scholarly journals Criteria for indication of breast reconstruction

1994 ◽  
Vol 112 (2) ◽  
pp. 548-550
Author(s):  
Flávio Henrique Mendes ◽  
Silvia Regina Ferreira Mendes ◽  
José Marcos Mélega
Keyword(s):  
Breast Reconstruction ◽  
Breast Tumor ◽  
Locally Advanced ◽  
Point Of View ◽  
Psychological Aspects ◽  
Surgical Indications ◽  
Immediate Reconstruction ◽  
New Techniques ◽  
Psychological Conditions ◽  
Delayed Reconstruction

Breast reconstruction has been affirmed as part of the treatment for locally advanced breast tumor, and the development of new techniques has been providing better results and widening surgical indications. The objective of this work was to establish and discuss the different criteria that are related to this indication, mainly in what refers to the timing for the procedure. Oncological, clinical and psychological aspects are evaluated according to experience accumulated in recent years, with immediate and delayed reconstruction, carried out in the most diverse specialized centers. The authors conclude that, in reference to the safety and benefits of immediate reconstruction, it would be indicated for any patient who wants it and presents favorable clinical and psychological conditions, without having any absolut contraindication from the oncological point of view.

scholarly journals Psychosocial Aspects of Immediate versus Delayed Breast Reconstruction

Breast Care ◽  
2017 ◽  
Vol 12 (6) ◽  
pp. 374-377 ◽  
Author(s):  
Anne-Sophie Heimes ◽  
Kathrin Stewen ◽  
Annette Hasenburg
Keyword(s):  
Breast Cancer ◽  
Breast Reconstruction ◽  
Cancer Patients ◽  
Well Being ◽  
Psychological Outcomes ◽  
Psychosocial Aspects ◽  
Breast Cancer Patients ◽  
Immediate Reconstruction ◽  
Delayed Breast Reconstruction ◽  
Delayed Reconstruction

Background: Only little is known about the psychosocial aspects of breast cancer patients after mastectomy with immediate versus delayed breast reconstruction. Methods: We systematically screened PubMed using the following key words: mastectomy, immediate vs. delayed reconstruction, psychosocial aspects and quality of life. To highlight different psychological outcomes, studies were categorized into those describing: anxiety, depression, body image and satisfaction with the surgical outcome. We also compared patients after mastectomy alone with those undergoing immediate or delayed reconstruction. Results: Methodologies and psychological outcomes varied among the identified studies, making it difficult to compare results. There are contradictory outcomes concerning the psychosocial aspects of breast cancer patients after mastectomy alone compared with those who underwent an immediate or delayed reconstruction following mastectomy. Some studies show that immediate reconstruction after mastectomy had a positive impact on patients' psychological well-being. In contrast, other studies indicated that in the long-term view the compared patient groups were very similar concerning psychosocial aspects. Conclusion: Analyzing different aspects of psychosocial well-being after breast cancer surgery, there might be an advantage in choosing immediate reconstruction, if oncological safety allows it.

scholarly journals Mandibular reconstruction of the chin area in patients with tumors of the maxillofacial region and oral mucosa

2019 ◽  
Vol 9 (2) ◽  
pp. 35-44
Author(s):  
М. А. Kropotov ◽  
V. A. Sobolevsky ◽  
Yu. Yu. Dikov ◽  
L. P. Yakovleva ◽  
A. V. Khodos ◽  
...  
Keyword(s):  
Locally Advanced ◽  
Outcome Data ◽  
Point Of View ◽  
Segmental Resection ◽  
Defect Closure ◽  
Immediate Reconstruction ◽  
Mandibular Body ◽  
Mandibular Tumors ◽  
Mandibular Defect ◽  
Fibular Free Flap

Background. Locally advanced squamous cell carcinoma of the oral cavity invades the mandible in 13–38 % of cases. Even a small segmental resection of the mandible, for instance, in the chin area, causes significant functional and cosmetic impairment and requires immediate reconstruction of the bone defect. Currently available methods of defect closure require a comparative assessment.Materials and methods. This article is based on the outcome data from patients with mandibular tumors treated from 1998 through 2018. We identified 471 cases of mandibular surgery including marginal resection and midline mandibulotomy; 203 (43.1 %) patients underwent segmental resection. Of them, we selected 99 patients with an isolated chin defect combined either with a mandibular body defect or with a subtotal defect in the mandible.Results. In this study, we analyzed the treatment outcomes in patients with primary and secondary mandibular tumors involving the chin as the most difficult for reconstruction from the point of view of the surgeon and the most important for the patient from the functional and aesthetic point of view.Conclusions. A mandibular defect located in the chin area requires immediate reconstruction. The preferable method of defect closure is the application of a reconstruction plate with a musculocutaneous flap or implantation of vascularized bone grafts. Implantation of a fibular free flap is preferable for the closure of extensive mandibular defects involving the chin area. 

scholarly journals Iatrogenic Pneumothorax as a Complication to Delayed Breast Reconstruction With Tissue Expander—A Case Report

2017 ◽  
Vol 3 ◽  
pp. 2513826X1774758
Author(s):  
Cecilie Balslev Willert ◽  
Rikke Bredgaard
Keyword(s):  
Breast Reconstruction ◽  
Tissue Expander ◽  
Tissue Expansion ◽  
Reconstruction Method ◽  
Complication Rates ◽  
Unique Case ◽  
Immediate Reconstruction ◽  
Delayed Breast Reconstruction ◽  
New Perspective ◽  
Delayed Reconstruction

Breast reconstruction with expander implant is the most common breast reconstructive procedure. Irradiated patients are seldom reconstructed this way because the tissue expansion is difficult and the complication rates are higher. Pneumothorax is a serious condition and can be seen as a complication to the operation. Literature is sparse; hence, the only study is by Schneider et al who found an incidence of 0.55%. The study focused on immediate reconstruction only and did not report the percentage of irradiated patients. We present a unique case of iatrogenic pneumothorax in a previously irradiated patient undergoing delayed reconstruction with expander insertion. This provides a new perspective to the complication, raising the question whether irradiated patients are at higher risk. As a plastic surgeon, it is important to be aware of this complication and to take account of radiation when selecting reconstruction method.

A Meta-Analysis of Autologous Microsurgical Breast Reconstruction and Timing of Adjuvant Radiation Therapy

2020 ◽  
Author(s):  
Adee J. Heiman ◽  
Sairisheel R. Gabbireddy ◽  
Vasanth S. Kotamarti ◽  
Joseph A. Ricci
Keyword(s):  
Radiation Therapy ◽  
Breast Reconstruction ◽  
Free Flap ◽  
Adjuvant Radiation ◽  
Complication Rates ◽  
Flap Reconstruction ◽  
Fat Necrosis ◽  
Free Flap Reconstruction ◽  
Immediate Reconstruction ◽  
Delayed Reconstruction

Abstract Background Postmastectomy radiation therapy (PMRT) decreases loco-regional recurrence and improves survival in patients with locally advanced breast cancer. Autologous free flap reconstruction, while more durable in the setting of radiation than alloplastic reconstruction, is still susceptible to radiation-induced fibrosis, contracture, fat necrosis, volume loss, and distortion of breast shape. Options for reconstruction timing (immediate vs. delayed) have been discussed to mitigate these effects, but a clear optimum is not known. Methods A systematic review of the literature was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using search terms “breast reconstruction AND (radiation OR irradiation OR radiotherapy)” were used. Inclusion criteria consisted of studies reporting complications for free flap breast reconstruction in the setting of PMRT. Patients who underwent PMRT were pooled into two groups: those who underwent immediate free flap reconstruction prior to PMRT and those who underwent delayed reconstruction after PMRT. Results Out of the 23 studies, 12 focused on immediate reconstruction, seven focused on delayed reconstruction, and four studies included both groups. Overall, 729 patients underwent immediate reconstruction, while 868 underwent delayed reconstruction. Complete and partial flap loss rates were significantly higher in patients undergoing delayed reconstruction, while infection and wound-healing complication rates were higher in those undergoing immediate reconstructions. Rates of unplanned reoperations, vascular complications, hematoma/seroma, and fat necrosis did not differ significantly between the two groups. However, rates of planned revision surgeries were higher in the delayed reconstruction group. Conclusion Immediate free flap breast reconstruction is associated with superior flap survival compared with delayed reconstruction. Rates of complications are largely comparable, and rates of revision surgeries are equivalent. The differences in long-term aesthetic outcomes are not, however, clearly assessed by the available literature. Even in the face of PMRT, immediate free flap breast reconstruction is an effective approach.

scholarly journals Exploring the Lived Experience of Undergoing an Immediate Versus Delayed Deep Inferior Epigastric Artery Perforator (DIEP) Flap Reconstruction in Women Who Require Post-Mastectomy Radiotherapy

2021 ◽  
Vol 9 (8) ◽  
Author(s):  
Rachel O’Connell ◽  
Jennifer Rusby ◽  
Amrit Sagha ◽  
Sofia Georgopoulou ◽  
Anna Kirby ◽  
...  
Keyword(s):  
Decision Making ◽  
Breast Reconstruction ◽  
Relevant Literature ◽  
Self Regulation ◽  
Diep Flap ◽  
Theory Approach ◽  
Structured Interviews ◽  
Immediate Reconstruction ◽  
Purposive Sampling ◽  
Delayed Reconstruction

Introduction Post-mastectomy radiotherapy (PMRT) is recommended to women at high risk of local recurrence. There is a paucity of published work on the experience of women who undergo deep inferior epigastric perforator (DIEP) flap breast reconstruction in the context of requiring PMRT. The aim of the study was to explore and understand the patient experience of these women. Methods Purposive sampling was used to identify patients who had undergone an immediate reconstruction with PMRT and women who had undergone a delayed reconstruction after PMRT. Purposive sampling was used to identify and invite women to participate in the study. Semi-structured interviews were conducted using a grounded theory approach with a topic guide which was derived from relevant literature. Results Twenty women participated in the study. Ten women had undergone immediate reconstruction followed by PMRT and 10 women had undergone delayed reconstruction after PMRT. The results suggest that, regardless of the surgical pathway or the consequences of treatment, overall women were satisfied with the treatment decision they had made. Patients described the challenges around decision-making and their post-operative experience. However, patients were grateful to have had a breast reconstruction and in the most part happy with the treatment pathway they underwent. Conclusion The findings of this study suggest that women are motivated by a variety of factors when presented with the choice of immediate versus delayed breast reconstruction and can justify the treatment path they have taken. This study highlights the importance of discussing reconstruction options in terms of context of a person’s life and coping strategies. Patients appeared to use self-regulation in their behaviour to cope with their illness threat and decision-making. The women who chose delayed reconstruction were motivated by the delayed gratification of having a reconstruction that had not been subjected to PMRT.

Feasibility of Immediate Breast Reconstruction for Locally Advanced Breast Cancer

1999 ◽  
Vol 6 (7) ◽  
pp. 671-675 ◽  
Author(s):  
Lisa A. Newman ◽  
Henry M. Kuerer ◽  
Kelly K. Hunt ◽  
Frederick C. Ames ◽  
Merrick I. Ross ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Reconstruction ◽  
Advanced Breast Cancer ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Immediate Breast Reconstruction ◽  
Advanced Breast

Emotional expectations reported by hospitalized women in southeastern Brazil before being submitted to mastectomy with immediate breast reconstruction: A clinical-qualitative study

2017 ◽  
Vol 41 (S1) ◽  
pp. s507-s507
Author(s):  
G.L. Almeida ◽  
R.M.C. Sena ◽  
V.L.P. Alves ◽  
C. Cardoso-Filho ◽  
E.R. Turato
Keyword(s):  
Breast Cancer ◽  
Breast Reconstruction ◽  
Immediate Breast Reconstruction ◽  
University Hospital ◽  
Southeastern Brazil ◽  
Immediate Reconstruction ◽  
Female Population ◽  
Competing Interest ◽  
Health Assistant ◽  
The Aesthetic

IntroductionBreast cancer is a type that more affects female population in the world. Surgical indication, present in most cases, is a mutilating procedure and mentally traumatic for majority of women subjected. Thus, immediate breast reconstruction, which is the choice to rebuild the breast during the mastectomy surgery, is an alternative to reduce discomforts associated with loss of the breast, in addition to being associated potentially with improved emotional and psychosocial quality of life.ObjectiveTo discuss, from psychological viewpoint, the emotional expectations about surgical results of a planned mastectomy with immediate breast reconstruction, reported by women with breast cancer treated in a university hospital in Campinas, state of São Paulo.MethodQualitative design, particularized in the clinical-qualitative method, adequate to health assistant settings, using the semi-directed interview with open-ended questions in-depth, fully transcribed and after submitted to content clinical-qualitative analysis. Intentional sample closed by criterion of information theoretical saturation with 12 sequential participants.ResultsAmongst the emergent categories from free-floating readings, we have chosen the following to presentation:.–The desire of healing above expectations of the aesthetic aspects;–The perception of the surgical approach predominantly with aesthetic effects;–The desire of a contra-lateral healthy breast withdrawal, too.ConclusionsFace the proposal of mastectomy with immediate reconstruction, days before the surgery, women reported to be well emotionally organized for the procedure, although in different ways. This occurs probably due to emotional meanings built by many experiences from their psychological histories, as well as from values provided by the socio-cultural environments.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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

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