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Medicina
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Updates in Breast Reconstruction: Review from Evidence
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Updates in Breast Reconstruction: Review from Evidence

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Surgery".

Deadline for manuscript submissions: closed (31 December 2020) | Viewed by 32213

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editors

Dr. Andrea Sisti

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Guest Editor
Division of Plastic Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
Interests: breast cancer; breast reconstruction; oncoplastic surgery; craniofacial surgery; maxillofacial surgery; nerve surgery; pediatric plastic surgery
Special Issues, Collections and Topics in MDPI journals
Dr. Roberto Cuomo

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Guest Editor
Plastic and Reconstructive Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
Interests: plastic surgery; regenerative surgery; wound care; breast reconstruction; nipple–areola reconstruction; body-contouring surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Breast cancer treatment has changed dramatically in the last 50 years. The advancement of technologies and better patient management have made new strategies possible for breast reconstruction. Breast reconstruction is an integral part of “breast cancer treatment” in many countries. Many techniques have been introduced, and all of them have strengths and weaknesses that should be carefully investigated.

In light of this, there is concern about different access to the most advanced and expensive treatments for breast reconstruction due to social disparities.

The use of biomaterials, such as acellular dermal matrices, and microsurgical reconstruction represent a burden on health systems and are not accessible for everyone.

The final step of breast reconstruction is the nipple–areola complex reconstruction; this is a very important surgical procedure for which a lot of techniques have been described. Clarity is needed on this topic, based on scientific evidence.

Dr. Andrea Sisti
Dr. Roberto Cuomo
Guest Editors

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Keywords

  • breast reconstruction
  • acellular dermal matrix
  • pre-pectoral
  • sub muscular
  • nipple reconstruction
  • areola reconstruction
  • breast reconstruction disparities

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Published Papers (7 papers)

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Research

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12 pages, 276 KiB  
Article
Protocol for Prevention and Monitoring of Surgical Site Infections in Implant-Based Breast Reconstruction: Preliminary Results
by Giovanni Papa, Andrea Frasca, Nadia Renzi, Chiara Stocco, Giuseppe Pizzolato, Vittorio Ramella and Zoran Marij Arnež
Medicina 2021, 57(2), 151; https://doi.org/10.3390/medicina57020151 - 8 Feb 2021
Cited by 5 | Viewed by 2927
Abstract
Surgical site infection in implant-based breast reconstruction is a complication with variable incidence reported in the literature. Due to potential loss of implant and reconstruction, it can have a strong psychological impact on patients. Background and objectives: This study aimed primarily at analyzing [...] Read more.
Surgical site infection in implant-based breast reconstruction is a complication with variable incidence reported in the literature. Due to potential loss of implant and reconstruction, it can have a strong psychological impact on patients. Background and objectives: This study aimed primarily at analyzing the current status of the surgical site infection (SSI), (type, time of onset, clinical presentation, pathogens and management) in patients who underwent implant-based breast reconstruction at our Breast Unit. Secondarily, we wanted to establish whether introduction of a new, updated evidence-based protocol for infection prevention can reduce SSI in implant-based breast reconstruction. Materials and Methods: A single-center retrospective study was performed primarily to evaluate the incidence and features of SSI after implant-based breast reconstruction from 2007 to 2020. In June 2020, a protocol for prevention of SSI in implant-based breast reconstruction was introduced in clinical practice. Secondarily, a data analysis of all patients who underwent implant-based breast reconstruction in compliance with this protocol was performed after preliminarily assessing its efficacy. Results: 756 women were evaluated after mastectomy and implant-based breast reconstruction for breast cancer. A total of 26 surgical site infections were detected. The annual incidence of SSI decreased over time (range 0–11.76%). Data relating to infections’ features, involved pathogens and implemented treatments were obtained. Since the introduction of the protocol, 22 patients have been evaluated, for a total of 29 implants. No early infections occurred. Conclusions: Surgical site infection rates at our Breast Unit are comparable to those reported in the literature. The SSI rates have shown a decreasing trend over the years. No SSI has occurred since the introduction of the prevention protocol for surgical site infection in June 2020. Full article
(This article belongs to the Special Issue Updates in Breast Reconstruction: Review from Evidence)
10 pages, 2367 KiB  
Article
Prediction of the Ideal Implant Size Using 3-Dimensional Healthy Breast Volume in Unilateral Direct-to-Implant Breast Reconstruction
by Jeong-Hoon Kim, Jin-Woo Park and Kyong-Je Woo
Medicina 2020, 56(10), 498; https://doi.org/10.3390/medicina56100498 - 24 Sep 2020
Cited by 4 | Viewed by 4618
Abstract
Background and objectives: There is no consensus regarding accurate methods for assessing the size of the implant required for achieving symmetry in direct-to-implant (DTI) breast reconstruction. The purpose of this study was to determine whether the ideal implant size could be estimated using [...] Read more.
Background and objectives: There is no consensus regarding accurate methods for assessing the size of the implant required for achieving symmetry in direct-to-implant (DTI) breast reconstruction. The purpose of this study was to determine whether the ideal implant size could be estimated using 3D breast volume or mastectomy specimen weight, and to compare prediction performances between the two variables. Materials and Methods: Patients who underwent immediate DTI breast reconstruction from August 2017 to April 2020 were included in this study. Breast volumes were measured using 3D surface imaging preoperatively and at postoperative three months. Ideal implant size was calculated by correcting the used implant volume by the observed postoperative asymmetry in 3D surface imaging. Prediction models using mastectomy weight or 3D volume were made to predict the ideal implant volume. The prediction performance was compared between the models. Results: A total of 56 patients were included in the analysis. In correlation analysis, the volume of the implant used was significantly correlated with the mastectomy specimen weight (R2 = 0.810) and the healthy breast volume (R2 = 0.880). The mean ideal implant volume was 278 ± 123 cc. The prediction model was developed using the healthy breast volume: Implant volume (cc) = healthy breast volume × 0.78 + 26 cc (R2 = 0.900). The prediction model for the ideal implant size using the 3D volume showed better prediction performance than that of using the mastectomy specimen weight (R2 = 0.900 vs 0.759, p < 0.001). Conclusions: The 3D volume of the healthy breast is a more reliable predictor than mastectomy specimen weight to estimate the ideal implant size. The estimation formula obtained in this study may assist in the selection of the ideal implant size in unilateral DTI breast reconstruction. Full article
(This article belongs to the Special Issue Updates in Breast Reconstruction: Review from Evidence)
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13 pages, 1022 KiB  
Article
Intraoperative Intercostal Nerve Block for Postoperative Pain Control in Pre-Pectoral versus Subpectoral Direct-To-Implant Breast Reconstruction: A Retrospective Study
by Jin-Woo Park, Jeong Hoon Kim and Kyong-Je Woo
Medicina 2020, 56(7), 325; https://doi.org/10.3390/medicina56070325 - 30 Jun 2020
Cited by 5 | Viewed by 2914
Abstract
Background and Objectives: Patients undergoing mastectomy and implant-based breast reconstruction have significant acute postsurgical pain. The purpose of this study was to examine the efficacy of intercostal nerve blocks (ICNBs) for reducing pain after direct-to-implant (DTI) breast reconstruction. Materials and Methods: Between January [...] Read more.
Background and Objectives: Patients undergoing mastectomy and implant-based breast reconstruction have significant acute postsurgical pain. The purpose of this study was to examine the efficacy of intercostal nerve blocks (ICNBs) for reducing pain after direct-to-implant (DTI) breast reconstruction. Materials and Methods: Between January 2019 and March 2020, patients who underwent immediate DTI breast reconstruction were included in this study. The patients were divided into the ICNB or control group. In the ICNB group, 4 cc of 0.2% ropivacaine was injected intraoperatively to the second, third, fourth, and fifth intercostal spaces just before implant insertion. The daily average and maximum visual analogue scale (VAS) scores were recorded by the patient from operative day to postoperative day (POD) seven. Pain scores were compared between the ICNB and control groups and analyzed according to the insertion plane of implants. Results: A total of 67 patients with a mean age of 47.9 years were included; 31 patients received ICNBs and 36 patients did not receive ICNBs. There were no complications related to ICNBs reported. The ICNB group showed a significantly lower median with an average VAS score on the operative day (4 versus 6, p = 0.047), lower maximum VAS scores on the operative day (5 versus 7.5, p = 0.030), and POD 1 (4 versus 6, p = 0.030) as compared with the control group. Among patients who underwent subpectoral reconstruction, the ICNB group showed a significantly lower median with an average VAS score on the operative day (4 versus 7, p = 0.005), lower maximum VAS scores on the operative day (4.5 versus 8, p = 0.004), and POD 1 (4 versus 6, p = 0.009), whereas no significant differences were observed among those who underwent pre-pectoral reconstruction. Conclusions: Intraoperative ICNBs can effectively reduce immediate postoperative pain in subpectoral DTI breast reconstruction; however, it may not be effective in pre-pectoral DTI reconstruction. Full article
(This article belongs to the Special Issue Updates in Breast Reconstruction: Review from Evidence)
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10 pages, 619 KiB  
Article
Disparities in Access to Autologous Breast Reconstruction
by David J. Restrepo, Maria T. Huayllani, Daniel Boczar, Andrea Sisti, Minh-Doan T. Nguyen, Jordan J. Cochuyt, Aaron C. Spaulding, Brian D. Rinker, Galen Perdikis and Antonio J. Forte
Medicina 2020, 56(6), 281; https://doi.org/10.3390/medicina56060281 - 8 Jun 2020
Cited by 13 | Viewed by 2222
Abstract
Background and objectives: This study aimed to determine if age, race, region, insurance, and comorbidities affect the type of breast reconstruction that patients receive. Materials and methods: This analysis used the Florida Inpatient Discharge Dataset from 1 January 2013 to 30 September 2017, [...] Read more.
Background and objectives: This study aimed to determine if age, race, region, insurance, and comorbidities affect the type of breast reconstruction that patients receive. Materials and methods: This analysis used the Florida Inpatient Discharge Dataset from 1 January 2013 to 30 September 2017, which contains deidentified patient-level administrative data from all acute care hospitals in the state of Florida. We included female patients, diagnosed with breast cancer, who underwent mastectomy and a subsequent breast reconstruction. We performed an χ2 test and logistic regression in this analysis. Results: On the multivariable analysis, we found that age, race, patient region, insurance payer, and Elixhauser score were all variables that significantly affected the type of reconstruction that patients received. Our results show that African American (odds ratio (OR): 0.68, 95%CI: 0.58–0.78, p < 0.001) and Hispanic or Latino (OR: 0.82, 95%CI: 0.72–0.93, p = 0.003) patients have significantly lower odds of receiving implant reconstruction when compared to white patients. Patients with Medicare (OR: 1.57, 95%CI: 1.33–1.86, p < 0.001) had significantly higher odds and patients with Medicaid (OR: 0.61, 95%CI: 0.51–0.74, p < 0.001) had significantly lower odds of getting autologous reconstruction when compared to patients with commercial insurance. Conclusions: Our study demonstrated that, in the state of Florida over the past years, variables, such as race, region, insurance, and comorbidities, play an important role in choosing the reconstruction modality. More efforts are needed to eradicate disparities and give all patients, despite their race, insurance payer, or region, equal access to health care. Full article
(This article belongs to the Special Issue Updates in Breast Reconstruction: Review from Evidence)
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11 pages, 1059 KiB  
Article
Submuscular and Pre-pectoral ADM Assisted Immediate Breast Reconstruction: A Literature Review
by Roberto Cuomo
Medicina 2020, 56(6), 256; https://doi.org/10.3390/medicina56060256 - 26 May 2020
Cited by 42 | Viewed by 5567
Abstract
Background and objectives: Breast cancer treatment has deeply changed in the last fifty years. Acellular dermal matrices (ADMs) were introduced for breast reconstruction, with encouraging results, but with conflicting reports too. The present paper aims to summarize the current data on breast [...] Read more.
Background and objectives: Breast cancer treatment has deeply changed in the last fifty years. Acellular dermal matrices (ADMs) were introduced for breast reconstruction, with encouraging results, but with conflicting reports too. The present paper aims to summarize the current data on breast reconstruction using acellular dermal matrices. Materials and Methods: We reviewed the literature regarding the use of ADM-assisted implant-based breast reconstruction. Results: The main techniques were analyzed and described. Conclusions: Several authors have recently reported positive results. Nevertheless, an increased complications’ rate has been reported by other authors. Higher cost compared to not-ADM-assisted breast reconstruction is another concern. Full article
(This article belongs to the Special Issue Updates in Breast Reconstruction: Review from Evidence)
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Review

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11 pages, 1442 KiB  
Review
Lipotransfer Strategies and Techniques to Achieve Successful Breast Reconstruction in the Radiated Breast
by Kristina Crawford and Matthew Endara
Medicina 2020, 56(10), 516; https://doi.org/10.3390/medicina56100516 - 1 Oct 2020
Cited by 5 | Viewed by 7896
Abstract
Radiation therapy is frequently a critical component of breast cancer care but carries with it side effects that are particularly damaging to reconstructive efforts. Autologous lipotransfer has the ability to improve radiated skin throughout the body due to the pluripotent stem cells and [...] Read more.
Radiation therapy is frequently a critical component of breast cancer care but carries with it side effects that are particularly damaging to reconstructive efforts. Autologous lipotransfer has the ability to improve radiated skin throughout the body due to the pluripotent stem cells and multiple growth factors transferred therein. The oncologic safety of lipotransfer to the breasts is demonstrated in the literature and is frequently considered an adjunctive procedure for improving the aesthetic outcomes of breast reconstruction. Using lipotransfer as an integral rather than adjunctive step in the reconstructive process for breast cancer patients requiring radiation results in improved complication rates equivalent to those of nonradiated breasts, expanding options in these otherwise complicated cases. Herein, we provide a detailed review of the cellular toxicity conferred by radiotherapy and describe at length our approach to autologous lipotransfer in radiated breasts. Full article
(This article belongs to the Special Issue Updates in Breast Reconstruction: Review from Evidence)
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8 pages, 302 KiB  
Review
Nipple–Areola Complex Reconstruction
by Andrea Sisti
Medicina 2020, 56(6), 296; https://doi.org/10.3390/medicina56060296 - 16 Jun 2020
Cited by 8 | Viewed by 4436
Abstract
The reconstruction of the nipple–areola complex is the last step in the breast reconstruction process. Several techniques have been described over the years. The aim of this review is to provide clarity on the currently available reconstructive options. Full article
(This article belongs to the Special Issue Updates in Breast Reconstruction: Review from Evidence)
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