[Comparison of Two Umbilicoplasty Techniques in 72 Patients after Breast Reconstruction with a Free DIEP Flap] / Vergleich zweier Techniken der Umbilikoplastik bei 72 Patientinnen nach Brustrekonstruktion mit freier DIEP-Lappenplastik.

INTRODUCTION: The appearance of the umbilicus after DIEP flap surgery or abdominoplasty plays an important role in aesthetic perception (1). Although the umbilicus has no function, there is no doubt about the importance of its shape for the self-esteem of patients, especially after breast cancer (2). In the present study, we compared two of the preferred techniques described in the literature on 72 patients in terms of aesthetic outcome, complications and sensitivity: the caudal flap (domed shape) and the oval shape of the umbilicus. PATIENTS AND METHODS: Seventy-two patients who underwent a DIEP flap for breast reconstruction between January 2016 and July 2018 were retrospectively included in this study. Two techniques for umbilical reconstruction were compared: the transverse oval shape of the umbilicus and umbilicoplasty using a caudal flap, which results in a dome shape of the umbilicus. To compare the aesthetic results, an evaluation by the patients and an assessment by three independent plastic surgeons were carried out at least 6 months postoperatively. Patients and surgeons were asked to rate the general appearance of the umbilicus, including scarring and shape, on a scale from 1 to 6 (1=very good, 2=good, 3=fair, 4=sufficient, 5=poor, 6=insufficient). Furthermore, the occurrence of wound healing disorders was examined, and patients were asked about the sensitivity of the umbilicus. RESULTS: Both techniques showed similar degrees of aesthetic satisfaction (p=0,49) as part of the patients' self-assessment. The plastic surgeons gave the caudal flap technique a significantly better rating than the umbilicus with a transverse oval shape (p=0,042). More wound healing disorders occurred in the caudal lobule (11,1%) compared with the transverse oval umbilicus. However, this was not significant (p=0,16). A surgical revision was not necessary. The caudal flap umbilicus showed a tendency to improved sensitivity (60 vs. 45%), but this was not significant (p=0,19). CONCLUSION: Patient satisfaction showed similar results for the two methods of umbilicoplasty. On average, both techniques were given a good rating for their results. However, surgeons rated the caudal flap umbilicoplasty as more aesthetically pleasing.

Topische Applikation von Tranexamsäure im Rahmen der subkutanen Mastektomie bei Frau-zu-Mann Transidentität.

INTRODUCTION: Tranexamic acid (TXA) is an antifibrinolytic drug that can be used to treat and prevent bleeding. Its application in plastic and reconstructive surgery has been very limited to date. To our knowledge, there is a lack of published data on the topical application of TXA in transgender patients undergoing subcutaneous mastectomy. METHODS: We performed a retrospective data analysis of female-to-male transgender patients who underwent subcutaneous mastectomy. A total of 22 patients were treated with topical TXA, while 29 patients served as controls. The primary endpoint was the amount of wound secretion in the first 48 hours after surgery. Secondary endpoints were the duration of drainage and the occurrence of postoperative bleeding. RESULTS: Within the first 48 hours, the TXA group had an average drain volume of 97±50 ml compared with 180±111 ml in the control group (p<0.01). There was a significantly lower flow rate over the entire period in the group of TXA patients (113±86 ml vs. 265±197 ml). The time of drains in situ was 2.3±0.7 days in TXA patients, while the drains in the control group were in place for an average of 3.4±1.3 days (p<0.01). In the group of patients treated with TXA, there was a tendency towards a lower number of postoperative bleeding and haematoma (9vs. 17%). DISCUSSION: There was a significant reduction in the amount of drain fluid within the first 48 hours and over the entire period after topical application of TXA. Also there was a reduction in the length of time patients had a drain in place in the TXA-treated patients. This study demonstrated a significant advantage for the topical application of TXA in subcutaneous mastectomy in female-to-male transgender patients.

[Treatment of phyllodes tumours of the breast: evaluation of 66 cases and literature review]. / Zur Therapie von Phylloides-Tumoren der Brust ­ eine Aufarbeitung von 66†Fällen mit Literaturübersicht.

Phyllodes tumours (PTs) of the breast are classified as benign, borderline and malignant based on the constellation of defined histological parameters. Surgical excision is the primary therapy, but the need to maintain certain safety margins is still controversially discussed for all three categories.This paper aims to provide a critical opinion on the existing recommendation on safety margins for resection.In our breast centre, all patients with phyllodes tumours were identified retrospectively on the basis of the histopathological documentation from 1999 to 2018. The cases were evaluated, in particular, with a view to recurrences and the occurrence of multicentricity.A total of 66 patients were diagnosed with a PT. In 38 cases, the tumours were benign, in 15 borderline and in 13 malignant. Local recurrences were observed in one benign PT, 7 borderline and 5 malignant PTs. Two PTs that were initially classified as borderline tumours progressed to malignant PTs. Multicentricity occurred in about 20 % of borderline and malignant PTs but only in 5 % of benign PTs.The resection margins for phyllodes tumours should be chosen depending on dignity and recurrence. The key question to be challenged is whether or not there is a need to maintain a certain safety margin in benign PTs. In case of recurrence of borderline or malignant PTs, a mastectomy should be considered early.

[Long-term results after reconstruction of the nipple-areola complex]. / Langzeitergebnisse nach Rekonstruktion des Mamillen-Areola-Komplexes.

The reconstruction of the nipple-areola complex (NAC) is an aesthetically and psychosocial important final step in breast reconstruction. While numerous publications examine the long-term results using various techniques to reconstruct the nipple, to our knowledge there have been few studies on the long-term results after areolar reconstruction. The study therefore examines the long-term results after areola reconstruction in women with autologous breast reconstruction. In the period 2014-2016 we performed NAC reconstructions in 126 patients in our clinic. The areola was reconstructed by full skin transplantation from the groin or upper eyelids. A total of 27 women with a median age of 52 ± 8.6 years after a median period of 1.7 ± 0.7 years were examined with regard to colour change, size change and satisfaction with the reconstruction result of the MAK. The results showed a noticeable colour fading with good satisfaction of the patients with the result. We observed an increase in the size of the neoareoles by an average of 13,9 percent with full skin from the groin and 34,6 percent with full skin from the upper eyelids. Patients should be informed preoperatively of colour fading and size changes of the neo-areola.

[How well are patients informed on the websites of German university breast centres about the possibilities of breast reconstruction?] / Wie gut werden Patientinnen auf Internetseiten von deutschen universitären Brustzentren über die Möglichkeiten der Brustrekonstruktion informiert?

INTRODUCTION: In recent decades, the internet has become one of the most important sources of information for patients. How substantial are the possibilities to find out about breast reconstruction on the homepages of university hospitals in Germany? Is there information about plastic surgery with its spectrum of modern reconstructive possibilities? METHODS: A total of 35 homepages of university breast centres in Germany was analysed for the indication of cooperation with a plastic surgeon or a department for plastic surgery and their links, with information on reconstructive possibilities such as implant reconstruction, autologous soft tissue reconstruction with pedicled and free flaps as well as lipofilling. RESULTS: A plastic surgeon or a cooperating department is mentioned on 49 % of the homepages. Of those homepages, 20 % contain a direct link. 91 % of the homepages describe the possibility of breast reconstruction in general, 80 % of the websites the use of autologous tissue. In 51 % of the cases, a free tissue transfer is mentioned, whereas only 23 % describe the procedures like DIEP flap, TMG, or I-GAP in more detail. Only two centres use detailed illustrations. Six websites (17 %) describe reconstruction by pedicled TRAM flap only. Breast reconstruction with a silicone implant is mentioned on 71 % of the websites. The possibility of lipofilling is discussed in 31 %. DISCUSSION: About half of the websites of university breast centres do not show any cooperation with a plastic surgeon. There are significant gaps in the information on free tissue transfer for breast reconstruction.

[Adequate Antibiotic Prophylaxis and Therapy of Periprosthetic Infections of the Breast - Review of 468 Consecutive Implant Removals]. / Gezielte Antibiotika-Prophylaxe und Therapie periprothetischer Infektionen der Brust ­ Erfahrungen aus 468 konsekutiven Implantatentfernungen.

Background Periprosthetic infections are feared complications in aesthetic as well as in reconstructive breast surgery. The purpose of our study was to evaluate our institution's specific culture data and to identify most common organisms and suitable antibiotics for prophylaxis and first line treatment in implant-based breast surgery. Patients and Methods We analyzed all patients with a change or removal of breast implants in the period from 01.01.2012 to 31.12.2015 retrospectively. Based on the medical records, the surgical indications were identified and specifically analyzed for signs of infection and capsular fibrosis. In addition, we assessed all microbiological data of these interventions. Results 468 implant removals or exchanges were performed in 360 patients. Microbiological smears were gathered from 169 patients (249 implants). Bacteria were cultured from 23 implants (21 patients). In 6 additional implants (four patients) a periprosthetic infection was present, without pathogen detection. In most cases, advanced capsular fibrosis was the reason for implant exchange. In 17 smears bacterial detection was carried out despite absence of clinical signs of infection. In 17 cases coagulase-negative staphylococci were detected. In 4 Staphylococcus aureus, and once each E. coli, Morganella morganii and Proprionibacterium acnes (one double infection). All pathogens were sensitive to piperacillin/tazobactam and vancomycin. One resistancy was seen to cefuroxime and amoxicillin/clavulanic acid, and 2 to gentamicin, ciprofloxacin and clindamycin. Conclusion In the majority of cases, pathogen detection was an incidental finding, while capsular contracture caused surgical revision. Pathogens and resistance patterns found in this study differed from the majority of international publications. In our institution, Cefuroxime and amoxicillin/clavulanic acid have been proven to be a reasonable choice for prevention and treatment of periprosthetic infections. Especially in fulminant infections piperacillin/tazobactam would be our choice for initial treatment, until the specific antibiogram is available.