Delayed-immediate breast reconstruction: An assessment of complications and outcomes in the context of anticipated post-mastectomy radiotherapy.

INTRODUCTION: The detrimental effects of post-mastectomy radiotherapy on breast reconstruction are well known. We report our experience with a delayed-immediate approach involving an initial subcutaneous implant with definitive reconstruction after adjuvant radiotherapy. METHODS: Patients were identified retrospectively from hospital, theatre and implant registry records. Details regarding demographics, cancer pathology, surgical data and oncological therapies were collected. Primary outcomes included complication rates of first-stage surgery and time to definitive reconstruction. RESULTS: A total of 115 patients underwent mastectomy and temporary subcutaneous implant (36 nipple sparing) between 2008 and 2019. Five were smokers with eleven having a body mass index > 30. The median age was 46 years (27-76 years) and tumour size 50 mm. Almost 95% underwent radiotherapy, 82% chemotherapy and 70% had axillary node clearance. Median mastectomy weight was 464 g (123-1300 g) with median temporary implant volume 375 cc (180-655 cc). Complications of first-stage surgery at three months included 5.2% implant loss (n = 6), 14.8% infection rate, 17.4% readmission rate and 10.4% returned to theatre. Reconstructive failure occurred in four cases (3.5%). A total of 76 patients completed definitive reconstruction, including 26 autologous, 21 latissimus dorsi with implant, and 28 implant-only reconstructions. The median time to reconstruction following the completion of radiotherapy was 12 months. This increased in those who had implant complications (28 vs. 15 months) or radiotherapy (16 vs. 10 months) versus those without. CONCLUSIONS: Delayed-immediate breast reconstruction using a temporary subcutaneous implant has been shown to be a safe, feasible and potentially beneficial method than simple mastectomy and delayed reconstruction with a complication rate comparable to that of immediate implant reconstruction.

Sex Differences in Peer Selection and Socialization for Alcohol Use from Adolescence to Young Adulthood and the Influence of Marital and Parental Status.

BACKGROUND: Peer selection and socialization influences for alcohol and other substance use have been a prominent area of research especially, though not exclusively, across adolescence. This study used 4-wave prospective data from 1,004 young adults to evaluate selection and socialization influences for young adults' alcohol use and friends' alcohol use from late adolescence to later young adulthood, and incorporated the time-varying predictors of marital and parental status. In addition, sex differences in peer selection and socialization processes were tested. METHODS: Participants were recruited from high schools, and assessments were based on self-reports initially collected in adolescence (at age 17.0 years) via paper-and-pencil surveys and in young adulthood at ages 23.8, 28.9, and 33.5 years via computer-based individual interviews (computer-assisted personal interview and audio computer-assisted self-interviewing). Initial sampling included a 76% participation rate, and the retention rate was 83%. Cross-lagged panel regression models were used to evaluate hypotheses about peer selection and socialization. RESULTS: Findings indicated that friend selection processes were stronger than socialization processes across adolescence to young adulthood. Adopting marital and (especially) parental roles was negatively associated with young adults' alcohol use and percentage of friends using alcohol, and the magnitude of these relationships was stronger and more consistent for females. CONCLUSIONS: These findings indicated that across the adolescence-to-young adulthood transition, peer selection processes were more influential than peer socialization. Marital and parental roles were associated with both lower young adult alcohol use and a lower percentage of friends using alcohol, with stronger role-related effects for females relative to males.

A comparison of electronic portal dosimetry verification methods for use in stereotactic radiotherapy.

Three methods of transit dosimetry using Electronic Portal Imaging Devices (EPIDs) were investigated for use in routine in-vivo dosimetry for cranial stereotactic radiosurgery and radiotherapy. The approaches examined were (a) A full Monte Carlo (MC) simulation of radiation transport through the linear accelerator and patient; (b) Calculation of the expected fluence by a treatment planning system (TPS); (c) Point doses calculated along the central axis compared to doses calculated using parameters acquired using the EPID. A dosimetric comparison of each of the three methods predicted doses at the imager plane to within ±5% and a gamma comparison for the MC and TPS based approaches showed good agreement for a range of dose and distance to agreement criteria. The MC technique was most time consuming, followed by the TPS calculation with the point dose calculation significantly quicker than the other methods.