Search Results (92)

Background and Objectives: Breast reconstruction after mastectomy has been shown to significantly improve psychosocial wellbeing and quality of life. Enhanced Recovery After Surgery (ERAS) protocols, especially those tailored to breast reconstruction, have revolutionized recovery by reducing complications, pain, opioid use, and hospital stay while improving patient satisfaction. The purpose of this narrative review was to present existing practices and supporting evidence within current ERAS protocols, as well as propose a modern ERAS framework centered around enhancing the patient experience following breast reconstruction. Methods: A focused literature search was conducted to identify studies investigating emerging approaches to patient care and surgical techniques adopted as part of a broader ERAS workflow Results: Some recent innovations include digital ERAS tracking, robot-assisted techniques, neurotization, and closed incision negative pressure therapy (ciNPT). These innovations show promise in reducing morbidity following reconstruction and may greatly improve sensory and functional outcomes. These advancements also reflect a shift toward more holistic, patient-centered care, extending beyond immediate clinical needs to address long-term wellbeing through psychosocial support and patient-reported outcome measures. Incorporating tools that validate patient perspectives helps guide interventions to optimize satisfaction and recovery. Conclusions: Future research should aim to standardize ERAS protocols by incorporating evidence-based practices, reinforcing breast reconstruction as a patient-centered, evidence-driven process that is focused on comprehensive recovery and improved quality of life. Full article

Background and Clinical Significance: Breast reconstruction following mastectomy is a critical aspect of treatment for many patients, offering both physical and psychological benefits. Traditional methods include autologous tissue flaps and implants, with implant-based techniques being the most prevalent in the Western world. However, complications such as capsular contracture remain a concern. Acellular dermal matrices (ADM) have emerged as a valuable alternative, improving outcomes by reducing capsular contracture rates and enhancing tissue integration. Case Presentation: This case report presents the first use of a novel ADM, biocade^® (biotrics bioimplants AG, Berlin, Germany) in breast reconstruction following a mastectomy. A 55-year-old female patient underwent a left-sided nipple-sparing mastectomy, followed by prepectoral direct-to-implant reconstruction using an ADM-wrapped implant. The patient tolerated the procedure well, with no immediate complications observed. Postoperative monitoring focused on wound healing and assessing for signs of complications related to the implant. The use of the ADM resulted into satisfactory aesthetic and functional outcomes. Conclusions: The successful outcome of this case highlights the potential benefits of using collagen matrices in breast reconstruction, particularly in preserving mastectomy scenarios. The immediate results and improved aesthetics offered by prepectoral direct-to-implant reconstruction with ADM align well with patient expectations for a more natural appearance and faster recovery. However, this case report also highlights the need for ongoing research to fully explore the potential of these biomaterials and address associated challenges. Full article

Background/Objectives: The aim of this case series is to evaluate the outcomes and safety of video-assisted mastectomy, illustrating the harmonious collaboration of oncologic and plastic surgery. This novel minimally invasive technique allows immediate prosthetic reconstruction and represents a cost-effective alternative to robotic breast surgery. Methods: Video-assisted, single-port nipple-sparing mastectomies were performed in patients with small to medium-sized breasts, followed by immediate direct-to-implant reconstruction with either prepectoral or dual plane implant placement. The patients’ electronic medical records were analyzed, including demographic characteristics, operative times and histopathology reports. Results: A total of 18 patients underwent successful video-assisted mastectomy, without conversion to traditional open procedure. Fifteen of the operations were risk-reducing mastectomies. Twelve patients had complementary procedures performed concurrently on the previously operated contralateral breast (delayed reconstruction/expander-to-implant exchange). Moreover, three patients benefited from additional minimally invasive techniques during the same surgery (prophylactic laparoscopic hysterectomy). Immediate breast reconstruction with polyurethane or microtextured breast implants up to 450 cc was performed, with satisfactory aesthetic outcomes and no cancer recurrences at 6 to 12 months postoperative follow-up. Early complications included transient hypercapnia, areolar congestion and cellulitis. No skin necrosis or implant-related complications were reported. The most frequently encountered late issues were contour irregularities. Conclusions: Video-assisted mastectomy facilitates the safe removal of proven pathologic or healthy breast tissue with minimal damage to the breast’s skin envelope, facilitating single-stage breast reconstruction. Full article

Oncoplastic breast-conserving surgery (OBCS), or oncoplastic surgery, has revolutionized the surgical management of breast cancer by integrating oncologic principles with reconstructive techniques to optimize both cancer control and aesthetic outcomes following breast-conserving surgery (BCS). Since its inception in the 1980s, the field has evolved significantly, incorporating a range of volume displacement and volume replacement strategies to restore breast contour after partial mastectomy. This review explores the current practices and key surgical considerations of OBCS. It highlights the role of preoperative multidisciplinary planning, patient selection, anatomical and vascular knowledge, and intraoperative technique in optimizing results. Barriers to access—including disparities in training, insurance, and geographic availability—are addressed, alongside efforts by professional societies like the American Society of Breast Surgeons (ASBS) to standardize definitions and practices. The review also outlines strategies for minimizing complications and enhancing oncologic, reconstructive, and patient-reported outcomes. By offering a comprehensive framework for clinical decision-making, this paper aims to support broader adoption and refinement of OBCS as a standard component of breast cancer care. Full article

Background: Implant-based breast reconstruction (IBBR) is a widely adopted technique following mastectomy in breast cancer patients. However, the impact of chemotherapy type and duration on the development of capsular contracture remains unclear. Methods: This nationwide, retrospective, cohort study used Health Insurance Review and Assessment Service data to identify breast cancer patients who received chemotherapy and underwent immediate IBBR between January 2015 and December 2018. Follow-up continued until January 2024, with a median follow-up of 5.2 years. A total of 4303 patients (direct-to-implant [DTI], n = 2083; tissue expander insertion [TEI], n = 2220) were included. Results: Chemotherapy type and duration were not significantly associated with capsular contracture risk in either the DTI or TEI groups. In the DTI cohort, no significant difference in contracture incidence was found between neoadjuvant and adjuvant chemotherapy before or after matching (p = 0.056 and p = 0.121, respectively). In the TEI cohort, an initially significant difference (p = 0.019) was no longer observed after matching (p = 0.213). Similarly, chemotherapy duration (≤12 weeks vs. >12 weeks) did not impact contracture risk in either cohort. Multivariate analysis identified age, radiotherapy, lymphedema, and axillary lymph node dissection (ALND) as independent risk factors for contracture (p < 0.005). Comorbidities, such as diabetes and autoimmune diseases, also showed no significant association with contracture risk. Conclusions: These findings suggest that chemotherapy decisions should not be guided by contracture concerns. Instead, optimizing reconstruction outcomes should focus on modifiable factors, such as radiotherapy, lymphedema, and ALND. Full article

Several postmastectomy breast reconstruction techniques and procedures have been implemented, although with limited evaluation of benefits and adverse effects. We conducted a systematic review on the plane and timing of reconstruction, and on the use of nipple-sparing mastectomy, acellular dermal matrix, and autologous fat grafting as the evidence base for an updated clinical practice guideline on breast reconstruction for Ontario Health (Cancer Care Ontario). Both immediate and delayed reconstruction may be considered, with preferred timing depending on factors such as patient preferences, type of mastectomy, skin perfusion, comorbidities, pre-mastectomy breast size, and desired reconstructive breast size. Immediate reconstruction may provide greater psychological or quality of life benefits. In patients who are candidates for skin-sparing mastectomy and without clinical, radiological, and pathological indications of nipple-areolar complex involvement, nipple-sparing mastectomy is recommended provided it is technically feasible and acceptable aesthetic results can be achieved. Surgical factors including incision location are important to reduce necrosis by preserving blood supply and to minimize nerve damage. There is a role for both prepectoral and subpectoral implants; risks and benefits will vary, and decisions should be made during consultation between the patient and surgeons. In patients who are suitable candidates for implant reconstruction and have adequate mastectomy flap thickness and vascularity, prepectoral implants should be considered. Acellular dermal matrix (ADM) has led to an increased use of prepectoral reconstruction. ADM should not be used in case of poor mastectomy flap perfusion/ischemia that would otherwise be considered unsuitable for prepectoral reconstruction. Care should be taken in the selection and handling of acellular dermal matrix (ADM) to minimize risks of infection and seroma. Limited data from small studies suggest that prepectoral reconstruction without ADM may be feasible in some patients. Autologous fat grafting is recommended as a treatment for contour irregularities, rippling following implant-based reconstruction, and to improve tissue quality of the mastectomy flap after radiotherapy. Full article

Background and Objectives: Breast reconstruction following mastectomy improves quality of life and psychosocial outcomes, yet it is not consistently performed despite multiple federal mandates. Current data shows decreased reconstruction in minority races, those with a low socioeconomic status, and those holding public health insurance. Many barriers remain misunderstood or unstudied. This study examines barriers to post-mastectomy breast reconstruction to promote a supportive clinical climate by addressing multifactorial obstacles to equitable access to care. Materials and Methods: The California Cancer Registry Data Surveillance, Epidemiology, and End Results (SEER) database and California Health and Human Services Agency Cancer Surgeries Database (2013–2021 and 2000–2021, respectively) were used in this retrospective observational study on mastectomy with immediate breast reconstruction (IBR), delayed breast reconstruction (DBR), or mastectomy only (MO) rates. Data were collected on age, sex, race, insurance type, hospital type, socioeconomic status, and residence. Pearson’s chi-square analysis was performed. Results: We found that 168,494 mastectomy and reconstruction surgeries were performed (82.36% MO, 7% IBR, 10.6% DBR). The 40–49 age group received significantly less MO (38.1%) compared to the 70–74 age group (94.8%, (p = <0.001). Significantly more reconstruction was carried out in patients with private, HMO, or PPO insurance (IBR 75.86%, DBR 75.32%, p = <0.001). Almost all breast surgeries were in urban areas as opposed to rural/isolated rural areas (96.02% vs. 1.55%, p = <0.001). There was no significant difference between races. Of all surgeries, 7.46% were completed in a cancer center with significantly higher rates of IBR. LA County, San Luis Obispo/Ventura County, and Northern CA had significantly more MO than other regions (p = <0.001). Conclusions: Reconstruction rates after mastectomy are low, with only 17.64% of patients undergoing reconstruction. Nationally, 70.5% of patients received MO, with 29.6% undergoing reconstruction. Significant factors positively contributing to reconstruction were private insurance, high SES, cancer center care, and urban residency. Identified barriers include public health insurance enrollment, rural or non-urban residence, older age, low SES, and non-white race/ethnicity, indicating potential monetary influences on care. Full article

Background/Objectives: In the setting of breast surgery, indocyanine green angiography (ICGA) allows estimating the perfusion of cutaneous tissues during surgical interventions, in order to reduce vascularization-related complications. This study has a dual objective: to evaluate the correlation between preoperative factors and the level of skin vascularization, measured by ICGA, in patients undergoing subcutaneous mastectomy for breast cancer; and to establish any relationship between low intraoperative vascularization and the onset of postoperative complications. Methods: This is a preliminary, non-randomized, prospective clinical study that includes 46 female patients undergoing subcutaneous mastectomy with reconstruction for breast cancer between February 2022 and July 2024. The relationship between vascularization and the following preoperative variables was assessed: smoking, previous breast surgeries, prior radiotherapy, neoadjuvant or prior chemotherapy/anti-Her2 therapy, and the thickness of breast subcutaneous tissue evaluated through mammography. For the analysis, three ICGA procedures were performed, using 0.125 mg/kg of indocyanine green (ICG) for each procedure before the surgical incision (V1), at the end of the demolition phase (V2), and at the end of the reconstruction phase (V3). The results of this analysis were finally correlated with the occurrence of any postoperative complications. Results: Vascularization was conventionally classified as “low” and “good” using a cutoff of 33%. Previous surgeries on the ipsilateral breast and neoadjuvant or prior chemotherapy/anti-Her2 therapy were found to be predictive factors of “low” vascularization (p = 0.031). Patients with “low” vascularization at time V3 showed a significantly higher risk of developing complications (p = 0.038). Incision length emerged as an independent predictor of complications, with a 23% increase in risk per additional centimeter (p = 0.006), independent of perfusion level. Conclusions: This study supports the use of ICGA as a useful tool to improve outcomes in patients undergoing subcutaneous mastectomy with prosthetic reconstruction for breast cancer. The results of this preliminary work are encouraging, and recruiting a larger number of patients could provide more significant data. Full article

Background/Objectives: Breast reconstruction (BR) following mastectomy plays a critical role in post-cancer care by offering both physical and psychological benefits. Despite advancements in techniques and shared decision-making (SDM), BR uptake remains inconsistent. This systematic review aims to synthesize evidence on objective (medical and socioeconomic) and subjective (psychological and personal) factors influencing BR decision-making among women undergoing mastectomy for breast cancer. Methods: A systematic search was conducted across PubMed, ScienceDirect, OVID, and Google Scholar, identifying peer-reviewed studies published between January 2013 and 25 July 2024. Eligible studies examined determinants of BR decisions in women undergoing therapeutic mastectomy, excluding perspectives of non-patient stakeholders and post-decision outcomes. The risk of bias and study quality were assessed using the Quality Appraisal for Diverse Studies (QuADS) tool. This review was registered in PROSPERO (CRD42023456198) and followed PRISMA guidelines. Results: Twenty-seven studies comprising 994,528 participants across 16 countries met the inclusion criteria. The objective factors included age, comorbidities, insurance coverage, physician recommendations, and healthcare access. The subjective factors encompassed body image concerns, self-esteem, fear of recurrence, and emotional readiness. Younger age, private insurance, and active physician counseling were associated with increased BR uptake, while older age, lack of information, and financial or logistical barriers reduced uptake. Regional disparities were noted across healthcare systems. Conclusions: BR decisions are influenced by complex, interrelated clinical, psychological, and systemic factors. Integrating SDM tools, enhancing patient education, and addressing healthcare inequities are essential for supporting informed and equitable BR decision-making. Future research should prioritize longitudinal studies and policy interventions to improve access to and patient satisfaction with BR outcomes. Full article

Background/Objectives: Immediate implant-based breast reconstruction is an established option for selected patients undergoing mastectomy. However, patients with large and ptotic breasts present specific reconstructive challenges, often requiring tailored approaches to minimize complications and optimize aesthetics. This pilot study aimed to evaluate the clinical feasibility and effectiveness of a mobile application developed to support intraoperative decision-making based on an institutional algorithm for breast reconstruction. It is also important to underline that this pilot study was exploratory in nature and primarily aimed at assessing feasibility and adherence to an app-based decision pathway, rather than comparative efficacy. Methods: We conducted a prospective observational study from October 2023 to December 2024 at the University Hospital of Sassari. Female patients with large and ptotic breasts undergoing immediate implant-based reconstruction were included. A mobile app, developed using MIT App Inventor 2, implemented our institution’s algorithm and guided surgeons through both preoperative and intraoperative decision-making. Surgical options included subpectoral, prepectoral with autologous fascial flaps, or prepectoral with acellular dermal matrix (ADM) reconstruction, depending on flap thickness and fascia integrity. Results: Sixteen patients (21 reconstructed breasts) were included. Surgical planning and execution followed app-generated recommendations in all cases, with no intraoperative deviations. Subpectoral reconstruction was performed in six patients, prepectoral with ADM in eight, and prepectoral with fascial flaps in two. The app was rated positively by all surgeons and facilitated consistent decision-making. Conclusions: The proposed mobile application, described in this pilot study, proved to be a feasible and effective decision-support tool for implant-based breast reconstruction in patients with challenging anatomy. It standardized surgical choices, supported training, and has the potential to enhance reproducibility and safety in complex reconstructive procedures. Full article

Background/Objectives: As the incidence of breast cancer increases, reliable, effective, and innovative solutions are required for breast deformities following breast-conserving surgery. We aimed to evaluate the biocompatibility and efficacy of optimized three-dimensional (3D) micro-nanofiber scaffolds and demonstrate their clinical potential through preclinical experiments. Methods: Seven-week-old male Sprague-Dawley rats were randomized into four groups. Group I (control group) received a 2-dimensional (2D) micro-nanofiber scaffold weighing 0.2 g; Groups II–IV received 3D micro-nanofiber scaffolds weighing 0.2, 0.3, and 0.6 g, respectively. These were subcutaneously implanted into the dorsal region and harvested with the surrounding tissues at 4, 8, and 16 weeks for histological evaluation. Results: The number of inflammatory cells was higher in Group IV than in Groups II and III at 4 weeks, with a significant increase in Group IV (p < 0.01) compared with that in Group I. At 8 weeks, it was significantly increased in Group III compared with that in Group I. Furthermore, at 16 weeks, it was significantly reduced in Group IV (p < 0.05) compared with that in Group I. The fibrosis depth in the 3D scaffolds revealed significant differences in Groups II, III, and IV (p < 0.001) compared with Group I at 4 weeks. The collagen fiber densities in the 3D groups were higher than those in the 2D group at 8 and 16 weeks. There were no statistically significant differences between the 3D groups. Conclusions: Absorbable 3D micro-nanofiber scaffolds enhance tissue integration and extracellular matrix formation following post-mastectomy breast reconstruction. Full article

Background: Robotic surgical systems offer enhanced precision, motion scaling, tremor filtration, and visualization, making them highly suitable for the complex anatomical demands of plastic and reconstructive surgery. While widely implemented in other specialties, their integration in plastic surgery remains limited. This systematic review evaluates the clinical applications, outcomes, and limitations of robotic-assisted techniques in plastic and reconstructive procedures. Methods: Following PRISMA guidelines, a systematic search was conducted across PubMed, Embase, Scopus, and Web of Science for studies published between January 1980 and March 2025. Clinical studies reporting robotic applications in plastic surgery were included, while cadaveric, animal, and non-English studies were excluded. Data extraction and quality assessment were performed using Covidence and validated tools including the CARE checklist, NOS, GRADE, and SYRCLE. A total of 1428 studies were screened, and 31 met the inclusion criteria. Results: Robotic systems were primarily applied in microsurgery (n = 16), breast reconstruction (n = 8), and craniofacial/aesthetic surgery (n = 7). Common platforms included the Symani Surgical System, Da Vinci systems, and ARTAS. Robotic-assisted approaches improved precision, aesthetic outcomes, flap survival, and patient satisfaction, particularly in procedures involving lymphaticovenous anastomosis and nipple-sparing mastectomy. However, challenges included steep learning curves, longer operative times, high equipment costs, and the lack of haptic feedback. Quality assessment rated all studies as moderate. Conclusions: Robotic-assisted surgery demonstrates considerable potential in enhancing plastic and reconstructive outcomes. As systems become more compact, cost-effective, and integrated with AI and biomimetic technologies, their broader adoption is anticipated. Further high-quality studies are needed to optimize these systems and support widespread clinical implementation. Full article

Background/Objectives: Deep inferior epigastric perforator (DIEP) flap reconstruction is considered the gold standard for autologous breast reconstruction due to its favorable aesthetic results and low donor site morbidity. Nevertheless, it remains associated with potentially life-threatening complications such as deep vein thrombosis (DVT) and pulmonary embolism (PE). This report aims to describe a complex clinical case in which severe thromboembolic and ischemic complications occurred despite adherence to standard prophylactic protocols. Methods: We present the case of a 65-year-old female with multiple thromboembolic risk factors—including obesity, a history of heavy smoking, hormone therapy, and prior COVID-19 infection—who underwent immediate bilateral breast reconstruction with DIEP flaps following mastectomy. Results: Within the first 24 h postoperatively, the patient developed a massive pulmonary embolism requiring intensive care management. Despite appropriate anticoagulation and supportive measures, she subsequently experienced full-thickness necrosis of the central portion of the abdominal flap. Thrombophilia screening and diagnostic imaging did not reveal peripheral venous thrombosis, raising the hypothesis of a hypercoagulable state potentially related to prior SARS-CoV-2 infection. Conclusions: This case underscores the importance of individualized risk stratification and suggests that current prophylaxis protocols may be insufficient for patients with overlapping thrombotic risk factors. The findings advocate for further investigation into the long-term vascular effects of COVID-19 and support reconsidering extended or intensified prophylaxis in high-risk populations undergoing complex microsurgical procedures. Full article

Background: Few studies have compared the risk of reoperation by timing in breast reconstruction surgery after mastectomy. We evaluated the first and total number of reoperations by reconstruction timing in women with breast cancer undergoing primary mastectomy. Methods: A cohort study of 23,301 primary mastectomies in women with breast cancer undergoing either immediate breast reconstruction (IBR) or delayed reconstruction was carried out within Kaiser Permanente between 2010 and 2022. The first reoperation rate was calculated using cause-specific Cox Proportional Hazards Models, while Multiplicative Cox Proportional Hazards Models were used to account for mortality and timing in reoperation. Patients were continuously monitored for death, outcome of interest, loss to follow-up through healthcare membership termination, or study end date (31 December 2022). Results: In total, 78.4% (n = 18,276) of the cohort underwent IBR. The average follow-up time was 5.9 years (±3.8). The following covariates were imbalanced (standardized mean difference [SMD] ≥ 0.20) between IBR and delayed groups: BMI, smoking status, year of mastectomy, bilateral procedures, and reconstruction type. The crude incidence of first reoperation was 33.04% vs. 31.72% in IBR vs. delayed patients and the risk of reoperation was 18% higher in IBR patients (HR = 1.18, 95% CI = 1.12–1.25). There was no difference in the risk of reoperation by timing (p > 0.05) when assessing multiple reoperations. The reoperation risk was the highest for IBR patients who did not complete reconstruction or single-stage reconstruction. In addition, the first reoperation rate of IBR patients was higher in those who underwent expander–implant-based reconstruction. Conclusions: The first reoperation rate was higher in IBR patients compared to those who delayed reconstruction, although we failed to detect a difference for multiple returns to surgery, except in certain subgroups. Assessing reoperation risk by timing among different reconstruction modalities can aid patients in making informed decisions about the type of breast reconstruction to undergo. Full article

Objectives: The term ‘prosthesis’ in reference to breast implants is used to clarify its distinction from the general term ‘breast implant’, which is widely adopted by plastic surgeons. This terminology highlights the role of the implant as a functional tissue substitute, particularly in post-mastectomy reconstruction, rather than solely as a cosmetic enhancement. This distinction is relevant for understanding the long-term implications of implant-based reconstruction and the associated complications. The aim of this systematic review was to compile and analyze the current evidence on the long-term complications associated with breast implants. We explored how these complications vary depending on implant type, surgical techniques, patient-specific factors, and the indication for implantation (cosmetic vs. reconstructive). These indications were analyzed separately to avoid assumptions regarding their correlation with surgical techniques. Methods: A systematic search was conducted across PubMed, Web of Science, and Scopus for studies published up to December 2024, following PRISMA 2020 guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. An initial search identified 1480 studies. After screening and applying inclusion criteria, 11 studies were selected for the final analysis. Studies included in this review reported long-term complications in human subjects, were published in English, and evaluated breast implants. The quality of the included studies was assessed using the ROBINS-E tool. Additionally, subgroup analyses examined differences based on implant type (silicone vs. saline), surgical techniques, and patient characteristics, such as age, comorbidities, and the duration of follow-up. Results: This review study was performed between September 2024 and December 2024. A total of 11 studies were included in the review. The included studies were published between 1997 and 2021, providing a long-term perspective on breast implant complications. The most frequently reported complications were capsular contracture, implant rupture, seroma, and infection, with capsular contracture being the most prevalent. Silicone implants were associated with a higher risk of rupture compared to saline implants. Techniques using textured implants and dual-plane placements were found to reduce the incidence of capsular contracture. Patient-related factors, such as age and smoking status, were identified as significant risk factors for complications, while longer follow-up periods revealed more late-onset complications. Conclusions: This review underscores the importance of understanding the long-term risks of breast implants and highlights the need for personalized surgical planning and thorough follow-up care. Future studies should focus on standardizing outcomes reporting and further evaluating the safety and effectiveness of new implant materials and surgical approaches. Full article