Impact of Nipple-Areolar Complex Reconstruction on Patient Reported Outcomes After Alloplastic Breast Reconstruction: A BREAST-Q Analysis.

Introduction: The nipple-areola complex (NAC) is essential for breast aesthetics and self-image. However, large-scale studies on patient satisfaction after NAC reconstruction in implant-based breast reconstruction are limited, especially those accounting for confounders. This study aims to evaluate the long-term impact of NAC reconstruction on patient-reported outcomes (PROs) using the BREAST-Q, hypothesizing that NAC reconstruction yields better PROs than no reconstruction.

Long-term Nipple Projection Retention Following Local Flap-based Reconstruction: Insights From 3D Imaging Analysis.

Loss of nipple projection is a common concern following local tissue nipple-areolar complex (NAC) reconstruction, with contracture leading to inevitable projection loss over time. While multiple techniques have been developed, few studies have measured long-term projection loss, and none have utilized 3D imaging for accurate assessment. This study aimed to analyze long-term nipple projection loss using 3D imaging to improve patient education and expectations.

Local Antibiotic Delivery Systems for Infection Prophylaxis in Implant-Based Breast Reconstruction: What Is the Evidence?

Background: Infection is a major complication of implant-based breast reconstruction (IBBR), leading to implant loss, increased healthcare costs, and poor outcomes. Local antibiotic delivery systems offer targeted infection prevention by providing sustained antibiotic release at the surgical site. The aim of this study is to review the existing literature on the efficacy of local antibiotic delivery systems in preventing infection in IBBR.

Risk of Radiation-Induced Capsular Contracture Following Subpectoral or Prepectoral Implant-Based Breast Reconstruction.

Introduction: Radiation significantly increases the risk of capsular contracture after implant-based breast reconstruction. However, the relationship between anatomic plane placement (e.g.

Longitudinal Modeling in Surgical Oncology Research: A Primer Examining Patient-Reported Outcomes.

Background: Oncologic research increasingly prioritizes patient-reported outcomes (PROs) to support patient-centered care. Long-term evaluation of PROs requires longitudinal data analysis, which traditional cross-sectional methods, such as linear regression, cannot adequately address. Advanced statistical models, including linear mixed-effects (LME) and generalized estimating equations (GEEs), are essential to capture the complexity of longitudinal data.

Assessing the Impact of Frailty on Patient-Reported Outcomes and Clinical Complications in Two-Stage Implant-Based Breast Reconstruction.

Background: The 5-item modified frailty index (5-mFI) is used to predict clinical outcomes in breast reconstruction, but its relationship to patient-reported outcomes (PROs) after two-stage implant-based reconstruction (IBR) is unclear. This study evaluates how frailty is associated with clinical outcomes and PROs using the BREAST-Q. We hypothesized that higher 5-mFI scores would correlate with poorer outcomes and PROs.

Complications and Patient-Reported Outcomes in Prepectoral vs Submuscular Breast Reconstruction Following Nipple Sparing Mastectomy.

Background: Preprectoral breast reconstruction and nipple-sparing mastectomy (NSM) have both risen in popularity due to advances in reconstructive techniques. However, it is unknown whether exposed lactiferous ducts in a NSM may increase the risk for infection after prepectoral implant-based breast reconstruction. We aimed to assess complication rates and BREAST-Q Physical Well-Being of the Chest (PWBC) scores in patients who underwent NSM and implant-based breast reconstruction in a prepectoral vs.

Fifty years of free tissue transfer: the past, present and future of microsurgical reconstruction.

G. Ian Taylor and Rollin Daniel described the first fasciocutaneous vascularized free tissue transfer in 1973 using the groin flap. Over the last 50 years, the field of microsurgery has advanced significantly, with the advent of improved surgical instruments, discovery and description of numerous flaps, and a growing application and indications for free tissue transfer.

Long-Term Opioid Use After Free Flap Breast Reconstruction: Incidence and Associated Factors.

Opioid dependence can occur in 6% to 10% of patients undergoing breast reconstruction. With the expansion of interdisciplinary initiatives to decrease opioid use after surgery, an updated look at the incidence of and risk factors for prolonged opioid dependence after free flap breast reconstruction is essential. We retrospectively identified all cases of free flap breast reconstruction completed at our institution from 2017 to 2020.

Nipple Position and Clinical Outcomes Following Nipple-Sparing Mastectomy: An Examination of Prepectoral and Subpectoral Implant-Based Reconstruction Utilizing 3D Imaging.

Background: Nipple-sparing mastectomy (NSM) has become increasingly popular in recent years. However, the impact of prepectoral vs subpectoral implant reconstruction on nipple position, clinical outcomes, and patient-reported outcomes (PROs) after NSM remains unknown.

Objective: We hypothesized that prepectoral reconstruction would lead to a more anatomic nipple position and improved clinical outcomes and PROs when compared to subpectoral reconstruction following NSM.

Combined Autologous Breast Reconstruction and Gynecologic Procedures: Does Timing Affect Clinical and Patient-Reported Outcomes?

Background: Patients with or at risk for breast cancer may opt for risk-reducing gynecologic surgeries, including bilateral salpingo-oophorectomies and/or total abdominal hysterectomy. The timing and safety of combining these procedures with autologous breast reconstruction (ABR) are debated. This study assesses the impact of concurrent ABR and gynecologic surgeries on clinical and patient-reported outcomes.

Moving Toward the Outpatient DIEP Flap: Factors Influencing Early Discharge.

Background: Enhanced recovery after surgery (ERAS) protocols can reduce the length of stay (LOS) for surgical patients, including those undergoing unilateral deep inferior epigastric artery perforator (DIEP) flap breast reconstruction, allowing most patients to be discharged by postoperative day 2. However, some patients require a prolonged inpatient stay because of difficulty completing postoperative milestones. This study aims to identify factors associated with increased LOS after DIEP flap breast reconstruction and to assess safety of earlier discharge.

Improving the Evaluation of Aesthetic Outcomes in DIEP Flap Breast Reconstruction: Validation of the Aesthetic Grading Tool.

Introduction: This study aimed to develop and validate an aesthetic grading tool (AGT) for bilateral DIEP flap breast reconstruction and investigate the correlation of BREAST-Q scores with perceived aesthetic outcomes.

Methods: The AGT utilized a Likert scale to rate aesthetic outcomes based on photographs of post-reconstruction breasts. The validation involved iterative testing with healthcare providers and patients.

Enhancing Patient Decision-Making in Breast Reconstruction: A Systematic Review of Decision Aid Efficacy.

Background: Patients often struggle to select a breast reconstruction option that aligns with their personal values. Decision aids have become popular tools to assist patients in navigating these choices. This systematic review assesses the effectiveness of available breast reconstruction decision aids.

Management of the Infected Tissue Expander.

Background: Tissue expander (TE) infection is a critical postoperative complication in 2-stage implant-based breast reconstruction (IBBR). The authors assessed risk factors associated with TE infection and reconstructive loss and examined reconstructive salvage rates.

Methods: The authors retrospectively reviewed patients who underwent IBBR with TE placement from 2017 to 2022.

Trends and Early Complications in Direct-to-Implant Breast Reconstruction: An Updated Analysis of the ACS-NSQIP Database.

Rates of direct-to-implant (DTI) breast reconstruction, in which breast implants are placed at the time of mastectomy, have been consistently rising. Advances in surgical adjuncts and technology, such as acellular dermal matrices (ADM), have made DTI reconstruction safer and more reliable. However, few studies have characterized early (30-day) postoperative complications following DTI.

Immediate Lymphatic Reconstruction with Vascularized Omentum Lymph Node Transplant: Reducing the Risk of Both Painful Contracture and Lymphedema.

Patients undergoing extensive lymph node dissection and radiation are at high risk for not only lymphedema but also painful contracture. In a standard lymphadenectomy, immediate lymphatic reconstruction using a lymphovenous bypass is effective in reconstructing the lymphatic defect. However, a more aggressive nodal clearance leaves the patient with a large cavity and skeletonized neurovascular structures, often resulting in severe contracture, pain, cosmetic deformity, and venous stricture.

Analyzing mastectomy and reconstruction weight in immediate autologous breast reconstruction: A preliminary study.

Background: This study aims to explore the ideal breast size by assessing the relationship between mastectomy to free flap weight ratio and complications as well as patient-reported outcomes in autologous breast reconstruction (ABR).

Method: A retrospective review of patients undergoing bilateral immediate ABR with mastectomy and flap weights available was completed. Patients were divided into three groups based on the ratio of mastectomy to flap weights.

Social Determinants of Health and Patient-reported Outcomes Following Autologous Breast Reconstruction, Using Insurance as a Proxy.

Background:  Insurance type can serve as a surrogate marker for social determinants of health and can influence many aspects of the breast reconstruction experience. We aimed to examine the impact of insurance coverage on patients reported outcomes with the BREAST-Q (patient reported outcome measure for breast reconstruction patients, in patients receiving) in patients receiving deep inferior epigastric artery perforator (DIEP) flap breast reconstruction.

Methods:  We retrospectively examined patients who received DIEP flaps at our institution from 2010 to 2019.

Clinical, functional, and patient-reported outcomes of radial forearm versus anterolateral thigh free tissue transfer for reconstruction of glossectomy defects.

Background: There is a lack of literature of health-related quality of life endpoints for radial forearm (RF) versus anterolateral thigh (ALT) free flap reconstruction for glossectomy defects. Our goal was to perform a comprehensive evaluation of clinical, functional, and quality of life outcomes after glossectomy reconstruction using a RF or ALT flap.

Methods: A retrospective review was performed on patients who underwent glossectomy and immediate reconstruction with RF or ALT flaps between 2016 and 2021.

Missing Data in Patient-Reported Outcomes Research: Utilizing Multiple Imputation to Address an Unavoidable Problem.

Background: Patient-reported outcomes (PROs) have become a focus in postoperative surgical care. Unfortunately, studies using PROs can be subject to missing data, which may lead to biases or inaccurate conclusions. Multiple imputation (MI) is a statistical method for addressing missing data in clinical research.

Surgical Management of Textured Breast Implants: Assessing Risk and Analyzing Patient-Reported Outcomes.

Background: Textured implants have been linked to breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL). Patients who undergo explantation have options for reconstruction, but data on safety and patient-reported outcomes (PROs) are limited. The purpose of this study was to classify complications and PROs in patients opting for surgical management of textured implants.

Amniotic Band Syndrome: Head-to-Toe Manifestations and Clinical Management Guidelines.

Learning Objectives: After studying this article, the participant should be able to: 1. Understand and describe the basic principles underlying the intrinsic versus extrinsic proposed mechanisms for the development of amniotic band syndrome (ABS). 2.