ABSTRACT
BACKGROUND: Immediate postmastectomy breast reconstruction in morbidly obese patients represents a challenge because neither prosthetic nor abdominal-based options may be suitable. METHODS: This study compared a previously published cohort of immediate prosthetic reconstruction of 346 patients (511 breasts) of whom 49 patients (67 breasts) were morbidly obese (defined as a body mass index > 35) with a morbidly obese patient population whose breasts were reconstructed immediately following postmastectomy with latissimus flap and tissue expander (21 patients and 22 breasts) in the same time period. The preoperative risk factors of mastectomy such as tobacco use, diabetes, and prior radiation and the postoperative complications of mastectomy such as skin necrosis, seroma, and prosthesis loss were examined. The explantation of the tissue expander provided a defined endpoint of reconstruction failure. RESULTS: The average body mass index in the tissue expander/implant group and in the latissimus flap plus tissue expander/implant group was 40.9 and 40.1, respectively. The risk profile of diabetes and tobacco use was similar in both groups. Fifteen of the 67 breasts (22.3%) of the tissue expander/implant group and 15 of the 23 breasts (65.2%) of the latissimus flap group had received prior radiation. The prosthesis loss was 13 of 67 breasts (19.4%) that had tissue-expander-alone reconstruction and 1 of 22 (4.8%) in the latissimus group that had tissue expander reconstruction. Modification of donor-site incision and skin-island location in the latissimus group of patients can minimize scar deformity. CONCLUSION: The loss rate in immediate postmastectomy reconstruction in morbidly obese patients with latissimus flap plus tissue expander was substantially lower than the loss rate in those with breast reconstructed with tissue expander alone.
ABSTRACT
BACKGROUND: Human acellular dermis has been adopted for routine use in tissue expander reconstruction. The purported benefits include higher intraoperative fill volume, facilitation of lower pole expansion, and enhanced definition of the lower pole of the breast. Recently, concerns have arisen about an increase in postoperative complications with its use. METHODS: A retrospective review was conducted of patients who had immediate postmastectomy breast reconstruction with a tissue expander from July of 2001 to July of 2011. All tissue expander reconstructions before 2005 were performed submuscularly only and all subsequent to 2005 with the use of AlloDerm (LifeCell, Branchburg, N.J.) acellular dermis. Patient demographics were collected, and complications were recorded. RESULTS: The study cohort included 346 patients and 511 immediate breast reconstructions; 232 patients and 346 breasts were reconstructed with and 114 patients and 165 breasts without acellular dermis. Age, body mass index, diabetes, and tobacco use were equivalent in the two groups. Seroma occurrence in the acellular dermis group was nearly twice (30.0 versus 15.1 percent) that of the no acellular dermis breasts, but the tissue expander loss was only slightly higher (11.6 versus 8.5 percent) and not statistically significant. Body mass index in patients who lost their tissue expander was 31 kg/m, statistically significantly higher than in those who did not. CONCLUSIONS: The presence of acellular dermis did not increase the incidence of tissue expander loss, despite a doubling of frequency of seroma. Prior radiation and use of acellular dermis did culminate in a prohibitively high loss rate of the tissue expander.
Subject(s)
Acellular Dermis , Mammaplasty/methods , Skin Transplantation/methods , Tissue Expansion Devices , Tissue Expansion/methods , Adult , Age Factors , Aged , Body Mass Index , Breast Neoplasms/surgery , Cohort Studies , Collagen , Female , Follow-Up Studies , Graft Rejection , Graft Survival , Humans , Logistic Models , Mammaplasty/adverse effects , Mastectomy/methods , Middle Aged , Postoperative Complications/physiopathology , Postoperative Complications/surgery , Postoperative Period , Retrospective Studies , Risk Assessment , Seroma/etiology , Seroma/physiopathology , Time Factors , Transplantation, Autologous , Wound Healing/physiologyABSTRACT
This study evaluated the response of religious denominations to sexual reproductive health issues among youths using a close-ended, structured, 32-item questionnaire and an interview. The majority (71% men, 71% women) of the respondents attended church regularly; were unmarried (92% men, 83% women); were sexually active (71% men, 45% women); used drugs (65% men, 62% women). The majority of the respondents (46% men, 63% women) were reprimanded and/or ostracized by the Church. The findings suggest that issues encompassing sexuality and drugs among youth do not resonate well with the conventional religious practice of the Church, hence a significant incidence of ostracism and the likelihood of premarital sex and drug use.