Surgical Results, Aesthetic Outcome, and Patient Satisfaction after Microsurgical Autologous Breast Reconstruction following Failed Implant Reconstruction

2010 ◽  
Vol 126 (1) ◽  
pp. 26-36 ◽  
Author(s):  
Noortje J. Visser ◽  
Tim H. C. Damen ◽  
Reinier Timman ◽  
Stefan O. P. Hofer ◽  
Marc A. M. Mureau
2021 ◽  
Vol 6 (2) ◽  

Background: Breast reconstruction has been shown to have significant psychosocial benefits for breast cancer patients. Multiple techniques have been used to improve patient satisfaction, aesthetic outcomes, and decrease complications. However, while these techniques are advantageous, they have some significant disadvantages. We are presenting a novel two-stage, pre-mastectomy permanent implant reconstruction (PPIR) technique in an attempt to overcome some of these disadvantages. Methods: Five patients met the essential criteria: they underwent PPIR by insertion of silicone implants three weeks before a proposed mastectomy. The Short Form-36 quality of life questionnaire and the Michigan Breast Reconstruction Outcomes Survey were used before and after the surgery to assess outcome and patient satisfaction. Paired sample t-tests were used to compare changes in the survey scores for various psychosocial subscales and to determine whether score changes after reconstruction were significant. Result: Five patients underwent seven breast reconstructions using PPIR. None of the patients experienced surgical complications (e.g. mastectomy flap complication, wound dehiscence, surgical site infection, or implant-related complications). The PPIR technique resulted in improved psychosocial outcomes and body image with high patient satisfaction. Conclusion: Pre-mastectomy permanent implant reconstruction is a promising potential technique with good aesthetic outcome and patient satisfaction that carries no tissue expander complications and eliminates multiple clinic visits and the usage of a dermal substitute.


Author(s):  
Ronnie L. Shammas ◽  
Amanda R. Sergesketter ◽  
Mahsa Taskindoust ◽  
Sonali Biswas ◽  
Scott T. Hollenbeck ◽  
...  

Abstract Background Free-flap breast reconstruction after failed implant reconstruction is associated with improved patient outcomes. How the level of satisfaction achieved compares between patients with and without previously failed implant reconstruction remains unknown. The aim of this study was to assess the influence of prior failed implant-based reconstruction on long-term patient-reported outcomes after free-flap breast reconstruction. Methods All patients undergoing free-flap breast reconstruction between 2015 and 2019 were identified. Patient satisfaction using the BREAST-Q and decisional regret using the Decision Regret Scale were compared between patients with and without a history of implant breast reconstruction. Results Overall, 207 patients were contacted and 131 completed the BREAST-Q and Decision Regret Scale. A total of 23 patients had a history of failed implant-based reconstruction requiring free-flap-flap salvage, most commonly due to infection (39.1%), chronic pain (34.8%), capsular contracture (26%), and implant malposition (26.1%). Following definitive free-flap reconstruction, patients with prior failed implant reconstruction had significantly lower BREAST-Q scores for satisfaction with breast (61.2 ± 16.7 vs. 70.4 ± 18.7; p = 0.04) and sexual well-being (38.5 ± 18.2 vs. 52.8 ± 24.7; p = 0.01) and reported higher decision regret (19.1 ± 18.6 vs. 9.6 ± 15.6, respectively). There were no significant differences for psychosocial well-being (p = 0.67), physical well-being (chest; p = 0.27), and physical well-being (abdomen; p = 0.91). Conclusion A history of failed implant-based reconstruction is associated with reduced satisfaction and increased decision regret with the final reconstructive outcome. This data underscores the importance of appropriate patient selection at the initial consultation, and informed preoperative counseling regarding long-term outcomes in patients presenting for free-flap reconstruction after a failed implant-based reconstruction.


2014 ◽  
Vol 37 (11) ◽  
pp. 609-618 ◽  
Author(s):  
Chrisovalantis Lakhiani ◽  
Ziyad S. Hammoudeh ◽  
Johnathon M. Aho ◽  
Michael Lee ◽  
Yvonne Rasko ◽  
...  

2017 ◽  
Vol 56 (2) ◽  
pp. 225-231 ◽  
Author(s):  
Alexander A. Juhl ◽  
Søren Christensen ◽  
Robert Zachariae ◽  
Tine E. Damsgaard

Medicina ◽  
2020 ◽  
Vol 56 (6) ◽  
pp. 281
Author(s):  
David J. Restrepo ◽  
Maria T. Huayllani ◽  
Daniel Boczar ◽  
Andrea Sisti ◽  
Minh-Doan T. Nguyen ◽  
...  

Background and objectives: This study aimed to determine if age, race, region, insurance, and comorbidities affect the type of breast reconstruction that patients receive. Materials and methods: This analysis used the Florida Inpatient Discharge Dataset from 1 January 2013 to 30 September 2017, which contains deidentified patient-level administrative data from all acute care hospitals in the state of Florida. We included female patients, diagnosed with breast cancer, who underwent mastectomy and a subsequent breast reconstruction. We performed an χ2 test and logistic regression in this analysis. Results: On the multivariable analysis, we found that age, race, patient region, insurance payer, and Elixhauser score were all variables that significantly affected the type of reconstruction that patients received. Our results show that African American (odds ratio (OR): 0.68, 95%CI: 0.58–0.78, p < 0.001) and Hispanic or Latino (OR: 0.82, 95%CI: 0.72–0.93, p = 0.003) patients have significantly lower odds of receiving implant reconstruction when compared to white patients. Patients with Medicare (OR: 1.57, 95%CI: 1.33–1.86, p < 0.001) had significantly higher odds and patients with Medicaid (OR: 0.61, 95%CI: 0.51–0.74, p < 0.001) had significantly lower odds of getting autologous reconstruction when compared to patients with commercial insurance. Conclusions: Our study demonstrated that, in the state of Florida over the past years, variables, such as race, region, insurance, and comorbidities, play an important role in choosing the reconstruction modality. More efforts are needed to eradicate disparities and give all patients, despite their race, insurance payer, or region, equal access to health care.


2019 ◽  
Vol 89 (5) ◽  
pp. 536-540 ◽  
Author(s):  
Shirley Shechter ◽  
Or Friedman ◽  
Amir Inbal ◽  
Ehud Arad ◽  
Tehillah Menes ◽  
...  

2018 ◽  
Vol 80 ◽  
pp. S303-S307
Author(s):  
Eva A. Huis ʼt Veld ◽  
Chao Long ◽  
Gloria R. Sue ◽  
Arhana Chattopadhyay ◽  
Gordon K. Lee

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Klemen Lovšin ◽  
Uroš Ahčan ◽  
Andrej Lapoša

Abstract Aims The purpose of secondary breast reconstruction is to restore patient’s integrity. Autologous breast reconstruction has become the superior method of breast reconstruction, especially in cases with inadequate skin envelope and post-radiotherapy tissue damage. A 3D-template-enhanced secondary autologous breast reconstruction with restoration of innervation was developed at our department. Methods Thirty patients are planned to be included in the prospective double-blinded study. The reconstruction is performed with the deep inferior epigastric perforator (DIEP) free flap using 3D template from the contralateral healthy breast. Additionally, coaptation of the anterior branch of the 3rd intercostal nerve with the dominant lateral intercostal nerve innervating the DIEP flap is performed. Breast-Q questionnaires are collected before and after the reconstruction and the breast sensation is assessed on regular intervals. Results The preliminary results show an improvement in the sensation of the reconstructed breast and higher patient satisfaction score. Prior to abstract submission, no significant complications have been noted, in one patent abnormal sensation of the breast was reported. Conclusions According to previous studies, patients with innervated free flap reconstruction express higher level of satisfaction as the sensation of the reconstructed breast contributes significantly to the level of satisfaction. Furthermore, use of 3D model from the contralateral breast produces results that are superior to traditional methods. Preliminary results showed that the combination of both methods improved patient satisfaction regarding the aesthetic outcome and functional result. With the appropriate patient selection this type of optimised breast reconstruction should be performed.


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