Genevieve Hattingh, Diego A Hanssen, J. Medina, Mansi Sanghvi, Ajay Shah
: Primary osteosarcoma of the breast (OSB) is a rare malignancy of the breast with poor prognosis. There are some reported cases of this infrequent malignant neoplasia, showing that in some instances it can be related to prior trauma or local irradiation in the area. Most malignant mesenchymal neoplasia can be found on the extremities, retroperitoneum, the trunk area and less common, breast, heart, thyroid and the lung. We present a 68-year-old female without any significant medical problems but with prior history of right breast cancer treated with partial mastectomy, adjuvant chemotherapy and local radiation in 2004, presenting to our breast clinic in 2020 with a palpable lesion and biopsy proven poorly differentiated malignant neoplasm, favoring poorly differentiated mammary carcinoma with osteoblastic giant cells. This patient went for a right total mastectomy with final pathology showing high grade osteoblastic osteosarcoma, requiring subsequent re-excision for positive margins. Here we discuss the recommended management and treatment for such a rare diagnosis, as currently no official treatment guidelines exist. We recommend wide local excision without lymph node biopsy and adjuvant chemotherapy. Radiation may be an option but should be decided upon on a case by case basis given the lack of data on its efficacy.
{"title":"Osteosarcoma of the breast: a case report of a rare breast malignancy in a patient with prior partial mastectomy","authors":"Genevieve Hattingh, Diego A Hanssen, J. Medina, Mansi Sanghvi, Ajay Shah","doi":"10.21037/abs-20-104","DOIUrl":"https://doi.org/10.21037/abs-20-104","url":null,"abstract":": Primary osteosarcoma of the breast (OSB) is a rare malignancy of the breast with poor prognosis. There are some reported cases of this infrequent malignant neoplasia, showing that in some instances it can be related to prior trauma or local irradiation in the area. Most malignant mesenchymal neoplasia can be found on the extremities, retroperitoneum, the trunk area and less common, breast, heart, thyroid and the lung. We present a 68-year-old female without any significant medical problems but with prior history of right breast cancer treated with partial mastectomy, adjuvant chemotherapy and local radiation in 2004, presenting to our breast clinic in 2020 with a palpable lesion and biopsy proven poorly differentiated malignant neoplasm, favoring poorly differentiated mammary carcinoma with osteoblastic giant cells. This patient went for a right total mastectomy with final pathology showing high grade osteoblastic osteosarcoma, requiring subsequent re-excision for positive margins. Here we discuss the recommended management and treatment for such a rare diagnosis, as currently no official treatment guidelines exist. We recommend wide local excision without lymph node biopsy and adjuvant chemotherapy. Radiation may be an option but should be decided upon on a case by case basis given the lack of data on its efficacy.","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":"43565016","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}
: Mastectomy is used in breast cancer treatment and as risk-reducing in women with genetic high risk of breast cancer. Immediate breast reconstruction including direct to implant but also autologous breast reconstruction is increasingly offered to women planned to have mastectomy. Either simple mastectomy or skin sparring mastectomy followed by immediate breast reconstruction, two specific issues are crucial. (I) Oncologic safety. That is, removal of any diagnosed pathologic finding, but also all breast tissue including the often breast tissue containing Coopers ligaments and thereby minimizing residual breast tissue. (II) Low complication rate. During mastectomy, the skin flaps are dissected from the breast gland. The interruption of blood supply to the skin flaps from below results in diminished perfusion of the skin flaps. This comprises a risk of necrosis and infection and ultimately prolonged time to adjuvant therapy, prolonged recovery, and possible loss of reconstruction. Tumescent technique with epinephrine solution meets both challenges, especially when used under visual guidance. It accentuates breast tissue and makes it easier to dissect the breast tissue and Coopers ligaments free from the subcutaneous fatty tissue. Furthermore, it is atraumatic and preserves the insulating fatty tissue and the blood supply running through this. Maintaining skin flap perfusion diminishes the risk of necrosis and infection. On top of that, tumescent mastectomy leaves more fatty tissue resulting in a more pleasant aesthetic result regardless of either simple or skin sparring mastectomy and regardless of either direct to implant or autologous reconstruction. The powerful ICG-angiography, often used to assess areas with low perfusion and previously shown to be superior to clinical assessment, can, however, not be relied on when tumescent mastectomy technique has been used.
{"title":"Perspectivising tumescent mastectomy: innovation in preserving mastectomy skin flap perfusion—a narrative review","authors":"C. Bille","doi":"10.21037/ABS-21-4","DOIUrl":"https://doi.org/10.21037/ABS-21-4","url":null,"abstract":": Mastectomy is used in breast cancer treatment and as risk-reducing in women with genetic high risk of breast cancer. Immediate breast reconstruction including direct to implant but also autologous breast reconstruction is increasingly offered to women planned to have mastectomy. Either simple mastectomy or skin sparring mastectomy followed by immediate breast reconstruction, two specific issues are crucial. (I) Oncologic safety. That is, removal of any diagnosed pathologic finding, but also all breast tissue including the often breast tissue containing Coopers ligaments and thereby minimizing residual breast tissue. (II) Low complication rate. During mastectomy, the skin flaps are dissected from the breast gland. The interruption of blood supply to the skin flaps from below results in diminished perfusion of the skin flaps. This comprises a risk of necrosis and infection and ultimately prolonged time to adjuvant therapy, prolonged recovery, and possible loss of reconstruction. Tumescent technique with epinephrine solution meets both challenges, especially when used under visual guidance. It accentuates breast tissue and makes it easier to dissect the breast tissue and Coopers ligaments free from the subcutaneous fatty tissue. Furthermore, it is atraumatic and preserves the insulating fatty tissue and the blood supply running through this. Maintaining skin flap perfusion diminishes the risk of necrosis and infection. On top of that, tumescent mastectomy leaves more fatty tissue resulting in a more pleasant aesthetic result regardless of either simple or skin sparring mastectomy and regardless of either direct to implant or autologous reconstruction. The powerful ICG-angiography, often used to assess areas with low perfusion and previously shown to be superior to clinical assessment, can, however, not be relied on when tumescent mastectomy technique has been used.","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":"45560182","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}
N. Ecanow, A. Chichura, K. Kopkash, C. Pesce, M. Sullivan, K. Yao
{"title":"Gestational gigantomastia complicated by breast infarctive necrosis in the setting of COVID-19 infection: a case report","authors":"N. Ecanow, A. Chichura, K. Kopkash, C. Pesce, M. Sullivan, K. Yao","doi":"10.21037/abs-21-140","DOIUrl":"https://doi.org/10.21037/abs-21-140","url":null,"abstract":"","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":"43976132","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}
Bridgette Bolshem, A. Fahey, A. Melillo, Katherine A. Rodby, G. Rapaport, J. Gaughan, M. Matthews
Between 65–75% of breast reconstructions in the U.S. employ tissue expander (TE) and implant-based reconstruction (1). This method provides practical advantages including shorter operative time and faster recovery (1,2). Despite these advantages, there are still pitfalls to TE-based reconstruction. The overall prevalence of TE failure is unclear since this varies by institution, patient population, follow-up period. Original Article
{"title":"Identification of factors that predict premature tissue expander loss in immediate breast reconstruction","authors":"Bridgette Bolshem, A. Fahey, A. Melillo, Katherine A. Rodby, G. Rapaport, J. Gaughan, M. Matthews","doi":"10.21037/abs-21-77","DOIUrl":"https://doi.org/10.21037/abs-21-77","url":null,"abstract":"Between 65–75% of breast reconstructions in the U.S. employ tissue expander (TE) and implant-based reconstruction (1). This method provides practical advantages including shorter operative time and faster recovery (1,2). Despite these advantages, there are still pitfalls to TE-based reconstruction. The overall prevalence of TE failure is unclear since this varies by institution, patient population, follow-up period. Original Article","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":"48440228","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 pain, or mastalgia, is a common symptom and a frequent reason for breast center referrals. It can be categorized as cyclical or non-cyclical pain. Cyclical breast pain is more common and varies with the menstrual cycle. Non-cyclical breast pain includes true breast pain and extramammary causes. Categorizing breast pain helps to guide the work-up and management. A thorough history and physical exam should be performed in all patients presenting with breast pain. Though breast pain alone is rarely a sign of breast cancer, breast imaging may be still be appropriate. If there are no concerning findings on the physical exam, the imaging work-up is determined by patient age and the type of breast pain. Management of breast pain without suspicious findings on physical exam or breast imaging is driven by the severity of the pain. Reassurance of the negative findings and that the patient does not have breast cancer is often all that is required. Breast pain frequently resolves spontaneously and no further treatments are necessary. If pain is persistent or impacting quality of life, initial management is centered on conservative therapies such as physical support. Medications can be considered for severe and persistent pain, but the side effects of these therapies need to be considered.
{"title":"Work-up and management of breast pain","authors":"Pamela Li, A. Simpson, Jill M. Dietz","doi":"10.21037/abs-20-102","DOIUrl":"https://doi.org/10.21037/abs-20-102","url":null,"abstract":"Breast pain, or mastalgia, is a common symptom and a frequent reason for breast center referrals. It can be categorized as cyclical or non-cyclical pain. Cyclical breast pain is more common and varies with the menstrual cycle. Non-cyclical breast pain includes true breast pain and extramammary causes. Categorizing breast pain helps to guide the work-up and management. A thorough history and physical exam should be performed in all patients presenting with breast pain. Though breast pain alone is rarely a sign of breast cancer, breast imaging may be still be appropriate. If there are no concerning findings on the physical exam, the imaging work-up is determined by patient age and the type of breast pain. Management of breast pain without suspicious findings on physical exam or breast imaging is driven by the severity of the pain. Reassurance of the negative findings and that the patient does not have breast cancer is often all that is required. Breast pain frequently resolves spontaneously and no further treatments are necessary. If pain is persistent or impacting quality of life, initial management is centered on conservative therapies such as physical support. Medications can be considered for severe and persistent pain, but the side effects of these therapies need to be considered.","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":"47832675","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}
Department of Plastic Surgery, Herlev and Gentofte Hospital, Herlev, Denmark; Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark; Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA Contributions: (I) Conception and design: All authors; (II) Administrative support: CA Salzberg, LR Hölmich; (III) Provision of study materials or patients: All authors; (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: Lisbet Rosenkrantz Hölmich. Department of Plastic Surgery, Herlev and Gentofte Hospital, Herlev, Denmark; Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark. Email: lisbet.rosenkrantz.hoelmich@regionh.dk.
{"title":"Immediate or delayed breast reconstruction: the aspects of timing, a narrative review","authors":"L. Hölmich, Farah Sayegh, C. Salzberg","doi":"10.21037/abs-21-44","DOIUrl":"https://doi.org/10.21037/abs-21-44","url":null,"abstract":"Department of Plastic Surgery, Herlev and Gentofte Hospital, Herlev, Denmark; Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark; Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA Contributions: (I) Conception and design: All authors; (II) Administrative support: CA Salzberg, LR Hölmich; (III) Provision of study materials or patients: All authors; (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: Lisbet Rosenkrantz Hölmich. Department of Plastic Surgery, Herlev and Gentofte Hospital, Herlev, Denmark; Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark. Email: lisbet.rosenkrantz.hoelmich@regionh.dk.","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":"47158057","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}
: Complete surgical excision of nipple adenoma with clear margins offers the lowest risk of recurrence of this locally infiltrative yet benign entity. A thorough triple assessment including histological assessment is crucial to exclude any malignant pathology, and confirm the diagnosis. There are many excisional and ablative techniques published that can give clear resection margins, but there remains a paucity of data on acceptable aesthetic outcomes. It is important to balance between adequate surgical margins to prevent recurrence and a good aesthetic outcome, particularly in a young patient. We wish to highlight a good aesthetic outcome following a simple circular excision with purse-string closure of the nipple defect. We present a 28-year-old lady with a progressively ulcerative lesion that involved the entire nipple. Ultrasound did not show any other underlying lesions or intraductal extension. Punch biopsy confirms the diagnosis of a benign nipple adenoma. She was counselled for complete nipple excision and the defect was primarily closed with purse-string technique. This may not be a novel technique as it has been described for closure of other defects. However, the benefit of a purse-string closure of a circular nipple excision defect to reduce scarring may be underreported in the literature. This technique helps to conceal the scar within the areola, retain its natural corrugated appearance, and prevent distortion to the overall shape of the areolar complex. The final outcome of a complete nipple excision resembles that of a ‘scarless’ excision and remains aesthetically pleasing. We hope to allay fears of clinician and patients faced with similar condition by offering a safe, easily reproducible, single staged technique that offers high patient satisfaction in selected patients. Using this technique may even preclude the need for further nipple reconstruction.
{"title":"“Scarless” excision of a nipple adenoma case report—a good aesthetic outcome after a circular nipple excision with purse-string closure technique","authors":"J. X. Hing, E. Kua, Wai Peng Lee","doi":"10.21037/abs-21-66","DOIUrl":"https://doi.org/10.21037/abs-21-66","url":null,"abstract":": Complete surgical excision of nipple adenoma with clear margins offers the lowest risk of recurrence of this locally infiltrative yet benign entity. A thorough triple assessment including histological assessment is crucial to exclude any malignant pathology, and confirm the diagnosis. There are many excisional and ablative techniques published that can give clear resection margins, but there remains a paucity of data on acceptable aesthetic outcomes. It is important to balance between adequate surgical margins to prevent recurrence and a good aesthetic outcome, particularly in a young patient. We wish to highlight a good aesthetic outcome following a simple circular excision with purse-string closure of the nipple defect. We present a 28-year-old lady with a progressively ulcerative lesion that involved the entire nipple. Ultrasound did not show any other underlying lesions or intraductal extension. Punch biopsy confirms the diagnosis of a benign nipple adenoma. She was counselled for complete nipple excision and the defect was primarily closed with purse-string technique. This may not be a novel technique as it has been described for closure of other defects. However, the benefit of a purse-string closure of a circular nipple excision defect to reduce scarring may be underreported in the literature. This technique helps to conceal the scar within the areola, retain its natural corrugated appearance, and prevent distortion to the overall shape of the areolar complex. The final outcome of a complete nipple excision resembles that of a ‘scarless’ excision and remains aesthetically pleasing. We hope to allay fears of clinician and patients faced with similar condition by offering a safe, easily reproducible, single staged technique that offers high patient satisfaction in selected patients. Using this technique may even preclude the need for further nipple reconstruction.","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":"47959846","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}
V. Man, M. Cheung, Christine Lo, Tina Lam, A. Kwong
{"title":"Superparamagnetic iron oxide sentinel lymph node biopsy in early breast cancer: an analysis of artefacts on post-operative breast imaging","authors":"V. Man, M. Cheung, Christine Lo, Tina Lam, A. Kwong","doi":"10.21037/abs-21-110","DOIUrl":"https://doi.org/10.21037/abs-21-110","url":null,"abstract":"","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":"49519606","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}
Farima Dalaei, D. L. Dyrberg, C. Bille, C. Salzberg, J. A. Sørensen, J. Thomsen
Breast animation deformity (BAD) is a common and afflicting sequelae of breast reconstruction or augmentation, and is estimated to occur with variable severity in anywhere from zero to 75% of reconstructions/augmentation (1). It is characterized by an unsightly deformation, a motion deformity, resulting in displacement of the implant and skin rippling associated with contraction of the pectoral muscle (2). BAD is an aesthetic concern, as well as a functional problem. Muscle twitching, pain, and impaired shoulder function are significant problems, especially in physically active women thus affecting patient’s healthrelated quality of life (HR-QOL) (3-5). Review Article
{"title":"An update on breast animation deformity grading systems—a systematic review","authors":"Farima Dalaei, D. L. Dyrberg, C. Bille, C. Salzberg, J. A. Sørensen, J. Thomsen","doi":"10.21037/ABS-21-46","DOIUrl":"https://doi.org/10.21037/ABS-21-46","url":null,"abstract":"Breast animation deformity (BAD) is a common and afflicting sequelae of breast reconstruction or augmentation, and is estimated to occur with variable severity in anywhere from zero to 75% of reconstructions/augmentation (1). It is characterized by an unsightly deformation, a motion deformity, resulting in displacement of the implant and skin rippling associated with contraction of the pectoral muscle (2). BAD is an aesthetic concern, as well as a functional problem. Muscle twitching, pain, and impaired shoulder function are significant problems, especially in physically active women thus affecting patient’s healthrelated quality of life (HR-QOL) (3-5). Review Article","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":"43143213","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 field of breast reconstruction has witnessed tremendous advancements over the years both in terms of breast conservation as well as reconstruction following a mastectomy. The field of oncoplastic surgery has quickly become the standard of care where techniques engrained in the field of cosmetic, aesthetic plastic surgery are now employed to provide the most optimal means of reconstruction for patients undergoing a partial mastectomy. However, other techniques including local pedicle flaps as well as fat grafting or lipofilling have also become useful adjuncts to improve the overall cosmetic results for these patients. For patients undergoing reconstruction following a mastectomy, new technologies are constantly emerging to optimize reconstruction using a prosthesis-based approach, not simply in terms of the devices themselves, but also in terms of surgical techniques and in particular acellular dermal matrices (ADM). The frequent use of ADM has ushered in an era where the prosthesis has returned to a subcutaneous or prepectoral location which was previously plagued with high complications including capsular contracture. Early studies examining this approach have demonstrated high satisfaction and promising results. However, just as there have been beneficial developments in breast reconstruction, so have controversies arisen, the most prevalent of which is the description of breast implant associatedanaplastic large cell lymphoma associated with textured devices. Tremendous advancements have also occurred in the arena of autologous reconstruction where free tissue transfer has quickly become the gold standard means of reconstruction. However, whereas previously the abdominal donor site was the only means of autologous reconstruction, novel donor sites including the thigh and lumbar region are quickly gaining in popularity with the increased comfort with perforator flaps and microvascular surgery. With the growing experience with microsurgery, free tissue transfer no longer focuses solely on achieving a viable flap, but on optimizing patient satisfaction and outcomes. The creation of a sensate flap through neurotization is also quickly becoming commonplace, but long-term outcomes remain to be determined. Finally, the field of lymphedema super microsurgery is now a critical component for reconstruction in patients undergoing treatment for breast cancer. Given the need for multimodality therapy including chemotherapy and radiation, coupled with the need for an axillary dissection in patients with more advanced disease, the risks of lymphedema are only expected to increase. The two physiologic techniques, the lymphovenous bypass (LVB) and vascularized lymph node transfer (VLNT) have proven to be remarkably effective and have dramatically altered the treatment for breast cancer related lymphedema (BCRL) and proven to be an effective means at improving the quality of life of patients suffering from BCRL. The current compendium of articles in the se
{"title":"Novel innovations and advancements in breast reconstruction","authors":"E. Chang","doi":"10.21037/ABS-21-17","DOIUrl":"https://doi.org/10.21037/ABS-21-17","url":null,"abstract":"The field of breast reconstruction has witnessed tremendous advancements over the years both in terms of breast conservation as well as reconstruction following a mastectomy. The field of oncoplastic surgery has quickly become the standard of care where techniques engrained in the field of cosmetic, aesthetic plastic surgery are now employed to provide the most optimal means of reconstruction for patients undergoing a partial mastectomy. However, other techniques including local pedicle flaps as well as fat grafting or lipofilling have also become useful adjuncts to improve the overall cosmetic results for these patients. For patients undergoing reconstruction following a mastectomy, new technologies are constantly emerging to optimize reconstruction using a prosthesis-based approach, not simply in terms of the devices themselves, but also in terms of surgical techniques and in particular acellular dermal matrices (ADM). The frequent use of ADM has ushered in an era where the prosthesis has returned to a subcutaneous or prepectoral location which was previously plagued with high complications including capsular contracture. Early studies examining this approach have demonstrated high satisfaction and promising results. However, just as there have been beneficial developments in breast reconstruction, so have controversies arisen, the most prevalent of which is the description of breast implant associatedanaplastic large cell lymphoma associated with textured devices. Tremendous advancements have also occurred in the arena of autologous reconstruction where free tissue transfer has quickly become the gold standard means of reconstruction. However, whereas previously the abdominal donor site was the only means of autologous reconstruction, novel donor sites including the thigh and lumbar region are quickly gaining in popularity with the increased comfort with perforator flaps and microvascular surgery. With the growing experience with microsurgery, free tissue transfer no longer focuses solely on achieving a viable flap, but on optimizing patient satisfaction and outcomes. The creation of a sensate flap through neurotization is also quickly becoming commonplace, but long-term outcomes remain to be determined. Finally, the field of lymphedema super microsurgery is now a critical component for reconstruction in patients undergoing treatment for breast cancer. Given the need for multimodality therapy including chemotherapy and radiation, coupled with the need for an axillary dissection in patients with more advanced disease, the risks of lymphedema are only expected to increase. The two physiologic techniques, the lymphovenous bypass (LVB) and vascularized lymph node transfer (VLNT) have proven to be remarkably effective and have dramatically altered the treatment for breast cancer related lymphedema (BCRL) and proven to be an effective means at improving the quality of life of patients suffering from BCRL. The current compendium of articles in the se","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":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68292461","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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