scholarly journals Tissue Expansion: Further Attempts to Improve Results in Breast Reconstruction

2011 ◽  
Vol 2011 ◽  
pp. 1-7
Author(s):  
Donald A. Hudson ◽  
Kevin G. Adams ◽  
Saleigh Adams
Keyword(s):  
Breast Reconstruction ◽  
Tissue Expander ◽  
Tissue Expansion ◽  
Simple Method ◽  
Second Stage ◽  
Pectoral Nerve ◽  
Medial Pectoral Nerve ◽  
Mean Size ◽  
The Mean ◽  
A Prospective Study

Tissue expansion, is a simple method of breast reconstruction. Method. A prospective study of 27 patients treated over a 43 month period is described. At the first stage the expander is inserted in the dual plane, and the medial pectoral nerve is divided. The tissue expander is over-expanded. Second stage: a de-epithelialized vertical triangle is used to aid anterior projection, an inframammary fold is created and a silicone gel prosthesis inserted. Z-plasties are added to the transverse scar. The contralateral breast can be treated or left alone. Complications were recorded and the results were assessed by 4 plastic surgeons using a visual analogue scale. Results. 19 patients had expanders inserted at mastectomy (2 bilateral) and 8 underwent delayed reconstruction, with a mean age of 47 years (range 30–65 years). A single prosthesis was inserted in 15 patients (mean size 320 mL) and two prosthesis were stacked in 12 patients (mean volume of 400 mL). The mean delay from full expansion to the second stage was 10 weeks (range 3 weeks–11 months). A contralateral augmentation was performed in 5 patients, pexy in 10, a reduction in 2 and in 8 patients no procedure was performed. One patient required explantation. The mean visual analogue assessment was 7. Conclusion. This technique should be considered enhance the cosmetic results in tissue expansion.

scholarly journals Tissue Expansion after Non-Skin-Sparing Mastectomy: A Comparative Study of Expansion Courses of Prepectoral and Subpectoral Tissue Expander Placement with Acellular Dermal Matrix

2021 ◽  
Vol 10 (19) ◽  
pp. 4502
Author(s):  
Daiwon Jun ◽  
Jin Kwan Kim ◽  
Byung Yeun Kwon ◽  
Young Jin Kim ◽  
Ji Young Rhu ◽  
...  
Keyword(s):  
Tissue Expander ◽  
Tissue Expansion ◽  
Acellular Dermal Matrix ◽  
Radical Excision ◽  
Dermal Matrix ◽  
Final Volume ◽  
Fill Volume ◽  
The Mean ◽  
Number Of Visits ◽  
Acellular Dermal

Although skin- or nipple-sparing mastectomy has been popular in the treatment of breast cancer, the radical excision of breast tissue is unavoidable in certain circumstances. However, the ability of an acellular dermal matrix (ADM) to expand remains questionable, and this situation may further hinder tissue expansion. From October 2017 to January 2020, patients who underwent immediate breast reconstruction with tissue expander placement using ADM whose initial fill volume was less than 50 mL were retrospectively reviewed. The primary outcomes were the number of visits and number of days required to complete the expansion, and the secondary outcomes were the amount of postoperative expansions, expander fill ratio and expander volume. Between the prepectoral group (n = 26) and subpectoral group (n = 39), the mean number of days (81.46 days versus 88.64 days, p = 0.365) and mean number of visits (5.08 versus 5.69, p = 0.91) required to complete expansion exhibited no significant differences. Additionally, there were no significant differences in the mean amount of postoperative expansion (314.23 mL versus 315.38 mL, p = 0.950), the mean final volume (353.08 mL versus 339.62 mL, p = 0.481) or the mean final volume ratio (0.89 versus 0.86, p = 0.35) between the two groups. Therefore, we suggest that prepectoral tissue expander placement after conventional mastectomy can be a valid option.

scholarly journals Latissimus Dorsi Muscle Flap Transfer Through Endoscopic Approach Combined With the Implant After Tissue Expansion for Breast Reconstruction of Mastectomy Patients

2021 ◽  
Author(s):  
Jian-Xun Ma ◽  
Bi Li ◽  
You-Chen Xia ◽  
Wei-Tao You ◽  
Jie Zhang ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Latissimus Dorsi ◽  
Muscle Flap ◽  
Tissue Expansion ◽  
Latissimus Dorsi Muscle ◽  
Harvest Time ◽  
Latissimus Dorsi Muscle Flap ◽  
Dorsi Muscle ◽  
Drain Time ◽  
The Mean

Abstract Background: The increasing demand for breast reconstruction and good outcomes lead plastic surgeons to look for a new method to obtain more natural and aesthetically pleasing appearance of the reconstructed breasts.Methods: A retrospective review of thirty-one patients undergoing tissue expander (TE)/implant two-stage breast reconstruction with latissimus dorsi muscle flap (LDMF) transfer through endoscopic approach in Peking University Third Hospital from April 2016 to August 2020 was performed. The LDMF harvest time, drain time, and complications were reviewed. The 3D volume was obtained to assess the symmetry of bilateral breasts.Results: The mean endoscopic LDMF harvest time was 90.4 minutes (70.0~120.0 min). The average drain time after the final reconstruction was 10.1 days (6~19 days). In the mean follow-up of 11.2 months (6~28 months), there were no postoperative complications noted. The average post–reconstruction breasts asymmetry was 4.8%±2.4%, the reconstructed side achieved good volume symmetry to the contralateral side (P=0.256).Conclusions: The novel type of two-stage breast reconstruction protocol, which includes tissue expansion followed by implant insertion with endoscopy-assisted LDMF transfer, could effectively reduce visible scars, avoid the patch effect, shorten the LDMF harvest time and reduce the incidence of complications. It is a promising method for breast reconstruction because it achieves good outcomes in the mastectomy patients.

scholarly journals Effect of contralateral augmentation on postoperative complications after the second stage of tissue expander/implant breast reconstruction

Gland Surgery ◽  
2020 ◽  
Vol 9 (5) ◽  
pp. 1182-1192
Author(s):  
Jin-Woo Park ◽  
Suhwan Kim ◽  
Byung-Joon Jeon ◽  
Goo-Hyun Mun ◽  
Sa Ik Bang ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Breast Reconstruction ◽  
Tissue Expander ◽  
Second Stage ◽  
Implant Breast Reconstruction

scholarly journals National Multidisciplinary Survey of Regional Anesthesia Preferences in Breast Reconstruction

2020 ◽  
Vol 28 (2) ◽  
pp. 105-111
Author(s):  
Linden K. Head ◽  
Anne Lui ◽  
Erin Cordeiro ◽  
Kirsty U. Boyd
Keyword(s):  
Breast Reconstruction ◽  
Regional Anesthesia ◽  
Primary Outcome ◽  
Response Rate ◽  
Intercostal Nerve ◽  
Autologous Reconstruction ◽  
Nerve Blocks ◽  
Pectoral Nerve ◽  
A Prospective Study ◽  
Alloplastic Reconstruction

Background: The purpose of this work was to determine the regional anesthesia preferences of plastic surgeons (PS) and anesthesiologists (A) involved in breast reconstruction in Canada. Methods: Online surveys were sent to members of the Canadian Society of Plastic Surgeons (CSPS) and the Canadian Anesthesiologists Society (CAS). The primary outcome was regional anesthesia preferences in breast reconstruction (delayed, immediate, alloplastic, autologous). Secondary outcomes included the availability and the influence of specialty and academic status on preferences. Statistical analysis used descriptive statistics and Pearson χ2 test. Results: Responses from CSPS and CAS totaled 141 (response rate = 30%) and 217 (response rate = 14%), respectively. Compared with non-academic centres (NAC), academic centres (AC) had significantly greater access to (AC = 60%, NAC = 39%, P = .001) and preferred to use regional anesthesia more often (AC = 36%, NAC = 10%, P < .001). The following proportions of physicians preferred to use regional anesthesia: 40% (PS = 32%, A = 44%, P = .081) for immediate alloplastic reconstruction, 23% (PS = 24%, A = 22%, P = .821) for delayed alloplastic reconstruction, 34% (PS = 18%, A = 41%, P < .001) for immediate autologous reconstruction, and 19% (PS = 13%, A = 21%, P = .195) for delayed autologous reconstruction. Regional anesthesia preferences were significantly different between plastic surgeons and anesthesiologists ( P < .001)—anesthesiologists favoured paravertebral blocks for all reconstructions, while plastic surgeons favoured pectoral nerve blocks for immediate alloplastic reconstruction and intercostal nerve blocks for all other reconstructions. Conclusions: Plastic surgeons and anesthesiologists prefer not to use regional anesthesia in the majority breast reconstructions. Among those who deploy regional anesthesia, plastic surgeons and anesthesiologist have divergent preferences with respect to modality. There is a need for a prospective study comparing paravertebral blocks and intercostal nerve blocks.

scholarly journals A Prospective Study to Assess the Effectiveness of Extracorporeal Shock Wave Lithotripsy Versus Ureteroscopy for Proximal Ureteral Calculi Between Sizes 5 to 10 mm

2020 ◽  
Vol 19 (2) ◽  
pp. 65-69
Author(s):  
Bikash Bahadur Rayamajhi ◽  
Anjan Khadka ◽  
Narayan Thapa
Keyword(s):  
Ureteral Calculi ◽  
National Guidelines ◽  
Female Ratio ◽  
Stone Clearance ◽  
Extracorporeal Shock Wave ◽  
Mean Size ◽  
Surgical Options ◽  
The Mean ◽  
Enhanced Computed Tomography ◽  
A Prospective Study

Introduction: There are various international guidelines for the surgical treatment of upper ureteral calculi. For upper ureteral stone of less than 10 mm size, ESWL and URS are regarded as first line treatment. However, there is lack of national guidelines for appropriate surgical options for such stone in our settings. Methods: The study was prospective comparative type involving 100 patients who were divided into ESWL and URS groups comprising 50 patients in each. ESWL and URS were performed after confirmation of stone size with ultrasonography and non-contrast enhanced computed tomography. All patients underwent X-ray KUB at one week and six weeks post procedure for confirmation of stone clearance. Those with residual calculi of size < 5 mm were considered stone free. Statistical analysis was done using Graph pad prism version 6. Results: The mean age of patients in ESWL and URS groups were 41.28 ± 15.3 years and 42.84 ± 16.1 years respectively. The male to female ratio was higher in ESWL group. The mean size of the stone pre ESWL was 8.58 mm and pre URS was 8.44 mm. The percentage of stone clearance at one week and six weeks for ESWL was 56% and 90% respectively whereas for URS, it was more than 90% at both one week and six weeks. The complications were higher with URS (20%) than ESWL (8%). Conclusions: The ESWL and URS are equally effective in stone clearance. The duration is longer with ESWL and the complications were more in URS group.

scholarly journals TISSUE EXPANSION

2010 ◽  
Vol 17 (04) ◽  
pp. 611-615
Author(s):  
MUHAMMAD AHMAD
Keyword(s):  
Tissue Expander ◽  
Major Complication ◽  
Tissue Expansion ◽  
Inclusion Criteria ◽  
Flap Surgery ◽  
Exclusion Criteria ◽  
Acute Injuries ◽  
Fill Volume ◽  
Safe Technique ◽  
The Mean

Objective: To share the experience of tissue expansion. Study Design: Descriptive. Duration: June 2005 to May 2009. Setting: Aesthetic Plastic Surgery, Rawalpindi. Inclusion Criteria: Patients of all ages and sex undergoing tissue expansion. Exclusion Criteria: Patients having acute injuries, burns and defects which were closed primarily. Patients undergoing primarily flap surgery. Materials and Methods: The shape and size of the tissue expander was chosen according to the deformity and expected wound geometry. All the surgerieswere performed under general anaesthesia. Drains were removed after 48 – 72 hours. Slightly filled (20 – 50ml) tissue expanders were used. Tissue expansion was started after 7 – 12 days and were filled twice weekly. Results: Total 19 patients (12 males & 7 females) were included in the study. The mean age in males was 32.9 years (range 13 – 44 years) and 21.1 years (range 19 – 36 years) in females. The differentdeformities included contractures 31.6%, Postburn scar 21.1%, hypertrophic scar 15.8% followed by congenital naevus 10.5%. The fill volume ranged from a 140 ml to 480 ml over a period of 8–13 weeks. No major complication was noted. Slight loss of distal flap occurred in 2 patients. No infection/rupture of tissue expander was seen. Conclusion: Tissue expansion is a safe technique for reconstruction of defects, with an obvious advantage of the availability of the adjacent skin.

scholarly journals Latissimus dorsi muscle flap transfer through endoscopic approach combined with the implant after tissue expansion for breast reconstruction of mastectomy patients

BMC Surgery ◽  
2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Jian-Xun Ma ◽  
Bi Li ◽  
You-Chen Xia ◽  
Wei-Tao You ◽  
Jie Zhang ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Latissimus Dorsi ◽  
Muscle Flap ◽  
Tissue Expansion ◽  
Latissimus Dorsi Muscle ◽  
Harvest Time ◽  
Two Stage ◽  
Latissimus Dorsi Muscle Flap ◽  
Dorsi Muscle ◽  
The Mean

Abstract Background Implant-based breast reconstruction is easy to be performed but has flaws that an unnatural appearance might be presented when no sufficient coverage existing. While autologous tissue reconstruction also has disadvantages like donor site scar and skin patch effect. There is a demand for a new method to obtain natural and aesthetic appearance while surmounting drawbacks of conventional breast reconstruction surgery. Methods A retrospective review of thirty-one patients undergoing tissue expander (TE)/implant two-stage breast reconstruction with latissimus dorsi muscle flap (LDMF) transfer through endoscopic approach in Peking University Third Hospital from April 2016 to August 2020 was performed. The LDMF harvest time, drain time, and complications were reviewed. The 3D volume was obtained to assess the volume symmetry of bilateral breasts. The BREAST-Q reconstruction module was used to evaluate the satisfaction. Results The mean endoscopic LDMF harvest time was 90.4 min. In the mean follow-up of 11.2 months, there were no severe capsular contracture happened. The reconstructed side achieved good volume symmetry to the contralateral side (P = 0.256). Based on the evaluation of the BREAST-Q scores, the outcome of Satisfaction with Breasts was excellent or good in 87.1% of the cases. Conclusions The novel type of two-stage breast reconstruction protocol, which includes tissue expansion followed by implant insertion with endoscopy-assisted LDMF transfer, could effectively reduce visible scars, avoid the patch effect, while require short time for LDMF harvest and present low incidence of complications. It is a promising method for breast reconstruction because it achieves good outcomes in the mastectomy patients.

Risk Factors and Risk Scoring Tool for Infection during Tissue Expansion in Tissue Expander and Implant Breast Reconstruction

2013 ◽  
Vol 19 (6) ◽  
pp. 618-626 ◽  
Author(s):  
Hirofumi Kato ◽  
Gojiro Nakagami ◽  
Yoshiko Iwahira ◽  
Reiko Otani ◽  
Takashi Nagase ◽  
...  
Keyword(s):  
Risk Factors ◽  
Breast Reconstruction ◽  
Tissue Expander ◽  
Tissue Expansion ◽  
Risk Scoring ◽  
Scoring Tool ◽  
Implant Breast Reconstruction

scholarly journals Carbon Dioxide based versus Saline Tissue Expansion for Breast Reconstruction; A Meta-Analysis

2021 ◽  
Vol 107 (1_suppl) ◽  
pp. 14-14
Author(s):  
A.M.E. Elkholy ◽  
A. Awadeen
Keyword(s):  
Carbon Dioxide ◽  
Breast Reconstruction ◽  
Meta Analysis ◽  
Tissue Expander ◽  
Radical Mastectomy ◽  
Tissue Expansion ◽  
Wound Dehiscence ◽  
Self Esteem ◽  
Significant Difference ◽  
Review Manager

Introduction: Radical mastectomy shall be a lifesaving procedure for patients with breast cancer. However, it is associated with considerable alteration of patients’ self-esteem and body image. Currently, 40% of women are subjected to breast reconstruction subsequent to radical mastectomy, ranking such surgery the most common reconstruction approach. Two-stage tissue expander-to-implant is the preferable technique that accomplished the desired aesthetic outcomes. The current study was executed to assess the safety and efficacy of Carbon-dioxide based tissue expansion, in contrast to saline-based tissue expansion. Materials and Methods: Comprehensive literature review up to 1 December 2020 was carried out throughout the following databases; PubMed, Google Scholar, Web of Science, Scopus, WHO Global Health Library, Clinical trials, Cochrane, SIGLE, NYAM, mRCT, and ICTRP to identify all clinical studies compared carbon-dioxide based and saline-based tissue expansion. Data analysis was done using Review Manager version 5.3 (RevMan5.3). The significant difference was established at P < 0.05. Results: This meta-analysis included four articles which comprised 619 reconstructed breasts. Of them, 374 breasts were reconstructed using carbon-dioxide based tissue expander, whereby 245 breasts were reconstructed using saline-based tissue expander. Carbon-dioxide based tissue expander accomplished statistically significant shorter duration to accomplish complete expansion (MD-36.28;95%CI-44.09,-28.47; P<0.001) and shorter duration to achieve complete reconstruction (MD-41.91;95%CI-54.24,-29.58; P<0.001). There was no statistically significant difference between carbon-dioxide and saline-based tissue expanders regarding the success rate (RR 1;95%CI 0.96, 1.06; P=0.85), device malfunction (RR 0.94;95%CI 0.11, 8.06; P=0.96), and implant extrusion (RR 0.71;95%CI 0.14, 3.62; P=0.68). There was no statistically significant difference between both methods regarding total; complications (RR 0.93;95%CI 0.64, 1.37; P=0.72). This includes wound infection (RR 0.46;95%CI 0.08, 2.72; P=0.39), wound dehiscence (RR 0.47;95%CI 0.10, 2.25; P=0.34), seroma (RR 1.01;95%CI 0.40, 2.57; P=0.99), and hematoma (RR 0.28;95%CI 0.06, 1.29; P=0.1). Conclusions: Carbon-dioxide based tissue expander is a safe, effective, and promising approach with considerable advancement relative to saline-based tissue expander, principally regarding the time to accomplish complete implant expansion and the time to achieve complete breast reconstruction.

scholarly journals Two-Stage Cranioplasty: Tissue Expansion Directly over the Craniectomy Defect Prior to Cranioplasty

2016 ◽  
Vol 9 (4) ◽  
pp. 355-360 ◽  
Author(s):  
EllianneJacira dos Santos Rubio ◽  
Eelke M. Bos ◽  
Ruben Dammers ◽  
Maarten J. Koudstaal ◽  
Anton G. Dumans
Keyword(s):  
Decompressive Craniectomy ◽  
Behavioral Problems ◽  
Skin Flap ◽  
Tissue Expander ◽  
Tissue Expansion ◽  
Skull Defect ◽  
Simple Method ◽  
Bone Damage ◽  
Custom Made ◽  
Titanium Cranioplasty

Performing a skull reconstruction for a long-term existing large cranium defect usually needs either skin enhancement or skin flaps and cranioplasty. This procedure can be accompanied with aesthetic and functional complications. The presented case describes a 27-year-old man in need of a cranial reconstruction following decompressive craniectomy as treatment for severe traumatic brain injury. Autologous cranioplasty after decompressive craniectomy failed due to bone flap infection. Because of cognitive behavioral problems, a protective helmet needed to be worn in awaiting cranioplasty. The final titanium cranioplasty was placed subsequent to scalp expansion. The expansion was realized by placing a temporary and custom-made polymethylmethacrylate (PMMA) plate over the defect with a tissue expander on top of it, using the existing scar and skull defect. Our reported technique avoids additional skin flap creation and accompanied complications such as additional scalp and bone damage. In cognitive damaged patients who need to wear a helmet constantly, this simple method provides, concurrently, protection of the brain and tissue expansion. We demonstrate a successful novel technical manner to provide scalp enhancement by positioning a temporary PMMA graft over the skull defect and placing the tissue expander on top of it.

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