Choosing the Optimal Tissue Expander Size: A Single Center Randomized Clinical Trial on Chinese Microtia Patients’ Normal Ears Using 3D Scanning

The tissue expansion technique is the most suitable procedure for Chinese patients with microtia. However, it is difficult to determine whether the expanded flap is sufficient, and there are no clear or objective guidelines for determining the volume of the expander for different sizes of auricles. One hundred patients with unilateral microtia who visited our department in 2021 were randomly selected for auricular data collection using 3D scanning. The auricle length, width, projection, perimeter, and surface area were measured. Eight different volumes of expanders underwent CT and the surface areas of these expanders were measured. The surface areas of the auricles and expanders were compared and the correlation between them was explored. The average auricle parameters were calculated. The scatter plot showed a linear relationship between auricle length and auricle surface area (R2 = 0.9913), which demonstrated that the auricle area was approximately equal to the auricle length multiplied by 76.921. Additionally, the surface area of the expanders was measured and made into a table for selection against the surface area of the auricles. Using our equation, the auricle surface could be estimated by simply measuring the non-defective auricle length; therefore, the suitable volume of the expander could be determined.

Physico-dosimetric aspects of radiotherapy treatment of breast cancer patients with an established tissue expander

According to the data for 2019, breast cancer occupies a leading position among malignant neoplasms in the female population in the Russian Federation. Currently, there is an increase in the number of young breast cancer patients. In this regard, the requirements for the quality of life of patients, in particular the aesthetic results of special treatment, are increasing, which contributes to the introduction of methods of reconstructive surgery in oncomammology. The two-stage installation of a silicone breast implant is the most common method of breast reconstruction in oncological practice, in which a tissue expander is installed in patients at the first stage after mastectomy, and at the second stage it is replaced with a permanent implant. At the same time, the issue of radiotherapy in patients who have undergone the surgical stage of breast cancer treatment with reconstructive plastic surgery remains relevant to date. As is known, radiotherapy plays an important role in the combined and complex treatment of breast cancer, increasing, in general, locoregional control in operated patients. On the other hand, it may increase the risk of late complications of breast reconstruction, such as the development of capsular contractures and protrusions. It should also be emphasized that at present, the impact of hypofractive radiotherapy regimes, which are the most promising in clinical development, primarily on endoprostheses in patients during two-stage reconstruction, remains insufficiently studied. This article presents a brief analysis of the physical and dosimetric planning of radiotherapy in patients with breast cancer after the installation of a tissue expander who were treated on the basis of the RNCRR.

A Comparative Analysis of Immediate and Delayed-immediate Breast Reconstruction after Postmastectomy Radiation Therapy

Background Postmastectomy radiation therapy (PMRT) is an important component in the treatment of locally advanced breast cancer. Optimal timing of therapy in relation to autologous breast reconstruction (ABR) remains clinically debated. Herein, we comparatively analyze short- and long-term outcomes between immediate ABR (I-ABR) and delayed-immediate ABR (DI-ABR) in the setting of PMRT. Methods Adult patients undergoing ABR with PMRT were separated into cohorts based on reconstructive timeline: I-ABR or DI-ABR. The groups were propensity matched 1:1 by age, body mass index, and comorbidities. Surgical site events and long-term clinical outcomes (readmissions, reoperations, and revision procedures) were collected. Univariate analyses were completed using Pearson's chi-squared tests and Fisher's exact tests, and statistical significance was set at p < 0.05. Results One hundred and thirty-two flaps (66 in each cohort) were identified for inclusion. Patients with I-ABR were more likely to experience fat necrosis (p = 0.034) and skin necrosis (p < 0.001), require additional office visits (p < 0.001) and outpatient surgeries (p = 0.015) to manage complications, and undergo revision surgery after reconstruction (p < 0.001). DI-ABR patients, however, had a 42.4% incidence of complications following tissue expander placement prior to reconstruction, with 16.7% of patients requiring reoperation during this time. Only one patient (I-ABR) experienced flap loss due to a vascular complication. Conclusion The complications encountered in both of these groups were not prohibitive to offering either treatment. Patients should be made aware of the specific and unique risks of these reconstruction timelines and involved throughout the entire decision-making process. Plastic surgeons should continue to strive to elucidate innovative approaches that facilitate enhanced quality of life without compromising oncologic therapy.

Reconstruction of congenital microtia after ear canaloplasty using V-Y advancement of a temporal triangular flap

Background Reconstruction of congenital microtia remains challenging, particularly in patients with a history of ear canaloplasty due to insufficient regional soft tissue. The insertion of a tissue expander prior to implantation of the cartilage framework has traditionally been employed. However, this procedure could induce additional morbidity. Herein, we present a method using V-Y advancement of a temporal triangular flap to gain additional soft tissue in these challenging cases.Methods Congenital microtia patients with a history of ear canaloplasty who underwent auricular reconstruction using the Nagata technique between 2016 and 2020 were reviewed. To obtain additional soft tissue, V-Y advancement of a temporal triangular flap was performed concurrently with implantation of the costal cartilage framework, without prior insertion of a tissue expander. The outcomes of these patients with respect to postoperative complications and esthetics were evaluated.Results Eight patients with bilateral lesions were included. No specific complications developed after the first-stage surgery. However, one patient experienced complications after the second stage (auricular elevation). An analysis of the esthetic results showed most patients had excellent outcomes, achieving a satisfactory convolution. The median number of operations needed to complete reconstruction was 2, which was fewer than required using the conventional method with prior insertion of a tissue expander.Conclusions In patients with a history of previous canaloplasty, V-Y advancement of a temporal triangular flap could serve as an alternative to tissue expansion for microtia reconstruction. This technique provided reliable and satisfactory results with a reduced number of surgical stages.

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

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.

Breast Reconstruction after Mastectomy with the Use of an Implant and Serratus Anterior Fascia Flap—Initial Clinical Evaluation

Prosthesis-based techniques are the predominant form of breast reconstruction worldwide. The most performed surgical technique involves the placement of the expander in a partial submuscular plane. The coverage of the implant remains a difficult management problem that can lead to complications and poor outcomes. The use of the serratus fascia flap may be the best choice to create a subpectoral pocket for the placement of a tissue expander, with excellent results in terms of morbidity and cost-effectiveness. A total of 20 breast reconstructions with the inferolateral coverage with the serratus fascia were performed. Patients demonstrated a low overall complication rate (9.5%), such as seroma and infection, with complete resolution during the follow-up and no major complications. The US examination of the soft tissues over the implant reported thickness measurements that demonstrated a good coverage over the inferolateral area. Our study shows that using the serratus fascia flap to create a pocket with the pectoralis major for the placement of the tissue expander is an effective technique during two-stage breast reconstruction. The resulting low rate of morbidity and the US findings collected reveal the safety of this procedure. Its success relies on appropriate patient selection and specific intraoperative technique principles.