Vertical Mastectomy Incision in Implant Breast Reconstruction After Skin Sparing Mastectomy: Advantages and Outcomes.

BACKGROUND: The type of since skin-sparing mastectomy (SSM) incision directly impacts the final aesthetic and functional results of reconstruction. Different incisions are used for SSM depending on tumor location, previous biopsy scars, breast weight, and ptosis degree. A vertical scar is less visible to the patient, reminiscent of a mastopexy, and patients may not have the stigma of mastectomy. OBJECTIVE: This study investigates complication rates, patient demographics, patient reported outcomes, and plastic surgeon evaluations to compare vertical incision mastectomy to other incisions. METHODS: After institutional review board approval, a retrospective chart review was performed. A total population of 167 patients that underwent mastectomy with tissue expander reconstruction was separated into vertical incision and nonvertical incision mastectomy groups consisting of 38 and 129 patients, respectively. Patient demographics, complications, tumor margins, staging, breast weight, and breast implant volume were compared. BREASTQ Survey analysis was conducted using patient reported outcomes from the patient's perspective. Aesthetic evaluations of postoperative photos were systematically scored by plastic surgeons to obtain data from the plastic surgeon's perspective. RESULTS: Vertical incision orientation did not increase surgical complication rates or mastectomy skin necrosis (P = 0.142). Vertical incisions did not interfere with obtaining adequate tumor margins (P = 0.907). Vertical incisions did not have a significantly different breast weight or implant volume. There was no statistical difference for patient satisfaction or plastic surgeon aesthetic evaluation. CONCLUSIONS: The use of vertical incision does not increase complication rates; does not interfere with tumor margins; and can be applied to all age, BMI, breast weight, and breast implant volume groups.

Outcomes of Breast Reconstruction After Mastectomy Using Tissue Expander and Implant Reconstruction.

OBJECTIVE: Considerable attention has been given to patient-reported outcomes in breast reconstruction. The objective of this study is to evaluate the effect of postreconstruction change in breast volume on validated patient satisfaction survey scores. METHODS: Patients undergoing skin-sparing mastectomy followed by tissue expander/implant reconstruction between July 2010 and July 2014 by a single surgeon were given postoperative patient-reported satisfaction surveys (BREAST-Q). Retrospective chart review of patients with completed surveys was undertaken to record patient characteristics and compare preoperative breast volume (extrapolated from mastectomy mass) with postoperative implant volume, and percent change in volume was calculated. Regressions were utilized to correlate percent change with satisfaction in each category. RESULTS: A total of 160 patient surveys were included. Sixty-five percent of breasts analyzed had increased volume after reconstruction, whereas 35% had decreased volume. The increased volume group had significantly lower body mass index (P = 0.0001) and was significantly younger (P = 0.009) than the decreased volume group. Patients who experienced increase in breast volume reported statistically greater satisfaction with breasts (P = 0.019), overall outcome (P = 0.012), sexual well-being (P = 0.002), and information (P = 0.042) compared with the decreased volume group. Moreover, linear regression revealed that as percent change increased, so did satisfaction with outcome (P = 0.02), sexual well-being (P = 0.005), information (P = 0.018), and surgeon (P = 0.036). Notably, there was not a significant difference in complication rate (P = 0.146) or tumor margin (0.914) between the groups. CONCLUSION: Patients who undergo tissue expander/implant breast reconstruction with final implants that are larger in volume than their native breasts have increased patient satisfaction scores in several categories without increase in complication rate or difference in tumor margin. There is a positive linear relationship between percent change and patient satisfaction.

Human error and patient safety: interdisciplinary course.

BACKGROUND: The medical community has only recently begun to address how human error affects patient safety. In order to confront human error in medicine, there is a need to teach students who are entering the health professions how potential errors may manifest and train them to prevent or mitigate these problems. PURPOSE: The objective is to describe a semester-long, interdisciplinary, human error and patient safety course taught at the University of South Florida. METHODS: Six interdisciplinary groups, composed of students from five of the university's colleges, were formed. The curriculum consisted of expert lecturers, readings, case studies, and analysis of patient safety problems. Students were evaluated based on their group's work on the final project and peer evaluations. RESULTS: Nursing students scored the highest in each category evaluated. Physicians and medical students had the lowest evaluations in team participation and active engagement. All students rated the course highly and indicated that it enhanced their ability to work in interprofessional settings. CONCLUSIONS: The students showed improved knowledge and substantive skill level relative to patient safety and human error concepts. Working in interdisciplinary teams gave the students a better understanding of the role each discipline can have in improving health care systems and health care delivery.

An Innovative Solution to Complex Inguinal Defect: Deepithelialized SIEA Flap With Mini Abdominoplasty.

Introduction: We describe a novel technique of contralateral pedicled deepithelialized superficial inferior epigastric artery flaps, followed by abdominal advancement coverage, as an alternative treatment of radiated complicated inguinal or lower abdominal defects, avoiding the donor-site defect typically seen with other methods of coverage. Methods: Two male patients with histories of liposarcoma after excision and radiation to one side of lower abdomen/inguinal area presented with complicated wounds that were reconstructed with this technique. Results: Successful obliteration of dead space and wound closure were achieved with the combination of a superficial inferior epigastric artery flap with an abdominal advancement flap. In each case, patients went on to heal uneventfully without need for any secondary procedures. Discussion: The use of a superficial inferior epigastric artery flap for lower abdomen/groin defect closure is an option as an alternative to rectus abdominis myocutaneous flap and anterolateral thigh flaps and should be considered in patients with vascular anatomy conducive for this muscle-sparing procedure. Conclusions: A second layer-overlay coverage with an abdominal advancement flap creates a more durable repair in the complicated radiated wound and a well-concealed abdominoplasty scar.