scholarly journals The effect of early arm exercise on drainage volume after total mastectomy and tissue expander insertion in breast cancer patients: a prospective study

2021 ◽  
Vol 48 (6) ◽  
pp. 583-589
Author(s):  
Oh Young Joo ◽  
Seung Jin Moon ◽  
Dong Won Lee ◽  
Dae Hyun Lew ◽  
Won Jai Lee ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Tissue Expander ◽  
Exercise Group ◽  
Breast Cancer Patients ◽  
Arm Exercise ◽  
Early Exercise ◽  
Drainage Volume ◽  
Drain Removal ◽  
Significant Difference ◽  
Exercise Restriction

Background In prosthesis-based breast reconstruction patients, the drain tends to be kept in place longer than in patients who undergo only mastectomy. Postoperative arm exercise also increases the drainage volume. However, to preserve shoulder function, early exercise is recommended. In this study, we investigated the effect of early exercise on the total drainage volume and drain duration in these patients.Methods We designed a prospective randomized trial involving 56 patients who underwent immediate breast reconstruction following mastectomy using tissue expanders. In each group, the patients were randomized either to perform early arm exercises using specific shoulder movement guidelines 2 days after surgery or to restrict arm movement above the shoulder height until drain removal. The drain duration and the total amount of drainage were the primary endpoints.Results There were no significant differences in age, height, weight, body mass index, or mastectomy specimen weight between the two groups. The total amount of drainage was 1,497 mL in the early exercise group and 1,336 mL in the exercise restriction group. The duration until complete removal of the drains was 19.71 days in the early exercise group and 17.11 days in the exercise restriction group.Conclusions Exercise restriction after breast reconstruction did not lead to a significant difference in the drainage volume or the average time until drain removal. Thus, early exercise is recommended for improved shoulder mobility postoperatively. More long-term studies are needed to determine the effect of early exercise on shoulder mobility in prosthesis-based breast reconstruction patients.

scholarly journals Novel Pre-Mastectomy Permanent Implant Reconstruction

2021 ◽  
Vol 6 (2) ◽  
Keyword(s):  
Patient Satisfaction ◽  
Breast Reconstruction ◽  
Short Form ◽  
Tissue Expander ◽  
Silicone Implants ◽  
Life Questionnaire ◽  
Dermal Substitute ◽  
Breast Cancer Patients ◽  
Permanent Implant ◽  
Implant Reconstruction

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.

scholarly journals Does Acellular Dermal Matrix Thickness Affect Complication Rate in Tissue Expander Based Breast Reconstruction?

2016 ◽  
Vol 2016 ◽  
pp. 1-6
Author(s):  
Jessica F. Rose ◽  
Sarosh N. Zafar ◽  
Warren A. Ellsworth IV
Keyword(s):  
Breast Reconstruction ◽  
Skin Necrosis ◽  
Tissue Expander ◽  
Retrospective Chart Review ◽  
Acellular Dermal Matrix ◽  
Complication Rates ◽  
Dermal Matrix ◽  
Drain Removal ◽  
Dermal Matrices ◽  
Acellular Dermal

Background. While the benefits of using acellular dermal matrices (ADMs) in breast reconstruction are well described, their use has been associated with additional complications. The purpose of this study was to determine if ADM thickness affects complications in breast reconstruction. Methods. A retrospective chart review was performed including all tissue expander based breast reconstructions with AlloDerm (LifeCell, Branchburg, NJ) over 4 years. We evaluated preoperative characteristics and assessed postoperative complications including seroma, hematoma, infection, skin necrosis, and need for reintervention. We reviewed ADM thickness and time to Jackson-Pratt (JP) drain removal. Results. Fifty-five patients underwent 77 ADM-associated tissue expander based breast reconstructions, with average age of 48.1 years and average BMI of 25.9. Average ADM thickness was 1.21 mm. We found higher complication rates in the thick ADM group. Significant associations were found between smokers and skin necrosis (p<0.0001) and seroma and prolonged JP drainage (p=0.0004); radiated reconstructed breasts were more likely to suffer infections (p=0.0085), and elevated BMI is a significant predictor for increased infection rate (p=0.0037). Conclusion. We found a trend toward increased complication rates with thicker ADMs. In the future, larger prospective studies evaluating thickness may provide more information.

scholarly journals Short-term Outcomes and Safety of Radiotherapy for Immediate Breast Reconstruction with Autologous Flap Transfer Following Breast-conserving Surgery

2020 ◽  
Author(s):  
Shu-Ling Zhang ◽  
Jun Song ◽  
Yan-Ru Wang ◽  
Yi-Jia Guo ◽  
Jian-Zhu Zhao ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Breast Reconstruction ◽  
Skin Color ◽  
Postoperative Radiotherapy ◽  
Partial Mastectomy ◽  
Breast Cancer Patients ◽  
Flap Transfer ◽  
Significant Difference ◽  
Good Cosmetic ◽  
The Impact

Abstract Background: The outcomes of immediate autologous breast reconstruction (IABR) after partial mastectomy followed by postoperative radiotherapy (RT) in terms of aesthetics, treatment-related complications, and local control are unclear. In this study, we evaluated the efficacy of IABR after partial mastectomy with or without breast RT, and thus the impact of radiation on autologous flap transfer.Method: A retrospective cohort study involving consecutive breast cancer patients who underwent IABR after partial mastectomy between July 2011 and December 2017 at Shengjing Hospital was performed. Patients were divided into two groups based on whether or not they received RT after IABR. We compared aesthetic outcomes and changes in the flap size over the three-dimensional coordinates at various timepoints (pre-RT, 1, 6, and 12 months post-RT), as well as postoperative complications, survival, and recurrence rates between the two groups. Results: No significant difference was found in the rate of regional recurrence between the two groups (3.13% vs. 3.85%, P=1.00), and no local recurrences occurred in either group. At the timepoints pre-RT, 1, and 6 months post-RT (approximately 4, 7, and 12 months after IABR, respectively), 77 (91.7%), 70 (83.3%), and 83 (98.8%) patients, respectively, had achieved very good or good cosmetic outcomes, and only changes in breast skin color at 1 month after RT (7 months after IABR) significantly differed between the RT and non-RT groups, with very good or good cosmetic result rates of 62.5% vs. 96.2%, respectively (P<0.001). No significant difference in the reduction of flap size was observed at any timepoint between the RT and non-RT groups. The flap size was significantly reduced at 4 months after IABR compared with the initial size during surgery, and then tended to be stable in both groups. There were no significant differences between the two groups in the rates of postoperative complications including necrosis of the flap, infection, hematoma, or seroma (all P>0.05). Finally, no grade 3 or greater RT-associated adverse events occurred during or after RT.Conclusion: RT following IABR provides aesthetically satisfactory results without intolerable adverse complications and may safely be performed in patients who underwent IABR after partial mastectomy.

scholarly journals Effect of exercise on shoulder function and morbidity following mastectomy with axillary dissection in patients with breast cancer: a prospective randomized clinical study

2018 ◽  
Vol 5 (10) ◽  
pp. 3217
Author(s):  
Sri Aurobindo Prasad Das ◽  
Sathasivam Sureshkumar ◽  
Vijayakumar C. ◽  
Vikram Kate ◽  
Srinivasan K.
Keyword(s):  
Breast Cancer ◽  
Range Of Motion ◽  
Exercise Intervention ◽  
Exercise Group ◽  
Breast Cancer Surgery ◽  
Exercise Interventions ◽  
Randomized Clinical Study ◽  
Shoulder Range Of Motion ◽  
Drain Removal ◽  
Significant Difference

Background: There are no guidelines for the exercises performed in physical rehabilitation after breast cancer surgery and, specifically, for how to minimize these postoperative complications. Hence this study was conducted to study the effect of exercise intervention on upper extremity range of motion, strength, lymphedema, pain and activities of daily living (ADL).Methods: A total of 75 patients were included in the study in accordance to inclusion criteria. They were randomized into exercise group (n=38) and no exercise group (n=37). Patients in the exercise group were given a set of 19 active or active assisted range of motion exercises and strengthening exercises with frequent follow up. The other group were did not receive any strict exercise, they were given a few free hand exercise when they had some shoulder complaints based on treating physician discretion. Apart from demographic data other parameters studied were pain, numbness, active shoulder range of motion, muscle strength, lymphedema and ADL. These were evaluated before surgery, 24 hours after drain removal and 3 weeks /6 weeks/ 3 months of post-surgery.Results: Demographic parameters were comparable between the groups. Pain score, shoulder ROM were better in the exercise group compared to no exercise group and this difference was found to be significant (p <0.001). More patients in no exercise group experienced numbness. There was no statistically significant difference in the grip strength between the two groups. The incidence of lymphedema was higher in no exercise group compared to exercise group and this was extremely significant. (p < 0.001). Patients in no exercise group had higher disability scores for ADL which was significant compared to exercise group.Conclusions: Exercise interventions resulted in significantly reduced pain, improved shoulder ROM and lowered ADL impairment. Exercise intervention significantly reduced the incidence of lymphedema, but there was no effect on strength.

scholarly journals A novel technique for an immediate nipple reconstruction with a rectangle flap in implant-based breast reconstruction

2021 ◽  
Author(s):  
Piotr Pluta ◽  
Janusz Piekarski ◽  
Marek Zadrożny
Keyword(s):  
Breast Cancer ◽  
Breast Reconstruction ◽  
Cancer Patients ◽  
Breast Surgery ◽  
Tissue Expander ◽  
Reconstruction Technique ◽  
Nipple Reconstruction ◽  
Breast Cancer Patients ◽  
Alternative Approach ◽  
The Given

IntroductionA nipple reconstruction complements breast mound restoring in postmastectomy breast cancer patients. It positively affects patients' welfare, both in psycho-social and sexual aspects. An immediate nipple reconstruction is an alternative approach to delayed surgery. We describe an original technique for an immediate nipple reconstruction by the use of a modified rectangular flap.Material and methodsOne hundred seventeen nipple reconstructions in 112 breast cancer patients were performed. This technique was used during skin-sparing mastectomy, including 104 implants (88.9%) and 13 tissue-expander (11.1%) breast reconstructions. Synthetic meshes covered with titanium supported lower breast poles in 72 implantations (61.5%); in remaining cases, (38.5%) muscles covered the entire implant. Preoperative chemotherapy was applied in 18.75% of the patients; adjuvant chemo- and hormonal therapy obtained 29.5% and 74.1% of the patients, respectively. Twenty-four patients (21.4%) were irradiated postoperatively.ResultsIn 5 out of 117 surgeries (4.3%), necrosis of the rectangular flap was observed. Twelve months since surgery, two-loss of projection of reconstructed nipple was reported (1.7%). In the twelfth month of observation, of the subgroup of 102 patients with permanent nipple presentation, 93.1% gave a positive opinion regarding the procedure.ConclusionsThe given immediate nipple reconstruction technique performed during a skin-sparing mastectomy and implant/expander-based breast reconstruction was an effective and safe adjunct curative breast surgery.

Post-Mastectomy Surgical Pocket Irrigation With Triple Antibiotic Solution vs Chlorhexidine Gluconate: A Randomized Controlled Trial Assessing Surgical Site Infections in Immediate Tissue Expander Breast Reconstruction

2021 ◽  
Author(s):  
Lyly Nguyen ◽  
Ashkan Afshari ◽  
Japjit Green ◽  
Jeremy Joseph ◽  
Jun Yao ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Breast Reconstruction ◽  
Controlled Trial ◽  
Tissue Expander ◽  
Surgical Site Infections ◽  
Chlorhexidine Gluconate ◽  
Bilateral Mastectomy ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Antibiotic Solution

Abstract Background Post-mastectomy pocket irrigation solution choice is debated and primarily surgeon dependent. We compare triple antibiotic solution (TAS) to 0.05% chlorhexidine gluconate (CHG). Objectives The purpose of this study was to determine surgical site infection (SSI) rates after using TAS vs CHG for breast pocket irrigation in immediate tissue expander breast reconstruction. Methods A prospective, blinded, randomized controlled trial was performed in patients (18-81 years old) undergoing bilateral mastectomy with tissue expander (TE) reconstruction. In each patient, one mastectomy pocket was randomized to TAS and the other to CHG. Both the TE and the pocket were irrigated in the respective solution. The primary outcome was the incidence of surgical site infections (SSI). Secondary outcomes were rates of mastectomy flap necrosis, hematoma, and seroma. Results Eighty-eight patients undergoing bilateral immediate breast reconstruction were enrolled. Demographic and operative characteristics were equivalent as each patient served as their own control. Between the TAS and CHG groups, there was no difference in the incidence of SSI (5 [4.5%] vs 7 [8.0%], p = 0.35), including minor infections (2 [2.3%] vs 1 [1.1%], p = 0.56), major infections (2 [2.3%] vs 6 [6.8%], p = 0.15), and those resulting in explantation (2 [2.3%] vs 5 [4.5%], p = 0.25). There was also no difference in necrosis, hematoma, or seroma formation. No patients who developed SSI had radiation. Conclusions This study does not demonstrate a statistically significant difference in SSI between TAS and CHG irrigation, though TAS approached statistical significance for lower rates of infectious complications.

scholarly journals Short-term outcomes and safety of radiotherapy for immediate breast reconstruction with autologous flap transfer following breast-conserving surgery

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shu-Ling Zhang ◽  
Jun Song ◽  
Yan-Ru Wang ◽  
Yi-Jia Guo ◽  
Jian-Zhu Zhao ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Postoperative Complications ◽  
Breast Reconstruction ◽  
Cancer Patients ◽  
Partial Mastectomy ◽  
Breast Cancer Patients ◽  
Flap Transfer ◽  
Significant Difference ◽  
Good Cosmetic ◽  
The Impact

Abstract Background The outcomes of immediate autologous breast reconstruction (IABR) after partial mastectomy followed by postoperative radiotherapy (RT) in terms of aesthetics, treatment-related complications, and local control are unclear. In this study, we evaluated the efficacy of IABR after partial mastectomy with or without breast RT, and thus the impact of radiation on autologous flap transfer. Method A retrospective cohort study involving consecutive breast cancer patients who underwent IABR after partial mastectomy between July 2011 and December 2017 at Shengjing Hospital was performed. Patients were divided into two groups based on whether or not they received RT after IABR. We compared aesthetic outcomes and changes in the flap size over the three-dimensional coordinates at various timepoints (pre-RT, 1, 6, and 12 months post-RT), as well as postoperative complications, survival, and recurrence rates between the two groups. Results In total, 84 breast cancer patients were enrolled, with 32 patients in the RT group and 52 in the non-RT group. At a median follow-up time of 33.3 months, no significant difference was found in the rate of regional recurrence between the two groups (3.13% vs. 3.85%, P = 1.00), and no local recurrences occurred in either group. At the timepoints pre-RT, 1, and 6 months post-RT (approximately 4, 7, and 12 months after IABR, respectively), 77 (91.7%), 70 (83.3%), and 83 (98.8%) patients, respectively, had achieved very good or good cosmetic outcomes, and only changes in breast skin color at 1 month after RT significantly differed between the RT and non-RT groups, with very good or good cosmetic result rates of 62.5% vs. 96.2%, respectively (P < 0.001). No significant difference in the reduction of flap size was observed at any timepoint between the two groups. There were no significant differences between the two groups in the rates of postoperative complications including necrosis of the flap, infection, hematoma, or seroma (all P > 0.05). Additionally, no grade 3 or greater RT-associated adverse events occurred during or after RT. Conclusion RT following IABR provides aesthetically satisfactory results without intolerable adverse complications and may safely be performed in patients who underwent IABR after partial mastectomy.

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.

scholarly journals P.134 Movement medicine: A systematic review on the effect of early aerobic exercise initiation on symptom recovery following concussion

2021 ◽  
Vol 48 (s3) ◽  
pp. S58-S58
Author(s):  
A Kempenaar ◽  
M Bayley
Keyword(s):  
Aerobic Exercise ◽  
Early Period ◽  
Exercise Group ◽  
Initial Symptom ◽  
Brain Concussion ◽  
Early Exercise ◽  
Post Concussion Syndrome ◽  
Significant Difference ◽  
Promising Treatment ◽  
Symptom Recovery

Background: Mounting evidence supports aerobic exercise as a promising treatment option for individuals experiencing persistent post-concussion symptoms beyond four weeks. The purpose of this review was to determine whether initiating structured aerobic exercise within the early period (first two weeks) following concussion affects symptom recovery compared to standard care. Methods: A systematic literature search was performed using MEDLINE, Embase, PsycINFO and CENTRAL databases, combining keywords: (brain concussion, post-concussion syndrome, mild traumatic brain injury) AND (exercise, exercise therapy, physical activity, kinesiotherapy). Results were limited to Randomized Controlled Trials (RCTs). All selected articles underwent quality assessment. Results: The search generated 112 unique abstracts, of which 5 met inclusion criteria. Sample sizes ranged from 16 to 103 participants. Of the four studies that were able to analyze between-group differences, one showed significantly faster recovery in the early aerobic exercise group compared to control, while three showed no significant difference. Two studies demonstrated a trend toward faster initial symptom resolution in the early exercise group. Conclusions: Preliminary RCT evidence suggests that aerobic exercise initiated in the early postconcussion period does not exacerbate symptoms or prolong recovery time, and may potentially hasten recovery. Larger, more rigorous RCTs are required to define the optimal exercise parameters to facilitate symptom recovery.

scholarly journals 1443 Comparison of Outcomes Between Immediate Direct-to-Implant Breast Reconstruction versus Two-Stage Implant Breast Reconstruction; a Systematic Review and Meta-analysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
O Kelly ◽  
I Balasubramanian ◽  
C Cullinane ◽  
R Prichard
Keyword(s):  
Systematic Review ◽  
Breast Reconstruction ◽  
Meta Analysis ◽  
Capsular Contracture ◽  
Tissue Expander ◽  
Immediate Breast Reconstruction ◽  
Two Stage ◽  
Significant Difference ◽  
Implant Reconstruction ◽  
Implant Breast Reconstruction

Abstract Background Direct-to-implant (DTI) breast reconstruction is increasingly performed as the preferred method of immediate breast reconstruction following mastectomy. The proposed advantages of DTI over two-stage tissue expander (TE)/implant reconstruction relate to fewer surgical procedures. This systematic review and meta-analysis aims to evaluate the safety and efficacy of DTI versus conventional TE/implant breast reconstruction. Method A systematic review was performed (PubMed, Embase, Scopus) to identify relevant studies that compared outcomes between DTI and TE/Implant reconstructions. Publications up to October 2020 were included. The primary outcome was overall complication rate. Secondary outcomes included infection rate and implant loss. Results Nineteen studies, including 32,971 implant-based breast reconstructions, were analysed. Median age was 48 years. Mean BMI was 25.9. There was no statistically significant difference between the two groups. Duration of follow up ranged from 1-60 months. Overall complications were significantly more likely to occur in the DTI group (OR 1.81 [1.17-2.79]). Overall complications refers to all reported complications including seroma, haematoma, would dehiscence, infection, skin necrosis and capsular contracture. Implant loss was also significantly higher in the DTI cohort (OR 1.31 [1.12-1.78]). There was no significant difference in infection rates between the two groups. Subgroup analyses, focusing on high-powered multicentre studies showed that the risks of overall complications were significantly higher in the DTI group (OR 1.51 [1.06-2.14]). Conclusions This meta-analysis demonstrates significantly greater risk of complications and implant loss in the DTI breast reconstruction group. These findings serve to aid both patients and clinicians in the decision-making process regarding implant reconstruction following mastectomy

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