sydney, NSW, Australia; Royal North Shore Hospital, Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia; Division of Plastic Surgery, Columbia University Medical Centre, New York-Presbyterian Hospital, New York, NY, USA Contributions: (I) Conception and design: All authors; (II) Administrative support: D Goltsman, S Warrier, JA Ascherman; (III) Provision of study materials or patients: D Goltsman, S Warrier, JA Ascherman; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Jeffrey A. Ascherman, MD. 161 Fort Washington Avenue, Suite 509, Columbia University Medical Center, New York, NY 10032, USA. Email: jaa7@cumc.columbia.edu.
Chris O'Brien Lifehouse Camperdown，澳大利亚新南威尔士州；澳大利亚新南威尔士州坎珀敦悉尼大学阿尔弗雷德王子皇家学术外科研究所；澳大利亚新南威尔士州北悉尼马特医院波切中心的乳腺和肿瘤外科；澳大利亚新南威尔士州悉尼悉尼大学北方临床学院皇家北岸医院；哥伦比亚大学医学中心整形外科，纽约长老会医院，纽约，美国贡献：（I）构思和设计：所有作者；（II） 行政支持：D Goltsman、S Warrier、JA Ascherman；（III） 提供研究材料或患者：D Goltsman、S Warrier、JA Ascherman；（IV） 数据收集和汇编：所有作者；（V） 数据分析和解释：所有作者；（VI） 手稿写作：所有作者；（VII） 手稿的最终批准：所有作者。通信地址：Jeffrey A.Ascherman，MD。161 Fort Washington Avenue，Suite 509，Columbia University Medical Center，New York，NY 10032，USA电子邮件：jaa7@cumc.columbia.edu.
{"title":"Association between body mass index and adverse surgical outcomes of implant-based breast reconstruction: a prospective cohort study of 5,545 breast reconstructions","authors":"D. Goltsman, S. Warrier, C. Mak, A. Spillane, J. Ascherman","doi":"10.21037/abs-21-2","DOIUrl":"https://doi.org/10.21037/abs-21-2","url":null,"abstract":"Chris O’Brien Lifehouse Camperdown, New South Wales, Australia; Royal Prince Alfred Institute of Academic Surgery, The University of Sydney, Camperdown, New South Wales, Australia; Breast and Surgical Oncology at the Poche Centre, The Mater Hospital, North Sydney, NSW, Australia; Royal North Shore Hospital, Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia; Division of Plastic Surgery, Columbia University Medical Centre, New York-Presbyterian Hospital, New York, NY, USA Contributions: (I) Conception and design: All authors; (II) Administrative support: D Goltsman, S Warrier, JA Ascherman; (III) Provision of study materials or patients: D Goltsman, S Warrier, JA Ascherman; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Jeffrey A. Ascherman, MD. 161 Fort Washington Avenue, Suite 509, Columbia University Medical Center, New York, NY 10032, USA. Email: jaa7@cumc.columbia.edu.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49521204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Checkpoint Kinase 2 (CHEK2) *1100delC is a rare genetic mutation that confers an elevated lifetime risk of breast cancer that increases with each afflicted family member. This variant may be found in 1.1% of breast cancer patients, or up to 2.9% of breast cancer patients with Northeastern European heritage. Given a lifetime risk that ranges from 20–44%, patients with CHEK2*1100delC may consider the option of bilateral prophylactic mastectomy. We describe the case of a 35-year-old female with a strong family history of breast cancer who tested positive for the CHEK2*1100delC mutation. The patient opted to undergo bilateral prophylactic nipple-sparing mastectomy with temporary tissue expander placement and breast reconstruction 6 months later. The patient continues to report a good post-operative outcome six years after her bilateral mastectomy. To our knowledge, no case reports describing prophylactic mastectomy for CHEK2 mutation have been published. Due to a lifetime risk of breast cancer approaching that of other well-studied mutations, patients with CHEK2*1100delC should be offered the option of bilateral prophylactic mastectomy with extensive discussion of risks, benefits, alternatives, cosmetic outcome, and psychosocial consequences. So far, no clear survival benefit has been identified in patients who have undergone prophylactic mastectomy compared to routine surveillance. However, patients may benefit from improved breast and psychosocial well-being, as prophylactic mastectomy can reduce the risk of breast cancer by more than 90%. Depending on the experience and expertise of the clinician, both skin or nipplesparing mastectomy may be considered as they have equivalent outcomes.
{"title":"Prophylactic nipple-sparing mastectomy for CHEK2 mutation: a case report","authors":"K. Yuan, Kevin M. Lin-Hurtubise, Mark Y Lee","doi":"10.21037/abs-21-71","DOIUrl":"https://doi.org/10.21037/abs-21-71","url":null,"abstract":"Checkpoint Kinase 2 (CHEK2) *1100delC is a rare genetic mutation that confers an elevated lifetime risk of breast cancer that increases with each afflicted family member. This variant may be found in 1.1% of breast cancer patients, or up to 2.9% of breast cancer patients with Northeastern European heritage. Given a lifetime risk that ranges from 20–44%, patients with CHEK2*1100delC may consider the option of bilateral prophylactic mastectomy. We describe the case of a 35-year-old female with a strong family history of breast cancer who tested positive for the CHEK2*1100delC mutation. The patient opted to undergo bilateral prophylactic nipple-sparing mastectomy with temporary tissue expander placement and breast reconstruction 6 months later. The patient continues to report a good post-operative outcome six years after her bilateral mastectomy. To our knowledge, no case reports describing prophylactic mastectomy for CHEK2 mutation have been published. Due to a lifetime risk of breast cancer approaching that of other well-studied mutations, patients with CHEK2*1100delC should be offered the option of bilateral prophylactic mastectomy with extensive discussion of risks, benefits, alternatives, cosmetic outcome, and psychosocial consequences. So far, no clear survival benefit has been identified in patients who have undergone prophylactic mastectomy compared to routine surveillance. However, patients may benefit from improved breast and psychosocial well-being, as prophylactic mastectomy can reduce the risk of breast cancer by more than 90%. Depending on the experience and expertise of the clinician, both skin or nipplesparing mastectomy may be considered as they have equivalent outcomes.","PeriodicalId":72212,"journal":{"name":"Annals of breast surgery : an open access journal to bridge breast surgeons across the world","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45562714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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