Single versus Double Drainage for Immediate Two-Stage Implant-Based Breast Reconstruction: A Propensity Score-Matched Analysis.

BACKGROUND: Reports evaluating plastic surgeons' practices indicate there are conflicting trends regarding the use of one or two drains for implant-based breast reconstruction (IBBR). Our study aimed to perform a matched cohort analysis to examine the postoperative outcomes and complications of immediate IBBR with tissue expander (TE) using two drains versus a single drain. METHODS: A propensity score-matched analysis (nearest neighbor, 1:1 matching) of immediate reconstructions using two versus one drain was conducted. Female patients undergoing immediate two-stage IBBR with TEs between January 2011 and May 2021 were included. The covariables were as follows: BMI, mastectomy weight, lymph node surgery, TE surface, plane of reconstruction, use of acellular dermal matrix products, fluorescence imaging use, and intraoperative TE volume. RESULTS: After matching using propensity scores, 192 reconstructions were included in the final analysis: 96 in each group. The rate of 30-day complications and overall complications during the first phase of IBBR were comparable between groups. The time for drain removal, time to initiate and finalize expansions, and time for TE-to-implant exchange were comparable between groups. Diabetes (OR 3.74, p = 0.025) and an increased estimated blood loss (OR 1.004, p = 0.01) were the only independent predictors for seroma formation. CONCLUSION: In this matched cohort analysis evaluating the role of one versus two drains for two-stage IBBR, we found a comparable rate of complications and surgical outcomes between the two cohorts. Using two drains for immediate IBBR needs to be tailored depending on intraoperative findings. 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 .

Application of magnetic resonance imaging with intraoperative color Doppler ultrasound in the treatment of patients with polyacrylamide hydrogel injected for breast augmentation: a retrospective study of 204 cases for 12 years.

Purpose: Polyacrylamide hydrogel (PAHG), which had been used widely for breast augmentation, has been banned for more than 15 years. Patients who had been injected PAHG for breast augmentation need evacuation surgery to remove as much as possible. To provide a series of diagnosis and treatment process MRI and intraoperative color Doppler ultrasound are combined for maximal removal of PAHG. Methods: The patients who received evacuation surgery in Peking University Third Hospital from 2010 to 2022 after PAHG injection for breast augmentation were included in this research. MR scanning was performed preoperatively and postoperatively in some of these patients and color Doppler ultrasound was applied to help evacuate PAHG intraoperatively. The mean clearance rate of PAHG was calculated according to the MRI outcomes. Results: Two hundred and 4 patients had received evacuation surgery after PAHG injection for breast augmentation with an average age of 42.8 years and an average body mass index of 21.2 kg/m2. The average PAHG retention time was 13.5 years. Among them, 52 patients underwent pre- and postoperative MRI scanning. The mean three-dimensional (3D) volume of PAHG was 684.8 mL (range, 350.0-1,123.9 mL), and the average residual 3D volume of PAHG was 53.7 mL (range, 12.4-98.3 mL). The mean clearance rate was 92.1%. Conclusion: MRI and intraoperative color Doppler ultrasound can provide effective and precise location information of PAHG for evacuation surgery, which is a reliable method to ensure the maximal removal of PAHG.

Qual o impacto da capsulectomia nos sintomas sistêmicos atribuídos às próteses mamárias de silicone? Revisão sistemática da literatura / What is the impact of capsulectomy on systemic symptoms attributed to silicone breast implants? Systematic literature review

Introdução: Diversos estudos têm analisado a possível relação entre a prótese mamária de silicone e sintomas sistêmicos. A remoção das próteses de mama com capsulectomia tem sido indicada na tentativa de melhorar esses sintomas. É necessário que o cirurgião tenha dados embasados na literatura para informar ao paciente se há relação entre retirada de prótese de mama com capsulectomia e melhora dos sintomas, qual a taxa de melhora e por quanto tempo se mantém. Método: Foi realizada pesquisa nos bancos de dados virtuais Cochrane Library e PubMed de janeiro de 1990 até abril de 2023. A busca foi realizada pela combinação de termos livres ("breast implant illness", "breast capsulectomy" e "breast implant explantation") e pelo uso de operadores booleanos para descritores Mesh como [autoimmune diseases (MeSH Terms)] e [breast implant (MeSH Terms)]. Resultados: Foram obtidos 1.203 artigos, sendo 14 selecionados para o estudo, consistindo em 7 artigos de coorte retrospectivo, 3 de coorte prospectivo e 4 caso-controle. A taxa de melhora variou entre 50 e 100% dos casos e o tempo de acompanhamento variou entre 2 meses e 2,7 anos. Diversos tipos de capsulectomia foram realizados nos estudos, com taxas semelhantes de melhora. Conclusão: Há evidências de melhora dos sintomas sistêmicos em pacientes com prótese mamária de silicone submetidas a retirada de prótese de mama com capsulectomia. A melhora dos sintomas persistiu durante o período em que as pacientes foram acompanhadas nos estudos. Estudos mais recentes demonstraram que o tipo de capsulectomia não tem influência na melhora dos sintomas sistêmicos.

Introduction: Several studies have analyzed the possible relationship between silicone breast implants and systemic symptoms. Removal of breast implants with capsulectomy has been indicated in an attempt to improve these symptoms. The surgeon must have data based on the literature to inform the patient whether there is a relationship between the removal of a breast prosthesis with capsulectomy and improvement in symptoms, what is the rate of improvement, and how long it lasts. Method: A search was carried out in the Cochrane Library and PubMed virtual databases from January 1990 to April 2023. The search was carried out using a combination of free terms ("breast implant illness", "breast capsulectomy," and "breast implant explantation") and by using Boolean operators for Mesh descriptors such as [autoimmune diseases (MeSH Terms)] and [breast implant (MeSH Terms)]. Results: 1,203 articles were obtained, 14 of which were selected for the study, consisting of 7 retrospective cohort articles, 3 prospective cohort articles, and 4 case-control articles. The improvement rate varied between 50 and 100% of cases, and the follow-up time varied between 2 months and 2.7 years. Several types of capsulectomies were performed in the studies, with similar rates of improvement. Conclusion: There is evidence of improvement in systemic symptoms in patients with silicone breast implants who underwent breast implant removal with capsulectomy. The improvement in symptoms persisted during the period in which the patients were followed in the studies. More recent studies have demonstrated that the type of capsulectomy does not influence the improvement of systemic symptoms.

Predictors for Prolonged TE-to-Implant Exchange During Implant-Based Breast Reconstruction: A Single Institution Experience.

BACKGROUND: There is limited evidence regarding the factors causing a prolonged time for tissue expander (TE) exchange into a definitive implant using two-stage implant-based breast reconstruction (IBBR). This study aimed to review our experience with IBBR, focusing on the time for TE-to-implant exchange and determining which factors cause a prolonged time for exchange. METHODS: A retrospective review was performed to include women undergoing immediate two-stage IBBR with TEs after total mastectomy between January 2011 and May 2021. Reconstructions with irradiated TEs were excluded. Cases that had a prolonged time for TE-to-implant exchange were defined as those undergoing exchange longer than 232 days, which corresponds to the 75th percentile of the overall study group. RESULTS: We included 442 reconstructions in our analysis. The median age for our series was 51 years and the median body mass index was 26.43-kg/m2. The median time for TE-to-implant exchange was 155 days [IQR, 107-232]. Cases that had a prolonged time for TE-to-implant exchange were defined as those undergoing exchange on postoperative day 232 or afterward. Diabetes (OR 4.05, p = 0.006), neoadjuvant chemotherapy (OR 2.76, p = 0.006), an increased length of stay (OR 1.54, p = 0.013), and a lengthier time to complete outpatient expansions (OR 1.018, p < 0.001) were independently associated with a prolonged time for exchange. CONCLUSION: As evident from our analysis, the time for exchange is highly heterogeneous among patients. Although several factors affect the timing for TE-to-implant exchange, efforts must be directed to finalize outpatient expansions as soon as possible to expedite the transition into a definitive implant. 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 .

Sentinel lymph node biopsy and immediate two-stage implant-based breast reconstruction: A propensity score-matched analysis.

BACKGROUND: There are important differences between patients requiring sentinel lymph node biopsy (SLNB) and those who do not require axillary surgery at the time of breast reconstruction. We aimed to perform a propensity score-matched analysis to evaluate the impact of SLNB at the time of immediate implant-based breast reconstruction (IBBR) with tissue expanders compared with IBBR alone. METHODS: Consecutive female patients undergoing total mastectomy and immediate two-stage IBBR between January 2011 and May 2021 were included. A 1:1 nearest-neighbor matching method without replacement was implemented with a caliper width of 0.01. Patients were matched for age, diabetes, hypertension, hyperlipidemia, premastectomy radiotherapy, neoadjuvant chemotherapy, the plane of prosthesis placement, mastectomy specimen weight, number of drains, and radiation of the expander. RESULTS: We included 320 two-stage immediate IBBRs after propensity score matching, 160 reconstructions per group. Relevant surgical variables were comparable between groups. A higher rate of 30-day seroma formation was reported in immediate reconstructions that had SLNB at the time of mastectomy compared with reconstructions that did not have axillary surgery (16.3% versus 8.1%, p = 0.039). The time to complete outpatient expansions and time for expander-to-implant exchange were comparable between patients who underwent IBBRs with SLNB and those who did not. CONCLUSION: SLNB performed at the time of mastectomy and IBBR with tissue expander increased the risk of seroma formation compared with reconstructions that did not have axillary surgery. The rate of infection, hematoma, and unplanned procedures to manage complications did not differ between groups.

The L-shaped mastopexy / A mastopexia de aumento em L

Introduction: The mastopexy with implants and L-shaped scarring aims to correct grades I to II breast ptosis using implants in retroglandular space and retromuscular dual plane space, at the same surgical time. The objective is to describe the experience with the L-augmentation mastopexy technique, analyzing complications and reoperations. Methods: Retrospective study of 123 patients with mild to moderate breast ptosis, operated using the L-augmentation mastopexy technique from January 2011 to November 2021. Results: The mean age of patients was 35.6 years. The average volume of implants used was 315ml (range 175 to 600ml). The placement of the prosthesis was in retroglandular (46.5%) and dual plane retromuscular space (53.5%). The average operative time was two hours and fifty-four minutes. The main complications presented were superficial dehiscence (7.3%), recurrence of ptosis (7.3%) and unsightly scars (5.7%). Surgical reviews took place in 13 patients (10.5%). Conclusion: Safe and effective mastopexy technique with implant in the treatment of mild to moderate breast ptosis, providing well designed breasts with reduced L-shaped scars.

Introdução: A mastopexia com implantes e cicatriz em L visa corrigir ptoses mamárias graus I a II com utilização de implantes em espaço retroglandular e retromuscular dual plane, no mesmo tempo cirúrgico. O objetivo é descrever a experiência com a técnica de mastopexia de aumento em L, analisando complicações e reoperações. Método: Estudo retrospectivo de 123 pacientes com ptose mamária leve a moderada, operadas pela técnica de mastopexia de aumento em L no período de janeiro de 2011 a novembro de 2021. Resultados: A média de idade das pacientes foi de 35,6 anos. O volume médio de implantes utilizado foi de 315ml (variação de 175 a 600ml). O posicionamento da prótese foi em espaço retroglandular (46,5%) e retromuscular dual plane (53,5%). O tempo médio operatório foi de duas horas e cinquenta e quatro minutos. As principais complicações apresentadas foram deiscências superficiais (7,3%), recorrência da ptose (7,3%) e cicatrizes inestéticas (5,7%). Revisões cirúrgicas aconteceram em 13 pacientes (10,5%). Conclusão: Técnica de mastopexia com implante segura e eficaz no tratamento da ptose mamária leve a moderada, proporcionando mamas bem projetadas com cicatrizes reduzidas em L.

ADMs and synthetic meshes improve implant-based breast reconstruction aesthetics, but at what cost?

Acellular dermal matrices (ADMs) have shown promise for use in reconstructive breast surgery as they improve aesthetic outcomes and decrease capsular contracture rates. However, concerns about their use remain because of the higher cost and complication profile. We report a single institution's implant-based-reconstruction (IBR) experience between 2007 and 2021, including cases performed by 51 plastic surgeons. For each stage of IBR, data on age, comorbidities, type of mesh used, and acute complications were collected. Of 1379 patients who underwent subpectoral IBR, 937 received an ADM or synthetic mesh as part of their reconstruction. 256 patients out of 264 treated with prepectoral IBR received an ADM or mesh. Infection and wound dehiscence rates were highest for patients who underwent prepectoral IBR with ADM. Both subpectoral and prepectoral IBR with ADM were associated with higher rates of infection and wound complications compared to without ADM or mesh, but only the difference among the subpectoral cohort reached statistical significance. Prepectoral IBR with ADM or mesh had the lowest rates of capsular contracture and aesthetic reoperations. Although the use of Vicryl® mesh in subpectoral IBR was associated with a higher risk of capsular contracture and skin flap necrosis compared to reconstruction with ADMs (10.53% versus 3.29%; p < 0.05), Vicryl® was associated with fewer aesthetic revisions. Our study demonstrated that prepectoral IBR with ADM or mesh resulted in the fewest aesthetic reoperations and the lowest rates of capsular contracture. Infection and wound dehiscence rates were notably higher for patients who had reconstruction with ADM.

Galactorrhea after breast augmentation: case report and literature review / Galactorreia após mamoplastia de aumento: relato de caso e revisão da literatura

Introduction: Augmentation mammoplasty is one of the most frequently performed surgeries in plastic surgery. Among its rarer occurrences are galactorrhea, spontaneous milk output by the papilla, and galactocele, a collection of milky material in the surgical bed. There is little literature on this extremely rare occurrence, and through this article, we conduct a literature review and report on a case operated in our service. Case Report: We present a case of a 35-year-old patient who underwent breast augmentation surgery via the inframammary fold, with an implant placed in the subglandular plane, which evolved, on the thirtieth postoperative day, with galactorrhea exteriorized through the incision, and we propose a treatment for such intercurrence. Six months after the operation, the breasts were symmetrical, without signs of contracture or additional alterations; the patient was satisfied with the result and without new episodes of galactorrhea or galactocele. Conclusion: Although rare, with an incidence of less than 1%, galactorrhea can occur as a postoperative complication, and knowledge about it, as well as the forms of treatment, will benefit both patient and surgeon.

Introdução: A mamoplastia de aumento é uma das cirurgias mais frequentemente realizadas na cirurgia plástica. Entre suas intercorrências mais raras, está a galactorreia, saída de leite pela papila de forma espontânea, e o galactocele, uma coleção de material leitoso no leito cirúrgico. Pouca literatura existe sobre esta raríssima intercorrência e por meio deste artigo realizamos uma revisão da literatura e relato de um caso operado no nosso serviço. Relato de Caso: Apresentamos um caso de uma paciente de 35 anos que foi submetida a cirurgia de mamoplastia de aumento via sulco inframamário, com implante alocado no plano subglandular, que evoluiu, no trigésimo dia pós-operatório, com galactorreia exteriorizada pela incisão, e propomos um tratamento para tal intercorrência. Com seis meses de pós-operatório, as mamas se encontravam simétricas, sem sinais de contratura ou alterações adicionais, paciente satisfeita com o resultado e sem novos episódios de galactorreia ou galactocele. Conclusão: Embora rara, com uma incidência de menos de 1%, a galactorreia pode ocorrer como intercorrência pós-operatória e o conhecimento desta, bem como as formas de tratamento, irá beneficiar tanto paciente como cirurgião.

Complications Including Capsular Contracture in Direct-to-Implant Breast Reconstruction With Textured Anatomical Versus Smooth Round Implants: A Single Center Retrospective Analysis.

PURPOSE: Implant-based breast reconstruction is the most common reconstruction method used after mastectomy in breast cancer patients. Many studies have compared the smooth round implants and textured anatomical implants. This study aimed to compare the complications, including capsular contracture, between these two implants used in direct-to-implant (DTI) breast reconstruction. METHODS: This retrospective chart review was performed using a prospectively maintained database from a single center. We identified patients who underwent mastectomy with DTI single-stage breast reconstruction at our hospital between August 2011 and June 2021. The overall complications, including capsular contracture, postoperative infection, seroma, hematoma, implant rupture, implant exposure, rippling, implant malposition, and nipple necrosis, were analyzed. RESULTS: In total, 340 breasts of 323 patients were reconstructed by the DTI approach using either textured anatomical (n = 203) or smooth round (n = 137) implants. The incidence of overall complications and capsular contracture was significantly lower with smooth round implants than with textured anatomical implants. Multivariate analysis showed that smooth round implants were associated with a reduced risk of overall complications (odds ratio [OR], 0.465; 95% confidence interval [CI], 0.265-0.813) and capsular contracture (OR, 0.475; 95% CI, 0.235-0.962). Particularly, smooth round implants were associated with a decreased risk of overall complications in patients not receiving adjuvant chemotherapy and a decreased risk of capsular contracture in patients with body mass index < 25 kg/m² and in those not receiving adjuvant radiotherapy. CONCLUSION: Smooth round implants demonstrated a decreased risk of overall complications and capsular contracture when compared with textured anatomical implants. These results may be utilized in counseling patients regarding the advantages and disadvantages of smooth round implants in DTI breast reconstruction.

Subpectoral versus prepectoral two-stage breast reconstruction: A propensity score-matched analysis of 30-day morbidity and long-term outcomes.

BACKGROUND: Approximately 80% of patients undergoing total mastectomy in the US opt for implant-based breast reconstruction (IBBR). A two-stage reconstruction with tissue expander (TE) remains the most common technique. Since the implementation of ADMs, a prepectoral approach has gained popularity and is becoming the standard of care. Herein, we compared the surgical and postoperative outcomes of prepectoral versus subpectoral two-stage IBBR. METHODS: A retrospective chart review was performed between January 2011 and December 2020. We included female patients undergoing immediate two-stage IBBR. The primary outcomes of this study were to compare the 30-day morbidity and the overall rate of complications during the first and second stages of reconstruction, and to compare the time to initiate postmastectomy radiotherapy (PMRT). Propensity score matching was implemented. RESULTS: After matching, 154 reconstructions were analyzed, 77 in each group. The two matched groups exhibited comparable (p > 0.05) characteristics for all analyzed demographic and intraoperative independent variables. Reconstructions in the prepectoral group had a shortened median time for drain removal (13-days vs. 15-days, p = 0.001). The intraoperative expansion volumes were higher in the prepectoral group (300 ml versus 200 ml, p = 0.025). The 30-day morbidity and first- and second-stage complication rates were not significantly different between groups. The time to start postmastectomy radiation therapy (PMRT) was not significantly different between groups (134-days versus 126.5-days, p = 0.58). CONCLUSION: Prepectoral and subpectoral TE placement had comparable complication rates during the first and second stages of IBBR. Timing for TE-to-Implant exchange and initiation of PMRT were comparable between the two approaches.

Simultaneous Fat Grafting During Tissue Expander-to-Implant Exchange: A Propensity Score-Matched Analysis.

BACKGROUND: Implant-based breast reconstruction (IBBR) is the most common technique for breast reconstruction. The primary resource for correcting deformities, once patients have achieved an adequate volume with two-stage IBBR, is autologous fat grafting. We compared the surgical outcomes of simultaneous fat grafting during TE-to-implant exchange (SFG + TtIE) versus no fat grafting during TE-to-implant exchange (No-FGX). METHODS: A retrospective review was performed of all consecutive patients undergoing two-stage implant-based breast reconstruction with TE from January 2011 to December 2020. Propensity score matching was implemented to optimize comparability. The control group did not receive fat grafting at the time of TE-to-implant exchange. RESULTS: After propensity score matching, 196 reconstructions were evaluated, 98 in each group. Reconstructions in the SFG + TtIE received larger implants during exchange in comparison with the No-FGX group (539 ± 135.1-cc versus 495.97 ± 148-cc, p=0.035). The mean volume of fat lipoinjected during TE-to-implant exchange in the SFG + TtIE group was 88.79 ± 41-ml. A higher proportion of reconstructions in the SFG + TtIE group underwent additional fat grafting after exchange versus the No-FGX group (19% versus 9%, p = 0.041). After propensity score matching, only the rate of fat necrosis after exchange was significantly higher in the SFG + TtIE group (10% versus 2%, p = 0.017). The rate of breast cancer recurrence (3% versus 5%, p = 1.00) was comparable between the groups. CONCLUSION: SFG + TtIE is a safe procedure to improve the envelope of reconstructed breasts during two-stage IBBR. SFG + TtIE does not increase the rate of periprosthetic infection or wound-related complication versus no fat grafting during TE-to-implant exchange, but increases the rate of fat necrosis. LEVEL OF EVIDENCE III: Therapeutic study. 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.

Outcomes of smooth round implant-based immediate breast reconstruction: Long-term follow-up results.

The issue of breast implant-associated anaplastic large cell lymphoma in 2019 has resulted in the discontinuation of textured breast implants and resumption in the use of smooth round implants. However, in the field of breast reconstruction, long-term follow-up data for direct-to-implant reconstruction using smooth round implants is insufficient. This retrospective study aimed to evaluate the long-term outcomes of breast reconstruction using smooth round implants. This study included 185 patients (208 breasts) who underwent smooth round implant-based immediate breast reconstruction between 2007 and 2018. Their demographic information and surgical and oncological data were collected. Early (within 90 days) and late (after 90 days) complications, reoperations, implant maintenance, and the survival rate were analyzed to evaluate the long-term outcomes and identify the related factors. The mean follow-up period was 112.08 months. The most common early complications were skin necrosis (9.13%) and infection (3.85%). The factors influencing the development of early complications were the mastectomy specimen weight (237.14 ± 114.84 cc and 298.04 ± 141.53 cc for no complication and any complication, respectively; p = 0.0123) and implant volume (222.79 ± 77.76 cc and 264.48 ± 89.03 cc for no complication and any complication, respectively; p = 0.0082). The most common late complication was capsular contracture (13.46%). Approximately 91.35% of the implants were maintained during the follow-up period. The factors affecting the development of early complications and implant maintenance were the mastectomy specimen weight and implant volume. This study provides information on long-term follow-up results useful in cases where only smooth round implants are available, which can then serve as a basis for future related studies.

Síndrome autoimune induzida por adjuvantes (ASIA) sinais e sintomas experienciados por mulheres / Implementation of an intravenous therapy team based on convergent-assistance research / Síndrome autoinmune inducido por adyuvante (ASIA) signos y síntomas experimentados por mujeres

Objetivo: Identificar sinais e sintomas experienciados por mulheres com síndrome autoimune induzida por adjuvantes (ASIA) devido ao uso de prótese mamária e os tratamentos realizados. Método: Estudo de campo de abordagem qualitativa realizado por meio de entrevistas online utilizan-do-se a técnica bola de neve. Incluíram-se 13 participantes. Resultados: A partir da análise dos dados, foram elencadas quatro categorias: conhecimento acerca da síndrome; sinais e sintomas; tratamento; e cuidados e implicações de Enfermagem. Identificaram-se mais de 120 sinais e sintomas, e o explante foi mencionado como tratamento definitivo por todas as entrevistadas. Os sinais e sintomas apresentados pelas participantes vão ao encontro do que é descrito pela literatura. Conclusão: Antes da descoberta da doença, as participantes realizaram tratamento com foco no alívio dos sintomas. Após o diag-nóstico, todas as mulheres procederam com o explante

Objective: To identify signs and symptoms experienced by women with autoimmune/inflammatory syndrome induced by adjuvants (ASIA) due to the use of breast implants and the treatments performed. Method: Field study with a qualitative approach carried out through online interviews using the snowball technique. 13 participants were included. Results: Based on data analysis, four categories were listed: knowledge about the syndrome; signs and symptoms; treatment; and nursing care and implications. Over 120 signs and symptoms were identified, and the explant was mentioned as a defi-nitive treatment by all interviewees. The signs and symptoms presented by the participants are in line with what is described in the literature. Conclusion:Before discovering the disease, the participants underwent treatment focused on symptom relief. After diagnosis, all women proceeded with the explant.Keywords: Autoimmune diseases. Prothesis implantation. Breast implantation. Silicones. Perioperative nursing

Objetivo: Identificar los signos y síntomas experimentados por mujeres con síndrome autoinmune inducido por adyuvantes (ASIA) debido al uso de implantes mamarios y los tratamientos realizados. Método: Estudio de campo con enfoque cualitativo realizado a través de entrevistas en línea utilizando la técnica de bola de nieve. Se incluyeron 13 participantes. Resultados: Con base en el análisis de los datos, se enumeraron cuatro categorías: conocimiento sobre el síndrome; signos y síntomas; tratamiento; y cuidados e implicaciones de enfermería. Se identificaron más de 120 signos y sínto-mas, y todos los entrevistados mencionaron el explante como tratamiento definitivo. Los signos y síntomas presentados por los participantes están en línea con lo descrito en la literatura. Conclusión: Antes de descubrir la enfermedad, los participantes realizaban un tratamiento enfocado en el alivio de los síntomas. Después del diagnóstico, todas las mujeres procedieron al explante

Prepectoral versus subpectoral two-stage implant-based breast reconstruction: U.S. medical center experience and narrative review.

Background and Objective: With the incorporation of autologous fat grafting, acellular dermal matrix (ADM) products, and nipple-sparing mastectomy, prepectoral device placement has become more popular in selected patients when compared to partial submuscular (dual plane) or complete submuscular device placement. In this article, we aimed to present a review of the current state-of-the-art for implant-based breast reconstruction (IBBR) using expanders. Additionally, we present a case series of our experience with IBBR evaluating perioperative outcomes, complications, and patient-reported outcomes (PRO). Methods: For our series, we retrospectively evaluated adult female patients undergoing 2-stage immediate IBBR after total mastectomy between 2011 and 2021. We performed a systematic search across PubMed MEDLINE for articles evaluating outcomes of prepectoral versus subpectoral two-stage IBBR with expanders published from database inception through February 28th, 2023. Key Content and Findings: Both prepectoral and subpectoral are safe alternatives for two-stage IBBR. Due to current advancements in the field of breast reconstruction, prepectoral IBBR has gained popularity and has a comparable rate of complications compared to a subpectoral approach in selected patients according to high-quality articles. In patients with several comorbidities, current tobacco use, history of preoperative radiation, and limited perfusion of the mastectomy flaps, subpectoral device placement should be given special consideration as a layer of vascularized tissue can decrease the risk of major complications or unplanned procedures. As prepectoral device placement does not require dissection of the pectoral muscles, faster recovery, better implant position, decreased pain, and a shorter time to complete expansion is expected. The plane of reconstruction does not seem to significantly affect the time for expander-to-implant exchange or PRO for quality-of-life (QOL) according to most studies. Conclusions: Prepectoral and subpectoral IBBR demonstrated a comparable rate of complications in selected patients. Nonetheless, perioperative outcomes seem to be improved using a prepectoral approach in terms of reduced pain, reduced time to conclude outpatient expansions, and less animation deformity.

Clinical use of perioperative magnetic resonance imaging-based breast volumetric analysis in final implant volume prediction for two-stage breast reconstruction.

Purpose: Breast volume is an important factor in breast reconstruction; however, the surgeon is expected to deliver the volume expectation with his aesthetic inspiration. Therefore, objective volumetry must be developed. This study aimed to conduct an MRI-based breast volumetric analysis. With periodic analysis of 2-stage breast reconstruction, we suggest the possibility of clinical use of breast volumetry in implant volume prediction. Methods: This retrospective study included 140 patients who underwent unilateral 2-stage breast reconstruction (tissue expander followed by implant insertion) between January 1, 2017 and December 31, 2019. The MRI image was converted into a 3-dimensional image with a reconstruction program (A-VIEW, Coreline Soft). MRI image was obtained before the surgery and then at 1, 3, 6, 12, and 24 months postoperatively. The volume was automatically calculated. Results: Compared with the preoperative volume, maximized volume and differences were noted at 1 month and minimized at 1 year. The correlation between MRI-based preoperative breast volumetry and the mastectomy specimen volume was 0.611. Volume difference between the MRI-based preoperative state and the implant volume showed a minimal difference at 1 year. The final implant size prediction formula was calculated using the 1-year postoperative volume (P < 0.001, R2 = 0.594). Conclusion: To avoid breast reconstruction based solely on the surgeon's subjective assessment, MRI-based breast volumetry could be a useful method to develop more scientific and objective breast reconstruction planning. We suggest a volume prediction formula that describes the relationship between the postoperative breast volume and the final breast implant size.

Reconstruções mamárias: análise evolutiva das técnicas e estado da arte atual / Breast reconstructions: an evolutionary analysis of techniques and current state of the art

Introdução: O câncer que mais acomete mulheres em todo o mundo é o de mama. Não bastasse o mal que a doença ativa é capaz de causar, após a cura as sequelas continuam atormentando a vida de milhares de mulheres. O trauma psicológico de uma mutilação pode ter repercussões psicológicas de difícil controle. A mastectomia salva a vida da mulher com câncer mamário; entretanto, a perda da mama pode manter o biopsicossocial da paciente doente. Reconstruir as mamas se torna, então, tempo crucial no tratamento destas mulheres. Métodos: O estudo dos acervos públicos e pessoais dos autores permitiram discorrer sobre a evolução artística e técnica das reconstruções mamárias através dos anos. Resultados: Estudos e reflexões de cirurgiões plásticos em todo o mundo possibilitaram a padronização de uma série de técnica e ferramentas para reconstrução da mama, que vão compor o arsenal do cirurgião moderno. Existem várias, incluindo técnicas com retalhos locais, como o plug flap e as técnicas de mamoplastia, retalhos de vizinhança, como retalho toracodorsal, materiais aloplásticos (expansores teciduais e próteses), numerosos retalhos autólogos, incluindo retalhos microcirúrgicos ou, ainda, técnicas combinadas frente aos variados tipos de casos. Paralelamente, a indústria de produtos médico-hospitalares desenvolveu material aloplástico (próteses e expansores) mais adequados e de melhor qualidade, que propiciam reconstruções mais seguras e mais previsíveis no que concerne ao uso dos implantes. Conclusão: O estado da arte atual da reconstrução mamária encontra pilares históricos bem fundamentados e auxílio tecnológico avançado, provendo condições para tratamentos refinados, de alta exigência e preparo do artista.

Introduction: The cancer that most affects women around the world is breast cancer. If the harm that the active disease is capable of causing was not enough, after the cure, the consequences continue to torment the lives of thousands of women. Furthermore, the psychological trauma of mutilation can have psychological repercussions that are difficult to control. Mastectomy saves the life of a woman with breast cancer; however, breast loss can keep the patient sick in the biopsychosocial aspect. Rebuilding the breasts then becomes crucial in the treatment of these women. Methods: The study of the authors' public and personal collections allowed us to discuss the artistic and technical evolution of breast reconstructions over the years. Results: Studies and reflections from plastic surgeons worldwide have enabled the standardization of a series of techniques and tools for breast reconstruction that will make up the arsenal of the modern surgeon. It includes techniques with local flaps, such as the plug flap and mammoplasty techniques, neighborhood flaps, such as the thoracodorsal flap, alloplastic materials (tissue expanders and prostheses), the numerous autologous flaps, including microsurgical flaps or, also, the combined techniques for the various types of cases. At the same time, the medical-hospital products industry has developed alloplastic materials (prostheses and expanders) that are more suitable and of better quality, which provide safer and more predictable reconstructions concerning the use of implants. Conclusion: The current state of the art in breast reconstruction finds well-founded historical pillars and advanced technological aid, providing conditions for advanced treatments.

Case Report: Implantation of Dedifferentiated to Poorly Differentiated Thyroid Carcinoma After Endoscopic Thyroid Surgery.

Background: Endoscopic thyroidectomy is widely accepted for its advantages. However, implant metastasis remains a significant complication of endoscopic thyroidectomy. Methods: This is the first report of breast implantation diagnosed with poorly differentiated thyroid carcinoma following endoscopic thyroidectomy. Results: We present a case of a 35-year-old woman who was initially diagnosed with a 3.0 cm conventional papillary thyroid carcinoma after endoscopic thyroidectomy via total areola. Two years later, she was reported to have recurring poorly differentiated thyroid carcinoma in the right areola. Implantation after endoscopic thyroidectomy is rare, and even rarer is dedifferentiated papillary thyroid carcinoma around the implant site. Conclusions: Stringently evaluated endoscopic surgery indications, appropriate preoperative evaluation, meticulous surgical technique, and adequate protective measures can significantly reduce the incidence of local implantation or recurrence.

The investigation of the relation between expansion strategy and outcomes of two-stage expander-implant breast reconstruction.

BACKGROUND: Numerous risk factors for the complications of two-stage, immediate implant-based breast reconstruction have been identified, although few studies have directly examined the impact of breast size and expansion protocols on the surgical outcomes of breast reconstruction. This study aimed to evaluate the impact of breast size, expansion velocity, and volume-related variables on postoperative complications of breast reconstruction. METHODS: The cohort involved patients who underwent immediate breast expander reconstruction at a single center between 2017 and 2019. The breast size was classified into three categories according to the weight of the mastectomy specimen as small (<300 g), medium (≥300 g, ≤500 g), or large (>500 g). Multifactorial logistic regressions were used to assess the impact of variables, and receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut-off value for predicting the complication event. RESULTS: Of the 174 breasts (168 patients), 51 (29.3%), 66 (37.9%), and 57 (32.6%) breasts were classified as small, medium, and large, respectively. The rate of infection (P=0.014) and expander/implant failure (P=0.007) significantly differed according to breast size, with the rate being the highest in large breasts. Multivariate logistic regression analysis showed that body mass index (BMI) [odds ratio (OR): 1.25; P=0.003], nipple-sparing mastectomy (OR: 2.82; P=0.036), sentinel biopsy (OR: 5.10; P=0.016), final expansion volume (OR: 0.99; P=0.022), and expansion velocity (OR: 0.703; P=0.024) were significant independent predictors of any complication. In the ROC analysis, breast weight >696 g could predict the possibility of revision surgery, with a sensitivity of 42.9% and specificity of 81.8%. CONCLUSIONS: The final expansion volume and expansion velocity have a significant negative relationship with overall complications in breast reconstruction. A standard expansion protocol needs to be established to ensure the success of two-stage breast reconstruction.

Breast Implant Illness: onde estamos e para onde vamos? / Breast Implant Illness: where are we and where are we going?

Apesar dos mais de 60 anos de história, dezenas de estudos e grandes amostras populacionais, nos últimos anos diversos pacientes têm retornado ao consultório do cirurgião plástico. Apresentam dúvidas a respeito do silicone, algumas devido aos relatos recentes de BIA-ALCL (Anaplastic Large Cell Lymphoma), mas a grande maioria pela possibilidade de sintomas sistêmicos relacionados aos implantes e que despertam o desejo da sua remoção. Procedimento conhecido como explante. Este fenômeno, cujas dúvidas são inúmeras e as respostas mínimas, é conhecido na literatura mundial como Breast Implant Illness (BII). Na Internet e redes sociais, centenas de sinais e sintomas têm sido relacionados às próteses de silicone, usualmente inespecíficos. Os sintomas mais comuns referidos pelas pacientes são fadiga crônica, artralgia, confusão mental, mialgia, perda de memória, dificuldade de concentração e olhos secos. Até o momento, não existem testes diagnósticos para BII, nenhum método baseado em evidência científica para diferenciá-la de outras condições e há muito pouco conhecimento a respeito do seu início, curso, fatores de risco, causas e manejo adequado. A opção pela retirada dos implantes vem crescendo vertiginosamente nos últimos anos, sendo uma das dez cirurgias mais realizadas nos Estados Unidos no ano passado. A literatura mostra taxas de melhora dos sintomas variáveis após o explante e as pacientes mostram-se, via de regra, satisfeitas com seu resultado estético e apresentam níveis de ansiedade e estresse menores após o procedimento. São necessários estudos prospectivos, randomizados bem desenhados correlacionando períodos distintos das pacientes, desde o pré-operatório do implante até o pós-explante.

Despite more than 60 years of history, numerous studies and large population samples, in recent years, several patients have returned to the plastic surgeons office. They have doubts about the silicone, some due to the recent reports of BIAALCL, but the vast majority due to the possibility of systemic symptoms related to the implants and which arouse the desire for its removal. Procedure known as explant. This phenomenon, whose doubts are numerous and the responses are minimal, is known in the world literature as Breast Implant Illness (BII). On the Internet and social networks, hundreds of signs and symptoms have been related to silicone implants, usually nonspecific. The most common symptoms reported by patients are chronic fatigue, arthralgia, mental confusion, myalgia, memory loss, difficulty concentrating and dry eyes. So far, there are no diagnostic tests for BII, no method based on scientific evidence to differentiate it from other conditions, and there is very little knowledge about its onset, course, risk factors, causes and proper management. The option for removing the implants has been growing dramatically in recent years, being one of the ten most performed surgeries in the United States last year. The literature shows variable improvement rates after the explantation and the patients are, as a rule, satisfied with their aesthetic result and have lower levels of anxiety and stress after the procedure. Prospective, well-designed randomized studies correlating different periods are necessary, from the preoperative period of the implant until after the explantation.

The Impact of implant-based reconstruction on persistent pain after breast cancer surgery: A systematic review.

INTRODUCTION: With the increasing number of breast cancer survivors and reconstruction operations, persistent pain following breast cancer surgery (PPBCT) and its management is becoming a challenge for plastic surgeons. To date, most studies compared the difference in the level of PPBCT in reconstruction versus nonreconstruction groups. We systematically reviewed the literature to assess the impact of implant-based reconstruction on PPBCT levels. MATERIALS AND METHODS: PubMed, Embase, CINAHL, and Scopus databases were searched for relevant articles. We used five search strategies: (persistent pain after breast cancer surgery AND reconstruction), (chronic postsurgical pain AND breast reconstruction), (Breast Implantation [MeSH Terms] AND "Chronic Pain" [MeSH Terms]), (breast reconstruction AND chronic pain), and (postmastectomy pain syndrome AND breast reconstruction). RESULTS: A total of 2281 articles were detected. After scanning for the title and abstract, full-text articles were reviewed to identify the eligible articles. Eleven articles were included in the final review, with seven of these reporting no increased chance of PPBCT following reconstruction with implants, whereas two articles described lower chances of PPBCT following implant-based reconstruction. CONCLUSION: We discovered that implant-based reconstruction does not increase the risk of PPBCT in comparison to other surgical techniques or mastectomy alone. This relationship may facilitate doctors and their patients in the decision-making of the appropriate reconstruction technique to use. In addition, our results should prompt plastic surgeons to prescribe the same dosage and frequency of analgesics to patients undergoing implant reconstruction as they would to their patients not undergoing reconstruction.