scholarly journals Current status of and trends in post-mastectomy breast reconstruction in Korea

2020 ◽  
Vol 47 (2) ◽  
pp. 118-125 ◽  
Author(s):  
Woo Jin Song ◽  
Sang Gue Kang ◽  
Eun Key Kim ◽  
Seung Yong Song ◽  
Joon Seok Lee ◽  
...  
Keyword(s):  
Big Data ◽  
Health Insurance ◽  
Breast Reconstruction ◽  
Tissue Expander ◽  
Perforator Flap ◽  
Free Tissue Transfer ◽  
Current Status ◽  
Autologous Reconstruction ◽  
Annual Changes ◽  
Reconstruction Rate

Since April 2015, post-mastectomy breast reconstruction has been covered by the Korean National Health Insurance Service (NHIS). The frequency of these procedures has increased very rapidly. We analyzed data obtained from the Big Data Hub of the Health Insurance Review and Assessment Service (HIRA) and determined annual changes in the number of breast reconstruction procedures and related trends in Korea. We evaluated the numbers of mastectomy and breast reconstruction procedures performed between April 2015 and December 2018 using data from the HIRA Big Data Hub. We determined annual changes in the numbers of total, autologous, and implant breast reconstructions after NHIS coverage commenced. Data were analyzed using Microsoft Excel. The post-mastectomy breast reconstruction rate increased from 19.4% in 2015 to 53.4% in 2018. In 2015, implant reconstruction was performed in 1,366 cases and autologous reconstruction in 905 (60.1% and 39.8%, respectively); these figures increased to 3,703 and 1,570 (70.2% and 29.7%, respectively) in 2018. Free tissue transfer and deep inferior epigastric perforator flap creation were the most common autologous reconstruction procedures. For implant-based reconstructions, the rates of directto-implant and tissue-expander breast reconstructions (first stage) were similar in 2018. This study summarizes breast reconstruction trends in Korea after NHIS coverage was expanded in 2015. A significant increase over time in the post-mastectomy breast reconstruction rate was evident, with a trend toward implant-based reconstruction. Analysis of data from the HIRA Big Data Hub can be used to predict breast reconstruction trends and convey precise information to patients and physicians.

Algorithmic Approach for Intraoperative Salvage of Venous Congestion in DIEP Flaps

2018 ◽  
Vol 34 (06) ◽  
pp. 404-412 ◽  
Author(s):  
Erica Bartlett ◽  
Dmitry Zavlin ◽  
Zachery Menn ◽  
Aldona Spiegel
Keyword(s):  
Breast Reconstruction ◽  
Drainage System ◽  
Perforator Flap ◽  
Free Tissue Transfer ◽  
Deep Drainage ◽  
Autologous Breast Reconstruction ◽  
Venous Anastomosis ◽  
Intraoperative Complication ◽  
Flap Failure ◽  
Internal Mammary

Background Flap congestion is a frequently described intraoperative complication during autologous breast reconstruction with abdominal perforator flaps, which, if not addressed, can lead to detrimental results such as flap failure. Here, we describe our institution's algorithm of intraoperative salvage of congested flaps and present their outcomes. Patients and Methods All patient charts from 2002 to 2016 of a single plastic surgeon were reviewed for patients who underwent deep inferior epigastric perforator flap breast reconstruction resulting in 602 patients and 831 flaps. Of those, 38 women (6.3%) with 40 congested flaps (4.8%) were included in this study. Based on the algorithm guiding the selection of additional venous anastomosis, the patients' surgical details, outcomes, as well as their demographic characteristics are evaluated. Results Average age and body mass index of our cohort were 47.0 ± 8.0 years and 26.1 ± 3.9, respectively. Ten patients (26.3%) were current or former smokers while 20 (52.6%) required external radiation. Thirty-two congested flaps (80.0%) were predominantly salvaged with a superficial inferior epigastric vein (SIEV)-to-deep inferior epigastric vein (comitante) anastomosis. An SIEV-to-internal mammary vein comitante anastomosis was the second favorite option (5 flaps, 12.5%). Five patients suffered minor complications within a mean follow-up of 18.8 ± 12.3 months without flap failure, bleeding, or infection. Conclusions Venous flap congestion is an uncommon intraoperative intricacy during free tissue transfer for autologous breast reconstruction. Our proposed algorithm primarily recommends adding an additional venous anastomosis between the superficial and deep drainage system and results and favorable outcomes without major complications.

Patient-Reported Satisfaction and Quality of Life in Postmastectomy Radiated Patients: A Comparison between Delayed and Delayed Immediate Autologous Breast Reconstruction in a Predominantly Minority Patient Population

2019 ◽  
Vol 35 (06) ◽  
pp. 445-451 ◽  
Author(s):  
George N. Kamel ◽  
David Nash ◽  
Joshua Jacobson ◽  
Robin Berk ◽  
Karan Mehta ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Breast Reconstruction ◽  
Medical Center ◽  
Tissue Expander ◽  
Well Being ◽  
Minority Population ◽  
Autologous Reconstruction ◽  
Autologous Breast Reconstruction ◽  
Patient Reported

Background Delayed immediate (DI) autologous breast reconstruction consists of immediate postmastectomy tissue expander placement, radiation therapy, and subsequent autologous reconstruction. The decision between timing of reconstructive methods is challenging and remains to be elucidated. We aim to compare patient reported outcomes and quality of life between delayed and DI reconstruction. Methods A retrospective review of all patients, who underwent autologous breast reconstruction at Montefiore Medical Center from January 2009 to December 2016, was conducted. Patients who underwent postmastectomy radiotherapy were divided into two cohorts: delayed and DI autologous breast reconstruction. Patients were mailed a BREAST-Q survey and their responses, demographic information, complications, and need for revisionary procedures were analyzed. Results A total of 79 patients met inclusion criteria: 34.2% (n = 27) in the delayed and 65.8% (n = 52) in the DI group. 77.2% (n = 61) of patients were a minority population. Patients in each cohort had similar baseline characteristics; however, the DI cohort was more likely to have bilateral reconstruction (46.2% [n = 24] vs. 7.4% [n = 2]; p = 0.0005) and to have major mastectomy flap necrosis (22.4% [n = 17] vs. 0.0% [n = 0]; p = 0.002). Premature tissue expander removal occurred in 17.3% (n = 9) of patients in the DI group. BREAST-Q response rates were 44.4% (n = 12) in the delayed group and 57.7% (n = 30) in the DI group. Responses showed similar satisfaction with their breasts, well-being, and overall outcome. Conclusion Delayed and DI autologous breast reconstruction yield similar patient-reported satisfaction; however, patients undergoing DI reconstruction have higher rates of major mastectomy necrosis. Furthermore, patients in the DI group risk premature tissue expander removal.

scholarly journals Breast Reconstruction and Post Mastectomy Radiotherapy: A Primer for Members of a Multidisciplinary Team

2021 ◽  
pp. 80-87
Author(s):  
Aska Arnautovic ◽  
Sigurast Olafsson ◽  
Julia Wong ◽  
Shailesh Agarwal ◽  
Justin Broyles
Keyword(s):  
Breast Cancer ◽  
Breast Reconstruction ◽  
Treatment Plan ◽  
Tissue Expander ◽  
Autologous Reconstruction ◽  
Reconstructive Procedures ◽  
Radiation Delivery ◽  
Permanent Implant ◽  
Staged Reconstruction ◽  
Timely Administration

Background: Post-mastectomy radiation therapy (PMRT) is a key component in managing breast cancer with increased potential for locoregional recurrence. Breast reconstruction has evolved to include various techniques that can be categorized according to the type of reconstruction (implant-based versus autologous reconstruction), and the timing of reconstruction (one versus two-step techniques). Methods/Results: This review article aims to provide a digestible summary of PMRT in the context of breast reconstruction by summarizing salient existing literature with a focus on considerations of the plastic surgeon. The main findings summarized in this review include the technique and timing of breast reconstruction, how breast reconstruction can affect radiation delivery, and the type of reconstruction. Within implant-based reconstruction, existing data on the location of the implant in the context of PMRT and PMRT delivery to the tissue expander versus permanent implant are reviewed. Each consideration may alter the probability of successful reconstruction and patient satisfaction.Conclusion: It is essential for the multidisciplinary breast cancer team to have knowledge of the various reconstructive options, and to understand the safety and comparative effectiveness of staged reconstruction in the setting of PMRT. Additionally, one must consider that reconstructive procedures may have implications on the timely administration of PMRT. This review serves as a reference for members of the oncologic care team when discussing reconstructive options with patients who will receive PMRT as part of their treatment plan.

scholarly journals Breast reconstruction statistics in Korea from the Big Data Hub of the Health Insurance Review and Assessment Service

2018 ◽  
Vol 45 (5) ◽  
pp. 441-448 ◽  
Author(s):  
Jae-Won Kim ◽  
Jun-Ho Lee ◽  
Tae-Gon Kim ◽  
Yong-Ha Kim ◽  
Kyu Jin Chung
Keyword(s):  
Big Data ◽  
Health Insurance ◽  
Breast Reconstruction

scholarly journals Latissimus Dorsi Flap in Breast Reconstruction

2018 ◽  
Vol 25 (1) ◽  
pp. 107327481774463 ◽  
Author(s):  
Rachita Sood ◽  
Jeena M. Easow ◽  
Geoffrey Konopka ◽  
Zubin J. Panthaki
Keyword(s):  
Breast Reconstruction ◽  
Latissimus Dorsi ◽  
Perforator Flap ◽  
Radical Mastectomy ◽  
Latissimus Dorsi Flap ◽  
Breast Cancer Surgery ◽  
Soft Tissue Coverage ◽  
Autologous Reconstruction ◽  
Immediate Reconstruction ◽  
Form And Function

Background: Surgeons employ the latissimus dorsi flap (LDF) for reconstruction of a large variety of breast cancer surgery defects, including quadrantectomy, lumpectomy, modified radical mastectomy, and others. The LDF may be used in delayed or immediate reconstruction, in combination with tissue expanders for a staged reconstruction, with implant-based immediate reconstruction, or alone as an autogenous flap. Methods: The authors discuss the historical uses and more recent developments in the LDF. More recent advancements, including the “scarless” approach and augmentation with the thoracodorsal artery perforator flap, are discussed. Results: The LDF is a reliable means for soft tissue coverage providing form and function during breast reconstruction with acceptable perioperative and long-term morbidities. Conclusions: When there is a paucity of tissue, the LDF can provide tissue volume in autologous reconstruction, as well as a reliable vascular pedicle for implant-based reconstruction as in the setting of irradiated tissue.

scholarly journals Free Tissue Breast Reconstruction

2019 ◽  
Vol 33 (01) ◽  
pp. 059-066 ◽  
Author(s):  
Rami Dibbs ◽  
Jeff Trost ◽  
Valerie DeGregorio ◽  
Shayan Izaddoost
Keyword(s):  
Breast Reconstruction ◽  
Free Flap ◽  
Donor Site ◽  
Perforator Flap ◽  
Free Tissue Transfer ◽  
Donor Site Morbidity ◽  
Fat Grafting ◽  
Microsurgical Technique ◽  
Deep Inferior Epigastric Perforator ◽  
Aesthetic Breast

AbstractFree tissue transfer serves as a modern workhorse for breast reconstruction. Advancements in microsurgical technique have allowed for the development of free flap procedures that produce an aesthetic breast while minimizing donor site morbidity. Here, the authors review the use of different free flap procedures for breast reconstruction with a focus on the preferred and most commonly used flap, the deep inferior epigastric perforator flap. Each flap has its advantages and drawbacks, and certain patient risk factors increase postoperative complications. Other techniques of breast reconstruction including pedicled flaps and adjunctive fat grafting are also briefly discussed.

Breast Cancer Reconstruction in the Elderly

2011 ◽  
Vol 77 (12) ◽  
pp. 1640-1643 ◽  
Author(s):  
Marissa Howard-Mcnatt ◽  
Clay Forsberg ◽  
Edward A. Levine ◽  
Anthony Defranzo ◽  
Malcolm Marks ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Reconstruction ◽  
Elderly Women ◽  
Ductal Carcinoma ◽  
Tissue Expander ◽  
Perforator Flap ◽  
The Elderly ◽  
Immediate Breast Reconstruction ◽  
Tram Flap ◽  
Local Skin

Mastectomy is a surgical choice for breast cancer, yet breast reconstruction is underused in women older than age 60 years. Because of a paucity of information examining breast cancer reconstruction in the elderly, we sought to review our experience. By retrospective chart review, we evaluated 89 women older than 60 years having mastectomy and reconstruction from January 1998 to June 2008. Mean patient age was 65 years (range, 60 to 74 years). The majority (41%) had Stage 1 disease or Stage 2 (30%). Ductal carcinoma in situ comprised 25 per cent and Stage 3 totaled 2 per cent. Mastectomy for ipsilateral breast tumor recurrence after radiation therapy and lumpectomy comprised 11 per cent. Most underwent immediate breast reconstruction (89%). Reconstructive techniques included two-stage implant (58%), transverse rectus abdominus musculocutaneous (TRAM) flap (10%), latissimus dorsi musculocutaneous flap with implant (2%), or deep inferior epigastric perforator flap (1%). Complications included a 12 per cent infection rate, removal of two expanders resulting from exposure, one TRAM failure, and one TRAM required debriding. Four patients undergoing mastectomy with tissue expander had radiation resulting in one expander being removed. One local skin recurrence was treated with removal of implant and skin resection. Two patients have died from metastatic disease. Age should not be a contraindication for breast reconstruction in elderly women.

scholarly journals The Fleur-de-PAP Flap for Bilateral Breast Reconstruction

2016 ◽  
Vol 02 (01) ◽  
pp. e1-e3 ◽  
Author(s):  
Katharine Saussy ◽  
Mark Stalder ◽  
Stephen Delatte ◽  
Robert Allen ◽  
Hugo St Hilaire
Keyword(s):  
Breast Reconstruction ◽  
Female Patient ◽  
Donor Site ◽  
Perforator Flap ◽  
Autologous Reconstruction ◽  
Autologous Breast Reconstruction ◽  
Posterior Thigh ◽  
Single Donor ◽  
Ptotic Breasts ◽  
Artery Perforator

AbstractThe authors present the case of a 42-year-old female patient who underwent autologous breast reconstruction using a new perforator flap designed from the medial and posterior thigh. Due to a prior abdominoplasty, the patient's abdominal donor site was unavailable to reconstruct her large, ptotic breasts, so an alternate approach was undertaken. The fleur-de-PAP flap is based on the same perforators employed by the standard profunda artery perforator (PAP) flap, but simultaneously incorporates tissue from both the transverse and vertical PAP flap skin paddles. This design maximizes flap volume at a single donor site and provides a reasonable secondary option for autologous reconstruction in large-breasted patients in whom the abdomen is not available.

scholarly journals Two-Stage Tissue-Expander Breast Reconstruction: A Focus on the Surgical Technique

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Elisa Bellini ◽  
Marianna Pesce ◽  
PierLuigi Santi ◽  
Edoardo Raposio
Keyword(s):  
Breast Cancer ◽  
Body Image ◽  
Surgical Technique ◽  
Breast Reconstruction ◽  
Tissue Expander ◽  
Psychological Trauma ◽  
Cancer Tissue ◽  
Autologous Reconstruction ◽  
Two Stage ◽  
Aesthetic Result

Objective. Breast cancer, the most common malignancy in women, comprises 18% of all female cancers. Mastectomy is an essential intervention to save lives, but it can destroy one’s body image, causing both physical and psychological trauma. Reconstruction is an important step in restoring patient quality of life after the mutilating treatment. Material and Methods. Tissue expanders and implants are now commonly used in breast reconstruction. Autologous reconstruction allows a better aesthetic result; however, many patients prefer implant reconstruction due to the shorter operation time and lack of donor site morbidity. Moreover, this reconstruction strategy is safe and can be performed in patients with multiple health problems. Tissue-expander reconstruction is conventionally performed as a two-stage procedure starting immediately after mammary gland removal. Results. Mastectomy is a destructive but essential intervention for women with breast cancer. Tissue expansion breast reconstruction is a safe, reliable, and efficacious procedure with considerable psychological benefits since it provides a healthy body image. Conclusion. This article focuses on this surgical technique and how to achieve the best reconstruction possible.

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