Optimizing Donor Site Morbidity in DIEP Flap Reconstruction: Advancements in Minimizing Anterior Fascial Defects: A Systematic Review.

Numerous minimally invasive deep inferior epigastric perforator flap (MI-DIEP) techniques have been described in the literature to reduce donor site morbidities. This systematic review aimed to summarize existing MI-DIEP techniques and postoperative outcomes relative to conventional harvest (cDIEP).A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to include articles with novel DIEP harvesting techniques.

Cephalic Vein Transposition for Head and Neck Reconstruction: An Anatomical Study.

This study aims to evaluate the anatomical feasibility and utility of cephalic vein transposition for venous outflow in head and neck reconstruction, particularly in vessel-depleted necks.Bilateral dissections were performed on 11 fresh cadavers to assess the cephalic vein's length, course, and suitability for transposition. The vein was freed, transected at the antecubital fossa, and transposed via a subcutaneous tunnel to the neck.

Expanding the Criteria for Robotic Deep Inferior Epigastric Perforator Flaps: Case Report With Long Intramuscular Course.

Robotic harvest of the deep inferior epigastric perforator flap is gaining traction among plastic surgeons. However, its use is often limited to cases with short intramuscular length of the perforator (<4 cm) due to the need for a larger anterior fascial incision. We present a case of robotic-assisted transabdominal preperitoneal harvest of a 15-cm pedicle, including 9.

Linear and Area Coverage With Closed Incision Negative Pressure Therapy Management: International Multidisciplinary Consensus Recommendations.

Closed incision negative pressure therapy (ciNPT) with foam dressings has received broad recognition for its ability to support incision healing for a variety of surgical procedures. Over time, these dressings have evolved to include linear and 'area' shapes to better conform to different incision types and surface geometries. To address new studies on these configurations and provide guidance for dressing selection, an international, multidisciplinary panel of experts was convened.

Indonesian Translation and Cultural Adaptation of the BREAST-Q Reconstruction Module.

Background: The BREAST-Q reconstruction module, a patient-reported outcome measurement tool, is widely used to assess the impact of breast surgery on patient satisfaction and health-related quality of life. However, translation to the Indonesian language has not been attempted or used for Indonesian-speaking women with breast cancer.

Methods: The Indonesian translation of the BREAST-Q reconstruction module was performed in accordance with the International Society of Pharmacoeconomics and Outcomes Research guidelines, which included forward translation and reconciliation, back translation and review, cognitive debriefing, and cultural adaptation.

The Translation and Cultural Adaptation of LYMPH-Q Upper Extremity Module to the Indonesian Language.

Background: The LYMPH-Q Upper Extremity module is a patient-reported outcome measurement tool developed by the Q-Portfolio team at McMaster University, Canada, and is widely used to determine the health-related quality of life of patients with upper extremity lymphedema. However, the translation of these patient-reported outcome measurement tools to the Indonesian language has not been attempted by any institution.

Methods: The Indonesian translation of the LYMPH-Q Upper Extremity module was performed according to the International Society of Pharmacoeconomics and Outcomes Research guidelines.

The Efficacy of Single-Application NPWTi-d for the Salvage of Infected Breast Prostheses: A Multi-Center Study.

Background: Breast prosthesis infections are challenging and traditionally managed with prosthesis removal and delayed reconstruction. Single-application negative pressure wound therapy with instillation and dwell (NPWTi-d) has shown promise for salvaging infected implants, though prior studies have been small and heterogeneous. This study analyzes outcomes and compares protocols from four institutions.

Comparing Safety Profiles of Skin-Sparing and Nipple-Sparing Mastectomy With Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Retrospective Analysis.

Background: Mastectomy is performed prior to or concurrently with deep inferior epigastric perforator (DIEP) flap breast reconstruction. However, the complication rates of nipple-sparing mastectomy (NSM) versus skin-sparing mastectomy (SSM) with DIEP are not well-characterized.

Methods: This retrospective study included patients who underwent SSM or NSM with DIEP reconstruction between January 2019 and July 2022 at an academic institution.

Evolution and Adaptations of Robotic DIEP Flap Surgery: A Systematic Review.

Background: The integration of robotic technology into surgical procedures has gained considerable attention for its promise to enhance a variety of clinical outcomes. Robotic deep inferior epigastric perforator (DIEP) flap harvest has emerged as a novel approach for autologous breast reconstruction. This systematic review aims to provide a comprehensive overview of the current techniques, outcomes, and complications of robotic DIEP flap surgery.

Accessibility of Neurotization in Deep Inferior Epigastric Perforator Flap Reconstruction: Inequities and Implications for Preauthorization.

Background:  Breast anesthesia and hypoesthesia occur commonly after mastectomy and negatively impact quality of life. Neurotization during deep inferior epigastric perforator (DIEP) breast reconstruction offers enhanced sensory recovery. However, access to neurotization for DIEP reconstruction patients has not been evaluated.

Secondary reduction mammaplasty techniques and outcomes: Cleveland Clinic experience.

Background: Information on optimal techniques and outcomes following secondary reduction mammaplasty remains sparse, with only 280 patient cases reported in the literature to date.

Methods: A total of 7179 medical charts of patients who underwent nononcological breast reduction at the Cleveland Clinic Health System from January 2001 to October 2023 were screened to identify whether the procedure was a secondary reduction. Patient charts were then reviewed to extract demographic, surgical, and outcome data.

Neoadjuvant Reirradiation for Radiation Therapy-Associated Angiosarcoma of the Breast.

Purpose: Radiation-associated angiosarcoma of the breast (RAASB) is a rare side effect after breast radiation and has been associated with poor outcomes. At this time, there is no consensus regarding management of RAASB, and the role of reirradiation remains controversial. We present our modern institutional outcomes in managing RAASB with incorporation of neoadjuvant hyperfractionated reirradiation.

Nipple necrosis rate with submuscular versus prepectoral implant-based reconstruction in nipple sparing mastectomy: Does it differ?

Background: This study aims to compare the rate of nipple necrosis between the submuscular (SM) versus the prepectoral (PP) implant placement after immediate breast reconstruction (IBR).

Methods: An institutional review board-approved database was reviewed of patients who underwent nipple sparing mastectomy (NSM) with IBR at our institution between 2016 and 2019. Patients who had SM versus PP IBR were compared.

Comprehensive Care of Women With Genetic Predisposition to Breast and Ovarian Cancer.

Women at risk for hereditary breast and ovarian cancer syndromes are frequently seen in primary care and gynecology clinics. They present with a distinctive set of clinical and emotional needs that revolve around complex risk management discussions and decision making. The care of these women calls for the creation of individualized care plans that facilitate adjustment to the mental and physical changes associated with their choices.

Predictors of Complications in Autologous Breast Reconstruction Using DIEP Flaps: Implications for Management.

Background: Deep inferior epigastric perforator (DIEP) flaps are the standard for autologous breast reconstruction. This study investigated risk factors for DIEP complications in a large, contemporary cohort to optimize surgical evaluation and planning.

Methods: This retrospective study included patients who underwent DIEP breast reconstruction between 2016 and 2020 at an academic institution.

Incidence of Venous Thromboembolism Based on Caprini Score in Deep Inferior Epigastric Perforator Flap Breast Reconstruction.

Background:  Deep inferior epigastric perforator (DIEP) flaps are commonly used for autologous breast reconstruction, but reported rates of venous thromboembolism (VTE) are up to 6.8%. This study aimed to determine the incidence of VTE based on preoperative Caprini score following DIEP breast reconstruction.

The prevention and treatment of breast cancer- related lymphedema: A review.

Background: Breast cancer- related lymphedema (BCRL) affects about 3 to 5 million patients worldwide, with about 20,000 per year in the United States. As breast cancer mortality is declining due to improved diagnostics and treatments, the long-term effects of treatment for BCRL need to be addressed.

Methods: The American Society of Breast Surgeons Lymphatic Surgery Working Group conducted a large review of the literature in order to develop guidelines on BCRL prevention and treatment.

Simultaneous contralateral prophylactic mastectomy compared to unilateral nipple-sparing mastectomy for breast cancer surgical treatment: Are complications higher?

Background: This study compared post-operative reconstructive complications and oncologic treatment between patients who underwent unilateral versus bilateral nipple sparing mastectomy (NSM) with implant based reconstruction (IBR).

Methods: Patients diagnosed with unilateral breast cancer who underwent NSM with IBR between 2010 and 2019 were reviewed. Patient demographics, surgical details, adjuvant therapy and postoperative complications were analyzed.

Maxillary and Mandibular Healing After Facial Allotransplantation.

Introduction: Facial transplantation has emerged as a viable option in treating devastating facial injuries.Despite the high healing rate of Le Fort III and bilateral sagittal split osteotomies (BSSO) in nontransplant patients, few studies have reported assessment of maxillary and mandibular healing in face transplant patients compared with nontransplant patients. The aim of this study was to examine differences in bone healing in our patients.

Youngest Composite Full-Face Transplant: A Model for Vascularized Composite Allograft in Younger Populations.

Background: The field of face transplantation continues to evolve, with more complex defects being addressed, and, at the same time, increased outcome expectations. Given our unique long-term experience in this field, we consented one of the youngest patients to undergo a full-face transplant.

Methods: An 18-year-old woman presented with complete destruction of her central face and craniofacial structures.

Oncologic safety of axillary lymph node dissection with immediate lymphatic reconstruction.

Purpose: Immediate lymphatic reconstruction (ILR) at the time of axillary lymph node dissection (ALND) can reduce the incidence of lymphedema in patients with breast cancer. The oncologic safety of ILR is unknown and has not been reported. The purpose of this study was to evaluate if ILR is associated with increased breast cancer recurrence rates.

Sensory Restoration in Abdominally Based Free Flaps for Breast Reconstruction Using Nerve Allograft.

Background: Neurotization in breast reconstruction can be performed with the aid of nerve grafts and conduits to decrease the tedious dissection and overcome size mismatch. However, there has yet to be a formal analysis of this approach. The goal of this study was to evaluate sensory recovery after neurotized abdominally based free flaps for breast reconstruction using the authors' novel technique and analyze factors that could affect sensory recovery.