Judging an Expander by Its Cover: A Propensity-Matched Analysis of the Impact of Tissue Expander Surface Texture on First-Stage Breast Reconstruction Outcomes

2020 ◽  
Vol 147 (1) ◽  
pp. 1e-6e
Author(s):  
Wen-Kuan Chiu ◽  
Megan Fracol ◽  
Lauren N. Feld ◽  
Cecil S. Qiu ◽  
John Y. S. Kim
Keyword(s):  
Breast Reconstruction ◽  
Surface Texture ◽  
Tissue Expander ◽  
The Impact

scholarly journals Does chemotherapy or radiotherapy affect the postoperative complication in breast cancer patients who underwent immediate breast reconstruction with tissue expander?

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sung Mi Jung ◽  
Byung-Joon Jeon ◽  
Jinsun Woo ◽  
Jai Min Ryu ◽  
Se Kyung Lee ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Postoperative Complications ◽  
Breast Reconstruction ◽  
Cancer Patients ◽  
Tissue Expander ◽  
Immediate Breast Reconstruction ◽  
Breast Cancer Patients ◽  
The Impact ◽  
To Receive

Abstract Background Immediate breast reconstruction with tissue expander in breast cancer patients who were expected to receive adjuvant therapy, such as chemotherapy or radiotherapy, has been a topic of debate. Postoperative complications from tissue expander procedures can delay the timing of adjuvant treatment and subsequently increase the probability of recurrence. The purpose of this study was to identify the impact of chemotherapy and radiotherapy on postoperative complications in patients who underwent immediate reconstruction (IR) using tissue expander. Methods We conducted a retrospective study of 1081 breast cancer patients who underwent mastectomy and IR using tissue expander insertion between 2012 and 2017 in Samsung Medical Center. The patients were divided into two groups based on complications (complication group vs. no complication group). Complication group was regarded to have surgical removal or conservative treatment based on clinical findings such as infection, capsular contracture, seroma, hematoma, rupture, malposition, tissue viability, or cosmetic problem. The complication group had 59 patients (5.5%) and the no complication group had 1022 patients (94.5%). Results In univariate analysis, adjuvant radiotherapy and adjuvant chemotherapy were significantly associated with postoperative complications. In multivariate analysis, however, only higher pathologic N stage was significantly associated with postoperative complications (p < 0.001). Chemotherapy (p = 0.775) or radiotherapy (p = 0.825) were not risk factors for postoperative complications. Conclusions IR with tissue expander after mastectomy may be a treatment option even when the patients are expected to receive adjuvant chemotherapy or radiotherapy. These results will aid patients who are concerned about the complications of IR caused by chemotherapy or radiotherapy determine whether or not to have IR. Trial registration Patients were selected and registered retrospectively, and medical records were evaluated.

The Impact of Virtual Surgical Planning on the Value of Orthognathic Surgery for the Maxillofacial Surgeon

FACE ◽  
2021 ◽  
pp. 273250162110019
Author(s):  
Ashley Rogers ◽  
Karina Charipova ◽  
Stephen B. Baker
Keyword(s):  
Breast Reconstruction ◽  
Plastic Surgery ◽  
Orthognathic Surgery ◽  
Planning Process ◽  
Tissue Expander ◽  
Diep Flap ◽  
Muscle Flaps ◽  
Presurgical Planning ◽  
Recent Developments ◽  
The Impact

Background: The practice of orthognathic surgery traditionally involved time-intensive presurgical planning that was associated with decreased compensation relative to other procedures within the specialty. This limited reimbursement and subsequent reduction in the incidence of these procedures has been described in the literature. The introduction of VSP has streamlined the presurgical planning process. The purpose of this study is to provide a reevaluation of the relative value units (RVUs) per unit time for orthognathic surgery and to make a comparison to other commonly performed plastic surgery procedures in the context of recent developments in VSP. Methods: RVU data for both orthognathic and common plastic surgery procedures were collected using Current Procedural Terminology (CPT) codes. A range of operative times was then used to calculate work RVUs per hour of both orthognathic surgery and other procedures commonly performed by plastic surgeons including: unilateral deep inferior epigastric perforator (DIEP) flap breast reconstruction, bilateral breast tissue expander placement, bilateral breast reduction, bilateral breast reconstruction using latissimus dorsi muscle flaps, and panniculectomy. Results: Hourly RVUs for orthognathic procedures compare favorably to hourly RVUs for other commonly performed plastic surgery procedures when examined within a range of expected average operative times. Conclusions: Accounting for the reduced time commitment to preoperative planning that VSP achieves, the authors demonstrate a significant RVU/hour increase in orthognathic procedures than that described in the literature published prior to the implementation of VSP. Orthognathic surgery remains competitive for maxillofacial surgeons when compared to other procedures in plastic surgery when RVUs/hour is the metric of comparison.

scholarly journals Does chemotherapy or radiotherapy affect the postoperative complication in patients who underwent immediate breast reconstruction with tissue expander?

2020 ◽  
Author(s):  
Sung Mi Jung ◽  
Byung-Joon Jeon ◽  
Jinsun Woo ◽  
Jai Min Ryu ◽  
Se Kyung Lee ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Postoperative Complications ◽  
Breast Reconstruction ◽  
Capsular Contracture ◽  
Univariate Analysis ◽  
Tissue Expander ◽  
Immediate Breast Reconstruction ◽  
Surgical Removal ◽  
The Impact ◽  
To Receive

Abstract Background: Immediate breast reconstruction with tissue expander in patients who were expected to receive adjuvant therapy, such as chemotherapy or radiotherapy, has been a topic of debate. Postoperative complications from tissue expander procedures can delay the timing of adjuvant treatment and subsequently increase the probability of recurrence. The purpose of this study was to identify the impact of chemotherapy and radiotherapy on postoperative complications in patients who underwent immediate reconstruction (IR) using tissue expander.Methods: We conducted a retrospective study of 1,081 breast cancer patients who underwent mastectomy and IR using tissue expander insertion between 2012 and 2017 in Samsung Medical Center. The patients were divided into two groups based on complications (complication group vs. no complication group). Complication group was regarded to have surgical removal or conservative treatment based on clinical findings such as infection, capsular contracture, seroma, hematoma, rupture, malposition, tissue viability, or cosmetic problem. The complication group had 59 patients (5.5%) and the no complication group had 1,022 patients (94.5%). Results: In univariate analysis, adjuvant radiotherapy and adjuvant chemotherapy were significantly associated with postoperative complications. In multivariate analysis, however, only higher pathologic N stage was significantly associated with postoperative complications (p < 0.001). Chemotherapy (p = 0.775) or radiotherapy (p = 0.825) were not risk factors for postoperative complications.Conclusions: IR with tissue expander after mastectomy may be a treatment option even when the patients are expected to receive adjuvant chemotherapy or radiotherapy. These results will aid patients who are concerned about the complications of IR caused by chemotherapy or radiotherapy determine whether or not to have IR.

The Impact of Breast Mass on Outcomes of Total Skin-Sparing Mastectomy and Immediate Tissue Expander–Based Breast Reconstruction

2015 ◽  
Vol 135 (3) ◽  
pp. 672-679 ◽  
Author(s):  
Frederick Wang ◽  
Michael Alvarado ◽  
Cheryl Ewing ◽  
Laura Esserman ◽  
Robert Foster ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Tissue Expander ◽  
Breast Mass ◽  
The Impact

scholarly journals Postmastectomy Radiation Therapy (PMRT) before and after 2-Stage Expander-Implant Breast Reconstruction: A Systematic Review

Medicina ◽  
2019 ◽  
Vol 55 (6) ◽  
pp. 226 ◽  
Author(s):  
Jeremie D. Oliver ◽  
Daniel Boczar ◽  
Maria T. Huayllani ◽  
David J. Restrepo ◽  
Andrea Sisti ◽  
...  
Keyword(s):  
Systematic Review ◽  
Radiation Therapy ◽  
Breast Reconstruction ◽  
Tissue Expander ◽  
Optimal Timing ◽  
Implant Placement ◽  
Postmastectomy Radiation ◽  
Postmastectomy Radiation Therapy ◽  
The Impact ◽  
Implant Breast Reconstruction

Background: In those undergoing treatment for breast cancer, evidence has demonstrated a significant improvement in survival, and a reduction in the risk of local recurrence in patients who undergo postmastectomy radiation therapy (PMRT). There is uncertainty about the optimal timing of PMRT, whether it should be before or after tissue expander or permanent implant placement. This study aimed to summarize the data reported in the literature on the effect of the timing of PMRT, both preceding and following 2-stage expander-implant breast reconstruction (IBR), and to statistically analyze the impact of timing on infection rates and the need for explantation. Methods: A comprehensive systematic review of the literature was conducted using the PubMed/Medline, Ovid, and Cochrane databases without timeframe limitations. Articles included in the analysis were those reporting outcomes data of PMRT in IBR published from 2009 to 2017. Chi-square statistical analysis was performed to compare infection and explantation rates between the two subgroups at p < 0.05. Results: A total of 11 studies met the inclusion criteria for this study. These studies reported outcomes data for 1565 total 2-stage expander-IBR procedures, where PMRT was used (1145 before, and 420 after, implant placement). There was a statistically significant higher likelihood of infection following pre-implant placement PMRT (21.03%, p = 0.000079), compared to PMRT after implant placement (9.69%). There was no difference in the rate of explantation between pre-implant placement PMRT (12.93%) and postimplant placement PMRT (11.43%). Conclusion: This study suggests that patients receiving PMRT before implant placement in 2-stage expander–implant based reconstruction may have a higher risk of developing an infection.

scholarly journals Does Chemotherapy or Radiotherapy Affect for Postoperative Complication in Patients Who Underwent Immediate Breast Reconstruction With Tissue Expander?

2020 ◽  
Author(s):  
Sung Mi Jung ◽  
Byung-Joon Jeon ◽  
Jinsun Woo ◽  
Jai Min Ryu ◽  
Se Kyung Lee ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Postoperative Complications ◽  
Breast Reconstruction ◽  
Univariate Analysis ◽  
Tissue Expander ◽  
Immediate Breast Reconstruction ◽  
Axillary Lymph ◽  
N Stage ◽  
The Impact ◽  
To Receive

Abstract Background: Immediate breast reconstruction with tissue expander in patients who were expected to receive adjuvant therapy, such as chemotherapy or radiotherapy, has been a topic of debate. Postoperative complications from tissue expander procedures can delay the timing of adjuvant treatment and subsequently increase the probability of recurrence. The purpose of this study was to identify the impact of chemotherapy and radiotherapy on postoperative complications in patients who underwent immediate reconstruction (IR) using tissue expander.Method: We conducted a retrospective study of 1,081 breast cancer patients who underwent mastectomy and IR using tissue expander insertion between 2012 and 2017 in Samsung Medical Center. The patients were divided into two groups based on complications (complication group vs. no complication group). The complication group had 59 patients (5.5%) and the no complication group had 1,022 patients (94.5%). Results: In univariate analysis, lymphovascular invasion (LVI), pathologic N stage, pathologic prognostic stage, axillary lymph node dissection (ALND), adjuvant radiotherapy, and adjuvant chemotherapy were significantly associated with postoperative complications. In multivariate analysis, however, higher pathologic N stage was significantly associated with postoperative complications. Chemotherapy or radiotherapy were not risk factors for postoperative complications.Conclusions: IR with tissue expander after mastectomy may be a treatment option even when the patients are expected to receive adjuvant chemotherapy or radiotherapy. These results will aid preoperative counseling to patients who are concerned about the complications of IR caused by chemotherapy or radiotherapy.

scholarly journals Physico-dosimetric aspects of radiotherapy treatment of breast cancer patients with an established tissue expander

2021 ◽  
Vol 67 (6) ◽  
pp. 785-790
Author(s):  
Georgii Panshin ◽  
Pavel Polushkin ◽  
Aleksei Smyslov ◽  
Timur Izmailov
Keyword(s):  
Breast Cancer ◽  
Breast Reconstruction ◽  
Cancer Patients ◽  
Tissue Expander ◽  
Special Treatment ◽  
Malignant Neoplasms ◽  
Breast Cancer Patients ◽  
Two Stage ◽  
Female Population ◽  
The Impact

According to the data for 2019, breast cancer occupies a leading position among malignant neoplasms in the female population in the Russian Federation. Currently, there is an increase in the number of young breast cancer patients. In this regard, the requirements for the quality of life of patients, in particular the aesthetic results of special treatment, are increasing, which contributes to the introduction of methods of reconstructive surgery in oncomammology. The two-stage installation of a silicone breast implant is the most common method of breast reconstruction in oncological practice, in which a tissue expander is installed in patients at the first stage after mastectomy, and at the second stage it is replaced with a permanent implant. At the same time, the issue of radiotherapy in patients who have undergone the surgical stage of breast cancer treatment with reconstructive plastic surgery remains relevant to date. As is known, radiotherapy plays an important role in the combined and complex treatment of breast cancer, increasing, in general, locoregional control in operated patients. On the other hand, it may increase the risk of late complications of breast reconstruction, such as the development of capsular contractures and protrusions. It should also be emphasized that at present, the impact of hypofractive radiotherapy regimes, which are the most promising in clinical development, primarily on endoprostheses in patients during two-stage reconstruction, remains insufficiently studied. This article presents a brief analysis of the physical and dosimetric planning of radiotherapy in patients with breast cancer after the installation of a tissue expander who were treated on the basis of the RNCRR.

scholarly journals Does chemotherapy or radiotherapy affect the postoperative complication in patients who underwent immediate breast reconstruction with tissue expander?

2021 ◽  
Author(s):  
Sung Mi Jung ◽  
Byung-Joon Jeon ◽  
Jinsun Woo ◽  
Jai Min Ryu ◽  
Se Kyung Lee ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Postoperative Complications ◽  
Breast Reconstruction ◽  
Capsular Contracture ◽  
Univariate Analysis ◽  
Tissue Expander ◽  
Immediate Breast Reconstruction ◽  
Surgical Removal ◽  
The Impact ◽  
To Receive

Abstract Background: Immediate breast reconstruction with tissue expander in patients who were expected to receive adjuvant therapy, such as chemotherapy or radiotherapy, has been a topic of debate. Postoperative complications from tissue expander procedures can delay the timing of adjuvant treatment and subsequently increase the probability of recurrence. The purpose of this study was to identify the impact of chemotherapy and radiotherapy on postoperative complications in patients who underwent immediate reconstruction (IR) using tissue expander. Methods: We conducted a retrospective study of 1,081 breast cancer patients who underwent mastectomy and IR using tissue expander insertion between 2012 and 2017 in Samsung Medical Center. The patients were divided into two groups based on complications (complication group vs. no complication group). Complication group was regarded to have surgical removal or conservative treatment based on clinical findings such as infection, capsular contracture, seroma, hematoma, rupture, malposition, tissue viability, or cosmetic problem. The complication group had 59 patients (5.5%) and the no complication group had 1,022 patients (94.5%). Results: In univariate analysis, adjuvant radiotherapy and adjuvant chemotherapy were significantly associated with postoperative complications. In multivariate analysis, however, only higher pathologic N stage was significantly associated with postoperative complications ( p < 0.001). Chemotherapy ( p = 0.775) or radiotherapy ( p = 0.825) were not risk factors for postoperative complications. Conclusions: IR with tissue expander after mastectomy may be a treatment option even when the patients are expected to receive adjuvant chemotherapy or radiotherapy. These results will aid patients who are concerned about the complications of IR caused by chemotherapy or radiotherapy determine whether or not to have IR. Trial registration: Patients were selected and registered retrospectively, and medical records were evaluated.

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