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Clinical Guidance for Breast Reconstruction

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (30 June 2021) | Viewed by 13248

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Prof. Dr. Gottfried Wechselberger

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Guest Editor

Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital of the Brothers of St. John of God, Paracelsus Medical University Salzburg, Kajetanerplatz 1, 5020 Salzburg, Austria
Interests: autologous tissue breast reconstruction; DIEP flap; TMG (TUG) flap; nipple sparing mastectomy; total mastectomy; partial breast defects; implant based breast reconstruction

Special Issue Information

Dear Colleagues,

Breast tumors are one of the most common malignancies among women all over the world. Thus, the scientific progress and advancements in surgical breast tumor removal and breast reconstruction have a high impact on the mortality and morbidity, as well as on psychosocial wellbeing, for thousands of women all over the world. Surgical treatment of localized breast cancer and the subsequent breast reconstruction has evolved rapidly during the last years. The results are getting better and better. There are many surgical options to recreate a natural-appearing breast after tumor removal.

Therefore, I encourage you to submit your work on the recent advances in breast reconstruction to this Special Issue of the highly-impacted Journal of Clinical Medicine.

Prof. Dr. Gottfried Wechselberger
Guest Editor

Manuscript Submission Information

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Keywords

Autologous tissue breast reconstruction
Nipple sparing mastectomy
Total mastectomy
Partial breast defects
Implant-based breast reconstruction

Published Papers (4 papers)

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Research

8 pages, 1035 KiB

Open AccessArticle

The Effect of Perioperative Blood Transfusions on Microvascular Anastomoses

by Lidia Sanchez-Porro Gil, Xavier Leon Vintro, Susana Lopez Fernandez, Carmen Vega Garcia, Gemma Pons Playa, Manuel Fernandez Garrido and Jaume Masia Ayala

J. Clin. Med. 2021, 10(6), 1333; https://doi.org/10.3390/jcm10061333 - 23 Mar 2021

Cited by 4 | Viewed by 2159

Abstract

Introduction: Perioperative transfusions are associated with complications of free flaps. The purpose of the present study was to find out whether there is a significant relationship between the risk of developing complications in vascular anastomoses and the history of transfusions. Methods: We studied 372 patients retrospectively with microsurgical reconstruction between 2009 and 2017 with regards to the number of red blood cell concentrates transfused. Complications were analyzed relative to flap loss and complications in microvascular anastomoses. Results: 130 patients (34.9%) received blood transfusions. Some 55% of them were transfused between the day of the intervention and the first postoperative day. Ninety-six patients were reoperated on (25.7%). Of those, thirty-six patients (37.5%) corresponded to anastomosis failure. The percentage of patients transfused among those who required reoperation was 55.2%. The percentage of patients transfused among those who were reoperated on within the first 72 h due to an alteration in the anastomosis was 60.6%, while it was 25.6% (Chi square P = 0.0001) for the rest of the patients. Conclusions: Although there is a strong association between transfusion and vascular anastomosis failure, it is not possible to establish the causation between the two. Full article

(This article belongs to the Special Issue Clinical Guidance for Breast Reconstruction)

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13 pages, 1780 KiB

Open AccessArticle

Age and Overweight Are Not Contraindications for a Breast Reconstruction with a TMG-Flap—A Risk and Complication Analysis of a Retrospective Double Center Study Including 300 Patients

by Karl Schwaiger, Laurenz Weitgasser, Maximilian Mahrhofer, Kathrin Bachleitner, Selim Abed, Julia Wimbauer, Elisabeth Russe, Thomas Schoeller and Gottfried Wechselberger

J. Clin. Med. 2021, 10(5), 926; https://doi.org/10.3390/jcm10050926 - 01 Mar 2021

Cited by 7 | Viewed by 1744

Abstract

Introduction: The transverse myocutaneous gracilis (TMG) flap has become a popular and reliable alternative for autologous breast reconstruction. Initially described as a valuable tissue source for women with low body-mass index, indications nowadays have widely expanded. The Western civilization demographic development with its aging population and the steady growing average BMI has led to increasing breast reconstructions with TMG flaps in overweight and aged individuals. Patients and Methods: A total of 300 TMG free flaps for unilateral autologous breast reconstruction were evaluated in the form of a retrospective double center cohort study. Data extraction, study group formation and statistical analysis (One-way analysis of variance (ANOVA), Pearson’s chi-squared statistical analysis and relative risk calculation) were done specifically to evaluate age and BMI as risk factors for postoperative complications and outcome. Results: No significant differences in patients’ age and BMI in the complication groups compared to the no-complication group could be found. No significant difference regarding the occurrence of complications could be found in any of the formed risk-groups. No significant increase of minor-, major- or overall complications, flap loss or revision surgeries were found in the elderly patient groups or for patients with overweight. Conclusion: Age and overweight do not significantly increase the risk for postoperative complications after breast reconstructions with free TMG flaps. The findings of this study support the fact that microsurgical breast reconstruction with a free TMG flap should not solely be reserved for younger patients and females with a lower BMI. Full article

(This article belongs to the Special Issue Clinical Guidance for Breast Reconstruction)

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11 pages, 9821 KiB

Open AccessArticle

Autologous Unilateral Breast Reconstruction with Venous Supercharged IMAP-Flaps: A Step by Step Guide of the Split Breast Technique

by Kathrin Bachleitner, Laurenz Weitgasser, Amro Amr and Thomas Schoeller

J. Clin. Med. 2020, 9(9), 3030; https://doi.org/10.3390/jcm9093030 - 20 Sep 2020

Cited by 4 | Viewed by 5091

Abstract

Various techniques for breast reconstruction ranging from reconstruction with implants to free tissue transfer, with the disadvantage of either carrying a foreign body or dealing with donor site morbidity, have been described. In patients who had a unilateral mastectomy and offer a contralateral mamma hypertrophy a breast reconstruction can be performed with the excess tissue from the hypertrophic side using the split breast technique. Here a local internal mammary artery perforator (IMAP) flap of the hypertrophic breast can be used for reconstruction avoiding the downsides of implants or a microsurgical reconstruction and simultaneously reducing the enlarged donor breast in order to achieve symmetry. Methods: Between April 2010 and February 2019 the split breast technique was performed in five patients after mastectomy due to breast cancer. Operating time, length of stay, complications and the need for secondary operations were analyzed and the surgical technique including flap supercharging were described in detail. Results: All five IMAP-flaps survived and an aesthetically pleasant result could be achieved using the split breast technique. An average of two secondary corrections to achieve better symmetry were necessary after each breast reconstruction. Complications included venous flap congestion, partial flap necrosis and asymmetry. No breast cancer recurrence was recorded. An overall approval of the surgical technique among patients was observed. Conclusions: The use of the contralateral breast for unilateral total breast reconstruction represents an additional highly useful technique for selected patients, is safe and reliable results can be achieved. Although this technique is carried out as a single-stage procedure, including breast reduction and reconstruction at the same time, secondary operations may be necessary to achieve superior symmetry and a satisfying aesthetic result. Survival of the IMAP-flaps can be improved by venous supercharging of the flaps onto the thoracoepigastric vein. Full article

(This article belongs to the Special Issue Clinical Guidance for Breast Reconstruction)

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13 pages, 3861 KiB

Open AccessArticle

Bilateral Simultaneous Breast Reconstruction with DIEP- and TMG Flaps: Head to Head Comparison, Risk and Complication Analysis

by Laurenz Weitgasser, Karl Schwaiger, Fabian Medved, Felix Hamler, Gottfried Wechselberger and Thomas Schoeller

J. Clin. Med. 2020, 9(7), 2031; https://doi.org/10.3390/jcm9072031 - 28 Jun 2020

Cited by 10 | Viewed by 3717

Abstract

Background: A two center retrospective cohort study of simultaneous bilateral breast reconstructions using double deep inferior epigastric perforator (DIEP) flaps and double transverse myocutaneous/upper gracilis (TMG) flaps was conducted. The aim of this study was to compare surgical procedures, complications, and overall outcome. Patients and Methods: Two study groups, either receiving a simultaneous bilateral breast reconstruction, with double DIEP flaps (n = 152) in group 1, or double TMG flaps (n = 86) in group 2, were compared. A detailed risk and complication analysis was performed. Patient characteristics, operative time and the need for further operations were evaluated. Results: Double DIEP patients had donor site complications in 23.7% and double TMG patients in 16.3% (p = 0.9075, RR 1.45). Flap loss rates of 3.5% (double TMG) and 2.6% (double DIEP) were recorded (p = 0.7071, RR 1.33). The need for postoperative lipofilling was significantly higher in double TMG patients (65.1% vs. 38.2 %, p = 0.0047, RR 1.71). Conclusion: Complication analysis favors the double DIEP procedure. Donor site morbidity was lower and less severe in the double TMG group. Later fat grafting was more frequently needed after double TMG reconstructions. Further studies, preferably of prospective nature, are needed to evaluate the benefit of bilateral simultaneous breast reconstructions. Full article

(This article belongs to the Special Issue Clinical Guidance for Breast Reconstruction)

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