Refinements in the Techniques of 2-Stage Breast Reconstruction
| Autor: | Amy L. Strong, Tandon R, Rahul Vemula, Abigail E. Chaffin, Freeman, David A. Jansen, Tim Matatov, Rao R |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
medicine.medical_specialty Reconstructive Surgeon medicine.medical_treatment Mammaplasty Tissue Expansion 030230 surgery 03 medical and health sciences 0302 clinical medicine Outcome Assessment Health Care medicine Inframammary fold Humans Acellular Dermis Mastectomy Retrospective Studies business.industry Tissue Expansion Devices Middle Aged Surgery Plastic surgery Private practice 030220 oncology & carcinogenesis Female business Breast reconstruction Tissue expansion Follow-Up Studies |
| Zdroj: | Annals of plastic surgery. 76 |
| ISSN: | 1536-3708 |
| Popis: | BACKGROUND Two-stage breast reconstruction with tissue expanders is one of the most common plastic surgery procedures. Acellular dermal matrix (ADM) has become popular for its ability to improve expansion parameters and aesthetics, albeit with a higher complication profile. We present data that support redefining 2-stage reconstruction to include tissue expanders regardless of final reconstructive modality to act as a bridge. Furthermore, we show that cooperation with the ablative surgeon and technical refinements support ADM omission from the first stage of reconstruction. METHODS We retrospectively reviewed charts from the senior author's (D.A.J.) private practice over a 10-year follow-up period. Inclusion criteria included all women over 18 years who underwent mastectomy and had a tissue expander placed immediately or in a delayed fashion and successfully completed tissue expansion and are finished with the second stage of reconstruction or awaiting second stage of reconstruction. Demographic data, tissue expander filling data, final reconstruction, aesthetic outcome, and complications were tabulated. RESULTS A total of 118 women (165 breasts) met inclusion criteria. There were no statistically significant differences in initial fill volume (P = 0.094), number of visits until final expansion (P = 0.677), or final fill volume (P = 0.985) between the ADM and non-ADM cohorts. In addition, non-ADM patients had superior aesthetic scores with respect to defects other than scarring (P = 0.015), projection (P = 0.013), and inframammary fold quality (P = 0.009). Fifteen percent of women decided to change desired final reconstruction modality during the tissue expansion phase. CONCLUSIONS This reconstructive algorithm emphasizes surgical cooperation between the ablative and reconstructive surgeon, improved technique, and patient education. This focus translates into maintained tissue expansion, aesthetically pleasing results, and allows for the omission of ADM from reconstruction. |
| Databáze: | OpenAIRE |
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