Ancillary considerations in breast surgery

2021 ◽  
pp. 1145-1150
Author(s):  
Emily G. Clark ◽  
Melissa A. Mueller ◽  
Gregory R.D. Evans
Keyword(s):  
Breast Reconstruction ◽  
Breast Surgery ◽  
Capsular Contracture ◽  
Acellular Dermal Matrix ◽  
Fat Grafting ◽  
Dermal Matrix ◽  
Oncological Safety ◽  
Acellular Dermal ◽  
Radiographic Changes ◽  
Suspicious Lesions

Debated topics and new and evolving techniques in breast surgery are discussed in this chapter. Antibiotics and the use of closed-suction drains vary among surgeons, but the existing evidence favours discontinuation of antibiotics within 24 hours in most cases, and the indications for drains are limited but include breast reconstruction with acellular dermal matrix (ADM). ADM is a biological tissue substitute with many applications in breast surgery. The product selected and surgical technique used are often case specific; cost and patient anatomy play major roles. Although not suitable for all patients, ADM is an asset to prosthetic breast reconstruction. In addition, ADM is useful in the correction of breast surgery complications, including malpositioning and capsular contracture. It may be combined with fat grafting to mask rippling. Fat grafting, or lipomodelling, is an evolving science with promising results. Technique is critical for good results, and is described in this chapter. Radiographic changes after fat grafting are usually discernible from suspicious lesions, and growing evidence supports the oncological safety of this procedure

Citation Analysis in Breast Reconstruction Publications Between 2000 and 2010

2021 ◽  
pp. 229255032110499
Author(s):  
Rebecca Miller ◽  
Sheina Macadam ◽  
Daniel Demsey
Keyword(s):  
Breast Reconstruction ◽  
Citation Analysis ◽  
Case Series ◽  
Acellular Dermal Matrix ◽  
Fat Grafting ◽  
Fat Graft ◽  
Level Of Evidence ◽  
Dermal Matrix ◽  
Number Of Patients ◽  
Acellular Dermal

Introduction and Purpose: Breast reconstruction is an active area of plastic surgery research. Citation analysis allows for quantitative analysis of publications, with more citations presumed to indicate greater influence. We performed citation analysis to evaluate the most cited papers on breast reconstruction between 2000 to 2010 to identify contemporary research trends. Methods: The SCI-EXPANDED database was used to identify the 50 most cited papers. Data points included authorship, publication year, publication journal, study design, level of evidence, number of surgeons/institutions, center of surgery, primary outcome assessed, implant/flap/acellular dermal matrix/fat graft, acellular dermal matrix brand and use with implants/flaps, fat graft use with implants/flaps, unilateral/bilateral, one-/two-stage, immediate/delayed, number of patients/procedures, complications. Descriptive analysis of trends was performed based on results. Results: 20% of papers were published in 2006, 16% in 2007 and 12% in both 2004/2009. 66% were published in Plastic and Reconstructive Surgery. The majority were retrospective or case series, and of Level III or IV evidence. The one Level I study was a prospective multicenter trial. 21 and 7 papers discussed procedures by single/multiple surgeons, respectively. Results from single/multiple centers were discussed in 18 and 6 papers, respectively. 30 papers discussed implant-based reconstruction, 22 papers flap-based (19 microsurgical), 15 papers acellular dermal matrix, and five papers fat grafting. The primary focus in the majority was complications or outcomes. Conclusion: Our analysis demonstrates continually evolving techniques in breast reconstruction. However, there is notable lack of high quality evidence to guide surgical decision-making in the face of increasing surgical options.

Prosthetic-Based Breast Reconstruction

2020 ◽  
Author(s):  
Jonathan Nguyen ◽  
Justin Williams ◽  
Albert Losken
Keyword(s):  
Breast Reconstruction ◽  
Breast Implant ◽  
Tissue Expander ◽  
Acellular Dermal Matrix ◽  
Large Cell ◽  
Fat Grafting ◽  
Immediate Reconstruction ◽  
Dermal Matrix ◽  
Prosthetic Reconstruction ◽  
Acellular Dermal

Prosthetic reconstruction is the most popular option for breast reconstruction after mastectomy. There are several different techniques, such as prepectoral versus subpectoral placement, and delayed versus immediate reconstruction, each with their own sets of risks and benefits. With the advent of improved implant technology, acellular dermal matrix, and fat grafting, prepectoral direct to implant has become an accepted and increasingly popular method of reconstruction, with similar to improved complication rates and outcomes as traditional staged tissue expander reconstruction. Prosthetic reconstruction has had some recent controversies, including breast implant associated anaplastic large cell lymphoma and breast implant illness, and many future studies are being directed towards these topics. This review contains 5 figures, and 53 references. Keywords: breast reconstruction, breast implant, acellular dermal matrix, prepectoral reconstruction, tissue expander, fat grafting, capsular contracture, immediate reconstruction, breast implant associated anaplastic large cell lymphoma, breast implant illness

Breast Reconstruction with Implants and Tissue Expanders

2019 ◽  
pp. 669-676
Author(s):  
Ruth J. Barta ◽  
Omotinuwe Adepoju ◽  
Bruce Cunningham
Keyword(s):  
Breast Reconstruction ◽  
Acellular Dermal Matrix ◽  
Fat Grafting ◽  
Implant Design ◽  
Patient Specific ◽  
Dermal Matrix ◽  
Tissue Expanders ◽  
Aesthetic Results ◽  
The Aesthetic ◽  
Acellular Dermal

This chapter details breast reconstruction following breast surgery. Over the past decade the number of women choosing reconstruction with tissue expanders and implants has steadily increased, while the percentage of women having autologous reconstruction has plateaued or fallen off. The authors explain the use of tissue expanders and implants and detail the advancements made in the ability to evaluate tissue in real-time intervals. Additional advances in technique, implant design, acellular dermal matrix, and fat grafting have improved the aesthetic results of breast reconstruction even further, and these techniques are discussed in detail. The authors address patient-specific indications and contraindications, the use of acellular dermal matrix, the assessment of the defect and perfusion, patient markings, room setup, and operative technique.

scholarly journals Evidence for the Use of Acellular Dermal Matrix in Implant-Based Breast Reconstruction

2019 ◽  
Vol 33 (04) ◽  
pp. 229-235 ◽  
Author(s):  
Paula R. Gravina ◽  
Rowland W. Pettit ◽  
Matthew J. Davis ◽  
Sebastian J. Winocour ◽  
Jesse C. Selber
Keyword(s):  
Breast Reconstruction ◽  
Capsular Contracture ◽  
Acellular Dermal Matrix ◽  
Patient Specific ◽  
Dermal Matrix ◽  
Biological Scaffolds ◽  
Dermal Matrices ◽  
Tissue Grafts ◽  
Cellular Components ◽  
Acellular Dermal

AbstractAcellular dermal matrices (ADMs) are tissue grafts that have been specially processed to remove all cellular components. These machined biological scaffolds have become popular in a variety of surgical settings due to their rapid incorporation into living tissue. As ADMs are highly malleable and cause minimal inflammation, they have come to serve as a useful tool in implant-based breast reconstruction procedures. The major benefits of using an ADM in this setting include superior initial breast contouring, decreased risk of capsular contracture after implant insertion, and consistent sustained positioning of the reconstructed breast. Despite these advantages, these tissue grafts are foreign to the host, and postoperative complications following ADM insertion, including infection and seroma, have been well documented. When considering using ADMs in this setting, it is important to first consider patient-specific factors that could preclude their use, such as low body mass index, small breasts, or a history of radiation exposure to the breast tissue. ADM grafts are also expensive, which may present another barrier to their use. Review of the literature ultimately suggests a continued role for ADMs in implant-based breast reconstruction, and continued research in this field is warranted.

scholarly journals Acellular dermal matrices in immediate breast reconstruction: a literature review

2021 ◽  
Vol 8 (2) ◽  
pp. 933
Author(s):  
Mohammed Attallah Alharbi ◽  
Fahad K. Aljindan ◽  
Reshan Mane Al Reshan ◽  
Khalid Dakhelallah Almutairi ◽  
Fatimah Mofeed Almosabh ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Reconstructive Surgery ◽  
Capsular Contracture ◽  
Acellular Dermal Matrix ◽  
Immediate Breast Reconstruction ◽  
Dermal Matrix ◽  
Different Types ◽  
Dermal Matrices ◽  
Breast Reconstructive Surgery ◽  
Acellular Dermal

There has been an increase in invasive breast carcinoma which many times end up with a mastectomy. The psychological effects of mastectomy can be overwhelming, urging the need for optimum breast reconstruction procedures. Acellular dermal matrices are widely used nowadays due to their favorable outcomes with a few complications. In this study, we review the literature to explore the different types used, cons, and pros of this procedure. Databases like PubMed, Medline, Web of science, Embase, Google scholar, and Scopus were used and searched for following terms “implant-based reconstruction” or “breast reconstruction” or “acellular dermal matrix”. All studies that discuss the use of acellular dermal matrices for breast reconstructive surgery were included. Acellular dermal matrices may allow a relatively easy, affordable and time-efficient breast reconstructive surgery. They are associated with less incidence of infection and capsular contracture making them an excellent fit for most procedures. However, m ore studies are needed to help understand possible risk factors, and complications and how to avoid them.

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