Disparities in pathways to reduction mammaplasty: A single institution review of 425 women with macromastia.

BACKGROUND: Reduction mammaplasty improves the quality of life by providing functional and aesthetic benefits to women with macromastia. This study contributes to the existing literature on socioeconomic and clinical barriers to referral for plastic surgery procedures by focusing specifically on reduction mammaplasty. METHODS: Patients with macromastia were identified via a chart review in a single institution from 2021-2022. The treatment pathway for each patient was characterized by reception of referral, completion of plastic surgery consultation, and eventual reception of surgery. After controlling for clinical covariates, multivariate logistic regression was applied to quantify the independent impact of race, insurance, and language status on the completion of surgery (p < 0.05). RESULTS: The final patient cohort included 425 women with macromastia. Among the 151 patients who were first seen by a primary care physician, 64 (42%) completed an initial plastic surgery consultation. Among all patients, 160 (38%) eventually underwent reduction mammaplasty. Multivariate regression predictions indicated a lower likelihood of completing breast reduction surgery in patients with current smoking history (OR: 0.08, 95% CI: 0.01-0.59) and higher body mass index (BMI) (OR: 0.94, 95% CI: 0.90-0.97) (p < 0.05). Minority race and ethnicity, private insurance status, and primary language status were not significant predictors of this outcome (p > 0.05). CONCLUSIONS: In this study, the socioeconomic variables were not independent predictors of breast reduction surgery completion. However, the association of minority race and ethnicity and nonprivate insurance status with the most common reasons for breast reduction deferral suggest an indirect influence of socioeconomic status on the treatment pathway.

A Rare Entity Developing After Breast Reconstruction: Pyoderma Gangrenosum.

Pyoderma gangrenosum (PG) is a rare and persistent neutrophilic dermatosis with an unknown cause. The condition typically manifests clinically as a pustule or plaque that quickly evolves into a necrotic ulcer with undermined violet-colored margins. A surgical debridement might worsen the disease due to the pathergy phenomenon. This case report presents a 48-year-old woman who underwent a late breast reconstruction with a transverse rectus abdominis myocutaneous flap and was subsequently diagnosed with PG. The report details the delays in the diagnosis and management of the disease, providing a comprehensive account of the course of events.

Complications of Superomedial Versus Inferior Pedicle Reduction Mammaplasty: A Systematic Review and Meta-Analysis.

BACKGROUND: The superomedial pedicle reduction mammoplasty has gained popularity and is an important alternative approach for reduction mammoplasty, while the inferior pedicle reduction mammaplasty remains by far the most performed as it is considered to provide the best vascularization to the nipple-areola complex, allowing safe removal of large amount of redundant tissue. The authors conducted the first systematic review and meta-analysis in an attempt to declare the differences of the superomedial pedicle versus the inferior pedicle reduction technique by comparing the postoperative complications. METHODS: PubMed, MEDLINE, and Cochrane Library for clinical studies were queried from inception to January 1, 2024. Review Manager Version 5.4 was used for this meta-analysis. A random effects model was applied to OR, and 95%CI were determined using the Mantel-Haenszel method. The I2 test was used to assess heterogeneity, and the Newcastle-Ottawa scale was used to assess the risk of bias in the nonrandomized studies. RESULTS: Twelve observational comparative studies were included. The superomedial pedicle technique had a statistically lower rate of overall complications (OR 0.59, 95% CI 0.47-0.75; p < 0.0001) and delayed wound healing (OR 0.46, 95% CI 0.33-0.64; p < 0.00001) than the inferior pedicle technique. No significant differences in wound dehiscence, infection, seroma, hematoma, skin necrosis, fat necrosis, NAC necrosis, nipple sensation decrease or loss, asymmetry, hypertrophic scarring, and reoperation were noted. CONCLUSIONS: Both two techniques are equally safe and reliable, while the superomedial pedicle technique resulted in a statistically lower rate of overall complications and delayed wound healing. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

[Comparison of breastfeeding duration in women before and after breast reduction surgery]. / Comparaison de la durée d'allaitement maternel chez les femmes avant et après mammoplastie de réduction.

BACKGROUND: Breast reduction surgery often concern women of childbearing age. However, it can interfere with the ability to breastfeed, whereas the benefits of breastfeeding are well known. Current data in the literature do not provide precise information on the possibilities of breastfeeding after breast reduction surgery. OBJECTIVES: The aim of this study was to assess long-term breastfeeding ability of women after breast reduction performed in our centre. METHODS: This is a retrospective comparative study including patients treated with breast reduction at Saint-Louis Hospital between 2010 and 2017 and who have had children before or after surgery. Operative details were retrieved from medical records and ability to breastfeed was assessed during a phone interview. Breastfeeding before surgery was compared to breastfeeding after surgery. RESULTS: We analysed 21 births before and 35 births after breast reduction. Breastfeeding initiation was similar in the two groups (90% vs. 83%, P=0.7), but the median duration was significantly shorter after breast reduction compared with before (3 weeks vs. 10 weeks; P<0.01), the rate of breastfed child at 3 months was lower after surgery (11% vs. 43%; P<0.01), the use of infant formula was higher after surgery (100% vs. 74%, P<0.01), and we found a higher rate of discontinuation caused by hypogalactia (69% vs. 11%; P<0.001). CONCLUSION: Breastfeeding is possible but more difficult to sustain over time after breast reduction. Patients need to be made aware of that before surgery, and patients who still want to breastfeed should be encouraged at the maternity.

Correlation Between General Satisfaction with the Breasts and Appearance of the Scars in Patients Undergoing Inverted T-Scar Reduction Mammaplasty: A Prospective PROMs-Based Study.

BACKGROUND: Inverted-T scar reduction mammaplasty is still the most chosen technique for breast reduction even if scars are relevant. Sometimes, surgical scars may be esthetically unpleasant and may cause severe pain, tenderness, sleep disturbances, anxiety, and depression in these patients. This study aimed to assess any possible correlation between general satisfaction with the breast and appearance of the scars in patients who underwent inverted T-scar reduction mammaplasty. Secondary aim was to evaluate average variations of BREAST-Q and SCAR-Q at different postoperative times. MATERIALS AND METHODS: 121 patients who underwent breast reduction using Pitanguy technique with inferiorly based dermo-adipose flap according to Ribeiro were enrolled in this prospective cross-sectional study. All patients filled the BREAST-Q REDUCTION and SCAR-Q questionnaires in paper form at 1, 6 and 12 months after surgery. BREAST-Q REDUCTION "Satisfaction with breast" scale was also administered preoperatively. Values were exported in Prism 9 for the statistical analysis. RESULTS: Correlation index of Pearson between "Satisfaction with breast" and "Appearance of scar" was 0.09 at 1 month post-operative and - 0.07 and 0.21 at 6 and 12 months PO respectively. "Satisfaction with breast" mean value tends to rise over time. "Appearance of scar" mean value tends to decrease over time. CONCLUSION: No correlation at different postoperative times between the general satisfaction with the breast and appearance of the scars was found. Data showed that satisfaction with the breast and appearance of the scars in patients who underwent inverted T-scar reduction mammaplasty tend to improve over time. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Application of Liposuction and Superior Pedicle Vertical Mammoplasty for Severe Breast Hypertrophy.

BACKGROUND: Vertical mammoplasty techniques have been widely used for breast reduction. The authors present the combination of superior pedicle vertical mammoplasty with liposuction in different regions in the treatment of severe breast hypertrophy in obese patients. We also propose some innovative methods in terms of surgical approach, breast parenchymal anatomy pattern and liposuction. METHODS: A retrospective study of 50 female patients with severe hypertrophic breasts and obesity who underwent breast reduction in our department from February 2019 to February 2022 was performed. Pre- and postoperative photographs, breast parenchyma distribution and postoperative patient satisfaction were recorded. RESULTS: Fifty patients underwent breast reduction. Through clinical examination, patient photo evaluation and satisfaction survey results. Good breast shape and projection, full upper pole of the breast, and high satisfaction results were obtained. There were no serious complications. CONCLUSION: This technique is acceptable and reproducible. It is suitable for patients with varying degrees of breast hypertrophy, especially those with severe hypertrophic breasts and obesity. There are fewer associated complications and a lower rate of re-repair. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Modified Superomedial Pedicle Breast Reduction Technique for Cases with SN-N Distance Exceeding 33 cm.

BACKGROUND: Symptomatic breast hypertrophy affects the quality of life of a large number of women globally. Many reduction mammoplasty techniques have been described for patients with breast hypertrophy. The aim of this study was to provide our clinic's experience in utilizing the modified superomedial pedicle breast reduction technique in specific patients suffering from breast hypertrophy, with sternal notch-to-nipple distance of more than 33 cm. METHOD: Our study included twenty patients who underwent, from January 2022 to December 2023, the modified superomedial pedicle breast reduction technique due to symptomatic breast hypertrophy with sternal notch-to-nipple distance of more than 33 cm in the Plastic and Reconstructive Surgery Department at Nicosia General Hospital in Cyprus. Patient demographics, comorbidities, pre- and postoperative breast anthropometric measurements and surgical complications were recorded and analyzed. RESULTS: The average age at the time of the reduction was 48 years. The mean preoperative body mass index was 28.52 kg/m2. Patients' comorbidities included one (5%) patient with diabetes, seven (35%) with obesity and three (15%) with hypertension. The mean preoperative sternal notch-to-nipple distance was 35.25 cm for the right breast and 34.90 cm for the left breast, while the mean postoperative was 20.65 cm for both breasts. The total mean resection weight of both breasts was 1643.45 g. Surgical complications were minor including two (10%) cases of local hematoma and one (5%) case of T-Junction wound breakdown. All patients were relieved from their preoperative symptoms and were satisfied with the final result. CONCLUSION: Our modified superomedial pedicle technique is a safe, effective and versatile pedicle to be used with many advantages, in specific patients suffering from breast hypertrophy with sternal notch-to-nipple distance of more than 33 cm, including its shape and rotational abilities, viability of the nipple and excellent outcome of glandular plication and breast reshaping. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Successful breastfeeding after breast reduction surgery or mastopexy: A retrospective comparative study.

Breastfeeding has been widely encouraged by health care systems for many years. Breast reduction or mastopexy, are very frequent procedures often performed on young women. The main objective of this study is to evaluate the impact of breast surgery on breastfeeding by comparing the success rate of breastfeeding in operated women versus unoperated women. Secondary objectives are to evaluate the breastfeeding success rate according to the surgical technique or the weight resected. A retrospective comparative study was conducted. Women of childbearing age who underwent breast reduction surgery or mastopexy at Henri-Mondor Hospital were contacted to answer a questionnaire about their pregnancies. Two hundred nine patients answered and two groups of patients were constituted, a preoperative group of 104 women who had a pregnancy before surgery and a postoperative group formed by 61 women who had a pregnancy after surgery. Breastfeeding success rate was 82% in the preoperative group versus 41% in the postoperative group. A statistically significant difference was found on the success rate of breastfeeding, as well as the rate of exclusive breastfeeding, with significantly lower rates in the postoperative group. In contrast, there was no significant difference between the different pedicles used, neither according to the weight of the resected gland. The cause of failure in the postoperative group was in most cases insufficient milk. Breast reduction surgery or mastopexy seems to have negative impact on the ability of operated women to breastfeed. This impact is multifactorial so these results should be interpreted with caution and further studies are needed to improve the management of these patients.

Quality of life and satisfaction after breast augmentation: A systematic review and meta-analysis of Breast-Q patient-reported outcomes.

BACKGROUND: Breast augmentation ranks among the most popular plastic surgery procedures. Yet, reports on post-operative patient-reported quality of life (QoL) and satisfaction remain conflicting. METHODS: A systematic review was conducted following the PRISMA guidelines. Three databases were searched for eligible studies that reported pre-and/or post-operative Breast-Q™ augmentation scores for patient QoL (psychosocial, sexual, and physical well-being) and/or satisfaction. RESULTS: A total of 39 studies (53 patient cohorts and 18,322 patients) were included in the quantitative synthesis. The pairwise meta-analysis revealed significant improvements in patient-reported psychosocial (MD: +38.10) and sexual well-being (MD: +40.20) as well as satisfaction with breast (MD: +47.88) (all p < 0.00001). Physical well-being improved slightly after breast augmentation (MD: +6.97; p = 0.42). The single-arm meta-analysis yielded comparable results, with Breast-Q™ scores in psychosocial and sexual well-being as well as satisfaction with breast increasing from 37.2, 31.1, and 26.3 to 75.0, 70.6, and 72.7, respectively (all p < 0.00001). Physical well-being improved by 8.1 (75.8 pre-operatively to 83.9 post-operatively; p = 0.17). Subgroup analyses highlighted higher QoL and satisfaction following breast augmentation for purely esthetic purposes and alloplastic mammaplasty. Although patient-reported physical and sexual well-being increased in the long term, psychosocial well-being was the highest in the short term. CONCLUSION: Patient satisfaction with breast, psychosocial, and sexual well-being increased significantly after breast augmentation. In contrast, patient-reported physical well-being yielded ambivalent results, varying by mammaplasty technique and post-operative follow-up time. Plastic surgeons should be sensitized about our findings to refine eligibility criteria and gain a deeper understanding of the patients' perceived surgical experience. PROSPERO TRIAL REGISTRATION NO: CRD42023409605.

Effect of pedicle type on breast reduction: Clinical and patient-reported outcomes.

PURPOSE: The choice of pedicle in reduction mammaplasty is highly variable with prior studies demonstrating high patient satisfaction in most cases. This study aimed to examine the impact of pedicle type on clinical and patient-reported outcomes in patients undergoing reduction mammaplasty. METHODS: A total of 588 patients underwent bilateral reduction mammaplasty with Wise pattern or modified Robertson incision by 13 surgeons at a single institution. Clinical outcomes were compared according to the pedicle type in all patients and BREAST-Q responders (32% response rate). Survey respondents were sub-grouped by resection volume, and the BREAST-Q satisfaction scores were compared. RESULTS: Among all included reduction mammoplasties, 439 (75%) were performed using inferior pedicles, and 149 (25%) using superior or superomedial pedicles. Responders and non-responders were similar in preoperative characteristics including age, body measurements, and comorbidities. Although a higher incidence of infection occurred among the responders, clinical outcomes were comparable across all pedicle types. A total of 187 patients completed the BREAST-Q. Compared to the superior pedicle group, respondents in the inferior pedicle group reported higher nipple satisfaction, even when adjusted for resection weight over 500 g. In contrast, the superior pedicle group had better sexual well-being scores, which persisted in resection weight less than 500 g (all p values <0.05). CONCLUSION: Inferior pedicles were associated with greater nipple satisfaction and superior pedicles were associated with greater sexual satisfaction. Our findings suggest that those with resections less than 500 g were more satisfied with superior pedicles whereas those with greater resections were more satisfied with inferior pedicles.

Síndrome de Mondor associada à mamoplastia de aumento: relato de caso / Mondor syndrome associated with breast augmentation: case report

A forma mamária da síndrome de Mondor é uma afecção rara e autolimitada que se caracteriza pela tromboflebite de veias superficiais da mama. Entender tal síndrome é de suma importância para o diagnóstico correto e o tratamento preciso e não iatrogênico, tendo em vista apresentar considerável relação com o carcinoma mamário. Esse relato de caso retrata o surgimento da síndrome de Mondor em uma paciente jovem de 22 anos, após uma mamoplastia de aumento. O sinal característico da afecção, o cordão fibroso, manifestou-se na mama direita a partir do vigésimo terceiro dia de pós-operatório, desaparecendo por completo após 10 semanas. O diagnóstico foi dado pelo cirurgião plástico que acompanhou a paciente mediante anamnese e exame físico, sem a urgência de um exame complementar, como a mamografia. Vale ressaltar que tal afecção rara pode acometer o sexo masculino - em menor frequência - e afetar outras regiões, como o pênis e o escroto. Ademais, é salutar reconhecer e diagnosticar a síndrome de Mondor, visto que as cirurgias com o fitoestético estão em constante crescimento na atualidade, com o escopo de conduzir os pacientes da melhor forma para um tratamento eficaz e menos invasivo (exceto na presença concomitante de câncer de mama, por exemplo), além de tranquilizá-los a respeito da afecção.

The breast form of Mondor syndrome is a rare and self-limited condition characterized by thrombophlebitis of the superficial veins of the breast. Understanding this syndrome is extremely important for correct diagnosis and precise, non-iatrogenic treatment, given that it has a considerable relationship with breast carcinoma. This case report portrays the emergence of Mondor syndrome in a young 22-year-old patient, after breast augmentation. The characteristic sign of the condition, the fibrous cord, appeared in the right breast from the twenty-third day after surgery, disappearing completely after 10 weeks. The diagnosis was given by the plastic surgeon who followed the patient through anamnesis and physical examination, without the urgency of a complementary exam, such as a mammography. It is worth mentioning that this rare condition can affect males - less frequently - and affect other regions, such as the penis and scrotum. Furthermore, it is beneficial to recognize and diagnose Mondor syndrome, as surgeries using phytoaesthetics are constantly growing today, intending to guide patients in the best way possible for an effective and less invasive treatment (except in the concomitant presence of cancer). breast, for example), in addition to reassuring them about the condition.

Reconstrução mamária: Experiência de 10 anos / Breast reconstruction: 10 years experience

Introdução: A reconstrução mamária pós-tratamento cirúrgico do câncer de mama (um dos principais cânceres que acometem as mulheres) tem sido progressivamente mais indicada, haja vista o benefício da recuperação psicológica e da qualidade de vida, seja utilizando implantes e/ou tecidos autólogos. O presente trabalho visa demonstrar a experiência da equipe, discutir técnicas operatórias e complicações em relação aos dados da literatura mundial, além de verificar a aplicabilidade da técnica na prática clínica da equipe. Método: Estudo observacional retrospectivo desenvolvido em hospital universitário em Juiz de Fora a partir da revisão de prontuários de pacientes submetidas a mastectomia com reconstrução mamária entre 2010 e 2020. Resultados: Das 860 mamas abordadas, 84% foram imediatas à cirurgia oncológica e 16% foram tardias; o principal acesso ao tecido mamário foi a incisão de Stewart, seguido de incisões inframamárias estendidas, periareolares e T invertido; quanto às técnicas reconstrutoras, destaca-se 35% dos casos com retalho com músculo grande dorsal, 25% com prótese pré-peitoral, 20% com retalho miocutâneo transverso do músculo reto abdominal e 10% com retalho muscular local. As complicações mais incidentes foram deiscência de sítio cirúrgico, seguida de necrose cutânea, seroma, infecção de sítio cirúrgico e hematoma, além de outros menos comuns como dor crônica e ruptura de prótese após mamografia. Conclusão: A reconstrução mamária pós-mastectomia é indispensável para a recuperação física e emocional da mulher, sendo as técnicas utilizadas nos últimos dez anos consistentes, confiáveis, de baixa morbidade e com ótimos resultados estéticos quando bem indicadas.

Introduction: Breast reconstruction after surgical treatment for breast cancer (one of the main cancers that affect women) has been progressively more recommended, given the benefits of psychological recovery and quality of life, whether using implants and/or autologous tissues. The present work aims to demonstrate the team's experience, and discuss operative techniques and complications concerning data from the world literature, in addition to verifying the applicability of the technique in the team's clinical practice. Method: Retrospective observational study developed at a university hospital in Juiz de Fora based on a review of medical records of patients who underwent mastectomy with breast reconstruction between 2010 and 2020. Results: Of the 860 breasts treated, 84% underwent immediate oncological surgery and 16% were late; the main access to the breast tissue was the Stewart incision, followed by extended inframammary, periareolar, and inverted T incisions; regarding reconstructive techniques, 35% of cases used a latissimus dorsi muscle flap, 25% used a prepectoral prosthesis, 20% used a transverse rectus abdominis myocutaneous flap and 10% used a local muscle flap. The most common complications were surgical site dehiscence, followed by skin necrosis, seroma, surgical site infection, and hematoma, in addition to other less common complications such as chronic pain and prosthesis rupture after mammography. Conclusion: Postmastectomy breast reconstruction is essential for a woman's physical and emotional recovery, with the techniques used in the last ten years being consistent, reliable, with low morbidity, and with excellent aesthetic results when correctly indicated.

"Normal" breast dimensions in obese women-reference values and the effect of weight loss.

BACKGROUND: Breast hypertrophy may cause significant suffering, such as back- and breast pain, painful shoulder groves, and eczemas. Furthermore, women with breast hypertrophy may have lower quality of life than women without breast hypertrophy. Although 50% of the women undergoing breast reduction in the US have body mass index (BMI) >30 kg/m2, the current standard of normality is based on studies focusing on women <40 years of age and BMIs <25 kg/m2. This study aimed to present reference values for breast measurements for women with obesity and to investigate the relationship between BMI loss and each breast measurement. MATERIALS AND METHODS: One hundred and six women underwent laparoscopic Roux-en-Y gastric bypass in Gothenburg, Sweden. The participants' breast anthropometrics were measured before and after bariatric surgery and their perception of the skin on their breasts was measured using the Sahlgrenska Excess Skin Questionnaire. RESULTS: Breast volume, sternal notch to nipple (SNN) distance, and ptosis increased significantly with increasing BMI. For instance, women with BMIs between 30-34.9 kg/m2 have a mean breast volume of approximately 770 ml, those with BMIs of 40-44.9 kg/m2 have approximately 1150 ml, and those with BMIs above 50 kg/m2 have approximately 1400 ml. Furthermore, the percent change in the respective breast measurements relative to percent BMI change can be predicted, for instance, with a 20% reduction in BMI, the breast volume, SNN-distance, and ptosis decrease by 25%, 4%, and 20% respectively. CONCLUSIONS: This article presents the first standard of normality for breast anthropometrics in women with obesity and a model for predicting the change in breast anthropometrics relative to BMI. CLINICAL TRIAL REGISTRATION: This is a longitudinal observation study, registered https://fou.nu/is/gsb/ansokan/49651, No: VGFOUGSB-49651. Trial registry name: "Överskottshud efter överviktskirurgi - dess utveckling samt behov och effekt av plastikkirurgi" ("Excess skin after bariatric surgery - its development and the need and effect of plastic surgery").

Aeromonas hydrophila Infection following Leech Therapy for the Treatment of Nipple-Areola Complex Congestion after Breast Reduction: A Case Report.

Several strategies for the management of venous congestion of the nipple-areola complex (NAC) after reduction mammaplasty have been proposed. Among these, hirudotherapy represents an ancient but still effective method, even though the risk of infections related to leeches should be considered. We report a peculiar case of breast infection and sepsis after leech therapy in a patient who underwent a reduction mammaplasty. A prompt surgical debridement of the wounds and necrotic tissues associated with targeted antibiotic therapy led to a fast improvement of clinical conditions, and partial preservation of the NAC was obtained. Accurate knowledge of the clinical presentation of soft tissue infections related to leeching allows for an early diagnosis and would serve as a warning for surgeons who approach such breast cosmetic procedures.

Evaluation of long-term outcome following therapeutic mammaplasty: the effect of wound complication on initiation of adjuvant therapy and subsequent oncological outcome.

INTRODUCTION: Therapeutic mammaplasty (TM) facilitates large tumour resection while maintaining optimal aesthetic outcome. It carries higher wound complication risks, which may delay adjuvant therapy initiation. Whether this delay affects oncological outcome requires evaluation. METHODS: Data were collected for consecutive patients receiving TM at the Leeds breast unit (2009-2017). A prospectively maintained database was used to determine tumour characteristics, wound complication rates, receipt of adjuvant therapy and breast cancer recurrence or death. RESULTS: In total 112 patients (median age of 54 years) underwent 114 TM procedures. The most common histological subtypes were invasive ductal carcinoma (61.4%), invasive lobular carcinoma (13.2%) and ductal carcinoma in situ (13.2%). Of the patients, 88.2% had oestrogen receptor-positive cancer and 14% had human epidermal growth factor receptor-positive cancer; 26.3% had multifocal cancer. The median tumour size was 30mm. The median Nottingham Prognostic Index was 4.2. The local recurrence rate was 3.5% (median follow-up of 8.6 years). The 5- and 10-year disease-free survival (DFS) was 88.5% and 83.5%, and the equivalent overall survival (OS) rates were 94% and 83.5%. Wound complication rate was 23.6% (n=27), the commonest being wound infection (11.4%; n=13) and T-junction wound breakdown (10.5%; n=12). The median time to adjuvant therapy was 72 days (interquartile range [IQR] 56-90) for patients with wound complications, and 51 days (IQR 42-58) for those without. However, this delay did not affect DFS or OS (log-rank test; p=0.58 and p=0.94, respectively). This was confirmed on Cox regression analysis. CONCLUSION: Our study finding demonstrates that although wound complications after TM leads to a modest delay to adjuvant therapy, the long-term oncological outcomes were comparable with those in patients without wound complications.

No drains in reduction mammaplasty - a systematic review.

Breast reduction mammaplasty is the only effective therapeutic intervention for patients with symptomatic breast hypertrophy. In this procedure, closed suction drains have become a standard of care, while the literature supporting use of drains is lacking. In fact, with emerging data we found out that drains might not be so necessary. This review aimed to systematically compare the number of complications in drained and undrained breasts and to evaluate the safety of omitting drains in reduction mammaplasty in clinical practice. A systematic review of literature was conducted identifying all studies on drainage in reduction mammaplasty. The analysed databases revealed 13 eligible studies to be included in this review. There were 308 drained breasts and 859 undrained breasts in total in patients from 16 to 73 years of age. The resected tissue weight per side fluctuated from 108 to 1,296 grams. In total, there was only 2.4% incidence of haematoma complications in undrained breasts and 3.9% in drained breasts. Closed suction drains are still being routinely used in reduction mammaplasty, although aborting drain use is proven to be not only safe, but advantageous. The clear benefit is increased patient comfort, shortened hospital stay, decreased cost of the procedure and nurse care, and decreased rate of complications.

Robotic-assisted free flap harvesting for diverse soft tissue reconstruction: a PRISMA scoping review of clinical outcomes over the last decade.

Introduction: The aim of our study was to assess the advantages and limitations of robotic technology in diverse reconstructive procedures. METHODS: A scoping review was conducted in Oct'23, on published studies from 2013 to 2023, focussing on robotic-assisted free flap harvesting. Three databases Ovid-MEDLINE, Scopus, and PubMed were searched. Original research studies reporting robotic-assisted free flap harvest were included. Studies on lesion excision, microvascular anastomosis, local flap harvest, roboticassisted flap inset, review articles, abstract-only studies, non-English documents, and animal studies were excluded from this review. RESULTS: Sixteen studies met the inclusion criteria out of a total of 318, searched initially. These studies included a total of 128 patients, who underwent robotic-assisted free flap harvest for the reconstruction of various defects, with 140 free flaps harvested. The most common flaps harvested by robotic technique were deep inferior epigastric artery perforator (DIEP) flap 120 (85.7%), radial forearm free (RFF) flap 11 (7.9%), latissimus dorsii flap 4 (2.9%), rectus abdominus flap 4 (2.9%), and omental flap 1 (0.7%). Breast reconstruction was the major procedure done i.e. 120 (85.7%) followed by head and neck 11 (7.9%) and limb defects 9 (6.4%) reconstruction procedures. The reported clinical outcomes were acceptable in all the studies with a 99% flap success rate and minimal complications. Variability in operating time was observed depending upon surgical steps undertaken with robotic systems. CONCLUSIONS: This scoping review highlights the role of robotic-assisted free flap harvesting in plastic surgery and its potential benefits on clinical outcomes, due to its high precision and minimal invasiveness. However, challenges like cost effectiveness, resource distribution and learning curve are there.

Is Immediate Breast Reconstruction With a Latissimus Dorsi Myocutaneous Flap Safe for Starting Adjuvant Chemotherapy in Patients With Breast Cancer?

INTRODUCTION: Immediate breast reconstruction following mastectomy reduces perceptions of mutilation and femininity issues in oncological patients, but surgical complications should not delay chemotherapy. This study evaluated postsurgical complications in patients who underwent radical breast surgery followed by immediate reconstruction with latissimus dorsi myocutaneous flaps and silicone implants, along with resulting impacts in delaying chemotherapy. MATERIALS AND METHODS: This retrospective study utilized a prospectively maintained database. Clinical, surgical, and oncological data from 196 women were collected according to the operated side. Patients were grouped according to the time elapsed between surgery and the first cycle of adjuvant chemotherapy: ≤ 60 days (group 1), 61 to 90 days (group 2), or > 90 days (group 3). RESULTS: A total of 198 immediate reconstructions were performed on 196 patients between August 1, 2010 and March 31, 2020; after surgery, 47.4% had minor complications and 7.1% had major complications. Ninety-six patients (48.5%) received adjuvant chemotherapy. The mean time elapsed between surgery and the first chemotherapy cycle was 65.4 days (median: 59), with 52.7% of the patients assigned to group 1, 37.4% to group 2, and 9.9% to group 3. The occurrence of major postoperative complications significantly affected the start of chemotherapy (64.0 vs. 94.5 days; P = .044). Additionally, patients with 2 or more comorbidities were more likely to experience major complications (OR: 3.35; 95% CI: 1.03-10.95; P = .045) than those with 1 or 0. CONCLUSION: Major postoperative complications significantly delayed initiation of adjuvant chemotherapy in oncological patients who underwent radical breast surgery followed by immediate reconstruction with a latissimus dorsi myocutaneous flap and silicone implants.

Factors influencing the decision-making process in breast reconstruction from the perspective of reconstructive surgeons: A qualitative study involving Korean plastic surgeons.

BACKGROUND: Little research has been conducted on factors influencing the decision-making process for immediate breast reconstruction (IBR) options from the perspective of reconstructive surgeons, despite its significant impact on doctor-patient communication and shared decision-making. This study aims to explore the multiple factors and the mechanisms by which they interact using a qualitative methodology. We also address potential barriers to shared decision-making in IBR. METHODS: Semistructured interviews were conducted with a purposive sample of reconstructive surgeons. Thematic analysis was used to identify key influences on IBR decision-making process from the perspective of reconstructive surgeons. RESULTS: Four major themes were identified: 1. Patient clinical scenarios; 2. Nonclinical practice environments; 3. Reconstructive surgeon preferences; and 4. Patient consultation. Reconstructive surgeons demonstrated diverse approaches to patient clinical scenarios. High-volume centers were significantly influenced by nonclinical factors such as scheduling and operating room allocation systems. Reconstructive surgeons often had strong personal preferences for specific IBR options, shaped by their expertise, experience, and clinical environment. Based on the preliminary decision, surgeons provided information with varying degrees of neutrality. Patients varied in their knowledge and participation, resulting in variation in the final decision authority among surgeons. CONCLUSIONS: This study highlights the need to address nonclinical environmental constraints to improve shared decision-making process in IBR. Surgeons should recognize power imbalances in the doctor-patient relationship and be aware of their biases.

Combination of Superior and Superomedial Pedicle Techniques in Reduction Mammaplasty: A Modified Approach to Increase Upper Pole Fullness.

OBJECTIVE: Creation of the upper pole fullness is one of the basic goals in reduction mammaplasty. The superior pedicle (S-P) technique brings extra tissue to the upper pole, but folding of a long pedicle can compromise circulation of the nipple-areola complex (NAC). Although the pedicle is not folded in superomedial pedicle (SM-P) technique, it has disadvantage of not bringing extra tissue to the upper pole. We designed a new approach by combining the advantages of S-P and SM-P techniques. Thereby, we aimed to increase upper pole fullness in SM-P or superolateral pedicle (SL-P) mammaplasty. METHOD: We operated 20 female patients (study group) with the modified SM-P/SL-P technique for breast reduction between 2010 and 2022. Preoperatively, mean sternal notch-nipple distance was 32.6 ± 2.5 cm. The upper pole fullness was created by using a superiorly based glandular flap, while the SM-P (17 patients) or SL-P (three patients) was used to carry the NAC. We assessed the success rate of the upper pole fullness, compared with two control groups of 40 patients who underwent conventional SM-P mammaplasty (control group I: 20 patients) and who underwent conventional S-P mammaplasty (control group II: 20 patients). Two plastic surgeons, who do not know which technique was used, assessed before and after photographs of 60 patients regarding success rate of upper pole fullness. To evaluate the success rate, the degree of the difference in the upper pole fullness between before and after photographs has been scored 1-10 for each patient. Below 5 was considered as no difference (unsuccessful), 5-7 as moderate difference (average), 8-10 as significant difference (successful). Photographs of the patients had been taken from five different angles: frontal, right and left oblique views, and right and left sides. RESULTS: Out of 10, mean score was 8.2 ± 1.2 in study group, 7.1 ± 1.8 in control group I, 8.2 ± 1.5 in control group II. Postoperatively, no major complications were observed, such as glandular necrosis, total NAC necrosis, partial (> 50%) NAC necrosis, skin necrosis, or poor NAC sensitivity in none of 60 patients. CONCLUSION: By using this modification, it is possible to increase upper pole fullness in SM-P/SL-P mammaplasty. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/00266 .