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1.
J Surg Oncol ; 123(1): 80-88, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33051871

RESUMO

BACKGROUND: Even though meshes and matrices are widely used in breast reconstruction, there is little high-quality scientific evidence for their risks and benefits. The aim of this study was to compare first-year surgical complication rates in implant-based immediate breast reconstruction with a biological mesh with that of a synthetic mesh, in the same patient. METHODS: This study is a clinical, randomized, prospective trial. Patients operated on with bilateral mastectomy and immediate breast reconstruction were randomized to biological mesh on one side and synthetic mesh on the other side. RESULTS: A total of 48 breasts were randomized. As the synthetically and the biologically reconstructed breasts that were compared belonged to the same woman, systemic factors were exactly the same in the two groups. The most common complication was seroma formation with a frequency of 38% in the biological group and 3.8% in the synthetical group (p = .011). A higher frequency of total implant loss could be seen in the biologic mesh group (8.5% vs. 2%), albeit not statistically significant (p = .083). CONCLUSIONS: In the same patient, a synthetic mesh seems to yield a lower risk for serious complications, such as implant loss, than a biological mesh.


Assuntos
Implante Mamário/efeitos adversos , Implantes de Mama/efeitos adversos , Neoplasias da Mama/cirurgia , Mamoplastia/efeitos adversos , Mastectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Telas Cirúrgicas/estatística & dados numéricos , Adulto , Idoso , Neoplasias da Mama/patologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Prognóstico , Estudos Prospectivos
2.
Plast Reconstr Surg ; 146(6): 1213-1220, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33234945

RESUMO

BACKGROUND: Reduction mammaplasty effectively alleviates symptoms and restores quality of life. However, operating on adolescents remains controversial, partly because of fear of potential postoperative breast growth. This cross-sectional study provides surgeons with a method to predict the optimal timing, or biological "sweet spot," for reduction mammaplasty to minimize the risk of breast regrowth in adolescents. METHODS: The authors reviewed the medical records of women aged 12 to 21 years who underwent reduction mammaplasty from 2007 to 2019. Collected data included symptomology, perioperative details, and postoperative outcomes. RESULTS: Four hundred eighty-one subjects were included in analyses and were, on average, 11.9 years old at first menses (menarche) and 17.9 years old at surgery. Six percent of subjects experienced postoperative breast growth. Breast size appears to stabilize considerably later in obese adolescents compared to healthy-weight and overweight patients, and breast growth in obese macromastia patients may not end until 9 years after menarche. Operating on obese women before this time point increased the likelihood of glandular breast regrowth by almost 120 percent (OR, 1.18; 95 percent CI, 1.11 to 1.26). Surgery performed less than 3 years after menarche, the commonly regarded end of puberty, increased the likelihood of glandular regrowth by over 700 percent in healthy-weight and overweight subjects (OR, 7.43; 95 percent CI, 1.37 to 40.41). CONCLUSIONS: Findings suggest that reduction mammaplasty age restrictions imposed by care providers and third-party payors may be arbitrary. Surgical readiness should be determined on an individual basis incorporating the patient's biological and psychological maturity, obesity status, potential for postoperative benefit, and risk tolerance for postoperative breast growth. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Mama/anormalidades , Mama/crescimento & desenvolvimento , Hipertrofia/cirurgia , Mamoplastia/métodos , Obesidade/cirurgia , Tempo para o Tratamento , Adolescente , Mama/cirurgia , Criança , Estudos Transversais , Feminino , Humanos , Hipertrofia/etiologia , Hipertrofia/psicologia , Obesidade/complicações , Obesidade/psicologia , Seleção de Pacientes , Período Pós-Operatório , Qualidade de Vida , Recidiva , Resultado do Tratamento , Adulto Jovem
3.
Plast Reconstr Surg ; 146(6): 1221-1225, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33234946

RESUMO

BACKGROUND: Robotically assisted latissimus dorsi harvest permits harvest of the latissimus dorsi muscle without a back incision, as compared to the traditional open technique. The authors hypothesized that robotic harvest has lower donor-site complication rates, decreased opioid requirements, and a shorter length of stay than the traditional open technique. METHODS: A retrospective review was performed of all consecutive pedicled latissimus dorsi flaps for breast reconstruction between 2011 and 2015. All procedures were conducted by two surgeons who performed both robotic and open cases. RESULTS: Fifty-two patients were identified; 25 underwent robotically assisted latissimus dorsi harvest and 27 underwent the open technique. Demographic data between the two groups were similar. Median length of stay for robotic harvest was shorter than that for the traditional technique (2 days versus 3 days; p = 0.031). Postoperative morphine requirement was less in the robotic compared to the traditional technique, but the difference was not significant (158 mg versus 184 mg; p = 0.826). Seroma rate was higher in the robotic group (16 percent versus 0 percent; p = 0.034). The mean duration of surgery was longer in the robotic cohort (388 minutes versus 311 minutes; p = 0.002). CONCLUSIONS: This study demonstrates robotically assisted latissimus dorsi harvest as an effective alternative to the traditional open technique in select patients. Advantages of robotic harvest include no back scar, a shorter length of stay, and lower opioid requirements, although the difference was not significant; disadvantages include longer operative time and a higher seroma rate. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Mamoplastia/efeitos adversos , Dor Pós-Operatória/diagnóstico , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Seroma/epidemiologia , Coleta de Tecidos e Órgãos/efeitos adversos , Sítio Doador de Transplante/patologia , Adulto , Analgésicos Opioides/uso terapêutico , Feminino , Seguimentos , Humanos , Tempo de Internação/estatística & dados numéricos , Mamoplastia/métodos , Pessoa de Meia-Idade , Morfina/uso terapêutico , Duração da Cirurgia , Manejo da Dor/estatística & dados numéricos , Medição da Dor/estatística & dados numéricos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Estudos Retrospectivos , Seroma/etiologia , Seroma/patologia , Músculos Superficiais do Dorso/transplante , Ferida Cirúrgica/complicações , Ferida Cirúrgica/patologia , Coleta de Tecidos e Órgãos/métodos , Sítio Doador de Transplante/cirurgia , Resultado do Tratamento
4.
Plast Reconstr Surg ; 146(6): 1227-1236, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33234948

RESUMO

BACKGROUND: Fat grafting to the reconstructed breast may result in the development of benign lesions on physical examination, prompting further investigation with imaging and biopsy. The aim of this study was to assess the influence of fat grafting on the incidence of imaging and biopsies after postmastectomy reconstruction. METHODS: Patients who underwent autologous or implant-based reconstruction following mastectomy from 2010 to 2018 were identified. Those receiving fat grafting as part of their reconstructive course were propensity matched 1:1 to those that did not with body mass index, reconstruction timing, and reconstruction type as covariates in a multivariable logistic regression model. RESULTS: A total of 186 patients were identified, yielding 93 propensity-matched pairs. Fat-grafted patients had higher incidences of palpable masses (38.0 percent versus 18.3 percent; p = 0.003) and postreconstruction imaging (47.3 percent versus 29.0 percent; p = 0.01), but no significant difference in the number of biopsies performed (11.8 percent versus 7.5 percent; p = 0.32). Imaging was predominately interpreted as normal (Breast Imaging-Reporting and Data System 1, 27.9 percent) or benign (Breast Imaging-Reporting and Data System 2, 48.8 percent), with fat necrosis being the most common finding [n = 20 (45.5 percent)]. No demographic, oncologic, reconstructive, or fat grafting-specific variables were predictive of receiving postreconstruction imaging on multivariate analysis. Fat grafting was not associated with decreased 5-year overall survival or locoregional recurrence-free survival. CONCLUSIONS: Fat grafting to the reconstructed breast is associated with increased incidences of palpable masses and subsequent postreconstruction imaging with benign radiographic findings. Although the procedure is oncologically safe, both patients and providers should be aware that concerning physical examination findings can be benign sequelae of fat grafting and may lead to increased imaging after breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Tecido Adiposo/transplante , Neoplasias da Mama/cirurgia , Mama/patologia , Mamoplastia/efeitos adversos , Recidiva Local de Neoplasia/epidemiologia , Adulto , Idoso , Biópsia/estatística & dados numéricos , Mama/diagnóstico por imagem , Mama/cirurgia , Implantes de Mama/efeitos adversos , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Incidência , Lipectomia/métodos , Mamoplastia/instrumentação , Mamoplastia/métodos , Mamografia/estatística & dados numéricos , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/etiologia , Recidiva Local de Neoplasia/patologia , Pontuação de Propensão , Estudos Retrospectivos , Fatores de Tempo , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos , Resultado do Tratamento , Ultrassonografia Mamária/estatística & dados numéricos
5.
Plast Reconstr Surg ; 146(6): 721e-730e, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33234949

RESUMO

BACKGROUND: Implementation of payment reform for breast reconstruction following mastectomy demands a comprehensive understanding of costs related to the complex process of reconstruction. Bundled payments for services to women with breast cancer may profoundly impact reimbursement and access to breast reconstruction. The authors' objectives were to determine the contribution of cancer therapies, comorbidities, revisions, and complications to costs following immediate reconstruction and the optimal duration of episodes to incentivize cost containment for bundled payment models. METHODS: The cohort was composed of women who underwent immediate breast reconstruction between 2009 and 2016 from the MarketScan Commercial Claims and Encounters database. Continuous enrollment for 3 months before and 24 months after reconstruction was required. Total costs were calculated within predefined episodes (30 days, 90 days, 1 year, and 2 years). Multivariable models assessed predictors of costs. RESULTS: Among 15,377 women in the analytic cohort, 11,592 (75 percent) underwent tissue expander, 1279 (8 percent) underwent direct-to-implant, and 2506 (16 percent) underwent autologous reconstruction. Adjuvant therapies increased costs at 1 year [tissue expander, $39,978 (p < 0.001); direct-to-implant, $34,365 (p < 0.001); and autologous, $29,226 (p < 0.001)]. At 1 year, most patients had undergone tissue expander exchange (76 percent) and revisions (81 percent), and a majority of complications had occurred (87 percent). Comorbidities, revisions, and complications increased costs for all episode scenarios. CONCLUSIONS: Episode-based bundling should consider separate bundles for medical and surgical care with adjustment for procedure type, cancer therapies, and comorbidities to limit the adverse impact on access to reconstruction. The authors' findings suggest that a 1-year time horizon may optimally capture reconstruction events and complications.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Reforma dos Serviços de Saúde , Acesso aos Serviços de Saúde/economia , Mamoplastia/economia , Mastectomia/efeitos adversos , Demandas Administrativas em Assistência à Saúde/economia , Demandas Administrativas em Assistência à Saúde/estatística & dados numéricos , Adulto , Implantes de Mama/economia , Neoplasias da Mama , Estudos de Coortes , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Renda/estatística & dados numéricos , Seguro Saúde/economia , Seguro Saúde/estatística & dados numéricos , Mamoplastia/instrumentação , Mamoplastia/métodos , Mamoplastia/estatística & dados numéricos , Pessoa de Meia-Idade , Retalhos Cirúrgicos/economia , Retalhos Cirúrgicos/transplante , Dispositivos para Expansão de Tecidos/economia , Transplante Autólogo/economia , Transplante Autólogo/estatística & dados numéricos , Estados Unidos
6.
Aesthet Surg J ; 40(Suppl 2): S38-S44, 2020 11 17.
Artigo em Inglês | MEDLINE | ID: mdl-33202008

RESUMO

Implant-based breast reconstruction is the most common means to rebuild the breast following mastectomy. Although largely successful in restoring breast shape, suboptimal results may occur secondary to inadequate size or projection, malposition, rippling and contour irregularities, nipple malposition, capsular contracture, or implant rotation/flipping. This article reviews common strategies to improve implant reconstruction outcomes with revisional surgery.


Assuntos
Implante Mamário , Implantes de Mama , Neoplasias da Mama , Mamoplastia , Implante Mamário/efeitos adversos , Implantes de Mama/efeitos adversos , Humanos , Mamoplastia/efeitos adversos , Mastectomia , Estudos Retrospectivos
7.
Aesthet Surg J ; 40(Suppl 2): S29-S37, 2020 11 17.
Artigo em Inglês | MEDLINE | ID: mdl-33202009

RESUMO

BACKGROUND: Prepectoral placement of prosthetic devices is rapidly becoming the preferred method of breast reconstruction. OBJECTIVES: The objective of this study was to review long-term surgical and aesthetic outcomes following prepectoral prosthetic breast reconstruction. METHODS: The study included 90 patients (139 breasts). Follow-up for all patients ranged from at least 1 year up to a maximum of 4.3 years. Parameters analyzed included preoperative and postoperative breast symmetry, rippling, edge visibility, and capsular contracture, as well as secondary procedures such as fat grafting, implant exchange, contralateral procedures, and autologous flap conversion. RESULTS: The incidence of breast symmetry, which was noted preoperatively in 84.4% of patients, gradually declined to 68.9% after 1 to 2 years and to 56.7% after 2 to 5 years. Rippling and edge visibility were noted in 19.4% and 12.9% of patients, respectively. Explantation without replacement of the device was performed in 12 breasts (8.6%). Secondary procedures included autologous fat grafting (23.7%), implant replacement (7.2%), conversion to an autologous flap (12.2%), and a contralateral breast procedure in 15 of 41 patients (36.6%). Capsular contracture (grade 3-4) was demonstrated in 14 of 139 breasts (10.1%). CONCLUSIONS: Prepectoral breast reconstruction can provide good to excellent short-term (1-2 years) and longer-term (2-4.3 years) benefits; however, over time, the quality of prepectoral breast reconstruction as well as breast symmetry can change due to various factors.


Assuntos
Implante Mamário , Implantes de Mama , Neoplasias da Mama , Mamoplastia , Implante Mamário/efeitos adversos , Implantes de Mama/efeitos adversos , Estética , Humanos , Mamoplastia/efeitos adversos , Mastectomia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos
8.
Aesthet Surg J ; 40(Suppl 2): S45-S54, 2020 11 17.
Artigo em Inglês | MEDLINE | ID: mdl-33202010

RESUMO

With continuous technical and functional advances in the field of breast reconstruction, there is now a greater focus on the artistry and aesthetic aspects of autologous reconstruction. Whereas once surgeons were most concerned with flap survival and vessel patency, they are now dedicated to reconstructing a similarly or even more aesthetically pleasing breast than before tumor resection. We discuss the approach to shaping the breast through the footprint, conus, and skin envelope. We then discuss how donor site aesthetics can be optimized through flap design, scar management, and umbilical positioning. Each patient has a different perception of their ideal breast appearance, and through conversation and counseling, realistic goals can be set to reach optimal aesthetic outcomes in breast reconstruction.


Assuntos
Neoplasias da Mama , Mamoplastia , Mama/cirurgia , Neoplasias da Mama/cirurgia , Estética , Humanos , Retalhos Cirúrgicos
9.
Aesthet Surg J ; 40(Suppl 2): S1-S12, 2020 11 17.
Artigo em Inglês | MEDLINE | ID: mdl-33202011

RESUMO

The aesthetics of breast reconstruction inherently rely on both the ablative and reconstructive procedures. Mastectomy flap quality remains one of the most critical factors in determining the success of a reconstruction and its aesthetic outcome. Maintaining the segmental perfusion to the nipple and skin envelope during mastectomy requires preserving the subcutaneous tissue superficial to the breast capsule. Because this layer of tissue varies in thickness among different patients and within each breast, anatomic dissection along the appropriate planes is required rather than a "one-size-fits-all" mentality. A team-based approach between the breast surgeon and plastic surgeon will optimize both the ablative and reconstructive procedures while engaging in a process of shared decision-making with the patient. Preoperative clinical analysis and utilization of imaging to assess individual breast anatomy will help guide mastectomies as well as decisions on reconstructive modalities. Critical assessment of mastectomy flaps is paramount and requires flexibility to adapt reconstructive paradigms intraoperatively to minimize the risk of complications and provide the best aesthetic result.


Assuntos
Neoplasias da Mama , Mamoplastia , Mastectomia Subcutânea , Neoplasias da Mama/cirurgia , Estética , Humanos , Mastectomia , Mamilos/cirurgia
10.
Aesthet Surg J ; 40(Suppl 2): S13-S21, 2020 11 17.
Artigo em Inglês | MEDLINE | ID: mdl-33202012

RESUMO

Nipple-sparing mastectomy (NSM) has been associated with improved quality of life and patient satisfaction with similar oncologic outcomes compared with traditional mastectomy techniques. By conserving the nipple-areola complex and the majority of the breast skin envelope, NSM allows for improved aesthetic outcomes after breast reconstruction. However, the technique is also associated with a steep learning curve that must be considered to achieve optimal outcomes. It is important that the plastic surgeon functions in concert with the extirpative breast surgeon to optimize outcomes because the reconstruction is ultimately dependent on the quality of the overlying mastectomy flaps. Various other factors influence the complex interplay between aesthetic and reconstructive outcomes in NSM, including preoperative evaluation, specific implant- and autologous-based considerations, as well as techniques to optimize and correct nipple-areola complex position. Management strategies for complications necessary to salvage a successful reconstruction are also reviewed. Lastly, techniques to expand indications for NSM and maximize nipple viability as well as preshape the breast are discussed. Through thoughtful preoperative planning and intraoperative technique, ideal aesthetic results in NSM may be achieved.


Assuntos
Neoplasias da Mama , Mamoplastia , Mastectomia Subcutânea , Neoplasias da Mama/cirurgia , Estética , Humanos , Mamoplastia/efeitos adversos , Mastectomia , Mastectomia Subcutânea/efeitos adversos , Mamilos/cirurgia , Qualidade de Vida , Estudos Retrospectivos
11.
Aesthet Surg J ; 40(Suppl 2): S55-S65, 2020 11 17.
Artigo em Inglês | MEDLINE | ID: mdl-33202013

RESUMO

Aesthetic concern is one of the main driving forces behind the popularity of the oncoplastic approach to breast conservation therapy. Oncoplastic options at the time of lumpectomy include volume replacement techniques such as flaps and volume displacement techniques such as the oncoplastic reduction. These techniques can be employed to ensure preservation of breast shape and contour, size and symmetry, inframammary fold position, and position of the nipple-areola complex. The importance of aesthetic outcomes is not only to improve overall patient satisfaction but also to minimize the need for revisional surgeries for shape and symmetry. The purpose of this review is to discuss ways to optimize the aesthetic result and to review the evidence behind aesthetic outcomes.


Assuntos
Neoplasias da Mama , Mamoplastia , Neoplasias da Mama/cirurgia , Estética , Humanos , Mastectomia , Mastectomia Segmentar
12.
Aesthet Surg J ; 40(Suppl 2): S22-S28, 2020 11 17.
Artigo em Inglês | MEDLINE | ID: mdl-33202014

RESUMO

Prepectoral breast reconstruction has become a popular method of postmastectomy breast reconstruction due to its numerous benefits in properly selected patients. Prepectoral reconstruction, as compared with retropectoral position, offers the advantage of leaving the pectoralis muscle undisturbed and in its original anatomic position, resulting in significantly decreased acute and chronic pain, improved upper extremity strength and range of motion, and avoidance of animation deformity. The use of acellular dermal matrices (ADMs) allows for precise control of the breast pocket, resulting in aesthetic outcomes and high patient satisfaction. ADMs have the added benefit of reducing capsular contracture, especially in the setting of postmastectomy radiation therapy. Although prepectoral breast reconstruction is effective, the breast implant is placed closer to the skin flap with less vascularized soft tissue coverage. Therefore, optimizing outcomes in prepectoral breast reconstruction requires careful patient selection, intraoperative mastectomy flap evaluation, and perioperative surgical algorithms specific to prepectoral reconstruction.


Assuntos
Derme Acelular , Implante Mamário , Implantes de Mama , Neoplasias da Mama , Mamoplastia , Implante Mamário/efeitos adversos , Neoplasias da Mama/cirurgia , Humanos , Mamoplastia/efeitos adversos , Mastectomia
13.
Plast Reconstr Surg ; 146(5): 945-953, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33136936

RESUMO

BACKGROUND: There is ongoing debate regarding the optimal timing of contralateral prophylactic mastectomy fueled by concern that performing it at the time of the mastectomy for the index breast cancer may delay adjuvant therapy. The study objective was to examine the effect of simultaneous contralateral prophylactic mastectomy with immediate breast reconstruction on the complication rate and adjuvant therapy timing. METHODS: A retrospective study was conducted of consecutive patients who underwent contralateral prophylactic mastectomy with immediate breast reconstruction and received adjuvant therapy over a 6-year period. Demographic, treatment, and outcomes data were collected, and relationships between multiple variables and outcomes were evaluated. RESULTS: Of 241 patients (482 breasts) included, 186 (372 breasts) underwent simultaneous index breast mastectomy and contralateral prophylactic mastectomy with immediate breast reconstruction followed by adjuvant therapy (immediate group), and 55 (110 breasts) underwent index mastectomy, then adjuvant therapy, followed by delayed contralateral prophylactic mastectomy with immediate breast reconstruction (delayed group). Demographics were similar, although breast cancer stage (p < 0.001), tumor category (p = 0.0072), and nodal category (p < 0.001) were significantly higher in the delayed group. In the immediate group, complications before adjuvant therapy occurred in 31 patients (16.7 percent), and in six patients (3.2 percent) complications occurred only in the contralateral prophylactic mastectomy breast; delay to adjuvant therapy occurred in 11 patients (5.9 percent), in four (2.2 percent) of whom the contralateral prophylactic mastectomy breast was responsible for the delay. CONCLUSIONS: Contralateral prophylactic mastectomy with immediate breast reconstruction can be performed safely at the time of the index mastectomy in carefully selected patients. These findings will engage patients seeking contralateral prophylactic mastectomy in shared decision-making regarding optimal timing with respect to the risks and benefits. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Neoplasias da Mama/cirurgia , Quimioterapia Adjuvante , Mamoplastia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Mastectomia Profilática/efeitos adversos , Radioterapia Adjuvante , Tempo para o Tratamento , Adulto , Feminino , Humanos , Mastectomia/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
15.
Plast Reconstr Surg ; 146(5): 978-985, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33136939

RESUMO

BACKGROUND: Breast implant removal is becoming a common procedure in light of the current events and controversies with silicone breast implants. The authors believe strongly in informing patients about the indications and options regarding both explantation and the management of the secondary breast deformity. METHODS: Relevant literature regarding the management of the explant patient was reviewed and organized to provide an update on prior publications addressing the explant patient population. RESULTS: Surgical management options after implant removal include breast contouring and volume restoration. Fat augmentation has been used in both aesthetic and reconstructive breast surgery. CONCLUSIONS: The authors review the surgical management for explantation, breast contouring, and autologous fat grafting for volume restoration. In the explant patient, autologous fat grafting serves as a reliable option for volume restoration.


Assuntos
Implantes de Mama , Remoção de Dispositivo , Mamoplastia/métodos , Complicações Pós-Operatórias/cirurgia , Implantes de Mama/efeitos adversos , Feminino , Humanos , Complicações Pós-Operatórias/etiologia
16.
Plast Reconstr Surg ; 146(5): 548e-551e, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33136940

RESUMO

The umbilicus offers no functional importance to the adult human but remains a key aesthetic landmark of the anterior abdominal wall, and its absence can be a cause for concern in aesthetic and reconstructive patients. Umbilical reconstruction or transposition for abdominoplasty and abdominally based flap operations is frequently complicated by umbilical death, infections, development of wounds needing prolonged wound care, and generally poor aesthetic outcomes. A multitude of techniques have been described to create the "ideal" neoumbilicus, but none has proven to be superior to the technique that comes before it. Our data demonstrate that, in a select set of patients, it may be beneficial to electively remove the umbilicus. Thus, umbilical reconstruction can be performed as an adjunct procedure to the primary operation with a superior aesthetic result and minimal risk for complications. This article describes the authors' approach to delayed neoumbilical reconstruction in patients undergoing elective umbilical resection.


Assuntos
Abdominoplastia/efeitos adversos , Estética , Mamoplastia/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Umbigo/cirurgia , Parede Abdominal/irrigação sanguínea , Parede Abdominal/cirurgia , Abdominoplastia/métodos , Adulto , Artérias Epigástricas/transplante , Feminino , Retalhos de Tecido Biológico/efeitos adversos , Retalhos de Tecido Biológico/irrigação sanguínea , Retalhos de Tecido Biológico/transplante , Humanos , Mamoplastia/métodos , Retalho Perfurante/efeitos adversos , Retalho Perfurante/irrigação sanguínea , Retalho Perfurante/transplante , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
17.
Plast Reconstr Surg ; 146(5): 964-975, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33141527

RESUMO

BACKGROUND: Despite the rise in rates of contralateral prophylactic mastectomy, few studies have used patient-reported outcomes to assess satisfaction between unilateral and bilateral breast reconstruction with autologous tissue. The purpose of this study was to investigate patient satisfaction and quality of life following autologous reconstruction to determine whether differences exist between unilateral and bilateral reconstructions to better guide clinical decision-making. METHODS: The current study examined prospectively collected BREAST-Q results following abdominal free flap breast reconstruction procedures performed at a tertiary academic medical center from 2009 to 2017. The reconstruction module of the BREAST-Q was used to assess outcomes between laterality groups (unilateral versus bilateral) at 1 year, 2 years, 3 years, and more than 3 years. RESULTS: Overall, 405 patients who underwent autologous breast reconstruction completed the BREAST-Q. Cross-sectional analysis at 1 year, 2 years, and 3 years revealed similar satisfaction scores between groups; however, bilateral reconstruction patients demonstrated higher satisfaction scores at more than 3 years (p = 0.04). Bilateral reconstruction patients reported lower scores of abdominal well-being at 1 year, 2 years, and more than 3 years (p = 0.01, p = 0.03, and p = 0.01, respectively). CONCLUSIONS: These results suggest that satisfaction with breasts does not differ with the laterality of the autologous reconstruction up to 3 years postoperatively but may diverge thereafter. Bilateral reconstruction patients, however, have lower satisfaction with the abdominal donor site. These data can be used in preoperative counseling, informed consent, and expectations management in patients considering contralateral prophylactic mastectomy.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Retalhos Cirúrgicos , Adulto , Autoenxertos , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Reto do Abdome/transplante , Fatores de Tempo , Sítio Doador de Transplante
18.
Plast Reconstr Surg ; 146(5): 539e-547e, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33141528

RESUMO

BACKGROUND: Reduction mammaplasty provides symptomatic relief to patients with macromastia. Insurance companies act as gatekeepers of health care by determining the medical necessity of surgical procedures, including reduction mammaplasty. The authors sought to evaluate insurance coverage and policy criteria for reduction mammaplasty. METHODS: The authors conducted a cross-sectional analysis of U.S. insurance policies on reduction mammaplasty. Insurance providers were selected based on their enrolment data and market share. The authors conducted telephone interviews and Web-based searches to identify the policies. Medical necessity criteria were abstracted from the publicly available policies that offered coverage. RESULTS: The authors reviewed 63 insurers. One in 10 insurers had no established policy for reduction mammaplasty. Of the 48 publicly available policies, shoulder pain and backache were the most common symptoms required for preapproval (98 percent and 98 percent). A minimum resection volume was requested by 88 percent of policies. One-third of policies (31 percent) offered a choice between removal of a minimum weight per breast or a volume based on body surface area. Over half of companies (54 percent) used body surface area calculations to predict minimum resection volume. Medical necessity that extended beyond national recommendations included trial of weight loss (23 percent) and nipple position (10 percent). CONCLUSIONS: Insurance policy criteria for reduction mammaplasty are discordant with current national recommendations and current clinical evidence. Many policies use outdated criteria that do not correlate with symptom relief and consequently limit access to reduction mammaplasty. Here, the authors propose a comprehensive guideline to maximize coverage of reduction mammaplasty.


Assuntos
Mama/anormalidades , Hipertrofia/cirurgia , Cobertura do Seguro/normas , Seguro Saúde/normas , Mamoplastia/economia , Políticas , Mama/cirurgia , Estudos Transversais , Feminino , Guias como Assunto , Humanos , Hipertrofia/economia , Cobertura do Seguro/economia , Seguro Saúde/economia , Mamoplastia/métodos , Mamoplastia/normas , Estados Unidos
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