Lipomodelling for the management of symptomatic peristomal contour abnormalities: a pilot and feasibility study.

AIM: Lipomodelling has been successfully used in reconstructive breast surgery but not yet in patients with permanent stomas. METHOD: A feasibility study of six patients with permanent stomas was undertaken. Patients underwent lipomodelling of the peristomal area. The number of leakages and quality of life were measured before and for 6 months after the procedure. RESULTS: All patients reported an improvement in their stoma-related quality of life and a reduction in the number of leakages experienced (mean: 2.25 leakages/24 h before lipomodelling and 0.5 leakages/24 h after lipomodelling). CONCLUSION: Lipomodelling appears to be an effective method to reduce stoma leakages caused by peristomal skin contour abnormalities.

Long term results of treatment of breast cancer without axillary surgery - Predicting a SOUND approach?

BACKGROUND: Traditionally axillary surgery has been used to provide staging information and until recently was thought to improve loco-regional control. However, a more minimal approach to the axilla is now being adopted. The aim of this study was to assess long term outcomes of patients with 'low-risk' breast cancers who did not undergo any axillary surgery. 'Low-risk' criteria were: postmenopausal, <20 mm grade 1 or <15 mm grade 2, LVI-ve, ER +ve. METHODS: Women with invasive breast cancer that did not undergo any axillary surgery were identified. Patients were censored when an event or death occurred or at last follow-up at breast clinic or with their General Practitioner. RESULTS: Between 05/01/1995-20/11/2006, 194 patients (199 tumours) were operated upon without axillary surgery. Median follow-up was 10.4 years. 128 patients met low-risk criteria and 71 did not (patient choice = 42, medical fitness = 29). In the 'low risk' cohort there were two axillary recurrences, with a cumulative incidence of 0.8% and 1.9% at 5 and 10 years respectively. DDFS was 99.2% (94.1-99.9%), and 97% (90.0-99%) at 5 and 10 years respectively and DFS was 96.6% (91.1-98.7%) and 91.2% (82.6-95.6%). OS was 90.3% (95% CI: 83.6-94.4) and 75.5% (95% CI: 65.9-82.8) at 5 and 10 years respectively. CONCLUSION: Axillary recurrence and DDFS in this low-risk cohort is favourable. In the modern era of breast cancer management it is possible to define a group of women in whom axillary surgery can be omitted.

Role of lipomodelling in improving aesthetic outcomes in patients undergoing immediate and delayed reconstructive breast surgery.

AIMS: The objective of this article is to report our findings regarding large-volume fat transfer in patients who have undergone autologous breast reconstruction with the latissimus dorsi (LD) flap and/or implant-based reconstruction with subsequent lipomodelling for symmetrisation. METHODS: We retrospectively collected data on all patients who have undergone lipomodelling from October 2008 to October 2011. Fat was harvested using a low-negative pressure syringe method and centrifuged at 3000 r.p.m. for 3 min. The purified fat was injected in 1 mL increments into multilayered microtunnels, starting from deeper layers and moving to superficial layers in the subcutaneous tissue. Patient satisfaction was assessed using validated Picker questions in a face-to-face consultation during follow-up visits, and the results were documented in the case notes. RESULTS: Thirty-one patients underwent lipomodelling following autologous breast reconstruction using the LD flap and implant-based reconstruction. Three patients in the study group had bilateral lipomodelling, and one patient required 3 lipomodelling sessions. Seven patients required 2 sessions, and 21 patients required a single session to achieve bilateral symmetry. The mean volume of fat that was harvested was 396 mL, and the mean injected volume of fat was 247 mL. Four patients (1 breast cancer recurrence, 2 patients with fat necrosis and 1 patient with oil cysts) developed postoperative complications. Twenty-nine patients (93%) were satisfied with the postoperative cosmetic outcome. CONCLUSION: Lipomodelling offers an additional tool to refine breast reconstructive surgery. This study demonstrates that large volumes of fat can be injected for sculpture optimisation and for reshaping reconstructed breasts with improved softness and a natural feel.

Prevention of postoperative seroma-related morbidity by quilting of latissimus dorsi flap donor site: a systematic review.

OBJECTIVE: To systematically analyze the effectiveness of quilting of latissimus dorsi (LD) flap donor site in the prevention of seroma and related morbidities. METHODS: All published studies comparing the effectiveness of quilting versus no-quilting of LD flap donor site in the prevention of seroma and related morbidities in patients undergoing breast reconstruction were analysed systemically. RESULTS: Five comparative studies on quilting versus no-quilting encompassing 440 patients were suitable for statistical analysis. There was no heterogeneity among trials. Therefore, in the fixed-effects model, quilting was effective in terms of reducing the incidence of donor-site seroma formation, reducing the average volume of the seroma, and reducing the total volume of drained seroma. In addition, quilting did not increase the risk of postoperative complications. Combined quilting and fibrin glue was also effective in reducing the average volume of the seroma and total drained volume of the seroma. Combination of quilting and glue did not influence the incidence of seroma formation at LD flap donor site and overall operative complications. CONCLUSION: Quilting of the LD flap donor site is helpful in reducing the incidence of seroma formation, reducing seroma volume, and reducing total drained seroma volume. Combined quilting and fibrin glue further enhances its effectiveness. Quilting with or without fibrin glue may be considered an option in patients undergoing LD flap breast reconstruction to control seroma-related morbidity. However, a major multicenter randomized controlled trial is required to achieve stronger and reliable evidence before recommending it as a routine procedure.