735 Records downloaded - Mon Apr 16 00:38:11 UTC 2018 RECORD 1 TITLE Breast reconstruction with Alloderm Ready to Use: A meta-analysis of nine observational cohorts AUTHOR NAMES Wu L.-H. Zhang M.-X. Chen C.-Y. Fang Q.-Q. Wang X.-F. Tan W.-Q. AUTHOR ADDRESSES (Wu L.-H.; Zhang M.-X.; Chen C.-Y.; Fang Q.-Q.; Wang X.-F.; Tan W.-Q., tanweixxxx@zju.edu.cn) Department of Plastic Surgery, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu, China. CORRESPONDENCE ADDRESS W.-Q. Tan, Department of Plastic Surgery, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, N1 Shangcheng Road, Yiwu, China. Email: tanweixxxx@zju.edu.cn SOURCE Breast (2018) 39 (89-96). Date of Publication: 1 Jun 2018 ISSN 1532-3080 (electronic) 0960-9776 BOOK PUBLISHER Churchill Livingstone ABSTRACT Background: AlloDerm-RTU is a new member of human acellular dermal matrix (HADM) which was launched in 2012. The present meta-analysis aimed to investigate whether AlloDerm-RTU was superior compared with previous HADMs. Methods: All available databases were searched for retrospective or prospective studies regarding breast reconstruction with AlloDerm-RTU compared with other HADMs. The primary outcome was the incidence of complications among different HADMs. Results: Two prospective and seven retrospective studies with a total of 1406 patients were enrolled. There was no significant difference in any of the complications, including the incidence of hematoma (RR 0.78, 95%CI 0.19 to 3.19; P = 0.73), seroma (RR 0.98, 95%CI 0.43 to 2.26; P = 0.97), cellulitis (RR 0.82, 95%CI 0.32 to 2.11; P = 0.68), necrosis (RR 0.69, 95%CI 0.44 to 1.10; P = 0.12), infection (RR 0.68, 95%CI 0.37 to 1.25; P = 0.22), explantation (RR 0.61, 95%CI 0.35 to 1.06; P = 0.08), and total complications (RR 0.91, 95%CI 0.55 to 1.52; P = 0.73). Subgroup analysis showed that AlloDerm-RTU demonstrated no superiority compared with FD AlloDerm, AlloMax, or DermACELL. Sensitivity analysis indicated that the outcomes were stabilized. No publication bias existed in the present meta-analysis. Conclusion: Four HADM products, AlloDerm-RTU, FD AlloDerm, AlloMax, and DermACELL, showed similar risks of complications. However since most of the included studies had a low level of evidence, further random trials with large numbers of patients are needed. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction surgical mesh EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult article cellulitis clinical trial (topic) complication explant female hematoma human incidence infection male meta analysis necrosis outcome assessment prospective study publishing retrospective study sensitivity analysis seroma LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20180251151 PUI L2000629143 DOI 10.1016/j.breast.2018.03.007 FULL TEXT LINK http://dx.doi.org/10.1016/j.breast.2018.03.007 COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 2 TITLE The use of acellular dermal matrix in immediate two-stage prosthetic breast reconstruction provides protection from postmastectomy radiation therapy: a clinicopathologic perspective AUTHOR NAMES Park T.H. Chung S.W. Song S.Y. Lew D.H. Roh T.S. Lee D.W. AUTHOR ADDRESSES (Park T.H.) Department of Plastic and Reconstructive Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea. (Chung S.W.; Song S.Y.; Lew D.H.; Roh T.S.; Lee D.W., psleedw@gmail.com) Institute for Human Tissue Restoration, Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, South Korea. CORRESPONDENCE ADDRESS D.W. Lee, Institute for Human Tissue Restoration, Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, South Korea. Email: psleedw@gmail.com SOURCE Journal of Materials Science: Materials in Medicine (2018) 29:3 Article Number: 27. Date of Publication: 1 Mar 2018 ISSN 1573-4838 (electronic) 0957-4530 BOOK PUBLISHER Springer New York LLC, barbara.b.bertram@gsk.com ABSTRACT Although there is ample evidence showing that radiation therapy increases the risk of complications of breast reconstruction, the efficacy of human acellular dermal matrix (CGCryoDerm®) in immediate tissue expander breast reconstruction in the setting of postmastectomy radiation therapy has not been fully elucidated. In this study, we report our institutional experience with pertinent refined surgical technique, and determine whether acellular dermal matrices have a protective effect in this increasingly prevalent clinical setting. Twenty-six patients who underwent immediate two-stage breast reconstruction in the setting of postmastectomy radiation therapy with at least 2 years of follow-up were retrieved. Fifteen patents were reconstructed with ADM, whereas 11 patients were reconstructed without ADM. The occurrence of complications was assessed according to the reconstruction type (with ADM vs without ADM). Furthermore, in patients reconstructed with ADM (n = 15), immunohistochemistry was performed to analyze the breast capsule with ADM compared with that without ADM in the same patient, according to the expression of alpha-smooth muscle actin (α-SMA). The occurrence of complications was significantly associated with the reconstruction type (with ADM vs. without ADM, p = 0.015). On the basis of the results of α-SMA staining, α-SMA+ myofibroblasts were relatively highly expressed throughout the breast capsule without ADM. On the contrary, α-SMA+ myofibroblasts present at the breast capsule adjacent to the ADM were scarce and irregularly scattered. Use of an acellular dermal matrix may be recommended to patients who are concerned about complications after immediate two-stage breast reconstruction in the setting of postmastectomy radiation therapy. EMTREE DRUG INDEX TERMS alpha smooth muscle actin (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast prosthesis breast radiotherapy breast reconstruction mastectomy postoperative care EMTREE MEDICAL INDEX TERMS adult article clinical article controlled study female follow up human human cell human tissue immunohistochemistry myofibroblast priority journal protein expression retrospective study surgical technique EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Dermatology and Venereology (13) Radiology (14) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Internal Medicine (6) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20180168476 PUI L621063535 DOI 10.1007/s10856-018-6036-6 FULL TEXT LINK http://dx.doi.org/10.1007/s10856-018-6036-6 COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 3 TITLE Dutch breast reconstruction guideline AUTHOR NAMES Mureau M.A.M. van der Hulst R.R.W.J. Woerdeman L.A.E. van Leeuwenhoek A. van Turnhout A.A.W.M. Posch N.A.S. Menke-Pluijmers M.B.E. Luiten E.J.T. Westenberg A.H. Gopie J.P. Zonderland H.M. Westerhof M. Krol-Warmerdam E.M.M. Niël-Weise B.S. AUTHOR ADDRESSES (Mureau M.A.M., m.mureau@erasmusmc.nl; van der Hulst R.R.W.J.) Maastricht University Medical Centre, Orbis Medical Centre, Viecuri Medical Centre, Maastricht, Netherlands. (Woerdeman L.A.E.; van Leeuwenhoek A.) Netherlands Cancer Institute, Amsterdam, Netherlands. (van Turnhout A.A.W.M.) Tergooi Hospital, Hilversum Site, Netherlands. (Posch N.A.S.) Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, Netherlands. (Menke-Pluijmers M.B.E.) Albert Schweitzer Hospital, Dordrecht, Netherlands. (Luiten E.J.T.) Amphia Hospital, Breda, Netherlands. (Westenberg A.H.) Arnhem Radiotherapy Institute, Arnhem, Netherlands. (Gopie J.P.; Krol-Warmerdam E.M.M.) Leiden University Medical Centre, Leiden, Netherlands. (Zonderland H.M.) Academic Medical Centre, Amsterdam, Netherlands. (Westerhof M.) Netherlands Breast Cancer Association, Utrecht, Netherlands. (Niël-Weise B.S.) Knowledge Institute for Medical Specialists (KIMS), Utrecht, Netherlands. CORRESPONDENCE ADDRESS M.A.M. Mureau, Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, PO Box 2040, Rotterdam, Netherlands. SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2018) 71:3 (290-304). Date of Publication: 1 Mar 2018 ISSN 1878-0539 (electronic) 1748-6815 BOOK PUBLISHER Churchill Livingstone ABSTRACT Treatment of breast cancer is complex and multidisciplinary by nature, with protocols that are updated continuously. During preoperative multidisciplinary team meetings, regularly there is discussion between team members regarding optimal timing and type of breast reconstruction, due to conflicting interests of oncological and reconstructive treatments. Therefore, a multidisciplinary, evidence-based guideline for breast reconstruction in women undergoing breast conserving therapy or mastectomy for breast cancer, or following prophylactic mastectomy was developed by a multidisciplinary working group. The guideline was drafted in accordance with the AGREE II instrument, designed to assess the quality of guidelines with broad international support. For the recommendations, scientific evidence was considered together with other key aspects, such as working group member expertise, patient preferences, costs, availability of facilities and/or organizational aspects. Recommendations provide an answer to the primary questions, and are based on the best scientific evidence available together with the most important considerations by the working group. In accordance with the GRADE method, the level of scientific evidence and the importance given to considerations by the working group jointly determined the strength of the recommendation. The guideline aims to provide practical guidance for plastic surgeons and other members of the multidisciplinary breast cancer team. The implementation of the present breast reconstruction guideline may contribute to optimizing the delivery of care and support for breast reconstruction patients, it may stimulate evidence-based plastic surgery, it may reduce undesirable variation in clinical practice between health care providers, and improve the overall quality of life of breast reconstruction patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (radiotherapy, surgery) breast reconstruction Netherlands practice guideline EMTREE MEDICAL INDEX TERMS acellular dermal matrix autologous fat grafting breast implant cancer patient cancer radiotherapy clinical practice deep inferior epigastric perforator flap diagnostic imaging evidence based medicine experimental therapy health care availability health care cost health care delivery health care facility health care organization health care personnel health care planning high risk patient human latissimus dorsi flap latissimus dorsi muscle mastectomy nipple sparing mastectomy partial mastectomy patient participation patient preference plastic surgeon plastic surgery priority journal prophylactic mastectomy quality of life review skin transposition flap tissue graft treatment indication EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) Health Policy, Economics and Management (36) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20180111217 PUI L620703810 DOI 10.1016/j.bjps.2017.12.020 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2017.12.020 COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 4 TITLE Breast reconstruction in a regional breast cancer network: Ten years on AUTHOR NAMES Tatterton M. AUTHOR ADDRESSES (Tatterton M.) Royal Bournemouth Hospital, United Kingdom. CORRESPONDENCE ADDRESS M. Tatterton, Royal Bournemouth Hospital, United Kingdom. SOURCE European Journal of Surgical Oncology (2018) 44 Supplement 1 (S17). Date of Publication: 1 Mar 2018 CONFERENCE NAME Association for Cancer Surgery Annual Scientific Conference and the NCRI Cancer Conference 2017 CONFERENCE LOCATION Glasgow, United Kingdom CONFERENCE DATE 2017-11-05 to 2017-11-08 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Background: The final annual report of the 'National Mastectomy and Breast Reconstruction Audit' (NA) was published in 2011. In 2007 we performed a multi-centre audit, reviewing all breast reconstructions within the Dorset Breast Cancer Network. 2 We now present results following a reaudit of all breast reconstructions performed within the same cancer network over a one year period and compare then against the NA and 2007 audit results. Method: Retrospective case note review of 73 patients who underwent breast reconstruction in Dorset during 2014. Results: Average age at reconstruction within the Dorset network was 59 years (NA 51), compared to 50 in 2007. 70% of patients in Dorset had immediate reconstruction (NA 67%), whilst 30% underwent delayed reconstruction (NA 33%), almost identical to Dorset figures in 2007 (71% and 29% respectively). A pedicled flap was the most common reconstruction in Dorset in 2007. An implantbased reconstruction with an acellular dermal matrix (ADM) was the most common procedure in 2014 (32%). 63% of patients undergoing reconstruction had invasive disease compared to 47% of patients in 2007 (NA 76%). Implant-based complication rates in Dorset have increased from 7.79% to 17% since 2007. 17% of reconstructive patients in the NA required re-admission due to complications compared to only 6% in Dorset. There was no post-operative mortality in Dorset (NA 0.1%). Conclusion: Rates of immediate versus delayed reconstruction remain comparable in all audits. The Dorset network is now reconstructing patients with an age increase of nearly a decade and an increasing rate of invasive disease. Rates of implant-based reconstruction with ADM are increasing which is reflected in an increase in implant-based complication rates. Despite this, the complication re-admission rate in Dorset remains well below NA figures. This re-audit also clearly highlights the shifting practice in breast reconstruction since the NA began. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer breast reconstruction EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult complication conference abstract controlled study female hospital readmission human implant major clinical study middle aged pedicled skin flap retrospective study surgical mortality LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L621417812 DOI 10.1016/j.ejso.2018.01.513 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2018.01.513 COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 5 TITLE Assessing value in breast reconstruction: A systematic review of cost-effectiveness studies AUTHOR NAMES Sheckter C.C. Matros E. Momeni A. AUTHOR ADDRESSES (Sheckter C.C.; Momeni A., amomeni@stanford.edu) Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, United States. (Sheckter C.C.) Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, United States. (Matros E.) The Plastic and Reconstructive Surgery Service at Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, United States. CORRESPONDENCE ADDRESS A. Momeni, Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, 770 Welch Road, #400, Palo Alto, United States. Email: amomeni@stanford.edu SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2018) 71:3 (353-365). Date of Publication: 1 Mar 2018 ISSN 1878-0539 (electronic) 1748-6815 BOOK PUBLISHER Churchill Livingstone ABSTRACT Introduction: Breast reconstruction is one of the most common procedures performed by plastic surgeons and is achieved through various choices in both technology and method. Cost-effectiveness analyses are increasingly important in assessing differences in value between treatment options, which is relevant in a world of confined resources. A thorough evaluation of the cost-effectiveness literature can assist surgeons and health systems evaluate high-value care models. Methods: A systematic review of PubMed, Web of Science, and the Cost-Effectiveness Analysis Registry was conducted. Two reviewers independently evaluated all publications up until August 17, 2017. Results: After removal of duplicates, 1996 records were screened, from which 53 studies underwent full text review. All the 13 studies included for final analysis mention an incremental cost-effectiveness ratio. Five studies evaluated the cost-effectiveness of technologies including acellular dermal matrix (ADM) in staged prosthetic reconstruction, ADM in direct-to-implant (DTI) reconstruction, preoperative computed tomography angiography in autologous reconstruction, indocyanine green dye angiography in evaluating anastomotic patency, and abdominal mesh reinforcement in abdominal tissue transfer. The remaining eight studies evaluated the cost-effectiveness of different reconstruction methods. Cost-effective strategies included free vs. pedicled abdominal tissue transfer, DTI vs. staged prosthetic reconstruction, and fascia-sparing variants of free abdominal tissue transfer. Conclusions: Current evidence demonstrates multiple cost-effective technologies and methods in accomplishing successful breast reconstruction. Plastic surgeons should be well informed of such economic models when engaging payers and policymakers in discussions regarding high-value breast reconstruction. EMTREE DRUG INDEX TERMS indocyanine green EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction cost effectiveness analysis EMTREE MEDICAL INDEX TERMS acellular dermal matrix angiography article computed tomographic angiography deep inferior epigastric perforator flap direct to implant reconstruction human priority journal rectus abdominis muscle systematic review transverse rectus abdominis musculocutaneous flap CAS REGISTRY NUMBERS indocyanine green (3599-32-4) EMBASE CLASSIFICATIONS Dermatology and Venereology (13) Health Policy, Economics and Management (36) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170843161 PUI L619470057 DOI 10.1016/j.bjps.2017.09.010 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2017.09.010 COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 6 TITLE Prepectoral implant-based breast reconstruction; complete acellular dermal matrix wrap or anterior circumferential cover AUTHOR NAMES Nadeem R. AUTHOR ADDRESSES (Nadeem R., nadeem_rana@hotmail.com) Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom. CORRESPONDENCE ADDRESS R. Nadeem, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom. Email: nadeem_rana@hotmail.com SOURCE Breast Journal (2018) 24:2 (223-224). Date of Publication: 1 Mar 2018 ISSN 1524-4741 (electronic) 1075-122X BOOK PUBLISHER Blackwell Publishing Inc., subscrip@blackwellpub.com EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant (adverse device effect) breast reconstruction prepectoral implant based breast reconstruction EMTREE MEDICAL INDEX TERMS Braxon dermal matrix breast areola graft necrosis human implant capsular contracture (complication) letter mastectomy Mentor implant nipple areola complex necrosis nipple sparing mastectomy nonhuman operation duration postoperative infection risk reduction seroma skin sparing mastectomy thorax wall wound dehiscence DEVICE TRADE NAMES Braxon dermal matrix Mentor implant EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20170554138 PUI L617615651 DOI 10.1111/tbj.12881 FULL TEXT LINK http://dx.doi.org/10.1111/tbj.12881 COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 7 TITLE One-stage muscle-sparing breast reconstruction in elderly patients: A new tool for retaining excellent quality of life AUTHOR NAMES Maruccia M. Di Taranto G. Onesti M.G. AUTHOR ADDRESSES (Maruccia M., marucciam@gmail.com; Di Taranto G.; Onesti M.G.) Department of Plastic and Reconstructive Surgery, Sapienza University, Rome, Italy. CORRESPONDENCE ADDRESS M. Maruccia, Department of Plastic and Reconstructive Surgery, Sapienza University, Rome, Italy. Email: marucciam@gmail.com SOURCE Breast Journal (2018) 24:2 (180-183). Date of Publication: 1 Mar 2018 ISSN 1524-4741 (electronic) 1075-122X BOOK PUBLISHER Blackwell Publishing Inc., subscrip@blackwellpub.com ABSTRACT More than 50% of breast cancer care occurs in elderly but women aged 65 and over generally have lower breast reconstruction (BR) rates. In medical literature, few papers focused on BR in elderly patients and usually the reported techniques are multisteps such as expander-implant reconstruction, local, and free flaps. We present a one-stage reconstruction technique employed in elderly patients: muscle-sparing immediate BR with subcutaneous implant and Braxon acellular dermal matrix. We prove the feasibility and safety of the technique and believe that this new procedure could represent a potential benefit in elderly BR. EMTREE DRUG INDEX TERMS antineoplastic agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction quality of life EMTREE MEDICAL INDEX TERMS acellular dermal matrix aged article Braxon breast cancer (disease management, drug therapy, radiotherapy, surgery) breast implant breast tissue expander cancer adjuvant therapy female free tissue graft human major clinical study mastectomy neoadjuvant chemotherapy treatment outcome DEVICE TRADE NAMES Braxon EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) Drug Literature Index (37) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170505376 PUI L617317058 DOI 10.1111/tbj.12860 FULL TEXT LINK http://dx.doi.org/10.1111/tbj.12860 COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 8 TITLE Characteristics and outcomes of older women with breast cancer undergoing breast reconstruction: Analysis of the Age Gap Trial AUTHOR NAMES Athanasiou I. Reed M. Shrestha A. Cheung K.L. Audisio R. Wyld L. AUTHOR ADDRESSES (Athanasiou I.) Doncaster and Bassetlaw Teaching Hospitals, United Kingdom. (Reed M.) Brighton and Sussex Medical School, United Kingdom. (Shrestha A.; Wyld L.) University of Sheffield, United Kingdom. (Cheung K.L.) School of Medicine, University of Nottingham, United Kingdom. (Audisio R.) University of Liverpool, United Kingdom. CORRESPONDENCE ADDRESS I. Athanasiou, Doncaster and Bassetlaw Teaching Hospitals, United Kingdom. SOURCE European Journal of Surgical Oncology (2018) 44 Supplement 1 (S50). Date of Publication: 1 Mar 2018 CONFERENCE NAME Association for Cancer Surgery Annual Scientific Conference and the NCRI Cancer Conference 2017 CONFERENCE LOCATION Glasgow, United Kingdom CONFERENCE DATE 2017-11-05 to 2017-11-08 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Background: Age related practice variance is widespread in early breast cancer (EBC) management. The Age Gap cohort study has examined comorbidity and frailty adjusted UK practice across all domains of treatment in women >70 with EBC. This abstract presents data from the sub-group who underwent oncoplastic and reconstructive procedures. Method: The Age Gap study is a multicenter observational study which has recruited 3000 women >70 years of age with EBC recruiting between January 2014 e June 2017 at 54 sites. Data were collected on baseline health, fitness and frailty, cancer characteristics, treatment, quality of life and adverse events. Results: Reconstructive surgery was performed on 31/924 (3.4%) women having mastectomy. This percentage is slightly higher than the UK National Mastectomy and Reconstruction Audit (2010) at 2.5%. 9 were implant only, 16 implant and ADM/dermal sling and 4 DIEP flaps. Median age of the reconstructed cohort was 73 (range 70-82) versus 77 (70 -101) for the whole population (P<0.05). Median Charlson comorbidity score was 3 (3-8) versus 4 (3-17) (P<0.05) and ADL frailty score was 20 (19-20) versus 20 (1-20) (P<0.05). The 30-day mortality was zero. There were 17 early local complications (7 seromas, 2 haematomas, 5 infections and 3 flap necrosis), no systemic complications. There were 3 longer term complications: 1 functional impairment, 2 chronic pain. Similar findings were seen with therapeutic mammoplasty procedures with 43/1406 (3%) undergoing breast conservation. Age, fitness and frailty characteristics were similarly skewed towards younger, fitter women and outcomes were similarly good. Conclusion: Oncoplastic and reconstructive surgery may be safely performed in a selected group of fit older women with moderate morbidity and no mortality. The low reconstruction rate in this population may reflect patient/surgeon preferences and whilst there is no evidence to preclude oncoplastic procedures, careful audit is required to ensure patient safety. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer breast reconstruction EMTREE MEDICAL INDEX TERMS adult adverse event cancer surgery Charlson Comorbidity Index chronic pain cohort analysis complication conference abstract deep inferior epigastric perforator flap dermis female frailty functional disease graft necrosis hematoma human implant infection major clinical study male mastectomy morbidity mortality multicenter study observational study patient safety quality of life reconstructive surgery seroma surgeon LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L621417795 DOI 10.1016/j.ejso.2018.01.021 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2018.01.021 COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 9 TITLE Reply to Rana Nadeem's Letter to the Editor AUTHOR NAMES Vidya R. Masià J. Cawthorn S. Berna G. Bozza F. Gardetto A. Kolacinska A. Dell'Antonia F. Tiengo C. Bassetto F. Caputo G.G. Governa M. AUTHOR ADDRESSES (Vidya R., raghavan.vidya@nhs.net) Breast Care Center, Royal Wolverhampton Hospital, Wolverhampton, United Kingdom. (Masià J.) Plastic and Reconstructive Surgery Department, Hospital de la Santa Creu i Sant Pau (Universitat Autònoma de Barcelona), Barcelona, Spain. (Cawthorn S.) Breast Care Center, North Bristol NHS Trust, Bristol, United Kingdom. (Berna G.; Dell'Antonia F.) Plastic and Reconstructive Surgery Department, Ulss 9 General Hospital, Treviso, Italy. (Bozza F.) Breast Care Center, Venetian Oncology Institute, Padova, Italy. (Gardetto A.) Plastic and Reconstructive Surgery Department, South Tyrol Healthcare Company, Brixen, Italy. (Kolacinska A.) Cancer Center Copernicus Memorial Hospital, Medical University of Lodz, Lodz, Poland. (Tiengo C.; Bassetto F.) Plastic and Reconstructive Surgery Department, University Hospital of Padua, Padua, Italy. (Caputo G.G.; Governa M.) Plastic and Reconstructive Surgery, Surgery and Odontology Department, University Hospital of Verona, Verona, Italy. CORRESPONDENCE ADDRESS R. Vidya, Breast Care Center, Royal Wolverhampton Hospital, Wolverhampton, United Kingdom. Email: raghavan.vidya@nhs.net SOURCE Breast Journal (2018) 24:2 (225-226). Date of Publication: 1 Mar 2018 ISSN 1524-4741 (electronic) 1075-122X BOOK PUBLISHER Blackwell Publishing Inc., subscrip@blackwellpub.com EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant conservative treatment muscle sparing technique EMTREE MEDICAL INDEX TERMS breast reconstruction evaluation study follow up human hydration learning curve letter mastectomy operation duration outcome assessment patient safety patient satisfaction patient selection seroma EMBASE CLASSIFICATIONS General Pathology and Pathological Anatomy (5) Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20170547319 PUI L617586868 DOI 10.1111/tbj.12882 FULL TEXT LINK http://dx.doi.org/10.1111/tbj.12882 COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 10 TITLE Subcutaneous implant breast reconstruction: the importance of objectively assessing the outcomes AUTHOR NAMES Onesti M.G. Fanelli B. Di Taranto G. AUTHOR ADDRESSES (Onesti M.G.; Fanelli B.; Di Taranto G., giuseppeditaranto89@gmail.com) Plastic Surgery Unit, Department of Surgery “P. Valdoni”, Sapienza University, Rome, Italy. CORRESPONDENCE ADDRESS G. Di Taranto, Via dei Campani, Rome, Italy. Email: giuseppeditaranto89@gmail.com SOURCE European Journal of Surgical Oncology (2018) 44:2 (220-227). Date of Publication: 1 Feb 2018 ISSN 1532-2157 (electronic) 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast implant breast reconstruction patient-reported outcome postoperative pain (complication, disease management) EMTREE MEDICAL INDEX TERMS acellular dermal matrix cancer surgery follow up human letter patient satisfaction priority journal quality of life surgical mesh visual analog scale EMBASE CLASSIFICATIONS Cancer (16) Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20170886888 PUI L619857849 DOI 10.1016/j.ejso.2017.11.025 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2017.11.025 COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 11 TITLE Complete resorption of Veritas® in acellular dermal matrix (ADM)-assisted implant-based breast reconstructions—is there a need for tighter regulation of new products developed for use in breast reconstruction? AUTHOR NAMES Mazari F.A.K. Asgeirsson K.S. Whisker L. Gutteridge E. Rasheed T. Douglas Macmillan R. AUTHOR ADDRESSES (Mazari F.A.K., fayyaz.mazari@nhs.net; Asgeirsson K.S.; Whisker L.; Gutteridge E.; Rasheed T.; Douglas Macmillan R.) Nottingham Breast Institute, City Hospital, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham, United Kingdom. CORRESPONDENCE ADDRESS F.A.K. Mazari, Nottingham Breast Institute, City Hospital, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham, United Kingdom. Email: fayyaz.mazari@nhs.net SOURCE European Journal of Plastic Surgery (2018) (1-8). Date of Publication: 11 Jan 2018 ISSN 1435-0130 (electronic) 0930-343X BOOK PUBLISHER Springer Verlag, service@springer.de ABSTRACT Background: Veritas® collagen matrix is derived from bovine pericardium and is currently used in soft tissue and breast reconstruction. This study reports the experience of implant-based breast reconstruction using Veritas® collagen matrix in a specialist breast unit. Methods: This case series included all consecutive patients undergoing mastectomy and implant-based reconstruction using Veritas® over an 18-month period. Demographics, risk factors, operative parameters and postoperative outcomes were recorded prospectively. Results: Nineteen patients underwent a total of 30 breast reconstruction procedures over the study period. Of these, 57.9% (N = 11) had bilateral procedures. Breast cancer was the commonest indication. Forty percent (N = 12) had concomitant axillary surgery. Forty percent (N = 12) had two-stage reconstruction. Prophylactic antibiotics and drains were used in all cases. Median mastectomy weight was 308 g (interquartile range (IQR) 205–363 g). Median implant volume was 350 ml (IQR 275–400 ml). Twenty percent (N = 6) had minor complications within 3 months. Forty-two percent (N = 8) of patients had complete resorption of Veritas® (50%, N = 15 reconstructions) with “bottoming out” of implants requiring revision surgery. Ten percent (N = 3) developed capsular contracture following radiotherapy and 3.3% (N = 1) had implant loss due to pain following postoperative infection. Product outcomes were reported to the manufacturers. Conclusions: Veritas® collagen matrix has a comparable immediate postoperative complication rate when compared to other acellular dermal matrix. However, the long-term resorption rate in this series is high resulting in frequent correctional surgery. Level of Evidence: Level III, risk/prognostic study. EMTREE DRUG INDEX TERMS antibiotic agent collagen endogenous compound EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast cancer breast reconstruction implant capsular contracture EMTREE MEDICAL INDEX TERMS adult adverse device effect cancer prognosis cancer surgery case study clinical article complication female graft failure human male mastectomy pain postoperative infection prospective study radiotherapy risk factor surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20180027712 PUI L620199156 DOI 10.1007/s00238-017-1389-5 FULL TEXT LINK http://dx.doi.org/10.1007/s00238-017-1389-5 COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 12 TITLE Novel devices for implant-based breast reconstruction: Is the use of meshes to support the lower pole justified in terms of benefits? A review of the evidence AUTHOR NAMES Cook L.J. Kovacs T. AUTHOR ADDRESSES (Cook L.J.; Kovacs T., tibor.kovacs@gstt.nhs.uk) Guy’s and St Thomas’ NHS Trust, London, United Kingdom. CORRESPONDENCE ADDRESS T. Kovacs, Guy’s and St Thomas’ NHS Trust, London, United Kingdom. Email: tibor.kovacs@gstt.nhs.uk SOURCE ecancermedicalscience (2018) 12 Article Number: 796. Date of Publication: 10 Jan 2018 ISSN 1754-6605 (electronic) BOOK PUBLISHER Cancer Intelligence, info@cancerintelligence.com ABSTRACT The use of novel devices such as acellular dermal matrices (ADMs) to support the lower pole in implant-based breast reconstructions (IBBRs) has been described as one of the most important advances in breast reconstructive surgery following mastectomy. However, the majority of outcomes studies focus primarily on providing evidence for the rates of short-term complications associated with their use, as opposed to their reported benefits. Given the high costs associated with using ADMs, together with an increasing number of alternative, cheaper synthetic products entering the market, it is important to clarify whether their use is actually justified and whether the alternative products offer equivalent or superior outcomes. The purpose of this article is to present a comprehensive and updated review of the evidence for the benefits of using different products for lower pole support (LPS) in IBBR compared to reconstructions without. A secondary aim was to determine if there is any evidence to support the use of one product over another. EMTREE DRUG INDEX TERMS polyglactin polypropylene EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) breast implant breast reconstruction EMTREE MEDICAL INDEX TERMS acellular dermal matrix biocompatibility body image cost effectiveness analysis esthetic surgery evidence based medicine follow up human lower pole support technique pain assessment patient safety patient-reported outcome psychological aspect review surgical mesh treatment outcome treatment response CAS REGISTRY NUMBERS polyglactin (26780-50-7, 34346-01-5) polypropylene (25085-53-4, 9003-07-0) EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20180058351 PUI L620313390 DOI 10.3332/ecancer.2018.796 FULL TEXT LINK http://dx.doi.org/10.3332/ecancer.2018.796 COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 13 TITLE Bovine Acellular Dermal Matrix in Immediate Breast Reconstruction: A Retrospective, Observational Study with SurgiMend AUTHOR NAMES Scheflan M. Grinberg-Rashi H. Hod K. AUTHOR ADDRESSES (Scheflan M.) Tel Aviv, Israel From private practice; MedTech Industries; and the Research Division, Epidemiological Service, Assuta Medical Center (Grinberg-Rashi H.; Hod K.) SOURCE Plastic and reconstructive surgery (2018) 141:1 (1e-10e). Date of Publication: 1 Jan 2018 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Acellular dermal matrices can be combined with implant-based breast reconstruction to help optimize outcomes. SurgiMend PRS is a fetal bovine dermis-derived acellular dermal matrix composed of type I collagen and approximately 30 percent type III collagen, sharing many of the properties of human cadaveric acellular dermal matrix.METHODS: This was a retrospective, single-center analysis of 111 adult patients (147 breasts) undergoing one-stage (83.7 percent) or two-stage (16.3 percent) immediate breast reconstruction after mastectomy. The aims were to characterize the safety profile of SurgiMend and investigate associations between risk factors and complications.RESULTS: The mean age of the patients was 47.9 years and the mean body mass index was 24.7 kg/m. After a median follow-up of 24.3 months, the overall rates of minor and major complications were 25.2 percent (n = 37 of 147) and 12.9 percent (n = 19 of 147), respectively. The most common major complications were seroma [n = 12 (8.2 percent)] and necrosis [n = 9 (6.1 percent)]. All occurred within 3 months after surgery. The rate of capsular contracture was 2.7 percent (n = 4). A total of 2.7 percent of implanted breasts (n = 4) required explantation. In a univariate analysis, smokers had a greater risk of major complications (p = 0.013), and postoperative radiation therapy and obesity were associated with an increased risk of capsular contracture (p = 0.006) and explantation (p = 0.006), respectively. In a multivariate analysis, several factors were associated with complications or explantation, including obesity (p < 0.05), preoperative chemotherapy (p < 0.001), and mastectomy weight (p < 0.05). These associations align with other studies of implant-based reconstruction and do not appear to be specific to this acellular dermal matrix.CONCLUSION: The results are consistent with previous analyses of SurgiMend, and support its value in implant-based breast reconstruction.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen EMTREE DRUG INDEX TERMS acellular dermal matrix EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix procedures EMTREE MEDICAL INDEX TERMS adolescent adult aged animal bovine breast reconstruction female follow up human mastectomy middle aged outcome assessment postoperative complication (epidemiology, etiology) retrospective study risk factor statistical model very elderly young adult CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 29280856 (http://www.ncbi.nlm.nih.gov/pubmed/29280856) PUI L620882902 DOI 10.1097/PRS.0000000000003982 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000003982 COPYRIGHT Copyright 2018 Medline is the source for the citation and abstract of this record. RECORD 14 TITLE Trends in post-mastectomy breast reconstruction types at a breast cancer tertiary referral centre before and after introduction of acellular dermal matrices AUTHOR NAMES Kankam H.K.N. Hourston G.J.M. Fopp L.J. Benson J.R. Benyon S.L. Irwin M.S. Agrawal A. Forouhi P. Malata C.M. AUTHOR ADDRESSES (Kankam H.K.N.; Hourston G.J.M.) Cambridge University Medical School, Cambridge, United Kingdom. (Fopp L.J.; Benyon S.L.; Irwin M.S.; Malata C.M., cmalata@hotmail.com) Department of Plastic & Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom. (Benson J.R.; Benyon S.L.; Irwin M.S.; Agrawal A.; Forouhi P.; Malata C.M., cmalata@hotmail.com) Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom. (Benson J.R.; Malata C.M., cmalata@hotmail.com) Postgraduate Medical Institute, Faculty of Health Sciences, Anglia Ruskin University, Cambridge & Chelmsford, United Kingdom. CORRESPONDENCE ADDRESS C.M. Malata, Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 186, Cambridge, United Kingdom. Email: cmalata@hotmail.com SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2018) 71:1 (21-27). Date of Publication: 1 Jan 2018 ISSN 1878-0539 (electronic) 1748-6815 BOOK PUBLISHER Churchill Livingstone ABSTRACT Background Reconstructive breast surgery has continued to evolve over the last decade with a key change being the adoption of acellular dermal matrices (ADMs) as an adjunct for implant-based procedures. This retrospective observational study assesses the effect of ADMs on post-mastectomy reconstructive practice performed in a single institution. Methods We conducted a review of all patients undergoing breast reconstruction at a University Teaching Hospital for an 18-month period before and after adopting ADMs. Demographic, procedural and complication data for these two cohorts were compared (χ(2) and Student's t-tests). Results A total of 264 women (336 breasts), mean age 47.5 years, were identified: 137 before and 127 after the introduction of ADM. Implant-only reconstructions increased from 16% to 52% following the adoption of ADM (p < 0.01), whereas the proportion of both latissimus dorsi and deep inferior epigastric perforator flap reconstructions decreased significantly (31%–11% and 49%–34%, respectively, p < 0.01). The rate of early complications for the implant-only procedures was not significantly different with or without ADM (26% versus 20%, respectively, p = 0.44), despite there being no difference in the rate of adjuvant radiotherapy (22% versus 35%, respectively, p = 0.30). Conclusions This study showed that since ADM introduction to our centre, more breast reconstructions have been of the implant-only type with consequent reductions in the more complex and expensive autologous techniques. Implant-only procedures that incorporated ADM use had similar complication rates to those that did not. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast cancer (radiotherapy, surgery) breast reconstruction mastectomy tertiary care center EMTREE MEDICAL INDEX TERMS adjuvant radiotherapy adult article breast implant (adverse device effect) breast radiotherapy cancer surgery deep inferior epigastric perforator flap demography female hematoma human implant capsular contracture (complication) latissimus dorsi flap major clinical study medical record review observational study postoperative complication priority journal retrospective study seroma superficial inferior epigastric artery flap surgical infection wound dehiscence EMBASE CLASSIFICATIONS Cancer (16) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170649007 MEDLINE PMID 28917935 (http://www.ncbi.nlm.nih.gov/pubmed/28917935) PUI L618271636 DOI 10.1016/j.bjps.2017.08.016 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2017.08.016 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 15 TITLE The evolving role of pre-pectoral ADM-assisted implant-based immediate breast reconstruction following skin-sparing mastectomy AUTHOR NAMES Wazir U. Mokbel K. AUTHOR ADDRESSES (Wazir U.; Mokbel K., kefahmokbel@hotmail.com) The London Breast Institute, The Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK CORRESPONDENCE ADDRESS K. Mokbel, The London Breast Institute, The Princess Grace Hospital, 42-52 Nottingham Place, London W1U 5NY, UK Email: kefahmokbel@hotmail.com SOURCE American Journal of Surgery (2018). Date of Publication: 2018 ISSN 1879-1883 (electronic) 0002-9610 BOOK PUBLISHER Elsevier Inc., usjcs@elsevier.com ABSTRACT Introduction: The increasing use of acellular dermal matrix (ADM) and fat transfer in the context of breast reconstruction, following skin sparing mastectomy (SSM) for therapeutic and risk reducing purposes, combined with the need to eliminate animation deformities, reduce post-operative dysfunctional pain and the risk of capsular contracture, has prompted surgeons to investigate the possibility of placing the mammary implant over the pectoralis major muscle with complete coverage with ADM thus reviving the pre-pectoral approach which was previously abandoned due to high complications rates and poor aesthetics in the pre-ADM era. Methods: We reviewed the literature regarding this evolving technique of muscle sparing ADM-assisted implant-based immediate breast reconstruction. Results and conclusions: Several authors have recently reported positive early results confirming the potential benefits of eliminating breast animation and reducing postoperative pain, however, most of these reports contain insufficient numbers of patients (<100) and were retrospective in nature with a very short-term follow-up and lack of data regarding objective aesthetic assessment. Prospective data are required for more definitive recommendations. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast cancer breast implant breast reconstruction cancer surgery mastectomy xenograft EMTREE MEDICAL INDEX TERMS adult article female follow up human muscle postoperative pain prospective study systematic review LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20180076937 PUI L620554783 DOI 10.1016/j.amjsurg.2018.01.021 FULL TEXT LINK http://dx.doi.org/10.1016/j.amjsurg.2018.01.021 COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 16 TITLE Indications and Controversies for Implant-Based Breast Reconstruction Utilizing Biological Meshes AUTHOR NAMES Zenn M.R. AUTHOR ADDRESSES (Zenn M.R., drzenn@careplasticsurgery.com) 2001 Weston Parkway, Cary, United States. SOURCE Clinics in Plastic Surgery (2018) 45:1 (55-63). Date of Publication: 1 Jan 2018 ISSN 1558-0504 (electronic) 0094-1298 BOOK PUBLISHER W.B. Saunders ABSTRACT The advent of acellular dermal matrices (ADMs) has changed the way implant reconstruction is performed and has opened the door to muscle-sparing techniques that can be performed as an NSM (nipple-sparing mastectomy) with DTI (direct to implant) with excellent cosmesis and less patient morbidity. The article discusses differences in types of ADMs and outlines some current strategies and controversies with ADM use. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix (adverse device effect, device economics) breast reconstruction EMTREE MEDICAL INDEX TERMS AlloDerm RTU breast augmentation breast cancer (prevention, surgery) breast implant breast malformation (complication) breast reduction DermACELL esthetics family history health care cost high risk patient human implant capsular contracture (complication) mastectomy metformin morbidity patient selection prosthesis infection (complication) review seroma (complication) smoking surgical mesh surgical technique SurgiMend PRS treatment indication tumor localization tumor suppressor gene tumor volume DEVICE TRADE NAMES AlloDerm , United StatesLifecell AlloDerm RTU , United StatesLifecell AlloMax , United StatesDavol DermACELL , United StatesLifeNet DermaMatrix , United StatesSynthes FlexHD , United StatesEthicon Neoform , United StatesMentor Permacol , United StatesCovidien Strattice , United StatesLifecell SurgiMend PRS , United StatesTEI DEVICE MANUFACTURERS (United States)Covidien (United States)Davol (United States)Ethicon (United States)Lifecell (United States)LifeNet (United States)Mentor (United States)Synthes (United States)TEI EMBASE CLASSIFICATIONS Health Policy, Economics and Management (36) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170657399 PUI L618317682 DOI 10.1016/j.cps.2017.08.004 FULL TEXT LINK http://dx.doi.org/10.1016/j.cps.2017.08.004 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 17 TITLE Subcutaneous implant-based breast reconstruction, a modern challenge in postmastectomy radiation planning AUTHOR NAMES Mitchell M.P. Wagner J. Butterworth J. AUTHOR ADDRESSES (Mitchell M.P., mmitchell2@kumc.edu) Department of Radiation Oncology, The University of Kansas Medical Center, Kansas City, United States. (Wagner J.) Department of Surgery, The University of Kansas Medical Center, Kansas City, United States. (Butterworth J.) Department of Plastic Surgery, The University of Kansas Medical Center, Kansas City, United States. CORRESPONDENCE ADDRESS M.P. Mitchell, Kansas University Medical Center, Department of Radiation Oncology, 3901 Rainbow Boulevard, Kansas City, United States. Email: mmitchell2@kumc.edu SOURCE Practical Radiation Oncology (2018). Date of Publication: 2018 ISSN 1879-8500 BOOK PUBLISHER Elsevier Inc., usjcs@elsevier.com ABSTRACT Purpose: A growing trend in breast reconstruction has been placement of tissue expanders in the pre pectoral space. This is a change from the practice of placement under the pectoralis major with or without an acellular dermal matrix (ADM) sling. The move toward pre pectoral placement with an ADM wrap has the intent of decreasing post-operative pain and decreasing animation deformities. The cosmesis of pre pectoral reconstructions in the setting of post mastectomy radiation has also appeared improved in our early experience, when compared to submuscular reconstructions. We sought to review the risks and benefits of this technique in the setting of post mastectomy radiation. Methods and materials: Cases of ADM wrapped prepectoral tissue expander breast reconstructions in patients needing postmastectomy radiation therapy were reviewed in a single institution. Results: Thirty patients were treated with ADM wrapped prepectoral tissue expanders. On review of radiation plans, there were patients with anatomical variations, for whom standard dosimetric criteria were not met with partially wide tangent fields. Use of a medial electron field matched to steep photon tangents was not advised due to undercoverage of the tumor bed related to implant placement. Boost treatment was also omitted as a result of concerns regarding the implant location. Conclusions: While new advances in plastic surgery may improve on cosmetic outcomes for breast cancer patients, increased discussion with radiation oncologists is needed to appropriately select candidates for these procedures. Prospective trials are necessary to ensure that these new techniques do not compromise oncologic outcomes. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction cancer radiotherapy radiation oncologist tissue expander EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult anatomical variation article breast cancer cancer patient cancer surgery clinical article esthetic surgery female human human tissue mastectomy photon prospective study radiotherapy LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20180251683 PUI L2000599244 DOI 10.1016/j.prro.2017.09.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.prro.2017.09.001 COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 18 TITLE Innovations and advancements with prosthetic breast reconstruction AUTHOR NAMES Nahabedian M.Y. AUTHOR ADDRESSES (Nahabedian M.Y., DrNahabedian@aol.com) Inova Fairfax Hospital Falls Church, VA USA CORRESPONDENCE ADDRESS M.Y. Nahabedian, National Center For Plastic Surgery, McLean, VA, USA Email: DrNahabedian@aol.com SOURCE Breast Journal (2018). Date of Publication: 2018 ISSN 1524-4741 (electronic) 1075-122X BOOK PUBLISHER Blackwell Publishing Inc., subscrip@blackwellpub.com ABSTRACT Prosthetic breast reconstruction has evolved over the years to provide results that now mimic that of a natural breast. This is due to a variety of innovations and advancements related to mastectomy techniques, acellular dermal matrices, autologous fat grafting, and improved breast implants. The evolution of prosthetic breast reconstruction has gone full-circle and included prepectoral placement in the 1970s and 80s, partial or total subpectoral placement from 1985 to 2015, and now gradually trending back to prepectoral. There are several techniques and strategies that now allow for patients to achieve results that are superior to any time over the past 50 years. This manuscript will review the salient aspects of prosthetic breast reconstruction and how its evolution has progressed over the years. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant breast reconstruction tissue expander EMTREE MEDICAL INDEX TERMS adult article human mastectomy publication radiotherapy LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20180148131 PUI L620931287 DOI 10.1111/tbj.12998 FULL TEXT LINK http://dx.doi.org/10.1111/tbj.12998 COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 19 TITLE How to optimize aesthetic outcomes in implant-based breast reconstruction AUTHOR NAMES Nava M.B. Catanuto G. Rocco N. AUTHOR ADDRESSES (Nava M.B.) Department of Surgery, Valduce Hospital, Como, Italy. (Nava M.B.) Department of Plastic Surgery, University of Milan, Milan, Italy. (Nava M.B.; Catanuto G.; Rocco N., nicolarocco2003@gmail.com) Group for Reconstructive and Therapeutic Advancements, Milan, Naples, Italy. (Catanuto G.) Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Catania, Italy. (Rocco N., nicolarocco2003@gmail.com) Department of Clinical Medicine and Surgery, University of Naples, Naples, Italy. CORRESPONDENCE ADDRESS N. Rocco, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Via S. Pansini 5, Naples, Italy. Email: nicolarocco2003@gmail.com SOURCE Archives of Plastic Surgery (2018) 45:1 (4-13). Date of Publication: 1 Jan 2018 ISSN 2234-6171 (electronic) 2234-6163 BOOK PUBLISHER Korean Society of Plastic and Reconstructive Surgeons, 1355-3 Seocho-Dong, Seocho-Gu, Seoul, South Korea. ABSTRACT The evolution of breast reconstructive surgery keeps pace with the evolution of breast oncologic surgery. The reconstructive choice should always balance the optimal local control of disease and the best cosmetic result, reflecting an informed decision that is shared with the patient, who is always at the center of the decision-making process. Implant-based breast reconstruction following mastectomy represents a complex choice. In order to obtain optimal results, the following considerations are mandatory: thorough preoperative planning, a complete knowledge of the devices that are used, accurately performed surgery, and appropriate follow-up. EMTREE DRUG INDEX TERMS polypropylene EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast implant breast reconstruction outcome assessment process optimization EMTREE MEDICAL INDEX TERMS acellular dermal matrix aggressiveness algorithm anatomical concepts anxiety body contouring body fat distribution breast areola breast prosthesis breast tissue cell adhesion cell transplantation clinical assessment computer assisted tomography cosmetic industry decision making esthetic surgery evaluation and follow up evolution footprint test human knowledge lumpectomy mammography mastectomy morphology necrosis nuclear magnetic resonance imaging oncology nursing partial mastectomy patient satisfaction preoperative care quality of life assessment review skin tension smoking surgical technique tissue transplantation CAS REGISTRY NUMBERS polypropylene (25085-53-4, 9003-07-0) EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Clinical and Experimental Biochemistry (29) Internal Medicine (6) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20180120072 PUI L620757260 DOI 10.5999/aps.2017.00528 FULL TEXT LINK http://dx.doi.org/10.5999/aps.2017.00528 COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 20 TITLE Patients and surgeons can safely choose implant- ADM/ mesh reconstruction following previous radiotherapy to the breast; a retrospective cohort study AUTHOR NAMES Rowland M. Little K. Mitchell G. AUTHOR ADDRESSES (Rowland M.) North West Deanery, Liverpool, United Kingdom. (Little K.; Mitchell G.) Royal Liverpool Hospital, Liverpool, United Kingdom. CORRESPONDENCE ADDRESS M. Rowland, North West Deanery, Liverpool, United Kingdom. SOURCE Breast Cancer Research and Treatment (2018) 167:1 (366-367). Date of Publication: 1 Jan 2018 CONFERENCE NAME 1st UK Interdisciplinary Breast Cancer Symposium CONFERENCE LOCATION Manchester, United Kingdom CONFERENCE DATE 2018-01-15 to 2018-01-16 ISSN 0167-6806 BOOK PUBLISHER Springer New York LLC ABSTRACT Introduction: The need for reconstruction in a breast that has previously undergone radiotherapy is increasing, with woman often keen to explore immediate implant- ADM/mesh-based reconstruction. Our retrospective cohort aims to show it if feasible and safe in selected women. Methods: Single-unit reconstructive database was used to identify all women who had undergone implant-ADM/mesh reconstructions having previous radiotherapy to the ipsilateral breast. Full case-note review was performed Results: Twenty-one women met inclusion criteria, undergoing skinsparing mastectomy and immediate reconstruction between 2010 and 2017; 19/21 (90%) achieving a successful reconstruction with implant in situ to date, mean follow-up of 28 months. Mean age at reconstruction was 59 years with 20/21 women deemed ASA1-2. The majority of women were non-smokers (17/21) with mean interval of 11 years (range 2-34 years) from radiotherapy to reconstruction. Recurrent DCIS or invasive disease was the most common reason for mastectomy (13/21); other reasons included risk-reduction and cosmesis. Fourteen women had a variable-volume device placed with mean volume of 270 cc at insertion (range 0-460 cc); pocket-drains and antibiotic cover were routine. Most common adjunct used was STRATTICE (10/21); dermal-sling, BioDesign & TiLoop were also used. Post-operative seroma requiring drainage occurred in 6/21 women and 6/21 had delayed wound-healing beyond 2 weeks. One patient lost the implant due to infection and 1/21 for poor cosmesis. Five women had skin-flap redness during the healing period. No apparent themes were identified in the 2/21 woman who lost implants; both underwent successful salvage with autologous tissue. Ten women underwent unplanned further procedures, most commonly lipomodelling (8/21). Conclusions: Implant-based reconstructions are a safe option after previous breast radiotherapy; surgeons need to be highly selection on whom to offer this to and be observant to common post-operative events such as redness, seroma and slower wound-healing. Radiotherapy skin change may increase the need of further procedures such as lipomodelling. EMTREE DRUG INDEX TERMS antibiotic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast radiotherapy cancer radiotherapy cancer surgery cohort analysis patient history of radiotherapy retrospective study surgeon surgical mesh EMTREE MEDICAL INDEX TERMS adolescent adult cancer recurrence child clinical article conference abstract dermis esthetic surgery female follow up human infection intraductal carcinoma mastectomy middle aged radiotherapy risk reduction seroma skin flap wound healing impairment LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L620694932 DOI 10.1007/s10549-017-4585-x FULL TEXT LINK http://dx.doi.org/10.1007/s10549-017-4585-x COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 21 TITLE The Use of TIGR Matrix in Breast Aesthetic and Reconstructive Surgery: Is a Resorbable Synthetic Mesh a Viable Alternative to Acellular Dermal Matrices? AUTHOR NAMES Pompei S. Evangelidou D. Arelli F. Ferrante G. AUTHOR ADDRESSES (Pompei S.) Plastic and Reconstructive Surgery Unit, San Camillo General Hospital, Circonvallazione Gianicolense, 87, Rome, Italy. (Evangelidou D., dr.evangelidou@gmail.com) Plastic and Reconstructive Surgery Department, CosmeSurge and Emirates Hospital, Jumeirah Beach Road, P.O. Box 71860, Dubai, United Arab Emirates. (Arelli F.) Plastic and Reconstructive Surgery Unit, San Camillo General Hospital, Circonvallazione Gianicolense, 87, Rome 00152, Italy. (Ferrante G.) National Center of Disease Prevention and Health Promotion, Italian National Institute of Health, Viale Regina Elena, Rome, Italy. CORRESPONDENCE ADDRESS D. Evangelidou, Burj Residences Tower 8, Apartment 1803, Downtown Dubai, Dubai, United Arab Emirates. Email: dr.evangelidou@gmail.com SOURCE Clinics in Plastic Surgery (2018) 45:1 (65-73). Date of Publication: 1 Jan 2018 ISSN 1558-0504 (electronic) 0094-1298 BOOK PUBLISHER W.B. Saunders ABSTRACT The authors document their experience in the use of synthetic 100% bioresorbable surgical mesh (TIGR Matrix, Novus Scientific, Uppsala, Sweden) in breast reconstruction as well as in breast aesthetic surgery. They performed a retrospective review on patients who underwent implant-based breast reconstruction as well as patients who underwent breast reduction mammoplasty procedures with the use of TIGR Matrix Surgical Mesh. When compared with other synthetic but nonresorbable meshes, it appears to show a potentially lower seroma and infection rates, but most importantly, a lower rate of revisional and mesh explantation surgeries. EMTREE DRUG INDEX TERMS polyurethan foam EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix (device comparison) bioresorbable surgical mesh (adverse device effect, device comparison) breast reconstruction esthetic surgery surgical mesh (adverse device effect, device comparison) EMTREE MEDICAL INDEX TERMS adult aged body weight loss breast cancer (surgery) breast disease (surgery) breast fibroadenoma (surgery) breast implant breast necrosis (complication) breast ptosis (surgery) breast reduction clinical article cost control device infection (complication) female follow up health care cost hematoma (complication) human implant capsular contracture (complication) mastectomy outcome assessment postoperative care retrospective study review seroma (complication) surgical infection (complication) TIGR Matrix tissue expander wound dehiscence (complication) DEVICE TRADE NAMES TIGR Matrix DEVICE MANUFACTURERS Allergan Mentor (Germany)Polytech Silimed CAS REGISTRY NUMBERS polyurethan foam (9009-54-5) EMBASE CLASSIFICATIONS Cancer (16) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170660314 PUI L618326511 DOI 10.1016/j.cps.2017.08.005 FULL TEXT LINK http://dx.doi.org/10.1016/j.cps.2017.08.005 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 22 TITLE Patient and surgeon satisfaction for cosmetic outcome with immediate implant-based breast reconstruction using titanium-coated polypropylene mesh AUTHOR NAMES Munir A. Huws A. Sharaiha Y. Udayasankar S. Krishnan V.M. Holt S. Khawaja S. AUTHOR ADDRESSES (Munir A.; Huws A.; Sharaiha Y.; Udayasankar S.; Krishnan V.M.; Holt S.; Khawaja S.) Prince Philip Hospital, Llanelli, United Kingdom. CORRESPONDENCE ADDRESS A. Munir, Prince Philip Hospital, Llanelli, United Kingdom. SOURCE Breast Cancer Research and Treatment (2018) 167:1 (353-354). Date of Publication: 1 Jan 2018 CONFERENCE NAME 1st UK Interdisciplinary Breast Cancer Symposium CONFERENCE LOCATION Manchester, United Kingdom CONFERENCE DATE 2018-01-15 to 2018-01-16 ISSN 0167-6806 BOOK PUBLISHER Springer New York LLC ABSTRACT Background: Titanium-coated polypropylene mesh (TCPM) is an alternative to acellular dermal matrix for the implant-based breast reconstruction. The primary aim of this study was to assess patients and surgeon satisfaction for cosmetic outcome after the procedure. Methods: Between 2013 and 2017, implant breast reconstructions after conservative mastectomies using TCMP were performed in 37 patients (with 44 reconstructions). Patients were administered a short questionnaire (adapted from Breast Q) and surgeons graded the cosmetic outcome as excellent, good, fair or failed. Results: Forty-four mastectomies with reconstructions were performed in 37 women. Twenty-eight patients had therapeutic mastectomies with nine of them also had contralateral risk-reducing mastectomies. Patient satisfaction survey was available in 27 patients. Overall, 91% of patients were satisfied with their cosmetic outcome when clothed and 65% were satisfied with their cosmetic outcome when unclothed. 25/27 patients thought that having reconstruction is a much better option. Surgeon's opinion was excellent in three, good in 29 and fair in four patients and failed in five patients. With median follow-up of 17.5 months, five of 37 patients had implant loss. Conclusions: Most of the patients are satisfied by the cosmetic outcome after undergoing immediate breast reconstruction using the titanium-coated polypropylene mesh. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) polypropylene titanium EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction implant patient satisfaction surgeon EMTREE MEDICAL INDEX TERMS adult case report clinical article conference abstract female follow up graft failure human mastectomy questionnaire thinking treatment failure CAS REGISTRY NUMBERS polypropylene (25085-53-4, 9003-07-0) titanium (7440-32-6) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L620694775 DOI 10.1007/s10549-017-4585-x FULL TEXT LINK http://dx.doi.org/10.1007/s10549-017-4585-x COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 23 TITLE Liposomal bupivacaine and post-operative narcotic usage in tissue expander breast reconstruction AUTHOR NAMES Sorta D. Buchanan D. Stime K. Hathaway B.A. AUTHOR ADDRESSES (Sorta D.; Buchanan D.; Stime K.; Hathaway B.A.) University of Washington, Seattle, United States. (Buchanan D.) Spokane Plastic Surgeons, Spokane, United States. CORRESPONDENCE ADDRESS D. Sorta, University of Washington, Seattle, United States. SOURCE Journal of Investigative Medicine (2018) 66:1 (94). Date of Publication: 1 Jan 2018 CONFERENCE NAME 2018 Western Medical Research Conference, WMRC 2018 CONFERENCE LOCATION Carmel, CA, United States CONFERENCE DATE 2018-01-25 to 2018-01-27 ISSN 1708-8267 BOOK PUBLISHER BMJ Publishing Group ABSTRACT Purpose of study To evaluate postoperative narcotic use in patients undergoing tissue expander based breast reconstruction with the use of liposomal bupivacaine (LB), a lipid-based multivesicular drug delivery technology which releases local anaesthetic over an extended period of time. Methods used IRB approval was obtained for a retrospective chart review of patients who underwent tissue expander based breast reconstruction by a single surgeon from November 2014 to September 2017. The study group included 62 patients and 108 reconstructed breasts. All reconstructions utilised acellular dermal matrix and both subpectoral and prepectoral techniques were included. All patients received intraoperative infiltration of either 0.25% bupivacaine or liposomal bupivacaine. Post-operatively both total oral and IV narcotic use and oral and IV narcotic use per hour in morphine milligram equivalents were analysed. Specific conversion factors applied to milligrams narcotic used are as follows: PO hydrocodone=1, PO oxycodone=1, PO hydromorphone=4, and IV hydromorphone=5.5. Standard statistical t-tests were applied to compare the mean outcome variables between groups. Mean morphine equivalents of total oral and IV narcotic usage and oral and IV narcotic usage per hour between the two groups were compared. Statistically significant difference was considered at a P value less than or equal to 0.05 between groups. Summary of results Total oral narcotic use was similar between the LB and non-LB groups. Total IV narcotic use showed a large discrepancy with 6.7 mg in the LB group and 16.1 mg in the non-LB group (p=0.062) although this finding did not reach the threshold for significance. Similarly, oral narcotic use per hour was comparable in the two groups while IV narcotic use per hour showed a statistically significant difference with 0.17 mg/hr in the LB group and 0.39 mg/hr in the non- LB gorup (p=0.046). Conclusions In tissue expander breast reconstruction, while liposomal bupivacaine did not influence oral narcotic usage, there was a significant reduction in IV narcotic usage. (Table Presented). EMTREE DRUG INDEX TERMS (MAJOR FOCUS) bupivacaine EMTREE DRUG INDEX TERMS morphine EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction tissue expander EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult conference abstract controlled study drug delivery system female human human tissue major clinical study male medical record review outcome variable retrospective study statistical significance surgeon surgery CAS REGISTRY NUMBERS bupivacaine (18010-40-7, 2180-92-9, 55750-21-5, 38396-39-3) morphine (52-26-6, 57-27-2) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L620637128 DOI 10.1136/jim-2017-000663.73 FULL TEXT LINK http://dx.doi.org/10.1136/jim-2017-000663.73 COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 24 TITLE Radiation Therapy and Immediate Breast Reconstruction: Novel Approaches and Evidence Base for Radiation Effects on the Reconstructed Breast AUTHOR NAMES See M.S.-F. Farhadi J. AUTHOR ADDRESSES (See M.S.-F., Marlene_see@yahoo.com; Farhadi J.) Department of Plastic Surgery, St. Thomas’ Hospital, Guy's and St. Thomas’ Hospitals NHS Foundation Trust, Westminster Bridge Road, London, United Kingdom. (Farhadi J.) Reconstructive and Aesthetic Surgery, University of Basel, Petersplatz 1, Basel, Switzerland. (Farhadi J.) Centre for Plastic Surgery, Klinik Pyramide am See, Bellerivestrasse 34, Zürich, Switzerland. CORRESPONDENCE ADDRESS M.S.-F. See, Department of Plastic Surgery, St. Thomas’ Hospital, Guy's and St. Thomas’ Hospitals NHS Foundation Trust, Westminster Bridge Road, London, United Kingdom. Email: Marlene_see@yahoo.com SOURCE Clinics in Plastic Surgery (2018) 45:1 (13-24). Date of Publication: 1 Jan 2018 ISSN 1558-0504 (electronic) 0094-1298 BOOK PUBLISHER W.B. Saunders ABSTRACT Patients who undergo breast reconstruction experience higher complication rates if they have had a history of radiotherapy. However, implant-based reconstruction confers significantly higher complication and reconstruction failure rates compared with autologous reconstruction. This article analyses the factors that contribute to the complications of the different breast reconstruction modalities and the strategies described to mitigate these problems. EMTREE DRUG INDEX TERMS antibiotic agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast radiotherapy breast reconstruction immediate breast reconstruction EMTREE MEDICAL INDEX TERMS acellular dermal matrix autotransplantation breast cancer (radiotherapy, surgery) breast implant (adverse device effect) breast tissue expander cost effectiveness analysis esthetics fat necrosis (complication) human implant capsular contracture (complication) mastectomy nonhuman patient satisfaction polyglactin suture postmastectomy radiotherapy postoperative complication (complication) review risk factor surgical infection (complication, drug therapy, prevention) treatment failure DEVICE MANUFACTURERS (United States)Ethicon EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) Drug Literature Index (37) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170697648 PUI L618571345 DOI 10.1016/j.cps.2017.08.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.cps.2017.08.001 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 25 TITLE Indications and Controversies for Implant-Only Based Breast Reconstruction AUTHOR NAMES Brown M. Namnoum J.D. AUTHOR ADDRESSES (Brown M., drbrown@torontoplasticsurgery.com) Surgery, University of Toronto, Toronto, Canada. (Namnoum J.D.) Emory University, Atlanta, United States. (Namnoum J.D.) Private Practice, Atlanta Plastic Surgery, Atlanta, United States. CORRESPONDENCE ADDRESS M. Brown, 790 Bay Street, Suite 410, Toronto, Canada. Email: drbrown@torontoplasticsurgery.com SOURCE Clinics in Plastic Surgery (2018) 45:1 (47-54). Date of Publication: 1 Jan 2018 ISSN 1558-0504 (electronic) 0094-1298 BOOK PUBLISHER W.B. Saunders ABSTRACT Today's demographic of the breast reconstruction patient is younger, often prophylactic or at an early stage of diagnosis, and is more likely to be bilateral. These factors combined with an increase in breast implant options, internal support matrices, fat transfer, technologies for intraoperative real time assessment of tissue perfusion, and an increasing appreciation for morbidity associated with autogenous procedures have resulted in an increase in the percentage of women seeking alloplastic breast reconstruction. This article discusses the indications for implant-only reconstruction and reviews the authors’ approach to the use of adjunctive techniques that are used in most of their patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast implant breast reconstruction EMTREE MEDICAL INDEX TERMS acellular dermal matrix alloplastic breast reconstruction autoderm autograft breast tissue expander direct to implant reconstruction human mastectomy patient preference pectoral muscle review surgical technique treatment indication EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170659763 PUI L618324986 DOI 10.1016/j.cps.2017.08.003 FULL TEXT LINK http://dx.doi.org/10.1016/j.cps.2017.08.003 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 26 TITLE Adherence to best practice consensus guidelines for implant-based breast reconstruction: Results from the iBRA national practice questionnaire survey AUTHOR NAMES Mylvaganam S. Conroy E.J. Williamson P.R. Barnes N.L.P. Cutress R.I. Gardiner M.D. Jain A. Skillman J.M. Thrush S. Whisker L.J. Blazeby J.M. Potter S. Holcombe C. AUTHOR ADDRESSES (Mylvaganam S.) New Cross Hospital, Royal Wolverhampton Hospitals NHS Trust, Wednesfield Way, Wolverhampton, WV10 0QP, UK (Conroy E.J.; Williamson P.R.) Clinical Trials Research Centre (CTRC), North West Hub for Trials Methodology/University of Liverpool, Liverpool, L12 2AP, UK (Barnes N.L.P.) Breast Unit, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK (Cutress R.I.) Breast Unit, University Hospital Southampton, Tremona Road, Southampton, Hampshire, SO16 6YD, UK (Cutress R.I.) Faculty of Medicine, University of Southampton, University Road, Southampton, SO17 1BJ, UK (Gardiner M.D.; Jain A.) Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7HE, UK (Gardiner M.D.; Jain A.) Department of Plastic Surgery, Imperial College London NHS Trust, London, SW7 2AZ, UK (Skillman J.M.) Department of Plastic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK (Thrush S.) Breast Unit, Worcester Royal Hospital, Charles Hastings Way, Worcester, WR5 1DD, UK (Whisker L.J.) Breast Institute, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham, NG5 1PB, UK (Blazeby J.M.; Potter S., shelley.potter@bristol.ac.uk) Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Canynge Hall 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK (Potter S., shelley.potter@bristol.ac.uk) Bristol Breast Cancer Centre, North Bristol NHS Trust, Southmead Hospital, Bristol, BS10 5NB, UK (Holcombe C.) Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Prescot Street, Liverpool, L7 8XP, UK CORRESPONDENCE ADDRESS S. Potter, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK Email: shelley.potter@bristol.ac.uk SOURCE European Journal of Surgical Oncology (2018). Date of Publication: 2018 ISSN 1532-2157 (electronic) 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: The 2008 National Mastectomy and Breast Reconstruction Audit demonstrated marked variation in the practice and outcomes of breast reconstruction in the UK. To standardise practice and improve outcomes for patients, the British professional associations developed best-practice guidelines with specific guidance for newer mesh-assisted implant-based techniques. We explored the degree of uptake of best-practice guidelines within units performing implant-based reconstruction (IBBR) as the first phase of the implant Breast Reconstruction Evaluation (iBRA) study. Methods: A questionnaire developed by the iBRA Steering Group was completed by trainee and consultant leads at breast and plastic surgical units across the UK. Simple summary statistics were calculated for each survey item to assess compliance with current best-practice guidelines. Results: 81 units from 79 NHS Trusts completed the questionnaire. Marked variation was observed in adherence to guidelines, especially those relating to clinical governance and infection prevention strategies. Less than half (n = 28, 47%) of units obtained local clinical governance board approval prior to offering new mesh-based techniques and prospective audit of the clinical, cosmetic and patient-reported outcomes of surgery was infrequent. Most units screened for methicillin-resistant staphylococcus aureus prior to surgery but fewer than 1 in 3 screened for methicillin-sensitive strains. Laminar-flow theatres (recommended for IBBR) were not widely-available with less than 1 in 5 units having regular access. Peri-operative antibiotics were widely-used, but the type and duration were highly-variable. Conclusions: The iBRA national practice questionnaire has demonstrated variation in reported practice and adherence to IBBR guidelines. High-quality evidence is urgently required to inform best practice. EMTREE DRUG INDEX TERMS meticillin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction consensus implant practice guideline questionnaire EMTREE MEDICAL INDEX TERMS adult article clinical article consultation female health care quality human infection prevention laminar flow male methicillin resistant Staphylococcus aureus nonhuman outcome assessment patient-reported outcome statistics student surgery trust LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20180121684 PUI L620767116 DOI 10.1016/j.ejso.2018.01.098 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2018.01.098 COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 27 TITLE Acellular Dermal Matrix in Immediate Expander/Implant Breast Reconstruction: A Multicenter Assessment of Risks and Benefits AUTHOR NAMES Sorkin M. Qi J. Kim H.M. Hamill J.B. Kozlow J.H. Pusic A.L. Wilkins E.G. AUTHOR ADDRESSES (Sorkin M.) Ann Arbor, Mich.; and New York, N.Y. From the Section of Plastic Surgery, Department of Surgery, and the Center for Statistical Consultation and Research, Department of Biostatistics, University of Michigan; and Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center (Qi J.; Kim H.M.; Hamill J.B.; Kozlow J.H.; Pusic A.L.; Wilkins E.G.) SOURCE Plastic and reconstructive surgery (2017) 140:6 (1091-1100). Date of Publication: 1 Dec 2017 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Acellular dermal matrix has gained widespread acceptance in immediate expander/implant reconstruction because of perceived benefits, including improved expansion dynamics and superior aesthetic results. Although previous investigators have evaluated its risks, few studies have assessed the impact of acellular dermal matrix on other outcomes, including patient-reported measures.METHODS: The Mastectomy Reconstruction Outcomes Consortium Study used a prospective cohort design to evaluate patients undergoing postmastectomy reconstruction from 10 centers and 58 participating surgeons between 2012 and 2015. The analysis focused on women undergoing immediate tissue expander reconstruction following mastectomies for cancer treatment or prophylaxis. Medical records and patient-reported outcome data, using the BREAST-Q and Numeric Pain Rating Scale instruments, were reviewed. Bivariate analyses and mixed-effects regression models were applied.RESULTS: A total of 1297 patients were evaluated, including 655 (50.5 percent) with acellular dermal matrix and 642 (49.5 percent) without acellular dermal matrix. Controlling for demographic and clinical covariates, no significant differences were seen between acellular dermal matrix and non-acellular dermal matrix cohorts in overall complications (OR, 1.21; p = 0.263), major complications (OR, 1.43; p = 0.052), wound infections (OR, 1.49; p = 0.118), or reconstructive failures (OR, 1.55; p = 0.089) at 2 years after reconstruction. There were also no significant differences between the cohorts in the time to expander/implant exchange (p = 0.78). No significant differences were observed in patient-reported outcome scores, including satisfaction with breasts, psychosocial well-being, sexual well-being, physical well-being, and postoperative pain.CONCLUSIONS: In this multicenter, prospective analysis, the authors found no significant acellular dermal matrix effects on complications, time to exchange, or patient-reported outcome in immediate expander/implant breast reconstruction. Further studies are needed to develop criteria for more selective use of acellular dermal matrix in these patients.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant tissue expander EMTREE MEDICAL INDEX TERMS breast augmentation breast reconstruction breast tumor (surgery) Canada clinical trial cohort analysis devices evaluation study female human mastectomy middle aged multicenter study patient satisfaction postoperative complication (etiology) procedures prospective study risk factor tissue expansion treatment outcome United States LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 28806288 (http://www.ncbi.nlm.nih.gov/pubmed/28806288) PUI L619758384 DOI 10.1097/PRS.0000000000003842 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000003842 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 28 TITLE Options in Acellular Dermal Matrix-Device Assembly AUTHOR NAMES Sigalove S. AUTHOR ADDRESSES (Sigalove S.) Warrenville, Ill. From the Institute of Aesthetic Plastic Surgery and Cantera Spa SOURCE Plastic and reconstructive surgery (2017) 140:6 Prepectoral Breast Reconstruction (39S-42S). Date of Publication: 1 Dec 2017 ISSN 1529-4242 (electronic) ABSTRACT Prepectoral prosthetic breast reconstruction has become increasingly popular during the last several years. Original shortcomings and poor outcomes in the 1970s have been overcome with the use of the bioengineered breast concept-namely, use of improved form stable breast implants, autologous fat grafting, and acellular dermal matrices (ADMs). Careful use of these reconstructive tools combined with improved mastectomy skin flaps has lead to successful early outcomes. Prepectoral breast reconstruction mitigates the animation deformities and muscle tightness previously associated with dual-plane prosthetic breast reconstruction while at the same time producing reproducible and outstanding aesthetic outcomes. The use of ADM is a critical component to performing prepectoral breast reconstruction. There are many techniques utilized to inset the ADM. Various methods of direct in vivo inset have been performed. These techniques are employed following completion of the mastectomy and are performed with both 2-stage as well as single-stage direct-to-implant reconstruction. Various ex vivo techniques have also been used for prepectoral breast reconstruction. Various prefabricated constructs of ADM and implant/tissue expander can be created on the back table while the mastectomy is in progress, which decreases operative time and improves surgical efficiency. This article will describe briefly the history of prepectoral reconstruction as well as describing the various techniques used for creating the ADM-device interphase. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix procedures EMTREE MEDICAL INDEX TERMS breast augmentation breast implant breast reconstruction breast tumor (surgery) devices esthetics female human tissue expander tissue expansion LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 29166346 (http://www.ncbi.nlm.nih.gov/pubmed/29166346) PUI L620049162 DOI 10.1097/PRS.0000000000004049 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000004049 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 29 TITLE Prepectoral Immediate Direct-to-Implant Breast Reconstruction with Anterior AlloDerm Coverage AUTHOR NAMES Jones G. Yoo A. King V. Jao B. Wang H. Rammos C. Elwood E. AUTHOR ADDRESSES (Jones G.) Peoria, Ill.; and Boston, Mass. From the University of Illinois College of Medicine; University of Massachusetts; and Illinois Plastic Surgery (Yoo A.; King V.; Jao B.; Wang H.; Rammos C.; Elwood E.) SOURCE Plastic and reconstructive surgery (2017) 140:6 Prepectoral Breast Reconstruction (31S-38S). Date of Publication: 1 Dec 2017 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Staged subpectoral expander-implant breast reconstruction is widely performed. Disruption of the pectoralis major origin and the frequent occurrence of animation deformity and functional discomfort associated with subpectoral reconstruction remain ongoing concerns. Prepectoral single-stage direct-to-implant reconstruction resolves many of these issues. In this study, the authors explored the rationale for prepectoral single-stage implant-based breast reconstruction with anterior AlloDerm coverage as an alternative to the staged approach.METHODS: Seventy-three breasts in 50 patients were reconstructed using a single-stage direct-to-implant prepectoral approach with total anterior AlloDerm coverage during a 24-month period. The decision to proceed with single-stage reconstruction was predicated upon the adequacy of mastectomy skin flap blood flow based on indocyanine green fluorescence perfusion assessment. The patients were followed up for a maximum of 32 months.RESULTS: Ninety-seven percent of patients achieved complete healing within 8 weeks. There were 2 implant losses (2.7%) due to infection. Major seroma rate requiring repeated aspiration and drain insertion was 1.2%. There were no full-thickness skin losses. Capsular contracture was 0% in nonradiated patients. There were no cases of animation deformity. The authors were unable to establish significant correlation between complications and any of the usually stated risk factors, such as smoking, obesity, and large mastectomy weights, presumably due to the rigorous application of intraoperative skin perfusion assessment.CONCLUSION: Single-stage direct-to-implant reconstruction using a prepectoral approach appears to be a safe and effective means of breast reconstruction in many patients, assuming adequate skin perfusion is present. EMTREE DRUG INDEX TERMS collagen (drug therapy) surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast implant procedures EMTREE MEDICAL INDEX TERMS adipose tissue adult breast augmentation breast reconstruction breast tumor (surgery) devices female human mastectomy middle aged surgical flaps tissue expander tissue expansion transplantation CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 29166345 (http://www.ncbi.nlm.nih.gov/pubmed/29166345) PUI L620049133 DOI 10.1097/PRS.0000000000004048 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000004048 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 30 TITLE Delayed prosthetic breast reconstruction without the use of acellular dermal matrix AUTHOR NAMES Mittermiller P.A. Nazerali R.S. Glaus S.W. Perez M.G. Luan A. Kahn D.M. Lee G.K. AUTHOR ADDRESSES (Mittermiller P.A.; Nazerali R.S.; Glaus S.W.; Luan A.; Kahn D.M.; Lee G.K., glee@stanford.edu) Division of Plastic and Reconstructive Surgery, Stanford Hospital and Clinics, Stanford, United States. (Perez M.G.) Stanford University School of Medicine, Stanford, United States. CORRESPONDENCE ADDRESS G.K. Lee, Division of Plastic and Reconstructive Surgery, Stanford Hospital and Clinics, Stanford, United States. Email: glee@stanford.edu SOURCE European Journal of Plastic Surgery (2017) 40:6 (533-540). Date of Publication: 1 Dec 2017 ISSN 1435-0130 (electronic) 0930-343X BOOK PUBLISHER Springer Verlag, service@springer.de ABSTRACT Background: Since the widespread adoption of acellular dermal matrices (ADM) in immediate breast reconstruction, many surgeons have applied the same techniques to delayed reconstruction. To counteract this trend, we present a method of performing delayed prosthetic breast reconstruction without the use of ADM. This approach produces excellent aesthetic outcomes while eliminating the cost of relatively expensive ADM. Methods: A retrospective review was performed on patients who underwent delayed implant-based breast reconstruction without ADM at a single institution between 2001 and 2013. Results: A total of 31 patients met inclusion criteria. In our cohort, radiation therapy was performed on 14 patients (45%). Expanders were filled intraoperatively to a median volume of 150 cm(3), and median permanent implant size was 500 cm(3). Operative time averaged 62 minutes for unilateral expander insertion and 92 minutes for bilateral insertion. After expander placement, complications requiring reoperation occurred in five patients (16%), of which four (75%) had prior radiation therapy. Permanent implants were placed in 29 patients (94%), and six of these patients (21%) underwent additional procedures. Thirteen patients without prior radiation (76%) and eight patients with prior radiation (57%) did not undergo any unplanned surgical interventions during the reconstructive process. Conclusions: Our study shows delayed breast reconstruction can be successfully performed without ADM. Since delayed reconstruction is generally performed less frequently than immediate reconstruction, plastic surgeons are advised to critically review their techniques, as the operation should be approached differently. While ADM may have specific benefits in immediate reconstruction, those benefits do not directly translate in delayed reconstruction. Level of Evidence: Level IV, risk/ prognostic study. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast cancer (radiotherapy, surgery) breast prosthesis (adverse device effect) breast reconstruction therapy delay EMTREE MEDICAL INDEX TERMS article breast tissue expander (adverse device effect) cancer patient cancer radiotherapy clinical article cohort analysis debridement device infection (surgery, complication) disease course female follow up human mastectomy medical device complication (complication) medical record review nipple operation duration patient preference priority journal reoperation retrospective study skin fibrosis EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170245115 PUI L615137866 DOI 10.1007/s00238-017-1300-4 FULL TEXT LINK http://dx.doi.org/10.1007/s00238-017-1300-4 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 31 TITLE Important Considerations for Performing Prepectoral Breast Reconstruction AUTHOR NAMES Sbitany H. AUTHOR ADDRESSES (Sbitany H.) San Francisco, Calif. From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco SOURCE Plastic and reconstructive surgery (2017) 140:6 Prepectoral Breast Reconstruction (7S-13S). Date of Publication: 1 Dec 2017 ISSN 1529-4242 (electronic) ABSTRACT Prepectoral breast reconstruction has emerged as an excellent technique for postmastectomy reconstruction, as it allows for full preservation of a patient's pectoralis major muscle and chest wall function. This reduces pain, eliminates animation deformity, and results in high patient satisfaction. Safely performed prepectoral breast reconstruction requires a careful patient selection process before committing to the procedure, taking into account comorbidities, radiation status, and oncologic criteria such as tumor location and breast cancer stage. Furthermore, a thorough intraoperative assessment of mastectomy skin flaps is critical, with careful and precise confirmation that the skin is viable and well perfused, prior to proceeding with prepectoral breast reconstruction. This can be done both clinically and with perfusion assessment devices. The use of acellular dermal matrix (ADM) has enhanced outcomes and aesthetics of prepectoral reconstruction, by providing implant coverage and soft-tissue support. The ADM also adds the benefit of reducing capsular contracture rates and offers full control over the aesthetic definition of the newly reconstructed breast pocket. Aesthetic enhancement of results requires routine use of oversizing implants in the skin envelope, careful selection of full capacity or cohesive gel implants, and autologous fat grafting. In this way, patients in all clinical scenarios can benefit from the full muscle-sparing technique of prepectoral breast reconstruction, including those undergoing immediate reconstruction, delayed reconstruction, and delayed conversion from a subpectoral to prepectoral plane to correct animation deformity. EMTREE MEDICAL INDEX TERMS breast reconstruction breast tumor (surgery) female human mastectomy patient care patient selection peroperative care plastic surgery procedures surgical flaps LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 29166342 (http://www.ncbi.nlm.nih.gov/pubmed/29166342) PUI L620049060 DOI 10.1097/PRS.0000000000004045 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000004045 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 32 TITLE Repositioning the inframammary fold after DIEP flap reconstruction: using biologic mesh to provide a more stable result AUTHOR NAMES Carruthers K. Tiwari P. Kocak E. AUTHOR ADDRESSES (Carruthers K.) Department of Surgery, Division of Plastic Surgery, West Virginia University, 1 Medical Center Dr., Morgantown, United States. (Tiwari P.; Kocak E., DrK@mwbreast.com) Midwest Breast and Aesthetic Surgery, 1329 Cherry Way Drive, Suite 700, Gahanna, United States. CORRESPONDENCE ADDRESS E. Kocak, Midwest Breast and Aesthetic Surgery, 1329 Cherry Way Drive, Suite 700, Gahanna, United States. Email: DrK@mwbreast.com SOURCE European Journal of Plastic Surgery (2017) (1-4). Date of Publication: 1 Dec 2017 ISSN 1435-0130 (electronic) 0930-343X BOOK PUBLISHER Springer Verlag, service@springer.de ABSTRACT Traditional techniques for elevating the inframammary fold (IMF) position have relied mainly on isolated sutures to maintain the repositioned fold. Furthermore, most published reports focus on implant-based reconstructions, rather than the unique challenges of revising autologous reconstruction. Therefore, to improve the durability of the IMF repair in the autologous reconstructed breast, we have developed a method which utilizes biologic mesh to distribute the forces over a greater area of the chest wall. In our initial experience using this technique to elevate the IMF during revisions of autologous tissue breast reconstructions, we have found it to provide a stable and long-lasting result that can improve symmetry when the IMF position is not ideal. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) biological product EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction deep inferior epigastric perforator flap EMTREE MEDICAL INDEX TERMS thorax wall LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170848976 PUI L619498846 DOI 10.1007/s00238-017-1381-0 FULL TEXT LINK http://dx.doi.org/10.1007/s00238-017-1381-0 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 33 TITLE Sacrocolpopexy: A Modification of the Standard Laparoscopic Procedure to Adopt It to the Properties of a Biologic Matrix Patch AUTHOR NAMES Karon M. AUTHOR ADDRESSES (Karon M., mkaron@mw.twcbc.com) Department of Obstetrics/Gynecology, Women's Hospital Saint Joseph East, KentuckyOne Health, University of Louisville, 160 North Eagle Creek, Suite 205, Lexington, United States. CORRESPONDENCE ADDRESS M. Karon, Department of Obstetrics/Gynecology, Women's Hospital Saint Joseph East, KentuckyOne Health, University of Louisville, 160 North Eagle Creek, Suite 205, Lexington, United States. Email: mkaron@mw.twcbc.com SOURCE Journal of Gynecologic Surgery (2017) 33:6 (248-252). Date of Publication: 1 Dec 2017 ISSN 1557-7724 (electronic) 1042-4067 BOOK PUBLISHER Mary Ann Liebert Inc., info@liebertpub.com ABSTRACT Objective: By 80 years of age, 11.1% of women are expected to undergo pelvic organ prolapse (POP) surgery and one-third of women are expected to undergo reoperation. The "gold standard" procedure is sacrocolpopexy, which uses a graft to support the vaginal apex to the ligaments of the sacrum. The conventional graft (polypropylene mesh) has been associated with dyspareunia, persistent pelvic pain, and increased mesh erosion. In an effort to combat these complications, a noncrosslinked acellular dermal matrix (ADM; STRATTICE™ Reconstructive Matrix, LifeCell, an ACELITY Company, Bridgewater, NJ) was utilized for this study. Materials and Methods: Sacrocolpopexy, with ADM, was used for 9 patients between January 2011 and December 2013. The patients completed Pelvic Floor Distress Inventory-20 (PFDI-20) and pelvic floor impact questionnaires and reported on postsurgical outcome satisfaction. Patient satisfaction with clinical outcomes was assessed. Biopsies of the sacrocolpopexy were performed and tissue samples were sent for histology testing if a patient returned for another procedure. Results: During sacrocolpopexy, an ADM was trimmed to fit each patient's anatomy, attached to the vaginal cuff or cervix using sutures, and, when possible, incorporated with the round ligament on each side. The entire sacrocolpopexy was kept in the retroperitoneal space. The postoperative PFDI-20 average score was 25.47 ± 29.68. The postsurgical pelvic floor impact score was, on average, 98%. Patient reported satisfaction with postsurgical outcomes ranged from 70% to 100%. Histology testing showed dense and loose connective tissue with blood vessels, and fibroblast cells and minimal inflammation. Conclusions: Other specialties have adopted the use of ADM for defect repairs and breast reconstruction. ADMs can also be used in sacrocolpopexy. (J GYNECOL SURG 33:248) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix pelvic organ prolapse (surgery) sacrocolpopexy EMTREE MEDICAL INDEX TERMS adult aged article biopsy clinical article clinical outcome female histology human human tissue laparoscopic surgery patient satisfaction postoperative period priority journal surgical mesh surgical technique DEVICE TRADE NAMES STRATTICE , United StatesLifecell DEVICE MANUFACTURERS (United States)Lifecell EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170873225 PUI L619672333 DOI 10.1089/gyn.2017.0060 FULL TEXT LINK http://dx.doi.org/10.1089/gyn.2017.0060 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 34 TITLE Reply: Direct-to-Implant Breast Reconstruction without the Use of an Acellular Dermal Matrix Is Cost Effective and Oncologically Safe AUTHOR NAMES Serrurier L.C.J. Rayne S. Venter M. Benn C.-A. AUTHOR ADDRESSES (Serrurier L.C.J.) University of the Witwatersrand and, Milpark Breast Care Centre of Excellence, Johannesburg, South Africa (Rayne S.; Venter M.; Benn C.-A.) SOURCE Plastic and reconstructive surgery (2017) 140:6 (821e-822e). Date of Publication: 1 Dec 2017 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction EMTREE MEDICAL INDEX TERMS breast augmentation human LANGUAGE OF ARTICLE English MEDLINE PMID 29176426 (http://www.ncbi.nlm.nih.gov/pubmed/29176426) PUI L619879346 DOI 10.1097/PRS.0000000000003896 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000003896 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 35 TITLE Direct-to-Implant Breast Reconstruction without the Use of an Acellular Dermal Matrix Is Cost Effective and Oncologically Safe AUTHOR NAMES Parisi D. Ciancio F. Portincasa A. Innocenti A. AUTHOR ADDRESSES (Parisi D.) Department of Plastic and Reconstructive Surgery, University of Foggia, Foggia, Italy Department of Plastic and Reconstructive Surgery, University of Bari, Foggia, Italy Department of Plastic and Reconstructive Surgery, University of Foggia, Foggia, Italy Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy (Ciancio F.; Portincasa A.; Innocenti A.) SOURCE Plastic and reconstructive surgery (2017) 140:6 (820e-821e). Date of Publication: 1 Dec 2017 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction EMTREE MEDICAL INDEX TERMS breast augmentation breast tumor (surgery) human LANGUAGE OF ARTICLE English MEDLINE PMID 28820815 (http://www.ncbi.nlm.nih.gov/pubmed/28820815) PUI L619870647 DOI 10.1097/PRS.0000000000003836 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000003836 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 36 TITLE Two-Stage Prosthetic Breast Reconstruction: A Comparison Between Prepectoral and Partial Subpectoral Techniques AUTHOR NAMES Nahabedian M.Y. Cocilovo C. AUTHOR ADDRESSES (Nahabedian M.Y.) Washington, DC; and Falls Church, VA From the Georgetown University Hospital and Inova Fairfax Hospital (Cocilovo C.) SOURCE Plastic and reconstructive surgery (2017) 140:6 Prepectoral Breast Reconstruction (22S-30S). Date of Publication: 1 Dec 2017 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Prosthetic breast reconstruction with prepectoral placement may confer clinical advantages compared with subpectoral placement. The purpose of this study was to assess and compare clinical outcomes following 2-stage reconstruction following prepectoral and partial subpectoral placement of tissue expanders and implants.METHODS: A retrospective review of 39 (prepectoral) and 50 (partial subpectoral) patients was completed. Acellular dermal matrix was used in all patients. Mean age was 50.4 and 49.2 years, respectively. Body mass index (BMI) > 30 was noted in 15.4% of prepectoral and 18% of partial subpectoral patients. Radiation therapy was delivered to 38.5% of prepectoral patients and to 22% of partial subpectoral patients. Mean follow-up was 8.7 and 13 months for the prepectoral cohort and partial subpectoral cohorts.RESULTS: The percentage of patients having at least 1 adverse event was 20.5% in the prepectoral and 22% in the partial subpectoral cohorts. The incidence of surgical-site infection and seroma was 8.1% and 4.8%, respectively, for the prepectoral cohort and 4.8% and 2.4%, respectively, for the partial subpectoral cohorts. Device explantation was 6.5% for the prepectoral and 7.2% for the partial subpectoral patients. Explantation did not occur in patients who had radiation or who had a BMI > 30. Four patients (6 breasts-7.2%) required conversion from partial subpectoral to prepectoral because of animation deformity.CONCLUSIONS: Prepectoral reconstruction is a viable alternative to partial subpectoral reconstruction. Proper patient selection is an important variable. Prepectoral reconstruction can be safely performed in patients with a BMI < 40 and in patients having postmastectomy radiation therapy. EMTREE DRUG INDEX TERMS antiinfective agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) legislation and jurisprudence procedures EMTREE MEDICAL INDEX TERMS body mass breast augmentation breast implant breast reconstruction breast tumor (surgery) comparative study devices female human mastectomy middle aged postoperative care prospective study retrospective study LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 29166344 (http://www.ncbi.nlm.nih.gov/pubmed/29166344) PUI L620049115 DOI 10.1097/PRS.0000000000004047 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000004047 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 37 TITLE The Economics of Prepectoral Breast Reconstruction AUTHOR NAMES Glasberg S.B. AUTHOR ADDRESSES (Glasberg S.B.) New York, N.Y. From the Department of Plastic Surgery, Lenox Hill Hospital/Manhattan Eye, Ear, and Throat Hospital, Northwell Health System, Hofstra School of Medicine SOURCE Plastic and reconstructive surgery (2017) 140:6 Prepectoral Breast Reconstruction (49S-52S). Date of Publication: 1 Dec 2017 ISSN 1529-4242 (electronic) ABSTRACT The world of breast reconstruction over the last several years has seen a dramatic shift in focus to discussion and the application of placing tissue expanders and implants back into the prepectoral space. Although this technique failed during the early advent of breast reconstruction, newer technologies such as advances in fat grafting, improved acellular dermal matrices, better methods of assessing breast flap viability, and enhanced implants appear to have set the stage for the resurgence and positive early results seen with this technique. The main benefits of a switch to prepectoral breast reconstruction clinically appears to be less associated pain, lower incidence of animation deformities, and its associated symptoms as well as presumably better aesthetics. Early data suggest that the results are extremely promising and early adopters have attempted to define the ideal patients for prepectoral breast reconstruction. As with any new operative procedure, an assessment of finances and costs are crucial to its successful implementation. Although current data are minimal, this article attempts to build the fundamentals of an economic model that exhibits and displays potential savings through the use of prepectoral breast reconstruction. EMTREE DRUG INDEX TERMS narcotic analgesic agent (drug therapy) EMTREE MEDICAL INDEX TERMS ambulatory surgery breast reconstruction breast tumor (rehabilitation, surgery) contracture (prevention) economics esthetics female human joint characteristics and functions length of stay operation duration patient satisfaction physiology postoperative complication (etiology, prevention) postoperative pain (etiology, prevention) procedures reoperation return to work statistics and numerical data tissue expansion LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 29166348 (http://www.ncbi.nlm.nih.gov/pubmed/29166348) PUI L620049191 DOI 10.1097/PRS.0000000000004051 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000004051 COPYRIGHT Copyright 2018 Medline is the source for the citation and abstract of this record. RECORD 38 TITLE Mastectomy and breast reconstruction in a district general hospital: Audit and comparison to national mastectomy and breast reconstruction (2009) audit data AUTHOR NAMES Alder L. Graja T. AUTHOR ADDRESSES (Graja T.) Dorset County Hospital NHS Trust, Dorchester, United Kingdom. (Alder L.) Portsmouth Hospital NHS Trust, Portsmouth, United Kingdom. CORRESPONDENCE ADDRESS L. Alder, Portsmouth Hospital NHS Trust, Portsmouth, United Kingdom. SOURCE International Journal of Surgery (2017) 47 Supplement 1 (S22). Date of Publication: 1 Nov 2017 CONFERENCE NAME 2017 ASiT International Surgical Conference CONFERENCE LOCATION Bournemouth, United Kingdom CONFERENCE DATE 2017-03-31 to 2017-04-02 ISSN 1743-9159 BOOK PUBLISHER Elsevier Ltd ABSTRACT Aim: To compare our district general hospital mastectomy and reconstruction figures with those of the 2009 National mastectomy and reconstruction audit. Method: A retrospective case note audit against standards and descriptions set in the 2009 National Mastectomy and reconstruction audit. Consecutive cases of women undergoing mastectomy with or without reconstruction, and those requiring secondary procedures were audited across Jan 2014-Dec 2014. Excluding factors were male mastectomy and reconstructions for non-cancer cases. Data was collected for a number key standards and desciptors set out in the National audit figures. Result: 91 cases were included in the audit (median age=63). The majority of cancers were 20-50mm Grade 2 invasive ductal carcinoma ER/PR positive. 75 women underwent mastectomy. 21% (n=19) of these underwent reconstructions, the majority being immediate implant based reconstruction using acellular dermal matrix. In addition there were 16 secondary procedures, 54% were exchange of expander to fixed volume implant. All breast patients had reconstruction consultations. Plastic referrals for free flaps were available however waiting times were longer than anticipated. Conclusion: The majority of our standards were achieved, local figures compare to national descriptions and standards. However, there are improvements locally regarding rapid access to plastics pathway and assessment for free flaps. EMTREE DRUG INDEX TERMS plastic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction cancer surgery general hospital mastectomy EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult breast carcinoma cancer size consultation female free tissue graft human implant major clinical study male middle aged retrospective study LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L619900355 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 39 TITLE A Tumor Ultrasound-guided Incision (TUGI) Approach to Nipple-sparing Mastectomy: Balancing Oncologic Safety and Technical Outcomes AUTHOR NAMES Fernando E.J. Eskenazi B.R. Djohan R.S. Grobmyer S.R. AUTHOR ADDRESSES (Fernando E.J.; Grobmyer S.R., grobmys@ccf.org) Division of Surgical Oncology, Department of General Surgery, Cleveland Clinic, Cleveland, United States. (Eskenazi B.R.; Djohan R.S.) Department of Plastic Surgery, Cleveland Clinic, Cleveland, United States. CORRESPONDENCE ADDRESS S.R. Grobmyer, Division of Breast Services, Department of General Surgery, 9500 Euclid Ave, Cleveland, United States. Email: grobmys@ccf.org SOURCE Clinical Breast Cancer (2017) 17:7 (572-577). Date of Publication: 1 Nov 2017 ISSN 1938-0666 (electronic) 1526-8209 BOOK PUBLISHER Elsevier Inc., usjcs@elsevier.com ABSTRACT Not all breast cancer patients are candidates for nipple-sparing mastectomy (NSM) through standard incisions. We present our initial experience with a tumor ultrasound-guided incision approach to NSM through a retrospective review of our cohort of 13 patients. We show that oncologic safety is preserved with this technique with good technical result. Tumor ultrasound-guided incision safely extends the indications for NSM. Background Nipple-sparing mastectomy (NSM) is a prevalent operation for patients with breast cancer. Indications have been limited to tumors accessible via radial, infra-mammary, or periareolar incisions out of concern for oncologic and technical safety. We study an alternative approach to NSM based on tumor ultrasound-guided incisions (TUGI) and report its oncologic and technical outcomes. Materials and Methods A retrospective chart review examined patients who underwent TUGI NSM between 2013 and 2016. Operative notes, postoperative notes, pathology reports, and postoperative photography were analyzed. Results Ninety-four patients had mastectomy with reconstruction performed over a 3-year period by the senior authors. Of those, 31 (33%) were NSM and 13 (14%) had the TUGI technique, forming the study group. The median tumor size was 1.5 cm, with a median distance from the nipple areolar complex of 5 cm. Sixty-two percent of the incisions were in the upper quadrants of the breast. Median operative time was 207 minutes. Zero patients had positive margins. One hundred percent of patients underwent immediate tissue expander placement, 46% with acellular dermal matrix. For final reconstruction, 23% had a free flap, 69% implant, and 8% are still pending. Eight percent of patients had wound infection, and 15% of patients had NAC necrosis. No cancer recurrence has been observed at a median follow-up of 17 months. Conclusion TUGI offers a valuable, oncologically sound alternative approach to traditional NSM. The technical results and outcomes support its use in selected patients with breast cancer undergoing NSM. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) incision interventional ultrasonography mastectomy nipple sparing mastectomy tumor ultrasound guided incision EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult article breast areola breast reconstruction breast tissue expander cancer size cohort analysis debridement deep inferior epigastric perforator flap female follow up hematoma human lymph node dissection major clinical study medical photography necrosis nipple operation duration outcome assessment patient safety postoperative care retrospective study sentinel lymph node biopsy surgical infection EMBASE CLASSIFICATIONS Cancer (16) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170335670 PUI L616070775 DOI 10.1016/j.clbc.2017.04.003 FULL TEXT LINK http://dx.doi.org/10.1016/j.clbc.2017.04.003 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 40 TITLE Nipple-Sparing Mastectomy and Direct-to-Implant Breast Reconstruction AUTHOR NAMES Colwell A.S. Christensen J.M. AUTHOR ADDRESSES (Colwell A.S.) Boston, Mass. From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School (Christensen J.M.) SOURCE Plastic and reconstructive surgery (2017) 140:5 Advances in Breast Reconstruction (44S-50S). Date of Publication: 1 Nov 2017 ISSN 1529-4242 (electronic) ABSTRACT Breast reconstruction following mastectomy has evolved to preserve the native skin and nipple of the breast and create a natural-appearing reconstruction in 1 or 2 surgeries. Nipple-sparing procedures appear to be oncologically safe with low risks of cancer recurrence. In our series of 2,182 nipple-sparing mastectomies, there was no development or recurrence of cancer in the nipple. Direct-to-implant single-stage surgery offers the patient a complete reconstruction at the time of mastectomy. Patient selection centers on preoperative breast anatomy combined with postoperative goals for size and uplift of the breast. The best candidates for nipple-sparing mastectomy and direct-to-implant breast reconstruction include those with grade I-II breast ptosis and those desiring to stay approximately the same breast size. The choice of incision and width of the implant play key roles in nipple centralization. Partial muscle coverage with acellular dermal matrix remains the most common technique to support the implant and offers the advantage of more soft-tissue coverage in the upper pole. With experience, complications and revisions are similar in this approach compared with more traditional 2-stage tissue expander-implant reconstruction. Thus, nipple-sparing mastectomy and direct-to-implant breast reconstruction is emerging as a preferred method of breast reconstruction when the breast skin envelope is sufficiently perfused. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) procedures EMTREE MEDICAL INDEX TERMS analgesia breast reconstruction breast tumor (surgery) female human nipple patient selection postoperative care subcutaneous mastectomy LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 29064921 (http://www.ncbi.nlm.nih.gov/pubmed/29064921) PUI L619015194 DOI 10.1097/PRS.0000000000003949 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000003949 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 41 TITLE Breast reconstruction in a regional breast cancer network: Ten years on AUTHOR NAMES Tatterton M. AUTHOR ADDRESSES (Tatterton M.) Royal Bournemouth Hospital, United Kingdom. CORRESPONDENCE ADDRESS M. Tatterton, Royal Bournemouth Hospital, United Kingdom. SOURCE European Journal of Surgical Oncology (2017) 43:11 (2216). Date of Publication: 1 Nov 2017 CONFERENCE NAME Joint BASO-ACS Annual Scientific Conference and NCRI Cancer Conference 2017 CONFERENCE LOCATION Liverpool, United Kingdom CONFERENCE DATE 2017-11-05 to 2017-11-08 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Background: The final annual report of the 'National Mastectomy and Breast Reconstruction Audit' (NA) was published in 2011. In 2007 we performed a multi-centre audit, reviewing all breast reconstructions within the Dorset Breast Cancer Network. We now present results following a re-audit of all breast reconstructions performed within the same cancer network over a one year period and compare then against the NA and 2007 audit results.Method: Retrospective case note review of 73 patients who underwent breast reconstruction in Dorset during 2014.Results: Average age at reconstruction within the Dorset network was 59 years (NA 51), compared to 50 in 2007.Seventy percent of patients in Dorset had immediate reconstruction (NA 67%), whilst 30% underwent delayed reconstruction (NA 33%), almost identical to Dorset figures in 2007 (71% and 29% respectively). A pedicled flap was the most common reconstruction in Dorset in 2007. An implant-based reconstruction with an acellular dermal matrix (ADM) was the most common procedure in 2014 (32%). 63% of patients undergoing reconstruction had invasive disease compared to 47% of patients in 2007 (NA 76%). Implant-based complication rates in Dorset have increased from 7.79% to 17% since 2007. 17% of reconstructive patients in the NA required re-admission due to complications compared to only 6% in Dorset. There was no post-operative mortality in Dorset (NA 0.1%).Conclusion: Rates of immediate versus delayed reconstruction remain comparable in all audits. The Dorset network is now reconstructing patients with an age increase of nearly a decade and an increasing rate of invasive disease. Rates of implant-based reconstruction with ADM are increasing which is reflected in an increase in implant-based complication rates. Despite this, the complication re-admission rate in Dorset remains well below NA figures. This re-audit also clearly highlights the shifting practice in breast reconstruction since the NA began. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer breast reconstruction EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult complication controlled study female hospital readmission human implant major clinical study male pedicled skin flap retrospective study surgical mortality LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L620017263 DOI 10.1016/j.ejso.2017.10.114 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2017.10.114 COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 42 TITLE What's New in Acellular Dermal Matrix and Soft-Tissue Support for Prosthetic Breast Reconstruction AUTHOR NAMES Kim J.Y.S. Mlodinow A.S. AUTHOR ADDRESSES (Kim J.Y.S.) Chicago, Ill. From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine (Mlodinow A.S.) SOURCE Plastic and reconstructive surgery (2017) 140:5 Advances in Breast Reconstruction (30S-43S). Date of Publication: 1 Nov 2017 ISSN 1529-4242 (electronic) ABSTRACT Of the nearly 90,000 implant-based breast reconstructions performed in the United States, the majority use internal soft-tissue support. Aesthetically, these constructs may allow for better positioning of prosthesis, improve lower pole expansion, and increase projection. They may have particular utility in direct-to-implant, nipple-sparing mastectomies, and prepectoral reconstructions. In recent years, new permutations of acellular dermal matrices have evolved with diverse shapes, sizes, form-factor innovations, and processing characteristics. The literature is largely limited to retrospective studies (and meta-analyses thereof), making robust comparisons of 1 iteration vis-à-vis another difficult. Although synthetic mesh may provide a cost-effective alternative in primary and secondary reconstruction, comparative studies with acellular dermal matrix are lacking. This review aims to provide a balanced overview of recent biologic and synthetic mesh innovation. As this technology (and concomitant techniques) evolve, the reconstructive surgeon is afforded more-and better-choices to improve care for patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix procedures surgical mesh tissue scaffold EMTREE MEDICAL INDEX TERMS breast reconstruction breast tumor (surgery) female human skin transplantation LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 29064920 (http://www.ncbi.nlm.nih.gov/pubmed/29064920) PUI L619015163 DOI 10.1097/PRS.0000000000003950 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000003950 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 43 TITLE Consenting practise in xenogeneic mesh insertion for breast reconstruction AUTHOR NAMES Vozza A. Wilson B. Bell S. Derbyshire M. Pervaz M. AUTHOR ADDRESSES (Vozza A.; Wilson B.; Bell S.; Derbyshire M.; Pervaz M.) Queen Elizabeth Hospital, Gateshead, United Kingdom. CORRESPONDENCE ADDRESS A. Vozza, Queen Elizabeth Hospital, Gateshead, United Kingdom. SOURCE International Journal of Surgery (2017) 47 Supplement 1 (S22). Date of Publication: 1 Nov 2017 CONFERENCE NAME 2017 ASiT International Surgical Conference CONFERENCE LOCATION Bournemouth, United Kingdom CONFERENCE DATE 2017-03-31 to 2017-04-02 ISSN 1743-9159 BOOK PUBLISHER Elsevier Ltd ABSTRACT Introduction: Biological/synthetic meshes are popular as pectoral extenders in breast reconstruction surgery, consisting of acellular dermal or collagen matrices (ADM/ACM). These use porcine or bovine elements. Religious/personal practises may preclude xenogeneic mesh insertion. Informed consent is essential practise; a recent revision to Royal College of Surgeons guidelines (2016) advises doctors should no longer assume what patients want or need to know. No guidance exists from Association of Breast Surgery (ABS)/British Association of Plastic, Reconstructive and Aesthetic Surgeons with regard to this. We aim to explore current consenting practise. Method: Retrospective single centre review of 50 patients over a 4-year period having undergone skin-sparing mastectomy with immediate or delayed reconstruction and mesh insertion. Result: 0/50 patients had reference to animal origins in consent forms/clinical notes. Breast Care Nurses were asked about conversant/material information relayed; verbal information provided variably, but no identified protocol for enquiring about religious/personal practices. Conclusion: Consenting surgeons should establish patients' religious/personal practices for true informed consent. Animal origins of ADM/ACMs should be provided in material format to breast cancer patients at this particularly stressful time. We plan to ascertain broader consenting practise through further review of clinical/nursing records locally, and via distribution of a national questionnaire. EMTREE DRUG INDEX TERMS collagen endogenous compound EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction EMTREE MEDICAL INDEX TERMS adult animal model breast cancer breast care cancer patient cancer surgery clinical article college dermis female human informed consent male mastectomy medical record nurse practice guideline questionnaire retrospective study surgeon CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L619900391 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 44 TITLE Clinical, histological, and ultrasound follow-up of breast reconstruction with one-stage muscle-sparing “wrap” technique: A single-center experience AUTHOR NAMES Onesti M.G. Maruccia M. Di Taranto G. Albano A. Soda G. Ballesio L. Scuderi N. AUTHOR ADDRESSES (Onesti M.G.; Maruccia M., marucciam@gmail.com; Di Taranto G.; Albano A.; Scuderi N.) Department Surgery “P.Valdoni”, Unit of Plastic and Reconstructive Surgery, Sapienza University, Rome, Italy. (Soda G.) Department of Molecular medicine, Sapienza University of Rome, Rome, Italy. (Ballesio L.) Department of Radiological, Oncological, Anatomo-pathological Sciences, Sapienza University of Rome, Rome, Italy. CORRESPONDENCE ADDRESS M. Maruccia, Department Surgery “P.Valdoni”, Unit of Plastic and Reconstructive Surgery, Sapienza University, Viale del Policlinico 155, Rome, Italy. Email: marucciam@gmail.com SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2017) 70:11 (1527-1536). Date of Publication: 1 Nov 2017 ISSN 1878-0539 (electronic) 1748-6815 BOOK PUBLISHER Churchill Livingstone ABSTRACT Background Prepectoral implant placement and complete coverage with porcine acellular matrix after mastectomy is a new concept in breast surgery presented in few cases in the literature. This paper aimed to present our single-center experience in one-stage breast reconstruction muscle-sparing “wrap” technique by evaluating clinical and aesthetic outcomes, ultrasound and histological examination, and patient quality of life. Methods From January 2014 to January 2017, 52 patients (40 unilateral, 12 bilateral) underwent one-stage muscle-sparing breast reconstructions with Braxon(®) acellular dermal matrix and implant. In 3 patients, a surgical biopsy and histological examination with immunohistochemical analysis of the periprosthetic tissue were performed. All patients underwent breast ultrasound examination, and the occurrence of capsular contracture was assessed through the Baker classification and by measuring the mammary compliance scores with the Antoon Paar Mammary compliance system. Breast appearance was evaluated using a visual analogue scale (VAS) and in terms of quality of life using the EOCRT QLQ C-30 and QLQ BR-23 questionnaires. Results Early and late postoperative complications are reported. Histological and ultrasound evaluation showed a complete integration of the matrix. According to the VAS scale, the EOCRT QLQ C-30, and QLQ BR-23, patients' satisfaction resulted in a high score in terms of quality of life and aesthetic outcomes. Conclusion The results of this new surgical technique in selected cases are promising in terms of effectiveness and low rate of postoperative complications, but further long-terms evaluations are required. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction echomammography histopathology one stage breast reconstruction muscle sparing wrap technique patient-reported outcome physical appearance EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult aged article Braxon breast biopsy breast disease (complication) breast implant (adverse device effect) breast tissue clinical effectiveness device infection (complication) female human human tissue immunohistochemistry implant capsular contracture (complication) major clinical study patient satisfaction postoperative complication (complication) priority journal quality of life red breast syndrome (complication) visual analog scale wound healing impairment (complication) DEVICE TRADE NAMES Braxon EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170533449 MEDLINE PMID 28736191 (http://www.ncbi.nlm.nih.gov/pubmed/28736191) PUI L617489256 DOI 10.1016/j.bjps.2017.06.023 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2017.06.023 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 45 TITLE Evaluation of the effectiveness of the prepectoral breast reconstruction with Braxon dermal matrix: First multicenter European report on 100 cases AUTHOR NAMES Vidya R. Masià J. Cawthorn S. Berna G. Bozza F. Gardetto A. Kołacińska A. Dell'Antonia F. Tiengo C. Bassetto F. Caputo G.G. Governa M. AUTHOR ADDRESSES (Vidya R., raghavan.vidya@nhs.net) Breast Care Center, Royal Wolverhampton Hospital, Wolverhampton, United Kingdom. (Masià J.) Plastic and Reconstructive Surgery Department, Hospital de la Santa Creu i Sant Pau (Universitat Autònoma de Barcelona), Barcelona, Spain. (Cawthorn S.) Breast Care Center, North Bristol NHS Trust, Bristol, United Kingdom. (Berna G.; Dell'Antonia F.) Plastic and Reconstructive Surgery Department, Ulss 9 General Hospital, Treviso, Italy. (Bozza F.) Breast Care Center, Venetian Oncology Institute, Padova, Italy. (Gardetto A.) Plastic and Reconstructive Surgery Department, South Tyrol Healthcare Company, Brixen, Italy. (Kołacińska A.) Department of Surgical Oncology and Head and Neck Cancer Surgery, Medical University of Lodz, Cancer Center Copernicus Memorial Hospital, Medical University of Lodz, Lodz, Poland. (Tiengo C.; Bassetto F.) Plastic and Reconstructive Surgery Department, University Hospital of Padua, Padua, Italy. (Caputo G.G.; Governa M.) Plastic and Reconstructive Surgery, Surgery and Odontology Department, University Hospital of Verona, Verona, Italy. CORRESPONDENCE ADDRESS R. Vidya, Breast Care Center, Royal Wolverhampton Hospital, Wolverhampton, United Kingdom. Email: raghavan.vidya@nhs.net SOURCE Breast Journal (2017) 23:6 (670-676). Date of Publication: 1 Nov 2017 ISSN 1524-4741 (electronic) 1075-122X BOOK PUBLISHER Blackwell Publishing Inc., subscrip@blackwellpub.com ABSTRACT We report the outcomes of the European prospective study on prepectoral breast reconstruction using preshaped acellular dermal matrix for complete breast implant coverage. Seventy-nine patients were enrolled between April 2014 and August 2015 all over Europe using a single protocol for patient selection and surgical procedure, according to the Association of Breast Surgery and British Association of Plastic Reconstructive and Aesthetic Surgeons joint guidelines for the use of acellular dermal matrix in breast surgery. The preshaped matrix completely wraps the breast implant, which is placed above the pectoralis major, without detaching the muscle. A total of 100 prepectoral breast reconstructions with complete implant coverage were performed. This series, with mean follow-up of 17.9 months, had two cases of implant loss (2.0%) including one necrosis of the nipple and one wound breakdown (1.0% respectively). No implant rotations were observed. Good cosmetic outcomes were obtained with natural movement of the breasts and softness to the touch; none of the patients reported experiencing pain or reduction in the movements of the pectoralis major muscle postoperatively. The use of preshaped acellular dermal matrix for a complete breast implant coverage in selected patients is safe and gives satisfactory results, both from the aesthetic view point and the low postoperative complication rates. Further studies reporting long-term outcomes are planned. EMTREE DRUG INDEX TERMS cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction prepectoral breast reconstruction EMTREE MEDICAL INDEX TERMS adult aged article breast implant breast necrosis breast surgery female follow up hematoma human implant loss major clinical study multicenter study nipple pain patient selection pectoralis major muscle postoperative complication prospective study seroma wound dehiscence EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170332833 PUI L616036405 DOI 10.1111/tbj.12810 FULL TEXT LINK http://dx.doi.org/10.1111/tbj.12810 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 46 TITLE Reply: Comparison of Different Acellular Dermal Matrices in Breast Reconstruction: The 50/50 Study AUTHOR NAMES Pittman T.A. AUTHOR ADDRESSES (Pittman T.A., troy.a.pittman@gunet.georgetown.edu) Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, NW, 1st Floor PHC, Washington, D.C. 20007, SOURCE Plastic and reconstructive surgery (2017) 140:5 (751e). Date of Publication: 1 Nov 2017 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction EMTREE MEDICAL INDEX TERMS breast augmentation human LANGUAGE OF ARTICLE English MEDLINE PMID 29068954 (http://www.ncbi.nlm.nih.gov/pubmed/29068954) PUI L619688867 DOI 10.1097/PRS.0000000000003807 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000003807 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 47 TITLE Thoracodorsal artery perforator flap as an autologous alternative to acellular dermal matrix AUTHOR NAMES Hashem T. Farahat A. AUTHOR ADDRESSES (Hashem T., hashimotoo@hotmail.com; Farahat A.) Cairo University, Department of Breast Surgery, National Cancer Institute, Cairo, Egypt. (Hashem T., hashimotoo@hotmail.com) National Cancer Institute, Department of Surgical Oncology, Nr 1.Fom el Khalig, Kasr el Aini str, Cairo, Egypt. CORRESPONDENCE ADDRESS T. Hashem, Cairo University, Department of Breast Surgery, National Cancer Institute, Cairo, Egypt. Email: hashimotoo@hotmail.com SOURCE World Journal of Surgical Oncology (2017) 15:1 Article Number: 185. Date of Publication: 16 Oct 2017 ISSN 1477-7819 (electronic) BOOK PUBLISHER BioMed Central Ltd., info@biomedcentral.com ABSTRACT Background: Thoracodorsal artery perforator (TDAP) flap is one of the relatively new techniques in breast reconstruction. This pedicled flap retains the benefits of perforator flaps as regards minimal donor site morbidity without the need for microvascular anastomosis. Its role in partial breast reconstruction has been well documented. However, there are few reports about the role of this flap in total breast reconstruction. Methods: This study included 47 cases who presented to the breast unit of the National Cancer Institute of Cairo University from 2013 to 2015. All patients underwent nipple-sparing mastectomy with immediate implant-based reconstruction. The TDAP flap was used to complete the subpectoral pocket for the implants in a way similar to the acellular dermal matrix. Results: Overall complication rate was 14.9%. Capsular contracture occurred in 6.4%.There were no donor site complications. The majority of patients were satisfied with their cosmetic results. Sixty-eight percent rated their result as "excellent" or "good." Conclusion: Thoracodorsal artery perforator flap can play a significant role in total breast reconstruction. In settings with limited resources, this flap can serve as an available autologous alternative to acellular dermal matrix. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast cancer (surgery) mastectomy nipple sparing mastectomy thoracodorsal artery perforator flap EMTREE MEDICAL INDEX TERMS adult article cancer risk cancer staging clinical article cohort analysis controlled study esthetic surgery female follow up gene mutation human implant capsular contracture (complication) informed consent physical examination postoperative hemorrhage (complication) postoperative period prospective study treatment outcome tumor suppressor gene EMBASE CLASSIFICATIONS Dermatology and Venereology (13) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170729731 PUI L618780357 DOI 10.1186/s12957-017-1254-9 FULL TEXT LINK http://dx.doi.org/10.1186/s12957-017-1254-9 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 48 TITLE Cost analysis of post-mastectomy reconstruction: A comparison of immediate single-stage direct-to-implant and two-stage tissue expander-to-implant breast reconstruction with acellular dermal matrix vs abdominal based perforator free flap AUTHOR NAMES Tran B.N.N. Singhal D. Lee B.T. AUTHOR ADDRESSES (Tran B.N.N.; Singhal D.; Lee B.T.) Beth Israel Deaconess Medical Center, Boston, United States. CORRESPONDENCE ADDRESS B.N.N. Tran, Beth Israel Deaconess Medical Center, Boston, United States. SOURCE Journal of the American College of Surgeons (2017) 225:4 Supplement 2 (e106). Date of Publication: 1 Oct 2017 CONFERENCE NAME 103rd Annual American College of Surgeons Clinical Congress, ACS 2017 CONFERENCE LOCATION San Diego, CA, United States CONFERENCE DATE 2017-10-22 to 2017-10-26 ISSN 1879-1190 BOOK PUBLISHER Elsevier Inc. ABSTRACT INTRODUCTION: Autologous and implant-based reconstruction are the 2 most popular techniques in breast reconstruction post mastectomy. The current standard of care for breast implant reconstruction is 2-stage tissue expander-to-implant reconstruction (TE/ I+ADM). Immediate single-stage direct-to-implant breast reconstruction with acellular dermal matrix (SSI+ADM) has gained much popularity recently. We performed cost analysis to compare these 2 types of implant-based breast reconstruction with the most popular autologous reconstruction, deep inferior epigastric perforator flap (DIEP). METHODS: A comparative cost analysis of TE/I+ADM, SSI+ADM, and DIEP flap was performed. Medicare reimbursement costs for each procedure and their associated complications were calculated. Pooled probabilities of perioperative complications including cellulitis, seroma, hematoma, skin necrosis, capsular contracture, implant removal, flap loss, partial flap loss, and fat necrosis, were calculated using published studies from 2010 to 2016. RESULTS: Average actual cost for successful TE/I+ADM, SSI+ADM, and DIEP flap were $13,304.55, $8,055.71, $10,237.13 respectively. The overall pooled complications for TE/I+ADM, SSI+ADM, and DIEP flap were 32%, 11%. Incorporating pooled complication data from published literature resulted in an increase in cost to $13,842.78, $8,278.08, and $11,422.27 respectively for each group. The expected costs for successful TE/ I+ADM, SSI+ADM, and DIEP flap were $9,029.80, $7,107.55, and $7,414.75, significantly lower than the actual costs. CONCLUSIONS: SSI+ADM reconstruction was the most costeffective method of reconstruction at baseline as well as with pooled complications. TE/I+ADM reconstruction incurred the highest perioperative complication cost. Long-term costs associated with implant-based reconstruction such as revision, implant rupture, implant replacement, and additional need for future MRI screenings should be considered when making decision about treatment plans. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction cost benefit analysis deep inferior epigastric perforator flap mastectomy tissue expander EMTREE MEDICAL INDEX TERMS adverse device effect cellulitis complication fat necrosis graft failure hematoma human implant capsular contracture medicare nuclear magnetic resonance imaging peroperative complication probability reimbursement rupture seroma skin necrosis LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L619489681 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 49 TITLE Characterizing infections in prosthetic breast reconstruction: A validity assessment of national health databases AUTHOR NAMES Piper M.L. Roussel L.O. Koltz P.F. Wang F. Singh K. Chin R. Sbitany H. Langstein H.N. AUTHOR ADDRESSES (Piper M.L.; Wang F.; Chin R.; Sbitany H., hani.sbitany@ucsf.edu) Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco, San Francisco, United States. (Roussel L.O.; Koltz P.F.; Singh K.; Langstein H.N.) Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, United States. CORRESPONDENCE ADDRESS H. Sbitany, 505 Parnassus Avenue, Suite M-593, San Francisco, United States. Email: hani.sbitany@ucsf.edu SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2017) 70:10 (1345-1353). Date of Publication: 1 Oct 2017 ISSN 1878-0539 (electronic) 1748-6815 BOOK PUBLISHER Churchill Livingstone ABSTRACT Introduction Current guidelines in the United States require reporting only the 30-day postoperative outcomes to standardized databases, including the National Surgical Quality Improvement Program (NSQIP). Thus, many breast implant-related complications go unreported in standard databases. We sought to characterize late periprosthetic infections following implant-based breast reconstruction. Methods We conducted a retrospective analysis of all women who underwent expander/implant reconstruction from 2005 to 2014 at two institutions. All periprosthetic infections were identified and divided into early and late cohorts (≤30 days or >30 days). Infection was defined as any episode where antibiotics were initiated or a prosthetic device was explanted because of clinical evidence of the infection. Results In the 1820 patients (2980 breasts) identified, 421 periprosthetic infections occurred (14%). Of these, 173 (41%) were early and 248 (59%) were late (mean time to infection = 66.4 ± 101.9 days). Patients with late infections were more likely to be current smokers or have diabetes than patients with early infections (p < 0.034 for both). Infections caused by gram-negative bacteria and antimicrobial-resistant strains of Staphylococcus were more common in the early infection group (p < 0.001 for both). Implant loss due to infection was more common in the late infection group (p = 0.037). Discussion Late periprosthetic infections following implant-based breast reconstruction are underestimated in national outcome databases and have unique risk factors and microbiology compared to early infections. A system-level change in reevaluating and redefining a timeline for tracking and treating implant infections is necessary, given the substantial morbidity associated with, and frequency of, late periprosthetic infections. EMTREE DRUG INDEX TERMS antibiotic agent (drug therapy, intratracheal drug administration, intravenous drug administration, oral drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast implant (adverse device effect) breast reconstruction breast tissue expander (adverse device effect) prosthesis infection (drug therapy, complication, drug therapy) EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult article bacterium culture breast cancer (radiotherapy, surgery) breast radiotherapy cancer radiotherapy cancer surgery catheter controlled study cytoreductive surgery diabetes mellitus female furunculosis human infection risk interventional radiology invasive procedure major clinical study mastectomy Mediport methicillin resistant Staphylococcus aureus mixed infection omentectomy ovary cancer (surgery) prediction priority journal retrospective study seroma smoking surgical drainage validity EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) Drug Literature Index (37) Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170424614 MEDLINE PMID 28619483 (http://www.ncbi.nlm.nih.gov/pubmed/28619483) PUI L616778789 DOI 10.1016/j.bjps.2017.05.004 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2017.05.004 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 50 TITLE Cost analysis of postmastectomy reconstruction: A comparison of two staged implant reconstruction using tissue expander and acellular dermal matrix with abdominal-based perforator free flaps AUTHOR NAMES Tran B.N.N. Fadayomi A. Lin S.J. Singhal D. Lee B.T. AUTHOR ADDRESSES (Tran B.N.N.; Fadayomi A.; Lin S.J.; Singhal D.; Lee B.T., blee3@bidmc.harvard.edu) Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, Boston, United States. CORRESPONDENCE ADDRESS B.T. Lee, Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, Boston, United States. Email: blee3@bidmc.harvard.edu SOURCE Journal of Surgical Oncology (2017) 116:4 (439-447). Date of Publication: 15 Sep 2017 ISSN 1096-9098 (electronic) 0022-4790 BOOK PUBLISHER John Wiley and Sons Inc., P.O.Box 18667, Newark, United States. ABSTRACT Background and Objectives: Two staged tissue expander-implant with acellular dermal matrix (TE/I + ADM) and deep inferior epigastric perforator (DIEP) flap are the most common implant and autologous methods of reconstruction in the U.S. Implant-based techniques are disproportionally more popular, partially due to its presumed cost effectiveness. We performed a comprehensive cost analysis to compare TE/I + ADM and DIEP flap. Methods: A comparative cost analysis of TE/I + ADM and DIEP flap was performed. Medicare reimbursement costs for each procedure and their associated complications were calculated. Pooled probabilities of complications including cellulitis, seroma, skin necrosis, implant removal, flap loss, partial flap loss, and fat necrosis, were calculated using published studies from 2010 to 2016. Results: Average actual cost for successful TE/I + ADM and DIEP flap were $13 304.55 and $10 237.13, respectively. Incorporating pooled complication data from published literature resulted in an increase in cost to $13 963.46 for TE/I + ADM and $12 624.29 for DIEP flap. The expected costs for successful TE/I + ADM and DIEP flap were $9700.35 and $8644.23, which are lower than the actual costs. Conclusions: DIEP flap breast reconstruction incurs lower costs compared to TE/I + ADM. These costs are lower at baseline and when additional costs from pooled complications are incorporated. EMTREE DRUG INDEX TERMS antibiotic agent (drug therapy, intravenous drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix (adverse device effect, device economics) breast implant (adverse device effect, device economics) breast reconstruction breast tissue expander (adverse device effect, device economics) cost benefit analysis deep inferior epigastric perforator flap health care cost mastectomy EMTREE MEDICAL INDEX TERMS antibiotic therapy article cellulitis (complication, disease management) comparative study device infection (complication, drug therapy) device removal fat necrosis (complication, disease management) graft failure (complication, disease management) human medicare priority journal seroma (complication, disease management, surgery) skin necrosis (complication, disease management, surgery) EMBASE CLASSIFICATIONS Health Policy, Economics and Management (36) Drug Literature Index (37) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170412747 MEDLINE PMID 28591940 (http://www.ncbi.nlm.nih.gov/pubmed/28591940) PUI L616678082 DOI 10.1002/jso.24692 FULL TEXT LINK http://dx.doi.org/10.1002/jso.24692 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 51 TITLE Cost analysis of postmastectomy reconstruction: A comparison of two staged implant reconstruction using tissue expander and acellular dermal matrix with abdominal based perforator free flaps AUTHOR NAMES Tran B.N.N. Fadayomi A. Lin S.J. Singhal D. Lee B.T. Lee B.T. Nahabedian M.Y. AUTHOR ADDRESSES (Tran B.N.N.; Fadayomi A.; Lin S.J.; Singhal D.; Lee B.T.; Lee B.T.; Nahabedian M.Y.) SOURCE Journal of Surgical Oncology (2017) 116:4 (448-449). Date of Publication: 15 Sep 2017 ISSN 1096-9098 (electronic) 0022-4790 BOOK PUBLISHER John Wiley and Sons Inc., P.O.Box 18667, Newark, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix (device economics) breast reconstruction breast tissue expander (device economics) cost benefit analysis mastectomy perforator flap EMTREE MEDICAL INDEX TERMS accuracy contracture deep inferior epigastric perforator flap editorial health care cost health insurance hospital charge hospital planning human medicare priority journal reimbursement reoperation rupture EMBASE CLASSIFICATIONS Health Policy, Economics and Management (36) Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20170412745 PUI L616678081 DOI 10.1002/jso.24694 FULL TEXT LINK http://dx.doi.org/10.1002/jso.24694 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 52 TITLE Prospective unbiased experience with three acellular dermal matrices in breast reconstruction AUTHOR NAMES Chang E.I. Liu J. AUTHOR ADDRESSES (Chang E.I., eichang@mdanderson.org; Liu J.) Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, United States. CORRESPONDENCE ADDRESS E.I. Chang, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, United States. Email: eichang@mdanderson.org SOURCE Journal of Surgical Oncology (2017) 116:3 (365-370). Date of Publication: 1 Sep 2017 ISSN 1096-9098 (electronic) 0022-4790 BOOK PUBLISHER John Wiley and Sons Inc., P.O.Box 18667, Newark, United States. ABSTRACT Background: The use of acellular dermal matrix (ADM) has become the standard of care in breast reconstruction. However, the majority of current studies are biased or combine large databases introducing inherent flaws. Here, we present a prospective single surgeon experience comparing three ADM. Methods: All expander based breast reconstructions between 2014 and 2015 using ADM were included. Results: Eighteen patients (32 breasts) underwent reconstruction using Flex Pliable, 15 patients (22 breasts) used Alloderm, and 14 patients (20 breasts) had Dermacell. There were no significant differences in patient demographics or comorbidities. All expanders were placed into a subpectoral position, and there were no direct to implant cases. Average intraoperative fill was comparable, (Flex: 225 cc, Alloderm: 180 cc, Dermacell: 130 cc). There were no differences in seroma, infection, or mastectomy skin flap necrosis rates. There were no cases of red breast, expander explanation or failed reconstruction in any cohort. Time to drain removal was significantly shorter in Flex and Dermacell patients compared to Alloderm (20 days vs 15 days vs 26 days, respectively; P = 0.01). Conclusions: While there are differences between available ADM, successful outcomes can be achieved with proper patient selection, sound surgical technique, and diligent post-operative management. EMTREE DRUG INDEX TERMS antineoplastic agent (drug therapy) cefadroxil (oral drug administration) clindamycin (oral drug administration) cotrimoxazole (oral drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction personal experience surgical mesh (adverse device effect, device comparison, device economics) EMTREE MEDICAL INDEX TERMS adjuvant therapy adult antibiotic prophylaxis article breast disease (complication) breast necrosis (complication) breast tissue expander cancer chemotherapy cellulitis (complication) clinical article cohort analysis comorbidity comparative effectiveness controlled study cost benefit analysis cost control debridement device removal explant follow up graft necrosis (complication) hematoma (complication) hospital readmission human infection (complication) intraductal carcinoma (drug therapy, surgery) intraoperative period latissimus dorsi flap mastectomy middle aged neoadjuvant chemotherapy nipple necrosis (complication) pectoralis major muscle plastic surgeon priority journal prospective study red breast (complication) reoperation seroma (complication) silicone breast implant surgical infection (complication) treatment failure wound dehiscence (complication) DRUG TRADE NAMES bactrim duricef DEVICE TRADE NAMES Alloderm Dermacell Flex Pliable CAS REGISTRY NUMBERS cefadroxil (50370-12-2) clindamycin (18323-44-9) cotrimoxazole (8064-90-2) EMBASE CLASSIFICATIONS Cancer (16) Health Policy, Economics and Management (36) Drug Literature Index (37) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170314658 MEDLINE PMID 28444764 (http://www.ncbi.nlm.nih.gov/pubmed/28444764) PUI L615836268 DOI 10.1002/jso.24656 FULL TEXT LINK http://dx.doi.org/10.1002/jso.24656 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 53 TITLE Revisiting an Old Place: Single-Surgeon Experience on Post-Mastectomy Subcutaneous Implant-Based Breast Reconstruction AUTHOR NAMES Woo A. Harless C. Jacobson S.R. AUTHOR ADDRESSES (Woo A.; Harless C.; Jacobson S.R., Jacobson.steven2@gmail.com) Department of Surgery Plastic, Surgery Mayo Clinic, Rochester, United States. CORRESPONDENCE ADDRESS S.R. Jacobson, Department of Surgery Plastic, Surgery Mayo Clinic, Rochester, United States. Email: Jacobson.steven2@gmail.com SOURCE Breast Journal (2017) 23:5 (545-553). Date of Publication: 1 Sep 2017 ISSN 1524-4741 (electronic) 1075-122X BOOK PUBLISHER Blackwell Publishing Inc., subscrip@blackwellpub.com ABSTRACT Significant advances have been made to the reconstructive tools available to plastic surgeons allowing for the re-exploration of subcutaneous breast reconstruction. The purpose of the current study is to examine the safety, efficacy, and aesthetic results of subcutaneous breast reconstruction by a single-surgeon. A retrospective chart review was performed on all patients undergoing subcutaneous implant-based breast reconstruction between April 2012 and September 2014. All implants were fully wrapped in Alloderm and placed in the subcutaneous (pre-pectoral) plane. Primary outcome was a successful subcutaneous breast reconstruction. All complications were recorded. Aesthetics of the preoperative and postoperative photographs were examined. A total of 135 breasts (79 patients) were reconstructed. Direct-to-implant reconstruction was performed in 8 patients (10%). Successful breast reconstruction was achieved for 130 breasts in 76 patients (96%). Sixty-nine patients (87%) had a course free of any unexpected event or complication. There were no patients with implant extrusion or skin necrosis requiring operative intervention. When comparing pre-mastectomy breasts with post-mastectomy reconstructions, there was an improvement in the overall aesthetic outcome. Subcutaneous post-mastectomy breast reconstruction is safe and effective with comparable complication rates to standard techniques. Yet, this minimally invasive approach does not sacrifice the aesthetic results. Long-term studies will be required to prove the durability of aesthetic results overtime. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast implant breast reconstruction postoperative period subcutaneous mastectomy EMTREE MEDICAL INDEX TERMS adult aged article cyanoacrylic acid octyl ester female foam dressing graft salvage hematoma (complication) human major clinical study outcome assessment postoperative complication (complication) postoperative infection (complication) retrospective study seroma (complication) skin necrosis (complication) surgical mesh wound dehiscence (complication) wound dressing DEVICE TRADE NAMES Alloderm , United StatesLifecell BioPatch , United StatesEthicon dermabond , United StatesEthicon Tegaderm , United StatesSt Paul DEVICE MANUFACTURERS (United States)Ethicon (United States)Lifecell (United States)St Paul EMBASE CLASSIFICATIONS Cancer (16) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170196616 PUI L614833011 DOI 10.1111/tbj.12790 FULL TEXT LINK http://dx.doi.org/10.1111/tbj.12790 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 54 TITLE Prepectoral Breast Reconstruction: A Safe Alternative to Submuscular Prosthetic Reconstruction following Nipple-Sparing Mastectomy AUTHOR NAMES Sbitany H. Piper M. Lentz R. AUTHOR ADDRESSES (Sbitany H.) San Francisco, Calif. From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco (Piper M.; Lentz R.) SOURCE Plastic and reconstructive surgery (2017) 140:3 (432-443). Date of Publication: 1 Sep 2017 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Nipple-sparing mastectomy with immediate prosthetic reconstruction is routinely performed because of excellent aesthetic results and safe oncologic outcomes. Typically, subpectoral expanders are placed, but in select patients, this can lead to significant postoperative pain and animation deformity, caused by pectoralis major muscle disinsertion and stretch. Prepectoral reconstruction is a technique that eliminates dissection of the pectoralis major by placing the prosthesis completely above the muscle with complete acellular dermal matrix coverage.METHODS: A single surgeon's experience with immediate prosthetic reconstruction following nipple-sparing mastectomy from 2012 to 2016 was reviewed. Patient demographics, adjuvant treatment, length and characteristics of the expansion, and incidence of complications during the tissue expander stage were compared between the partial submuscular/partial acellular dermal matrix (dual-plane) cohort and the prepectoral cohort.RESULTS: Fifty-one patients (84 breasts) underwent immediate prepectoral tissue expander placement, compared with 115 patients (186 breasts) undergoing immediate partial submuscular expander placement. The groups had similar comorbidities and postoperative radiation exposure. There was no significant difference in overall complication rate between the two groups (17.9 percent versus 18.8 percent; p = 0.49).CONCLUSIONS: Prepectoral breast reconstruction provides a safe and effective alternative to partial submuscular reconstruction, that yields comparable aesthetic results with less operative morbidity. In the authors' experience, the incidence of acute and chronic postoperative pain and animation deformity is significantly lower following prepectoral breast reconstruction. This technique is now considered for all patients who are safe oncologic candidates and are undergoing nipple-sparing mastectomy and prosthetic reconstruction.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) conservative treatment nipple procedures subcutaneous mastectomy EMTREE MEDICAL INDEX TERMS adult aged breast reconstruction breast tumor (surgery) female human middle aged postoperative complication prospective study tissue expansion LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 28574950 (http://www.ncbi.nlm.nih.gov/pubmed/28574950) PUI L618411087 DOI 10.1097/PRS.0000000000003627 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000003627 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 55 TITLE Muscle-sparing ADM-assisted breast reconstruction technique using complete breast implant coverage: A dual-institute UK-based experience AUTHOR NAMES Vidya R. Cawthorn S.J. AUTHOR ADDRESSES (Vidya R., Raghavan.Vidya@nhs.net) Breast Care Centre, Royal Wolverhampton Hospital NHS Trust, Wolverhampton Road, Wolverhampton, United Kingdom. (Cawthorn S.J.) Breast Care Centre, North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom. SOURCE Breast Care (2017) 12:4 (251-254). Date of Publication: 1 Sep 2017 ISSN 1661-3805 (electronic) 1661-3791 BOOK PUBLISHER S. Karger AG ABSTRACT Background: We report our early experience of a novel muscle-sparing breast (prepectoral) reconstruction technique using a pre-shaped Braxon® mesh (acellular dermal matrix) which completely wraps around the breast implant. Methods: All patients who underwent prepectoral implant-based breast reconstruction between April 2014 and September 2015 were included in the analysis. The dermal matrix Braxon® used is a pre-shaped matrix which forms a complete implant mesh wrap. The new breast created is placed over the chest wall without disturbing the pectoralis musculature. Results: A total of 51 (42 unilateral and 9 bilateral) muscle-sparing breast reconstructions were carried out. Complications included implant loss (n = 1; 1.7%) secondary to wound infection, seroma (n = 4; 6.7%), and superficial wound dehiscence (n = 1; 1.7%) which was re-sutured without further complication. The median follow-up period was 16.4 (range 8-25) months. Conclusion: The early experience appears highly satisfactory with good clinical outcome. The novel prepectoral implant-based breast reconstruction using the mesh wrap provides an effective alternative to the more traditional submuscular implant-based technique. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix (adverse device effect) breast implant (adverse device effect) breast reconstruction EMTREE MEDICAL INDEX TERMS adult aged article body mass Braxon clinical outcome female human major clinical study mastectomy priority journal seroma (complication) skin necrosis (complication) wound dehiscence (complication) wound infection (complication) DEVICE TRADE NAMES Braxon EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170640475 PUI L618232992 DOI 10.1159/000464401 FULL TEXT LINK http://dx.doi.org/10.1159/000464401 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 56 TITLE Acellular dermal matrix based nipple reconstruction: A modified technique AUTHOR NAMES Vidya R. Salem F. Iqbal F.M. Sircar T. AUTHOR ADDRESSES (Vidya R., Raghavan.vidya@nhs.net; Salem F., Fathi.salem@nhs.net; Sircar T., tapan.sircar@nhs.net) Breast Unit, Royal Wolverhampton Hospital, Wolverhampton, United Kingdom. (Iqbal F.M., fahad.iqbal@kclalumni.net) Medical School, Keele University, David Weatherall Building, Stoke-on-Trent, United Kingdom. CORRESPONDENCE ADDRESS R. Vidya, Breast Unit, Royal Wolverhampton Hospital, Wolverhampton, United Kingdom. Email: Raghavan.vidya@nhs.net SOURCE JPRAS Open (2017) 13 (62-67). Date of Publication: 1 Sep 2017 ISSN 2352-5878 (electronic) BOOK PUBLISHER Elsevier Ltd ABSTRACT Nipple areolar reconstruction (NAR) has evolved with the advancement in breast reconstruction and can improve self-esteem and, consequently, patient satisfaction. Although a variety of reconstruction techniques have been described in the literature varying from nipple sharing, local flaps to alloplastic and allograft augmentation, over time, loss of nipple projection remains a major problem. Acellular dermal matrices (ADM) have revolutionised breast reconstruction more recently. We discuss the use of ADM to act as a base plate and strut to give support to the base and offer nipple bulk and projection in a primary procedure of NAR with a local clover shaped dermal flap in 5 breasts (4 patients). We used 5-point Likert scales (1 = highly unsatisfied, 5 = highly satisfied) to assess patient satisfaction. Median age was 46 years (range: 38–55 years). Nipple projection of 8 mm, 7 mm, and 7 mms were achieved in the unilateral cases and 6 mm in the bilateral case over a median 18 month period. All patients reported at least a 4 on the Likert scale. We had no post-operative complications. It seems that nipple areolar reconstruction [NAR] using ADM can achieve nipple projection which is considered aesthetically pleasing for patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast surgery nipple nipple areolar reconstruction EMTREE MEDICAL INDEX TERMS adult article base plate body image breast modified technique (surgery) breast reconstruction case report female human human tissue Likert scale medical device patient satisfaction self esteem skin allograft skin flap strut surgical technique EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170450665 PUI L616892539 DOI 10.1016/j.jpra.2017.05.004 FULL TEXT LINK http://dx.doi.org/10.1016/j.jpra.2017.05.004 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 57 TITLE Tissue expansion for breast reconstruction: Methods and techniques AUTHOR NAMES Bertozzi N. Pesce M. Santi P. Raposio E. AUTHOR ADDRESSES (Bertozzi N., nicolo.bertozzi@yahoo.com; Raposio E.) Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Cutaneous, Mini-invasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy. (Bertozzi N., nicolo.bertozzi@yahoo.com; Raposio E.) Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Plastic Surgery Department, IRCCS San Martino University Hospital, National Institute for Cancer Research, Genoa, Italy. (Pesce M.; Santi P.) Department of Plastic and Reconstructive Surgery, San Martino-IST University of Genova, Genova, Italy. CORRESPONDENCE ADDRESS N. Bertozzi, Cutaneous, Mininvasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Via Gramsci 14, Parma, Italy. Email: nicolo.bertozzi@yahoo.com SOURCE Annals of Medicine and Surgery (2017) 21 (34-44). Date of Publication: 1 Sep 2017 ISSN 2049-0801 BOOK PUBLISHER Elsevier Ltd ABSTRACT Objective In this work, the authors review recent data on the different methods and techniques of TE/implant-based reconstruction to determine the complication profiles and the advantages and disadvantages of the different techniques. This information will be valuable for surgeons performing breast reconstructions. Materials and methods A thorough literature review was conducted by the authors concerning the current strategy of tissue expander (TE)/implant-based breast reconstruction following breast cancer surgery. Results Loss of the breast can strongly affect a woman's personal and social life while breast reconstruction reduces the sense of mutilation felt by women after a mastectomy, and provides psychosocial as well as aesthetic benefits. TE/implant-based reconstruction is the most common breast reconstructive strategy, constituting almost 65% of all breast reconstructions in the US. Although numerous studies have been published on various aspects of alloplastic breast reconstructions, most studies are single-center observations. No evidence-based guidelines are available as yet. Conventional TE/implant-based reconstruction can be performed as a two-stage procedure either in the immediate or delayed setting. Moreover, the adjunctive use of acellular dermal matrix further broadened the alloplastic breast reconstruction indication and also enhanced aesthetic outcomes. Conclusions TE/implant-based reconstruction has proved to be a safe, cost-effective, and reliable technique that can be performed in women with various comorbidities. Short operative time, fast recovery, and absence of donor site morbidity are other advantages over autologous breast reconstruction. EMTREE DRUG INDEX TERMS bacitracin cefazolin gentamicin irrigation solution vancomycin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction tissue expansion EMTREE MEDICAL INDEX TERMS adipose derived stem cell autologous fat graft autotransplantation breast areola breast augmentation breast cancer breast implant rupture (complication) cancer radiotherapy cancer staging clinical outcome erythema (complication) esthetics health care cost hematoma (complication) human implant capsular contracture (complication) mastectomy meta analysis (topic) patient satisfaction pectoral muscle postoperative care postoperative complication preoperative care priority journal review self concept seroma (complication) skin flap skin necrosis (complication) surgical technique tattooing tissue expander CAS REGISTRY NUMBERS bacitracin (1405-87-4) cefazolin (25953-19-9, 27164-46-1) gentamicin (1392-48-9, 1403-66-3, 1405-41-0) vancomycin (1404-90-6, 1404-93-9) EMBASE CLASSIFICATIONS Clinical and Experimental Biochemistry (29) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170535304 PUI L617465041 DOI 10.1016/j.amsu.2017.07.048 FULL TEXT LINK http://dx.doi.org/10.1016/j.amsu.2017.07.048 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 58 TITLE Breast reconstruction with anatomical implants: A review of indications and techniques based on current literature AUTHOR NAMES Gardani M. Bertozzi N. Grieco M.P. Pesce M. Simonacci F. Santi P. Raposio E. AUTHOR ADDRESSES (Gardani M., marco.gardani@hotmail.it) Department of Surgery, Breast Unit, Piacenza Hospital, Piacenza, Italy. (Gardani M., marco.gardani@hotmail.it; Bertozzi N.; Grieco M.P.; Simonacci F.; Raposio E.) Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma, Italy. (Gardani M., marco.gardani@hotmail.it; Bertozzi N.; Grieco M.P.; Simonacci F.; Raposio E.) Cutaneous, Mini-invasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy. (Pesce M.; Santi P.) Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy. (Pesce M.; Santi P.) Plastic Surgery Department, IRCCS San Martino University Hospital, National Institute for Cancer Research, Italy. CORRESPONDENCE ADDRESS M. Gardani, Department of Surgery, Breast Unit, Piacenza Hospital, Piacenza, Italy. Email: marco.gardani@hotmail.it SOURCE Annals of Medicine and Surgery (2017) 21 (96-104). Date of Publication: 1 Sep 2017 ISSN 2049-0801 BOOK PUBLISHER Elsevier Ltd ABSTRACT One important modality of breast cancer therapy is surgical treatment, which has become increasingly less mutilating over the last century. Breast reconstruction has become an integrated part of breast cancer treatment due to long-term psychosexual health factors and its importance for breast cancer survivors. Both autogenous tissue-based and implant-based reconstruction provides satisfactory reconstructive options due to better surgeon awareness of “the ideal breast size”, although each has its own advantages and disadvantages. An overview of the current options in breast reconstruction is presented in this article. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast implant breast reconstruction EMTREE MEDICAL INDEX TERMS abdominal wall musculature acellular dermal matrix anaplastic large cell lymphoma (complication) antibiotic prophylaxis autotransplantation breast cancer breast prosthesis breast tissue expander cancer radiotherapy debridement drain fibrosis (complication) human infection (complication) mastectomy meta analysis (topic) necrosis (complication) pectoral muscle postoperative pain priority journal randomized controlled trial (topic) review risk factor seroma (complication) silicone prosthesis skin flap thrombosis (complication) treatment outcome EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170553480 PUI L617589465 DOI 10.1016/j.amsu.2017.07.047 FULL TEXT LINK http://dx.doi.org/10.1016/j.amsu.2017.07.047 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 59 TITLE Subcutaneous implant breast reconstruction: Time to reconsider? AUTHOR NAMES Tasoulis M.-K. Iqbal F.M. Cawthorn S. MacNeill F. Vidya R. AUTHOR ADDRESSES (Tasoulis M.-K., mtasoulis@med.uoa.gr; MacNeill F.) Breast Surgery Unit, The Royal Marsden Hospital NHS Foundation Trust, Fulham Road, London, United Kingdom. (Iqbal F.M.) Keele University, David Weatherall Building, Stoke-on-Trent, United Kingdom. (Cawthorn S.) Breast Unit, Southmead Hospital Bristol, Southmead Road, Westbury-on-Trym, Bristol, United Kingdom. (Vidya R.) Breast Department, Royal Wolverhampton Hospital, Wolverhampton Road, Wolverhampton, United Kingdom. CORRESPONDENCE ADDRESS M.-K. Tasoulis, Breast Surgery Unit, The Royal Marsden Hospital NHS Foundation Trust, Fulham Road, London, United Kingdom. Email: mtasoulis@med.uoa.gr SOURCE European Journal of Surgical Oncology (2017) 43:9 (1636-1646). Date of Publication: 1 Sep 2017 ISSN 1532-2157 (electronic) 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Improvements in breast surgery techniques such as skin and nipple preserving mastectomy and innovative prosthetics (implants, acellular dermal matrices and meshes) is renewing interest in subcutaneous (pre-pectoral) implant reconstruction. The aim of this paper is to review the current literature in an attempt to provide a rationale that may support a return to subcutaneous implant placement, so minimising the pain and functional problems resulting from submuscular breast reconstruction. EMTREE DRUG INDEX TERMS polyurethan silicone sodium chloride EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation breast cancer (surgery) EMTREE MEDICAL INDEX TERMS breast implant cancer surgery esthetics human nonhuman pain patient selection postoperative complication (complication) priority journal review surgical mesh CAS REGISTRY NUMBERS polyurethan (61789-63-7) silicone (63148-53-8, 8043-93-4, 8055-24-1) sodium chloride (7647-14-5) EMBASE CLASSIFICATIONS Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170399328 MEDLINE PMID 28528191 (http://www.ncbi.nlm.nih.gov/pubmed/28528191) PUI L616586700 DOI 10.1016/j.ejso.2017.04.008 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2017.04.008 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 60 TITLE A direct comparison of porcine (Strattice™) and bovine (Surgimend™) acellular dermal matrices in implant-based immediate breast reconstruction AUTHOR NAMES Ball J.F. Sheena Y. Tarek Saleh D.M. Forouhi P. Benyon S.L. Irwin M.S. Malata C.M. AUTHOR ADDRESSES (Ball J.F.; Sheena Y.; Tarek Saleh D.M.; Benyon S.L.; Irwin M.S.; Malata C.M., charles.malata@addenbrookes.nhs.uk) Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, United Kingdom. (Forouhi P.; Benyon S.L.; Irwin M.S.; Malata C.M., charles.malata@addenbrookes.nhs.uk) Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, United Kingdom. (Malata C.M., charles.malata@addenbrookes.nhs.uk) Postgraduate Medical Institute, Faculty of Medical Science, Anglia Ruskin University, Cambridge and Chelmsford, United Kingdom. CORRESPONDENCE ADDRESS C.M. Malata, Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, United Kingdom. Email: charles.malata@addenbrookes.nhs.uk SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2017) 70:8 (1076-1082). Date of Publication: 1 Aug 2017 ISSN 1878-0539 (electronic) 1748-6815 BOOK PUBLISHER Churchill Livingstone ABSTRACT Introduction Acellular dermal matrix (ADM) assisted implant-based breast reconstruction (IBBR) has grown in popularity over traditional submuscular techniques. Numerous human, bovine or porcine derived ADMs are available with the type used varying considerably worldwide. Yet, comparative evidence for the efficacy of different ADMs particularly xenogenic is limited. This study directly compares early outcomes of porcine (Strattice™) and bovine (Surgimend™) ADMs in IBBR. Method Retrospective study of sequential experience of immediate IBBR using Strattice or Surgimend ADM. Data was collected for patients undergoing ADM assisted IBBR after prophylactic or therapeutic mastectomy in Cambridge (October 2011–March 2016). Patient demographics, adjuvant and neoadjuvant therapies, operative details, postoperative management and outcomes were analysed. Key results Total of 81 patients underwent IBBR with ADM; 38 bilateral and 43 unilateral (n = 119 breasts). Strattice was used in 30 breasts (25%) and Surgimend in 89 (75%). Analysis of patient specific variables showed statistical significance only for higher mastectomy weight in the Strattice group (367.1 ± 159.3 g versus 296.3 ± 133.4 g; P = 0.0379). Strattice was associated with higher rates of skin erythema post-operatively (16.7% versus 4.5%; P = 0.044). Analysed per woman or per breast, there was no statistically significant difference in rates of haematoma, infection, wound dehiscence, skin necrosis or seroma, although there was a trend towards more complications with Strattice. Conclusion This study found significantly higher rates of skin erythema and a trend towards higher complication rates with Strattice in IBBR. Randomised controlled trials comparing different ADM outcomes are needed to inform best practice. EMTREE DRUG INDEX TERMS antibiotic agent (oral drug administration) gentamicin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction dermal implant (device comparison) surgical mesh (device comparison) EMTREE MEDICAL INDEX TERMS adult aged antibiotic therapy article bovine controlled study debridement deep inferior epigastric perforator flap device comparison erythema (complication) female follow up graft necrosis (complication) hematoma (complication) hospital admission hospital readmission human infection (complication) major clinical study mastectomy nonhuman outcome assessment pig postoperative complication (complication) priority journal retrospective study sentinel lymph node biopsy seroma (complication) skin necrosis (complication) wound dehiscence (complication) wound infection (complication) DEVICE TRADE NAMES Strattice , United StatesLifecell Surgimend , United StatesTEI DEVICE MANUFACTURERS (United States)Lifecell (United States)TEI CAS REGISTRY NUMBERS gentamicin (1392-48-9, 1403-66-3, 1405-41-0) EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170428643 MEDLINE PMID 28624524 (http://www.ncbi.nlm.nih.gov/pubmed/28624524) PUI L616797008 DOI 10.1016/j.bjps.2017.05.015 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2017.05.015 COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 61 TITLE Acellular bovine pericardium in implant-based breast reconstruction: A systematic review of the literature AUTHOR NAMES Mallikarjuna U. Mujahid M. Pilkington R. Shaheer M. Mujahid P. AUTHOR ADDRESSES (Mallikarjuna U., drmallikarjuna@gmail.com; Mujahid M.; Pilkington R.; Shaheer M.; Mujahid P.) Breast Surgery, Gateshead Health NHS Trust, Queen Elizabeth Hospital, Gateshead, United Kingdom. CORRESPONDENCE ADDRESS U. Mallikarjuna, Breast Surgery, Gateshead Health NHS Trust, Queen Elizabeth Hospital, Gateshead, United Kingdom. Email: drmallikarjuna@gmail.com SOURCE European Journal of Plastic Surgery (2017) 40:4 (265-270). Date of Publication: 1 Aug 2017 ISSN 1435-0130 (electronic) 0930-343X BOOK PUBLISHER Springer Verlag, service@springer.de ABSTRACT Background: The use of bovine acellular pericardium as a pectoral extender is a relatively newer biologic in prosthetic breast reconstruction. Fewer studies with smaller sample sizes have been conducted on the outcome and complications of its use lacking comprehensive data. We therefore reviewed the published literature and conducted a systematic review to summarise both aesthetic benefits and reported complications. Methods: A literature search of electronic databases (Medline/PubMed and Embase) between January 2010 and July 2016 was conducted. The search terms breast reconstruction, Veritas®, bovine pericardial patch, bovine pericardium and acellular collagen matrix were used. Inclusion criteria were restricted to articles containing data on bovine pericardial collagen matrix used in breast reconstruction either immediate or delayed. Graph Pad Prism statistical software was used for summarising and depicting results. Results: Data from 87 patients included in five articles which met the inclusion criteria were collated. In total, 135 procedures were performed using Veritas®. Sixty-six patients’ procedures were immediate reconstruction, 57 procedures were delayed reconstruction, and seven patients lack the details of the type of reconstruction. Complications were reported for 80 patients seroma was noticed in 12 patients (15%); skin necrosis was noticed in 5 patients (6.25%); infection was noticed in 6 patients (7.5%); and haematoma was noticed in 3 patients (3.75%). No patient presented with a capsular contracture. In total, 9 patients have received radiotherapy. Conclusion: Use of acellular bovine pericardium is safe according to the results published in the literature so far. Randomised controlled study comparing acellular dermal matrix with acellular bovine pericardium using a similar group of patients with minimal or no inter surgeon variance are warranted to compare and contrast outcomes. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular bovine pericardium breast implant breast reconstruction pericardium surgical mesh (adverse device effect) EMTREE MEDICAL INDEX TERMS acellular collagen matrix collagen fiber contracture (complication) esthetics hematoma (complication) human infection complication (complication) nonhuman pericardial patch priority journal review safety seroma (complication) skin necrosis (complication) DEVICE TRADE NAMES Veritas , United StatesSynovis DEVICE MANUFACTURERS (United States)Synovis EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170190052 PUI L614783681 DOI 10.1007/s00238-017-1284-0 FULL TEXT LINK http://dx.doi.org/10.1007/s00238-017-1284-0 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 62 TITLE A head to head comparison between SurgiMend® - Fetal bovine acellular dermal matrix and tutomesh® - A bovine pericardium collagen membrane in breast reconstruction in 45 cases AUTHOR NAMES Eichler C. Efremova J. Brunnert K. Kurbacher C.M. Gluz O. Puppe J. Warm M. AUTHOR ADDRESSES (Eichler C., ceichler@gmail.com; Efremova J.; Warm M.) Breast Center, Municipal Hospital Holweide, Neufelder Str. 32, Cologne, Germany. (Eichler C., ceichler@gmail.com) Department of Gynecology and Obstetrics, Municipal Hospital Holweide, Cologne, Germany. (Brunnert K.) Department of Senology, Clinic for Senology, Osnabrueck, Germany. (Kurbacher C.M.) Clinic Center Bonn-Friedensplatz, Bonn, Germany. (Kurbacher C.M.; Puppe J.; Warm M.) Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany. (Gluz O.) West German Study Group (WSG), Moenchengladbach, Germany. (Gluz O.) Breast Center Niederrhein Moenchengladbach, Moenchengladbach, Germany. CORRESPONDENCE ADDRESS C. Eichler, Breast Center, Municipal Hospital Holweide, Neufelder Str. 32, Cologne, Germany. Email: ceichler@gmail.com SOURCE In Vivo (2017) 31:4 (677-682). Date of Publication: 1 Jul 2017 ISSN 1791-7549 (electronic) 0258-851X BOOK PUBLISHER International Institute of Anticancer Research, 1st km Kapandritiou - Kalamou Rd., P.O. Box 22, Kapandriti, Attica, Greece. subscriptions@iiar-anticancer.org ABSTRACT Background/Aim: The use of acellular dermal matrices (ADM) has become a widely used option in breast reconstruction. A great deal of literature is available, totaling over 3,200 ADM reconstructions. Head-to-head comparisons between SurgiMend® and Tutomesh® are not yet reported. These are the first comparative clinical data reported on the use of Tutomesh® in breast reconstruction. Postoperative complication rates and costs for these devices were evaluated. Patients and Methods: This is a retrospective analysis of a 2-year experience with both SurgiMend® - fetal bovine acellular dermal matrix and Tutomesh® - a bovine pericardium collagen membrane in breast reconstruction in 45 cases from 2014-2015. Results: Forty-five patients received a total of 45 implant-based reconstructions using SurgiMend® (18 cases; 40%) or Tutomesh® (27 cases; 60%). Gross complication rates were 27.8% for SurgiMend® and 37.0% for Tutomesh® including hematoma, postoperative skin irritation, infection, red breast syndrome and revision surgery. The most common complication was postoperative red breast syndrome. Severe complications requiring revision surgery did not differ significantly in patients treated with SurgiMend® (0 cases, 0%) compared to Tutomesh® (1 case, 3.7%). Conclusion: This retrospective analysis shows similar overall clinical complication rates for Tutomesh® and SurgiMend®. Severe complication rates are comparable to those reported in literature for both products. Although the retrospective nature of this work limits its clinical impact, it is possible to opt for the cheaper alternative (Tutomesh®). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix (adverse device effect) breast reconstruction surgical mesh (adverse device effect) EMTREE MEDICAL INDEX TERMS adult article breast disease (complication) clinical article hematoma (complication) human medical device complication (complication) postoperative complication (complication) postoperative infection (complication) postoperative period red breast syndrome (complication) retrospective study skin irritation (complication) subcutaneous mastectomy DEVICE TRADE NAMES SurgiMend Tutomesh EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170619319 MEDLINE PMID 28652438 (http://www.ncbi.nlm.nih.gov/pubmed/28652438) PUI L618093723 DOI 10.21873/invivo.11112 FULL TEXT LINK http://dx.doi.org/10.21873/invivo.11112 COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 63 TITLE Increased rate of biointegration of dermacell acellular dermal matrix through the inclusion of fenestrations AUTHOR NAMES Cottler P.S. Ning B. Seaman S.A. Thuman J. Salopek L.S. Rodeheaver G.T. Pineros-Fernandez A. Hu S. Campbell C.A. AUTHOR ADDRESSES (Cottler P.S.; Salopek L.S.; Rodeheaver G.T.; Pineros-Fernandez A.; Campbell C.A.) University of Virginia, Plastic Surgery, Charlottesville, United States. (Ning B.; Seaman S.A.; Hu S.) University of Virginia, Biomedical Engineering, Charlottesville, United States. (Thuman J.) University of Virginia, School of Medicine, Charlottesville, United States. CORRESPONDENCE ADDRESS P.S. Cottler, University of Virginia, Plastic Surgery, Charlottesville, United States. SOURCE Wound Repair and Regeneration (2017) 25:4 (A6). Date of Publication: 1 Jul 2017 CONFERENCE NAME 29th Annual Meeting of the Wound Healing Society, SAWC-Spring/WHS Joint Meeting CONFERENCE LOCATION San Diego, CA, United States CONFERENCE DATE 2017-04-05 to 2017-04-09 ISSN 1067-1927 BOOK PUBLISHER Blackwell Publishing Inc. ABSTRACT The use of acellular dermal matrices (ADM) in implant-based breast reconstruction has grown significantly since the first reports in 2005. There are several products available with various biomechanical properties due to fabrication and processing. Recently, the inclusion of fenestrations into the ADM has been reported to improve outcomes, but with limited information regarding the in vivo effects of structural changes. This in vivo study evaluated whether fenestrations increase the rate and level of biointegration of DermACELL in terms of angiogenesis, inflammation, and cellular infiltration. Photo-acoustic microscopy (PAM) was used to serially evaluate the effects of fenestrations on ADM biointegration in a murine window chamber model of ADM-assisted breast reconstruction. PAM provides a noninvasive assessment of hemoglobin concentration and oxygen saturation; generating 3-dimensional maps of the nascent ADM-associated microvasculature and metabolic consumption of oxygen. ADM samples (with and without fenestrations) were placed into window chambers and imaged at Days 2, 10, and 14. The results of the PAM imaging were then corroborated by quantified immunohistochemical analysis at 21 days. PAM imaging demonstrated an increase in vascular ingrowth and oxygen saturation by Days 10-14 at the ADM edge. Inclusion of the fenestrations resulted in the arborization of neovasculature into the ADM at these additional openings. At Day 21, cell migration averaged 810 mm from the edge of the fenestrations, leading to significant overall increase in macrophage, fibroblast, and myofibroblasts infiltration into the ADM structure. The additional surface area created by the fenestrations provided an increased opportunity for inflammatory and wound healing cells to migrate into the ADM and promote vasculogenesis and remodeling, leading to more rapid integration. It is hypothesized that the decreased clinical complication rate is due to more rapid integration. These results can provide insights into further structural modifications of ADM to optimize integration time, and lead to improved reconstructive outcomes. EMTREE DRUG INDEX TERMS endogenous compound hemoglobin oxygen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix EMTREE MEDICAL INDEX TERMS acoustic microscopy angiogenesis animal experiment animal tissue breast reconstruction cell infiltration complication fibroblast immunohistochemistry in vivo study inflammation macrophage microvasculature murine myofibroblast nonhuman oxygen saturation wound healing CAS REGISTRY NUMBERS hemoglobin (9008-02-0) oxygen (7782-44-7) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L619737764 DOI 10.1111/wrr.12573 FULL TEXT LINK http://dx.doi.org/10.1111/wrr.12573 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 64 TITLE A Guide to Prepectoral Breast Reconstruction: A New Dimension to Implant-based Breast Reconstruction AUTHOR NAMES Vidya R. Iqbal F.M. AUTHOR ADDRESSES (Vidya R., raghavan.vidya@nhs.net) Birmingham University, Birmingham, United Kingdom. (Vidya R., raghavan.vidya@nhs.net) Breast Unit, New Cross Hospital, Wolverhampton, United Kingdom. (Iqbal F.M.) Medical School, Keele University, Stoke-on-Trent, United Kingdom. CORRESPONDENCE ADDRESS R. Vidya, Consultant Oncoplastic Breast Surgeon, New Cross Hospital, Wednesfield Road, Wolverhampton, United Kingdom. Email: raghavan.vidya@nhs.net SOURCE Clinical Breast Cancer (2017) 17:4 (266-271). Date of Publication: 1 Jul 2017 ISSN 1938-0666 (electronic) 1526-8209 BOOK PUBLISHER Elsevier Inc., usjcs@elsevier.com ABSTRACT Acellular dermal matrix has revolutionized implant-based breast reconstruction. Breast reconstruction has evolved from the traditional submuscular to the new prepectoral implant based (also known as muscle-sparing) reconstruction. The new technique is emerging as a highly popular surgery owing to its more minimal approach. We conducted a narrative review to guide prepectoral breast reconstruction, highlighting the technique, the need for appropriate patient selection, and areas for further research. We show that prepectoral breast reconstruction is safe, feasible, and has excellent short-term outcomes (cosmesis and patient satisfaction). Its main advantages are that it avoids animation deformity, prevents shoulder dysfunction, and has a lower incidence of capsular contracture. Selection for the prepectoral technique is dependent on patient factors (eg, body mass index, lifestyle), breast size, flap assessment, and adjuvant radiotherapy. Whereas the initial short-term results are promising, long-term outcomes are yet to be reported and is an area that requires further research. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation breast cancer (surgery) breast implant breast reconstruction EMTREE MEDICAL INDEX TERMS absorbable suture acellular dermal matrix adjuvant radiotherapy body mass breast endoprosthesis breast malformation breast tissue expander cancer patient cancer surgery feasibility study health care cost human implant capsular contracture lifestyle patient safety patient satisfaction patient selection radical mastectomy review risk factor shoulder disease silicone breast implant surgical drape surgical mesh surgical technique tissue flap treatment indication EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170126027 MEDLINE PMID 28190760 (http://www.ncbi.nlm.nih.gov/pubmed/28190760) PUI L614458849 DOI 10.1016/j.clbc.2016.11.009 FULL TEXT LINK http://dx.doi.org/10.1016/j.clbc.2016.11.009 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 65 TITLE Clinical experiences with the use of ULTRAPRO(®) mesh in single-stage direct-to-implant immediate postmastectomy breast reconstruction in 102 patients: A retrospective cohort study AUTHOR NAMES Pukancsik D. Kelemen P. Gulyás G. Újhelyi M. Kovács E. Éles K. Mészáros N. Kenessey I. Pálházi P. Kovács T. Kásler M. Mátrai Z. AUTHOR ADDRESSES (Pukancsik D., d.pukancsik@gmail.com; Kelemen P.; Gulyás G.; Újhelyi M.; Mátrai Z.) National Institute of Oncology, Department of Breast and Sarcoma Surgery, Ráth György Str. 7-9, Budapest, Hungary. (Kovács E.) National Institute of Oncology, Department of Radiological Diagnostics, Ráth György Str. 7-9, Budapest, Hungary. (Éles K.) National Institute of Oncology, Department of Surgical and Molecular Pathology, Ráth György Str. 7-9, Budapest, Hungary. (Mészáros N.) National Institute of Oncology, Department of Radiotherapy, Ráth György Str. 7-9, Budapest, Hungary. (Kenessey I.) National Institute of Oncology, National Cancer Registry, Ráth György Str. 7-9, Budapest, Hungary. (Kenessey I.) Semmelweis University, 2nd Department of Pathology, Üllői Str. 93, Budapest, Hungary. (Pálházi P.) Semmelweis University, Department of Anatomy, Histology and Embryology, Tűzoltó Str. 58, Budapest, Hungary. (Kovács T.) Guy's and St Thomas's Hospitals NHS Foundation Trust, Department of Breast Surgery, Great Maze Pond, London, United Kingdom. (Kásler M.) National Institute of Oncology, Ráth György Str. 7-9, Budapest, Hungary. CORRESPONDENCE ADDRESS D. Pukancsik, National Institute of Oncology, Department of Breast and Sarcoma Surgery, Ráth György Str. 7-9, Budapest, Hungary. Email: d.pukancsik@gmail.com SOURCE European Journal of Surgical Oncology (2017) 43:7 (1244-1251). Date of Publication: 1 Jul 2017 ISSN 1532-2157 (electronic) 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Background Acellular dermal matrices have been used for direct-to-implant (DTI) breast reconstruction (BR), eliminating the load of the lower pole skin envelope. However, the available allograft matrices add considerable health care costs. This study examined the long-term follow-up of synthetic ULTRAPRO(®) mesh as a low-cost potential alternative to biological matrices. Patients and methods A retrospective cohort study was performed between January 2013 and January 2016, involved 112 early-stage breast cancer and/or BRCA 1/2 patients, and evaluated 189 immediate DTI BRs following skin-, areola- or nipple-sparing mastectomy using ULTRAPRO(®) mesh. Patient characteristics and postoperative complications were recorded, and quality of life was rated by the patients using the EORTC-QLQ-C30-BR23 questionnaire. Aesthetic outcomes and palpability of the implants were evaluated by four breast surgeons on a 5-point Likert scale. All recorded parameters were statistically analysed. Results Ten patients were lost-to-follow-up, resulting in 102 patients and 174 breast surgery cases analysed. The mean age was 43 years, with 23.4 months of follow-up on average. Forty-six patients (45.1%) had previous radiotherapy with pre-existing scars. In total, 32 complications (18.3%) were recorded, including 12 minor (6.9%) and 20 major (11.4%) complications requiring revision. All median quality of life scores were above 83 points, representing a high score, with an average 4-point rating for the aesthetic outcome and natural consistency of the breast. Conclusion Partially absorbable ULTRAPRO(®) mesh could be used successfully in DTI BR, offering a safe, less expensive alternative to biological matrices. Adequate indications and patient selection are necessary. EMTREE DRUG INDEX TERMS BRCA1 protein (endogenous compound) BRCA2 protein (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction mastectomy postoperative period surgical mesh (adverse device effect, device economics) EMTREE MEDICAL INDEX TERMS adult article body mass breast cancer (surgery) cancer radiotherapy cancer staging cancer surgery cohort analysis comorbidity contracture (complication) early cancer (surgery) female follow up gene mutation health care cost hematoma (complication) human major clinical study postoperative complication (complication) postoperative infection (complication) priority journal quality of life retrospective study risk factor seroma (complication) silicone breast implant skin necrosis (complication) smoking habit surgical patient surgical technique DEVICE TRADE NAMES ULTRAPRO EMBASE CLASSIFICATIONS Cancer (16) Health Policy, Economics and Management (36) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170126772 MEDLINE PMID 28215734 (http://www.ncbi.nlm.nih.gov/pubmed/28215734) PUI L614461555 DOI 10.1016/j.ejso.2017.01.236 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2017.01.236 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 66 TITLE Evidence-Based Medicine: Alloplastic Breast Reconstruction AUTHOR NAMES Lennox P.A. Bovill E.S. Macadam S.A. AUTHOR ADDRESSES (Lennox P.A.) Vancouver, British Columbia, Canada From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of British Columbia (Bovill E.S.; Macadam S.A.) SOURCE Plastic and reconstructive surgery (2017) 140:1 (94e-108e). Date of Publication: 1 Jul 2017 ISSN 1529-4242 (electronic) ABSTRACT LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Understand the different advances that have resulted in improved outcomes in implant-based reconstruction. 2. Gain knowledge about specific techniques that have evolved rapidly in recent years and how to implement these. 3. Gain an understanding of controversies associated with alloplastic reconstruction. 4. Recognize undesirable outcomes in implant-based breast reconstruction and understand strategies for correction.SUMMARY: There have been multiple advances in implant-based breast reconstruction. Many of these have resulted in improvements in patient outcomes and care. Understanding new techniques and technologies ensures competence in providing care for the alloplastic breast reconstruction patient. This article was prepared to accompany practice-based assessment with ongoing surgical education for the Maintenance of Certification for the American Board of Plastic Surgery. It is structured to outline the care of the patient with the postmastectomy breast deformity. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) evidence based medicine procedures EMTREE MEDICAL INDEX TERMS acellular dermal matrix adipose tissue breast augmentation breast reconstruction breast tumor (radiotherapy, surgery) female human mastectomy time factor tissue scaffold transplantation LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 28654611 (http://www.ncbi.nlm.nih.gov/pubmed/28654611) PUI L618332801 DOI 10.1097/PRS.0000000000003472 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000003472 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 67 TITLE A Microbiological and Ultrastructural Comparison of Aseptic versus Sterile Acellular Dermal Matrix as a Reconstructive Material and a Scaffold for Stem Cell Ingrowth AUTHOR NAMES Mendenhall S.D. Schmucker R.W. Daugherty T.H.F. Kottwitz K.M. Reichensperger J.D. Koirala J. Cederna P.S. Neumeister M.W. AUTHOR ADDRESSES (Mendenhall S.D.) Springfield, Ill.; and Ann Arbor, Mich. From the Institute for Plastic Surgery, the Laboratory for Regenerative Medicine and Applied Sciences, the Division of Infectious Diseases, Southern Illinois University School of Medicine; and the Section of Plastic Surgery, University of Michigan School of Medicine (Schmucker R.W.; Daugherty T.H.F.; Kottwitz K.M.; Reichensperger J.D.; Koirala J.; Cederna P.S.; Neumeister M.W.) SOURCE Plastic and reconstructive surgery (2017) 140:1 (97-108). Date of Publication: 1 Jul 2017 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Recent data suggest an increased risk for infection when acellular dermal matrix is used in breast reconstruction. This may be because some acellular dermal matrices are actually not terminally sterilized but are instead "aseptically processed." This study evaluates aseptic and sterile matrices for evidence of bacterial contamination and whether or not terminal sterilization affects matrix collagen architecture and stem cell ingrowth.METHODS: Five separate samples of 14 different matrices were analyzed by fluorescent in situ hybridization using a bacterial DNA probe to detect bacterial DNA on the matrices. Separate samples were incubated for bacteria, acid-fast bacilli, and fungi for 2 to 6 weeks to detect living organisms. The impact of terminal sterilization on the collagen network and stem cell ingrowth on the matrices was then assessed.RESULTS: Traces of bacterial DNA were encountered on all matrices, with more bacteria in the aseptic group compared with the sterile group (3.4 versus 1.6; p = 0.003). The number of positive cultures was the same between groups (3.8 percent). Electron microscopy demonstrated decreased collagen organization in the sterile group. Stem cell seeding on the matrices displayed a wide variation of cellular ingrowth between matrices, with no difference between aseptic and sterile groups (p = 0.2).CONCLUSIONS: Although there was more evidence of prior bacterial contamination on aseptically processed matrices compared with sterile matrices; clinical cultures did not differ between groups. Terminal sterilization does not appear to affect stem cell ingrowth but may come at the cost of damaging the collagen network.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V. EMTREE DRUG INDEX TERMS bacterial DNA (drug analysis) collagen fungal DNA (drug analysis) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) asepsis instrument sterilization microbiology stem cell ultrastructure EMTREE MEDICAL INDEX TERMS acellular dermal matrix cell culture comparative study human scanning electron microscopy tissue scaffold CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 28654596 (http://www.ncbi.nlm.nih.gov/pubmed/28654596) PUI L618332624 DOI 10.1097/PRS.0000000000003448 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000003448 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 68 TITLE Corrigendum to “Mesh versus acellular dermal matrix in immediate implant-based breast reconstruction – A prospective randomized trial” [Eur J Surg Oncol 42 (5) (2016) 665–671] (S0748798316001013) (10.1016/j.ejso.2016.02.007)) AUTHOR NAMES Gschwantler-Kaulich D. Schrenk P. Bjelic-Radisic V. Unterrieder K. Leser C. Fink-Retter A. Salama M. Singer C. AUTHOR ADDRESSES (Gschwantler-Kaulich D., daphne.gschwantler@kaulich.at; Leser C.; Fink-Retter A.; Singer C.) Medical University of Vienna, Breast Cancer Center, Department of Gynaecological Oncology, Waehringer Guertel 18-20, Vienna, Austria. (Schrenk P.) AKH Linz Breast Cancer Center, Krankenhausstrasse 9, Linz, Austria. (Bjelic-Radisic V.) Medical University of Graz, Department of Gynaecology, Auenbruggerplatz 1, Graz, Austria. (Unterrieder K.) Private Hospital Villach, Breast Cancer Center, Department of Gynaecology, Dr.-Walter-Hochsteiner-Straße 4, Villach, Austria. (Salama M.) Otto Wagner Hospital, Department of Surgery, Baumgartner Hoehe 1, Vienna, Austria. CORRESPONDENCE ADDRESS D. Gschwantler-Kaulich, Medical University of Vienna, Breast Cancer Center, Department of Gynaecological Oncology, Waehringer Guertel 18-20, Vienna, Austria. Email: daphne.gschwantler@kaulich.at SOURCE European Journal of Surgical Oncology (2017) 43:7 (1380-1381). Date of Publication: 1 Jul 2017 ISSN 1532-2157 (electronic) 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT The authors wish to correct two errors in the above-named article, which results in a different conclusion to that which was originally reported. The p-value referring to complications in the ADM (Protexa(®)) group versus the TiLOOP(®) Bra group was reported in the article as 0.0001. The authors state that the Chi square test used to calculate the p-value should have a continuity correction due to the small sample size. The corrected p-value for severe complications would therefore be p = 0.105 or, when calculated with Fisher's exact test, p = 0.068. In addition, Figure 2 in the article did not include a group of two patients (9%) who were randomised to the ADM (Protexa(®)) group who could not be evaluated for cosmetic result following surgery. A revised Figure is included below. [Figure presented] Following the correction of these two errors, the authors would like to amend the conclusion to their article, as follows: To verify the results of this study, which showed a higher risk of implant loss associated with the use of an ADM (Protexa(®)), although not statistically significant, larger prospective randomized trials with different ADMs and mesh products are warranted. The authors apologise for any confusion that these errors may have caused. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) error EMTREE MEDICAL INDEX TERMS erratum EMBASE CLASSIFICATIONS Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170370809 PUI L616384149 DOI 10.1016/j.ejso.2017.05.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2017.05.001 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 69 TITLE Dermal Autograft Using Donor Breast as Alternative to Acellular Dermal Matrices in Tissue Expander Breast Reconstruction: A Comparative Review AUTHOR NAMES North W.D. Kubajak C.S. St Martin B. Rinker B. AUTHOR ADDRESSES (North W.D.) From the *University of Kentucky Department of Surgery, Division of Plastic and Reconstructive Surgery; and †University of Kentucky College of Medicine, Lexington, KY (Kubajak C.S.; St Martin B.; Rinker B.) SOURCE Annals of plastic surgery (2017) 78:6S Suppl 5 (S282-S285). Date of Publication: 1 Jun 2017 ISSN 1536-3708 (electronic) ABSTRACT BACKGROUND: Shifting preference for implant-based breast reconstruction has resulted in an increased use of acellular dermal matrix (ADM) in tissue-expander breast reconstruction. The benefits afforded by ADM must be weighed against a potential increased risk for postoperative complications. Dermal autograft-assisted breast reconstruction using autograft harvest from the lower abdomen has been shown to result in equivalent aesthetics and patient satisfaction compared with ADM at a lower cost, with fewer complications. The purpose of this study was to review a series of patients who underwent bilateral mastectomy and immediate dermal autograft-assisted tissue expander (TE) breast reconstruction using the non-cancerous breast as a donor site, comparing the outcomes with a concurrent cohort of patients undergoing ADM-assisted reconstruction to determine the relative safety, cost, and effectiveness of the 2 procedures.METHODS: The study population included all patients who underwent dermal autograft-assisted TE breast reconstruction, using the contralateral cancer-free breast as the source of dermal autograft, between 2010 and 2015. The ADM cohort consisted of patients who underwent bilateral mastectomy and immediate ADM-assisted TE breast reconstruction during the same period. Univariate analysis was performed for demographic data, complications, operative cost, and operative time. Data were compared using the Wilcoxon rank sum test for nonparametric data and χ analyses for continuous and categorical variables. Significance was defined as P value less than 0.05.RESULTS: Seventeen patients received dermal autograft using the non-cancerous breast donor site. Twenty-seven patients who underwent ADM-assisted reconstruction during the same period were identified. Significantly higher cost was demonstrated between groups (ADM, US $9999.87; autograft, US $3924.19; P < 0.0001). No significance difference existed operative time (autograft, 97 min; ADM, 120 min). No difference was found in wound healing complications (ADM, 14.8%; autograft, 23.53%; P = 0.47). No significant difference was found in major complications (ADM, 26%; autograft, 17.65%; P = 0.52) or infectious complications (ADM, 26%; autograft, 17.65%; P = 0.52).CONCLUSIONS: Dermal autograft-assisted breast reconstruction using the contralateral non-cancerous breast as the source of dermal autograft harvest represents a lower cost alternative to ADM without increased risk of postoperative complications. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix physiology procedures EMTREE MEDICAL INDEX TERMS adult aged analysis of variance autotransplantation breast reconstruction breast tumor (surgery) cohort analysis comparative study female graft rejection graft survival human mastectomy middle aged nonparametric test organ donor pathology prognosis retrospective study risk assessment skin transplantation tissue expander tissue expansion treatment outcome LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 28296716 (http://www.ncbi.nlm.nih.gov/pubmed/28296716) PUI L621554373 DOI 10.1097/SAP.0000000000001041 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0000000000001041 COPYRIGHT Copyright 2018 Medline is the source for the citation and abstract of this record. RECORD 70 TITLE Clinical Outcomes in Breast Reconstruction Patients Using a Sterile Acellular Dermal Matrix Allograft AUTHOR NAMES Ortiz J.A. AUTHOR ADDRESSES (Ortiz J.A., juan.a.ortizperez.mil@mail.mil) Womack Army Medical Center, Fort Bragg, NC, 28310, USA SOURCE Aesthetic plastic surgery (2017) 41:3 (542-550). Date of Publication: 1 Jun 2017 ISSN 1432-5241 (electronic) ABSTRACT BACKGROUND: Human acellular dermal matrices (ADMs) have enabled successful breast reconstructions while decreasing muscle donor morbidity and pain for the patient. However, some literature reports indicate an increase in complications, especially infection. The decellularization and terminal sterilization properties of DermACELL (D-ADM), a human ADM, may reduce the rate of complications in augmented breast reconstruction while still maintaining successful outcomes. In the study presented here, we evaluate the quality and safety of outcomes with the use of D-ADM during tissue expander breast reconstruction.METHODS: A retrospective chart review was conducted of patients who underwent breast reconstruction with the use of D-ADM, at a single-military hospital-based practice, resulting in a population of 38 subjects and 58 breasts who had breast reconstruction augmented with D-ADM.RESULTS: Fifty-six breasts (96.6%) in thirty-six patients demonstrated successful outcomes with a median 27 weeks' time to complete healing. Post-reconstruction radiation and chemotherapy were applied to 24.1 and 25.9% of reconstructions, respectively. Complications rates were minimal with rates of 1.7% for surgical site infection and 1.7% for red breast syndrome.CONCLUSION: The low complication rates combined with the high success and patient satisfaction rates observed for D-ADM support the use of this ADM in breast reconstruction.LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) procedures transplantation utilization EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult allograft breast reconstruction breast tumor (surgery) cohort analysis esthetics female follow up graft survival human mastectomy middle aged pathology pathophysiology postoperative complication (epidemiology) retrospective study risk assessment surgical flaps tissue expansion treatment outcome United States LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 28280894 (http://www.ncbi.nlm.nih.gov/pubmed/28280894) PUI L621606881 DOI 10.1007/s00266-017-0817-z FULL TEXT LINK http://dx.doi.org/10.1007/s00266-017-0817-z COPYRIGHT Copyright 2018 Medline is the source for the citation and abstract of this record. RECORD 71 TITLE Long term follow-up on prepectoral ADM-assisted breast reconstruction: evidences after 4 years AUTHOR NAMES Berna G. Cawthorn S.J. AUTHOR ADDRESSES (Berna G., gberna@ulss.tv.it) Department of Plastic and Reconstructive Surgery, Ulss 2, Ca’ Foncello General Hospital, Treviso, Italy. (Cawthorn S.J.) Breast Care Center, North Bristol NHS Trust, Bristol, United Kingdom. CORRESPONDENCE ADDRESS G. Berna, Department of Plastic and Reconstructive Surgery, Ulss 2, Ca’ Foncello General Hospital, Treviso, Italy. Email: gberna@ulss.tv.it SOURCE European Journal of Plastic Surgery (2017) 40:3 (255-258). Date of Publication: 1 Jun 2017 ISSN 1435-0130 (electronic) 0930-343X BOOK PUBLISHER Springer Verlag, service@springer.de ABSTRACT Prepectoral implant-based breast reconstruction is on the rise because of the advantages related to preservation of the pectoralis major muscle. Indeed, this reconstructive procedure improves the aesthetic outcomes and the postoperative recovery time, avoiding the risk of breast animation and deformity. On the other hand, the subcutaneous implant positioning has higher risk of capsular contracture and for this reason, the subpectoral breast reconstruction has been preferred for many years; but the introduction of a pre-shaped acellular dermal matrix (ADM) which allows a complete implant coverage led to the onset of the new prepectoral technique, solving the problem of a stiff periprosthetic capsule formation. In fact, the use of ADMs in breast reconstruction has been shown to decrease the capsular contracture formation. Nevertheless, no long-term outcomes have been reported with the use of a pre-shaped ADM for prepectoral breast reconstruction. The authors present the first ten patients who had a prepectoral ADM-assisted breast reconstruction showing no evidences of capsular contracture after a median follow-up of 4 years. Level of Evidence: Level V, therapeutic study. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction follow up long term care EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult article breast implant clinical article female human mastectomy middle aged nipple sparing mastectomy pectoralis major muscle priority journal retrospective study subcutaneous fat surgical flaps surgical technique DEVICE TRADE NAMES acellular dermal matrix Braxon Natrelle 410 , United StatesAllergan DEVICE MANUFACTURERS (United States)Allergan EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170146160 PUI L614559194 DOI 10.1007/s00238-017-1285-z FULL TEXT LINK http://dx.doi.org/10.1007/s00238-017-1285-z COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 72 TITLE Effect of adipose-derived stem cells on acellular dermal matrix engraftment in a rabbit model of breast reconstruction AUTHOR NAMES Jin U.S. Hong K.Y. Hwang Y.-I. AUTHOR ADDRESSES (Jin U.S.) Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, South Korea. (Hong K.Y.) Department of Plastic and Reconstructive Surgery, Dongguk University Medical Center, Dongguk University School of Medicine, South Korea. (Hwang Y.-I., hyi830@snu.ac.kr) Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, South Korea. CORRESPONDENCE ADDRESS Y.-I. Hwang, Department of Anatomy and Cell Biology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, South Korea. Email: hyi830@snu.ac.kr SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2017) 70:6 (806-813). Date of Publication: 1 Jun 2017 ISSN 1878-0539 (electronic) 1748-6815 BOOK PUBLISHER Churchill Livingstone ABSTRACT Acellular dermal matrix (ADM) is frequently used in implant-based breast reconstruction. Although there are several advantages, ADM implantation also increases the risk of certain complications. Recently, ADM seeded with adipose-derived stem cells (ADSCs) were shown to induce angiogenesis and improve wound healing. This study aimed to investigate the effects of ADSCs on ADM engraftment in a rabbit model of implant-based breast reconstruction. Silicone implants were inserted to submuscular pocket of 16 female New Zealand rabbits using ADM with or without seeding of fluorescent PKH26-labelled rabbit ADSCs. The marginal and central ADMs in each group were evaluated at 1 and 3 months after insertion. We performed a histological analysis including the number of CD31(+) blood vessels, vimentin(+) fibroblasts and lymphocytes; live/dead analysis; and gene expression analysis related to angiogenesis, inflammation and hypoxia. The implant was exposed in one rabbit with ADM without ADSCs during the study period. At 1 month, a histological analysis revealed more blood vessels and fibroblasts and reduced immune cell infiltration in marginal ADM with ADSCs. At 3 months, only angiogenesis was histologically different between groups. Conversely, cellularity was not significantly different in the central ADM between groups at month 1 or 3. ADSC supplementation increased the gene expression level associated with angiogenesis and inflammation, but not hypoxia. PKH26-labelled ADSCs were observed in both marginal and central ADMs at month 3. ADM seeded with ADSCs might be useful in promoting early incorporation with recipient tissue. This study supports the potential of ADM seeded with ADSCs as a reliable material for implant-based breast reconstruction. EMTREE DRUG INDEX TERMS hypoxia inducible factor 1alpha (endogenous compound) tumor necrosis factor (endogenous compound) vasculotropin A (endogenous compound) vimentin (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix adipose derived stem cell breast reconstruction engraftment EMTREE MEDICAL INDEX TERMS angiogenesis animal cell animal tissue article blood vessel cell count cell infiltration controlled study female fibroblast gene expression histology hypoxia immunocompetent cell immunofluorescence in vitro study inflammation lymphocyte lymphocyte count New Zealand rabbit nonhuman priority journal rabbit model silicone prosthesis CAS REGISTRY NUMBERS vasculotropin A (489395-96-2) EMBASE CLASSIFICATIONS Clinical and Experimental Biochemistry (29) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170257764 MEDLINE PMID 28347699 (http://www.ncbi.nlm.nih.gov/pubmed/28347699) PUI L615242929 DOI 10.1016/j.bjps.2017.02.016 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2017.02.016 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 73 TITLE Outcomes After Elevation of Serratus Anterior Fascia During Prosthetic Breast Reconstruction AUTHOR NAMES Seth A.K. Hirsch E.M. Kim J.Y.S. Fine N.A. AUTHOR ADDRESSES (Seth A.K.) From the *Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, MA; and †Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (Hirsch E.M.; Kim J.Y.S.; Fine N.A.) SOURCE Annals of plastic surgery (2017) 78:6 (641-645). Date of Publication: 1 Jun 2017 ISSN 1536-3708 (electronic) ABSTRACT BACKGROUND: Achieving optimal inferolateral coverage is critical to successful prosthetic breast reconstruction. Serratus anterior fascia (SF) elevation, a promising alternative to muscle flaps and acellular dermis (ADM), has not been rigorously studied. This study evaluates complication rates after mastectomy and immediate tissue expander (TE) coverage using SF, relative to other existing methods of reconstruction.METHODS: Retrospective review of consecutive patients undergoing mastectomy with immediate TE reconstruction over 10 years at 1 institution was performed. Patients with serratus muscle (SM) or SF elevation were analyzed. ADM reconstructions were used for comparative analysis only. Relevant demographic and clinical data were recorded. Complications were categorized by type and end outcome, including nonoperative (no further surgery), operative (surgery except explantation), and explantation.RESULTS: The SM and SF elevation was performed in 375 (487 breasts) and 177 (255 breasts) patients, respectively. Mean follow-up was 43.8 months. The SM and SF patients were demographically similar, but SF had higher intraoperative fill volumes (P < 0.0001) and required fewer postoperative expansions (P < 0.0001). There were no differences in complications between SM and SF patients. Regression analysis, adjusted for several variables, revealed that SF was not an independent risk factor for complications. The ADM- and SF-assisted reconstruction also showed no differences in outcomes.CONCLUSIONS: Our review demonstrates that SF elevation is a safe, feasible alternative for achieving inferolateral coverage during prosthetic breast reconstruction. Furthermore, this technique allows for greater fill volumes and less expansions than SM. As a readily available alternative to muscle flaps and ADM, SF elevation should be considered integral to any prosthetic breast reconstruction algorithm. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast implant fascia procedures EMTREE MEDICAL INDEX TERMS acellular dermal matrix breast reconstruction breast tumor (radiotherapy, surgery) female human mastectomy middle aged retrospective study tissue expander treatment outcome LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 28106627 (http://www.ncbi.nlm.nih.gov/pubmed/28106627) PUI L620422097 DOI 10.1097/SAP.0000000000000967 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0000000000000967 COPYRIGHT Copyright 2018 Medline is the source for the citation and abstract of this record. RECORD 74 TITLE Evaluation of a novel breast reconstruction technique using the Braxon® acellular dermal matrix: a new muscle-sparing breast reconstruction AUTHOR NAMES Berna G. Cawthorn S.J. Papaccio G. Balestrieri N. AUTHOR ADDRESSES (Berna G.) Department of Plastic and Reconstructive Surgery, Ulss 9 General Hospital, Treviso, Italy (Cawthorn S.J.) Breast Care Center, North Bristol NHS Trust, Bristol, UK (Papaccio G.) Breast Care Center, Ulss 12 General Hospital, Mestre, Italy (Balestrieri N.) Breast Care Center, Ulss 9 General Hospital, Treviso, Italy SOURCE ANZ journal of surgery (2017) 87:6 (493-498). Date of Publication: 1 Jun 2017 ISSN 1445-2197 (electronic) ABSTRACT BACKGROUND: Implant-based breast reconstruction is becoming increasingly popular because of the widespread adoption of acellular dermal matrix (ADM), which allows surgeons to obtain good aesthetic results with fewer operations. To develop more conservative surgical techniques, a retrospective, three-centre, proof-of-concept study was performed to study the effectiveness of a new, immediate, muscle-sparing breast reconstruction technique using the patented Braxon® ADM, which enables subcutaneous positioning of the breast implant without detaching the pectoralis major.METHODS: Ethics committee of the study coordinating centre approved medical record review on 19 women who underwent muscle-sparing breast reconstruction between November 2012 and January 2014. The first 10 implants were performed using 0.9-mm-thick porcine ADM, with preservatives. In the subsequent 15 implants, the product was changed to 0.6-mm-thick porcine dry ADM, without preservatives.RESULTS: Nineteen patients (25 implants) received six bilateral and 13 unilateral muscle-sparing breast reconstructions. For the first type of ADM used (0.9-mm-thick with preservatives), the rate of implant loss was 12% (n = 3) because of seroma (8%, n = 2) and infection (4%, n = 1). Minor complications, such as seroma (8%, n = 2), occurred when using the 0.6-mm-thick Braxon® ADM and were treated by aspiration. Symmetrical and natural breasts with good shape, ptosis and softness to the touch were obtained. None of the patients reported experiencing pain.CONCLUSIONS: The preliminary results are encouraging from aesthetic and clinical viewpoints. Further studies are planned to evaluate long-term results. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) procedures standards surgery utilization EMTREE MEDICAL INDEX TERMS acellular dermal matrix animal breast augmentation breast implant breast reconstruction complication esthetic surgery esthetics female human implant capsular contracture incidence middle aged outcome assessment pectoral muscle pig psychology retrospective study seroma statistics and numerical data veterinary LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25266930 (http://www.ncbi.nlm.nih.gov/pubmed/25266930) PUI L621426811 DOI 10.1111/ans.12849 FULL TEXT LINK http://dx.doi.org/10.1111/ans.12849 COPYRIGHT Copyright 2018 Medline is the source for the citation and abstract of this record. RECORD 75 TITLE Management of a case of Mucor colonization in breast tissue expander seroma pocket AUTHOR NAMES Atwood D.N. Yuen J.C. Yuen B. Kumbla P.A. AUTHOR ADDRESSES (Atwood D.N.) University of Arkansas for Medical Sciences, College of Medicine, Little Rock, United States. (Kumbla P.A.) Banner MD Anderson Cancer Center, Division of Surgical Oncology, Gilbert, United States. (Yuen B.) University of Arkansas for Medical Sciences, Department of Family Medicine, Little Rock, United States. (Yuen J.C., James.Yuen@BannerHealth.com) University of Arkansas for Medical Sciences, Department of Surgery, Little Rock, United States. CORRESPONDENCE ADDRESS J.C. Yuen, Plastic and Reconstructive Surgery, Division of Surgical Oncology, Banner MD Anderson Cancer Center, Gilbert, United States. Email: James.Yuen@BannerHealth.com SOURCE JPRAS Open (2017) 12 (76-81). Date of Publication: 1 Jun 2017 ISSN 2352-5878 (electronic) BOOK PUBLISHER Elsevier Ltd ABSTRACT Mucormycosis is a rare and potentially life-threatening opportunistic infection with approximately 500 cases per year in the United States (Spellberg et al., 2005). There are six major presentations, which include rhino-orbital-cerebral, pulmonary, cutaneous, gastrointestinal, disseminated, and uncommon (e.g. osteomyelitis, endocarditis) Petrikkos et al. (2012).(2) While not a prominent pathogen in immunocompetent patients, immunocompromised patients such as those with prolonged neutropenia, organ and/or bone marrow suppression, and diabetes mellitus are prone to dissemination resulting in rapid death without prompt intervention (Spellberg et al. 2005). With a mortality rate reaching 90% (Spellberg et al. 2005), it is imperative that therapy be initiated rapidly once a diagnosis is made. Successful treatment consists of management of underlying risk factors, surgical debridement, and antifungal therapies (Spellberg et al. 2005). The dilemma whether to pursue extensive debridement presents when the wound is cultured positive but the patient is not systemically ill. We present the first reported case of successful salvage of breast reconstruction with retention of tissue extender and acellular dermal matrix (ADM) despite colonization of a recalcitrant seroma pocket by Mucor. EMTREE DRUG INDEX TERMS antineoplastic agent (drug therapy) ertapenem (drug combination, drug therapy, intravenous drug administration) hydrogen peroxide levofloxacin (drug therapy, oral drug administration) piperacillin plus tazobactam (drug combination, drug therapy, intravenous drug administration) posaconazole (drug therapy, oral drug administration) vancomycin (drug combination, drug therapy, intravenous drug administration) voriconazole (drug therapy, oral drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tissue expander (adverse device effect) mucormycosis (drug therapy, complication, diagnosis, drug therapy, surgery) EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult article benign breast tumor (complication) breast carcinoma (drug therapy, surgery) breast cellulitis (complication, diagnosis, drug therapy) breast cellulitis (drug therapy) breast disease (complication, diagnosis, drug therapy) breast reconstruction breast seroma (complication) cancer adjuvant therapy cancer staging case report debridement drug substitution drug withdrawal erythema female fine needle aspiration biopsy follow up fungal colonization fungus growth glycemic control human liver function test mastectomy Mucor non insulin dependent diabetes mellitus nonhuman obesity patient monitoring postoperative care salvage therapy silicone breast implant surgical drainage surgical mesh tissue extender tissue flap treatment duration treatment outcome wound closure wound dehiscence wound irrigation DEVICE TRADE NAMES AlloDerm , United StatesLifecell DEVICE MANUFACTURERS (United States)Lifecell CAS REGISTRY NUMBERS ertapenem (153773-82-1, 153832-38-3, 153832-46-3) hydrogen peroxide (7722-84-1) levofloxacin (100986-85-4, 138199-71-0) posaconazole (171228-49-2) vancomycin (1404-90-6, 1404-93-9) voriconazole (137234-62-9) EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170288491 PUI L615441753 DOI 10.1016/j.jpra.2017.03.004 FULL TEXT LINK http://dx.doi.org/10.1016/j.jpra.2017.03.004 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 76 TITLE Nipple-sparing mastectomy using a hemi-periareolar incision with or without minimal medial-lateral extensions; clinical outcome and patient satisfaction: A single centre prospective observational study AUTHOR NAMES El Hage Chehade H. Headon H. Wazir U. Carmaichael A.R. Choy C. Kasem A. Mokbel K. AUTHOR ADDRESSES (El Hage Chehade H.; Headon H.; Wazir U.; Carmaichael A.R.; Choy C.; Kasem A.; Mokbel K., kefahmokbel@hotmail.com) The London Breast Institute, Princess Grace Hospital, London, United Kingdom. CORRESPONDENCE ADDRESS K. Mokbel, Email: kefahmokbel@hotmail.com SOURCE American Journal of Surgery (2017) 213:6 (1116-1124). Date of Publication: 1 Jun 2017 ISSN 1879-1883 (electronic) 0002-9610 BOOK PUBLISHER Elsevier Inc., usjcs@elsevier.com ABSTRACT Background Nipple-sparing mastectomy (NSM) is becoming a viable oncoplastic option. There is debate regarding the best approach that balances oncological safety with aesthetics. In this study, we describe an approach involving a hemi-periareolar incision and evaluate its safety and outcomes. Methods Patients treated at single center between 2012 and 2015 were observed prospectively. After a histologically negative subareolar biopsy, immediate reconstruction with implant and acellular dermal matrix was performed after NSM. Primary end points were wound complications and explantation. Secondary end points included local recurrence, quality of life, patient satisfaction, and esthetic outcome. Results Sixty-three patients were included with 92 procedures. Twenty-seven percent received chemotherapy and 12.7% received radiotherapy. Mean follow-up was 27.6 months. There were only 2 wound complications, and no recurrences. Mean outcome scores were promising (Breast Q = 88%, subjective esthetic = 9.2, objective esthetic = 9.3, hardening = 2.6). Conclusions NSM via a hemi-periareolar incision is oncologically safe with a low-complication rate and high patients’ satisfaction. EMTREE DRUG INDEX TERMS antineoplastic agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, disease management, drug therapy, radiotherapy, surgery) clinical outcome hemi periareolar incision incision mastectomy nipple sparing mastectomy patient satisfaction EMTREE MEDICAL INDEX TERMS adult article cancer chemotherapy cancer hormone therapy cancer patient cancer radiotherapy cancer surgery esthetic surgery female follow up human major clinical study middle aged multimodality cancer therapy neoadjuvant chemotherapy observational study patient safety priority journal prospective study quality of life wound complication (complication) EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160599450 MEDLINE PMID 27523925 (http://www.ncbi.nlm.nih.gov/pubmed/27523925) PUI L611689810 DOI 10.1016/j.amjsurg.2016.04.016 FULL TEXT LINK http://dx.doi.org/10.1016/j.amjsurg.2016.04.016 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 77 TITLE The effect of skin expansion on acellular dermis in an experimental model AUTHOR NAMES Güçlü Karadağ T. Aral A.M. Tuncer S. Şencan A. Elmas Ç. AUTHOR ADDRESSES (Güçlü Karadağ T.; Aral A.M.) a Department of Plastic Surgery , Yıldırım Beyazıt University, Yenimahalle Research and Training Hospital , Ankara , Turkiye (Tuncer S.) b Faculty of Medicine, Department of Plastic and Reconstructive Surgery , Gazi University , Ankara , Turkiye (Şencan A.) c Bagcilar Research and Training Hospital , Istanbul , Turkiye (Elmas Ç.) d Faculty of Medicine, Department of Histology , Gazi University , Ankara , Turkiye SOURCE Journal of plastic surgery and hand surgery (2017) 51:3 (187-192). Date of Publication: 1 Jun 2017 ISSN 2000-6764 (electronic) ABSTRACT OBJECTIVE: Although acellular dermis is widely used in prosthesis-based breast reconstruction, there is no study evaluating its expandability and histological, ultra-structural related changes. The purpose of this study is to determine whether acellular dermis could be expanded and whether the histological changes occurring in the skin with tissue expansion is different from normal when acellular dermis is used.METHODS: Twenty-two male Wistar rats were used in this study. In group 1 (n = 6), a rectangular-shaped tissue expander with final volume of 35 ml was placed subcutaneously. In group 2 (n = 6) tissue expander was placed submuscularly. In group 3 (n = 6), a 4 × 5 cm, acellular dermis was inserted and sutured in place, tissue expander was placed underneath acellular dermis. Group 4 (n =  4) was control, no procedure was done after creation of a pocket. After day 30, tissue expanders were inflated with 2 ml every 2 days with saline solution. On day 66, midvertical, midhorizontal surface expansion measurements were recorded. Samples were examined macroscopically. Biopsies were taken from mid-point of the expanded full-thickness flap. Histological evaluation, total skin thickness, epidermal thickness, and the amount of vascularisation were measured.RESULTS: There was no expansion noted on the acellular dermis; however, acellular dermis increased vascularity and decreased the thinning of the overlying skin and thickening of the epidermis when compared to other groups.CONCLUSION: Acellular dermis use can be beneficial in implant-based breast reconstruction in terms of morbidity and its tissue support. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix anatomy and histology skin transplantation tissue expansion EMTREE MEDICAL INDEX TERMS animal skin tissue expander Wistar rat LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 27540822 (http://www.ncbi.nlm.nih.gov/pubmed/27540822) PUI L620010298 DOI 10.1080/2000656X.2016.1213734 FULL TEXT LINK http://dx.doi.org/10.1080/2000656X.2016.1213734 COPYRIGHT Copyright 2018 Medline is the source for the citation and abstract of this record. RECORD 78 TITLE Comparison of two cadaveric acellular dermal matrices for immediate breast reconstruction: A prospective randomized trial AUTHOR NAMES Hinchcliff K.M. Orbay H. Busse B.K. Charvet H. Kaur M. Sahar D.E. AUTHOR ADDRESSES (Hinchcliff K.M., kmhinchcliff@ucdavis.edu; Orbay H.; Kaur M.; Sahar D.E.) University of California – Davis Medical Center, Department of Surgery, Division of Plastic Surgery, Sacramento, United States. (Busse B.K.; Charvet H.) University of California – Davis Medical Center, Department of Surgery, Sacramento, United States. CORRESPONDENCE ADDRESS K.M. Hinchcliff, University of California – Davis Medical Center, Division of Plastic Surgery, Cypress Building, 2221 Stockton Blvd., Suite E, Sacramento, United States. Email: kmhinchcliff@ucdavis.edu SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2017) 70:5 (568-576). Date of Publication: 1 May 2017 ISSN 1878-0539 (electronic) 1748-6815 BOOK PUBLISHER Churchill Livingstone ABSTRACT AlloDerm RTU(®) and AlloMaxTM are two acellular dermal matrices (ADMs) used in implant-based breast reconstruction. In this study, we examined whether different processing methods for the ADMs lead to a disparity in histologic, clinical, and financial outcomes after breast reconstruction. Thirty patients undergoing implant-based breast reconstruction were randomized into AlloMax or AlloDerm arms (n = 15, each). ADM was placed at the time of immediate reconstruction. Patients were evaluated for complications on postoperative days 7, 14, and 30. During implant exchange, ADM biopsies were taken and compared histologically for vascular and cellular infiltration. Patient satisfaction was evaluated using the BRECON-31 questionnaire 1 year after implant exchange. A cost analysis was performed comparing the two ADMs. Patient demographics and complication rates were similar between the two groups (p > 0.05). Histologically, vessel density and fibroblast/inflammatory cell infiltrate were greater on the dermal side than on the implant side (p < 0.01) in both ADMs, suggesting greater vascular and cellular in-growth from the dermal side. Vessel density in the middle portion of the Allomax biopsies was significantly higher than the same site in the Alloderm biopsies (p < 0.05). The extent of fibroblast/inflammatory cell infiltration was similar in both arms (p > 0.05). The BRECON-31 satisfaction questionnaire yielded similar responses across all metrics between the two study arms. The negotiated price was slightly different when comparing the two ADMs, with no significant difference in ADM reimbursement. In this study, AlloDerm RTU and AlloMax were successfully used for implant-based breast reconstruction with comparable outcomes. EMTREE DRUG INDEX TERMS bacitracin cefazolin gentamicin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction EMTREE MEDICAL INDEX TERMS adult article cell infiltration cellulitis (complication) comparative study controlled study cost benefit analysis demography fibroblast hematoma (complication) human patient satisfaction patient selection postoperative period priority journal prospective study questionnaire randomized controlled trial seroma (complication) surgical infection (complication) surgical mesh (adverse device effect, clinical trial) CAS REGISTRY NUMBERS bacitracin (1405-87-4) cefazolin (25953-19-9, 27164-46-1) gentamicin (1392-48-9, 1403-66-3, 1405-41-0) EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170213506 MEDLINE PMID 28341592 (http://www.ncbi.nlm.nih.gov/pubmed/28341592) PUI L614947197 DOI 10.1016/j.bjps.2017.02.024 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2017.02.024 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 79 TITLE ADM assisted immediate breast reconstruction with a vertical incision and horizontal dermal flap AUTHOR NAMES Powell-Brett S. Shetty G. AUTHOR ADDRESSES (Powell-Brett S.; Shetty G.) Breast Unit, Peterborough City Hospital, Peterborough, United Kingdom. CORRESPONDENCE ADDRESS S. Powell-Brett, Breast Unit, Peterborough City Hospital, Peterborough, United Kingdom. SOURCE European Journal of Surgical Oncology (2017) 43:5 (S50). Date of Publication: 1 May 2017 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2017 CONFERENCE LOCATION Belfast, United Kingdom CONFERENCE DATE 2017-05-15 to 2017-05-16 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT There are several areas of contention with the use of acellular dermal matrix (ADM) including scar placement; this has traditionally been horizontal, over the pectoralis to protect the implant and ADM. This can present an aesthetic challenge, producing a boxy shape with less natural projection in large and ptotic breasts. Our series uses a vertical incision with horizontal skin reduction and dermal flap to improve aesthetic outcome with minimal complications. All patients who underwent immediate implant-based, subpectoral, ADM assisted, single stage breast reconstruction following a vertical incision skin sparing mastectomy with a horizontal dermal flap between June 2014 and January 2016 were included. Data collected prospectively included demographics, adjuvant therapy and post-operative complications. A single, oncoplastic trained consultant performed all operations. 24 patients (30 breasts) were identified; average age 47, Mean BMI 25.2, cup size range C to F. Four significant post-operative complications arose, one implant loss, one seroma requiring drainage, one case of C-diff and one case of prolonged erythema and blistering along the wound line (possible infection). In our series we believe we have a practical, reproducible, single-stage method that has excellent outcomes with minimal complications and improved cosmetic result. We therefore recommend the vertical incision with horizontal skin reduction and dermal flap as a valuable addition to reconstructive techniques, especially in larger and more ptotic breasts. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction incision skin flap EMTREE MEDICAL INDEX TERMS acellular dermal matrix adjuvant chemotherapy adult blister body mass clinical article complication consultation erythema female graft failure human human cell implant infection male mastectomy middle aged seroma wound LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616281091 DOI 10.1016/j.ejso.2017.01.191 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2017.01.191 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 80 TITLE A comparative study of titanium-coated propylene mesh with acellular dermal matrix in implant based breast reconstruction AUTHOR NAMES McKenna A. Hamilton-Burke W. Bathla S. Bird N. Shrotri A. Martin L. AUTHOR ADDRESSES (McKenna A.; Hamilton-Burke W.; Bathla S.; Bird N.; Shrotri A.; Martin L.) Aintree University Hospital, Liverpool, United Kingdom. CORRESPONDENCE ADDRESS A. McKenna, Aintree University Hospital, Liverpool, United Kingdom. SOURCE European Journal of Surgical Oncology (2017) 43:5 (S47). Date of Publication: 1 May 2017 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2017 CONFERENCE LOCATION Belfast, United Kingdom CONFERENCE DATE 2017-05-15 to 2017-05-16 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Background: Breast cancer is the most common cancer affecting women in the Western world. Reconstructive surgery following mastectomy has been shown to improve self-esteem and quality of life. Implant based breast reconstruction (IBBR) is the most common approach used. Biological and synthetic meshes are utilised as adjuncts to reconstruction to improve aesthetic outcomes. The objective of this study was to evaluate the short and medium-term outcomes for patients undergoing IBBR utilising these adjuncts following mastectomy. Methods: A retrospective review of a single centre experience with implant based breast reconstruction was undertaken. Comparison of 2 consecutive cohorts of patients using either biological porcine acellular dermal matrix -StratticeTM (May 2010 to September 2013) or synthetic titanized TiLOOP®Bra mesh (Jan 2013 to August 2015) was undertaken. Patient demographics, complications, and outcomes were analysed. Results: One hundred and fourteen cases of implant based breast reconstructions were performed between 2010 and 2015 at a regional tertiary referral centre. Seventy-nine patients had TiLOOP®Bra based breast reconstructions and 35 had Strattice™ ADM breast reconstructions. Median follow up was 37 months in the Strattice™ ADM cohort and 18 months in the TiLOOP®Bra cohort. Implant explantation rate was 6% in both cohorts. Complication rates in the Strattice™ ADM cohort was 22% and 18% in the TiLOOP®Bra cohort. There was no significant difference in post-operative complication rates between the 2 groups (p = 0.608). Conclusion: This study suggests that there is no significant difference in post-operative outcome when using a synthetic TiLOOP®Bra mesh compared to a biological ADM mesh. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) propylene titanium EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction comparative study implant EMTREE MEDICAL INDEX TERMS controlled study explant female follow up human major clinical study male mastectomy nonhuman pig postoperative complication retrospective study tertiary care center CAS REGISTRY NUMBERS propylene (115-07-1) titanium (7440-32-6) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616281043 DOI 10.1016/j.ejso.2017.01.180 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2017.01.180 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 81 TITLE Clinical and patient reported outcomes in breast reconstruction using acellular dermal matrix AUTHOR NAMES Powell-Brett S. Goh S. AUTHOR ADDRESSES (Powell-Brett S.; Goh S.) Breast Unit, Peterborough City Hospital, Peterborough, United Kingdom. CORRESPONDENCE ADDRESS S. Powell-Brett, Breast Unit, Peterborough City Hospital, Peterborough, United Kingdom. SOURCE European Journal of Surgical Oncology (2017) 43:5 (S57). Date of Publication: 1 May 2017 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2017 CONFERENCE LOCATION Belfast, United Kingdom CONFERENCE DATE 2017-05-15 to 2017-05-16 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: There is a lack of published patient reported outcome measures (PROMs) for the use of acellular dermal matrix (ADM) based breast reconstruction. This cohort study reviewed our clinical outcomes and PROMs. Methods: All patients undergoing mastectomy with ADM assisted immediate breast reconstruction under a single surgeon between June 2013 and September 2016 were included. A prospectively kept database, clinic letters and operation notes were analysed. All patients received BREASTQ ™ pre and post-operative questionnaires. Results: Forty-eight consecutive patients with 62 reconstructions were included. Mean hospital stay was 3.8 days. All patients received 48 hours of intravenous antibiotics, followed by a two-week course of oral antibiotics. Mean post-operative follow up was 17 months. There were 6 cases of skin necrosis (9.7%), and 2 infections (3.2%). These resulted in 4 explantations (6.4%); 3 following skin necrosis and 1 following infection. There was no observed 'red skin' syndrome. Post-operative mean score for 'satisfaction with outcome' was 83.1%. Mean score for 'Psychosocial well-being' was 70.7% and the mean score for 'physical well-being' was 77.9%. Conclusion: Our complication rates were comparable to those published, and PROMs were consistently good. The skin necrosis rate was potentially due to earlier practice of performing single-stage immediate reconstruction using fixed volume breast implants. We have modified our patient selection criteria and ADM based reconstructive techniques with experience. Longer term clinical and patient reported outcome should be sought. EMTREE DRUG INDEX TERMS antibiotic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction female male patient-reported outcome EMTREE MEDICAL INDEX TERMS breast implant clinical article complication data base doctor patient relation drug therapy explant follow up hospitalization human infection mastectomy patient selection physical well-being questionnaire satisfaction skin necrosis skin redness surgeon LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616281190 DOI 10.1016/j.ejso.2017.01.217 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2017.01.217 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 82 TITLE Acellular dermal matrix assisted subpectoral versus prepectoral implant placement; comparing pain and patient reported outcomes AUTHOR NAMES Baker B. Irri R. MacCallum V. Chattopadhyay R. Murphy J. Harvey J. AUTHOR ADDRESSES (Baker B.; Irri R.; MacCallum V.; Chattopadhyay R.; Murphy J.; Harvey J.) Nightingale Centre, University Hospital South Manchester, Manchester, United Kingdom. (MacCallum V.; Harvey J.) University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom. CORRESPONDENCE ADDRESS B. Baker, Nightingale Centre, University Hospital South Manchester, Manchester, United Kingdom. SOURCE European Journal of Surgical Oncology (2017) 43:5 (S18). Date of Publication: 1 May 2017 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2017 CONFERENCE LOCATION Belfast, United Kingdom CONFERENCE DATE 2017-05-15 to 2017-05-16 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Background/Aims: Pre-pectoral implant based acellular dermal matrix (ADM) assisted immediate breast reconstruction (IBR) is gaining popularity, including complete implant coverage with ADM. Perceived benefits are a reduction in postoperative pain and breast animation deformity, with preservation of upper limb mobility. We aimed to compare pain, patient reported outcome measures (PROMs), length of stay (LoS), and safety of prepectoral versus subpectoral Strattice™ assisted IBR. Methods: Consecutive patients were recruited prospectively, having either cancer resection or prophylactic mastectomy. There were no exclusion criteria. Patients scored pain contemporaneously three times per day for the first seven post-operative days on a likert scale, and completed the BREAST-Q™ reconstruction module three months post-operatively. Results: 38 patients were recruited. There was no significant difference in pain scores between groups (prepectoral n = 21, mean 1.45 vs subpectoral 10, 1.51; p = 0.45) during the first seven days. 31 BREAST-Qs™ were returned; Q scores were similar for prepectoral (mean 76) and subpectoral (mean 79) groups, but patients reported significantly more visible implant rippling in the prepectoral versus subpectoral group (7/13 vs 2/17, p = 0.02). There was no significant difference in LoS (prepectoral 2.1 days vs subpectoral 2.3; p = 0.44) or safety profile. 1 patient required re-operation for implant removal secondary to infection in the prepectoral group. Conclusions: This is the first study to compare pain and PROMs in prepectoral breast reconstruction with subpectoral; these were equivalent between groups. Prepectoral implant placement with complete ADM cover is safe. Prepectoral reconstruction is feasible but further studies are required to compare short and long term outcomes. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix implant pain patient-reported outcome EMTREE MEDICAL INDEX TERMS breast reconstruction cancer surgery clinical article controlled study female human infection length of stay Likert scale male prophylactic mastectomy reoperation safety LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616281053 DOI 10.1016/j.ejso.2017.01.077 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2017.01.077 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 83 TITLE Management of Mastectomy Skin Necrosis in Implant Based Breast Reconstruction AUTHOR NAMES Sue G.R. Long C. Lee G.K. AUTHOR ADDRESSES (Sue G.R.) From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA (Long C.; Lee G.K.) SOURCE Annals of plastic surgery (2017) 78:5 Supplement 4 (S208-S211). Date of Publication: 1 May 2017 ISSN 1536-3708 (electronic) ABSTRACT BACKGROUND: Mastectomy skin necrosis is a significant problem after breast reconstruction. This complication may lead to poor wound healing and need for implant removal, which may delay subsequent oncologic treatment. We sought to characterize factors associated with mastectomy skin necrosis and propose a management algorithm.METHODS: A retrospective review was performed on consecutive patients undergoing implant-based breast reconstruction by the senior author from 2006 through 2015. Patient-level factors including age, race, body mass index, history of hypertension, history of diabetes, history of smoking, and history of radiation were collected. Surgical factors including type of mastectomy, location of implant placement, and immediate versus delayed reconstruction were collected. The incidence and treatment of mastectomy skin necrosis were analyzed.RESULTS: A total of 293 patients underwent either unilateral or bilateral implant-based breast reconstructions after mastectomy with a total of 471 reconstructed breasts. Mastectomy skin necrosis was observed in 8.1% of reconstructed breasts. Skin necrosis was not associated with age, hypertension, diabetes, prior radiation, or type of mastectomy. The incidence of skin necrosis was higher among smokers (17.9% vs 5.0%, P < 0.001), among patients with higher body mass index (11.4% vs 6.1%, P = 0.05), patients who underwent immediate reconstruction compared to delayed (9.6% vs 0%, P = 0.004), placement of expander under acellular dermal matrix compared with submuscular placement (12.0% vs 5.2%, P = 0.02), and use of higher initial expander fill volume compared with lower fill volume (11.4% vs 5.4%, P = 0.02).The median necrosis size was 8 cm. The median time to treatment was 15 days postoperatively. In 55% of patients minor necrosis was treated with clinic debridement, whereas 43% had larger areas of necrosis requiring operative debridement. The median size treated with clinic debridement was 5.5 cm, compared to 15 cm for operative debridement. All necrosis was treated in a timely fashion and did not delay adjuvant therapy.CONCLUSIONS: Mastectomy skin necrosis occurred in 8.1% of breasts after implant-based reconstruction. Necrosis less than 10 cm can be treated successfully with local debridement in the clinic setting. Timely and appropriate treatment of skin necrosis with debridement and primary closure expedites wound healing and facilitates tissue expander breast reconstruction. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast implant pathology procedures EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult aged breast reconstruction demography female human middle aged necrosis postoperative complication (therapy) retrospective study risk factor skin surgical flaps very elderly LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 28301366 (http://www.ncbi.nlm.nih.gov/pubmed/28301366) PUI L620156491 DOI 10.1097/SAP.0000000000001045 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0000000000001045 COPYRIGHT Copyright 2018 Medline is the source for the citation and abstract of this record. RECORD 84 TITLE Current trends and outcomes of breast reconstruction following nipple-sparing mastectomy: results from a national multicentric registry with 1006 cases over a 6-year period AUTHOR NAMES Casella D. Calabrese C. Orzalesi L. Gaggelli I. Cecconi L. Santi C. Murgo R. Rinaldi S. Regolo L. Amanti C. Roncella M. Serra M. Meneghini G. Bortolini M. Altomare V. Cabula C. Catalano F. Cirilli A. Caruso F. Lazzaretti M.G. Meattini I. Livi L. Cataliotti L. Bernini M. AUTHOR ADDRESSES (Casella D., donatocasella@gmail.com; Calabrese C., c.cal@iol.it; Orzalesi L., lorenzo.orzalesi@unifi.it; Gaggelli I., ilaria.gaggelli@gmail.com; Santi C., caterinasanti12@gmail.com; Bernini M., marco.bern@tin.it) Oncologic and Reconstructive Surgery, Breast Unit Surgery, Careggi University Hospital, L.go Brambilla 3, Florence, Italy. (Cecconi L., l.cecconi@disia.unifi.it) Statistics, Department of Statistics, Informatics and Application “G.Parenti”, University of Florence, Viale Morgagni 59, Florence, Italy. (Murgo R., romurgo@libero.it) Breast Unit Surgery, San Giovanni Rotondo Hospital, Viale Cappuccini 1, S.Giovanni Rotondo, Italy. (Rinaldi S., solostefano@alice.it) Breast Unit Surgery, San Paolo Hospital, Via Capo Scardicchio 92, Bari, Italy. (Regolo L., lea.regolo@fsm.it) Breast Unit Surgery, Maugeri Hospital, Via Maugeri 10, Pavia, Italy. (Amanti C., claudio.amanti@uniroma1.it) Breast Unit Surgery, Sant’Andrea Hospital, Via di Grottarossa 1035, Rome, Italy. (Roncella M., m.roncella@ao-pisa.toscana.it) Breast Unit Surgery, Cisanello Hospital, Via Roma 67, Pisa, Italy. (Serra M., magserra@hotmail.com) Breast Unit Surgery, Sant’Orsola Hospital, Via Massarenti 9, Bologna, Italy. (Meneghini G., centro.donna@ulss5.it) Breast Unit, Montecchio Maggiore Hospital, Via Ca’ Rotte 7, Montecchio Maggiore, Italy. (Bortolini M., bortolini.m@gmail.com) Breast Unit Surgery, Valdese Hospital, Via Pellico 19, Turin, Italy. (Altomare V., v.altomare@unicampus.it) Breast Unit, Campus Biomedico Hospital, Via Alvaro del Portillo 200, Rome, Italy. (Cabula C., cabula@tin.it) Breast Unit Surgery, Businco Hospital, Via Jenner 1, Cagliari, Italy. (Catalano F., dr.francescacatalano@virgilio.it) Breast Unit, Cannizzaro Hospital, Via Messina 829, Catania, Italy. (Cirilli A., cirilli.alfredo@libero.it) Breast Unit Surgery, Policlinico Hospital, P.zza Giulio Cesare 11, Bari, Italy. (Caruso F., francesco.caruso@ccocatania.it) Breast Unit Surgery, Humanitas Hospital, Via Vittorio Emanuele da Bormida 64, Catania, Italy. (Lazzaretti M.G., m.lazzaretti@ausl.mo.it) Breast Unit Surgery, Ramazzini Hospital, Via Molinari 2, Carpi (Modena), Italy. (Meattini I., icro.meattini@unifi.it; Livi L., lorenzo.livi@unifi.it) Radiation-Oncology, Oncology Department, Careggi University Hospital, L.go Brambilla 3, Florence, Italy. (Cataliotti L., luigi.cataliotti@gmail.com) President European Breast Centres Certification, President Senonetwork Italia Onlus, Florence, Italy. CORRESPONDENCE ADDRESS M. Bernini, Oncologic and Reconstructive Surgery, Breast Unit Surgery, Careggi University Hospital, L.go Brambilla 3, Florence, Italy. Email: marco.bern@tin.it SOURCE Breast Cancer (2017) 24:3 (451-457). Date of Publication: 1 May 2017 ISSN 1880-4233 (electronic) 1340-6868 BOOK PUBLISHER Springer Tokyo, orders@springer.jp ABSTRACT Background: Reconstruction options following nipple-sparing mastectomy (NSM) are diverse and not yet investigated with level IA evidence. The analysis of surgical and oncological outcomes of NSM from the Italian National Registry shows its safety and wide acceptance both for prophylactic and therapeutic cases. A further in-depth analysis of the reconstructive approaches with their trend over time and their failures is the aim of this study. Methods: Data extraction from the National Database was performed restricting cases to the 2009–2014 period. Different reconstruction procedures were analyzed in terms of their distribution over time and with respect to specific indications. A 1-year minimum follow-up was conducted to assess reconstructive unsuccessful events. Univariate and multivariate analyses were performed to investigate the causes of both prosthetic and autologous failures. Results: 913 patients, for a total of 1006 procedures, are included in the analysis. A prosthetic only reconstruction is accomplished in 92.2 % of cases, while pure autologous tissues are employed in 4.2 % and a hybrid (prosthetic plus autologous) in 3.6 %. Direct-to-implant (DTI) reaches 48.7 % of all reconstructions in the year 2014. Prophylactic NSMs have a DTI reconstruction in 35.6 % of cases and an autologous tissue flap in 12.9 % of cases. Failures are 2.7 % overall: 0 % in pure autologous flaps and 9.1 % in hybrid cases. Significant risk factors for failures are diabetes and the previous radiation therapy on the operated breast. Conclusions: Reconstruction following NSM is mostly prosthetic in Italy, with DTI gaining large acceptance over time. Failures are low and occurring in diabetic and irradiated patients at the multivariate analysis. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction mastectomy nipple sparing mastectomy outcome assessment EMTREE MEDICAL INDEX TERMS abdominal flap acellular dermal matrix adult article autograft autologous tissue flap breast cancer (radiotherapy, surgery) breast prosthesis (adverse device effect) breast tissue expander controlled study diabetes mellitus disease registry evidence based medicine follow up human latissimus dorsi flap major clinical study prosthesis complication (complication) risk factor surgical technique tissue flap treatment failure trend study EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160656616 MEDLINE PMID 27600636 (http://www.ncbi.nlm.nih.gov/pubmed/27600636) PUI L612097816 DOI 10.1007/s12282-016-0726-z FULL TEXT LINK http://dx.doi.org/10.1007/s12282-016-0726-z COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 85 TITLE Drainless reconstruction with ADM: A Case series AUTHOR NAMES Potiszil K. Ahmad S. AUTHOR ADDRESSES (Potiszil K.; Ahmad S.) Royal Cornwall Hospital, Truro, United Kingdom. CORRESPONDENCE ADDRESS K. Potiszil, Royal Cornwall Hospital, Truro, United Kingdom. SOURCE European Journal of Surgical Oncology (2017) 43:5 (S42). Date of Publication: 1 May 2017 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2017 CONFERENCE LOCATION Belfast, United Kingdom CONFERENCE DATE 2017-05-15 to 2017-05-16 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: A commonly reported side effects of acellular dermal matrix (ADM) use in breast reconstruction is seroma. Traditionally drains have been used post-operatively to reduce this. However, there are studies showing no increased rate of seroma with ADM use, no increased risk of infection with seroma and an increased risk of infection with drain use. This led us to believe there may be unnecessary drain use occurring in breast reconstructions. Methods: A prospective study over 2 years of immediate breast reconstructions with implants and ADM by one surgeon in a single institution. Inclusion guidelines involved: 1) BMI < 35/low breast volume 2) Nonsmoking status 3) No high risk co-morbidities. Results: 44 patients were included. Clinical but asymptomatic seromas were seen in 6 cases (14%). None of these cases led to infection or implant loss, with 1 case needing a minor wound re-suture. Explantation occurred in 2 cases, with one being due to infection with USS confirming no seroma present at any point and one being due to wound necrosis that led to infection. The re-operation rate was 7% (3 patients). Conclusion: In our experience, drain use is not always necessary after implant/ADM based reconstruction. In a specific set of patients, not using drains in breast reconstructions with ADM appears safe and causes no permanent complications. Although clinical seromas may be seen, these have been small, asymptomatic and needed no intervention. This is a small set of patients and further investigation with larger numbers and longer follow up is needed. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) case study EMTREE MEDICAL INDEX TERMS acellular dermal matrix body mass breast reconstruction clinical article comorbidity complication drain explant female follow up graft failure human implant infection male necrosis practice guideline prospective study reoperation seroma smoking cessation surgeon suture wound LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616281184 DOI 10.1016/j.ejso.2017.01.162 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2017.01.162 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 86 TITLE Immediate breast reconstruction using ADM and implant: 5-year experience AUTHOR NAMES Apte A. Walsh M. Chandrasekharan S. Chakravorty A. AUTHOR ADDRESSES (Apte A.; Walsh M.; Chandrasekharan S.; Chakravorty A.) Colchester Hospital University NHS Foundation Trust, Colchester, United Kingdom. CORRESPONDENCE ADDRESS A. Apte, Colchester Hospital University NHS Foundation Trust, Colchester, United Kingdom. SOURCE European Journal of Surgical Oncology (2017) 43:5 (S59-S60). Date of Publication: 1 May 2017 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2017 CONFERENCE LOCATION Belfast, United Kingdom CONFERENCE DATE 2017-05-15 to 2017-05-16 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: With more frequent use of ADM & pre-pectoral biomesh in Immediate Breast Reconstruction (IBR), debate is still on to measure the outcomes of using sub-pectoral implants and ADMs. Aim of our study is to share our experience and PROMS data in single-stage IBR using ADM and implant. Methods: In this prospective study, consecutive patients undergoing single-stage-IBR with fixed-volume-implant and ADM from Feb. 2012 - Sept. 2016 received a standardised questionnaire, 6 weeks post-surgery. This included pre-operative, operative and post-operative outcomes, complications, patient satisfaction, cosmesis and return to activities. Results: 67 patients (73 procedures, 6 bilateral) underwent reconstruction. 98.4% patients felt that adequate information was given including non-availability of long-term data on ADMs. Tumour biology: IDC-37, ILC-12, Mixed-6, DCIS-11, ER+ve-52, HER2+ve-12, Average NPI- 3.9 (range 2.1-7). 12 patients had neo-adjuvant chemotherapy, 19 chemotherapy, 11 Herceptin and 20 had radiotherapy. Average hospital-stay: 1.66 days (range 1-5). Return to light activities: 2.55 weeks (range 0-6) & normal activities: 5.4 weeks (range 1-12) Implant loss - 4 patients (3 smokers). One red-breast-syndrome. 98.4% would recommend reconstruction. Conclusion: IBR using ADM and implant is an acceptable option in selected group as suggested by this PROMs and outcome data. However, IBR with ADMs can be fraught with problems and therefore appropriate patient selection with realistic expectations is essential for an acceptable outcome. EMTREE DRUG INDEX TERMS endogenous compound epidermal growth factor receptor 2 trastuzumab EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction implant EMTREE MEDICAL INDEX TERMS biology chemotherapy clinical trial complication doctor patient relation esthetic surgery expectation female graft failure hospitalization human intraductal carcinoma major clinical study male neoadjuvant therapy patient satisfaction patient selection prospective study questionnaire radiotherapy smoking surgery CAS REGISTRY NUMBERS epidermal growth factor receptor 2 (137632-09-8) trastuzumab (180288-69-1) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616281217 DOI 10.1016/j.ejso.2017.01.224 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2017.01.224 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 87 TITLE Immediate nipple-areolar complex reconstruction for patients undergoing skin sparing mastectomy and implant based reconstruction or therapeutic mammoplasty AUTHOR NAMES Highton L. Murphy J. AUTHOR ADDRESSES (Highton L.; Murphy J.) Nightingale Breast Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom. CORRESPONDENCE ADDRESS L. Highton, Nightingale Breast Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom. SOURCE European Journal of Surgical Oncology (2017) 43:5 (S54-S55). Date of Publication: 1 May 2017 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2017 CONFERENCE LOCATION Belfast, United Kingdom CONFERENCE DATE 2017-05-15 to 2017-05-16 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: We describe a technique of immediate NAC reconstruction for patients undergoing skin sparing mastectomy and implant-based reconstruction or therapeutic mammoplasty following central excision. Method: Nipple reconstruction is performed using a modified CV flap, planned at the correct height along the edge of the wise pattern or periareolar incision. A new areola is designed, de-epithelialised and reconstructed using a full thickness skin graft harvested from skin usually discarded. NAC tattooing may be performed at a later date if desired. Results: We have performed this procedure on 32 breasts in 21 patients. This included 19 risk-reducing mastectomies, 9 therapeutic mastectomies, 2 therapeutic mammoplasties following central excision and 2 major revisions to existing implant reconstructions. The incision was wise pattern in 29 breasts and peri-areolar in 3 breasts. Reconstruction was direct to implant in 29 breasts and expander based in 1 breast, including a variety of techniques in either the pre or post pectoral plane and utilising dermal sling or ADM. There have been no significant complications. Mean follow up is 9 months (2-24 months). Cosmetic results have been excellent to date and no revisional surgery has been required. Conclusions: Immediate NAC reconstruction is a reliable technique with good cosmetic outcomes. The application of simple techniques for NAC reconstruction in the primary procedure allows reconstruction of the whole breast in a single stage. There is an immediate focal point to the reconstruction to improve cosmesis, patient satisfaction and psychosocial function without delay, which is particularly beneficial for patients undergoing bilateral risk reducing mastectomies. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast areola breast reconstruction dermis female implant male mastectomy EMTREE MEDICAL INDEX TERMS clinical article esthetic surgery excision follow up full thickness skin graft height human incision patient satisfaction social psychology surgery tattooing LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616281153 DOI 10.1016/j.ejso.2017.01.207 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2017.01.207 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 88 TITLE Outcome following 150 prepectoral implant based breast reconstruction using Braxon® (ADM): UK experience AUTHOR NAMES Vidya R. Smith A.H. Salem F. Garg N. Dhespande A. Bhaskar P. Sircar T. Cawthorn S. AUTHOR ADDRESSES (Vidya R.; Salem F.; Sircar T.; Cawthorn S.) Royal Wolverhampton Hospital, Wolverhampton, United Kingdom. (Smith A.H.) Southmead NHS Trust, Bristol, United Kingdom. (Garg N.) Ipswich NHS Trust, Ipswich, United Kingdom. (Dhespande A.) Wigan NHS Trust, Wigan, United Kingdom. (Bhaskar P.) University Hospital of North Tees, Stockton on Tees, United Kingdom. CORRESPONDENCE ADDRESS R. Vidya, Royal Wolverhampton Hospital, Wolverhampton, United Kingdom. SOURCE European Journal of Surgical Oncology (2017) 43:5 (S1). Date of Publication: 1 May 2017 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2017 CONFERENCE LOCATION Belfast, United Kingdom CONFERENCE DATE 2017-05-15 to 2017-05-16 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Prepectoral breast reconstruction is an evolving new technique that is replacing standard submuscular reconstruction. We report the UK experience of a novelmuscle-sparingbreast reconstruction procedure with a preshaped acellular dermal matrix completely wrapping the breast implant. Methods: All patients who underwent a muscle-sparing breast reconstruction from Jan 2014 to Sept 2016 were included in the audit and the data was collected from the data base prospectively. All surgeons were mentored for the first five cases. Braxon® is the only dermal matrix, which is pre-shaped and is 0.6 mm thick. The mesh is porcine derived ADM, which totally wraps the implant and is placed prepectorally over the chest wall to form a new breast. Results: A total of 161 prepectoral breast implant reconstructions were carried out in five centres in the UK with a follow up of 3-35 months. 128 were unilateral and 24 were bilateral procedures. The age ranged between 30-76 years (median 56 yrs). The implant size varied between 120-540 cc (median 360 cc). Complications included hematoma 1.8%, (n = 3), implant loss 3.7% (n = 6), seroma needing aspiration in 11% (n = 19) and superficial skin necrosis 1.8% (n = 3). The outcomes have been excellent, with high patient satisfaction, less pain, a more natural shape and feeling with good cosmetic outcome. Conclusion: The Braxon® wrap-around muscle sparing technique adds a new dimension to implant based breast reconstruction. It eliminates the problem of implant animation and procedure of choice in athletes, active patients who do not want disturbance of their musculoskeletal structure. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast implant breast reconstruction EMTREE MEDICAL INDEX TERMS acellular dermal matrix aspiration athlete clinical article complication data base female follow up graft failure hematoma human male muscle nonhuman pain patient satisfaction pig seroma skin necrosis surgeon thorax wall LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616281024 DOI 10.1016/j.ejso.2017.01.020 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2017.01.020 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 89 TITLE Pre-pectoral implant based breast reconstruction AUTHOR NAMES Highton L. Murphy J. AUTHOR ADDRESSES (Highton L.; Murphy J.) Nightingale Breast Centre, University Hospitals of South Manchester NHS Foundation Trust, Manchester, United Kingdom. CORRESPONDENCE ADDRESS L. Highton, Nightingale Breast Centre, University Hospitals of South Manchester NHS Foundation Trust, Manchester, United Kingdom. SOURCE European Journal of Surgical Oncology (2017) 43:5 (S22). Date of Publication: 1 May 2017 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2017 CONFERENCE LOCATION Belfast, United Kingdom CONFERENCE DATE 2017-05-15 to 2017-05-16 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: The conventional approach to implant-based breast reconstruction is for the implant to be placed behind the pectoralis major (PM) with or without acellular dermal matrices (ADM). Improved upper pole implant coverage with this technique comes with the disadvantages of post-operative pain, animation and PM functional pain. We report a case series of pre-pectoral implant based reconstruction. Methods: A cohesive gel anatomical implant is placed in the pre-pectoral plane and completely covered with ADM. We use two sheets, which are sutured together and secured to the fascia of the PM, lateral chest wall and inframammary fold to contain the implant. Patients are discharged with drain(s) for 7 days and prescribed prophylactic antibiotics. Results: To date, 145 breast reconstructions have been performed in 95 patients since January 2014. The indications were: risk-reducing mastectomy (40%), therapeutic mastectomy (25%), revision of previous sub-pectoral reconstruction (32%) and delayed expander reconstruction (3%). Mean age was 46 years (20-78 years), mastectomy weight 475g (73-1679g) and implant volume 432cc (165-620cc). Post-operative inpatient stay was 0.9 days (0-2) with a follow up of 362 days (10-1260). Implant loss occurred in 3%. Minor complications occurred in 11%. Revisional surgery has been required in 4.5%. Conclusion: Pre-pectoral implant placement with total ADM coverage represents a novel approach to implant-based breast reconstruction. The technique is reliable in delivering excellent cosmetic results and patient satisfaction. Despite concerns, rippling has not been problematic. Patients are counselled on the potential advantages and disadvantages of pre and post pectoral reconstruction to ensure informed decision-making. EMTREE DRUG INDEX TERMS antibiotic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction implant EMTREE MEDICAL INDEX TERMS adult aged case study decision making dermis doctor patient relation drain drug therapy fascia female follow up graft failure human major clinical study male mastectomy patient satisfaction surgery thorax wall LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616281119 DOI 10.1016/j.ejso.2017.01.093 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2017.01.093 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 90 TITLE Patient selection and outcome in one stage dermal sling assisted immediate breast reconstruction AUTHOR NAMES Khan A. Hicks G. Pogson C. Al-Sarakbi W. AUTHOR ADDRESSES (Khan A.; Hicks G.; Pogson C.; Al-Sarakbi W.) Croydon University Hospital, London, United Kingdom. CORRESPONDENCE ADDRESS A. Khan, Croydon University Hospital, London, United Kingdom. SOURCE European Journal of Surgical Oncology (2017) 43:5 (S47). Date of Publication: 1 May 2017 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2017 CONFERENCE LOCATION Belfast, United Kingdom CONFERENCE DATE 2017-05-15 to 2017-05-16 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Background: One stage breast reconstruction with autologous inferior dermal flap has traditionally only been considered in women with high BMIs and macromastia. This study reports the use of this technique for large as well as smaller sized breasts in slimmer patients that traditionally would not be considered for this technique. We look at the complication rate post procedure, in particular implant loss rate and also patient satisfaction. Methods: A retrospective review of electronic medical records was used to identify all patients who had undergone skin sparing mastectomy and immediate reconstruction with a dermal sling and implant between Feb 2015 to Oct 2016. Patient demographics, intraoperative details, postoperative complications and patient satisfaction were all recorded. Results: In the defined study period, 49 dermal sling procedures were carried out on 45 patients. The mean patient age was 47 (range 35-68). The median patient BMI was 31 (range 19.9 to 47) with a median breast weight of 860g (range 372-2100g). Post operatively there were 3 cases of wound infections requiring antibiotics. Two cases of post-operative haematomas required a washout and only one patient lost their implant. Conclusions: Immediate breast reconstruction with inferior dermal sling and implant is a safe technique with low complication rates. Our unit has demonstrated that this technique can be used in patients with an array of BMIs and breast sizes with good outcomes. In the current economic climate this technique should be considered in a wider range of patients as it avoids the cost and also potential morbidity of acellular dermal matrices. In addition patients wishing to avoid the use of animal material or free flaps benefit from this technique. EMTREE DRUG INDEX TERMS antibiotic agent endogenous compound EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction dermis female male patient selection EMTREE MEDICAL INDEX TERMS adult body mass climate clinical article complication electronic medical record free tissue graft graft failure hematoma human human versus animal comparison implant mastectomy middle aged morbidity nonhuman patient satisfaction retrospective study wound infection LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616281052 DOI 10.1016/j.ejso.2017.01.182 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2017.01.182 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 91 TITLE Pyoderma gangrenosum following breast reconstruction surgery: A rare complication AUTHOR NAMES Kanesalingam K. Khan A. Karat I. Kousparos G. Osman H. J Laidlaw I. Daoud R. AUTHOR ADDRESSES (Kanesalingam K.; Khan A.; Karat I.; Kousparos G.; Osman H.; J Laidlaw I.; Daoud R.) Frimley Park Hospital, Surrey, United Kingdom. CORRESPONDENCE ADDRESS K. Kanesalingam, Frimley Park Hospital, Surrey, United Kingdom. SOURCE European Journal of Surgical Oncology (2017) 43:5 (S61). Date of Publication: 1 May 2017 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2017 CONFERENCE LOCATION Belfast, United Kingdom CONFERENCE DATE 2017-05-15 to 2017-05-16 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Post surgical pyoderma gangrenosum (PSPG) is rare cutaneous inflammatory skin disorder, which is characterised by painful and necrotic ulceration. We present two patients who developed PSPG following breast reconstructions. Method: Patient 1: 39 year old BRCA carrier had bilateral skin sparing mastectomies and immediate implant and dermal sling reconstructions. Five days after surgery she developed worsening wound breakdown and necrosis despite antibiotics and underwent bilateral implant removal and skin debridement. Post op her wound edges continued to deteriorate and a clinical diagnosis of PSPG was made. She was started on steroids and made an uneventful recovery. Patient 2: A 65-year-old lady underwent a skin and nipple-sparing mastectomy with an immediate implant and ADM reconstruction. Eight days later, she developed skin blisters and wound breakdown of incision site. She had her implant removed and skin edges debrided. Histology confirmed PSPG. She was started on steroids and made an uneventful recovery. Discussion: The diagnosis of PSPG is often made late. Acute onset of nipple sparing skin deterioration and necrosis despite antibiotics should raise the clinical suspicion of PSPG. Histology diagnosis should be attempted however a negative result does not exclude this diagnosis. Steroids and/ or immunosuppressants such as cyclosporine or tacrolimus (systemic or topical) have been shown to result in rapid improvement of symptoms. Conclusion: PSPG although rare, causes significant morbidity to patients following breast surgery especially following implant reconstructive surgery. Therefore early diagnosis and treatment is crucial to limit the degree of scarring and reduce the risk of potential implant loss. EMTREE DRUG INDEX TERMS antibiotic agent cyclosporine steroid tacrolimus EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction pyoderma gangrenosum EMTREE MEDICAL INDEX TERMS adult aged blister case report complication debridement dermis deterioration diagnosis disease carrier drug combination drug therapy early diagnosis female graft failure histology human human tissue implant incision mastectomy morbidity necrosis nipple reconstructive surgery scar formation surgery symptom topical drug administration CAS REGISTRY NUMBERS cyclosporin (79217-60-0) tacrolimus (104987-11-3) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616281050 DOI 10.1016/j.ejso.2017.01.230 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2017.01.230 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 92 TITLE Titanium-coated polypropylene mesh for immediate implantbased breast reconstruction e Our initial experience AUTHOR NAMES Munir A. Huws A. Shariaha Y. Udyashankar S. Lodwick E. Holt S. Khawaja S. AUTHOR ADDRESSES (Munir A.; Huws A.; Shariaha Y.; Udyashankar S.; Lodwick E.; Holt S.; Khawaja S.) Prince Philip Hospital, Llanelli, United Kingdom. CORRESPONDENCE ADDRESS A. Munir, Prince Philip Hospital, Llanelli, United Kingdom. SOURCE European Journal of Surgical Oncology (2017) 43:5 (S54). Date of Publication: 1 May 2017 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2017 CONFERENCE LOCATION Belfast, United Kingdom CONFERENCE DATE 2017-05-15 to 2017-05-16 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Background: The use of titanium-coated polypropylene mesh (TCPM) is an alternative to acellular dermal matrix for the implant based breast reconstruction by providing extra implant coverage especially in the lower half. The aim of our study was to analyse short-term outcomes of TCPM based implant breast reconstruction and compare the patient- and procedure- related factors to implant loss and surgical complications. Methods: Between September 2013 and September 2016 implant breast reconstructions after conservative mastectomies using TCMP was performed in 27 patients (with 33 reconstructions). Complications were divided into major (need for additional surgery), minor (conservative treatment), and implant loss. Univariate analyses were performed to determine the influence of the patient- and procedure-related factors on postoperative complications and implant loss. Results: Thirty-three mastectomies with reconstructions were performed in 27 women. Twenty six patients had therapeutic mastectomies with 6 of them also having contralateral risk reducing mastectomies. With median follow-up of 17.5 months, four of 32 patients had implant loss. Reasons for implant loss were skin necrosis in 2 cases, infection in 1 case and necrosis with infection in another case. One of these patients had a revised reconstruction one year later. One additional patient required implant replacement because of capsule contracture. No risk factors were observed for patient-associated complications. Univariate analysis revealed an increased risk for implant loss in patients with skin necrosis (p < 0.01). Conclusions: This titanium-coated polypropylene mesh shows acceptable complication rates and its use in immediate implant breast reconstruction is safe and effective. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) polypropylene titanium EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction EMTREE MEDICAL INDEX TERMS clinical article complication conservative treatment contracture controlled study female follow up graft failure human implant infection mastectomy peroperative complication risk factor skin necrosis surgery univariate analysis CAS REGISTRY NUMBERS polypropylene (25085-53-4, 9003-07-0) titanium (7440-32-6) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616281146 DOI 10.1016/j.ejso.2017.01.205 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2017.01.205 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 93 TITLE One stage ADM-assisted breast reconstruction, as safe as two stage submuscular implant breast reconstruction AUTHOR NAMES Wilson R. Kirwan C. O'Donoghue J. Linforth R. Johnson R. Harvey J. AUTHOR ADDRESSES (Wilson R.; Kirwan C.; Johnson R.; Harvey J.) University Hospital of South Manchester, Manchester, United Kingdom. (Kirwan C.; Harvey J.) University of Manchester, Manchester, United Kingdom. (O'Donoghue J.) Royal Victoria Infirmary, Newcastle, United Kingdom. (Linforth R.) Bradford Royal Infirmary, Bradford, United Kingdom. CORRESPONDENCE ADDRESS R. Wilson, University Hospital of South Manchester, Manchester, United Kingdom. SOURCE European Journal of Surgical Oncology (2017) 43:5 (S14). Date of Publication: 1 May 2017 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2017 CONFERENCE LOCATION Belfast, United Kingdom CONFERENCE DATE 2017-05-15 to 2017-05-16 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction It has been suggested that direct to implant ADM-assisted reconstructions pose a greater risk of post-operative complications than a two-stage procedure but evidence is limited. Our aim was to assess unplanned explantation rates between direct to implant and two-stage procedures in both Strattice™-assisted and submuscular reconstructions. Methods: Retrospective case note, implant database and theatre log review of consecutive immediate implant-based reconstructions performed from January 2009 to December 2015. Results: 373 patients underwent 375 Strattice™-assisted and 135 submuscular reconstructions. Of the Strattice™-assisted reconstructions, 285 (76%) were direct to implant, 72 (19%) were Becker™ implants and 18 (5%) were two-stage procedures. Of the submuscular reconstructions 3 (2%) were direct to implant, 14 (10%) were Becker™ implants and 118 (88%) were two-stage procedures. Unplanned explantation rates as a complication of the primary surgery were 4.9% in the Strattice™-assisted direct to implant reconstructions compared to 6.8% in the two-stage submuscular reconstructions. In the Strattice™-assisted group, total unplanned explantation was 6.4%, with 15 due to infection and 9 wound breakdown. Of the Strattice ™-assisted explants, 14 (5%) were direct-to-implant, 7 (10%) were Becker™ implants and 3 (17%) were two-stage. In the submuscular group, total unplanned explantation was 8.9%, with 7 due to infection and 5 wound breakdown. Of the submuscular explants, 1 (33%) was direct to implant, 3 (21%) were Becker™ implants and 8 (7%) were two-stage. Conclusions: A one stage procedure with ADM appears as safe, with similar proportion of explantations, as a two-stage submuscular procedure, with the benefits of a single operative stay. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction surgical mesh EMTREE MEDICAL INDEX TERMS complication data base explant female human human tissue infection major clinical study male surgery wound LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616281206 DOI 10.1016/j.ejso.2017.01.063 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2017.01.063 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 94 TITLE Effect of ADM-assisted breast reconstruction on reducing the need for long-term (five year) revisional surgery compared to a submuscular technique AUTHOR NAMES Wilson R.L. Kirwan C.C. O'Donoghue J.M. Linforth R.A. Johnson R.K. Harvey J.R. AUTHOR ADDRESSES (Wilson R.L.; Kirwan C.C.; Johnson R.K.; Harvey J.R.) University Hospital of South Manchester, Manchester, United Kingdom. (Kirwan C.C.; Harvey J.R.) University of Manchester, Manchester, United Kingdom. (O'Donoghue J.M.) Royal Victoria Infirmary, Newcastle, United Kingdom. (Linforth R.A.) Bradford Royal Infirmary, Bradford, United Kingdom. CORRESPONDENCE ADDRESS R.L. Wilson, University Hospital of South Manchester, Manchester, United Kingdom. SOURCE European Journal of Surgical Oncology (2017) 43:5 (S37). Date of Publication: 1 May 2017 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2017 CONFERENCE LOCATION Belfast, United Kingdom CONFERENCE DATE 2017-05-15 to 2017-05-16 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Core studies reported a five-year revision rate of 35-40% in implant-based reconstruction. There is little evidence to demonstrate the impact ADMs have on revision rates. Our aim was to compare the five-year revision rates between Strattice™-assisted reconstruction and a submuscular technique. Methods: Retrospective case note, implant database and theatre log review of consecutive implant-based reconstructions performed from January 2009-November 2011 with a minimum of five-years follow-up. Results: 117 patients underwent immediate implant-based reconstruction. 88 Strattice™-assisted (62 patients) and 49 submuscular (42 patients) reconstructions were included. Median follow-up was 5.7 years in the Strattice™-assisted group and 6.1 years in the submuscular. There was no significant difference in preoperative risk factors between groups. The five-year revision rate, per patient, is 52% in both the Strattice™- assisted and submuscular group (p = 0.9). In total, 45 (51%) Strattice™ reconstructions required revisional surgery compared to 26 (53%) submuscular (p = 0.8). There was no difference in the median time to first revisional surgery of 18 months (Strattice) versus 20 months (submuscular) (p = 0.4). Revision rates in those having prior or adjuvant radiotherapy are 53% in the Strattice™-assisted group (n = 8) and 100% in the submuscular (n = 5) (p = 0.1). There was a significant reduction in the need for revisional surgery for capsular contracture in the Strattice™ group (Strattice™ n = 7, submuscular n = 15, p = 0.02). Conclusions: Revision rates at five-years are equivalent between the Strattice™-assisted and submuscular reconstructions. Strattice™ may have particular benefit in preventing revisional surgery in those receiving chest wall radiotherapy and in reducing capsular contracture. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction EMTREE MEDICAL INDEX TERMS adjuvant radiotherapy controlled study data base female follow up human implant capsular contracture major clinical study male radiotherapy risk factor surgery surgical mesh thorax wall LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616281112 DOI 10.1016/j.ejso.2017.01.145 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2017.01.145 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 95 TITLE Multicentre audit of prepectoral implant based immediate breast reconstruction using Braxon AUTHOR NAMES Jafferbhoy S. Houlihan M. Parmeshwar R. Narayanan S. Soumian S. Harries S. Jones L. Clarke D. AUTHOR ADDRESSES (Jafferbhoy S.; Houlihan M.; Narayanan S.; Soumian S.) University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom. (Parmeshwar R.) Royal Lancaster Infirmary, Lancashire, United Kingdom. (Harries S.; Jones L.; Clarke D.) South Warwickshire NHS Trust, Warwick, United Kingdom. CORRESPONDENCE ADDRESS S. Jafferbhoy, University Hospitals of North Midlands, Stoke-on-Trent, United Kingdom. SOURCE European Journal of Surgical Oncology (2017) 43:5 (S36). Date of Publication: 1 May 2017 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2017 CONFERENCE LOCATION Belfast, United Kingdom CONFERENCE DATE 2017-05-15 to 2017-05-16 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Immediate breast reconstruction using subpectoral implant and acellular dermal matrix (ADM) has become standard practice in the UK. Detaching pectoralis major from the chest wall in the subpectoral technique is associated with postoperative pain. Prepectoral implant based reconstruction using a novel preshaped ADM mesh ''BRAXON'' has recently been introduced in the UK. We report the early experience from 3 Breast Units using this technique in immediate breast reconstruction. Methods: Patients requiring immediate breast reconstruction suitable for Braxon from December 2015 to October 2016 were included. Information regarding demographics, indication for surgery, operative details, immediate and delayed complications and follow up details were collected and analysed. Results: A total of 78 cases were identified of which 13 were bilateral procedures. Their BMI ranged from 19-39 kg/m2. Four patients were diabetic and 3 were smokers. Implant size used ranged from 200-535cc and the average length of stay in the hospital was 1.6 days. During the median follow up of 28 weeks, 16 patients (20%) had seromas aspirated and 20 patients (25%) required a further course of antibiotics. Seventeen patients (22%) were readmitted within 30 days and 8 implants (10%) were explanted due to infection (2 bilateral procedures). Conclusion: Our early experience using this novel technique has shown the complication rates comparable to the traditional subpectoral technique. Post-operative recovery is quicker and animation deformity is eliminated as pectoralis muscle is spared. However, long term studies are required to assess rippling and impact from adjuvant treatment. EMTREE DRUG INDEX TERMS adjuvant antibiotic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction controlled study implant EMTREE MEDICAL INDEX TERMS body mass clinical trial complication controlled clinical trial deformity diabetes mellitus female follow up hospital human human tissue infection length of stay major clinical study male multicenter study pectoral muscle seroma smoking surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616281098 DOI 10.1016/j.ejso.2017.01.142 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2017.01.142 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 96 TITLE Outcome of 602 cases of sling-assisted implant-based breast reconstruction AUTHOR NAMES Barber M. AUTHOR ADDRESSES (Barber M.) Edinburgh Breast Unit, Edinburgh, United Kingdom. CORRESPONDENCE ADDRESS M. Barber, Edinburgh Breast Unit, Edinburgh, United Kingdom. SOURCE European Journal of Surgical Oncology (2017) 43:5 (S14-S15). Date of Publication: 1 May 2017 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2017 CONFERENCE LOCATION Belfast, United Kingdom CONFERENCE DATE 2017-05-15 to 2017-05-16 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction The use of extrinsic slings to assist implant-based breast reconstruction offers the possibility of a one-stage procedure and may have cosmetic benefits, however, concerns remain over outcome. Methods: All cases where an extrinsic sling was used in a breast reconstructive procedure in Edinburgh from initial use on 7/7/2008 to 30/6/2016 were reviewed. Results: 602 sheets of sling material (220 Strattice®, 213 Veritas®, 76 TiLoop®, 72 Permacol® and 20 with 4 other materials) were used in 576 breasts of 383 patients. 103 reconstructions were lost (17.1%). Loss rate was 9.0% at 3 months and 12.6% at 6 months. 18 of 94 patients (19.1%) requiring adjuvant therapy had this delayed due to complications. 69 of 203 patients (34%) having unilateral surgery have undergone contralateral symmetrisation. Patients underwent a mean of 1.4 further operations (0-9) on the affected breast. Implant loss varied significantly with smoking (33% loss in smokers vs 11.3% in non-smokers, p<0.0001) and with use of radiotherapy (25.9% loss with radiotherapy vs 14.2% without, p = 0.0037). There was no significant variation with operating surgeon, type of sling used, breast weight, patient weight, nipple preservation or chemotherapy use. Long term loss rate in non-smokers who did not receive radiotherapy was 9.6%. There was limited evidence of an improvement in results over time. Conclusions: While offering potential cosmetic and financial benefits, sling-assisted implant breast reconstruction has a significant rate of reconstruction loss, need for further surgery and delay in adjuvant therapy. These should be important considerations for patient selection and consent. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction implant EMTREE MEDICAL INDEX TERMS adjuvant chemotherapy complication female graft failure human major clinical study male nipple patient selection radiotherapy smoking surgeon surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616281218 DOI 10.1016/j.ejso.2017.01.066 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2017.01.066 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 97 TITLE Salvage of infected breast implants with continuous periprosthetic antibiotic irrigation: A retrospective audit AUTHOR NAMES Kelsall J. Gutteridge E. Whisker L. AUTHOR ADDRESSES (Kelsall J.; Gutteridge E.; Whisker L.) Nottingham City Hospital, Nottingham, United Kingdom. CORRESPONDENCE ADDRESS J. Kelsall, Nottingham City Hospital, Nottingham, United Kingdom. SOURCE European Journal of Surgical Oncology (2017) 43:5 (S24). Date of Publication: 1 May 2017 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2017 CONFERENCE LOCATION Belfast, United Kingdom CONFERENCE DATE 2017-05-15 to 2017-05-16 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Infection in the setting of prosthetic breast reconstruction is a much feared complication as it may result in implant loss; causing psychological distress, poor cosmesis, further surgical procedures, and additional health care costs. Explantation in this setting has traditionally been the standard of care. Our institution has developed a protocol utilising intra-operative lavage, +/- exchange of the prosthesis, followed by continuous peri-prosthetic antibiotic irrigation for at least 48hrs; in order to attempt implant salvage in selected patients. We have audited our results and present our technique and outcomes for discussion. Methods: A retrospective audit was undertaken of all infected breast prosthesis irrigation cases over the preceding 5 yrs at our institution, including immediate and delayed reconstructions and revision surgery with either implants or tissue expanders. Patient demographics, surgical and perioperative data, and final outcomes following irrigation were collected. Results: Of 20 cases identified, 15 were successfully salvaged. Irrigation was undertaken for at least 48 hrs (range 2-6 days, median = 3). 14 had undergone immediate reconstruction, 2 delayed, and 4 revision procedures. The most common risk factor was obesity (13/20); others included concurrent fat grafting (4/20), smoking (4/20), previous irradiation (3/20); and diabetes (2/20). 12 had either an acellular dermal matrix or synthetic mesh in situ. 9 grew sensitive S. aureus, 2 grew Propionibacterium, and in 9 no organism was cultured. Conclusion: Our protocol utilising intra-operative lavage and post-operative peri-prosthetic antibiotic irrigation is a simple technique. It offers an opportunity to salvage an infected implant reconstruction in selected patients. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) antibiotic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast implant EMTREE MEDICAL INDEX TERMS acellular dermal matrix breast prosthesis clinical article diabetes mellitus female human human cell human tissue irradiation lavage male nonhuman obesity Propionibacterium risk factor smoking surgery tissue expander LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616281147 DOI 10.1016/j.ejso.2017.01.100 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2017.01.100 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 98 TITLE GP Communication: What do they know? What do they want? AUTHOR NAMES Zammit W. Zammit C. AUTHOR ADDRESSES (Zammit C.) Brighton and Sussex NHS Trust, East Susssex, United Kingdom. (Zammit W.) Portsmouth University, Portsmouth, United Kingdom. CORRESPONDENCE ADDRESS W. Zammit, Portsmouth University, Portsmouth, United Kingdom. SOURCE European Journal of Surgical Oncology (2017) 43:5 (S39). Date of Publication: 1 May 2017 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2017 CONFERENCE LOCATION Belfast, United Kingdom CONFERENCE DATE 2017-05-15 to 2017-05-16 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: We wanted to assess the acquaintance of GPs with the terminology used in the letters sent from breast outpatient consultations and the letter format they prefer. The aim is to improve communication between primary and tertiary care. Method: Two samples of breast cancer outpatient letters were handed to GPs attending post-graduate educational events. One letter had a systemic summary highlighting the diagnosis and management plan, followed by a short descriptive paragraph of the consultation (Format 1). The other letter had the same information but was much longer with a narrative description of events (Format 2). A questionnaire was then handed to the GPs to assess their preference of the style of correspondence and knowledge of terminology used in breast cancer care. Results: 54 GPs answered the questionnaire: 39% said they had enough time to fully read correspondence. 87% preferred the shorter letter version (Format 1). 73% preferred the letter to be addressed to the referring GP. While the majority (>70%) understood basic biological information, including ER, HER2, mammoplasty and sentinel node, less than 17% understood the acronyms DIEP, TRAM or implant with ADM reconstruction. Conclusion: A descriptive summary at the beginning of correspondence in outpatient letters was the preferred option particularly with the limited administration time available. Acronyms need to be explained particularly when they involve specialised treatment options. Further research on communication between primary and tertiary care needs to be addressed to optimise patient care. EMTREE DRUG INDEX TERMS endogenous compound epidermal growth factor receptor 2 EMTREE MEDICAL INDEX TERMS breast cancer breast reconstruction case report consultation deep inferior epigastric perforator flap diagnosis female human human tissue implant male narrative nomenclature outpatient patient care postgraduate student questionnaire sentinel lymph node tertiary health care writing CAS REGISTRY NUMBERS epidermal growth factor receptor 2 (137632-09-8) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616281137 DOI 10.1016/j.ejso.2017.01.151 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2017.01.151 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 99 TITLE Impact of Acellular Dermal Matrix (ADM) Use Under Mastectomy Flap Necrosis on Perioperative Outcomes of Prosthetic Breast Reconstruction AUTHOR NAMES Kim S.Y. Bang S.I. AUTHOR ADDRESSES (Kim S.Y.; Bang S.I., si55.bang@samsung.com) Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong 81, Gangnam-gu, Seoul, 06351, South Korea SOURCE Aesthetic plastic surgery (2017) 41:2 (275-281). Date of Publication: 1 Apr 2017 ISSN 1432-5241 (electronic) ABSTRACT BACKGROUND: There is conflicting data on the potential necrotic complications of acellular dermal matrix (ADM) use in breast reconstruction, and most studies focus on mastectomy flap necrosis as an outcome measure associated with ADM use. The aim of this study was to examine cases with necrotic complications with and without the use of ADM and to investigate whether ADM affected perioperative outcomes in cases with necrotic complications.METHODS: Patients who experienced mastectomy flap necrosis following mastectomy with tissue expander placement between January 2009 and March 2015 were retrospectively reviewed. The primary outcome was explantation of the expander, and other associated outcomes such as seroma or infection were also recorded.LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .RESULTS: A total of 57 breasts with mastectomy flap necrosis were identified: 32 of which were in the non-ADM group and 25 in the ADM group. The rate of explantation was 28% (7/25) in the ADM group versus 6.3% (2/32) in the non-ADM group, which was significantly different (P = 0.034). The ADM group had a significantly higher rate of "major" infection requiring surgical debridement than the non-ADM group (P = 0.016). Multivariate analysis showed that the use of ADM was trending toward an increasing expander rate with borderline significance (P = 0.05).CONCLUSION: This study demonstrated that ADM use under mastectomy flap necrosis was a potential risk for explantation of the expander and major infection. Surgeons should be cautious with the use of ADM with devascularized mastectomy skin flaps prone to necrosis. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adverse device effect pathology EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult breast augmentation breast tumor (surgery) device removal devices female human infection (etiology, therapy) mastectomy middle aged necrosis (etiology, surgery) procedures retrospective study seroma (etiology, therapy) surgical flaps tissue expander tissue expansion treatment outcome vascularization LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 28204936 (http://www.ncbi.nlm.nih.gov/pubmed/28204936) PUI L620871851 DOI 10.1007/s00266-017-0794-2 FULL TEXT LINK http://dx.doi.org/10.1007/s00266-017-0794-2 COPYRIGHT Copyright 2018 Medline is the source for the citation and abstract of this record. RECORD 100 TITLE Acellular dermal matrix reduces capsule formation in two-stage breast reconstruction AUTHOR NAMES Chopra K. Buckingham B. Matthews J. Sabino J. Tadisina K.K. Silverman R.P. Goldberg N.H. Slezak S. Singh D.P. AUTHOR ADDRESSES (Chopra K.; Buckingham B.; Matthews J.; Sabino J.; Tadisina K.K.; Silverman R.P.; Goldberg N.H.; Slezak S.) Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, United States. (Chopra K.) Department of Plastic & Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, United States. (Singh D.P., dsingh.md@gmail.com) Department of Plastic Surgery, Anne Arundel Medical Center, Annapolis, United States. CORRESPONDENCE ADDRESS D.P. Singh, Department of Plastic Surgery, Anne Arundel Medical Center, Annapolis, United States. Email: dsingh.md@gmail.com SOURCE International Wound Journal (2017) 14:2 (414-419). Date of Publication: 1 Apr 2017 ISSN 1742-481X (electronic) 1742-4801 BOOK PUBLISHER Blackwell Publishing Ltd, customerservices@oxonblackwellpublishing.com ABSTRACT Acellular dermal matrix (ADM) is commonly employed to create an inferior pocket for the tissue expander in two-stage breast reconstruction. The authors sought to determine whether placement of ADM during the first stage of reconstruction decreases the amount of capsule formation at implant exchange. Patients who underwent mastectomy and tissue expander reconstruction were included in this study. Two biopsies were obtained at the time of implant exchange, one from the pocket adjacent to the ADM and the other from the area adjacent to the pectoralis muscle. Pathology analysis was performed on each sample. Ten patients underwent immediate breast reconstruction with Alloderm during the 3-month study period. Capsule thickness was significantly greater in the areas where the expander was in direct contact with the pectoralis muscle (782 ± 194 µm) compared to those in contact with human acellular dermal matrix (hADM) (47·91 ± 110·82 µm; P < 0·05). Analysis of the sub-pectoral capsule demonstrated diffuse deposition of collagen, neutrophils, contractile myofibroblasts and synovia-like metaplasia, characteristic of a foreign body response. Conversely, within the inferior pocket where the hADM was in direct contact with the expander, we noted migration of host epithelial cells, fibroblasts, mesenchymal cells and angiogenesis, indicating host tissue regeneration. Acellular dermal matrix, when placed at the first stage of breast reconstruction, significantly reduces thickness and inflammatory character of the capsule in comparison to the patient's native tissue. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction EMTREE MEDICAL INDEX TERMS adult article breast cancer (surgery) breast tissue expander clinical article controlled study female foreign body reaction foreign body response histology human intraductal carcinoma (surgery) mastectomy pathology pectoral muscle silicone prosthesis surgical mesh tissue regeneration DEVICE MANUFACTURERS Lifecell EMBASE CLASSIFICATIONS Dermatology and Venereology (13) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160596068 MEDLINE PMID 27524677 (http://www.ncbi.nlm.nih.gov/pubmed/27524677) PUI L611663633 DOI 10.1111/iwj.12620 FULL TEXT LINK http://dx.doi.org/10.1111/iwj.12620 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 101 TITLE Surgical and oncologic outcomes after pre-pectoral breast reconstruction for mastectomy patients: The MedStar Georgetown University experience AUTHOR NAMES Tambar S. Tousimis E. Willey S. Pittman T. Chan M. Seevaratnam S. AUTHOR ADDRESSES (Tambar S.) Georgetown University, Washington, United States. (Tousimis E.; Willey S.; Pittman T.; Seevaratnam S.) Medstar Georgetown University Hospital, Washington, United States. (Chan M.) Virginia Commonwealth University, Richmond, United States. CORRESPONDENCE ADDRESS S. Tambar, Georgetown University, Washington, United States. SOURCE Annals of Surgical Oncology (2017) 24:2 Supplement 1 (286-287). Date of Publication: 1 Apr 2017 CONFERENCE NAME 18th Annual Meeting of the American Society of Breast Surgeons, ASBS 2017 CONFERENCE LOCATION Las Vegas, NV, United States CONFERENCE DATE 2017-04-26 to 2017-04-30 ISSN 1534-4681 BOOK PUBLISHER Springer New York LLC ABSTRACT Background/Objective: Sub-pectoral (SP), implant-based breast reconstruction with acellular dermal matrix (ADM) has become an established technique for breast reconstruction after total mastectomy. Sub-pectoral placement of the implant with partial muscle coverage with ADM has achieved desirable cosmetic outcomes with less pain as compared to full muscle coverage. However, the disadvantages of this technique include infection, capsular contracture, postoperative pain, and animation deformity. With the widespread use of ADM, pre-pectoral (PP) prosthetic-based breast reconstruction has emerged as a new alternative to the partial or total SP approach. We reviewed our first patients who underwent PP implant reconstruction at MedStar Georgetown University Hospital between December 2015 and November 2016 and compared them to patients who underwent SP reconstruction during the same time period. Methods: A retrospective chart review of patients undergoing either PP or retro-pectoral breast reconstruction at a single institution over 11 months was performed. Patient selection for PP reconstruction was based on surgeon preference of patients who were athletic and benefit from no animation deformity, low BMI, non-smokers, whose tumor was at least 1 cm from the overlying skin or nipple areolar complex, and no macromastia. Furthermore, the SPY Elite® image obtained intraoperatively showed adequate perfusion to the skin and nipple-areolar complex. Data was collected pertaining to patient demographics, tumor biology, reconstruction type, post-operative pain scores, narcotic use, and surgical and oncologic outcomes. Results: Twenty-four patients were identified during the study period that underwent PP breast reconstruction. Age- and stage-matched control groups were obtained with 24 patients who underwent SP reconstruction in the same time period. Mean age of patients for PP was 50 years (range 32-71) and for SP was 48 years (range 32-74). Mean BMI was 22.3 for PP group (range 19-28) and 23 for SP group (range 18-35). The average breast size in the PP group was 35 with B and C cup being the most common (n=9,9). In the SP group, the average breast size was 35 with B being the most common (n=8). There were no D cups in the PP group, but there were 5 patients with D cups in the SP group. In the PP group, 64% of patients had invasive ductal cancer, 67% had in-situ ductal cancer, and 4% had invasive lobular cancer. In the SP group, 50% of patients had invasive ductal cancer, 63% had in-situ cancers, and 21% had invasive lobular cancer. In the SP group, 30% were stage 0, 37.5% were stage I and 33.3% were stage II which was equivalent to the PP group. Eighteen percent were BRCA positive in the PP group and 21% in the SP group. Ninety-one percent of patients in the PP group had nipple-sparing mastectomy, and 82% of them were bilateral procedures. Comparatively, 100% of patients in the SP group had NSM, and 83% were bilateral. The average pain score was 4.12 in the PP group (range from 2 to 7) and 5 in the SP group (range 2-7, p-value 0.08). Postoperative narcotic use was significantly lower in the PP group (p 0.02). There were 4 skin flaps with ischemia and 4 implant losses noted in the SP group. The PP group had significantly lower surgical complications including 1 skin flap with ischemia and 2 implant losses. Two patients in the SP group had nipple ischemia which progressed to full necrosis requiring removal of the NAC. No such patients were noted in the PP group. The median follow-up was 24 weeks for the PP group and 43 weeks for the SP group, and there were no local recurrences reported. Conclusions: Pre-pectoral breast reconstruction is an emerging technique for immediate breast reconstruction after mastectomy. In carefully selected patients who are either undergoing prophylactic surgery or who have stage 1-2 cancer with low BMI, lack of macromastia, non-smokers, and have good flap perfusion intraoperatively with SPY technology were excellent candidates for this technique. Our study has shown that patients undergoing PP breast reconstruction had less postoperative complications with less narcotic use and equivalent oncologic outcomes as compared to the SP approach. Further prospective studies with longer follow-up are necessary to determine that PP reconstruction is associated with decreased post-operative pain, length of stay, animation deformity with improved aesthetic outcomes, and equivalent oncologic outcomes. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction female male mastectomy university hospital EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult aged biology body mass breast areola breast hypertrophy cancer size carcinoma in situ control group controlled study deformity doctor patient relation follow up graft failure graft perfusion human implant ischemia length of stay major clinical study medical record review necrosis normal human Paget nipple disease patient selection peroperative complication postoperative pain prospective study relapse skin flap statistical significance surgeon surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616338217 DOI 10.1245/s10434-017-5854-y FULL TEXT LINK http://dx.doi.org/10.1245/s10434-017-5854-y COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 102 TITLE Re: "Impact of Acellular Dermal Matrix (ADM) Use Under Mastectomy Flap Necrosis on Perioperative Outcomes of Prosthetic Breast Reconstruction" AUTHOR NAMES Graf R.M. Ono M.C. AUTHOR ADDRESSES (Graf R.M., ruthgraf@uol.com.br.Pietà; Ono M.C.) Department of Plastic Surgery, Federal University of Paraná, Curitiba, Brazil (Graf R.M., ruthgraf@uol.com.br.Pietà) Pietà Centro Médico, Rua Solimões, 1175, Mercês, Curitiba, Paraná, 80.810-070, Brazil SOURCE Aesthetic plastic surgery (2017) 41:2 (282-283). Date of Publication: 1 Apr 2017 ISSN 1432-5241 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix mastectomy EMTREE MEDICAL INDEX TERMS breast reconstruction breast tumor (surgery) human LANGUAGE OF ARTICLE English MEDLINE PMID 28233127 (http://www.ncbi.nlm.nih.gov/pubmed/28233127) PUI L618154233 DOI 10.1007/s00266-017-0815-1 FULL TEXT LINK http://dx.doi.org/10.1007/s00266-017-0815-1 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 103 TITLE Direct-to-Implant Breast Reconstruction without the Use of an Acellular Dermal Matrix Is Cost Effective and Oncologically Safe AUTHOR NAMES Serrurier L.C. Rayne S. Venter M. Benn C.-A. AUTHOR ADDRESSES (Serrurier L.C.) Johannesburg, South Africa From the University of the Witwatersrand and Milpark Breast Care Centre of Excellence (Rayne S.; Venter M.; Benn C.-A.) SOURCE Plastic and reconstructive surgery (2017) 139:4 (809-817). Date of Publication: 1 Apr 2017 ISSN 1529-4242 (electronic) ABSTRACT CONCLUSIONS: This reconstruction method compares very favorably with published data from other units as far as early and late complications and cosmetic outcome are concerned. It has a complication rate similar to that of reconstructions using an acellular dermal matrix and is more cost effective.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.BACKGROUND: Direct-to-implant breast reconstruction is a predictable, reliable, and cost-effective reconstruction. Most units performing direct-to-implant reconstructions recommend the use of an acellular dermal matrix or a mesh to reinforce the lower pole of the breast reconstruction.METHODS: Two hundred seventy-two consecutive patients with 488 immediate direct-to-implant breast reconstructions performed in a 34-month period are included in this group. Mean follow-up of this group is 35 months.RESULTS: Four hundred eight reconstructions were performed through a lazy-S mastectomy, and 80 were performed through a Wise pattern mastectomy. Two local recurrences occurred. Minor complications accounted for 5.5 percent (n = 27): seromas, 3.4 percent (n = 17); wound healing problems, 0.6 percent (n = 3); and grade 2 capsular contracture, 1.4 percent (n = 7). Major complications accounted for 4.3 percent (n = 21): infection, 0.8 percent (n = 4); prosthetic loss, 0.4 percent (n = 2); hematoma, 0.4 percent (n = 2); and wounds requiring débridement, 2 percent (n = 10). The additional cost of acellular dermal matrix is dependent on manufacturer and size, but increases the cost of the procedure by 35.5 to 47.7 percent. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cost benefit analysis economics EMTREE MEDICAL INDEX TERMS acellular dermal matrix adolescent adult aged breast augmentation breast reconstruction breast tumor (surgery) female human middle aged procedures retrospective study time factor young adult LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 28350650 (http://www.ncbi.nlm.nih.gov/pubmed/28350650) PUI L616570719 DOI 10.1097/PRS.0000000000003222 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000003222 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 104 TITLE Transition from Round to Shaped Implants in Immediate Breast Reconstruction: Our Preferred Approach and Clinical Outcomes AUTHOR NAMES Imahiyerobo T.A. Small K.H. Sackeyfio R. Hoffman H. Talmor M. AUTHOR ADDRESSES (Imahiyerobo T.A.) Division of Plastic Surgery, Department of Surgery, New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA (Small K.H.; Talmor M., MiaTMD@aol.com) Division of Plastic Surgery, Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College, 425 East 61st Street, 10th Floor, New York, NY, 10065, USA (Sackeyfio R.) Private Plastic Surgery Practice, Grand Rapids, MI, USA (Hoffman H.) Hofstra North Shore Long Island Jewish School of Medicine, Long Island, NY, USA SOURCE Aesthetic plastic surgery (2017) 41:2 (284-292). Date of Publication: 1 Apr 2017 ISSN 1432-5241 (electronic) ABSTRACT BACKGROUND: Smooth, round, silicone implants predominate device-based breast reconstruction in the USA; despite their prevalence, complications can include bottoming out, superior contour deformity, rippling, and/or lateral malposition. This complication profile increases the need for revision surgery and subsequent patient dissatisfaction. With the resurgence of shaped, textured, silicone implants in the USA, we report the senior author's success with these devices and outline a strategy to optimize outcomes in breast reconstruction surgery.METHODS: A retrospective chart review was conducted on a prospectively collected IRB-approved database of nipple-sparing mastectomies (NSMs) with immediate breast reconstruction with smooth, round, silicone implants (Group A) in 2011 in comparison to textured, shaped, silicone implants (Group B) in 2012. Changes in operative technique were highlighted and extrapolated. Outcomes were reviewed.RESULTS: In Group A, 128 NSMs were performed in 76 patients. In Group B, 109 NSMs were performed in 59 patients. Thirteen percent of patients in Group A had direct to implant reconstruction as compared with 21% in Group B. Patients with textured, shaped implants were more likely to have acellular dermal matrix (61 vs 34%, p < 0.0001) than those with smooth, round implants. Patients who had smooth, round implants were more likely to have postoperative nipple malposition (18 vs 0%, p < 0.0001,) and rippling (29 vs 0%, p < 0.0001.) Patients with textured, shaped implants had fewer operative revision reconstructions as compared with those with smooth, round implants (36.71 vs 12.8%, p < 0.0001) Based on these results, our technique has evolved and has eight key technical modifications.CONCLUSION: With a few adaptations in surgical technique, the transition to textured, shaped, silicone devices for breast reconstruction can be seamless with superior breast contour and reduced complications/revision rates.LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast implant procedures prosthesis design EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult adverse device effect aged breast augmentation devices female human middle aged retrospective study subcutaneous mastectomy time factor tissue expansion LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 28032163 (http://www.ncbi.nlm.nih.gov/pubmed/28032163) PUI L620869857 DOI 10.1007/s00266-016-0738-2 FULL TEXT LINK http://dx.doi.org/10.1007/s00266-016-0738-2 COPYRIGHT Copyright 2018 Medline is the source for the citation and abstract of this record. RECORD 105 TITLE Validation of a NSQIP-based prediction model for surgical site infections after breast reconstruction AUTHOR NAMES Wang F. Hall N. Sbitany H. Esserman L. AUTHOR ADDRESSES (Wang F.; Sbitany H.; Esserman L.) University of California, San Francisco, United States. (Hall N.) Alpert Medical School of Brown University, Providence, United States. CORRESPONDENCE ADDRESS F. Wang, University of California, San Francisco, United States. SOURCE Annals of Surgical Oncology (2017) 24:2 Supplement 1 (52). Date of Publication: 1 Apr 2017 CONFERENCE NAME 18th Annual Meeting of the American Society of Breast Surgeons, ASBS 2017 CONFERENCE LOCATION Las Vegas, NV, United States CONFERENCE DATE 2017-04-26 to 2017-04-30 ISSN 1534-4681 BOOK PUBLISHER Springer New York LLC ABSTRACT Background/Objective: The Breast Reconstruction Risk Assessment (BRA) Score is a model developed to predict the risk of surgical site infections (SSI) within 30 days after breast reconstruction. This was derived from the National Surgical Quality Improvement Program (NSQIP) database, where the average risk of SSI was 3.75%. We aim to externally validate this model in our cohort of patients who have undergone total skin-sparing mastectomy (TSSM) with immediate breast reconstruction. Methods: We reviewed all cases of TSSM with immediate breast reconstruction between 2005-2013 performed at our institution. SSIs in our cohort were defined as any infections requiring oral antibiotics, intravenous antibiotics, or procedures for resolution. The BRA Score variables included type of reconstruction, age, BMI, ASA class 3+, bleeding disorder, prior PCI or cardiac surgery, diabetes, active smoking, dyspnea, and hypertension. We compared the BRA Score model with models derived from our own dataset. We generated a new model using variables associated with complications after breast reconstruction, including age, BMI, diabetes, incision, lymph node dissection, prior radiation, and acellular dermal matrix Results: We identified 746 patients who had undergone TSSM with immediate breast reconstruction, with an overall 30-day SSI risk of 5.2%. The 1-year SSI risk was 16.4% in the 684 patients who underwent prosthetic breast reconstruction. The BRA Score for 30-day SSI did not fit our data well (C-statistic 0.509). We generated a risk prediction model using specific variables associated with breast reconstruction, and 10-fold cross-validation yielded improved discrimination for overall 30-day risk of SSI (C-statistic 0.583) and 1-year SSI risk in prosthetic breast reconstruction (C-statistic 0.625). Conclusions: Many risk prediction models have been published, but few are used clinically due to lack of validation or relevance to the population studied. The BRA Score model does not incorporate several important variables associated with breast reconstruction outcomes, such as lymph node dissection status, prior radiation, and the use of acellular dermal matrix. Our new model with these variables achieves better discrimination with our data but requires external validation. An improved SSI risk model could be developed using a larger cohort, with variables specific to breast reconstruction. EMTREE DRUG INDEX TERMS antibiotic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction disease model prediction surgical infection validation process EMTREE MEDICAL INDEX TERMS acellular dermal matrix animal model bleeding body mass complication controlled study diabetes mellitus drug therapy dyspnea female heart surgery human hypertension incision lymph node dissection major clinical study male mastectomy population model radiation risk assessment smoking LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616338170 DOI 10.1245/s10434-017-5854-y FULL TEXT LINK http://dx.doi.org/10.1245/s10434-017-5854-y COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 106 TITLE Technique to Promote Symmetry in 2-Staged Bilateral Breast Reconstruction in the Setting of Unilateral Postmastectomy Radiation AUTHOR NAMES Roh D.S. Treiser M.D. Lafleur E.H. Chun Y.S. AUTHOR ADDRESSES (Roh D.S.) From the *Harvard Combined Plastic Surgery Residency Program; and †Division of Plastic Surgery, Brigham & Women's Hospital, Boston, MA (Treiser M.D.; Lafleur E.H.; Chun Y.S.) SOURCE Annals of plastic surgery (2017) 78:4 (386-391). Date of Publication: 1 Apr 2017 ISSN 1536-3708 (electronic) ABSTRACT BACKGROUND: Bilateral breast reconstruction in the setting of unilateral postmastectomy radiation therapy (PMRT) remains one of the most difficult reconstructive challenges due to significant radiation-induced asymmetry from capsular contracture and superior migration of the irradiated reconstructed breast. We describe a novel and straightforward intraoperative technique for creating compensatory asymmetry to maximize postradiation symmetry in immediate bilateral tissue expander (TE) and acellular dermal matrix (ADM) reconstruction requiring unilateral PMRT.METHODS: A cohort of 25 bilateral TE/ADM breast reconstructions with planned unilateral PMRT was performed using this approach, and outcomes were reviewed. On the PMRT side, the ADM edge was inset to a lower inframammary fold (IMF) position resulting in a near "bottoming-out" effect. On the non-PMRT side, the ADM was inset using a triple point stitch onto the IMF in a higher chest wall location. The planned PMRT side TE was overexpanded and second-stage exchanges were performed 6+ months post-PMRT.RESULTS: Post-PMRT results showed improved symmetry as the PMRT side migrated superiorly to match the contralateral non-irradiated side. Minimal pocket or IMF adjustments were required during second-stage procedures, with just 6 patients (24%) requiring minor lowering and 1 patient (4%) requiring elevation of the PMRT side IMF. Thus, most (72%) patients undergoing bilateral mastectomy and unilateral PMRT did not require any IMF modifications during the second-stage procedure.CONCLUSIONS: A differential ADM inset and TE pocket creation for bilateral TE/ADM breast reconstructions with planned unilateral PMRT can minimize the typical adverse aesthetic effects of PMRT on reconstruction results and maximize symmetry. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) esthetics physiology procedures EMTREE MEDICAL INDEX TERMS adjuvant radiotherapy adult breast implant breast reconstruction breast tumor (radiotherapy, surgery) cohort analysis comparative study female human mastectomy middle aged pathology retrospective study risk assessment treatment outcome wound healing LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 28273056 (http://www.ncbi.nlm.nih.gov/pubmed/28273056) PUI L619187560 DOI 10.1097/SAP.0000000000000892 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0000000000000892 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 107 TITLE Does surgical technique impact post-operative outcomes of breast reconstruction? AUTHOR NAMES Gabriel A. Sigalove S. Sigalove N. Storm-Dickerson T. Rice J. Maxwell P. Griffin L. Parekh M. Macarios D. AUTHOR ADDRESSES (Gabriel A.) Department of Plastic Surgery, Loma Linda University, Loma Linda, United States. (Sigalove S.) Department of Plastic Surgery, DuPage Medical Group, Central DuPage Hospital, Winfield, United States. (Sigalove N.) Department of Breast Surgery, Central DuPage Hospital, Northwestern Medicine, Winfield, United States. (Storm-Dickerson T.) Compass Oncology, Portland, United States. (Storm-Dickerson T.) Compass Oncology, Vancouver, United States. (Rice J.) PeaceHealth Plastic Surgery, Vancouver, United States. (Maxwell P.) Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, United States. (Griffin L.) Acelity, San Antonio, United States. (Parekh M.; Macarios D.) LifeCell Corporation, Acelity Company, Bridgewater, United States. CORRESPONDENCE ADDRESS A. Gabriel, Department of Plastic Surgery, Loma Linda University, Loma Linda, United States. SOURCE Annals of Surgical Oncology (2017) 24:2 Supplement 1 (278-279). Date of Publication: 1 Apr 2017 CONFERENCE NAME 18th Annual Meeting of the American Society of Breast Surgeons, ASBS 2017 CONFERENCE LOCATION Las Vegas, NV, United States CONFERENCE DATE 2017-04-26 to 2017-04-30 ISSN 1534-4681 BOOK PUBLISHER Springer New York LLC ABSTRACT Background/Objective: In 2015, approximately 106,338 breast reconstructions were performed in the US. Nearly 81% of these procedures were implant-based reconstructions. One of the more commonly used techniques in implant-based reconstruction is the dual plane (DP) technique, where the implant is placed under the pectoralis muscle, and reinforcement of the skin flap is achieved through the use of an acellular dermal matrix (ADM). A new surgical technique is the pre-pectoral (PP) technique which is a less invasive procedure and involves the placement of implant above the pectoral muscle with full anterior reinforcement using ADM. The goal of this study was to assess the impact of surgical technique on post-operative outcomes of breast reconstruction. Methods: This was a single site, retrospective cohort study that included data on breast reconstruction procedures from June 2013 to March 2016. Variables collected included patient demographics, comorbidities, chemotherapy and radiation exposure, surgical technique, the use of closed incision negative pressure therapy (ciNPT) and outcomes including length of hospital stay (LOS) and 90-day complications. Two-sided T-tests and Chi-square or Fisher's Exact tests were performed at α = 0.05. General linear models and logistic regression models were also performed in order to control for possible confounding variables. Results: The study included data on 176 patients (DP=117, PP=59) and 335 breasts (DP=225, PP=110). The PP group had a higher BMI (29.5 vs. 26.3 kg/m2; p=0.0017), and a significantly higher proportion of patients with diabetes (13.6% vs. 2.6%; p=0.0073), hypertension (35.6% vs. 17.1%; p=0.0061), and prior breast surgery (36.8% vs. 22.2%; p=0.0415). A higher proportion of PP patients received ciNPT (57.6% vs. 25.6%; p < 0.0001) compared to the DP group. There were no differences in complication rates between the 2 groups. The PP group had a significantly lower LOS compared to DP (mean: 1.1 vs. 1.8 days, p < 0.0001). Nearly 95% of PP patients were discharged after 1 hospital day compared to only 25.6% of the DP patients (p < 0.0001). Results of multiple regression models were similar to the univariate analyses after controlling for effects of age, BMI, ciNPT use, diabetes, hypertension, and prior breast surgery. No significant differences were found in the proportion of patient breasts with any complication (p=0.5875) whereas there was a significantly shorter LOS in the PP group (p < 0.0001) compared to DP group. Conclusions: This is one of the first studies to explore the length of hospital stay between PP and DP groups. The shorter LOS in the PP group may be a result of less invasive nature of the technique; however, additional data are needed to support this finding. Complication rates were similar between the 2 groups even though the PP group had higher BMI and higher proportions of patients with diabetes, hypertension, and prior breast surgery. Studies with longer-term follow-up are needed. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction incision EMTREE MEDICAL INDEX TERMS acellular dermal matrix body mass chemotherapy cohort analysis comorbidity complication confounding variable controlled study diabetes mellitus female follow up hospitalization human hypertension implant invasive procedure logistic regression analysis major clinical study male multiple regression pectoral muscle radiation exposure reinforcement statistical model Student t test univariate analysis vacuum assisted closure LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616338187 DOI 10.1245/s10434-017-5854-y FULL TEXT LINK http://dx.doi.org/10.1245/s10434-017-5854-y COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 108 TITLE Use of Acellular Dermal Matrix in Breast Surgery: Our Experience and Analysis of Satisfaction Using BREAST-Q AUTHOR NAMES Barone M. Cogliandro A. Persichetti P. AUTHOR ADDRESSES (Barone M.) Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University, Rome, Italy (Cogliandro A.; Persichetti P.) SOURCE Plastic and reconstructive surgery (2017) 139:4 (1014e-1015e). Date of Publication: 1 Apr 2017 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix satisfaction EMTREE MEDICAL INDEX TERMS breast breast reconstruction human mastectomy LANGUAGE OF ARTICLE English MEDLINE PMID 28002277 (http://www.ncbi.nlm.nih.gov/pubmed/28002277) PUI L617820914 DOI 10.1097/PRS.0000000000003191 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000003191 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 109 TITLE Reply: Acellular Dermal Matrix-Assisted Direct-to-Implant Breast Reconstruction and Capsular Contracture: A 13-Year Experience AUTHOR NAMES Salzberg C.A. AUTHOR ADDRESSES (Salzberg C.A.) Division of Plastic Surgery, Icahn School of Medicine, Mount Sinai Medical System, New York, N.Y SOURCE Plastic and reconstructive surgery (2017) 139:4 (1015e-1016e). Date of Publication: 1 Apr 2017 ISSN 1529-4242 (electronic) EMTREE DRUG INDEX TERMS collagen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction EMTREE MEDICAL INDEX TERMS breast augmentation breast implant breast tumor (surgery) contracture (surgery) human implant capsular contracture (surgery) CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 28350687 (http://www.ncbi.nlm.nih.gov/pubmed/28350687) PUI L617823785 DOI 10.1097/PRS.0000000000003192 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000003192 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 110 TITLE Extended submuscular implant-based breast reconstruction with pectoralis-serratus sling and acellular dermal matrix AUTHOR NAMES Kolker A.R. Piccolo P.P. AUTHOR ADDRESSES (Kolker A.R., adam@kolkermd.com; Piccolo P.P.) Dubin Breast Center and Department of Surgery, Division of Plastic Surgery, Icahn School of Medicine at Mount Sinai, 710 Park Avenue, New York, United States. CORRESPONDENCE ADDRESS A.R. Kolker, Dubin Breast Center and Department of Surgery, Division of Plastic Surgery, Icahn School of Medicine at Mount Sinai, 710 Park Avenue, New York, United States. Email: adam@kolkermd.com SOURCE Aesthetic Surgery Journal (2017) 37:4 (485-491). Date of Publication: 1 Apr 2017 ISSN 1527-330X (electronic) 1090-820X BOOK PUBLISHER Oxford University Press, jnl.info@oup.co.uk EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction breast tissue expander (adverse device effect, device economics) pectoralis serratus sling thorax muscle EMTREE MEDICAL INDEX TERMS adult aged article attitude assessment breast carcinoma (disease management, surgery) breast implant BREAST Q Reconstruction Module esthetic surgery female graft necrosis (complication) health care cost hematoma (complication) human implant capsular contracture (complication) major clinical study male middle aged patient satisfaction pectoralis major muscle poliglecaprone suture polyglactin suture postoperative infection (complication) postoperative pain (complication) priority journal quality of life quality of life assessment quality of life outcomes questionnaire reoperation seroma (complication) suction drain surgical mesh DEVICE TRADE NAMES Allergan Style 133MV-12 Allergan Allergan Style MF410-335 cc Allergan AlloDerm , United StatesLifecell Monocryl , United StatesEthicon Natrelle Style 133 , United StatesAllergan Vicryl , United StatesEthicon DEVICE MANUFACTURERS Allergan (United States)Allergan (United States)Ethicon (United States)Lifecell EMBASE CLASSIFICATIONS Cancer (16) Health Policy, Economics and Management (36) Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20170320545 PUI L615914336 DOI 10.1093/asj/sjw200 FULL TEXT LINK http://dx.doi.org/10.1093/asj/sjw200 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 111 TITLE In vitro evaluation of decellularized ECM-derived surgical scaffold biomaterials AUTHOR NAMES Luo X. Kulig K.M. Finkelstein E.B. Nicholson M.F. Liu X.-H. Goldman S.M. Vacanti J.P. Grottkau B.E. Pomerantseva I. Sundback C.A. Neville C.M. AUTHOR ADDRESSES (Luo X.; Kulig K.M.; Finkelstein E.B.; Nicholson M.F.; Pomerantseva I.; Sundback C.A.; Neville C.M., neville@helix.mgh.harvard.edu) Center for Regenerative Medicine, Massachusetts General Hospital, Boston, United States. (Luo X.) Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China. (Finkelstein E.B.) The Department of Biomedical and Chemical Engineering, Syracuse Biomaterials Institute, Syracuse University, Syracuse, United States. (Liu X.-H.; Goldman S.M.) DSM Biomedical, Exton, United States. (Vacanti J.P.; Pomerantseva I.; Sundback C.A.; Neville C.M., neville@helix.mgh.harvard.edu) Department of Surgery, Massachusetts General Hospital, Boston, United States. (Vacanti J.P.; Grottkau B.E.; Pomerantseva I.; Sundback C.A.; Neville C.M., neville@helix.mgh.harvard.edu) Harvard Medical School, Boston, United States. (Grottkau B.E.; Neville C.M., neville@helix.mgh.harvard.edu) Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, United States. CORRESPONDENCE ADDRESS C.M. Neville, Center for Regenerative Medicine, Massachusetts General Hospital, Boston, United States. Email: neville@helix.mgh.harvard.edu SOURCE Journal of Biomedical Materials Research - Part B Applied Biomaterials (2017) 105:3 (585-593). Date of Publication: 1 Apr 2017 ISSN 1552-4981 (electronic) 1552-4973 BOOK PUBLISHER John Wiley and Sons Inc., P.O.Box 18667, Newark, United States. ABSTRACT Decellularized extracellular matrix (ECM) biomaterials are increasingly used in regenerative medicine for abdominal tissue repair. Emerging ECM biomaterials with greater compliance target surgical procedures like breast and craniofacial reconstruction to enhance aesthetic outcome. Clinical studies report improved outcomes with newly designed ECM scaffolds, but their comparative biological characteristics have received less attention. In this study, we investigated scaffolds derived from dermis (AlloDerm Regenerative Tissue Matrix), small intestinal submucosa (Surgisis 4-layer Tissue Graft and OASIS Wound Matrix), and mesothelium (Meso BioMatrix Surgical Mesh and Veritas Collagen Matrix) and evaluated biological properties that modulate cellular responses and recruitment. An assay panel was utilized to assess the ECM scaffold effects upon cells. Results of the material-conditioned media study demonstrated Meso BioMatrix and OASIS best supported cell proliferation. Meso BioMatrix promoted the greatest migration and chemotaxis signaling, followed by Veritas and OASIS; OASIS had superior suppression of cell apoptosis. The direct adhesion assay indicated that AlloDerm, Meso BioMatrix, Surgisis, and Veritas had sidedness that affected cell-material interactions. In the chick chorioallantoic membrane assay, Meso BioMatrix and OASIS best supported cell infiltration. Among tested materials, Meso BioMatrix and OASIS demonstrated characteristics that facilitate scaffold incorporation, making them promising choices for many clinical applications. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 585–593, 2017. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) decellularized extracellular matrix extracellular matrix surgical mesh (device comparison) tissue engineering EMTREE MEDICAL INDEX TERMS 3T3 cell line animal tissue apoptosis article cell adhesion cell adhesion assay cell infiltration cell invasion cell migration cell proliferation chemotaxis chorioallantoic membrane assay comparative effectiveness conditioned medium controlled study evaluation study human human cell in vitro study intracellular signaling MDA-MB-231 cell line nonhuman skin fibroblast surface property umbilical vein endothelial cell DEVICE TRADE NAMES AlloDerm Lifecell Gelfoam Pfizer Meso BioMatrix OASIS Cook Biotech Surgisis Cook Biotech Veritas Synovis DEVICE MANUFACTURERS Cook Biotech Lifecell Pfizer Synovis EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Clinical and Experimental Biochemistry (29) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20151050166 MEDLINE PMID 26663848 (http://www.ncbi.nlm.nih.gov/pubmed/26663848) PUI L607355907 DOI 10.1002/jbm.b.33572 FULL TEXT LINK http://dx.doi.org/10.1002/jbm.b.33572 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 112 TITLE Results from the BRIOS randomised trial – Authors' reply AUTHOR NAMES Mullender M.G. Dikmans R.E.G. Negenborn V.L. Ruhé P.Q. Mureau M.A.M. Bouman M.-B. AUTHOR ADDRESSES (Mullender M.G., m.mullender@vumc.nl; Dikmans R.E.G.; Negenborn V.L.; Bouman M.-B.) Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, Netherlands. (Mullender M.G., m.mullender@vumc.nl; Dikmans R.E.G.; Negenborn V.L.; Bouman M.-B.) EMGO Institute for Health and Care Research Amsterdam, Amsterdam, Netherlands. (Ruhé P.Q.) Department of Plastic, Reconstructive and Hand Surgery, Meander Medical Centre, Amersfoort, Netherlands. (Mureau M.A.M.) Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, Netherlands. SOURCE The Lancet Oncology (2017) 18:4 (e191). Date of Publication: 1 Apr 2017 ISSN 1474-5488 (electronic) 1470-2045 BOOK PUBLISHER Lancet Publishing Group, cususerv@lancet.com EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction EMTREE MEDICAL INDEX TERMS breast implant device removal gold standard human letter mastectomy medical decision making medical expert organ size patient selection postoperative complication (complication) risk assessment risk factor skill skin flap skin flap survival smoking tissue blood flow EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20170242144 PUI L615113231 DOI 10.1016/S1470-2045(17)30161-4 FULL TEXT LINK http://dx.doi.org/10.1016/S1470-2045(17)30161-4 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 113 TITLE Results from the BRIOS randomised trial AUTHOR NAMES Potter S. Wilson R.L. Harvey J. Holcombe C. Kirwan C.C. AUTHOR ADDRESSES (Potter S., shelley.potter@bristol.ac.uk) Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom. (Holcombe C.) Breast Unit, Royal Liverpool and Boradgreen University Hospitals NHS Trust, Liverpool, United Kingdom. (Wilson R.L.; Harvey J.; Kirwan C.C.) Institute of Cancer Sciences, University of Manchester, Manchester, United Kingdom. SOURCE The Lancet Oncology (2017) 18:4 (e189). Date of Publication: 1 Apr 2017 ISSN 1474-5488 (electronic) 1470-2045 BOOK PUBLISHER Lancet Publishing Group, cususerv@lancet.com EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction EMTREE MEDICAL INDEX TERMS breast disease (complication) breast implant conceptual framework device removal human letter mastectomy multicenter study (topic) patient selection practice guideline prospective study randomized controlled trial (topic) red breast syndrome (complication) risk benefit analysis smoking surgical patient surgical technique syndrome (complication) United Kingdom EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20170242147 PUI L615113245 DOI 10.1016/S1470-2045(17)30164-X FULL TEXT LINK http://dx.doi.org/10.1016/S1470-2045(17)30164-X COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 114 TITLE Results from the BRIOS randomised trial AUTHOR NAMES Kovacs T. Charalampoudis P. Hout B.A. Dumitru D. Kothari A. AUTHOR ADDRESSES (Kovacs T.; Charalampoudis P., petros.charalampoudis@gmail.com; Hout B.A.; Dumitru D.; Kothari A.) Breast Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. SOURCE The Lancet Oncology (2017) 18:4 (e190). Date of Publication: 1 Apr 2017 ISSN 1474-5488 (electronic) 1470-2045 BOOK PUBLISHER Lancet Publishing Group, cususerv@lancet.com EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction EMTREE MEDICAL INDEX TERMS breast implant esthetics graft survival human hypoxia ischemia letter mastectomy multicenter study (topic) nipple sparing mastectomy postoperative complication (complication) practice guideline randomized controlled trial (topic) skin flap skin sparing mastectomy surgeon surgical infection (complication) surgical technique surgical wound United Kingdom EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20170242148 PUI L615113250 DOI 10.1016/S1470-2045(17)30165-1 FULL TEXT LINK http://dx.doi.org/10.1016/S1470-2045(17)30165-1 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 115 TITLE Comparison of Different Acellular Dermal Matrices in Breast Reconstruction: The 50/50 Study AUTHOR NAMES Pittman T.A. Fan K.L. Knapp A. Frantz S. Spear S.L. AUTHOR ADDRESSES (Pittman T.A.) Washington, D.C. From the Department of Plastic Surgery, MedStar Georgetown University Hospital; Georgetown University School of Medicine; and private practice (Fan K.L.; Knapp A.; Frantz S.; Spear S.L.) SOURCE Plastic and reconstructive surgery (2017) 139:3 (521-528). Date of Publication: 1 Mar 2017 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Acellular dermal matrix has enjoyed extensive use in primary and secondary alloplastic breast aesthetic and reconstructive surgery. The objective of this study was to examine clinical outcomes between available acellular dermal matrix products: DermACELL (LifeNet Health, Virginia Beach, Va.) and AlloDerm Ready To Use (LifeCell Corp., Branchburg, N.J.).METHODS: A retrospective chart review was performed on 58 consecutive patients (100 breasts) reconstructed with either DermACELL (n = 30 patients; 50 breasts) or AlloDerm Ready To Use (n = 28 patients; 50 breasts). The mastectomies were performed by three different breast surgeons. All reconstructions were performed by the same plastic surgeon (T.A.P.). Statistical analysis was performed by means of Fisher's exact test.RESULTS: Differences in the average age, body mass index, percentage having neoadjuvant/adjuvant chemotherapy or breast irradiation, and numbers of therapeutic and prophylactic mastectomies between the two groups were not statistically significant (p < 0.05). Complications in both cohorts of patients were clinically recorded for 90 days after immediate reconstruction. When comparing outcomes, patients in the DermACELL group had a significantly lower incidence of "red breast syndrome" (0 percent versus 26 percent; p = 0.0001) and fewer days before drain removal (15.8 days versus 20.6 days; p = 0.017). No significant differences were seen in terms of seroma, hematoma, delayed healing, infection, flap necrosis, or explantation.CONCLUSION: Patients reconstructed with DermACELL as compared with AlloDerm Ready To Use have significantly decreased number of days to drain removal and red breast syndrome and equivalent rates of other complications, including seroma, infection, flap necrosis, and explantation.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix procedures EMTREE MEDICAL INDEX TERMS breast reconstruction comparative study female human middle aged postoperative complication (epidemiology) retrospective study CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 28234811 (http://www.ncbi.nlm.nih.gov/pubmed/28234811) PUI L616564685 DOI 10.1097/PRS.0000000000003048 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000003048 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 116 TITLE Patient satisfaction with implant based breast reconstruction associated with implant volume and mastectomy specimen weight ratio AUTHOR NAMES Baek W.Y. Byun I.H. Kim Y.S. Lew D.H. Jeong J. Roh T.S. AUTHOR ADDRESSES (Baek W.Y.; Byun I.H.; Kim Y.S.; Lew D.H.; Roh T.S., ROHTS@yuhs.ac) Institute of Human Tissue Restoration, Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine, Seoul, South Korea. (Jeong J.) Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea. CORRESPONDENCE ADDRESS T.S. Roh, Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, South Korea. Email: ROHTS@yuhs.ac SOURCE Journal of Breast Cancer (2017) 20:1 (98-103). Date of Publication: 1 Mar 2017 ISSN 2092-9900 (electronic) 1738-6756 BOOK PUBLISHER Korean Breast Cancer Society, jbc.editorial@gmail.com ABSTRACT Purpose: Breast volume assessment is one of the most important steps during implant-based breast reconstruction because it is critical in selecting implant size. According to previous studies, there is a close relationship between the mastectomy specimen weight and resected breast volume. The aim of this study was to evaluate long-term patient satisfaction with implant-based breast reconstruction guided by the ratio of implant volume to mastectomy specimen weight. In doing so, we describe the ideal ratio for patient satisfaction. Methods: A total of 84 patients who underwent implant-based breast reconstruction for breast cancer were included in this study. The patients were grouped by the ratio of implant size to mastectomy specimen weight (group 1, <65%; group 2, 65%–75%; and group 3, > 75%). Outcome analysis was performed using a questionnaire of patient satisfaction and the desired implant size. Results: Pa tient satisfaction scores concerning the postoperative body image, size, and position of the reconstructed breast were significantly higher in group 2. The average ratio of the ideal implant volume to mastectomy specimen weight for each group was 71.9% (range, 54.5%–96.7%), with the differences across the three groups being not significant (p= 0.244). Conclusion: Since there is an increase in breast reconstruction, selecting the appropriate breast implant is undoubtedly important. Our novel technique using the ratio of implant volume to mastectomy specimen weight provides physicians a firm guide to intraoperative selection of the proper implant in reconstructive breast surgery. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast implant breast reconstruction mastectomy patient satisfaction EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult article body position breast tissue expander controlled study female human major clinical study middle aged outcome assessment questionnaire rating scale sensitivity and specificity silicone prosthesis telephone interview DEVICE TRADE NAMES AlloDerm , United StatesLifecell CGDerm DEVICE MANUFACTURERS (United States)Lifecell EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170257812 PUI L615243273 DOI 10.4048/jbc.2017.20.1.98 FULL TEXT LINK http://dx.doi.org/10.4048/jbc.2017.20.1.98 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 117 TITLE Paget's Disease of the nipple in a reconstructed breast. How to manage margins around the implant capsule? Case report and literature review AUTHOR NAMES Headon R. Abd Elwahab S. Tormey S. AUTHOR ADDRESSES (Headon R.; Abd Elwahab S.; Tormey S.) Mid-Western Breast Unit, University Hospital Limerick, Ireland. CORRESPONDENCE ADDRESS R. Headon, Mid-Western Breast Unit, University Hospital Limerick, Ireland. SOURCE Irish Journal of Medical Science (2017) 186:3 Supplement 1 (S120). Date of Publication: 1 Mar 2017 CONFERENCE NAME 25th Sylvester O'Halloran Perioperative Scientific Symposium CONFERENCE LOCATION Limerick, Ireland CONFERENCE DATE 2017-03-02 to 2017-03-04 ISSN 0021-1265 BOOK PUBLISHER Springer London ABSTRACT Ductal carcinoma in situ is a very common diagnosis in breast clinics and screening programs. Management of ductal carcinoma in situ (DCIS) has evolved significantly in the last two decades, however, width of resection margins is still a matter of debate. This case report presents a problem that is becoming more common in recent times due to the increase in rates of onco-plastic breast cancer surgery and use of implants. Our patient is a 46 years old lady who was diagnosed with DCIS of the left breast and had a skin and nipple-sparing mastectomy with immediate implant reconstruction using acellular dermal matrix (ADM). She then developed Paget's disease of the ipsilateral nipple in less than 1 year. After discussion with patient, she was treated by central resection down to implant capsule with preservation of the implant as per her wish. Her final histology revealed margins less than one mm. She was determined to preserve her implant. In this report, we review the literature and discuss management of DCIS margin close to an implant capsule. Implant capsule is fibrous shell that forms around artificial breast xenograft. There have been multiple reports of lymphoma developing in the implant, but as far as we know, there is little literature to describe cancer cells behavior around these capsules, and no literature about DCIS in this setting. There are currently no guidelines to advise on how to manage these patients. To the best of our knowledge, this is the first case to be reported with this issue. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) implant intraductal carcinoma EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult animal model behavior case report diagnosis female histology human human tissue lymphoma mastectomy microcapsule middle aged Paget bone disease practice guideline tumor model xenograft LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L614953730 DOI 10.1007/s11845-017-1578-z FULL TEXT LINK http://dx.doi.org/10.1007/s11845-017-1578-z COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 118 TITLE Discussion: Comparison of Different Acellular Dermal Matrices in Breast Reconstruction: The 50/50 Study AUTHOR NAMES Brown M.H. AUTHOR ADDRESSES (Brown M.H.) Toronto, Ontario, Canada From the Department of Surgery, University of Toronto SOURCE Plastic and reconstructive surgery (2017) 139:3 (529-530). Date of Publication: 1 Mar 2017 ISSN 1529-4242 (electronic) EMTREE DRUG INDEX TERMS collagen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction EMTREE MEDICAL INDEX TERMS breast augmentation breast implant human CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 28234812 (http://www.ncbi.nlm.nih.gov/pubmed/28234812) PUI L617823561 DOI 10.1097/PRS.0000000000003049 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000003049 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 119 TITLE Characterization of an Acellular Scaffold for a Tissue Engineering Approach to the Nipple-Areolar Complex Reconstruction AUTHOR NAMES Pashos N.C. Scarritt M.E. Eagle Z.R. Gimble J.M. Chaffin A.E. Bunnell B.A. AUTHOR ADDRESSES (Pashos N.C.; Scarritt M.E.; Eagle Z.R.; Gimble J.M.; Bunnell B.A., bbunnell@tulane.edu) Center for Stem Cell Research and Regenerative Medicine, Department of Pharmacology, Tulane University School of Medicine, 1430 Tulane Avenue, SL-99, New Orleans, United States. (Chaffin A.E.) Department of Surgery, Tulane University School of Medicine, New Orleans, United States. (Bunnell B.A., bbunnell@tulane.edu) Department of Pharmacology, Tulane University School of Medicine, New Orleans, United States. (Pashos N.C.) Bioinnovation PhD Program, School of Science and Engineering, Tulane University, New Orleans, United States. (Gimble J.M.) LaCell LLC, New Orleans, United States. (Bunnell B.A., bbunnell@tulane.edu) Division of Regenerative Medicine, Tulane National Primate Research Center, Covington, United States. SOURCE Cells Tissues Organs (2017) 203:3 (183-193). Date of Publication: 1 Mar 2017 ISSN 1422-6421 (electronic) 1422-6405 BOOK PUBLISHER S. Karger AG ABSTRACT A significant number of patients undergo mastectomies and breast reconstructions every year using many surgical-based techniques to reconstruct the nipple-areolar complex (NAC). Described herein is a tissue engineering approach that may permit a human NAC onlay graft during breast reconstruction procedures. By applying decellularization, which is the removal of cellular components from tissue, to an intact whole donor NAC, the extracellular matrix (ECM) structure of the NAC is preserved. This creates a biologically derived scaffold for cells to repopulate and regenerate the NAC. A detergent-based decellularization method was used to derive whole NAC scaffolds from nonhuman primate rhesus macaque NAC tissue. Using both histological and quantitative analyses for the native and decellularized tissues, the derived ECM graft was assessed. The bioactivity of the scaffold was evaluated following cell culture with bone marrow-derived mesenchymal stem cells (BMSCs). The data presented here demonstrate that scaffolds are devoid of cells and retain ECM integrity and a high degree of bioactivity. The content of collagen and glycosaminoglycans were not significantly altered by the decellularization process, whereas the elastin content was significantly decreased. The proliferation and apoptosis of seeded BMSCs were found to be approximately 65 and <1.5%, respectively. This study characterizes the successful decellularization of NAC tissue as compared to native NACs based on structural protein composition, lubricating protein retention, the maintenance of adhesion molecules, and bioactivity when reseeded with cells. These histological and quantitative analyses provide the foundation for a novel approach to NAC reconstruction. EMTREE DRUG INDEX TERMS collagen (endogenous compound) DNA (endogenous compound) elastin (endogenous compound) fibronectin (endogenous compound) glycosaminoglycan (endogenous compound) laminin (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction nipple areolar complex reconstruction tissue engineering tissue scaffold EMTREE MEDICAL INDEX TERMS adolescent animal tissue apoptosis article bone marrow derived mesenchymal stem cell cell culture cell proliferation cell viability child collagen fiber colorimetry controlled study DNA content DNA isolation extracellular matrix female gel electrophoresis histology human human cell immunohistochemistry keratinocyte male nonhuman priority journal rhesus monkey stem cell tissue section CAS REGISTRY NUMBERS collagen (9007-34-5) DNA (9007-49-2) elastin (9007-58-3) fibronectin (86088-83-7) laminin (2408-79-9) EMBASE CLASSIFICATIONS Clinical and Experimental Biochemistry (29) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170101353 MEDLINE PMID 28125805 (http://www.ncbi.nlm.nih.gov/pubmed/28125805) PUI L614339331 DOI 10.1159/000455070 FULL TEXT LINK http://dx.doi.org/10.1159/000455070 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 120 TITLE Two-stage implant-based breast reconstruction compared with immediate one-stage implant-based breast reconstruction augmented with an acellular dermal matrix: an open-label, phase 4, multicentre, randomised, controlled trial AUTHOR NAMES Dikmans R.E.G. Negenborn V.L. Bouman M.-B. Winters H.A.H. Twisk J.W.R. Ruhé P.Q. Mureau M.A.M. Smit J.M. Tuinder S. Eltahir Y. Posch N.A. van Steveninck-Barends J.M. Meesters-Caberg M.A. van der Hulst R.R.W.J. Ritt M.J.P.F. Mullender M.G. AUTHOR ADDRESSES (Dikmans R.E.G.; Negenborn V.L.; Bouman M.-B.; Winters H.A.H.; Smit J.M.; Ritt M.J.P.F.; Mullender M.G., m.mullender@vumc.nl) Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Centre, Amsterdam, Netherlands. (Twisk J.W.R.) Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, Netherlands. (Dikmans R.E.G.; Negenborn V.L.; Bouman M.-B.; Winters H.A.H.; Mullender M.G., m.mullender@vumc.nl) EMGO Institute for Health and Care Research Amsterdam, Amsterdam, Netherlands. (Bouman M.-B.; Winters H.A.H.; Smit J.M.) Alexander Monro Breast Cancer Hospital, Bilthoven, Netherlands. (Ruhé P.Q.) Department of Plastic, Reconstructive, and Hand Surgery, Meander Medical Centre, Amersfoort, Netherlands. (Mureau M.A.M.) Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, Netherlands. (Tuinder S.; van der Hulst R.R.W.J.) Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre, Maastricht, Netherlands. (Eltahir Y.) Department of Plastic, Reconstructive, and Hand Surgery, University Medical Centre Groningen, Groningen, Netherlands. (Posch N.A.; van Steveninck-Barends J.M.) Department of Plastic, Reconstructive, and Hand Surgery, Haga Ziekenhuis, Den Haag, Netherlands. (Meesters-Caberg M.A.) Department of Plastic, Reconstructive, and Hand Surgery, Orbis Medisch Centrum, Sittard, Netherlands. CORRESPONDENCE ADDRESS M.G. Mullender, Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Centre, PO Box 7057, Amsterdam, Netherlands. Email: m.mullender@vumc.nl SOURCE The Lancet Oncology (2017) 18:2 (251-258). Date of Publication: 1 Feb 2017 ISSN 1474-5488 (electronic) 1470-2045 BOOK PUBLISHER Lancet Publishing Group, cususerv@lancet.com ABSTRACT Background The evidence justifying the use of acellular dermal matrices (ADMs) in implant-based breast reconstruction (IBBR) is limited. We did a prospective randomised trial to compare the safety of IBBR with an ADM immediately after mastectomy with that of two-stage IBBR. Methods We did an open-label, randomised, controlled trial in eight hospitals in the Netherlands. Eligible women were older than 18 years with breast carcinoma or a gene mutation linked with breast cancer who intended to undergo skin-sparing mastectomy and immediate IBBR. Randomisation was done electronically, stratified per centre and in blocks of ten to achieve roughly balanced groups. Women were assigned to undergo one-stage IBBR with ADM (Strattice, LifeCell, Branchburg, NJ, USA) or two-stage IBBR. The primary endpoint was quality of life and safety was assessed by the occurrence of adverse outcomes. Analyses were done per protocol with logistic regression and generalised estimating equations. This study is registered at Nederlands Trial Register, number NTR5446. Findings 142 women were enrolled between April 14, 2013, and May 29, 2015, of whom 59 (91 breasts) in the one-stage IBBR with ADM group and 62 (92 breasts) in the two-stage IBBR group were included in analyses. One-stage IBBR with ADM was associated with significantly higher risk per breast of surgical complications (crude odds ratio 3·81, 95% CI 2·67–5·43, p<0·001), reoperation (3·38, 2·10–5·45, p<0·001), and removal of implant, ADM, or both (8·80, 8·24–9·40, p<0·001) than two-stage IBBR. Severe (grade 3) adverse events occurred in 26 (29%) of 91 breasts in the one-stage IBBR with ADM group and in five (5%) of 92 in the two-stage IBBR group. The frequency of mild to moderate adverse events was similar in the two groups. Interpretation Immediate one-stage IBBR with ADM was associated with adverse events and should be considered very carefully. Understanding of selection of patients, risk factors, and surgical and postsurgical procedures needs to be improved. Funding Pink Ribbon, Nuts-Ohra, and LifeCell. EMTREE DRUG INDEX TERMS BRCA1 protein (endogenous compound) BRCA2 protein (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction one stage implant based breast reconstruction two stage implant based breast reconstruction EMTREE MEDICAL INDEX TERMS adult adverse outcome article breast carcinoma (surgery) breast implant controlled study device removal disease severity female gene mutation genetic linkage high risk patient human intermethod comparison major clinical study mastectomy multicenter study Netherlands open study patient safety patient satisfaction phase 4 clinical trial postoperative complication (complication) prospective study quality of life randomized controlled trial reoperation risk factor skin necrosis (complication) surgical mesh wound dehiscence (complication) wound infection (complication) DEVICE MANUFACTURERS (United States)Lifecell EMBASE CLASSIFICATIONS Dermatology and Venereology (13) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) CLINICAL TRIAL NUMBERS LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170076870 MEDLINE PMID 28012977 (http://www.ncbi.nlm.nih.gov/pubmed/28012977) PUI L614221770 DOI 10.1016/S1470-2045(16)30668-4 FULL TEXT LINK http://dx.doi.org/10.1016/S1470-2045(16)30668-4 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 121 TITLE Innovative Management of Implant Exposure in ADM/Implant-Based Breast Reconstruction with Negative Pressure Wound Therapy AUTHOR NAMES Accurso A. Rocco N. Accardo G. Reale P. Salerno C. Mattera E. D'Andrea F. AUTHOR ADDRESSES (Accurso A.; Accardo G.; Reale P.; Salerno C.) Department of Surgery, Breast Unit, University Hospital "Federico II", Naples, Italy (Rocco N., nicolarocco2003@gmail.com) Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via S. Pansini 5, 80131, Naples, Italy (Mattera E.) Department of Clinical and Experimental Medicine Flaviano Magrassi, Clinical Medicine Hospital Unit, Ambulatory of Vulnology, Second University of Naples, Naples, Italy (D'Andrea F.) Department of Plastic and Reconstructive Surgery, University of Naples "Federico II", Naples, Italy SOURCE Aesthetic plastic surgery (2017) 41:1 (36-39). Date of Publication: 1 Feb 2017 ISSN 1432-5241 (electronic) ABSTRACT INTRODUCTION: One-stage implant-based breast reconstruction has been recently improved by the introduction of biological [acellular dermal matrix (ADM)] and synthetic meshes. Advantages of ADMs in implant-based breast reconstruction derive from the expansion of the space available for the direct positioning of an implant, but their use could be associated with several complications. Although the majority of complications can be easily managed, mistakes in dealing with the first clinical signs of a potential adverse event can lead to implant loss.CASE PRESENTATION: We report a case of ADM/implant exposure following NAC-sparing mastectomy and immediate implant-based reconstruction, successfully managed with an innovative staged treatment using negative pressure wound therapy, which allowed a rapid re-positioning of the prosthesis after complete clearance of bacteria from the implant pocket.DISCUSSION: The safest strategy to manage implant exposure and concomitant bacterial growth is reported to be implant removal and delayed re-positioning after several months, following prolonged targeted antibiotic therapy. Our case shows how a short-time implant re-positioning following implant removal for implant exposure could be successfully pursued thanks to the shrewd use of negative pressure wound therapy with great advantages in terms of patient satisfaction and post-operative quality of life, offering women experiencing this complication the option of not delaying reconstruction for months after resolution of the complication, potentially avoiding major surgical procedures such as autologous tissue reconstructions.LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) prosthesis complication EMTREE MEDICAL INDEX TERMS adverse device effect breast augmentation breast implant breast reconstruction breast tumor (surgery) case report device removal female follow up human middle aged pathology physiology postoperative period procedures reoperation subcutaneous mastectomy surgical infection (diagnosis, surgery) vacuum assisted closure wound healing LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 28032164 (http://www.ncbi.nlm.nih.gov/pubmed/28032164) PUI L619647208 DOI 10.1007/s00266-016-0739-1 FULL TEXT LINK http://dx.doi.org/10.1007/s00266-016-0739-1 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 122 TITLE Long term risk of explantation with Strattice™ assisted breast reconstruction, is it any different to submuscular reconstruction? AUTHOR NAMES Wilson R.L. Kirwan C.C. Johnson R.K. Harvey J.R. AUTHOR ADDRESSES (Wilson R.L.; Kirwan C.C.; Johnson R.K.; Harvey J.R.) CORRESPONDENCE ADDRESS R.L. Wilson, SOURCE Cancer Research (2017) 77:4 Supplement 1. Date of Publication: 1 Feb 2017 CONFERENCE NAME 39th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2016-12-06 to 2016-12-10 ISSN 1538-7445 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Introduction The most recent meta-analysis published, containing only studies from 2011 onwards, reports acellular dermal matrix (ADM) assisted breast reconstructions are associated with a significant increase in risk of infection, seroma and mastectomy flap necrosis but not implant loss when compared to submuscular reconstructions. We hypothesised that implant loss associated with ADM-assisted reconstruction did not exclusively occur within the first 30 days after surgery and studies with shortterm follow-up may underestimate the risk. We aimed to determine with long-term follow-up at what time point explantation occurs after Strattice™ ADM-assisted reconstruction and if it differs from traditional submuscular implant based reconstruction. Methods A retrospective case note review was completed for all immediate implant based reconstructions performed between 1st January 2009 and 3 1st December 2015 in a single tertiary centre in England. Implant losses, the timings and causes of loss were determined. Results In total there were 510 immediate implant based reconstructions performed in 373 patients, of which 135 were submuscular and 375 ADM-assisted. In the ADM group a total of 22 (5.9%) implants were lost as a complication of their primary surgery. 14 implants were lost due to infection and eight due to wound breakdown. Implants were lost over a range of 14-661 days, median 76 days. Implant loss occurred within 30 days in six (27%), <90 days in 13 (59%) and over 90 days in nine breasts (41%). There were seven unplanned explantations, six were changed to autologous reconstructions (three for cosmetic reasons and three as a result of radiotherapy damage); one patient had a completion mastectomy for recurrent cancer. In the submuscular group a total of 11 (8.1 %) implants were lost as a complication of their primary surgery. Six implants were lost due to infection and five due to wound breakdown. Implants were lost over a range of 12-274 days, median 49 days. Implant loss occurred within 30 days in four (36%), <90 days in seven (64%) and over 90 days in nine breasts (36%). There were a further six unplanned explantations, two for pain and four for cosmetic reasons. Comparing the two groups there were no differences in total implant loss rate or time to implant loss. Conclusions Implant loss within the first 3 months of ADM-assisted breast reconstruction is 3.5%; however, implant loss can occur more than 90 days after ADM-assisted breast reconstruction. Patients and clinicians should be aware that the risk of explantation continues for up to two years post-operatively with an ADM-assisted reconstruction whereas with submuscular coverage there were no implant losses beyond nine months follow-up. There were no differences in explantation rates between submuscular and ADM-assisted breast reconstructions. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction explant EMTREE MEDICAL INDEX TERMS acellular dermal matrix cancer recurrence complication controlled study England female follow up graft failure graft necrosis human implant infection male mastectomy meta analysis pain radiotherapy seroma surgery wound LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616062712 DOI 10.1158/1538-7445.SABCS16-P3-14-05 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS16-P3-14-05 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 123 TITLE Elucidating the tumor immune microenvironment phenotype in early stage untreated BRCA mutated breast cancer patients AUTHOR NAMES Force J. Abbott S. Broadwater G. Kimmick G. Westbrook K. Hwang S. Kauff N. Stashko I. Weinhold K. Nair S. Hyslop T. Blackwell K. Castellar E. Marcom P.K. AUTHOR ADDRESSES (Force J.; Abbott S.; Broadwater G.; Kimmick G.; Westbrook K.; Hwang S.; Kauff N.; Stashko I.; Weinhold K.; Nair S.; Hyslop T.; Blackwell K.; Castellar E.; Marcom P.K.) CORRESPONDENCE ADDRESS J. Force, SOURCE Cancer Research (2017) 77:4 Supplement 1. Date of Publication: 1 Feb 2017 CONFERENCE NAME 39th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2016-12-06 to 2016-12-10 ISSN 1538-7445 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Introduction The most recent meta-analysis published, containing only studies from 2011 onwards, reports acellular dermal matrix (ADM) assisted breast reconstructions are associated with a significant increase in risk of infection, seroma and mastectomy flap necrosis but not implant loss when compared to submuscular reconstructions. We hypothesised that implant loss associated with ADM-assisted reconstruction did not exclusively occur within the first 30 days after surgery and studies with short-term follow-up may underestimate the risk. We aimed to determine with long-term follow- up at what time point explantation occurs after Strattice™ ADM-assisted reconstruction and if it differs from traditional submuscular implant based reconstruction. Methods A retrospective case note review was completed for all immediate implant based reconstructions performed between 1st January 2009 and 31st December 2015 in a single tertiary centre in England. Implant losses, the timings and causes of loss were determined. Results In total there were 510 immediate implant based reconstructions performed in 373 patients, of which 135 were submuscular and 375 ADM-assisted. In the ADM group a total of 22 (5.9%) implants were lost as a complication of their primary surgery. 14 implants were lost due to infection and eight due to wound breakdown. Implants were lost over a range of 14-661 days, median 76 days. Implant loss occurred within 30 days in six (27%), <90 days in 13 (59%) and over 90 days in nine breasts (41%). There were seven unplanned explantations, six were changed to autologous reconstructions (three for cosmetic reasons and three as a result of radiotherapy damage); one patient had a completion mastectomy for recurrent cancer. In the submuscular group a total of 11 (8.1%) implants were lost as a complication of their primary surgery. Six implants were lost due to infection and five due to wound breakdown. Implants were lost over a range of 12-274 days, median 49 days. Implant loss occurred within 30 days in four (36%), <90 days in seven (64%) and over 90 days in nine breasts (36%). There were a further six unplanned explantations, two for pain and four for cosmetic reasons. Comparing the two groups there were no differences in total implant loss rate or time to implant loss. Conclusions Implant loss within the first 3 months of ADM-assisted breast reconstruction is 3.5%; however, implant loss can occur more than 90 days after ADM- assisted breast reconstruction. Patients and clinicians should be aware that the risk of explantation continues for up to two years post-operatively with an ADM-assisted reconstruction whereas with submuscular coverage there were no implant losses beyond nine months follow-up. There were no differences in explantation rates between submuscular and ADM-assisted breast reconstructions. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer patient female microenvironment mutation phenotype seroma EMTREE MEDICAL INDEX TERMS acellular dermal matrix breast reconstruction complication controlled study England explant follow up graft failure graft necrosis human implant infection male mastectomy meta analysis pain radiotherapy surgery wound LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616062603 DOI 10.1158/1538-7445.SABCS16-P2-04-19 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS16-P2-04-19 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 124 TITLE Risk factors affecting post-operative complication after immediate reconstruction with implant for operable breast cancer patients AUTHOR NAMES Park S.J. Choi J.H. Lee M.H. Jung S.-Y. Lee E.S. AUTHOR ADDRESSES (Park S.J.; Choi J.H.; Lee M.H.; Jung S.-Y.; Lee E.S.) CORRESPONDENCE ADDRESS S.J. Park, SOURCE Cancer Research (2017) 77:4 Supplement 1. Date of Publication: 1 Feb 2017 CONFERENCE NAME 39th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2016-12-06 to 2016-12-10 ISSN 1538-7445 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Purpose : Immediate breast reconstruction (IBR) with implant after nipple-areola complex (NAC) sparing mastectomy is an increasing treatment for breast cancer patients. Old age, obesity, smoking history, large volume of implant and adjuvant oncologic therapies have been known as risk factors for post-operative complication after IBR. However, less is known about the risk factors after IBR with implant in Asian women with relatively low body mass index (BMI), small volume of breast and less history of smoking. We analyzed the risk factors for post-operative complications after IBR with implant in patients receiving NAC sparing mastectomy. Methods : We investigated a prospectively maintained database from 2012 to 2015 at National Cancer Center. A total of 278 breast reconstructions (230 unilateral, 24 bilateral) in 254 patients were performed by a single surgeon; 99.3% (276 of 278 breasts) were oncologic, and 0.7% (2 of 278 breasts) were prophylactic mastectomy. For each patient, we collected data on age, BMI, history of smoking and diabetes mellitus, volume of implant, adjuvant oncologic therapies, distances from tumor to nipple and skin, imprecise magnetic resonance image (MRI) finding (no discernible enhancing, non-mass enhancement, and multifocal tumor), and use of acellular dermal matrix (ADM). Results : Mean age was 44.8±7.6 years and mean BMI was 22.5±2.9 kg/m2 . Patients with smoking history was 4.3% (n=11). Mean implant size was 242.3±57.7mL. Patients underwent chemotherapy in 39% (n=99) and radiotherapy in 29 . 1% (n=74). Compared to western studies, our patients showed lower BMI, less history of smoking, and smaller size of implant insertion. Overall post-operative complication rate was 8.3% (n=23) and the complication rate was similar to the results of western studies; which included wound dehiscence (4.3%, n=12), infection (2.9%, n=8), and implant loss (2.9%, n=8). The use of ADM was independently associated with postoperative complications (30.0% in patients used ADM vs 6.6% in patients without ADM, respectively; OR, 6.016, 95% CI, 2.018-17.939; p=0.001). Other factors were not significantly related to post-operative complications. Conclusions : Our study is the largest study to investigate the risk factors for post-operative complications after IBR with implant in Asian countries. Compared to western studies, the patients had lower BMI, less history of smoking and smaller size of implant. Although known risk factors, such as smoking, obesity and size of implant, were not significantly associated with post-operative complication in our study, the incidence of post-operative complication was similar to that of western studies. These results might be caused by higher post-operative complication rate after use of ADM compared with western studies. Further study is warranted to evaluate the impact of ADM on post-operative complication on Asian countries. EMTREE DRUG INDEX TERMS adjuvant EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer patient female graft failure implant male risk factor EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult body mass breast areola breast reconstruction cancer center cancer size chemotherapy complication controlled study data base diabetes mellitus human infection major clinical study nuclear magnetic resonance imaging obesity prophylactic mastectomy radiotherapy smoking surgeon wound dehiscence LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616062850 DOI 10.1158/1538-7445.SABCS16-P3-14-11 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS16-P3-14-11 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 125 TITLE Breast cancer patients after kidney and liver transplantation: A Report from Asan medical center AUTHOR NAMES Jung I. Kim H.J. AUTHOR ADDRESSES (Jung I.; Kim H.J.) CORRESPONDENCE ADDRESS I. Jung, SOURCE Cancer Research (2017) 77:4 Supplement 1. Date of Publication: 1 Feb 2017 CONFERENCE NAME 39th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2016-12-06 to 2016-12-10 ISSN 1538-7445 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Purpose : Immediate breast reconstruction (IBR) with implant after nipple-areola complex (NAC) sparing mastectomy is an increasing treatment for breast cancer patients. Old age, obesity, smoking history, large volume of implant and adjuvant oncologic therapies have been known as risk factors for post-operative complication after IBR. However, less is known about the risk factors after IBR with implant in Asian women with relatively low body mass index (BMI), small volume of breast and less history of smoking. We analyzed the risk factors for post-operative complications after IBR with implant in patients receiving NAC sparing mastectomy. Methods : We investigated a prospectively maintained database from 2012 to 2015 at National Cancer Center. A total of 278 breast reconstructions (230 unilateral, 24 bilateral) in 254 patients were performed by a single surgeon; 99.3% (276 of 278 breasts) were oncologic, and 0.7% (2 of 278 breasts) were prophylactic mastectomy. For each patient, we collected data on age, BMI, history of smoking and diabetes mellitus, volume of implant, adjuvant oncologic therapies, distances from tumor to nipple and skin, imprecise magnetic resonance image (MRI) finding (no discernible enhancing, non-mass enhancement, and multifocal tumor), and use of acellular dermal matrix (ADM). Results : Mean age was 44.8±7.6 years and mean BMI was 22.5±2.9 kg/m . Patients with smoking history was 4.3% (n=11). Mean implant size was 242.3±57.7mL. Patients underwent chemotherapy in 39% (n=99) and radiotherapy in 29.1% (n=74). Compared to western studies, our patients showed lower BMI, less history of smoking, and smaller size of implant insertion. Overall post-operative complication rate was 8.3% (n=23) and the complication rate was similar to the results of western studies; which included wound dehiscence (4.3%, n=12), infection (2.9%, n=8), and implant loss (2.9%, n=8). The use of ADM was independently associated with post-operative complications (30.0% in patients used ADM vs 6.6% in patients without ADM, respectively; OR, 6.016, 95% CI, 2.018-17.939; p=0.001). Other factors were not significantly related to post-operative complications. Conclusions : Our study is the largest study to investigate the risk factors for post-operative complications after IBR with implant in Asian countries. Compared to western studies, the patients had lower BMI, less history of smoking and smaller size of implant. Although known risk factors, such as smoking, obesity and size of implant, were not significantly associated with post-operative complication in our study, the incidence of post-operative complication was similar to that of western studies. These results might be caused by higher post-operative complication rate after use of ADM compared with western studies. Further study is warranted to evaluate the impact of ADM on post-operative complication on Asian countries. EMTREE DRUG INDEX TERMS adjuvant EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer patient female kidney liver transplantation male EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult body mass breast areola breast reconstruction cancer center cancer size chemotherapy complication controlled study data base diabetes mellitus graft failure human implant infection major clinical study nuclear magnetic resonance imaging obesity prophylactic mastectomy radiotherapy risk factor smoking surgeon wound dehiscence LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616062704 DOI 10.1158/1538-7445.SABCS16-P2-04-25 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS16-P2-04-25 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 126 TITLE Soft Tissue Adjuncts in Revisionary Aesthetic Breast Surgery AUTHOR NAMES Suri S. Bagiella E. Factor S.H. Taub P.J. AUTHOR ADDRESSES (Suri S.) From the Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY (Bagiella E.; Factor S.H.; Taub P.J.) SOURCE Annals of plastic surgery (2017) 78:2 (230-235). Date of Publication: 1 Feb 2017 ISSN 1536-3708 (electronic) ABSTRACT Reconstructive breast surgery is challenging and continually evolving. In the past decade, numerous soft tissue adjuncts, such as acellular dermal matrices (ADMs), have revolutionized breast reconstruction serving as a tool to improve results and minimize the need for revision. The use of ADMs has been widely discussed in primary and secondary breast reconstruction after mastectomy. They have been shown to be an effective and safe option to correct complications; however, there is a relative paucity of literature on their use in revisional surgery after aesthetic breast procedures. The authors queried PubMed for existing literature regarding the use of ADMs in secondary breast surgery. Five case series from an initial search of 278 articles met the inclusion criteria. An overall infection rate of 2% and a complication rate of implant malposition was 0.8% with the use of ADMs. Although the literature is sparse regarding their use in this setting, early reports indicate that they are both safe and efficacious with a reasonable rate of complications. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix procedures EMTREE MEDICAL INDEX TERMS breast reconstruction female human outcome assessment reoperation LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 27220022 (http://www.ncbi.nlm.nih.gov/pubmed/27220022) PUI L618634265 DOI 10.1097/SAP.0000000000000835 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0000000000000835 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 127 TITLE Advanced Imaging Techniques for Investigation of Acellular Dermal Matrix Biointegration AUTHOR NAMES DeGeorge B.R. Ning B. Salopek L.S. Pineros-Fernandez A. Rodeheaver G.T. Peirce-Cottler S. Hu S. Cottler P.S. Campbell C.A. AUTHOR ADDRESSES (DeGeorge B.R.) Charlottesville, Va. From the Departments of Plastic Surgery and Biomedical Engineering, University of Virginia (Ning B.; Salopek L.S.; Pineros-Fernandez A.; Rodeheaver G.T.; Peirce-Cottler S.; Hu S.; Cottler P.S.; Campbell C.A.) SOURCE Plastic and reconstructive surgery (2017) 139:2 (395-405). Date of Publication: 1 Feb 2017 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Biointegration, a concept involving a dynamic interplay among three processes-inflammation, cellular infiltration, and angiogenesis-is key to understanding the interaction between acellular dermal matrices and the host. The current standard for evaluating acellular dermal matrix biointegration involves histologic analysis at fixed time points; however, the authors' approach uses advanced imaging techniques to serially assess biointegration in real time.METHODS: The authors have adapted two advanced imaging techniques-two-photon microscopy and photoacoustic microscopy-to investigate biointegration in a murine deepithelialized dorsal skin-fold window chamber model, specifically engineered to recapitulate the host microenvironment of acellular dermal matrix-assisted breast reconstruction. Four mice per group were assessed. Two-photon imaging of dual-transgenic mice allows for detection of fluorescently labeled perivascular cells, and macrophage lineage cells. Photoacoustic microscopy noninvasively assesses oxygen and hemoglobin concentration in living tissues, generating high-resolution, three-dimensional mapping of the nascent acellular dermal matrix-associated microvasculature and metabolic consumption of oxygen. These outcomes were corroborated by confirmatory histologic analysis at the terminal time point.RESULTS: The acellular dermal matrix/host interface is characterized by robust inflammation (0 to 3 days), increased oxygen consumption and neoangiogenesis in the matrix border zone (10 to 14 days), and vascular and inflammatory cell penetration into the center of the matrix (>21 days).CONCLUSION: The data broaden the core knowledge of acellular dermal matrix biology, and serve as a potential template for elucidating the key differences among various commercially available and developmental products to guide the reconstructive surgeon to better select a reconstructive adjunct that meets their specific needs. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix angiogenesis diagnostic imaging EMTREE MEDICAL INDEX TERMS animal cellular, subcellular and molecular biological phenomena and functions inflammation microscopy mouse photoacoustics LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 28121875 (http://www.ncbi.nlm.nih.gov/pubmed/28121875) PUI L616834146 DOI 10.1097/PRS.0000000000002992 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000002992 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 128 TITLE Study on the usefulness of the skin wound therapeutic agent 'Neo dermal activator' in breast cancer surgery AUTHOR NAMES Kim J.H. Lim S.M. Kim S.I. Park S.H. Park H.S. Kim J.Y. AUTHOR ADDRESSES (Kim J.H.; Lim S.M.; Kim S.I.; Park S.H.; Park H.S.; Kim J.Y.) CORRESPONDENCE ADDRESS J.H. Kim, SOURCE Cancer Research (2017) 77:4 Supplement 1. Date of Publication: 1 Feb 2017 CONFERENCE NAME 39th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2016-12-06 to 2016-12-10 ISSN 1538-7445 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Background : Wound infection after breast cancer surgery is considered to be factors that increase the discomfort of the patient and increase of the extension and the use of antibiotics in the treatment time period, in particular breast cancer post-operative wound infection resulting slow the implementation of adjunctive therapy such as radiation therapy or chemotherapy after surgery can cause, it is important to effectively prevent, there has been a development of a variety of skin wound therapeutic agent to reduce them. The purpose of this study was to evaluate the effects of the wound dressing with existing wound dressing Neo dermal activator compared to the patients receiving preoperative chemotherapy. Methods : A total of 54 breast cancer patients who recieved BCS & mastectomy devided two group(each 27 patients) through the random assignment between Jan, 2016 and June, 2016. Day one weeks after surgery to examine the wound infection rate (surgical site infection, SSI rate). After six months of outpatient surgery visits to check the wounds of patients, using the VAS records the scar of the wound satisfaction. For patients who underwent radiation therapy, check out the time it took to begin radiation therapy after surgery. All tests were twosided. All statistical analyses were performed using SPSS version 20.0 (SPSS Inc., Chicago, Illinois, USA). Eligbility criteria is : one side breast cancer not inflammatory breast cancer recieved BCS and mastectomy only (without immediate reconstruction surgery) stage IV breast cancer. EMTREE DRUG INDEX TERMS antibiotic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cancer surgery dermis female inflammatory breast cancer skin injury EMTREE MEDICAL INDEX TERMS ambulatory surgery cancer patient controlled study drug therapy human Illinois infection rate information processing major clinical study male mastectomy preoperative chemotherapy radiotherapy reconstructive surgery satisfaction scar statistical analysis surgery surgical infection wound dressing LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L616063581 DOI 10.1158/1538-7445.SABCS16-OT204-01 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS16-OT204-01 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 129 TITLE Radiologic-Pathologic Correlation: Acellular Dermal Matrix (Alloderm(®)) Used in Breast Reconstructive Surgery AUTHOR NAMES Lee C.U. Bobr A. Torres-Mora J. AUTHOR ADDRESSES (Lee C.U., lee.christine@mayo.edu) Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, United States. (Bobr A.; Torres-Mora J.) Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, United States. CORRESPONDENCE ADDRESS C.U. Lee, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, United States. Email: lee.christine@mayo.edu SOURCE Journal of Clinical Imaging Science (2017) 7:1 Article Number: 203164. Date of Publication: 1 Jan 2017 ISSN 2156-5597 (electronic) BOOK PUBLISHER Medknow Publications, B9, Kanara Business Centre, off Link Road, Ghatkopar (E), Mumbai, India. ABSTRACT Acellular dermal matrix (ADM) such as Alloderm(®) is sometimes used in tissue reconstruction in primary and reconstructive breast surgeries. As ADM is incorporated into the native tissues, the evolving imaging findings that would correlate with varying degrees of host migration and neoangiogenesis into the matrix can be challenging to recognize. In the setting of a palpable or clinical area of concern after breast reconstructive surgery following breast cancer, confident diagnosis of a mass representing ADM rather than recurring or developing disease can be challenging. Such diagnostic imaging uncertainties generally result in short-term imaging and clinical follow-up, but occasionally, biopsy is performed for histopathological confirmation of benignity. A case of biopsy-proven Alloderm(®) is described. To the best of our knowledge, this is the first radiologic-pathologic correlation of ADM in the literature. EMTREE DRUG INDEX TERMS collagen (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction echomammography surgical mesh EMTREE MEDICAL INDEX TERMS adult article breast augmentation breast biopsy breast cancer breast tissue cancer risk capillary case report cellular distribution collagen fiber connective tissue elective surgery female fibroblast follow up high risk patient human human tissue microscopy needle biopsy nipple palpation priority journal prophylactic mastectomy vascularization DEVICE TRADE NAMES Alloderm , United StatesLifecell DEVICE MANUFACTURERS (United States)Lifecell CAS REGISTRY NUMBERS collagen (9007-34-5) EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) General Pathology and Pathological Anatomy (5) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170400612 PUI L616545520 DOI 10.4103/jcis.JCIS_7_17 FULL TEXT LINK http://dx.doi.org/10.4103/jcis.JCIS_7_17 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 130 TITLE Staged Suprapectoral Expander/Implant Reconstruction without Acellular Dermal Matrix following Nipple-Sparing Mastectomy AUTHOR NAMES Salibian A.H. Harness J.K. Mowlds D.S. AUTHOR ADDRESSES (Salibian A.H.) Orange, Calif. From St. Joseph Hospital and the Departments of Plastic Surgery and Surgery, University of California Irvine Medical Center (Harness J.K.; Mowlds D.S.) SOURCE Plastic and reconstructive surgery (2017) 139:1 (30-39). Date of Publication: 1 Jan 2017 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Since the introduction of nipple-sparing mastectomy as an oncologically safe procedure for the treatment of breast cancer, reconstructive efforts for immediate staged expander/implant reconstruction have focused on submuscular implantation with or without acellular dermal matrix. Suprapectoral reconstruction without acellular dermal matrix has received little attention in the reconstructive literature of nipple-sparing mastectomy.METHODS: Between 2005 and 2015, 155 patients (250 breasts) underwent nipple-sparing mastectomy with prepectoral staged expander/implant reconstruction using thick mastectomy skin flaps without acellular dermal matrix. Patients with different breast sizes, including those patients with very large breasts who required a primary mastopexy, were considered candidates for the suprapectoral reconstruction. Tumor-related data, comorbidities, and preoperative or postoperative radiation therapy were evaluated for correlation with the final outcome.RESULTS: Patients were followed up for an average of 55.5 months (range, 138.1 to 23.6 months). The tumor recurrence rate was 2.6 percent. Adverse outcomes such as capsular contracture, implant dystopia, and rippling were studied. Aesthetic outcome, based on a three-point evaluation scale, showed 53.6 percent of patients as having a very good result, 31.6 percent showing a good result, 9 percent showing a fair result, and 5.8 percent showing a poor result.CONCLUSIONS: The suprapectoral two-stage expander/implant reconstruction without acellular dermal matrix in nipple-sparing mastectomy has certain advantages with respect to breast shape, less morbidity related to expansion, ease of reconstruction, and cost effectiveness. These advantages have to be weighed against those of subpectoral reconstruction with acellular dermal matrix to determine the method of choice.CLINCAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix procedures subcutaneous mastectomy EMTREE MEDICAL INDEX TERMS adult breast augmentation breast implant clinical trial comparative study devices female follow up human middle aged outcome assessment postoperative complication prospective study tissue expander tissue expansion LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 28027223 (http://www.ncbi.nlm.nih.gov/pubmed/28027223) PUI L617825203 DOI 10.1097/PRS.0000000000002845 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000002845 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 131 TITLE One-Stage Immediate Breast Reconstruction: A Concise Review AUTHOR NAMES Bertozzi N. Pesce M. Santi P. Raposio E. AUTHOR ADDRESSES (Bertozzi N., nicolo.bertozzi@yahoo.com; Raposio E., edoardo.raposio@unipr.it) Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma, Italy. (Bertozzi N., nicolo.bertozzi@yahoo.com; Raposio E., edoardo.raposio@unipr.it) Cutaneous Mini-Invasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy. (Pesce M., mariannap86@hotmail.com; Santi P., Plsanti@unige.it) Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy. (Pesce M., mariannap86@hotmail.com; Santi P., Plsanti@unige.it) Plastic Surgery Department, San Martino University Hospital, National Institute for Cancer Research Genoa, Genoa, Italy. CORRESPONDENCE ADDRESS N. Bertozzi, Department of Medicine and Surgery, Plastic Surgery Division, University of Parma, Parma, Italy. Email: nicolo.bertozzi@yahoo.com SOURCE BioMed Research International (2017) 2017 Article Number: 6486859. Date of Publication: 2017 ISSN 2314-6141 (electronic) 2314-6133 BOOK PUBLISHER Hindawi Limited, 410 Park Avenue, 15th Floor, 287 pmb, New York, United States. ABSTRACT Background. One-stage direct-to-implant immediate breast reconstruction (IBR) is performed simultaneously with breast cancer resection. We explored indications, techniques, and outcomes of IBR to determine its feasibility, safety, and effectiveness. Material and Methods. We reviewed the available literature on one-stage direct-to-implant IBR, with or without acellular dermal matrix (ADM), synthetic mesh, or autologous fat grafting. We analyzed the indications, preoperative work-up, surgical technique, postoperative care, outcomes, and complications. Results. IBR is indicated for small-to-medium nonptotic breasts and contraindicated in patients who require or have undergone radiotherapy, due to unacceptably high complications rates. Only patients with thick, well-vascularized mastectomy flaps are IBR candidates. Expandable implants should be used for ptotic breasts, while anatomical shaped implants should be used to reconstruct small-to-medium nonptotic breasts. ADMs can be used to cover the implant during IBR and avoid muscle elevation, thereby minimizing postoperative pain. Flap necrosis, reoperation, and implant loss are more common with IBR than conventional two-staged reconstruction, but IBR has advantages such as lack of secondary surgery, faster recovery, and better quality of life. Conclusions. IBR has good outcomes and patient-satisfaction rates. With ADM use, a shift from conventional reconstruction to IBR has occurred. Drawbacks of IBR can be overcome by careful patient selection. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction one stage direct to implant immediate breast reconstruction EMTREE MEDICAL INDEX TERMS acellular dermal matrix breast cancer (surgery) breast implant breast tissue expander cancer surgery graft necrosis human mastectomy patient care planning patient satisfaction patient selection postoperative complication postoperative pain preoperative evaluation quality of life reoperation review surgical mesh surgical technique EMBASE CLASSIFICATIONS Cancer (16) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170749032 PUI L618848432 DOI 10.1155/2017/6486859 FULL TEXT LINK http://dx.doi.org/10.1155/2017/6486859 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 132 TITLE Short-Term Complications Associated With Acellular Dermal Matrix-Assisted Direct-to-Implant Breast Reconstruction AUTHOR NAMES Hunsicker L.M. Ashikari A.Y. Berry C. Koch R.M. Salzberg C.A. AUTHOR ADDRESSES (Hunsicker L.M.) From the *Revalla Plastic Surgery, Littleton, CO; †Ashikari Breast Center; and ‡New York Group for Plastic Surgery, LLP, New York, NY (Ashikari A.Y.; Berry C.; Koch R.M.; Salzberg C.A.) SOURCE Annals of plastic surgery (2017) 78:1 (35-40). Date of Publication: 1 Jan 2017 ISSN 1536-3708 (electronic) ABSTRACT BACKGROUND: Although direct-to-implant breast reconstruction is a more concise procedure than 2-stage expander/implant reconstruction, it is less frequently performed. Skeptics of direct-to-implant reconstruction cite risk of postoperative complications as a reason for its rejection. To determine whether these perceptions are valid, we evaluated our 13-year experience of acellular dermal matrix (ADM)-assisted, direct-to-implant breast reconstruction. We report complication and reoperation rates associated with this technique as well as predictors for these outcomes.METHODS: This retrospective study included all patients who underwent immediate, ADM-assisted, direct-to-implant, breast reconstruction from December 2001 to May 2014 at 2 practices. Postoperative complications, defined as those occurring within the first 12 months after reconstructive surgery, were evaluated. Univariate/multivariate analyses were performed to determine the influence of patient-, breast-, and surgery-related characteristics on the development of complications.RESULTS: A total of 1584 breast reconstructions (721 bilateral, 142 unilateral) in 863 patients were performed; 35% were oncologic, and 65% were prophylactic reconstructions. Complication rate was 8.6% and included skin necrosis (5.9%), infection (3.0%), implant loss (2.9%), seroma (1.1%), and hematoma (0.9%). Reoperative rate in breasts with complications was 3.2%. Age 50 years or older, smoking, nonnipple-sparing mastectomy, and implant size of 600 mL or greater strongly predicted the development of complications (P < 0.001).CONCLUSIONS: Our cumulative 13-year experience demonstrates that immediate, ADM-assisted, direct-to-implant breast reconstruction is safe, effective, and reliable. Complication and reoperation rates are less than 10% and are comparable to those reported for 2-stage procedures in the published literature. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix mastectomy procedures EMTREE MEDICAL INDEX TERMS adult aged breast augmentation female follow up human middle aged outcome assessment postoperative complication (epidemiology, etiology) reoperation retrospective study risk factor statistics and numerical data LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26849284 (http://www.ncbi.nlm.nih.gov/pubmed/26849284) PUI L618700407 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 133 TITLE Patient-Reported Outcomes of Aesthetics and Satisfaction in Immediate Breast Reconstruction after Nipple-Sparing Mastectomy with Implants and Fat Grafting AUTHOR NAMES Qureshi A.A. Odom E.B. Parikh R.P. Myckatyn T.M. Tenenbaum M.M. AUTHOR ADDRESSES (Qureshi A.A.; Odom E.B.; Parikh R.P.; Myckatyn T.M.; Tenenbaum M.M., tenebaumm@wudosis.wustl.edu) Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, 1020 North Mason Road, Suite 110, Building 3, St. Louis, United States. CORRESPONDENCE ADDRESS M.M. Tenenbaum, Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, 1020 North Mason Road, Suite 110, Building 3, St. Louis, United States. Email: tenebaumm@wudosis.wustl.edu SOURCE Aesthetic Surgery Journal (2017) 37:9 (999-1008). Date of Publication: 2017 ISSN 1527-330X (electronic) 1090-820X BOOK PUBLISHER Oxford University Press, jnl.info@oup.co.uk ABSTRACT Background: Direct-to-implant (DTI) and tissue expander/implant (TE/I) reconstructions are the most common implant-based reconstructions after nipple-sparing mastectomy (NSM). However, there are little data beyond complication rates comparing these options. Fat grafting has emerged as an adjunct in NSM reconstructions to improve aesthetic results; however, its impact on patient perceptions of aesthetic outcomes remain unknown. To improve patient-centered care, aesthetic outcomes must be considered from the patients' perspective. Objectives: To evaluate patient-reported outcomes of aesthetic satisfaction and quality of life in patients undergoing immediate DTI vs TE/I reconstruction after NSM and to assess the role of fat grafting on these outcomes. Methods: This is a prospective cohort study comparing NSM patients undergoing DTI or TE/I reconstruction. Patient-reported outcomes were evaluated using the BREAST-Q. Continuous and categorical variables were analyzed using t test and Fisher's exact test, respectively. Results: Fifty-nine patients underwent 113 reconstructions with either DTI (n = 41) or TE/I (n = 18). Mean follow up was 12.1 months. DTI and TE/I patients had comparable satisfaction with outcome, though TE/I patients had significantly larger final implant sizes. TE/I who underwent fat grafting also had significantly higher satisfaction with outcome and psychosocial wellbeing. Conclusions: Patient-reported outcomes are comparable between DTI and TE/I reconstructions after NSM. In order for TE/I patients to achieve a similar level of satisfaction, they may require a larger final implant and additional operations compared to DTI patients. Additionally, fat grafting improves overall satisfaction. TE/I patients may have different aesthetic expectations than DTI patients, emphasizing patient-centered discussions are essential to optimizing outcomes after NSM. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction direct to implant breast reconstruction esthetics fat grafting mastectomy nipple sparing mastectomy patient satisfaction patient-reported outcome skin graft tissue expander implant breast reconstruction EMTREE MEDICAL INDEX TERMS 133MV device acellular dermal matrix adult Allergan Style 375 FF implant Alloderm RTU article breast areola breast cancer (disease management, prevention, surgery) breast implant (adverse device effect, device comparison) BREAST Q score breast tissue expander (device comparison) cancer surgery clinical article cohort analysis controlled study device infection (complication) female follow up hematoma (complication) human intermethod comparison Karnofsky Performance Status middle aged patient care patient preference physical well-being postoperative complication (complication) priority journal prophylactic mastectomy psychological well-being quality of life quality of life assessment retrospective study sexual behavior Sientra RB 370 cc implant skin flap surgical patient DEVICE TRADE NAMES 133MV device , IrelandAllergan Allergan Style 375 FF implant Allergan Alloderm RTU , United StatesLifecell Sientra RB 370 cc implant DEVICE MANUFACTURERS (United States)Allergan Allergan (Ireland)Allergan (United States)Lifecell EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Surgery (9) CLINICAL TRIAL NUMBERS ClinicalTrials.gov (NCT01969448) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170701775 PUI L618636667 DOI 10.1093/asj/sjx048 FULL TEXT LINK http://dx.doi.org/10.1093/asj/sjx048 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 134 TITLE One-Step Prepectoral Breast Reconstruction With Dermal Matrix-Covered Implant Compared to Submuscular Implantation: Functional and Cost Evaluation AUTHOR NAMES Cattelani L. Polotto S. Arcuri M.F. Pedrazzi G. Linguadoca C. Bonati E. AUTHOR ADDRESSES (Cattelani L., cattelanil@hotmail.com; Arcuri M.F.; Bonati E.) Breast Surgical Unit, University Hospital of Parma, Parma, Italy (Polotto S.) University Plastic and Reconstructive Unit, University Hospital of Parma, Parma, Italy (Pedrazzi G.) Neuroscience Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy (Linguadoca C.) Pharmacological and Drug Clinical Governance Service, University Hospital of Parma, Parma, Italy CORRESPONDENCE ADDRESS L. Cattelani, Breast Surgical Unit, University Hospital of Parma, Via Gramsci 14, 43125 Parma (PR), Italy Email: cattelanil@hotmail.com SOURCE Clinical Breast Cancer (2017). Date of Publication: 2017 ISSN 1938-0666 (electronic) 1526-8209 BOOK PUBLISHER Elsevier Inc., usjcs@elsevier.com ABSTRACT Background: The breast reconstructive subpectoral technique commonly leads to functional consequences. Recently, a new conservative prepectoral breast reconstruction (PPBR) technique was proposed and its surgical safety and aesthetic effectiveness proved. The aim of this prospective nonrandomized study was to compare the functional and economical outcomes of the PPBR procedure versus the subpectoral one. Patients and Methods: From February 2015 to September 2016, 86 patients underwent mastectomy with immediate implant-based reconstruction. Thirty-nine patients were assigned to group 1 and received prepectoral acellular dermal matrix-wrapped implant reconstruction. The remaining 45 patients were assigned to group 2 and received a subpectoral implant or tissue expander. We recorded the operating time, length of hospital stay, analgesic consumption, postoperative pain, upper limb function, esthetic satisfaction, and quality of life. Additional surgical procedures for reconstruction completion or contralateral operation for symmetrization were also recorded. Results: Compared to group 2 patients, group 1 patients showed less postoperative pain and faster upper limb functional recovery. Patients in group 1 also recorded a lower analgesic consumption and an earlier return to usual work. Moreover, the muscle-sparing technique improved aesthetic outcomes and largely reduced the need for symmetrization. Conclusion: Immediate breast reconstruction by using prepectoral muscle-sparing acellular dermal matrix-wrapped implant resulted in lower pain intensity and significant upper limb functional advantages compared to submuscular implant placement. Furthermore, when considering a series of ascertained benefits, PPBR is also economically advantageous, although future studies should better define its cost-effectiveness. EMTREE DRUG INDEX TERMS analgesic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction implant mastectomy muscle neoplasm postoperative pain tissue expander upper limb EMTREE MEDICAL INDEX TERMS adult controlled study cost effectiveness analysis female hospitalization human major clinical study male operation duration pain intensity prospective study quality of life remission satisfaction LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170901063 PUI L619940513 DOI 10.1016/j.clbc.2017.11.015 FULL TEXT LINK http://dx.doi.org/10.1016/j.clbc.2017.11.015 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 135 TITLE Rare case of laryngeal edema and anaphylaxis to Ofirmev (IV Acetaminophen): Case Report AUTHOR NAMES Delva G. Muse I. AUTHOR ADDRESSES (Delva G.; Muse I.) Albert Einstein College of Medicine, United States. CORRESPONDENCE ADDRESS G. Delva, Albert Einstein College of Medicine, United States. SOURCE Regional Anesthesia and Pain Medicine (2017) 42:6. Date of Publication: 2017 CONFERENCE NAME 42nd Annual Regional Anesthesiology and Acute Pain Medicine Meeting, ASRA 2017 CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2017-04-06 to 2017-04-08 ISSN 1532-8651 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Introduction In the acute pain setting, Ofirmev (IV Acetaminophen) has grown to be a popular adjunct in the administration of balanced analgesia leading to decreases in opioid consumption and reduction in fever. However, like any other medication there are side effects. This is the case of a patient presenting with the presumption of anaphylaxis after administration of Ofirmev. Her symptoms were detected shortly after administration with confirmatory elevation of tryptase levels during follow up. Results/Case report The patient is a 64-year old female who presented to the operating room for I&D of left breast cellulitis and removal of left breast tissue expander. At the end of the procedure, patient developed wheezing, stridor, airway edema and hypotension ten minutes into Ofirmev administration. Patient's medical history includes breast cancer s/p chemotherapy and radiation, severe depression, bipolar disorder, hypothyroidism, hypertension, and morbid obesity. She also had an allergy history to penicillin (anaphylaxis), aspirin (GI bleeding), and pollen allergy. The patient's medication list prior to surgery included vancomycin (first dose a day prior with no complications), SQ Heparin, amitriptyline, abilify, clonazepam, flexeral, duloxetine, lamictal, losartan, levothyroxine, and hydromorphone. One month prior, the patient had bilateral mastectomy and alloderm tissue expander placement under general anesthesia with endotracheal intubation and with no intraoperative complications. In our case, the medications received in the perioperative period were as follows: Midazolam, propofol, fentanyl, vancomycin, zofran, bupivacaine, Ofirmev, ephedrine, and phenylephrine. The only medications the patient has no record of previously receiving was Ofirmev, Bupivacaine, and Vancomycin (tolerated 1 dose the night prior), which may have sensitized her. Of note, Vancomycin was started within 5 minutes of LMA placement and was still infusing 50 minutes into the case. Ofirmev was started 10mins prior to end of procedure. Patient was immediately noted to be stridorous with increased pressor requirement. Patient was immediately intubated and eventually extubated in the ICU the next day. The presumptive cause of this patient's anaphylaxis reaction was Ofirmev. The patient was skin tested for opiates, local anesthetics, Penicillin, vancomycin, and ondansetron. Patient was shown to have a rash with PCN but no reaction to the other medications and an elevation of tryptase levels. Unfortunately, there is no validated skin testing methods for evaluating acetaminophen allergy thus the patient was advised to strictly avoid IV acetaminophen. Discussion Perioperative anaphylaxis during surgery is not so uncommon. Data has shown an incidence rate ranging from 1:3500 to 1:20000. The three most common causes of intraoperative anaphylaxis are muscle relaxants, antibiotics, and latex. According to FDA reports, there were 266 people reported to have side effects to Ofirmev as of November 2016. Among them 6 patients (2.26%) had anaphylaxis. Our patient would make 7 patients thus making it (2.63%). Angioedema was noted in 8 out of 266 patients (3.01%). Despite IV Acetaminophen's growth as a popular adjunct in the administration of balanced analgesia, this patient's unfortunate case demonstrates the importance of vigilant monitoring in the acute pain setting. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) paracetamol EMTREE DRUG INDEX TERMS acetylsalicylic acid amitriptyline aripiprazole bupivacaine clonazepam duloxetine endogenous compound ephedrine fentanyl heparin hydromorphone hypertensive factor lamotrigine latex levothyroxine losartan midazolam ondansetron penicillin derivative phenylephrine propofol tryptase vancomycin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anaphylaxis larynx edema EMTREE MEDICAL INDEX TERMS adult adverse drug reaction analgesia angioneurotic edema bipolar depression breast cancer breast tissue expander cancer surgery cellulitis chemotherapy clinical trial complication drug therapy endotracheal intubation female follow up gastrointestinal hemorrhage gene expression general anesthesia human hypertension hypotension hypothyroidism major clinical study mastectomy medical history middle aged monitoring morbid obesity muscle night operating room perioperative period peroperative complication pollen allergy radiation rash side effect stridor surgery surgical mesh wheezing CAS REGISTRY NUMBERS acetylsalicylic acid (493-53-8, 50-78-2, 53663-74-4, 53664-49-6, 63781-77-1) amitriptyline (50-48-6, 549-18-8) aripiprazole (129722-12-9) bupivacaine (18010-40-7, 2180-92-9, 55750-21-5, 38396-39-3) clonazepam (1622-61-3) duloxetine (116539-59-4, 136434-34-9) ephedrine (299-42-3, 50-98-6) fentanyl (437-38-7) heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5) hydromorphone (466-99-9, 71-68-1) lamotrigine (84057-84-1) levothyroxine (51-48-9) losartan (114798-26-4) midazolam (59467-70-8) ondansetron (103639-04-9, 116002-70-1, 99614-01-4) paracetamol (103-90-2) phenylephrine (532-38-7, 59-42-7, 61-76-7) propofol (2078-54-8) tryptase (97501-93-4) vancomycin (1404-90-6, 1404-93-9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L619777519 DOI 10.1097/AAP.0000000000000680 FULL TEXT LINK http://dx.doi.org/10.1097/AAP.0000000000000680 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 136 TITLE Nipple-sparing mastectomy using a hemi-periareolar incision - Comment on the BREAST-Q analysis AUTHOR NAMES Negenborn V.L. Young-Afat D.A. AUTHOR ADDRESSES (Negenborn V.L., v.negenborn@vumc.nl) Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands (Negenborn V.L., v.negenborn@vumc.nl; Young-Afat D.A.) EMGO Institute for Health and Care Research Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands CORRESPONDENCE ADDRESS V.L. Negenborn, Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands Email: v.negenborn@vumc.nl SOURCE American Journal of Surgery (2017). Date of Publication: 2017 ISSN 1879-1883 (electronic) 0002-9610 BOOK PUBLISHER Elsevier Inc., usjcs@elsevier.com EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant incision mastectomy nipple patient-reported outcome reconstructive surgery LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20170530593 PUI L617476834 DOI 10.1016/j.amjsurg.2017.07.013 FULL TEXT LINK http://dx.doi.org/10.1016/j.amjsurg.2017.07.013 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 137 TITLE Acellular dermal matrices and paraffinoma: A modern tool for a nearly obsolete disease AUTHOR NAMES Grassetti L. Torresetti M. Scalise A. Lazzeri D. Di Benedetto G. AUTHOR ADDRESSES (Grassetti L.; Torresetti M., torresetti.matteo@gmail.com; Scalise A.; Di Benedetto G.) Department of Plastic and Reconstructive Surgery, Marche Polytechnic Medical School, Ancona, Italy. (Lazzeri D.) Plastic and Reconstructive Surgery Unit, Villa Salaria Clinic, Rome, Italy. CORRESPONDENCE ADDRESS M. Torresetti, Department of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, Regional Hospital, Via Conca 1, Ancona, Italy. Email: torresetti.matteo@gmail.com SOURCE Archives of Plastic Surgery (2017) 44:3 (234-237). Date of Publication: 2017 ISSN 2234-6171 (electronic) 2234-6163 BOOK PUBLISHER Korean Society of Plastic and Reconstructive Surgeons, 1355-3 Seocho-Dong, Seocho-Gu, Seoul, South Korea. ABSTRACT Paraffinoma is a destructive complication of paraffin oil injection, usually associated with massive tissue destruction, thus requiring radical surgery and subsequent complex reconstruction. Although breast and penile paraffinomas have been widely described and their management is quite standardized, paraffinomas of the knee are still rare and only few case reports or small case series are available in the current literature. We describe the case of a 77-year-old man with a large paraffinoma of the right knee that occurred after self-injection of paraffin oil, 58 years before. He underwent wide surgical resection of the soft tissues overlying the knee and subsequent two-stage reconstruction by using acellular dermal matrix and, after 20 days, split-thickness skin grafts. Follow-up after 16 months showed no signs of skin ulcerations or inflammation, with an overall improvement in function. Even though conventional flap reconstructions may be still useful, the authors believe that acellular dermal matrices represent a safe, reliable, and less invasive alternative for challenging soft tissue reconstructions even in elderly patients with multiple medical problems. EMTREE DRUG INDEX TERMS liquid paraffin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix granuloma (diagnosis, surgery) knee disease (diagnosis, surgery) knee paraffinoma (diagnosis, surgery) EMTREE MEDICAL INDEX TERMS aged article case report Caucasian debridement follow up giant cell human insulin dependent diabetes mellitus knee pain knee swelling male preoperative evaluation radiography range of motion self injection skin fistula skin graft skin ulcer smoking soft tissue DEVICE MANUFACTURERS (United States)Integra CAS REGISTRY NUMBERS liquid paraffin (8012-95-1) EMBASE CLASSIFICATIONS Dermatology and Venereology (13) Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170423601 PUI L616774361 DOI 10.5999/aps.2017.44.3.234 FULL TEXT LINK http://dx.doi.org/10.5999/aps.2017.44.3.234 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 138 TITLE Breast surgery: Management of complications and how to avoid them ORIGINAL (NON-ENGLISH) TITLE Brustchirurgie: Fehlervermeidung und Management bei Komplikationen AUTHOR NAMES Brunnert K. AUTHOR ADDRESSES (Brunnert K., drbrunnert.senologie@t-online.de) Klinik für Senologie, Lürmannstraße 28, Osnabrück, Austria. CORRESPONDENCE ADDRESS K. Brunnert, Klinik für Senologie, Lürmannstraße 28, Osnabrück, Austria. Email: drbrunnert.senologie@t-online.de SOURCE Gynakologische Praxis (2017) 42:4 (649-659). Date of Publication: 2017 ISSN 0341-8677 BOOK PUBLISHER Hans Marseille Verlag GmbH, Buenkleinstrabe 12, Munchen, Germany. ABSTRACT The best management of complications is to avoid them. Skin sparing mastectomy (SSM/NSM), with or without sparing the nipple-areolacomplex (NAC), enables us to preserve a more natural breast with more sensitivity, avoiding the traumatic loss of the organ. But the standard procedure of SSM/NSM with partially placing the implant under the pectoralis major muscle, with or without the use of ADM or mesh, may cause an irritating breast animation deformity in conjunction with more pain postoperatively. On the other hand in thin patients the alternate prepectoral placement of the implant may lead to more visibility of the implant with palpable folds or rippling. Therefore the prepectoral implantation seems to be restricted to patients with a more ample subcutaneous fat pad. The additional use of ADM/mesh plus autologous transplantation of fat as a sufficient cover needs to be investigated in carefully planned future studies. But «the bioengineered breast» is no method for all seasons; autologous flap surgery, pedicled TRAM flap, muscle sparing or with the help of a microsurgical anastomosis, is still the method of choice in certain situations. The individual method of harvesting and transplantation of the flap depends on the experience, preference and skill of the performing surgeon. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction postoperative complication (complication) EMTREE MEDICAL INDEX TERMS anastomosis article autotransplantation breast malformation human pectoralis major muscle postoperative pain silicone breast implant subcutaneous fat surgical mesh transverse rectus abdominis musculocutaneous flap EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE German LANGUAGE OF SUMMARY English, German EMBASE ACCESSION NUMBER 20170878470 PUI L619737638 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 139 TITLE One-stage breast reconstruction techniques in elderly patients to preserve quality of life AUTHOR NAMES Maruccia M. Mazzocchi M. Dessy L.A. Onesti M.G. AUTHOR ADDRESSES (Maruccia M., marucciam@gmail.com; Dessy L.A.; Onesti M.G.) Department of Surgery P. Valdoni, Unit of Plastic and Reconstructive Surgery Sapienza University, Rome, Italy. (Mazzocchi M.) Department of Plastic and Reconstructive Surgery, University of Perugia, Perugia, Italy. CORRESPONDENCE ADDRESS M. Maruccia, Department of Surgery P. Valdoni, Unit of Plastic and Reconstructive Surgery Sapienza University, Rome, Italy. Email: marucciam@gmail.com SOURCE European Review for Medical and Pharmacological Sciences (2016) 20:24 (5058-5066). Date of Publication: 1 Dec 2016 ISSN 1128-3602 BOOK PUBLISHER Verduci Editore, g.lombardi@verduci.it ABSTRACT OBJECTIVE: The aim of this study was to review one-stage breast reconstruction techniques performed in elderly patients at our institution to identify the criteria of selection of each in terms of outcomes and quality of life. PATIENTS AND METHODS: Patients older than 65 years who underwent one-stage breast reconstruction between January 2004 and July 2014 at our hospital were included. Patients and procedure-related data were collected from the medical records. In particular, patient's age, comorbidities and related ASA physical status, type of one-stage breast reconstruction technique, and criteria of selection were analyzed. Outcomes and results were also evaluated in terms of quality of life using the EORTC QLQ-C30 and -BR23 questionnaires 1 year after surgery. RESULTS: A total of 840 women underwent breast reconstruction, of whom 138 elderly women received one-stage breast reconstruction. There were 118 cases (85.5%) of monolateral reconstructions and 20 cases (14.5%) of bilateral reconstructions, resulting in 138 breast reconstructions. These were performed with permanent inflatable expanders in the sub-muscular position (Group A, n= 50), with acellular dermal matrix and partial sub-muscular anatomic implant (Group B, n= 50), and with Braxon® acellular dermal matrix and anatomic implant with muscle-sparing technique (Group C, n= 38). The EORTC questionnaires showed the best results in Group C regarding the quality of life. CONCLUSIONS: The elderly population is rapidly increasing, and 50% of all breast cancers occur in women older than 65 years; among them, only 2% undergo breast reconstruction. A major aspect of breast cancer treatment and subsequent quality of life is the opportunity for a post-mastectomy reconstructive surgery. As survival rates are improving, a larger proportion of patients live with the long-term consequences of their treatment, and breast reconstruction ensures a better quality of life. To increase the reconstruction rates, surgery should be onestage, less invasive as possible, allowing rapid recovery, especially in elderly women, in whom comorbidities are often present with a higher anaesthetic risk. Our study highlighted that nonskin sparing mastectomy (SSM) and delayed reconstructions should be addressed with Becker implants; immediate reconstructions after SSM should be followed by acellular dermal matrix (ADM)-assisted implant reconstruction, preferring the wrap technique offers a better quality of life in elderly patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) breast reconstruction quality of life EMTREE MEDICAL INDEX TERMS acellular dermal matrix aged article breast tissue expander comorbidity controlled study electronic medical record female human major clinical study mastectomy population research questionnaire risk factor skin sparing mastectomy DEVICE TRADE NAMES Becker , United StatesMentor DEVICE MANUFACTURERS (United States)Mentor EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170234552 MEDLINE PMID 28051266 (http://www.ncbi.nlm.nih.gov/pubmed/28051266) PUI L615009419 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 140 TITLE Host Integration of an Acellular Dermal Matrix: Braxon Mesh in Breast Reconstruction AUTHOR NAMES Iqbal F.M. Bhatnagar A. Vidya R. AUTHOR ADDRESSES (Iqbal F.M.) Keele University, Stoke-on-Trent, United Kingdom. (Bhatnagar A.) Department of Pathology, New Cross Hospital, United Kingdom. (Vidya R., raghavan.vidya@nhs.net) Breast Unit, New Cross Hospital, Wolverhampton, United Kingdom. CORRESPONDENCE ADDRESS R. Vidya, New Cross Hospital, Wolverhampton Road, Wolverhampton, United Kingdom. Email: raghavan.vidya@nhs.net SOURCE Clinical Breast Cancer (2016) 16:6 (e209-e211). Date of Publication: 1 Dec 2016 ISSN 1938-0666 (electronic) 1526-8209 BOOK PUBLISHER Elsevier Inc., usjcs@elsevier.com EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction surgical mesh EMTREE MEDICAL INDEX TERMS breast augmentation breast cancer breast implant case report donor site esthetics female fibroblast high risk patient histology human human tissue infection rate letter mastectomy muscle sparing breast reconstruction pectoralis major muscle postoperative pain seroma (complication) skin sparing mastectomy surgical technique tissue reaction treatment outcome vascularization DEVICE TRADE NAMES BRAXON mesh Strattice mesh EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Clinical and Experimental Biochemistry (29) Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20160844005 MEDLINE PMID 27471076 (http://www.ncbi.nlm.nih.gov/pubmed/27471076) PUI L613294040 DOI 10.1016/j.clbc.2016.06.009 FULL TEXT LINK http://dx.doi.org/10.1016/j.clbc.2016.06.009 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 141 TITLE Surgeon-Controlled Study and Meta-Analysis Comparing FlexHD and AlloDerm in Immediate Breast Reconstruction Outcomes AUTHOR NAMES Sobti N. Liao E.C. AUTHOR ADDRESSES (Sobti N.) Boston, Mass. From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital (Liao E.C.) SOURCE Plastic and reconstructive surgery (2016) 138:5 (959-967). Date of Publication: 1 Nov 2016 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: The use of acellular dermal matrix has facilitated immediate prosthesis-based breast reconstruction. However, few studies directly compare surgical outcomes following acellular dermal matrix-based reconstruction with two of the most commonly available materials, AlloDerm and FlexHD. Those studies that are available often do not adequately control for the surgeon as a variable. The authors hypothesize that complication rates will not differ significantly between AlloDerm and FlexHD when practice and surgeon variables are properly controlled.METHODS: Retrospective review was conducted to identify consecutive implant-based reconstruction procedures performed at a tertiary academic medical institution by a single plastic surgeon over 6 years. Univariate and binomial regression analyses were conducted to compare patient characteristics and clinical endpoints across acellular dermal matrix groups (AlloDerm/AlloDerm ready-to-use versus FlexHD Pliable/Perforated).RESULTS: Of the 233 patients that underwent matrix-based breast reconstruction, 11 (4.7 percent) developed surgical-site infection. The infection rate was not statistically different between patients who received FlexHD [n = 5 (5.0 percent)] versus AlloDerm [n = 6 (4.6 percent)] on either univariate (p = 0.89) or binomial regression analysis (p = 0.56). Likewise, there were no statistical differences in rates of seroma, hematoma, explantation, or delayed wound healing.CONCLUSIONS: Clinical endpoints of interest were all equivalent between acellular dermal matrix types. This study uniquely reports a single-surgeon case series comparing outcomes between different acellular dermal matrix types. Instead of focusing on acellular dermal matrix as a predictor of outcome, other patient and surgeon factors should be addressed to improve results and innovate better alternatives.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III. EMTREE DRUG INDEX TERMS collagen (drug therapy) surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix procedures EMTREE MEDICAL INDEX TERMS adult breast reconstruction breast tumor (drug therapy, radiotherapy, surgery) comparative study female hematoma (epidemiology, etiology) human mastectomy meta analysis middle aged multimodality cancer therapy postoperative complication (epidemiology, etiology) prophylactic mastectomy retrospective study seroma (epidemiology, etiology) surgical infection (epidemiology, etiology) treatment outcome wound healing CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 27782982 (http://www.ncbi.nlm.nih.gov/pubmed/27782982) PUI L616299689 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 142 TITLE Do Processing Methods Make a Difference in Acellular Dermal Matrix Properties? AUTHOR NAMES Nilsen T.J. Dasgupta A. Huang Y.-C. Wilson H. Chnari E. AUTHOR ADDRESSES (Nilsen T.J.) Mr Nilsen is a Senior Engineer, Dr Dasgupta is a Senior Scientist, and Dr Chnari is an Associate Director, Research and Development, Wound Care, and General and Plastic Surgery; and Dr Huang is a Staff Scientist, Research and Development and Allograft Materials Research, Musculoskeletal Transplant Foundation, Edison, NJ. Dr Wilson is a Clinical Assistant Professor of Plastic Surgery, Liberty University College of Osteopathic Medicine, Lynchburg, VA (Dasgupta A.) Mr Nilsen is a Senior Engineer, Dr Dasgupta is a Senior Scientist, and Dr Chnari is an Associate Director, Research and Development, Wound Care, and General and Plastic Surgery; and Dr Huang is a Staff Scientist, Research and Development and Allograft Materials Research, Musculoskeletal Transplant Foundation, Edison, NJ. Dr Wilson is a Clinical Assistant Professor of Plastic Surgery, Liberty University College of Osteopathic Medicine, Lynchburg, VA (Huang Y.-C.) Mr Nilsen is a Senior Engineer, Dr Dasgupta is a Senior Scientist, and Dr Chnari is an Associate Director, Research and Development, Wound Care, and General and Plastic Surgery; and Dr Huang is a Staff Scientist, Research and Development and Allograft Materials Research, Musculoskeletal Transplant Foundation, Edison, NJ. Dr Wilson is a Clinical Assistant Professor of Plastic Surgery, Liberty University College of Osteopathic Medicine, Lynchburg, VA (Wilson H.) Mr Nilsen is a Senior Engineer, Dr Dasgupta is a Senior Scientist, and Dr Chnari is an Associate Director, Research and Development, Wound Care, and General and Plastic Surgery; and Dr Huang is a Staff Scientist, Research and Development and Allograft Materials Research, Musculoskeletal Transplant Foundation, Edison, NJ. Dr Wilson is a Clinical Assistant Professor of Plastic Surgery, Liberty University College of Osteopathic Medicine, Lynchburg, VA (Chnari E.) Mr Nilsen is a Senior Engineer, Dr Dasgupta is a Senior Scientist, and Dr Chnari is an Associate Director, Research and Development, Wound Care, and General and Plastic Surgery; and Dr Huang is a Staff Scientist, Research and Development and Allograft Materials Research, Musculoskeletal Transplant Foundation, Edison, NJ. Dr Wilson is a Clinical Assistant Professor of Plastic Surgery, Liberty University College of Osteopathic Medicine, Lynchburg, VA SOURCE Aesthetic surgery journal (2016) 36 Supplement 2 (S7-S22). Date of Publication: 1 Nov 2016 ISSN 1527-330X (electronic) ABSTRACT CONCLUSIONS: Aseptically processed FlexHD Pliable and BellaDerm provide a suitable, biocompatible option for tissue repair and regeneration in aesthetic and reconstructive surgical applications.BACKGROUND: The use of acellular dermal matrices (ADMs) has become the standard of practice in many reconstructive and aesthetic surgical applications. Different methods used to prepare the allograft tissue for surgical use can alter the ADMs natural properties. Aseptic processing has been shown to retain the natural properties of ADMs more favorably than terminally sterilized ADMs. Terminal sterilization has been historically linked to alteration of biological materials. In vitro work was conducted to compare ADM processing methods.OBJECTIVES: Characterize aseptically processed ADMs and compare cell-matrix interaction characteristics to terminally sterilized ADMs.METHODS: Two aseptically processed ADMs, FlexHD Pliable and BellaDerm, were characterized via histological evaluation, biomechanical integrity, enzymatic degradation, and in vitro cell studies. FlexHD Pliable was compared to Alloderm Ready-to-Use (RTU).RESULTS: Histological evaluation revealed that FlexHD Pliable had a uniform, open structure compared to BellaDerm. Mechanical characterization demonstrated that BellaDerm had higher strength and stiffness compared to FlexHD Pliable, which maintained higher elasticity. Immunohistochemical analysis verified that key matrix proteins remained intact after aseptic processing. Cell studies found that fibroblasts attached more readily, and proliferated faster on FlexHD Pliable compared to BellaDerm. Additionally, fibroblasts infiltrated into FlexHD Pliable from both sides and on the dermal side in BellaDerm and produced an abundance of multi-layered matrix proteins (collagen, fibronectin) when compared to AlloDerm RTU which was sparse. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix EMTREE MEDICAL INDEX TERMS biomechanics breast reconstruction cell culture cell proliferation fibroblast human instrument sterilization physiology procedures reconstructive surgery waste management CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 27697888 (http://www.ncbi.nlm.nih.gov/pubmed/27697888) PUI L614500688 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 143 TITLE The effect of sterile acellular dermal matrix use on complication rates in implant-based immediate breast reconstructions AUTHOR NAMES Lee J.H. Park Y. Choi K.W. Chung K.-J. Kim T.G. Kim Y.-H. AUTHOR ADDRESSES (Lee J.H., junojunho@gmail.com; Park Y.; Choi K.W.; Chung K.-J.; Kim T.G.; Kim Y.-H.) Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu, South Korea. CORRESPONDENCE ADDRESS J.H. Lee, Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu, South Korea. Email: junojunho@gmail.com SOURCE Archives of Plastic Surgery (2016) 43:6 (523-528). Date of Publication: 1 Nov 2016 ISSN 2234-6171 (electronic) 2234-6163 BOOK PUBLISHER Korean Society of Plastic and Reconstructive Surgeons, 1355-3 Seocho-Dong, Seocho-Gu, Seoul, South Korea. ABSTRACT Background The use of acellular dermal matrix (ADM) in implant-based immediate breast reconstruction has been increasing. The current ADMs available for breast reconstruction are offered as aseptic or sterile. No published studies have compared aseptic and sterile ADM in implant-based immediate breast reconstruction. The authors performed a retrospective study to evaluate the outcomes of aseptic versus sterile ADM in implant-based immediate breast reconstruction. Methods Implant-based immediate breast reconstructions with ADM conducted between April 2013 and January 2016 were included. The patients were divided into 2 groups: the aseptic ADM (AlloDerm) group and the sterile ADM (MegaDerm) group. Archived records were reviewed for demographic data and postoperative complication types and frequencies. The complications included were infection, flap necrosis, capsular contracture, seroma, hematoma, and explantation for any cause. Results Twenty patients were reconstructed with aseptic ADM, and 68 patients with sterile ADM. Rates of infection (15.0% vs. 10.3%), flap necrosis (5.0% vs. 7.4%), capsular contracture (20.0% vs. 14.7%), seroma (10.0% vs. 14.7%), hematoma (0% vs. 1.5%), and explantation (10.0% vs. 8.8%) were not significantly different in the 2 groups. Conclusions Sterile ADM did not provide better results regarding infectious complications than aseptic ADM in implant-based immediate breast reconstruction. EMTREE DRUG INDEX TERMS antibiotic agent (intravenous drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant (adverse device effect) breast reconstruction EMTREE MEDICAL INDEX TERMS adult article controlled study female graft infection (complication) graft necrosis (complication) hematoma (complication) human implant capsular contracture (complication) incidence major clinical study postoperative complication (complication) retrospective study seroma (complication) treatment outcome DEVICE MANUFACTURERS (United States)Allergan EMBASE CLASSIFICATIONS Drug Literature Index (37) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160864763 PUI L613417642 DOI 10.5999/aps.2016.43.6.523 FULL TEXT LINK http://dx.doi.org/10.5999/aps.2016.43.6.523 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 144 TITLE Use of Acellular Dermal Matrix versus Latissimus Dorsi Flap for Breast Reconstruction: Clinical and Patient-Reported Outcomes AUTHOR NAMES Youssef M.M.G. Pucher P.H. Kennedy K. Osborne C. Graja T. AUTHOR ADDRESSES (Youssef M.M.G., mina.youssef@nhs.net; Pucher P.H.; Kennedy K.; Osborne C.; Graja T.) Department of Surgery, Dorset County Hospital, Dorset, United Kingdom. (Youssef M.M.G., mina.youssef@nhs.net) National Cancer Institute, Cairo University, Cairo, Egypt. (Osborne C.) Department of Surgery, Yeovil District Hospital, Somerset, United Kingdom. CORRESPONDENCE ADDRESS M.M.G. Youssef, Department of Surgery, Dorset County Hospital, Dorset, United Kingdom. Email: mina.youssef@nhs.net SOURCE Breast Journal (2016) 22:6 (702-704). Date of Publication: 1 Nov 2016 ISSN 1524-4741 (electronic) 1075-122X BOOK PUBLISHER Blackwell Publishing Inc., subscrip@blackwellpub.com EMTREE DRUG INDEX TERMS antibiotic agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction clinical outcome latissimus dorsi flap patient-reported outcome surgical mesh (adverse device effect) EMTREE MEDICAL INDEX TERMS adult age aged antibiotic therapy assessment of humans body mass breast clinical article comparative effectiveness controlled study human implant loss (complication) length of stay letter medical device complication (complication) Modified EORTC 10801 Patient Satisfaction Questionnaire operation duration patient satisfaction postoperative infection (complication) seroma (complication, therapy) surgical infection (complication, drug therapy) surgical patient DEVICE TRADE NAMES Strattice , United StatesLifecell DEVICE MANUFACTURERS (United States)Lifecell EMBASE CLASSIFICATIONS Drug Literature Index (37) Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20160813195 MEDLINE PMID 27508508 (http://www.ncbi.nlm.nih.gov/pubmed/27508508) PUI L613161239 DOI 10.1111/tbj.12664 FULL TEXT LINK http://dx.doi.org/10.1111/tbj.12664 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 145 TITLE Response to: Gschwantler-Kaulich et al (2016) Mesh versus acellular dermal matrix in immediate implant-based breast reconstruction – A prospective randomized trial doi:10.1016/j.ejso.2016.02.007 AUTHOR NAMES Potter S. Holcombe C. Blazeby J. AUTHOR ADDRESSES (Potter S., shelley.potter@bristol.ac.uk; Blazeby J.) Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Canynge Hall, United Kingdom. (Holcombe C.) Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Prescot Street, Liverpool, United Kingdom. CORRESPONDENCE ADDRESS S. Potter, Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Canynge Hall, United Kingdom. Email: shelley.potter@bristol.ac.uk SOURCE European Journal of Surgical Oncology (2016) 42:11 (1767-1768). Date of Publication: 1 Nov 2016 ISSN 1532-2157 (electronic) 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction implant based breast reconstruction surgical mesh EMTREE MEDICAL INDEX TERMS comparative study human letter multicenter study (topic) patient satisfaction patient-reported outcome postoperative complication priority journal quality of life randomized controlled trial (topic) United Kingdom EMBASE CLASSIFICATIONS Surgery (9) CLINICAL TRIAL NUMBERS ISRCTN (ISRCTN37664281) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20160781610 MEDLINE PMID 27424788 (http://www.ncbi.nlm.nih.gov/pubmed/27424788) PUI L612960293 DOI 10.1016/j.ejso.2016.05.041 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2016.05.041 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 146 TITLE Impact of surgical technique on length of stay and early outcomes in breast reconstruction: A preliminary analysis AUTHOR NAMES Gabriel A. Sigalove S.R. Griffin L. Parekh M.H. Macarios D. Maxwell G.P. AUTHOR ADDRESSES (Gabriel A.) PeaceHealth Medical Group, Vancouver, United States. (Sigalove S.R.) DuPage Medical Group/ DMG Aesthetics, Glen Ellyn, United States. (Griffin L.) Acelity, San Antonio, United States. (Parekh M.H.; Macarios D.) LifeCell, An Acelity company, Bridgewater, United States. (Maxwell G.P.) Loma Linda University Medical Center, Loma Linda, United States. CORRESPONDENCE ADDRESS A. Gabriel, PeaceHealth Medical Group, Vancouver, United States. SOURCE Value in Health (2016) 19:7 (A742). Date of Publication: 1 Nov 2016 CONFERENCE NAME ISPOR 19th Annual European Congress CONFERENCE LOCATION Vienna, Austria CONFERENCE DATE 2016-10-29 to 2016-11-02 ISSN 1524-4733 BOOK PUBLISHER Elsevier Ltd ABSTRACT Objectives: Pre-pectoral breast reconstruction is a novel and less invasive surgical technique compared to sub-pectoral procedures, potentially resulting in reduced pain, morbidity and early recovery. This preliminary analysis aims to determine if surgical technique is associated with different length of stay and complication rates in a breast reconstruction cohort. Methods: This was a single-site, retrospective cohort study that includes data from breast reconstruction procedures from July 2014-April 2016. Data collected included patient-related variables including demographics and chemotherapy/ radiation exposure, surgery-related variables such as technique, and patient outcomes including hospital length of stay and post-operative complications occurring within 90 days. Hospital length of stay was categorized as 1 day or more than 1 day. To compare the pre-pectoral and subpectoral groups, Chi-square tests were performed to examine categorical variables. All tests were two-sided and significance was set at an alpha of 0.05. Results: The preliminary data set included 108 patients (n= 50 sub-pectoral technique; n= 58 pre-pectoral technique). The pre-pectoral group had a significantly higher BMI (29.7 kg/m2 vs. 25.1 kg/m2; p< 0.001), higher proportion of patients with diabetes (12% vs. 0%; p= 0.011) and hypertension (28% vs. 8%; p= 0.009), and incisional negative-pressure-wound therapy use (64% vs. 32%; p< 0.001). No significant differences were found in patient age, chemotherapy/radiation exposure, or type of ADM used. There was a significant difference between groups in the percentage of subjects that were discharged after one hospital day. Twenty-six percent of the sub-pectoral patients were discharged after one day compared to 94.8% of the subjects that underwent the pre-pectoral technique (p< 0.001). Complication rates were similar between the two groups. Conclusions: This preliminary data analysis demonstrated a significantly lower length of stay among patients undergoing the pre-pectoral technique compared to sub-pectoral technique for breast reconstruction. Additional data analysis is warranted, along with controlling for potential confounders to understand the true differences between technique and outcomes. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction length of stay vacuum assisted closure EMTREE MEDICAL INDEX TERMS body mass chemotherapy chi square test cohort analysis complication controlled study data analysis diabetes mellitus drug therapy hospital human hypertension major clinical study postoperative complication radiation exposure surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L613235677 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 147 TITLE Use of acellular dermal matrices in one-stage implant-based breast reconstruction AUTHOR NAMES Dong J.-Y. Yan Y. Liu M.-F. Guo Z.-Z. Guo J.-Y. Ye C.-S. AUTHOR ADDRESSES (Dong J.-Y.; Yan Y.; Liu M.-F.; Guo Z.-Z.; Guo J.-Y.; Ye C.-S., ycsnfyy@163.com) Breast Center, Nanfang Hospital, Southern Medical University, Guangzhou, China. CORRESPONDENCE ADDRESS C.-S. Ye, Breast Center, Nanfang Hospital, Southern Medical University, Guangzhou, China. Email: ycsnfyy@163.com SOURCE Acta Academiae Medicinae Sinicae (2016) 38:5 (607-610). Date of Publication: 30 Oct 2016 ISSN 1000-503X BOOK PUBLISHER Chinese Academy of Medical Sciences, xcb@imicams.ac.cn ABSTRACT Implant-based breast reconstruction is the most common choice in breast cancer patients. Recently, the acellular dermal matrix (ADM) technique has been widely used in implant-based breast reconstruction in the western countries. This article briefly reviews the biological characteristics, history, types, surgical techniques, and postoperative complications of ADM. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant breast reconstruction surgical technique EMTREE MEDICAL INDEX TERMS breast cancer (surgery) cancer patient human postoperative complication (complication) review EMBASE CLASSIFICATIONS Cancer (16) Surgery (9) LANGUAGE OF ARTICLE Chinese LANGUAGE OF SUMMARY English, Chinese EMBASE ACCESSION NUMBER 20170034097 MEDLINE PMID 27825422 (http://www.ncbi.nlm.nih.gov/pubmed/27825422) PUI L614029845 DOI 10.3881/j.issn.1000-503X.2016.05.021 FULL TEXT LINK http://dx.doi.org/10.3881/j.issn.1000-503X.2016.05.021 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 148 TITLE Short-term outcome and QoL in 108 patients after immediate breast reconstruction with implants and acellular dermis AUTHOR NAMES Bjelic-Radisic V. AUTHOR ADDRESSES (Bjelic-Radisic V.) Medical University Graz, Gynecology- Breast Unit, Graz, Austria. CORRESPONDENCE ADDRESS V. Bjelic-Radisic, Medical University Graz, Gynecology- Breast Unit, Graz, Austria. SOURCE European Journal of Surgical Oncology (2016) 42:9 (S132). Date of Publication: 1 Sep 2016 CONFERENCE NAME 36th Congress of the European Society of Surgical Oncology in Partnership with the Polish Society of Surgical Oncology, ESSO 36 CONFERENCE LOCATION Krakow, Poland CONFERENCE DATE 2016-09-14 to 2016-09-16 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Background: In postmastectomy breast reconstruction acellular dermal matrices are used for tissue support, implant positioning, rapid revascularization and esthetic results. Material and methods: We assessed peri- and post-operative results and quality of life (QoL) in 108 breast cancer patients undergoing immediate postmastectomy breast reconstruction with implants and acellular dermal matrices between 2012 and 2015. The EORTC QLQ C30, EORTC QLQ BR23 and BRR31 QoL questionnaires were used. Results: The median follow-up of the 108 patients was 14 months. 7 patients had preoperative irradiation. 14 patients had a prophylactic skinsparing mastectomy. The median hospital stay/drainage was 5 days. Complications occurred in 9 cases: wound healing problems (4), implant dislocation (1), seroma (1), hematoma (4), infection (2). Three implants had to be removed (all in patients after radiation therapy). QoL and satisfaction data were similar to those in a healthy population (reference data). Conclusion: Our results are consistent with previously published data. Complications and reoperations were more common in patients after radiation therapy. Despite better materials and operative technique, prior radiation therapy is a risk factor at immediate breast reconstruction. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction implant EMTREE MEDICAL INDEX TERMS breast cancer cancer patient dislocation female follow up hematoma hospitalization human infection major clinical study mastectomy preoperative radiotherapy quality of life questionnaire radiotherapy reoperation risk factor satisfaction seroma surgical technique wound healing LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L614692290 DOI 10.1016/j.ejso.2016.06.172 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2016.06.172 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 149 TITLE Reducing infection risk in implant-based breast-reconstruction surgery: Challenges and solutions AUTHOR NAMES Ooi A.S.H. Song D.H. AUTHOR ADDRESSES (Ooi A.S.H.; Song D.H., dsong@surgery.bsd.uchicago.edu) Section of Plastic and Reconstructive Surgery, University of Chicago Medicine and Biological Sciences, Chicago, United States. (Ooi A.S.H.) Department of Plastic, Reconstructive, and Aesthetic Surgery, Singapore General Hospital, Singapore. CORRESPONDENCE ADDRESS D.H. Song, Section of Plastic and Reconstructive Surgery, University of Chicago Medicine and Biological Sciences, MC 6035, 5841 South Maryland Avenue, Chicago, United States. Email: dsong@surgery.bsd.uchicago.edu SOURCE Breast Cancer: Targets and Therapy (2016) 8 (161-172). Date of Publication: 1 Sep 2016 ISSN 1179-1314 (electronic) BOOK PUBLISHER Dove Medical Press Ltd., PO Box 300-008, Albany, Auckland, New Zealand. ABSTRACT Implant-based procedures are the most commonly performed method for postmastectomy breast reconstruction. While donor-site morbidity is low, these procedures are associated with a higher risk of reconstructive loss. Many of these are related to infection of the implant, which can lead to prolonged antibiotic treatment, undesired additional surgical procedures, and unsatisfactory results. This review combines a summary of the recent literature regarding implant-related breast-reconstruction infections and combines this with a practical approach to the patient and surgery aimed at reducing this risk. Prevention of infection begins with appropriate reconstructive choice based on an assessment and optimization of risk factors. These include patient and disease characteristics, such as smoking, obesity, large breast size, and immediate reconstructive procedures, as well as adjuvant therapy, such as radiotherapy and chemotherapy. For implant-based breast reconstruction, preoperative planning and organization is key to reducing infection. A logical and consistent intraoperative and postoperative surgical protocol, including appropriate antibiotic choice, mastectomy-pocket creation, implant handling, and considered acellular dermal matrix use contribute toward the reduction of breast-implant infections. EMTREE DRUG INDEX TERMS antibiotic agent cefepime cephalosporin cotrimoxazole doxycycline gentamicin linezolid tetracycline vancomycin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction infection risk postoperative infection (complication, prevention, radiotherapy) EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult body mass breast prosthesis Brucella clinical feature comorbidity female hormonal therapy human mastectomy Pasteurella multocida Pseudomonas review risk factor risk reduction Staphylococcus aureus Staphylococcus epidermidis Streptomyces systematic review (topic) CAS REGISTRY NUMBERS cefepime (88040-23-7) cephalosporin (11111-12-9) cotrimoxazole (8064-90-2) doxycycline (10592-13-9, 17086-28-1, 564-25-0, 94088-85-4) gentamicin (1392-48-9, 1403-66-3, 1405-41-0) linezolid (165800-03-3) tetracycline (23843-90-5, 60-54-8, 64-75-5, 8021-86-1) vancomycin (1404-90-6, 1404-93-9) EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Cancer (16) Drug Literature Index (37) Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160674755 PUI L612204627 DOI 10.2147/BCTT.S97764 FULL TEXT LINK http://dx.doi.org/10.2147/BCTT.S97764 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 150 TITLE Is Single-Stage Prosthetic Reconstruction Cost Effective? A Cost-Utility Analysis for the Use of Direct-to-Implant Breast Reconstruction Relative to Expander-Implant Reconstruction in Postmastectomy Patients AUTHOR NAMES Krishnan N.M. Fischer J.P. Basta M.N. Nahabedian M.Y. AUTHOR ADDRESSES (Krishnan N.M.) Washington, D.C.; and Philadelphia, Pa. From the Department of Plastic Surgery, Georgetown University Hospital; and the Division of Plastic Surgery, Perleman School of Medicine, University of Pennsylvania (Fischer J.P.; Basta M.N.; Nahabedian M.Y.) SOURCE Plastic and reconstructive surgery (2016) 138:3 (537-547). Date of Publication: 1 Sep 2016 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Prosthetic breast reconstruction is most commonly performed using the two-stage (expander-implant) technique. However, with the advent of skin-sparing mastectomy and the use of acellular dermal matrices, one-stage prosthetic reconstruction has become more feasible. Prior studies have suggested that one-stage reconstruction has economic advantages relative to two-stage reconstruction despite a higher revision rate. This is the first cost-utility analysis to compare the cost and quality of life of both procedures to guide patient care.METHODS: A comprehensive literature review was conducted using the MEDLINE, EMBASE, and Cochrane databases to include studies directly comparing matched patient cohorts undergoing single-stage or staged prosthetic reconstruction. Six studies were selected examining 791 direct-to-implant reconstructions and 1142 expander-implant reconstructions. Costs were derived adopting both patient and third-party payer perspectives. Utilities were derived by surveying an expert panel. Probabilities of clinically relevant complications were combined with cost and utility estimates to fit into a decision tree analysis.RESULTS: The overall complication rate was 35 percent for single-stage reconstruction and 34 percent for expander-implant reconstruction. The authors' baseline analysis using Medicare reimbursement revealed a cost decrease of $525.25 and a clinical benefit of 0.89 quality-adjusted life-year when performing single-stage reconstructions, yielding a negative incremental cost-utility ratio. When using national billing, the incremental cost-utility further decreased, indicating that direct-to-implant breast reconstruction was the dominant strategy. Sensitivity analysis confirmed the robustness of the authors' conclusions.CONCLUSIONS: Direct-to-implant breast reconstruction is the dominant strategy when used appropriately. Surgeons are encouraged to consider single-stage reconstruction when feasible in properly selected patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation cost benefit analysis economics procedures EMTREE MEDICAL INDEX TERMS breast reconstruction decision tree female human mastectomy postoperative complication quality of life tissue expander LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 27556599 (http://www.ncbi.nlm.nih.gov/pubmed/27556599) PUI L616293547 DOI 10.1097/PRS.0000000000002428 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000002428 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 151 TITLE Acellular dermal matrix as a core strut for projection in nipple reconstruction: Approaches for three different methods of breast reconstruction AUTHOR NAMES Park G.-Y. Yoon E.-S. Cho H.-E. Lee B.-I. Park S.-H. AUTHOR ADDRESSES (Park G.-Y.; Yoon E.-S., yesanam2@korea.ac.kr; Cho H.-E.; Lee B.-I.; Park S.-H.) Department of Plastic Surgery and Reconstructive Surgery, Korea University College of Medicine, Seoul, South Korea. CORRESPONDENCE ADDRESS E.-S. Yoon, Department of Plastic Surgery, Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbukgu, Seoul, South Korea. Email: yesanam2@korea.ac.kr SOURCE Archives of Plastic Surgery (2016) 43:5 (424-429). Date of Publication: 1 Sep 2016 ISSN 2234-6171 (electronic) 2234-6163 BOOK PUBLISHER Korean Society of Plastic and Reconstructive Surgeons, 1355-3 Seocho-Dong, Seocho-Gu, Seoul, South Korea. ABSTRACT Background The objective of this paper was to describe a novel technique for improving the maintenance of nipple projection in primary nipple reconstruction by using acellular dermal matrix as a strut in one of three different configurations, according to the method of prior breast reconstruction. The struts were designed to best fill the different types of dead spaces in nipple reconstruction depending on the breast reconstruction method. Methods A total of 50 primary nipple reconstructions were performed between May 2012 and May 2015. The prior breast reconstruction methods were latissimus dorsi (LD) flap (28 cases), transverse rectus abdominis myocutaneous (TRAM) flap (10 cases), or tissue expander/ implant (12 cases). The nipple reconstruction technique involved the use of local flaps, including the C-V flap or star flap. A 1× 2-cm acellular dermal matrix was placed into the core with O-, I-, and L-shaped struts for prior LD, TRAM, and expander/implant methods, respectively. The projection of the reconstructed nipple was measured at the time of surgery and at 3, 6, and 9 months postoperatively. Results The nine-month average maintenance of nipple projection was 73.0% ±9.67% for the LD flap group using an O-strut, 72.0%±11.53% for the TRAM flap group using an I-strut, and 69.0%±10.82% for the tissue expander/implant group using an L-strut. There were no cases of infection, wound dehiscence, or flap necrosis. Conclusions The application of an acellular dermal matrix with a different kind of strut for each of 3 breast reconstruction methods is an effective addition to current techniques for improving the maintenance of long-term projection in primary nipple reconstruction. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction nipple reconstruction EMTREE MEDICAL INDEX TERMS adult aged article clinical article clinical assessment female graft necrosis human latissimus dorsi flap middle aged retrospective study transverse rectus abdominis musculocutaneous flap EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160701794 PUI L612439725 DOI 10.5999/aps.2016.43.5.424 FULL TEXT LINK http://dx.doi.org/10.5999/aps.2016.43.5.424 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 152 TITLE "Breast in a Day": Examining Single-Stage Immediate, Permanent Implant Reconstruction in Nipple-Sparing Mastectomy AUTHOR NAMES Choi M. Frey J.D. Alperovich M. Levine J.P. Karp N.S. AUTHOR ADDRESSES (Choi M.) New York, N.Y. From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center (Frey J.D.; Alperovich M.; Levine J.P.; Karp N.S.) SOURCE Plastic and reconstructive surgery (2016) 138:2 (184e-191e). Date of Publication: 1 Aug 2016 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Nipple-sparing mastectomy with immediate, permanent implant reconstruction offers patients a prosthetic "breast in a day" compared to tissue expander techniques requiring multiple procedures.METHODS: Patients undergoing nipple-sparing mastectomy with immediate, permanent implant reconstruction were reviewed with patient demographics and outcomes analyzed.RESULTS: Of 842 nipple-sparing mastectomies from 2006 to June of 2015, 160 (19.0 percent) underwent immediate, permanent implant reconstruction. The average age and body mass index were 46.5 years and 23.3 kg/m. The majority of implants were either Allergan Style 20 (48.1 percent) or Style 15 (22.5 percent). The average implant size was 376.2 ml, and 91.3 percent of reconstructions used acellular dermal matrix. The average number of reconstructive operations was 1.3. Follow-up was 21.9 months. The most common major complication was major mastectomy flap necrosis (8.1 percent). The rate of reconstructive failure was 5.6 percent and implant loss was 4.4 percent. The most common minor complication was minor mastectomy flap necrosis (14.4 percent). The rates of full-thickness and partial-thickness nipple necrosis were 4.4 and 7.5 percent, respectively. Age older than 50 years (p = 0.0276) and implant size greater than 400 ml (p = 0.0467) emerged as independent predictors of overall complications. Obesity (p = 0.4073), tobacco use (p = 0.2749), prior radiation therapy (p = 0.4613), and acellular dermal matrix (p = 0.5305) were not associated with greater complication rates.CONCLUSION: Immediate, permanent implant reconstruction in nipple-sparing mastectomy provides patients with a breast in a day in less than two procedures, with a low complication rate.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant procedures tissue expander EMTREE MEDICAL INDEX TERMS breast reconstruction breast tumor (surgery) female follow up human middle aged nipple retrospective study subcutaneous mastectomy time factor treatment outcome LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 27465178 (http://www.ncbi.nlm.nih.gov/pubmed/27465178) PUI L615777182 DOI 10.1097/PRS.0000000000002333 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000002333 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 153 TITLE Uneventful versus Successful Reconstruction and Outcome Pathways in Implant-Based Breast Reconstruction with Acellular Dermal Matrices AUTHOR NAMES Qureshi A.A. Broderick K.P. Belz J. Funk S. Reaven N. Brandt K.E. Tenenbaum M.M. Margenthaler J.A. Aft R.L. Myckatyn T.M. AUTHOR ADDRESSES (Qureshi A.A.) St. Louis, Mo.; and La Canada, Calif. From the Division of Plastic and Reconstructive Surgery and the Department of Surgery, Washington University School of Medicine; and Strategic Health Resources (Broderick K.P.; Belz J.; Funk S.; Reaven N.; Brandt K.E.; Tenenbaum M.M.; Margenthaler J.A.; Aft R.L.; Myckatyn T.M.) SOURCE Plastic and reconstructive surgery (2016) 138:2 (173e-183e). Date of Publication: 1 Aug 2016 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Meaningful data to help guide resource allocation for staged tissue expander/implant-based breast reconstruction are currently lacking. The authors seek to differentiate uneventful from successful reconstruction and identify common outcome pathways and factors that portend a deviation from an uneventful, two-stage, two-operation course.METHODS: A retrospective analysis of expander/implant reconstructions with or without acellular dermal matrix (2003 to 2009) was performed. Related postreconstructive events (including mastectomy flap necrosis, seroma, wound dehiscence, cellulitis, explantation, hematoma, and capsular revisions) were assessed for 2 years. Uneventful reconstruction was defined as exchange to breast implant within 2 years of tissue expander placement without complications, whereas successful reconstruction was defined as exchange to breast implant within 2 years with or without complications. Factors affecting reconstructive success were analyzed, and patterns of postreconstructive events were summarized as outcome pathways.RESULTS: Four hundred thirteen patients (295 with acellular dermal matrix and 118 without), with 602 breasts (432 with acellular dermal matrix and 170 without) underwent reconstruction. Forty-six percent of patients (48 percent with acellular dermal matrix and 40 percent without), experienced uneventful reconstruction. Reconstructive success was achieved in 337 patients (82 percent; 82.0 percent with acellular dermal matrix and 80.5 percent without), with reconstructive failure occurring in 58 patients. Multiple logistic regression analyses determined that cellulitis, seroma, and skin necrosis (OR, 15.8, 7.7, and 8.4, respectively) were highly predictive of reconstructive failure. The authors identified 10 distinct pathways experienced by tissue expander/implant patients that were characterized by specific postreconstructive events.CONCLUSION: The present study will facilitate discussions among patients, providers, and payers by providing a framework for understanding the myriad outcome pathways in implant-based reconstruction.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant patient satisfaction procedures tissue expander EMTREE MEDICAL INDEX TERMS breast reconstruction breast tumor (surgery) female follow up human mastectomy middle aged retrospective study treatment outcome LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 27465177 (http://www.ncbi.nlm.nih.gov/pubmed/27465177) PUI L615777143 DOI 10.1097/PRS.0000000000002402 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000002402 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 154 TITLE Acellular dermal matrices in breast reconstructions - a literature review AUTHOR NAMES Skovsted Yde S. Brunbjerg M.E. Damsgaard T.E. AUTHOR ADDRESSES (Skovsted Yde S.; Brunbjerg M.E.; Damsgaard T.E.) a Plastic Surgical Research Unit, Department of Plastic Surgery , Aarhus University Hospital , Aarhus , Denmark SOURCE Journal of plastic surgery and hand surgery (2016) 50:4 (187-196). Date of Publication: 1 Aug 2016 ISSN 2000-6764 (electronic) ABSTRACT During the last two decades, acellular dermal matrices (ADM) have been more widely used in reconstructive procedures i.e. breast reconstructions. Several, both synthetic and biologic products derived from human, porcine and bovine tissue, have been introduced. Until this point postoperative complications for the acellular dermal matrices, as a group, have been the main focus. The purpose of this literature review is to summarize the current knowledge on the each biologic product used in breast reconstructions, including product specific complication frequencies. A systematic search of the literature was performed in the PubMed and EMBASE databases, identifying 55 relevant articles, mainly evidence level III. AlloDerm seems to be associated with severe complicating matters in the reconstructive process compared to other products. This could be due to the higher number of investigating studies relative to the others. The surgical area faces certain challenges comparing results, due to surgical variance, the data collection and follow-up. More well-defined guidelines and more high-evidence randomized studies could increase the overall level of evidence in this area. EMTREE DRUG INDEX TERMS collagen (adverse drug reaction) surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix procedures EMTREE MEDICAL INDEX TERMS breast reconstruction human postoperative complication CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26881927 (http://www.ncbi.nlm.nih.gov/pubmed/26881927) PUI L617391941 DOI 10.3109/2000656X.2016.1140053 FULL TEXT LINK http://dx.doi.org/10.3109/2000656X.2016.1140053 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 155 TITLE Acellular Dermal Matrix-Assisted Direct-to-Implant Breast Reconstruction and Capsular Contracture: A 13-Year Experience AUTHOR NAMES Salzberg C.A. Ashikari A.Y. Berry C. Hunsicker L.M. AUTHOR ADDRESSES (Salzberg C.A.) New York, N.Y.; and Littleton, Colo. From the Icahn School of Medicine, Mount Sinai Health Systems; the Ashikari Breast Center; and Revalla Plastic Surgery & Medical Aesthetics (Ashikari A.Y.; Berry C.; Hunsicker L.M.) SOURCE Plastic and reconstructive surgery (2016) 138:2 (329-337). Date of Publication: 1 Aug 2016 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Use of acellular dermal matrix for implant-based breast reconstruction appears to be associated with a lower incidence of capsular contracture compared with standard reconstruction. The majority of acellular dermal matrix studies were, however, of short duration; thus, long-term incidence of capsular contracture with acellular dermal matrix use is unknown.METHODS: Patients undergoing acellular dermal matrix-assisted breast reconstruction from December of 2001 to May of 2014 at two institutions were evaluated. Cumulative incidence of capsular contracture was determined by the performing surgeon. A retrospective chart review was performed on prospectively gathered data on patient-, breast-, surgery-, and implant-related characteristics that were analyzed as potential risk factors for the development of capsular contracture.RESULTS: A total of 1584 breast reconstructions in 863 patients were performed. Mean follow-up of patients was 4.7 years; 45 percent of patients had greater than or equal to 5 years of follow-up. The cumulative incidence of capsular contracture was 0.8 percent. Smaller implant size (<400 ml) and postoperative radiotherapy were significantly associated with an increased risk of capsular contracture, but the incidence of capsular contracture was 1.9 percent in irradiated breasts. All capsular contractures developed within the first 2 years, with no new events with longer follow-up.CONCLUSIONS: In this long-term study, the cumulative incidence of capsular contracture with acellular dermal matrix-assisted reconstruction remains low, even in irradiated breasts. Capsular contracture appears to be an early event, and longer follow-up does not appear to increase the incidence, suggesting that acellular dermal matrix may truly mitigate the development of capsular contracture as opposed to delaying its occurrence.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant forecasting procedures EMTREE MEDICAL INDEX TERMS adult aged breast augmentation breast reconstruction female follow up human implant capsular contracture (prevention) mastectomy middle aged retrospective study young adult LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 27064232 (http://www.ncbi.nlm.nih.gov/pubmed/27064232) PUI L615777330 DOI 10.1097/PRS.0000000000002331 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000002331 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 156 TITLE A Meta-analysis of Outcomes Using Acellular Dermal Matrix in Breast and Abdominal Wall Reconstructions: Event Rates and Risk Factors Predictive of Complications AUTHOR NAMES Adetayo O.A. Salcedo S.E. Bahjri K. Gupta S.C. AUTHOR ADDRESSES (Adetayo O.A.) From the *Department of Plastic Surgery, Loma Linda University, Loma Linda, CA; and †Department of Epidemiology and Biostatistics, School of Public Health Loma Linda University, Loma Linda, CA (Salcedo S.E.; Bahjri K.; Gupta S.C.) SOURCE Annals of plastic surgery (2016) 77:2 (e31-e38). Date of Publication: 1 Aug 2016 ISSN 1536-3708 (electronic) ABSTRACT BACKGROUND: The use of acellular dermal matrix (ADM) has gained acceptance in breast and abdominal wall reconstructions. Despite its extensive use, there is currently a wide variation of reported outcomes in the literature. This study definitively elucidates the outcome rates associated with ADM use in breast and abdominal wall surgeries and identifies risk factors predisposing to the development of complications.METHODS: A literature search was conducted using the Medline database (PubMed, US National Library of Medicine) and the Cochrane Library. A total of 464 articles were identified, of which 53 were eligible for meta-analysis. The endpoints of interest were the incidences of seroma, cellulitis, infection, wound dehiscence, implant failure, and hernia. The effects of various risk factors such as smoking, radiation, chemotherapy, and diabetes on the development of complications were also evaluated.RESULTS: A majority of the studies were retrospective (68.6%) with a mean follow-up of 16.8 months (SD ± 10.1 months) in the breast group and 14.2 months (SD ± 7.8 months) in the abdominal wall reconstructive group. The overall risks and complications were as follows: cellulitis, 5.1%; implant failure, 5.9%; seroma formation, 8%; wound dehiscence, 8.1%; wound infection, 16.1%; hernia, 27.6%; and abdominal bulging, 28.1%. Complication rates were further stratified separately for the breast and abdominal cohorts, and the data were reported. This provides additional information on the associated abdominal wall morbidity in patients undergoing autologous breast reconstruction in which mesh reinforcement was considered as closure of the abdominal wall donor site. Radiation resulted in a significant increase in the rates of cellulitis (P = 0.021), and chemotherapy was associated with a higher incidence of seroma (P = 0.014).CONCLUSION: This study evaluates the overall complication rates associated with ADM use by conducting a meta-analysis of published data. This will offer physicians a single comprehensive source of information during informed consent discussions as well as an awareness of the risk factors predictive of complications. EMTREE DRUG INDEX TERMS collagen surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix procedures surgery EMTREE MEDICAL INDEX TERMS abdominal wall abdominoplasty breast reconstruction female human meta analysis outcome assessment postoperative complication (epidemiology, etiology) risk factor CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 22156884 (http://www.ncbi.nlm.nih.gov/pubmed/22156884) PUI L618635902 DOI 10.1097/SAP.0b013e31822afae5 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0b013e31822afae5 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 157 TITLE Porcine acellular dermis-based breast reconstruction: complications and outcomes following adjuvant radiotherapy AUTHOR NAMES Headon H. El Hage Chehade H. Kasem A. Carmichael A.R. Mokbel K. AUTHOR ADDRESSES (Headon H.; El Hage Chehade H.; Kasem A.; Carmichael A.R.; Mokbel K., kefahmokbel@hotmail.com) The London Breast Institute, Princess Grace Hospital, 42-52 Nottingham Place, London, United Kingdom. CORRESPONDENCE ADDRESS K. Mokbel, The London Breast Institute, Princess Grace Hospital, 42-52 Nottingham Place, London, United Kingdom. Email: kefahmokbel@hotmail.com SOURCE European Journal of Plastic Surgery (2016) 39:4 (319-320). Date of Publication: 1 Aug 2016 ISSN 1435-0130 (electronic) 0930-343X BOOK PUBLISHER Springer Verlag, service@springer.de EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix adjuvant radiotherapy breast reconstruction surgical mesh EMTREE MEDICAL INDEX TERMS body mass capsulotomy debridement expectation follow up human letter mastectomy nonhuman patient risk patient satisfaction patient selection pig postoperative complication postoperative period priority journal wound complication wound dehiscence DEVICE TRADE NAMES Strattice , United StatesLifecell DEVICE MANUFACTURERS (United States)Lifecell EMBASE CLASSIFICATIONS Dermatology and Venereology (13) Radiology (14) Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20160231953 PUI L609140969 DOI 10.1007/s00238-016-1187-5 FULL TEXT LINK http://dx.doi.org/10.1007/s00238-016-1187-5 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 158 TITLE Discussion: Acellular Dermal Matrix-Assisted Direct-to-Implant Breast Reconstruction and Capsular Contracture: A 13-Year Experience AUTHOR NAMES Maxwell G.P. Gabriel A. AUTHOR ADDRESSES (Maxwell G.P.) Loma Linda, Calif. From the Department of Plastic Surgery, Loma Linda University Medical Center (Gabriel A.) SOURCE Plastic and reconstructive surgery (2016) 138:2 (338-339). Date of Publication: 1 Aug 2016 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction EMTREE MEDICAL INDEX TERMS breast augmentation breast implant breast tumor (surgery) contracture (surgery) human implant capsular contracture (surgery) LANGUAGE OF ARTICLE English MEDLINE PMID 27465157 (http://www.ncbi.nlm.nih.gov/pubmed/27465157) PUI L617332792 DOI 10.1097/PRS.0000000000002422 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000002422 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 159 TITLE Decreased hernia recurrence using autologous platelet-rich plasma (PRP) with Strattice™ mesh in a rodent ventral hernia model AUTHOR NAMES Van Eps J. Fernandez-Moure J. Cabrera F. Wang X. Karim A. Corradetti B. Chan P. Dunkin B. Tasciotti E. Weiner B. Ellsworth W. AUTHOR ADDRESSES (Van Eps J.; Fernandez-Moure J.; Dunkin B.; Ellsworth W.) Department of Surgery, Houston Methodist Hospital, Houston, United States. (Van Eps J.; Fernandez-Moure J.; Cabrera F.; Wang X.; Karim A.; Corradetti B.; Chan P.; Tasciotti E.; Weiner B., bkweiner@houstonmethodist.org) Surgical Advanced Technologies Lab, Center for Regenerative Medicine, Houston Methodist Research Institute, Houston, United States. (Corradetti B.) Department of Life and Environmental Sciences, Università Politecnica delle Marche, Via Brecce Bianche, Ancona, Italy. (Dunkin B.) Methodist Institute for Technology, Innovation, and Education (MITIE), Houston Methodist Research Institute, Houston, United States. (Dunkin B.; Weiner B., bkweiner@houstonmethodist.org; Ellsworth W.) Weill Cornell Medical College, Cornell University, New York, United States. (Weiner B., bkweiner@houstonmethodist.org) Houston Methodist Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, United States. CORRESPONDENCE ADDRESS B. Weiner, Houston Methodist Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, United States. Email: bkweiner@houstonmethodist.org SOURCE Surgical Endoscopy and Other Interventional Techniques (2016) 30:8 (3239-3249). Date of Publication: 1 Aug 2016 ISSN 1432-2218 (electronic) 0930-2794 BOOK PUBLISHER Springer New York LLC, barbara.b.bertram@gsk.com ABSTRACT Background: Recurrence after ventral hernia repair (VHR) remains a multifactorial problem still plaguing surgeons today. Some of the many contributing factors include mechanical strain, poor tissue-mesh integration, and degradation of matrices. The high recurrence rate witnessed with the use of acellular dermal matrices (ADM) for definitive hernia repair has reduced their use largely to bridging repair and breast reconstruction. Modalities that improve classic cellular metrics of successful VHR could theoretically result in improved rates of hernia recurrence; autologous platelet-rich plasma (PRP) may represent one such tool, but has been underinvestigated for this purpose. Methods: Lewis rats (32) had chronic ventral hernias created surgically and then repaired with Strattice™ mesh alone (control) or mesh + autologous PRP. Samples were harvested at 3 and 6 months postoperatively and compared for gross, histologic, and molecular outcomes of: neovascularization, tissue incorporation, peritoneal adhesions, hernia recurrence, and residual mesh thickness. Results: Compared to control at 3 months postoperatively, PRP-treated rats displayed significantly more neovascularization of implanted mesh and considerable upregulation of both angiogenic genes (vEGF 2.73-fold, vWF 2.21-fold) and myofibroblastic genes (αSMA 9.68-fold, FSP-1 3.61-fold, Col1a1 3.32-fold, Col31a1 3.29-fold). Histologically, they also showed enhanced tissue deposition/ingrowth and diminished chronic immune cell infiltration. Peritoneal adhesions were less severe at both 3 (1.88 vs. 2.94) and 6 months (1.63 vs. 2.75) by Modified Hopkins Adhesion Scoring. PRP-treated rats experienced decreased hernia recurrence at 6 months (0/10 vs. 7/10) and had significantly improved ADM preservation as evidenced by quantification of residual mesh thickness. Conclusions: PRP is an autologous source of pro-regenerative growth factors and chemokines uniquely suited to soft tissue wound healing. When applied to a model of chronic VHR, it incites enhanced angiogenesis, myofibroblast recruitment and tissue ingrowth, ADM preservation, less severe peritoneal adhesions, and diminished hernia recurrence. We advocate further investigation regarding PRP augmentation of human VHR. EMTREE DRUG INDEX TERMS alpha smooth muscle actin (endogenous compound) calvasculin (endogenous compound) vasculotropin (endogenous compound) von Willebrand factor (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) abdominal wall hernia (surgery) hernioplasty recurrent disease rodent disease (surgery) surgical mesh thrombocyte rich plasma EMTREE MEDICAL INDEX TERMS adult alpha smooth muscle actin gene animal cell animal experiment animal model animal tissue article cell infiltration controlled study FSP 1 gene gene histopathology immunocompetent cell male neovascularization (pathology) (complication) nonhuman peritoneum adhesion (complication) postoperative complication (complication) priority journal rat thickness upregulation vascular endothelial growth factor gene von Willebrand factor gene DEVICE TRADE NAMES Strattice CAS REGISTRY NUMBERS vasculotropin (127464-60-2) von Willebrand factor (109319-16-6) EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Clinical and Experimental Biochemistry (29) Gastroenterology (48) General Pathology and Pathological Anatomy (5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015523675 MEDLINE PMID 26578432 (http://www.ncbi.nlm.nih.gov/pubmed/26578432) PUI L606981764 DOI 10.1007/s00464-015-4645-4 FULL TEXT LINK http://dx.doi.org/10.1007/s00464-015-4645-4 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 160 TITLE Ultrasonography findings of alloderm® used in postmastectomy alloplastic breast reconstruction: A case report and literature review AUTHOR NAMES Kim Y.S. AUTHOR ADDRESSES (Kim Y.S., ing29@hanmail.net) Department of Radiology, College of Medicine, Yeungnam University, Daegu, South Korea. CORRESPONDENCE ADDRESS Y.S. Kim, Department of Radiology, College of Medicine, Yeungnam University, 170, Hyeonchung-ro, Nam-gu, Daegu, South Korea. Email: ing29@hanmail.net SOURCE Iranian Journal of Radiology (2016) 13:3 Article Number: e38252. Date of Publication: 1 Jul 2016 ISSN 2008-2711 (electronic) 1735-1065 BOOK PUBLISHER Kowsar Medical Publishing Company, info@anesthpain.com ABSTRACT AlloDerm® (LifeCell Corp.; Brancburg, NJ) is an acellular dermal matrix (ADM) that serves as an immunologically inert scaffold in plastic surgery. In breast reconstruction, it is used as a filler for lumpectomy defects and can be used to create the inferolateral portion of the tissue expander pocket or implant pocket in postmastectomy patients. However, there are limited reports of the radiologic findings of AlloDerm® in patients who have undergone postmastectomy reconstruction. Familiarity with the imaging features of AlloDerm® is essential for correct diagnosis.We report the ultrasonography features of AlloDerm® in a 43-year-old female patient 3 months after postmastectomy reconstruction. It may help distinguish AlloDerm® from tumor recurrence or other foreign body materials such as gossypiboma. This is important as misdiagnosis can often lead to unnecessary surgical intervention. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction echography mastectomy EMTREE MEDICAL INDEX TERMS adult allograft article cancer size cancer survival case report computer assisted tomography female foreign body human image analysis intraductal carcinoma (surgery) postoperative care thorax radiography DEVICE TRADE NAMES AlloDerm , United StatesLifecell DEVICE MANUFACTURERS (United States)Lifecell EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170035001 PUI L613965238 DOI 10.5812/iranjradiol.38252 FULL TEXT LINK http://dx.doi.org/10.5812/iranjradiol.38252 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 161 TITLE Reply: Use of Acellular Dermal Matrix in Postmastectomy Breast Reconstruction: Are All Acellular Dermal Matrices Created Equal? AUTHOR NAMES Ranganathan K. Momoh A.O. AUTHOR ADDRESSES (Ranganathan K.) Division of Plastic and Reconstructive Surgery, University of Michigan Health Systems, Ann Arbor, Mich (Momoh A.O.) SOURCE Plastic and reconstructive surgery (2016) 138:1 (146e-147e). Date of Publication: 1 Jul 2016 ISSN 1529-4242 (electronic) EMTREE DRUG INDEX TERMS collagen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction EMTREE MEDICAL INDEX TERMS breast augmentation human CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 27348677 (http://www.ncbi.nlm.nih.gov/pubmed/27348677) PUI L618988971 DOI 10.1097/PRS.0000000000002272 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000002272 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 162 TITLE Reply: Use of Acellular Dermal Matrix in Postmastectomy Breast Reconstruction: Are All Acellular Dermal Matrices Created Equal? AUTHOR NAMES Momoh A.O. Wilkins E.G. AUTHOR ADDRESSES (Momoh A.O.) Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich (Wilkins E.G.) SOURCE Plastic and reconstructive surgery (2016) 138:1 (149e-150e). Date of Publication: 1 Jul 2016 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction EMTREE MEDICAL INDEX TERMS breast augmentation human LANGUAGE OF ARTICLE English MEDLINE PMID 27351474 (http://www.ncbi.nlm.nih.gov/pubmed/27351474) PUI L618988977 DOI 10.1097/PRS.0000000000002275 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000002275 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 163 TITLE Use of Acellular Dermal Matrix in Postmastectomy Breast Reconstruction: Are All Acellular Dermal Matrices Created Equal? AUTHOR NAMES Hoffman L. Small K. Talmor M. AUTHOR ADDRESSES (Hoffman L.) Division of Plastic Surgery, Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, N.Y (Small K.; Talmor M.) SOURCE Plastic and reconstructive surgery (2016) 138:1 (148e-149e). Date of Publication: 1 Jul 2016 ISSN 1529-4242 (electronic) EMTREE DRUG INDEX TERMS collagen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction EMTREE MEDICAL INDEX TERMS breast augmentation human CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 27351473 (http://www.ncbi.nlm.nih.gov/pubmed/27351473) PUI L617332806 DOI 10.1097/PRS.0000000000002274 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000002274 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 164 TITLE Different Acellular Dermal Matrix Preparations, Different Surgeons, Different Outcomes: What Factors Matter? AUTHOR NAMES Liao E.C. AUTHOR ADDRESSES (Liao E.C.) Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass SOURCE Plastic and reconstructive surgery (2016) 138:1 (145e-146e). Date of Publication: 1 Jul 2016 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix clinical competence procedures standards EMTREE MEDICAL INDEX TERMS breast reconstruction female human surgeon treatment outcome LANGUAGE OF ARTICLE English MEDLINE PMID 27351472 (http://www.ncbi.nlm.nih.gov/pubmed/27351472) PUI L615777559 DOI 10.1097/PRS.0000000000002273 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000002273 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 165 TITLE Techniques to Repair Implant Malposition after Breast Augmentation: A Review AUTHOR NAMES Chopra K. Gowda A.U. Kwon E. Eagan M. Grant Stevens W. AUTHOR ADDRESSES (Chopra K.) Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospita, United States. (Chopra K.; Gowda A.U.) Division of Plastic and Reconstructive Surgery, University of Maryland, Baltimore, United States. (Kwon E.; Eagan M.; Grant Stevens W., drstevens@hotmail.com) Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, United States. CORRESPONDENCE ADDRESS W. Grant Stevens, Marina Plastic Surgery Associates, 4644 Lincoln Boulevard, Marina del Rey, United States. Email: drstevens@hotmail.com SOURCE Aesthetic Surgery Journal (2016) 36:6 (660-671). Date of Publication: 19 Jun 2016 ISSN 1527-330X (electronic) 1090-820X BOOK PUBLISHER Oxford University Press, jnl.info@oup.co.uk ABSTRACT Background Implant malposition is a complication of breast augmentation that adversely affects aesthetic outcomes. It is one of the most common reasons for revisionary aesthetic breast surgery yet there is a lack of peer reviewed literature dedicated to the management of this complication. Objectives The purpose of this article was to summarize the malposition literature, review the types and causes of this complication, and evaluate the strengths and weakness of procedures aimed at addressing it. Methods A review of the literature was performed using the PubMed database. Articles describing surgical techniques for correction of implant malposition, as well as outcome data for patients undergoing revision with described techniques, were included. Articles describing revisionary surgery following breast reconstruction were excluded. A series of cases are presented to illustrate techniques discussed. Results Search criteria resulted in 763 articles. Title and abstract review followed by application of inclusion and exclusion criteria resulted in a total of 21 clinical studies from 1988 to 2014 that were included in this review. All studies included in this study were of level IV or V evidence. Conclusions Despite the overall low level of evidence in the literature regarding secondary breast augmentation, a thorough understanding of the corrective techniques presented will allow surgeons to make the most informed judgments. Weighing the strengths and weakness of these surgical techniques in the context of each patient will allow surgeons to develop the most appropriate treatment strategy. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation breast implant (adverse device effect) implant malposition (complication) medical device complication (complication) EMTREE MEDICAL INDEX TERMS acellular dermal matrix anatomy article autologous dermal graft capsular flap capsulorrhaphy dual plane repositioning fat grafting human implant inferior malposition (complication) implant lateral malposition (complication) implant medial malposition (complication) implant superiorl malposition (complication) information retrieval Medline neosubpectoral pocket outcome assessment preoperative evaluation priority journal risk benefit analysis risk factor skin graft subglandular site exchange surgical mesh surgical technique synthetic mesh systematic review tissue graft EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160462196 MEDLINE PMID 26988217 (http://www.ncbi.nlm.nih.gov/pubmed/26988217) PUI L610884917 DOI 10.1093/asj/sjv261 FULL TEXT LINK http://dx.doi.org/10.1093/asj/sjv261 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 166 TITLE Implant-based breast reconstruction: Strategies to achieve optimal outcomes and minimize complications AUTHOR NAMES Nahabedian M.Y. AUTHOR ADDRESSES (Nahabedian M.Y., drnahabedian@aol.com) Department of Plastic Surgery, Georgetown University, 3800 Reservoir Rd, NW, Washington, United States. CORRESPONDENCE ADDRESS M.Y. Nahabedian, Department of Plastic Surgery, Georgetown University, 3800 Reservoir Rd, NW, Washington, United States. Email: drnahabedian@aol.com SOURCE Journal of Surgical Oncology (2016) 113:8 (895-905). Date of Publication: 15 Jun 2016 ISSN 1096-9098 (electronic) 0022-4790 BOOK PUBLISHER John Wiley and Sons Inc., P.O.Box 18667, Newark, United States. ABSTRACT Breast reconstruction using prosthetic devices is the most commonly performed procedure in women following mastectomy. The goal is to provide an outcome that is predictable and reproducible while minimizing complications and optimizing aesthetics. There are various strategies by which this can be achieved. It begins with proper patient selection because most adverse events occur in high-risk patients. This in turn is related to the timing of the reconstruction that can be performed immediately following the mastectomy or on a delayed basis. Many surgeons have been combining the use of acellular dermal matrices with prosthetic devices that require strict attention to detail to ensure success. There are various options for achieving device coverage that include total muscle, partial muscle, and subcutaneous coverage. The radiated patient poses additional challenges and limitations that must be understood to achieve a desired outcome. Finally, autologous fat grafting has become a valuable tool to improve outcomes in both radiated and non-radiated women. These factors will be reviewed with the intent of improving outcomes and minimizing complications in the setting of prosthetic breast reconstruction. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast implant breast reconstruction postoperative complication (complication) treatment outcome EMTREE MEDICAL INDEX TERMS acellular dermal matrix breast tissue expander cancer radiotherapy composite skin graft female fluorescence angiography human mastectomy patient selection priority journal review surgical technique EMBASE CLASSIFICATIONS Cancer (16) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160179984 MEDLINE PMID 26919072 (http://www.ncbi.nlm.nih.gov/pubmed/26919072) PUI L608746340 DOI 10.1002/jso.24210 FULL TEXT LINK http://dx.doi.org/10.1002/jso.24210 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 167 TITLE Clinical outcome and patient satisfaction with the use of bovine-derived acellular dermal matrix (SurgiMend™) in implant based immediate reconstruction following skin sparing mastectomy: A prospective observational study in a single centre AUTHOR NAMES Headon H. Kasem A. Manson A. Choy C. Carmichael A.R. Mokbel K. AUTHOR ADDRESSES (Headon H.; Kasem A.; Manson A.; Choy C.; Carmichael A.R.; Mokbel K., kefahmokbel@hotmail.com) London Breast Institute, Princess Grace Hospital, 42-52 Nottingham Place, London, United Kingdom. CORRESPONDENCE ADDRESS K. Mokbel, London Breast Institute, Princess Grace Hospital, 42-52 Nottingham Place, London, United Kingdom. Email: kefahmokbel@hotmail.com SOURCE Surgical Oncology (2016) 25:2 (104-110). Date of Publication: 1 Jun 2016 ISSN 1879-3320 (electronic) 0960-7404 BOOK PUBLISHER Elsevier Ltd ABSTRACT Introduction The advent of acellular dermal matrix devices (ADMs) has enhanced both the scope of implant-based immediate breast reconstruction (IBR) following skin sparing mastectomy (SSM) for the treatment or risk reduction of breast cancer. Currently, there are a wide range of options available for the use of ADMs. Methods This is a prospective observational single institution study of 118 consecutive patients undergoing a total of 164 SSM and IBR procedures either for treatment for breast cancer or for risk reduction, between 2012 and 2014. IBR was performed using an implant and bovine-derived ADM (SurgiMend™). Nipple sparing mastectomy (NSM) accounted for 103 procedures. IBR was performed as a single stage procedure in 23% of patients. The primary endpoint of this prospective study was the explantation rate and secondary endpoints included quality of life, patient satisfaction, aesthetic outcome assessed objectively, surgical complications, overall and disease free survival. Results Forty-six patients (39%) had a bilateral and 72 underwent a unilateral SSM. Of those who underwent a unilateral SSM, 25 had a contralateral adjustment procedure. Out of 164 procedures, 117 (71%) were for the treatment of breast cancer. Sixty-one patients received chemotherapy (52%) and 32 (27%) had radiotherapy. In this study 27 patients underwent post-mastectomy radiotherapy. At a mean follow of 21 months, the explantation rate was 1.2%, 4% (6 patients) developed wound complications. The patient satisfaction with the procedure was found to be very high. The mean Breast Q Score was 85 and the mean overall patient satisfaction rating was 9 out of a possible 10. The mean objective assessment score was 8.9 out of a possible 10 and the mean subjective capsular contracture severity score was 2.9 out of 10. There were two cases of local recurrence (1.7%), one distant recurrence (0.8%) and one patient died of metastatic breast cancer (0.8%). Overall survival was 99.2% and locoregional disease free survival (LRFS) was 98.3%. One patient (0.8%) developed a mild inflammatory reaction secondary to the underlying mesh. Conclusions SurgiMend™ is an effective adjunct to implant based IBR following SSM. It is associated with a very low rate of implant loss and a high level of patient satisfaction and is associated with a very low incidence of inflammatory reaction. Neither prior radiotherapy nor post-mastectomy radiotherapy (PMRT) represents a contraindication to its use. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction immediate breast reconstruction patient satisfaction skin sparing mastectomy EMTREE MEDICAL INDEX TERMS adult breast cancer (radiotherapy, surgery) breast implant cancer chemotherapy cancer radiotherapy cancer recurrence cancer survival disease free survival female human major clinical study mastectomy metastatic breast cancer (radiotherapy, surgery) nipple sparing mastectomy observational study overall survival postoperative complication (complication) priority journal prospective study review risk reduction treatment outcome DEVICE TRADE NAMES surgimend EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160295742 MEDLINE PMID 27312036 (http://www.ncbi.nlm.nih.gov/pubmed/27312036) PUI L609610480 DOI 10.1016/j.suronc.2016.03.004 FULL TEXT LINK http://dx.doi.org/10.1016/j.suronc.2016.03.004 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 168 TITLE Evaluation of Sidestream Darkfield Microscopy for Real-Time Imaging Acellular Dermal Matrix Revascularization AUTHOR NAMES DeGeorge B.R. Olenczak J.B. Cottler P.S. Drake D.B. Lin K.Y. Morgan R.F. Campbell C.A. AUTHOR ADDRESSES (DeGeorge B.R.) From the Department of Plastic Surgery, University of Virginia Health System, Charlottesville, VA (Olenczak J.B.; Cottler P.S.; Drake D.B.; Lin K.Y.; Morgan R.F.; Campbell C.A.) SOURCE Annals of plastic surgery (2016) 76 Supplement 4 (S255-S259). Date of Publication: 1 Jun 2016 ISSN 1536-3708 (electronic) ABSTRACT BACKGROUND: Acellular dermal matrices (ADMs) serve as a regenerative framework for host cell integration and collagen deposition to augment the soft tissue envelope in ADM-assisted breast reconstruction-a process dependent on vascular ingrowth. To date noninvasive intra-operative imaging techniques have been inadequate to evaluate the revascularization of ADM.METHODS: We investigated the safety, feasibility, and efficacy of sidestream darkfield (SDF) microscopy to assess the status of ADM microvascular architecture in 8 patients at the time of tissue expander to permanent implant exchange during 2-stage ADM-assisted breast reconstruction. The SDF microscopy is a handheld device, which can be used intraoperatively for the real-time assessment of ADM blood flow, vessel density, vessel size, and branching pattern. The SDF microscopy was used to assess the microvascular architecture in the center and border zone of the ADM and to compare the native, non-ADM-associated capsule in each patient as a within-subject control.RESULTS: No incidences of periprosthetic infection, explantation, or adverse events were reported after SDF image acquisition. Native capsules demonstrate a complex, layered architecture with an average vessel area density of 14.9 mm/mm and total vessel length density of 12.3 mm/mm. In contrast to native periprosthetic capsules, ADM-associated capsules are not uniformly vascularized structures and demonstrate 2 zones of microvascular architecture. The ADM and native capsule border zone demonstrates palisading peripheral vascular arcades with continuous antegrade flow. The central zone of the ADM demonstrates punctate perforating vascular plexi with intermittent, sluggish flow, and intervening 2- to 3-cm watershed zones.CONCLUSIONS: Sidestream darkfield microscopy allows for real-time intraoperative assessment of ADM revascularization and serves as a potential methodology to compare revascularization parameters among commercially available ADMs. Thr SDF microscopy demonstrates that the periprosthetic capsule in ADM-assisted implant-based breast reconstruction is not a uniformly vascularized structure. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix angiogenesis procedures tissue scaffold EMTREE MEDICAL INDEX TERMS anatomy and histology breast augmentation breast implant clinical trial computer system devices diagnostic imaging feasibility study female human microscopy microvasculature peroperative care physiology tissue expander tissue expansion tissue regeneration LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 27187248 (http://www.ncbi.nlm.nih.gov/pubmed/27187248) PUI L618112721 DOI 10.1097/SAP.0000000000000832 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0000000000000832 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 169 TITLE Refinements in the Techniques of 2-Stage Breast Reconstruction AUTHOR NAMES Freeman M.D. Vemula R. Rao R. Matatov T.S. Strong A.L. Tandon R. Chaffin A.E. Jansen D.A. AUTHOR ADDRESSES (Freeman M.D.) From the *Tulane University School of Medicine, †Division of Plastic and Reconstructive Surgery, Tulane University School of Medicine, New Orleans; ‡Private Practice, Metairie, LA (Vemula R.; Rao R.; Matatov T.S.; Strong A.L.; Tandon R.; Chaffin A.E.; Jansen D.A.) SOURCE Annals of plastic surgery (2016) 76 Supplement 4 (S304-S311). Date of Publication: 1 Jun 2016 ISSN 1536-3708 (electronic) ABSTRACT 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. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) procedures EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult breast reconstruction devices female follow up human mastectomy middle aged outcome assessment retrospective study tissue expander tissue expansion LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26954734 (http://www.ncbi.nlm.nih.gov/pubmed/26954734) PUI L618111336 DOI 10.1097/SAP.0000000000000763 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0000000000000763 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 170 TITLE Skin-Reduction Breast Reconstructions with Prepectoral Implant AUTHOR NAMES Caputo G.G. Marchetti A. Dalla Pozza E. Vigato E. Domenici L. Cigna E. Governa M. AUTHOR ADDRESSES (Caputo G.G.) Verona and Rome, Italy From the Department of Plastic and Reconstructive Surgery, Azienda Ospedaliera Universitaria Integrata; and the Department of Surgery, "Sapienza" University of Rome (Marchetti A.; Dalla Pozza E.; Vigato E.; Domenici L.; Cigna E.; Governa M.) SOURCE Plastic and reconstructive surgery (2016) 137:6 (1702-1705). Date of Publication: 1 Jun 2016 ISSN 1529-4242 (electronic) ABSTRACT UNLABELLED: Skin-reduction mastectomy with prepectoral implant reconstruction is a novel technique for immediate breast reconstruction, with subcutaneous implant placement in patients eligible for skin-reducing mastectomy. Implants were placed above the pectoralis muscles in a compound pocket made by a dermal flap and acellular dermal matrix. The procedure was performed on 33 breasts in 27 selected patients. In three cases, there was skin ischemia; in one case, it healed spontaneously; and in two patients, a surgical necrosectomy and primary closure were needed. No implant loss occurred. This new technique proved to be a useful alternative, with good cosmetic results, in selected patients requiring mastectomy. These preliminary results need to be confirmed by long-term and comparative studies.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast implant procedures surgical flaps transplantation EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult aged breast reconstruction breast tumor (surgery) female follow up human mastectomy middle aged nipple pectoral muscle retrospective study time factor treatment outcome LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 27219226 (http://www.ncbi.nlm.nih.gov/pubmed/27219226) PUI L615396082 DOI 10.1097/PRS.0000000000002227 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000002227 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 171 TITLE Duoderm®-Bra for Nipple-Sparing Mastectomy AUTHOR NAMES Dayicioglu D. Trotta R. Agoris C. Kumar A. AUTHOR ADDRESSES (Dayicioglu D.) From the *Division of Plastic Surgery, Department of Surgery, University of South Florida, Morsani College of Medicine; †University of South Florida, Morsani College of Medicine; and ‡Clinical and Translational Science Institute, University of South Florida, Morsani College of Medicine, Tampa, FL (Trotta R.; Agoris C.; Kumar A.) SOURCE Annals of plastic surgery (2016) 76 Supplement 4 (S280-S285). Date of Publication: 1 Jun 2016 ISSN 1536-3708 (electronic) ABSTRACT BACKGROUND: Nipple-sparing mastectomy (NSM) with tissue expander reconstruction is a widely used technique that can produce aesthetically pleasing reconstruction results after mastectomy. Nipple position and healthy mastectomy flaps with good vascularity are important determinants of an adequate aesthetic final result. An initial high fill volume of the expander can produce a more natural breast mound appearance postoperatively. However, this can often lead to ischemia with loss of the nipple-areolar complex (NAC). Conversely, low intraoperative fill rates are conducive to enhanced tissue circulation and viability. But this may lead to poor skin envelope draping and nipple placement lower than desired. We have developed a new technique called "Duoderm®-bra" that brings together both mastectomy skin tissue health and aesthetic success with optimal nipple positioning. We hypothesized that with Duoderm®-bra, the NAC can be stabilized in the desired high position and ptosis can be reduced. We also hypothesized that by eliminating the need for acellular dermal matrix and intraoperative fill, "Duoderm®-bra" would decrease the rate of complications. The objective of this study was to evaluate the effects of using novel "Duoderm®-bra" technique in NSM.METHODS: After an institutional review board approval, a retrospective chart review of 35 consecutive patients was done with 65 breasts undergoing NSM and tissue expander reconstruction by the same plastic surgeon. Patients in whom "Duoderm®-bra" was used were compared with patients without the "Duoderm®-bra." Patients with acellular dermal matrix were excluded. Age, ptosis grade, preoperative nipple to IMF ratio (R/L), tumor characteristics, mastectomy specimen weight (R/L), time from mastectomy to first fill, time from mastectomy to final fill, final fill volume (R/L), NAC and skin necrosis, and other complications requiring surgery were recorded. Postoperative photographs for NAC positioning (side view most projected point versus at a lower point) were assessed using a scoring system. Two groups were then compared.RESULTS: Complications were higher in the non-Duoderm® group compared with Duoderm®-bra (odds ratio, 4.5; 95% confidence interval [CI], 1.35-15.04; P = 0.021). Optimum nipple positioning was significantly higher with Duoderm®-bra compared with no Duoderm®-bra (odds ratio, 50.0; 95% CI, 10.9-230.1; P < 0.0001). There was no difference in timing from mastectomy to completion of expansion in the Duoderm® group compared with no Duoderm®-bra group (mean difference, -2.35; 95% CI, -10.37 to 5.68).CONCLUSIONS: Use of "Duoderm®-bra" without intraoperative tissue expansion in NSM is a new technique. This technique improves nipple position with less ptosis and greater elevation, decreases flap and NAC necrosis complications, and does not increase total reconstructive period in NSM patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hydrocolloid dressing procedures surgery EMTREE MEDICAL INDEX TERMS adult aged breast reconstruction devices female human middle aged nipple outcome assessment retrospective study subcutaneous mastectomy tissue expander tissue expansion LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26918525 (http://www.ncbi.nlm.nih.gov/pubmed/26918525) PUI L618111414 DOI 10.1097/SAP.0000000000000753 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0000000000000753 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 172 TITLE Are prophylactic postoperative antibiotics necessary for immediate breast reconstruction? Results of a prospective randomized clinical trial AUTHOR NAMES Phillips B.T. Fourman M.S. Bishawi M. Zegers M. O'Hea B.J. Ganz J.C. Huston T.L. Dagum A.B. Khan S.U. Bui D.T. AUTHOR ADDRESSES (Phillips B.T., brett.phillips@duke.edu) Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Hospital, Durham, United States. (Bishawi M.) Division of Cardiovascular and Thoracic Surgery, Duke University Hospital, Durham, United States. (Fourman M.S.) Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, United States. (Zegers M.) Department of Surgery, Stony Brook University Hospital, Stony Brook, United States. (O'Hea B.J.) Division of Breast Surgery, Stony Brook University Hospital, Stony Brook, United States. (Ganz J.C.; Huston T.L.; Dagum A.B.; Khan S.U.; Bui D.T.) Division of Plastic and Reconstructive Surgery, Stony Brook University Hospital, Stony Brook, United States. CORRESPONDENCE ADDRESS B.T. Phillips, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Hospital, Durham, United States. Email: brett.phillips@duke.edu SOURCE Journal of the American College of Surgeons (2016) 222:6 (1116-1124). Date of Publication: 1 Jun 2016 ISSN 1879-1190 (electronic) 1072-7515 BOOK PUBLISHER Elsevier Inc., usjcs@elsevier.com ABSTRACT Background Closed-suction drains, implants, and acellular dermal matrix (ADM) are routinely used in tissue expander-based immediate breast reconstruction (TE-IBR). Each of these factors is thought to increase the potential for surgical site infection (SSI). Although CDC guidelines recommend only 24 hours of antibiotic prophylaxis after TE-IBR, current clinical practices vary significantly. This study evaluated the difference in SSI between 2 different prophylactic antibiotic durations. Study Design A noninferiority randomized controlled trial was designed in which TE-IBR patients received antibiotics either 24 hours postoperatively or until drain removal. The primary outcome was SSI, as defined by CDC criteria. Operative and postoperative protocols were standardized. Secondary endpoints included clinical outcomes up to 1 year and all implant loss, or reoperation. Results There were 112 TE-IBR patients (180 breasts) using ADM who were randomized into 2 study arms, with 62 patients in the 24-hour group and 50 in the extended group. Surgical site infection was diagnosed in 12 patients in the 24-hour group and 11 in the extended group (19.4% vs 22.0%, p = 0.82). The extended group had 7 patients who required IV antibiotics and an overall implant loss in 7 patients (14.0%). The 24-hour group had 4 patients who required IV antibiotics, with 3 requiring removal (4.8%). Patients with diabetes, postoperative seroma, or wound dehiscence were all more likely to develop SSI (p < 0.02). Conclusions In a randomized controlled noninferiority trial, 24 hours of antibiotics is equivalent to extended oral antibiotics for SSI in TE-IBR patients. Additional multicenter trials will further assess this important aspect of TE-IBR postoperative care. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) cefalexin (adverse drug reaction, clinical trial, drug therapy, intravenous drug administration) cefazolin (adverse drug reaction, clinical trial, drug therapy, intravenous drug administration, oral drug administration) clindamycin (adverse drug reaction, clinical trial, drug therapy, intravenous drug administration, oral drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) antibiotic prophylaxis breast reconstruction postoperative care surgical infection (drug therapy, complication, drug therapy, prevention) EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult breast implant (adverse device effect, clinical trial) breast tissue expander (adverse device effect, clinical trial) cellulitis (complication, drug therapy, prevention) Clostridium difficile infection (side effect) comparative study conference paper controlled study device removal diabetes mellitus diarrhea (side effect) dosage schedule comparison gastrointestinal symptom (side effect) graft necrosis (complication) hematoma (complication) human major clinical study mastectomy mastitis (complication, drug therapy, prevention) outcome assessment postoperative complication (complication) postoperative seroma (complication) priority journal prospective study prosthesis complication (complication) prosthesis infection (complication, prevention) randomized controlled trial rash (side effect) reoperation seroma (complication) suction drain surgical mesh tissue expander infection (complication, prevention) tissue expander loss (complication) treatment duration urinary tract infection (side effect) vaginitis (side effect) wound dehiscence (complication) DEVICE TRADE NAMES 15 Fr Blake Alloderm Lifecell Jackson Pratt Natrelle Allergan DEVICE MANUFACTURERS Allergan Lifecell CAS REGISTRY NUMBERS cefalexin (15686-71-2, 23325-78-2) cefazolin (25953-19-9, 27164-46-1) clindamycin (18323-44-9) EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) Adverse Reactions Titles (38) Surgery (9) CLINICAL TRIAL NUMBERS ClinicalTrials.gov (NCT01244698) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160317417 MEDLINE PMID 27106640 (http://www.ncbi.nlm.nih.gov/pubmed/27106640) PUI L610048165 DOI 10.1016/j.jamcollsurg.2016.02.018 FULL TEXT LINK http://dx.doi.org/10.1016/j.jamcollsurg.2016.02.018 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 173 TITLE Revisions in Implant-Based Breast Reconstruction: How Does Direct-to-Implant Measure Up? AUTHOR NAMES Clarke-Pearson E.M. Lin A.M. Hertl C. Austen W.G. Colwell A.S. AUTHOR ADDRESSES (Clarke-Pearson E.M.) Boston, Mass. From the Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School (Lin A.M.; Hertl C.; Austen W.G.; Colwell A.S.) SOURCE Plastic and reconstructive surgery (2016) 137:6 (1690-1699). Date of Publication: 1 Jun 2016 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Immediate direct-to-implant breast reconstruction is increasingly performed for breast cancer treatment or prevention. The advantage over traditional tissue expander/implant reconstruction includes the potential for fewer surgical procedures.METHODS: Retrospective, single-institution, three-surgeon review identified patients undergoing implant-based reconstruction from 2006 to 2011.RESULTS: Six hundred eighty-two reconstructions were performed in 432 women with an average follow-up of 5 years. Four hundred sixty-five were direct-to-implant reconstructions with acellular dermal matrix while 217 were tissue expander/implant reconstructions without acellular dermal matrix. The overall revision rate in direct-to-implant reconstruction was 20.9 percent. There was no difference in total revision rates between direct-to-implant and tissue expander reconstruction (20.9 percent versus 20.3 percent; p = 0.861). Subgroup analysis showed no difference in revision for malposition (3.4 percent versus 5.5 percent; p = 0.200), size change (6.7 percent versus 5.5 percent; p = 0.569), fat grafting (8.6 percent versus 9.7 percent; p = 0.647), or capsular contracture (4.5 percent versus 3.2 percent; p = 0.429). Multivariable logistic regression analysis showed complications were associated with higher rates of revision for malposition or size in both groups (OR, 2.8; 95 percent CI, 1.56 to 5.13; p = 0.001). Smoking, preoperative irradiation, skin necrosis, and one surgeon were associated with higher rates of fat grafting, whereas increasing body mass index was associated with lower rates. Postoperative radiotherapy and hematoma were predictive of revision for capsular contracture.CONCLUSIONS: The 5-year revision rate in this series of direct-to-implant reconstruction was approximately 21 percent and similar to the revision rate in tissue expander/implant reconstruction. Surgical complications, radiotherapy, and the surgeon influenced the rate of revision similarly in both groups.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast implant procedures tissue expander EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult aged breast augmentation breast reconstruction breast tumor (surgery) female follow up human mastectomy middle aged reoperation retrospective study time factor treatment outcome very elderly LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 27219225 (http://www.ncbi.nlm.nih.gov/pubmed/27219225) PUI L615396005 DOI 10.1097/PRS.0000000000002173 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000002173 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 174 TITLE Underpromise AUTHOR NAMES Spear S.L. AUTHOR ADDRESSES (Spear S.L.) Washington, D.C. From the Department of Plastic Surgery, Georgetown University Medical Center SOURCE Plastic and reconstructive surgery (2016) 137:6 (1961-1962). Date of Publication: 1 Jun 2016 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant breast reconstruction mastectomy patient satisfaction surgical flaps EMTREE MEDICAL INDEX TERMS female human patient education postoperative complication psychology LANGUAGE OF ARTICLE English MEDLINE PMID 27219249 (http://www.ncbi.nlm.nih.gov/pubmed/27219249) PUI L615596497 DOI 10.1097/PRS.0000000000002145 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000002145 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 175 TITLE Cryptococcemia in an elderly woman with retroperitoneal diffuse large B-cell lymphoma after rituximab-containing chemotherapy AUTHOR NAMES Cheng M.-W. Wu A.Y.-J. Liu C.-P. Lim K.-H. Weng S.-L. Tseng H.-K. AUTHOR ADDRESSES (Cheng M.-W.; Wu A.Y.-J.; Liu C.-P.; Tseng H.-K., eric120008@gmail.com) Division of Infectious Diseases, Department of Internal Medicine, MacKay Memorial Hospital, Zhongshan District, Taipei, Taiwan. (Liu C.-P.; Lim K.-H.; Tseng H.-K., eric120008@gmail.com) School of Medicine, MacKay Medical College, Number 46, Section 3, Zhongzheng Road, Sanzhi District, New Taipei City, Taiwan. (Liu C.-P.; Tseng H.-K., eric120008@gmail.com) Microbiology Section, Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan. (Lim K.-H.) Division of Hematology and Oncology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan. (Weng S.-L.) Department of Laboratory Medicine, MacKay Memorial Hospital, Taipei, Taiwan. CORRESPONDENCE ADDRESS H.-K. Tseng, School of Medicine, MacKay Medical College, Number 46, Section 3, Zhongzheng Road, Sanzhi District, New Taipei City, Taiwan. Email: eric120008@gmail.com SOURCE International Journal of Gerontology (2016) 10:2 (112-116). Date of Publication: 1 Jun 2016 ISSN 1873-958X (electronic) 1873-9598 BOOK PUBLISHER Elsevier (Singapore) Pte Ltd, 3 Killiney Road, 08-01, Winsland House I, Singapore, Singapore. ABSTRACT Cryptococcemia is a bloodstream fungal infection caused by encapsulated yeasts of Cryptococcus neoformans. We reported an 88-year-old woman in whom C. neoformans colonies of smooth and mucoid phenotypes were sequentially cultured from the blood during treatment of retroperitoneal diffuse large B-cell lymphoma using rituximab-containing chemotherapy. The most likely cause was disease progression of pulmonary cryptococcoma. She was successfully treated with optimal antifungal therapy. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) rituximab (adverse drug reaction, drug combination, drug therapy) EMTREE DRUG INDEX TERMS amphotericin B (drug combination, intravenous drug administration) antibiotic agent (drug therapy) C reactive protein (endogenous compound) creatinine (endogenous compound) cyclophosphamide (drug combination, drug therapy) dexamethasone (drug combination, drug therapy) fluconazole (drug therapy, intravenous drug administration, oral drug administration) flucytosine (drug combination, oral drug administration) fungal DNA granulocyte colony stimulating factor (drug therapy) lactate dehydrogenase (endogenous compound) micafungin prednisolone (adverse drug reaction, drug combination, drug therapy) procalcitonin (endogenous compound) tamoxifen (drug therapy, oral drug administration) vincristine (adverse drug reaction, drug combination, drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) bloodstream infection (drug therapy, drug therapy) cancer chemotherapy cryptococcemia (drug therapy, drug therapy) cryptococcosis (drug therapy, drug therapy) large cell lymphoma (drug therapy, drug therapy) EMTREE MEDICAL INDEX TERMS abdominal pain aged antibiotic therapy antifungal susceptibility article blood culture body weight loss bone marrow biopsy breast cancer (drug therapy, surgery) cancer adjuvant therapy case report cause of death coagulase negative Staphylococcus computer assisted tomography creatinine blood level Cryptococcus laurentii Cryptococcus neoformans DNA extraction febrile neutropenia female fever (drug therapy, side effect) flank pain follow up fungus identification general condition deterioration human human tissue intermediate risk patient lactate dehydrogenase blood level leukocyte count lung nodule lymph node dissection lymphocyte count mastectomy medical history molecular typing needle biopsy neutropenia (drug therapy) neutrophil count phenotype priority journal respiratory tract infection restriction fragment length polymorphism treatment duration urinalysis urine culture very elderly CAS REGISTRY NUMBERS amphotericin B (1397-89-3, 30652-87-0) C reactive protein (9007-41-4) creatinine (19230-81-0, 60-27-5) cyclophosphamide (50-18-0) dexamethasone (50-02-2) fluconazole (86386-73-4) flucytosine (2022-85-7) lactate dehydrogenase (9001-60-9) micafungin (208538-73-2) prednisolone (50-24-8) procalcitonin (56645-65-9) rituximab (174722-31-7) tamoxifen (10540-29-1) vincristine (57-22-7) EMBASE CLASSIFICATIONS Hematology (25) Drug Literature Index (37) Adverse Reactions Titles (38) Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160485906 PUI L611025101 DOI 10.1016/j.ijge.2015.02.005 FULL TEXT LINK http://dx.doi.org/10.1016/j.ijge.2015.02.005 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 176 TITLE Reducing Infectious Complications in Implant Based Breast Reconstruction: Impact of Early Expansion and Prolonged Drain Use AUTHOR NAMES Hanna K.R. Tilt A. Holland M. Colen D. Bowen B. Stovall M. Lee A. Wang J. Drake D. Lin K. Uroskie T. Campbell C.A. AUTHOR ADDRESSES (Hanna K.R.) From the *Department of Plastic and Reconstructive Surgery, University of Virginia, Charlottesville; and †Department of Plastic and Reconstructive Surgery, Eastern Virginia Medical School, Virginia Beach, VA (Tilt A.; Holland M.; Colen D.; Bowen B.; Stovall M.; Lee A.; Wang J.; Drake D.; Lin K.; Uroskie T.; Campbell C.A.) SOURCE Annals of plastic surgery (2016) 76 Supplement 4 (S312-S315). Date of Publication: 1 Jun 2016 ISSN 1536-3708 (electronic) ABSTRACT INTRODUCTION: The most common modality of breast reconstruction continues to be implant based, with infection being the most significant complication. Risk factors including radiation, obesity, and smoking have been associated with infection and other surgical complications. We hypothesized that prolonged drain use may likewise be associated with postoperative complications, particularly infection, and that early postoperative expansion may allow for earlier drain removal and improved outcomes.METHODS: A retrospective chart review was performed to identify all immediate, tissue expander-based breast reconstruction patients using acellular dermal matrix. Time to first expansion, postoperative day (POD) of drain removal, and complication data including infection, seroma, wound separation, and skin necrosis were collected. Early expansion was defined as occurring before POD14, and prolonged drain duration as removal after POD21. Logistic regression was used to identify risk factors for complications. Fisher's exact test was used to compare complications between early and late drain removal and early and late expansion. Spearman correlation was used to define the relationship of early expansion and drain duration.RESULTS: Three hundred twenty-three breast reconstructions met inclusion criteria. Our overall infection rate was 11.8%, seroma was 2.2%, skin necrosis 1.9%, and wound separation 4.3%. Logistic regression revealed prolonged drain use as an independent risk factor for infection (odds ratio, 3.3; P = 0.002). Earlier expansion was correlated with earlier post operative drain removal (r = 0.3, P = 0.001) with fewer early expansion patients (7.4%) requiring prolonged drain use than those undergoing late expansion (24.7%). Smoking was also associated with skin flap necrosis (odds ratio, 8.0; P = 0.002).CONCLUSIONS: Prolonged drain use was associated with postoperative infection and may represent an independent source of infection or may be an indicator of delayed healing. Early tissue expansion was associated with earlier drain removal and so may help avoid infectious complications and improve outcomes. Early expansion was not associated with an increase in complications. Results from this study have informed our current drain management practice. Whether this has led to a reduction in our infection rate is a future topic of study. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) procedures EMTREE MEDICAL INDEX TERMS adult adverse effects aged breast augmentation breast implant devices Drainage female follow up human middle aged necrosis (epidemiology, etiology, prevention) pathology postoperative complication (epidemiology, etiology, prevention) retrospective study risk factor seroma (epidemiology, etiology, prevention) skin statistical model surgical infection (epidemiology, etiology, prevention) time factor tissue expander tissue expansion treatment outcome wound dehiscence (epidemiology, etiology, prevention) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26914348 (http://www.ncbi.nlm.nih.gov/pubmed/26914348) PUI L618111345 DOI 10.1097/SAP.0000000000000760 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0000000000000760 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 177 TITLE Chylous fistula after sentinel lymph biopsy AUTHOR NAMES Tan B. Bloom R. AUTHOR ADDRESSES (Tan B., bennytanmd@gmail.com; Bloom R.) Section of Plastic Surgery, Banner MD Anderson Cancer Center, 2940 E Banner Gateway Drive, Gilbert, United States. CORRESPONDENCE ADDRESS B. Tan, Section of Plastic Surgery, Banner MD Anderson Cancer Center, 2940 E Banner Gateway Drive, Gilbert, United States. Email: bennytanmd@gmail.com SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2016) 69:6 (873-874). Date of Publication: 1 Jun 2016 ISSN 1878-0539 (electronic) 1748-6815 BOOK PUBLISHER Churchill Livingstone EMTREE DRUG INDEX TERMS triacylglycerol (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) biopsy chyle chyle leak (complication) fistula (complication) lymphatic system disease (complication) sentinel lymph node biopsy EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult axillary lymph node breast carcinoma (surgery) breast tissue expander cancer surgery case report device removal drain (adverse device effect) female follow up frozen section hospital discharge human human tissue letter low fat diet lymph node dissection lymph vessel mastectomy middle aged nasogastric tube priority journal sentinel lymph node metastasis (surgery) skin flap subclavian vein surgical drainage thoracic duct triacylglycerol blood level EMBASE CLASSIFICATIONS Cancer (16) Hematology (25) Biophysics, Bioengineering and Medical Instrumentation (27) Clinical and Experimental Biochemistry (29) General Pathology and Pathological Anatomy (5) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20160245802 MEDLINE PMID 27019946 (http://www.ncbi.nlm.nih.gov/pubmed/27019946) PUI L609241580 DOI 10.1016/j.bjps.2016.03.009 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2016.03.009 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 178 TITLE Optimizing Safety, Predictability, and Aesthetics in Direct to Implant Immediate Breast Reconstruction: Evolution of Surgical Technique AUTHOR NAMES Kalus R. Dixon Swartz J. Metzger S.C. AUTHOR ADDRESSES (Kalus R.) From the *Plastic Surgery of the Carolinas, Mount Pleasant, SC; †Division of Plastic Surgery, Medical University of South Carolina, Charleston, SC; and ‡Klinikum der Johann Wolfgang Goethe Universitat, Frankfurt am Main, Germany (Dixon Swartz J.; Metzger S.C.) SOURCE Annals of plastic surgery (2016) 76 Supplement 4 (S320-S327). Date of Publication: 1 Jun 2016 ISSN 1536-3708 (electronic) ABSTRACT BACKGROUND: Although immediate breast reconstruction with the insertion of a permanent prosthesis rather than a tissue expander (direct to implant [DTI]) has become gradually more preferred and requested by patients, the technique has yet to be fully embraced by most plastic surgeons, presumably due to concerns of patient safety and perceived higher complication and revision rates, despite not being supported by the literature.OBJECTIVES: The authors review the senior author's protocol for patient selection and surgical technique in DTI reconstructions. A simple device is introduced which adds predictability and control in determining the inset suture line for the acellular dermal matrix and thus the position of the inframammary fold and lateral mammary fold, resulting in improved aesthetic outcomes, reduced complications, and reduced reoperation rates.METHODS: A retrospective review of our one surgeon experience with 134 DTI breast reconstructions in 77 patients between 2006 and 2015 is presented. The series is further subdivided into 74 reconstructions in 43 patients in whom their reconstruction was performed before the use of a patented 2-dimensional (2-D) template, and 60 reconstructions in 34 patients in whom the template was used.RESULTS: The overall complication rate requiring reoperation in the first 54 reconstructions was 50% versus 15% in the last 84. Failure of the reconstruction, defined by explantation, occurred in 11 of 74 reconstructions (14.9%) before the use of 2-D templates, and in 5 of 60 reconstructions (8.3%) in which templates were used, representing a 44% reduction. The revision rate specifically for implant malposition dropped from 18.6% before the use of templates to 2.9% after the incorporation of templates. Fifty-three reconstructions in 33 patients (40%) had no complications and no reoperations, correctly described as "one and done."CONCLUSIONS: Direct to implant reconstruction can be technically more demanding and exacting than 2-stage expander/implant reconstructions. A review of this single surgeon series confirms that despite a learning curve with a higher complication rate early in the series, in the setting of proper patient selection DTI immediate reconstruction is both safe and reliable, and can potentially have clinical, psychological, and aesthetic advantages for patients when compared with a 2-stage expander/implant reconstruction, with 40% of patients having 1 operation only. The use of a patented 2-D template has reduced complications and the rate of reoperation. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) procedures EMTREE MEDICAL INDEX TERMS adult aged breast augmentation breast implant devices esthetics female human middle aged outcome assessment patient safety patient selection postoperative complication (epidemiology) reoperation retrospective study statistics and numerical data very elderly LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26954737 (http://www.ncbi.nlm.nih.gov/pubmed/26954737) PUI L618111343 DOI 10.1097/SAP.0000000000000771 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0000000000000771 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 179 TITLE Primitive neuroectodermal tumor of the breast: A case report and review of the literature AUTHOR NAMES Zhang F. Yang B. Yan N. Xu H. Yang Y. Chen B. Tang L. Xu Y. AUTHOR ADDRESSES (Zhang F.; Yan N.; Xu H.; Yang Y.; Chen B.) Department of Oncology, Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou, China. (Zhang F.; Yan N.) Department of Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China. (Yang B.) Department of Interventional Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China. (Tang L., bobbytang_1982@163.com; Xu Y., xiaoxu2384@163.com) Department of Oncology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China. CORRESPONDENCE ADDRESS Y. Xu, Department of Oncology, Renji Hospital, Shanghai Jiaotong University School of Medicine, No. 160, Pujian Road, Shanghai, China. Email: xiaoxu2384@163.com SOURCE International Journal of Clinical and Experimental Medicine (2016) 9:5 (8780-8787). Date of Publication: 30 May 2016 ISSN 1940-5901 (electronic) BOOK PUBLISHER E-Century Publishing Corporation, 40 White Oaks Lane, Madison, United States. ABSTRACT Background: Primitive neuroectodermal tumor (PNET) is a rare aggressive type of sarcoma characterized by translocation involving the EWS gene. Peripheral PNET is rarely observed in female breast. So far, only 11 cases of PNETs of breast have been reported in literatures, and no Chinese case has ever been reported. We presented, here, a case of primary PNET of breast occurred in a 32-year-old Chinese woman. At her first visit to the hospital, this woman complained of a palpable mass in her right breast noticed by herself for 6 months. No lesion of metastasis was found by imaging. The diagnosis was established by surgery, immunohistochemical staining and fluorescence in situ hybridization (FISH). The patient received 6 cycles of chemotherapy after surgery using a regimen of cyclophosphamide (CTX) 500 mg/m(2) + doxorubicin (ADM) 50 mg/m(2) + vincristine (VCR) 2 mg. Since then, she had been on regular follow-up and remained disease free for 51 months after surgery. Conclusion: PNET of breast mainly affects young females. In spite of its extream rarity, PNET of breast should be taken into consideration upon differential diagnosis of breast tumors and positively treated by multidisciplinary planning advisory teams. EMTREE DRUG INDEX TERMS cyclophosphamide (drug therapy) doxorubicin (drug therapy) RNA binding protein EWS (endogenous compound) vincristine (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (drug therapy, diagnosis, drug therapy, surgery) neuroectoderm tumor (drug therapy, diagnosis, drug therapy, surgery) EMTREE MEDICAL INDEX TERMS adult case report digital mammography female fluorescence in situ hybridization follow up human human tissue immunohistochemistry mastectomy multiple cycle treatment review CAS REGISTRY NUMBERS cyclophosphamide (50-18-0) doxorubicin (23214-92-8, 25316-40-9) vincristine (57-22-7) EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Cancer (16) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160412276 PUI L610545564 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 180 TITLE A direct comparison of porcine (StratticeTM) and bovine (SurgimendTM) acellular dermal matrices in implant-based immediate breast reconstruction AUTHOR NAMES Ball J. Sheena Y. Tarek D. Forouhi P. Benyon S. Irwin M. Malata C. AUTHOR ADDRESSES (Ball J.; Sheena Y.; Benyon S.; Irwin M.; Malata C.) Department of Plastic and Reconstructive Surgery, Cambridge University Hospital, Cambridge, United Kingdom. (Tarek D.) Clinical School of Medicine, University of Cambridge, Cambridge, United Kingdom. (Forouhi P.) Cambridge Breast Unit, Cambridge University Hospital, Cambridge, United Kingdom. (Malata C.) Postgraduate Medical Institute, Faculty of Medical Sciences, Anglia Ruskin University, Cambridge, Chelmsford, United Kingdom. CORRESPONDENCE ADDRESS J. Ball, Department of Plastic and Reconstructive Surgery, Cambridge University Hospital, Cambridge, United Kingdom. SOURCE European Surgical Research (2016) 57 Supplement 1 (37). Date of Publication: 1 May 2016 CONFERENCE NAME 51st Congress of the European Society for Surgical Research CONFERENCE LOCATION Prague, Czech Republic CONFERENCE DATE 2016-05-25 to 2016-05-28 ISSN 1421-9921 BOOK PUBLISHER S. Karger AG ABSTRACT Background: Background: Acellular dermal matrices (ADMs) improve the results of immediate post mastectomy implant based breast reconstruction. Porcine (Strattice) and Bovine (Surgimend) derived ADMs are commonly used, however comparative data for different ADMs is limited. This study is the first to compare the use of Strattice and Surgimend ADMs in IBBR. Material and Methods: Method: Patients having undergone skin sparing mastectomy with immediate ADM/implant breast reconstruction from November 2013 to March 2016 were identified from a prospective register and data regarding demographics, adjuvant therapies, operative details, postoperative management and outcomes were collected retrospectively. Mastectomies were performed by an oncological breast surgeon, followed by reconstruction by one of three plastic surgeons. Result: Results: 119 breasts were reconstructed in 81 patients (38 bilateral, 43 unilateral). Strattice was used in the first 30 breasts (25%) and Surgimend in the next 89 (75%). Mean patient age was 45 years (r=24-70). There was no difference is patient or disease characteristics or the type of axillary surgery. Five breasts in the Surgimend group had had previous radiotherapy (RT). 13 Surgimend and 7 Strattice breasts required adjuvant RT (p=0.24). Skin erythema was significantly less common in the Surgimend group (6% vs 20% p=0.03), with a trend towards fewer other complications including seroma (6% vs 10%), haematomas requiring return to theatre (1% vs 7%) and infections (6% vs 10%). Conclusion: Conclusion: This study supports experience of higher complication rates in post-mastectomy breast reconstruction with Strattice compared with Surgimend. More data comparing different ADM outcomes is needed to inform best practice. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix bovine breast reconstruction nonhuman pig surgical mesh EMTREE MEDICAL INDEX TERMS adjuvant chemotherapy adjuvant radiotherapy adult erythema hematoma human infection major clinical study mastectomy middle aged patient history of radiotherapy plastic surgeon postoperative care seroma surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L615728302 DOI 10.1159/446131 FULL TEXT LINK http://dx.doi.org/10.1159/446131 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 181 TITLE Clinical outcome and patient satisfaction with the use of bovine derived acellular dermal matrix (Surgi MendTM) in implant based immediate reconstruction following skin sparing mastectomy in the setting of radiotherapy: A prospective, observational study AUTHOR NAMES Headon H. Kasem A. Manson A. Choy C. El Hage Chehade H. Carmichael A.R. Mokbel K. AUTHOR ADDRESSES (Headon H.; Kasem A.; Manson A.; Choy C.; El Hage Chehade H.; Carmichael A.R.; Mokbel K.) London Breast Institute, London, United Kingdom. CORRESPONDENCE ADDRESS H. Headon, London Breast Institute, London, United Kingdom. SOURCE European Journal of Surgical Oncology (2016) 42:5 (S46). Date of Publication: 1 May 2016 CONFERENCE NAME Association of Breast Surgery Conference, ABS 2016 CONFERENCE LOCATION Manchester, United Kingdom CONFERENCE DATE 2016-05-16 to 2016-05-17 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: The advent of acellular dermal matrix devices (ADMs) has enhanced both the scope of implant-based immediate breast reconstruction (IBR) following skin sparing mastectomy (SSM) for the treatment or risk reduction of breast cancer, especially in the setting of radiotherapy. Currently, there are a wide range of options available for the use of ADMs. Methods: This is a prospective observational single institution study of 118 consecutive patients undergoing a total of 164 SSM and IBR procedures either for treatment for breast cancer or for risk reduction, between 2012 and 2014. IBR was performed using an implant and bovine-derived ADM (SurgiMend™). Nipple sparing mastectomy (NSM) accounted for 103 procedures. IBR was performed as a single stage procedure in 23% of patients and 27% of patients received radiotherapy. The primary endpoint of this prospective study was the explantation rate and secondary endpoints included quality of life, patient satisfaction, aesthetic outcome assessed objectively, surgical complications, overall and disease free survival. Results: At a mean follow up of 21 months, the explantation rate was 1.2% and the overall complication rate was 6.25%. Out of those who received radiotherapy (n=32), 27 patients received post-mastectomy radiotherapy and 5 received it prior to surgery. In this subgroup, we observed two complications including one case of partial wound dehiscence requiring surgical debridement and implant replacement in a patient who had undergone post-mastectomy radiotherapy and chemotherapy. One other patient who received radiotherapy prior to surgery developed capsular contracture after two years requiring capsulotomy and fat transfer. No patients who received radiotherapy lost their implants. The incorporation of the ADM was less complete in the radiotherapy subgroup. Overall survival was 99.2% and locoregional disease free survival was 98.3%. Conclusions: SurgiMend™ is an effective adjunct to implant based IBR following SSM. It is associated with a very low rate of implant loss and a high level of patient satisfaction and is associated with a very low incidence of inflammatory reaction. Neither prior radiotherapy nor postmastectomy radiotherapy (PMRT) represents a contraindication to its use. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix bovine clinical outcome implant capsular contracture mastectomy nonhuman observational study patient satisfaction EMTREE MEDICAL INDEX TERMS breast cancer breast reconstruction capsulotomy chemotherapy complication controlled study debridement disease free survival explant female follow up graft failure human inflammation major clinical study nipple overall survival patient history of radiotherapy peroperative complication prospective study quality of life radiotherapy risk reduction surgery wound dehiscence LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L614540380 DOI 10.1016/j.ejso.2016.02.179 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2016.02.179 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 182 TITLE Outcomes of 35 consecutive immediate breast reconstructions using tissue expander/ direct-to-implant and acellular dermal matrix without the use of surgical drains AUTHOR NAMES Rajput L. Thiruchelvam P. Bramhall R. MacNeill F. AUTHOR ADDRESSES (Rajput L.; Bramhall R.; MacNeill F.) The Royal Marsden Hospital, London, United Kingdom. (Thiruchelvam P.) Nottingham University Hospital, Nottingham, United Kingdom. CORRESPONDENCE ADDRESS L. Rajput, The Royal Marsden Hospital, London, United Kingdom. SOURCE European Journal of Surgical Oncology (2016) 42:5 (S59-S60). Date of Publication: 1 May 2016 CONFERENCE NAME Association of Breast Surgery Conference, ABS 2016 CONFERENCE LOCATION Manchester, United Kingdom CONFERENCE DATE 2016-05-16 to 2016-05-17 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Methods: We present a retrospective review of 35 consecutive ADMTE/ DTI immediate breast reconstructions undertaken with no surgical drains at a single institution over 20 months. Results: 58 ADM-TE/DTI breast reconstructions were undertaken in 35 patients (21 bilateral). The average age was 47.1 years (18.3 - 37.3), BMI 22.6 (18.3 - 37.3). Of the 35 patients, 9 (26%) had surgery for risk reduction and 26(74%) for cancer. 12 patients had neoadjuvant chemotherapy (NACT) and 3 neoadjuvant endocrine therapy. Nipple preservation was performed in 27 of 35 (77%) patients. 17 (49%) had an infra-mammary fold, 8 (23%) circumareolar, 2 wise pattern and 1 lateral 'envelope' incision. 5 patients had axillary clearance, 17 sentinel node biopsy and 12 patients had no axillary surgery. Surgimend was used as the ADM in 34 of 35 (97%), with Strattice in 1 patient. 3 patients had TE and 32 DTI, the average implant was 404gm (245 - 695). The average mastectomy weight was 288gm(86-1160gm). All patients had 1 dose of intravenous antibiotics on induction and 2 post-operative doses. Average duration of stay was 1.91 days (1-6) and 10 patients only stayed one night. The average follow up was 12.3 months. Post-operatively, 13 (38%) patients had a clinically documented seroma, of which 2 (5.8%) required an ultrasound-guided aspiration b/c discomfort. There was 1 case of red breast syndrome, which resolved with conservative management; 4 infections - 2 treated with oral antibiotics and 2 with intravenous antibiotics, and 1 case of full thickness skin necrosis secondary to a hot water bottle, necessitating explantation and reconstruction salvage to TUG autologous flap. There were no implant explantations at 3 months and 2 at 12 months. Conclusion: This series of 35 consecutive patients demonstrates that immediate ADM-TE/DTI breast reconstruction can be undertaken safely, without the use of surgical drains. EMTREE DRUG INDEX TERMS antibiotic agent hot water EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction tissue expander EMTREE MEDICAL INDEX TERMS adult aspiration biopsy body mass breast disease clearance clinical article conservative treatment drug therapy explant female follow up hormonal therapy human human tissue incision infection malignant neoplasm mastectomy neoadjuvant therapy night nipple retrospective study risk reduction sentinel lymph node seroma skin necrosis surgery surgical mesh thickness ultrasound LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L614540359 DOI 10.1016/j.ejso.2016.02.227 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2016.02.227 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 183 TITLE Mesh versus acellular dermal matrix in immediate implant-based breast reconstruction - A prospective randomized trial AUTHOR NAMES Gschwantler-Kaulich D. Schrenk P. Bjelic-Radisic V. Unterrieder K. Leser C. Fink-Retter A. Salama M. Singer C. AUTHOR ADDRESSES (Gschwantler-Kaulich D., daphne.gschwantler@kaulich.at; Leser C.; Fink-Retter A.; Singer C.) Medical University of Vienna, Breast Cancer Center, Department of Gynaecological Oncology, Waehringer Guertel 18-20, Vienna, Austria. (Schrenk P.) AKH Linz Breast Cancer Center, Krankenhausstrasse 9, Linz, Austria. (Bjelic-Radisic V.) Medical University of Graz, Department of Gynaecology, Auenbruggerplatz 1, Graz, Austria. (Unterrieder K.) Private Hospital Villach, Breast Cancer Center, Department of Gynaecology, Dr.-Walter-Hochsteiner-Straße 4, Villach, Austria. (Salama M.) Otto Wagner Hospital, Department of Surgery, Baumgartner Hoehe 1, Vienna, Austria. CORRESPONDENCE ADDRESS D. Gschwantler-Kaulich, Medical University of Vienna, Breast Cancer Center, Department of Gynaecological Oncology, Waehringer Guertel 18-20, Vienna, Austria. Email: daphne.gschwantler@kaulich.at SOURCE European Journal of Surgical Oncology (2016) 42:5 (665-671). Date of Publication: 1 May 2016 ISSN 1532-2157 (electronic) 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Background Comparative studies on the use of meshes and acellular dermal matrices (ADM) in implant-based breast reconstruction (IBBR) have not yet been performed. Methods This prospective, randomized, controlled, multicenter pilot study was performed at four Austrian breast cancer centers. Fifty patients with oncologic or prophylactic indication for mastectomy and IBBR were randomized to immediate IBBR with either an ADM (Protexa®) or a titanized mesh (TiLOOP® Bra). Complications, failed reconstruction, cosmetic outcome, patients' quality of life and the thickness of the overlying tissue were recorded immediately postoperatively and 3 and 6 months after surgery. Results 48 patients participated in the study (Protexa® group: 23; TiLOOP® Bra group: 25 patients). The overall complication rate was 31.25% with similar rates in both groups (Protexa® group: 9 versus TiLOOP® Bra group: 6; p = 0.188). There was a higher incidence of severe complications leading to failed reconstructions with implant loss in the Protexa® group than in the TiLOOP® Bra group (7 versus 2; p < 0.0001). An inverted T-incision technique led to significantly more complications and reconstructive failure with Protexa® (p = 0.037, p = 0.012, respectively). There were no significant differences in patients' satisfaction with cosmetic results (p = 0.632), but surgeons and external specialists graded significantly better outcomes with TiLOOP® Bra (p = 0.034, p = 0.032). Conclusion This pilot study showed use of TiLOOP® Bra or Protexa® in IBBR is feasible leading to good cosmetic outcomes and high patient satisfaction. To validate the higher failure rates in the Protexa® group, data from a larger trial are required. NCT02562170 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction implant based breast reconstruction surgical mesh (adverse device effect, clinical trial) titanized mesh (adverse device effect, clinical trial) EMTREE MEDICAL INDEX TERMS adult article breast cancer (surgery) clinical article female hematoma (complication) human infection (complication) intermethod comparison mastectomy multicenter study patient satisfaction pilot study priority journal prospective study quality of life randomized controlled trial seroma (complication) wound healing (complication) DEVICE TRADE NAMES Protexa TiLOOP Bra EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) CLINICAL TRIAL NUMBERS ClinicalTrials.gov (nct02562170) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160186255 MEDLINE PMID 26947961 (http://www.ncbi.nlm.nih.gov/pubmed/26947961) PUI L608793382 DOI 10.1016/j.ejso.2016.02.007 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2016.02.007 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 184 TITLE Drainless breast reconstruction: Can it be safe when ADM are used? AUTHOR NAMES Potiszil K. Ahmad S. AUTHOR ADDRESSES (Potiszil K.) University of Exeter, Exeter, United Kingdom. (Potiszil K.) Lifcell, England, United Kingdom. (Ahmad S.) Royal Cornwall Hospital, Cornwall, United Kingdom. CORRESPONDENCE ADDRESS K. Potiszil, University of Exeter, Exeter, United Kingdom. SOURCE European Journal of Surgical Oncology (2016) 42:5 (S43). Date of Publication: 1 May 2016 CONFERENCE NAME Association of Breast Surgery Conference, ABS 2016 CONFERENCE LOCATION Manchester, United Kingdom CONFERENCE DATE 2016-05-16 to 2016-05-17 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: One of the most common reported side effects of acellular dermal matrix (ADM) use in breast reconstruction is seroma. Traditionally drains have been used post-operatively to reduce this. However, there is also evidence showing no increased rate of seroma with ADM use, no increased risk of infection with seroma and an increased risk of infection with drain use. This led us to think that there may be a degree of unnecessary drain use occurring in breast reconstructions Methods: A prospective study over 1 year of immediate breast reconstructions by one surgeon in a single institution. Surgical and patient characteristics were recorded, along with clinical follow-up and complications. Inclusion criteria involved: 1) BMI < 35/low breast volume 2) Non-smoking status 3) No high risk co-morbidities. Results: There were a total of 20 patients with 11 ADM / implant reconstructions. Clinical but asymptomatic seromas were seen in 6 cases (30%). None of these cases led to infection or implant loss, with 1 case needing a minor wound re-suture. Only one implant was lost and this was due to infection with USS confirming no seroma present at any point. Conclusion: We may be overusing drains in breast reconstruction. In a specific set of patients, not using drains in breast reconstructions with ADM appears safe and causes no permanent complications. Though clinically seromas may be seen, these have been small, asymptomatic and needed no intervention in our experience. This is a small set of patients and further investigation with larger numbers and longer follow up is needed to fully confirm these results. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction EMTREE MEDICAL INDEX TERMS acellular dermal matrix body mass clinical article comorbidity drain follow up graft failure human implant infection prospective study seroma smoking cessation surgeon surgery suture wound LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L614540686 DOI 10.1016/j.ejso.2016.02.167 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2016.02.167 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 185 TITLE Comparison of Histological Characteristics of Acellular Dermal Matrix Capsules to Surrounding Breast Capsules in Acellular Dermal Matrix-Assisted Breast Reconstruction AUTHOR NAMES Yu D. Hanna K.R. LeGallo R.D. Drake D.B. AUTHOR ADDRESSES (Yu D.) From the Departments of *Plastic and Maxillofacial Surgery, and †Pathology, University of Virginia Health System, Charlottesville, VA (Hanna K.R.; LeGallo R.D.; Drake D.B.) SOURCE Annals of plastic surgery (2016) 76:5 (485-488). Date of Publication: 1 May 2016 ISSN 1536-3708 (electronic) ABSTRACT INTRODUCTION: Despite the widespread adaptation of acellular dermal matrix (ADM) to breast reconstruction, we are just now exploring how these materials integrate and perform in vivo. The goal of this study was to compare the histological characteristics between expander capsules to an area without the ADM.METHODS: Women undergoing implant-based breast reconstruction at the University of Virginia Health System using a decellularized regenerative dermal matrix were enrolled in this prospective, evaluator-blinded, institutional review board-approved study. Twenty-four non-ADM and 24 ADM breast capsule biopsy specimens were collected from 15 women and analyzed for the histological parameters of inflammation, vascular proliferation, capsule fibrosis, foreign body giant cell inflammatory reaction, and myofibroblasts using a previously described semiquantitative scoring system. The pathologist evaluating the specimens was blinded to the tissue source and biopsy location.RESULTS: There was significantly less inflammation and fewer myofibroblasts in the ADM capsule biopsy samples compared with the no-ADM capsule biopsy samples (inflammation: ADM, 0.83; no-ADM, 1.83; P = 0.001; myofibroblasts: ADM, 0.79; no-ADM, 1.46; P = 0.024). Significantly less vascular proliferation in the ADM samples was seen compared with the no-ADM samples (ADM, 0.75; no-ADM, 1.42; P = 0.036). No statistical difference in the presence of an inflammatory capsule was observed in the no-ADM biopsy samples compared with the ADM capsule biopsy samples (P = 0.060).CONCLUSIONS: When used for staged breast reconstruction, this unique, sterile ADM seems to induce less inflammation. Moreover, the significantly decreased presence of myofibroblasts in this material supports the observed clinical findings of decreased capsular contracture in ADM-assisted breast reconstruction. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix pathology procedures EMTREE MEDICAL INDEX TERMS adult aged biopsy breast breast augmentation clinical trial comparative study female foreign body reaction (etiology) human middle aged postoperative complication (etiology) prospective study single blind procedure surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 27070347 (http://www.ncbi.nlm.nih.gov/pubmed/27070347) PUI L616451126 DOI 10.1097/SAP.0000000000000368 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0000000000000368 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 186 TITLE ADM-based immediate breast reconstruction; is there a risk of explantation after 30 days? AUTHOR NAMES Haley A. Williams K. Rowland M. Harvey J. Kirwan C. Johnson R. AUTHOR ADDRESSES (Haley A.; Williams K.; Rowland M.; Harvey J.; Kirwan C.; Johnson R.) University Hospital of South Manchester, Manchester, Lancashire, United Kingdom. (Kirwan C.) Institute of Cancer Sciences, University of Manchester, Manchester, Lancashire, United Kingdom. CORRESPONDENCE ADDRESS A. Haley, University Hospital of South Manchester, Manchester, Lancashire, United Kingdom. SOURCE European Journal of Surgical Oncology (2016) 42:5 (S46). Date of Publication: 1 May 2016 CONFERENCE NAME Association of Breast Surgery Conference, ABS 2016 CONFERENCE LOCATION Manchester, United Kingdom CONFERENCE DATE 2016-05-16 to 2016-05-17 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Nationally up to 85% of women undergoing immediate breast reconstruction opt for an implant-based procedure. Acellular dermal matrix (ADM) has revolutionised this technique, offering a number of perceived cosmetic advantages compared to full muscle coverage, however the medium and long-term outcomes remain uncertain. Methods: All cases where ADM was used in an immediate breast reconstructive procedure in a single breast unit from February 2009 to October 2015 were identified on a retrospectively collected database. Follow up data was completed to December 2015. Results: A total of 349 immediate breast reconstructions (IBR) were performed in 257 patients (92 bilateral), with a median age of 48 years (range 24-76). Median follow up time was 35 months (range 1-80). 32 (12%) patients required emergency re-operation, of which 19 (60%) had their reconstructions salvaged. Final explant rate was 5% (n=13). Complications requiring emergency reoperation occurred at <1month in 14 patients (6 haematomas, 2 infections, 6 wound-breakdowns), 1-3 months in 12 patients (4 infections, 8 breakdowns) and >3 months in 6 patients (5 infections, 1 breakdown). Conclusions: This represents the largest and longest series of immediate breast reconstructions using ADM reported in the UK. The overall explantation rate is low, but the risk is ongoing in the first 3 months, rather than just confined to 30 days post-surgery. Early surgical intervention is a useful tool in the successful salvage of postoperative complications and may improve overall outcomes. Clinician and patient vigilance during the first 3-month at risk period is key. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction explant EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult aged alertness complication controlled study data base emergency follow up hematoma human human tissue infection major clinical study postoperative complication reoperation surgery wound LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L614540371 DOI 10.1016/j.ejso.2016.02.177 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2016.02.177 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 187 TITLE How achievable are ABS/BAPRAS guidelines for artificial dermal matrix assisted breast reconstruction? AUTHOR NAMES Iqbal F. Bell H. Tandon M. Narayanan S. Soumian S. AUTHOR ADDRESSES (Iqbal F.; Bell H.) Keele University, Newcastle under Lyme, United Kingdom. (Tandon M.; Narayanan S.; Soumian S.) Royal Stoke University Hospital, Stoke on Trent, United Kingdom. CORRESPONDENCE ADDRESS F. Iqbal, Keele University, Newcastle under Lyme, United Kingdom. SOURCE European Journal of Surgical Oncology (2016) 42:5 (S12-S13). Date of Publication: 1 May 2016 CONFERENCE NAME Association of Breast Surgery Conference, ABS 2016 CONFERENCE LOCATION Manchester, United Kingdom CONFERENCE DATE 2016-05-16 to 2016-05-17 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Acellular dermal matrices (ADM) are being increasingly used for implant-based breast reconstruction. The reported benefits include a favourable aesthetic outcome and shorter length of hospital stay, however there are concerns over the short-term post-operative outcomes. We aim to audit our local rates against the joint ABS/BAPRAS guidelines in 2013. Methods: A retrospective audit of all consecutive patients who underwent breast reconstruction using ADM (Strattice®) from Feb 2013 to Jun 2015 at the Royal Stoke University Hospital was done (N=56). Results: Median age was 49 (range: 29-80) years; 47/55 (85.5%) were non-smokers; median BMI was 24 (19-37) kg/m(2); 31/56 (55.4%) had sentinel node biopsies, 14/56 had axillary nodal clearance, 11/56 did not require axillary interrogation. Median hospital stay after ADM was 2 (1-6) days. 49/56 had skin-sparing mastectomies, the remainder had skin reduction. Of these, 7/56 (12.5%) required return to theatre vs. target standard of <5%. 3/56 (5.4%) required explant vs. target standard of <5%, 3/56 (5.4%) had skin flap necrosis, 18/56 (32.1%) had erythema, 9/56 patients (16.1%) required seroma aspiration, and 4/56 (7.1%) developed haematomas. Conclusion: Our short-term complication rates are higher than the target standard; this may be due to the initial learning curve with ADM use. Further work is required to see whether these standards are achievable. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction dermis practice guideline EMTREE MEDICAL INDEX TERMS adult aged aspiration biopsy body mass clearance controlled study erythema explant graft necrosis hematoma hospitalization human human tissue joint learning curve major clinical study mastectomy sentinel lymph node seroma university hospital LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L614540800 DOI 10.1016/j.ejso.2016.02.057 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2016.02.057 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 188 TITLE Evaluation of the early post-operative effectiveness of a novel muscle-sparing breast reconstruction technique using braxon® (acellular dermal matrix)-multicentre European experience AUTHOR NAMES Vidya R. Cawthorn S. AUTHOR ADDRESSES (Vidya R.) Wolverhampton, United Kingdom. (Cawthorn S.) Bristol, United Kingdom. CORRESPONDENCE ADDRESS R. Vidya, Wolverhampton, United Kingdom. SOURCE European Journal of Surgical Oncology (2016) 42:5 (S3). Date of Publication: 1 May 2016 CONFERENCE NAME Association of Breast Surgery Conference, ABS 2016 CONFERENCE LOCATION Manchester, United Kingdom CONFERENCE DATE 2016-05-16 to 2016-05-17 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: We report initial results of a prospective audit of novel muscle-sparing subcutaneous implant breast reconstruction technique using a new Braxon® ADM. This was carried out in UK and Europe. Methods: All patients who underwent muscle-sparing breast reconstruction since 2014 were included in the study. The pre-shaped Braxon® ADM completely wraps the implant after rehydration in saline for 5 minutes. The ADM with the implant is placed on the muscle, without detaching the pectoralis major. Results: A total of 110 patients had Braxon® ADM plus implant reconstruction. 70 patients had unilateral and 20 patients had bilateral procedures. Complications included an implant loss of 1.8%; wound necrosis of 0.9% and 3.6% wound dehiscence. The short-term outcomes have been excellent, with high patient satisfaction, less pain, a more natural shape and feeling and good cosmetic outcomes. Conclusion: The initial experience appears highly satisfactory, although long-term follow-up is required. EMTREE DRUG INDEX TERMS sodium chloride EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction comparative effectiveness controlled study muscle EMTREE MEDICAL INDEX TERMS clinical trial complication controlled clinical trial follow up graft failure human implant major clinical study multicenter study necrosis pain patient satisfaction rehydration wound dehiscence CAS REGISTRY NUMBERS sodium chloride (7647-14-5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L614540409 DOI 10.1016/j.ejso.2016.02.028 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2016.02.028 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 189 TITLE Nipple sparing mastectomy and immediate implant reconstruction using the hemi-Y incision: Technique, indications and pitfalls AUTHOR NAMES Nabulyato W. Hariparsad S. Malata C. Forouhi P. AUTHOR ADDRESSES (Nabulyato W.; Hariparsad S.; Malata C.; Forouhi P.) Addenbrookes Cambridge University Hospital, Cambridge, United Kingdom. CORRESPONDENCE ADDRESS W. Nabulyato, Addenbrookes Cambridge University Hospital, Cambridge, United Kingdom. SOURCE European Surgical Research (2016) 57 Supplement 1 (13). Date of Publication: 1 May 2016 CONFERENCE NAME 51st Congress of the European Society for Surgical Research CONFERENCE LOCATION Prague, Czech Republic CONFERENCE DATE 2016-05-25 to 2016-05-28 ISSN 1421-9921 BOOK PUBLISHER S. Karger AG ABSTRACT Background: Nipple-sparing mastectomy (NSM) is well established in risk-reduction surgery and allows excellent cosmetic outcomes. It is increasingy being adopted in breast cancer treatment. Traditional NSM involves either inframammary fold (IMF) or periareolar incisions. IMF incisions provide poor surgical access for removing tissues, particularly from the upper pole of the breast. Periareolar incisions give relatively limited access, particularly for reconstruction and are prone to nipple-areolar necrosis. We report an approach using a hemi-Y incision which avoids these shortcomings. Material and Methods: We reviewed the records of all NSMs performed by the senior author with a hemi-Y incision from November 2009- February 2015. The incision comprised a periareolar component (from 3-6 o'clock on the left breast and 6-9 o'clock on the right breast) with a vertical extension from 6 o'clock inferiorly onto the breast mound. All patients had immediate implant-based reconstruction. Result: 18 small-to-moderately sized breasts in 11 patients (BMI=21-26) underwent prophylactic NSM (4 contralateral breasts were treated with nipple removal for malignancy). Reconstruction was undertaken with expandable implants in 18 breasts, fixed-volume implants in 4 breasts. 14 reconstructions also utilised acellular dermal matrices. One breast developed wound dehiscence (returning to theatre) whilst the rest healed without depigmentation, scar hypertrophy or nipple projection problems. Conclusion: We present an innovative approach to NSM that optimizes surgical access, takes cognisance of cosmesis and minimises nipple-areola necrosis rates. As NSM is increasingly being extended to breast cancer surgery, the hemi-Y incision will become a useful addition to the armamentarium of the oncoplastic and reconstructive breast surgeon. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast areola implant incision mastectomy EMTREE MEDICAL INDEX TERMS body mass breast cancer cancer size cancer surgery clinical article depigmentation dermis esthetic surgery female human human tissue information processing necrosis rest scar surgeon surgery wound dehiscence LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L615728143 DOI 10.1159/446131 FULL TEXT LINK http://dx.doi.org/10.1159/446131 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 190 TITLE Comparison of immediate postoperative pain in implant-based breast reconstructions AUTHOR NAMES Gassman A.A. Yoon A.P. Festekjian J. Da Lio A.L. Tseng C.Y. Crisera C. AUTHOR ADDRESSES (Gassman A.A., Andrew.Gassman@UTSouthwestern.edu) UT Southwestern, Department of Plastic Surgery, 1801 Inwood Road, Dallas, United States. (Yoon A.P.; Festekjian J.; Da Lio A.L.; Tseng C.Y.; Crisera C.) University of California Los Angeles, Division of Plastic and Reconstructive Surgery, Los Angeles, United States. (Yoon A.P.) David Geffen School of Medicine, UCLA, Los Angeles, United States. CORRESPONDENCE ADDRESS A.A. Gassman, UT Southwestern, Department of Plastic Surgery, 1801 Inwood Road, Dallas, United States. Email: Andrew.Gassman@UTSouthwestern.edu SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2016) 69:5 (604-616). Date of Publication: 1 May 2016 ISSN 1878-0539 (electronic) 1748-6815 BOOK PUBLISHER Churchill Livingstone ABSTRACT Background Implant-based techniques represent the most common form of breast reconstruction. However, substantial postoperative pain has been associated with implant-based breast reconstruction. Objective The objective of this study is to evaluate immediate postoperative pain in implant-based breast reconstruction. Methods We reviewed 378 patients who underwent implant-based reconstruction between January 2004 and December 2012. Each patient's visual analog scale (VAS) score, pain medication, and patient-controlled analgesia (PCA) attempts were used to assess in-hospital postoperative pain. We evaluated timing of reconstruction post mastectomy, tissue expander (TE) designed fill volume, TE initial fill volume, and single-stage immediate implant (II) versus TE reconstruction. Results No significant differences in pain parameters were noted between the immediate and delayed postmastectomy reconstruction cohorts. TEs with larger (>300 cc) designed volumes required significantly more narcotic use (p = 0.02) and PCA attempts (p < 0.01). Narcotic use was higher in the larger (>250-cc) TE initial fill group starting on postoperative day 2, but overall differences in VAS score and PCA attempts were not significant. Morphine equivalence (p < 0.01) and non-opioid oral analgesic use (average p = 0.03) of the TE cohort were significantly higher than those of the II cohort. Conclusion Patients undergoing TE-based implant reconstruction show greater analgesic use than those with single-stage II-based reconstruction. This may indicate a higher immediate postoperative pain in TE procedures than in II procedures. Furthermore, higher initial fill and designed volume of TE require more morphine equivalence postoperatively. These findings may warrant further preoperative discussion for better pain management and patient satisfaction. EMTREE DRUG INDEX TERMS analgesic agent (drug therapy, oral drug administration) benzodiazepine (drug combination, drug therapy) muscle relaxant agent (drug combination, drug therapy) narcotic agent (drug therapy, intravenous drug administration, oral drug administration) nonsteroid antiinflammatory agent (drug combination, drug therapy) opiate (drug combination, drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast implant breast reconstruction postoperative pain (drug therapy, complication, drug therapy) EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult analgesia article bilateral reconstruction clinical evaluation cohort analysis comparative study controlled study correlation analysis delayed reconstruction drug use female hospitalization human immediate reconstruction length of stay major clinical study mastectomy morphine equivalence pain assessment pain parameters patient controlled analgesia patient satisfaction postoperative complication (complication) postoperative period priority journal silicone prosthesis tissue expander treatment outcome visual analog scale CAS REGISTRY NUMBERS benzodiazepine (12794-10-4) muscle relaxant agent (9008-44-0) opiate (53663-61-9, 8002-76-4, 8008-60-4) EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) Neurology and Neurosurgery (8) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160174711 MEDLINE PMID 26947947 (http://www.ncbi.nlm.nih.gov/pubmed/26947947) PUI L608702092 DOI 10.1016/j.bjps.2015.12.009 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2015.12.009 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 191 TITLE National trends in immediate and delayed post mastectomy reconstruction in England; A seven-year population based cohort study AUTHOR NAMES Mennie J. Mohanna P.-N. O'Donoghue J. Rainsbury R. Cromwell D. AUTHOR ADDRESSES (Mennie J.; Cromwell D.) Royal College of Surgeons of England, London, United Kingdom. (Mennie J.; Mohanna P.-N.) Guy's and St Thomas' Hospital, London, United Kingdom. (O'Donoghue J.) Royal Victoria Infirmary, Newcastle, United Kingdom. (Rainsbury R.) Royal Hampshire County Hospital, Winchester, United Kingdom. CORRESPONDENCE ADDRESS J. Mennie, Royal College of Surgeons of England, London, United Kingdom. SOURCE European Journal of Surgical Oncology (2016) 42:5 (S22). Date of Publication: 1 May 2016 CONFERENCE NAME Association of Breast Surgery Conference, ABS 2016 CONFERENCE LOCATION Manchester, United Kingdom CONFERENCE DATE 2016-05-16 to 2016-05-17 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT In recent years, access to post-mastectomy reconstruction has improved. However little is known about the trend in type of reconstruction technique. Knowing this information is not only crucial for service planning, but also for ensuring the delivery of equitable care across the country. Our aim was to firstly examine reconstruction procedural trends in England, and second to evaluate regional variation. Women with breast cancer who underwent unilateral index mastectomy between 2007 and 2014 were identified using the national Hospital Episode Statistics database. Women were grouped into categories based on reconstruction procedure. A multinomial model accounting for age, disease, comorbidities, ethnicity, and deprivation was developed. Adjusted rates of implant and free flap reconstructions were then calculated across Cancer Networks using the last 4 years of data. Between 2007 and 2014, 21,862 women underwent immediate reconstruction and 7,750 delayed reconstruction. Immediate implant reconstruction rose significantly from 30%-54%, whilst free flap reconstruction increased marginally from 17%-21%. Adjusted immediate implant and free flap rates ranged from 17-68% and 9-63%, respectively, across regions. Free flaps dominated in the delayed setting rising from 25%-42%, with adjusted rates ranging from 23-74% across regions. Significant regional variation exists in the type of reconstruction performed, suggesting that women have unequal and geographically dependent reconstruction procedures. These patterns need to be examined to determine if variation is related to service provision and/or capacity barriers. With the increase in immediate implant post-mastectomy reconstructions, likely attributable to ADM, long-term results need to be closely monitored to ensure we are not creating a significant future workload. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cohort analysis England mastectomy EMTREE MEDICAL INDEX TERMS breast cancer comorbidity data base ethnicity female free tissue graft hospital human implant major clinical study model statistics workload LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L614540492 DOI 10.1016/j.ejso.2016.02.092 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2016.02.092 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 192 TITLE Immediate implant-based breast reconstruction using the TIGR® Matrix mesh AUTHOR NAMES Schrenk P. AUTHOR ADDRESSES (Schrenk P., peter.schrenk@liwest.at) Breast Cancer Center, Kepler University Clinic, Linz, Austria. CORRESPONDENCE ADDRESS P. Schrenk, Breast Cancer Center, Kepler University Clinic, Linz, Austria. Email: peter.schrenk@liwest.at SOURCE Breast Cancer Management (2016) 5:2 (53-59). Date of Publication: 1 May 2016 ISSN 1758-1931 (electronic) 1758-1923 BOOK PUBLISHER Future Medicine Ltd., info@futuremedicine.com ABSTRACT Background: Different types of acellular dermal, synthetic and biological matrices have been used in connection with immediate implant-based breast reconstruction. Patients & methods: A new long-term absorbable surgical matrix, TIGR® Matrix mesh was used in a total of 29 patients undergoing a total of 37 mastectomies and immediate reconstruction. Results: Early postoperative results showed no adverse reactions to the mesh and a good integration into the tissue. Conclusion: It may therefore constitute an alternative to acellular, dermal or other synthetic matrices currently available. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction immediate implant based breast reconstruction surgical mesh EMTREE MEDICAL INDEX TERMS adult aged article breast cancer (surgery) cancer surgery clinical article female follow up human mastectomy patient satisfaction polyglactin suture postoperative care postoperative complication (complication) priority journal seroma DEVICE TRADE NAMES TIGR Matrix EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160391716 PUI L610485446 DOI 10.2217/bmt-2016-0003 FULL TEXT LINK http://dx.doi.org/10.2217/bmt-2016-0003 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 193 TITLE Patient reported outcome following extended latissimus dorsi flap breast reconstruction AUTHOR NAMES Dube M. Sheikh H. Wilkins H. Rastall S. AUTHOR ADDRESSES (Dube M.; Sheikh H.; Wilkins H.; Rastall S.) Princess Royal Hospital, Telford, United Kingdom. CORRESPONDENCE ADDRESS M. Dube, Princess Royal Hospital, Telford, United Kingdom. SOURCE European Journal of Surgical Oncology (2016) 42:5 (S38). Date of Publication: 1 May 2016 CONFERENCE NAME Association of Breast Surgery Conference, ABS 2016 CONFERENCE LOCATION Manchester, United Kingdom CONFERENCE DATE 2016-05-16 to 2016-05-17 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Autologous breast reconstruction using extended latissimus dorsi flap (ELD) has been a well-established surgical option for breast reconstruction for decades. With the advent of implant based breast reconstruction with acellular dermal matrix ELD flap breast reconstruction numbers are decreasing nationally. We present patient reported outcome of 85 ELD flap breast reconstruction. Method: A validated breast reconstruction satisfaction questionnaire sent to all 73 patients who had ELD flap breast reconstruction from November 2011 to October 2014. Retrospective case note analysis also performed alongside. Results: 73women had ELDre construction with a total of 85 flaps. 50 immediate (10 bilateral) and 23 delayed (2 bilateral).Average hospital stay was 6 days (range 4-8).Median age 51 (range 31-73).Median followup 21 months range (12 - 48 months). 34 patients had implant with ELD flap. 32 patients had nipple reconstruction. 5 had symmetrisation surgery in the form of contralateral breast reduction. 3 had breast wound infection and implant was removed in 1 patient. 78% returned patient's satisfaction questionnaire. 98% happy with their new breast and felt feminine. 95% would recommend other and 88% were happy with nipple areolar reconstruction service. We also noticed greater satisfaction in the patients with ELD flap without implant. Conclusions: In carefully selected patients ELD flap breast reconstruction provides excellent aesthetic outcome. Reconstruction with ELD flap provides long term results and with very low complications. Although implant based reconstruction gaining popularity but ELD flap breast reconstruction still has a secure place in the reconstruction algorithm. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reduction latissimus dorsi flap patient-reported outcome EMTREE MEDICAL INDEX TERMS adult aged breast areola doctor patient relation female follow up hospitalization human implant instrument validation major clinical study patient satisfaction questionnaire surgery wound infection LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L614540491 DOI 10.1016/j.ejso.2016.02.152 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2016.02.152 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 194 TITLE The Inframammary Fold (IMF) Fixation Suture: Proactive Control of the IMF in Primary Breast Augmentation AUTHOR NAMES Campbell C.F. Small K.H. Adams W.P. AUTHOR ADDRESSES (Campbell C.F.; Small K.H.; Adams W.P., dr@dr-adams.com) Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, United States. CORRESPONDENCE ADDRESS W.P. Adams, Department of Plastic Surgery, University of Texas Southwestern Medical Center, 6901 Snider Plaza, Suite 120, University Park, United States. Email: dr@dr-adams.com SOURCE Aesthetic Surgery Journal (2016) 36:5 (619-623). Date of Publication: 1 May 2016 ISSN 1527-330X (electronic) 1090-820X BOOK PUBLISHER Oxford University Press, jnl.info@oup.co.uk EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast breast augmentation inframammary fold suture EMTREE MEDICAL INDEX TERMS acellular dermal matrix article breast implant breast malformation cost foreign body reaction human incision operation duration operative blood loss postoperative complication priority journal surgical anatomy EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20160360744 MEDLINE PMID 26399314 (http://www.ncbi.nlm.nih.gov/pubmed/26399314) PUI L610299333 DOI 10.1093/asj/sjv178 FULL TEXT LINK http://dx.doi.org/10.1093/asj/sjv178 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 195 TITLE Reconstructive breast surgery: Compatibility of Strattice® matrix with radiation therapy AUTHOR NAMES Hashmi D. Fasih T. AUTHOR ADDRESSES (Hashmi D.; Fasih T.) Queen Elizabeth Hospital, Gateshead, United Kingdom. CORRESPONDENCE ADDRESS D. Hashmi, Queen Elizabeth Hospital, Gateshead, United Kingdom. SOURCE European Journal of Surgical Oncology (2016) 42:5 (S18). Date of Publication: 1 May 2016 CONFERENCE NAME Association of Breast Surgery Conference, ABS 2016 CONFERENCE LOCATION Manchester, United Kingdom CONFERENCE DATE 2016-05-16 to 2016-05-17 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Strattice is a porcine acellular dermal matrix used in breast reconstruction. It acts as a hammock for breast implants and to define the infra mammary fold. Method: All patients underwent strattice based reconstruction between 2010-15. The strattice matrix was used to create the subpectoral pouch in which the implant was placed. Patients were divided into those who had immediate reconstruction and those who had previous mastectomies and delayed reconstruction. Indication for surgery, size of implant, follow up time and significant complications were recorded. Furthermore, patients were divided based on their adjuvant therapy, such as radiotherapy, and whether it was pre or post-operative. Results: There were 76 cases with average age of 52 years (33-79). 36 cases had a skin sparing mastectomy with immediate reconstruction, 36 had delayed reconstruction, 2 had mastectomy and immediate reconstruction and 2 were re-do operations. 32 (42%) had radiation; 4 pre-reconstruction, 11 post-reconstruction and 17 had radiation to the chest wall after mastectomy. The average size of implant used was 422g (195-765). Follow up time was 27 months (1-62). Conclusion: Radiotherapy is safe post-reconstructively but carries higher risk of complication after chest wall radiation. This elevated risk should be emphasised to the patients to help cope with these issues. (Table Presented). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) patient history of mastectomy EMTREE MEDICAL INDEX TERMS adjuvant chemotherapy adult aged follow up human major clinical study radiation radiotherapy skin surgery surgical mesh thorax wall LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L614540373 DOI 10.1016/j.ejso.2016.02.077 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2016.02.077 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 196 TITLE Are National ABS/BAPRAS targets being met in the North West of England in implant based breast reconstruction? AUTHOR NAMES Mastan S. Teasdale R.L. Rowland M.P. Kandola S.K. Henderson J.R. Kirwan C.C. Harvey J.R. AUTHOR ADDRESSES (Teasdale R.L.; Rowland M.P.; Kandola S.K.; Henderson J.R.) North West Breast Trainees Research Collaborative, North West, United Kingdom. (Kirwan C.C.; Harvey J.R.) University Hospital of South Manchester, Manchester, United Kingdom. (Teasdale R.L.; Rowland M.P.) Pennine Acute NHS Trust, Manchester, United Kingdom. (Mastan S.) Wrightington,Wigan and Leigh NHS Trust, Wigan, United Kingdom. (Kirwan C.C.; Harvey J.R.) Institute of Cancer, University of Manchester, Manchester, United Kingdom. (Henderson J.R.) Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom. (Kandola S.K.) Lancashire Teaching Hospitals NHS Trust, Preston, United Kingdom. CORRESPONDENCE ADDRESS S. Mastan, Wrightington,Wigan and Leigh NHS Trust, Wigan, United Kingdom. SOURCE European Journal of Surgical Oncology (2016) 42:5 (S42). Date of Publication: 1 May 2016 CONFERENCE NAME Association of Breast Surgery Conference, ABS 2016 CONFERENCE LOCATION Manchester, United Kingdom CONFERENCE DATE 2016-05-16 to 2016-05-17 ISSN 1532-2157 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Surgeons take precautions to prevent post-operative complications, however a recent covert surveillance audit of infection prophylaxis in implant surgery highlighted high inter-surgeon and intrasurgeon variability in practice. We assessed rates of post-operative infection, unplanned return to theatre, readmission and implant loss at three months with a multi-centre study in North West England to compare with the quality criteria set in ABS/BAPRAS Oncoplastic Breast Reconstruction Guidelines for Best Practice. Methods: A retrospective review of implant based reconstructions, in 5 centres, between 01/01/12 and 31/12/12 was performed. Unplanned readmission, return to theatre, infection and implant loss at three months were assessed. Results: 191 patients underwent implant based breast reconstruction. 58 (30%) pedicle flap, 16 (8%) dermal sling, 48 (25%) ADM and 68 (36%) implant alone. Complication rates are largely comparable to Best Practice guidelines (table 1), however infection rates (determined by reference to clinical signs of infection or further use of antibiotics) are high at 29 (15%). Conclusion: Although our sample size is relatively small, the standard set in the ABS/BAPRAS guidelines for implant loss appears achievable in unselected breast units. The high infection rate undoubtedly reflects our broad definition of infection and retrospectively collected data, however this represents an area where improvement is required. Standardising practice with an evidenced-based 'Theatre Infection Checklist' to ensure best practice recommendations are followed may improve outcomes. (Table Presented). EMTREE DRUG INDEX TERMS antibiotic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction England implant EMTREE MEDICAL INDEX TERMS checklist clinical trial consensus development controlled clinical trial controlled study dermis graft failure hospital readmission human infection rate major clinical study multicenter study pedicled skin flap postoperative infection retrospective study sample size LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L614540657 DOI 10.1016/j.ejso.2016.02.165 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2016.02.165 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 197 TITLE Two-stage implant-based breast reconstruction is safer than immediate one-stage implant-based breast reconstruction augmented with an a cellular dermal matrix: A multicentre randomized controlled trial AUTHOR NAMES Dikmans R. Negenborn V. Bouman M.B. Hay W. Twisk J. Ruhé Q. Mureau M. Smit J.M. Tuinder S. Eltahir Y. Posch N. Meesters-Caberg M. Ritt M. Mullender M. AUTHOR ADDRESSES (Dikmans R.; Negenborn V.; Bouman M.B.; Hay W.; Ritt M.; Mullender M.) VU University Medical Center, Plastic- Reconstructive and Hand Surgery, Amsterdam, Netherlands. (Twisk J.) VU University Medical Center, Department of Epidemiology and Biostatistics, Amsterdam, Netherlands. (Ruhé Q.) Meander Medical Centre, Plastic- Reconstructive and Hand Surgery, Amersfoort, Netherlands. (Mureau M.) Erasmus MC Cancer Institute, Plastic- Reconstructive and Hand Surgery, Rotterdam, Netherlands. (Smit J.M.) Alexander Monro Breast Cancer Hospital, Plastic- Reconstructive and Hand Surgery, Bilthoven, Netherlands. (Tuinder S.) Maastricht University Medical Centre, Plastic- Reconstructive and Hand Surgery, Maastricht, Netherlands. (Eltahir Y.) University Medical Centre Groningen, Plastic- Reconstructive and Hand Surgery, Groningen, Netherlands. (Posch N.) Haga Ziekenhuis, Plastic- Reconstructive and Hand Surgery, The Hague, Netherlands. (Meesters-Caberg M.) Orbis Medical Centre, Plastic- Reconstructive and Hand Surgery, Sittard, Netherlands. CORRESPONDENCE ADDRESS R. Dikmans, VU University Medical Center, Plastic- Reconstructive and Hand Surgery, Amsterdam, Netherlands. SOURCE European Journal of Cancer (2016) 57 SUPPL. 2 (S3). Date of Publication: April 2016 CONFERENCE NAME 10th European Breast Cancer Conference, EBCC-10 CONFERENCE LOCATION Amsterdam, Netherlands CONFERENCE DATE 2016-03-09 to 2016-03-11 ISSN 0959-8049 BOOK PUBLISHER Elsevier Ltd ABSTRACT Background: The evidence justifying the use of acellular dermal matrices (ADMs) in implant-based breast reconstruction (IBBR) is limited. The aim of this prospective randomized trial was to compare the outcomes of direct IBBR augmented with an ADM (Strattice™, LifeCell Cooperation) with those of two-stage IBBR. We report on the first results on the safety outcomes of the two procedures. Material and Methods: A non-blinded randomized controlled trial was conducted at eight hospitals in the Netherlands. Patients who intended to undergo skin-sparing mastectomy and immediate IBBR were randomized to one of two procedures for IBBR: one-stage ADM-assisted IBBR or two-stage IBBR. The primary endpoint was quality of life. In the present article, we assessed the effect of the procedure on the occurrence of adverse outcomes. Analyses were performed with logistic regression and the general linear model. The trial is registered in the Dutch National Trial Register (NTR TC 5446) and the public CCMO register in the Netherlands (NL41125.029.12). The inclusion of patients is completed. Results: Between April 14, 2013, and May 29, 2015, 140 patients were enrolled in the study. Eventually, 59 patients (91 breasts) in the one stage IBBR group and 59 (87 breasts) in the two-stage IBBR group were included for analysis. The overall medical complication rates (38.5% vs 10.3%, OR = 6.28, p = 0.001), the medical re-operation rates (32.6% vs 9.6%, OR = 3.96, p = 0.009) and the implant explantation rates (27.0% vs 2.4%, OR = 15.17, p = 0.001) were significantly higher in the one-stage group. This remained the case after controlling for multiple confounding factors (p < 0.001). Conclusions: Immediate one-stage ADM-assisted IBBR was associated with a significantly higher rate of post-operative complications compared with two-stage IBBR. There was no evidence of adverse tissue reactions to the ADM itself. These results indicate that immediate one-stage ADM-assisted IBBR should be considered very carefully. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer breast reconstruction European human implant randomized controlled trial EMTREE MEDICAL INDEX TERMS acellular dermal matrix adverse outcome breast explant hospital logistic regression analysis mastectomy Netherlands patient postoperative complication procedures quality of life register safety skin statistical model surgical mesh tissue reaction LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72220505 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 198 TITLE Outcome of 529 cases of sling-assisted implant-based breast reconstruction AUTHOR NAMES Barber M. AUTHOR ADDRESSES (Barber M.) Western General Hospital, Edinburgh Breast Unit, Edinburgh, United Kingdom. CORRESPONDENCE ADDRESS M. Barber, Western General Hospital, Edinburgh Breast Unit, Edinburgh, United Kingdom. SOURCE European Journal of Cancer (2016) 57 SUPPL. 2 (S59). Date of Publication: April 2016 CONFERENCE NAME 10th European Breast Cancer Conference, EBCC-10 CONFERENCE LOCATION Amsterdam, Netherlands CONFERENCE DATE 2016-03-09 to 2016-03-11 ISSN 0959-8049 BOOK PUBLISHER Elsevier Ltd ABSTRACT Background: The use of extrinsic slings to assist implant-based breast reconstruction has revolutionised this technique. It offers the possibility of a one-stage procedure and is felt to have benefits on cosmetic result, however, there are concerns over outcome. Materials and Methods: All cases where an extrinsic sling was used in a breast reconstructive procedure in Edinburgh, Scotland, UK from initial use on 7/7/2008 to 31/6/2015 were reviewed. Statistical analysis was performed using chi square and t tests. Results: Median follow up was 759 days (range 16-2197). 529 sheets of sling material (220 Strattice®, 184 Veritas®, 72 Permacol®, 34 TiLoop® and 18 with 3 other materials) were used in 505 breasts of 338 patients. The sling material used has changed over time. 41.6% of mastectomies were performed for primary cancer, 13.2% for DCIS, 4.3% for recurrence and 40.8% for risk reduction. 87% of procedures were primary reconstructions, 10.4% were salvage procedures following previous reconstruction and 2.6% were delayed reconstructions. 65.4% used a fixed volume implant at first procedure. 9 patients have had locoregional recurrence, 12 metastatic recurrence and 6 have died. Ninety-six reconstructions were lost (18.1%). Loss rate was 9.2% at 3 months and 13.8% at 6 months. 18 of 74 patients (24.3%) requiring adjuvant therapy had this delayed due to reconstructive problems. 59 of 182 patients (32.4%) having unilateral surgery have undergone contralateral symmetrisation. Patients underwent a mean of 1.4 further operations (0-9) on the affected breast. Implant loss varied significantly with smoking (34.1% loss in smokers vs 11.8% in non-smokers, p < 0.0001) and with use of radiotherapy (27.3% loss with radiotherapy vs 15.1% without, p = 0.0021). There was no statistically significant variation with operating surgeon, type of sling used, breast weight, patient weight, nipple preservation, associated axillary surgery or chemotherapy use. Long term loss rate in non-smokers who did not receive radiotherapy was 9.7%. There was no evidence of an improvement in results over time. Conclusions: While offering potential cosmetic and financial benefits, sling-assisted implant breast reconstruction has a significant rate of reconstruction loss, need for further surgery and delay in adjuvant therapy. These should be important considerations for patient selection and consent. EMTREE DRUG INDEX TERMS cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer breast reconstruction European implant EMTREE MEDICAL INDEX TERMS adjuvant therapy breast chemotherapy follow up human intraductal carcinoma mastectomy nipple patient patient selection preservation primary tumor procedures radiotherapy risk reduction salvage therapy smoking statistical analysis Student t test surgeon surgery surgical mesh United Kingdom weight LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72220653 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 199 TITLE Nipple-areola complex reconstruction techniques: A literature review AUTHOR NAMES Sisti A. Grimaldi L. Tassinari J. Cuomo R. Fortezza L. Bocchiotti M.A. Roviello F. D'Aniello C. Nisi G. AUTHOR ADDRESSES (Sisti A., asisti6@gmail.com; Grimaldi L.; Tassinari J.; Cuomo R.; Fortezza L.; D'Aniello C.; Nisi G.) Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy. (Bocchiotti M.A.) Department of Plastic Surgery, University of Turin, San Giovanni Battista Hospital, Turin, Italy. (Roviello F.) Oncologic Surgery, General and Specialist Surgery Department, University of Siena, Siena, Italy. CORRESPONDENCE ADDRESS A. Sisti, Plastic Surgery Division, General and Specialist Surgery Department, University of Siena, Siena, Italy. Email: asisti6@gmail.com SOURCE European Journal of Surgical Oncology (2016) 42:4 (441-465). Date of Publication: 1 Apr 2016 ISSN 1532-2157 (electronic) 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Many techniques for nipple-areola complex (NAC) reconstruction are described. Clarity is required on the currently available options. Since a complete list of all the techniques described until now is not available, a possibly comprehensive literature overview was carried out from 75 papers (years 1946-2015). The local flap was the most frequently described technique for the nipple reconstruction with no significant difference in complications' rate among the various types of techniques. Complications in nipple reconstruction were 46.9% after graft, 7.9% after local flap, and 5.3% in case of flaps with autologous graft/alloplastic/allograft augmentation, while complications in areola reconstruction were 10.1% after graft, and 1.6% after areola tattoo. Flaps appear to be more reliable than grafts in nipple reconstruction, while tattoo is thought to be safer than graft in areola reconstruction. The loss of projection, although considerable (45%-75%), had not significant impact on patients' satisfaction. Due to contraction, overcorrection of 25-50% of the desired result is advisory when adopting local flaps, in order to prevent loss of projection. The use of flaps with autologous graft/alloplastic/allograft augmentation (cartilage, fat, calcium hydroxylapatite, acellular dermal matrix, polymethylmethacrylate, biologic collagen) showed a minor loss of nipple projection but may expose to a relative increased number of postoperative flap necrosis. EMTREE DRUG INDEX TERMS collagen fat hydroxyapatite poly(methyl methacrylate) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) breast reconstruction nipple areola complex reconstruction surgical technique EMTREE MEDICAL INDEX TERMS acellular dermal matrix allograft autograft breast augmentation cartilage graft composite skin graft conservative treatment depigmentation (complication) follow up graft necrosis (complication) human patient satisfaction postoperative complication (complication) postoperative infection (complication) postoperative pain (complication) priority journal review sensory dysfunction (complication) skin ischemia (complication) skin scar (complication) swelling (complication) tattooing wound dehiscence (complication) CAS REGISTRY NUMBERS collagen (9007-34-5) hydroxyapatite (1306-06-5, 51198-94-8) poly(methyl methacrylate) (39320-98-4, 9008-29-1) EMBASE CLASSIFICATIONS Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160127093 MEDLINE PMID 26868167 (http://www.ncbi.nlm.nih.gov/pubmed/26868167) PUI L608328730 DOI 10.1016/j.ejso.2016.01.003 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2016.01.003 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 200 TITLE Seroma in Prosthetic Breast Reconstruction AUTHOR NAMES Jordan S.W. Khavanin N. Kim J.Y. AUTHOR ADDRESSES (Jordan S.W.; Khavanin N.; Kim J.Y.) Chicago, Ill. From the Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine SOURCE Plastic and reconstructive surgery (2016) 137:4 (1104-1116). Date of Publication: 1 Apr 2016 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Seroma, as a complication of prosthetic breast reconstruction, results in patient distress, increased office visits, undesirable aesthetic outcomes, and--importantly--may escalate to infection and frank prosthesis loss. Herein, the authors review the pathophysiology and risk factors and attempt to collate published practices for avoidance and management of seroma.METHODS: A systematic literature review was performed using MEDLINE, Web of Science, Embase, and Cochrane Library for studies published between 2000 and January of 2015. Random-effects meta-analysis was used to estimate the overall pooled incidence of seroma and to examine the effect of drain number and acellular dermal matrix use.RESULTS: Seventy-two relevant primary articles and three systematic reviews were identified. Fifty-one citations met inclusion criteria, including two randomized controlled trials. The overall pooled incidence was 5.4 percent (95 percent CI, 4.1 to 6.7 percent). Obesity, acellular dermal matrix, and preoperative irradiation were cited risk factors. Pooled relative risk for acellular dermal matrix was 1.83 (95 percent CI, 1.28 to 2.62). Drain practices were collated from 34 articles.CONCLUSIONS: Seromas following prosthetic breast reconstruction are complicated by the hypovascular, proinflammatory milieu of the mastectomy skin flap, the geometrically complex dead space, and the presence of a foreign body with potential contamination and biofilm. There is reasonable evidence to suggest that these factors contribute to a progression of seroma to infection and prosthesis loss. These findings have motivated this summary article on current practice guidelines and strategies to prevent and treat seromas.Risk, II. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation EMTREE MEDICAL INDEX TERMS female human incidence meta analysis pathophysiology postoperative complication (epidemiology, etiology, prevention) risk factor seroma (epidemiology, etiology, prevention) statistical model LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 27018665 (http://www.ncbi.nlm.nih.gov/pubmed/27018665) PUI L611608984 DOI 10.1097/01.prs.0000481102.24444.72 FULL TEXT LINK http://dx.doi.org/10.1097/01.prs.0000481102.24444.72 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 201 TITLE Current Trends and Controversies in Breast Augmentation AUTHOR NAMES Hidalgo D.A. Sinno S. AUTHOR ADDRESSES (Hidalgo D.A.; Sinno S.) New York, N.Y. From the Division of Plastic Surgery, Weill Cornell Medical College; and the Department of Plastic Surgery, New York University Medical Center SOURCE Plastic and reconstructive surgery (2016) 137:4 (1142-1150). Date of Publication: 1 Apr 2016 ISSN 1529-4242 (electronic) ABSTRACT RESULTS: There were 1067 respondents. Fifty percent of surgeons never use anatomically shaped implants and another 42 percent do so less than half the time. Autologous fat is used infrequently as a primary technique but more often as a supplemental technique. Approximately 7 percent report a case of anaplastic large cell lymphoma. Eighty-five percent do not use preoperative three-dimensional imaging. More than half of surgeons use acellular dermal matrix in secondary procedures. Approximately half do not use insertion funnels. Preoperative sizing with silicone implants, inframammary incisions, partial submuscular pockets, and smooth silicone implants larger than 300 cc are dominant practice preferences. Postoperative massage is still popular with over half of respondents. Just over half do not use pharmacologic agents for capsular contracture. Capsular contracture and size change were the most frequent reasons for reoperation. Capsular contracture is typically treated with anterior capsulectomy the first time, and either total capsulectomy or anterior capsulectomy with acellular dermal matrix use when recurrent. Almost half of respondents perform fewer than 50 breast augmentations yearly.CONCLUSIONS: There is an established most common approach to breast augmentation among respondents. Most surgeons are slow to embrace controversial practices and to adopt new technologies, although acellular dermal matrix use is becoming more popular. The 7 percent incidence of anaplastic large cell lymphoma was noteworthy.BACKGROUND: A survey was conducted to study current attitudes and common practices in breast augmentation.METHODS: A 35-item electronic questionnaire was sent to the entire active American Society of Plastic Surgeons membership. It was divided into current controversies, new technologies, common practices, secondary procedures, and member demographics. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) health personnel attitude trends EMTREE MEDICAL INDEX TERMS breast reconstruction clinical practice conflict devices female human perioperative period procedures statistics and numerical data United States LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 27018669 (http://www.ncbi.nlm.nih.gov/pubmed/27018669) PUI L611609069 DOI 10.1097/01.prs.0000481110.31939.e4 FULL TEXT LINK http://dx.doi.org/10.1097/01.prs.0000481110.31939.e4 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 202 TITLE The effects of enteral glutamine on radiotherapy induced dermatitis in breast cancer AUTHOR NAMES Eda K. Uzer K. Murat T. Cenk U. AUTHOR ADDRESSES (Eda K., ekucuktulu@yahoo.com) Kanuni Research and Training Hospital, Dept of Radiation Oncology, Trabzon, Turkey. (Uzer K.) Kanuni Research and Training Hospital, Dept of General Surgery, Trabzon, Turkey. (Murat T.) Karadeniz Technical University Medical School, Department of Public Health, Trabzon, Turkey. (Cenk U.) 9 Eylul University Medical School, Department of Radiation Oncology, Izmir, Turkey. CORRESPONDENCE ADDRESS K. Eda, Kanuni Research and Training Hospital, Dept of Radiation Oncology, Trabzon, Turkey. Email: ekucuktulu@yahoo.com SOURCE Clinical Nutrition (2016) 35:2 (436-439). Date of Publication: 1 Apr 2016 ISSN 1532-1983 (electronic) 0261-5614 BOOK PUBLISHER Churchill Livingstone ABSTRACT Purpose: Radiotherapy is a critical component of breast cancer treatment. Many skin reactions ranging from erythema to moist desquamation and ulceration can be induced by high dose external beam radiotherapy. There is no golden standard for treating radiation dermatitis. Glutamine is an amino acid which improved wound healing through its anabolic effects and improvements in wound matrix formation in burn patients. We designed a study to show effects of glutamine in radiation induced dermatitis. Material and method: Forty patients who received radiotherapy for breast cancer were randomized into 2 groups. In group 1 the patients were treated with 15 gr of enteral glutamine whereas the patients in group 2 were treated with placebo. The radiation induced skin reactions were evaluated in both groups. Results: In glutamine treated group 88, 9% of patients developed grade I toxicity comparing to 80% of patients in placebo group developed grade II toxicity. This difference between the groups was statistically significant. (p < 0.001). Conclusion: Enteral glutamine minimizes radiation induced dermatitis. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) glutamine (adverse drug reaction, clinical trial, drug comparison - placebo, drug therapy, intravenous drug administration) EMTREE DRUG INDEX TERMS antineoplastic agent (drug therapy) placebo EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast carcinoma (drug therapy, drug therapy, radiotherapy, surgery) cancer radiotherapy radiation dermatitis (drug therapy, complication, drug therapy) EMTREE MEDICAL INDEX TERMS absence of side effects (side effect) adult article clinical article controlled study double blind procedure human mastectomy middle aged partial mastectomy randomized controlled trial CAS REGISTRY NUMBERS glutamine (56-85-9, 6899-04-3) EMBASE CLASSIFICATIONS Dermatology and Venereology (13) Radiology (14) Cancer (16) Drug Literature Index (37) Adverse Reactions Titles (38) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015903109 MEDLINE PMID 25869479 (http://www.ncbi.nlm.nih.gov/pubmed/25869479) PUI L603632001 DOI 10.1016/j.clnu.2015.03.009 FULL TEXT LINK http://dx.doi.org/10.1016/j.clnu.2015.03.009 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 203 TITLE Mesh- and matrix-supported implant reconstruction ORIGINAL (NON-ENGLISH) TITLE Netz- und matrixgestützte Implantatrekonstruktion AUTHOR NAMES Nestle-Krämling C. Thill M. AUTHOR ADDRESSES (Nestle-Krämling C., carolin.nestle-kraemling@sana.de) Sana Kliniken Düsseldorf-Gerresheim, Gräulingerstr. 120, Düsseldorf, Germany. (Thill M.) Klinik für Gynäkologie und Geburtshilfe, Agaplesion Markus Krankenhaus, Frankfurt/Main, Germany. CORRESPONDENCE ADDRESS C. Nestle-Krämling, Sana Kliniken Düsseldorf-Gerresheim, Gräulingerstr. 120, Düsseldorf, Germany. Email: carolin.nestle-kraemling@sana.de SOURCE Gynakologe (2016) 49:3 (166-172). Date of Publication: 1 Mar 2016 ISSN 1433-0393 (electronic) 0017-5994 BOOK PUBLISHER Springer Verlag, service@springer.de ABSTRACT During the past decades, the technique of implant-based reconstructive breast surgery has continually developed. These changes are based on the innovative oncologic techniques of skin- (SSM) and nipple-sparing mastectomy (NSM), in combination with new materials such as synthetic meshes (SM) and acellular dermal matrices (ADM). The aim is immediate complete implant coverage and stabilization of the implant site—cranially by the mobilized pectoralis major muscle, and caudally using mesh or ADM attached to the muscle—with simultaneous stabilization of the implant. This approach reliably achieves a superior cosmetic result than standard techniques without mesh or ADM support. Furthermore, additional muscle preparations from the serratus anterior or even the latissimus dorsi for implant coverage can be avoided. The surgical techniques of mesh- and ADM-supported implant reconstruction are demanding, not yet standardized, and associated with a remarkable learning curve. There are a steadily growing number of new medical products including SMs and ADMs, which are often introduced into clinical application without significant scientific evidence or prior clinical trials. The web-based implant and mesh register of the German Working Group of Esthetic, Plastic and Reconstructive Surgery in Gynecology (AWOgyn), in which more than 110 breast surgeons document their cases, enables ongoing evaluation of the impact of these innovative materials. The specific indications for established or innovative mesh or ADM materials represent a field of active discussion, exchange of experiences, and clinical research. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) implant surgical mesh EMTREE MEDICAL INDEX TERMS article EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE German LANGUAGE OF SUMMARY English, German EMBASE ACCESSION NUMBER 20160109718 PUI L608199532 DOI 10.1007/s00129-015-3827-4 FULL TEXT LINK http://dx.doi.org/10.1007/s00129-015-3827-4 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 204 TITLE Revisiting the Management of Capsular Contracture in Breast Augmentation: A Systematic Review AUTHOR NAMES Wan D. Rohrich R.J. AUTHOR ADDRESSES (Wan D.; Rohrich R.J.) Dallas, Texas From the Department of Plastic Surgery, University of Texas Southwestern Medical Center SOURCE Plastic and reconstructive surgery (2016) 137:3 (826-841). Date of Publication: 1 Mar 2016 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Capsular contracture is a complication of breast augmentation that frequently requires revision surgery. "Capsulectomy, site change, and implant exchange" has been referred to as the gold standard treatment of clinically significant contractures. However, the actual clinical evidence behind this algorithm remains elusive at best. A systematic review of the literature was performed to clarify the true evidence behind the surgical management of capsular contracture.METHODS: A search of the MEDLINE database was performed for clinical studies involving the surgical treatment of capsular contracture following breast augmentation. Resulting articles were reviewed using a priori criteria.RESULTS: The systematic review was performed in April of 2015. The primary search for "breast augmentation" yielded 9490 articles. When filtered for "treatment of capsular contracture," 461 articles resulted. Review of these articles and pertinent references using a priori criteria yielded 24 final articles. No controlled trials met final inclusion criteria.CONCLUSIONS: There is limited clinical evidence behind the surgical management of capsular contracture. Site change and implant exchange are associated with reduced contracture recurrence rates and likely play a beneficial role in treating capsular contracture. The data on capsulectomy are less conclusive. Acellular dermal matrix may be a useful adjunct but still requires long-term data. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix adverse effects EMTREE MEDICAL INDEX TERMS breast implant breast reconstruction esthetics female follow up human implant capsular contracture (surgery) physiology procedures prosthesis complication reoperation risk assessment skin transplantation treatment outcome wound healing LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26910663 (http://www.ncbi.nlm.nih.gov/pubmed/26910663) PUI L611138977 DOI 10.1097/01.prs.0000480095.23356.ae FULL TEXT LINK http://dx.doi.org/10.1097/01.prs.0000480095.23356.ae COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 205 TITLE Evolving trends in breast surgery: Oncoplastic to onco-aesthetic surgery AUTHOR NAMES Carmichael A.R. Mokbel K. AUTHOR ADDRESSES (Carmichael A.R., amtulcarmichael@googlemail.com; Mokbel K.) The London Breast Institute, The Princess Grace Hospital, London, United Kingdom. CORRESPONDENCE ADDRESS A.R. Carmichael, The London Breast Institute, The Princess Grace Hospital, 42-52 Nottingham Place, London, United Kingdom. Email: amtulcarmichael@googlemail.com SOURCE Archives of Plastic Surgery (2016) 43:2 (222-223). Date of Publication: 1 Mar 2016 ISSN 2234-6171 (electronic) 2234-6163 BOOK PUBLISHER Korean Society of Plastic and Reconstructive Surgeons, 1355-3 Seocho-Dong, Seocho-Gu, Seoul, South Korea. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast surgery onco aesthetic surgery oncoplastic surgery EMTREE MEDICAL INDEX TERMS acellular dermal matrix article breast cancer breast implant breast reconstruction cancer radiotherapy cancer survival comorbidity human EMBASE CLASSIFICATIONS Cancer (16) Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20160251304 PUI L609295501 DOI 10.5999/aps.2016.43.2.222 FULL TEXT LINK http://dx.doi.org/10.5999/aps.2016.43.2.222 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 206 TITLE A head to head comparison between SurgiMend® - Fetal bovine acellular dermal matrix and Epiflex® - Decellularized human skin tissue in breast reconstruction in 127 cases AUTHOR NAMES Eichler C. Vogt N. Brunnert K. Sauerwald A. Puppe J. Warm M. AUTHOR ADDRESSES (Eichler C.; Vogt N.; Brunnert K.; Sauerwald A.; Puppe J.; Warm M.) Breast Center, Municipal Hospital Holweide, Cologne, NRW, Germany; Municipal Hospital Holweide, Cologne, NRW, Germany; Clinic for Senology, Osnarbrueck, Germany; Hospital Düren GmbH, Dueren, NRW, Germany; University of Cologne, Cologne, NRW, Germany CORRESPONDENCE ADDRESS C. Eichler, SOURCE Cancer Research (2016) 76:4 SUPPL. 1. Date of Publication: 15 Feb 2016 CONFERENCE NAME 38th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2015-12-08 to 2015-12-12 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Introduction: The use of acellular dermal matrices (ADM) has become a widely used option in breast reconstruction. A great deal of literature is available, totaling over 2400 ADM reconstructions. Nonetheless, head to head comparisons between SurgiMend® and Epiflex® are not yet reported. In fact, this is the first clinical data report on the use of Epiflex®. This work will therefore compare postoperative complication rates and costs for these ADMs. Methods: This analysis is a retrospective review of a single surgeon's 6-year experience with both SurgiMend® - an acellular bovine dermal collagen matrix for soft-tissue reconstruction and Epiflex® - a decellularized human skin tissue from 2008 to 2013. Results: One hundred patients had a total of 127 implant based reconstructions using SurgiMend® (64 cases; 50.4 %) or Epiflex® (63 cases; 49.6%). Gross complication rates were 11.1 % for SurgiMend® and 40.6 % for Epiflex® including hematoma, postoperative skin irritation, infection, necrosis and revision surgery. The most common complication was postoperative red breast syndrome . Severe complications requiring revision surgery were significantly increased in patients treated with Epiflex® (12.5 %) compared to SurgiMend® (4.8 %). Conclusions: This retrospective analysis favors the use of SurgiMend® over Epiflex® due to significantly lower gross complication rates. Severe complication rates are comparable to those reported in literature for both products. Although results promote the use of SurgiMend®, the single surgeon, retrospective nature of this work limits its clinical impact. EMTREE DRUG INDEX TERMS collagen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast cancer breast reconstruction human skin skin allograft tissues EMTREE MEDICAL INDEX TERMS breast clinical study hematoma implant infection necrosis patient postoperative complication skin irritation soft tissue surgeon surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72247829 DOI 10.1158/1538-7445.SABCS15-P2-13-05 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS15-P2-13-05 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 207 TITLE Clinical outcome and patient satisfaction with the use of bovine-derived acellular dermal matrix (SurgiMendTM) in implant-based immediate reconstruction following skin sparing mastectomy: A prospective observational study AUTHOR NAMES Wazir U. Kasem A. Headon H. Choy C. Manson A. Heeney J. Mead O. Mokbel K. AUTHOR ADDRESSES (Wazir U.; Kasem A.; Headon H.; Choy C.; Manson A.; Heeney J.; Mead O.; Mokbel K.) London Breast Institute, London, United Kingdom. CORRESPONDENCE ADDRESS U. Wazir, London Breast Institute, London, United Kingdom. SOURCE Cancer Research (2016) 76:4 SUPPL. 1. Date of Publication: 15 Feb 2016 CONFERENCE NAME 38th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2015-12-08 to 2015-12-12 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT The advent of acellular dermal matrix devices (ADMs) has facilitated immediate breast reconstruction (IBR) with mammary implants following skin sparing mastectomy (SSM) for breast cancer treatment or risk reduction. This is a prospective observational single institution study of 118 consecutive patients undergoing a total of 164 SSM and IBR procedures using an implant and bovine-derived ADM (SurgiMend) for breast cancer or risk reduction purposes during 2012-2014. The primary endpoint was the explantation rate and secondary endpoints included patient quality of life, patient satisfaction, objective assessment of aesthetic outcome, surgical complications, recurrence and mortality. The mean age of the patients was 50.1 years (median age of 48, range of 27-78). Median follow up time was 21 months (mean of 21.4 months, range of 2-40 months). 46 patients had a bilateral SSM and IBR, 5 of whom had bilateral breast cancer and 3 for risk reduction due to a significant genetic mutation. The remaining 37 patients had unilateral breast cancer and a contralateral risk reducing mastectomy. 27 (37.5%) of the 72 patients who had unilateral SSM underwent contralateral adjustment procedures to optimise symmetry, including 9 augmentation mammoplasty, 12 mastopexy and 4 reduction mammaplasty procedures and 2 combined augmentation-mastopexies. 61 patients (51.7%) received chemotherapy, 5 of whom had primary systemic therapy prior to surgery. 32 (27.1%) patients received radiotherapy (10 patients had prior radiotherapy and 22 patients had post mastectomy radiation: PMR). Those with ER positive disease received hormonal therapy. Those with Her2 positivity received Herceptin +/- Pertuzumab. Over the study period, 2 implants had to be removed resulting in an explantation rate of 1.2%. Overall, wound complications were observed in 6 (3.7%) cases. There were 2 cases of local recurrence (1.7%), one distant recurrence (0.8%) and one patient died of metastatic breast cancer (0.8%). Overall survival was 99.2% and locoregional disease free survival (LRFS) was 98.3%. One patient (0.8%) developed a mild inflammatory reaction secondary to the underlying mesh. Wound complications were observed in 3 other patients (2 haematomas and wound dehiscence/persistent seroma requiring implant replacement). Patient satisfaction with the procedure was very high. The mean Breast Q Score was 85 and mean overall patient satisfaction was 9 out of a possible 10. The mean objective assessment score was 8.9 out of a possible 10 and the mean subjective capsular contracture severity score was 2.9 out of 10. In patients undergoing reoperations, the incorporation rate of the mesh was found to be very high almost approaching 95%. SurgiMendTM is an effective adjunct to IBR using implants following SSM for breast cancer or risk reduction, with a very low rate of implant loss and a high level of patient satisfaction. Furthermore, this ADM seems to incorporate readily and is associated with a very low incidence of inflammatory reactions. Neither prior radiotherapy nor PMR radiation represents a contraindication to its use. EMTREE DRUG INDEX TERMS pertuzumab trastuzumab EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast cancer human implant mastectomy observational study patient satisfaction skin EMTREE MEDICAL INDEX TERMS breast breast augmentation breast reconstruction breast reduction cancer therapy chemotherapy contracture devices disease free survival explant follow up hormonal therapy inflammation metastatic breast cancer mortality mutation overall survival patient patient history of radiotherapy postoperative complication procedures quality of life radiation radiotherapy risk risk reduction seroma surgery systemic therapy wound wound complication LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72247828 DOI 10.1158/1538-7445.SABCS15-P2-13-04 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS15-P2-13-04 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 208 TITLE Acellular dermal allograft fenestrations decrease outpatient expander fills and increase direct to implant incidence in implant-based immediate breast reconstruction AUTHOR NAMES Daar D.A. Bourgeois J.M. Mowlds D.S. Wirth G.A. Paydar K.Z. AUTHOR ADDRESSES (Daar D.A.; Bourgeois J.M.; Mowlds D.S.; Wirth G.A.; Paydar K.Z.) University of California Irvine, Orange, United States. CORRESPONDENCE ADDRESS D.A. Daar, University of California Irvine, Orange, United States. SOURCE Cancer Research (2016) 76:4 SUPPL. 1. Date of Publication: 15 Feb 2016 CONFERENCE NAME 38th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2015-12-08 to 2015-12-12 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Introduction: The innovation of fenestrated allograft (acellular dermal matrix, ADM) has improved patient outcomes in two-stage tissue expander/implant breast reconstruction. This technical alteration utilizes optimal fenestration overlap and has enhanced the efficiency of the reconstructive experience. We present a follow-up study of one- and two-stage breast reconstruction with a more refined, standardized method of surgeon-designed fenestration of ADM. Methods: We conducted a retrospective review of 52 patients (91 breasts) having undergone one- and two-stage breast reconstruction using fenestrated ADM at our institution from 2013 to 2014. Results: Mean intra-operative fill volume (IOFV) measured 402cc (SD=118cc), and IOFV as a percent of tissue expander size averaged 79.1% (SD=16.7%). Ten breasts were expanded to 100% and completed reconstruction in one stage with implant placement. IOFV as a percentage of total fill volume at completion of expansion averaged 73.6% (SD=16.6%). Two-stage reconstruction patients underwent 1.8 post-operative expansions on average (range 0-4) and averaged 81.2cc (SD=29.3cc) per in-office expansion. Days to full expansion averaged 45.1 days, while days to exchange averaged 137.8 days (Table 1). Mean days to exchange between our first 24 breasts to complete reconstruction vs. our last 23 breasts to complete reconstruction differed significantly, with 205 ± 43.8 days vs. 137.7 ± 138.1 days, respectively (p=0.03). The major complication rate requiring re-operation within 30 days post-operatively was 11.0%. Four breasts experienced partial mastectomy flap necrosis requiring re-operation with implant salvage (4.4%). Six breasts (6.6%) underwent explantation due to: infection (three), flap necrosis (two), and patient preference (one) (Table 2). (Table Presented) Conclusion: Our fenestrated technique is demonstrated to increase intra-operative fill volume, decrease number of post-operative expansions and time to full expansion, and improve expansion rate with subjectively less pain. We believe our patients benefited from improved cosmetic outcomes with better shape, maintenance of breast footprint, and enhanced comfort due to the decreased number of intra-office fills and increased intra-operative expansion. EMTREE DRUG INDEX TERMS cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) allograft breast cancer breast reconstruction fenestration human implant outpatient EMTREE MEDICAL INDEX TERMS acellular dermal matrix breast comfort explant follow up graft necrosis infection pain partial mastectomy patient patient preference surgeon tissue expander tissues LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72247830 DOI 10.1158/1538-7445.SABCS15-P2-13-06 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS15-P2-13-06 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 209 TITLE Post-mastectomy breast reconstruction: Defining the effects of adjuvant treatment modalities on surgical outcomes AUTHOR NAMES Sbitany H. AUTHOR ADDRESSES (Sbitany H.) University of California, San Francisco, United States. CORRESPONDENCE ADDRESS H. Sbitany, University of California, San Francisco, United States. SOURCE Cancer Research (2016) 76:4 SUPPL. 1. Date of Publication: 15 Feb 2016 CONFERENCE NAME 38th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2015-12-08 to 2015-12-12 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Post-mastectomy breast reconstruction is routinely offered immediately at the time of mastectomy, and can be performed using prosthetic or autologous techniques. Successful surgical outcomes are routine with these procedures, but can be complicated when adjuvant treatment modalities for breast cancer are employed. The most common adjuvant treatments effecting outcomes in post-mastectomy breast reconstruction are radiation, chemotherapy/hormonal therapy, and axillary lymph node dissection. Adjuvant radiation therapy has been shown to increase the complication rate in prosthetic breast reconstruction, specifically with increased rates of implant infection (22%, p=0.0), full-thickness mastectomy skin necrosis (11.5%, p=.001), and expander/implant removal (17.7%, p=0.0). Such complication rates are improvements over earlier reports, likely due to altered incision placement in nipple sparing mastectomy to the periareolar area, waiting at least 6 months following radiation completion prior to implant exchange, and the use of acellular dermal matrices (shown on multivariate analysis to reduce explantation rates in setting of radiation). With autologous breast reconstruction, adjuvant radiation has been shown to increase rates of volume flap volume loss (19.75%, p=.0001), but not flap loss rates (1.23%, p=1). The use of adjuvant chemotherapy and hormonal therapy has not been shown to negatively impact outcomes in prosthetic breast reconstruction, to any statistically significant amount. This includes tamoxifen and herceptin therapy. Similarly, the use of hormonal therapy does not significantly effect overall outcomes in autologous breast reconstruction. The use of axillary lymph node dissection has been shown to have a significant negative impact on outcomes in prosthetic breast reconstruction, compared to sentinel lymph node biopsy. On multivariate analysis, axillary lymph node dissection increased rates of breast implant loss (RR 2.0, p=.021), relative to sentinel lymph node biopsy. This is due to the decreased lymphatic drainage of remaining breast tissue, and resultant increase in infection and implant loss. EMTREE DRUG INDEX TERMS adjuvant tamoxifen trastuzumab EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adjuvant therapy breast cancer breast reconstruction mastectomy EMTREE MEDICAL INDEX TERMS acellular dermal matrix adjuvant chemotherapy axillary lymph node breast breast implant explant graft failure hormonal therapy implant incision infection lymph node dissection lymphatic drainage multivariate analysis nipple procedures radiation radiotherapy sentinel lymph node biopsy skin necrosis therapy thickness LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72247380 DOI 10.1158/1538-7445.SABCS15-ES3-3 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS15-ES3-3 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 210 TITLE Outpatient mastectomy with reconstruction in a freestanding surgery center using multimodality opiod-sparing perioperative analgesia including liposomal bupivacaine AUTHOR NAMES Rock D.T. Jandik A.L. Wittenborn W.S. Fairfax K. Sandadi S. AUTHOR ADDRESSES (Rock D.T.; Jandik A.L.; Wittenborn W.S.; Fairfax K.; Sandadi S.) Regional Breast Care, Fort Myers, FL; Medical Anesthesia and Pain Management Consultants, Fort Myers, FL; Wittenborn Plastic Surgery, Fort Myers, FL; Lee Memorial Health System, Fort Myers, FL CORRESPONDENCE ADDRESS D.T. Rock, SOURCE Cancer Research (2016) 76:4 SUPPL. 1. Date of Publication: 15 Feb 2016 CONFERENCE NAME 38th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2015-12-08 to 2015-12-12 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT HYPOTHESIS: The introduction of effective non-narcotic analgesics and the long-acting local anesthetic bupivacaine liposome (Exparel) has resulted in improved postoperative pain control and decreased reliance on opioid analgesics that often have the undesirable adverse effects of sedation, nausea, respiratory depression, and dysphoria or confusion. This has resulted in shorter postoperative care unit stays, earlier return to normal activity, and improved patient satisfaction without sacrificing appropriate pain control. Based on a positive experience with these agents in the inpatient setting, we hypothesized that mastectomy with immediate implant-based reconstruction could be performed safely in a freestanding outpatient surgery center using a multimodality opioid-sparing analgesic regimen. METHOD: Over a 6 month period we performed unilateral or bilateral mastectomy with concurrent implant-based reconstruction on 20 patients. One patient had a unilateral mastectomy and 19 patients had bilateral mastectomy performed. Sixteen of the patients had nipple sparing mastectomy procedures. Reconstruction was performed with tissue expanders in 6 patients and as a single stage procedure with silicone gel implants in 14 patients. Acellular dermal matrix was used to support the implant in all but 1 patient. All patients were given gabapentin 600mg on the evening prior to and morning of surgery. Acetaminophen 1gm IV was given prior to induction of anesthesia in the preoperative area and again 6 hours later in the post anesthesia care unit. Ketorolac 30mg IV was given during the last half of the surgical procedure. All patients had general anesthesia with standard inhalational agents and IV fentanyl as needed. The retropectoral and serratus fascia were infiltrated with liposomal bupivacaine after surgical removal of the breast tissue, before reconstruction was started. The drain sites were also infiltrated with liposomal bupivacaine. Patients were discharged with prescriptions for gabapentin 300mg twice daily for 7 days followed by 300mg nightly for 7 days, carisoprodol 350mg every 6 hours as needed for muscle spasms, ibuprofen 800 mg every 8 hours for 5 days, hydrocodone/acetaminophen every 4 hours as needed for pain, and oral antibiotics of the surgeon's choice. RESULTS: All 20 patients completed their surgery and were discharged home after a brief stay in the postoperative care unit. No patient required readmission for pain control or any other complication in the perioperative period. No patient reported inadequate pain control. All patients were highly satisfied with their perioperative care as reported during postoperative follow-up phone calls the day after surgery and during their post-operative follow up visit. CONCLUSION: In our experience, outpatient mastectomy with reconstruction in a freestanding surgery center is safe and has a high degree of patient satisfaction when using a multimodality opioid-sparing analgesia regimen including liposomal bupivacaine. By avoiding opioid-related adverse effects, patients have a more rapid recovery, earlier return to activities of daily living, and therefore improved quality of life. Proper patient selection requires a multidisciplinary team approach for success. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) bupivacaine EMTREE DRUG INDEX TERMS analgesic agent antibiotic agent carisoprodol fentanyl gabapentin ibuprofen ketorolac local anesthetic agent narcotic analgesic agent opiate paracetamol silicone gel EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) analgesia breast cancer human mastectomy outpatient surgery EMTREE MEDICAL INDEX TERMS acellular dermal matrix adverse drug reaction ambulatory surgery anesthesia breast daily life activity dysphoria fascia follow up general anesthesia hospital patient hospital readmission implant inhalational drug administration muscle spasm nausea nipple pain patient patient satisfaction patient selection perioperative period postoperative care postoperative pain prescription procedures quality of life recovery room respiration depression sedation surgeon surgical technique tissue expander LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72247819 DOI 10.1158/1538-7445.SABCS15-P2-12-18 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS15-P2-12-18 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 211 TITLE Indications for nipple sparing mastectomy AUTHOR NAMES Petit J.-Y. AUTHOR ADDRESSES (Petit J.-Y.) Istituto Europeo Di Oncologia, Milano, Italy. CORRESPONDENCE ADDRESS J.-Y. Petit, Istituto Europeo Di Oncologia, Milano, Italy. SOURCE Cancer Research (2016) 76:4 SUPPL. 1. Date of Publication: 15 Feb 2016 CONFERENCE NAME 38th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2015-12-08 to 2015-12-12 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Indications for nipple sparing mastectomy Jean-Yves Petit (EIO - Milan) Benefit of the nipple areola complex (NAC) conservation has been shown (1,). To reduce the risk of local recurrences (LR), inclusion criteria and/or add localized radiation therapy have been proposed. The LR rate in patients receiving NSM is comparable with the rate in modified radical or skin-sparing mastectomies(2) Same conclusions have been raised in a study of one thousand NSM in Milan(3). LR were observed in 3 to 6% of patients at 5 years, consistent with traditional mastectomy. Today, the quality of the surgery allows for a more radical glandular removal in the retro areolar area. The significant risk factors associated with LR for the group of invasive carcinomas were grade, over expression/amplification of HER2/neu and breast cancer molecular subtype Luminal B. In the group of intra epithelial neoplasia the risk factors were age ( < 45 years), absence of estrogen receptors, grade, HER2/neu overexpression and high Ki-67(4). The quality of the duct resection in the nipple questions the role of the intra operative radiotherapy. J. Rusby demonstrated that although several ducts were originating from the base of the areola, most of them are concentrated in the axis of the nipple and concluded that a subtotal removal of the duct can be performed(5). We decided at the IEO to postpone the radiotherapy on the NAC to the cases with non radical cancer resection . Tips and trick will be shown to improve the quality of the NSM and the quality of the breast reconstruction. Indication of implant versus autologous flap reconstruction will be discussed as well as the use of ADM. The risk and the type of complications and specially nipple areola necrosis will be evaluated. EMTREE DRUG INDEX TERMS estrogen receptor EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer mastectomy nipple EMTREE MEDICAL INDEX TERMS breast areola breast reconstruction cancer surgery human implant invasive carcinoma necrosis neoplasm patient radiotherapy risk risk factor skin surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72247379 DOI 10.1158/1538-7445.SABCS15-ES3-2 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS15-ES3-2 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 212 TITLE Immediate breast reconstruction with anatomical implants following mastectomy: The radiation perspective AUTHOR NAMES Ben-David M. Granot H. Gelernter I. Scheflan M. AUTHOR ADDRESSES (Ben-David M., Merav.ben-david@sheba.health.gov.il; Granot H.) Radiation Oncology Unit, Chaim Sheba Medical Center, Ramat Gan, Israel. (Ben-David M., Merav.ben-david@sheba.health.gov.il) Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. (Gelernter I.) Statistical Laboratory, School of Mathematics, Tel Aviv University, Tel Aviv, Israel. (Scheflan M.) Department of Surgery, Assuta and Herzliya Medical Centers, Ramat Gan, Israel. CORRESPONDENCE ADDRESS M. Ben-David, Radiation Oncology Unit, Chaim Sheba Medical Center, 5 Mendes Street, Ramat Gan, Israel. Email: Merav.ben-david@sheba.health.gov.il SOURCE Medical Dosimetry (2016) 41:2 (142-147). Date of Publication: 2 Feb 2016 ISSN 1873-4022 (electronic) 0958-3947 BOOK PUBLISHER Elsevier Inc., usjcs@elsevier.com ABSTRACT Immediate implant-based breast reconstruction followed by postmastectomy radiation therapy (PMRT) is controversial because of the risk of compromised treatment plans and concerns regarding cosmetic outcomes. We evaluated the effects of immediate direct-to-implant breast reconstruction with anatomical implants on the quality of PMRT delivered by 3-dimensional conformal radiotherapy (3D-CRT). In this retrospective, single-institution study, patients who had undergone reconstruction with direct anatomic implant, performed by a single surgeon, received 3D-CRT between 2008 and 2013. For each patient, 2 plans (including or excluding internal mammary nodes [IMN]) were created and calculated. The primary end point was the dose distribution among reconstructed breasts, heart, lungs, and IMNs, and between right and left breasts. Of 29 consecutive patients, 11 received right-sided and 18 received left-sided PMRT to a total dose of 50 Gy. For plans excluding IMN coverage, mean D(mean) for right and left reconstructed breasts was 49.09 Gy (98.2% of the prescribed dose) and 48.51 Gy (97.0%), respectively. For plans including IMNs, mean D(mean) was 49.15 Gy (98.3%) for right and 48.46 Gy (96.9%) for left reconstructed breasts; the mean IMN D(mean) was 47.27 Gy (right) and 47.89 Gy (left). Heart D(mean) was below 1.56 Gy for all plans. Mean total lung volume receiving a dose of ≥ 20 Gy was 13.80% to 19.47%. PMRT can be delivered effectively and safely by 3D-CRT after direct-to-implant breast reconstruction with anatomical implants, even if patients require IMN treatment. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast implant breast reconstruction mastectomy EMTREE MEDICAL INDEX TERMS acellular dermal matrix article breast cancer (radiotherapy, surgery) clinical article computer assisted radiotherapy dosimetry human internal mammary lymph node postmastectomy radiation therapy priority journal radiation dose distribution radiotherapy planning system retrospective study treatment planning DEVICE TRADE NAMES Natrelle 410 , United StatesAllergan SurgiMend , United StatesTEI Varian Real-time Position Management , United StatesVarian DEVICE MANUFACTURERS (United States)Allergan (United States)TEI (United States)Varian EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160167397 MEDLINE PMID 26923467 (http://www.ncbi.nlm.nih.gov/pubmed/26923467) PUI L608663309 DOI 10.1016/j.meddos.2015.11.002 FULL TEXT LINK http://dx.doi.org/10.1016/j.meddos.2015.11.002 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 213 TITLE Updated Evidence of Acellular Dermal Matrix Use for Implant-Based Breast Reconstruction: A Meta-analysis AUTHOR NAMES Lee K.-T. Mun G.-H. AUTHOR ADDRESSES (Lee K.-T.; Mun G.-H., supramicro@gmail.com) Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. CORRESPONDENCE ADDRESS G.-H. Mun, Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. Email: supramicro@gmail.com SOURCE Annals of Surgical Oncology (2016) 23:2 (600-610). Date of Publication: 1 Feb 2016 ISSN 1534-4681 (electronic) 1068-9265 BOOK PUBLISHER Springer New York LLC, barbara.b.bertram@gsk.com ABSTRACT Background: Although the use of acellular dermal matrix (ADM) has increased exponentially, debates regarding its safety are still ongoing. There have been several meta-analyses; however, potential learning curve effects of using ADM might affect their outcomes. The present meta-analysis reappraised the potential benefits and risks of ADM on the outcome of implant-based breast reconstruction using recent publications. Methods: Electronic databases were searched to identify relevant studies comparing the outcome of ADM use with traditional submuscular technique, which were published from 2011 to 2014. The relative risks of postoperative complications and mean difference of expander dynamics between the two groups were computed. Results: A total of 23 studies representing 6199 cases were analyzed. There was one randomized controlled study and three prospective cohort studies. The use of ADM significantly elevated the risks of infection, seroma, and mastectomy flap necrosis, but did not affect the risks of implant loss, unplanned reoperation, and total complications. The risks of capsular contracture and implant malposition were significantly reduced by the application of ADM. The ADM allows for significantly greater intraoperative expansion and reduced frequency of injection to complete expansion. Conclusions: According to this meta-analysis, the increasing risks for serious complication and overall morbidity related to ADM use might not be remarkable, while its benefits for preventing late complications and improving expander dynamics might be appreciable. Although future well-controlled studies would be required, the implant-based breast reconstruction using ADM may be reliable and advantageous. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant breast reconstruction EMTREE MEDICAL INDEX TERMS article breast tissue expander graft necrosis (complication) human implant capsular contracture (complication) implant loss (complication) implant malposition (complication) mastectomy meta analysis meta analysis (topic) nonhuman outcome assessment postoperative complication (complication) postoperative infection (complication) randomized controlled trial (topic) reoperation seroma (complication) systematic review (topic) EMBASE CLASSIFICATIONS Dermatology and Venereology (13) Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015461424 MEDLINE PMID 26438439 (http://www.ncbi.nlm.nih.gov/pubmed/26438439) PUI L606537618 DOI 10.1245/s10434-015-4873-9 FULL TEXT LINK http://dx.doi.org/10.1245/s10434-015-4873-9 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 214 TITLE Aesthetic and oncologic outcomes after one-stage immediate breast reconstruction using a permanent biodimensional expandable implant AUTHOR NAMES Agusti A. Ward A. Montgomery C. Mohammed K. Gui G.P.H. AUTHOR ADDRESSES (Agusti A.; Ward A.; Montgomery C.; Mohammed K.; Gui G.P.H., gerald.gui@rmh.nhs.uk) Academic Surgery, Breast Unit, Royal Marsden NHS Foundation Trust, Fulham Road, London, United Kingdom. CORRESPONDENCE ADDRESS G.P.H. Gui, Academic Surgery, Breast Unit, Royal Marsden NHS Foundation Trust, Fulham Road, London, United Kingdom. Email: gerald.gui@rmh.nhs.uk SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2016) 69:2 (211-220). Date of Publication: 1 Feb 2016 ISSN 1878-0539 (electronic) 1748-6815 BOOK PUBLISHER Churchill Livingstone ABSTRACT SummaryIntroduction Immediate breast reconstruction (IBR) with implants is the commonest method of reconstructive surgery after mastectomy. With careful patient selection, a stable implant pocket can be created at the primary operation to decrease the likelihood of further surgery to adjust the reconstructed side. One-stage IBR is cost effective but failed procedures requiring early revision may be costly as permanent expanders are expensive. Methods Data were prospectively collected on all women undergoing a planned one-stage immediate breast reconstruction between 1997 and 2010. All patients had a Style 150 implant (Allergan, Marlow, UK). Descriptive statistics, Kaplan-Meier plots and, where applicable, Cox Proportional Hazards Regression was used to compare outcomes between groups. Results 249 planned one-stage IBRs were performed in 193 women, median age 45 years (range 20-77) with median follow-up of 101 months (range 27-159 months). 18/193 (9%) patients required implant exchange at 12 months and 66% of patients maintained their original implants at the time of census. Implant assisted latissimus appears to be robust even when radiotherapy was delivered. Disease free survival and breast cancer mortality were as expected for the breast cancer stage treated. Conclusion With careful patient selection, one-stage implant IBR using a definitive anatomical expandable implant provides good long term reconstruction and safe oncologic outcome. Direct to implant decision algorithms may be influenced by future developments in acellular dermal matrix technology, but the ability to create a single-stage stable implant pocket with good surgical technique should not be forgotten. EMTREE DRUG INDEX TERMS anastrozole (drug therapy) letrozole (drug therapy) tamoxifen (drug therapy) trastuzumab (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (radiotherapy, surgery) breast implant breast reconstruction esthetic surgery mastectomy plastic surgery EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult aged algorithm article cancer chemotherapy cancer hormone therapy cancer mortality cancer radiotherapy cancer staging disease free survival distant metastasis estrogen receptor positive breast cancer (drug therapy) female follow up human Kaplan Meier method latissimus dorsi muscle major clinical study patient selection priority journal progesterone receptor positive breast cancer (drug therapy) statistics treatment outcome DEVICE TRADE NAMES McGhan 150 , United KingdomAllergan Style 150 , United KingdomAllergan DEVICE MANUFACTURERS (United Kingdom)Allergan CAS REGISTRY NUMBERS anastrozole (120511-73-1) letrozole (112809-51-5) tamoxifen (10540-29-1) trastuzumab (180288-69-1) EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015532015 MEDLINE PMID 26776905 (http://www.ncbi.nlm.nih.gov/pubmed/26776905) PUI L607014637 DOI 10.1016/j.bjps.2015.09.017 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2015.09.017 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 215 TITLE Risk Factors for Complications in Immediate Expander-Implant Breast Reconstruction for Non-obese Patients: Impact of Breast Size on Complications AUTHOR NAMES Woo K.-J. Paik J.M. Mun G.-H. Pyon J.-K. Bang S.I. AUTHOR ADDRESSES (Woo K.-J.; Paik J.M.; Mun G.-H.; Pyon J.-K.; Bang S.I., si55.bang@samsung.com) Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul, 135-710, Korea SOURCE Aesthetic plastic surgery (2016) 40:1 (71-78). Date of Publication: 1 Feb 2016 ISSN 1432-5241 (electronic) ABSTRACT BACKGROUND: Although obesity is a well-known risk factor for complications in immediate expander-implant breast reconstruction, no studies have identified risk factors for non-obese patients. The purpose of this study was to identify risk factors for complications in non-obese patients.METHODS: A retrospective analysis of prospectively collected data from 397 consecutive immediate expander-implant breast reconstructions in 367 non-obese patients at a single institution over a 5-year period was conducted. Univariable and multivariable analysis were performed to determine the influence of six patient-related and eight procedure-related characteristics on complications.RESULTS: Mean BMI was 21.7 ± 2 kg/m(2) and median mastectomy weight was 298.0 g (range: 40-1164 g). Multivariable analysis showed that neither BMI nor the use of acellular dermal matrix was a predictor for complications. Adjuvant radiation (odds = 3.12, p < 0.001) and mastectomy weight (p < 0.001) were independent risk factors for complications. A 100 g increase in the mastectomy weight was significantly associated with a 23 % increase in the odds of overall complications (p = 0.003), major complications (p = 0.004), and skin flap complications (p = 0.007), as well as a 28 % increase in the odds of seroma (p = 0.044), but was not associated with reconstruction failure. Adjuvant radiation (p < 0.001) and hypertension (p < 0.001) were risk factors for reconstruction failure.CONCLUSIONS: Breast size was an independent risk factor for complications in non-obese patients while BMI was not. In the reconstruction of large breasts, greater attention and additional adjunctive procedures would be needed to prevent complications.LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adverse device effect anatomy and histology procedures EMTREE MEDICAL INDEX TERMS adjuvant radiotherapy adult body mass breast breast augmentation breast reconstruction breast tumor (surgery) female human mastectomy middle aged organ size postoperative complication (epidemiology, etiology) retrospective study time factor tissue expander LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26530484 (http://www.ncbi.nlm.nih.gov/pubmed/26530484) PUI L621449169 DOI 10.1007/s00266-015-0568-7 FULL TEXT LINK http://dx.doi.org/10.1007/s00266-015-0568-7 COPYRIGHT Copyright 2018 Medline is the source for the citation and abstract of this record. RECORD 216 TITLE Single-stage breast reconstruction using Strattice™: A retrospective study AUTHOR NAMES Dikmans R.E.G. El Morabit F. Ottenhof M.J. Tuinder S.M.H. Twisk J.W.R. Moues C. Bouman M.B. Mullender M.G. AUTHOR ADDRESSES (Dikmans R.E.G., r.dikmans@vumc.nl; El Morabit F.; Bouman M.B.; Mullender M.G.) Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, P.O. Box 7057, Amsterdam, Netherlands. (Ottenhof M.J.) Department of Plastic, Reconstructive and Hand Surgery, BovenIJ Hospital, Amsterdam, Netherlands. (Tuinder S.M.H.) Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, NUTRIUM Maastricht, Maastricht, Netherlands. (Twisk J.W.R.) Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands. (Moues C.) Department of Plastic, Reconstructive and Hand Surgery, Medisch Spectrum Twente, Enschede, Netherlands. CORRESPONDENCE ADDRESS R.E.G. Dikmans, Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, P.O. Box 7057, Amsterdam, Netherlands. Email: r.dikmans@vumc.nl SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2016) 69:2 (227-233). Date of Publication: 1 Feb 2016 ISSN 1878-0539 (electronic) 1748-6815 BOOK PUBLISHER Churchill Livingstone ABSTRACT SummaryIntroduction Strattice™, a porcine acellular dermal matrix, has emerged as a product to augment implant-based breast reconstruction. It aims to resolve problems related to poor tissue coverage of the implant. Presently, evidence justifying the use of Strattice in breast reconstruction is lacking. The objective of this study is to assess the clinical outcomes of a patient cohort that underwent single-stage implant-based breast reconstruction with the additional use of Strattice. Methods We conducted a retrospective chart review of patients who underwent single-stage breast reconstruction with the use of Strattice. All cases of breast reconstruction after oncologic or prophylactic mastectomy between 2010 and 2014 in one of eight different centres in the Netherlands were included. Patient demographics, treatment characteristics and clinical outcome data were collected. The outcomes were presented using descriptive statistics, and the associations were evaluated using Fisher's exact test. Results Eighty-eight patients who underwent either unilateral (60 patients) or bilateral (25 patients) (n = 110 breasts) single-stage breast reconstruction with the use of Strattice were identified. The indication for mastectomy was therapeutic in 69.1% (76) of cases and prophylactic in 30.9% (34) of cases. The reported minor complications included seroma (20.9%), skin necrosis (20.0%), wound dehiscence (11.8%), erythema/inflammation (14.5%) and infection (11.8%). In 22 breasts (22.7%), reoperation was necessary, with explantation of the implant in 11 breasts (11.8%). Conclusions In this cohort, the total complication rate was very high (78%). Although most complications were minor, reoperation was performed in 22.7%, with explantation of the implant in 11.8% of breasts. We suggest that patient selection, experience of the surgeon and handling of early complications are factors playing a crucial role in the success of the operation. The use of a Strattice sheet in single-stage implant-based breast reconstruction may be a promising technique, but more evidence from prospective, randomized studies is necessary to justify its use. Level of evidence: IV. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction surgical mesh EMTREE MEDICAL INDEX TERMS adult article erythema (complication) female hematoma (complication) human major clinical study medical record review outcome assessment postoperative infection (complication) priority journal reoperation seroma (complication) skin necrosis (complication) treatment indication wound dehiscence (complication) DEVICE TRADE NAMES Strattice EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160215055 MEDLINE PMID 26723835 (http://www.ncbi.nlm.nih.gov/pubmed/26723835) PUI L609006697 DOI 10.1016/j.bjps.2015.11.008 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2015.11.008 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 217 TITLE Autologous dermal fat graft modification for skate flap nipple reconstruction AUTHOR NAMES Kurlander D.E. Collis G. Bernard S. AUTHOR ADDRESSES (Kurlander D.E.) Department of Plastic Surgery, Case Western Reserve University, School of Medicine, Cleveland, United States. (Collis G.; Bernard S., bernars2@ccf.org) Department of Plastic Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, United States. SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2016) 69:2 (e44-e45). Date of Publication: 1 Feb 2016 ISSN 1878-0539 (electronic) 1748-6815 BOOK PUBLISHER Churchill Livingstone EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) autologous dermal fat graft autotransplantation breast reconstruction composite skin graft skate flap nipple reconstruction EMTREE MEDICAL INDEX TERMS acellular dermal matrix breast areola donor site follow up full thickness skin graft human letter nipple priority journal subcutaneous fat tattooing EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20160215051 MEDLINE PMID 26620252 (http://www.ncbi.nlm.nih.gov/pubmed/26620252) PUI L609006637 DOI 10.1016/j.bjps.2015.10.023 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2015.10.023 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 218 TITLE Erratum to: The Multi Centre Canadian Acellular Dermal Matrix Trial (MCCAT): Study protocol for a randomized controlled trial in implant-based breast reconstruction AUTHOR NAMES Zhong T. Temple-Oberle C. Hofer S.O.P. Beber B. Semple J. Brown M. Macadam S. Lennox P. Panzarella T. McCarthy C. Baxter N. AUTHOR ADDRESSES (Zhong T., toni.zhong@uhn.ca; Hofer S.O.P., stefan.hofer@uhn.ca; Beber B., b.beber@utoronto.ca; Semple J., john.semple@wchospital.ca; Brown M., Mitchell.brown@wchospital.ca) University Health Network, Division of Plastic and Reconstructive Surgery, Toronto, Canada. (Temple-Oberle C., Claire.Temple-Oberle@albertahealthservices.ca) Tom Baker Cancer Centre, Alberta Health Services, Plastic Surgery Oncology, Calgary, Canada. (Macadam S., drsmacadam@gmail.com; Lennox P., klennox@telus.net) Vancouver General Hospital and University of British Columbia, Division of Plastic and Reconstructive Surgery, Vancouver, Canada. (Panzarella T., panzar@uhnresearch.ca) Division of Biostatistics, University Health Network, Toronto, Canada. (McCarthy C., McCarthC@mskcc.org) Memorial Sloan-Kettering Cancer Center, Plastic and Reconstructive Surgery, New York, United States. (Baxter N., BaxterN@smh.ca) St Michael's Hospital, Toronto, and Keenan Research Centre, Department of Surgery, Toronto, Canada. CORRESPONDENCE ADDRESS T. Zhong, University Health Network, Division of Plastic and Reconstructive Surgery, Toronto, Canada. Email: toni.zhong@uhn.ca SOURCE Trials (2016) 17:1 Article Number: 39. Date of Publication: 20 Jan 2016 ISSN 1745-6215 (electronic) BOOK PUBLISHER BioMed Central Ltd., info@biomedcentral.com EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) error EMTREE MEDICAL INDEX TERMS erratum EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20160073627 PUI L607783347 DOI 10.1186/s13063-016-1179-6 FULL TEXT LINK http://dx.doi.org/10.1186/s13063-016-1179-6 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 219 TITLE Single-stage immediate breast reconstruction with acellular dermal matrix: Experience gained and lessons learnt from patient reported outcome measures AUTHOR NAMES Apte A. Walsh M. Chandrasekharan S. Chakravorty A. AUTHOR ADDRESSES (Apte A., anuapte@gmail.com; Walsh M., maia.walsh@hotmail.com; Chandrasekharan S., Sekharan.Chandra@colchesterhospital.nhs.uk; Chakravorty A., arunmoy.chakravorty@colchesterhospital.nhs.uk) Colchester Hospital University NHS Foundation Trust, Colchester General Hospital, Turner Rd, Essex, United Kingdom. CORRESPONDENCE ADDRESS M. Walsh, Colchester Hospital University NHS Foundation Trust, Colchester General Hospital, Turner Rd, Essex, United Kingdom. Email: maia.walsh@hotmail.com SOURCE European Journal of Surgical Oncology (2016) 42:1 (39-44). Date of Publication: 1 Jan 2016 ISSN 1532-2157 (electronic) 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction Acellular Dermal Matrix (ADM) assisted breast reconstruction has transformed the single-stage Immediate Breast Reconstruction (IBR) with an impact on the cosmetic outcomes. However, there is limited data available on patient reported outcomes. This study highlights the Patient Reported Outcome Measures (PROMs), post-operative complications and lessons learnt from ADM assisted single-stage immediate breast reconstruction. Methods This prospective study enrolled consecutive patients from Feb 2012 - May 2015 undergoing mastectomy with direct-to-implant ADM assisted breast reconstruction, using Strattice™ (Acelity, San Antonio, TX, USA). Patients were recruited from the beginning of our unit's use of ADMs and completed a post-operative questionnaire at 6 weeks, covering pre-operative, operative and post-operative outcomes. Information on tumour biology and post-operative complications was obtained from the medical notes. Results This study included 49 patients undergoing a total of 53 procedures. Following surgery 93.3% of women reported a high level of body confidence when clothed. 6.7% of patients reported severe post-operative pain during the first week. Mean length of hospital stay was 1.7 days, return to light activities was within 2.5 weeks and normal activities in 5.4 weeks. Implant loss at 3 months occurred in 5.7% of procedures, of which two thirds were smokers. Conclusions PROMs for Strattice™ ADM based reconstruction show high levels of satisfaction with cosmetic outcomes, low incidences of severe post-operative pain and a short recovery process. PROMs help us to better describe patients' experience, allowing women to make more informed choices about ADM based breast reconstruction, which reassures and helps to achieve better outcomes. EMTREE DRUG INDEX TERMS antibiotic agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction postoperative complication (complication) single stage immediate breast reconstruction surgical mesh EMTREE MEDICAL INDEX TERMS adult article breast carcinoma (radiotherapy, surgery) breast implant (adverse device effect) clinical article clinical practice debridement female hematoma (complication, surgery) human implant loss (complication) incidence intraductal carcinoma (radiotherapy, surgery) length of stay mastectomy middle aged outcome assessment physical activity postoperative pain (complication) priority journal prospective study prosthesis complication (complication) red breast syndrome (complication) seroma (complication, drug therapy) smoking wound healing impairment (complication, drug therapy, prevention, surgery) DEVICE TRADE NAMES Memory shape , United StatesMentor Strattice DEVICE MANUFACTURERS (United States)Mentor EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20151013059 MEDLINE PMID 26651226 (http://www.ncbi.nlm.nih.gov/pubmed/26651226) PUI L607195353 DOI 10.1016/j.ejso.2015.10.009 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2015.10.009 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 220 TITLE Tissue Expander Reconstruction After Total Skin-Sparing Mastectomy: Defining the Effects of Coverage Technique on Nipple/Areola Preservation AUTHOR NAMES Sbitany H. Wang F. Peled A.W. Alvarado M. Ewing C.A. Esserman L.J. Foster R.D. AUTHOR ADDRESSES (Sbitany H.) From the Divisions of *Plastic and Reconstructive Surgery, and †Surgical Oncology, University of California, San Francisco, San Francisco, CA (Wang F.; Peled A.W.; Alvarado M.; Ewing C.A.; Esserman L.J.; Foster R.D.) SOURCE Annals of plastic surgery (2016) 77:1 (17-24). Date of Publication: 1 Jan 2016 ISSN 1536-3708 (electronic) ABSTRACT BACKGROUND: Total skin-sparing mastectomy (TSSM) has become increasingly frequent in recent years, as inclusion criteria continue to expand. Options for tissue expander coverage in these patients include complete submuscular tissue expander coverage and acellular dermal matrix (ADM)-assisted coverage. This study compares both techniques with regard to relevant outcomes, during a recent 1-year period at our institution.METHODS: All women undergoing TSSM and immediate expander placement between January 2012 and January 2013 were prospectively tracked. Patient demographics, expander coverage type, adjuvant treatment, length and characteristics of expansion, and incidence of complications were analyzed.RESULTS: In 1 year, 127 patients underwent TSSM on 202 breasts. Overall, 113 expanders underwent submuscular coverage, and 89 underwent ADM-assisted coverage. Mean intraoperative fill volume was 52 mL in the submuscular cohort and 205 mL in the ADM cohort (P = 0.0001). Mean tissue expander size was 404 mL in the submuscular cohort and 454 mL in the ADM cohort (P = 0.0002). χ analysis demonstrated no differences between the cohorts in incidence of complications, including partial/complete nipple necrosis.CONCLUSIONS: The use of ADM for expander coverage after TSSM allowed for greater initial expander fill. With large and ptotic breasts, this allows for reduced incidence of skin folds in the preserved breast skin pocket, and greater control over final nipple position, as the amount of loose, mobile skin is reduced by the greater initial fill. The safety profile of ADM use after TSSM is equivalent to that of submuscular coverage, with no differences in partial or complete nipple necrosis. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix procedures subcutaneous mastectomy EMTREE MEDICAL INDEX TERMS adult breast reconstruction breast tumor (surgery) clinical trial comparative study devices female follow up human middle aged nipple prospective study statistical model tissue expander tissue expansion treatment outcome LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25057918 (http://www.ncbi.nlm.nih.gov/pubmed/25057918) PUI L618111223 DOI 10.1097/SAP.0000000000000292 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0000000000000292 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 221 TITLE Skin Flap Necrosis After Mastectomy With Reconstruction: A Prospective Study AUTHOR NAMES Matsen C.B. Mehrara B. Eaton A. Capko D. Berg A. Stempel M. Van Zee K.J. Pusic A. King T.A. Cody H.S. Pilewskie M. Cordeiro P. Sclafani L. Plitas G. Gemignani M.L. Disa J. El-Tamer M. Morrow M. AUTHOR ADDRESSES (Matsen C.B., cindy.matsen@hsc.utah.edu) Breast Care Team, Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, United States. (Mehrara B.; Pusic A.; Cordeiro P.; Disa J.) Plastic and Reconstructive Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, United States. (Eaton A.) Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, United States. (Capko D.; Berg A.; Stempel M.; Van Zee K.J.; King T.A., wus@mskcc.org; Cody H.S.; Pilewskie M.; Sclafani L.; Plitas G.; Gemignani M.L.; El-Tamer M.; Morrow M.) Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, United States. CORRESPONDENCE ADDRESS C.B. Matsen, Breast Care Team, Department of Surgery, Huntsman Cancer Institute at the University of Utah, Salt Lake City, United States. Email: cindy.matsen@hsc.utah.edu SOURCE Annals of Surgical Oncology (2016) 23:1 (257-264). Date of Publication: 1 Jan 2016 ISSN 1534-4681 (electronic) 1068-9265 BOOK PUBLISHER Springer New York LLC, barbara.b.bertram@gsk.com ABSTRACT Background: Rates of mastectomy with immediate reconstruction are rising. Skin flap necrosis after this procedure is a recognized complication that can have an impact on cosmetic outcomes and patient satisfaction, and in worst cases can potentially delay adjuvant therapies. Many retrospective studies of this complication have identified variable event rates and inconsistent associated factors. Methods: A prospective study was designed to capture the rate of skin flap necrosis as well as pre-, intra-, and postoperative variables, with follow-up assessment to 8 weeks postoperatively. Uni- and multivariate analyses were performed for factors associated with skin flap necrosis. Results: Of 606 consecutive procedures, 85 (14 %) had some level of skin flap necrosis: 46 mild (8 %), 6 moderate (1 %), 31 severe (5 %), and 2 uncategorized (0.3 %). Univariate analysis for any necrosis showed smoking, history of breast augmentation, nipple-sparing mastectomy, and time from incision to specimen removal to be significant. In multivariate models, nipple-sparing, time from incision to specimen removal, sharp dissection, and previous breast reduction were significant for any necrosis. Univariate analysis of only moderate or severe necrosis showed body mass index, diabetes, nipple-sparing mastectomy, specimen size, and expander size to be significant. Multivariate analysis showed nipple-sparing mastectomy and specimen size to be significant. Nipple-sparing mastectomy was associated with higher rates of necrosis at every level of severity. Conclusions: Rates of skin flap necrosis are likely higher than reported in retrospective series. Modifiable technical variables have limited the impact on rates of necrosis. Patients with multiple risk factors should be counseled about the risks, especially if they are contemplating nipple-sparing mastectomy. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast necrosis (complication, etiology) breast reconstruction graft necrosis (complication, etiology) mastectomy EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult aged article breast augmentation breast implant breast reduction breast tissue expander cancer surgery deep inferior epigastric perforator flap diabetes mellitus disease severity follow up human intraductal carcinoma (surgery) invasive carcinoma (surgery) major clinical study nipple sparing mastectomy obesity phyllodes tumor (surgery) postoperative period prospective study skin sparing mastectomy smoking transverse rectus abdominis musculocutaneous flap EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) General Pathology and Pathological Anatomy (5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015206760 MEDLINE PMID 26193963 (http://www.ncbi.nlm.nih.gov/pubmed/26193963) PUI L605254638 DOI 10.1245/s10434-015-4709-7 FULL TEXT LINK http://dx.doi.org/10.1245/s10434-015-4709-7 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 222 TITLE Pioneering technique using Acellular Dermal Matrix in the rescue of a radiation ulcer AUTHOR NAMES Naseem S. Patel A.D. Devalia H. AUTHOR ADDRESSES (Naseem S.; Patel A.D.; Devalia H.) SOURCE Il Giornale di chirurgia (2016) 37:1 (46-48). Date of Publication: 1 Jan 2016 ISSN 0391-9005 ABSTRACT BACKGROUND: Radiotherapy as an adjuvant to mastectomy is integral to the treatment of breast cancer, but can result in skin ulceration. Skin ulceration following radiotherapy is traditionally managed by removing the implant and allowing the skin to heal by secondary intention.CASE REPORT: A 42-year-old woman underwent radiotherapy following a breast reconstruction. She developed a 2 x 3cm radiation ulcer. The ulcer was managed by removing the implant and performing capsulectomy. A Beckers 50 expander was placed and reinforced with acellular dermal matrix inferolaterally. At follow-up the patient had a good cosmetic outcome.CONCLUSION: Post-radiation skin ulcers present a challenge to treat with no current standardised management. The use of acellular dermal matrix may present a new technique to promote healing in these testing cases. EMTREE DRUG INDEX TERMS antineoplastic hormone agonists and antagonists (drug therapy) tamoxifen (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix adverse effects procedures EMTREE MEDICAL INDEX TERMS adjuvant radiotherapy adult breast augmentation breast reconstruction breast tumor (drug therapy, radiotherapy, surgery) colloid carcinoma (surgery) device removal esthetics female human mastectomy multimodality cancer therapy Paget nipple disease (drug therapy, radiotherapy, surgery) radiation dermatitis (etiology, surgery) reconstructive surgery skin ulcer (etiology, surgery) tissue expander CAS REGISTRY NUMBERS tamoxifen (10540-29-1) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 27142826 (http://www.ncbi.nlm.nih.gov/pubmed/27142826) PUI L616754320 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 223 TITLE Innovative combination of therapeutic mammoplasty and expandable-implant breast augmentation for immediate partial breast reconstruction AUTHOR NAMES Choo A.M.H. Forouhi P. Malata C.M. AUTHOR ADDRESSES (Choo A.M.H.) University of Cambridge, Cambridge, United Kingdom. (Forouhi P.; Malata C.M., cmalata@hotmail.com) Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom. (Malata C.M., cmalata@hotmail.com) Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom. (Malata C.M., cmalata@hotmail.com) Postgraduate Medical Institute, Faculty of Health Sciences at Anglia Ruskin University, Cambridge, Chelmsford, United Kingdom. CORRESPONDENCE ADDRESS C.M. Malata, Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom. Email: cmalata@hotmail.com SOURCE International Journal of Surgery Case Reports (2016) 23 (146-150). Date of Publication: 2016 ISSN 2210-2612 BOOK PUBLISHER Elsevier Ltd ABSTRACT Introduction: Therapeutic mammoplasty is used in the treatment of suitably-sized and appropriately-located breast cancers to achieve adequate cancer excision, resulting in well-shaped but smaller breasts. In patients wishing to maintain or increase their breast size, simultaneous augmentation will be required. Presentation of case: A 48-year-old female underwent an "augmentation-therapeutic mastopexy". She required mastectomy for a multifocal cancer of the right breast and breast conservation for a unifocal localised cancer in the upper part of the left breast. She requested right immediate breast reconstruction and hoped for larger breasts than she had. Due to complications during neoadjuvant chemotherapy, the right reconstruction plan was changed from a deep inferior epigastric perforator (DIEP) flap to an implant-based technique. On the left, an extended superomedial pedicle therapeutic mammoplasty was combined with a subpectoral augmentation using an expandable-implant. Discussion: The use of expandable-implants for reconstruction of partial mastectomy defects in combination with therapeutic mammoplasty has not been reported. This case report shows that such "augmentation-therapeutic mastopexy" is feasible. Conclusion: A "novel" oncoplastic technique herein termed "augmentation-therapeutic mastopexy" is described for partial breast reconstruction during the treatment of a patient with bilateral breast cancer. It enabled adequate treatment of her cancer while reshaping the breast and achieving the desired larger breast size. It should be considered in selected breast-conservation patients who wish to maintain or increase their breast size. EMTREE DRUG INDEX TERMS antineoplastic agent (adverse drug reaction, drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) augmentation therapeutic mastopexy breast augmentation breast implant breast reconstruction cancer surgery EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult article breast carcinoma (drug therapy, surgery) cancer adjuvant therapy case report contracture deep inferior epigastric perforator flap female free tissue graft gland tissue guide wire histology human human tissue incision mastectomy middle aged multiple cancer (surgery) pectoralis major muscle priority journal sentinel lymph node biopsy suction drain surgical mesh unspecified side effect (side effect) wide excision DEVICE TRADE NAMES Strattice EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) Adverse Reactions Titles (38) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160339196 PUI L610112348 DOI 10.1016/j.ijscr.2016.04.031 FULL TEXT LINK http://dx.doi.org/10.1016/j.ijscr.2016.04.031 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 224 TITLE Florid pustular dermatitis of breast: A case report on a unusual complication from acellular dermal matrix use AUTHOR NAMES James J. Jackson L. Saunders C. AUTHOR ADDRESSES (James J., drjustinjamesj@yahoo.co.uk; Jackson L., lee.jackson@health.wa.gov.au; Saunders C.) Breast Surgery Unit, Fiona Stanley Hospital, Department of Multidisciplinary Breast Service, 102-118 Murdoch Drive, Murdoch, Australia. (James J., drjustinjamesj@yahoo.co.uk) Monash University, Faculty of Medicine, Nursing and Health Sciences, , Australia. (Saunders C.) University of Western Australia, School of Surgery, Harry Perkins Institute of Medical Research, Fiona Stanley Hospital, Murdoch, Australia. CORRESPONDENCE ADDRESS L. Jackson, Breast Surgery Unit, Fiona Stanley Hospital, Department of Multidisciplinary Breast Service, 102-118 Murdoch Drive, Murdoch, Australia. Email: lee.jackson@health.wa.gov.au SOURCE International Journal of Surgery Case Reports (2016) 22 (59-61). Date of Publication: 2016 ISSN 2210-2612 BOOK PUBLISHER Elsevier Ltd ABSTRACT Introduction Idiopathic erythematous reaction of the breast (Red breast syndrome) is a known complication following breast reconstruction with acellular dermal matrix. However pustular dermatitis like presentation is not previously known. Presentation of case We present a 42-year-old lady who developed bilateral pustular dermatitis like appearance following breast reconstruction with acellular dermal matrix slings. Though surgical washout was done, both expanders and flex HD could be preserved. Discussion Acellular dermal matrix use is the only possible explanation for such a presentation and this can be considered a variant of red breast syndrome. Conclusion Pustular dermatitis like presentation can be associated with acelluar dermal matrix use and should be considered in similar clinical presentations, since this can avoid unnecessary surgical procedures. EMTREE DRUG INDEX TERMS antibiotic agent (drug therapy, intravenous drug administration, oral drug administration) antineoplastic agent (drug therapy) C reactive protein (endogenous compound) vancomycin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix dermatitis (drug therapy, complication, drug therapy) florid pustular breast dermatitis (drug therapy, complication, drug therapy) medical device complication (drug therapy, complication, drug therapy) EMTREE MEDICAL INDEX TERMS adult antibiotic therapy antisepsis article axillary lymph node breast carcinoma (drug therapy, surgery) breast self examination breast tissue expander (adverse device effect) cancer adjuvant therapy cancer surgery case report device infection (complication) emergency ward female human lymph node dissection lymph node metastasis (surgery) mastectomy polypropylene suture postoperative period priority journal pustule skin redness skin sparing mastectomy surgical mesh (adverse device effect) DEVICE TRADE NAMES FlexHD , United StatesMusculoskeletal Transplant Foundation Pliable DEVICE MANUFACTURERS (United States)Musculoskeletal Transplant Foundation CAS REGISTRY NUMBERS C reactive protein (9007-41-4) vancomycin (1404-90-6, 1404-93-9) EMBASE CLASSIFICATIONS Dermatology and Venereology (13) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160287106 PUI L609619335 DOI 10.1016/j.ijscr.2016.02.040 FULL TEXT LINK http://dx.doi.org/10.1016/j.ijscr.2016.02.040 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 225 TITLE Improved pocket control in immediate microsurgical breast reconstruction with simultaneous implant placement through the use of mesh AUTHOR NAMES Momeni A. Kanchwala S.K. AUTHOR ADDRESSES (Momeni A., amomeni@stanford.edu) Division of Plastic and Reconstructive SurgeryStanford University Medical CenterPalo Alto, California (Kanchwala S.K.) Division of Plastic SurgeryUniversity of Pennsylvania Health SystemsPhiladelphia, Pennsylvania CORRESPONDENCE ADDRESS A. Momeni, Division of Plastic and Reconstructive SurgeryStanford University Medical CenterPalo Alto, California Email: amomeni@stanford.edu SOURCE Microsurgery (2016). Date of Publication: 2016 ISSN 1098-2752 (electronic) 0738-1085 BOOK PUBLISHER John Wiley and Sons Inc., P.O.Box 18667, Newark, United States. ABSTRACT Background: Autologous breast reconstruction is associated with long-term patient satisfaction that is superior to implant-based approaches. Occasionally, however, patients who desire autologous reconstruction present with inadequate donor-site volume. A hybrid approach, combining free flap reconstruction with simultaneous implant placement, is a solution. We present our experience with the use of mesh for improved pocket control using this reconstructive modality. Methods: A retrospective analysis of a prospectively maintained database of patients undergoing autologous breast reconstruction was performed. Patients who underwent bilateral immediate breast reconstruction with free microsurgical abdominal tissue transfer with simultaneous implant placement were included for analysis. Results: A total of 19 patients (38 breasts) with a mean age of 42.7 years (range, 31-57 years) and mean BMI of 26.3 (range, 23.6-30.8) were included in the study. No flap loss or implant-related complications were encountered during a mean follow-up of 14.2 months. The most common implant volume was 150 cc (N=15; [78.9%]). No patient requested an implant change due to malposition or insufficient volume. Secondary fat grafting was performed in 5 patients (26.3%), 4 of which had undergone adjuvant radiotherapy. Three cases of red breast syndrome were observed following acellular dermal matrix placement. This prompted a transition to using polyglactin mesh thereafter without any untoward sequelae. Conclusions: Abdominal flap transfer with simultaneous implant placement is a safe reconstructive option in select patients. Improved implant pocket control is achieved through the use of mesh, thus, minimizing problems related to implant malposition. Adjuvant radiotherapy does not appear to put the reconstruction at risk with the occasional flap volume loss being easily remedied by secondary fat grafting. EMTREE DRUG INDEX TERMS polyglactin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction implant microsurgery EMTREE MEDICAL INDEX TERMS acellular dermal matrix adjuvant radiotherapy adult adverse drug reaction body mass breast disease clinical article controlled study data base female follow up graft failure human human tissue retrospective study side effect LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160777131 PUI L612946677 DOI 10.1002/micr.30123 FULL TEXT LINK http://dx.doi.org/10.1002/micr.30123 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 226 TITLE Acellular dermal matrices for breast reconstruction surgery AUTHOR NAMES Rolph R. Duffy J.M.N. Mehta S.N. Tan-Koay A.G. Farhadi J. AUTHOR ADDRESSES (Rolph R., r.rolph1@nhs.net; Mehta S.N.; Farhadi J.) Guys and St Thomas' NHS Foundation Trust, Department of Plastic and Reconstructive Surgery, Westminster Bridge Road, London, United Kingdom. (Rolph R., r.rolph1@nhs.net; Mehta S.N.; Farhadi J.) University Hospital Basel, Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Basel, Switzerland. (Duffy J.M.N.) Balliol College, University of Oxford, iHOPE: International Collaboration to Harmonise Outcomes for Pre-eclampsia, Oxford, Oxfordshire, United Kingdom. (Tan-Koay A.G.) NHMRC Clinical Trials Centre, University of Sydney, Systematic Reviews and Health Technology Assessments, Sydney, Australia. CORRESPONDENCE ADDRESS R. Rolph, Guys and St Thomas' NHS Foundation Trust, Department of Plastic and Reconstructive Surgery, Westminster Bridge Road, London, United Kingdom. Email: r.rolph1@nhs.net SOURCE Cochrane Database of Systematic Reviews (2015) 2015:12 Article Number: CD011966. Date of Publication: 13 Dec 2015 ISSN 1469-493X (electronic) BOOK PUBLISHER John Wiley and Sons Ltd, Southern Gate, Chichester, West Sussex, United Kingdom. vgorayska@wiley.com ABSTRACT This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of acellular dermal matrices in prosthetic breast reconstructions following cancer and prophylactic breast surgery. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix (clinical trial) breast reconstruction EMTREE MEDICAL INDEX TERMS article breast cancer (prevention, surgery) breast malformation (complication, therapy) cancer prevention cancer surgery clinical effectiveness clinical protocol device safety female human outcome assessment priority journal randomized controlled trial (topic) EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) General Pathology and Pathological Anatomy (5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20180098418 PUI L620551369 DOI 10.1002/14651858.CD011966 FULL TEXT LINK http://dx.doi.org/10.1002/14651858.CD011966 COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 227 TITLE One-stage immediate implant-based breast reconstruction, using biological matrices after conservative mastectomies: Preliminary experience of the University Hospital of Tor Vergata, Rome AUTHOR NAMES Buonomo O.C. Varvaras D. Montuori M. Vanni G. Venditti D. Elia S. Santurro L. Granai A.V. Petrella G. Rossi P. AUTHOR ADDRESSES (Buonomo O.C.; Varvaras D.; Montuori M., mauro.montuori@hotmail.it; Vanni G.; Venditti D.; Elia S.; Santurro L.; Granai A.V.; Petrella G.; Rossi P.) Department of Surgery, University Hospital of Tor Vergata, Rome, Italy. CORRESPONDENCE ADDRESS M. Montuori, Department of Surgery, University Hospital of Tor Vergata, Rome, Italy. Email: mauro.montuori@hotmail.it SOURCE Chirurgia (Turin) (2015) 28:6 (221-226). Date of Publication: 1 Dec 2015 ISSN 0394-9508 BOOK PUBLISHER Edizioni Minerva Medica, subscriptions.dept@minervamedica.it ABSTRACT Aim. Aim of our study was to achieve one-stage immediate implant based breast reconstruction, using biological matrices after conservative mastectomies, evaluate patients outcome and complications, in patients suffering from stage Tis-T1-T2 (<3 cm) breast cancer who underwent conservative mastectomy and reconstructive surgery. Methods. The inclusion criteria were: aged 20-65 years; nonsmokers; no diabetes or systemic connective disease; BMI<30; Patients should not be subjected to post-mastectomy radiotherapy; informed consent. During our study, through a randomization system, we used two different types of acellular dermal matrices (ADM): SurgiMend® and Tutomesh®. Results. From February 2012 to March 2014, 22 patients were enrolled, for a total of 38 reconstructions (average age 49 years). Ten patients did not have any mesh-related complications. Four patients showed a dehiscence with bilateral implant exposure, which required removal of the implants; minor wound dehiscence (healing within a month) was observed in 4 patients; 2 patients presented an asymmetry of the inframammary folds and a hematoma was found in two patients. Conclusion. The introduction of the ADM has helped to overcome several reconstructive limitations, allowing an immediate prosthetic reconstruction, after a conservative mastectomy. Complications have been drastically reduced due to an accurate selection of patients. In conclusion, one-stage breast reconstruction with acellular biological matrices, in selected patients, may be a new and realistic frontier in breast surgery, with the real possibility of providing women with breast cancer, a better quality of life compared to the traditional two-stage reconstruction. EMTREE DRUG INDEX TERMS amiloride plus hydrochlorothiazide antidiuretic agent cortisone EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast cancer (diagnosis, surgery) breast implant breast reconstruction simple mastectomy EMTREE MEDICAL INDEX TERMS adult article blood analysis body mass clinical article controlled study electrocardiography female hematoma (complication) histopathology human human tissue Italy necrosis postoperative complication (complication) quality of life randomized controlled trial thorax radiography treatment outcome wound dehiscence (complication) DEVICE TRADE NAMES SurgiMend , United StatesTEI Tutomesh , GermanyTutogen DEVICE MANUFACTURERS (Germany)Tutogen (United States)TEI CAS REGISTRY NUMBERS amiloride plus hydrochlorothiazide (57017-78-4) cortisone (53-06-5) EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20170024920 PUI L614003633 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 228 TITLE Porcine acellular dermis-based breast reconstruction: complications and outcomes following adjuvant radiotherapy AUTHOR NAMES Ng C.E. Pieri A. Fasih T. AUTHOR ADDRESSES (Ng C.E., isao.nce@gmail.com; Pieri A.; Fasih T.) Surgical Department, Queen Elizabeth Hospital, Gateshead, United Kingdom. CORRESPONDENCE ADDRESS C.E. Ng, Surgical Department, Queen Elizabeth Hospital, Gateshead, United Kingdom. Email: isao.nce@gmail.com SOURCE European Journal of Plastic Surgery (2015) 38:6 (459-462). Date of Publication: 1 Dec 2015 ISSN 1435-0130 (electronic) 0930-343X BOOK PUBLISHER Springer Verlag, service@springer.de ABSTRACT Background: Acellular dermal matrices (ADM) such as Strattice(TM) are increasingly used in UK during implant-based reconstruction. However, there are mixed opinions regarding the compatibility of radiotherapy treatment in pre- and post-reconstructed breasts. The aims of this study are to audit the rates of radiation induced complications in patients who underwent breast reconstruction using Strattice(TM) and establish whether there is an association between timing of radiotherapy and complication rates. Methods: Retrospective data collection was performed for all patients who underwent skin-sparing mastectomy and immediate or delayed Strattice(TM)-based reconstruction, and received pre- or post-reconstruction radiotherapy from July 2010 to November 2014. Results: The age ranged from 33 to 78 years (mean age 51 ± 10.6) with a mean follow-up time of 21 months. There were 25 Strattice(TM)-based reconstructions performed. Sixteen had delayed reconstruction, and 9 had skin-sparing mastectomy and immediate reconstruction. There were 4 (16 %) abandoned procedures due to inability to stretch the mastectomy flap secondary to poor skin compliance. Two women (8 %) presented 4 and 9 months later with wound breakdown. One case (4 %) developed severe capsular contracture following radiotherapy post-reconstruction and 1 case (4 %) of implant rupture. There were no episodes of extrusion or implant infection. Overall complication rates were 32 %. The majority (75 %) of complications occurred in breasts reconstructed post-radiotherapy; however, this is not significant when analysed using chi-square (p = 0.43). Conclusions: Our evidence suggests that there is no difference in complication rates in pre- and post-radiation individuals; this would suggest that implant-based reconstruction using Strattice(TM) should not be an absolute contraindication in pre- or post-radiotherapy patients. However, when planning these procedures, it is paramount that the increased risks are emphasised to patients in order to better manage patient expectation in cases where complications arise. Level of Evidence: Level III, risk / prognostic study. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction cancer adjuvant therapy cancer radiotherapy surgical mesh EMTREE MEDICAL INDEX TERMS adult article breast cancer (radiotherapy, surgery, therapy) compliance (physical) controlled study female follow up human middle aged nonhuman partial mastectomy porcine model priority journal skin compliance skin function treatment outcome DEVICE TRADE NAMES Strattice EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015249255 PUI L605501038 DOI 10.1007/s00238-015-1130-1 FULL TEXT LINK http://dx.doi.org/10.1007/s00238-015-1130-1 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 229 TITLE A Meta-analysis of Postoperative Complications of Tissue Expander/Implant Breast Reconstruction Using Acellular Dermal Matrix AUTHOR NAMES Zhao X. Wu X. Dong J. Liu Y. Zheng L. Zhang L. AUTHOR ADDRESSES (Zhao X.) Department of Plastic Surgery, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuhan, 430060, Hubei, People's Republic of China (Wu X.) Department of Plastic Surgery, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuhan, 430060, Hubei, People's Republic of China. 904949860@qq.com (Dong J.) Department of Plastic Surgery, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuhan, 430060, Hubei, People's Republic of China (Liu Y.) Department of Plastic Surgery, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuhan, 430060, Hubei, People's Republic of China (Zheng L.) Department of Plastic Surgery, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuhan, 430060, Hubei, People's Republic of China (Zhang L.) Department of Plastic Surgery, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuhan, 430060, Hubei, People's Republic of China SOURCE Aesthetic plastic surgery (2015) 39:6 (892-901). Date of Publication: 1 Dec 2015 ISSN 1432-5241 (electronic) ABSTRACT BACKGROUND: Acellular dermal matrix (ADM) is commonly used for tissue expander/implant breast (TE/I-based) reconstruction. But the relation between ADM and postoperative complications remains controversial. A few meta-analyses were conducted in 2011-2012 and the result revealed that ADM can increase the risk of complications. The purpose of our study is to offer updated evidence for ADM clinical application by analyzing the effect of ADM on complications of TE/I-based breast reconstruction.METHODS: The literature published from January 2010 to February 2015 was searched in EMbase, Medline, Science Direct, the Cochrane Central Register of Controlled Trials (CENTRAL), CBMdisc, CNKI, VIP, and the references of those included studies were also searched by hand. According to inclusive criteria, 11 studies were selected and the values were extracted from the included literature. Complications with four different categories assigned for overall complications, infection, hematoma/seroma, and explantation were collected. RevMan 5.1 was used for meta-analysis. The evidence level was assessed by using the GRADE system.RESULTS: Eleven published studies were included. The results showed that compared to the control group, the ADM group increased the rate of overall complications (OR = 1.33, 95% CI 1.03-1.70, p = 0.03), infection (OR = 1.47, 95% CI 1.04-2.06, p = 0.03), hematoma/seroma (OR = 1.66, 95% CI 1.13-2.44, p = 0.01), but there was no significant difference in explantation (OR = 1.37, 95% CI 0.89-2.11, p = 0.15). Based on the GRADE system, all the evidence was at level C and weak recommendation.CONCLUSIONS: In TE/I-based breast reconstruction, ADM increased the incidence of overall complications, infection, and hematoma/seroma; the incidence of explantation remains unknown. For the poor quality of the original studies, a prudent choice is suggested; and more high-quality, large-sample studies are needed.NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix adverse effects procedures EMTREE MEDICAL INDEX TERMS breast implant breast reconstruction female human meta analysis postoperative complication (epidemiology, etiology) tissue expander LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26377821 (http://www.ncbi.nlm.nih.gov/pubmed/26377821) PUI L612336959 DOI 10.1007/s00266-015-0555-z FULL TEXT LINK http://dx.doi.org/10.1007/s00266-015-0555-z COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 230 TITLE Low incidence of complications using polyglactin 910 (Vicryl) mesh in breast reconstruction: A systematic review AUTHOR NAMES Rodriguez-Unda N. Leiva S. Cheng H.-T. Seal S.M. Cooney C.M. Rosson G.D. AUTHOR ADDRESSES (Rodriguez-Unda N.; Leiva S.; Cheng H.-T.; Cooney C.M.; Rosson G.D., gedge@jhmi.edu) Department of Plastic Surgery, Johns Hopkins University School of Medicine, McElderry 8161, 601 North Caroline Street, Baltimore, United States. (Seal S.M.) William H. Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, United States. CORRESPONDENCE ADDRESS G.D. Rosson, Department of Plastic Surgery, Johns Hopkins University School of Medicine, McElderry 8161, 601 North Caroline Street, Baltimore, United States. Email: gedge@jhmi.edu SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2015) 68:11 (1543-1549). Date of Publication: 1 Nov 2015 ISSN 1878-0539 (electronic) 1748-6815 BOOK PUBLISHER Churchill Livingstone ABSTRACT Background Mastectomy and breast reconstruction are essential parts of the treatment of breast cancer. Acellular dermal matrices (ADMs) have been used for the reconstruction of the lower pole due to many advantages; however, its cost is seen as a major drawback in this era of concern for the allocation of health-care funds. Recently, polyglactin 910 (Vicryl; Ethicon, Somerville, NJ, USA) mesh has been published as an alternative. We assessed the published literature, in particular investigating for studies that compare Vicryl mesh with ADM. Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Searched databases included Medline/PubMed, Cochrane Reviews, Embase, Web of Science, ClinicalTrials, and SCOPUS. Search criteria were as follows: (1) reporting of clinical data using Vicryl mesh in breast reconstruction, (2) reporting of original data, and (3) outcome of interest reported. Results We retrieved 290 de-duplicated articles. After title and abstract screening, we dismissed 258 articles, and thus full text was reviewed for 32 articles; only three retrospective articles met inclusion criteria. The total population included 112 patients and 156 breasts. The reported incidence of complications was as follows: infection 2.6% (confidence interval (CI): 0.7-6.6%), reconstruction failure 3.2% (CI: 1.0-7%), and seroma 1.3% (CI: 0.2-4.6%). A seven- to 12-fold cost difference was reported. Follow-up length ranged from 1.2 to 3.6 years. No studies directly compared Vicryl mesh with ADM. Conclusions Although the evidence is limited, polyglactin 910 (Vicryl) mesh for immediate breast reconstruction appears to be a potentially safe, effective, and less expensive alternative to ADM. Prospective studies are needed to further compare mesh with ADM. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) polyglactin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction postoperative complication (complication) surgical mesh (device economics) EMTREE MEDICAL INDEX TERMS acellular dermal matrix comparative effectiveness follow up health care cost human meta analysis (topic) outcome assessment postoperative infection priority journal randomized controlled trial (topic) retrospective study review seroma systematic review (topic) DEVICE TRADE NAMES Vicryl , United StatesEthicon DEVICE MANUFACTURERS (United States)Ethicon CAS REGISTRY NUMBERS polyglactin (26780-50-7, 34346-01-5) EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Health Policy, Economics and Management (36) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015312422 MEDLINE PMID 26275493 (http://www.ncbi.nlm.nih.gov/pubmed/26275493) PUI L605693050 DOI 10.1016/j.bjps.2015.06.018 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2015.06.018 COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 231 TITLE Effects of postmastectomy radiation therapy on immediate tissue expander and acellular dermal matrix reconstruction AUTHOR NAMES Wong J.S. Chen Y.H. Truong L.T. Bellon J.R. Punglia R.S. Moreau J.M. Chun Y.S. Hergrueter C.A. AUTHOR ADDRESSES (Wong J.S.; Chen Y.H.; Bellon J.R.; Punglia R.S.) Dana-Farber Cancer Institute, Boston, United States. (Wong J.S.; Truong L.T.; Bellon J.R.; Punglia R.S.; Moreau J.M.; Chun Y.S.; Hergrueter C.A.) Brigham and Women's Hospital, Boston, United States. CORRESPONDENCE ADDRESS J.S. Wong, Dana-Farber Cancer Institute, Boston, United States. SOURCE International Journal of Radiation Oncology Biology Physics (2015) 93:3 SUPPL. 1 (E11). Date of Publication: 1 Nov 2015 CONFERENCE NAME 57th Annual Meeting of the American Society for Radiation Oncology, ASTRO 2015 CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2015-10-18 to 2015-10-21 ISSN 0360-3016 BOOK PUBLISHER Elsevier Inc. ABSTRACT Purpose/Objective(s): Post-mastectomy radiation therapy (PMRT) delivered to an immediate reconstruction (often a tissue expander [TE]) increases the risk of complications. A cellular dermal matrix (ADM) has been used with a TE to improve cosmetic outcome and minimize capsular contracture. We hypothesized that ADM used with a TE in a PMRT setting would lessen complications and improve cosmetic outcome. We conducted a prospective trial to assess the success of this approach. Materials/Methods: From 2009 - 2012, we prospectively evaluated patients with stage I-III breast cancer who underwent mastectomy, immediate TE-ADM reconstruction, and PMRT. T4 tumors were excluded. Type of final reconstruction (implant, autologous flap) was at the plastic surgeon's discretion. Patients were followed at 6-month intervals after PMRT for a minimum of 2 years. Data on final reconstruction, treatment, major complications (infection requiring hospitalization, major revision, pain requiring implant removal) and cosmetic outcome were collected. The prescribed chest wall dose was 50-50.4 Gy via photons in 25-28 fractions, with 0.5-cm bolus to the scar every other day. No boost was given. Success was defined as 90% of patients attaining all of the following: 1) final reconstruction, 2) no major complications, and 3) physician-rated excellent or good cosmetic outcome. Results: Thirty-two patients were enrolled. Four were unevaluable at 2 years: 1 left the country, 2 developed metastases and 1 withdrew consent. Median follow up from end of RT was 24 months. Median age was 41.5 (range, 24-63). Median BMI was 23.8 (range, 19-41.4). Nine percent had stage I disease, 72% had stage II and 19% had stage III disease; 88% received chemotherapy. Fifty-three percent underwent bilateral reconstruction. There were no local recurrences. At 2 years, the success rate among evaluable patients was 71% (20/28; 19 implants and 1 flap; 90% confidence interval, 54-85%). Of the 8 failures, 2 implants failed solely due to cosmetic scores, 2 had infections, 1 had significant capsular contracture (eventually revised to flap), 1 implant was revised to a flap, 1 flap required major revision, and 1 TE was removed due to pain and had no final reconstruction. Therefore, 96% (27/28) ultimately had an implant (23) or a flap (4) reconstruction. Conclusion: At two years, 71% met our strict criteria for success in this small prospective series of patients receiving PMRT to a TE-ADM reconstruction. The great majority ultimately achieved a final reconstruction. The results with longer follow up will be of interest. Further details including TE/implant volumes and dosimetry will be reported. Additional study of how to optimize reconstruction with PMRT is warranted. EMTREE DRUG INDEX TERMS cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix American oncology radiotherapy society tissue expander EMTREE MEDICAL INDEX TERMS breast cancer chemotherapy confidence interval contracture dosimetry follow up hospitalization human implant infection mastectomy metastasis neoplasm pain patient photon physician plastic surgeon risk scar thorax wall LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72109458 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 232 TITLE Use of Acellular Dermal Matrix in Postmastectomy Breast Reconstruction: Are All Acellular Dermal Matrices Created Equal? AUTHOR NAMES Ranganathan K. Santosa K.B. Lyons D.A. Mand S. Xin M. Kidwell K. Brown D.L. Wilkins E.G. Momoh A.O. AUTHOR ADDRESSES (Ranganathan K.; Santosa K.B.; Lyons D.A.; Mand S.; Xin M.; Kidwell K.; Brown D.L.; Wilkins E.G.; Momoh A.O.) Ann Arbor, Mich. From the Section of Plastic Surgery, Department of Surgery, Department of Biostatistics, University of Michigan Health System, and the University of Michigan Medical School SOURCE Plastic and reconstructive surgery (2015) 136:4 (647-653). Date of Publication: 1 Oct 2015 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: AlloDerm and FlexHD are two types of acellular dermal matrices commonly used in implant-based reconstruction. Although the use of acellular dermal matrix has revolutionized immediate breast reconstruction in the setting of breast cancer, it remains unclear which type of acellular dermal matrix is best. The purpose of this retrospective cohort study was to compare postoperative complication rates between these two types of acellular dermal matrix.METHODS: The authors reviewed the records of all patients who underwent implant-based breast reconstruction at their institution between 1998 and 2013. Dependent variables of seroma, hematoma, infection, delayed wound healing, implant exposure, and return to the operating room for management of complications were recorded.RESULTS: A total of 309 consecutive patients were identified. Of these, AlloDerm was used in 123 patients (39.8 percent) and FlexHD was used in 186 patients (60.2 percent). Most patients in the authors' cohort underwent immediate reconstruction [n = 288 (93.2 percent)], with a mean follow-up of 20.0 months. Patients receiving AlloDerm were half as likely to have major infections compared with patients receiving FlexHD (OR, 0.50; 95 percent CI, 0.16 to 1.00; p < 0.05). The rates of other complications were similar between the two groups.CONCLUSION: There are significantly increased odds of a major infection in patients who undergo implant-based breast reconstruction using FlexHD compared with AlloDerm.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix procedures EMTREE MEDICAL INDEX TERMS adult aged breast augmentation breast tumor (surgery, surgery) comparative study evaluation study female follow up human mastectomy middle aged outcome assessment postoperative complication (epidemiology, etiology, prevention, epidemiology, etiology, prevention) retrospective study statistical model surgical infection (epidemiology, etiology, prevention, epidemiology, etiology, prevention) CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26397242 (http://www.ncbi.nlm.nih.gov/pubmed/26397242) PUI L607571470 DOI 10.1097/PRS.0000000000001569 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000001569 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 233 TITLE Capsular Contracture in Implant-Based Breast Reconstruction: Examining the Role of Acellular Dermal Matrix Fenestrations AUTHOR NAMES Mowlds D.S. Salibian A.A. Scholz T. Paydar K.Z. Wirth G.A. AUTHOR ADDRESSES (Mowlds D.S.; Salibian A.A.; Scholz T.; Paydar K.Z.; Wirth G.A.) Orange, Calif. From the Department of Plastic Surgery, University of California, Irvine SOURCE Plastic and reconstructive surgery (2015) 136:4 (629-635). Date of Publication: 1 Oct 2015 ISSN 1529-4242 (electronic) ABSTRACT METHODS: A retrospective review of all fenestrated acellular dermal matrix-assisted, implant-based breast reconstructions performed by the two senior authors, with a minimum of 1-year follow-up after permanent implant placement, was completed. Patient demographics, details of extirpative and reconstructive procedures, and complications were examined. Capsular contractures were scored according to the Baker grading scale and compared to those reported in the literature.RESULTS: Thirty patients (50 breasts) underwent fenestrated acellular dermal matrix-assisted reconstruction, with mean follow-up times of 3.3 and 2.6 years after expander placement and implant exchange, respectively. Seven patients (23 percent) had a body mass index greater than 30 kg/m, three (10 percent) were active smokers, and six breasts (12 percent) were irradiated. Complications included one infection (2 percent), six cases (12 percent) of incisional superficial skin necrosis, and one (2 percent) tissue expander extrusion. Zero breasts had clinically significant Baker grade III/IV capsular contracture. The average Baker grade was 1.1.CONCLUSIONS: Fenestrated acellular dermal matrices decrease capsular contracture to rates similar to what is seen with nonfenestrated matrices. Further research is necessary to determine whether this observation is a result of decreased need for inferolateral acellular dermal matrix coverage to achieve these effects or modified physical interaction of acellular dermal matrices with surrounding soft tissues.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.BACKGROUND: Acellular dermal matrices have been proposed to decrease the incidence of capsular contracture in implant-based breast reconstructions. The authors have modified acellular dermal matrices with fenestrations to facilitate greater lower pole expansion and improve contour. The effect of fenestrations on the ability of matrices to suppress capsule formation, however, has not been examined. EMTREE DRUG INDEX TERMS silicone gel EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix procedures EMTREE MEDICAL INDEX TERMS adult aged breast augmentation breast implant devices evaluation study female follow up human implant capsular contracture (prevention, prevention) mastectomy middle aged retrospective study tissue expander treatment outcome LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26090760 (http://www.ncbi.nlm.nih.gov/pubmed/26090760) PUI L607571411 DOI 10.1097/PRS.0000000000001570 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000001570 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 234 TITLE American College of Surgeons 2015 Annual Clinical Congress AUTHOR ADDRESSES SOURCE Journal of the American College of Surgeons (2015) 221:4 SUPPL. 1. Date of Publication: October 2015 CONFERENCE NAME 101st Annual Clinical Congress of the American College of Surgeons CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2015-10-04 to 2015-10-08 ISSN 1072-7515 BOOK PUBLISHER Elsevier Inc. ABSTRACT The proceedings contain 391 papers. The topics discussed include: cost-effectiveness analysis of contralateral prophylactic mastectomy compared to unilateral mastectomy with routine surveillance for unilateral, sporadic breast cancer; efficacy and long-term outcomes after cryo-assisted lumpectomy for breast cancer; neoadjuvant chemotherapy and wound complications: a NSQIP database review; predictors of elective surgery in symptomatic uncomplicated diverticular disease; quantification and categorization of ethical issues discussed at surgical morbidity and mortality conferences; where the sun shines: industry payments to surgeons; platelet-rich plasma enhances mechanical properties of non-crosslinked acellular dermal matricies in rat model of ventral hernia repair; prospective, international study of laparoscopic vs open ventral hernia repair; and long-term clinical and holistic outcomes in children with cleft lip and/or palate: a multidisciplinary, mixed-methods approach. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American college human surgeon EMTREE MEDICAL INDEX TERMS abdominal wall hernia adjuvant chemotherapy breast cancer child classification cleft lip cost effectiveness analysis data base diverticulosis elective surgery hernioplasty industry mastectomy morbidity mortality palate partial mastectomy rat rat model thrombocyte rich plasma wound complication LANGUAGE OF ARTICLE English PUI L72170393 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 235 TITLE Discussion: Use of Acellular Dermal Matrix in Postmastectomy Breast Reconstruction: Are All Acellular Dermal Matrices Created Equal? AUTHOR NAMES Wagner D.S. AUTHOR ADDRESSES (Wagner D.S.) Akron, Ohio From Northeast Ohio Medical University and Akron Plastic Surgeons, LLC SOURCE Plastic and reconstructive surgery (2015) 136:4 (654-656). Date of Publication: 1 Oct 2015 ISSN 1529-4242 (electronic) EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix procedures EMTREE MEDICAL INDEX TERMS breast augmentation female human postoperative complication (etiology, etiology) CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 26397243 (http://www.ncbi.nlm.nih.gov/pubmed/26397243) PUI L607567929 DOI 10.1097/PRS.0000000000001625 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000001625 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 236 TITLE Discussion: Capsular Contracture in Implant-Based Breast Reconstruction: Examining the Role of Acellular Dermal Matrix Fenestrations AUTHOR NAMES Aliotta R. Gurunluoglu R. AUTHOR ADDRESSES (Aliotta R.; Gurunluoglu R.) Cleveland, Ohio From the Department of Plastic Surgery, Cleveland Clinic SOURCE Plastic and reconstructive surgery (2015) 136:4 (636-637). Date of Publication: 1 Oct 2015 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix procedures EMTREE MEDICAL INDEX TERMS breast augmentation female human implant capsular contracture (prevention, prevention) LANGUAGE OF ARTICLE English MEDLINE PMID 26397241 (http://www.ncbi.nlm.nih.gov/pubmed/26397241) PUI L607567860 DOI 10.1097/PRS.0000000000001627 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000001627 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 237 TITLE The Laminated Nature of the Pectoralis Major Muscle and the Redefinition of the Inframammary Fold. Clinical Implications in Aesthetic and Reconstructive Breast Surgery. AUTHOR NAMES Maclin M.M. Deigni O.A. Bengtson B.P. AUTHOR ADDRESSES (Maclin M.M., drmaclin@earthlink.net) Parkcrest Plastic Surgery, 845 North New Ballas Court, Suite 300, St Louis, United States. (Deigni O.A.) St Louis University, St Louis, United States. (Bengtson B.P.) Bengtson Center for Aesthetics and Plastic Surgery, Michigan State University, East Lansing, United States. CORRESPONDENCE ADDRESS M.M. Maclin, Parkcrest Plastic Surgery, 845 North New Ballas Court, Suite 300, St Louis, United States. Email: drmaclin@earthlink.net SOURCE Clinics in Plastic Surgery (2015) 42:4 (465-479). Date of Publication: 1 Oct 2015 ISSN 1558-0504 (electronic) 0094-1298 BOOK PUBLISHER W.B. Saunders EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anatomic landmark breast reconstruction inframammary fold pectoralis major muscle EMTREE MEDICAL INDEX TERMS acellular dermal matrix breast augmentation dissection human incision peroperative care review risk assessment skinfold surgical anatomy surgical approach surgical risk thorax wall treatment outcome treatment planning EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2015312304 MEDLINE PMID 26408437 (http://www.ncbi.nlm.nih.gov/pubmed/26408437) PUI L605692872 DOI 10.1016/j.cps.2015.06.011 FULL TEXT LINK http://dx.doi.org/10.1016/j.cps.2015.06.011 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 238 TITLE Prosthetic breast reconstruction in previously irradiated breasts: A meta-analysis AUTHOR NAMES Lee K.-T. Mun G.-H. AUTHOR ADDRESSES (Lee K.-T.; Mun G.-H., supramicro@gmail.com) Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-dong 50, Gangnam-gu, Seoul, South Korea. CORRESPONDENCE ADDRESS G.-H. Mun, Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-dong 50, Gangnam-gu, Seoul, South Korea. SOURCE Journal of Surgical Oncology (2015) 112:5 (468-475). Date of Publication: 1 Oct 2015 ISSN 1096-9098 (electronic) 0022-4790 BOOK PUBLISHER John Wiley and Sons Inc., P.O.Box 18667, Newark, United States. ABSTRACT Background and Objectives The present review evaluated the impacts of pre-reconstruction radiotherapy on outcome of prosthetic breast reconstruction and compared the safety of prosthetic reconstruction with that of other modalities, including autologous tissue reconstruction and the combination of flap and implant in the setting of pre-reconstruction radiation. Methods Studies presenting outcomes of prosthetic breast reconstruction in the setting of pre-reconstruction radiation published in the past 10 years were identified and reviewed. Results Twenty studies were analyzed. Prosthetic reconstruction in previously irradiated breasts showed significantly increased risks for complications, including reconstruction failure (relative risk, 2.58; 95% confidence interval, 1.86-3.57) than those cases without radiation, regardless of the specific surgical technique used, including one-/two-stage reconstruction, use of an acellular dermal matrix or not, and the timing of the reconstruction (immediate/delayed). Autologous tissue reconstruction and a combination flap and implant showed a 92% and 72% decreased risk of reconstruction failure, respectively, in previously irradiated breasts compared with that of prosthetic reconstruction. Conclusions The results suggest that prior irradiation significantly increases the risk of complications in patients undergoing prosthetic reconstruction, and using an autologous flap or combining it with an implant can be considered to reconstruct previously irradiated breasts. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (radiotherapy, surgery) breast reconstruction cancer surgery EMTREE MEDICAL INDEX TERMS article autotransplantation bibliographic database breast implant breast prosthesis cancer patient cancer radiotherapy clinical evaluation Cochrane Library evidence based practice graft dysfunction (complication) graft necrosis (complication) hematoma (complication) human implant capsular contracture (complication) Medline meta analysis ovid patient safety postoperative complication (complication) priority journal reconstruction failure (complication) reoperation seroma (complication) surgical infection (complication) surgical patient surgical risk treatment outcome EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015384878 MEDLINE PMID 26374273 (http://www.ncbi.nlm.nih.gov/pubmed/26374273) PUI L606059992 DOI 10.1002/jso.24032 FULL TEXT LINK http://dx.doi.org/10.1002/jso.24032 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 239 TITLE Review of AlloDerm Acellular Human Dermis Regenerative Tissue Matrix in Multiple Types of Oculofacial Plastic and Reconstructive Surgery AUTHOR NAMES Bee Y.-S. Alonzo B. Ng J.D. AUTHOR ADDRESSES (Bee Y.-S.) Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. (Alonzo B.) National Defense Medical Center, Taipei, Taiwan. (Ng J.D., ngj@ohsu.edu) Yuh-Ing Junior College of Health Care and Management, Kaohsiung, Taiwan. (Ng J.D., ngj@ohsu.edu) Scripps Mercy Hospital, San Diego, United States. (Ng J.D., ngj@ohsu.edu) Casey Eye Institute, Oregon Health and Science University, 3375 SW Terwilliger Blvd, Portland, United States. CORRESPONDENCE ADDRESS J.D. Ng, Casey Eye Institute, Oregon Health and Science University, 3375 SW Terwilliger Blvd, Portland, United States. SOURCE Ophthalmic Plastic and Reconstructive Surgery (2015) 31:5 (348-351). Date of Publication: 21 Sep 2015 ISSN 1537-2677 (electronic) 0740-9303 BOOK PUBLISHER Lippincott Williams and Wilkins, kathiest.clai@apta.org ABSTRACT Purpose: AlloDerm acellular human dermis is used for repair or replacement of damaged or inadequate skin tissue. It has been used successfully in multiple types of surgeries, including abdominal wall reconstruction, breast reconstruction, and head and neck reconstruction. Its application to ophthalmic plastic and reconstructive surgery is less well described. This study seeks to evaluate the efficacy and factors influencing surgical outcomes using Alloderm in multiple types of oculofacial plastic surgery. Methods: Institutional Review Board-approved retrospective review of 84 patients who underwent surgical procedures using Alloderm. Preoperative demographic data, comorbidities, smoking, clinical etiology, surgical methods, Alloderm type, and outcome (cosmetic and functional) were evaluated. Results: This study included 84 patients, accounting for a total of 98 procedures. Mean age was 52.5 years (3-93 years). Etiologies necessitating surgery included malignancy in 26 patients (31.0%), trauma in 19 patients (22.6%), congenital lesions in 15 patients (17.9%), and senile change in 11 patients (13.1%). Surgical procedures included lower eyelid posterior lamella elongation, socket and fornix reconstruction, scar repair, patch grafts, and filler. Mean duration of follow up was 530 days. Overall, 92.8% of patients had favorable outcomes. Factors associated with significantly worse outcomes included smoking, congenital anomaly etiologies, and previous graft/flaps in the same area (p = 0.03, p = 0.029, and p = 0.007, respectively). Conclusions: This study suggests that Alloderm acellular human dermis can be used safely and effectively in multiple types of oculofacial procedures. Smoking, congenital anomaly etiologies, and previous graft/flap were associated with poor cosmetic and functional outcomes. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix face surgery oculofacial surgery plastic surgery EMTREE MEDICAL INDEX TERMS adult aged article child congenital malformation (surgery) eyelid reconstruction female follow up human injury (surgery) major clinical study male outcome assessment patient history of surgery priority journal smoking surgical technique tissue regeneration DEVICE TRADE NAMES 'Alloderm' , United StatesLifecell DEVICE MANUFACTURERS (United States)Lifecell EMBASE CLASSIFICATIONS Ophthalmology (12) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014928665 MEDLINE PMID 25369836 (http://www.ncbi.nlm.nih.gov/pubmed/25369836) PUI L600581667 DOI 10.1097/IOP.0000000000000339 FULL TEXT LINK http://dx.doi.org/10.1097/IOP.0000000000000339 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 240 TITLE Acellular Dermal Matrix (Strattice™) in implant based immediate breast reconstruction-single unit experience AUTHOR NAMES Monib S. Maalo J. Lai L. AUTHOR ADDRESSES (Monib S.; Maalo J.; Lai L.) West Hertfordshire NHS Trust, Breast Unit, Watford, United Kingdom. CORRESPONDENCE ADDRESS S. Monib, West Hertfordshire NHS Trust, Breast Unit, Watford, United Kingdom. SOURCE European Journal of Cancer (2015) 51 SUPPL. 3 (S307-S308). Date of Publication: September 2015 CONFERENCE NAME European Cancer Congress 2015, ECC 2015 CONFERENCE LOCATION Vienna, Austria CONFERENCE DATE 2015-09-25 to 2015-09-29 ISSN 0959-8049 BOOK PUBLISHER Elsevier Ltd ABSTRACT Background: The use of acellular dermal matrix (Strattice™) in implantbased immediate breast reconstruction (IBR) has gained popularity in recent years. Potential advantages using this technique are improved aesthetic outcomes, allowing slightly larger implant based reconstructions. However, there are also complications which are specific to implants and Strattice™. The purpose of this study is to evaluate the surgical outcomes of breast reconstruction using implants with acellular dermal matrix. Material and Methods: Retrospective review of all implant-based IBR using Strattice™ performed between 2010 and 2014 at West Hertfordshire Hospitals NHS Trust to assess the outcomes, complications and impact on adjuvant therapy. Results: Fourty patients who underwent mastectomy with immediate breast reconstruction using implant-based IBR with ADM(Strattice™) were reviewed. All but one patients had confirmed diagnosis of breast cancer. 8 patients had nipple-sparing mastectomy(2 bilateral) and 1 had areolasparing mastectomy. Mean age of patients was 52.9 years, mean height 162.0cm, mean weight 65.5kg, and mean BMI 24.4kg/m(2). The majority of patients(62%) presented symptomatically, whilst 38% were screen detected. Four(10%) patients had early complications, 2 of whom resulted in loss of implant. One patient had nipple necrosis and another had 'red breast'. 1 patient had seroma requiring multiple aspirations. 5 patients underwent adjuvant chest wall radiotherapy of whom one patient developed early contracture. No patient suffered any significant delay to adjuvant therapy. Conclusions: Low complication rates and good outcomes were observed with the use of acellular dermal matrix in implant-based immediate breast reconstruction. Longer follow up is required to assess outcomes following radiotherapy. EMTREE DRUG INDEX TERMS adjuvant EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction European implant neoplasm surgical mesh EMTREE MEDICAL INDEX TERMS adjuvant therapy aspiration breast breast cancer contracture diagnosis follow up height hospital human mastectomy necrosis nipple patient radiotherapy seroma thorax wall weight LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72067535 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 241 TITLE Systematic review and critical appraisal of the impact of acellular dermal matrix use on the outcomes of implant-based breast reconstruction AUTHOR NAMES Potter S. Browning D. Savović J. Holcombe C. Blazeby J.M. AUTHOR ADDRESSES (Potter S.) Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK (Browning D.) Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK (Browning D.) Department of Surgery, Royal United Hospital, Bath, UK (Savović J.) Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK (Holcombe C.) Breast Unit, Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK (Blazeby J.M.) Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK (Blazeby J.M.) Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK SOURCE The British journal of surgery (2015) 102:9 (1010-1025). Date of Publication: 1 Aug 2015 ISSN 1365-2168 (electronic) ABSTRACT BACKGROUND: Acellular dermal matrix (ADM) may improve outcomes in implant-based breast reconstruction (IBBR). The aim of this study was critically to appraise and evaluate the current evidence for ADM-assisted IBBR.METHODS: Comprehensive electronic searches identified complete papers published in English between January 2000 and August 2013, reporting any outcome of ADM-assisted IBBR. All systematic reviews, randomized clinical trials (RCTs) and non-randomized studies (NRSs) with more than 20 ADM recipients were included. Studies were critically appraised using AMSTAR for systematic reviews, the Cochrane risk-of-bias tool for RCTs and its adaptation for NRSs. Characteristics and results of identified studies were summarized.RESULTS: A total of 69 papers (8 systematic reviews, 1 RCT, 40 comparative studies and 20 case series) were identified, all of which were considered at high risk of bias, mostly due to patient selection and selective outcome reporting. The median ADM group sample size was 51.0 (i.q.r. 33.0-127.0). Most studies were single-centre (54), and they were often single-surgeon (16). ADM was most commonly used for immediate (40) two-stage IBBR (36) using human ADM (47), with few studies evaluating ADM-assisted single-stage procedures (10). All reported clinical outcomes (for example implant loss) and more than half of the papers (33) assessed process outcomes, but few evaluated cosmesis (16) or patient-reported outcomes (10). Heterogeneity between study design and, especially, outcome measurement precluded meaningful data synthesis.CONCLUSION: Current evidence for the value of ADMs in IBBR is limited. Use in practice should therefore be considered experimental, and evaluation within registries or well designed and conducted studies, ideally RCTs, is recommended to prevent widespread adoption of a potentially inferior intervention. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix procedures EMTREE MEDICAL INDEX TERMS breast augmentation female human outcome assessment LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26109277 (http://www.ncbi.nlm.nih.gov/pubmed/26109277) PUI L606136788 DOI 10.1002/bjs.9804 FULL TEXT LINK http://dx.doi.org/10.1002/bjs.9804 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 242 TITLE Embrace the Change: Incorporating Single-Stage Implant Breast Reconstruction into Your Practice AUTHOR NAMES Rodriguez-Feliz J. Codner M.A. AUTHOR ADDRESSES (Rodriguez-Feliz J.; Codner M.A.) Atlanta, Ga. From Emory University and Mark Codner MD Plastic Surgery SOURCE Plastic and reconstructive surgery (2015) 136:2 (221-231). Date of Publication: 1 Aug 2015 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Multiple studies have reported on the safety of nipple-sparing mastectomy and low complication rates associated with single-stage implant breast reconstruction. Yet many plastic surgeons continue to be resistant to change. This article presents the senior author's (M.A.C.) experience during his transition period from the latissimus dorsi flap with adjustable implants to a "one-and-done" approach using shaped implants and fetal bovine acellular dermal matrix.METHODS: A literature review was performed selecting articles discussing single-stage implant reconstruction, indications, outcomes, technique, and complications. Additional articles were selected after review of the references of identified articles. Clinical pearls discussed include patient selection, implant selection, and mastectomy incision choices, with a detailed description of the senior author's operative technique.RESULTS: Twenty-seven single-stage implant reconstructions were performed. Average mastectomy weight was 343.82 g. The average implant volume was 367 cc. Shaped implants were most commonly used. Acellular dermal matrix was used in all breasts. Complications included erythema requiring intravenous antibiotics (three patients), skin ischemia caused by methylene blue (one patient), seroma (one patient), unilateral partial nipple necrosis (one patient), mastectomy skin necrosis (one patient), and exposed/infected implants that were salvaged using a sequential irrigation protocol described by Sforza et al. in 2014 (two patients).CONCLUSIONS: Breast reconstruction after mastectomy has evolved toward less invasive, single-stage procedures. Aesthetic refinements include nipple-sparing mastectomy, use of acellular dermal matrix, shaped implants, and fat grafting. Selected patients will benefit from a one-and-done breast implant reconstruction with no additional oncologic risk. Surgeons must embrace the change and provide their patients with a procedure that will offer the best aesthetic outcomes.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix nipple procedures transplantation EMTREE MEDICAL INDEX TERMS adipose tissue adult adverse effects aged autotransplantation breast reconstruction breast tumor (surgery) clinical practice cohort analysis conservative treatment esthetics female human middle aged pathology pathophysiology patient selection physiology plastic surgery postoperative complication (surgery) retrospective study standards subcutaneous mastectomy treatment outcome trends wound healing LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26218372 (http://www.ncbi.nlm.nih.gov/pubmed/26218372) PUI L606531276 DOI 10.1097/PRS.0000000000001448 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000001448 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 243 TITLE Current attitudes to breast reconstruction surgery for women at risk of post-mastectomy radiotherapy: A survey of UK breast surgeons AUTHOR NAMES Duxbury P.J. Gandhi A. Kirwan C.C. Jain Y. Harvey J.R. AUTHOR ADDRESSES (Duxbury P.J., paula.duxbury@uhsm.nhs.uk; Gandhi A.; Kirwan C.C.; Jain Y.; Harvey J.R.) Manchester Academic Health Science Centre, The University of Manchester, University Hospital of South Manchester, Wythenshawe Hospital, Southmoor Road, UK Manchester, United Kingdom. CORRESPONDENCE ADDRESS P.J. Duxbury, Nightingale Centre, University Hospital of South Manchester, Wythenshawe Hospital, Southmoor Road, Manchester, United Kingdom. Email: paula.duxbury@uhsm.nhs.uk SOURCE Breast (2015) 24:4 (502-512). Date of Publication: 1 Aug 2015 ISSN 1532-3080 (electronic) 0960-9776 BOOK PUBLISHER Churchill Livingstone ABSTRACT Decision-making for women requiring reconstruction and post-mastectomy radiotherapy (PMRT) includes oncological safety, cosmesis, patient choice, potential delay/interference with adjuvant treatment and surgeon/oncologist preference. This study aimed to quantitatively assess surgeons' attitudes and perceptions about reconstructive options in this setting, and to ascertain if surgical volume influenced advice given. A questionnaire was sent to surgical members of the UK Association of Breast Surgery (ABS) in March-June 2014. The questionnaire elicited information on surgeon volume, reconstructive practice and drivers influencing decision-making. Response rate was 42% (148/355), representing 71% of UK breast units. Delayed breast reconstruction (DBR) was offered more commonly than immediate implant, delayed-immediate or immediate autologous reconstruction (. p < 0.05). Cosmesis was thought to be equivalent between IBR and DBR by 15% of surgeons, and 26% believe IBR and DBR offer similar Health-related Quality of Life (HRQoL). Surgeon volume had no effect on reconstruction choice. Common decision-making drivers included negative effects of radiotherapy upon reconstructive and cosmetic outcome. The majority of surgeons (77%) believe the current evidence base is insufficient to guide decision-making. Despite surgeons believing that cosmesis and quality of life are not equivalent between IBR and DBR, DBR remains the commonest approach to this difficult clinical scenario. Surgeons perceive they are using a variety of newer techniques such as Delayed-Immediate Reconstruction and Acellular Dermal Matrices to try to ameliorate the effects of PMRT. This survey demonstrates that there is wide variation in reported surgical practice in this difficult setting. There is widespread acknowledgement of the lack of evidence to guide decision-making. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction cancer radiotherapy mastectomy perception physician attitude postmastectomy radiotherapy surgeon EMTREE MEDICAL INDEX TERMS article breast cancer (radiotherapy, surgery) breast implant esthetic surgery evidence based medicine female health survey human medical decision making medical practice outcome assessment practice guideline priority journal quality of life quantitative analysis questionnaire surgical technique treatment response United Kingdom EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015066727 MEDLINE PMID 26021276 (http://www.ncbi.nlm.nih.gov/pubmed/26021276) PUI L604495951 DOI 10.1016/j.breast.2015.05.002 FULL TEXT LINK http://dx.doi.org/10.1016/j.breast.2015.05.002 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 244 TITLE Patient-Report Satisfaction and Health-Related Quality of Life in TiLOOP® Bra-Assisted or Implant-Based Breast Reconstruction Alone AUTHOR NAMES M D. J A. A S. A G. T R. B G. J S. AUTHOR ADDRESSES (M D., max.dieterich@uni-rostock.de; J A.; A S.; A G.; T R.; B G.; J S.) Breast Unit, Department of Obstetrics and Gynecology, Interdisciplinary Breast Center, University of Rostock, Suedring 81, 18059, Rostock, Germany, SOURCE Aesthetic plastic surgery (2015) 39:4 (523-533). Date of Publication: 1 Aug 2015 ISSN 1432-5241 (electronic) ABSTRACT INTRODUCTION: Implant-based breast reconstructions (IBBR) using alternatives to acellular dermal matrixes are increasing. Data on complications are limited, and information concerning health-related quality of life (HR-QoL) following the use of these synthetic meshes do not exist.METHODS: Between January 2006 and January 2013, patients undergoing immediate or delayed-immediate IBBR with or without titanium covered polypropylene mesh (TiLOOP® Bra) were investigated. HR-QoL was assessed using the validated self-reporting BREAST-Q questionnaire. Patient demographics and complications were evaluated retrospectively. Stepwise regression backward elimination analysis was performed to identify influential factors on each BREAST-Q domain.RESULTS: Of the 90 women, 42 had IBBR alone and 48 in combination with TiLOOP® Bra. The mean follow-up was 18 months in the TiLOOP® Bra and 17.5 months in the implant alone group (p = 0.827). The overall complication rate was 21.1 %, with 14.6 % in the TiLOOP® Bra and in 28.6 % in the implant alone group (p = 0.105). Capsular contraction rate was 4.4 % in the TiLOOP® Bra and 16.7 % in the implant alone group (p = 0.052). The analysis of the HR-QoL showed no significant differences between the groups. Surgeries prior to IBBR had a positive influence on HR-QoL. TiLOOP® Bra was associated with a negative effect on "satisfaction with breast" (β = -5.72; p < 0.001), as it was no longer observed for "satisfaction with outcome" and other domains. EMTREE DRUG INDEX TERMS polypropylene titanium EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast implant breast reconstruction patient satisfaction quality of life self report EMTREE MEDICAL INDEX TERMS adult female human middle aged prosthesis retrospective study surgical mesh CAS REGISTRY NUMBERS polypropylene (25085-53-4, 9003-07-0) titanium (7440-32-6) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26085227 (http://www.ncbi.nlm.nih.gov/pubmed/26085227) PUI L609964025 DOI 10.1007/s00266-015-0520-x FULL TEXT LINK http://dx.doi.org/10.1007/s00266-015-0520-x COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 245 TITLE A Review of the Use of Acellular Dermal Matrices in Postmastectomy Immediate Breast Reconstruction AUTHOR NAMES Chao A.H. AUTHOR ADDRESSES (Chao A.H.) Albert H. Chao, MD, is Assistant Professor in the Department of Plastic Surgery at Ohio State University and a board-certified plastic surgeon with specialty training in oncologic reconstructive surgery. His clinical practice focuses on oncologic reconstruction and microsurgery, and his research interests include patient outcomes and the role of technology SOURCE Plastic surgical nursing : official journal of the American Society of Plastic and Reconstructive Surgical Nurses (2015) 35:3 (131-4; quiz 135-6). Date of Publication: 1 Jul 2015 ISSN 1550-1841 (electronic) ABSTRACT Acellular dermal matrices (ADMs) are now commonly used in postmastectomy implant-based immediate breast reconstruction. In 2-stage reconstructions involving placement of a tissue expander followed by an implant, they can improve the aesthetic outcome and expedite the expansion process. The use of ADMs has also allowed for 1-stage immediate placement of an implant following mastectomy (direct-to-implant reconstruction). However, the use of ADMs is associated with an increased risk of certain types of complications. An understanding of the use of these materials is essential to the postoperative care of patients who undergo ADM-assisted breast reconstruction. In this article, the use of ADMs in postmastectomy immediate breast reconstruction is reviewed. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix mastectomy procedures EMTREE MEDICAL INDEX TERMS adverse effects breast augmentation breast implant devices female human postoperative complication (etiology) time factor tissue expander tissue expansion LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26313677 (http://www.ncbi.nlm.nih.gov/pubmed/26313677) PUI L615155425 DOI 10.1097/PSN.0000000000000103 FULL TEXT LINK http://dx.doi.org/10.1097/PSN.0000000000000103 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 246 TITLE Nipple-sparing mastectomy via an inframammary fold incision with implant-based reconstruction in patients with prior cosmetic breast surgery AUTHOR NAMES Dent B.L. Cordeiro C.N. Small K. Clemons J.A. Kessler E.G. Swistel A. Talmor M. AUTHOR ADDRESSES (Dent B.L.; Talmor M., miatmd@aol.com) Department of Clinical Surgery, Division of Plastic Surgery, Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, 425 East 61st Street, New York, United States. (Cordeiro C.N.) Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, United States. (Small K.) Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, United States. (Clemons J.A.) Weill Cornell Medical College, Cornell University, New York, United States. (Kessler E.G.) Department of Surgery, University at Buffalo, Buffalo General Medical Center, Buffalo, United States. (Swistel A.) Department of Clinical Surgery, Division of Breast Surgery, Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, United States. CORRESPONDENCE ADDRESS M. Talmor, Department of Clinical Surgery, Division of Plastic Surgery, Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, 425 East 61st Street, New York, United States. Email: miatmd@aol.com SOURCE Aesthetic Surgery Journal (2015) 35:5 (548-557). Date of Publication: 1 Jul 2015 ISSN 1527-330X (electronic) 1090-820X BOOK PUBLISHER Oxford University Press, jnl.info@oup.co.uk ABSTRACT Background Nipple-sparing mastectomy through an inframammary fold incision (NSM-IMF) with implant-based reconstruction (IBR) is a cosmetically preferable approach to breast cancer treatment in appropriate candidates. However, patients who have undergone prior cosmetic breast surgery (CBS) may be at increased risk for postoperative complications secondary to existing surgical scars. Objective To assess whether prior CBS increases the risk of complications following NSM-IMF with IBR. Methods A retrospective chart review was conducted for 398 NSM-IMFs with IBR performed between July 2006 and December 2013. CBS cases were identified. Outcomes were reviewed. Results Of 398 NSM-IMF cases, 41 had prior CBS: 24 augmentations, 12 reductions, three mastopexies, and two augmentation mastopexies. NSM-IMF was performed an average of 8 years following CBS. CBS cases had lower BMIs (P =. 040), more breast tissue resected (P =. 021), wider breast bases (P =. 0002), more single-stage reconstructions (P <. 0001), more ADM use (P <. 0001), and larger permanent implants (P =. 0051) than those without CBS. Postoperatively, CBS cases had higher rates of mastectomy flap ischemia (P =. 0392) and hematoma (P =. 0335). Among CBS cases, single-stage reconstruction was associated with increased full-thickness flap ischemia (P =. 0066). Compared to prior augmentation cases, prior reduction/mastopexy cases had higher rates of capsular contracture (P =. 0409) and seroma (P =. 0226). Conclusions This series is the largest to date to evaluate the success of NSM-IMF with IBR in CBS patients. These women should be cautiously considered for IBR, particularly in the setting of single-stage reconstruction. EMTREE DRUG INDEX TERMS antibiotic agent (drug therapy, intravenous drug administration) insulin (drug therapy) oral antidiabetic agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation breast carcinoma (radiotherapy, surgery) breast reconstruction breast tissue expander (adverse device effect) implant based reconstruction incision mastectomy nipple sparing mastectomy through an inframammary fold incision silicone breast implant (adverse device effect) EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult aged antibiotic therapy breast breast reduction cancer patient cancer radiotherapy contracture (complication) controlled study diabetes mellitus (drug therapy) female flap ischemia (complication) hematoma (complication) human intraductal carcinoma (radiotherapy, surgery) ischemia (complication) major clinical study medical record review middle aged outcome assessment partial mastectomy patient counseling postoperative complication postoperative period priority journal review risk assessment seroma (complication) surgical infection (drug therapy) surgical patient surgical risk surgical technique CAS REGISTRY NUMBERS insulin (9004-10-8) EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20151012204 MEDLINE PMID 25911626 (http://www.ncbi.nlm.nih.gov/pubmed/25911626) PUI L607192137 DOI 10.1093/asj/sju158 FULL TEXT LINK http://dx.doi.org/10.1093/asj/sju158 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 247 TITLE Remodeling Characteristics and Collagen Distributions of Biologic Scaffold Materials Biopsied From Postmastectomy Breast Reconstruction Sites AUTHOR NAMES Cavallo J.A. Gangopadhyay N. Dudas J. Roma A.A. Jasielec M.S. Baty J. Baalman S. Frisella M.M. Tenenbaum M.M. Myckatyn T.M. Matthews B.D. Deeken C.R. AUTHOR ADDRESSES (Cavallo J.A.) From the *Section of Minimally Invasive Surgery, Department of Surgery, †Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO; ‡Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH; and §Department of Biostatistics, Washington University School of Medicine, St. Louis, MO (Gangopadhyay N.; Dudas J.; Roma A.A.; Jasielec M.S.; Baty J.; Baalman S.; Frisella M.M.; Tenenbaum M.M.; Myckatyn T.M.; Matthews B.D.; Deeken C.R.) SOURCE Annals of plastic surgery (2015) 75:1 (74-83). Date of Publication: 1 Jul 2015 ISSN 1536-3708 (electronic) ABSTRACT OBJECTIVE: The study purpose was to evaluate the associations between patient characteristics and the histologic remodeling scores of acellular dermal matrices (ADMs) biopsied from breast reconstruction sites in the first attempt to generate a multivariable risk prediction model of nonconstructive remodeling. It was hypothesized that host characteristics and surgical site assessments predict the degree of graft remodeling for ADMs used during breast reconstruction.METHODS: The ADMs were biopsied from the breast reconstruction sites of n = 62 patients during a subsequent breast procedure, stained with hematoxylin-eosin, and evaluated according to a semi-quantitative scoring system for remodeling characteristics (cell types, cell infiltration, extracellular matrix deposition, scaffold degradation, fibrous encapsulation, and neovascularization) and a mean composite score. Biopsies were stained with Sirius Red and Fast Green, and analyzed to determine the collagen I:III ratio. Based on univariate analyses between subject clinical characteristics and the histologic remodeling scores, cohort variables were selected for multivariable regression models using a P value of 0.20 or less.RESULTS: The composite score model yielded 3 variables: pack-year history, corticosteroid use, and radiation timing (r pseudo = 0.81). The model for collagen I yielded 2 variables: corticosteroid use and reason for reoperation (r pseudo = 0.78). The model for collagen III yielded 1 variable: reason for reoperation (r pseudo = 0.35).CONCLUSIONS: These preliminary results constitute the first steps in generating a risk prediction model that predicts the patients and clinical circumstances most likely to experience nonconstructive remodeling of biologic grafts used to reconstruct the breast. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) biomaterial collagen (drug analysis) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction pathology surgery tissue scaffold EMTREE MEDICAL INDEX TERMS adult aged biopsy breast female human mastectomy middle aged prospective study young adult CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25910026 (http://www.ncbi.nlm.nih.gov/pubmed/25910026) PUI L615135487 DOI 10.1097/SAP.0000000000000538 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0000000000000538 COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 248 TITLE Critical Evaluation of Risk Factors and Early Complications in 564 Consecutive Two-Stage Implant-Based Breast Reconstructions Using Acellular Dermal Matrix at a Single Center AUTHOR NAMES Selber J.C. Wren J.H. Garvey P.B. Zhang H. Erickson C. Clemens M.W. Butler C.E. AUTHOR ADDRESSES (Selber J.C.; Wren J.H.; Garvey P.B.; Zhang H.; Erickson C.; Clemens M.W.; Butler C.E.) Houston, Texas From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center SOURCE Plastic and reconstructive surgery (2015) 136:1 (10-20). Date of Publication: 1 Jul 2015 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Acellular dermal matrix for implant-based breast reconstruction appears to cause higher early complication rates, but long-term outcomes are perceived to be superior. This dichotomy is the subject of considerable debate. The authors hypothesized that patient characteristics and operative variables would have a greater impact on complications than the type of acellular dermal matrix used.METHODS: A retrospective cohort study was performed of consecutive patients who underwent two-stage, implant-based breast reconstruction with human cadaveric or bovine acellular dermal matrix from 2006 to 2012 at a single institution. Patient characteristics and operative variables were analyzed using logistic regression analyses to identify risk factors for complications.RESULTS: The authors included 564 reconstructions in the study. Radiation therapy and obesity increased the odds of all complications. Every 100-ml increase in preoperative breast volume increased the odds of any complication by 1 percent, the odds of infection by 27 percent, and the risk of explantation by 16 percent. The odds of seroma increased linearly with increasing surface area of acellular dermal matrix. Odds of infection were higher with an intraoperative expander fill volume greater than 50 percent of the total volume. Risk of explantation was twice as high when intraoperative expander fill volume was greater than 300 ml.CONCLUSIONS: Radiation therapy, obesity, larger breasts, higher intraoperative fill volumes, and larger acellular dermal matrices are all independent risk factors for early complications. Maximizing the initial mastectomy skin envelope fill must be balanced with the understanding that higher complication rates may result from a larger intraoperative breast mound.CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adverse effects procedures EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult animal bovine breast augmentation breast tumor (surgery) device removal evaluation study female follow up human middle aged multivariate analysis outcome assessment postoperative complication (etiology) retrospective study risk factor statistical model statistics and numerical data LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26111310 (http://www.ncbi.nlm.nih.gov/pubmed/26111310) PUI L605927984 DOI 10.1097/PRS.0000000000001327 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000001327 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 249 TITLE Tissue Expander Complications Predict Permanent Implant Complications and Failure of Breast Reconstruction AUTHOR NAMES Adkinson J.M. Miller N.F. Eid S.M. Miles M.G. Murphy R.X. AUTHOR ADDRESSES (Adkinson J.M.; Miller N.F.; Eid S.M.; Miles M.G.; Murphy R.X.) From the *Department of Surgery, Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, MI; and †Department of Surgery, Division of Plastic Surgery, and ‡Department of Community Health and Health Studies, Lehigh Valley Health Network, Allentown, PA SOURCE Annals of plastic surgery (2015) 75:1 (24-28). Date of Publication: 1 Jul 2015 ISSN 1536-3708 (electronic) ABSTRACT BACKGROUND: Two-stage tissue expander-based breast reconstruction is the most commonly used reconstructive modality following mastectomy. We sought to determine if patients who experienced complications during the expansion phase were at increased risk for complications or reconstructive failure after the exchange procedure.METHODS: A retrospective review of tissue expander-based breast reconstructions was performed from January 2007 through December 2011. Variables evaluated included age, presence of cancer, tobacco use, body mass index, comorbidities, use of acellular dermal matrix, chemotherapy, radiation, timing of reconstruction (delayed/immediate), intraoperative tissue expander fill, complications, and explantation or salvage of the reconstruction by means of debridement and closure or myocutaneous flap.RESULTS: A total of 196 patients underwent mastectomy with 304 tissue expander reconstructions. Tobacco use (active and remote), hypertension, and radiation were associated with complications. Patients with a salvaged tissue expander complication were 3 times more likely to have a complication after placement of a permanent implant and 9 times more likely to fail permanent implant reconstruction (ie, require explantation).CONCLUSIONS: Women with complications after placement of a tissue expander are at significantly increased risk for both complications and reconstructive failure after placement of a permanent implant. Consideration for earlier autologous reconstruction as a salvage should be strongly considered in patients with a tissue expander complication, particularly in smokers and those undergoing radiation therapy. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adverse effects procedures EMTREE MEDICAL INDEX TERMS breast reconstruction breast tumor (surgery) female human middle aged postoperative complication (epidemiology, etiology) retrospective study tissue expander tissue expansion treatment failure LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25003412 (http://www.ncbi.nlm.nih.gov/pubmed/25003412) PUI L609542147 DOI 10.1097/SAP.0000000000000142 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0000000000000142 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 250 TITLE Implant exposure repaired combining the use of acellular dermal matrix and lateral thoracodorsal flap AUTHOR NAMES Torresini G. Sozio A. Garreffa E. Brucchi M. Lucantoni R. AUTHOR ADDRESSES (Torresini G.; Garreffa E., emangar@live.it) Plastic and Reconstructive Surgery Outpatients’ Clinic, Division of General Surgery, Department of Surgery, Ospedale Civile Mazzini, Piazza Italia 1, Teramo, Italy. (Sozio A.; Brucchi M.) Breast Surgery Unit, Division of General Surgery, Department of Surgery, Ospedale Civile Mazzini, Teramo, Italy. (Lucantoni R.) Department of Surgery, Division of General Surgery, Ospedale Civile Mazzini, Teramo, Italy. CORRESPONDENCE ADDRESS E. Garreffa, Plastic and Reconstructive Surgery Outpatients’ Clinic, Division of General Surgery, Department of Surgery, Ospedale Civile Mazzini, Piazza Italia 1, Teramo, Italy. SOURCE European Journal of Plastic Surgery (2015) 38:5 (427-428). Date of Publication: 2 Jun 2015 ISSN 1435-0130 (electronic) 0930-343X BOOK PUBLISHER Springer Verlag, service@springer.de EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant exposure (complication) breast reconstruction lateral thoracodorsal flap postoperative complication (complication) tissue flap EMTREE MEDICAL INDEX TERMS adult breast cancer (surgery) case report debridement fasciocutaneous flap female human letter mastectomy mesotherapy middle aged priority journal skin flap thrombocyte rich plasma EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2015089374 PUI L604697132 DOI 10.1007/s00238-015-1101-6 FULL TEXT LINK http://dx.doi.org/10.1007/s00238-015-1101-6 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 251 TITLE Outcomes of immediate breast reconstruction using an implant and acellular dermal matrix: A systematic review of the different products currently in use AUTHOR NAMES Cook L. Douek M. AUTHOR ADDRESSES (Cook L.; Douek M.) Kings College London, London, United Kingdom. CORRESPONDENCE ADDRESS L. Cook, Kings College London, London, United Kingdom. SOURCE European Journal of Surgical Oncology (2015) 41:6 (S52). Date of Publication: June 2015 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2015 CONFERENCE LOCATION Bournemouth, United Kingdom CONFERENCE DATE 2015-06-15 to 2015-06-16 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Over the last 10-15 years there has been a significant increase in acellular dermal matrix (ADM) use for breast reconstruction, which has lead to the introduction of multiple alternative ADM products. We conducted a systematic review of studies reporting on the outcomes of ADMs currently used for immediate implant-based breast reconstruction. Methods: Ovid SP versions of EMBASE and MEDLINE databases were used. Search terms were: ((“breast” OR “breast reconstruction”) AND (“acellular dermal matrix” OR “acellular dermis” OR Strattice OR Surgimend OR Alloderm OR Human acellular dermis OR cadaveric dermis or acellular dermis-assisted or Dermamatrix or FlexHD or Neoform)). Strict inclusion and exclusion criteria were applied, data was abstracted using a pro forma and risk of bias was assessed using the Down's and Black checklist. Results: A total of 27 studies met inclusion criteria. 18/27 were retrospective case series and 9/27 were cohort studies with a non-ADM control group. There were no randomised controlled trials. There were 2 studies on bovine ADM use and 6 on porcine ADM use, with the remainder reporting on human ADMs. Significant risk of bias was demonstrated in the cohort studies, mainly as a result of allocation bias and a lack of information related to the distribution of potential confounders. Conclusions: There remains very little high quality evidence for the outcomes of breast reconstruction using an ADM, particularly for non-human ADMs. High risk of bias means individual study results cannot reliably be combined in the form of a meta-analysis. EMTREE DRUG INDEX TERMS metformin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction breast surgery implant systematic review EMTREE MEDICAL INDEX TERMS breast case study checklist cohort analysis control group data base dermis human meta analysis nonhuman randomized controlled trial risk surgical mesh LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72214362 DOI 10.1016/j.ejso.2015.03.130 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2015.03.130 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 252 TITLE Multicentre audit of acellular dermal matrix (ADM) assisted, implant-based breast reconstructions AUTHOR NAMES Mazari F. Azmy I. Rogers C. Olubowale O. Kolar K. Kazzazi N. AUTHOR ADDRESSES (Mazari F.; Azmy I.) Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield, United Kingdom. (Rogers C.; Olubowale O.; Kolar K.; Kazzazi N.) Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Doncaster, United Kingdom. CORRESPONDENCE ADDRESS F. Mazari, Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield, United Kingdom. SOURCE European Journal of Surgical Oncology (2015) 41:6 (S66). Date of Publication: June 2015 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2015 CONFERENCE LOCATION Bournemouth, United Kingdom CONFERENCE DATE 2015-06-15 to 2015-06-16 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: This retrospective audit was designed to assess the practice for ADM-assisted breast reconstructions according to “Joint ABS/ BAPRAS guidelines for ADM assisted breast reconstruction” published in 2013. Methods: Standards were identified for demographics, information, operation, outcomes and satisfaction. Data was collected from case-notes and electronic records for five oncoplastic consultants, across three hospitals in two NHS Trusts. Results: Demographics: 103 patients were included. Mean age was 51 (SD10) years. Median BMI was 24 (IQR 21-27). 10% (n = 10) were current smokers. 17% (n = 17) had bilateral procedures. 94% (n = 92%) were discussed in MDT pre-operatively. ADM were only discussed in MDT in 25% (n = 24). Information: 90% (n = 90) patients received written information. 98% (n = 101) received information regarding implant, 67% (n = 69) for ADM origin and 89% (n = 91) for revision possibility. Operation: Surgery was performed as day-case in only 4% (n = 4). Median stay was 1 day (IQR 1-7). All patients had prophylactic antibiotics. Median specimen weight was 370grams (IQR 260-560). ADMs used included Strattice (51%, n = 51), Surgimend (38%, n = 39), Permacol (2%, n = 2), Tiloop (5%, n = 5) and Seri (5%, n = 5). Drains were used in 92% (n = 95) for median of 7 days (IQR 5-13). Outcomes: 50% (n = 52) had seroma. 17% (n = 17) had wound infection and 32% (n = 33) received therapeutic antibiotics. 18% (n = 19) has re-operation, but only 5% (n = 5) within 30 days. Implant loss rate was 11% (n = 13) while ADM loss rate was 4% (n = 5). 77% (n = 10) of implants lost were within 3months. Implant loss rate was significantly higher in active smokers. Satisfaction: Pre and post-operative photography was performed in 73% (n = 75). Patient satisfaction was recorded in 57% (59). Conclusion: ADM-assisted breast reconstructions produce good results. Smoking remains the most important risk factor for implant loss. Improvement can be made to provide more information, MDT discussion, reduce implant loss and increase patient satisfaction. EMTREE DRUG INDEX TERMS antibiotic agent nitrogen 13 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction breast surgery clinical audit human implant EMTREE MEDICAL INDEX TERMS consultation hospital patient patient satisfaction photography procedures risk factor satisfaction seroma smoking surgery surgical mesh weight wound infection LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72214410 DOI 10.1016/j.ejso.2015.03.179 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2015.03.179 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 253 TITLE An audit of Acellular Dermal Matrix (ADM) assisted breast reconstruction procedures-are antibiotics unavoidable? AUTHOR NAMES Metry M. Thomas R. Youssef M. Mclean N. Serra P. Carr M. AUTHOR ADDRESSES (Metry M.; Thomas R.; Youssef M.; Mclean N.; Serra P.; Carr M.) Northumbria Healthcare, Northumberland, United Kingdom. CORRESPONDENCE ADDRESS M. Metry, Northumbria Healthcare, Northumberland, United Kingdom. SOURCE European Journal of Surgical Oncology (2015) 41:6 (S29). Date of Publication: June 2015 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2015 CONFERENCE LOCATION Bournemouth, United Kingdom CONFERENCE DATE 2015-06-15 to 2015-06-16 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: The use of ADM grafts in breast reconstruction has been widely adopted in the UK. Following the National Mastectomy and Breast Reconstruction Audit, joint guidelines from ABS and BAPRAS were published in 2013 with regards to the use of ADMs in breast reconstruction. The aim is to audit clinical outcomes in our district general unit against these guidelines. Methods: Data was collected retrospectively from medical records over a one-year period. Indications; cautions; surgical technique; postoperative infection; implant loss; patient reported outcome measures; unit and organisation criteria were recorded. Results: 23 consecutive patients were included. Median age was 52 years (40-69); Median BMI 24 (18.5-43). 14 (60.8%) had immediate reconstruction with expander or dual chamber implant, 5 (21%) had delayed 2nd stage reconstruction and 4 patients (17.3%) had risk-reducing mastectomy. There was 0% return to theatre for local complications; target <5%. There was a 4% rate of implant loss within 3 months; target <5%. 100% received written information about breast reconstruction. 2 (8.6%) had proven wound infection; target <10%. 5 (23%) took a further course of antibiotics for suspected wound infection with a simultaneous possible diagnosis of 'Red Breast Syndrome.' Conclusion: Our unit is meeting the targets for safe use of ADMs. The high antibiotic use for suspected infection is reflected by the possible presence of Red Breast Syndrome post-operatively. The debate lies in the need for antibiotics in this instance, against the risk posed by no antibiotics to the possible loss of implant in an obviously erythematous breast. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) antibiotic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction breast surgery clinical audit human procedures EMTREE MEDICAL INDEX TERMS breast diagnosis implant infection mastectomy medical record organization patient postoperative infection risk surgical technique United Kingdom wound infection LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72214277 DOI 10.1016/j.ejso.2015.03.041 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2015.03.041 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 254 TITLE Use of acellular dermal matrix (ADM) in nipple reconstruction following breast reconstruction; the 'central-pillar technique' AUTHOR NAMES Thiruchelvam P. Concepcion M. Bramhall R. Gui G. AUTHOR ADDRESSES (Thiruchelvam P.; Bramhall R.; Gui G.) Royal Marsden Hospital, London, United Kingdom. (Concepcion M.) London Clinic, London, United Kingdom. CORRESPONDENCE ADDRESS P. Thiruchelvam, Royal Marsden Hospital, London, United Kingdom. SOURCE European Journal of Surgical Oncology (2015) 41:6 (S69). Date of Publication: June 2015 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2015 CONFERENCE LOCATION Bournemouth, United Kingdom CONFERENCE DATE 2015-06-15 to 2015-06-16 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: A number of techniques for reconstructing the nippleareolar complex have been developed, but no single method reliably yields a consistent aesthetic result with low morbidity and durable nipple projection. In a recent retrospective study, the factor patients disliked most about their nipple reconstruction was the lack of projection. We propose the use of a nipple shaped cylinder of layered acellular dermal matrix (ADM) as an augment to nipple reconstruction. Methods: 10 patients were recruited to have nipple reconstruction following either skin sparing mastectomy, ADM and implant reconstruction or central excision. Nipple projection and diameter were recorded before, immediately after and following surgery at 6 and 12 months. Results: Of the 5 patients undergoing a nipple revision (one bilateral) - the average nipple height at the end of the procedure was 11.5mm. 12 months following revision surgery the average nipple height was 5.3mm. 3 patients had a further nipple revision between 6 and 12 months. In the nipple revision group, nipple diameter immediately following surgery was 11.5mm, and 9.2mm at 12 months. 4 patients undertaking a primary nipple reconstruction, 2 were bilateral, and of these, immediately following reconstruction the nipple height measured 10.2mm. At 12 months, the average nipple height was 5.2mm. Nipple diameter following surgery measured 10.2mm and 9.2mm at 12 months. Conclusion: We describe a case series of nipple reconstruction using an ADM as an augment, to improve durability of nipple height and diameter. Further improvements in surgical technique will hopefully result in better projection using this novel approach. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction breast surgery nipple EMTREE MEDICAL INDEX TERMS case study excision height human implant mastectomy morbidity patient procedures retrospective study skin surgery surgical technique LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72214422 DOI 10.1016/j.ejso.2015.03.191 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2015.03.191 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 255 TITLE Careful patient selection is critical in preventing complications after acellular dermal matrix assisted implant-based breast reconstruction AUTHOR NAMES Shah R. Laurence N. Sutton R. McIntosh J. AUTHOR ADDRESSES (Shah R.; Laurence N.; Sutton R.; McIntosh J.) Royal United Hospital, Bath, United Kingdom. CORRESPONDENCE ADDRESS R. Shah, Royal United Hospital, Bath, United Kingdom. SOURCE European Journal of Surgical Oncology (2015) 41:6 (S22). Date of Publication: June 2015 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2015 CONFERENCE LOCATION Bournemouth, United Kingdom CONFERENCE DATE 2015-06-15 to 2015-06-16 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Background: Acellular dermal matrix (ADM) assisted implant-based breast reconstruction has been taken up widely and relatively quickly by many reconstructive surgeons in the United Kingdom. Published data have demonstrated somewhat high complication rates associated with this technique. We reviewed the outcomes for ADM assisted implant-based breast reconstructions performed in our unit. Methods: All ADM assisted reconstructions performed in our unit were identified from a prospectively maintained database. Complications were recorded as well as patient co-morbidities, surgical technique and adjuvant therapies. Results: 53 ADM assisted reconstructions were performed in 46 patients (42 therapeutic and 11 prophylactic mastectomies). All patients were non-smokers, had not had previous radiotherapy, had no significant medical co-morbidities, and had a BMI in the range of 19-24. Eight patients had a post-operative complication (15.1%) from which 4 patients required a second operation. Two (3.8%) implants were lost (1 delayed wound healing (DWH) and 1 skin necrosis), both in patients who had previously undergone breast augmentation. One wound required revision for DWH (1.8%) and one patient required evacuation of a haematoma (1.8%). Three (5.7%) patients had a minor delay in receiving adjuvant treatments. Conclusion: Our results demonstrate a significantly lower implant loss rate (P < 0.0482, p < 0.0001) and complication rate (p < 0.0074) for ADM assisted implant-based breast reconstructions compared to recently published data, and our figures are within the target standards from the NMBRA. These results support a policy of careful patient selection to be key in reducing complication rates and implant loss with this technique. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction breast surgery human implant patient selection EMTREE MEDICAL INDEX TERMS adjuvant therapy breast augmentation data base hematoma mastectomy morbidity patient patient history of radiotherapy policy postoperative complication skin necrosis smoking surgeon surgical technique United Kingdom wound wound healing impairment LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72214255 DOI 10.1016/j.ejso.2015.03.019 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2015.03.019 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 256 TITLE Implant breast reconstruction with and without acellular dermal matrix - Audit and comparative analysis AUTHOR NAMES Voynov V. Narayanan S. Soumian S. AUTHOR ADDRESSES (Voynov V.) Royal Marsden NHS FT, London, United Kingdom. (Narayanan S.; Soumian S.) University Hospital of North Midlands, Stoke on Trent, United Kingdom. CORRESPONDENCE ADDRESS V. Voynov, Royal Marsden NHS FT, London, United Kingdom. SOURCE European Journal of Surgical Oncology (2015) 41:6 (S69). Date of Publication: June 2015 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2015 CONFERENCE LOCATION Bournemouth, United Kingdom CONFERENCE DATE 2015-06-15 to 2015-06-16 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: The most common form of immediate breast reconstruction after mastectomy is implant based. Acellular dermal matrix (ADM) has become a very popular addition to this type of reconstruction. The vast majority of published data relates to an ADM product which is not in use in the UK. With this in mind we audited our initial experience with Strattice and compared the outcome to that of non-ADM implant breast reconstruction. Methods: All consecutive patients with ADM assisted implant breast reconstruction until July 2014 were retrospectively audited against 'Oncoplastic breast reconstruction' and 'ADM assisted breast reconstruction' guidelines. Furthermore a comparison was done to all non-ADM implant reconstructions. Group difference analysis and logistic regression were used to examine the data. Results: The audit showed that unplanned return to theatre (6.9%), implant loss (6.9%) and therapeutic antibiotic use (37.9%) were higher than the suggested targets. The analysis showed no significant difference between ADM and non-ADM cases for erythema, seroma, skin necrosis, infection, implant loss, re-operation, therapeutic antibiotic use, or time to start of adjuvant therapy (p > 0.05 for all). Postoperative clinic visits were increased for the ADM group and this was close to becoming statistically significant (p = 0.053). On univariate and multivariate regression ADM was not a significant predictor for any of the above mentioned outcomes. On multivariate regression smoking was an independent predictor of infection (p = 0.0103) and skin necrosis (p < 0.0001), and prior breast radiotherapy was an independent predictor of seroma (p = 0.0054). Conclusions: ADM and non-ADM immediate implant breast reconstructions were comparable in terms of early postoperative complications and ADM (Strattice) did not significantly increase the complications. EMTREE DRUG INDEX TERMS antibiotic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction breast surgery clinical audit human implant EMTREE MEDICAL INDEX TERMS adjuvant therapy breast erythema hospital infection logistic regression analysis mastectomy patient postoperative complication radiotherapy seroma skin necrosis smoking surgical mesh United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72214423 DOI 10.1016/j.ejso.2015.03.192 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2015.03.192 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 257 TITLE Pre-pectoral implant placement with total acellular dermal matrix cover - A new technique for implant based breast reconstruction AUTHOR NAMES Highton L. O'Ceallaigh S. Murphy J. AUTHOR ADDRESSES (Highton L.; O'Ceallaigh S.; Murphy J.) University Hospital of South Manchester NHS Foundation Trust, Wythenshawe, Manchester, United Kingdom. CORRESPONDENCE ADDRESS L. Highton, University Hospital of South Manchester NHS Foundation Trust, Wythenshawe, Manchester, United Kingdom. SOURCE European Journal of Surgical Oncology (2015) 41:6 (S47). Date of Publication: June 2015 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2015 CONFERENCE LOCATION Bournemouth, United Kingdom CONFERENCE DATE 2015-06-15 to 2015-06-16 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: The conventional approach to implant based breast reconstruction involves sub-pectoral implant placement with partial detachment of the pectoralis major (PM). This may be accompanied by total sub muscular implant placement or a lower pole acellular dermal matrix (ADM) sling. Compared to pre-pectoral implant placement, the advantage of an improved cosmetic result comes with the disadvantages of PM functional impairment, breast animation and postoperative pain. A considerable number of women do not want their PMM detached for these reasons. We report a novel technique of pre-pectoral implant placement with total implant coverage by ADM. Methods: This technique was used in a total of 12 breasts in 9 patients (6 unilateral and 3 bilateral) January-November 2014. In 5 cases this followed skin-sparing-mastectomy with direct-to-implant reconstruction. In 3 cases the technique was used for revision of previous implant based reconstruction and in 1 case for revision of breast augmentation. A cohesive gel anatomical implant was placed in the pre-pectoral plane and completely covered with ADM. We utilised a contour and an 8 x 16cm sheet of Strattice™, which were sutured together and to the fascia of the PMM and inframammary fold to contain the implant. Patients required an overnight stay in hospital and simple analgesics. They were discharged with a drain(s) and prescribed prophylactic antibiotics. Results: The cosmetic outcome and patient satisfaction have been good to date. There has been no evidence of animation, implant dislocation, implant rim visibility or palpability or significant capsular contracture. There have been no complications in this series. Conclusion: Pre-pectoral implant placement with total ADM coverage represents a novel approach with good cosmetic results whilst avoiding the disadvantages of PM detachment. Whilst our small series has shown promising results longer term follow up and further studies are required. EMTREE DRUG INDEX TERMS analgesic agent antibiotic agent cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction breast surgery implant EMTREE MEDICAL INDEX TERMS breast breast augmentation contracture fascia female follow up functional disease hospital human mastectomy patient patient satisfaction postoperative pain skin surgical mesh LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72214344 DOI 10.1016/j.ejso.2015.03.112 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2015.03.112 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 258 TITLE Does acellular dermal matrix really improve aesthetic outcome in tissue expander/implant-based breast reconstruction? AUTHOR NAMES Ibrahim A.M. Koolen P.G. Ganor O. Markarian M.K. Tobias A.M. Lee B.T. Lin S.J. Mureau M.A. AUTHOR ADDRESSES (Ibrahim A.M.; Koolen P.G.; Ganor O.; Markarian M.K.; Tobias A.M.; Lee B.T.; Lin S.J.; Mureau M.A.) Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA, aibrahim@bidmc.harvard.edu SOURCE Aesthetic plastic surgery (2015) 39:3 (359-368). Date of Publication: 1 Jun 2015 ISSN 1432-5241 (electronic) ABSTRACT BACKGROUND: The expectation for improved results by women undergoing postmastectomy reconstruction has steadily risen. A majority of these operations are tissue expander/implant-based breast reconstructions. Acellular dermal matrix (ADM) offers numerous advantages in these procedures. Thus far, the evidence to justify improved aesthetic outcome has solely been based on surgeon opinion. The purpose of this study was to assess aesthetic outcome following ADM use in tissue expander/implant-based breast reconstruction by a panel of blinded plastic surgeons.METHODS: Mean aesthetic results of patients who underwent tissue expander/implant-based breast reconstruction with (n = 18) or without ADM (n = 20) were assessed with objective grading of preoperative and postoperative photographs by five independent blinded plastic surgeons. Absolute observed agreement as well as weighted Fleiss Kappa (κ) test statistics were calculated to assess inter-rater variability.RESULTS: When ADM was incorporated, the overall aesthetic score was improved by an average of 12.1 %. In addition, subscale analyses revealed improvements in breast contour (35.2 %), implant placement (20.7 %), lower pole projection (16.7 %), and inframammary fold definition (13.8 %). Contour (p = 0.039), implant placement (p = 0.021), and overall aesthetic score (p = 0.022) reached statistical significance. Inter-rater reliability showed mostly moderate agreement.CONCLUSIONS: Mean aesthetic scores were higher in the ADM-assisted breast reconstruction cohort including the total aesthetic score which was statistically significant. Aesthetic outcome alone may justify the added expense of incorporating biologic mesh. Moreover, ADM has other benefits which may render it cost-effective. Larger prospective studies are needed to provide plastic surgeons with more definitive guidelines for ADM use.LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant esthetics procedures utilization EMTREE MEDICAL INDEX TERMS adult adverse effects aged breast augmentation chi square distribution cohort analysis comparative study female follow up human mastectomy middle aged nonparametric test observer variation physiology prosthesis complication prosthesis design retrospective study risk assessment tissue expander treatment outcome wound healing LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25894022 (http://www.ncbi.nlm.nih.gov/pubmed/25894022) PUI L612016557 DOI 10.1007/s00266-015-0484-x FULL TEXT LINK http://dx.doi.org/10.1007/s00266-015-0484-x COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 259 TITLE A Comparison of Dermal Autograft and Acellular Dermal Matrix in Tissue Expander Breast Reconstruction: Long-term Aesthetic Outcomes and Capsular Contracture AUTHOR NAMES Lynch M.P. Chung M.T. Rinker B.D. AUTHOR ADDRESSES (Lynch M.P.; Chung M.T.; Rinker B.D.) From the *Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Kentucky; and †University of Kentucky College of Medicine, Lexington, KY SOURCE Annals of plastic surgery (2015) 74 Supplement 4 (S214-S217). Date of Publication: 1 Jun 2015 ISSN 1536-3708 (electronic) ABSTRACT BACKGROUND: The use of acellular dermal matrix (ADM) in tissue expander breast reconstruction has been touted to reduce capsular contracture rates and improve aesthetic outcomes. Autogenous dermal grafts have shown to be a safer and more cost-effective alternative to ADM. The purpose of this study was to compare the capsular contracture rates and long-term aesthetic outcomes of tissue expander breast reconstruction using dermal autografts with ADM-assisted reconstruction.METHODS: Patients undergoing tissue expander breast reconstruction with either ADM or dermal autografts were enrolled. Autografts were harvested from the lower abdomen. The capsular contracture rate was assessed via physical examination using the Baker scale. Standardized patient photographs were scored for aesthetic appearance on a 7-point Likert scale by blinded female observers. The ADM and autograft groups were compared using Student t test. Significance was defined as P < 0.05.RESULTS: Forty-eight patients were enrolled (76 breasts). The average follow-up time for the ADM group was 9.6 months and 9.9 months for the dermal autograft group. Twenty-seven patients received ADM, and 21 patients received dermal autograft. Capsular contracture scores were identical between the 2 groups (mean Baker grade = 1.15, P = 0.55). The average long-term aesthetic outcome score for dermal autograft-assisted breast reconstruction was 3.85, compared to 3.79 for ADM-assisted reconstruction. This difference was not statistically significant (P = 0.87).CONCLUSIONS: In addition to an improved safety profile and lower cost, dermal autograft-assisted tissue expander breast reconstruction affords equivalent aesthetic results and capsular contracture rates, when compared to ADM. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix procedures skin transplantation tissue expansion EMTREE MEDICAL INDEX TERMS adult aged autotransplantation breast augmentation comparative study devices esthetics evaluation study female follow up human implant capsular contracture (epidemiology, etiology) middle aged outcome assessment single blind procedure LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25389715 (http://www.ncbi.nlm.nih.gov/pubmed/25389715) PUI L608224659 DOI 10.1097/SAP.0000000000000375 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0000000000000375 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 260 TITLE Evaluation of the early post-operative effectiveness of a novel muscle-sparing breast reconstruction technique - Using Braxon (acellular dermal matrix) AUTHOR NAMES Humphries A. Williams S. Vidya R. Cawthorn S. AUTHOR ADDRESSES (Humphries A.; Williams S.; Cawthorn S.) North Bristol NHS Trust, Bristol, United Kingdom. (Vidya R.) University Hospital of North Midlands, Stoke on Trent, United Kingdom. CORRESPONDENCE ADDRESS A. Humphries, North Bristol NHS Trust, Bristol, United Kingdom. SOURCE European Journal of Surgical Oncology (2015) 41:6 (S71-S72). Date of Publication: June 2015 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2015 CONFERENCE LOCATION Bournemouth, United Kingdom CONFERENCE DATE 2015-06-15 to 2015-06-16 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: We report initial results of a novel muscle-sparing subcutaneous implant breast reconstruction technique using a new Braxon® ADM Methods: All patients who underwent muscle-sparing breast reconstruction in 2 Breast Units in 2014 were included in the study. The Braxon mesh which comes pre-shaped completely wraps the implant which is placed on the muscle, without detaching the pectoralis major. It is rehydrated in saline in 10 minutes. Results: A total of 22-patients underwent mastectomy and Braxon ADM plus implant reconstruction, 5 bilateral and 17 unilateral; a total of 27 reconstructions. The rate of implant loss was 3.7% (n = 1 due to wound breakdown), seroma 14% (n = 4) and infection 0%. Excellent cosmetic outcomes so far were obtained with a low complication rate. None of the patients reported experiencing pain or the “dancing breast syndrome” at 1 month Conclusions: The initial experience appears highly satisfactory. A feasibility study for a randomized trial comparing Braxon with submuscular /ADM implant reconstruction is planned. EMTREE DRUG INDEX TERMS cosmetic sodium chloride EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction breast surgery muscle EMTREE MEDICAL INDEX TERMS breast dancing feasibility study human implant infection mastectomy pain patient seroma wound LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72214431 DOI 10.1016/j.ejso.2015.03.200 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2015.03.200 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 261 TITLE An initial experience using a titanium-coated polypropylene mesh (TiLoop® Bra) for implant based breast reconstruction AUTHOR NAMES Shrestha A. Acharya R. Chatterjee S. AUTHOR ADDRESSES (Shrestha A.; Acharya R.; Chatterjee S.) Hope Hospital, Manchester, United Kingdom. CORRESPONDENCE ADDRESS A. Shrestha, Hope Hospital, Manchester, United Kingdom. SOURCE European Journal of Surgical Oncology (2015) 41:6 (S61). Date of Publication: June 2015 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2015 CONFERENCE LOCATION Bournemouth, United Kingdom CONFERENCE DATE 2015-06-15 to 2015-06-16 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Titanium-coated polypropylene mesh (TCPM) is considered as an alternative to acellular dermal matrix (ADM) in implant based breast reconstruction (IBBR). TCPM is used as a hammock to envelop the lower pole of the implant or expander, as with the ADM. The aim of this study is to examine the limitations and complications of TCPM for IBBR and associated risk factors. Methods: A retrospective analysis of 23 patients who underwent immediate or delayed IBBR using TCPM was carried out. Primary endpoint considered the incidence of removal of implant or expander with or without mesh. Results: 26 procedures IBBR with TCPM was carried out in 23 patients, 3 had bilateral procedures. Time from procedure was a median of 413 days (range 47- 764). 4 reconstructions failed and implants were removed. 2 patients were smokers, 1 had radiotherapy prior to reconstruction and 1 had recurrent seroma and removal was after 12 months. 3 other patients developed seroma and 2 developed skin necrosis. 16 out of 23 patients had immediate breast reconstruction after have skin sparing mastectomy, only 1 requiring contralateral reduction. 3 underwent delayed reconstruction using expander with TCPM. Conclusion: Careful selection of patients needs to be carried out to ensure possible prevention of failure of reconstruction accounting for factors affecting wound healing. Advantages include remote scar mastectomy, good inframammary fold definition and ptosis, cost reduction, acceptability in patients who prefer not to have animal products. Results seem promising, however, larger sample size and longer follow up is required. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) polypropylene titanium EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction breast surgery implant EMTREE MEDICAL INDEX TERMS acellular dermal matrix animal product follow up human mastectomy patient prevention procedures ptosis radiotherapy risk factor sample size scar seroma skin skin necrosis smoking wound healing LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72214392 DOI 10.1016/j.ejso.2015.03.160 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2015.03.160 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 262 TITLE Comparison of three acellular collagen matrix materials to assist implant-based breast reconstruction AUTHOR NAMES Barber M. AUTHOR ADDRESSES (Barber M.) Edinburgh Breast Unit, Edinburgh, United Kingdom. CORRESPONDENCE ADDRESS M. Barber, Edinburgh Breast Unit, Edinburgh, United Kingdom. SOURCE European Journal of Surgical Oncology (2015) 41:6 (S35). Date of Publication: June 2015 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2015 CONFERENCE LOCATION Bournemouth, United Kingdom CONFERENCE DATE 2015-06-15 to 2015-06-16 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: The Edinburgh Breast Unit performed 419 implantbased breast reconstructions assisted by the use of acellular collagen matrix (ACM) between July 2008 and July 2014. Three types of matrix have been used for 402 of these procedures. The present study aimed to compare the use and outcome of Permacol, Strattice and Veritas to assist implantbased breast reconstruction. Methods: Cases of implant-based breast reconstruction using Permacol, Strattice and Veritas ACMs performed in Edinburgh were analysed with 6 months follow up. Results: Permacol (P), Strattice (S) and Veritas (V) were used in 72, 220 and 110 breast reconstructions respectively. Patient and breast weight, indications for mastectomy and proportion of bilateral cases did not differ between groups. Smoking, use of chemotherapy, incision used, associated axillary surgery, nipple preservation and use of fixed volume implant or expander did vary between groups apparently reflecting changes in practice over time. Rates of postoperative erythema varied significantly between groups (P 15.3%, S 7.7%, V 0.9%, chi = 13.6, p = 0.0011). Surgeons ranked materials V 1, S 2 and P 3 (chi-35.3, p < 0.0001). There was no difference in rates of unplanned surgery at 6 months (P 25%, S 27.7%, V 31.8%, chi = 1.1, p = 0.58) or implant loss at 6 months between groups (P 12.4%, S 11.4% and V 12.5% , chi = 0.1, p = 0.95). Conclusions: While differences exist in the characteristics of ACMs available to assist implant-based breast reconstruction and surgeons have clear preferences, there were no differences in outcome in terms of failure rate or unplanned reoperations in the present study. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen EMTREE DRUG INDEX TERMS pralidoxime mesilate EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction breast surgery implant EMTREE MEDICAL INDEX TERMS breast chemotherapy erythema follow up human incision mastectomy nipple patient preservation procedures smoking surgeon surgery surgical mesh weight LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72214298 DOI 10.1016/j.ejso.2015.03.065 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2015.03.065 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 263 TITLE Acellular dermal matrix versus latissimus dorsi breast reconstruction: An investigation of the costs AUTHOR NAMES Potiszil K. Drew P. Brown I. El-Gammal M. English R. King P. Ahmad S. AUTHOR ADDRESSES (Potiszil K.; Drew P.; Brown I.; El-Gammal M.; English R.; King P.; Ahmad S.) Royal Cornwall Hospital Trust, Truro, United Kingdom. CORRESPONDENCE ADDRESS K. Potiszil, Royal Cornwall Hospital Trust, Truro, United Kingdom. SOURCE European Journal of Surgical Oncology (2015) 41:6 (S59). Date of Publication: June 2015 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2015 CONFERENCE LOCATION Bournemouth, United Kingdom CONFERENCE DATE 2015-06-15 to 2015-06-16 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: The use of acellular dermal matrix (ADM) is now widespread in breast reconstruction. This is reflected by many centres now using implant with ADM as their primary reconstructive option, as opposed to the autologous LD flap. However, cost comparisons have not yet been made in a large UK population. Methods: A retrospective analysis was performed of 5 years of data from immediate breast reconstructions by 5 surgeons in a single institution. All unilateral implant with ADM reconstructions were compared with all cases of LD flap reconstruction. Surgical and patient characteristics were recorded with complications. Costs of initial surgery, follow up, revisional surgery and materials were calculated. Results: LD reconstruction was shown to be more expensive to our hospital trust due to higher initial costs. Despite concerns of higher revision rates raising costs in implant and ADM reconstruction, this was not found to be the case in our cohort. Conclusion: Reconstruction with implant and ADM is replacing LD as the dominant method of breast reconstruction in the UK. Despite concerns regarding increased complication rates and need for revision, we have shown that for our hospital trust, ADM provides a cost effective alternative. (Table Presented). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction breast surgery latissimus dorsi muscle EMTREE MEDICAL INDEX TERMS follow up hospital human implant patient population surgeon surgery United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72214384 DOI 10.1016/j.ejso.2015.03.152 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2015.03.152 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 264 TITLE The use of Titanium mesh (TiLOOP®) in immediate breast reconstruction; low cost, low complications AUTHOR NAMES Caldon L. Allison C. Cain H. O'Donoghue J. Critchley A. AUTHOR ADDRESSES (Caldon L.; Allison C.; Cain H.; O'Donoghue J.; Critchley A.) Newcastle Upon Tyne Trust, Newcastle, United Kingdom. CORRESPONDENCE ADDRESS L. Caldon, Newcastle Upon Tyne Trust, Newcastle, United Kingdom. SOURCE European Journal of Surgical Oncology (2015) 41:6 (S69-S70). Date of Publication: June 2015 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2015 CONFERENCE LOCATION Bournemouth, United Kingdom CONFERENCE DATE 2015-06-15 to 2015-06-16 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Immediate Breast Reconstruction (IBR) is increasing. One-stage implant-based procedures are facilitated by non-autologous lower-pole coverage (Acellular dermal matrices and synthetic materials i.e. TiLOOP®). Published data regarding these materials is limited and costs vary. Methods: Consecutive series of short-term outcomes of mastectomy and definitive implant-based IBR with TiLOOP® at a single institution. Patients were identified through theatre records and implant registries November 2013 to January 2015. Data was extracted from electronic patient records, nursing and medical notes. Data analysed using SPSS version 22. Results: Twenty-one patients with 26 TiLOOP® assisted reconstructions with a mean follow up of 194 days (range 9-430) were analysed. Patients were a median age 51 (range 32-79) and median BMI of 25 (range 21-34). The majority had physical hobbies (n = 16), no major comorbidities (n = 17) and one was a smoker. The majority (n = 19) stated the desire for a simple reconstructive option and were satisfied with their current breast size (n = 18). 19 had in-situ or invasive breast cancer (n = 13 screen-detected), 2 were risk reducing (proven BRCA mutation). Complications included: 1 haematoma; 5 seromas requiring single (40-150ml) aspiration; 3 with seroma treated as suspected minor infection with oral antibiotics. One implant loss was seen in this series. There was no correlation of complications with cup size, comorbidities or smoking status. Conclusions: TiLOOP® is an economical non-autologous material available to provide lower-pole support and facilitate one-stage implant - based IBR, which is associated with a low complication rate. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) titanium EMTREE DRUG INDEX TERMS antibiotic agent nitrogen 13 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction breast surgery EMTREE MEDICAL INDEX TERMS acellular dermal matrix aspiration breast breast cancer data analysis software electronic medical record follow up hematoma human implant implant registry infection leisure mastectomy mutation nursing patient procedures risk seroma smoking LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72214424 DOI 10.1016/j.ejso.2015.03.193 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2015.03.193 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 265 TITLE Nipple-sparing mastectomy via an inframammary fold incision for patients with scarring from prior lumpectomy AUTHOR NAMES Huston T.L. Small K. Swistel A.J. Dent B.L. Talmor M. AUTHOR ADDRESSES (Huston T.L.; Small K.; Swistel A.J.; Dent B.L.; Talmor M.) From the *Divisions of Plastic Surgery and †Breast Surgery,Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY SOURCE Annals of plastic surgery (2015) 74:6 (652-657). Date of Publication: 1 Jun 2015 ISSN 1536-3708 (electronic) ABSTRACT BACKGROUND: Nipple-sparing mastectomy (NSM) through an inframammary fold (IMF) incision can provide superior cosmesis and a high level of patient satisfaction. Because of concerns for nipple-areolar complex (NAC) viability using this incision, selection criteria may be limited. Here, we evaluate the impact of scarring from prior lumpectomy on NAC viability.METHODS: A retrospective chart review was conducted on a prospectively collected database at a single institution between July 2006 and October 2012. A total of 318 NSMs through IMF incisions were performed. We compared the incidence of NAC ischemia in 122 NSM cases with prior lumpectomy with 196 NSM cases without prior lumpectomy. All 318 mastectomies were followed by implant-based reconstruction. Clinicopathologic factors analyzed included indications for surgery, technical details, patient demographics, comorbidities, and adjuvant therapy.RESULTS: The overall incidence of NAC ischemia was 20.4% (65/318). Nipple-areolar complex ischemia occurred in 24.6% (30/122) of cases with prior lumpectomy and 17.9% (35/196) of cases without prior lumpectomy (P = 0.1477). Among the 30 ischemic events in the 122 cases with prior lumpectomy, epidermolysis occurred in 20 (16.4%) and necrosis occurred in 10 (8.2%). Two cases (1.6%) required operative debridement. Seven cases (5.7%) were left with areas of residual NAC depigmentation. All other cases completely resolved with conservative management. There was no significant correlation between the incidence of ischemia and surgical indication, tumor staging, age, body mass index, tissue resection volume, sternal notch to nipple distance, prior radiation, single-stage reconstruction, sentinel or axillary lymph node dissection, acellular dermal matrix use, presence of periareolar lumpectomy scars, diabetes, or smoking history. At a mean follow-up of 505 days (range, 7-1504 days), patient satisfaction was excellent. Local recurrence of breast cancer occurred in 3 cases (2.5%), and distant recurrence occurred in 2 cases (1.6%).CONCLUSIONS: Patients with scarring from prior lumpectomy do not have a higher rate of NAC ischemia and may be considered for NSM via an IMF incision. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) postoperative complication (epidemiology) procedures vascularization EMTREE MEDICAL INDEX TERMS adult aged evaluation study female follow up human ischemia (epidemiology, etiology) middle aged nipple outcome assessment partial mastectomy reoperation retrospective study scar (etiology) surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25003464 (http://www.ncbi.nlm.nih.gov/pubmed/25003464) PUI L608226206 DOI 10.1097/SAP.0000000000000004 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0000000000000004 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 266 TITLE Regenerative biomaterials: a review AUTHOR NAMES Banyard D.A. Bourgeois J.M. Widgerow A.D. Evans G.R. AUTHOR ADDRESSES (Banyard D.A.; Bourgeois J.M.; Widgerow A.D.; Evans G.R.) Orange, Calif. From the Center for Tissue Engineering, Department of Plastic Surgery, University of California, Irvine SOURCE Plastic and reconstructive surgery (2015) 135:6 (1740-1748). Date of Publication: 1 Jun 2015 ISSN 1529-4242 (electronic) ABSTRACT The authors present a review of biomaterials, substances traditionally derived from human or animal tissue or, more recently, biodegradable synthetics modeled after naturally occurring resources. These constructs differ from purely synthetic materials in that they are degraded or incorporated into a host's tissue. These biomaterials include a diverse array of medical products, such as acellular dermal matrix, bone substitutes, and injectables. In this review, the authors examine various clinical applications, including burn reconstruction and wound healing, breast surgery, complex abdominal wall reconstruction, craniofacial repair, and cosmetic surgery. Biomaterials such as acellular dermal matrix have proven beneficial in difficult-to-treat applications; however, more prospective data are needed to determine their true efficacy and cost-effectiveness. EMTREE DRUG INDEX TERMS biomaterial (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) physiology EMTREE MEDICAL INDEX TERMS abdominal wall acellular dermal matrix adverse effects breast reconstruction female follow up human male nose reconstruction patient safety plastic surgery procedures risk assessment surgery surgical mesh thorax wall wound healing LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 26017603 (http://www.ncbi.nlm.nih.gov/pubmed/26017603) PUI L605489848 DOI 10.1097/PRS.0000000000001272 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000001272 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 267 TITLE Investigation of coding and HRG/income for oncoplastic procedures AUTHOR NAMES Ng V. Olsen S. AUTHOR ADDRESSES (Ng V.; Olsen S.) Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom. CORRESPONDENCE ADDRESS V. Ng, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom. SOURCE European Journal of Surgical Oncology (2015) 41:6 (S74-S75). Date of Publication: June 2015 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2015 CONFERENCE LOCATION Bournemouth, United Kingdom CONFERENCE DATE 2015-06-15 to 2015-06-16 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: It was found that our breast unit has not been coding our mastectomies and reconstructions properly and a potential loss in money was calculated. Aim: To look at all our mastectomies and immediate reconstructions and see whether they have been coded properly on the OPCS system Method: All skin sparing mastectomies and immediate reconstructions with ADM/Implant that were performed over a 6 month period were taken from our central database and the OPCS and HRG codes were compared and to look at the reason why they were inappropriately coded. Results: There were 24 cases covering all 3 consultants. 9 achieved the correct HRG code (JA16Z Mastectomy and reconstruction - £6415). The remaining cases did not get a reconstruction HRG but instead JA07 and JA06 codes which are the HRGs usually assigned to mastectomies. The lost income on these 15 cases alone is about £80,000. Conclusion: Interventions were made and a re-audit will be performed of coding and HRG allocation for 3 months after these interventions. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast surgery procedures EMTREE MEDICAL INDEX TERMS breast clinical audit consultation data base human income mastectomy money skin LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72214442 DOI 10.1016/j.ejso.2015.03.211 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2015.03.211 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 268 TITLE Simplified skin excision pattern for skin-sparing/reducing mastectomy and direct-to-implant single-stage immediate (DISSI) breast reconstruction AUTHOR NAMES Papazian N. Atiyeh B. Becker H. Dibo S. Ibrahim A. AUTHOR ADDRESSES (Papazian N.; Atiyeh B.; Dibo S.; Ibrahim A., ai12@aub.edu.lb) Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon. (Becker H.) Plastic and Reconstructive Surgery, 670 Glades Road, Suite 220, Boca Raton, United States. CORRESPONDENCE ADDRESS A. Ibrahim, Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon. SOURCE European Journal of Plastic Surgery (2015) 38:4 (291-298) Article Number: A017. Date of Publication: 28 May 2015 ISSN 1435-0130 (electronic) 0930-343X BOOK PUBLISHER Springer Verlag, service@springer.de ABSTRACT Background One-stage implant-based breast reconstruction with minimal scarring is a highly appealing option to most patients. In fact, expander/implant reconstruction accounts for nearly 70% of all breast reconstructions. We present our experience with a simplified skin-preserving/reducing excision pattern in association with immediate breast reconstruction using permanent expander or prosthesis. Methods Thirty-two patients with 45 reconstructed breasts (unilateral or bilateral) between February 2010 and March 2014 are included in this study. All implants, except for two reconstructed breasts, were placed in a dual plane. Implants used were either a permanent expander or permanent silicone prosthesis. Results Two patients developed postoperative infections requiring removal of the implants. Minor wound dehiscence without implant extrusion occurred in one breast. One breast had a late deflation of the permanent expander secondary to trauma. Another patient required postoperative revision with fat grafting to improve breast contour. Conclusions One-stage prosthetic-based immediate breast reconstruction is a safe option with gratifying outcomes provided adequate patients’ selection and enough surgeons’ expertise to perform it. Level of Evidence: Level IV, therapeutic study. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction breast tissue expander (adverse device effect) direct to implant single stage immediate breast reconstruction mastectomy skin incision skin reducing mastectomy skin sparing mastectomy EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult aged article breast breast carcinoma (surgery) breast implant (adverse device effect) clinical article device removal female human intraductal carcinoma (surgery) organ preservation patient selection postoperative infection (complication) postoperative period priority journal prosthesis infection (complication) silicone prosthesis (adverse device effect) surgical patient treatment outcome wound dehiscence (complication) DEVICE TRADE NAMES Cohesive II Becker Siltex Contour Profile Becker 35 Becker DEVICE MANUFACTURERS Becker EMBASE CLASSIFICATIONS Dermatology and Venereology (13) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015083440 PUI L604622365 DOI 10.1007/s00238-015-1107-0 FULL TEXT LINK http://dx.doi.org/10.1007/s00238-015-1107-0 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 269 TITLE Acellular dermal matrix fenestrations and their effect on breast shape AUTHOR NAMES Wirth G.A. Mowlds D.S. Guidotti P. Salibian A.A. Nguyen A. Paydar K.Z. AUTHOR ADDRESSES (Wirth G.A., gwirth@uci.edu; Mowlds D.S.; Salibian A.A.; Nguyen A.; Paydar K.Z.) Department of Plastic Surgery, University of California, Irvine, 200 S. Manchester Avenue, Suite 650, Orange, United States. (Guidotti P.) Department of Mathematics, University of California, Irvine, 340 Rowland Hall, Irvine, United States. CORRESPONDENCE ADDRESS G.A. Wirth, Department of Plastic Surgery, University of California, Irvine, 200 S. Manchester Avenue, Suite 650, Orange, United States. SOURCE European Journal of Plastic Surgery (2015) 38:4 (267-272) Article Number: A013. Date of Publication: 6 May 2015 ISSN 1435-0130 (electronic) 0930-343X BOOK PUBLISHER Springer Verlag, service@springer.de ABSTRACT Background Acellular dermal matrices (ADMs) are increasingly being utilized in primary and secondary breast reconstruction as they confer several advantages, including soft tissue enhancement at the inferolateral pole of the breast. The senior authors have added fenestrations to ADMs to allow for more rapid expansion and improved breast aesthetics. The purpose of this study is to describe the benefits of ADM fenestration using a mathematical formula as a proof of concept for the effects of these modifications on breast shape. Methods The aggregate effect of symmetrically arranged fenestrations on the ADM’s mechanical properties is explained by a uniform reduction in the effective Young’s modulus of the graft in a direction perpendicular to the chest wall in the area of graft fenestration. Asymmetric reduction of the Young’s modulus is achieved by concentration of the fenestrations at either the cephalic or caudal ends of the ADM. Results The relaxed Young’s modulus facilitates an increased deflection of the ADM from its resting, unaltered state under the weight of the implant or tissue expander and is modeled using a one-dimensional boundary equation. The reduced inferior pole tension allows for enhanced expansion under the weight of the implant or tissue expander. The effects of asymmetrically arranged fenestrations are similarly modeled and appear to afford the surgeon greater precision in controlling inferior pole characteristics. Conclusions Acellular dermal matrix fenestration improves aesthetic outcome by facilitating greater inferior pole expansion. Mathematical models are provided to describe the modifications and elucidate the mechanism behind their effect on breast shape. Level of Evidence: Not ratable EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix fenestration breast breast reconstruction breast shape esthetic surgery fenestration EMTREE MEDICAL INDEX TERMS accuracy article breast implant breast tissue expander human mathematical model mechanics outcome assessment priority journal surgical technique tension thorax wall Young modulus EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015023894 PUI L604291955 DOI 10.1007/s00238-015-1090-5 FULL TEXT LINK http://dx.doi.org/10.1007/s00238-015-1090-5 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 270 TITLE Technical results and complication rates after nipple-sparing mastectomy and direct-to-implant breast reconstruction using porcine acellular dermal matrix for implant coverage AUTHOR NAMES Reitsamer R. Peintinger F. AUTHOR ADDRESSES (Reitsamer R.; Peintinger F.) CORRESPONDENCE ADDRESS R. Reitsamer, SOURCE Cancer Research (2015) 75:9 SUPPL. 1. Date of Publication: 1 May 2015 CONFERENCE NAME 37th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2014-12-09 to 2014-12-13 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Objective: To evaluate the feasibility and complication rates of nipple-sparing mastectomy (NSM) and direct-to-implant breast reconstruction using a porcine acellular dermal matrix (ADM) for implant coverage. Methods: NSM and direct-to-implant breast reconstruction using a porcine ADM for implant coverage was performed in a series of 91 breasts in 63 patients. Technical results, complications, and cosmetic results were collected from patient records. Results: Short-term complications within one month comprised minor complications as minimal nipple necrosis in 13.2%, and infection in 1.1%. Major complications, as hemorrhage with surgical evacuation in 4.4%, and implant loss due to skin breakdown in 4.4%, totaled in 8.8%. Within three months after primary surgery 3 further severe complications with reoperation ocurred. In 87.9% no second surgical intervention was necessary and cosmetic results were good or excellent. After a mean follow-up of 12 months (range 5 - 35 months) no further complications could be observed. Patient satisfaction was high for 92.3% of the patients and subjective cosmetic result was excellent in 90.1% and satisfactory in 2.2%. Conclusion: Direct-to-implant breast reconstruction using a porcine ADM for implant coverage after NSM is an innovative approach resulting in a high patient satisfaction. The technique is challenging but feasible and complication rates are acceptably low. EMTREE DRUG INDEX TERMS cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast cancer breast reconstruction implant mastectomy nipple EMTREE MEDICAL INDEX TERMS bleeding breast follow up human infection medical record necrosis patient patient satisfaction reoperation skin surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71929510 DOI 10.1158/1538-7445.SABCS14-P2-14-10 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS14-P2-14-10 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 271 TITLE Reducing postoperative infections and red breast syndrome in patients with acellular dermal matrix-based breast reconstruction: the relative roles of product sterility and lower body mass index AUTHOR NAMES Lewis P. Jewell J. Mattison G. Gupta S. Kim H. AUTHOR ADDRESSES (Lewis P.; Jewell J.; Mattison G.; Gupta S.; Kim H.) From the Department of Plastic Surgery, Loma Linda University, Loma Linda, CA SOURCE Annals of plastic surgery (2015) 74 Supplement 1 (S30-S32). Date of Publication: 1 May 2015 ISSN 1536-3708 (electronic) ABSTRACT PURPOSE: The use of human acellular dermal matrices (ADM) has become routinely used in implant-based breast surgery. Notwithstanding the many benefits for tissue support, the morbidity associated with its use includes seroma and infection, among other potential complications. Some patients experience a specific complication called red breast syndrome (RBS), which has been linked to ADM use, but its exact etiology remains elusive. In our institution, AlloDerm aseptic regenerative tissue matrix was recently replaced with a ready-to-use sterile version that undergoes terminal sterilization, eliminating the need for rehydration. We want to determine if this change in processing affected complications, including RBS.METHODS: We conducted a retrospective chart review analyzing patients from January 1, 2011, to June 1, 2013, who underwent breast surgery with human ADM. Patients with aseptic AlloDerm were compared to patients with sterile AlloDerm. Data were analyzed using the Fisher exact test.RESULTS: A total of 167 reconstructed breasts from 105 patients met inclusion criteria: 56% (n=93) with aseptic ADM, 44% (n=74) with sterile ADM. When comparing the two, patients had a decrease in overall necrosis, infection, seroma, and RBS with sterile ADM. However, the rates did not reach statistical significance. For example, the incidence of RBS decreased from 7.5% to 2.7% (P=0.301) and seroma decreased from 8.6% to 2.7% (P=0.188). The infection rate proved to be equivocal at 11.8% with aseptic ADM to 10.8% with sterile ADM (P=1.000). The only statistically significant change was a decrease in the total complication rate from 41.9% to 27.0% (P=0.046). The absolute risk reduction for total complications was 14.9% with a number-needed-to-treat of 7.CONCLUSION: According to our study, sterile AlloDerm has a clinically decreased incidence of complications compared to aseptic AlloDerm. Whereas RBS decreased, it was interesting to see that it was not eliminated altogether. This suggests that the etiology may be unrelated to ADM processing and warrants further investigation. Overall, the most notable difference was the statistically significant decrease in the total complication rate. Therefore, the change to sterile AlloDerm seems to be beneficial. Further benefit arises from ease of preparation in the operating room. EMTREE DRUG INDEX TERMS collagen surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix procedures EMTREE MEDICAL INDEX TERMS bacterial infection (etiology, prevention) body mass breast disease (etiology, prevention) breast reconstruction female human infertility middle aged postoperative complication (etiology, prevention) retrospective study syndrome CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25695440 (http://www.ncbi.nlm.nih.gov/pubmed/25695440) PUI L608005199 DOI 10.1097/SAP.0000000000000475 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0000000000000475 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 272 TITLE A tissue engineered nipple and areola complex AUTHOR NAMES Pashos N.C. Scarritt M.E. Gimble J.M. Chaffin A.E. Bunnell B.A. AUTHOR ADDRESSES (Pashos N.C.; Scarritt M.E.; Gimble J.M.; Bunnell B.A.) Center for Stem Cell Research and Regenerative Medicine, Tulane University, School of Medicine, New Orleans, United States. (Bunnell B.A.) Department of Pharmacology, Tulane University, School of Medicine, New Orleans, United States. (Pashos N.C.) Bioinnovation PhD Program, School of Science and Engineering, Tulane University, New Orleans, United States. (Chaffin A.E.) Department of Surgery, Tulane University, School of Medicine, New Orleans, United States. (Gimble J.M.) LA Cell, New Orleans, United States. CORRESPONDENCE ADDRESS N.C. Pashos, Center for Stem Cell Research and Regenerative Medicine, Tulane University, School of Medicine, New Orleans, United States. SOURCE Molecular Therapy (2015) 23 SUPPL. 1 (S254-S255). Date of Publication: May 2015 CONFERENCE NAME 18th Annual Meeting of the American Society of Gene and Cell Therapy, ASGCT 2015 CONFERENCE LOCATION New Orleans, LA, United States CONFERENCE DATE 2015-05-13 to 2015-05-16 ISSN 1525-0016 BOOK PUBLISHER Nature Publishing Group ABSTRACT There are more than 2.8 million breast cancer survivors in the United States, many of who have undergone reconstructive surgery. Approximately 36% of patients with early stage diagnoses and 60% of patients with late stage diagnoses undergo mastectomies. Moreover, immediate breast reconstruction following mastectomies has become more common, significantly increasing at an average rate of 5% per year, from 20.8% in 1998 to 37.8% in 2008. This increasing trend is not surprising as breast reconstruction likely provides psychological benefits for women who undergo mastectomies. There is evidence to suggest that nipple and areola complex (NAC) reconstruction affects psychological wellbeing by enhancing body image and selfesteem, or decreasing the feeling of distress felt by female patients with mastectomies. Due to this, there exists a need for a reproducible and more naturally aesthetic architecture for NAC reconstruction. Current strategies for NAC reconstruction are limited to surgical techniques that create a NAC-like structure from existing local tissue, secondary site grafting, 3D tattooing, or using commercially available acellular dermal matrix sheets, such as Alloderm. Generating a tissue engineered, biocompatible NAC implant, made of decellularized whole NAC, for use in place of surgically created NAC structures is a promising approach to NAC reconstruction following mastectomies. To date, no tissue engineering and cellular therapy strategies have been developed focused on NAC reconstruction. The application of decellularization to the whole, semi-glandular NAC can create a non-immunogenic NAC that retains the microarchitecture and gross structures of a native NAC. This tissue engineering approach to whole NAC structure regeneration allows for the effective removal of cellular material, the retention of the extracellular matrix components and structure, as well as cell adhesion molecules. Once decellularized, NAC scaffolds would be seeded with autologous cells to create a graft that is patient-specific. Preliminary studies have shown, using tissues from a Rhesus Macaque Non- Human Primate animal model, that biologically derived scaffolds were able to be reproducibly isolated with effective removal of nuclear material-less than ∼50ng of 200bp DNA per mg of sample remaining. Through histological analysis of the NAC scaffolds it was shown that the presence of extracellular matrix and adhesion proteins were maintained after the decellularization process. Additionally, bioactivity of the scaffolds were assessed using rhesus bone marrow-derived stem cells for one week, under dynamic cell culture conditions. Herein, a tissue engineered, regenerative medicine approach to reconstruct the nipple and areola complex using a biologically derived scaffold and autologous cell sources is described. EMTREE DRUG INDEX TERMS cell adhesion molecule DNA protein EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American cell therapy gene nipple society tissues EMTREE MEDICAL INDEX TERMS acellular dermal matrix adhesion animal model architecture biological activity body image bone marrow breast cancer breast reconstruction cancer survivor cell culture diagnosis extracellular matrix female human implant mastectomy nonhuman patient plastic surgery primate psychological well-being regeneration regenerative medicine rhesus monkey stem cell surgical mesh surgical technique tattooing tissue engineering United States LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71881693 DOI 10.1038/mt.2015.74 FULL TEXT LINK http://dx.doi.org/10.1038/mt.2015.74 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 273 TITLE Variation in UK reconstructive practice in the face of post-mastectomy radiotherapy AUTHOR NAMES Harvey J.R. Bundred N.J. Kirwan C.C. Gandhi A. Duxbury P.J. AUTHOR ADDRESSES (Harvey J.R.; Bundred N.J.; Kirwan C.C.; Gandhi A.; Duxbury P.J.) CORRESPONDENCE ADDRESS J.R. Harvey, SOURCE Cancer Research (2015) 75:9 SUPPL. 1. Date of Publication: 1 May 2015 CONFERENCE NAME 37th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2014-12-09 to 2014-12-13 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Approximately 30-40% of women are not offered immediate breast reconstruction because the possibility of post-mastectomy radiotherapy (PMRT) is unknown at the time of mastectomy. Breast reconstruction may be delayed until final pathology is available and need for radiotherapy established. Surgical literature is replete with studies of varying quality, reporting complication rates for a range of reconstructive procedures, highlighting the need for surgical trials of reconstructive techniques in women at risk of PMRT. Decisions for these patients are complex, involving multiple clinicians including surgeons and oncologists. To inform a surgical trial design, we aimed to determine current UK surgical practice and gain an understanding of the drivers behind decision-making. Methods: A questionnaire, validated in a pilot population, was posted to Consultant members of the Association of Breast Surgery (UK). We collected data on current practice in conducting Delayed, Immediate and Delayed-immediate reconstructive surgery. We collated data on type and volume of procedure performed and factors affecting decision-making including delay to adjuvant treatment, risk of complications, perception of patients' quality of life (QoL) and aesthetic satisfaction. Results: Of 355 surgeons, 130(37%) responded. Of these, 77% felt the current evidence base was not adequate to guide surgical decisions and 80% felt a need for further trials to guide best treatment. Despite a lack of scientific evidence demonstrating a difference in cosmesis or QoL between Immediate and Delayed reconstruction, 85% felt there is not equivalent cosmesis and 71% felt there is not equivalent QoL between the two groups. There is considerable heterogeneity in reconstructive approach to patients at risk of PMRT (Table 1). Delayed reconstruction remains the most popular option, being regularly used by 94% of surgeons despite only 34% of surgeons believing the majority of patients are satisfied with the approach. Significantly fewer surgeons perform Immediate implant based reconstruction (with or without ADM) than Delayed (p<0.01). Implant reconstruction is performed by 71% of surgeons in patients at risk of PMRT, but only 44% of surgeons felt patients were happy with the final results. The three most important drivers in making a reconstructive choice were 1. Effect of PMRT on the cosmetic result 2. Minimising risk of complications and avoiding delay to adjuvant treatment 3. Pre-operative uncertainty over the need for PMRT. Conclusions: Surgeons employ a variety of approaches to reconstruction in the face of PMRT, the most common approach being delayed reconstruction. Decision-making is based upon individual surgeon's perception of risks including likely delay to adjuvant therapy and effect of PMRT on the reconstruction. Drivers appeared to be more surgeon-centred rather than patient-based. There is awareness of a lack of evidence to support decision-making and the need for high quality studies. Randomised clinical trials are needed to provide an evidence base for outcomes. EMTREE DRUG INDEX TERMS cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer mastectomy radiotherapy United Kingdom EMTREE MEDICAL INDEX TERMS adjuvant therapy breast reconstruction breast surgery clinical trial (topic) consultation decision making female human implant oncologist pathology patient plastic surgery population procedures quality of life questionnaire risk satisfaction study design surgeon surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71929509 DOI 10.1158/1538-7445.SABCS14-P2-14-09 FULL TEXT LINK http://dx.doi.org/10.1158/1538-7445.SABCS14-P2-14-09 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 274 TITLE Abdominal wall neuropraxia: a previously unreported complication of latissimus dorsi flap breast reconstruction AUTHOR NAMES Citron I. Miller M.C. Lancaster K. Ho-Asjoe M. AUTHOR ADDRESSES (Citron I., isabelle.citron@gmail.com; Miller M.C.; Lancaster K.; Ho-Asjoe M.) Department of Plastic Surgery, St Thomas’ Hospital, Westminister Bridge Road, London, United Kingdom. CORRESPONDENCE ADDRESS I. Citron, Department of Plastic Surgery, St Thomas’ Hospital, Westminister Bridge Road, London, United Kingdom. SOURCE European Journal of Plastic Surgery (2015) 38:5 (417-418). Date of Publication: 15 Apr 2015 ISSN 1435-0130 (electronic) 0930-343X BOOK PUBLISHER Springer Verlag, service@springer.de ABSTRACT The latissimus dorsi flap is one of the most commonly used in breast reconstruction. We report the case of a 61-year-old female, who developed abdominal wall neuropraxia as a complication of latissimus dorsi free flap harvest. The cause of injury was compression of the T8–T12 spinal root outlets due to lateral spinal flexion during the procedure, which caused demyelination of the nerve roots. This complication is previously unreported in the literature. Level of Evidence: Level V, risk/prognostic study. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) abdominal wall neuropraxia (complication) breast reconstruction latissimus dorsi flap nerve compression (complication) postoperative complication EMTREE MEDICAL INDEX TERMS abdominal bulge acellular dermal matrix adult article breast carcinoma (radiotherapy, surgery) breast tissue expander cancer radiotherapy case report demyelination (complication) denervation electromyography female human mastectomy middle aged patient positioning priority journal reinnervation spinal root EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) Neurology and Neurosurgery (8) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015941036 PUI L603880202 DOI 10.1007/s00238-015-1080-7 FULL TEXT LINK http://dx.doi.org/10.1007/s00238-015-1080-7 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 275 TITLE Red breast syndrome: a review of available literature AUTHOR NAMES Wu P.S. Winocour S. Jacobson S.R. AUTHOR ADDRESSES (Wu P.S.; Winocour S.; Jacobson S.R.) Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA SOURCE Aesthetic plastic surgery (2015) 39:2 (227-230). Date of Publication: 1 Apr 2015 ISSN 1432-5241 (electronic) ABSTRACT UNLABELLED: There is scant literature regarding a recently identified clinical entity termed red breast syndrome. Its clinical presentation has been described as a non-infectious, self-limited erythema of a post-mastectomy breast reconstructed using acellular dermal matrix. Its incidence, risk factors, pathophysiology, clinical course, management, and long-term sequelae are largely unknown. We present a review of the available literature on this phenomenon and highlight some opportunities for further research.LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix adverse effects procedures EMTREE MEDICAL INDEX TERMS breast reconstruction erythema (etiology) female human mastectomy syndrome LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25608912 (http://www.ncbi.nlm.nih.gov/pubmed/25608912) PUI L608212664 DOI 10.1007/s00266-014-0444-x FULL TEXT LINK http://dx.doi.org/10.1007/s00266-014-0444-x COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 276 TITLE Implant-based breast reconstruction with meshes and matrices: biological vs synthetic AUTHOR NAMES Jacobs J.M. Salzberg C.A. AUTHOR ADDRESSES (Jacobs J.M.; Salzberg C.A.) Assistant Professor of Plastic Surgery, Mount Sinai Medical System, New York, NY, USA SOURCE British journal of hospital medicine (London, England : 2005) (2015) 76:4 (211-216). Date of Publication: 1 Apr 2015 ISSN 1750-8460 ABSTRACT This article presents an overview of the different acellular dermal matrices and synthetic meshes used in modern-day primary and secondary implant-based breast reconstruction. Case examples are given, along with a description of the senior author's pioneering direct-to-implant reconstruction. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant procedures surgical mesh EMTREE MEDICAL INDEX TERMS breast augmentation breast reconstruction breast tumor (surgery) female human mastectomy LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25853352 (http://www.ncbi.nlm.nih.gov/pubmed/25853352) PUI L606658210 DOI 10.12968/hmed.2015.76.4.211 FULL TEXT LINK http://dx.doi.org/10.12968/hmed.2015.76.4.211 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 277 TITLE State of the art and science in postmastectomy breast reconstruction AUTHOR NAMES Kronowitz S.J. AUTHOR ADDRESSES (Kronowitz S.J.) Houston, Texas From the Department of Plastic and Reconstructive Surgery, The University of Texas M. D. Anderson Cancer Center SOURCE Plastic and reconstructive surgery (2015) 135:4 (755e-771e). Date of Publication: 1 Apr 2015 ISSN 1529-4242 (electronic) ABSTRACT LEARNING OBJECTIVES: After reading this article, the participant should be able to: 1. Examine clinicopathologic factors to determine the best timing for breast reconstruction. 2. Develop treatment plans for all patients for breast preserving reconstruction. 3. Determine the best approaches for partial and whole breast reconstruction. 4. Be familiar with advanced techniques in breast reconstruction.BACKGROUND: Often, the decision to perform a partial or total mastectomy hinges on reconstructive issues, not oncology-related considerations.METHODS: Innovative timing and reconstruction approaches are being implemented after partial mastectomy and breast reconstruction after mastectomy.RESULTS: Among patients undergoing repair of a partial mastectomy defect, immediate or delayed repair before radiation allows for use of remaining breast tissue for repair. Innovative approaches include breast remodeling, local rotation advancement, and concentric mastopexy and breast reduction techniques to recontour remaining breast tissue. Delayed repair after whole-breast radiation usually is not preferred and is performed with autologous fat grafting or a flap. However, partial breast radiation allows for safe delayed repair after irradiation using the same techniques used for preradiation repair. The optimal timing for breast reconstruction after mastectomy remains a topic of controversy. Adjunct techniques for implant-based postmastectomy reconstruction include the use of acellular dermal matrix and autologous fat grafting, especially in the setting of radiation therapy. Techniques also include a more focused use of flaps only in the setting of radiation therapy with increasing use of new perforator-based autologous tissue flap options.CONCLUSION: Innovative approaches to breast reconstruction have evolved to provide restorative healing for patients and hasten return to their modern, active lifestyles. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) mastectomy procedures EMTREE MEDICAL INDEX TERMS algorithm breast reconstruction human surgical flaps LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25811587 (http://www.ncbi.nlm.nih.gov/pubmed/25811587) PUI L604638540 DOI 10.1097/PRS.0000000000001118 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000001118 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 278 TITLE Initial experience with use of a synthetic mesh in patients undergoing tissue expander breast reconstruction AUTHOR NAMES Manning A.T. Sharma S. Cronin P.A. Barry M. Kell M.R. AUTHOR ADDRESSES (Manning A.T.; Sharma S.; Cronin P.A.; Barry M.; Kell M.R.) Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland. CORRESPONDENCE ADDRESS A.T. Manning, Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland. SOURCE Irish Journal of Medical Science (2015) 184 SUPPL. 5 (S179). Date of Publication: March 2015 CONFERENCE NAME 23rd Sylvester O'Halloran Perioperative Scientific Symposium CONFERENCE LOCATION Limerick, Ireland CONFERENCE DATE 2015-03-06 to 2015-03-07 ISSN 0021-1265 BOOK PUBLISHER Springer-Verlag London Ltd ABSTRACT Background: Tissue-expander (TE) followed by permanent implant insertion is now the most common form of breast reconstruction for patients undergoing mastectomy. The use of Acellular Dermal Matrices (ADM's) for reinforcement at time of TE insertion is associated with higher likelihood of seroma formation, infection and reconstructive failure. TIGR® Matrix Surgical Mesh is a fully absorbable and completely synthetic alternative to ADM's. We report on our initial experience with use of TIGR® Matrix in patients undergoing breast reconstruction with TE insertion. Methods: Patients undergoing breast reconstruction with TE insertion in which TIGR® Matrix Surgical Mesh was used for reinforcement were identified and data prospectively collected. Patient demographics, indications for surgery, length of hospital stay, perioperative and post-operative complications were identified. Results: 10 patients were identified who underwent unilateral (n = 8) or bilateral (n = 2) breast reconstruction in which TIGR® Matrix was used. Median length of post-operative hospital stay was 3 days. There were no peri-operative seromas or wound infections, and at early follow there have been no cases of reconstructive failure. Conclusions: Our initial experience with the use of a fully absorbable fully synthetic mesh for reinforcement following TE insertion has been positive with no post-operative complications identified. Although longer follow-up is required, TIGR® Matrix Surgical Mesh may be a useful accessory to expander-implant based breast reconstruction. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction human patient tissue expander EMTREE MEDICAL INDEX TERMS acellular dermal matrix follow up hospitalization implant infection mastectomy postoperative complication reinforcement seroma surgery surgical mesh wound infection LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L72219229 DOI 10.1007/s11845-015-1259-8 FULL TEXT LINK http://dx.doi.org/10.1007/s11845-015-1259-8 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 279 TITLE Direct to implant breast reconstruction without the use of an acellular-dermal matrix AUTHOR NAMES Serrurier L.C. Benn C. Rayne S. AUTHOR ADDRESSES (Serrurier L.C.) Plastic Surgery, Milpark Hospital, Johannesburg, South Africa. (Benn C.; Rayne S.) Surgery, Milpark Hospital, Johannesburg, South Africa. CORRESPONDENCE ADDRESS L.C. Serrurier, Plastic Surgery, Milpark Hospital, Johannesburg, South Africa. SOURCE Breast (2015) 24 SUPPL. 1 (S135). Date of Publication: March 2015 CONFERENCE NAME 14th St. Gallen International Breast Cancer Conference: Primary Therapy of Early Breast Cancer CONFERENCE LOCATION Vienna, Austria CONFERENCE DATE 2015-03-18 to 2015-03-21 ISSN 0960-9776 BOOK PUBLISHER Churchill Livingstone ABSTRACT Goals: Direct to implant breast reconstruction is emerging internationally as a predictable and reliable reconstructive method. There are obvious advantages to this technique, however most international authors recommend the use of an ADM or a mesh to reinforce the lower pole of the breast reconstruction. This might potentially simplify the procedure, but is not necessarily associated with decreased complications and a better cosmetic outcome. It however significantly increases the costs of the procedure. Methods: 273 consecutive patients with 490 immediate direct to implant breast reconstructions from 2 institutions over a 34 month period are included in this study. Mean follow up of this group is 35 months with a maximum and minimum follow 58 and 24 months respectively. Results: Short term, long term complications and cosmetic outcome will be presented. These results will be compared to the published literature on direct to implant reconstruction using an ADM. Conclusion: This method of breast reconstruction compares very favorably with published data from other units as far as early and late complications are concerned as well as cosmetic outcome. It avoids the potential higher seroma rate associated with ADMs and is significantly more cost effective. EMTREE DRUG INDEX TERMS cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast cancer breast reconstruction implant therapy EMTREE MEDICAL INDEX TERMS follow up human patient procedures seroma LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71865746 DOI 10.1016/S0960-9776(15)70345-0 FULL TEXT LINK http://dx.doi.org/10.1016/S0960-9776(15)70345-0 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 280 TITLE Operative therapy of breast cancer: Current challenges ORIGINAL (NON-ENGLISH) TITLE Operative Therapie des Mammakarzinoms: Aktuelle Herausforderungen AUTHOR NAMES Blohmer J.-U. AUTHOR ADDRESSES (Blohmer J.-U., jens.blohmer@charite.de) Gynäkologie m.S. Senologie, Charité – Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany. CORRESPONDENCE ADDRESS J.-U. Blohmer, Gynäkologie m.S. Senologie, Charité – Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany. SOURCE Onkologe (2015) . Date of Publication: 19 Feb 2015 ISSN 1433-0415 (electronic) 0947-8965 BOOK PUBLISHER Springer Verlag, service@springer.de ABSTRACT Background: Surgical removal of breast cancer and evaluation of axillary lymph node status are important components of the multimodal treatment of breast cancer. A lot of new data based on published studies and meta-analyses are continuously being published.Objective: The results of clinically relevant studies as well as the German guidelines and therapy recommendations are presented and discussed. Recommendations for the clinical practice are derived from the results.Material and methods: A selective review of prospective randomized studies, systematic reviews and meta-analyses in the field of breast surgery from PubMed from 2013 and 2014 was performed. The corresponding sections of the German S3 guidelines on early detection, treatment and follow-up of breast cancer and the therapy recommendations of the working group on gynecological oncology (AGO) were selected and compared with the results in the literature.Results and discussion: Preoperative magnetic resonance imaging (MRI) of the breast can reduce the re-excision rate only in patients with lobular invasive breast cancer. It has no impact on re-excision rates for other patients, on recurrence rates and overall survival. Intraoperative ultrasound can reduce the re-excision rate even in patients with palpable breast cancer. “No ink on margin” between invasive breast cancer with and without accompanying ductal carcinoma in situ (DCIS) and the cutting edge is sufficient if radiotherapy and state of the art systemic adjuvant therapy are performed after breast-conserving breast surgery. The recommended tumor-free margin for patients with pure DCIS, breast-conserving surgery and radiotherapy of the whole breast is 2 mm. Wider margins have no impact on local control and survival of patients with invasive and pre-invasive breast cancer. A sufficient detection rate for sentinel nodes after neoadjuvant chemotherapy is only possible if some preconditions are achieved. The use of synthetic meshes and acellular dermal matrices to extend the pectoralis major muscle and cover the implant can optimize the immediate reconstruction after skin-sparing mastectomy. The complication rate is higher with this technique compared with conventional expander/implant reconstruction. There is no method of reconstruction which can be performed in every patient, which is why an individual approach taking all methods of autologous and allogeneic reconstruction into account is necessary. EMTREE DRUG INDEX TERMS ink EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer excision surgery therapy EMTREE MEDICAL INDEX TERMS acellular dermal matrix adjuvant chemotherapy adjuvant therapy axillary lymph node breast breast surgery clinical practice follow up German (citizen) human implant intraductal carcinoma mastectomy Medline meta analysis neoplasm nuclear magnetic resonance imaging oncology overall survival partial mastectomy patient pectoralis major muscle peroperative echography radiotherapy recurrence risk skin survival systematic review (topic) LANGUAGE OF ARTICLE German LANGUAGE OF SUMMARY English, German EMBASE ACCESSION NUMBER 2015758671 PUI L602387615 DOI 10.1007/s00761-014-2840-x FULL TEXT LINK http://dx.doi.org/10.1007/s00761-014-2840-x COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 281 TITLE Assessment of patient factors, surgeons, and surgeon teams in immediate implant-based breast reconstruction outcomes AUTHOR NAMES Gfrerer L. Mattos D. Mastroianni M. Weng Q.Y. Ricci J.A. Heath M.P. Lin A. Specht M.C. Haynes A.B. Austen W.G. Liao E.C. AUTHOR ADDRESSES (Gfrerer L.; Mattos D.; Mastroianni M.; Weng Q.Y.; Ricci J.A.; Heath M.P.; Lin A.; Specht M.C.; Haynes A.B.; Austen W.G.; Liao E.C.) Boston, Mass. From the Division of Plastic and Reconstructive Surgery, the Division of Surgical Oncology, and the Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Harvard Medical School; and the Center for Regenerative Medicine, Harvard Stem Cell Institute SOURCE Plastic and reconstructive surgery (2015) 135:2 (245e-252e). Date of Publication: 1 Feb 2015 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Outcome studies of immediate implant-based breast reconstruction have focused largely on patient factors, whereas the relative impact of the surgeon as a contributing variable is not known. As the procedure requires collaboration of both a surgical oncologist and a plastic surgeon, the effect of the surgeon team interaction can have a significant impact on outcome. This study examines outcomes in implant-based breast reconstruction and the association with patient characteristics, surgeon, and surgeon team familiarity.METHODS: A retrospective review of 3142 consecutive implant-based breast reconstruction mastectomy procedures at one institution was performed. Infection and skin necrosis rates were measured. Predictors of outcomes were identified by unadjusted logistic regression followed by multivariate logistic regression. Surgeon teams were grouped according to number of cases performed together.RESULTS: Patient characteristics remain the most important predictors for outcomes in implant-based breast reconstruction, with odds ratios above those of surgeon variables. The authors observed significant differences in the rate of skin necrosis between surgical oncologists with an approximately two-fold difference between surgeons with the highest and lowest rates. Surgeon teams that worked together on fewer than 150 procedures had higher rates of infection.CONCLUSIONS: Patient characteristics are the most important predictors for surgical outcomes in implant-based breast reconstruction, but surgeons and surgeon teams are also important variables. High-volume surgeon teams achieve lower rates of infection. This study highlights the need to examine modifiable risk factors associated with optimum implant-based breast reconstruction outcomes, which include patient and provider characteristics and the surgical team treating the patient.CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) statistics and numerical data EMTREE MEDICAL INDEX TERMS acellular dermal matrix breast breast augmentation breast reconstruction breast tumor (epidemiology, surgery, therapy) comorbidity cooperation female human infection (epidemiology, surgery) mastectomy multimodality cancer therapy necrosis obesity (epidemiology) oncology pathology patient care patient selection plastic surgery postoperative complication (epidemiology) procedures retrospective study risk smoking statistical model surgical infection (epidemiology, surgery) tertiary care center treatment outcome LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25626807 (http://www.ncbi.nlm.nih.gov/pubmed/25626807) PUI L603855793 DOI 10.1097/PRS.0000000000000912 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000000912 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 282 TITLE SERI surgical scaffold, prospective clinical trial of a silk-derived biological scaffold in two-stage breast reconstruction: 1-year data AUTHOR NAMES Fine N.A. Lehfeldt M. Gross J.E. Downey S. Kind G.M. Duda G. Kulber D. Horan R. Ippolito J. Jewell M. AUTHOR ADDRESSES (Fine N.A.; Lehfeldt M.; Gross J.E.; Downey S.; Kind G.M.; Duda G.; Kulber D.; Horan R.; Ippolito J.; Jewell M.) Chicago, Ill.; South Pasadena, Los Angeles, and San Francisco, Calif.; McLean, Va.; Medford, Mass.; and Portland and Eugene, Ore. From the Northwestern Specialists in Plastic Surgery; private practice; University of Southern California Keck School of Medicine; California-Pacific Medical Center; Aesthetic Center for Plastic Surgery; Cedars Sinai Medical Center; Silk Therapeutics, Inc.; and Oregon Health Science University SOURCE Plastic and reconstructive surgery (2015) 135:2 (339-351). Date of Publication: 1 Feb 2015 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: SERI Surgical Scaffold is a long-term bioresorbable silk-derived biological scaffold developed to provide soft-tissue support and repair.METHODS: SURE-001 (ClinicalTrials.gov identification no. NCT01256502) is a prospective, single-arm study in the United States of patients undergoing two-stage, implant-based breast reconstruction using SERI.RESULTS: A total of 139 patients were enrolled and will be followed for 2 years; in this article, the authors report interim data on 71 patients followed for 1 year. Investigator satisfaction scores (mean ± SD) at 6 and 12 months were 9.2 ± 0.98 and 9.4 ± 0.91, respectively (10 = very satisfied). SERI was rated easy/very easy to use in 98 percent or more of cases across five categories in stage I surgery. Patient satisfaction with the treated breast(s) (mean ± SD) was higher at 6 (4.3 ± 0.87; 5 = very satisfied) and 12 months (4.5 ± 0.82) compared with screening (3.6 ± 1.09; p < 0.0001). Key complication rates (per breast) were tissue necrosis (6.7 percent), seroma (5.7 percent), hematoma (4.8 percent), implant loss (3.8 percent), capsular contracture (1.9 percent), and breast infection (1.0 percent). None were attributed to SERI by the investigators. In 13 patients (14 breasts) who underwent unplanned radiation therapy, one complication was reported.CONCLUSIONS: In this interim report, high levels of investigator and patient satisfaction, and ease of use of SERI were reported. Prospectively collected complication rates were similar to those reported in primarily retrospective studies of two-stage, implant-based breast reconstructions using other implantable soft-tissue support materials such as acellular dermal matrices.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. EMTREE DRUG INDEX TERMS silk EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) devices surgical mesh tissue scaffold EMTREE MEDICAL INDEX TERMS adjuvant therapy adult adverse effects aged breast reconstruction breast tumor (radiotherapy, surgery) clinical trial device failure female follow up hematoma (epidemiology, etiology) human implant capsular contracture (epidemiology) male mastitis (epidemiology) middle aged multicenter study multimodality cancer therapy patient satisfaction postoperative complication (epidemiology) procedures prospective study seroma (epidemiology, etiology) surgical infection (epidemiology) tissue expander CLINICAL TRIAL NUMBERS LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25502862 (http://www.ncbi.nlm.nih.gov/pubmed/25502862) PUI L603856595 DOI 10.1097/PRS.0000000000000987 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000000987 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 283 TITLE Outcome of the use of acellular-dermal matrix to assist implant-based breast reconstruction in a single centre AUTHOR NAMES Barber M.D. Williams L. Anderson E.D.C. Neades G.T. Raine C. Young O. Kulkarni D. Young I. Dixon J.M. AUTHOR ADDRESSES (Barber M.D., matthew.barber@luht.scot.nhs.uk; Anderson E.D.C.; Neades G.T.; Young O.; Kulkarni D.; Young I.; Dixon J.M.) Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom. (Williams L.) Centre for Population Health Sciences, University of Edinburgh Medical School, Teviot Place, Edinburgh, United Kingdom. (Raine C.) Department of Plastic Surgery, St John's Hospital, Livingston, United Kingdom. CORRESPONDENCE ADDRESS M.D. Barber, Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom. Email: matthew.barber@luht.scot.nhs.uk SOURCE European Journal of Surgical Oncology (2015) 41:1 (100-105). Date of Publication: 2015 ISSN 1532-2157 (electronic) 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: The use of acellular dermal matrix (ADM) has transformed the technique of implant-based breast reconstruction. It offers the option of a one-stage procedure and is felt to have benefits in cosmetic outcome but the medium and long-term outcomes are unknown. Methods: All cases where ADM was used in a breast reconstructive procedure in the Edinburgh Breast Unit from its initial use on 7/7/2008 to 31/7/2012 were reviewed retrospectively. Follow up was completed to 30/11/2012. Results: 147 patients received 232 sheets of ADM (156 Strattice, 73 Permacol and 3 Alloderm). Mean follow up was 687 days. In 40 cases unplanned implant explantation occurred (17.2% or 27.2% of patients). 7 of 27 (25.9%) patients requiring adjuvant therapy had this delayed due to problems with the reconstruction. 30 of 80 patients (37.5%) undergoing unilateral surgery have undergone contralateral surgery. Implant loss varied significantly with smoking (34.6% loss rate in smokers vs 13.2% in non-smokers, p 1/4 0.001), with radiotherapy (28.1% loss rate vs 13.8% with no radiotherapy, p 1/4 0.001) and with incision type. There was no statistically significant variation by operating surgeon, type of ADM used, chemotherapy use, patient weight, breast weight or nipple preservation. Patients underwent a mean of 1.54 further operations (range 0-7). Conclusions: While offering potential cosmetic and financial benefits, the use of ADM with implant-based reconstructions has a significant rate of implant loss, further surgery and potential delay in adjuvant therapy. These must be considered when planning treatment and consenting patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast cancer (radiotherapy, surgery) breast implant (adverse device effect) breast reconstruction mastectomy EMTREE MEDICAL INDEX TERMS adult aged article body mass body weight change breast weight cancer radiotherapy cancer recurrence explant female follow up human implant explantation (complication) intraductal carcinoma (surgery) major clinical study medical device complication (complication) organ weight primary tumor (surgery) priority journal retrospective study risk reduction smoking surgical mesh treatment failure treatment outcome wound healing DEVICE TRADE NAMES Alloderm , United StatesLifecell Permacol , United StatesCovidien Strattice , United StatesLifecell DEVICE MANUFACTURERS (United States)Covidien (United States)Lifecell EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015735110 MEDLINE PMID 25238954 (http://www.ncbi.nlm.nih.gov/pubmed/25238954) PUI L602175673 DOI 10.1016/j.ejso.2014.07.475 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2014.07.475 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 284 TITLE Prepectoral implant placement and complete coverage with porcine acellular dermal matrix: A new technique for direct-to-implant breast reconstruction after nipple-sparing mastectomy AUTHOR NAMES Reitsamer R. Peintinger F. AUTHOR ADDRESSES (Reitsamer R., r.reitsamer@salk.at; Peintinger F.) University Hospital Salzburg, Breast Center Salzburg, Paracelsus Medical University Salzburg, Muellner Hauptstrasse 48, Salzburg, Austria. (Peintinger F.) Institute of Pathology Graz, Medical University Graz, Graz, Austria. CORRESPONDENCE ADDRESS R. Reitsamer, University Hospital Salzburg, Breast Center Salzburg, Paracelsus Medical University Salzburg, Muellner Hauptstrasse 48, Salzburg, Austria. SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2015) 68:2 (162-167). Date of Publication: 1 Feb 2015 ISSN 1878-0539 (electronic) 1748-6815 BOOK PUBLISHER Churchill Livingstone ABSTRACT Background Nipple-sparing mastectomy (NSM) and implant-based breast reconstruction are increasingly replacing conventional mastectomy for risk-reducing purposes in high-risk patients as well as for therapeutic purposes in breast cancer patients. For implant-based breast reconstruction, generally, subpectoral implant placement with partial detachment of the pectoralis major muscle (PMM) is recommended. The advantage of a potentially better cosmetic result has to be balanced with the disadvantages, such as partial injury of the PMM with subsequent muscular deficit, breast animation, and postoperative pain. We hypothesize that prepectoral implant placement and complete coverage with a porcine acellular dermal matrix (ADM) may provide an alternative to subpectoral implant placement with an excellent cosmetic result, avoiding the disadvantages of subpectoral implant placement. Methods In a total of 22 breasts in 13 patients (nine bilateral and four unilateral), NSM and immediate direct-to-implant breast reconstruction were performed with prepectoral implant placement. The implant was completely covered by a porcine ADM, which was sutured to the fascia of the PMM and the inframammary fold to keep the implant in place. Results The cosmetic results were excellent and patients were fully satisfied at a median follow-up of 6 months. Breast animation and implant dislocation could not be observed. Implant rims were not visible, and capsular contractures grade III and IV could not be observed. The complications comprised minimal nipple necrosis in two patients and hemorrhage with evacuation in one patient. Conclusion Prepectoral implant placement and complete coverage with porcine ADM represents a novel approach and a feasible alternative to subpectoral implant placement after NSM and implant-based breast reconstruction for patients who prefer their PMM to be left intact. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast implant breast reconstruction mastectomy nipple sparing mastectomy porcine acellular dermal matrix prepectoral implant placement EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult article clinical article female follow up human middle aged necrosis (complication) operative blood loss (complication) patient satisfaction pectoralis major muscle priority journal EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014893576 MEDLINE PMID 25455288 (http://www.ncbi.nlm.nih.gov/pubmed/25455288) PUI L600415687 DOI 10.1016/j.bjps.2014.10.012 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2014.10.012 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 285 TITLE The BREASTrial: stage I. Outcomes from the time of tissue expander and acellular dermal matrix placement to definitive reconstruction AUTHOR NAMES Mendenhall S.D. Anderson L.A. Ying J. Boucher K.M. Liu T. Neumayer L.A. Agarwal J.P. AUTHOR ADDRESSES (Mendenhall S.D.; Anderson L.A.; Ying J.; Boucher K.M.; Liu T.; Neumayer L.A.; Agarwal J.P.) Salt Lake City, Utah; and Springfield, Ill. From the Division of Plastic and Reconstructive Surgery, the Department of Surgery, the Division of Epidemiology, Department of Internal Medicine, and the Department of Pathology, University of Utah School of Medicine; and the Institute for Plastic Surgery, Southern Illinois University School of Medicine SOURCE Plastic and reconstructive surgery (2015) 135:1 (29e-42e). Date of Publication: 1 Jan 2015 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Use of acellular dermal matrix in tissue expander breast reconstruction has become a popular adjunct to the total submuscular technique. The question remains as to which matrix, if any, is ideal for breast reconstruction.METHODS: A randomized trial was conducted to analyze outcomes of immediate staged tissue expander breast reconstruction using either AlloDerm or DermaMatrix. The impact of obesity, radiation, and chemotherapy on complications and biointegration of matrix was investigated. The trial was divided into three stages, with stage I results reported here.RESULTS: One hundred twenty-eight patients (199 breasts) were randomized equally over 2.5 years. Most patients were white, healthy nonsmokers. The overall complication rate was 36.2 percent; half of the complications were minor. The AlloDerm and DermaMatrix groups had similar rates of complications (33.6 percent versus 38.8 percent; p = 0.52), consisting mostly of skin necrosis (17.8 percent versus 21.4 percent; p = 0.66) and infections (13.9 percent versus 16.3 percent; p = 0.29), both of which led to tissue expander losses (5 percent versus 11.2 percent; p = 0.11). The AlloDerm group required less time for completion of expansion (42 days versus 70 days; p < 0.001). Obesity was associated with poor matrix biointegration and a longer drain time, both of which were associated with higher complication rates.CONCLUSION: The Breast Reconstruction Evaluation Using Acellular Dermal Matrix as a Sling Trial is the largest randomized trial to date in matrix breast reconstruction and emphasizes the importance of careful patient and allograft selection to minimize complications.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix artificial skin procedures tissue expansion EMTREE MEDICAL INDEX TERMS breast reconstruction comparative study controlled study female human mastectomy middle aged randomized controlled trial treatment outcome CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25539349 (http://www.ncbi.nlm.nih.gov/pubmed/25539349) PUI L603225930 DOI 10.1097/PRS.0000000000000758 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000000758 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 286 TITLE The breast reconstruction evaluation of acellular dermal matrix as a sling trial (BREASTrial): design and methods of a prospective randomized trial AUTHOR NAMES Agarwal J.P. Mendenhall S.D. Anderson L.A. Ying J. Boucher K.M. Liu T. Neumayer L.A. AUTHOR ADDRESSES (Agarwal J.P.; Mendenhall S.D.; Anderson L.A.; Ying J.; Boucher K.M.; Liu T.; Neumayer L.A.) Salt Lake City, Utah; and Springfield, Ill. From the Division of Plastic and Reconstructive Surgery, the Department of Surgery, the Division of Epidemiology, Department of Internal Medicine, and the Department of Pathology, University of Utah School of Medicine; and the Institute for Plastic Surgery, Southern Illinois University School of Medicine SOURCE Plastic and reconstructive surgery (2015) 135:1 (20e-28e). Date of Publication: 1 Jan 2015 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Recent literature has focused on the advantages and disadvantages of using acellular dermal matrix in breast reconstruction. Many of the reported data are from low level-of-evidence studies, leaving many questions incompletely answered. The present randomized trial provides high-level data on the incidence and severity of complications in acellular dermal matrix breast reconstruction between two commonly used types of acellular dermal matrix.METHODS: A prospective randomized trial was conducted to compare outcomes of immediate staged tissue expander breast reconstruction using either AlloDerm or DermaMatrix. The impact of body mass index, smoking, diabetes, mastectomy type, radiation therapy, and chemotherapy on outcomes was analyzed. Acellular dermal matrix biointegration was analyzed clinically and histologically. Patient satisfaction was assessed by means of preoperative and postoperative surveys. Logistic regression models were used to identify predictors of complications.RESULTS: This article reports on the study design, surgical technique, patient characteristics, and preoperative survey results, with outcomes data in a separate report. After 2.5 years, we successfully enrolled and randomized 128 patients (199 breasts). The majority of patients were healthy nonsmokers, with 41 percent of patients receiving radiation therapy and 49 percent receiving chemotherapy. Half of the mastectomies were prophylactic, with nipple-sparing mastectomy common in both cancer and prophylactic cases. Preoperative survey results indicate that patients were satisfied with their premastectomy breast reconstruction education.CONCLUSION: Results from the Breast Reconstruction Evaluation Using Acellular Dermal Matrix as a Sling Trial will assist plastic surgeons in making evidence-based decisions regarding acellular dermal matrix-assisted tissue expander breast reconstruction.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix procedures EMTREE MEDICAL INDEX TERMS adolescent adult aged breast reconstruction breast tumor (surgery) controlled study female human methodology middle aged prospective study randomized controlled trial randomized controlled trial (topic) single blind procedure very elderly young adult LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25539330 (http://www.ncbi.nlm.nih.gov/pubmed/25539330) PUI L603226999 DOI 10.1097/PRS.0000000000000809 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000000809 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 287 TITLE Histologic characterization of acellular dermal matrices in a porcine model of tissue expander breast reconstruction AUTHOR NAMES Carruthers C.A. Dearth C.L. Reing J.E. Kramer C.R. Gagne D.H. Crapo P.M. Garcia O. Badhwar A. Scott J.R. Badylak S.F. AUTHOR ADDRESSES (Carruthers C.A.; Badylak S.F., badylaks@upmc.edu) Department of Bioengineering, University of Pittsburgh, Pittsburgh, United States. (Carruthers C.A.; Dearth C.L.; Reing J.E.; Kramer C.R.; Badylak S.F., badylaks@upmc.edu) McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Pittsburgh, United States. (Dearth C.L.; Badylak S.F., badylaks@upmc.edu) Department of Surgery, University of Pittsburgh, Pittsburgh, United States. (Gagne D.H.; Crapo P.M.; Badhwar A.; Scott J.R.) C. R. Bard Inc. (Davol), Providence, United States. (Garcia O.) Division of Plastic Surgery, Miller School of Medicine, University of Miami, Miami, United States. (Scott J.R.) Department of Molecular Pharmacology, Physiology and Biotechnology, Brown University, Providence, United States. CORRESPONDENCE ADDRESS S.F. Badylak, McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Pittsburgh, United States. Email: badylaks@upmc.edu SOURCE Tissue Engineering - Part A (2015) 21:1-2 (35-44). Date of Publication: 1 Jan 2015 ISSN 1937-335X (electronic) 1937-3341 BOOK PUBLISHER Mary Ann Liebert Inc., info@liebertpub.com ABSTRACT Background: Acellular dermal matrices (ADMs) have been commonly used in expander-based breast reconstruction to provide inferolateral prosthesis coverage. Although the clinical performance of these biologic scaffold materials varies depending on a number of factors, an in-depth systematic characterization of the host response is yet to be performed. The present study evaluates the biochemical composition and structure of two ADMs, AlloDerm(®) Regenerative Tissue Matrix and AlloMax™ Surgical Graft, and provides a comprehensive spatiotemporal characterization in a porcine model of tissue expander breast reconstruction. Methods: Each ADM was characterized with regard to thickness, permeability, donor nucleic acid content, (residual double-stranded DNA [dsDNA]), and growth factors (basic fibroblast growth factor [bFGF], vascular endothelial growth factor [VEGF], and transforming growth factor-beta 1 [TGF-β1]). Cytocompatibility was evaluated by in vitro cell culture on the ADMs. The host response was evaluated at 4 and 12 weeks at various locations within the ADMs using established metrics of the inflammatory and tissue remodeling response: cell infiltration, multinucleate giant cell formation, extent of ADM remodeling, and neovascularization. Results: AlloMax incorporated more readily with surrounding host tissue as measured by earlier and greater cell infiltration, fewer foreign body giant cells, and faster remodeling of ADM. These findings correlated with the in vitro composition and cytocompatibility analysis, which showed AlloMax to more readily support in vitro cell growth. Conclusions: AlloMax and AlloDerm demonstrated distinct remodeling characteristics in a porcine model of tissue expander breast reconstruction. EMTREE DRUG INDEX TERMS double stranded DNA (endogenous compound) fibroblast growth factor 2 (endogenous compound) transforming growth factor beta1 (endogenous compound) vasculotropin (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction breast tissue expander surgical mesh EMTREE MEDICAL INDEX TERMS angiogenesis animal cell animal experiment animal tissue article biochemical composition biocompatibility cell infiltration controlled study cytocompatibility giant cell in vitro study in vivo study morphometry mouse nonhuman nucleic acid analysis permeability porcine model priority journal spatiotemporal analysis thickness DEVICE TRADE NAMES AlloDerm , United StatesBard AlloMax , United StatesLifecell DEVICE MANUFACTURERS (United States)Bard (United States)Lifecell CAS REGISTRY NUMBERS fibroblast growth factor 2 (106096-93-9) vasculotropin (127464-60-2) EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Clinical and Experimental Biochemistry (29) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015682706 MEDLINE PMID 24941900 (http://www.ncbi.nlm.nih.gov/pubmed/24941900) PUI L601580673 DOI 10.1089/ten.tea.2014.0095 FULL TEXT LINK http://dx.doi.org/10.1089/ten.tea.2014.0095 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 288 TITLE Evaluating the effectiveness of cryopreserved acellular dermal matrix in immediate expander-based breast reconstruction: A comparison study AUTHOR NAMES Kim S.-Y. Lim S.Y. Mun G.-H. Bang S.-I. Oh K.S. Pyon J.-K. AUTHOR ADDRESSES (Kim S.-Y.; Lim S.Y.; Mun G.-H.; Bang S.-I.; Oh K.S.; Pyon J.-K., psbboy@gmail.com) Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. CORRESPONDENCE ADDRESS J.-K. Pyon, Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, South Korea. SOURCE Archives of Plastic Surgery (2015) 42:3 (316-320). Date of Publication: 1 May 2015 ISSN 2234-6171 (electronic) 2234-6163 BOOK PUBLISHER Korean Society of Plastic and Reconstructive Surgeons, 1355-3 Seocho-Dong, Seocho-Gu, Seoul, South Korea. kpseo@hitel.net ABSTRACT Background CGCryoDerm was first introduced in 2010 and offers a different matrix preservation processes for freezing without drying preparation. From a theoretical perspective, CGCryoDerm has a more preserved dermal structure and more abundant growth factors for angiogenesis and recellularization. In the current study, the authors performed a retrospective study to evaluate freezing- and freeze-drying-processed acellular dermal matrix (ADM) to determine whether any differences were present in an early complication profile. Methods Patients who underwent ADM-assisted tissue expander placement for two stage breast reconstruction between January of 2013 and March of 2014 were retrospectively reviewed and divided into two groups based on the types of ADM-assisted expander reconstruction (CGDerm vs. CGCryoDerm). Complications were divided into four main categories and recorded as follows: seroma, hematoma, infection, and mastectomy skin flap necrosis. Results In a total of 82 consecutive patients, the CGCryoDerm group had lower rates of seroma when compared to the CGDerm group without statistical significance (3.0% vs. 10.2%, P=0.221), respectively. Other complications were similar in both groups. Reconstructions with CGCryoDerm were found to have a significantly longer period of drainage when compared to reconstructions with CGDerm (11.91 days vs. 10.41 days, P=0.043). Conclusions Preliminary findings indicate no significant differences in early complications between implant/expander-based reconstructions using CGCryoderm and those using CGDerm. EMTREE DRUG INDEX TERMS antibiotic agent (intravenous drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction breast tissue expander cryopreservation EMTREE MEDICAL INDEX TERMS adult article comparative effectiveness female freeze drying graft necrosis (complication) hematoma (complication) human human tissue infection (complication) lymph node dissection major clinical study mastectomy peripheral circulation retrospective study seroma (complication) DEVICE TRADE NAMES CG CRYO CGDerm Mentor , United StatesMentor DEVICE MANUFACTURERS (United States)Mentor EMBASE CLASSIFICATIONS Dermatology and Venereology (13) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015055211 PUI L604439155 DOI 10.5999/aps.2015.42.3.316 FULL TEXT LINK http://dx.doi.org/10.5999/aps.2015.42.3.316 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 289 TITLE Risk factors contributing to revision rate in breast reconstruction patients AUTHOR NAMES Pinette W. Dhillon J. Lewis P. Hill M.E. Gupta S. AUTHOR ADDRESSES (Pinette W.; Dhillon J.; Lewis P.; Hill M.E.; Gupta S.) Loma Linda University, School of Medicine, Loma Linda, United States. CORRESPONDENCE ADDRESS W. Pinette, Loma Linda University, School of Medicine, Loma Linda, United States. SOURCE Journal of Investigative Medicine (2015) 63:1 (162). Date of Publication: January 2015 CONFERENCE NAME American Federation for Medical Research Western Regional Meeting, AFMR 2015 CONFERENCE LOCATION Carmel, CA, United States CONFERENCE DATE 2015-01-29 to 2015-01-31 ISSN 1081-5589 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Purpose of Study: Mastectomy and breast reconstruction patients are at increased risk for complications due to the nature of the treatment process, negatively affecting the aesthetics of the reconstructed breast. Often, additional revision surgeries are required to correct the shape of the breast due to such complications as capsular contracture, hypertrophic scars, or displacement of the breast implant. This study was conducted to identify factors that correlated with higher numbers of revision surgeries in breast reconstruction patients. Methods Used: This retrospective cohort study identified mastectomy patients who had procedures at LLUMC between 2008 and 2014. Data was collected on: smoking history, past medical history, chemotherapy and radiotherapy, cancer type and staging, mastectomy type, breast reconstruction type, the use of ADM, complications, and the number and type of breast revisions. Breast revision surgeries included those for hypertrophic scar resection, breast asymmetry, capsular contractures, displacement of tissue expanders or implants, and replacement of prostheses due to rupture or other complications. The data was collected and analyzed by t-test, ANOVA or Fisher's Exact Test with Microsoft Excel. Summary of Results: Data was obtained on 234 patients, and 27 were excluded due to incomplete data. Of the remaining 207 patients, 62 had unplanned revision surgeries. No significant differences in BMI, age, smoking history, or radiotherapy were found between patients that required revisions and those that did not. Additionally, there was no significant difference between the two groups in mastectomy-to-reconstruction time or complication rates. Neither radiotherapy, reconstruction type, nor the presence of complications significantly increased revision rates. However, the use of acellular dermal matrix (ADM) in the reconstructed breast was found to significantly reduce the average number of revisions (1.6 ± 0.97 vs 2.3 ± 1.3; p=0.02). Conclusions: Previous literature has identified many factors that increase the overall risk for complications to breast reconstructions. However, this data indicates that these same risk factors do not correlate with greater breast revision rates. On the other hand, the use of ADM appears to reduce the risk of future revision surgeries for these patients. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) American breast reconstruction human medical research patient risk factor EMTREE MEDICAL INDEX TERMS acellular dermal matrix analysis of variance breast breast implant chemotherapy cohort analysis contracture Fisher exact test hypertrophic scar implant mastectomy medical history neoplasm procedures prosthesis radiotherapy risk rupture smoking staging Student t test surgery tissue expander LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71770311 DOI 10.1097/JIM.0000000000000133 FULL TEXT LINK http://dx.doi.org/10.1097/JIM.0000000000000133 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 290 TITLE The efficacy of botulinum toxin a in post-mastectomy breast reconstruction: A pilot study AUTHOR NAMES Gabriel A. Champaneria M.C. Maxwell G.P. AUTHOR ADDRESSES (Gabriel A., gabrielallen@yahoo.com; Maxwell G.P.) Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, United States. (Gabriel A., gabrielallen@yahoo.com; Champaneria M.C.) 505 NE 87th Avenue, Vancouver, United States. CORRESPONDENCE ADDRESS A. Gabriel, 505 NE 87th Avenue, Vancouver, United States. Email: gabrielallen@yahoo.com SOURCE Aesthetic Surgery Journal (2015) 35:4 (402-409). Date of Publication: 2015 ISSN 1527-330X (electronic) 1090-820X BOOK PUBLISHER Oxford University Press, jnl.info@oup.co.uk ABSTRACT Background: Botulinum toxin A has been successfully used in a variety of areas to temporarily obliterate muscle mobility for either functional or aesthetic gain. Tissue expander-based breast reconstruction has been plagued with pain and discomfort. Objective: The purpose of this pilot study was to evaluate the role of a neurotoxin (Botulinum toxin A) in expander-based breast reconstruction. Methods: Thirty patients underwent mastectomies with immediate expander or acellular dermal matrix reconstruction. The neurotoxin group (n = 15) received 40 units of neurotoxin (Botulinum toxin A, Allergan, Inc, Irvine, CA) into each pectoralis major muscle through 4 serial injections and the placebo group (n = 15) received 4 serial injections of 0.9% NaCl. All patients were followed over 1 year, and patient demographics, VAS (visual analog score), laterality, office visits, amount of expansion and number of times to full expansion, and amount of narcotics required were recorded. Statistical significance was considered as p < .05. Results: There were no significant differences between the two groups in terms of age, laterality, expander size, or complications (p = .46-.66). There was a significant difference between the two groups in the VAS score, demonstrating decreased pain in the neurotoxin group (p < .05). In addition, there was a significant increase in the volume of expansion per visit in the neurotoxin group as compared to the placebo group (p < .05). There was no significant difference in narcotic use in the first 3 days after surgery; however, there was a significant decrease in use of narcotics from 7 to 45 days in the neurotoxin group (p < .05). There were no complications associated with the use of the neurotoxin. Conclusions: The infiltration of the pectoralis major muscle with neurotoxin in immediate, expander-based reconstruction may be beneficial in reducing pain and expediting expansions. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) botulinum toxin A (drug comparison - placebo, drug therapy, pharmacology) EMTREE DRUG INDEX TERMS narcotic agent placebo EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) analgesia breast reconstruction drug efficacy mastectomy postoperative pain (drug therapy, drug therapy) EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult article breast tissue expander clinical article controlled study female follow up hematoma (complication) human incidence infection (complication) outcome assessment pain assessment pain severity pectoralis major muscle pilot study priority journal seroma (complication) skin necrosis (complication) tissue expansion visual analog scale DRUG TRADE NAMES onabotulinumtoxin A , United StatesAllergan DRUG MANUFACTURERS (United States)Allergan CAS REGISTRY NUMBERS botulinum toxin A (93384-43-1, 1309378-01-5, 1800016-51-6) EMBASE CLASSIFICATIONS Clinical and Experimental Pharmacology (30) Drug Literature Index (37) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160062569 MEDLINE PMID 25825421 (http://www.ncbi.nlm.nih.gov/pubmed/25825421) PUI L607874629 DOI 10.1093/asj/sjv040 FULL TEXT LINK http://dx.doi.org/10.1093/asj/sjv040 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 291 TITLE Postoperative expansion is not a primary cause of infection in immediate breast reconstruction with tissue expanders AUTHOR NAMES Avraham T. Weichman K.E. Wilson S. Weinstein A. Haddock N.T. Szpalski C. Choi M. Karp N.S. AUTHOR ADDRESSES (Avraham T.; Weichman K.E.; Wilson S.; Weinstein A.; Choi M.; Karp N.S., nolan.karp@nyumc.org) Institute of Reconstructive Plastic Surgery, New York University, New York, United States. (Haddock N.T.) University of Texas Southwestern, Dallas, United States. (Szpalski C.) Department of Surgery, University Libre de Bruxelles, Brussels, Belgium. CORRESPONDENCE ADDRESS N.S. Karp, New York University Medical Center, Institute of Reconstructive Plastic Surgery, 305 East 47th Street, New York, United States. SOURCE Breast Journal (2015) 21:5 (501-507). Date of Publication: 1 Sep 2015 ISSN 1524-4741 (electronic) 1075-122X BOOK PUBLISHER Blackwell Publishing Inc., subscrip@blackwellpub.com ABSTRACT Perioperative infection is the most common and dreaded complication associated with tissue expander (TE) breast reconstruction. Historically, the expansion period was thought to be the time of greatest hazard to the implant. However, recent institutional observations suggest infectious complications occur prior to expansion. This investigation, therefore, was conducted to determine the timing of infectious complications associated with two-stage TE breast reconstructions. Following IRB approval, a retrospective review of all consecutive two-stage immediate TE breast reconstructions at a single institution from November 2007 to November 2011 was conducted. Reconstructions were then divided into two cohorts: those suffering infectious complications and those that did not. Infectious complications including minor cellulitis, major cellulitis, abscess drainage, and explantation were identified. Various operative and patient variables were evaluated in comparison. Eight hundred ninety immediate two-stage TE breast reconstructions met inclusion criteria. Patients suffering infection were older (55.4 years versus 49.3 years; p < 0.001), and more likely to have therapeutic mastectomy (94% versus 61%; p < 0.0001), the use of acellular dermal matrix (ADM; 72.5% versus 54.9%; p = 0.001), and greater initial TE fill (448.6 mL versus 404.7 mL; p = 0.0078). The average time to developing of infectious symptoms was 29.6 days (range 9-142 days), with 94.6% (n = 87) of infections prior to the start of expansion. Perioperative infections in immediate two-stage TE to implant breast reconstructions are significant and occur mostly prior to the start of expansion. Thus, challenging the conventional wisdom that instrumentation during expander filling as the primary cause of implant infections. Possible etiologic factors include greater age, therapeutic mastectomy versus prophylactic mastectomy, larger initial TE fill, and the use of ADM. EMTREE DRUG INDEX TERMS antibiotic agent (intravenous drug administration, oral drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction infectious complication (complication) tissue expander (adverse device effect) tissue expansion EMTREE MEDICAL INDEX TERMS abscess drainage acellular dermal matrix adult antibiotic therapy article breast cancer (surgery) breast implant cellulitis (complication) controlled study human major clinical study mastectomy operation duration perioperative period EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015174131 MEDLINE PMID 26132336 (http://www.ncbi.nlm.nih.gov/pubmed/26132336) PUI L605085007 DOI 10.1111/tbj.12448 FULL TEXT LINK http://dx.doi.org/10.1111/tbj.12448 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 292 TITLE Breast Reconstruction and Revision Surgery for Implant-associated Breast Deformities Using Porcine Acellular Dermal Matrix: A Multicenter Study of 156 Cases AUTHOR NAMES Hille-Betz U. Kniebusch N. Wojcinski S. Henseler H. Heyl V. Ohlinger R. Paepke S. Klapdor R. Krause-Bergmann B. AUTHOR ADDRESSES (Hille-Betz U., hille-betz.ursula@mh-hannover.de; Kniebusch N.; Klapdor R.) Frauenklinik/Brustzentrum der Medizinischen Hochschule Hannover, Hannover, Germany. (Wojcinski S.) Klinik für Frauenheilkunde und Geburtshilfe, Franziskus Hospital, Bielefeld, Germany. (Henseler H.) Klinik für Plastische Chirurgie der Medizinischen Hochschule Hannover, Hannover, Germany. (Heyl V.) Asklepios Paulinen Klinik, Wiesbaden, Germany. (Ohlinger R.) Brustzentrum der Frauenklinik der Ernst Moritz Arndt Universität Greifswald, Greifswald, Germany. (Paepke S.) Frauenklinik und Poliklinik der TU München, Munich, Germany. (Krause-Bergmann B.) Klinik für Senologie, St. Franziskus-Hospital, Munster, Germany. CORRESPONDENCE ADDRESS U. Hille-Betz, Frauenklinik/Brustzentrum der Medizinischen Hochschule Hannover, Hannover, Germany. SOURCE Annals of Surgical Oncology (2015) 22:4 (1146-1152). Date of Publication: 2015 ISSN 1534-4681 (electronic) 1068-9265 BOOK PUBLISHER Springer New York LLC, journals@springer-sbm.com ABSTRACT Background: Acellular dermal matrix is increasingly used as caudolateral coverage for breast implants in immediate breast reconstruction after skin-sparing mastectomy or in the correction of implant-associated breast deformities. Matrices of human, bovine, and porcine origin are available. The purpose of this retrospective multicenter study was to report experiences with porcine acellular dermal matrices, as only limited data can be found in the literature. Methods: In the hospital databases of five institutions, 127 patients were identified who underwent breast reconstructions in 156 breasts using an acellular porcine dermal matrix. Medical records were reviewed. Patients were divided into three groups: immediate expander-implant or direct to implant reconstructions (n = 98), delayed expander-implant reconstructions (n = 14), and revision surgery for implant-associated breast deformities (n = 44). Results: With a mean follow-up of 19.6 months, total major complication rate was 7.1 %: implant loss (3.2 %), skin flap necrosis (2.6 %), delayed skin healing (2.6 %), hematoma (1.9 %), seroma (1.3 %), infection (0.6 %), and capsular contracture (0.6 %). Total minor complication rate was 22.9 %, with seroma being the most frequent complication (19.2 %). In the group of immediate breast reconstructions, 20.4 % of the breasts had received radiotherapy in the past. These patients exhibited a significantly higher rate of seroma than patients without prior radiotherapy (35.0 vs. 14.9 %, p = 0.031). Conclusions: Complication rates using porcine acellular dermal matrix in breast reconstruction are comparable to complication rates reported in studies using human acellular dermal matrices. Thus, porcine acellular dermal matrices can safely be applied in breast reconstructive surgery. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant (adverse device effect) breast malformation (complication, disease management, surgery) breast reconstruction breast tissue expander (adverse device effect) esthetic surgery implant associated breast deformity (complication, disease management, surgery) medical device complication (complication, disease management, surgery) porcine acellular dermal matrix reoperation surgical mesh (adverse device effect) EMTREE MEDICAL INDEX TERMS adult animal tissue article controlled study data base experience female follow up graft necrosis (complication, disease management, surgery) health care cost hematoma (complication, disease management, surgery) human implant capsular contracture (complication, disease management, surgery) implant loss (complication, disease management, surgery) intervention study major clinical study medical record review middle aged nonhuman patient history of radiotherapy postoperative hemorrhage (complication, disease management, surgery) prosthesis complication (complication, disease management, surgery) prosthesis infection (complication, disease management, surgery) retrospective study seroma (complication, disease management, surgery) wound healing impairment (complication, disease management, surgery) DEVICE TRADE NAMES AlloDerm Strattice EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014834917 PUI L600197754 DOI 10.1245/s10434-014-4098-3 FULL TEXT LINK http://dx.doi.org/10.1245/s10434-014-4098-3 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 293 TITLE New Deep Dermal ADM Incorporates Well in Case Series of Complex Breast Reconstruction Patients AUTHOR NAMES Wilson H.B. AUTHOR ADDRESSES (Wilson H.B., hbwilson1@gmail.com) Centra Health, Inc., Division of Plastic Surgery, Liberty University College of Osteopathic Medicine, Lynchburg, United States. CORRESPONDENCE ADDRESS H.B. Wilson, Centra Medical Group Plastic Surgery Center, 1330 Oak Lane, Lynchburg, United States. SOURCE Medicine (United States) (2015) 94:21 Article Number: e745. Date of Publication: 5 May 2015 ISSN 1536-5964 (electronic) 0025-7974 BOOK PUBLISHER Lippincott Williams and Wilkins, LRorders@phl.lrpub.com ABSTRACT Breast cancer patients with significant comorbidities present reconstructive challenges due to a predictably high complication rate. During expander-based breast reconstruction, human acellular dermal matrix (ADM) is often used to prevent pectoralis muscle retraction, facilitate early expansion, and improve cosmetic outcome. Device infection and chronic seroma have been correlated to the addition of the graft by some large database reports but not others. This study describes the first reported experience with a new deep dermal ADM, FlexHD ® Pliable™ (MTF, Edison, NJ). Sixteen breasts in 10 consecutive patients identified retrospectively and followed prospectively had immediate expander-based breast reconstruction utilizing the new ADM. Patient comorbidities were catalogued, complications were recorded, and overall reconstructive success was assessed. At implant exchange, the ADM was examined for tissue ingrowth and biopsied for histologic examination. All 16 breasts had successful reconstructions. Two breasts (12.5%) developed device infection, requiring removal and later replacement of the expander. One breast (6.7%) developed chronic seroma, also requiring expander removal and later replacement. All the complicated patients had significant comorbidities, including obesity in all 3. At expander removal, the FlexHD Pliable showed near-complete visual tissue incorporation in 14 of 16 breasts (88%). This case series demonstrates significant reconstructive success in challenging patients utilizing a novel ADM. Visual and histologic assessment of tissue ingrowth into the graft suggests the high rate of complication may be due to patient comorbidities rather than addition of ADM. Additional experience is needed to confirm and the study is ongoing. EMTREE DRUG INDEX TERMS antibiotic agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction surgical mesh EMTREE MEDICAL INDEX TERMS adult article body image breast carcinoma (radiotherapy) breast tenderness breast tissue expander (adverse device effect) cancer radiotherapy cancer surgery clinical article comorbidity device infection (complication) device removal female human human tissue intraductal carcinoma (radiotherapy) mastectomy mastitis (complication, drug therapy) middle aged nipple sparing mastectomy obesity partial mastectomy patient history of surgery patient satisfaction postoperative care postoperative complication (complication) postoperative pain (complication) postoperative period priority journal range of motion retrospective study scoring system seroma (complication) tissue growth treatment outcome treatment response wellbeing DEVICE TRADE NAMES FlexHD Mentor Sientra EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015356760 MEDLINE PMID 26020380 (http://www.ncbi.nlm.nih.gov/pubmed/26020380) PUI L605917203 DOI 10.1097/MD.0000000000000745 FULL TEXT LINK http://dx.doi.org/10.1097/MD.0000000000000745 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 294 TITLE Early complications and implant loss in implant-based breast reconstruction with and without acellular dermal matrix (Tecnoss Protexa): A comparative study AUTHOR NAMES Potter S. Chambers A. Govindajulu S. Sahu A. Warr R. Cawthorn S. AUTHOR ADDRESSES (Potter S.) Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom. (Chambers A.; Govindajulu S.; Sahu A.; Cawthorn S., simon.cawthorn@nbt.nhs.uk) Breast Care Centre, North Bristol NHS Trust, Southmead Hospital, Southmead Road, Bristol, United Kingdom. (Warr R.) Department of Plastic Surgery, North Bristol NHS Trust, Bristol, United Kingdom. CORRESPONDENCE ADDRESS S. Cawthorn, Breast Care Centre, North Bristol NHS Trust, Southmead Hospital, Southmead Road, Bristol, United Kingdom. SOURCE European Journal of Surgical Oncology (2015) 41:1 (113-119). Date of Publication: 2015 ISSN 1532-2157 (electronic) 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Acellular dermal matrix (ADM) may improve outcomes in implant-based breast reconstruction, but recent evidence suggests complication rates may be higher when ADM is used. We retrospectively compared early complications and implant loss in implant-based breast reconstruction (BR) with and without ADM to evaluate the safety of the procedure in our centre. Methods: Case-notes of consecutive women undergoing implant-based BR from May 2011 to November 2012 were retrospectively reviewed. Data were extracted using a standardised pro-forma and the rate of early complications, major complications and implant loss compared between procedure groups. Results: Forty-six implant-based reconstructions were performed for malignancy (n 1/4 31, 67.4%) or prophylaxis (n 1/4 15, 32.6%) in 31 women over the 18-month study period. ADM (Tecnoss Protexa®, Tecnoss S.r.l.) was used in 31 (67.4%) cases. There were no differences in patient age, BMI, co-morbidities, smoking or chemotherapy between groups, but patients receiving ADM were more likely to have received radiotherapy prior to their reconstruction (n 1/4 6, 30% vs. n 1/4 0, 0%, p 1/4 0.043). The overall rate of early complications was 26.1% (n 1/4 12) but there was no significant difference between procedure groups (standardn 1/4 4, 27.7% vs. ADM-n 1/4 8, 25.8%; p 1/4 0.950). There were 2 (4.3%) major complications none of which were associated with ADM use (standard-n 1/4 2, 13.3% vs. ADM-n 1/4 0, 0.0%; p 1/4 0.038). There were 6 (13.0%) implant losses of which 4 were in the ADM group (standard- n 1/4 2, 13.3% vs. ADM-n 1/4 4, 12.9%; p 1/4 0.968). All of these were associated with pre-reconstruction radiotherapy. Conclusions: ADM-assisted implant-based reconstruction with Tecnoss Protexa® is safe and may improve outcomes for women by facilitating a single-stage procedure. Robust prospective evaluation is now needed to definitively evaluate the role of ADM in implant-based BR. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant (adverse device effect) breast reconstruction implant loss (complication) prosthesis complication (complication) EMTREE MEDICAL INDEX TERMS adult aged article breast cancer (radiotherapy, surgery) clinical article comparative study female human medical device complication (complication) patient safety postoperative complication (complication) priority journal prosthesis infection (complication) treatment outcome DEVICE TRADE NAMES Tecnoss Protexa EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015735106 MEDLINE PMID 24011501 (http://www.ncbi.nlm.nih.gov/pubmed/24011501) PUI L602175535 DOI 10.1016/j.ejso.2014.07.016 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2014.07.016 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 295 TITLE Daily serum collection after acellular dermal matrix-assisted breast reconstruction AUTHOR NAMES Caputo G.G. Franchini Z. Maritan M. Pozza E.D. Vigato E. Tedeschi U. Governa M. AUTHOR ADDRESSES (Caputo G.G., glendagiorgia.caputo@ospedaleuniverona.it; Maritan M.; Pozza E.D.; Vigato E.; Governa M.) Plastic and Reconstructive Surgery, Surgery and Odontology Department, University Hospital of Verona, Verona, Italy. (Franchini Z.; Tedeschi U.) General Surgery, Surgery and Odontology Department, University Hospital of Verona, Verona, Italy. CORRESPONDENCE ADDRESS G.G. Caputo, Plastic and Reconstructive Surgery, Surgery and Odontology Department, University Hospital of Verona, Piazzale Stefani 1, Verona, Italy. SOURCE Archives of Plastic Surgery (2015) 42:3 (321-326). Date of Publication: 1 May 2015 ISSN 2234-6171 (electronic) 2234-6163 BOOK PUBLISHER Korean Society of Plastic and Reconstructive Surgeons, 1355-3 Seocho-Dong, Seocho-Gu, Seoul, South Korea. kpseo@hitel.net ABSTRACT Background The acellular dermal matrix (ADM)-assisted breast reconstruction technique is widely known, but discouraging results due to early postoperative complications have been reported. As the literature identifies seroma as the most common issue after breast surgery without identifying its pathogenesis, we aimed to report the trend of postoperative daily serum collection after ADM-assisted breast reconstruction and compare it with data in the literature in order to discover more about this little-known topic. Methods A retrospective study on 28 consecutive patients who received ADM-assisted breast reconstruction between February 2013 and February 2014 was performed. In order to reduce the number of variables that could affect serum production, only one brand of ADM was used and all tissues were handled gently and precisely. The daily drainage volume was recorded per patient during the first four days of hospitalization. Likewise, postoperative complications were noted during routine follow-up. Results In total, five (17.9%) bilateral and 23 (82.1%) unilateral ADM-assisted breast reconstructions (33 implants) were performed. The mean age, body mass index, and length of hospital stay were 53.6 years, 21.3 kg/m2, and 4.5 days, respectively. One major complication led to implant loss (3.0%), and nine minor complications were successfully treated with ambulatory surgery (27.3%). Serum collection linearly decreased after 24 hours postoperatively. Conclusions Daily drainage decreased following the theoretical decline of acute inflammation. In concordance with the literature, daily serum production may not be related to the use of ADM. EMTREE DRUG INDEX TERMS povidone iodine EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction serum EMTREE MEDICAL INDEX TERMS adult article bilateral acellular dermal matrix assisted breast reconstruction body mass breast implant clinical article debridement device failure drainage tube female fibroblast hematoma (complication, surgery) hospitalization human human tissue inflammation retrospective study unilateral acellular dermal matrix assisted breast reconstruction wound dehiscence (complication, surgery) CAS REGISTRY NUMBERS povidone iodine (25655-41-8) EMBASE CLASSIFICATIONS Clinical and Experimental Biochemistry (29) Drug Literature Index (37) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015055212 PUI L604439168 DOI 10.5999/aps.2015.42.3.321 FULL TEXT LINK http://dx.doi.org/10.5999/aps.2015.42.3.321 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 296 TITLE Early surgical site infection following tissue expander breast reconstruction with or without acellular dermal matrix: National benchmarking using national surgical quality improvement program AUTHOR NAMES Winocour S. Martinez-Jorge J. Habermann E. Thomsen K. Lemaine V. AUTHOR ADDRESSES (Winocour S.; Martinez-Jorge J.; Lemaine V., lemaine.valerie@mayo.edu) Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, United States. (Habermann E.; Thomsen K.) Department of Health Sciences Research, Rochester, United States. CORRESPONDENCE ADDRESS V. Lemaine, Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, United States. SOURCE Archives of Plastic Surgery (2015) 42:2 (194-200). Date of Publication: 1 Mar 2015 ISSN 2234-6171 (electronic) 2234-6163 BOOK PUBLISHER Korean Society of Plastic and Reconstructive Surgeons, 1355-3 Seocho-Dong, Seocho-Gu, Seoul, South Korea. kpseo@hitel.net ABSTRACT Background Surgical site infections (SSIs) result in significant patient morbidity following immediate tissue expander breast reconstruction (ITEBR). This study determined a single ins-titution’s 30-day SSI rate and benchmarked it against that among national institutions par-ticipating in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Methods Women who underwent ITEBR with/without acellular dermal matrix (ADM) were identified using the ACS-NSQIP database between 2005 and 2011. Patient characteristics associated with the 30-day SSI rate were determined, and differences in rates between our institution and the national database were assessed. Results 12,163 patients underwent ITEBR, including 263 at our institution. SSIs occurred in 416 (3.4%) patients nationwide excluding our institution, with lower rates observed at our institution (1.9%). Nationwide, SSIs were significantly more common in ITEBR patients with ADM (4.5%) compared to non-ADM patients (3.2%, P= 0.005), and this trend was observed at our institution (2.1% vs. 1.6%, P=1.00). A multivariable analysis of all institutions identified age ≥ 50 years (odds ratio [OR], 1.4; confidence interval [CI], 1.1–1.7), body mass index ≥ 30 kg/m(2) vs. < 25 kg/m(2) (OR, 3.4; CI, 2.6–4.5), and operative time > 4.25 hours (OR, 1.9; CI, 1.5– 2.4) as risk factors for SSIs. Our institutional SSI rate was lower than the nationwide rate (OR, 0.4; CI, 0.2–1.1), although this difference was not statistically significant (P= 0.07). Conclusions The 30-day SSI rate at our institution in patients who underwent ITEBR was lower than the nation. SSIs occurred more frequently in procedures involving ADM both nationally and at our institution. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction surgical infection (complication) tissue expander (adverse device effect) EMTREE MEDICAL INDEX TERMS adult age aged article body mass breast augmentation female human major clinical study middle aged operation duration risk factor EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015845518 PUI L603180347 DOI 10.5999/aps.2015.42.2.194 FULL TEXT LINK http://dx.doi.org/10.5999/aps.2015.42.2.194 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 297 TITLE Breast reconstruction using de-epithelialized dermal flap after vertical-pattern skin-sparing mastectomy in macromastia AUTHOR NAMES Peker F. Yuksel F. Karagoz H. Ozturk S. AUTHOR ADDRESSES (Peker F.; Yuksel F.; Karagoz H.; Ozturk S.) Plastic and Reconstructive Surgery, Private Practice, Istanbul, Turkey SOURCE ANZ journal of surgery (2015) 85:1-2 (64-68). Date of Publication: 1 Jan 2015 ISSN 1445-2197 (electronic) ABSTRACT INTRODUCTION: Prophylactic mastectomy is performed to reduce the risk of breast cancer in high-risk conditions, and expectations about reconstruction are too high. Implant coverage with healthy tissue and skin reducing as an envelope are two concerns in the treatment of macromastia cases. We present our results obtained with a prosthetic reconstruction technique using an inferior pedicled de-epithelialized dermal flap after vertical-pattern skin-sparing mastectomy in this retrospective study.METHODS: Fourteen patients with macromastia and with a high risk of breast malignancy were treated with breast prosthesis using an inferior pedicled de-epithelialized dermal flap after vertical-pattern skin-sparing mastectomy, and were followed for 6 months to 2 years.RESULTS: Good aesthetic results were obtained in all of the patients with increased patient satisfaction. There were no serious complications and the patients were all satisfied.DISCUSSION: Since there is no dangerous T-point in vertical-pattern skin-sparing mastectomy in contrast to an inverted-T wise-pattern technique, where flaps are connected under great tension and susceptible to separation, it can be used safely in macromastia cases, as in smaller breasts. In addition, a de-epithelialized dermal flap is quite useful to cover the inferior pole of the prosthesis and it eliminates the need for an acellular dermal matrix. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction congenital malformation mastectomy surgical flaps EMTREE MEDICAL INDEX TERMS adult breast female follow up human hypertrophy (surgery) pathology retrospective study treatment outcome LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24754867 (http://www.ncbi.nlm.nih.gov/pubmed/24754867) PUI L606543125 DOI 10.1111/ans.12570 FULL TEXT LINK http://dx.doi.org/10.1111/ans.12570 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 298 TITLE Direct delayed breast reconstruction with TAP flap, implant and acellular dermal matrix (TAPIA) AUTHOR NAMES Børsen-Koch M. Gunnarsson G.L. Udesen A. Arffmann S. Jacobs J. Salzberg A. Thomsen Jø.B. AUTHOR ADDRESSES (Børsen-Koch M.; Arffmann S.; Thomsen Jø.B., jbth@dadlnet.dk) Department of Plastic Surgery, Lillebaelt Hospital, Odense University Hospital, Kabbeltoft 25, Vejle, Denmark. (Gunnarsson G.L.) Department of Plastic Surgery, Telemark Hospital, Skien, Norway. (Udesen A.) Department of Plastic Surgery, Odense University Hospital, Odense, Denmark. (Jacobs J.; Salzberg A.) Division of Plastic Surgery, New York Medical College, New York, United States. CORRESPONDENCE ADDRESS Jø.B. Thomsen, Department of Plastic Surgery, Lillebaelt Hospital, Odense University Hospital, Kabbeltoft 25, Vejle, Denmark. SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2015) 68:6 (815-821). Date of Publication: 1 Jun 2015 ISSN 1878-0539 (electronic) 1748-6815 BOOK PUBLISHER Churchill Livingstone ABSTRACT Background The latissimus dorsi (LD) flap is considered one of the working horses within the field of breast reconstruction and it offers several advantages. However, donor-site morbidity may pose a problem. This article describes a new and modified technique for delayed breast reconstruction combining the use of a propeller thoracodorsal artery perforator (TAP) flap with an acellular dermal matrix (ADM) and an implant. Methods The paper presents 43 delayed breast reconstructions in 38 women using a modified technique for harvesting the TAP flap in combination with an ADM and an implant for total breast reconstruction. The focus of this paper is the refinements of our technique and short-term outcome in complication rates. The data presented were collected retrospectively. Results Three patients experienced major complications including hematoma, partial flap necrosis, and venous congestion. In addition, seven patients experienced minor complications including small partial flap necrosis and epidermolysis. There were no cases of infection and all flaps survived. The reconstructive goal was achieved in a single-stage procedure in all but one, 42/43 cases (98%). Conclusions The propeller TAP flap combined with an ADM and an implant can safely be used for delayed breast reconstruction. The technique offers a single-stage reconstruction and the donor-site morbidity is limited. The method is safe and reliable with complication rates comparable to those of similar methods. Although there is a learning curve, this simple modified technique does not demand any perforator or other vessel dissection. Any trained plastic surgeon should be able to adopt the technique into the growing armamentarium of breast reconstruction possibilities. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant breast reconstruction thoracodorsal artery perforator flap EMTREE MEDICAL INDEX TERMS adult aged article clinical article epidermolysis (complication) female graft necrosis (complication) hematoma (complication) human latissimus dorsi flap postoperative complication (complication) priority journal surgical approach surgical technique treatment outcome EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015827096 MEDLINE PMID 25778875 (http://www.ncbi.nlm.nih.gov/pubmed/25778875) PUI L602975721 DOI 10.1016/j.bjps.2015.02.004 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2015.02.004 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 299 TITLE Rates of reconstruction failure in patients undergoing immediate reconstruction with tissue expanders and/or implants and postmastectomy radiation therapy AUTHOR NAMES Fowble B. Park C. Wang F. Peled A. Alvarado M. Ewing C. Esserman L. Foster R. Sbitany H. Hanlon A. AUTHOR ADDRESSES (Fowble B., BFowble@radonc.ucsf.edu; Park C.) Department of Radiation Oncology, University of California San Francisco, San Francisco, United States. (Wang F.; Peled A.; Foster R.; Sbitany H.) Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, United States. (Alvarado M.; Ewing C.; Esserman L.) Carol Franc Buck Breast Care Center, Department of Surgery, University of California San Francisco, San Francisco, United States. (Hanlon A.) University of Pennsylvania School of Nursing, Philadelphia, United States. CORRESPONDENCE ADDRESS B. Fowble, Department of Radiation Oncology, University of California San Francisco, San Francisco, United States. SOURCE International Journal of Radiation Oncology Biology Physics (2015) 92:3 (634-641). Date of Publication: 1 Jul 2015 ISSN 1879-355X (electronic) 0360-3016 BOOK PUBLISHER Elsevier Inc., usjcs@elsevier.com ABSTRACT Objectives Mastectomy rates for breast cancer have increased, with a parallel increase in immediate reconstruction. For some women, tissue expander and implant (TE/I) reconstruction is the preferred or sole option. This retrospective study examined the rate of TE/I reconstruction failure (ie, removal of the TE or I with the inability to replace it resulting in no final reconstruction or autologous tissue reconstruction) in patients receiving postmastectomy radiation therapy (PMRT). Methods and Materials Between 2004 and 2012, 99 women had skin-sparing mastectomies (SSM) or total nipple/areolar skin-sparing mastectomies (TSSM) with immediate TE/I reconstruction and PMRT for pathologic stage II to III breast cancer. Ninety-seven percent had chemotherapy (doxorubicin and taxane-based), 22% underwent targeted therapies, and 78% had endocrine therapy. Radiation consisted of 5000 cGy given in 180 to 200 cGy to the reconstructed breast with or without treatment to the supraclavicular nodes. Median follow-up was 3.8 years. Results Total TE/I failure was 18% (12% without final reconstruction, 6% converted to autologous reconstruction). In univariate analysis, the strongest predictor of reconstruction failure (RF) was absence of total TE/I coverage (acellular dermal matrix and/or serratus muscle) at the time of radiation. RF occurred in 32.5% of patients without total coverage compared to 9% with coverage (P=.0069). For women with total coverage, the location of the mastectomy scar in the inframammary fold region was associated with higher RF (19% vs 0%, P=.0189). In multivariate analysis, weight was a significant factor for RF, with lower weight associated with a higher RF. Weight appeared to be a surrogate for the interaction of total coverage, thin skin flaps, interval to exchange, and location of the mastectomy scar. Conclusions RFs in patients receiving PMRT were lowered with total TE/I coverage at the time of radiation by avoiding inframammary fold incisions and with a preferred interval of 6 months to exchange. EMTREE DRUG INDEX TERMS aromatase inhibitor (drug therapy) bevacizumab (drug therapy) doxorubicin (drug therapy) lapatinib (drug therapy) tamoxifen (drug therapy) taxane derivative (drug therapy) trastuzumab (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction breast tissue expander cancer radiotherapy cancer surgery mastectomy postmastectomy radiation therapy reconstruction failure tissue implant (adverse device effect) treatment failure EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult aged article autotransplantation breast cancer (drug therapy, radiotherapy, surgery) cancer chemotherapy cancer hormone therapy cancer patient cancer staging computer assisted radiotherapy female follow up human implant capsular contracture (complication) lymph node major clinical study medical record review muscle patient history of tumorectomy postoperative complication (complication) postoperative infection (complication) priority journal radiation dose retrospective study serratus muscle skin flap skin scar (complication) supraclavicular node three dimensional imaging CAS REGISTRY NUMBERS bevacizumab (216974-75-3) doxorubicin (23214-92-8, 25316-40-9) lapatinib (231277-92-2, 388082-78-8, 437755-78-7) tamoxifen (10540-29-1) trastuzumab (180288-69-1) EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015981336 MEDLINE PMID 25936815 (http://www.ncbi.nlm.nih.gov/pubmed/25936815) PUI L604052822 DOI 10.1016/j.ijrobp.2015.02.031 FULL TEXT LINK http://dx.doi.org/10.1016/j.ijrobp.2015.02.031 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 300 TITLE Results from the ASPIRE study for breast reconstruction utilizing the AeroForm™ patient controlled carbon dioxide-inflated tissue expanders AUTHOR NAMES Connell T.F. AUTHOR ADDRESSES (Connell T.F., phatconw@iinet.net.au) Subiaco, Australia. CORRESPONDENCE ADDRESS T.F. Connell, Subiaco, Australia. SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2015) 68:9 (1255-1261). Date of Publication: 1 Sep 2015 ISSN 1878-0539 (electronic) 1748-6815 BOOK PUBLISHER Churchill Livingstone ABSTRACT Background: Therapeutic or prophylactic mastectomy is often indicated for women with breast cancer, or for those at a high risk of developing cancer due to familial history or genetic mutations. Favorable aesthetic and psychological results make prosthetic reconstruction of the breast with placement of tissue expanders followed by permanent implant a popular choice for women diagnosed with breast cancer. This study describes the results of the ASPIRE trial, the objective of which was to provide supportive data to demonstrate the performance and safety of the AeroForm™ System in a population with broader selection criteria than previous studies. Results of the earlier PACE clinical studies (PACE 1 and 2) demonstrated that the AeroForm™ System could be used safely and effectively to achieve the desired expansion necessary for successful breast reconstruction. In the current ASPIRE trial described in the paper, performance of the device was evaluated by successful tissue expansion and exchange to breast implant(s) unless precluded by a non-device related event. Safety data was evaluated based on reported adverse events. Methods: A prospective, single center, open-label study in which subjects who met the inclusion criteria and agreed to participate were enrolled and implanted with the AeroForm expander either at the time of mastectomy (immediate) or sometime after mastectomy (delayed). In the event of a bilateral procedure, the expander was implanted in each side. Subjects were followed until the explant of the tissue expander(s) and exchange for silicone or saline breast implant(s). Results: Thirty-four expanders were placed in 21 subjects in the clinical trial; the average age of subjects was 49.7 ± 8.6 years with average BMI of 26.1 ± 4.7. Bilateral procedures accounted for 62% of the total and 88% of the reconstructions were completed with a latissimus dorsi flap (anterior approach) per the investigators standard procedure. Four (12%) of the cases (12%) were completed in two subjects using an inferior dermal flap. Overall success rate was 94% (32/34 breasts) with no device related reconstruction failures. Two subjects failed reconstruction, one due to infection and one due to wound healing issues, both requiring unilateral expander removal and revision surgery. However, successful second stage reconstruction was completed in both subjects in a delayed procedure. Conclusion: The ASPIRE trial reports confirmatory data in a more inclusive patient population than the previous PACE 1 and 2 trials, indicating that the AeroForm Expander, provides a time-saving, needle-free, safe and effective method of tissue expansion for breast reconstruction. There were no device related complications that precluded the subjects from achieving the study goal of a permanent implant exchange. Reported complications are similar to those reported in the literature for tissue expansion procedures. Further development may enable a single dose controller to operate both expanders in a bilateral patient and increase the size range offered with this promising technology. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) carbon dioxide EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction breast tissue expander (adverse device effect, clinical trial) EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult aged article breast cancer (surgery) breast implant clinical article clinical trial dermal implant device failure device removal device safety female human latissimus dorsi flap mastectomy medical device complication (complication) postoperative infection (complication) priority journal reoperation silicone breast implant tissue expansion wound healing impairment (complication) DEVICE TRADE NAMES AeroForm CAS REGISTRY NUMBERS carbon dioxide (124-38-9, 58561-67-4) EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015126601 MEDLINE PMID 26087955 (http://www.ncbi.nlm.nih.gov/pubmed/26087955) PUI L604853117 DOI 10.1016/j.bjps.2015.05.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2015.05.001 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 301 TITLE The impact of chemotherapy and radiation therapy on the remodeling of acellular dermal matrices in staged, prosthetic breast reconstruction AUTHOR NAMES Myckatyn T.M. Cavallo J.A. Sharma K. Gangopadhyay N. Dudas J.R. Roma A.A. Baalman S. Tenenbaum M.M. Matthews B.D. Deeken C.R. AUTHOR ADDRESSES (Myckatyn T.M.; Cavallo J.A.; Sharma K.; Gangopadhyay N.; Dudas J.R.; Roma A.A.; Baalman S.; Tenenbaum M.M.; Matthews B.D.; Deeken C.R.) St. Louis, Mo.; and Cleveland, Ohio From the Division of Plastic and Reconstructive Surgery, the Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine; and the Department of Anatomic Pathology, Cleveland Clinic SOURCE Plastic and reconstructive surgery (2015) 135:1 (43e-57e). Date of Publication: 1 Jan 2015 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: An acellular dermal matrix will typically incorporate, in time, with the overlying mastectomy skin flap. This remodeling process may be adversely impacted in patients who require chemotherapy and radiation, which influence neovascularization and cellular proliferation.METHODS: Multiple biopsy specimens were procured from 86 women (n = 94 breasts) undergoing exchange of a tissue expander for a breast implant. These were divided by biopsy location: submuscular capsule (control) as well as superiorly, centrally, and inferiorly along the paramedian acellular dermis. Specimens were assessed for cellular infiltration, cell type, fibrous encapsulation, scaffold degradation, extracellular matrix deposition, neovascularization, mean composite remodeling score, and type I and III collagen. Patients were compared based on five oncologic treatment groups: no adjuvant therapy (untreated), neoadjuvant chemotherapy with or without radiation, and chemotherapy with or without radiation.RESULTS: Biopsy specimens were procured 45 to 1805 days after implantation and demonstrated a significant reduction in type I collagen over time. Chemotherapy adversely impacted fibrous encapsulation (p = 0.03). Chemotherapy with or without radiation adversely impacted type I collagen (p = 0.02), cellular infiltration (p < 0.01), extracellular matrix deposition (p < 0.04), and neovascularization (p < 0.01). Radiation exacerbated the adverse impact of chemotherapy for several remodeling parameters. Neoadjuvant chemotherapy also caused a reduction in type I (p = 0.01) and III collagen (p = 0.05), extracellular matrix deposition (p = 0.03), and scaffold degradation (p = 0.02).CONCLUSION: Chemotherapy and radiation therapy limit acellular dermal matrix remodeling.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation drug effects radiation response EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult breast tumor (therapy) female human middle aged retrospective study LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25539350 (http://www.ncbi.nlm.nih.gov/pubmed/25539350) PUI L603225971 DOI 10.1097/PRS.0000000000000807 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000000807 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 302 TITLE Treatment of pseudoangiomatous stromal hyperplasia of the breast: Implant-based reconstruction with a vascularized dermal sling AUTHOR NAMES Jung B.K. Nahm J.H. Lew D.H. Lee D.W. AUTHOR ADDRESSES (Jung B.K.; Lew D.H.; Lee D.W., xyphoss@yuhs.ac) Institute for Human Tissue Restoration, Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, South Korea. (Nahm J.H.) Department of Pathology, Yonsei University College of Medicine, Seoul, South Korea. CORRESPONDENCE ADDRESS D.W. Lee, Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, South Korea. SOURCE Archives of Plastic Surgery (2015) 42:5 (630-634). Date of Publication: 1 Sep 2015 ISSN 2234-6171 (electronic) 2234-6163 BOOK PUBLISHER Korean Society of Plastic and Reconstructive Surgeons, 1355-3 Seocho-Dong, Seocho-Gu, Seoul, South Korea. kpseo@hitel.net ABSTRACT Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a benign mesenchymal lesion with incidental histologic findings. Surgical excision is recommended as the treatment of choice for PASH, although the recurrence rates after excision range from 15% to 22%. A 46-year-old-female presented with a six-month history of bilateral breast enlargement and painful sensation mimicking inflammatory carcinoma. Imaging studies demonstrated innumerable enhancing nodules in both breasts. Due to the growth of the lesions and progressive clinical symptoms, bilateral subcutaneous mastectomy was performed. Grossly, the specimens were round and well-circumscribed, and the histologic examination revealed PASH. After mastectomy, we created a pocket with the pectoralis major muscle and a lower skin flap, which was deepithelized. Anatomical mammary implants were inserted, and the nipple areolar complex was transferred to a new position as a free graft. The aesthetic result was satisfactory after twelve months of follow-up. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction hyperplasia (diagnosis) pseudoangiomatous stromal hyperplasia (diagnosis) EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult article breast augmentation case report echography edema electrocoagulation female follow up human human tissue mastectomy middle aged nuclear magnetic resonance imaging pain skinfold EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015392051 PUI L606093387 DOI 10.5999/aps.2015.42.5.630 FULL TEXT LINK http://dx.doi.org/10.5999/aps.2015.42.5.630 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 303 TITLE Further evidence that human acellular dermal matrix decreases inflammatory markers of capsule formation in implant-based breast reconstruction AUTHOR NAMES Leong M. Basu C.B. Hicks M.J. AUTHOR ADDRESSES (Leong M., mi2lng@earthlink.net; Basu C.B.) Michael E. DeBakey VA Medical Center, Department of Surgery and Pediatrics, Division of Plastic Surgery, Baylor College of Medicine, Operative Care Line, Mail Code 112, 2002 Holcombe Blvd., Houston, United States. (Hicks M.J.) Department of Pathology, Baylor College of Medicine, Houston, United States. CORRESPONDENCE ADDRESS M. Leong, Michael E. DeBakey VA Medical Center, Department of Surgery and Pediatrics, Division of Plastic Surgery, Baylor College of Medicine, Operative Care Line, Mail Code 112, 2002 Holcombe Blvd., Houston, United States. Email: mi2lng@earthlink.net SOURCE Aesthetic Surgery Journal (2015) 35:1 (40-47). Date of Publication: 2015 ISSN 1527-330X (electronic) 1090-820X BOOK PUBLISHER Oxford University Press, jnl.info@oup.co.uk ABSTRACT Background: Human acellular dermal matrix (HADM; previously termed "acellular cadaveric dermis") may limit inflammatory changes believed to play a role in capsular contracture, a common complication of implant-based breast reconstruction. Objectives: Differences between HADM and native breast capsule specimens were evaluated by immunohistochemical analysis of key inflammatory markers involved in capsule formation. Methods: Twenty consecutive patients underwent immediate, 2-stage, implant-based breast reconstruction with dual-plane HADM. During tissue expander-implant exchange, full-thickness biopsies of biointegrated HADM and native breast capsule (internal control) from the tissue-expander envelope were obtained. Immunohistochemical analysis was performed for endothelial cells (CD31), B cells (CD20), T cells (CD3), macrophages (CD68), collagen I and III, and myofibroblasts (á-smooth muscle actin). Observed levels of marker labeling were semiquantitatively scored from 0 (none) to 3 (severe) by a blinded histopathologist and were statistically analyzed with the Wilcoxon rank sum test. Results: A bilateral sample was obtained from 1 patient; all other samples were unilateral. Compared with capsule samples from native breast tissue, HADM samples had significantly lower levels of all inflammatory markers (P <.001). Conclusions: These lower levels of inflammatory markers support previous evidence that HADM may inhibit inflammatory and profibrotic signaling characteristics of breast capsule development and decrease the risk of capsular contracture. Further investigation is needed to determine the mechanism by which HADM inhibits these inflammatory cells, whether HADM reduces the incidence of breast capsular contracture, and if so, the longevity of this effect. EMTREE DRUG INDEX TERMS alpha smooth muscle actin (endogenous compound) CD20 antigen (endogenous compound) CD3 antigen (endogenous compound) CD68 antigen (endogenous compound) collagen type 1 (endogenous compound) collagen type 3 (endogenous compound) platelet endothelial cell adhesion molecule 1 (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast breast capsule breast implant breast reconstruction human acellular dermal matrix EMTREE MEDICAL INDEX TERMS adult article B lymphocyte blood vessel clinical article controlled study endothelium cell human human tissue immunohistochemistry macrophage myofibroblast priority journal quantitative study T lymphocyte tissue expander tissue implant DEVICE MANUFACTURERS Mentor EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Clinical and Experimental Biochemistry (29) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160037581 MEDLINE PMID 25568233 (http://www.ncbi.nlm.nih.gov/pubmed/25568233) PUI L607724535 DOI 10.1093/asj/sju014 FULL TEXT LINK http://dx.doi.org/10.1093/asj/sju014 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 304 TITLE Precision nipple positioning after nipple sparing mastectomy with hydrocolloid nipple adjuster AUTHOR NAMES Troy J.S. Chung S. Dayicioglu D. AUTHOR ADDRESSES (Troy J.S., jtroy@health.usf.edu; Chung S.; Dayicioglu D., ddayicio@health.usf.edu) Division of Plastic Surgery, University of South Florida, Tampa, United States. SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2015) 68:1 (e15-e17). Date of Publication: 1 Jan 2015 ISSN 1878-0539 (electronic) 1748-6815 BOOK PUBLISHER Churchill Livingstone EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) hydrocolloid dressing (adverse device effect) mastectomy nipple sparing mastectomy EMTREE MEDICAL INDEX TERMS acellular dermal matrix breast reconstruction cellulitis (complication) epidermolysis (complication) health care system human letter operation duration patient coding patient satisfaction photography prospective study skin flap skin necrosis (complication) statistics tissue expander tissue perfusion tissue preservation EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2014893331 PUI L600415582 DOI 10.1016/j.bjps.2014.09.038 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2014.09.038 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 305 TITLE Biological implant in single-stage reconstruction of mammary gland for cancer AUTHOR NAMES Zikiriakhodzhaev A.D. Ermoshchenkova M.V. AUTHOR ADDRESSES (Zikiriakhodzhaev A.D.; Ermoshchenkova M.V.) SOURCE Khirurgiia (2015) :1 (35-40). Date of Publication: 2015 ISSN 0023-1207 ABSTRACT Brief literature review about features of biological implants application for mammary gland reconstruction is presented in the article. Possible complications after such materials use, first experience of acellular dermal matrix administration for single-stage mammary gland reconstruction in 6 patients with breast cancer are also described. We offered surgical techniques, complications and methods of its treatment. We presented advantages of biological implant use which are consisted in decrease of surgical damage and duration of surgery, opportunity for enlargement of pocket for implant, decrease of pain syndrome. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation breast reconstruction EMTREE MEDICAL INDEX TERMS adverse effects breast implant breast tumor (surgery) classification female human mastectomy outcome assessment postoperative complication (prevention) procedures skin transplantation LANGUAGE OF ARTICLE Russian LANGUAGE OF SUMMARY English MEDLINE PMID 25909549 (http://www.ncbi.nlm.nih.gov/pubmed/25909549) PUI L604580282 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 306 TITLE Variance in the origin of the pectoralis major muscle: implications for implant-based breast reconstruction AUTHOR NAMES Madsen R.J. Chim J. Ang B. Fisher O. Hansen J. AUTHOR ADDRESSES (Madsen R.J.; Chim J.; Ang B.; Fisher O.; Hansen J.) From the Division of Plastic and Reconstructive Surgery, Oregon Health & Science University, Portland, OR SOURCE Annals of plastic surgery (2015) 74:1 (111-113). Date of Publication: 1 Jan 2015 ISSN 1536-3708 (electronic) ABSTRACT BACKGROUND: The pectoralis major muscle plays a crucial role in implant-based breast reconstruction. The goal of this study is to document variations of the origin of the pectoralis major muscle (PM). We hope to understand how many women have anatomy allowing for total submuscular coverage of an implant with the PM alone in immediate breast reconstruction.METHODS: Fifty patients undergoing mastectomy were recruited. Breast width and the costal origin of the natural inframammary fold (IMF) were measured preoperatively and intraoperatively. The PM width at its origin and the rib origin of the PM were measured intraoperatively. A ratio of the PM origin width to breast width was calculated.RESULTS: Forty-four percent of breasts studied had the IMF at the level of the seventh rib, 53% at the sixth rib, and 3% at the fifth rib. Twenty percent of PM muscles originated from the seventh rib, 68% from the sixth rib, and 12% from the fifth rib. Thirty-six percent of chests showed a PM originating one rib level above the IMF, 61% at the same level, and 3% one level below the IMF. Seventy-seven percent of chests showed a PM origin width to breast width ratio of <0.8.CONCLUSIONS: Overall, 72% of chests had either a high origin of the PM, a narrow PM relative to the breast width, or both. This anatomy is suboptimal for implant coverage using the PM alone. Surgeons performing implant-based breast reconstruction should be prepared to utilize wide dissection, alternative muscle recruitment, or supplemental acellular dermal matrix. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anatomy and histology anatomy and histology breast augmentation surgical flaps EMTREE MEDICAL INDEX TERMS adolescent adult aged female human mastectomy middle aged pectoral muscle pectoralis major muscle surgery young adult LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24051466 (http://www.ncbi.nlm.nih.gov/pubmed/24051466) PUI L605698394 DOI 10.1097/SAP.0b013e3182858881 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0b013e3182858881 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 307 TITLE Immediate prosthetic breast reconstruction in the previously augmented patient AUTHOR NAMES Mayer H.F. Loustau H.D. AUTHOR ADDRESSES (Mayer H.F., horacio.mayer@hospitalitaliano.org.ar; Loustau H.D.) Department of Plastic Surgery, Hospital Italiano de Buenos Aires, University of Buenos Aires School of Medicine, Perón 4190, 1er. Piso, Buenos Aires, Argentina. SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2015) 68:9 (1311-1313). Date of Publication: 1 Sep 2015 ISSN 1878-0539 (electronic) 1748-6815 BOOK PUBLISHER Churchill Livingstone EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation breast prosthesis breast reconstruction immediate prosthetic breast reconstruction EMTREE MEDICAL INDEX TERMS acellular dermal matrix breast cancer consultation dissection graft infection graft necrosis human infection risk letter mammary gland outcome assessment patient safety patient selection postoperative complication priority journal risk reduction subcutaneous mastectomy surgeon surgical technique EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2015113217 MEDLINE PMID 26070490 (http://www.ncbi.nlm.nih.gov/pubmed/26070490) PUI L604793180 DOI 10.1016/j.bjps.2015.05.020 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2015.05.020 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 308 TITLE The rectus sheath and serratus fascia "reverse" fashion flap for the coverage of the lower pole in immediate implant-based breast reconstruction AUTHOR NAMES D'Alessio R. Razzano S. D'Alessio M. D'Angelo D. D'Andrea F. AUTHOR ADDRESSES (D'Alessio R.) Plastic and Reconstructive Surgery Department, Cardarelli Hospital, Italy. (Razzano S., razzanosergio@gmail.com; D'Alessio M.; D'Angelo D.; D'Andrea F.) Department of Orthopaedic, Traumatologic, Rehabilitative and Plastic-Reconstructive Sciences, Second University of Naples, Italy. SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2015) 68:6 (868-870). Date of Publication: 1 Jun 2015 ISSN 1878-0539 (electronic) 1748-6815 BOOK PUBLISHER Churchill Livingstone EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast implant breast reconstruction rectus abdominis muscle EMTREE MEDICAL INDEX TERMS acellular dermal matrix female human letter operation duration partial mastectomy priority journal seroma (complication) subcutaneous mastectomy surgical technique suture technique EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2015780611 MEDLINE PMID 25726154 (http://www.ncbi.nlm.nih.gov/pubmed/25726154) PUI L602530563 DOI 10.1016/j.bjps.2015.02.010 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2015.02.010 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 309 TITLE Evolving options for breast reconstruction AUTHOR NAMES Caterson S.A. Carty M.J. Helliwell L.A. Hergrueter C.A. Pribaz J.J. Sinha I. AUTHOR ADDRESSES (Caterson S.A.; Carty M.J.; Helliwell L.A.; Hergrueter C.A.; Pribaz J.J.; Sinha I.) SOURCE Current Problems in Surgery (2015) 52:5 (192-224). Date of Publication: 2015 ISSN 1535-6337 (electronic) 0011-3840 BOOK PUBLISHER Mosby Inc., customerservice@mosby.com EMTREE DRUG INDEX TERMS antineoplastic agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, diagnosis, drug therapy, surgery) breast reconstruction EMTREE MEDICAL INDEX TERMS abdomen acellular dermal matrix adjuvant therapy autotransplantation breast implant breast prosthesis breast tissue expander cancer adjuvant therapy cancer diagnosis cancer risk disease association help seeking behavior high risk population human large cell lymphoma lymphedema (complication) mastectomy medical history partial mastectomy patient care planning patient safety patient selection pedicled skin flap pedicled TRAM flap personalized medicine physical disease (complication) plastic surgery population research review saline breast implant silicone breast implant surgical anatomy surgical approach surgical patient T cell lymphoma treatment indication treatment response EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20160003040 MEDLINE PMID 26058793 (http://www.ncbi.nlm.nih.gov/pubmed/26058793) PUI L607443855 DOI 10.1067/j.cpsurg.2015.04.001 FULL TEXT LINK http://dx.doi.org/10.1067/j.cpsurg.2015.04.001 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 310 TITLE Simple anchoring suture to minimise asymmetric nipple-areola complex (NAC) in immediate unilateral breast reconstruction with implant AUTHOR NAMES Lee J.H. Hur S.W. Kim Y.-H. Kim T.G. Lee S.J. Kang S.H. Choi J.E. AUTHOR ADDRESSES (Lee J.H., junojunho@gmail.com; Hur S.W.; Kim Y.-H.; Kim T.G.) Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu, South Korea. (Lee S.J.; Kang S.H.; Choi J.E.) Department of General Surgery, Yeungnam University College of Medicine, Daegu, South Korea. SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2015) 68:2 (273-275). Date of Publication: 1 Feb 2015 ISSN 1878-0539 (electronic) 1748-6815 BOOK PUBLISHER Churchill Livingstone EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) anchoring suture technique anthropometric parameters asymmetric nipple areola complex breast reconstruction suture technique EMTREE MEDICAL INDEX TERMS acellular dermal matrix breast implant human letter mastectomy pectoralis major muscle preoperative period priority journal skin tension suture anchor EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2015688865 MEDLINE PMID 25448372 (http://www.ncbi.nlm.nih.gov/pubmed/25448372) PUI L601643551 DOI 10.1016/j.bjps.2014.09.033 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2014.09.033 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 311 TITLE Seri™: A surgical scaffold for breast reconstruction or for bacterial growth? AUTHOR NAMES Almesberger D. Zingaretti N. Di Loreto C. Massarut S. Pasqualucci A. Parodi P.C. AUTHOR ADDRESSES (Almesberger D.; Zingaretti N., zingarettin@gmail.com; Parodi P.C.) Plastic and Reconstructive Surgery, Breast Unit, University of Udine, Italy. (Di Loreto C.) Institute of Anatomic Pathology, Breast Unit, University of Udine, Italy. (Massarut S.) Breast Surgery Unit, CRO, National Cancer Institute, Aviano, Italy. (Pasqualucci A.) Department of Anaesthesiology, University of Perugia, Italy. SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2015) 68:6 (870-871). Date of Publication: 1 Jun 2015 ISSN 1878-0539 (electronic) 1748-6815 BOOK PUBLISHER Churchill Livingstone EMTREE DRUG INDEX TERMS suture material EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) bacterial growth breast reconstruction tissue scaffold EMTREE MEDICAL INDEX TERMS acellular dermal matrix bacterium adherence breast prosthesis debridement histopathology human infection risk laparoscopic surgery letter mastectomy priority journal Pseudomonas aeruginosa surgical mesh tissue preservation tissue reaction DEVICE TRADE NAMES Seri EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2015783950 MEDLINE PMID 25733198 (http://www.ncbi.nlm.nih.gov/pubmed/25733198) PUI L602560761 DOI 10.1016/j.bjps.2015.02.012 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2015.02.012 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 312 TITLE Assessment of Patient Factors, Surgeons, and Surgeon Teams in Immediate Implant-Based Breast Reconstruction Outcomes AUTHOR NAMES Francis A.M. Clemens M.W. AUTHOR ADDRESSES (Francis A.M.; Clemens M.W.) SOURCE Breast Diseases (2015) 26:4 (328-330). Date of Publication: 2015 ISSN 1878-1918 (electronic) 1043-321X BOOK PUBLISHER Academic Press Inc., apjcs@harcourt.com EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation plastic surgeon surgical oncologist EMTREE MEDICAL INDEX TERMS acellular dermal matrix cancer radiotherapy cellulitis diabetes mellitus graft necrosis human ischemia mastectomy note obesity reoperation seroma skin necrosis smoking smoking cessation surgical infection EMBASE CLASSIFICATIONS Cancer (16) Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20160255866 PUI L609353198 DOI 10.1016/j.breastdis.2015.10.015 FULL TEXT LINK http://dx.doi.org/10.1016/j.breastdis.2015.10.015 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 313 TITLE Microbial growth within saline-filled tissue expanders AUTHOR NAMES Ford R.D. Schmitt W.P. Eichhorn M.G. Armstrong S.D. AUTHOR ADDRESSES (Ford R.D.; Schmitt W.P., William.schmitt@grmep.com; Eichhorn M.G.; Armstrong S.D.) Division of Plastic and Reconstructive Surgery, Grand Rapids Medical Education Partners/Michigan State University, 221 Michigan St. NE, Grand Rapids, United States. CORRESPONDENCE ADDRESS W.P. Schmitt, Division of Plastic and Reconstructive Surgery, Grand Rapids Medical Education Partners/Michigan State University, 221 Michigan St. NE, Grand Rapids, United States. SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2015) 68:4 (546-550). Date of Publication: 1 Apr 2015 ISSN 1878-0539 (electronic) 1748-6815 BOOK PUBLISHER Churchill Livingstone ABSTRACT Background Tissue expander based reconstruction is the most common restorative procedure used following mastectomy. Infection is a common complication in the post-operative period and may lead to failure of the reconstruction. Various previous studies have investigated the potential sources of infection during these procedures. The purpose of this study was to examine the fluid within the saline-filled tissue expander at time of implant exchange for the presence of microbial growth. Methods Twenty-five patients (39 breasts) were enrolled in the study. Fluid samples were sent for Gram stain, aerobic, anaerobic, fungal, and acid-fast bacilli (AFB) cultures. Average age was 53.1. Mean time to exchange was 7.7 months. Average follow-up was 25 months. Results None of the samples were positive for microbial growth at final culture (0/39). Discussion These results show the tissue expander fluid maintains a microbial-free environment during the expansion process, and is unlikely a significant source of contamination in cases of infection. Level of evidence Level II, prospective cohort, therapeutic study. EMTREE DRUG INDEX TERMS sodium chloride tissue expander fluid unclassified drug EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tissue expander microbial growth saline filled tissue expander EMTREE MEDICAL INDEX TERMS acellular dermal matrix acid fast bacterium adult aerobic bacterium anaerobic bacterium bacterium culture conference paper follow up fungus culture Gram positive bacterium human middle aged nonhuman priority journal DEVICE TRADE NAMES Inamed Style 133 MV , United StatesInamed DEVICE MANUFACTURERS (United States)Inamed CAS REGISTRY NUMBERS sodium chloride (7647-14-5) EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014983205 MEDLINE PMID 25497668 (http://www.ncbi.nlm.nih.gov/pubmed/25497668) PUI L600928600 DOI 10.1016/j.bjps.2014.11.019 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2014.11.019 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 314 TITLE Capsular contracture after breast augmentation: An update for clinical practice AUTHOR NAMES Headon H. Kasem A. Mokbel K. AUTHOR ADDRESSES (Headon H.) King’s College London Medical School, London, United Kingdom. (Kasem A.) Oncoplastic Breast Surgeon Medway NHS Trust, Kent, United Kingdom. (Mokbel K., kefahmokbel@hotmail.com) Aesthetic and Reconstructive Breast Surgery, The London Breast Institute, London, United Kingdom. CORRESPONDENCE ADDRESS K. Mokbel, Breast Surgery, The London Breast Institute, Princess Grace Hospital, 45 Nottingham Place, London, United Kingdom. SOURCE Archives of Plastic Surgery (2015) 42:5 (532-543). Date of Publication: 1 Sep 2015 ISSN 2234-6171 (electronic) 2234-6163 BOOK PUBLISHER Korean Society of Plastic and Reconstructive Surgeons, 1355-3 Seocho-Dong, Seocho-Gu, Seoul, South Korea. kpseo@hitel.net ABSTRACT Capsular contracture is the most common complication following implant based breast surgery and is one of the most common reasons for reoperation. Therefore, it is important to try and understand why this happens, and what can be done to reduce its incidence. A literature search using the MEDLINE database was conducted including search terms ‘capsular contracture breast augmentation’, ‘capsular contracture pathogenesis’, ‘capsular contracture incidence’, and ‘capsular contracture management’, which yielded 82 results which met inclusion criteria. Capsular contracture is caused by an excessive fibrotic reaction to a foreign body (the implant) and has an overall incidence of 10.6%. Risk factors that were identified included the use of smooth (vs. textured) implants, a subglandular (vs. submuscular) placement, use of a silicone (vs. saline) filled implant and previous radiotherapy to the breast. The standard management of capsular contracture is surgical via a capsulectomy or capsulotomy. Medical treatment using the off-label leukotriene receptor antagonist Zafirlukast has been reported to reduce severity and help prevent capsular contracture from forming, as has the use of acellular dermal matrices, botox and neopocket formation. However, nearly all therapeutic approaches are associated with a significant rate of recurrence. Capsular contracture is a multifactorial fibrotic process the precise cause of which is still unknown. The incidence of contracture developing is lower with the use of textured implants, submuscular placement and the use of polyurethane coated implants. Symptomatic capsular contracture is usually managed surgically, however recent research has focussed on preventing capsular contracture from occurring, or treating it with autologous fat transfer. EMTREE DRUG INDEX TERMS botulinum toxin A (drug therapy) polyurethan silicone sodium chloride zafirlukast (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation breast implant (adverse device effect, clinical trial) clinical practice implant capsular contracture (drug therapy, complication, drug therapy, etiology, surgery) EMTREE MEDICAL INDEX TERMS capsulectomy capsulotomy clinical trial (topic) human large cell lymphoma medical history meta analysis (topic) multicenter study (topic) nonhuman radiotherapy randomized controlled trial (topic) review risk factor subglandular implant placement submuscular device placement surgical anatomy surgical technique systematic review (topic) textured breast implant DEVICE TRADE NAMES MemoryGel Natrelle DEVICE MANUFACTURERS (United States)Allergan (United States)Mentor CAS REGISTRY NUMBERS botulinum toxin A (93384-43-1, 1309378-01-5) polyurethan (61789-63-7) silicone (63148-53-8, 8043-93-4, 8055-24-1) sodium chloride (7647-14-5) zafirlukast (107753-78-6) EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015392037 PUI L606093306 DOI 10.5999/aps.2015.42.5.532 FULL TEXT LINK http://dx.doi.org/10.5999/aps.2015.42.5.532 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 315 TITLE An Unusual Case of Noninvasive Adenocarcinoma Arising in a Localized Adenomyoma of the Gallbladder and Review of Literature AUTHOR NAMES Patel S. Slade J. Jakate S. AUTHOR ADDRESSES (Patel S., smita_c_patel@rush.edu; Slade J.; Jakate S.) Department of Pathology, Rush University Medical Center, 1750 W Harrison St, Chicago, United States. CORRESPONDENCE ADDRESS S. Patel, Department of Pathology, Rush University Medical Center, 1750 W Harrison St, Chicago, United States. Email: smita_c_patel@rush.edu SOURCE International Journal of Surgical Pathology (2015) 24:4 (341-346). Date of Publication: 2015 ISSN 1940-2465 (electronic) 1066-8969 BOOK PUBLISHER SAGE Publications Inc., claims@sagepub.com ABSTRACT Adenomyoma or adenomyomatosis (ADM) of the gallbladder generally carries little or no risk of malignant transformation. Rare cases of such malignant transformation are described in the literature only in segmental type of ADM and not in localized adenomyoma. We report a case of a 58-year-old asymptomatic woman found to have an incidental 3.3 × 3.2 × 2.3 cm well-circumscribed exophytic mass on surveillance ultrasound, originating from the fundus of the gallbladder and abutting the liver capsule. The patient underwent an open cholecystectomy with resection of the mass and underlying segment of the liver. The mass was discrete and well-circumscribed with a peripheral pseudocapsule. Histologically, it showed features typical of a benign adenomyoma with variably sized distended microcysts within fibromuscular stroma. Within the lesion, however, multiple small foci amounting to approximately 5% of the total lesion showed high-grade dysplasia or adenocarcinoma in situ. Apart from cytological distinctiveness, these foci were also selectively highlighted by positive immunostaining for p53 and higher Ki-67 reactivity. Away from this lesion, the gallbladder showed cholelithiasis, mild cholecystitis, and no additional adenomyoma. There was no invasion into the gallbladder mucosa or adjacent liver. This case is highly unusual since transformation to carcinoma is not previously described in a localized or discrete adenomyoma. In the short available follow-up (4 months to date), there is no evidence of recurrence or metastasis. The long-term prognosis is expected to be favorable due to lack of invasion and complete excision, even if there is no documented literature regarding its course. EMTREE DRUG INDEX TERMS alanine aminotransferase (endogenous compound) aspartate aminotransferase (endogenous compound) CA 19-9 antigen (endogenous compound) chloride (endogenous compound) hemoglobin (endogenous compound) Ki 67 antigen (endogenous compound) potassium (endogenous compound) protein p53 (endogenous compound) serum albumin (endogenous compound) sodium (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adenocarcinoma in situ (surgery) adenomyoma (surgery) gallbladder carcinoma (surgery) in situ adenocarcinoma of the gallbladder (surgery) EMTREE MEDICAL INDEX TERMS adult alkaline phosphatase blood level article autoimmune hepatitis bilirubin blood level breast cancer (surgery) cancer localization cancer prognosis cancer surgery case report cholecystectomy cholelithiasis clinical feature computer assisted tomography electrolyte blood level female follow up gallstone hematocrit human immunohistochemistry leukocyte count liver lobe liver surgery mastectomy middle aged physical examination platelet count primary tumor priority journal protein blood level ultrasound wedge resection CAS REGISTRY NUMBERS alanine aminotransferase (9000-86-6, 9014-30-6) aspartate aminotransferase (9000-97-9) chloride (16887-00-6) hemoglobin (9008-02-0) potassium (7440-09-7) serum albumin (9048-46-8) sodium (7440-23-5) EMBASE CLASSIFICATIONS Cancer (16) Gastroenterology (48) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160369579 PUI L610348476 DOI 10.1177/1066896915620011 FULL TEXT LINK http://dx.doi.org/10.1177/1066896915620011 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 316 TITLE Rash with DERMABOND PRINEO skin closure system use in bilateral reduction mammoplasty: A case series AUTHOR NAMES Knackstedt R.W. Dixon J.A. O'Neill P.J. Herrera F.A. AUTHOR ADDRESSES (Knackstedt R.W., rew27@musc.edu; Dixon J.A., dixonja@musc.edu; O'Neill P.J., oneillpj@musc.edu; Herrera F.A., herreraf@musc.edu) MUSC Division of Plastic Surgery, 96 Jonathan Lucas Street, Charleston, United States. CORRESPONDENCE ADDRESS R.W. Knackstedt, MUSC Division of Plastic Surgery, 96 Jonathan Lucas Street, Charleston, United States. SOURCE Case Reports in Medicine (2015) 2015 Article Number: 642595. Date of Publication: 2015 ISSN 1687-9635 (electronic) 1687-9627 BOOK PUBLISHER Hindawi Limited, 410 Park Avenue, 15th Floor, 287 pmb, New York, United States. ABSTRACT Background. Bilateral reduction mammoplasty is a common plastic surgery procedure that can be complicated by unfavorable scar formation along incision sites. Surgical adhesives can be utilized as an alternative or as an adjunct to conventional suture closures to help achieve good wound tension and provide an adequate barrier with excellent cosmesis. The recently introduced DERMABOND PRINEO Skin Closure System Skin Closure System combines the skin adhesive 2-octyl cyanoacrylate with a self-adhering polyester-based mesh. Proposed benefits of wound closure with DERMABOND PRINEO Skin Closure System, used with or without sutures, include its watertight seal, easy removal, microbial barrier, even distribution of tension, and reduction in wound closure time. Although allergic reactions to 2-octyl cyanoacrylate have been reported, few allergic reactions to DERMABOND PRINEO Skin Closure System have been noted in the literature. This case series describes three patients who experienced an allergic reaction to DERMABOND PRINEO Skin Closure System after undergoing elective bilateral reduction mammoplasties at our institution to further explore this topic. Methods. Retrospective chart review of bilateral reduction mammoplasty patients who received DERMABOND PRINEO Skin Closure System dressing at our institution was performed. Results. Three patients were identified as having a rash in reaction to DERMABOND PRINEO Skin Closure System after bilateral reduction mammoplasty. All three patients required systemic steroid treatment to resolve the rash. One patient was identified as having a prior adhesive reaction. Conclusions. DERMABOND PRINEO Skin Closure System has demonstrated its efficacy in optimizing scar healing and appearance. However, as we demonstrate these three allergic reactions to DERMABOND PRINEO Skin Closure System, caution must be utilized in its usage, namely, in patients with a prior adhesive allergy and in sites where moisture or friction may be apparent. EMTREE DRUG INDEX TERMS bismuth bismuth tribromophenate cyanoacrylic acid octyl ester (drug toxicity) meprednisone (drug therapy) petrolatum poliglecaprone polyglactin prednisone (drug therapy) unclassified drug EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) bilateral reduction mammoplasty breast reconstruction rash (drug therapy, complication, drug therapy) skin closure system (adverse device effect) surgical equipment (adverse device effect) EMTREE MEDICAL INDEX TERMS adult article case report female gauze dressing human medical history medical record review priority journal DEVICE TRADE NAMES DERMABOND PRINEO Skin Closure System CAS REGISTRY NUMBERS bismuth (7440-69-9) cyanoacrylic acid octyl ester (6701-17-3) meprednisone (1247-42-3) petrolatum (8009-03-8) poliglecaprone (41706-81-4) polyglactin (26780-50-7, 34346-01-5) prednisone (53-03-2) EMBASE CLASSIFICATIONS Dermatology and Venereology (13) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015957410 PUI L603833978 DOI 10.1155/2015/642595 FULL TEXT LINK http://dx.doi.org/10.1155/2015/642595 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 317 TITLE Delayed hypersensitivity reaction to acellular dermal matrix in breast reconstruction: the red breast syndrome? AUTHOR NAMES Ganske I. Hoyler M. Fox S.E. Morris D.J. Lin S.J. Slavin S.A. AUTHOR ADDRESSES (Ganske I.; Hoyler M.; Fox S.E.; Morris D.J.; Lin S.J.; Slavin S.A.) From the *Harvard Combined Plastic Surgery Residency, Boston; †Harvard Medical School, Boston; ‡Beth Israel Deaconess Medical Center Pathology Residency, Boston; and §Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA SOURCE Annals of plastic surgery (2014) 73 Supplement 2 (S139-S143). Date of Publication: 1 Dec 2014 ISSN 1536-3708 (electronic) ABSTRACT BACKGROUND: Acellular dermal matrix (ADM) has become a valuable tool in reconstructive breast surgery, in part because it has been considered to be a non-reactive and non-immunogenic entity. However, some patients who undergo breast reconstruction with ADMs develop postoperative erythema overlying their ADM grafts. The etiology of this phenomenon is poorly understood.METHODS: In this article, we summarize clinical cases in which patients developed localized breast erythema following reconstruction with ADMs. We review what is known about postoperative breast erythema after ADM-based breast reconstructions and the possible antigenicity of biologic mesh implants.RESULTS: We report 4 implant-based breast reconstruction patients who developed erythematous reactions overlying the region where ADM was placed: one demonstrated a delayed-type hypersensitivity reaction on punch biopsy of the affected skin, leading to removal of the biologic product; 2 others had a similar clinical presentation that responded to corticosteroids without removal of the biologic material, with 1 patient experiencing recrudescence of erythema that responded fully to a second course of corticosteroids; and a fourth showed erythema that was only moderately responsive to antibiotic therapy but which improved consistently after the patient initiated chemotherapy.CONCLUSION: We propose that the etiology of erythema overlying ADM grafts, and the so-called red breast syndrome, may in some patients be a delayed-type hypersensitivity reaction to the ADM product. Affected patients may benefit from treatment with corticosteroids or similar medications, and that such treatment may, in some cases, enable patients to retain the ADM grafts and enable salvage of the reconstructed breast. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adverse effects EMTREE MEDICAL INDEX TERMS acellular dermal matrix breast augmentation case report delayed hypersensitivity (diagnosis, etiology) erythema (diagnosis, etiology) female human middle aged postoperative complication (diagnosis, etiology) procedures syndrome LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24691314 (http://www.ncbi.nlm.nih.gov/pubmed/24691314) PUI L605114349 DOI 10.1097/SAP.0000000000000130 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0000000000000130 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 318 TITLE Outcomes of immediate implant-based breast reconstruction using an acellular dermal matrix AUTHOR NAMES Cook L. Massa M. Kothari A. Kovacs T. Hamed H. Douek M. AUTHOR ADDRESSES (Cook L.; Massa M.; Kothari A.; Kovacs T.; Hamed H.; Douek M.) King's College London, Research Oncology, London, United Kingdom. CORRESPONDENCE ADDRESS L. Cook, King's College London, Research Oncology, London, United Kingdom. SOURCE European Journal of Surgical Oncology (2014) 40:11 (S42-S43). Date of Publication: November 2014 CONFERENCE NAME 34th Congress of the European Society of Surgical Oncology in partnership with BASO 2014 CONFERENCE LOCATION Liverpool, United Kingdom CONFERENCE DATE 2014-10-29 to 2014-10-31 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Background: Despite widespread use of the ADMs in immediate implant based breast reconstruction there are mostly retrospective cohort studies of outcomes of this procedure. We evaluated the outcome of implant-based reconstruction with ADM at our institution. Material and methods: Prospectively collected data on all patients undergoing immediate breast reconstruction with the same ADM (Surgimend PRS, TEI, Boston), from January 2012-January 2014 were reviewed. Data was collected on patient demographics, co-morbidities, smoking history, adjuvant treatment and complications. Statistical analysis was carried out using the SPSS software package. Results: A total of 99 patients (138 reconstructions) met inclusion criteria (60 unilateral 39 bilateral reconstructions). Mean patient age was 48.6 years (range 20-73 SD 12.7) and mean length of stay 2.6 days (range 1-8 days; SD 1.02). Of 99 patients, 66 (66.7%) had therapeutic surgery alone (of which 6 were bilateral cancers), 16 (16.2 %) underwent risk-reducing mastectomy and 17 (17.2%) patients had bilateral surgery for cancer of one breast and opted for a contralateral mastectomy. Primary chemotherapy was administered to 19/99 (19.2%) and adjuvant to 36/99 (36.4%). 34 patients (34.3%) underwent post-operative radiotherapy. Patients were followed up for a median of 8 months (range 4-27 months). At least one complication was observed in 30/99 (30.3%) at 30 days and in 41/99 (41.4%) of patients overall, of which 24/99 had a complication graded as IIIb on the Clavien-Dindo scale. 30 day reoperation rate was 13/99 (13.1%) with the most common indication being infection or wound dehiscence requiring washout or debridement of the wound in 7 patients. Implant explantation rate at one year was 10.2% (10/99), seroma rate (when radiological drainage indicated) was 19% (19/99) and rate of wound infection requiring IV antibiotics was 15.2%(15/99). Logistic regression analysis showed that both age (OR 1.058 p=0.010 95%CI 1.014-1.105) and adjuvant chemotherapy (OR 5.295 p=0.014 95%CI 1.394-20.107) were independent predictors of 30 day complications, while age was the only independent predictor of developing a complication at any point during follow-up (OR 1.052 p=0.010 95%CI 1.012-1.093). The other variables had non significant associations. Conclusions: Immediate breast reconstruction using an implant and ADM post mastectomy is feasible in higher risk patients many of whom require adjuvant chemotherapy or radiotherapy. Awareness of complications and greater experience in managing these, are required in order to reduce their incidence. EMTREE DRUG INDEX TERMS adjuvant antibiotic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction European implant oncology society EMTREE MEDICAL INDEX TERMS adjuvant chemotherapy adjuvant therapy bilateral cancer breast chemotherapy cohort analysis data analysis software debridement explant follow up high risk patient human infection length of stay logistic regression analysis mastectomy morbidity neoplasm patient procedures radiotherapy reoperation risk seroma smoking software statistical analysis surgery United States wound wound dehiscence wound infection LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71815957 DOI 10.1016/j.ejso.2014.08.085 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2014.08.085 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 319 TITLE Mycobacterium abscesses infection following mastectomy and immediate implant based, acellular dermal matrix assisted breast reconstruction: Case report and literature review AUTHOR NAMES Haider M. Satpathy A. Thawder P. Abou-Samra W. AUTHOR ADDRESSES (Haider M.; Satpathy A.; Thawder P.; Abou-Samra W.) North Wales Cancer Treatment Centre, Oncoplastic Breast Surgery, Rhyl, United Kingdom. CORRESPONDENCE ADDRESS M. Haider, North Wales Cancer Treatment Centre, Oncoplastic Breast Surgery, Rhyl, United Kingdom. SOURCE European Journal of Surgical Oncology (2014) 40:11 (S62). Date of Publication: November 2014 CONFERENCE NAME 34th Congress of the European Society of Surgical Oncology in partnership with BASO 2014 CONFERENCE LOCATION Liverpool, United Kingdom CONFERENCE DATE 2014-10-29 to 2014-10-31 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Background: Implant based reconstruction accounts for 37% of immediate breast reconstruction following Mastectomy in United Kingdom. Surgical site infection is one of the complications of immediate breast reconstruction that can result in prolonged use of antibiotics. The infecting organisms are bacterial skin flora, usually Staphylococcus aureus and the coagulase negative staphylococci. Treatment of these cases often requires further surgical interventions and may result in suboptimal cosmesis and can lead to explantation in non responding infections. We are presenting two cases of infection with atypical mycobacterium to share the dilemma of sterile cultures in such patients. Methods & material and Results: Two patients who underwent mastectomy and immediate implant based reconstruction assisted by accelular dermal matrix (Strattice) were discharged from hospital with no immediate post-operative complications. These patients presented weeks after surgery with symptoms and clinical signs suggestive of surgical site infection. Periprosthetic fluid was aspirated under sterile conditions with ultrasonic guidance and the patients were started on empiric antibiotic regime. Initial cultures did not grow any identifiable micro-organisms, although the patients showed worsening of surgical site infection even on switching to broad spectrum antibiotics. Both the patients underwent explanation with resultant bad cosmetic result. Prolonged cultures showed growth of Mycobacterium Abcessus and the patients were prescribed anti-mycobacterial antibiotics. Patient made a slow recovery with progressive resolution of wound infection although it delayed the start of Chemotherapy. Conclusions: These two cases signify the identification of these slow growing organisms in the setting of immediate implant based reconstruction assisted by ADMs. Experience with such postoperative complications is limited due to the fact that these cases represent a minority of the periprosthetic infections. A delayed onset of infection, no growth on early culture reports, and no response to conventional antibiotics are important features to prompt necessary investigation and treatment. EMTREE DRUG INDEX TERMS antibiotic agent cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) abscess acellular dermal matrix breast reconstruction case report European human implant infection mastectomy Mycobacterium oncology society EMTREE MEDICAL INDEX TERMS atypical Mycobacterium axenic culture chemotherapy coagulase negative Staphylococcus explant hospital liquid patient postoperative complication skin flora Staphylococcus aureus surgery surgical infection surgical mesh ultrasound United Kingdom wound infection LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71816001 DOI 10.1016/j.ejso.2014.08.131 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2014.08.131 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 320 TITLE Current trends of breast reconstruction after mastectomy for breast cancer patients in China: A survey report AUTHOR NAMES Ying C. Chen J. Chen J. Yang B. Li L. Huang X. Shao Z. Shen Z. Yu P. Wu J. AUTHOR ADDRESSES (Ying C.; Chen J.; Chen J.; Yang B.; Li L.; Huang X.; Shao Z.; Shen Z.; Yu P.; Wu J., wujiongll22@vip.sina.com) Department of Breast Surgery, Fudan University Shanghai Cancer, Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China. CORRESPONDENCE ADDRESS J. Wu, Department of Breast Surgery, Fudan University Shanghai Cancer, Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China. Email: wujiongll22@vip.sina.com SOURCE Chinese Journal of Oncology (2014) 36:11 (851-857). Date of Publication: 1 Nov 2014 ISSN 0253-3766 BOOK PUBLISHER Chinese Academy of Medical Sciences, chinjoncol@yahoo.com.cn ABSTRACT Objective: To explore the current trends of breast reconstruction (BR) for breast cancer patients in China. Methods: A questionnaire was designed for this study, and it included questions on surgeon demographics, number of mastectomy and BR, type and timing of BR, reconstructive choices in the setting of preoperative or postoperative radiotherapy or chemotherapy, etc. All data were collected until December 2012. Questionnaires were sent to 52 members of the Committee of Breast Cancer Society by e-mail or mail. Results: By July 2013, 41 questionnaires had been returned. Among all, 5 were excluded for not performing BR. These 36 hospitals covered 22 provinces and municipalities in China. A total of 538 surgeons working in the general surgery or oncological surgery department, but only 123 (22. 9%) were qualified to perform BR. In 2012, except for 4 missing data, 24,763 mastectomies were performed in 32 hospitals; among them, 1120 (4.5%) received BR. According to these 36 respondents, 32 (88.9%) Performed prosthetic (1,843 cases in all) while 4 (11.1%) performed prosthetic BR with acellular dermal matrix (17 cases in all) from the time of their first BR operation to the end of 2012. During the same Period, 965 latissimus dorsi myocutaneous flaps with implant were performed in 23 (63.9%) hospitals while 738 latissimus dorsi myocutaneous flaps without implant were performed in 32 (88.9%) hospitals. At the same time, 366 pedicled transverse rectus abdominis myocutaneous flap BRs were performed in 28 (77.8%) hospitals, while 155 abdominal free flap BRs were carried out in 9 (25. 0%) hospitals. The overall complication rate was 18.2%. Postoperative radiotherapy had some effect on influencing the esthetic outcomes of BR, so the autologous BR was recommended, but the timing remained controversial. Regarding chemotherapy, most respondents concluded that it had no effect or only a mild effect. The overall cosmetic outcomes of the reconstructed breasts satisfied the majority of physicians and patients. Conclusions With more attention paid to the quality of life after mastectomy, more and more BRs are needed, but the ratio is still low in China. To improve this situation, more efforts are needed, including the improvement of the intrahospital framework of multi-disciplinary service, the training for doctors and the educational program for patients, etc. EMTREE DRUG INDEX TERMS antineoplastic agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, drug therapy, radiotherapy, surgery) breast reconstruction cancer surgery mastectomy EMTREE MEDICAL INDEX TERMS acellular dermal matrix article cancer chemotherapy cancer patient cancer radiotherapy China controlled study human latissimus dorsi flap pedicled skin flap questionnaire rectus abdominis muscle trend study EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) Drug Literature Index (37) LANGUAGE OF ARTICLE Chinese LANGUAGE OF SUMMARY English, Chinese EMBASE ACCESSION NUMBER 20151033715 MEDLINE PMID 25620484 (http://www.ncbi.nlm.nih.gov/pubmed/25620484) PUI L607278622 DOI 10.3760/cma.j.issn.0253-3766.2014.11.011 FULL TEXT LINK http://dx.doi.org/10.3760/cma.j.issn.0253-3766.2014.11.011 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 321 TITLE Use of fenestrations in acellular dermal allograft in two-stage tissue expander/implant breast reconstruction AUTHOR NAMES Martin J.B. Moore R. Paydar K.Z. Wirth G.A. AUTHOR ADDRESSES (Martin J.B.; Moore R.; Paydar K.Z.; Wirth G.A.) Orange, Calif. From the Department of Plastic Surgery, University of California, Irvine SOURCE Plastic and reconstructive surgery (2014) 134:5 (901-904). Date of Publication: 1 Nov 2014 ISSN 1529-4242 (electronic) ABSTRACT UNLABELLED: The authors present a new technique of alteration of the acellular dermal matrix through strategically placed fenestrations, improving the reconstructive experience and overall cosmetic outcome. The authors present a retrospective chart review following two surgeons' experience at the University of California, Irvine, Department of Plastic Surgery using surgeon-designed fenestrated acellular dermal matrices in two-stage tissue expander breast reconstruction. The authors found that this leads to improved intraoperative fill volume, decreased number of postoperative expansions, increased expansion rate with subjectively less pain, decreased time to full expansion, and subjectively improved cosmetic outcome.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast implant tissue expander utilization EMTREE MEDICAL INDEX TERMS acellular dermal matrix allograft breast reconstruction breast tumor (surgery) cohort analysis esthetics evaluation study female follow up graft rejection graft survival human implant capsular contracture (epidemiology) mastectomy pathology pathophysiology postoperative complication (surgery) procedures retrospective study risk assessment time treatment outcome United States university hospital LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25347626 (http://www.ncbi.nlm.nih.gov/pubmed/25347626) PUI L603137218 DOI 10.1097/PRS.0000000000000598 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000000598 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 322 TITLE Acellular dermal matrix for reoperative breast augmentation AUTHOR NAMES Maxwell G.P. Gabriel A. AUTHOR ADDRESSES (Maxwell G.P.; Gabriel A.) Loma Linda, Calif. From the Department of Plastic Surgery, Loma Linda University Medical Center SOURCE Plastic and reconstructive surgery (2014) 134:5 (932-938). Date of Publication: 1 Nov 2014 ISSN 1529-4242 (electronic) ABSTRACT Revisionary breast surgery in previously augmented patients is complex, with many variables that have to be considered. Obtaining durable repairs is challenging because these patients often present with thinned breast tissue, inadequate local tissue, and/or scarred breast envelope from multiple procedures. Capsular contracture, ptosis, tissue atrophy, and wrinkling/rippling are some of the most frequent reasons for reoperation. Conventional repair techniques generally involve a combination of capsule modification (capsular flaps), site change, mastopexy, and implant exchange. Recently, acellular dermal matrices have been introduced into revision surgery to reinforce soft tissue, reinforce the implant pocket, and potentially mitigate capsular contracture. Clinical outcomes of acellular dermal matrix-assisted revision surgery are reviewed from the published literature to evaluate the efficacy and safety of acellular dermal matrices for this indication. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) utilization EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult breast implant breast reconstruction esthetics evidence based medicine female follow up human implant capsular contracture (surgery) middle aged pathophysiology physiology procedures prosthesis complication reoperation risk assessment treatment outcome wound healing young adult LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25347629 (http://www.ncbi.nlm.nih.gov/pubmed/25347629) PUI L603137349 DOI 10.1097/PRS.0000000000000777 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000000777 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 323 TITLE The iBRA Study: A national multicentre audit of the practice and outcomes of implant-based breast reconstruction AUTHOR NAMES Potter S. Holcombe C. Mylvaganam S. Thrush S. Whisker L. Skillman J. AUTHOR ADDRESSES (Potter S.) University of Bristol, Bristol Centre for Surgical Research, School of Social and Community Medicine, Bristol, United Kingdom. (Holcombe C.) Liverpool and Broadgreen University Hospitals NHS Trust, Linda McCartney Breast Care Centre, Liverpool, United Kingdom. (Mylvaganam S.) University of Birmingham, Surgery, Birmingham, United Kingdom. (Thrush S.) Worcester Acute Hospitals NHS Trust, Breast Surgery, Worcester, United Kingdom. (Whisker L.) Nottingham University Hospitals NHS Trust, Breast Surgery, Nottingham, United Kingdom. (Skillman J.) University Hospitals of Coventry and Warwickshire NHS Trust, Plastic Surgery, Coventry, United Kingdom. CORRESPONDENCE ADDRESS S. Potter, University of Bristol, Bristol Centre for Surgical Research, School of Social and Community Medicine, Bristol, United Kingdom. SOURCE European Journal of Surgical Oncology (2014) 40:11 (S168-S169). Date of Publication: November 2014 CONFERENCE NAME 34th Congress of the European Society of Surgical Oncology in partnership with BASO 2014 CONFERENCE LOCATION Liverpool, United Kingdom CONFERENCE DATE 2014-10-29 to 2014-10-31 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Background: Implant-based breast reconstruction (IBBR) is the most commonly-performed reconstructive procedure in the UK. The introduction of techniques to augment the subpectoral pocket with autologous (e.g. dermal slings) and prosthetic materials (e.g. acellular dermal matrix) has revolutionalised the procedure, but there is a lack of high-quality outcome data to support the safety or efficacy of these novel techniques. The iBRA study aims to use the National Trainee Research Collaborative Network (NTRCN) to: • Define the current practice of IBBR in the UK • Compare the outcomes of the new approaches to implant-based reconstruction against standard practice and quality standards defined by the Oncoplastic Breast Reconstruction (OPBR): Guidelines for Best Practice. • Inform new guidelines • Determine the feasibility of a trial comparing different approaches to implant-based reconstruction iBRA is supported by the Association of Breast Surgery (ABS), the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), the Mammary Fold, the Reconstructive Surgery Trials Network (RSTN). Methods: Trainee leads will be identified at all breast and plastic surgical centres throughout the UK via the NTRCN, RSTN and the Mammary Fold. Trainee leads will liaise with local surgeons to complete a national practice questionnaire which will provide a comprehensive description of current national practice, variations in service provision and adherence with National Guidelines. Eligible centres identified using the questionnaire will progress to the prospective audit phase of the project. All patients receiving IBBR will be included and clinical and patient-reported outcomes assessed and compared against OPBR quality standards. Appropriate statistical methods will be used to compare the outcomes of different approaches to implantbased breast reconstruction. Exploratory analyses will consider the impact of potential risk factors such as smoking and radiotherapy on outcomes. Results: 45 centres have already agreed to participate in the iBRA study and it is anticipated that approximately 100 Units will recruit patients to the study. Conclusions: The iBRA study will provide comprehensive data relating to the practice and outcomes of IBBR in the UK. It will allow variations in the quality of care to be identified and addressed and the experiences of women undergoing the procedure in the future improved. EMTREE DRUG INDEX TERMS plastic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction clinical audit European human implant oncology society EMTREE MEDICAL INDEX TERMS acellular dermal matrix breast breast surgery female patient plastic surgery procedures prosthesis material questionnaire radiotherapy risk factor safety smoking statistical analysis student surgeon United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71816301 DOI 10.1016/j.ejso.2014.08.431 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2014.08.431 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 324 TITLE Vicryl mesh in expander/implant breast reconstruction: long-term follow-up in 38 patients AUTHOR NAMES Haynes D.F. Kreithen J.C. AUTHOR ADDRESSES (Haynes D.F.; Kreithen J.C.) Johnson City, Tenn.; and Bradenton, Fla. From the Division of Plastic Surgery, East Tennessee State University; and Lakewood Ranch Plastic Surgery SOURCE Plastic and reconstructive surgery (2014) 134:5 (892-899). Date of Publication: 1 Nov 2014 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Acellular dermal matrix has proven to be a useful adjunct in tissue expander or direct-to-implant breast reconstruction. Although versatile, acellular dermal matrix adds considerable cost. Vicryl (polyglactin) mesh has an established track record in many fields of surgery, and is considerably less costly than acellular dermal matrix. This study examines the use and long-term follow-up of Vicryl mesh in breast reconstruction.METHODS: Vicryl mesh was used in 46 breast reconstructions (38 patients; 35 immediate and three delayed). The mesh was used along the inframammary fold to maintain position of the inferior pectoral edge, and/or along the lateral border to maintain expander position and prevent lateral migration. Eight breasts received adjuvant radiation therapy.RESULTS: Mean follow-up at the time of review was 43 months. In the nonirradiated group (38 breasts), there was one postoperative infection (2.6 percent), which required expander removal. In the irradiated group, there were three complications requiring expander removal (37.5 percent): two infections and one device exposure after irradiation. Significant malposition was not observed in any breast where Vicryl mesh was used, and no visible mesh remained at the time of implant placement. The incidence of symptomatic capsular contracture in nonirradiated breasts was 3.2 percent. At latest follow-up, nonirradiated breasts had an average Baker capsule grade of 1.1, compared with 1.5 in the irradiated group.CONCLUSIONS: Vicryl mesh is an effective alternative to acellular dermal matrix in nonirradiated breast reconstruction and is available at approximately one-twentieth the cost. Acellular dermal matrix or full muscle coverage may be preferable in irradiated reconstructions.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV. EMTREE DRUG INDEX TERMS polyglactin (pharmacology) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast implant tissue expander EMTREE MEDICAL INDEX TERMS adjuvant therapy adult breast reconstruction breast tumor (radiotherapy, surgery) cohort analysis comparative study esthetics factual database female follow up human mastectomy middle aged pathophysiology postoperative complication (surgery) procedures prosthesis complication retrospective study risk assessment surgical mesh time treatment outcome United States CAS REGISTRY NUMBERS polyglactin (26780-50-7, 34346-01-5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25347625 (http://www.ncbi.nlm.nih.gov/pubmed/25347625) PUI L603137172 DOI 10.1097/PRS.0000000000000610 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000000610 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 325 TITLE A timesaving technique for shaping of acellular dermal matrix in primary breast reconstruction AUTHOR NAMES Siddique K. Azmy I. AUTHOR ADDRESSES (Siddique K.; Azmy I.) Chesterfield Royal Hospital NHS Foundation Trust, UK SOURCE Annals of the Royal College of Surgeons of England (2014) 96:7 (555-556). Date of Publication: 1 Oct 2014 ISSN 1478-7083 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix operation duration procedures EMTREE MEDICAL INDEX TERMS breast reconstruction esthetics female graft survival human skin transplantation subcutaneous mastectomy LANGUAGE OF ARTICLE English MEDLINE PMID 25245748 (http://www.ncbi.nlm.nih.gov/pubmed/25245748) PUI L614311050 DOI 10.1308/rcsann.2014.96.7.555a FULL TEXT LINK http://dx.doi.org/10.1308/rcsann.2014.96.7.555a COPYRIGHT Copyright 2017 Medline is the source for the citation and abstract of this record. RECORD 326 TITLE ASPS clinical practice guideline summary on breast reconstruction with expanders and implants AUTHOR NAMES Alderman A. Gutowski K. Ahuja A. Gray D. AUTHOR ADDRESSES (Alderman A.; Gutowski K.; Ahuja A.; Gray D.) Arlington Heights, Ill. From the American Society of Plastic Surgeons () SOURCE Plastic and reconstructive surgery (2014) 134:4 (648e-655e). Date of Publication: 1 Oct 2014 ISSN 1529-4242 (electronic) ABSTRACT LEARNING OBJECTIVES: After reading this article, participants should be able to: 1. Understand the evidence regarding the timing of expander/implant breast reconstruction in the setting of radiation therapy. 2. Discuss the implications of a patient's risk factors for possible outcomes and complications of expander/implant breast reconstruction. 3. Implement proper prophylactic antibiotic protocols. 4. Use the guidelines to improve their own clinical outcomes and reduce complications.SUMMARY: In March of 2013, the Executive Committee of the American Society of Plastic Surgeons approved an evidence-based guideline on breast reconstruction with expanders and implants, as developed by a guideline-specific work group commissioned by the society's Health Policy Committee. The guideline addresses ten clinical questions: patient education, immediate versus delayed reconstruction, risk factors, radiation therapy, chemotherapy, hormonal therapy, antibiotic prophylaxis, acellular dermal matrix, monitoring for cancer recurrence, and oncologic outcomes associated with implant-based reconstruction. The evidence indicates that patients undergoing mastectomy should be offered a preoperative referral to a plastic surgeon. Evidence varies regarding the association between postoperative complications and timing of postmastectomy expander/implant breast reconstruction. Evidence is limited regarding the optimal timing of expand/implant reconstruction in the setting of radiation therapy but suggests that irradiation to the expander or implant is associated with an increased risk of postoperative complications. Evidence also varies regarding the association between acellular dermal matrix and surgical complications in the setting of postmastectomy expander/implant reconstruction. Data support the use of an appropriate preoperative antibiotic, but antibiotics should be discontinued within 24 hours of the procedure, unless a surgical drain is present. Furthermore, postmastectomy expander/implant breast reconstruction does not adversely affect oncologic outcomes. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast implant standards tissue expander EMTREE MEDICAL INDEX TERMS breast reconstruction breast tumor (surgery, therapy) female human multimodality cancer therapy postoperative complication (epidemiology, etiology) practice guideline LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 25357060 (http://www.ncbi.nlm.nih.gov/pubmed/25357060) PUI L602118246 DOI 10.1097/PRS.0000000000000541 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0000000000000541 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 327 TITLE Rates of reconstruction failure (RF) in women undergoing immediate reconstruction (IR) with tissue expander/implant (TE/ I) and post-mastectomy radiation AUTHOR NAMES Fowble B.L. Park C. Peled A. Sbitany H. Foster R. Hanlon A. AUTHOR ADDRESSES (Fowble B.L.; Park C.; Peled A.; Sbitany H.; Foster R.) University of California San Francisco, San Francisco, United States. (Hanlon A.) University of Pennsylvania, Philadelphia, United States. CORRESPONDENCE ADDRESS B.L. Fowble, University of California San Francisco, San Francisco, United States. SOURCE International Journal of Radiation Oncology Biology Physics (2014) 90:1 SUPPL. 1 (S45). Date of Publication: 1 Sep 2014 CONFERENCE NAME 56th Annual Meeting of the American Society for Radiation Oncology, ASTRO 2014 CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2014-09-14 to 2014-09-17 ISSN 0360-3016 BOOK PUBLISHER Elsevier Inc. ABSTRACT Purpose/Objective(s): Rates of immediate reconstruction (IR) with mastectomy have increased. For some women TE/I immediate reconstruction is the preferred or only option. We examined the rate of TE/I RF defined as removal of the TE/I and no final reconstruction or need to convert to autologous tissue reconstruction in patients receiving PMRT. Materials/Methods: From January 2006-December 2012, 99 women had skin sparing (SSM, n = 29) or nipple skin sparing mastectomy (NSSM, n = 70), axillary dissection, PMRT. Forty-nine percent had bilateral mastectomies with IR. Ninety-eight percent had chemotherapy (CT) primarily AC + T. Twenty-eight percent received targeted (TT) therapies (trastuzumab, bevacizumab, lapatinib). Seventy-seven percent had hormonal therapy (HT). Median size of TE and PI was 400 cc (range, 265-752). Median age 41 yrs. (range, 24-69). Mean follow-up 3.8 yrs (0.6-10). Radiation was standardized (50 Gy to the TE/I, custom bolus qod, no scar boost, no prophylactic IMN RT, +/- SCV). Factors analyzed for association with RF were age, weight, SSM or NSSM, size of TE and PI, BRCA status, CT, TT, HT, smoking, co-morbidity, interval RT to exchange PI, timing and use of acellular dermal matrix (ADM) and/or serratus muscle (SM) coverage, location mastectomy scar. Fisher's exact test was used for categorical variables, ANOVA F-statistics for continuous variables and Stepwise logistic regression model to identify the strongest predictors of RF. Results: Total TE/I failure rate was 16% (10% without final reconstruction, 6% converted to TRAM or DIEP). In multivariate analysis the strongest predictor of RF was the absence of ADM or serratus coverage of TE at mastectomy (OR 6.4). RF occurred in 33% of these women vs. 9% with coverage at mastectomy. RF with coverage only at exchange was 22%. Other significant factors included short interval to exchange (RF 37% vs. 14%, OR 10.5) and weight < 120 lbs. (OR 5.25). Use of TT affected RF (43% RF with bevacizumab, 27% with trastuzumab). RF was 0% in BRCA+ women. Type of mastectomy and size of TE or PI did not affect RF. Four percent non-irradiated contralateral reconstructed breasts had RF. Conclusions: This study is unique both in its analysis of multiple factors for TE/I RF with SSM or NSSM and PMRT and the ability to use women (50%) with bilateral mastectomies and TE/I reconstruction as their own control. ADM or SM coverage at the time of mastectomy and delaying exchange ≥ 6 mo. are essential to decrease RF rate with PMRT. The role of TT requires further study. EMTREE DRUG INDEX TERMS bevacizumab lapatinib trastuzumab EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) female human mastectomy oncology radiation society tissues EMTREE MEDICAL INDEX TERMS acellular dermal matrix analysis of variance breast chemotherapy dissection Fisher exact test follow up hormonal therapy laryngeal mask logistic regression analysis model morbidity multivariate analysis muscle nipple patient scar skin smoking statistics therapy weight LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71623328 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 328 TITLE Comparison of AlloDerm and AlloMax tissue incorporation in rats AUTHOR NAMES Chauviere M.V. Schutter R.J. Steigelman M.B. Clark B.Z. Grayson J.K. Sahar D.E. AUTHOR ADDRESSES (Chauviere M.V.; Schutter R.J.; Steigelman M.B.; Clark B.Z.; Grayson J.K.; Sahar D.E.) From the *Department of Surgery, †Department of Pathology, and ‡Clinical Investigation Facility, David Grant USAF Medical Center, Travis AFB, CA; and §Division of Plastic Surgery, UC Davis School of Medicine, Sacramento, CA SOURCE Annals of plastic surgery (2014) 73:3 (282-285). Date of Publication: 1 Sep 2014 ISSN 1536-3708 (electronic) ABSTRACT BACKGROUND: Human acellular dermal matrices (HADMs) are used in a variety of settings. AlloMax is a new HADM currently being used for breast reconstruction and hernia repair. We compared the in vivo tissue integration of AlloMax to AlloDerm, a well-studied HADM, in rats.METHODS: We implanted AlloDerm and AlloMax patches into subcutaneous pockets on the backs of 32 male Sprague-Dawley rats. The animals were killed after either 4 or 8 weeks, and the patches were recovered and stained for histopathologic analyses. Microscopic end points included patch thickness, vascularization, tissue in-growth, fibroblast proliferation, and inflammation.RESULTS: All animals completed the study without complications or infection. There were no significant differences in graft thicknesses at 4 and 8 weeks. Microscopically, at 4 weeks, AlloDerm sections had significantly more microvessels than AlloMax (P = 0.02). This disparity increased by 8 weeks (P < 0.01). Similarly, we found greater tissue in-growth and fibroblast proliferation in AlloDerm than AlloMax sections at 4 (P < 0.01) and at 8 (P < 0.01) weeks. Inflammatory infiltrates consisted of lymphocytes, histiocytes, eosinophils, and plasma cells. Deep graft infiltration by predominately lymphocytic inflammatory cells was significantly higher in AlloDerm than AlloMax grafts at 4 (P = 0.01) and 8 (P = 0.02) weeks. Graft necrosis was uncommon, but marginal fibrosis was similar in both.CONCLUSIONS: AlloDerm grafts had greater neovascularization, tissue infiltration, fibroblast proliferation, and inflammatory reaction than AlloMax grafts when placed subcutaneously in rats. AlloDerm may be better incorporated than AlloMax when placed in vivo. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen EMTREE DRUG INDEX TERMS biomaterial surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix EMTREE MEDICAL INDEX TERMS animal comparative study male rat Sprague Dawley rat CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 23644440 (http://www.ncbi.nlm.nih.gov/pubmed/23644440) PUI L612768638 DOI 10.1097/SAP.0b013e31827a2d00 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0b013e31827a2d00 COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 329 TITLE Use of the pectoralis major, serratus anterior, and external oblique fascial flap for immediate one-stage breast reconstruction with implant AUTHOR NAMES Kim Y.W. Kim Y.J. Kong J.S. Cheon Y.W. AUTHOR ADDRESSES (Kim Y.W.; Kim Y.J.; Kong J.S.; Cheon Y.W.) Department of Plastic and Reconstructive Surgery, Gachon University Gil Medical Center, School of Medicine, Gachon University, 1198 Guwol-Dong, Namdong-Gu, Incheon, 405-760, Korea SOURCE Aesthetic plastic surgery (2014) 38:4 (704-710). Date of Publication: 1 Aug 2014 ISSN 1432-5241 (electronic) ABSTRACT BACKGROUND: Skin- or nipple-sparing mastectomy facilitates immediate one-stage reconstruction with an implant. Traditionally, an acellular dermal matrix or a muscle flap has been used because the inferolateral portion of the implant cannot be covered by the pectoralis major muscle. However, this method has drawbacks, including infection, cost, and donor-site morbidity. Therefore, we used an autologous conjoined fascial flap composed of the pectoralis major, serratus anterior, and external oblique fascia in patients with small-to-medium breasts.CONCLUSIONS: The conjoined fascial flap is a viable alternative for immediate one-stage breast reconstruction with an implant. We recommend appropriate patient selection with a body mass index greater than 20 kg/m(2) and small-to-medium sized nonptotic breasts.METHODS: A series of 11 immediate breast reconstructions in 11 patients was carried out from March 2010 to June 2011. The conjoined fascial flap and smooth round implants were used in all patients. Postoperative photographs were evaluated by a blinded panel and scored on a four-point scale. Patient satisfaction was evaluated by a postoperative questionnaire that had five items designed to evaluate quality of life with the reconstruction.RESULTS: The mean body mass index was 23.2 kg/m(2), follow-up period was 30.9 months, and implant volume was 286.3 cc. Regarding complications, we observed one case of partial skin flap necrosis and one case of seroma accumulation in the axilla, both of which healed with conservative care. The mean overall breast satisfaction score was 3.18 ± 0.5.LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 . EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) composite graft procedures EMTREE MEDICAL INDEX TERMS breast augmentation human patient selection quality of life LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24907100 (http://www.ncbi.nlm.nih.gov/pubmed/24907100) PUI L603987240 DOI 10.1007/s00266-014-0351-1 FULL TEXT LINK http://dx.doi.org/10.1007/s00266-014-0351-1 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 330 TITLE Persistence pays off: Being a catalyst for change in surgical practice AUTHOR NAMES Stanley K. Anderson K. AUTHOR ADDRESSES (Stanley K.; Anderson K.) California Pacific Medical Center, United States. CORRESPONDENCE ADDRESS K. Stanley, California Pacific Medical Center, United States. SOURCE American Journal of Infection Control (2014) 42:6 SUPPL. 1 (S106). Date of Publication: June 2014 CONFERENCE NAME 41st Annual Conference of the Association for Professionals in Infection Control and Epidemiology, APIC 2014 CONFERENCE LOCATION Anaheim, CA, United States CONFERENCE DATE 2014-06-07 to 2014-06-09 ISSN 0196-6553 BOOK PUBLISHER Mosby Inc. ABSTRACT ISSUE: In late 2009 routine surveillance of wound cultures identified a Number of infections post breast procedures. We began to follow NHSN breast procedures as part of our routine surveillance. The vast majority of complex surgical site infections were found in mastectomy patients (96%), and of these 81% were post immediate reconstruction. Of these immediate reconstruction cases we found that tIssue expanders were responsible for 95% of the complex surgical site infections. PROJECT: After an initial unsuccessful attempt at gaining the attention of the surgeons, we created a formal comprehensive report of these infections including statistical data analysis and literature review. We presented this report to the Plastic Surgery Department July 2012. This is where our story begins. Working with the Plastic Surgeons we identified a Number of risk factors to investigate. We researched all the usual variables: surgeon (both Plastic and General), skin antisepsis, perioperative antibiotics, preoperative skin bathing, and postoperative wound care. There were also some unique variables specific to this procedure type: nipple sparing vs. non nipple sparing mastectomy, use of acellular dermal matrix, subcutaneous vs. submuscular implant placement, and the technique/timing of the outpatient implant saline fills. We also wanted to assess if patient risk factors like chemotherapy, radiation, obesity, and smoking significantly increased the risk of developing these complex infections. RESULTS: Of statistical significance, we found that subcutaneous implant placement had a significantly higher complex infection rate than submuscular placement (p value = 0.0086) and nipple sparing mastectomies had a significantly higher complex infection rate than non nipple sparing mastectomies (p value 0.0280). A closer look at the data revealed nipple sparing mastectomies with subcutaneous implant placement had a significantly higher complex infection rate than non nipple sparing (p value= 0.0418) but the same is not true for nipple sparing mastectomies with submuscular placement (p value 1.00). Infection Prevention brought to light an Issue that the surgeons were unaware of because of the silos that exist in practice. Through our data analysis, research, surgeon discussions, and patient education (including implementation of a preoperative CHG bathing program) our medical center has decreased the Number of complex surgical site infections in patients undergoing tIssue expander placement immediately post mastectomy (Graph 1). We feel confident that this reduction is in part because of a greater Number of submuscular implant reconstructions being performed in 2013. LESSON LEARNED: In Infection Prevention we are proud of this story because it is an example of what our discipline does best!We conduct surveillance for this exact purpose: to identify areas to improve patient safety. We had the skills to analyze our data and prepare a report that was able to capture the attention of the surgeons. Because of this success we are empowered to continue to persist in our efforts to prevent infections. (Figure Presented). EMTREE DRUG INDEX TERMS antibiotic agent plastic sodium chloride EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) catalyst epidemiology infection control surgery EMTREE MEDICAL INDEX TERMS acellular dermal matrix antisepsis bath breast chemotherapy data analysis human implant infection infection prevention infection rate laryngeal mask mastectomy nipple obesity outpatient patient patient education patient risk patient safety plastic surgeon plastic surgery procedures radiation risk risk factor skill skin smoking statistical significance surgeon surgical infection tissue expander wound wound care LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71490771 DOI 10.1016/j.ajic.2014.03.235 FULL TEXT LINK http://dx.doi.org/10.1016/j.ajic.2014.03.235 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 331 TITLE The use of acellular dermal matrix (ADM) in breast reconstruction: An audit of practice AUTHOR NAMES Babar M. Lawn A. Conway A. Waheed S. Ball A. Johnson T. Kothari M. Laidlaw I. Karat I. Daoud R. AUTHOR ADDRESSES (Lawn A.; Johnson T.; Kothari M.) Ashford and St Peter's Hospital, Chertsey, United Kingdom. (Babar M.; Laidlaw I.; Karat I.; Daoud R.) Frimley Park Hospital, Frimley, United Kingdom. (Conway A.; Waheed S.; Ball A.) East Surrey Hospital, Redhill, United Kingdom. CORRESPONDENCE ADDRESS M. Babar, Frimley Park Hospital, Frimley, United Kingdom. SOURCE European Journal of Surgical Oncology (2014) 40:5 (654). Date of Publication: May 2014 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2014 CONFERENCE LOCATION Liverpool, United Kingdom CONFERENCE DATE 2014-05-19 to 2014-05-20 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Implant based breast reconstruction constitutes approximately 37% of immediate breast reconstructions within the UK and can be associated with complications in 40% of cases. The use of Acellular Dermal Matrix (ADM) derived from porcine (Strattice) or bovine (Surgimend) tissue acts as supportive reinforcement to the lower pole around the implant and its use is increasingly popular. It is reported that complications can be higher in ADM reconstructions. However, long-term follow up data is lacking and the ABS guidelines recommend local auditing of cases. Method: Retrospective analysis of all ADM breast reconstructions in 3 District General Hospitals belonging to the same local breast cancer network over a 3 year period. Data gathered included information on patient demographics, smoking history, significant co-morbidities, BMI, indication for surgery, neoadjuvant treatment and adjuvant treatment following reconstruction, operative information on scar placement, simultaneous axillary procedure, antibiotic prophylaxis, drain protocol, ADM type, size and prosthesis type. Complications were recorded in particular those leading to implant loss, significant infection and tissue necrosis. Result: 136 ADM and implant based breast reconstructions were performed on 120 patients over 3 years across 3 hospital sites by 7 consultant surgeons. The majority of cases used Strattice with 44 of the cases using Surgimend. Antibiotic and drain protocols varied across sites. Significant complications such as implant loss was seen in 6% of cases, significant infection in 9-13%, and skin necrosis in less than 2% of cases. Conclusion: ADM reconstruction is a safe and acceptable method of breast reconstruction and our data represents its successful application. Our outcome data is consistent with current literature. However, long-term data is required. National and local audit will provide a platform to evaluate these techniques further and formulate an evidence base for surgical protocols particularly with antibiotic and drain management. EMTREE DRUG INDEX TERMS antibiotic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction breast surgery clinical audit human EMTREE MEDICAL INDEX TERMS adjuvant therapy antibiotic prophylaxis breast cancer consultation follow up general hospital hospital implant infection morbidity patient procedures prosthesis reinforcement scar skin necrosis smoking surgeon surgery tissue necrosis tissues United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71415654 DOI 10.1016/j.ejso.2014.02.148 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2014.02.148 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 332 TITLE Comparison of outcomes using AlloDerm versus FlexHD for implant-based breast reconstruction AUTHOR NAMES Liu D.Z. Mathes D.W. Neligan P.C. Said H.K. Louie O. AUTHOR ADDRESSES (Liu D.Z.; Mathes D.W.; Neligan P.C.; Said H.K.; Louie O.) From the Department of Surgery, Division of Plastic Surgery, University of Washington School of Medicine, Seattle, Washington SOURCE Annals of plastic surgery (2014) 72:5 (503-507). Date of Publication: 1 May 2014 ISSN 1536-3708 (electronic) ABSTRACT BACKGROUND: Prosthetic reconstruction using human acellular dermis (ADM) is a common practice in breast reconstruction. AlloDerm and FlexHD are two different forms of ADM, each with unique characteristics. No studies have directly compared the postoperative complications of these 2 products.METHODS: The outcomes of 547 consecutive implant-based breast reconstructions were reviewed.RESULTS: Reconstruction was performed in 382 consecutive women (547 total breasts), employing mostly immediate reconstruction (81%). Mean follow-up was 6.4 months. Among immediate reconstructions, 165 used AlloDerm and 97 used FlexHD. Complications were similar by univariate analysis. In multivariate analysis, smoking and higher initial implant fill were risk factors for delayed healing. The use of FlexHD, single-stage reconstruction, and smoking were independent risk factors for implant loss.CONCLUSIONS: There is no significant difference in the complication rates between AlloDerm and FlexHD in immediate breast reconstruction. Multivariate analysis suggests that FlexHD may be a risk factor for implant loss. EMTREE DRUG INDEX TERMS collagen (drug administration, adverse drug reaction, drug therapy) surgical mesh surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix procedures EMTREE MEDICAL INDEX TERMS breast augmentation breast implant breast reconstruction cellulitis (drug therapy, epidemiology, etiology) comorbidity comparative study device failure analysis devices diabetes mellitus (epidemiology) epidemiology evaluation study female follow up human incidence mastectomy middle aged multivariate analysis obesity (epidemiology) prosthesis complication (etiology) retrospective study risk factor skin transplantation smoking statistics and numerical data surgical infection (epidemiology, etiology) tissue expander tissue expansion treatment outcome wound healing CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 23636114 (http://www.ncbi.nlm.nih.gov/pubmed/23636114) PUI L601525146 DOI 10.1097/SAP.0b013e318268a87c FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0b013e318268a87c COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 333 TITLE Dermal flap based single stage immediate breast reconstruction AUTHOR NAMES Parmeshwar R. Chiu W. Rajan S.S. AUTHOR ADDRESSES (Parmeshwar R.; Chiu W.; Rajan S.S.) University Hospitals of Morecambe Bay, NHS Foundation Trust, Lancaster, United Kingdom. CORRESPONDENCE ADDRESS R. Parmeshwar, University Hospitals of Morecambe Bay, NHS Foundation Trust, Lancaster, United Kingdom. SOURCE European Journal of Surgical Oncology (2014) 40:5 (658). Date of Publication: May 2014 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2014 CONFERENCE LOCATION Liverpool, United Kingdom CONFERENCE DATE 2014-05-19 to 2014-05-20 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Single stage implant based immediate breast reconstruction is commonly performed with acellular dermal matrices (ADM). Use of lower pole skin as dermal flap (DF) offers a viable alternative to ADMs in appropriate cases with the added advantage of it being autologous and cost efficient. We look into our series of single stage immediate breast reconstruction with Dermal flap. Method: We reviewed 27 consecutive cases of DF performed over a period of 5 years. All these patients had breast sizes of D cup or above with grade 2-3 ptosis. All had either a planned reduction (23, 85%) or simultaneous delayed reconstruction (4, 15%) of the contralateral side. The procedure involves creating a de-epithelialised dermal sling from lower pole skin, with Wise pattern mastectomy. DF is then stitched to margin of divided edge of Pectoralis major muscle to create pocket for adjustable implant which is usually adjusted, starting 3-4 weeks from surgery. Patients were followed up. Outcomes were prospectively audited. Results were reviewed for cosmetic outcome, patient satisfaction along with complications such as seroma, implant loss, Grade 2/3 capsular contracture rate. Result: There were no implant loss (one patient successfully treated with antibiotics for soft tissue infection). No cases of grade 2/3 capsular contracture over a mean follow up period of 26 months. Cosmetic outcome as measured objectively were good in 23 (85%) with high patient satisfaction scores. Conclusion: DF with adjustable implant is a reliable and effective single stage breast reconstruction technique with low complication rates and high patient satisfaction scores. EMTREE DRUG INDEX TERMS antibiotic agent cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction breast surgery skin flap EMTREE MEDICAL INDEX TERMS acellular dermal matrix breast contracture follow up human implant mastectomy patient patient satisfaction pectoralis major muscle procedures ptosis seroma skin soft tissue infection surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71415670 DOI 10.1016/j.ejso.2014.02.164 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2014.02.164 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 334 TITLE Outcomes following implant-based breast reconstruction using Strattice™ acellular dermal matrix AUTHOR NAMES Pilgrim S. Ball E. Aitken J. AUTHOR ADDRESSES (Pilgrim S.; Ball E.; Aitken J.) West Suffolk Hospital, Bury St Edmunds, United Kingdom. CORRESPONDENCE ADDRESS S. Pilgrim, West Suffolk Hospital, Bury St Edmunds, United Kingdom. SOURCE European Journal of Surgical Oncology (2014) 40:5 (622-623). Date of Publication: May 2014 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2014 CONFERENCE LOCATION Liverpool, United Kingdom CONFERENCE DATE 2014-05-19 to 2014-05-20 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Strattice™ acellular dermal matrix can be used in implant-based breast reconstruction following mastectomy to facilitate one-stage reconstruction with improved cosmesis in terms of infra-mammary fold definition when compared to total muscle coverage. Methods: A series of 51 implant-based reconstructions with Strattice® acellular dermal matrix were carried out in 44 consecutive patients undergoing mastectomy between January 2011 and November 2013 and followed up in a dedicated oncoplastic breast clinic. Results: The median age of the patients at the initial surgery was 50.4 years (range 31.5-73.0 years) with a median follow up of 20.2 months at the time of analysis. 27 (61.4%) patients received chemotherapy, 24 (61.4%) underwent radiotherapy. 39 (88.6%) reconstructions were immediate, of which 5 were planned as 2 stage procedures. 11 (25.0%) underwent contralateral reduction mammoplasty. 6 (13.6%) patients had their reconstructions taken down during the follow-up period (5 for infection, all of whom had undergone radiotherapy, one for locoregional recurrence); a further 8 (18.2%) required implant exchange and 7 (15.9%) patients, all of whom had undergone radiotherapy, were noted to have capsular contracture during follow up. 4 patients experienced capsular contracture requiring implant exchange. Conclusion: While the majority of implant-based breast reconstructions with Strattice™ acellular dermal matrix have a successful outcome, patients should be counselled pre-operatively that complications resulting in revision surgery or implant loss occur relatively frequently despite careful patient selection. The rates in this study are consistent with previouslypublished results for reconstructions using acellular dermal matrices. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction breast surgery implant EMTREE MEDICAL INDEX TERMS breast breast reduction chemotherapy contracture follow up hospital human infection mastectomy muscle patient patient selection procedures radiotherapy surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71415551 DOI 10.1016/j.ejso.2014.02.045 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2014.02.045 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 335 TITLE Outcome after dermal sling-assisted immediate breast reconstruction AUTHOR NAMES Lefemine V. Wyld L. Chandran V.P. Reed M.W.R. AUTHOR ADDRESSES (Lefemine V.; Chandran V.P.) Breast Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom. (Wyld L.; Reed M.W.R.) Department of Oncology, University of Sheffield, Sheffield, United Kingdom. CORRESPONDENCE ADDRESS V. Lefemine, Breast Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom. SOURCE European Journal of Surgical Oncology (2014) 40:5 (622). Date of Publication: May 2014 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2014 CONFERENCE LOCATION Liverpool, United Kingdom CONFERENCE DATE 2014-05-19 to 2014-05-20 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Dermal sling (DS) assisted immediate breast reconstruction is an alternative to Acellular Dermal Matrix (ADM) for patients with breast ptosis. Previous data from our Unit showed that patient satisfaction was high in the initial period. We now report longer follow up. Methods: Patients were identified from an electronic prospective database and their records reviewed. Patient satisfaction and quality of life were determined using the BREAST-Q© questionnaire. Results: Between October 2008 and August 2012, 44 patients underwent 58 DS assisted breast reconstruction procedures. Their median follow up was 29 (range 7-55) months. The most common immediate postoperative complication were superficial T-junction breakdown in 16 (27%) DS, superficial wound infection in 13 (22%) DS and seroma in eight (13%) DS. Only one patient required implant removal due to infection. At long term follow up two patients had their reconstruction converted to Latissimus dorsi flap for persistent asymmetry. Two further patients underwent mastectomy, one for pain and one for local recurrence. BREAST-Q© scores for outcome were 79.2 in 2011 and 71.8 in 2013. Conclusions: DS is an effective and safe alternative to ADM with less than 10 per cent conversion rate at 4.5 years. BREAST-Q© responses in 2013 indicated sustained high satisfaction with the reconstructed breast, that dropped only slightly at longer follow up. The BREAST-Q© scores were consistently superior when compared to the data of National Mastectomy and Breast Reconstruction Audit. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction breast surgery EMTREE MEDICAL INDEX TERMS acellular dermal matrix breast clinical audit data base follow up human implant infection latissimus dorsi flap mastectomy pain patient patient satisfaction postoperative complication procedures ptosis quality of life questionnaire satisfaction seroma wound infection LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71415549 DOI 10.1016/j.ejso.2014.02.043 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2014.02.043 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 336 TITLE The acellular dermal matrix onlay graft for areolar reconstruction AUTHOR NAMES Rao S.S. Seaman B.J. Davison S.P. AUTHOR ADDRESSES (Rao S.S.; Seaman B.J.; Davison S.P.) From the *Departments of Plastic Surgery, †Otolaryngology, and ‡DAVinci Plastic Surgery, Department of Otolaryngology, Georgetown University, Washington, DC SOURCE Annals of plastic surgery (2014) 72:5 (508-512). Date of Publication: 1 May 2014 ISSN 1536-3708 (electronic) ABSTRACT RESULTS: All 24 areola re-epithelialized in an average of 8.1 weeks. Graft take was 100% in 23 areolas, while 1 areola had only 75% graft take. Two patients underwent subsequent nipple projection procedures. Sixteen areolas were tattooed for color, with plans to tattoo the others. All patients had satisfactory transition from native skin to nipple-areolar complex. All surveyed patients stated they would undergo the procedure again. Average follow-up was 15.7 months.METHODS: A total of 19 patients and 24 nipple-areolar complexes of breast cancer or BRCA-positive patients status postmastectomy were treated. After nipple flap reconstruction was completed, the areolar complex was marked at 40-45 mm and de-epithelialized. ADM was reconstituted and cut to size. This was sewn into place as an areolar onlay graft using 5-0 chromic running sutures and a vaseline gauze bolster.CONCLUSION: The ADM onlay graft for areolar reconstruction is a feasible addition to the plastic surgeon's armamentarium. The primary benefits of this technique are grafting the donor bed of nipple reconstruction, avoidance of a skin graft donor site wound, and prevention of flattening of the breast dome, as seen with primary closure after nipple flap reconstruction. The cost of ADM must be taken into account ($31 per square centimeter), which could be offset by banking excess ADM at the time of breast reconstruction.BACKGROUND: Acellular dermal matrix (ADM) has been well described for use in breast reconstruction. The purpose of this study was to describe a novel use for ADM in areolar reconstruction. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix surgery EMTREE MEDICAL INDEX TERMS adult breast reconstruction breast tumor (surgery) feasibility study female human mastectomy nipple patient satisfaction procedures scar (etiology, prevention) skin transplantation surgical flaps suture technique tattooing LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 23503439 (http://www.ncbi.nlm.nih.gov/pubmed/23503439) PUI L601525117 DOI 10.1097/SAP.0b013e318268a83d FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0b013e318268a83d COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 337 TITLE The matrix: Strattice vs XCM in immediate implant-based breast reconstruction AUTHOR NAMES Fung V. Allison K. AUTHOR ADDRESSES (Fung V.; Allison K.) James Cook University Hospital, Middlesbrough, United Kingdom. CORRESPONDENCE ADDRESS V. Fung, James Cook University Hospital, Middlesbrough, United Kingdom. SOURCE European Journal of Surgical Oncology (2014) 40:5 (660). Date of Publication: May 2014 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2014 CONFERENCE LOCATION Liverpool, United Kingdom CONFERENCE DATE 2014-05-19 to 2014-05-20 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Use of acellular dermal matrices (ADMs) in assisting implant-based breast reconstruction has gained in popularity since they were introduced. There is continuing uncertainty regarding which ADM is 'better'. Complication rates and aesthetic outcomes are important, and ADM costs are also a significant factor. We have compared the use of 2 ADMs in breast reconstruction in a single NHS trust - Strattice® at a price of ∼ £1800 per 8x16cm sheet, and XCM® costing w£800 per 8x16cm sheet. A 2 year retrospective review identified 18 patients with 22 immediate breast reconstructions using ADM and implant, 9 using XCM® and 13 with Strattice®. Both groups received the same insetting procedure and postoperative management. Infection necessitated removal of the implant and ADM in 1 breast from each group. Red breast syndrome was identified in 1 Strattice patient, and skin flap necrosis resulting in salvage LD musculocutaneous flap (but without removal of the implant/ADM) was seen in 1 Strattice patient. There was no obvious difference in seroma or infection rate. To date, we have found that using XCM and Strattice have produced similar short term outcomes in immediate implant-based breast reconstruction, with little difference in handling properties and complications. In the current economic climate of reducing expenditure, the significantly lower price of XCM is a very attractive feature. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction breast surgery implant EMTREE MEDICAL INDEX TERMS acellular dermal matrix breast climate graft necrosis human infection infection rate myocutaneous flap patient procedures seroma LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71415678 DOI 10.1016/j.ejso.2014.02.172 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2014.02.172 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 338 TITLE Phenotypic switching of Cryptococcus neoformans var. grubii VNI in a case of retroperitoneal diffuse large B-cell lymphoma following modified Rituximab-CHOP chemotherapy AUTHOR NAMES Tseng H.K. Liu C.P. Chen Y.C. Cheng M.W. AUTHOR ADDRESSES (Tseng H.K.; Liu C.P.; Cheng M.W.) Mackay Memorial Hospital, Taipei, Taiwan. (Chen Y.C.) National Taiwan University Hospital, Taipei, Taiwan. CORRESPONDENCE ADDRESS H.K. Tseng, Mackay Memorial Hospital, Taipei, Taiwan. SOURCE Mycoses (2014) 57 SUPPL. 1 (106). Date of Publication: May 2014 CONFERENCE NAME 9th International Conference on Cryptococcus and Cryptococcosis CONFERENCE LOCATION Amsterdam, Netherlands CONFERENCE DATE 2014-05-15 to 2014-05-19 ISSN 0933-7407 BOOK PUBLISHER Blackwell Publishing Ltd ABSTRACT An 88 year-old woman with past history of breast cancer post mastectomy had retroperitoneal diffuse large B-cell lymphoma, germinal center type treated by modified rituximab-CHOP chemotherapy (rituximab, cyclophosphamide, vincristine, and prednisolone). She had neutropenic fever and final blood culture and urine culture yield two morphological phenotypes (smooth and mucoid) of Cryptococcus neoformans which VNI was confirmed. Central nervous system infection was favored but her family member declined lumbar puncture for CSF study due to personal issue. After completion of induction therapy with amphotericin-B and flucytosine two weeks, we switched to maintenance oral fluconazole 400 mg daily. Due to the controlled of her infection and improvement of her clinical condition, she was discharged. (Figure Presented). EMTREE DRUG INDEX TERMS (MAJOR FOCUS) rituximab EMTREE DRUG INDEX TERMS amphotericin B cyclophosphamide fluconazole flucytosine prednisolone vincristine EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) chemotherapy cryptococcosis Cryptococcus neoformans Filobasidiella large cell lymphoma EMTREE MEDICAL INDEX TERMS blood culture breast cancer central nervous system infection cerebrospinal fluid febrile neutropenia female germinal center human infection lumbar puncture mastectomy phenotype therapy urine culture LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71475266 DOI 10.1111/myc.12196 FULL TEXT LINK http://dx.doi.org/10.1111/myc.12196 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 339 TITLE Evaluation of a novel technique in immediate implant reconstruction with a new shaped accelular matrix graft (Braxon®) placed on the pectoralis muscle in a subcutaneous plane AUTHOR NAMES Cawthorn S. Berna G. AUTHOR ADDRESSES (Cawthorn S.) North Bristol NHS Trust, Bristol, United Kingdom. (Berna G.) Treviso Hospital, Treviso, Italy. CORRESPONDENCE ADDRESS S. Cawthorn, North Bristol NHS Trust, Bristol, United Kingdom. SOURCE European Journal of Surgical Oncology (2014) 40:5 (634). Date of Publication: May 2014 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2014 CONFERENCE LOCATION Liverpool, United Kingdom CONFERENCE DATE 2014-05-19 to 2014-05-20 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: The traditional sub-pectoral placement of the implant to reduce capsular contraction is now assisted by ADM to achieve better ptosis. Evidence that ADM reduces capsular contraction around implants in subcutaneous planes now exists both in animal models and revisional surgery in breast augmentation. Methods: We present the first reports of our initial experience of a new ADM assisted fixed volume reconstruction (Braxon®) where the implant wrapped in ADM is placed above the muscle in a subcutaneous plane. Results: Our preliminary results show reduction in post-operative pain and capsular contracture with good cosmetic outcomes up to one year of follow-up. Early complications due to seroma resulting in implant loss in 2 of 13 implants have been resolved by a change to a thinner ADM (0.6mm) without preservatives, with windows in the ADM behind the implant on the muscle with no further complications (7 reconstructions). Updated experience will be presented. Conclusion: Pectoralis preserving one-stage reconstruction with subcutaneous Braxon® appears to offer advantages with less post-operative pain, less contracture and good cosmetic outcomes. The learning curve will tell us if our experience provides the basis for a new dimension in the field of mastectomy and immediate implant-based reconstruction breast surgery. EMTREE DRUG INDEX TERMS cosmetic preservative EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast surgery implant pectoralis major muscle EMTREE MEDICAL INDEX TERMS animal model breast augmentation contracture follow up learning curve mastectomy muscle pain ptosis seroma surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71415588 DOI 10.1016/j.ejso.2014.02.082 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2014.02.082 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 340 TITLE 354 Acellular collagen matrix-augmented implant breast reconstructions in Edinburgh-trends over 5 years AUTHOR NAMES Barber M. AUTHOR ADDRESSES (Barber M.) Edinburgh Breast Unit, Edinburgh, United Kingdom. CORRESPONDENCE ADDRESS M. Barber, Edinburgh Breast Unit, Edinburgh, United Kingdom. SOURCE European Journal of Surgical Oncology (2014) 40:5 (603). Date of Publication: May 2014 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2014 CONFERENCE LOCATION Liverpool, United Kingdom CONFERENCE DATE 2014-05-19 to 2014-05-20 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: The use of an artificial sling to augment implant-based breast reconstruction has become the standard approach over the last 5 years, largely replacing submuscular expander placement in immediate reconstructions. Trends in practice and outcome in the Edinburgh Breast Unit are presented. Methods: Patient notes were examined for all procedures using a sling material to augment reconstructive breast surgery by surgeons working at the Edinburgh Breast Unit between July 2008 and November 2013. Results: 354 sheets of material have been used on 341 breasts in 242 patients by 15 surgeons. There have been substantial changes in material used over time based on cost and ease of handling, largely involving a migration from Permacol to Strattice to Veritas. Loss rates at 3 months were 8.7%, 12% at 6 months, 15.4% at 1 year and 17.7% at 2 years with 2 further reconstructions being lost after 2 years. There is a trend towards improvement in loss rate over time but this is not statistically significant. The loss rate in those who have not received radiotherapy and who do not smoke is substantially lower and remains under 10% in the long term. 24.7% of the patients having this approach to reconstruction are smokers. There has been substantial variation in definitive implant placement at first surgery and nipple preservation. Conclusions: There is no substantial learning curve in terms of reduced loss rates within 5 years of introducing the technique of sling-assisted implant-based breast reconstruction. Great care should be exercised in patient selection and consent. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction breast surgery implant EMTREE MEDICAL INDEX TERMS breast hospital patient human learning curve nipple patient patient selection preservation procedures radiotherapy smoke smoking surgeon surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71415491 DOI 10.1016/j.ejso.2014.02.200 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2014.02.200 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 341 TITLE Clinical experience with use of SERI® in two-stage implantbased breast reconstruction: 6-Month follow-up of 139 patients AUTHOR NAMES Karp N. Choi M. Ippolito J. Lehfeldt M. Jewell M. Fine N. AUTHOR ADDRESSES (Karp N.; Choi M.) KCNY Plastic Surgery, New York, United States. (Ippolito J.) Allergan Medical, Medford, United States. (Lehfeldt M.) Private Practice, South Pasadena, United States. (Jewell M.) Jewell Plastic Surgery Center, Eugene, United States. (Fine N.) Northwestern Specialists in Plastic Surgery, SC, Chicago, United States. CORRESPONDENCE ADDRESS N. Karp, KCNY Plastic Surgery, New York, United States. SOURCE European Journal of Surgical Oncology (2014) 40:5 (621). Date of Publication: May 2014 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2014 CONFERENCE LOCATION Liverpool, United Kingdom CONFERENCE DATE 2014-05-19 to 2014-05-20 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: SERI® is a silk-derived, long-term bioresorbable scaffold developed for soft tissue support. Methods: SURE-001(NCT01256502) is a prospective, single-arm, multicenter study in patients undergoing two-stage breast reconstruction. Institutional Review Board approvals were obtained from all study sites. At the time of mastectomy/stage I surgery, SERI was placed during subpectoral placement of a tissue expander, which was replaced with a permanent implant during stage II surgery. Results: A total of 139 subjects (214 breasts) were enrolled in SURE- 001 and will be followed for 24 months; data on all patients followed for 6 months are reported here. At 6 months, 75 subjects (118 breasts) had undergone stage II surgery. Subject satisfaction score (mean±SD; 5=very satisfied) was higher at 6 months (4.3±0.91) compared with screening (3.6±1.05; P<0.0001 [paired t-test]). Investigator satisfaction score (mean±SD; 10=very satisfied) at 6 months was 9.4±0.84. SERI was assessed as easy/very easy to use in >98% of instances across five categories during stage I surgery (before implantation: preparation, cutting/shaping; during implantation: positioning/drapability, suturing; after implantation: cutting/shaping). Key AEs in 214 breasts: tissue necrosis (6.1%), seroma (6.1%), hematoma (2.8%), breast infection (1.9%), cellulitis (1.9%), implant loss (1.9%), capsular contracture (0%). None were assessed by investigators as due to SERI. Conclusions: In the 139 patients enrolled and prospectively followed in SURE-001, subject satisfaction with the treated breasts increased from screening through 6 months. High degrees of investigator satisfaction and ease of use with SERI were reported. AE rates are comparable with those reported for implant-based breast reconstruction with ADMs. EMTREE DRUG INDEX TERMS silk EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction breast surgery follow up human patient EMTREE MEDICAL INDEX TERMS arm bioresorbable scaffold breast cellulitis contracture hematoma implant implantation institutional review mastitis multicenter study satisfaction screening seroma soft tissue Student t test surgery tissue expander tissue necrosis LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71415545 DOI 10.1016/j.ejso.2014.02.039 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2014.02.039 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 342 TITLE Introducing an oncoplastic MDT to facilitate teaching and training in the breast unit AUTHOR NAMES Lawn A. Johnson T. Kothari M. AUTHOR ADDRESSES (Lawn A.; Johnson T.; Kothari M.) Ashford and St Peter's Hospital, Chertsey, United Kingdom. CORRESPONDENCE ADDRESS A. Lawn, Ashford and St Peter's Hospital, Chertsey, United Kingdom. SOURCE European Journal of Surgical Oncology (2014) 40:5 (626). Date of Publication: May 2014 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2014 CONFERENCE LOCATION Liverpool, United Kingdom CONFERENCE DATE 2014-05-19 to 2014-05-20 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Oncoplastic surgery has become a challenging, rewarding and dynamic part of breast surgery. Despite oncoplastic surgery becoming increasing popular and fellowships becoming available following CCT, variation exists in techniques of oncoplastic and reconstructive breast surgery amongst breast units and no formal training in oncoplastic reconstructive surgery exists during speciality training. Our aim was to improve training in oncoplastic surgery in our department. Methods: We devised and set up a dedicated Oncoplastic and Reconstructive Multidisciplinary Team Meeting in our breast unit which is based in a district general hospital. This forms part of our weekly Breast Academic Forum aimed to facilitate teaching and training of the breast surgery team juniors and to encourage discussion between consultant trainers. Other members of the MDT include breast care nurses and radiologists, Patients who are thought to pose an 'interesting' oncoplastic challenge on clinical review or are due to undergo reconstructive surgery are discussed at this MDT meeting. An MDT proforma was devised and a case presentation is prepared by the trainees with a review of the history, radiology and professional hospital photography. Discussion is centred on the challenges faced based on the patients' native anatomy and an emphasis on the patient's own wishes for surgery. Any postoperative complications are also discussed for learning points. Results: 55 patients requiring oncoplastic and reconstructive techniques have been discussed on our Oncoplastic MDT. This has greatly facilitated training particularly concerning planning and decision making in oncoplastic surgery and knowledge in the process of requesting and ordering prosthesis and acellular dermal matrix. Conclusion: We believe that all units involved in breast reconstruction and oncoplastic surgery should devise an Oncoplastic MDT as a forum to facilitate teaching and training in these techniques. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast breast surgery teaching EMTREE MEDICAL INDEX TERMS acellular dermal matrix breast care breast reconstruction consultation decision making general hospital hospital human learning nurse patient photography planning plastic surgery postoperative complication prosthesis radiologist radiology student surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71415564 DOI 10.1016/j.ejso.2014.02.058 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2014.02.058 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 343 TITLE The cost effectiveness of acellular dermal matrix in expander-implant immediate breast reconstruction AUTHOR NAMES Krishnan N.M. Chatterjee A. Rosenkranz K.M. Powell S.G. Nigriny J.F. Vidal D.C. AUTHOR ADDRESSES (Krishnan N.M., Naveen.Krishnan07@gmail.com) Geisel School of Medicine at Dartmouth, Hanover, NH, United States. (Chatterjee A.; Nigriny J.F.; Vidal D.C.) Division of Plastic Surgery, Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States. (Rosenkranz K.M.) Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States. (Powell S.G.) Tuck School of Business at Dartmouth, Hanover, NH, United States. CORRESPONDENCE ADDRESS N.M. Krishnan, 1 Rope Ferry Road, Hanover, NH 03755, United States. Email: Naveen.Krishnan07@gmail.com SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2014) 67:4 (468-476). Date of Publication: April 2014 ISSN 1748-6815 1878-0539 (electronic) BOOK PUBLISHER Churchill Livingstone, 1-3 Baxter's Place, Leith Walk, Edinburgh, United Kingdom. ABSTRACT Background: Expander-implant breast reconstruction is often supplemented with acellular dermal matrix (ADM). The use of acellular dermal matrix has allowed for faster, less painful expansions and improved aesthetics, but with increased cost. Our goal was to provide the first cost utility analysis of using acellular dermal matrix in two-stage, expander-implant immediate breast reconstruction following mastectomy. Methods: A comprehensive literature review was conducted to identify complication rates for two-stage, expander-implant immediate breast reconstruction with and without acellular dermal matrix. The probabilities of the most common complications were combined with Medicare Current Procedural Terminology reimbursement codes and expert utility estimates to fit into a decision model. The decision model evaluated the cost effectiveness of acellular dermal matrix relative to reconstructions without it. Retail costs for ADM were derived from the LifeCell 2012 company catalogue for Alloderm. Results: The overall complication rates were 30% and 34.5% with and without ADM. The decision model revealed a baseline cost increase of $361.96 when acellular dermal matrix is used. The increase in Quality-Adjusted Life Years (QALYs) is 1.37 in the population with acellular dermal matrix. This yields a cost effective incremental cost-utility ratio (ICUR) of $264.20/QALY. Univariate sensitivity analysis confirmed that using acellular dermal matrix is cost effective even when using retail costs for unilateral and bilateral reconstructions. Conclusions: Our study shows that, despite an increased cost, acellular dermal matrix is a cost effective technology for patients undergoing two-stage, expander-implant immediate breast reconstruction due to its increased utility in successful procedures. Crown Copyright © 2013 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant (adverse device effect, device economics) breast reconstruction breast tissue expander (adverse device effect, device economics) EMTREE MEDICAL INDEX TERMS article cost effectiveness analysis cost utility analysis Current Procedural Terminology human medical device complication (complication) priority journal quality adjusted life year EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014187099 MEDLINE PMID 24508194 (http://www.ncbi.nlm.nih.gov/pubmed/24508194) PUI L52994016 DOI 10.1016/j.bjps.2013.12.035 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2013.12.035 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 344 TITLE Total skin-sparing mastectomy and immediate breast reconstruction: An evolution of technique over 986 cases AUTHOR NAMES Wang F. Peled A.W. Garwood E. Sbitany H. Foster R.D. Alvarado M. Ewing C. Hwang S. Esserman L.J. AUTHOR ADDRESSES (Wang F.; Peled A.W.; Garwood E.; Sbitany H.; Foster R.D.; Alvarado M.; Ewing C.; Hwang S.; Esserman L.J.) Department of Surgery, University of California, San Francisco, San Francisco, United States. CORRESPONDENCE ADDRESS F. Wang, Department of Surgery, University of California, San Francisco, San Francisco, United States. SOURCE Annals of Surgical Oncology (2014) 21 SUPPL. 2 (9). Date of Publication: April 2014 CONFERENCE NAME 15th Annual Meeting of the American Society of Breast Surgeons CONFERENCE LOCATION Las Vegas, NV, United States CONFERENCE DATE 2014-04-30 to 2014-05-04 ISSN 1068-9265 BOOK PUBLISHER Springer New York ABSTRACT Objective: Total skin-sparing mastectomy (TSSM) with complete preservation of the breast and nipple-areolar complex (NAC) skin and excision of nipple tissue was developed to improve aesthetic outcomes for treatment of early-stage breast cancer or for prophylactic indications. Over the past 12 years, TSSM has been offered for a wider range of indications as NAC preservation rates improved and as locoregional recurrence rates were shown to be similar to other mastectomy techniques. We aim to demonstrate that the technique of TSSM has developed into a feasible standard for mastectomy. Methods: We reviewed our experience of TSSM and immediate breast reconstruction from October 2001 to December 2012. Cases were divided into several learning cohorts defined by intentional changes in technique and management, which led to serial improvements in outcomes. The initial cohort focused on defining the appropriate placement of incisions for TSSM to maximize NAC survival. Subsequent improvements included increasing the minimum time from completion of radiation therapy to expander-implant exchange from 3 months to 6 months, switching from cephalosporins to trimethoprim-sulfamethoxazole for standard postoperative antibiotic prophylaxis unless contraindicated, and examining the utility of acellular dermal matrix in tissue expander/implant reconstruction. Postoperative complications and outcomes were obtained via retrospective chart review from 2001-2005 and gathered prospectively from 2005-2012. Results: A total of 640 patients underwent 986 cases of TSSM with mean follow-up time of 25 ± 20 months. The mean age at mastectomy was 47 ± 10 years. 32.5% of patients underwent neoadjuvant chemotherapy and 16.4% underwent adjuvant chemotherapy for breast cancer treatment. Comorbidities among patients included diabetes (1.6%), current or prior smoking (16.6%), and prior radiation history (7.7%). Of all TSSM cases, 35.0% were performed for prophylactic indications, while therapeutic cases included stage 0 (35.9%), stage 1 (28.9%), stage 2 (23.4%), stage 3 (10.9%), and stage 4 (0.9%) disease. Postmastectomy radiation therapy was performed in 18.9% of the therapeutic cases. Immediate breast reconstruction was performed in all cases with either tissue expander placement (85.1%), pedicle TRAM (6.3%), free TRAM (4.8%), permanent implant (3.0%), or latissimus flap (0.4%). Postoperative complications included the development of serious infection requiring IV antibiotics or operative intervention (9.8%), partial nipple necrosis (0.6%), complete nipple necrosis (1.0%), skin flap necrosis (8.4%), and expander/implant loss (8.4%). Radiation therapy was shown to increase the risk for developing serious infections (RR, 2.7; p < 0.05), major skin flap necrosis (RR, 2.1; p < 0.05), and expander/implant loss (RR, 3.6, p < 0.05) but had no significant effect on partial or complete NAC necrosis. Smoking history was shown to increase the risk of serious infection (RR, 1.9; p < 0.05), skin necrosis (RR, 1.6; p < 0.05), and expander/implant loss (RR, 1.8; p < 0.05). The 5-year cumulative incidence of locoregional recurrence was 3.0%, and the 5-year disease-free survival was 92.2%. Conclusion: Our technique of TSSM and immediate breast reconstruction has undergone substantial development since 2001. We have improved outcomes and decreased postoperative complications through a systematic series of learning cohorts. Serial improvements in technique and emerging data on longer term oncologic safety make this surgical approach feasible as a standard for mastectomy. EMTREE DRUG INDEX TERMS antibiotic agent cephalosporin derivative cotrimoxazole EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast breast reconstruction human mastectomy skin society surgeon EMTREE MEDICAL INDEX TERMS acellular dermal matrix adjuvant chemotherapy antibiotic prophylaxis breast cancer cancer therapy diabetes mellitus disease free survival excision follow up graft necrosis implant implantable cardioverter defibrillator incision infection learning medical record review necrosis nipple patient postoperative complication preservation radiation radiotherapy recurrence risk risk safety skin necrosis smoking surgery surgical approach survival tissue expander tissues LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71448687 DOI 10.1245/s10434-014-3672-z FULL TEXT LINK http://dx.doi.org/10.1245/s10434-014-3672-z COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 345 TITLE Immediate implant breast reconstruction with acellular dermal matrix for treatment of a large recurrent malignant phyllodes tumor AUTHOR NAMES Farias-Eisner G.T. Small K. Swistel A. Ozerdem U. Talmor M. AUTHOR ADDRESSES (Farias-Eisner G.T.; Small K.; Swistel A.; Ozerdem U.; Talmor M.) Division of Plastic Surgery, Weill Cornell Medical College, 425 East 61st Street, 10th Floor, New York, NY, 10065, USA SOURCE Aesthetic plastic surgery (2014) 38:2 (373-378). Date of Publication: 1 Apr 2014 ISSN 1432-5241 (electronic) ABSTRACT UNLABELLED: Phyllodes tumors (PT) are rare fibroepithelial breast tumors representing less than 1 % of all breast malignancies. These tumors are unpredictable and fast growing with a high local recurrence rate, making this disease challenging to treat. Previous literature focused on surgical resection, and breast reconstruction following a mastectomy in patients with PT is rarely addressed. We report a case of a recurrent malignant PT treated with a nipple-sparing mastectomy followed by immediate single-stage silicone implant breast reconstruction. While PT is a rare breast malignancy that presents challenges with both surgical resection and reconstruction, we demonstrate that nipple-sparing mastectomy with immediate implant breast reconstruction with AlloMax is curative and can offer an appealing cosmetic option.LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant procedures EMTREE MEDICAL INDEX TERMS breast reconstruction breast tumor (surgery) cancer staging case report computer assisted tomography esthetics female follow up human immunohistochemistry middle aged needle biopsy pathology phyllodes tumor (surgery) physiology rare disease subcutaneous mastectomy treatment outcome tumor invasion tumor recurrence (surgery) wound healing LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24570179 (http://www.ncbi.nlm.nih.gov/pubmed/24570179) PUI L602084544 DOI 10.1007/s00266-014-0283-9 FULL TEXT LINK http://dx.doi.org/10.1007/s00266-014-0283-9 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 346 TITLE Cost analysis of nipple-sparing mastectomy: Must new always be more expensive? AUTHOR NAMES Wexelman B. Martinson H. Tang R. Hughes K. Coopey S. Gadd M. Specht M. Smith B.L. AUTHOR ADDRESSES (Wexelman B.; Martinson H.; Tang R.; Hughes K.; Coopey S.; Gadd M.; Specht M.; Smith B.L.) Surgical Oncology, Massachusetts General Hospital, Boston, United States. CORRESPONDENCE ADDRESS B. Wexelman, Surgical Oncology, Massachusetts General Hospital, Boston, United States. SOURCE Annals of Surgical Oncology (2014) 21 SUPPL. 2 (123-124). Date of Publication: April 2014 CONFERENCE NAME 15th Annual Meeting of the American Society of Breast Surgeons CONFERENCE LOCATION Las Vegas, NV, United States CONFERENCE DATE 2014-04-30 to 2014-05-04 ISSN 1068-9265 BOOK PUBLISHER Springer New York ABSTRACT Objective: Early adoption of new medical technology and techniques usually requires increased resources of money and time. Nipple-sparing mastectomy (NSM) has theoretical potential for cost-savings compared to traditional skin-sparing mastectomy (SSM), as the larger skin envelope increases the options for single-stage reconstruction procedures, reducing expansion visits and subsequent surgeries. We seek to compare costs related to NSM vs SSM and the downstream health finance effects for the first postoperative year. Methods: One hundred seventy-two NSMs and 123 SSMs were performed at our institution in 2012 by 5 breast surgical oncologists. Twenty representative cases of each type were selected for retrospective chart review matching the proportion of bilateral mastectomies and reconstructions as in the entire series. Factors influencing cost, including operative time, type of implantable devices used, length of stay, number of post-op visits, and additional surgeries for each patient, were collected. A basic cost model was developed for the operation and outpatient care for 12 months follow-up. Independent t tests were used to assess statistical difference. Results: The operative cost and 1-year follow-up of the NSM patients was not significantly more expensive than standard SSM. Operative cost was calculated at $30/min, with additional costs added for implanted devices (tissue expanders, acellular dermal matrix, Vicryl Mesh) using 80% of the published retail price of the device to account for most hospital discounts. Length of stay (2.4 days NSM vs 2.1 SSM) was not statistically different and the mean number of additional surgeries for complications or revisions (0.6 vs 0.6) was the same between groups. The NSM cohort had 2.4 fewer postoperative outpatient visits (8.6 vs 11.0), though this was not statistically significant. Acellular dermal matrix products were a source of significant cost in the NSM group. Conclusion: In our cohort, NSM was not significantly more expensive than traditional SSM. Opportunities for cost savings may be obtained in NSM with decreased OR time and decreased post-op visits. Continued collaboration with our plastic surgery colleagues regarding choice of less expensive implantable devices at time of mastectomy may provide additional opportunities for cost savings. EMTREE DRUG INDEX TERMS polyglactin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cost benefit analysis human mastectomy nipple society surgeon EMTREE MEDICAL INDEX TERMS acellular dermal matrix cost control devices finance follow up health hospital length of stay medical record review medical technology model money operation duration outpatient outpatient care patient plastic surgery procedures skin Student t test surgery surgical oncologist tissue expander LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71448827 DOI 10.1245/s10434-014-3672-z FULL TEXT LINK http://dx.doi.org/10.1245/s10434-014-3672-z COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 347 TITLE Outcomes following elevation of serratus anterior fascia during prosthetic breast reconstruction AUTHOR NAMES Seth A.K. Hirsch E.M. Kim J.Y. Fine N.A. AUTHOR ADDRESSES (Seth A.K.; Hirsch E.M.; Kim J.Y.; Fine N.A.) Division of Plastic Surgery, Northwestern University, Feinberg School of Medicine, Chicago, United States. CORRESPONDENCE ADDRESS A.K. Seth, Division of Plastic Surgery, Northwestern University, Feinberg School of Medicine, Chicago, United States. SOURCE Annals of Surgical Oncology (2014) 21 SUPPL. 2 (108). Date of Publication: April 2014 CONFERENCE NAME 15th Annual Meeting of the American Society of Breast Surgeons CONFERENCE LOCATION Las Vegas, NV, United States CONFERENCE DATE 2014-04-30 to 2014-05-04 ISSN 1068-9265 BOOK PUBLISHER Springer New York ABSTRACT Objective: Achieving optimal inferolateral coverage is critical to successful prosthetic breast reconstruction. Serratus anterior fascia (SF) elevation, a promising alternative to muscle flaps and allograft implantation, has not been rigorously studied. This study evaluates complication rates following mastectomy and immediate tissue expander reconstruction using serratus anterior muscle (SM) or fascia. Methods: Retrospective review of consecutive patients undergoing mastectomy with immediate tissue expander reconstruction over a 10-year period at 1 institution was performed. Patients with SM or SF elevation were selected for analysis. Reconstructions using acellular dermis were excluded. Relevant demographic and clinical data were recorded. Complications were categorized by type and end-outcome, including nonoperative (no further surgery), operative (further surgery except explantation), and explantation. Results: Elevation of SM and SF was performed in 375 (487 breasts) and 177 (255 breasts) patients, respectively. Mean follow-up was 36.3 months. SM and SF patients were demographically similar, but SF had higher intraoperative fill volumes (p < 0.0001) and required fewer postoperative expansions (p < 0.0001). There were no differences in complication rates between SM and SF patients. Regression analysis, adjusted for several clinical variables, revealed that SF elevation was not an independent risk factor for any complication type. Conclusion: Our review, the largest to date, demonstrates that SF elevation is a safe, feasible alternative for achieving inferolateral coverage during prosthetic breast reconstruction. Furthermore, this technique provides the benefit of greater intraoperative fill volumes, and less postoperative expansions, than SM. As a readily available alternative to routine muscle flaps and allograft implantation, SF elevation should be considered integral to any prosthetic breast reconstruction algorithm. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast breast reconstruction fascia human society surgeon EMTREE MEDICAL INDEX TERMS acellular dermal matrix algorithm allograft clinical study explant follow up implantation mastectomy muscle muscle flap patient regression analysis risk factor surgery tissue expander LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71448807 DOI 10.1245/s10434-014-3672-z FULL TEXT LINK http://dx.doi.org/10.1245/s10434-014-3672-z COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 348 TITLE Recurrent breast cancer in the subpectoral space after implant reconstruction AUTHOR NAMES Pitcher A.A. Chao J.W. Varma S. Swistel A.J. Otterburn D.M. AUTHOR ADDRESSES (Pitcher A.A.) Columbia University, College of Physicians and Surgeons, New York NY, United States. (Chao J.W.; Varma S.; Swistel A.J.; Otterburn D.M., dmo9004@med.cornell.edu) Weill Cornell Medical College, 425, East 61st Street, New York, NY 10065, United States. CORRESPONDENCE ADDRESS D.M. Otterburn, Weill Cornell Medical College, 425, East 61st Street, New York, NY 10065, United States. Email: dmo9004@med.cornell.edu SOURCE Journal of Surgical Oncology (2014) 109:5 (431-433). Date of Publication: April 2014 ISSN 0022-4790 1096-9098 (electronic) BOOK PUBLISHER Wiley-Liss Inc., 111 River Street, Hoboken, United States. ABSTRACT Breast reconstruction after mastectomy is most commonly performed with a prosthetic implant placed beneath the pectoralis major. Recurrence may rarely be identified in the subpectoral space where the implant was placed. We report a case of recurrent breast cancer after implant-based reconstruction with isolated subpectoral recurrence discovered 5 years later during secondary revision of her reconstructed breast. © 2013 Wiley Periodicals, Inc. EMTREE DRUG INDEX TERMS cyclophosphamide (drug combination, drug therapy) doxorubicin (drug combination, drug therapy) epidermal growth factor receptor 2 (endogenous compound) estrogen receptor (endogenous compound) paclitaxel (drug therapy) progesterone receptor (endogenous compound) sodium chloride tamoxifen (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast carcinoma (drug therapy, drug therapy, surgery, therapy) breast implant saline implant EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult article axillary lymph node breast reconstruction breast tissue expander cancer adjuvant therapy case report female follow up histopathology human lymph node metastasis lymph vessel metastasis mastectomy micrometastasis priority journal subcutaneous fat young adult CAS REGISTRY NUMBERS cyclophosphamide (50-18-0) doxorubicin (23214-92-8, 25316-40-9) epidermal growth factor receptor 2 (137632-09-8) paclitaxel (33069-62-4) sodium chloride (7647-14-5) tamoxifen (10540-29-1) EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014204852 MEDLINE PMID 24258514 (http://www.ncbi.nlm.nih.gov/pubmed/24258514) PUI L52885467 DOI 10.1002/jso.23505 FULL TEXT LINK http://dx.doi.org/10.1002/jso.23505 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 349 TITLE Risk-reducing mastectomy and breast reconstruction for BRCA1, BRCA2 carriers and high-risk women and role of acellular dermal matrices in reducing the risk of revision surgery AUTHOR NAMES Valassiadou K. Lambert K. Desai M. AUTHOR ADDRESSES (Valassiadou K.; Lambert K.; Desai M.) University Hospitals of Leicester NHS Trust, Breast Surgery, Leicester, United Kingdom. CORRESPONDENCE ADDRESS K. Valassiadou, University Hospitals of Leicester NHS Trust, Breast Surgery, Leicester, United Kingdom. SOURCE European Journal of Cancer (2014) 50 SUPPL. 2 (S145). Date of Publication: March 2014 CONFERENCE NAME 9th European Breast Cancer Conference, EBCC-9 CONFERENCE LOCATION Glasgow, United Kingdom CONFERENCE DATE 2014-03-19 to 2014-03-21 ISSN 0959-8049 BOOK PUBLISHER Elsevier Ltd ABSTRACT Background: Breast reconstruction is an option for BRCA1 or BRCA2 mutation carriers and other high-risk women who elect to undergo prophylactic mastectomy to prevent breast cancer. The use of acellular dermal matrices has become increasingly popular in immediate and delayed tissue expander/implant-based reconstruction. However, their association with postoperative complication rates in this specific group is unclear. Material and Methods: All risk-reducing mastectomies (RRM) by a single surgeon in a University Hospital from 2003 to 2013 were reviewed. The type of surgery and the complications were recorded. Results: Outcomes from 92 RRM procedures in 48 patients (21 patients with previous breast cancer) were analysed, 26 (54%) were BRCA1 and 9 (19%) BRCA2 carriers. Incidental in situ cancer was found in 1 BRCA2 carrier but none in the non-BRCA positive cohort. Of 92 mastectomies, 83 (90%) had implant-based and 5 (5%) flapbased reconstructions, 30 (33%) were nipple preserving and 34 (37%) mastectomies had acellular dermal matrices (Strattice or Surgimend). In a median follow-up of 29 months (range 2-120), two patients from high-risk families and with previous breast cancer developed local- regional recurrences in the non-BRCA-positive cohort. All cause revision surgery was performed following 35 (38%) procedures and the incidence of infection/necrosis was 21% (19/92) (3 major, 18 minor). The risk of infection/necrosis was significantly higher in smokers (37% vs. 14%; P = 0.027) and breasts with previous radiotherapy although not statistically significant for the latter (30% vs. 19%; P = 0.416). There was a trend of reduced revision rate in patients who had acellular dermal matrix (35% vs. 49%; P = 0.269) with no effect on the infection/necrosis rate (21% vs. 23%; P = 1). Patients having 1-stage implant procedure had significantly higher risk of revision surgery as compared to 2-stage implant (47% vs. 17%; P = 0.008) Conclusions: Risk-reducing mastectomy in patients with BRCA1 and BRCA2 mutations and other high-risk women carries a significant risk of revision surgery and should be offered only after careful counselling, especially in smokers. 2-stage implant is superior to 1-stage and use of acellular dermal matrices is safe with no increased operative complication rate and may play an important role in reducing revision rate. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast cancer breast reconstruction female human mastectomy risk surgery EMTREE MEDICAL INDEX TERMS breast counseling follow up implant mutation neoplasm nipple patient patient history of radiotherapy postoperative complication procedures smoking surgeon tissues university hospital LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71404019 DOI 10.1016/S0959-8049(14)70094-2 FULL TEXT LINK http://dx.doi.org/10.1016/S0959-8049(14)70094-2 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 350 TITLE Applications of acellular dermal matrix in high-risk patient group having breast reconstruction AUTHOR NAMES Valassiadou K. Aslam M.I. Desai M. AUTHOR ADDRESSES (Valassiadou K.; Aslam M.I.; Desai M.) University Hospitals of Leicester NHS Trust, Breast Surgery, Leicester, United Kingdom. CORRESPONDENCE ADDRESS K. Valassiadou, University Hospitals of Leicester NHS Trust, Breast Surgery, Leicester, United Kingdom. SOURCE European Journal of Cancer (2014) 50 SUPPL. 2 (S152-S153). Date of Publication: March 2014 CONFERENCE NAME 9th European Breast Cancer Conference, EBCC-9 CONFERENCE LOCATION Glasgow, United Kingdom CONFERENCE DATE 2014-03-19 to 2014-03-21 ISSN 0959-8049 BOOK PUBLISHER Elsevier Ltd ABSTRACT Background: Patients may choose to have breast reconstruction with autologous tissue or implants. The two-stage tissue expander/implant reconstruction is currently the gold standard method of implant-based immediate breast reconstruction. There is tremendous interest in using acellular dermal matrix (ADM), particularly in the setting of one-stage direct to implant reconstruction where it was previously not usually performed without the intermediary use of a temporary tissue expander and also in high-risk cases such as smokers and following adjuvant radiotherapy. Material and Methods: All procedures using ADM by a single surgeon in a University Hospital from 2010 to 2013 were reviewed. The type of surgery and the complications were recorded. Results: Outcomes from 60 breast reconstruction procedures using ADM in 39 patients (21 patients with previous breast cancer) were analysed. ADM (Strattice or Surgimend) was used at the time of mastectomy in 46 (77%) procedures and during exchange or revision in 13 (22%) procedures. The infection/necrosis rate was not statistically different between the 2 groups (24% vs. 31%; P = 0.721). Patients with a history of smoking had a significant risk of developing infection or necrosis (although usually minor necrosis) as compared to non-smokers (50% vs. 15%; P = 0.006). Similarly patients with previous radiotherapy in ipsilateral breast had higher complication rate as compared to no radiotherapy (66% vs. 22%; P = 0.038). The rate of implant loss in smokers was 10% vs. 2.5% in non-smokers (P = 0.255) however it was significantly higher in patients with previous radiotherapy as compared to patients not having radiotherapy (50% vs. 6%; P = 0.010). For smokers, revision surgery was needed following 6 (32%) procedures compared to 7 (18%) in non-smokers (P = 0.314) and in patients with previous ipsilateral radiotherapy, revision surgery was performed in 3 (50%) cases compared to 10 (19%) in patients with no previous radiotherapy (P = 0.109). These differences are noticeable although not statistically significant which may be related to small numbers. Conclusions: Although ADM has proven to be a reliable tool in managing some of the most common and challenging problems in implantbased breast reconstruction, its use in high-risk patient population including smokers and patients with previous ipsilateral radiotherapy should be considered only after careful selection and counselling. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast cancer breast reconstruction high risk patient human EMTREE MEDICAL INDEX TERMS adjuvant therapy breast counseling gold standard implant infection mastectomy necrosis patient patient history of radiotherapy population procedures radiotherapy risk smoking surgeon surgery tissue expander tissues university hospital LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71404043 DOI 10.1016/S0959-8049(14)70094-2 FULL TEXT LINK http://dx.doi.org/10.1016/S0959-8049(14)70094-2 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 351 TITLE Tumescent technique does not increase the risk of complication following mastectomy with immediate reconstruction AUTHOR NAMES Khavanin N. Fine N.A. Bethke K.P. Mlodinow A.S. Khan S.A. Jeruss J.S. Hansen N.M. Kim J.Y.S. AUTHOR ADDRESSES (Khavanin N.; Fine N.A.; Mlodinow A.S.; Kim J.Y.S., jokim@nmh.org) Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States. (Bethke K.P.; Khan S.A.; Jeruss J.S.; Hansen N.M.) Lynn Sage Breast Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States. CORRESPONDENCE ADDRESS Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States. SOURCE Annals of Surgical Oncology (2014) 21:2 (384-388). Date of Publication: February 2014 ISSN 1068-9265 1534-4681 (electronic) BOOK PUBLISHER Springer New York, 233 Spring Street, New York, United States. ABSTRACT Background: Despite the growing interest in the advantages of tumescent mastectomy technique, there remain concerns that tumescent solution may increase postoperative complication rates. This study evaluates patient outcomes following tumescent mastectomy in the setting of immediate prosthetic reconstruction. Methods: Retrospective review of 1,491 breasts (1,030 patients) treated by 4 oncologic and 2 reconstructive surgeons between 2004 and 2012 at a single institution. The primary outcomes of interest included seroma, hematoma, infection, and mastectomy flap necrosis, as well as conversion to autologous reconstruction. Multiple logistic regression was used to determine the adjusted influence of tumescence on outcomes. Results: The tumescent cohort (n = 890 breasts) was younger and experienced lower rates of preoperative radiation than the nontumescent cohort (n = 601 breasts). Mean follow-up was 21.2 months. While tumescent procedures were on average 20 min faster, postoperative complication rates did not significantly differ between cohorts. Regression analysis controlling for potential confounders, including differences in surgeon technique, failed to identify tumescent mastectomy as an independent risk factor for complication [odds ratio (OR) = 1.2, 95 % confidence interval (CI) = 0.8-1.8, p = 0.385]. Individually, neither seroma, hematoma, infection, nor flap necrosis was affected significantly by the use of tumescence (OR = 1.66, 95 % CI = 0.73-3.78, p = 0.229; OR = 1.11, 95 % CI = 0.42-2.95, p = 0.837; OR = 0.84, 95 % CI = 0.4-1.75, p = 0.689; OR = 1.19, 95 % CI = 0.7-2.03, p = 0.67, respectively). Discussion: This longitudinal study is well equipped to assess the influence of tumescent mastectomy technique in the hands of experienced and high-volume oncologic surgeons on postoperative outcomes. Our analysis suggests that in the setting of an immediate prosthetic reconstruction, tumescent mastectomy does not independently affect postoperative complication rates. © 2013 Society of Surgical Oncology. EMTREE DRUG INDEX TERMS antibiotic agent (drug therapy, intravenous drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction mastectomy postoperative complication (complication) tumescent mastectomy EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult article body mass breast tissue expander cancer surgery cohort analysis follow up graft necrosis (complication) hematoma (complication) human major clinical study mastectomy flap necrosis (complication) medical record review middle aged operation duration outcome assessment postoperative infection (complication, drug therapy) preoperative radiotherapy retrospective study risk factor seroma (complication) EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014149853 MEDLINE PMID 24121881 (http://www.ncbi.nlm.nih.gov/pubmed/24121881) PUI L372492795 DOI 10.1245/s10434-013-3311-0 FULL TEXT LINK http://dx.doi.org/10.1245/s10434-013-3311-0 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 352 TITLE The effect of radiation on acellular dermal matrix and capsule formation in breast reconstruction: clinical outcomes and histologic analysis. AUTHOR NAMES Moyer H.R. Pinell-White X. Losken A. AUTHOR ADDRESSES (Moyer H.R.) Atlanta, Ga. From the Division of Plastic and Reconstructive Surgery, Emory University; and Atlanta Plastic Surgery. (Pinell-White X.; Losken A.) CORRESPONDENCE ADDRESS H.R. Moyer, Atlanta, Ga. From the Division of Plastic and Reconstructive Surgery, Emory University; and Atlanta Plastic Surgery. SOURCE Plastic and reconstructive surgery (2014) 133:2 (214-221). Date of Publication: Feb 2014 ISSN 1529-4242 (electronic) ABSTRACT The authors compared clinical outcomes to determine whether acellular dermal matrix altered the capsular tissue architecture in irradiated and nonirradiated breasts following matrix-assisted expander reconstruction. Part I included all 27 patients who underwent bilateral tissue expander reconstruction with acellular dermal matrix between 2007 and 2012 and subsequent unilateral radiation therapy. Part II included a subset of patients with capsular biopsy specimens taken at the time of implant exchange for histologic analysis. Specimens included irradiated and nonirradiated acellular dermal matrix and irradiated and nonirradiated native capsule. Clinical outcomes were analyzed in relation to capsule architecture and acellular dermal matrix performance. In part I, mean follow-up was 28 months. Grade III/IV contractures were identified in nine patients (all on the irradiated side), and 12 developed noncontracture complications (75 percent on the irradiated side). Nine patients were unable to continue with implant reconstruction and required salvage with autologous tissue. In part II, postirradiation biopsy specimens were taken of the peri-implant capsule in six patients at the time of secondary surgery. Elastin content and the total cellular infiltrate were significantly greater in the irradiated versus nonirradiated native capsules (p = 0.0015). Conversely, the irradiated matrix capsule was composed of similar amounts of cellular infiltrate and collagen as the nonirradiated matrix capsules and nonirradiated native capsules. Irradiated acellular dermal matrix showed the least amount of alpha-smooth actin staining but a similar number of blood vessels. Acellular dermal matrix appears to limit the elastosis and chronic inflammation seen in irradiated implant reconstructions and is potentially beneficial in these patients. Therapeutic, III. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction implant capsular contracture (etiology) radiotherapy (adverse drug reaction) tissue expansion EMTREE MEDICAL INDEX TERMS adult article female human methodology middle aged pathology radiation exposure treatment outcome LANGUAGE OF ARTICLE English MEDLINE PMID 24469157 (http://www.ncbi.nlm.nih.gov/pubmed/24469157) PUI L372661934 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 353 TITLE Poland's breast reconstruction with decellularized human dermal allograft AUTHOR NAMES Ortiz J.A. AUTHOR ADDRESSES (Ortiz J.A.) Department of Surgery, Womack Army Medical Center, 2817 Reilly Road, Stop A, Fort Bragg, NC 28310 SOURCE Military medicine (2014) 179:2 (e249-e252). Date of Publication: 1 Feb 2014 ISSN 1930-613X (electronic) ABSTRACT The eponym of Poland's syndrome is given to a condition described by Sir Alfred Poland in 1941. The condition is characterized by a myriad of anomalies of the chest wall with multiple theories of its etiology. Usually, the patient that presents to the reconstructive breast surgeon is a female with some degree of abnormal development of her affected ipsilateral breast. Numerous options of breast reconstruction have been described in the literature for patients with Poland's breast anomalies. These include the use of autologous tissue, prosthetic material, or a combination of both. The use of dermal allograft for breast reconstruction in breast cancer has become extremely helpful and prevalent. Currently, the use of dermal allograft with the aid of the pectoralis major muscle is one of the most common techniques for breast reconstruction. However, with the absence of the pectoralis major muscle as is in the case of Poland's syndrome the utility of this technique is unknown. In this article the author describes the case of a patient with severe breast hypoplasia secondary to Poland's syndrome and the successful use of decellularized human dermal allograft only and a tissue expander, followed by postoperative adjustable mammary prosthesis. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix procedures EMTREE MEDICAL INDEX TERMS adult allotransplantation breast implant breast reconstruction case report devices female human Poland syndrome (surgery) skin transplantation tissue expansion LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24491626 (http://www.ncbi.nlm.nih.gov/pubmed/24491626) PUI L603635790 DOI 10.7205/MILMED-D-13-00276 FULL TEXT LINK http://dx.doi.org/10.7205/MILMED-D-13-00276 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 354 TITLE Beyond biologics: absorbable mesh as a low-cost, low-complication sling for implant-based breast reconstruction. AUTHOR NAMES Tessler O. Reish R.G. Maman D.Y. Smith B.L. Austen Jr. W.G. AUTHOR ADDRESSES (Tessler O.) Boston, Mass. From the Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School. (Reish R.G.; Maman D.Y.; Smith B.L.; Austen Jr. W.G.) CORRESPONDENCE ADDRESS O. Tessler, Boston, Mass. From the Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School. SOURCE Plastic and reconstructive surgery (2014) 133:2 (90e-9e). Date of Publication: Feb 2014 ISSN 1529-4242 (electronic) ABSTRACT There is an intense push to decrease overall healthcare costs in the United States. Although the use of acellular dermal matrix in implant-based reconstruction has grown significantly over the past decade, potential drawbacks remain a source of debate. Matrices are costly and not universally available across institutions, whereas Vicryl mesh is widely available, relatively inexpensive, and resistant to bacteria biofilm formation. With the intent of maximizing the reconstructive and economic advantages of direct-to-implant breast reconstruction, the authors report the first experience in the literature using an absorbable mesh as an inferolateral sling. A retrospective review was performed of the first 50 consecutive patients (76 reconstructions) who underwent implant-based breast reconstruction with Vicryl mesh from August of 2011 until June of 2012. Fifty patients underwent 76 direct-to-implant reconstructions with Vicryl mesh between August of 2011 and June of 2012 (mean follow-up, 1.2 years). Five breasts (6.6 percent) had complications, with only one complication resulting in implant loss (1.3 percent). Implant positioning and contour were excellent, with only two patients [three breasts (3.9 percent)] undergoing revision procedures, for size enlargement. Using costs available at the authors' institution, use of Vicryl mesh instead of acellular dermal matrix resulted in a direct material cost savings of $172,112 in 10 months. Results to date have been encouraging, with a low complication rate (6.6 percent) and excellent aesthetic results. The technique has resulted in $172,112 in direct material cost savings over 10 months. Continued follow-up is planned to evaluate long-term results. Therapeutic, IV. EMTREE DRUG INDEX TERMS biomaterial EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) biodegradable implant (adverse drug reaction) breast augmentation (adverse drug reaction) surgical mesh (adverse drug reaction) EMTREE MEDICAL INDEX TERMS adult aged article cost economics female human methodology middle aged postoperative complication (etiology, prevention) retrospective study LANGUAGE OF ARTICLE English MEDLINE PMID 24469217 (http://www.ncbi.nlm.nih.gov/pubmed/24469217) PUI L372661993 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 355 TITLE First experience using contrast-enhanced ultrasound to evaluate vascularisation of acellular dermal matrices after implant-based breast reconstruction AUTHOR NAMES Parvizi D. Haas F. Peintinger F. Hubmer M. Rappl T. Koch H. Schintler M. Spendel S. Kamolz L.-P. Wurzer P. Tuca A. Fuchsjaeger M. Weinke R. AUTHOR ADDRESSES (Parvizi D., daryousch.parvizi@medunigraz.at; Haas F.; Hubmer M.; Rappl T.; Koch H.; Schintler M.; Spendel S.; Kamolz L.-P.; Wurzer P.; Tuca A.) Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, Graz, Austria. (Peintinger F.) Department of Senology, Breast Center of University Hospital Salzburg, LKH Leoben, Leoben, Austria. (Fuchsjaeger M.; Weinke R.) Department of Radiology, Medical University of Graz, Graz, Austria. CORRESPONDENCE ADDRESS D. Parvizi, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, Graz, Austria. SOURCE Breast Journal (2014) 20:5 (461-467). Date of Publication: 2014 ISSN 1524-4741 (electronic) 1075-122X BOOK PUBLISHER Blackwell Publishing Inc., subscrip@blackwellpub.com ABSTRACT Acellular dermal matrices (ADM) have been used frequently in therapeutic and prophylactic breast procedures. To date there have been no reports on vascularisation of ADMs and formation of tissue around them as seen with modern non-invasive imaging techniques such as contrast-enhanced ultrasound (CEUS). In this case series, we used CEUS to investigate the features of ADM in relation to vascular ingrowth and scaffold for "new" tissue formation. This is a retrospective evaluation of patients who underwent successful skin- and nipple-sparing mastectomy (SSM, NSM) with immediate IBBR using ADM from May 31, 2010, through December 28, 2012. Over a 24-month period, 16 patients, with an average age of 44 years (range 27-70 years), were evaluated with CEUS. No contrast agent allergies or side effects were reported for the ultrasound examination. After contrast agent injection (1-18 months postoperatively), homogeneous normal enhancement in the ADM and peripheral region with physiological tissue formation was seen in all patients. In this small study, the most obvious contribution of CEUS is the in vivo evaluation of vascular ingrowth and tissue formation after IBBR with ADM after follow-up of 1-18 months postoperatively. Level of Evidence III: Retrospective cohort or comparative study; case-control study; or systematic review of these studies. EMTREE DRUG INDEX TERMS sulfur hexafluoride (intravenous drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation breast implant contrast enhancement contrast-enhanced ultrasound echography vascularization EMTREE MEDICAL INDEX TERMS adult aged article breast cancer (surgery) cancer prevention cancer surgery clinical article female human in vivo culture inflammation (complication) mastectomy partial mastectomy patient history of chemotherapy patient history of radiotherapy retrospective study seroma (complication) silicone breast implant smoking EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) Drug Literature Index (37) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014731293 MEDLINE PMID 25041092 (http://www.ncbi.nlm.nih.gov/pubmed/25041092) PUI L53233040 DOI 10.1111/tbj.12301 FULL TEXT LINK http://dx.doi.org/10.1111/tbj.12301 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 356 TITLE Acellular bovine pericardium dermal matrix in immediate breast reconstruction after skin sparing mastectomy AUTHOR NAMES Gubitosi A. Docimo G. Parmeggiani D. Pirozzi R. Vitiello C. Schettino P. Avellino M. Casalino G. Amato M. Ruggiero R. Docimo L. AUTHOR ADDRESSES (Gubitosi A.; Docimo G.; Parmeggiani D.; Pirozzi R.; Vitiello C.; Schettino P.; Avellino M.; Casalino G.; Ruggiero R., roberto.ruggiero@unina2.it; Docimo L.) Department of Surgery, Second University of Naples, Via Pansini 5, Naples, Italy. (Amato M.) Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy. CORRESPONDENCE ADDRESS R. Ruggiero, Department of Surgery, Second University of Naples, Via Pansini 5, Naples, Italy. SOURCE International Journal of Surgery (2014) 12 Supplement.1 (205-208). Date of Publication: 2014 ISSN 1743-9159 (electronic) 1743-9191 BOOK PUBLISHER Elsevier Ltd ABSTRACT Introduction: Mastectomy for breast cancer may bring the patient to develop long term issues concerning the psychological and physical status. Immediate breast reconstruction (IBR) should be considered and proposed by physicians as an integrated procedure in the surgical approach to breast cancer to reduce further surgery. Acellular dermal matrix (ADM) has been used in revision breast reconstruction for fold malposition, capsular contracture and rippling also, showing good outcomes with low risk of complications. Aim of this study was to verify if the known advantages in using ADM for IBR would led to lower rates of seroma formation, infection, skin flap necrosis and overall complication related to the implant. Methods: We performed a prospective study, including all consecutive patients undergone to IBR with biological graft with ADM between January 2012 and January 2013 at our Institution. Data on major issues of the patients and complications were recorded. All patients underwent to IBR with ADM (Tutomesh) implant with or without fibrin sealant positioning. Results: A total of 24 patients underwent 28 immediate breast reconstruction with Tutomesh ADM implant. Main postoperative complications included seroma formation in 20.8% (5 pts), infection in 8.3% (2 pts) and hematoma in 4.2% (1 pt). There were any skin flap necrosis in the study. Diabetes was associated in two cases with edema and ecchymosis; hypertension with infection in one case (implant removal) and seroma in one case. First class of obesity (BMI 30e32.7) was associated with seroma in 3 cases, and with infection in one. In patient without fibrin sealant (12 patients e 13 breasts) complications were represented by hematoma (1 pt. 4.2%), infection (1 pt. 4.2%; implant removal) and seroma (4 pts 16.8%). Conclusions: The use of Tutomesh® bovine pericardium for immediate breast is safe and technically useful. Complications rate is not high, except for seroma formation that can be reduced by the contemporary use of fibrin sealant. EMTREE DRUG INDEX TERMS fibrin glue EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant breast reconstruction immediate breast reconstruction mastectomy pericardium surgical mesh EMTREE MEDICAL INDEX TERMS adult aged article bovine breast cancer (surgery) cancer surgery clinical article controlled study ecchymosis (complication) edema (complication) female graft necrosis (complication) hematoma (complication) human hypertension (complication) postoperative complication (complication) prospective study seroma (complication) skin flap surgical infection (complication) DEVICE TRADE NAMES Tutomesh EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014902730 MEDLINE PMID 24859403 (http://www.ncbi.nlm.nih.gov/pubmed/24859403) PUI L600453352 DOI 10.1016/j.ijsu.2014.05.007 FULL TEXT LINK http://dx.doi.org/10.1016/j.ijsu.2014.05.007 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 357 TITLE Imaging features of AlloDerm(®) used in postmastectomy breast reconstructions AUTHOR NAMES Lee C. Clapp A. Jacobson S. AUTHOR ADDRESSES (Lee C.; Clapp A.; Jacobson S.) Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. SOURCE Journal of Clinical Imaging Science (2014) 4:1 Article Number: 131641. Date of Publication: January/March 2014 ISSN 2156-5597 (electronic) BOOK PUBLISHER Medknow Publications, B9, Kanara Business Centre, off Link Road, Ghatkopar (E), Mumbai, India. ABSTRACT The purpose of this pictorial essay is to demonstrate the imaging features (ultrasound, mammogram, and magnetic resonance imaging (MRI)) of AlloDerm (®) (LifeCell Corp.; Branchburg, NJ), an acellular dermal matrix sometimes used in both primary and reconstructive breast surgeries. AlloDerm(®) is derived from cadaveric dermis and provides an immunologically inert scaffold in tissue reconstruction. Since there is little literature on the imaging of this substance, radiologists may be unfamiliar with its appearance in breast imaging. For this manuscript, ex vivo and in vivo images of AlloDerm(®) in postmastectomy patients were evaluated using different imaging modalities. The appearance of AlloDerm(®) can vary based on length of time postsurgery and incorporation into the host. AlloDerm(®) appears as an isodense to glandular tissue on a mammogram and isoechoic to glandular tissue on ultrasound imaging. On MRI, in comparison with normal breast parenchyma, AlloDerm(®) is hyperintense on T2-weighted imaging and isointense on T1-weighted imaging and demonstrates mild enhancement. To the best of the authors' knowledge, this is the first multimodality imaging description of AlloDerm(®) used in postmastectomy patients. The conformation of AlloDerm(®) at surgical placement and the degree of host cell migration and neoangiogenesis are factors to take into consideration when performing diagnostic evaluations; and, familiarity with the various imaging appearances of AlloDerm(®) can be helpful to exclude residual or recurrent disease. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction mastectomy nuclear magnetic resonance imaging surgical mesh EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult angiogenesis breast carcinoma (surgery) breast implant cancer surgery case report echography ex vivo study female follow up human mammography priority journal review DEVICE TRADE NAMES AlloDerm , United StatesLifecell DEVICE MANUFACTURERS (United States)Lifecell EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014421268 PUI L373353026 DOI 10.4103/2156-7514.131641 FULL TEXT LINK http://dx.doi.org/10.4103/2156-7514.131641 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 358 TITLE Complication prevalence following use of tutoplast-derived human acellular dermal matrix in prosthetic breast reconstruction: A retrospective review of 203 patients AUTHOR NAMES Rundell V.L.M. Beck R.T. Wang C.E. Gutowski K.A. Sisco M. Fenner G. Howard M.A. AUTHOR ADDRESSES (Rundell V.L.M.; Beck R.T.; Sisco M.; Fenner G.; Howard M.A., mhoward@northshore.org) Division of Plastic Surgery, NorthShore University HealthSystem, Evanston, United States. (Wang C.E.) Department of Surgery, NorthShore University HealthSystem, Evanston, United States. (Wang C.E.) Center for Clinical Research Informatics, NorthShore University HealthSystem, Evanston, United States. (Gutowski K.A.) Department of Plastic Surgery, Ohio State University, School of Medicine, Columbus, United States. CORRESPONDENCE ADDRESS M.A. Howard, Division of Plastic Surgery, NorthShore University HealthSystem, Evanston, United States. SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2014) 67:10 (1345-1351). Date of Publication: 2014 ISSN 1878-0539 (electronic) 1748-6815 BOOK PUBLISHER Churchill Livingstone ABSTRACT Use of human acellular dermal matrix (ADM) during prosthetic breast reconstruction has increased. Several ADM products are available produced by differing manufacturing techniques. It is not known if outcomes vary with different products. This study reports the complication prevalence following use of a tutoplast-derived ADM (T-ADM) in prosthetic breast reconstruction. We performed a retrospective chart review of 203 patients (mean follow-up times 12.2 months) who underwent mastectomy and immediate prosthetic breast reconstruction utilizing T-ADM, recording demographic data, surgical indications and complication (infection, seroma, hematoma, wound healing exceeding three weeks and reconstruction failure). During a four-year period, 348 breast reconstructions were performed Complications occurred in 16.4% of reconstructed breasts. Infection occurred in 6.6% of breast reconstructions (3.7% e major infection, requiring intravenous antibiotics and 2.9% minor infection, requiring oral antibiotics only). Seromas occurred in 3.4% and reconstruction failure occurred in 0.6% of breast reconstructions. Analysis suggested that complication prevalence was significantly higher in patients with a BMI >30 (p = 0.03). The complication profile following T-ADM use is this series is comparable to that reported for with other ADM products. T-ADM appears to be a safe and acceptable option for use in ADM-assisted breast reconstruction. EMTREE DRUG INDEX TERMS antibiotic agent (drug therapy, intravenous drug administration, oral drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction breast tissue expander (adverse device effect) medical device complication (complication) tissue implant (adverse device effect) EMTREE MEDICAL INDEX TERMS adult antibiotic therapy controlled study female follow up graft failure (complication) hematoma (complication) human major clinical study mastectomy medical record review middle aged postoperative complication prevalence priority journal prosthesis infection (complication, drug therapy, surgery) reconstruction failure (complication) reoperation retrospective study review risk reduction seroma (complication) surgical mesh tissue expander (adverse device effect) wound healing impairment (complication) DEVICE TRADE NAMES AlloMax , United StatesBard AlloMax , United StatesDavol RTI Biologics TutoPlast EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014737215 MEDLINE PMID 24917371 (http://www.ncbi.nlm.nih.gov/pubmed/24917371) PUI L53178482 DOI 10.1016/j.bjps.2014.05.032 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2014.05.032 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 359 TITLE Immediate breast reconstruction with acellular dermal matrix: Factors affecting outcome AUTHOR NAMES Lardi A.M. Ho-Asjoe M. Mohanna P.-N. Farhadi J. AUTHOR ADDRESSES (Lardi A.M., Alessia.Lardi@usb.ch; Ho-Asjoe M.; Mohanna P.-N.; Farhadi J.) Department of Plastic and Reconstructive Surgery, Guy's and St. Thomas Hospital, London, United Kingdom. (Lardi A.M., Alessia.Lardi@usb.ch; Farhadi J.) Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland. (Farhadi J.) Center for Plastic Surgery, Clinic Pyramide at the Lake, Zürich, Switzerland. CORRESPONDENCE ADDRESS A.M. Lardi, Department of Plastic and Reconstructive Surgery, Guy's and St. Thomas Hospital, London, United Kingdom. Email: Alessia.Lardi@usb.ch SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2014) 67:8 (1098-1105). Date of Publication: August 2014 ISSN 1878-0539 (electronic) 1748-6815 BOOK PUBLISHER Churchill Livingstone ABSTRACT Background The use of acellular dermal matrix (ADM) for coverage of the lower pole in immediate implant-based breast reconstruction has changed surgeons' practice. We present our experience using a porcine ADM (Strattice), focusing on short-term outcomes, patient selection, and technique adaptations that may influence outcome. Methods A two-center, retrospective, cohort study was performed from December 2008 to October 2012 at Guy's and St. Thomas' Hospitals, London, and Clinic Pyramide, Zürich. The study period was divided into two periods: Period 1 which spanned from December 2008 to October 2010 and Period 2 from January 2011 to October 2012 wherein technique adaptations were introduced. Short-term complications after reconstructive surgery were compared between Periods 1 and 2. Results A total of 149 patients underwent 200 reconstructions (110 one-stage and 90 two-stage) following oncologic (134 breasts) or prophylactic (66 breasts) mastectomy. The mean follow-up was 22.2 months. The total complication rate was 32.5%, including infection, 11.5%; hematoma, 5%; seroma, 10.5%; skin necrosis, 3.5%; and serious wound breakdowns with implant exposure, 1.5%. Complications resulted in 3% requiring an early exchange of implant/expander and in 12.5% requiring explantation. A significant reduction in total complications, infection, implant exposure, and implant loss were noted in Period 2. Multivariate analysis showed time period of surgery (Period 1), single-stage reconstruction, and patient characteristics (mastectomy weight >600 g, or body mass index (BMI) > 30, or smoking) to be statistically significant risk factors for the development of postoperative complications. Neoadjuvant chemotherapy showed a trend towards higher complication rates. Conclusion The high rate of early complications in this study was mostly related to patient characteristics and learning curves and highlights the importance of patient selection and technique principles in optimizing the outcome. © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. EMTREE DRUG INDEX TERMS amoxicillin plus clavulanic acid (intravenous drug administration, oral drug administration) antineoplastic agent (adverse drug reaction) cephalosporin (intravenous drug administration, oral drug administration) gentamicin (intravenous drug administration, oral drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction immediate breast reconstruction surgical mesh (adverse device effect) EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult aged article body mass cancer adjuvant therapy cancer chemotherapy cancer radiotherapy cohort analysis comparative study contracture (complication, side effect) controlled study device infection (complication, side effect) female follow up human major clinical study mastectomy multicenter study (topic) muscle hematoma (complication, side effect) patient selection postoperative complication (complication, side effect) postoperative pain (complication, side effect) priority journal prosthesis loosening (complication, side effect) retrospective study risk factor seroma (complication, side effect) skin flap skin necrosis (complication, side effect) time to treatment tissue expansion treatment outcome wound dehiscence (complication, side effect) wound healing (complication, side effect) DEVICE TRADE NAMES AlloDerm , United StatesLifecell DEVICE MANUFACTURERS (United States)Lifecell CAS REGISTRY NUMBERS amoxicillin plus clavulanic acid (74469-00-4, 79198-29-1) cephalosporin (11111-12-9) gentamicin (1392-48-9, 1403-66-3, 1405-41-0) EMBASE CLASSIFICATIONS Radiology (14) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) Adverse Reactions Titles (38) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014442165 PUI L53185186 DOI 10.1016/j.bjps.2014.05.020 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2014.05.020 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 360 TITLE Applications of acellular dermal matrix in revision breast reconstruction surgery. AUTHOR NAMES Spear S.L. Sher S.R. Al-Attar A. Pittman T. AUTHOR ADDRESSES (Spear S.L.) Washington, D.C. From the Department of Plastic Surgery, Georgetown University Hospital. (Sher S.R.; Al-Attar A.; Pittman T.) CORRESPONDENCE ADDRESS S.L. Spear, Washington, D.C. From the Department of Plastic Surgery, Georgetown University Hospital. SOURCE Plastic and reconstructive surgery (2014) 133:1 (1-10). Date of Publication: Jan 2014 ISSN 1529-4242 (electronic) ABSTRACT Acellular dermal matrix has been used for over a decade in primary breast reconstruction. Few articles have specifically examined its use in revision breast reconstruction for fold malposition, capsular contracture, rippling, and symmastia. One hundred thirty-five revision breast reconstructive procedures using acellular dermal matrix (AlloDerm) in 118 patients (154 breasts) over a 5-year period were reviewed. Most procedures were revisions or part of the second stage of previous mastectomy reconstructions; three were revisions after reconstruction of congenital chest wall deformities. Fifty-seven revisions (37 percent) were for inferior fold malposition, followed by 40 (25.9 percent) for inferior pole support, 42 (27.2 percent) for capsular contracture, 10 (6.4 percent) for rippling, and five (3.2 percent) for symmastia. The overall complication rate was 5 percent. Revisions with acellular dermal matrix were successful in 147 of 154 breasts (95.5 percent). The most common complication was capsular contracture, occurring in five breasts (3.2 percent). There was one infection (0.6 percent), failure to lower the inframammary fold in one breast (0.6 percent), and one persistence of rippling (0.6 percent). The mean follow-up was 207 days. Acellular dermal matrix has proven to be a reliable tool for managing some of the most common and challenging problems in implant-based breast reconstruction. Although there are few published data on the success of more conventional solutions to fold malposition, lower pole support, and capsular contracture, the addition of acellular dermal matrix to buttress these repairs has been shown to provide a high likelihood of success with a low risk of complications. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction (adverse drug reaction) mastectomy (adverse drug reaction) postoperative complication (surgery) reoperation EMTREE MEDICAL INDEX TERMS adolescent adult aged article breast (surgery) breast implant (adverse drug reaction) female follow up human implant capsular contracture methodology middle aged surgical flaps thorax wall (surgery) young adult LANGUAGE OF ARTICLE English MEDLINE PMID 24105085 (http://www.ncbi.nlm.nih.gov/pubmed/24105085) PUI L563040230 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 361 TITLE DermACELL: a novel and biocompatible acellular dermal matrix in tissue expander and implant-based breast reconstruction AUTHOR NAMES Bullocks J.M. AUTHOR ADDRESSES (Bullocks J.M., Jamal@drbullocks.com) Plastic Surgery Division, Baylor College of Medicine, One Baylor Plaza, Houston, United States. CORRESPONDENCE ADDRESS J.M. Bullocks, Plastic Surgery Division, Baylor College of Medicine, One Baylor Plaza, Houston, United States. SOURCE European Journal of Plastic Surgery (2014) 37:10 (529-538). Date of Publication: 2014 ISSN 1435-0130 (electronic) 0930-343X BOOK PUBLISHER Springer Verlag, service@springer.de ABSTRACT Background: Acellular dermal matrices present a new alternative to supporting expanders and implants for breast reconstruction in breast cancer patients following mastectomy. However, some studies have suggested that acellular dermal matrix may increase the complication rates in certain clinical settings. DermACELL acellular dermal matrix offers advanced processing in order to attempt to decrease bio-intolerance and complications.Methods: Ten consecutive patients that presented for breast reconstruction and were candidates for tissue expanders underwent the procedure with the use of an acellular dermal matrix. The patients underwent postoperative expansion/adjuvant cancer therapy, then tissue expander exchange for permanent silicone breast prostheses. Patients were followed through the postoperative course to assess complication outcomes. Histologic evaluation of host integration into the dermal matrix was also assessed.Results: Of the ten patients, eight completed reconstruction while two patients failed reconstruction. The failures were related to chronic seromas and infection. Histology analysis confirms rapid integration of mesenchymal cells into the matrix compared to other acellular dermal matrices.Conclusions: Based on our observations, DermACELL is an appropriate adjunct to reconstruction with expanders. Histological analysis of vascularization and recellularization support the ready incorporation of DermACELL into host tissue.Level of Evidence: Level IV, therapeutic study. EMTREE DRUG INDEX TERMS silicone EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast breast reconstruction implant tissue expander EMTREE MEDICAL INDEX TERMS breast cancer breast prosthesis cancer patient cancer therapy histology human infection mastectomy mesenchyme cell patient procedures processing vascularization LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014709872 PUI L53269198 DOI 10.1007/s00238-014-0995-8 FULL TEXT LINK http://dx.doi.org/10.1007/s00238-014-0995-8 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 362 TITLE Applications of acellular dermal matrix in revision breast reconstruction surgery AUTHOR NAMES Spear S.L. Sher S.R. Al-Attar A. Pittman T. AUTHOR ADDRESSES (Spear S.L.; Sher S.R.; Al-Attar A.; Pittman T.) Washington, D.C. From the Department of Plastic Surgery, Georgetown University Hospital SOURCE Plastic and reconstructive surgery (2014) 133:1 (1-10). Date of Publication: 1 Jan 2014 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Acellular dermal matrix has been used for over a decade in primary breast reconstruction. Few articles have specifically examined its use in revision breast reconstruction for fold malposition, capsular contracture, rippling, and symmastia.METHODS: One hundred thirty-five revision breast reconstructive procedures using acellular dermal matrix (AlloDerm) in 118 patients (154 breasts) over a 5-year period were reviewed. Most procedures were revisions or part of the second stage of previous mastectomy reconstructions; three were revisions after reconstruction of congenital chest wall deformities.RESULTS: Fifty-seven revisions (37 percent) were for inferior fold malposition, followed by 40 (25.9 percent) for inferior pole support, 42 (27.2 percent) for capsular contracture, 10 (6.4 percent) for rippling, and five (3.2 percent) for symmastia. The overall complication rate was 5 percent. Revisions with acellular dermal matrix were successful in 147 of 154 breasts (95.5 percent). The most common complication was capsular contracture, occurring in five breasts (3.2 percent). There was one infection (0.6 percent), failure to lower the inframammary fold in one breast (0.6 percent), and one persistence of rippling (0.6 percent). The mean follow-up was 207 days.CONCLUSIONS: Acellular dermal matrix has proven to be a reliable tool for managing some of the most common and challenging problems in implant-based breast reconstruction. Although there are few published data on the success of more conventional solutions to fold malposition, lower pole support, and capsular contracture, the addition of acellular dermal matrix to buttress these repairs has been shown to provide a high likelihood of success with a low risk of complications. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix procedures EMTREE MEDICAL INDEX TERMS adolescent adult aged breast breast implant breast reconstruction female follow up human implant capsular contracture mastectomy middle aged postoperative complication (surgery) reoperation surgical flaps thorax wall young adult LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24105085 (http://www.ncbi.nlm.nih.gov/pubmed/24105085) PUI L604091799 DOI 10.1097/01.prs.0000436810.88659.36 FULL TEXT LINK http://dx.doi.org/10.1097/01.prs.0000436810.88659.36 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 363 TITLE Biologic matrices in oncologic breast reconstruction after mastectomy AUTHOR NAMES Kocak E. Nagel T.W. Hulsen J.H. Carruthers K.H. Povoski S.P. Salgado C.J. Chao A.H. AUTHOR ADDRESSES (Kocak E., Ergun.Kocak@osumc.edu; Nagel T.W.; Hulsen J.H.) Department of Plastic Surgery, Ohio State University, 915 Olentangy River Road, Columbus, OH 43212, United States. (Carruthers K.H.) University of Toledo, College of Medicine, 3000 Arlington Ave., Toledo, OH 43614, United States. (Povoski S.P.) Department of Surgery, Division of Surgical Oncology, Ohio State University, 410 West 10th Avenue, Columbus, OH 43210, United States. (Salgado C.J.; Chao A.H.) Division of Plastic Surgery, University of Miami Hospital, 1321 NW 14th St, Ste 402, Miami, FL 33125, United States. CORRESPONDENCE ADDRESS E. Kocak, Department of Plastic Surgery, Ohio State University, 915 Olentangy River Road, Columbus, OH 43212, United States. Email: Ergun.Kocak@osumc.edu SOURCE Expert Review of Medical Devices (2014) 11:1 (65-75). Date of Publication: January 2014 ISSN 1743-4440 1745-2422 (electronic) BOOK PUBLISHER Expert Reviews Ltd., 2 Albert Place, London, United Kingdom. ABSTRACT As the demand for post-mastectomy breast reconstruction has continued to rise, options for the implantable soft-tissue replacement products which enhance the aesthetic and reconstructive outcome of these procedures has grown as well. While the most common product used in an alloplastic breast reconstruction is an acellular dermal matrix derived from human sources, many other options are currently available, each offering their own unique properties and benefits. This review presents a concise description of each of the biologic matrices currently available and discusses their use in the context of one-stage and two-stage breast reconstructions. © 2014 Informa UK Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) biologic matrix breast cancer breast reconstruction mastectomy tissue graft EMTREE MEDICAL INDEX TERMS acellular dermal matrix allograft breast implant breast tissue expander cancer surgery dermis graft failure hematoma human infection pig postoperative care review seroma skin allograft skin necrosis submucosa surgical technique DEVICE TRADE NAMES 'NeoForm' Mentor AlloDerm Ready to Use Lifecell AlloDerm Lifecell AlloMax Bard Biodesign Surgisis Cook Medical DermaMatrix Synthes FlexHD Acellular Hydrated Dermis Ethicon Strattice Lifecell SurgiMend TEI DEVICE MANUFACTURERS Bard Cook Medical Ethicon Lifecell Mentor Synthes TEI EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014071992 MEDLINE PMID 24308736 (http://www.ncbi.nlm.nih.gov/pubmed/24308736) PUI L372205887 DOI 10.1586/17434440.2014.864087 FULL TEXT LINK http://dx.doi.org/10.1586/17434440.2014.864087 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 364 TITLE Nipple-areolar complex ischemia after nipple-sparing mastectomy with immediate implant-based reconstruction: Risk factors and the success of conservative treatment AUTHOR NAMES Dent B.L. Small K. Swistel A. Talmor M. AUTHOR ADDRESSES (Dent B.L.; Small K.; Swistel A.; Talmor M., miatmd@aol.com) Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, 425 East 61st Street, New York, NY 10065, United States. CORRESPONDENCE ADDRESS M. Talmor, Department of Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, 425 East 61st Street, New York, NY 10065, United States. Email: miatmd@aol.com SOURCE Aesthetic Surgery Journal (2014) 34:4 (560-570). Date of Publication: May 2014 ISSN 1527-330X (electronic) 1090-820X BOOK PUBLISHER SAGE Publications Inc., claims@sagepub.com ABSTRACT Background: Nipple-sparing mastectomy performed via an inframammary fold incision with implant-based reconstruction is an oncologically safe procedure that provides excellent cosmesis. Objectives: The authors report their experience with conservative treatment of postoperative nipple-areolar complex (NAC) ischemia and an analysis of risk factors for NAC ischemia and conservative treatment failure. Methods: A retrospective chart review was conducted of 318 nipple-sparing mastectomies performed through inframammary fold incisions with implant-based reconstruction between July 2006 and October 2012. NAC dressings consisted of topical nitroglycerin, external warming for 24 hours, antibacterial petrolatum gauze, and a loose bra for 1 week. Patients were monitored for NAC ischemia as the primary endpoint. NAC ischemia was treated with bacitracin ointment. In cases of full-thickness ischemia, expanders were also partially deflated. Results: Partial- and full-thickness NAC ischemia occurred in 44 (13.8%) and 21 (6.6%) cases, respectively. All partial- and 17 full-thickness cases resolved with conservative treatment. Of these, 7 partial- and 2 full-thickness cases suffered residual depigmentation. Four full-thickness cases required operative debridement. Factors associated with NAC ischemia included increasing age (P = .035), higher body mass index (P = .0009), greater breast volume (P = .0023), and diabetes (P = .0046). Factors associated with conservative treatment failure included increasing age (P < .0001), higher body mass index (P = .014), greater breast volume (P = .020), smoking (P = .0449), acellular dermal matrix use (P < .0001), and single-stage reconstruction (P = .0090). Conclusions: Postoperative NAC ischemia can be effectively managed conservatively to preserve cosmesis and implant viability. Knowledge of risk factors for NAC ischemia and conservative treatment failure may improve future patient counseling and outcomes. © 2014 The American Society for Aesthetic Plastic Surgery, Inc. EMTREE DRUG INDEX TERMS bacitracin glyceryl trinitrate petrolatum EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast disease (complication, therapy) breast implant breast reconstruction ischemia (complication, therapy) mastectomy nipple areolar complex ischemia (complication, therapy) nipple sparing mastectomy postoperative complication (complication, therapy) EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult age aged bandages and dressings body mass breast tissue expander conservative treatment debridement depigmentation diabetes mellitus female human major clinical study medical record review middle aged priority journal retrospective study review smoking treatment failure warming CAS REGISTRY NUMBERS bacitracin (1405-87-4) glyceryl trinitrate (55-63-0) petrolatum (8009-03-8) EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014286269 MEDLINE PMID 24682442 (http://www.ncbi.nlm.nih.gov/pubmed/24682442) PUI L372935803 DOI 10.1177/1090820X14528352 FULL TEXT LINK http://dx.doi.org/10.1177/1090820X14528352 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 365 TITLE Aesthetic outcomes of acellular dermal matrix in tissue expander/implant-based breast reconstruction AUTHOR NAMES Forsberg C.G. Kelly D.A. Wood B.C. Mastrangelo S.L. DeFranzo A.J. Thompson J.T. David L.R. Marks M.W. AUTHOR ADDRESSES (Forsberg C.G.; Kelly D.A.; Wood B.C.; Mastrangelo S.L.; DeFranzo A.J.; Thompson J.T.; David L.R.; Marks M.W.) From the *Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine, Winston-Salem, NC; and†Department of Surgery, University of Louisville, Louisville, KY SOURCE Annals of plastic surgery (2014) 72:6 (S116-S120). Date of Publication: 2014 ISSN 1536-3708 (electronic) ABSTRACT INTRODUCTION: Tissue expander and implant-based breast reconstruction after mastectomy is the most common method of breast reconstruction. Modifications of the traditional total submuscular reconstruction (TSR) have been made using acellular dermal matrix (ADM) to create an inferolateral sling and a more natural implant pocket for superior aesthetic results. The objective of this study was to assess aesthetic outcomes when using ADM in breast reconstruction.METHODS: A retrospective chart review identified all patients who underwent implant-based breast reconstruction from 2005 to 2009 at our institution. Demographic information, complications, reoperations, and aesthetic outcome data were collected for all patients meeting inclusion criteria related to adequate follow-up and postoperative photographs. Five aesthetic outcomes were evaluated for all study patients by 18 blinded evaluators using postoperative photographs. Outcomes were scored on a scale of 1 to 5, with 5 representing the best possible aesthetic score.RESULTS: A total of 122 patients underwent 183 tissue expander-based reconstructions (ADM, n = 58; TSR, n = 125). The infection rate in patients with ADM was 16.2% compared to 5.9% in TSR patients, but this was not statistically significant (P = 0.09). Capsular contracture was more common in TSR patients (23.5%), compared to those with ADM (8.1%), P = 0.048. Aesthetic scores from the attending plastic surgeons were as follows: natural contour (ADM, 3.36; TSR, 3.02; P = 0.0001), symmetry of shape (ADM, 3.57; TSR, 3.27; P = 0.005), symmetry of size (ADM, 3.68; TSR, 3.42; P = 0.002), position on chest wall (ADM, 3.75; TSR, 3.45; P = 0.004), and overall aesthetic appearance (ADM, 3.56; TSR, 3.20; P = 0.0001).CONCLUSIONS: For all 5 aesthetic parameters evaluated, the ADM group scored significantly higher than the TSR group by 18 blinded evaluators. These consistent findings suggest that the use of ADM in breast reconstruction does confer a significant advantage in aesthetic outcomes for breast reconstruction. This is likely at the cost of a higher infection rate when using ADM; however, that may be offset by the advantage of a lower rate of capsular contracture in patients with ADM. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix procedures EMTREE MEDICAL INDEX TERMS breast augmentation breast tumor (epidemiology, surgery) comorbidity human male middle aged tissue expansion treatment outcome LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24374398 (http://www.ncbi.nlm.nih.gov/pubmed/24374398) PUI L602111412 DOI 10.1097/SAP.0000000000000098 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0000000000000098 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 366 TITLE Circumvertical mastectomy incision: refinement in the surgical scar of implant-based breast reconstruction AUTHOR NAMES Chapman-Jackson E.D. Griner D. Brzezienski M.A. AUTHOR ADDRESSES (Chapman-Jackson E.D.; Griner D.; Brzezienski M.A.) From the Department of Plastic Surgery, University of Tennessee College of Medicine, Chattanooga, TN SOURCE Annals of plastic surgery (2014) 72:6 (S97-102). Date of Publication: 2014 ISSN 1536-3708 (electronic) ABSTRACT Different surgical incisions have been proposed for skin-sparing mastectomy in an attempt to better disguise the remaining scar. These techniques are more hidden than the Stewart incision but can still leave scars in visible places and can restrict the natural shape of the upper pole. They can also add complexity and time to the mastectomy, requiring extensive retraction that could damage the salvaged skin flaps to perform an adequate mastectomy. We present a circumvertical mastectomy incision technique, which limits the mastectomy scar to the inferior pole, provides natural lateral contour, superior pole fullness, and contributes to a more youthful breast projection. Between November 2011 and November 2012, 51 women underwent circumvertical AlloDerm/tissue expansion reconstruction at our institution by a single surgeon. The reconstruction was bilateral in 30 patients and unilateral in 21 patients for a total of 81 breasts. Of the 81 reconstructed breasts, 5 patients went on to require a latissimus dorsi flap for definitive reconstruction and 3 failed breast reconstruction for a completion rate of 96%. The goal of creating breast reconstruction results comparable to those of cosmetic breast surgery is becoming a reality. Circumvertical incision is a technique that can prevent visible upper hemispheric breast scarring, limit upper pole constriction by scar placement, and preserves or restores breast projection. Following the principles of aesthetic breast surgery and repositioning the mastectomy scar, one can reconstruct a breast with a more disguised scar, which can be hidden from the patient's downward gaze. EMTREE DRUG INDEX TERMS collagen (drug therapy) surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation procedures EMTREE MEDICAL INDEX TERMS adult aged artificial skin breast tumor (surgery) female human mastectomy middle aged scar (prevention) CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24691348 (http://www.ncbi.nlm.nih.gov/pubmed/24691348) PUI L602111548 DOI 10.1097/SAP.0000000000000094 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0000000000000094 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 367 TITLE The impact of conflicts of interest in plastic surgery: an analysis of acellular dermal matrix, implant-based breast reconstruction. AUTHOR NAMES Lopez J. Prifogle E. Nyame T.T. Milton J. May Jr. J.W. AUTHOR ADDRESSES (Lopez J.) Boston and Waltham, Mass. From Harvard Medical School; the Division of Clinical Studies, TEI Biosciences; the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital; and the Department of Biostatistics, Boston University School of Public Health. (Prifogle E.; Nyame T.T.; Milton J.; May Jr. J.W.) CORRESPONDENCE ADDRESS J. Lopez, SOURCE Plastic and reconstructive surgery (2014) 133:6 (1328-1334). Date of Publication: Jun 2014 ISSN 1529-4242 (electronic) ABSTRACT Although conflicts of interest in biomedical research have received significant attention, the impact of conflicts of interest on surgical outcomes has not been fully explored. A systematic electronic search of the literature was performed for studies that evaluated surgical outcomes in acellular dermal matrix and non-acellular dermal matrix implant-based breast reconstruction. Surgical complications, including infection, seroma, hematoma, necrosis, and explantation, were used as outcome metrics and extracted from studies. Surgical outcomes were then pooled and compared between studies that disclosed conflicts of interest and those that did not disclose conflicts of interest. A total of 776 abstracts were identified, of which only 35 fulfilled the authors' inclusion criteria. Conflicts of interest were reported in 14 of these abstracts (40 percent). The pooled data from studies that reported no conflicts of interest and studies that reported conflicts of interest included a total of 8241 and 5384 breasts and 2852 and 1864 patients, respectively. Considered collectively, surgical complications were less common in studies that reported a conflict of interest than in studies that reported no conflicts of interest. When surgical outcome data were further stratified by acellular dermal matrix use, surgical complications were less common in studies with conflicts of interest when acellular dermal matrix was used. However, when acellular dermal matrix was not used, surgical complications were similar between authors that reported a conflict of interest and those that did not report a conflict of interest. Self-reported conflicts of interest are common in implant-based breast reconstruction research. Studies authored by groups with conflicts of interest are significantly associated with reporting lower surgical complications and therefore describing positive research findings, especially when industry-marketed products are being used in the study. Therapeutic, III. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation skin transplantation EMTREE MEDICAL INDEX TERMS adult aged article conflict of interest cost benefit analysis economics female human mastectomy methodology middle aged reoperation statistical model treatment failure LANGUAGE OF ARTICLE English MEDLINE PMID 24867714 (http://www.ncbi.nlm.nih.gov/pubmed/24867714) PUI L373729128 COPYRIGHT Copyright 2014 Medline is the source for the citation and abstract of this record. RECORD 368 TITLE Skin-sparing mastectomy and immediate tissue expander breast reconstruction in patients with macromastia using the Passot breast reduction pattern AUTHOR NAMES Rinker B. Thornton B.P. AUTHOR ADDRESSES (Rinker B.; Thornton B.P.) From the *Department of Surgery, Division of Plastic Surgery, University of Kentucky, Lexington, KY; and †The Kentucky Aesthetic Plastic Surgery Institute, Louisville, KY SOURCE Annals of plastic surgery (2014) 72:6 (S158-S164). Date of Publication: 2014 ISSN 1536-3708 (electronic) ABSTRACT Skin-sparing mastectomy (SSM) with immediate tissue expander reconstruction poses a challenge in the patient with macromastia or excessive ptosis. Skin reduction via the Wise pattern has been described but is associated with high rates of skin necrosis. The study group consisted of 43 women with grade 2 or 3 ptosis who underwent SSM and immediate reconstruction with tissue expanders, using the Passot (horizontal) skin reduction pattern. Age ranged from 31 to 67 years (mean, 51 years). The endpoints measured were time to final expansion, mastectomy skin flap necrosis, infectious complications, and total complications. Thirty reconstructions were bilateral and 13 were unilateral (73 breasts total). Follow-up ranged from 6 to 55 months (mean, 20). Common comorbid conditions included hypertension (n = 16), obesity (n = 22), and smoking (n = 9). The mean body mass index was 30.6 (range, 19.4-58.6). Twenty-one patients underwent chemotherapy; 12 received radiation. The mean initial fill was 196 mL (range, 0-420 mL), and the mean time to final expansion was 84 days (range, 28-225 days). Five patients did not complete the reconstruction, 2 because of cancer recurrence and 3 because of infection. There were 3 cases of mastectomy flap necrosis occurring after tissue expander placement (7%). There were 7 infectious complications (16%). The use of a horizontal breast reduction pattern at the time of expander placement produces consistently good esthetic outcomes and a low rate of skin necrosis, and it should be considered as an option in patients with macromastia or ptosis undergoing SSM and immediate reconstruction. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) procedures EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult aged breast breast reconstruction breast tumor (surgery) female human hypertrophy (surgery) intraductal carcinoma (surgery) mastectomy middle aged retrospective study tissue expander tissue expansion LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24835873 (http://www.ncbi.nlm.nih.gov/pubmed/24835873) PUI L602111629 DOI 10.1097/01.sap.0000435768.51143.c9 FULL TEXT LINK http://dx.doi.org/10.1097/01.sap.0000435768.51143.c9 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 369 TITLE Non-cross-linked porcine acellular dermal matrix in revision breast surgery: Long-term outcomes and safety with neopectoral pockets AUTHOR NAMES Maxwell G.P. Gabriel A. AUTHOR ADDRESSES (Maxwell G.P.; Gabriel A., gabrielallen@yahoo.com) Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, CA 92354, United States. CORRESPONDENCE ADDRESS A. Gabriel, Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, CA 92354, United States. Email: gabrielallen@yahoo.com SOURCE Aesthetic Surgery Journal (2014) 34:4 (551-559). Date of Publication: May 2014 ISSN 1527-330X (electronic) 1090-820X BOOK PUBLISHER SAGE Publications Inc., claims@sagepub.com ABSTRACT Background: Revision breast surgery represents a significant problem among patients who have undergone augmentation mammaplasty. Current techniques do not adequately prevent recurrence, thus requiring novel approaches, including placement of Strattice (LifeCell, Branchburg, New Jersey), a non.cross-linked porcine acellular dermal matrix, to minimize recurrence. Objective: The authors review their experience and long-term outcomes with placement of Strattice in revision breast surgery patients who underwent previous augmentation mammaplasty. Methods: All patients in the authors' practice with a previous history of augmentation mammaplasty who underwent revision breast surgery with placement of Strattice between January 2007 and December 2011, and who had a minimum of 12 months of follow-up, were included in this retrospective study. A total of 106 patients met the study's inclusion criteria. Results: Average patient age was 42.3 years and average follow-up time was 3.1 years. Indications for revision surgery included capsular contracture (51.9%), implant malposition (38.7%), and ptosis (8.5%); approximately 40% had .1 previous attempts to correct the presenting complaint. Revision surgery included creation of neosubpectoral pockets with retention of previous noncalcified capsules in 81% of patients with subpectoral implants. Presenting complaints were successfully resolved in all patients. The overall complication rate was 0.9%. Conclusions: Adding Strattice to traditional revision surgery procedures results in reliable, durable repair of the presenting complaint with minimal associated complications. Treatment with Strattice in conjunction with noncalcified capsules retained during site change also appears to be safe. The data support a role for Strattice in revision breast surgery for patients who have undergone previous augmentation mammaplasty. © 2014 The American Society for Aesthetic Plastic Surgery, Inc. EMTREE DRUG INDEX TERMS antibiotic agent (drug therapy, oral drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast surgery neopectoral pocket surgical mesh (adverse device effect) surgical technique EMTREE MEDICAL INDEX TERMS adult article breast augmentation breast implant (adverse device effect) breast ptosis (complication) breast reconstruction clinical article female follow up human implant capsular contracture (complication) implant malposition (complication) infection (complication, drug therapy) medical device complication (complication) patient safety priority journal retrospective study surgical patient treatment indication treatment outcome DEVICE MANUFACTURERS (United States)Lifecell EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014286267 MEDLINE PMID 24692599 (http://www.ncbi.nlm.nih.gov/pubmed/24692599) PUI L372935801 DOI 10.1177/1090820X14528207 FULL TEXT LINK http://dx.doi.org/10.1177/1090820X14528207 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 370 TITLE Breast reconstruction following nipple-sparing mastectomy: predictors of complications, reconstruction outcomes, and 5-year trends. AUTHOR NAMES Colwell A.S. Tessler O. Lin A.M. Liao E. Winograd J. Cetrulo C.L. Tang R. Smith B.L. Austen Jr. W.G. AUTHOR ADDRESSES (Colwell A.S.) Boston, Mass. From the Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School. (Tessler O.; Lin A.M.; Liao E.; Winograd J.; Cetrulo C.L.; Tang R.; Smith B.L.; Austen Jr. W.G.) CORRESPONDENCE ADDRESS A.S. Colwell, SOURCE Plastic and reconstructive surgery (2014) 133:3 (496-506). Date of Publication: Mar 2014 ISSN 1529-4242 (electronic) ABSTRACT Nipple-sparing mastectomy is increasingly used for treatment and prevention of breast cancer. Few data exist on risk factors for complications and reconstruction outcomes. A single-institution retrospective review was performed between 2007 and 2012. Two hundred eighty-five patients underwent 500 nipple-sparing mastectomy procedures for breast cancer (46 percent) or risk reduction (54 percent). The average body mass index was 24, and 6 percent were smokers. The mean follow-up was 2.17 years. Immediate breast reconstruction (reconstruction rate, 98.8 percent) was performed with direct-to-implant (59 percent), tissue expander/implant (38 percent), or autologous (2 percent) reconstruction. Acellular dermal matrix was used in 71 percent and mesh was used in 11 percent. Seventy-seven reconstructions had radiotherapy. Complications included infection (3.3 percent), skin necrosis (5.2 percent), nipple necrosis (4.4 percent), seroma (1.7 percent), hematoma (1.7 percent), and implant loss (1.9 percent). Positive predictors for total complications included smoking (OR, 3.3; 95 percent CI, 1.289 to 8.486) and periareolar incisions (OR, 3.63; 95 percent CI, 1.850 to 7.107). Increasing body mass index predicted skin necrosis (OR, 1.154; 95 percent CI, 1.036 to 1.286) and preoperative irradiation predicted nipple necrosis (OR, 4.86; 95 percent CI, 1.0197 to 23.169). An inframammary fold incision decreased complications (OR, 0.018; 95 percent CI, 0.0026 to 0.12089). Five-year trends showed increasing numbers of nipple-sparing mastectomy with immediate reconstruction and more single-stage versus two-stage reconstructions (p < 0.05). Nipple-sparing mastectomy reconstructions have a low number of complications. Smoking, body mass index, preoperative irradiation, and incision type were predictors of complications. Risk, III. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction (adverse drug reaction) breast tumor (surgery) mastectomy nipple (surgery) EMTREE MEDICAL INDEX TERMS adult aged article female human middle aged retrospective study treatment outcome LANGUAGE OF ARTICLE English MEDLINE PMID 24572843 (http://www.ncbi.nlm.nih.gov/pubmed/24572843) PUI L372947849 COPYRIGHT Copyright 2014 Medline is the source for the citation and abstract of this record. RECORD 371 TITLE An evaluation of resource utilisation of single stage porcine acellular dermal matrix assisted breast reconstruction: A comparative study AUTHOR NAMES Kilchenmann A.J.R. Lardi A.M. Ho-Asjoe M. Junge K. Farhadi J. AUTHOR ADDRESSES (Kilchenmann A.J.R., ashley.kilchenmann@stud.unibas.ch; Lardi A.M.) Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Petersgraben 4, Basel, Switzerland. (Kilchenmann A.J.R., ashley.kilchenmann@stud.unibas.ch; Lardi A.M.; Ho-Asjoe M.; Farhadi J.) Department of Plastic and Reconstructive Surgery, Guy's and St. Thomas' Hospital, Westminster Bridge Rd, London, United Kingdom. (Junge K.) Premier Research Germany Ltd., Europaplatz 5, Darmstadt, Germany. CORRESPONDENCE ADDRESS A.J.R. Kilchenmann, Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Petersgraben 4, Basel, Switzerland. SOURCE Breast (2014) 23:6 (876-882). Date of Publication: 1 Dec 2014 ISSN 1532-3080 (electronic) 0960-9776 BOOK PUBLISHER Churchill Livingstone ABSTRACT Objectives: To evaluate resource utilization of single stage porcine acellular dermal matrix (ADM) assisted breast reconstruction compared with tissue expander (TE), latissimus dorsi flap and implant (LD/I) and latissimus dorsi flap and TE (LD/TE) reconstructive techniques. Materials and methods: Clinical data was collected for length of stay, operative time, additional hospitalisations and operative procedures, and outpatient appointments for 101 patients undergoing unilateral implant based breast reconstruction. Resources utilised by ADM (Strattice Reconstructive Tissue Matrix™) patients were analysed and compared to the resource usage of traditional techniques. Results: 25 patients undergoing single stage ADM (. ADM/I) were compared with 27 having TE, 32 having LD/I and 17 having LD/TE reconstructions. Follow up was 24 months. Compared to TE, ADM/I had similar length of stay and operative time, lower rate and number of additional procedures, fewer, shorter re-admissions (. p<0.05) and fewer appointments (. p<0.05). Compared to LD/TE, ADM/I had shorter length of stay and operative time (. p<0.05), lower rate and number of additional procedures, fewer, shorter re-admissions (. p<0.05) and fewer appointments (. p<0.05). Compared to LD/I, ADM/I had shorter length of stay (. p<0.05) and operative time (. p<0.05), fewer appointments, similar rate and number of additional procedures but required more and longer re-admissions. Conclusion: In our experience, unilateral single stage ADM/I was associated with fewer resources utilised in comparison with two staged TE and LD/TE reconstructions in both complication-free and complicated settings over a 24-month period, despite requiring aesthetic revision in 60.9% of patients. Compared to LD/I, resource utilisation was commensurate in complication-free and complicated settings. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction single stage porcine acellular dermal matrix assisted breast reconstruction EMTREE MEDICAL INDEX TERMS article breast cancer (surgery) breast tissue expander cohort analysis follow up hospital readmission hospitalization human latissimus dorsi flap length of stay major clinical study mastectomy operation duration outpatient department retrospective study surgical technique DEVICE TRADE NAMES Strattice Reconstructive Tissue Matrix EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2015710141 MEDLINE PMID 25311295 (http://www.ncbi.nlm.nih.gov/pubmed/25311295) PUI L601971824 DOI 10.1016/j.breast.2014.09.008 FULL TEXT LINK http://dx.doi.org/10.1016/j.breast.2014.09.008 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 372 TITLE Surgical treatment of nipple malposition in nipple-sparing mastectomy device-based reconstruction. AUTHOR NAMES Small K. Kelly K.M. Swistel A. Dent B.L. Taylor E.M. Talmor M. AUTHOR ADDRESSES (Small K.) New York, N.Y. From the Division of Plastic Surgery, Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical College. (Kelly K.M.; Swistel A.; Dent B.L.; Taylor E.M.; Talmor M.) CORRESPONDENCE ADDRESS K. Small, SOURCE Plastic and reconstructive surgery (2014) 133:5 (1053-1062). Date of Publication: May 2014 ISSN 1529-4242 (electronic) ABSTRACT This article discusses the senior author's (M.T.) experience with nipple-areola complex malposition following nipple-sparing mastectomy, surgical options for treatment, and an analysis of risk factors. A retrospective review was conducted on a prospectively collected institutional review board-approved database of nipple-sparing mastectomy cases with immediate device-based reconstruction performed between July of 2006 and October of 2012. Malposition was graded as mild (1 cm), moderate (2 cm), or severe (>3 cm) displacement. Three hundred nineteen nipple-sparing mastectomies were reviewed. Malposition occurred in 44 (13.79 percent). Significant factors were age (p < 0.0001), diabetes mellitus (p = 0.0025), body mass index (p = 0.0093), preoperative sternal notch-to-nipple distance (p = 0.015), preoperative breast base width (p = 0.0001), periareolar mastectomy incision with lateral extension (p < 0.0001), prior radiation (p = 0.0004), prior lumpectomy (p = 0.0125), unilateral nipple-sparing mastectomy (p = 0.0004), and postoperative nipple-areola complex ischemia (p = 0.0174). Smoking status, breast volume resected, implant size, ablative surgeon, acellular dermal matrix, and single-stage reconstruction were not significant. Nineteen patients were satisfied. Eight were not offered surgical correction because of an inadequate skin envelope. Eight had crescent mastopexy, three had implant exchange and pocket revision, four had free nipple grafts, and two had pedicled nipple transposition. There were no incidences of necrosis or malposition after surgical correction. Nipple-sparing mastectomy followed by immediate device-based reconstruction has a risk of nipple malposition. Various surgical procedures are available to correct nipple malposition based on clinical presentation and are safe in certain populations. Risk, III. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (epidemiology, radiotherapy, surgery) nipple (surgery) Paget nipple disease (epidemiology, radiotherapy, surgery) partial mastectomy (adverse drug reaction) postoperative complication (epidemiology) EMTREE MEDICAL INDEX TERMS adult aged article breast augmentation carcinoma in situ (epidemiology, radiotherapy, surgery) female human lung carcinoma (epidemiology, radiotherapy, surgery) middle aged reoperation retrospective study risk factor statistics LANGUAGE OF ARTICLE English MEDLINE PMID 24445873 (http://www.ncbi.nlm.nih.gov/pubmed/24445873) PUI L373389730 COPYRIGHT Copyright 2014 Medline is the source for the citation and abstract of this record. RECORD 373 TITLE Direct-to-implant single-stage immediate breast reconstruction with acellular dermal matrix: predictors of failure. AUTHOR NAMES Gdalevitch P. Ho A. Genoway K. Alvrtsyan H. Bovill E. Lennox P. Van Laeken N. Macadam S. AUTHOR ADDRESSES (Gdalevitch P.) Vancouver, British Columbia, Canada From the Division of Plastic and Reconstructive Surgery, University of British Columbia. (Ho A.; Genoway K.; Alvrtsyan H.; Bovill E.; Lennox P.; Van Laeken N.; Macadam S.) CORRESPONDENCE ADDRESS P. Gdalevitch, SOURCE Plastic and reconstructive surgery (2014) 133:6 (738e-747e). Date of Publication: Jun 2014 ISSN 1529-4242 (electronic) ABSTRACT Direct-to-implant single-stage immediate breast reconstruction using acellular dermal matrix is a cost-effective alternative to two-stage expander-implant reconstruction. The purpose of this study was to identify predictors of direct-to-implant single-stage immediate breast reconstruction failure, defined as need for early (≤6 months) revision surgery. The authors conducted a retrospective cohort study of all patients with direct-to-implant single-stage immediate breast reconstruction in 2010 and 2011 at three University of British Columbia hospitals. Data were compared between successful and failed single-stage reconstructions. Predictors of failure were identified using multivariate logistic regression. Patient demographics and complications were compared to a random sample of control patients with two-stage alloplastic reconstruction without acellular dermal matrix. Of 164 breasts that underwent direct-to-implant single-stage immediate breast reconstruction, 52 (31.7 percent) required early revision. Increasing breast cup size was the only significant predictor of early revision compared with bra size A (OR for bra size B, 4.86; C, 4.96; D, 6.01; p < 0.05). Prophylactic mastectomies showed a trend toward successful single stage (OR, 0.47; p = 0.061), whereas smoking history trended toward failure (OR, 1.79; p = 0.065). Mastectomy flap necrosis was significantly higher in direct-to-implant single-stage immediate reconstruction cases compared to two-stage controls. Direct-to-implant breast reconstruction can be reliably performed in a single stage in patients with small breast size. Increasing breast cup size confers a higher chance of early revision. A two-stage approach may be more cost-effective in larger breasted patients. Risk, III. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation (adverse drug reaction) EMTREE MEDICAL INDEX TERMS adult aged article female human implant capsular contracture (epidemiology) methodology middle aged multicenter study patient selection postoperative complication (epidemiology) reoperation retrospective study risk factor statistical model statistics treatment failure LANGUAGE OF ARTICLE English MEDLINE PMID 24867734 (http://www.ncbi.nlm.nih.gov/pubmed/24867734) PUI L373729147 COPYRIGHT Copyright 2014 Medline is the source for the citation and abstract of this record. RECORD 374 TITLE An algorithmic approach for selective acellular dermal matrix use in immediate two-stage breast reconstruction: indications and outcomes. AUTHOR NAMES Jordan S.W. Khavanin N. Fine N.A. Kim J.Y. AUTHOR ADDRESSES (Jordan S.W.) Chicago, Ill. From the Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine. (Khavanin N.; Fine N.A.; Kim J.Y.) CORRESPONDENCE ADDRESS S.W. Jordan, SOURCE Plastic and reconstructive surgery (2014) 134:2 (178-188). Date of Publication: Aug 2014 ISSN 1529-4242 (electronic) ABSTRACT Acellular dermal matrix use has gained widespread acceptance--despite higher material costs--because of its ease of use and potential for enhanced cosmesis. The authors developed a resource-sensitive algorithm for selective acellular dermal matrix use with indications and contraindications based on body mass index, breast size, radiation therapy, flap vascularity, and pectoralis anatomy. The algorithm incorporates preoperative and intraoperative decision points. Complication rates and aesthetic scores were compared for procedures performed before and after adoption of the algorithm. Multiple logistic regression was used to determine the independent influence of the algorithm on postoperative outcomes. One hundred ninety-three breasts underwent reconstruction before and 179 underwent reconstruction after implementation of the algorithm. Overall complication rates did not differ between the cohorts (22.8 percent versus 20.7 percent; p=0.138). After adjusting for potential confounders, the algorithm did not significantly affect the incidence of infection, seroma, flap necrosis, explantation, or overall complications (all p>0.05). Aesthetic scores were not affected (2.75 of 4 versus 3.03 of 4; p=0.138). Acellular dermal matrix use decreased from 84 percent to 36 percent, resulting in a materials cost savings of $270,000 over the study period. This algorithm obviated placement of acellular dermal matrix in an estimated 48 percent of immediate tissue-expander reconstructions. Patients treated after adoption of this algorithm experienced similar complication rates and aesthetic outcomes as those who underwent reconstruction before. The authors' preliminary outcomes demonstrate that evidence-based measures can be taken to selectively use acellular dermal matrix without a concomitant worsening of patient outcomes. Therapeutic, III. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix algorithm breast reconstruction decision support system EMTREE MEDICAL INDEX TERMS adult article breast tumor (surgery) drug contraindication economics esthetics evaluation study female human incidence mastectomy methodology middle aged postoperative complication (epidemiology, etiology) retrospective study statistical model United States utilization review LANGUAGE OF ARTICLE English MEDLINE PMID 25068318 (http://www.ncbi.nlm.nih.gov/pubmed/25068318) PUI L373972873 COPYRIGHT Copyright 2014 Medline is the source for the citation and abstract of this record. RECORD 375 TITLE Long-term follow-up of changing practice patterns in breast reconstruction due to increased use of tissue expanders and perforator flaps AUTHOR NAMES Manahan M.A. Prucz R.B. Shridharani S.M. Baltodano P.A. Rosson G.D. AUTHOR ADDRESSES (Manahan M.A.; Prucz R.B.; Shridharani S.M.; Baltodano P.A.; Rosson G.D., gedge@jhmi.edu) Department of Plastic and Reconstructive Surgery, Johns Hopkins University, School of Medicine, JHOC 8th Floor, McElderry 8161, 601 North Caroline Street, Baltimore, United States. CORRESPONDENCE ADDRESS G.D. Rosson, Department of Plastic and Reconstructive Surgery, Johns Hopkins University, School of Medicine, JHOC 8th Floor, McElderry 8161, 601 North Caroline Street, Baltimore, United States. SOURCE Microsurgery (2014) 34:8 (595-601). Date of Publication: 1 Nov 2014 ISSN 1098-2752 (electronic) 0738-1085 BOOK PUBLISHER John Wiley and Sons Inc., P.O.Box 18667, Newark, United States. ABSTRACT Background: As the science of breast reconstruction evolves, significant changes in reconstruction strategies and outcomes are expected. The purpose of this study is to determine the changes in breast reconstruction trends and outcomes that occurred at a multidisciplinary academic institution during the last decade. Methods: We compared 265 patients over two distinct 6-month intervals separated by 5 years (2002 vs. 2007) and performed long-term follow-up (4.75 ± 3.38 years 2002, 2.99 ± 2.25 years 2007). We studied patients seeking prophylactic mastectomy, patients with early breast cancer, and patients with locally advanced disease. We analyzed demographic data, breast cancer history and treatment, type and timing of reconstruction, and complications. Results: Implant to flap reconstruction ratio was 48:49 in 2002 and 76:102 in 2007. Use of transverse rectus abdominis myocutaneous flap declined from 57 to 4%; conversely, deep inferior epigastric perforator flap increased from 27 to 91% (P < 0.001). Correspondingly, donor site chronic pain (4 vs. 0, P = 0.012) and postoperative abdominal wall bulge (9 vs. 3, P = 0.004) rates decreased. Timing of reconstruction showed increased staged cases in 2007 compared to 2002 (P = 0.045). Post-final reconstruction radiation therapy was reduced in 2007 (P = 0.016), with subsequent lower rates of implant rupture (P < 0.001). Conclusions: At our institution and over the last decade, increasing staged reconstructions have successfully reduced the rates of post-final reconstruction radiotherapy with optimized outcomes. Contrary to national trends, the rates of autologous flap reconstructions have increased with reduced donor site morbidity. This suggests that academic breast reconstruction trends are independent from national trends. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction breast tissue expander (adverse device effect) clinical practice long term care perforator flap EMTREE MEDICAL INDEX TERMS abdominal bulge (complication) abdominal wall acellular dermal matrix adult article breast cancer (radiotherapy, surgery) breast carcinoma (radiotherapy, surgery) cancer patient cancer radiotherapy cancer surgery carcinoma in situ (radiotherapy, surgery) cellulitis (complication) chronic pain deep inferior epigastric perforator flap deep vein thrombosis (complication) device infection (complication) disability (complication) dissection donor site early cancer (radiotherapy, surgery) fat necrosis (complication) female follow up graft failure (complication) graft necrosis (complication) hematoma (complication) hernia (complication) human lung embolism (complication) lymphedema (complication) major clinical study mastectomy medical device complication (complication) outcome assessment partial mastectomy pedicled skin flap postoperative pain (complication) prophylaxis retrospective study rupture (complication) seroma (complication) surgeon surgical infection (complication) transverse rectus abdominis musculocutaneous flap urinary tract infection (complication) venous congestion (complication) wound dehiscence (complication) EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014762873 MEDLINE PMID 24665002 (http://www.ncbi.nlm.nih.gov/pubmed/24665002) PUI L53075860 DOI 10.1002/micr.22245 FULL TEXT LINK http://dx.doi.org/10.1002/micr.22245 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 376 TITLE Advances in Breast Reconstruction of Mastectomy and Lumpectomy Defects AUTHOR NAMES Ballard T.N.S. Momoh A.O. AUTHOR ADDRESSES (Ballard T.N.S.; Momoh A.O., amomoh@umich.edu) Section of Plastic Surgery, Department of General Surgery, University of Michigan Health System, 2130 Taubman Center, 1500 East Medical Center Drive, SPC 5340, Ann Arbor, MI 48109-5340, United States. CORRESPONDENCE ADDRESS A.O. Momoh, Section of Plastic Surgery, Department of General Surgery, University of Michigan Health System, 2130 Taubman Center, 1500 East Medical Center Drive, SPC 5340, Ann Arbor, MI 48109-5340, United States. Email: amomoh@umich.edu SOURCE Surgical Oncology Clinics of North America (2014) 23:3 (525-548). Date of Publication: July 2014 ISSN 1558-5042 (electronic) 1055-3207 BOOK PUBLISHER W.B. Saunders ABSTRACT Breast reconstruction continues to evolve along with advances in the detection and management of breast cancer. With more patients diagnosed with breast cancer earlier in life and increased identification of genetic mutations predisposing patients to breast cancer, patients' desires and expectations regarding reconstruction have become more sophisticated. Restoration of the breast to a form as close as possible to its presurgical state continues to be a primary goal. The past decade has seen many advances in implant and autologous tissue-based reconstruction. The future of reconstruction for breast cancer patients is promising with continued research in ways to improve the care provided. © 2014 Elsevier Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast malformation (surgery) breast reconstruction partial mastectomy EMTREE MEDICAL INDEX TERMS acellular dermal matrix advanced cancer (surgery) autotransplantation breast cancer (surgery) breast implant breast tissue expander composite skin graft computed tomographic angiography deep inferior epigastric perforator flap free tissue graft graft perfusion human large cell lymphoma medical decision making medical technology patient safety pedicled skin flap peroperative care preoperative care review surgical approach surgical mesh tissue expansion tissue implant treatment outcome treatment planning DEVICE TRADE NAMES AlloDerm , United StatesLifecell Allomax , United StatesDavol FlexHD , United StatesEthicon SurgiMend , United StatesTEI DEVICE MANUFACTURERS (United States)Davol (United States)Ethicon (United States)Lifecell (United States)TEI EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014372942 MEDLINE PMID 24882349 (http://www.ncbi.nlm.nih.gov/pubmed/24882349) PUI L53108861 DOI 10.1016/j.soc.2014.03.012 FULL TEXT LINK http://dx.doi.org/10.1016/j.soc.2014.03.012 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 377 TITLE Immediate direct–to–implant breast reconstruction using anatomical implants AUTHOR NAMES Kim S.-E. Jung D.-W. Chung K.-J. Lee J.H. Kim T.G. Kim Y.-H. Lee S.J. Kang S.H. Choi J.E. AUTHOR ADDRESSES (Kim S.-E.; Jung D.-W.; Chung K.-J.; Lee J.H., junojunho@gmail.com; Kim T.G.; Kim Y.-H.) Departments of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu, South Korea. (Lee S.J.; Kang S.H.; Choi J.E.) Departments of Surgery, Yeungnam University College of Medicine, Daegu, South Korea. CORRESPONDENCE ADDRESS J.H. Lee, Departments of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu, South Korea. SOURCE Archives of Plastic Surgery (2014) 41:5 (529-534). Date of Publication: 1 Sep 2014 ISSN 2234-6171 (electronic) 2234-6163 BOOK PUBLISHER Korean Society of Plastic and Reconstructive Surgeons, 1355-3 Seocho-Dong, Seocho-Gu, Seoul, South Korea. kpseo@hitel.net ABSTRACT Background In 2012, a new anatomic breast implant of form-stable silicone gel was introduced onto the Korean market. The intended use of this implant is in the area of aesthetic breast surgery, and many reports are promising. Thus far, however, there have been no reports on the use of this implant for breast reconstruction in Korea. We used this breast implant in breast reconstruction surgery and report our early experience.Methods From November 2012 to April 2013, the Natrelle Style 410 form-stable anatomically shaped cohesive silicone gel-filled breast implant was used in 31 breasts of 30 patients for implant breast reconstruction with an acellular dermal matrix. Patients were treated with skin-sparing mastectomies followed by immediate breast reconstruction.Results The mean breast resection volume was 240 mL (range, 83–540 mL). The mean size of the breast implants was 217 mL (range, 125–395 mL). Breast shape outcomes were considered acceptable. Infection and skin thinning occurred in one patient each, and hematoma and seroma did not occur. Three cases of wound dehiscence occurred, one requiring surgical intervention, while the others healed with conservative treatment in one month. Rippling did not occur. So far, complications such as capsular contracture and malrotation of breast implant have not yet arisen.Conclusions By using anatomic breast implants in breast reconstruction, we achieved satisfactory results with aesthetics better than those obtained with round breast implants. Therefore, we concluded that the anatomical implant is suitable for breast reconstruction. EMTREE DRUG INDEX TERMS antibiotic agent (drug therapy, intravenous drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction silicone breast implant EMTREE MEDICAL INDEX TERMS adult areola sparing mastectomy article breast implant size breast resection volume cancer staging clinical article erythema female follow up human infection (complication, drug therapy) mastectomy medical parameters nipple sparing mastectomy outcome assessment skin disease (complication) skin sparing mastectomy skin thinning (complication) wound dehiscence (complication, surgery, therapy) DEVICE TRADE NAMES Biocell Natrelle 410 , United StatesAllergan EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014807349 PUI L600065958 DOI 10.5999/aps.2014.41.5.529 FULL TEXT LINK http://dx.doi.org/10.5999/aps.2014.41.5.529 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 378 TITLE Methylene blue dye-induced skin necrosis in immediate breast reconstruction: Evaluation and management AUTHOR NAMES Lee J.H. Chang C.H. Park C.H. Kim J.-K. AUTHOR ADDRESSES (Lee J.H.; Chang C.H.; Kim J.-K., Crossmatching@hanmail.net) Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea. (Park C.H.) Department of Breast and Thyroid Cancer, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea. CORRESPONDENCE ADDRESS J.-K. Kim, Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 110-746, South Korea. Email: Crossmatching@hanmail.net SOURCE Archives of Plastic Surgery (2014) 41:3 (258-263). Date of Publication: May 2014 ISSN 2234-6171 (electronic) 2234-6163 BOOK PUBLISHER Korean Society of Plastic and Reconstructive Surgeons, 1355-3 Seocho-Dong, Seocho-Gu, Seoul, South Korea. kpseo@hitel.net ABSTRACT Background For early breast cancer patients, skin-sparing mastectomy or nipple-sparing mastectomy with sentinel lymph node biopsy has become the mainstream treatment for immediate breast reconstruction in possible cases. However, a few cases of skin necrosis caused by methylene blue dye (MBD) used for sentinel lymph node localization have been reported. Methods Immediate breast reconstruction using a silicone implant was performed on 35 breasts of 34 patients after mastectomy. For sentinel lymph node localization, 1% MBD (3 mL) was injected into the subareolar area. The operation site was inspected in the postoperative evaluation. Results Six cases of immediate breast reconstruction using implants were complicated by methylene blue dye. One case of local infection was improved by conservative treatment. In two cases, partial necrosis and wound dehiscence of the incision areas were observed; thus, debridement and closure were performed. Of the three cases of wide skin necrosis, two cases underwent removal of the dead tissue and implants, followed by primary closure. In the other case, the breast implant was salvaged using latissimus dorsi musculocutaneous flap reconstruction. Conclusions The complications were caused by MBD toxicity, which aggravated blood disturbance and skin tension after implant insertion. When planning immediate breast reconstruction using silicone implants, complications of MBD should be discussed in detail prior to surgery, and appropriate management in the event of complications is required. © 2014 The Korean Society of Plastic and Reconstructive Surgeons. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) methylene blue (adverse drug reaction) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction skin necrosis (side effect, diagnosis, side effect) EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult article breast implant clinical article debridement female histology human human tissue immunohistochemistry mastectomy mastitis middle aged sentinel lymph node biopsy silicone prosthesis skin infection (side effect) skin tension tissue necrosis wound dehiscence (side effect) DEVICE TRADE NAMES AlloDerm , United StatesLifecell Siltex , United StatesMentor DEVICE MANUFACTURERS (United States)Lifecell (United States)Mentor CAS REGISTRY NUMBERS methylene blue (61-73-4) EMBASE CLASSIFICATIONS Dermatology and Venereology (13) Drug Literature Index (37) Adverse Reactions Titles (38) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014357053 PUI L373155099 DOI 10.5999/aps.2014.41.3.258 FULL TEXT LINK http://dx.doi.org/10.5999/aps.2014.41.3.258 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 379 TITLE Breast reconstruction following nipple-sparing mastectomy: Predictors of complications, reconstruction outcomes, and 5-year trends AUTHOR NAMES Garvey P.B. AUTHOR ADDRESSES (Garvey P.B.) CORRESPONDENCE ADDRESS P.B. Garvey, SOURCE Breast Diseases (2014) 25:3 (259-261). Date of Publication: 2014 ISSN 1878-1918 (electronic) 1043-321X BOOK PUBLISHER Academic Press Inc., apjcs@harcourt.com EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (radiotherapy, surgery) breast reconstruction mastectomy nipple nipple sparing mastectomy postoperative complication EMTREE MEDICAL INDEX TERMS acellular dermal matrix body mass breast areola breast implant (adverse device effect) breast necrosis (complication) breast tissue expander (adverse device effect) cancer patient cancer radiotherapy cancer surgery female follow up hematoma (complication) human incision major clinical study nipple necrosis (complication) note outcome assessment postoperative infection (complication) preoperative radiotherapy prosthesis loosening (complication) seroma (complication) skin necrosis (complication) smoking trend study EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2014845924 PUI L600239200 DOI 10.1016/j.breastdis.2014.07.005 FULL TEXT LINK http://dx.doi.org/10.1016/j.breastdis.2014.07.005 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 380 TITLE Capsular grafts and flaps in immediate prosthetic breast reconstruction. AUTHOR NAMES Mayer H.F. Loustau H.D. AUTHOR ADDRESSES (Mayer H.F., horacio.mayer@hospitalitaliano.org.ar) Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires School of Medicine, Perón 4190, 1st Floor (1181), Buenos Aires, Argentina, (Loustau H.D.) CORRESPONDENCE ADDRESS H.F. Mayer, Email: horacio.mayer@hospitalitaliano.org.ar SOURCE Aesthetic plastic surgery (2014) 38:1 (129-138). Date of Publication: Feb 2014 ISSN 1432-5241 (electronic) ABSTRACT Patients with previously augmented breasts and a diagnosis of breast cancer who are candidates for immediate prosthetic reconstruction can benefit from capsular tissues used for splinting the position of the pectoralis major muscle. A retrospective clinical review of patients with previously augmented breasts who are undergoing mastectomy and immediate prosthetic reconstruction with capsular tissues was undertaken. The bottom of the periprosthetic capsule was tailored in a novel and versatile fashion as grafts or flaps and used as a sling between the pectoralis major and the inframammary fold. Of the 21 patients in this study, 19 had unilateral reconstruction, whereas 2 had bilateral reconstructions. Capsular tissues were harvested as free capsular grafts in 15 cases and raised as a capsular flap in the remaining 8 cases. During the follow-up period, complications were detected in 7 patients (1 seroma, 1 infection, 1 hematoma, 1 superficial epidermolysis, 2 cases of rippling, and 1 mild capsular contracture). For eligible patients, the use of capsular tissues offers a readily available and cost-effective alternative to acellular dermal matrices with a negligible complication rate. Patient selection is key to ensuring a safe oncologic approach and must be carefully carried out in close collaboration with the breast surgeon. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation breast reconstruction breast tumor (surgery) postoperative complication (surgery) subcutaneous mastectomy surgical flaps EMTREE MEDICAL INDEX TERMS adult article female human methodology middle aged retrospective study LANGUAGE OF ARTICLE English MEDLINE PMID 24337173 (http://www.ncbi.nlm.nih.gov/pubmed/24337173) PUI L373988850 DOI 10.1007/s00266-013-0249-3 FULL TEXT LINK http://dx.doi.org/10.1007/s00266-013-0249-3 COPYRIGHT Copyright 2014 Medline is the source for the citation and abstract of this record. RECORD 381 TITLE Dermal fat graft from simultaneous abdominoplasty as an adjunct to revision aesthetic and reconstructive breast surgery: A poor man's acellular dermal matrix? AUTHOR NAMES Xie F. Nabulyato W.M. Malata C.M. AUTHOR ADDRESSES (Xie F.) University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom. (Nabulyato W.M.; Malata C.M., cmalata@hotmail.com) Department of Plastic and Reconstructive Surgery, Addenbrookes University Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 186, Hills Road, Cambridge, United Kingdom. (Malata C.M., cmalata@hotmail.com) Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge, United Kingdom. (Malata C.M., cmalata@hotmail.com) Anglia Ruskin University Postgraduate Medical Institute, Cambridge and Chelmsford, United Kingdom. CORRESPONDENCE ADDRESS C.M. Malata, Department of Plastic and Reconstructive Surgery, Addenbrookes University Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 186, Hills Road, Cambridge, United Kingdom. SOURCE International Journal of Surgery Case Reports (2014) 5:11 (829-832). Date of Publication: 2014 ISSN 2210-2612 BOOK PUBLISHER Elsevier Ltd ABSTRACT PRESENTATION OF CASE We report two patients requiring bilateral revision breast surgery for severely asymmetrical, tender, ptotic breasts and cosmetically poor abdomens. Both were denied assisted acellular dermal matrix reconstructive surgery on the state NHS system and unable to afford the private costs. We therefore utilised free dermal fat grafts, harvested from concomitant abdominoplasties to extend the pectoralis major muscle and smoothen surface irregularities.DISCUSSION Both patients achieved excellent cosmetic outcomes and aside from a small, spontaneously resolving abdominal site seroma in one patient, have remained free of any complications for over two years. This cost effective procedure is only feasible in patients with an adequate pannus who are amenable to the extra surgery and resultant scarring.CONCLUSION We herein report the use of free dermal fat graft in revision aesthetic and reconstructive surgery in a manner akin to recent acellular dermal matrix use. The comparable enhanced aesthetic outcomes, minimal complication rate and substantial cost savings merit dissemination to a global audience and encourage surgeons to consider this economic alternative.INTRODUCTION The global use of acellular dermal matrices as an adjunct to tissue expander or implant-based breast reconstruction, by surgeons wishing to cover and support the inferior breast pole, has increased in frequency in the last two decades. However despite the reported enhanced cosmetic outcomes, issues regarding their cost effectiveness have led to their infrequent use within the UK National Health Service and the need for an equally efficacious but cheaper alternative. EMTREE DRUG INDEX TERMS silicone gel EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) abdominoplasty acellular dermal matrix breast surgery composite skin graft EMTREE MEDICAL INDEX TERMS adult article breast carcinoma (radiotherapy, surgery) breast implant case report cost effectiveness analysis female health economics human human tissue invasive carcinoma (surgery) pannus pectoralis major muscle plastic surgery postoperative complication (complication) subcutaneous mastectomy surface property surgical technique EMBASE CLASSIFICATIONS Cancer (16) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014863778 PUI L600248832 DOI 10.1016/j.ijscr.2014.08.026 FULL TEXT LINK http://dx.doi.org/10.1016/j.ijscr.2014.08.026 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 382 TITLE The story of serratia marcescens: Pathologic risk factors in breast implant surgery AUTHOR NAMES Yao C.A. Wang D. Kulber D.A. AUTHOR ADDRESSES (Yao C.A.; Wang D.; Kulber D.A., David.Kulber@cshs.org) Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, United States. (Kulber D.A., David.Kulber@cshs.org) Center for Plastic and Reconstructive Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States. CORRESPONDENCE ADDRESS D. A. Kulber, Cedars-Sinai Medical Center, 8635 W. Third Street, Suite 990W, Los Angeles, CA 90048, United States. Email: David.Kulber@cshs.org SOURCE Archives of Plastic Surgery (2014) 41:4 (414-417). Date of Publication: July 2014 ISSN 2234-6171 (electronic) 2234-6163 BOOK PUBLISHER Korean Society of Plastic and Reconstructive Surgeons, 1355-3 Seocho-Dong, Seocho-Gu, Seoul, South Korea. kpseo@hitel.net ABSTRACT Serratia marcescens (S. marcescens) emerged as an opportunist in the setting of immunodeficiency in the 1970s, when serious infections occurred in San Francisco hospitals after USA. Navy experiments had aerosolized the bacteria to study biologic warfare. We investigate the risks of S. marcescens in San Franciscans who undergo mastectomy with implant reconstruction. From 2007 to 2011, the senior author took breast capsule cultures for all patients at the time of tissue expander exchange/explant. Of the 142 women who had reconstruction, 23 had positive cultures. Only the two patients who were positive for S. marcescens developed clinical infections that required explantation. Both had postoperative chemotherapy with transient neutropenia, and both had close ties to San Francisco. Clinical signs of infection emerged for both patients months after initial surgery, despite having previously well healed incisions. Other patients were culture positive for Pseudomonas, Proteus, Enterococcus and MRSA and did not develop require explant. While the link between San Francisco and S. marcescens is controversial, a patient's geography is a simple screening tool when considering postoperative risks, especially in the immunocompromised. Closer monitoring for neutropenia during chemotherapy, and a lower threshold to administer S. marcescens targeted antibiotics may be warranted in these patients. © 2014 The Korean Society of Plastic and Reconstructive Surgeons. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation Serratia marcescens EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult aged article breast tissue expander cellulitis (complication) Enterococcus Escherichia coli female human human tissue leukocyte count leukocytosis major clinical study mastectomy mastitis methicillin resistant Staphylococcus aureus middle aged neutropenia Propionibacterium Proteus Pseudomonas risk factor silicone prosthesis Staphylococcus United States wound dehiscence (complication) EMBASE CLASSIFICATIONS Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014514875 PUI L373665111 DOI 10.5999/aps.2014.41.4.414 FULL TEXT LINK http://dx.doi.org/10.5999/aps.2014.41.4.414 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 383 TITLE Discussion: Applications of acellular dermal matrix in revision breast reconstruction surgery AUTHOR NAMES Dumanian G.A. AUTHOR ADDRESSES (Dumanian G.A.) Chicago, Ill. From Northwestern Memorial Hospital SOURCE Plastic and reconstructive surgery (2014) 133:1 (11-13). Date of Publication: 1 Jan 2014 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix procedures EMTREE MEDICAL INDEX TERMS breast reconstruction female human mastectomy postoperative complication (surgery) reoperation LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24374665 (http://www.ncbi.nlm.nih.gov/pubmed/24374665) PUI L604089361 DOI 10.1097/01.prs.0000437226.85058.10 FULL TEXT LINK http://dx.doi.org/10.1097/01.prs.0000437226.85058.10 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 384 TITLE Discussion: Applications of acellular dermal matrix in revision breast reconstruction surgery. AUTHOR NAMES Baxter R. AUTHOR ADDRESSES (Baxter R., drbaxter@drbaxter.com) 6100 219th Street S.W., Suite 290, Mountlake Terrace, Wash. 98043, CORRESPONDENCE ADDRESS R. Baxter, Email: drbaxter@drbaxter.com SOURCE Plastic and reconstructive surgery (2014) 134:2 (323e). Date of Publication: Aug 2014 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction (adverse drug reaction) mastectomy (adverse drug reaction) postoperative complication (surgery) reoperation EMTREE MEDICAL INDEX TERMS female human methodology note LANGUAGE OF ARTICLE English MEDLINE PMID 25068353 (http://www.ncbi.nlm.nih.gov/pubmed/25068353) PUI L373972906 COPYRIGHT Copyright 2014 Medline is the source for the citation and abstract of this record. RECORD 385 TITLE Discussion: Applications of acellular dermal matrix in revision breast reconstruction surgery. AUTHOR NAMES Dumanian G.A. AUTHOR ADDRESSES (Dumanian G.A.) Chicago, Ill. From Northwestern Memorial Hospital. CORRESPONDENCE ADDRESS G.A. Dumanian, Chicago, Ill. From Northwestern Memorial Hospital. SOURCE Plastic and reconstructive surgery (2014) 133:1 (11-13). Date of Publication: Jan 2014 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction (adverse drug reaction) mastectomy (adverse drug reaction) postoperative complication (surgery) reoperation EMTREE MEDICAL INDEX TERMS female human methodology note LANGUAGE OF ARTICLE English MEDLINE PMID 24374665 (http://www.ncbi.nlm.nih.gov/pubmed/24374665) PUI L563040238 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 386 TITLE The exposed implant in breast reconstructive surgery: A strategy for salvage using acellular dermal matrix and platelet-rich plasma AUTHOR NAMES Torresini G. Sozio A. Garreffa E. Brucchi M. Lucantoni R. AUTHOR ADDRESSES (Torresini G.; Garreffa E., emangar@live.it) Plastic and Reconstructive Surgery Outpatients' Clinic, Department of Surgery, Ospedale Civile Mazzini, Piazza Italia 1, 64100 Teramo, Italy. (Sozio A.; Brucchi M.; Lucantoni R.) Division of General Surgery, Department of Surgery, Ospedale Civile Mazzini, Teramo, Italy. CORRESPONDENCE ADDRESS E. Garreffa, Plastic and Reconstructive Surgery Outpatients' Clinic, Department of Surgery, Ospedale Civile Mazzini, Piazza Italia 1, 64100 Teramo, Italy. Email: emangar@live.it SOURCE European Journal of Plastic Surgery (2014) 37:5 (287-292). Date of Publication: May 2014 ISSN 1435-0130 (electronic) 0930-343X BOOK PUBLISHER Springer Verlag, service@springer.de ABSTRACT The use of breast implants in breast reconstructive surgery is currently the most popular choice among surgeons. Following the introduction of acellular dermal matrices in breast reconstruction, some surgeons proposed their use also in complication repair surgery. In this work, we present our method of treatment of the exposed breast implant using an acellular dermal matrix (Strattice) combined with a series of mesotherapy with platelet-rich plasma (PRP). A group of five women, all treated with radiotherapy, who had a breast implant exposure following post-oncological reconstructive surgery were treated in our unit in the period from March 2011 to November 2012. Only those patients who presented an extrusion area less than 3-3.5 cm, without evident signs of implant infection, were included in this study. After perilesional tissue excision and pocket lavage, the acellular dermal matrix was fixed in the pocket and a new implant was positioned. After the surgery, patients underwent a four-session cycle of mesotherapy with autologous PRP. In four patients, the implant exposure was successfully resolved using the acellular dermal matrix without postoperative complications. One patient developed a prosthesis infection which required its explant and subsequent reconstruction with latissimus dorsi flap. The surgical technique that we describe is proposed, in selected cases, as an alternative to the classical procedures for those patients who are undecided about undergoing further surgery, with long time and demanding demolition. Further studies involving larger case series are necessary. Level of Evidence: Level V, therapeutic study. © 2013 Springer-Verlag. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant thrombocyte rich plasma EMTREE MEDICAL INDEX TERMS adult article clinical article female human latissimus dorsi flap mesotherapy middle aged plastic surgery postoperative complication priority journal prosthesis infection surgical technique DEVICE TRADE NAMES Strattice , United StatesLifecell DEVICE MANUFACTURERS (United States)Lifecell EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014292842 PUI L52732600 DOI 10.1007/s00238-013-0879-3 FULL TEXT LINK http://dx.doi.org/10.1007/s00238-013-0879-3 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 387 TITLE Role of acellular dermal matrix-assisted implants in breast reconstruction AUTHOR NAMES Winters Z.E. Colwell A.S. AUTHOR ADDRESSES (Winters Z.E., zoe.winters@bristol.ac.uk) Breast Cancer Surgery Patient Reported and Clinical Outcomes Research Group, University of Bristol, Southmead Hospital, Bristol BS10 5NB, United Kingdom. (Colwell A.S.) Division of Plastic Surgery, Massachusetts General Hospital, Boston, MA, United States. SOURCE British Journal of Surgery (2014) 101:5 (444-445). Date of Publication: April 2014 ISSN 1365-2168 (electronic) 0007-1323 ABSTRACT Too many unanswered questions to justify widespread adoption © 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant breast reconstruction EMTREE MEDICAL INDEX TERMS article female human methodology LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24615338 (http://www.ncbi.nlm.nih.gov/pubmed/24615338) PUI L1053026823 DOI 10.1002/bjs.9415 FULL TEXT LINK http://dx.doi.org/10.1002/bjs.9415 COPYRIGHT Copyright 2014 Medline is the source for the citation and abstract of this record. RECORD 388 TITLE Discussion: An algorithmic approach for selective acellular dermal matrix use in immediate two-stage breast reconstruction: indications and outcomes. AUTHOR NAMES Hanasono M.M. AUTHOR ADDRESSES (Hanasono M.M.) Houston, Texas From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center. CORRESPONDENCE ADDRESS M.M. Hanasono, SOURCE Plastic and reconstructive surgery (2014) 134:2 (189-190). Date of Publication: Aug 2014 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix algorithm breast reconstruction decision support system EMTREE MEDICAL INDEX TERMS female human methodology note LANGUAGE OF ARTICLE English MEDLINE PMID 25068319 (http://www.ncbi.nlm.nih.gov/pubmed/25068319) PUI L373972874 COPYRIGHT Copyright 2014 Medline is the source for the citation and abstract of this record. RECORD 389 TITLE Evaluation of AlloMax acellular dermal matrix for objective collagen deposition AUTHOR NAMES Brosious J.P. Wong N. Fowler G. Stephenson L.L. Wang W.Z. Zamboni W.A. Taghipour-Khiabani K. AUTHOR ADDRESSES (Brosious J.P.; Wong N.; Fowler G.; Stephenson L.L.; Wang W.Z.; Zamboni W.A.; Taghipour-Khiabani K., kkhiabani@medicine.nevada.edu) Department of Surgery, University of Nevada School of Medicine, 2040 West Charleston Boulevard, Las Vegas, NV 89102-2227, United States. CORRESPONDENCE ADDRESS K. Taghipour-Khiabani, Department of Surgery, University of Nevada School of Medicine, 2040 West Charleston Boulevard, Las Vegas, NV 89102-2227, United States. Email: kkhiabani@medicine.nevada.edu SOURCE Journal of Reconstructive Microsurgery (2014) 30:1 (31-34). Date of Publication: January 2014 ISSN 0743-684X 1098-8947 (electronic) BOOK PUBLISHER Thieme Medical Publishers, Inc., 333 7th Avenue, New York, United States. ABSTRACT Acellular dermal matrix products are popular in various aspects of surgical reconstruction including hernia repairs and breast reconstructions. The goal of this study was to determine quantitative collagen weights of AlloMax (C. R. Bard, Inc. [Davol], Warwick, RI) and of contralateral dermis for composition comparison. A rehydrated sample of AlloMax was subcutaneously implanted on the dorsum of 18 male Wistar rats. Rats were randomly assigned to groups on the basis of in vivo implant time: 1, 3, and 6 weeks. At the end of the implant time, the AlloMax was removed and a section of contralateral dermis was excised as a control. Hydroxyproline, rat Collagen I and Collagen III, and neoangiogenesis were determined in the sections. The results are reported as mean ± standard error of the mean. Analysis of variance was used to evaluate the between-group differences. A p value of 0.05 or less was considered significant. Hydroxyproline was significantly increased in the 6-week AlloMax implant (26.19 ± 1.05 vs. 15.03 ± 3.29). Collagen I and Collagen III were significantly increased following 3 weeks in vivo (612.5% ± 98.0 vs. 312.9% ± 82.7, p < 0.05 Collagen I). Neoangiogenesis was significantly increased at 3 and 6 weeks in vivo (2.3 ± 0.3 and 1.9 ± 0.3). Acellular AlloMax was rapidly incorporated into the rat dorsum. The measurement parameters were greater than or equivalent to contralateral dermis in this study.©2014 by Thieme Medical. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen type 1 (endogenous compound) collagen type 3 (endogenous compound) hydroxyproline (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix EMTREE MEDICAL INDEX TERMS angiogenesis animal experiment animal model article comparative study controlled study in vivo study male neoangiogenesis nonhuman priority journal rat time wound healing DEVICE TRADE NAMES AlloMax , United StatesBard DEVICE MANUFACTURERS (United States)Bard CAS REGISTRY NUMBERS hydroxyproline (51-35-4, 6912-67-0) EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014017133 MEDLINE PMID 23864532 (http://www.ncbi.nlm.nih.gov/pubmed/23864532) PUI L52689911 DOI 10.1055/s-0033-1349721 FULL TEXT LINK http://dx.doi.org/10.1055/s-0033-1349721 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 390 TITLE Pasteurella multocida infection of a tissue expander following breast reconstruction AUTHOR NAMES Martinez C.A. Boutros S.G. Hall J.A. AUTHOR ADDRESSES (Martinez C.A.; Boutros S.G., research@drseanboutros.com; Hall J.A.) Houston Plastic and Craniofacial Surgery, 6400 Fannin, Houston, TX 77030, United States. (Boutros S.G., research@drseanboutros.com; Hall J.A.) Division of Plastic Surgery, Department of Surgery, University of Texas School of Medicine at Houston, TX, United States. (Boutros S.G., research@drseanboutros.com) Westside Surgical Hospital, United States. SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2014) 67:7 (e180-e181). Date of Publication: July 2014 ISSN 1878-0539 (electronic) 1748-6815 BOOK PUBLISHER Churchill Livingstone EMTREE DRUG INDEX TERMS amoxicillin (drug therapy) bacitracin (drug therapy) ciprofloxacin (drug therapy) doxycycline (drug therapy, oral drug administration) gentamicin (drug therapy) paracetamol (drug therapy) tobramycin (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction breast tissue expander Pasteurella multocida infection (drug therapy, drug therapy) prosthesis infection (drug therapy, drug therapy) EMTREE MEDICAL INDEX TERMS abnormal sensation acellular dermal matrix adult antibiotic prophylaxis antibiotic therapy bacterium culture breast cancer case report debridement deep inferior epigastric perforator flap drain drainage tube erythema feeding apparatus female fever granulation tissue heat hospital discharge human letter mastectomy metastasis palpation physical examination priority journal sentinel lymph node tissue expander CAS REGISTRY NUMBERS amoxicillin (26787-78-0, 34642-77-8, 61336-70-7) bacitracin (1405-87-4) ciprofloxacin (85721-33-1) doxycycline (10592-13-9, 17086-28-1, 564-25-0, 94088-85-4) gentamicin (1392-48-9, 1403-66-3, 1405-41-0) paracetamol (103-90-2) tobramycin (32986-56-4) EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2014393015 MEDLINE PMID 24553315 (http://www.ncbi.nlm.nih.gov/pubmed/24553315) PUI L53008280 DOI 10.1016/j.bjps.2014.01.023 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2014.01.023 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 391 TITLE [Preparation and characterization of acellular adipose tissue matrix]. AUTHOR NAMES Fan X. Tian C. Fu Y. Li X. Deng L. Lü Q. AUTHOR ADDRESSES (Fan X.; Tian C.; Fu Y.; Li X.; Deng L.; Lü Q.) CORRESPONDENCE ADDRESS X. Fan, SOURCE Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery (2014) 28:3 (377-383). Date of Publication: Mar 2014 ISSN 1002-1892 ABSTRACT To prepare human acellular adipose tissue matrix and to evaluate the cellular compatibility so as to explore a suitable bio-derived scaffold for adipose tissue engineering. The adipose tissue was harvested from abdominal skin graft of breast cancer patients undergoing radical mastectomy or modified radical mastectomy, and then was treated with a series of decellularization processes including repeated freeze-thaw, enzyme digestion, and organic solvent extraction. The matrix was examined by histology, immunohistochemistry, DAPI fluorescence staining, and scanning electron microscopy to observe the the removal of cells and to analyze its composition of collagen type IV, laminin, and fibronectin, and microstructure. The 3rd passage human adipose-derived stem cells (hADSCs) were co-cultured with acellular adipose tissue matrix and different concentrations of extracted liquid (100%, 75%, 50%, and 25%). The cytotoxic effects of the matrix were tested by MTT. The biocompatibility of the matrix was detected by live/dead staining and scanning electron microscopy observation. The acellular adipose tissue matrix basically maintains intrinsical morphology. The matrix after acellular treatment consisted of extracellular matrix without any cell components, but there were abundant collagen type I; neither DNA nor lipid residual was detected. Moreover, the collagen was the main component of the matrix which was rich in laminin and fibronectin. At 1, 3, and 5 days after co-cultured with hADSCs, the cytotoxic effect of matrix was grade 0-1. The matrix displayed good cell compatibility and proliferation. The acellular adipose tissue matrix prepared by repeated freeze-thaw, enzyme digestion, and organic solvent extraction method remains abundant extracellular matrix and has good cellular compatibility, so it is expected to be an ideal bio-derived scaffold for adipose tissue engineering. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) tissue scaffold EMTREE DRUG INDEX TERMS biomaterial EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adipose tissue extracellular matrix stem cell tissue engineering EMTREE MEDICAL INDEX TERMS article cell adhesion cell culture cell culture technique cell proliferation cell separation cytology female human materials testing methodology scanning electron microscopy staining LANGUAGE OF ARTICLE Chinese MEDLINE PMID 24844024 (http://www.ncbi.nlm.nih.gov/pubmed/24844024) PUI L373980054 COPYRIGHT Copyright 2014 Medline is the source for the citation and abstract of this record. RECORD 392 TITLE Breast reconstruction AUTHOR NAMES Milas I. Zore Z. Roth A. Orešić T. Eljuga D. Gulan M. Guteša I. Stanec M. AUTHOR ADDRESSES (Milas I., ivan.milas@kbcsm.hr; Zore Z.; Roth A.; Orešić T.; Eljuga D.; Gulan M.; Guteša I.; Stanec M.) Department of Surgical Oncology, University Hospital for Tumors, University Hospital Center Sestre Milosrdnice, Ilica 197, Zagreb, Croatia. (Milas I., ivan.milas@kbcsm.hr) School of Medicine, University of Osijek, Ilica 197, Zagreb, Croatia. SOURCE Libri Oncologici (2014) 42:1-3 (29-35). Date of Publication: 2014 ISSN 0300-8142 BOOK PUBLISHER University Hospital for Tumors, libri.oncologici@kbcsm.hr ABSTRACT Breast cancer is most common cancer in women in Croatia. It is a leading cause of death in women wirh malignant disease. Breast cancer treatment causes anxiety in women also because of the fear of losing one or both breasts. This disease has a psychological impact effect and increasing number of women decide to undergo reconstruction. There has been a substantial progress in reconstructive tehniques in last two decades. This article summarizes short history, development and today's state of the art of reconstructive possibilities. As well as, advantages and disadvantages of reconstructive tehniques that help us choose the right timing and the right type of reconstruction. The final goal of breast reconstruction is oncological safety and women's statisfaction with the outcome. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction EMTREE MEDICAL INDEX TERMS acellular dermal matrix acollagen collagen dermal matrix breast cancer (radiotherapy, surgery) breast implant breast tissue expander cancer radiotherapy capsular contracture (complication) deep inferior epigastric perforator flap graft necrosis (complication) human latissimus dorsi flap patient satisfaction postoperative complication (complication) review seroma (complication) skin necrosis (complication) superficial inferior epigastric artery flap surgical technique tissue expansion transverse rectus abdominis musculocutaneous flap EMBASE CLASSIFICATIONS Cancer (16) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English, unknown EMBASE ACCESSION NUMBER 20170337581 PUI L616101964 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 393 TITLE Management of the post-breast reconstruction "hyperanimation deformity". AUTHOR NAMES Sbitany H. AUTHOR ADDRESSES (Sbitany H., hani.sbitany@ucsfmedctr.org) University of California, San Francisco, 505 Parnassus Avenue, Suite M-593, San Francisco, Calif. 94143, CORRESPONDENCE ADDRESS H. Sbitany, Email: hani.sbitany@ucsfmedctr.org SOURCE Plastic and reconstructive surgery (2014) 133:6 (897e-898e). Date of Publication: Jun 2014 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation (adverse drug reaction) muscle contraction pectoralis major muscle (surgery) skin transplantation EMTREE MEDICAL INDEX TERMS article female human methodology pathology pathophysiology scar LANGUAGE OF ARTICLE English MEDLINE PMID 24867763 (http://www.ncbi.nlm.nih.gov/pubmed/24867763) PUI L373729176 COPYRIGHT Copyright 2014 Medline is the source for the citation and abstract of this record. RECORD 394 TITLE Letter from america: Selling silk surgical scaffolds AUTHOR NAMES Freshwater M.F. AUTHOR ADDRESSES (Freshwater M.F., mfelix.freshwater@gmail.com) Department of Surgery, University of Miami, School of Medicine, 9155 S. Dadeland Blvd., Miami, United States. CORRESPONDENCE ADDRESS M.F. Freshwater, Department of Surgery, University of Miami, School of Medicine, 9155 S. Dadeland Blvd., Miami, United States. SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2014) 67:10 (1457-1459). Date of Publication: 2014 ISSN 1878-0539 (electronic) 1748-6815 BOOK PUBLISHER Churchill Livingstone EMTREE DRUG INDEX TERMS (MAJOR FOCUS) polyglactin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix market surgical mesh EMTREE MEDICAL INDEX TERMS Bombyx mori breast reconstruction cocoon food and drug administration human medical device nonhuman outcome assessment patient satisfaction plastic surgeon priority journal ptosis radius fracture satisfaction short survey surgeon satisfaction volar plate DEVICE TRADE NAMES surgimend Collagen Matrix CAS REGISTRY NUMBERS polyglactin (26780-50-7, 34346-01-5) EMBASE CLASSIFICATIONS Public Health, Social Medicine and Epidemiology (17) Biophysics, Bioengineering and Medical Instrumentation (27) Health Policy, Economics and Management (36) Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2015779463 MEDLINE PMID 25219672 (http://www.ncbi.nlm.nih.gov/pubmed/25219672) PUI L602526364 DOI 10.1016/j.bjps.2014.06.015 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2014.06.015 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 395 TITLE Secondary augmentation-mastopexy: Indications, preferred practices, and the treatment of complications AUTHOR NAMES Spring M.A. Macias L.H. Nadeau M. Stevens W.G. AUTHOR ADDRESSES (Spring M.A., drmichellespring@gmail.com; Macias L.H.; Stevens W.G.) Keck School of Medicine, University of Southern California, Los Angeles, United States. (Nadeau M.) University of Southern California, Los Angeles, United States. CORRESPONDENCE ADDRESS M.A. Spring, Keck School of Medicine, University of Southern California, Los Angeles, United States. Email: drmichellespring@gmail.com SOURCE Aesthetic Surgery Journal (2014) 34:7 (1018-1040). Date of Publication: 2014 ISSN 1527-330X (electronic) 1090-820X BOOK PUBLISHER Oxford University Press, jnl.info@oup.co.uk ABSTRACT Increasing the volume of the breast while simultaneously decreasing the skin envelope equates to surgery involving opposing forces. Increasing patient demand and the evolving perceptions of surgeons have led to the growing popularity of the combined augmentation-mastopexy operation. In turn, secondary augmentation-mastopexies and revisional surgeries of primary augmentation-mastopexies also have increased in popularity. In this article, the authors describe indications for secondary augmentation-mastopexy, techniques for performing this combined procedure safely and effectively, adjunctive procedures, potential pitfalls, and the treatment of complications. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) augmentation mastopexy breast augmentation reoperation EMTREE MEDICAL INDEX TERMS acellular dermal matrix article body weight fluctuation breast areola breast implant (adverse device effect) breast malformation breast surgery composite skin graft double bubble deformity elasticity excision human implant capsular contracture (complication) implant malposition (complication) implant rippling (complication) implant visibility (complication) informed consent lactation mammary artery mammography medical device complication (complication) nipple malformation patient satisfaction patient selection pectoralis major muscle postoperative care pregnancy preoperative care priority journal pseudoptosis recurrent disease sensation subpectoral implant animation deformity (complication) symmastia (complication) tissue necrosis (complication) treatment indication treatment planning vascularization wound dehiscence (complication) wound healing impairment (complication) EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 20160485173 MEDLINE PMID 25168806 (http://www.ncbi.nlm.nih.gov/pubmed/25168806) PUI L610961589 DOI 10.1177/1090820X14543943 FULL TEXT LINK http://dx.doi.org/10.1177/1090820X14543943 COPYRIGHT Copyright 2018 Elsevier B.V., All rights reserved. RECORD 396 TITLE The effect of reusable versus disposable draping material on infection rates in implant-based breast reconstruction: a prospective randomized trial AUTHOR NAMES Showalter B.M. Crantford J.C. Russell G.B. Marks M.W. DeFranzo A.J. Thompson J.T. Pestana I.A. David L.R. AUTHOR ADDRESSES (Showalter B.M.; Crantford J.C.; Russell G.B.; Marks M.W.; DeFranzo A.J.; Thompson J.T.; Pestana I.A.; David L.R.) From the *Department of Plastic and Reconstructive Surgery, Wake Forest Baptist Health, Winston-Salem, NC; and †Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC SOURCE Annals of plastic surgery (2014) 72:6 (S165-S169). Date of Publication: 2014 ISSN 1536-3708 (electronic) ABSTRACT BACKGROUND: Clinical infection remains a significant problem in implant-based breast reconstruction and is a physical and emotional strain to the breast reconstruction patient. Bacterial strikethrough of draping and gown material is a likely source of infection. Strategies to reduce infection in implant-based breast reconstruction are essential to improve patient outcomes.OBJECTIVE: The aim of this study is to determine if a disposable draping system is superior to reusable draping materials in the prevention of implant-based breast reconstruction infection.METHODS: This single-institution, prospective, randomized, single-blinded, IRB-approved study enrolled women with breast cancer who were eligible for implant-based breast reconstruction. The primary endpoint was clinical infection by postoperative day 30. Secondary endpoints included all other complications encountered throughout the follow-up period and culture data. Demographic data recorded included patient age, body mass index, diabetes, smoking, chemotherapy, radiation, and follow-up. Procedural data recorded included procedure type, procedure length, estimated blood loss, use of acellular dermal matrix, use of muscle flap, and inpatient versus outpatient setting.RESULTS: From March 2010 through January 2012, 107 women were randomized and 102 completed the study. Five patients were determined not to be candidates for reconstruction after randomization. There were 43 patients in the Reusable Group and 59 patients in the Disposable Group. There were no significant differences in patient demographic data, procedural data, or the type of procedure performed between groups. In the Reusable Group, there were 5 infections (12%) within 30 days compared to 0 (0%) infections in the Disposable Group (P = 0.012). There was no significant difference in secondary complications. There was a trend for positive wound cultures (11% vs. 3%, P = 0.10) and positive drape cultures (17% vs.4%, P = 0.08) in patients with clinical infection. There were no differences in the number of colony-forming units or positive cultures between groups.CONCLUSIONS: Disposable draping material is superior to a reusable draping system in the prevention of clinical infection within the immediate postoperative period. This study did not demonstrate a clear link between intraoperative culture data and the development of clinical infection. A completely disposable gown and draping system is recommended during implant-based breast reconstruction. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation surgical drape EMTREE MEDICAL INDEX TERMS adult breast tumor (surgery) comparative study controlled study disposable equipment female human microbiology middle aged prospective study randomized controlled trial recycling surgical infection (prevention) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24374400 (http://www.ncbi.nlm.nih.gov/pubmed/24374400) PUI L602111427 DOI 10.1097/SAP.0000000000000086 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0000000000000086 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 397 TITLE Reinforcement of the abdominal wall following breast reconstruction with abdominal flaps: a comparison of synthetic and biological mesh. AUTHOR NAMES Patel K.M. Shuck J. Hung R. Hannan L. Nahabedian M.Y. AUTHOR ADDRESSES (Patel K.M.) Washington, D.C. From the Department of Plastic Surgery, Georgetown University Hospital. (Shuck J.; Hung R.; Hannan L.; Nahabedian M.Y.) CORRESPONDENCE ADDRESS K.M. Patel, SOURCE Plastic and reconstructive surgery (2014) 133:3 (700-707). Date of Publication: Mar 2014 ISSN 1529-4242 (electronic) ABSTRACT Breast reconstruction using muscle-preserving abdominal flaps occasionally results in an abdominal bulge or hernia. The authors analyzed outcomes and complications following use of a synthetic or biological mesh for abdominal reinforcement following initial harvest or secondary repair of a bulge or hernia. A retrospective review was conducted of all patients (n = 818) who had abdominal flap-based breast reconstruction between 1995 and 2011. Ninety-seven patients met inclusion criteria; 61 had synthetic mesh and 36 had biological mesh (porcine acellular dermal matrix). Complications and outcomes were reviewed. Statistical analysis was performed to determine contributing factors and differences between cohorts. Overall complication rates for the synthetic and biological cohorts were 6.5 and 5.5 percent (p = 0.61), respectively, with slightly higher bulge rates in patients with synthetic compared with biological mesh (18 percent versus 8.3 percent; p = 0.25). Complication rates in primary and secondary placement of synthetic mesh were 5 and 7.3 percent, respectively; bulge rates were 15 and 19.5 percent, respectively. Complication rates in primary and secondary placement of biological mesh were 6.3 and 0 percent, respectively; bulge rates were 9.4 and 0 percent, respectively. Synthetic and biological mesh reconstruction for primary abdominal repair and secondary contouring have similar, low complication rates. Postoperative abdominal wall laxity and bulge occurred in an equal distribution following unilateral or bilateral flap reconstruction. Early investigation demonstrates that porcine acellular dermal matrix is as effective as synthetic mesh for abdominal wall reinforcement and repair, with limited morbidity associated with each. Therapeutic, III. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) abdominal wall (surgery) breast reconstruction surgical mesh wound closure EMTREE MEDICAL INDEX TERMS abdominal wall hernia (surgery) article comparative study female human methodology middle aged plastic surgery retrospective study surgical flaps LANGUAGE OF ARTICLE English MEDLINE PMID 24572859 (http://www.ncbi.nlm.nih.gov/pubmed/24572859) PUI L372947865 COPYRIGHT Copyright 2014 Medline is the source for the citation and abstract of this record. RECORD 398 TITLE An unusual breast lesion: Granular cell tumor of the breast with extensive chest wall invasion AUTHOR NAMES Coates S.J. Mitchell K. Olorunnipa O.B. Desimone R.A. Otterburn D.M. Simmons R.M. AUTHOR ADDRESSES (Coates S.J., sjc2002@med.cornell.edu) Weill Cornell Medical College, 1300 York Ave., New York, NY 10065, United States. (Mitchell K.; Olorunnipa O.B.; Otterburn D.M.) Department of Surgery, Division of Plastic Surgery, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, United States. (Desimone R.A.) Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, United States. (Simmons R.M.) Department of Surgery, Division of Breast Surgery, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, United States. CORRESPONDENCE ADDRESS S.J. Coates, Weill Cornell Medical College, 1300 York Ave., New York, NY 10065, United States. Email: sjc2002@med.cornell.edu SOURCE Journal of Surgical Oncology (2014) 110:3 (345-347). Date of Publication: September 2014 ISSN 1096-9098 (electronic) 0022-4790 BOOK PUBLISHER John Wiley and Sons Inc., P.O.Box 18667, Newark, United States. ABSTRACT Granular cell tumors (GCT) are generally benign soft tissue tumors. When located in the breast, they may be misdiagnosed as more typical tumors, such as invasive ductal carcinoma, based on misleading clinical or radiologic features. GCTs are frequently found in the setting of a known malignancy. We report the case of a patient with a large infra-mammary fold GCT, the management of which required a multidisciplinary operative approach due to extensive chest wall invasion. © 2014 Wiley Periodicals, Inc. EMTREE DRUG INDEX TERMS fluorodeoxyglucose EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast carcinoma (diagnosis, surgery) granular cell tumor (diagnosis, surgery) thorax wall tumor (surgery) EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult African American article axillary lymph node body weight loss breast biopsy breast lesion breast surgery breast tumor cancer surgery case report dermis female human incision lymph node dissection mammography microscopy middle aged nuclear magnetic resonance imaging nullipara partial mastectomy pectoralis major muscle pericardium pig plastic surgery pleura positron emission tomography preoperative evaluation priority journal rib rib resection sentinel lymph node biopsy skeletal muscle soft tissue thorax surgery thorax wall reconstruction tumor invasion tumor volume CAS REGISTRY NUMBERS fluorodeoxyglucose (29702-43-0) EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014520756 MEDLINE PMID 24863566 (http://www.ncbi.nlm.nih.gov/pubmed/24863566) PUI L373685918 DOI 10.1002/jso.23640 FULL TEXT LINK http://dx.doi.org/10.1002/jso.23640 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 399 TITLE Mesenchymal Stem Cells Seeded on Cross-Linked and Noncross-Linked Acellular Porcine Dermal Scaffolds for Long-Term Full-Thickness Hernia Repair in a Small Animal Model AUTHOR NAMES Mestak O. Matouskova E. Spurkova Z. Benkova K. Vesely P. Mestak J. Molitor M. Pombinho A. Sukop A. AUTHOR ADDRESSES (Mestak O., Mestak@gmail.com; Vesely P.; Mestak J.; Molitor M.) Department of Plastic Surgery, 1st Faculty of Medicine, Bulovka Hospital, Charles University in Prague, Prague, Czech Republic. (Matouskova E.) Laboratory of Cell Biology, Prague Burn Centre, 3rd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic. (Spurkova Z.; Benkova K.) Department of Pathology, Bulovka Hospital, Prague, Czech Republic. (Pombinho A.) Laboratory of Cell Differentiation, Institute of Molecular Genetics, Czech Academy of Sciences, Prague, Czech Republic. (Sukop A.) Department of Plastic Surgery, 3rd Faculty of Medicine, Charles University in Prague, University Hospital Kralovske Vinohrady, Prague, Czech Republic. CORRESPONDENCE ADDRESS O. Mestak, Bulovka Hospital, 1st Faculty of Medicine, Charles University in Prague, Budinova 2, Prague 8, 180 00, Czech Republic. Email: Mestak@gmail.com SOURCE Artificial Organs (2014) 38:7 (572-579). Date of Publication: July 2014 ISSN 1525-1594 (electronic) 0160-564X BOOK PUBLISHER Blackwell Publishing Inc., subscrip@blackwellpub.com ABSTRACT Biological meshes are biomaterials consisting of extracellular matrix that are used in surgery particularly for hernia treatment, thoracic wall reconstruction, or silicone implant-based breast reconstruction. We hypothesized that combination of extracellular matrices with autologous mesenchymal stem cells used for hernia repair would result in increased vascularization and increased strength of incorporation. We cultured autologous adipose-derived stem cells harvested from the inguinal region of Wistar rats on cross-linked and noncross-linked porcine extracellular matrices. In 24 Wistar rats, a standardized 2×4cm fascial defect was created and repaired with either cross-linked or noncross-linked grafts enriched with stem cells. Non-MSC-enriched grafts were used as controls. The rats were sacrificed at 3 months of age. The specimens were examined for the strength of incorporation, vascularization, cell invasion, foreign body reaction, and capsule formation. Both materials showed cellular ingrowth and neovascularization. Comparison of both tested groups with the controls showed no significant differences in the capsule thickness, foreign body reaction, cellularization, or vascularization. The strength of incorporation of the stem cell-enriched cross-linked extracellular matrix specimens was higher than in acellular specimens, but this result was statistically nonsignificant. In the noncross-linked extracellular matrix, the strength of incorporation was significantly higher in the stem cell group than in the acellular group. Seeding of biological meshes with stem cells does not significantly contribute to their increased vascularization. In cross-linked materials, it does not ensure increased strength of incorporation, in contrast to noncross-linked materials. Owing to the fact that isolation and seeding of stem cells is a very complex procedure, we do not see sufficient benefits for its use in the clinical setting. © 2013 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) cross linking full thickness skin graft hernioplasty mesenchymal stem cell surgical mesh EMTREE MEDICAL INDEX TERMS adipocyte adipose derived stem cell animal cell animal experiment animal tissue article cell differentiation cell invasion controlled study extracellular matrix female foreign body reaction inguinal region nonhuman osteoblast priority journal rat tensile strength vascularization DEVICE TRADE NAMES Permacol , IrelandCovidien DEVICE MANUFACTURERS (Ireland)Covidien EMBASE CLASSIFICATIONS Biophysics, Bioengineering and Medical Instrumentation (27) Clinical and Experimental Biochemistry (29) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014477216 MEDLINE PMID 24304366 (http://www.ncbi.nlm.nih.gov/pubmed/24304366) PUI L52904057 DOI 10.1111/aor.12224 FULL TEXT LINK http://dx.doi.org/10.1111/aor.12224 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 400 TITLE Porcine-derived acellular dermal matrix in primary augmentation mammoplasty to minimize implant-related complications and achieve an internal mastopexy: A case series AUTHOR NAMES Kornstein A. AUTHOR ADDRESSES (Kornstein A., andrewkornstein@gmail.com) Museum Mile Surgery Center, 1050 Fifth Avenue, New York, NY 10028, United States. CORRESPONDENCE ADDRESS A. Kornstein, Museum Mile Surgery Center, 1050 Fifth Avenue, New York, NY 10028, United States. Email: andrewkornstein@gmail.com SOURCE Journal of Medical Case Reports (2013) 7 Article Number: 275. Date of Publication: 30 Dec 2013 ISSN 1752-1947 (electronic) BOOK PUBLISHER BioMed Central Ltd., Floor 6, 236 Gray's Inn Road, London, United Kingdom. ABSTRACT Introduction. Patients who present for augmentation mammoplasty with poor quality mammary soft-tissue support may be at increased risk for post-operative complications. Non-crosslinked intact porcine-derived acellular dermal matrix (Strattice™ Reconstructive Tissue Matrix, LifeCell Corp., Branchburg, NJ, USA) may enhance soft-tissue support in such patients and reduce implant-related complications, including capsular contracture, rippling, palpability, and malposition. The objective of this case report series was to describe the outcomes of three patients with poor quality mammary soft-tissue support who underwent primary cosmetic breast augmentation with pre-emptive implantation of porcine-derived acellular dermal matrix. Case presentation. Case 1 concerns a 40-year-old Caucasian woman with post-partum soft tissue laxity and grade II ptosis. Case 2 concerns a 30-year-old Caucasian woman with congenital soft-tissue laxity and grade I + ptosis. Case 3 concerns a 49-year-old Caucasian woman with post-partum and post-weight-loss-induced laxity and grade III ptosis. In all three of our patients, porcine-derived acellular dermal matrix was sutured to the chest wall along the infra-mammary and/or a neo-infra-mammary fold and then laid passively superiorly or sutured under tension to the breast parenchyma or caudal edge of the pectoralis major muscle. In cases 1 and 2, a modified internal mastopexy technique was performed. Suturing the porcine-derived acellular dermal matrix to the posterior aspect of the breast parenchyma and/or caudal pectoralis muscle under appropriate tension in conjunction with radial plication of the porcine-derived acellular dermal matrix created a snug 'hand-in-glove' pocket and resulted in only minimal peri-areolar scarring. Case 3 required a vertical scar mastopexy. During a mean of 18 months of follow-up, all three patients had positive outcomes and no complications (that is, infection, hematoma, seroma, rippling, malposition, or capsular contracture). The surgeon and patients were generally highly satisfied with the aesthetic outcome of the breasts. Conclusions: Pre-emptive use of porcine-derived acellular dermal matrix may be beneficial in patients with primary augmentation with poor quality mammary soft-tissue support. © 2013 Kornstein; licensee BioMed Central Ltd. EMTREE DRUG INDEX TERMS bacitracin (drug combination, drug therapy) cefazolin (drug combination, drug therapy) celecoxib (drug therapy) cyclobenzaprine (drug therapy) gentamicin (drug combination, drug therapy) moxifloxacin (drug therapy) paracetamol (drug therapy) vancomycin (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation EMTREE MEDICAL INDEX TERMS adult article body weight loss case report esthetic surgery female follow up hematoma human infection prevention joint laxity middle aged pectoralis major muscle pig postoperative pain (complication, drug therapy) priority journal ptosis seroma silicone prosthesis surgical infection (drug therapy, prevention) CAS REGISTRY NUMBERS bacitracin (1405-87-4) cefazolin (25953-19-9, 27164-46-1) celecoxib (169590-42-5) cyclobenzaprine (303-53-7, 6202-23-9) gentamicin (1392-48-9, 1403-66-3, 1405-41-0) moxifloxacin (151096-09-2) paracetamol (103-90-2) vancomycin (1404-90-6, 1404-93-9) EMBASE CLASSIFICATIONS Surgery (9) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014111891 PUI L52941851 DOI 10.1186/1752-1947-7-275 FULL TEXT LINK http://dx.doi.org/10.1186/1752-1947-7-275 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 401 TITLE Latissimus dorsi muscle onlay patch alternative to acellular dermal matrix is useful for implant-based breast reconstruction AUTHOR NAMES Lee J. Bae Y. Lee S. AUTHOR ADDRESSES (Lee J.; Bae Y.; Lee S.) Pusan National University Hospital, Busan, South Korea. CORRESPONDENCE ADDRESS J. Lee, Pusan National University Hospital, Busan, South Korea. SOURCE Cancer Research (2013) 73:24 SUPPL. 1. Date of Publication: 15 Dec 2013 CONFERENCE NAME 36th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2013-12-10 to 2013-12-14 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Introduction: The implants-based breast reconstruction is very useful method for breast conserving surgery in breast cancer. Recently, acellular dermal matrix (ADM) is applied to release the inferior pectoralis muscle for maintaining breast contour and to prevent burst out from the implant pocket. Authors applied latissimus dorsi (LD) muscle onlay patch instead of ADM for implant-based breast reconstruction. Patients and methods: From January to December 2012, a total of 20 patients with breast tumor underwent 22 cases of implant-based breast reconstruction with ADM or LD muscle onlay patch. The cosmetic outcome is assessed with 4-point scoring system at 4 weeks after from chemotherapy or radiotherapy. And the statistical analysis was evaluated between 2 groups. After conventional breast conserving surgery was done, the origin of the pectoralis major muscle are released and the window is checked pectoralis major muscle medially, rectus sheath inferiorly, and serratus anterior muscle laterally. Then, LD flap is sutured to cover this window with avoiding the vessel injury. The implant is inserted in the subpectoral pocket and breast reconstruction is finished with LD flap. Results: Mean operation time of ADM group and LD muscle onlay patch group was 153.9 and 299.7 minutes, respectively. (p = 0.054). There were no significant differences between 2 groups; postoperative complication, cosmetic outcomes, and tumor characteristics. However, ADM was found to be much more expensive than LD muscle onlay patch.(p<0.001) Conclusion: Implant-based breast reconstruction with LD muscle onlay patch would be a feasible surgical technique alternative to ADM, when LD flap is planned for breast reconstruction. EMTREE DRUG INDEX TERMS cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast cancer breast reconstruction implant latissimus dorsi muscle EMTREE MEDICAL INDEX TERMS breast breast tumor chemotherapy human injury muscle neoplasm operation duration partial mastectomy patient pectoralis major muscle postoperative complication radiotherapy rectus abdominis muscle scoring system statistical analysis surgical technique LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71472011 DOI 10.1158/0008-5472.SABCS13-P2-19-04 FULL TEXT LINK http://dx.doi.org/10.1158/0008-5472.SABCS13-P2-19-04 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 402 TITLE Successful breast reconstruction using acellular dermal matrix can be recommended in healthy non-smoking patients AUTHOR NAMES Gunnarsson G.L. Børsen-Koch M. Arffmann S. Guldvog I. Wamberg P. Kjær C. Westvik T. Thomsen J.B. AUTHOR ADDRESSES (Gunnarsson G.L.; Guldvog I.; Westvik T.) Telemark Hospital Skien, Norway. (Børsen-Koch M.; Arffmann S.; Wamberg P.; Kjær C.; Thomsen J.B., jbth@dadlnet.dk) Lillebælt Hospital, Vejle Hospital, Odense University Hospital, Denmark. CORRESPONDENCE ADDRESS J. B. Thomsen, Plastikkirurgisk Afdeling Z, Vejle Sygehus, Kabbeltoft 25, 7100 Vejle, Denmark. Email: jbth@dadlnet.dk SOURCE Danish Medical Journal (2013) 60:12. Date of Publication: December 2013 ISSN 2245-1919 (electronic) BOOK PUBLISHER Danish Medical Association, Kristianiagade 14, Copenhagen, Denmark. ABSTRACT INTRODUCTION: We present Scandinavia's first series of immediate alloplastic breast reconstructions with an acellular dermal matrix. MATERIAL AND METHODS: Data were collected retrospectively in 76 cases of immediate breast reconstruction using an acellular dermal matrix (ADM) and an implant. RESULTS: A total of 59 women were reconstructed between June 2011 and January 2013. Cases included 42 unilateral and 17 bilateral reconstructions. A large number of patients had adjuvant therapy, hormone therapy (34), radiation therapy (27) or chemotherapy (38). The median age was 51 years (30-70 years) and the median follow-up period was 326 days (68-624 days). The co-morbidity factors included hypertension (11), diabetes (2) and 19 patients were smokers. Unsuccessful reconstructions counted ten cases (13%), eight of these due to necrosis and/or wound dehiscence (10%) and two due to infection (3%). The failure rate in non-smokers was 2/52 (4%) compared with 8/24 (33%) in smokers, p = 0.001. In hypertensive patients, the failure rate was 6/12 (50%) compared with 4/64 in normotensive patients (6%), p = 0.001. 70% of the failed reconstructions occurred in patients older than 65 years of age. CONCLUSION: Immediate alloplastic breast reconstruction using an ADM can be recommended to healthy non-smoking patients. EMTREE DRUG INDEX TERMS antibiotic agent (intravenous drug administration, oral drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction EMTREE MEDICAL INDEX TERMS adult aged article comorbidity fat necrosis (complication) female human hypertension infection (complication) major clinical study partial mastectomy postoperative complication retrospective study seroma (complication) skin necrosis (complication) smoking treatment failure wound dehiscence (complication) EMBASE CLASSIFICATIONS Surgery (9) Dermatology and Venereology (13) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013759828 MEDLINE PMID 24355452 (http://www.ncbi.nlm.nih.gov/pubmed/24355452) PUI L370377657 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 403 TITLE An analysis of a nationwide survey of current trend in breast reconstruction AUTHOR NAMES Debnath D. Samra K.S. Mitchell L.A.M. Cook L. Burger A. Karat I. Laidlaw I.J. Daoud R. AUTHOR ADDRESSES (Debnath D.; Samra K.S.; Mitchell L.A.M.; Cook L.; Burger A.; Karat I.; Laidlaw I.J.; Daoud R.) Frimley Park Hospital, Frimley, United Kingdom. CORRESPONDENCE ADDRESS D. Debnath, Frimley Park Hospital, Frimley, United Kingdom. SOURCE International Journal of Surgery (2013) 11:8 (604). Date of Publication: 2013 CONFERENCE NAME Association of Surgeons in Training, ASiT Conference 2013 CONFERENCE LOCATION Manchester, United Kingdom CONFERENCE DATE 2013-04-05 to 2013-04-07 ISSN 1743-9191 BOOK PUBLISHER Elsevier Ltd ABSTRACT Aims: We aimed to assess whether recent wider use of acellular dermal matrix (ADM)-based breast reconstruction affected other methods of breast reconstruction. Methods: An email-based survey, using surveymonkey.com, was performed of all members of the Association of Breast Surgeons. Results: Out of 438 members, 36 replied. 31 performed reconstruction, 29 of whomwere breast surgeons.16 surgeons worked in tertiary centres,15 were based in district general hospitals. Occurrences of different methods performed during last year were compared with those of the preceding year. There was a significant fall in use of free flap (14.03%, p<0.00000001) and Latissimus Dorsi flap (18.5%; p<0.00000001), and a rise of implant-only (19.91%; p=0.00002), ADM(69%; p=0.000006) and other breast reconstruction methods (such as fat transfer) (279.16%; p=0.09). Commonest complications encountered in ADM-based reconstructions were 1 to 2 cases of allergy (n=4), significant bleeding (n=2), infection (n=13) and explantation (n=14). ADM of porcine origin was used mostly (n=19). Funding (never=6; sometimes=5) and faith related issues (never=14; sometimes=1) in using ADM were limited. Conclusions: Admittedly a small response, although not so unexpected in email-based surveys, confirmed the trend of change in different methods used in breast reconstruction. This has implications on training, organisation and need for further research. EMTREE DRUG INDEX TERMS nitrogen 13 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction human surgeon EMTREE MEDICAL INDEX TERMS acellular dermal matrix allergy bleeding breast e-mail explant free tissue graft funding general hospital implant infection latissimus dorsi flap LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71271620 DOI 10.1016/j.ijsu.2013.06.093 FULL TEXT LINK http://dx.doi.org/10.1016/j.ijsu.2013.06.093 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 404 TITLE Synergistic interactions with a high intraoperative expander fill volume increase the risk for mastectomy flap necrosis AUTHOR NAMES Khavanin N. Jordan S. Lovecchio F. Fine N.A. Kim J. AUTHOR ADDRESSES (Khavanin N.; Jordan S.; Lovecchio F.; Fine N.A.; Kim J., jokim@nmh.org) Northwestern University Feinberg School of Medicine, Chicago, United States. CORRESPONDENCE ADDRESS J. Kim, Northwestern University Feinberg School of Medicine, 675 N. Saint Clair G19-250, Chicago, IL 60611, United States. Email: jokim@nmh.org SOURCE Journal of Breast Cancer (2013) 16:4 (426-431). Date of Publication: December 2013 ISSN 1738-6756 BOOK PUBLISHER Korean Breast Cancer Society, 665-8, Bupyeong-6-Dong, Bypyeong-Gu, Incheon, South Korea. ABSTRACT Purpose: Prosthetic-based breast reconstruction is performed with increasing frequency in the United States. Major mastectomy skin flap necrosis is a significant complication with outcomes ranging from poor aesthetic appearance to reconstructive failure. The present study aimed to explore the interactions between intraoperative fill and other risk factors on the incidence of flap necrosis in patients undergoing mastectomy with immediate expander/implant-based reconstruction. Methods: A retrospective review of 966 consecutive patients (1,409 breasts) who underwent skin or nipple sparing mastectomy with immediate tissue expander reconstruction at a single institution was conducted. Age, body mass index, hypertension, smoking status, premastectomy and postmastectomy radiation, acellular dermal matrix use, and application of the tumescent mastectomy technique were analyzed as potential predictors of flap necrosis both independently and as synergistic variables with high intraoperative fill. The following three measures of interaction were calculated: relative excess risk due to interaction, attributable proportion of risk due to interaction, and synergy index (SI). Results: Intraoperative tissue expander fill volume was high (≥66.7% of the maximum volume) in 40.9% (576 of 1,409 breasts) of cases. The unadjusted flap necrosis rate was greater in the high intraoperative fill cohort than in the low fill cohort (10.4% vs. 7.1%, p= 0.027). Multivariate logistic regression did not identify high intraoperative fill volume as an independent risk factor for flap necrosis (odds ratio 1.442, 95% confidence interval 0.973-2.137, p= 0.068). However, four risk factors were identified that interacted significantly with intraoperative fill volume, namely tumescence, age, hypertension, and obesity. The SI, or the departure from additive risks, was largest for tumescence (SI, 25.3), followed by hypertension (SI, 2.39), obesity (SI, 2.28), and age older than 50 years (SI, 1.17). Conclusion: In the postmastectomy, hypovascular milieu, multiple risk factors decreasing flap perfusion interact with high intraoperative fill volume to cross a threshold and synergistically increase the risk of flap necrosis. © 2013 Korean Breast Cancer Society. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) graft necrosis (complication) mastectomy tissue expander EMTREE MEDICAL INDEX TERMS adult age article body mass breast cancer (surgery) fascia female follow up human hypertension major clinical study middle aged obesity pectoralis major muscle retrospective study risk factor smoking EMBASE CLASSIFICATIONS Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2014045693 PUI L372137284 DOI 10.4048/jbc.2013.16.4.426 FULL TEXT LINK http://dx.doi.org/10.4048/jbc.2013.16.4.426 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 405 TITLE Post-mastectomy breast reconstruction. AUTHOR NAMES Thiruchelvam P.T. McNeill F. Jallali N. Harris P. Hogben K. AUTHOR ADDRESSES (Thiruchelvam P.T.) Imperial College NHS Trust, Charing Cross Hospital, London W6 8RF, UK. (McNeill F.; Jallali N.; Harris P.; Hogben K.) CORRESPONDENCE ADDRESS P.T. Thiruchelvam, Imperial College NHS Trust, Charing Cross Hospital, London W6 8RF, UK. SOURCE BMJ (Clinical research ed.) (2013) 347 Article Number: f5903. Date of Publication: 2013 ISSN 1756-1833 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction (adverse drug reaction) breast tumor (surgery, therapy) mastectomy (adverse drug reaction) EMTREE MEDICAL INDEX TERMS acellular dermal matrix adjuvant chemotherapy adjuvant therapy breast implant female human methodology psychological aspect review surgical flaps time LANGUAGE OF ARTICLE English MEDLINE PMID 24128977 (http://www.ncbi.nlm.nih.gov/pubmed/24128977) PUI L563011195 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 406 TITLE Breast reconstruction with acellular dermal matrix: A brief analysis of costs AUTHOR NAMES Cattin F. Semprini G. Concina S. Zanin C. Massarut S. Cedolini C. Parodi P.C. Risaliti A. AUTHOR ADDRESSES (Cattin F.; Concina S.; Cedolini C.; Risaliti A.) General Surgery Department, University of Udine, Udine, Italy. (Semprini G., semprini-gIoria@libero.it; Zanin C.; Parodi P.C.) Plastic and Reconstructive Surgery Department, University of Udine, Udine, Italy. (Massarut S.) SOC Senologia, IRCCS CRO Aviano, Aviano, Pordenone, Italy. CORRESPONDENCE ADDRESS General Surgery Department, University of Udine, Udine, Italy. SOURCE Chirurgia (Turin) (2013) 26:6 (451-452). Date of Publication: December 2013 ISSN 0394-9508 BOOK PUBLISHER Edizioni Minerva Medica, Corso Bramante 83-85, Torino, Italy. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast cancer (surgery) breast reconstruction health care cost EMTREE MEDICAL INDEX TERMS breast implant breast prosthesis clinical practice convalescence cost benefit analysis cost effectiveness analysis hospitalization human letter mastectomy muscle outpatient rehydration thorax wall EMBASE CLASSIFICATIONS Cancer (16) Public Health, Social Medicine and Epidemiology (17) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2014124048 PUI L372405963 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 407 TITLE The double-bubble deformity: cause, prevention, and treatment. AUTHOR NAMES Handel N. AUTHOR ADDRESSES (Handel N.) Santa Barbara, Calif. From the Division of Plastic Surgery, David Geffen School of Medicine, University of California, Los Angeles. CORRESPONDENCE ADDRESS N. Handel, Santa Barbara, Calif. From the Division of Plastic Surgery, David Geffen School of Medicine, University of California, Los Angeles. SOURCE Plastic and reconstructive surgery (2013) 132:6 (1434-1443). Date of Publication: Dec 2013 ISSN 1529-4242 (electronic) ABSTRACT The double-bubble deformity is a widely recognized complication of breast augmentation, but there have been very few articles in the peer-reviewed literature devoted exclusively to this topic. Prior publications addressing the anatomy of the inframammary fold and its relationship to the double-bubble deformity are systematically reviewed. Disagreements among authorities regarding the precise anatomical structure of the inframammary fold are addressed. The cause and surgical correction of the double-bubble deformity are discussed in detail as they relate to the anatomy of the fold. The key to understanding the causes and correction of the double bubble lies in an appreciation of the anatomy of the inframammary fold. Correction of the deformity varies depending on whether or not patients had preexisting anatomical features predisposing them to development of a double bubble. A variety of surgical strategies, including use of a dual-plane pocket, form-stable shaped implants, capsulorrhaphy, pocket plane conversion, and use of acellular dermal matrices can play a role in prevention and treatment of the double-bubble deformity. Therapeutic, V. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation (adverse drug reaction) breast implant postoperative complication (etiology, prevention, surgery) reoperation EMTREE MEDICAL INDEX TERMS adult breast (surgery) case report female histology human methodology middle aged review LANGUAGE OF ARTICLE English MEDLINE PMID 24281573 (http://www.ncbi.nlm.nih.gov/pubmed/24281573) PUI L563028991 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 408 TITLE The double-bubble deformity: cause, prevention, and treatment AUTHOR NAMES Handel N. AUTHOR ADDRESSES (Handel N.) Santa Barbara, Calif. From the Division of Plastic Surgery, David Geffen School of Medicine, University of California, Los Angeles SOURCE Plastic and reconstructive surgery (2013) 132:6 (1434-1443). Date of Publication: 1 Dec 2013 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: The double-bubble deformity is a widely recognized complication of breast augmentation, but there have been very few articles in the peer-reviewed literature devoted exclusively to this topic.METHODS: Prior publications addressing the anatomy of the inframammary fold and its relationship to the double-bubble deformity are systematically reviewed. Disagreements among authorities regarding the precise anatomical structure of the inframammary fold are addressed. The cause and surgical correction of the double-bubble deformity are discussed in detail as they relate to the anatomy of the fold.RESULTS: The key to understanding the causes and correction of the double bubble lies in an appreciation of the anatomy of the inframammary fold. Correction of the deformity varies depending on whether or not patients had preexisting anatomical features predisposing them to development of a double bubble.CONCLUSION: A variety of surgical strategies, including use of a dual-plane pocket, form-stable shaped implants, capsulorrhaphy, pocket plane conversion, and use of acellular dermal matrices can play a role in prevention and treatment of the double-bubble deformity.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast implant postoperative complication (etiology, prevention, surgery) procedures EMTREE MEDICAL INDEX TERMS adult anatomy and histology breast breast augmentation case report female human middle aged reoperation LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24281573 (http://www.ncbi.nlm.nih.gov/pubmed/24281573) PUI L603395698 DOI 10.1097/01.prs.0000434405.91316.96 FULL TEXT LINK http://dx.doi.org/10.1097/01.prs.0000434405.91316.96 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 409 TITLE Is innovation in surgery less than ideal? A case study of acellular dermal matrix assisted prosthetic breast reconstruction AUTHOR NAMES Potter S. Browning D. Savovic J. Warr R. Cawthorn S. Blazeby J. AUTHOR ADDRESSES (Potter S.; Savovic J.; Blazeby J.) Centre for Surgical Research, University of Bristol, Bristol, United Kingdom. (Cawthorn S.) Breast Care Centre, North Bristol NHS Trust, Bristol, United Kingdom. (Warr R.) Department of Plastic Surgery, North Bristol NHS Trust, Bristol, United Kingdom. (Potter S.; Blazeby J.) Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom. (Browning D.) Department of Surgery, Royal United Hospital Bath, Bath, United Kingdom. CORRESPONDENCE ADDRESS J. Blazeby, Centre for Surgical Research, University of Bristol, Bristol, United Kingdom. SOURCE Trials (2013) 14 SUPPL. 1 (130DUMMY). Date of Publication: 29 Nov 2013 CONFERENCE NAME 2nd Clinical Trials Methodology Conference: Methodology Matters CONFERENCE LOCATION Edinburgh, United Kingdom CONFERENCE DATE 2013-11-18 to 2013-11-19 ISSN 1745-6215 BOOK PUBLISHER BioMed Central Ltd. ABSTRACT Introduction: The introduction of innovative procedures requires appropriate evaluation. IDEAL recommendations propose four stages of evaluation, (Idea-Development-Evaluation-Assessment-Long-term study). The aim of this study was to review the introduction of an innovative surgical technique according to this framework. Methods: Literature searches identified articles published between 2000 and 2012 reporting acellular dermal matrix-assisted prosthetic breast reconstruction (ADMPBR). Studies were classified by IDEAL-stage as A) descriptive (IDEAL-1/2a) reporting the feasibility or development of ADMPBR or B)comparative (IDEAL-2b/3(RCTs) comparing ADMPBR with standard techniques. IDEAL study designs reported before and after 2008/9 were examined to explore progression of study design over time. Results: Of 236 abstracts, 50 papers reporting data on 3,648 patients were included. 24 (48.0%) were IDEAL-1/2a; 25 (50.0%) IDEAL-2b and 1 (2%) IDEAL-3. IDEAL-2b-studies significantly increased from period-1 (2005-2008) to period-2 (2009-2012) (n=1 to n=24, p<0.01). The number of IDEAL-1/2a-studies published annually remained constant (n=2-4). Almost all IDEAL-1/2a studies (n=20,87.0%) provided comprehensive descriptions of surgical technique, but less than half (n=11) reported patient-selection criteria and only 25% documented seeking patient consent IDEAL-2b-studies were significantly larger than IDEAL-1/2a-studies (IDEAL-1/2a-median = 39, inter-quartile range-20-65 vs.IDEAL-2bmedian= 73, inter-quartile range-36-186, p<0.01, Median-test) and more likely to report combined results from groups of surgeons (n=10 vs. n=5; p=0.06). Short-term complication reporting was more comprehensive in IDEAL-2b-studies but there were no differences in the reporting of histological or technical details across groups and IDEAL-1/2a-studies were significantly more likely to report long-term (p=0.03), patientreported (p<0.01) and cosmetic outcomes (p=0.05). Conclusions: The introduction of ADMPBR does not consider previous evidence and comparative studies are lacking. Well-designed and conducted studies are needed to appropriately evaluate novel surgical innovations to establish standards of care, protect patients and surgeons. EMTREE DRUG INDEX TERMS cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction case study clinical trial (topic) methodology surgery EMTREE MEDICAL INDEX TERMS comparative study human median test patient patient selection procedures study design surgeon surgical technique LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71799924 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 410 TITLE Dermal autografts as a substitute for acellular dermal matrices (ADM) in tissue expander breast reconstruction: A prospective comparative study AUTHOR NAMES Lynch M.P. Chung M.T. Rinker B.D. AUTHOR ADDRESSES (Lynch M.P., michael.lynch@uky.edu; Rinker B.D.) University of Kentucky, Department of Surgery, Division of Plastic and Reconstructive Surgery, Lexington, KY 40506, United States. (Chung M.T.) University of Kentucky College of Medicine, Lexington KY 40506, United States. CORRESPONDENCE ADDRESS M.P. Lynch, University of Kentucky, Department of Surgery, Division of Plastic and Reconstructive Surgery, Lexington, KY 40506, United States. Email: michael.lynch@uky.edu SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2013) 66:11 (1534-1542). Date of Publication: November 2013 ISSN 1748-6815 1878-0539 (electronic) BOOK PUBLISHER Churchill Livingstone, 1-3 Baxter's Place, Leith Walk, Edinburgh, United Kingdom. ABSTRACT The use of acellular dermal matrix (ADM) in tissue expander breast reconstruction has several advantages but increased complications have been reported. Dermal autografts may offer a safer and more cost-effective alternative. The purpose of this prospective study was to compare the outcomes of tissue expander breast reconstruction using dermal autografts with ADM-assisted reconstruction. Patients undergoing tissue expander breast reconstruction with either ADM or dermal autografts were enrolled. Autografts were harvested from the lower abdomen. At each follow-up visit, patients were surveyed on a seven-point scale for scar and overall satisfaction. Biopsies taken at the time of device exchange were evaluated histologically with CD34 staining to assess tissue integration and vessel ingrowth. Expansion parameters, complications, procedural costs, and operative times were compared. Forty-eight patients were enrolled (76 breasts). Twenty-seven patients received ADM, and twenty-one patients received dermal autograft. Wound healing complications were significantly higher in the ADM group (14.8% versus 4.8%, p-value = 0.03), as were major complications (18.5% versus 0%, p-value < 0.01). Histologic vessel counts in the autograft group averaged 21 vessels/mm(2), compared to 7 vessels/mm(2) in the ADM group (p-value < 0.01). There was no difference between the two groups in scar satisfaction or overall satisfaction. Patients receiving dermal autograft had a lower incidence of major complications and delayed wound healing than patients who received ADM. Despite harvest time, the overall cost of the ADM-assisted expander placement was higher. Dermal autograft-assisted breast reconstruction offers many of the benefits of ADM, but with a lower cost and improved safety profile. © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction breast tissue expander skin autograft EMTREE MEDICAL INDEX TERMS adult aged breast biopsy clinical article comparative study female follow up histopathology hospitalization cost human infectious complication (complication) mastectomy operation duration outcome assessment patient satisfaction postoperative complication (complication) priority journal prospective study review wound healing impairment (complication) EMBASE CLASSIFICATIONS Surgery (9) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013643688 MEDLINE PMID 23871569 (http://www.ncbi.nlm.nih.gov/pubmed/23871569) PUI L52684346 DOI 10.1016/j.bjps.2013.07.002 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2013.07.002 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 411 TITLE POBRAD Trial: Prospective trial evaluating outcomes of immediate implant breast reconstruction using an acellular dermal matrix AUTHOR NAMES Douek M. De Graaff F. Westbroek D. Garmo H. Castro F. Hamed H. Kothari A. AUTHOR ADDRESSES (Douek M.; De Graaff F.; Westbroek D.; Garmo H.) King's College London, London, United Kingdom. (Douek M.; De Graaff F.; Westbroek D.; Castro F.; Hamed H.; Kothari A.) Guy's and St Thomas' Hospitals, London, United Kingdom. CORRESPONDENCE ADDRESS M. Douek, King's College London, London, United Kingdom. SOURCE European Journal of Surgical Oncology (2013) 39:11 (S86). Date of Publication: November 2013 CONFERENCE NAME BASO - The Association for Cancer Surgery Scientific Conference 2013 CONFERENCE LOCATION London, United Kingdom CONFERENCE DATE 2013-11-04 to 2013-11-05 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Background: In the UK, 59% of women undergoing immediate reconstruction post-mastectomy, undergo implant-based reconstruction. The use of an acellular dermal matrix (ADM) presents a new paradigm in the evolution of implant breast reconstruction. This is the first trial to prospectively evaluate clinical outcomes. Methods: All patients requiring mastectomy and suitable for immediate implant-based reconstruction were recruited between July 2011 and July 2012. The trial received Ethics Committee approval and had a standardised protocol. Bovine derived ADM (Surgimend PRS, TEI, Boston, USA) was used and surgical technique was also standardised. Clinical outcome was evaluated by clinical assessment, using photography (standard views + 3D) and with validated patient satisfaction questionnaires (PROMS). The primary outcome at 3 months (including 30 days) has been analysed. Results: A total of 185 patients underwent mastectomy and were screened for inclusion into the trial. Of these, 38% underwent no reconstruction and 62% underwent immediate reconstruction (33% implant based and 29% autologous). A total of 42 patients were recruited and 2 patients were excluded due to a breach of protocol. On the 40 patients available for analysis, 56 breast reconstructions were performed. Mastectomy was undertaken for invasive cancer (n=24; 60%), for DCIS (n=8; 20%) and risk-reducing surgery (n=8; 20%). At 3 months minimum follow-up complications included suspected infection (n=12; 30%), culture positive infection (n=2; 5%), flap ischaemia or necrosis (n=10; 25%), haematoma (n=1; 2.5%) and explantation (n=1; 2.5%). A further 4 implants were explanted after 3 months minimum follow-up, following adjuvant chemotherapy and radiotherapy. Conclusion: Implant reconstruction with ADM is a feasible option for immediate reconstruction. Complications need to be identified early and managed actively. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction cancer surgery implant EMTREE MEDICAL INDEX TERMS adjuvant chemotherapy clinical assessment explant female follow up hematoma human infection intraductal carcinoma ischemia mastectomy necrosis patient patient satisfaction photography professional standard questionnaire radiotherapy risk surgery surgical technique tumor invasion United Kingdom United States LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71273729 DOI 10.1016/j.ejso.2013.07.125 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2013.07.125 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 412 TITLE Analysis of the National Surgical Quality Improvement Program database in 19,100 patients undergoing implant-based breast reconstruction: complication rates with acellular dermal matrix AUTHOR NAMES Ibrahim A.M. Shuster M. Koolen P.G. Kim K. Taghinia A.H. Sinno H.H. Lee B.T. Lin S.J. AUTHOR ADDRESSES (Ibrahim A.M.; Shuster M.; Koolen P.G.; Kim K.; Taghinia A.H.; Sinno H.H.; Lee B.T.; Lin S.J.) Boston, Mass. From the Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School SOURCE Plastic and reconstructive surgery (2013) 132:5 (1057-1066). Date of Publication: 1 Nov 2013 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: The use of acellular dermal matrices has become increasingly popular in immediate and delayed tissue expander/implant-based breast reconstruction. However, it is unclear whether their use is associated with increased postoperative complication rates. Using the American College of Surgeons National Surgical Quality Improvement Program database, the authors assessed baseline differences in demographics and comorbidities with and without acellular dermal matrix and determined whether postoperative complication rates varied.METHODS: Using the national surgical database (2005 to 2011), tissue expander/implant-based breast reconstruction cases were extracted using Current Procedural Terminology codes. Differences in preoperative demographics and comorbidities were assessed using chi-square and t test analysis using SPSS. The authors analyzed variations in complication rates and determined whether demographics and comorbidities affected outcomes using multivariate logistical analysis. A post hoc power study was calculated.RESULTS: Of 19,100 cases, 3301 involved acellular dermal matrix use. Overall complication rates were not statistically significant (acellular dermal matrix, 5.3 percent; non-acellular dermal matrix, 4.9 percent; p=0.396). Several risk factors were statistically significant associated factors of complications. Higher body mass index was associated with wound complications in both cohorts. In the non-acellular dermal matrix group, body mass index, smoking, and diabetes were associated with major complications, and radiotherapy and steroid use with minor complications.CONCLUSIONS: Acellular dermal matrix use did not appear to increase complication rates in tissue expander/implant-based breast reconstruction in this survey of a national surgical database. There was no significant difference in complication rates between the acellular dermal matrix and non-acellular dermal matrix groups.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III. EMTREE DRUG INDEX TERMS biomaterial (adverse drug reaction) EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult breast augmentation breast implant breast tumor (surgery) factual database female human male middle aged retrospective study tissue expansion total quality management LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24165587 (http://www.ncbi.nlm.nih.gov/pubmed/24165587) PUI L603393523 DOI 10.1097/PRS.0b013e3182a3beec FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0b013e3182a3beec COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 413 TITLE Analysis of the National Surgical Quality Improvement Program database in 19,100 patients undergoing implant-based breast reconstruction: complication rates with acellular dermal matrix. AUTHOR NAMES Ibrahim A.M. Shuster M. Koolen P.G. Kim K. Taghinia A.H. Sinno H.H. Lee B.T. Lin S.J. AUTHOR ADDRESSES (Ibrahim A.M.) Boston, Mass. From the Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School. (Shuster M.; Koolen P.G.; Kim K.; Taghinia A.H.; Sinno H.H.; Lee B.T.; Lin S.J.) CORRESPONDENCE ADDRESS A.M. Ibrahim, Boston, Mass. From the Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School. SOURCE Plastic and reconstructive surgery (2013) 132:5 (1057-1066). Date of Publication: Nov 2013 ISSN 1529-4242 (electronic) ABSTRACT The use of acellular dermal matrices has become increasingly popular in immediate and delayed tissue expander/implant-based breast reconstruction. However, it is unclear whether their use is associated with increased postoperative complication rates. Using the American College of Surgeons National Surgical Quality Improvement Program database, the authors assessed baseline differences in demographics and comorbidities with and without acellular dermal matrix and determined whether postoperative complication rates varied. Using the national surgical database (2005 to 2011), tissue expander/implant-based breast reconstruction cases were extracted using Current Procedural Terminology codes. Differences in preoperative demographics and comorbidities were assessed using chi-square and t test analysis using SPSS. The authors analyzed variations in complication rates and determined whether demographics and comorbidities affected outcomes using multivariate logistical analysis. A post hoc power study was calculated. Of 19,100 cases, 3301 involved acellular dermal matrix use. Overall complication rates were not statistically significant (acellular dermal matrix, 5.3 percent; non-acellular dermal matrix, 4.9 percent; p=0.396). Several risk factors were statistically significant associated factors of complications. Higher body mass index was associated with wound complications in both cohorts. In the non-acellular dermal matrix group, body mass index, smoking, and diabetes were associated with major complications, and radiotherapy and steroid use with minor complications. Acellular dermal matrix use did not appear to increase complication rates in tissue expander/implant-based breast reconstruction in this survey of a national surgical database. There was no significant difference in complication rates between the acellular dermal matrix and non-acellular dermal matrix groups. Therapeutic, III. EMTREE DRUG INDEX TERMS biomaterial (adverse drug reaction) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix (adverse drug reaction) breast augmentation (adverse drug reaction) breast tumor (surgery) EMTREE MEDICAL INDEX TERMS adult article breast implant (adverse drug reaction) factual database female human male middle aged retrospective study tissue expansion total quality management LANGUAGE OF ARTICLE English MEDLINE PMID 24165587 (http://www.ncbi.nlm.nih.gov/pubmed/24165587) PUI L563023380 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 414 TITLE Pie crusting of acellular dermal matrix may help decrease incidence of seromas in breast reconstruction AUTHOR NAMES Tan B.K.H. AUTHOR ADDRESSES (Tan B.K.H., bennytanmd@gmail.com) Banner MD Anderson Cancer Center, Plastic and Reconstructive Surgery, 2940 E Banner Gateway Drive, Gilbert, AZ 85234, United States. CORRESPONDENCE ADDRESS B.K.H. Tan, Banner MD Anderson Cancer Center, Plastic and Reconstructive Surgery, 2940 E Banner Gateway Drive, Gilbert, AZ 85234, United States. Email: bennytanmd@gmail.com SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2013) 66:11 (1629-1630). Date of Publication: November 2013 ISSN 1748-6815 1878-0539 (electronic) BOOK PUBLISHER Churchill Livingstone, 1-3 Baxter's Place, Leith Walk, Edinburgh, United Kingdom. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction incidence seroma EMTREE MEDICAL INDEX TERMS drain human infection risk letter mastectomy pectoralis major muscle pliability postoperative period priority journal skinfold thickness DEVICE TRADE NAMES Flex HD Pliable , United Statesmtf foundation DEVICE MANUFACTURERS (United States)mtf foundation EMBASE CLASSIFICATIONS Surgery (9) Dermatology and Venereology (13) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2013643709 MEDLINE PMID 23810606 (http://www.ncbi.nlm.nih.gov/pubmed/23810606) PUI L52649164 DOI 10.1016/j.bjps.2013.06.013 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2013.06.013 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 415 TITLE Breast reconstruction using implant and acellular dermal matrix: "The trapezoidal technique" AUTHOR NAMES Veneroso A. Gianquinto D. Trapasso M. Falco E. AUTHOR ADDRESSES (Veneroso A.; Gianquinto D.; Trapasso M., maria_trapasso@libero.it; Falco E.) Department of Surgery, S.Andrea Hospital of la Spezia, 19100 La Spezia, Italy. CORRESPONDENCE ADDRESS Department of Surgery, S.Andrea Hospital of la Spezia, 19100 La Spezia, Italy. SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2013) 66:11 (e332-e333). Date of Publication: November 2013 ISSN 1748-6815 1878-0539 (electronic) BOOK PUBLISHER Churchill Livingstone, 1-3 Baxter's Place, Leith Walk, Edinburgh, United Kingdom. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant breast reconstruction EMTREE MEDICAL INDEX TERMS human letter mastectomy pectoralis major muscle priority journal seroma suction drainage thorax wall tissue expander EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2013643714 MEDLINE PMID 23751974 (http://www.ncbi.nlm.nih.gov/pubmed/23751974) PUI L52622673 DOI 10.1016/j.bjps.2013.05.033 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2013.05.033 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 416 TITLE Risk analysis and stratification of surgical morbidity after immediate breast reconstruction AUTHOR NAMES Fischer J.P. Wes A.M. Tuggle C.T. Serletti J.M. Wu L.C. AUTHOR ADDRESSES (Fischer J.P., John.Fischer2@uphs.upenn.edu; Wes A.M.; Serletti J.M.; Wu L.C.) Division of Plastic Surgery, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, United States. (Tuggle C.T.) Section of Plastic Surgery, Yale School of Medicine, New Haven, CT, United States. CORRESPONDENCE ADDRESS J.P. Fischer, Division of Plastic Surgery, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, United States. Email: John.Fischer2@uphs.upenn.edu SOURCE Journal of the American College of Surgeons (2013) 217:5 (780-787). Date of Publication: November 2013 ISSN 1072-7515 1879-1190 (electronic) BOOK PUBLISHER Elsevier Inc., 360 Park Avenue South, New York, United States. ABSTRACT Background Surgical complications after breast reconstruction can be associated with significant morbidity, dissatisfaction, and cost. We used the ACS-NSQIP datasets from 2005 to 2011 to derive predictors of morbidity and to stratify risk after immediate breast reconstruction (IBR). Study Design Surgical complications after implant and autologous reconstruction were assessed using the ACS-NSQIP 2005 to 2011 datasets. Patient demographics, clinical characteristics, and operative factors were associated with the likelihood of experiencing a surgical complication. A "model cohort" of 12,129 patients was randomly selected from the study cohort to derive predictors. Weighted odds ratios derived from logistic regression analysis were used to create a composite risk score and to stratify patients. The remaining one-third of the cohort (n = 6,065) were used as the "validation cohort" to assess the accuracy value of the risk model. Results On adjusted analysis, autologous reconstruction (odds ratio [OR] 1.41, p < 0.001), American Society of Anesthesiologists physical status ≥ 3 (OR 1.25, p = 0.004), class I obesity (OR 1.38, p < 0.001), class II obesity (OR 1.91, p < 0.001), class III obesity (OR 1.70, p < 0.001), and active smoking (OR 1.46, p < 0.001) were associated with complications. Risk factors were weighted and patients were stratified into low (0 to 2, n = 9,133, risk = 7.14%), intermediate (3 to 4, n = 1,935, risk = 10.90%), high (5 to 7, n = 1,024, risk = 16.70%), and very high (8 to 9, n = 37, risk = 27.02%) risk categories based on their total risk score (p < 0.001). Internal validation of the "model cohort" using the "validation cohort" was performed demonstrating accurate prediction of risk across groups: low (7.1% vs 7.1%, respectively, p = 0.9), intermediate (10.9% vs 12.0%, respectively, p = 0.38), high (16.7% vs 16.8%, respectively, p = 0.95), and very high (27.0% vs 30.0%, respectively, p = 1.0). Conclusions Surgical complications after IBR are related to preoperatively identifiable factors that can be used to accurately risk stratify patients, which may assist with counseling, selection, and perioperative decision-making. © 2013 by the American College of Surgeons. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction postoperative complication (complication) EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult aged angina pectoris article breast implant cerebrovascular accident chronic obstructive lung disease cohort analysis congestive heart failure controlled study delirium diabetes mellitus disease association dyspnea female graft failure (complication) heart infarction heart surgery human hypertension kidney failure length of stay major clinical study mastectomy obesity outcome assessment paralysis peripheral vascular disease pneumonia predictive value priority journal renal replacement therapy reoperation risk assessment smoking surgical infection (complication) surgical mortality surgical risk transient ischemic attack wound dehiscence (complication) wound infection (complication) EMBASE CLASSIFICATIONS Surgery (9) Chest Diseases, Thoracic Surgery and Tuberculosis (15) Cardiovascular Diseases and Cardiovascular Surgery (18) Urology and Nephrology (28) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013711472 MEDLINE PMID 24074811 (http://www.ncbi.nlm.nih.gov/pubmed/24074811) PUI L52792173 DOI 10.1016/j.jamcollsurg.2013.07.004 FULL TEXT LINK http://dx.doi.org/10.1016/j.jamcollsurg.2013.07.004 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 417 TITLE Sustainable fat grafting. Optimizing fat grafting in an in vivo tissue engineering chamber model AUTHOR NAMES Debels H. Han X.L. Palmer J. Hamdi M. Abberton K. Morrison W. AUTHOR ADDRESSES (Debels H.; Hamdi M.) Plastic and Reconstructive Surgery, Free University of Brussels, Brussels, Belgium. (Han X.L.; Palmer J.; Abberton K.; Morrison W.) Adipose Tissue Engineering, O'Brien Institute, Fitzroy, Australia. CORRESPONDENCE ADDRESS H. Debels, Plastic and Reconstructive Surgery, Free University of Brussels, Brussels, Belgium. SOURCE Wound Repair and Regeneration (2013) 21:6 (A63). Date of Publication: November-December 2013 CONFERENCE NAME 23rd Annual Meeting of the European Tissue Repair Society CONFERENCE LOCATION Reims, France CONFERENCE DATE 2013-10-23 to 2013-10-25 ISSN 1067-1927 BOOK PUBLISHER Blackwell Publishing Inc. ABSTRACT Purpose: Autologous fat grafts are used in various body contour procedures, such as breast reconstruction. One of the main concerns is tissue resorption over time, raising questions of sustainability. The aim of this study is to gain insights in fat grafting and to improve long term outcome by adding a novel adipose derived matrix to the fat graft. Methodology: A known rat tissue engineering model is used. An arteriovenous loop, microsurgically created from the femoral vessels, is positioned inside a 2 ml hemispheric perforated chamber in the groin. 1 mL minced autologous fat, a novel adipose derived acellular matrix (ADM) or a combination of both is inserted within the chamber. The constructs are morphologically and histologically examined at 6 (n = 3) and 12 weeks (n = 6). Results: In groups where fat was used, the volume of grafted tissue remained stable at 6 weeks, but most of the inserted fat cells had died at that timepoint. In all groups, the amount of viable adipocytes rose between 6 and 12 weeks, indicating neoadipogenesis. At 12 weeks, theADM alone group showed almost similar results to fat whereas combining both resulted in significantly better results (2.5 times more viable fat). In this group the inserted disrupted fat, was almost entirely regenerated. Conclusion: The mechanisms behind fat grafting seem to be based on regeneration of fat, likely from adipose stem cells. However clinical results are variable and optimization of the technique is needed. At 12 weeks, excellent adipogenesis was seen when a novel matrix calledADM was added to the fat graft.We believe that the use of the ADM-matrix has a great potential in fat grafting. Moreover, we showed that a pedicled adipose fat flap can be generated in vivo, offering perspectives for larger reconstructive flap surgery as well. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) model society tissue engineering tissue repair EMTREE MEDICAL INDEX TERMS adipocyte adipogenesis adipose derived stem cell breast reconstruction inguinal region methodology procedures rat regeneration surgery tissues LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71279950 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 418 TITLE The Multi Centre Canadian Acellular Dermal Matrix Trial (MCCAT): Study protocol for a randomized controlled trial in implant-based breast reconstruction AUTHOR NAMES Zhong T. Temple-Oberle C. Hofer S. Beber B. Semple J. Brown M. Macadam S. Lennox P. Panzarella T. McCarthy C. Baxter N. Butler C. Causarano N. Choi J. Webb C. AUTHOR ADDRESSES (Zhong T., toni.zhong@uhn.ca; Hofer S., stefan.hofer@uhn.ca) Division of Plastic and Reconstructive Surgery, University Health Network, Toronto, ON, Canada. (Zhong T., toni.zhong@uhn.ca; Hofer S., stefan.hofer@uhn.ca; Beber B., b.beber@utoronto.ca; Semple J., john.semple@wchospital.ca; Brown M., Mitchell.brown@wchospital.ca) Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada. (Temple-Oberle C., Claire.Temple-Oberle@albertahealthservices.ca) Plastic Surgery Oncology, Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB, Canada. (Beber B., b.beber@utoronto.ca; Semple J., john.semple@wchospital.ca; Brown M., Mitchell.brown@wchospital.ca) Plastic and Reconstructive Surgery, Women's College Hospital, Toronto, ON, Canada. (Macadam S., drsmacadam@gmail.com; Lennox P., klennox@telus.net) Division of Plastic and Reconstructive Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada. (Panzarella T., panzar@uhnresearch.ca) Division of Biostatistics, University Health Network, Toronto, ON, Canada. (McCarthy C., McCarthC@mskcc.org) Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, United States. (Baxter N., BaxterN@smh.ca) Department of Surgery, St. Michael's Hospital, Toronto and the Keenan Research Centre, Toronto, ON, Canada. (Butler C.; Causarano N.) University Health Network, Women's College Hospital, Canada. (Choi J.) Vancouver General Hospital, Canada. (Webb C.) Tom Baker Cancer Centre, Canada. CORRESPONDENCE ADDRESS T. Zhong, Division of Plastic and Reconstructive Surgery, University Health Network, Toronto, ON, Canada. Email: toni.zhong@uhn.ca SOURCE Trials (2013) 14:1 Article Number: 356. Date of Publication: 28 Oct 2013 ISSN 1745-6215 (electronic) BOOK PUBLISHER BioMed Central Ltd., Floor 6, 236 Gray's Inn Road, London, United Kingdom. ABSTRACT Background: The two-stage tissue expander/implant (TE/I) reconstruction is currently the gold standard method of implant-based immediate breast reconstruction in North America. Recently, however, there have been numerous case series describing the use of one-stage direct to implant reconstruction with the aid of acellular dermal matrix (ADM). In order to rigorously investigate the novel application of ADM in one-stage implant reconstruction, we are currently conducting a multicentre randomized controlled trial (RCT) designed to evaluate the impact on patient satisfaction and quality of life (QOL) compared to the two-stage TE/I technique.Methods/designs: The MCCAT study is a multicenter Canadian ADM trial designed as a two-arm parallel superiority trial that will compare ADM-facilitated one-stage implant reconstruction compared to two-stage TE/I reconstruction following skin-sparing mastectomy (SSM) or nipple-sparing mastectomy (NSM) at 2 weeks, 6 months, and 12 months. The source population will be members of the mastectomy cohort with stage T0 to TII disease, proficient in English, over the age of 18 years, and planning to undergo SSM or NSM with immediate implant breast reconstruction. Stratified randomization will maintain a balanced distribution of important prognostic factors (study site and unilateral versus bilateral procedures). The primary outcome is patient satisfaction and QOL as measured by the validated and procedure-specific BREAST-Q. Secondary outcomes include short- and long-term complications, long-term aesthetic outcomes using five standardized photographs graded by three independent blinded observers, and a cost effectiveness analysis.Discussion: There is tremendous interest in using ADM in implant breast reconstruction, particularly in the setting of one-stage direct to implant reconstruction where it was previously not possible without the intermediary use of a temporary tissue expander (TE). This unique advantage has led many patients and surgeons alike to believe that one-stage ADM-assisted implant reconstruction should be the procedure of choice and should be offered to patients as the first-line treatment. We argue that it is crucial that this technique be scientifically evaluated in terms of patient selection, surgical technique, complications, aesthetic outcomes, cost-effectiveness, and most importantly patient-reported outcomes before it is promoted as the new gold standard in implant-based breast reconstruction.Trial registration: ClinicalTrials.gov: NCT00956384. © 2013 Zhong et al.; licensee BioMed Central Ltd. EMTREE DRUG INDEX TERMS antibiotic agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast cancer (surgery) breast implant breast reconstruction breast tissue expander nipple sparing mastectomy partial mastectomy silicone breast implant skin sparing mastectomy EMTREE MEDICAL INDEX TERMS adult antibiotic therapy article BREAST Q Canada cancer patient clinical protocol cohort analysis controlled study cost effectiveness analysis disease severity female human long term care major clinical study multicenter study outcome assessment patient satisfaction patient selection photography postoperative complication postoperative infection (complication, drug therapy) quality of life randomized controlled trial rating scale single blind procedure surgical technique treatment planning DEVICE TRADE NAMES AlloDerm , United StatesLifecell CPG 323 , United StatesMentor Style 410 , United StatesAllergan DEVICE MANUFACTURERS (United States)Allergan (United States)Lifecell (United States)Mentor EMBASE CLASSIFICATIONS Internal Medicine (6) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) CLINICAL TRIAL NUMBERS ClinicalTrials.gov (NCT00956384) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013738879 MEDLINE PMID 24165392 (http://www.ncbi.nlm.nih.gov/pubmed/24165392) PUI L52841851 DOI 10.1186/1745-6215-14-356 FULL TEXT LINK http://dx.doi.org/10.1186/1745-6215-14-356 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 419 TITLE Post-mastectomy breast reconstruction AUTHOR NAMES Thiruchelvam P.T.R. McNeill F. Jallali N. Harris P. Hogben K. AUTHOR ADDRESSES (Thiruchelvam P.T.R., paul.thiruchelvam@imperial.ac.uk; Jallali N.; Hogben K.) Imperial College NHS Trust, Charing Cross Hospital, London W68RF, United Kingdom. (McNeill F.; Harris P.) Royal Marsden Hospital, London, United Kingdom. CORRESPONDENCE ADDRESS Imperial College NHS Trust, Charing Cross Hospital, London W68RF, United Kingdom. SOURCE BMJ (Online) (2013) 347:7929 Article Number: f5903. Date of Publication: 19 Oct 2013 ISSN 1756-1833 (electronic) BOOK PUBLISHER BMJ Publishing Group, Tavistock Square, London, United Kingdom. EMTREE DRUG INDEX TERMS antineoplastic agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction mastectomy EMTREE MEDICAL INDEX TERMS acellular dermal matrix backache (complication) body image breast calcification (complication) breast cancer (drug therapy, epidemiology, prevention, radiotherapy, surgery) breast implant breast necrosis (complication) breast tissue expander cancer adjuvant therapy cancer incidence cancer radiotherapy cancer risk deep inferior epigastric perforator flap esthetics fat necrosis (complication) gracilis flap human informed consent latissimus dorsi flap lipomodelling mastitis (complication) nipple malformation (complication) partial mastectomy patient satisfaction postoperative pain (complication) priority journal quality of life review risk reduction self esteem seroma (complication) shoulder pain (complication) superficial inferior epigastric artery flap surgical technique therapy delay transverse rectus abdominis musculocutaneous flap treatment indication wellbeing EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Public Health, Social Medicine and Epidemiology (17) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2013665347 MEDLINE PMID 24128977 (http://www.ncbi.nlm.nih.gov/pubmed/24128977) PUI L370075608 DOI 10.1136/bmj.f5903 FULL TEXT LINK http://dx.doi.org/10.1136/bmj.f5903 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 420 TITLE Human acellular dermal matrix (AlloDerm(®)) dimensional changes and stretching in tissue expander/implant breast reconstruction AUTHOR NAMES Wu C. Cipriano J. Osgood Jr. G. Tepper D. Siddiqui A. AUTHOR ADDRESSES (Wu C.; Osgood Jr. G.) Wayne State University School of Medicine, Detroit, MI, United States. (Cipriano J.; Tepper D.; Siddiqui A., ASIDDIQ1@hfhs.org) Division of Plastic Surgery, Henry Ford Hospital, Ste. K-16, 2799 West Grand Blvd, Detroit, MI, United States. (Wu C.) Division of Plastic Surgery, Medical College of Wisconsin, Madison, WI, United States. CORRESPONDENCE ADDRESS A. Siddiqui, Division of Plastic Surgery, Henry Ford Hospital, Ste. K-16, 2799 West Grand Blvd, Detroit, MI, United States. Email: ASIDDIQ1@hfhs.org SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2013) 66:10 (1376-1381). Date of Publication: October 2013 ISSN 1748-6815 1878-0539 (electronic) BOOK PUBLISHER Churchill Livingstone, 1-3 Baxter's Place, Leith Walk, Edinburgh, United Kingdom. ABSTRACT Background Human acellular dermal matrix (HADM) is widely used for post-mastectomy tissue expander/implant breast reconstruction. Since HADM has been shown to stretch following placement in other surgical settings, we hypothesised that stretching would occur in breast reconstruction as well. The goal of the study was to quantify the in situ stretch properties of HADM over time in patients undergoing this procedure. Methods This was an open-label, prospective case series in adult women who underwent post-mastectomy tissue expander/implant breast reconstruction using HADM. HADM construct size was determined at postoperative day 1 and month 3 via ultrasound tracking of metallic 3-mm vessel clips embedded in the graft. Dimensional changes were further examined in four equally sized segments (medial, lateral and two central) of the matrix. Patient satisfaction was evaluated at month 3 (a modified version of the Breast Q™ patient questionnaire) and compared with satisfaction reported by a non-HADM reconstruction cohort. Results A total of 31 patients underwent breast reconstruction with HADM. Mean (standard deviation) perimeter increased from 38 (6) cm on postoperative day 1-42 (7) cm at month 3 (+11%; P = 0.002). Surface area increased from 73 (22) to 88 (28) cm(2) (+21%; range, 4-35%; P = 0.002). The greatest expansion occurred in the HADM medial and lateral segments (range, 18-30% across the four segments). Patient satisfaction was comparable with that of non-HADM patients. Complications in the HADM group included late seroma, red breast syndrome and urinary tract infection. Complications in the non-HADM cohort included cellulitis, expander explantation, delayed wound healing and skin necrosis. Conclusions During short-term follow-up, HADM exhibited a modest degree of stretching during tissue expander/implant breast reconstruction and was associated with few complications and a high level of patient satisfaction. © 2013 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Surgeon. EMTREE DRUG INDEX TERMS antibiotic agent (drug therapy) cefalexin (drug combination, drug therapy, oral drug administration) ciprofloxacin (drug therapy, oral drug administration) prednisone (drug combination, drug therapy, oral drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant breast reconstruction breast tissue expander human acellular dermal matrix muscle stretching EMTREE MEDICAL INDEX TERMS adult antibiotic therapy article aspiration blood vessel clip Breast Q questionnaire case study cellulitis (complication, drug therapy) cohort analysis controlled clinical trial controlled study debridement echography endoleak (complication) erythema (complication) female follow up human major clinical study mastectomy open study patient satisfaction perimeter postoperative complication (complication) priority journal red breast syndrome (drug therapy) red breast syndrome (drug therapy) seroma (complication, therapy) skin disease (drug therapy) skin necrosis (complication, surgery) structured questionnaire surgical patient urinary tract infection (complication, drug therapy) wound healing impairment (complication) DEVICE TRADE NAMES AlloDerm Regenerative Tissue Matrix , United StatesLifecell Ligaclips , United StatesEthicon Siltex Counter Profile expander , United StatesMentor DEVICE MANUFACTURERS (United States)Ethicon (United States)Lifecell (United States)Mentor CAS REGISTRY NUMBERS cefalexin (15686-71-2, 23325-78-2) ciprofloxacin (85721-33-1) prednisone (53-03-2) EMBASE CLASSIFICATIONS Dermatology and Venereology (13) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) CLINICAL TRIAL NUMBERS ClinicalTrials.gov (NCT01027637) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013563608 MEDLINE PMID 23790562 (http://www.ncbi.nlm.nih.gov/pubmed/23790562) PUI L52640565 DOI 10.1016/j.bjps.2013.05.018 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2013.05.018 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 421 TITLE Sterile "ready-to-use" AlloDerm decreases postoperative infectious complications in patients undergoing immediate implant-based breast reconstruction with acellular dermal matrix. AUTHOR NAMES Weichman K.E. Wilson S.C. Saadeh P.B. Hazen A. Levine J.P. Choi M. Karp N.S. AUTHOR ADDRESSES (Weichman K.E.) New York, N.Y. From the New York University Medical Center, Institute of Reconstructive Plastic Surgery. (Wilson S.C.; Saadeh P.B.; Hazen A.; Levine J.P.; Choi M.; Karp N.S.) CORRESPONDENCE ADDRESS K.E. Weichman, New York, N.Y. From the New York University Medical Center, Institute of Reconstructive Plastic Surgery. SOURCE Plastic and reconstructive surgery (2013) 132:4 (725-736). Date of Publication: Oct 2013 ISSN 1529-4242 (electronic) ABSTRACT Acellular dermal matrix is a commonly used adjunct in implant-based breast reconstruction. Several investigations have shown increased complications associated with its use. Therefore, the authors' institution placed strict limitations on its use and transitioned to sterile "ready-to-use" acellular dermal matrix. The purpose of this investigation was to compare the infectious complications associated with aseptic versus sterile acellular dermal matrix. A prospective study of all patients undergoing immediate implant-based breast reconstruction at a single academic medical center between November of 2010 and October of 2012 was conducted. AlloDerm (Life Cell Corporation, Branchburg, N.J.) was used as the source of acellular dermal matrix. Breasts were divided into three cohorts: total submuscular coverage, aseptic acellular dermal matrix, and sterile, ready-to-use acellular dermal matrix. Breasts were then compared based on demographic information, cancer qualities, and complications. A total of 546 reconstructed breasts met inclusion criteria: 64.3 percent (n = 351) with no acellular dermal matrix, 16.5 percent (n = 90) with aseptic matrix, and 19.2 percent (n = 105) with ready-to-use matrix. When comparing reconstructions with ready-to-use versus aseptic acellular dermal matrix, patients had a decrease in overall infection (8.5 percent versus 20.0 percent; p = 0.0088), major infection (4.7 percent versus 12.2 percent; p = 0.069), and need for explantation (1.9 percent versus 6.6 percent; p = 0.1470). When comparing patients undergoing reconstruction with ready-to-use matrix to total submuscular coverage, patients had similar overall infectious complications (8.5 percent versus 5.7 percent; p = 0.3602). Diabetes mellitus, seroma, mastectomy skin flap necrosis, and aseptic acellular dermal matrix were independent predictors of infectious complications. Ready-to-use acellular dermal matrix in immediate implant-based breast reconstruction provides a useful adjunct. In addition, it mitigates the risks of infectious complications when compared with aseptic acellular dermal matrix. Therapeutic, II. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen (drug therapy) EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction breast tumor (surgery) surgical infection (epidemiology, prevention) EMTREE MEDICAL INDEX TERMS adult article asepsis breast implant clinical trial comparative study female human incidence instrument sterilization methodology middle aged prospective study risk factor tissue expander CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 23783060 (http://www.ncbi.nlm.nih.gov/pubmed/23783060) PUI L563005162 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 422 TITLE Sterile "ready-to-use" AlloDerm decreases postoperative infectious complications in patients undergoing immediate implant-based breast reconstruction with acellular dermal matrix AUTHOR NAMES Weichman K.E. Wilson S.C. Saadeh P.B. Hazen A. Levine J.P. Choi M. Karp N.S. AUTHOR ADDRESSES (Weichman K.E.; Wilson S.C.; Saadeh P.B.; Hazen A.; Levine J.P.; Choi M.; Karp N.S.) New York, N.Y. From the New York University Medical Center, Institute of Reconstructive Plastic Surgery SOURCE Plastic and reconstructive surgery (2013) 132:4 (725-736). Date of Publication: 1 Oct 2013 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Acellular dermal matrix is a commonly used adjunct in implant-based breast reconstruction. Several investigations have shown increased complications associated with its use. Therefore, the authors' institution placed strict limitations on its use and transitioned to sterile "ready-to-use" acellular dermal matrix. The purpose of this investigation was to compare the infectious complications associated with aseptic versus sterile acellular dermal matrix.METHODS: A prospective study of all patients undergoing immediate implant-based breast reconstruction at a single academic medical center between November of 2010 and October of 2012 was conducted. AlloDerm (Life Cell Corporation, Branchburg, N.J.) was used as the source of acellular dermal matrix. Breasts were divided into three cohorts: total submuscular coverage, aseptic acellular dermal matrix, and sterile, ready-to-use acellular dermal matrix. Breasts were then compared based on demographic information, cancer qualities, and complications.RESULTS: A total of 546 reconstructed breasts met inclusion criteria: 64.3 percent (n = 351) with no acellular dermal matrix, 16.5 percent (n = 90) with aseptic matrix, and 19.2 percent (n = 105) with ready-to-use matrix. When comparing reconstructions with ready-to-use versus aseptic acellular dermal matrix, patients had a decrease in overall infection (8.5 percent versus 20.0 percent; p = 0.0088), major infection (4.7 percent versus 12.2 percent; p = 0.069), and need for explantation (1.9 percent versus 6.6 percent; p = 0.1470). When comparing patients undergoing reconstruction with ready-to-use matrix to total submuscular coverage, patients had similar overall infectious complications (8.5 percent versus 5.7 percent; p = 0.3602). Diabetes mellitus, seroma, mastectomy skin flap necrosis, and aseptic acellular dermal matrix were independent predictors of infectious complications.CONCLUSIONS: Ready-to-use acellular dermal matrix in immediate implant-based breast reconstruction provides a useful adjunct. In addition, it mitigates the risks of infectious complications when compared with aseptic acellular dermal matrix.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II. EMTREE DRUG INDEX TERMS collagen (drug therapy) surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix procedures EMTREE MEDICAL INDEX TERMS adult asepsis breast implant breast reconstruction breast tumor (surgery) clinical trial comparative study female human incidence instrument sterilization middle aged prospective study risk factor surgical infection (epidemiology, prevention) tissue expander CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 23783060 (http://www.ncbi.nlm.nih.gov/pubmed/23783060) PUI L603385351 DOI 10.1097/PRS.0b013e31829fe35b FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0b013e31829fe35b COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 423 TITLE Experimental total wrapping of breast implants with acellular dermal matrix: A preventive tool against capsular contracture in breast surgery? AUTHOR NAMES Schmitz M. Bertram M. Kneser U. Keller A.K. Horch R.E. AUTHOR ADDRESSES (Schmitz M., marweh.schmitz@uk-erlangen.de; Bertram M.; Kneser U.; Horch R.E.) Department of Plastic and Hand Surgery, Friedrich Alexander University of Erlangen-Nuremberg, University Hospital, Krankenhausstrasse 12, D-91054 Erlangen, Germany. (Keller A.K.) Institute for Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany. CORRESPONDENCE ADDRESS M. Schmitz, Department of Plastic and Hand Surgery, Friedrich Alexander University of Erlangen-Nuremberg, University Hospital, Krankenhausstrasse 12, D-91054 Erlangen, Germany. Email: marweh.schmitz@uk-erlangen.de SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2013) 66:10 (1382-1389). Date of Publication: October 2013 ISSN 1748-6815 1878-0539 (electronic) BOOK PUBLISHER Churchill Livingstone, 1-3 Baxter's Place, Leith Walk, Edinburgh, United Kingdom. ABSTRACT Background Capsular contracture remains a hitherto unsolved complication after implantation of silicone gel-filled breast prostheses. Based on clinical and experimental data, the use of an acellular dermal matrix as a sheath around implants may lead to lesser capsular contracture acting as a proposed biological environment mimicking wound bed tissue. The aim of our study was to analyse the tissue reaction after implantation of silicone prosthesis with and without an envelope of acellular dermal matrix. Methods Implantation of 60 silicone prostheses in the back of Lewis rats were carried out, randomly paired taking one rat from group A and one from group B. Group A included implants completely enveloped with xenogenic acellular dermis and group B undraped silicone implants. At 3, 6 and 12 weeks postoperatively, the samples were explanted and subjected to histological and immunohistochemical evaluation. Results A new myofibroblast tissue layer was identified in proximity to the implant in both groups. The thickness of the layer in group A was continuously thinner than in group B regarding the different explantation time points. Implants completely wrapped with acellular dermal matrix showed significantly lesser inflammatory signs at 3 and 12 weeks after implantation compared to controls. Cell proliferation after 12 weeks was significantly decreased in group A. Conclusion The slight myofibroblast layer and reduced rate of inflammation and proliferation in the treatment group show a positive effect of total acellular dermal matrix envelope and hypothesise the decrease of capsular contracture in long-term periods. © 2013 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Surgeon. EMTREE DRUG INDEX TERMS alpha smooth muscle actin (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation breast implant implant capsular contracture (complication, prevention) silicone prosthesis EMTREE MEDICAL INDEX TERMS animal experiment animal tissue article cell proliferation controlled study histopathology immunohistochemistry Lewis rat myofibroblast nonhuman priority journal rat thickness wound healing DEVICE TRADE NAMES Strattice , United StatesLifecell DEVICE MANUFACTURERS (United States)Lifecell EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013563610 MEDLINE PMID 23764323 (http://www.ncbi.nlm.nih.gov/pubmed/23764323) PUI L52625017 DOI 10.1016/j.bjps.2013.05.020 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2013.05.020 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 424 TITLE The use of human acellular dermal matrix in the first stage of implant-based breast reconstruction simplifies the exchange procedure AUTHOR NAMES Koltz P.F. Frey J.D. Langstein H.N. AUTHOR ADDRESSES (Koltz P.F.; Frey J.D.; Langstein H.N.) Division of Plastic Surgery, University of Rochester Medical Center, Rochester, N.Y SOURCE Plastic and reconstructive surgery (2013) 132:4 (691e-692e). Date of Publication: 1 Oct 2013 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant procedures EMTREE MEDICAL INDEX TERMS breast augmentation breast reconstruction female human treatment outcome LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 24076737 (http://www.ncbi.nlm.nih.gov/pubmed/24076737) PUI L603384823 DOI 10.1097/PRS.0b013e31829fe3d2 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0b013e31829fe3d2 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 425 TITLE The use of human acellular dermal matrix in the first stage of implant-based breast reconstruction simplifies the exchange procedure. AUTHOR NAMES Koltz P.F. Frey J.D. Langstein H.N. AUTHOR ADDRESSES (Koltz P.F.) Division of Plastic Surgery, University of Rochester Medical Center, Rochester, N.Y. (Frey J.D.; Langstein H.N.) CORRESPONDENCE ADDRESS P.F. Koltz, Division of Plastic Surgery, University of Rochester Medical Center, Rochester, N.Y. SOURCE Plastic and reconstructive surgery (2013) 132:4 (691e-692e). Date of Publication: Oct 2013 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation breast implant breast reconstruction EMTREE MEDICAL INDEX TERMS article female human methodology treatment outcome LANGUAGE OF ARTICLE English MEDLINE PMID 24076737 (http://www.ncbi.nlm.nih.gov/pubmed/24076737) PUI L563005088 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 426 TITLE AlloDerm plication: A novel technique for enhancing acellular dermis-assisted breast reconstruction AUTHOR NAMES Walker M.E. Broer P.N. Ng R. Wages D. Matthew M. Kwei S.L. AUTHOR ADDRESSES (Walker M.E.; Broer P.N.; Kwei S.L., stephanie.kwei@yale.edu) Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT 06520, United States. (Ng R.) Division of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, CT, United States. (Wages D.) North Shore Plastic Surgery, Peabody, MA, United States. (Matthew M.) Dermatology and Plastic Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 4419, United States. CORRESPONDENCE ADDRESS S.L. Kwei, Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT 06520, United States. Email: stephanie.kwei@yale.edu SOURCE European Journal of Plastic Surgery (2013) 36:9 (545-552). Date of Publication: September 2013 ISSN 0930-343X 1435-0130 (electronic) BOOK PUBLISHER Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany. ABSTRACT Background: The use of acellular dermal matrix (ADM) as an adjunct to immediate tissue expander or implant breast reconstruction has been widely established. Given the increased number of patients benefiting from ADM and the demand for greater projection in breast reconstruction, the authors have attempted to further enhance results by modifying existing techniques. We report on a novel technique employing longitudinal plication of the AlloDerm graft prior to its insertion as an inferolateral sling. Methods: A retrospective review of 36 patients (62 breasts) who underwent acellular dermis-assisted breast reconstruction was performed. Twenty-six patients (43 breasts) were reconstructed using AlloDerm plication, and ten patients (19 breasts) were reconstructed with unmodified AlloDerm. All patients were for immediate reconstructions with tissue expander or single-stage implant. Two groups were separated by the surgeon. The average initial fill volumes were compared, and patient demographic data was collected and analyzed. The number of expander fill sessions and final volumes were compared. The distribution of surgical oncologists, postoperative complications, and reoperation rates were reviewed. An ex vivo model was analyzed. Results: Patients with plicated AlloDerm experienced a significantly higher initial fill volume (247 vs. 165 cc; p = 0.01, Power = 86 %). The number of expansions per breast was 2.76 in the plicated group and 5.0 in the unmodified group (p = 0.00054, Power = 90 %). There was no significant difference in the average volume used per expansion (72.5 vs. 74.9 cc; p = 0.658). The average final fill volume in the plication patients was 418 and 538 cc in the unmodified group (p = 0.083). There were no significant differences in age (p = 0.18), BMI (p = 0.67), mastectomy resection specimen weight (p = 0.31), or history of preoperative radiation (χ(2) = 0.03, p = 0.86). Reoperation rates were not significantly different between the two groups (χ(2) = 0.01, p = 0.92). Conclusions: The authors have found that the plication technique increases initial fill volumes by decreasing pressure on the overlying tissues and also allows a higher percentage of patients to undergo single-stage breast reconstruction. The plication technique increases the total surface area of AlloDerm inset at the inframammary fold, increases the lower pole volume, and reduces the number of expansions required to achieve final volumes when compared to prior experiences with the traditional AlloDerm sling technique. Level of Evidence: IV, therapeutic study © 2013 Springer-Verlag Berlin Heidelberg. EMTREE DRUG INDEX TERMS antibiotic agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction EMTREE MEDICAL INDEX TERMS adult aged article clinical article demography erythema (complication, drug therapy) ex vivo study female human mastectomy postoperative complication postoperative infection (complication, drug therapy) preoperative radiotherapy priority journal reoperation retrospective study tissue expander DEVICE TRADE NAMES alloderm EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013525038 PUI L52496368 DOI 10.1007/s00238-013-0817-4 FULL TEXT LINK http://dx.doi.org/10.1007/s00238-013-0817-4 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 427 TITLE Initial experience with the use of foetal/neonatal bovine acellular dermal collagen matrix (SurgiMend™) for tissue-expander breast reconstruction AUTHOR NAMES Ohkuma R. Buretta K.J. Mohan R. Rosson G.D. Rad A.N. AUTHOR ADDRESSES (Ohkuma R.; Buretta K.J.; Mohan R.; Rosson G.D.; Rad A.N., dr.rad@sherberandrad.com) Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Hospital Outpatient Center, 601 N. Caroline St., McElderry 8152C, Baltimore, MD 21287, United States. CORRESPONDENCE ADDRESS A.N. Rad, Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Johns Hopkins Hospital Outpatient Center, 601 N. Caroline St., McElderry 8152C, Baltimore, MD 21287, United States. Email: dr.rad@sherberandrad.com SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2013) 66:9 (1195-1201). Date of Publication: September 2013 ISSN 1748-6815 1878-0539 (electronic) BOOK PUBLISHER Churchill Livingstone, 1-3 Baxter's Place, Leith Walk, Edinburgh, United Kingdom. ABSTRACT Background Acellular dermal matrix (ADM) is commonly used in staged breast reconstruction using tissue expanders (TEs). The literature on human ADM has reported variable outcomes, and there is a paucity of data for xenogenic sources of ADM. The aim of this study is to evaluate the early complications, risk factors and outcomes using SurgiMend™ in staged breast reconstruction. Methods An Institutional Review Board (IRB)-approved, retrospective analysis of a single surgeon's experience was performed. From August 2009 to May 2011, 65 patients underwent staged breast reconstruction using 95 sheets of SurgiMend™. The nominal TE fill volume was 383 ± 83 cc (range 250-550), mean intra-operative fill volume was 148 ± 86 cc (range 0-350) and mean final fill volume was 413 ± 176 cc (range 100-800). The mean clinic follow-up time was 16.9 ± 8.7 months; mean age was 50.9 ± 11.7 years; and average body mass index (BMI) was 26.0 ± 5.5 kg m (-2). Correlation with risk factors and clinical outcomes were analysed. Results The incidences of postoperative complications were: haematoma 3.2%, seroma 7.5% and re-operation due to infection 2.1%. Age, diabetes mellitus, and hypertension had a significant correlation with an increased overall complication rate. With respect to early complications, such as infection requiring re-operation, diabetes demonstrated a trend with an odds ratio of 11.69. Conclusion This study demonstrates that the use of SurgiMend™ is associated with low early complication rates and is well tolerated in staged breast reconstruction. © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen implant EMTREE DRUG INDEX TERMS antibiotic agent (drug therapy, intravenous drug administration, oral drug administration) cefadroxil (oral drug administration) cefazolin (intravenous drug administration) clindamycin (intravenous drug administration) suture material tissue adhesive EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction breast tissue expander EMTREE MEDICAL INDEX TERMS adult aged article body mass diabetes mellitus female follow up groups by age hematoma (complication) human hypertension major clinical study mastectomy outcome assessment pectoralis major muscle postoperative complication (complication) postoperative infection (complication, drug therapy, surgery) priority journal reoperation retrospective study risk factor seroma (complication) silicone breast implant surgical technique DRUG TRADE NAMES duricef DEVICE TRADE NAMES Biosyn suture Histoacryl Topical Skin Adhesive , United StatesTissueseal SurgiMend , United StatesTEI Vicryl suture DEVICE MANUFACTURERS (United States)TEI (United States)Tissueseal CAS REGISTRY NUMBERS cefadroxil (50370-12-2) cefazolin (25953-19-9, 27164-46-1) clindamycin (18323-44-9) EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013482280 MEDLINE PMID 23768943 (http://www.ncbi.nlm.nih.gov/pubmed/23768943) PUI L52628835 DOI 10.1016/j.bjps.2013.05.004 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2013.05.004 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 428 TITLE Analysis of clinically significant seroma formation in breast reconstruction using acellular dermal grafts AUTHOR NAMES Michelotti B.F. Brooke S. Mesa J. Wilson M.Z. Moyer K. Mackay D.R. Neves R.I. Potochny J. AUTHOR ADDRESSES (Michelotti B.F.; Brooke S.; Mesa J.; Wilson M.Z.; Moyer K.; Mackay D.R.; Neves R.I.; Potochny J.) Division of Plastic Surgery, Department of Surgery, Pennsylvania State University, College of Medicine, Milton S. Hershey Medical Center, Hershey, PA 17033, USA SOURCE Annals of plastic surgery (2013) 71:3 (274-277). Date of Publication: 1 Sep 2013 ISSN 1536-3708 (electronic) ABSTRACT With a rise in tissue expander-based breast reconstructions (TEBRs) using acellular dermal matrix (ADM), we have seen an increase in ADM-specific complications. In this study, we aimed to evaluate clinically significant seroma (CSS) formation-defined by the need for a drainage procedure-to determine if there was a difference in incidence between product types: AlloDerm (AL), DermaMatrix (DM), and FlexHD (FHD). This was a retrospective review of consecutive patients who underwent TEBR at a single institution. The total number of reconstructed breasts was separated into the following 4 groups according to the product type: AL, DM, FHD, or no ADM. We identified the total number of CSSs and compared these data between product types. A logistic regression was performed in an attempt to identify independent risk factors associated with seroma formation. In total, we identified 284 consecutive TEBRs. Overall, there were 17 (7.7%) seromas in 220 breast reconstructions in which ADM was used. When comparing the number of CSS between groups-AL (n = 2, 4.0%), DM (n = 6, 5.4%), FHD (n = 9, 14.75%), and no ADM (n = 1, 1.5%)-we found a significant difference in seroma incidence between product types (P = 0.016). Multivariate analysis identified a strong trend toward FHD as an independent predictor of seroma formation (P = 0.061). Our review suggests that there is strong trend in CSS formation with the use of FHD as compared to other product types and reconstructions in which no ADM was used. EMTREE DRUG INDEX TERMS collagen (adverse drug reaction) surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) procedures EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult aged breast reconstruction breast tumor (surgery) comparative study devices Drainage evaluation study female follow up human incidence intraductal carcinoma (surgery) mastectomy middle aged Paget nipple disease (surgery) postoperative complication (epidemiology, etiology, therapy) retrospective study risk factor seroma (epidemiology, etiology, therapy) statistical model tissue expander tissue expansion treatment outcome CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 23788150 (http://www.ncbi.nlm.nih.gov/pubmed/23788150) PUI L603120463 DOI 10.1097/SAP.0b013e3182923dc9 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0b013e3182923dc9 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 429 TITLE Matracell™ processed, sterilized acellular dermal matrix in implant-based breast reconstruction: Clinical and histologic outcomes AUTHOR NAMES Hanna K. Yu D. LeGallo R. Colen D. Drake D.B. AUTHOR ADDRESSES (Hanna K.; Yu D.; LeGallo R.; Colen D.; Drake D.B.) University of Virginia Health System, Charlottesville, United States. CORRESPONDENCE ADDRESS K. Hanna, University of Virginia Health System, Charlottesville, United States. SOURCE Journal of the American College of Surgeons (2013) 217:3 SUPPL. 1 (S91). Date of Publication: September 2013 CONFERENCE NAME 99th Annual Clinical Congress of the American College of Surgeons CONFERENCE LOCATION Washington, DC, United States CONFERENCE DATE 2013-10-06 to 2013-10-10 ISSN 1072-7515 BOOK PUBLISHER Elsevier Inc. ABSTRACT INTRODUCTION: This study describes our clinical experience with a novel ADM that has been irradiated to achieve sterility and processed to remove all cellular material and DNA through a method termed Matracell™. Additionally, we examined the histologic properties of thisADMcompared to native breast capsules biopsied at the time of implant exchange in a subset of patients. METHODS: Matracell™ processed ADM, DermACELL®, was used in the creation of an inferior pocket for tissue expanders. Rates of infection, seroma, and wound separation were collected. Complication rates were compared with a cohort group of patients who underwent reconstruction with AlloDerm®, an aseptic but not sterile ADM. Tissue biopsies comparing native breast pocket capsules and DermACELL® incorporated capsules were analyzed for markers of inflammation, vascularity, and fibrosis. RESULTS: Forty-two tissue expanders were placed in 28 patients using DermACELL®. Rate of major infection was 7%, seroma, 2.4%, and wound separation, 5%. The AlloDerm® group was comprised of 51 tissue expanders among 37 patients. Rates of wound separation were similar among the DermACELL® and AlloDerm® groups; however rates of seroma and infection were lower in the DermACELL® group, although the difference was not statistically significant. Blinded histologic evaluation of inflammation, vascularity and fibrosis was significantly less in the DermACELL® incorporated capsule than native capsule (p<0.05). CONCLUSIONS: Matracell™ processed ADM may have an advantage over AlloDerm® in terms of seroma and infection rates in breast reconstruction. Histologic analysis confirms Matracell™ processed ADM to have desirable properties of low immunogenicity, low levels of fibrosis, and minor inflammation. EMTREE DRUG INDEX TERMS DNA marker EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction college human implant surgeon EMTREE MEDICAL INDEX TERMS biopsy breast fibrosis immunogenicity infection infection rate inflammation patient seroma tissue expander tissues vascularization wound dehiscence LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71167380 DOI 10.1016/j.jamcollsurg.2013.07.205 FULL TEXT LINK http://dx.doi.org/10.1016/j.jamcollsurg.2013.07.205 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 430 TITLE Treatment of capsular contracture using complete implant coverage by acellular dermal matrix: a novel technique AUTHOR NAMES Cheng A. Lakhiani C. Saint-Cyr M. AUTHOR ADDRESSES (Cheng A.; Lakhiani C.; Saint-Cyr M.) University of Texas Southwestern Medical Center, Dallas, Texas, USA SOURCE Plastic and reconstructive surgery (2013) 132:3 (519-529). Date of Publication: 1 Sep 2013 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Capsular contracture is a frequent complication of breast reconstruction that affects 2.8 to 15.9 percent of patients. Use of acellular dermal matrix has been reported for treatment of contracture, with a recurrence rate of 6.3 percent, but this was limited to partial implant coverage only. The authors describe a novel surgical technique using acellular dermal matrix to completely cover the implant anteriorly to treat and prevent capsular contracture.METHODS: Charts were reviewed to identify patients who had received implant insertion with complete acellular dermal matrix coverage performed by a single surgeon. Patient demographic information, history of irradiation or capsular contracture, prior treatment, and postoperative complications were recorded.RESULTS: Eleven patients (16 breasts) were identified. Mean age and body mass index were 52.3 ± 6.9 years and 23.6 ± 4.4 kg/m, respectively. Four patients (five breasts) had a history of capsular contracture requiring previous capsulectomy and implant exchange. Ten cases were for correction of new-onset grade III (n = 2) or IV (n = 8) capsular contracture and one was to prevent future capsular contracture. Mean acellular dermal matrix size was 229.8 ± 46.5 cm (range, 144 to 256 cm). Average follow-up was 9.2 months (range, 2.4 to 18.8 months). One patient (one breast) developed an infection requiring implant removal. No patients experienced recurrent capsular contracture.CONCLUSIONS: Capsular contracture may be treated successfully using complete acellular dermal matrix coverage. This technique may be a useful addition to therapies currently used to treat recalcitrant capsular contracture (early recurrence or refractory to standard therapy). EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix procedures EMTREE MEDICAL INDEX TERMS adult breast augmentation breast tumor (surgery) case report evaluation study female follow up human implant capsular contracture (prevention, surgery) mastectomy middle aged retrospective study treatment outcome CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 23985627 (http://www.ncbi.nlm.nih.gov/pubmed/23985627) PUI L603762122 DOI 10.1097/PRS.0b013e31829acc1e FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0b013e31829acc1e COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 431 TITLE Treatment of capsular contracture using complete implant coverage by acellular dermal matrix: a novel technique. AUTHOR NAMES Cheng A. Lakhiani C. Saint-Cyr M. AUTHOR ADDRESSES (Cheng A.) University of Texas Southwestern Medical Center, Dallas, Texas, USA. (Lakhiani C.; Saint-Cyr M.) CORRESPONDENCE ADDRESS A. Cheng, University of Texas Southwestern Medical Center, Dallas, Texas, USA. SOURCE Plastic and reconstructive surgery (2013) 132:3 (519-529). Date of Publication: Sep 2013 ISSN 1529-4242 (electronic) ABSTRACT Capsular contracture is a frequent complication of breast reconstruction that affects 2.8 to 15.9 percent of patients. Use of acellular dermal matrix has been reported for treatment of contracture, with a recurrence rate of 6.3 percent, but this was limited to partial implant coverage only. The authors describe a novel surgical technique using acellular dermal matrix to completely cover the implant anteriorly to treat and prevent capsular contracture. Charts were reviewed to identify patients who had received implant insertion with complete acellular dermal matrix coverage performed by a single surgeon. Patient demographic information, history of irradiation or capsular contracture, prior treatment, and postoperative complications were recorded. Eleven patients (16 breasts) were identified. Mean age and body mass index were 52.3 ± 6.9 years and 23.6 ± 4.4 kg/m, respectively. Four patients (five breasts) had a history of capsular contracture requiring previous capsulectomy and implant exchange. Ten cases were for correction of new-onset grade III (n = 2) or IV (n = 8) capsular contracture and one was to prevent future capsular contracture. Mean acellular dermal matrix size was 229.8 ± 46.5 cm (range, 144 to 256 cm). Average follow-up was 9.2 months (range, 2.4 to 18.8 months). One patient (one breast) developed an infection requiring implant removal. No patients experienced recurrent capsular contracture. Capsular contracture may be treated successfully using complete acellular dermal matrix coverage. This technique may be a useful addition to therapies currently used to treat recalcitrant capsular contracture (early recurrence or refractory to standard therapy). EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation implant capsular contracture (prevention, surgery) EMTREE MEDICAL INDEX TERMS adult article breast tumor (surgery) case report evaluation study female follow up human mastectomy methodology middle aged retrospective study treatment outcome CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 23985627 (http://www.ncbi.nlm.nih.gov/pubmed/23985627) PUI L563004259 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 432 TITLE Trends in breast reconstruction: Patients, providers, and health care AUTHOR NAMES Pinell X. Carlson G.W. AUTHOR ADDRESSES (Pinell X.; Carlson G.W., gcarlso@emory.edu) Division of Plastic Surgery, Emory University School of Medicine, Atlanta, GA, United States. CORRESPONDENCE ADDRESS G.W. Carlson, Department of Surgery, Emory University School of Medicine, Winship Cancer Institute, 1365C Clifton Rd., Atlanta, GA 30322, United States. Email: gcarlso@emory.edu SOURCE Breast Journal (2013) 19:5 (461-462). Date of Publication: September-October 2013 ISSN 1075-122X 1524-4741 (electronic) BOOK PUBLISHER Blackwell Publishing Inc., 350 Main Street, Malden, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction EMTREE MEDICAL INDEX TERMS acellular dermal matrix cost effectiveness analysis data base editorial human mastectomy medicare operation duration patient preference patient satisfaction reimbursement EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2013616321 MEDLINE PMID 24073729 (http://www.ncbi.nlm.nih.gov/pubmed/24073729) PUI L369929803 DOI 10.1111/tbj.12153 FULL TEXT LINK http://dx.doi.org/10.1111/tbj.12153 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 433 TITLE Discussion: Treatment of capsular contracture using complete implant coverage by acellular dermal matrix: a novel technique AUTHOR NAMES Nahabedian M.Y. AUTHOR ADDRESSES (Nahabedian M.Y.) Department of Plastic Surgery, Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC 20007, USA. drnahabedian@aol.com SOURCE Plastic and reconstructive surgery (2013) 132:3 (530-531). Date of Publication: 1 Sep 2013 ISSN 1529-4242 (electronic) EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix procedures EMTREE MEDICAL INDEX TERMS breast augmentation female human implant capsular contracture (surgery) CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 23985628 (http://www.ncbi.nlm.nih.gov/pubmed/23985628) PUI L603762131 DOI 10.1097/PRS.0b013e318290f712 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0b013e318290f712 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 434 TITLE Discussion: Treatment of capsular contracture using complete implant coverage by acellular dermal matrix: a novel technique. AUTHOR NAMES Nahabedian M.Y. AUTHOR ADDRESSES (Nahabedian M.Y., drnahabedian@aol.com) Department of Plastic Surgery, Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC 20007, USA. CORRESPONDENCE ADDRESS M.Y. Nahabedian, Department of Plastic Surgery, Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC 20007, USA. Email: drnahabedian@aol.com SOURCE Plastic and reconstructive surgery (2013) 132:3 (530-531). Date of Publication: Sep 2013 ISSN 1529-4242 (electronic) EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation implant capsular contracture (surgery) EMTREE MEDICAL INDEX TERMS female human methodology note CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 23985628 (http://www.ncbi.nlm.nih.gov/pubmed/23985628) PUI L563004260 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 435 TITLE Breast reconstruction in a previously explanted patient: An interesting anatomical anomaly AUTHOR NAMES Egro F.M. Carlson G.W. AUTHOR ADDRESSES (Egro F.M., francescoegro@gmail.com; Carlson G.W.) Emory Division of Plastic and Reconstructive Surgery, Atlanta, GA 30308, United States. CORRESPONDENCE ADDRESS F. M. Egro, Emory Division of Plastic and Reconstructive Surgery, Atlanta, GA 30308, United States. Email: francescoegro@gmail.com SOURCE Archives of Plastic Surgery (2013) 40:5 (647-649). Date of Publication: September 2013 ISSN 2234-6163 2234-6171 (electronic) BOOK PUBLISHER Korean Society of Plastic and Reconstructive Surgeons, 1355-3 Seocho-Dong, Seocho-Gu, Seoul, South Korea. EMTREE DRUG INDEX TERMS anastrozole (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction pathological anatomy pectoralis major muscle EMTREE MEDICAL INDEX TERMS acellular dermal matrix aged article case report female human Paget nipple disease (drug therapy, surgery) Poland syndrome (complication, diagnosis) skin flap CAS REGISTRY NUMBERS anastrozole (120511-73-1) EMBASE CLASSIFICATIONS Internal Medicine (6) Surgery (9) Gerontology and Geriatrics (20) Drug Literature Index (37) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2013608487 PUI L369899145 DOI 10.5999/aps.2013.40.5.647 FULL TEXT LINK http://dx.doi.org/10.5999/aps.2013.40.5.647 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 436 TITLE Inferior Dermal Flap in Immediate Breast Reconstruction AUTHOR NAMES Torstenson T. Boughey J.C. Saint-Cyr M. AUTHOR ADDRESSES (Torstenson T.; Boughey J.C., Boughey.Judy@mayo.edu) Department of Surgery, Mayo Clinic, Rochester, United States. (Saint-Cyr M.) Department of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, United States. CORRESPONDENCE ADDRESS J.C. Boughey, Department of Surgery, Mayo Clinic, Rochester, MN, United States. Email: Boughey.Judy@mayo.edu SOURCE Annals of Surgical Oncology (2013) (1). Date of Publication: 2013 ISSN 1068-9265 1534-4681 (electronic) BOOK PUBLISHER Springer US ABSTRACT Background: The inferior dermal flap can be used in conjunction with implants or tissue expanders to avoid need for acellular dermal matrix in breast reconstruction and on occasion can serve as an alternative to an autologous flap by functioning as a reconstructed breast mound. Candidates for this procedure are women with high BMI or breast ptosis who desire a decrease in breast size at time of mastectomy with reconstruction. This procedure recruits the de-epithelialized excess skin inferiorly and laterally from a skin-sparing mastectomy and uses this to eliminate the need for acellular dermal matrix in a cost-conscious environment. Methods: The skin-sparing mastectomy is performed, and the inferior skin flap is de-epithelialized to create the inferior dermal pedicle. A gel implant is placed retropectorally, and the inferior dermal flap is sutured to the inferior border of the pectoralis major muscle and laterally to a muscle-sparing serratus pedicle to provide support and coverage of the implant. Results: We have performed this procedure in several patients and present a video outlining the technique of this procedure in a 54-year-old female diagnosed with left breast DCIS. Postoperative pictures taken at 6 weeks showed an excellent cosmetic result without complications. Conclusions: The inferior dermal flap is a simple and reproducible procedure that can reduce cost by eliminating the use of acellular dermal matrix. It provides an excellent cosmetic outcome in women undergoing mastectomy with large BMI and breast ptosis seeking reduction in breast size. © 2013 Society of Surgical Oncology. EMTREE DRUG INDEX TERMS cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction skin flap EMTREE MEDICAL INDEX TERMS acellular dermal matrix breast environment female human implant intraductal carcinoma mastectomy muscle oncology patient pectoralis major muscle procedures ptosis skin society tissue expander videorecording LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 23975284 (http://www.ncbi.nlm.nih.gov/pubmed/23975284) PUI L52744711 DOI 10.1245/s10434-013-3109-0 FULL TEXT LINK http://dx.doi.org/10.1245/s10434-013-3109-0 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 437 TITLE One stage implant-based reconstruction of the breast in a single patient: Comparison between mesh and modified dual plane technique AUTHOR NAMES Riggio E. Ottolenghi J. Grassi V. Nava M. AUTHOR ADDRESSES (Riggio E.; Ottolenghi J.; Nava M.) Plastic and Reconstructive Surgery Unit, IRCCS Foundation - National Cancer Institute, Milan, Italy. (Grassi V., grassivero@gmail.com) North West London Hospitals NHS Trust, Northwick Park Hospital, London, United Kingdom. CORRESPONDENCE ADDRESS V. Grassi, North West London Hospitals NHS Trust, Northwick Park Hospital, Watford Road, London, United Kingdom. Email: grassivero@gmail.com SOURCE Surgical Techniques Development (2013) 3:1 Article Number: e1. Date of Publication: 2013 ISSN 2038-9574 2038-9582 (electronic) BOOK PUBLISHER Page Press Publication, via Giuseppe Belli, Pavia, Italy. ABSTRACT Acellular dermal matrix and similar meshes are used in breast reconstruction to cover the inferior implant pocket. We considered whether using a modified dual-plane technique in immediate breast reconstruction could improve the outcome when compared with mesh reconstruction. The paper presents a case of a patient who underwent one-stage bilateral immediate breast reconstruction (IBR) with 470 g implants, using alloplastic mesh in one side and the composed dual-plane pocket in the other. In the case described, the composed dual plane technique gave a better result in terms of absence of rippling and smoother surface at the palpation; the mesh coverage gave a better inframammary contour. Our case suggests that the modified dual-plane technique gives a satisfactory cosmetic outcome. It also reduces costs and avoids meshrelated complications. This technique should therefore be considered as an option to the mesh in implant-based breast reconstruction. © E. Riggio et al., 2013. EMTREE DRUG INDEX TERMS antibiotic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction surgical mesh two plane implant EMTREE MEDICAL INDEX TERMS adult antibiotic prophylaxis article case report female follow up human mastectomy muscle strength muscle tone myotomy outcome assessment pectoralis major muscle silicone breast implant skin flap skinfold thickness wound irrigation DEVICE TRADE NAMES Natrelle , United StatesAllergan Tiloop , GermanyGfE Medizintechnik DEVICE MANUFACTURERS (United States)Allergan (Germany)GfE Medizintechnik EMBASE CLASSIFICATIONS Surgery (9) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013508594 PUI L369564650 DOI 10.4081/std.2013.e1 FULL TEXT LINK http://dx.doi.org/10.4081/std.2013.e1 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 438 TITLE A comparative study of CG CryoDerm and AlloDerm in direct-to-implant immediate breast reconstruction AUTHOR NAMES Lee J.H. Park K.R. Kim T.G. Ha J.-H. Chung K.-J. Kim Y.-H. Lee S.J. Kang S.H. AUTHOR ADDRESSES (Lee J.H., psjhlee@naver.com; Park K.R.; Kim T.G.; Ha J.-H.; Chung K.-J.; Kim Y.-H.) Departments of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu, South Korea. (Lee S.J.; Kang S.H.) Departments of General Surgery, Yeungnam University College of Medicine, Daegu, South Korea. CORRESPONDENCE ADDRESS J. H. Lee, Departments of Plastic and Reconstructive Surgery, Yeungnam University Hospital, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu705-717, South Korea. Email: psjhlee@naver.com SOURCE Archives of Plastic Surgery (2013) 40:4 (374-379). Date of Publication: July 2013 ISSN 2234-6163 2234-6171 (electronic) BOOK PUBLISHER Korean Society of Plastic and Reconstructive Surgeons, 1355-3 Seocho-Dong, Seocho-Gu, Seoul, South Korea. ABSTRACT Background To date, various types of acellular dermal matrix (ADM) have been developed for clinical use. AlloDerm is the most familiar type of ADM to most surgeons in breast reconstruction. It is prepared by freeze-drying. CG CryoDerm is the first form of ADM that requires no drying process. Therefore, theoretically, it has a higher degree of preservation of the dermal structures than AlloDerm. We conducted this study to compare the clinical course and postoperative outcomes of patients who underwent direct-to-implant breast reconstructions using AlloDerm and those who did using CG CryoDerm. Methods We performed a retrospective analysis of the medical records in a consecutive series of 50 patients who underwent direct-to-implant breast reconstruction using AlloDerm (n=31) or CryoDerm (n=19). We then compared the clinical course and postoperative outcomes of the two groups based on the overall incidence of complications and the duration of drainage. Results The mean follow-up period was 16 months. There were no significant differences in the overall incidence of complications (seroma, infection, skin flap necrosis, capsular contracture, and implant loss) between the two groups. Nor was there any significant difference in the duration of drainage. Conclusions CG CryoDerm has the merits of short preparation time and easy handling during surgery. Our results indicate that CG CryoDerm might be an alternative allograft material to AlloDerm in direct-to-implant breast reconstruction. © 2013 The Korean Society of Plastic and Reconstructive Surgeons. EMTREE DRUG INDEX TERMS antibiotic agent (intravenous drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant breast surgery CG CryoDerm surgical mesh EMTREE MEDICAL INDEX TERMS adult article clinical article comparative study female follow up graft necrosis (complication) human implant capsular contracture (complication) medical record review postoperative infection (complication) retrospective study seroma (complication) DEVICE TRADE NAMES Biocell , United StatesAllergan DEVICE MANUFACTURERS (United States)Allergan EMBASE CLASSIFICATIONS Surgery (9) Dermatology and Venereology (13) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013472179 PUI L369424976 DOI 10.5999/aps.2013.40.4.374 FULL TEXT LINK http://dx.doi.org/10.5999/aps.2013.40.4.374 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 439 TITLE Impact and outcome of human acellular dermal matrix size for immediate and two-stage breast reconstruction. AUTHOR NAMES Cayci C. Santner F. Jacobson S.R. AUTHOR ADDRESSES (Cayci C.) Section of Plastic Surgery, University of Michigan; and the Division of Plastic Surgery, University of Illinois-Chicago, Chicago, IL, USA. (Santner F.; Jacobson S.R.) CORRESPONDENCE ADDRESS C. Cayci, Section of Plastic Surgery, University of Michigan; and the Division of Plastic Surgery, University of Illinois-Chicago, Chicago, IL, USA. SOURCE Plastic and reconstructive surgery (2013) 132:1 (11-18). Date of Publication: Jul 2013 ISSN 1529-4242 (electronic) ABSTRACT Following mastectomy, patients may choose to have breast reconstruction with autologous tissue or implants. Human acellular dermal matrix has been described as a tissue supplement where the implant is covered, without requiring further muscle elevation or dissection. The authors evaluated the impact of different matrix sizes. Fifty-two patients (average age, 48.5 years) and 88 operated breasts were evaluated. The cohort was divided into two, depending on matrix size. In group A, a small matrix with a surface area of 48 or 96 cm was used. In group B, a larger matrix with either 128 or 160 cm was used. Intraoperative fill volumes, expansion procedure, and complications were analyzed. Size difference was significant (69.2 versus 135.5 cm). The calculated mean initial filling volume-to-excised pathology tissue weight ratio and the initial filling-to-final implant volume ratio were significant. Average number of fills to reach final expansion volume was 62.3 percent, or 4.7 times lower in group B. Seven complications were reported without any statistical difference between groups. This study suggests that using a larger human acellular dermal matrix in breast reconstruction offers a potential to increase the initial expander fill volume-to-breast pathology weight ratio and initial expander fill volume-to-final implant volume ratio. Larger matrices can reduce the number of subsequent expansions and may even decrease the risk of postoperative complications. This study also revealed that using a larger matrix is a safe method that does not increase complications. Therapeutic, III. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant breast reconstruction postoperative complication (epidemiology, prevention) EMTREE MEDICAL INDEX TERMS adult aged article breast tumor (surgery) comparative study female follow up human incidence mastectomy methodology middle aged retrospective study standard time tissue expander United States (epidemiology) LANGUAGE OF ARTICLE English MEDLINE PMID 23806904 (http://www.ncbi.nlm.nih.gov/pubmed/23806904) PUI L369816875 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 440 TITLE Use of porcine acellular dermal matrix in revisionary cosmetic breast augmentation AUTHOR NAMES Pozner J.N. White J.B. Newman M.I. AUTHOR ADDRESSES (Pozner J.N.; Newman M.I.) Department of Plastic Surgery, Cleveland Clinic Florida, Weston, FL, United States. (White J.B., JeremyWhiteMD@gmail.com) ARC Plastic Surgery, 3230 Stirling Rd, Hollywood, FL 33021, United States. CORRESPONDENCE ADDRESS J.B. White, ARC Plastic Surgery, 3230 Stirling Rd, Hollywood, FL 33021, United States. Email: JeremyWhiteMD@gmail.com SOURCE Aesthetic Surgery Journal (2013) 33:5 (681-690). Date of Publication: July 2013 ISSN 1090-820X 1527-330X (electronic) BOOK PUBLISHER SAGE Publications Inc., 2455 Teller Road, Thousand Oaks, United States. ABSTRACT Background: Aesthetic breast augmentation can be fraught with postoperative complications, particularly capsular contracture (CC), skin surface irregularities, and implant or inframammary fold malposition. Similar complications have been addressed successfully in reconstructive breast surgery with acellular dermal matrix (ADM) products. Objective: The authors present their initial experience with porcine ADM (PADM) in aesthetic breast augmentation.Methods: Retrospective chart review was performed for 93 consecutive patients (179 breasts) who underwent revisionary cosmetic breast augmentation with or without mastopexy between May 2009 and September 2012. Porcine ADM (Strattice; Lifecell Corp, Branchburg, New Jersey) was placed bilaterally in 74 patients and unilaterally in 19 patients. All patients were operated upon by 1 surgeon (J.N.P.). Product use description and complications were recorded, including infection, extrusion, CC, and implant malposition. Results: Average follow-up was 12 months (range, 1-39 months). There were 2 major complications (1.6% of breasts): an infection in 1 breast thatrequired implant explantation approximately 2 weeks postoperatively and an extrusion that required PADM removal. Two additional patients had highriding implants resulting from folded PADM that required revision; both cases were corrected by excising the folded PADM segment. Seven other patients required office procedures to correct minor imperfections. Two CC recurrences were suspected (1 patient) in the 76 breasts that underwent capsulectomy and PADM placement. Conclusions: Porcine ADM demonstrated great utility as an adjunct in revisionary cosmetic breast surgery. The product helped to provide good aesthetic outcomes with low complication rates. Prospective, randomized trials may prove helpful in defining the role of PADM further in these challenging cases. © 2013 The American Society for Aesthetic Plastic Surgery, Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation esthetic surgery EMTREE MEDICAL INDEX TERMS adult animal tissue article female follow up human implant capsular contracture (complication) major clinical study medical record review nonhuman postoperative complication (complication) postoperative infection (complication) priority journal surgeon surgical error EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013418219 MEDLINE PMID 23813397 (http://www.ncbi.nlm.nih.gov/pubmed/23813397) PUI L369240419 DOI 10.1177/1090820X13491279 FULL TEXT LINK http://dx.doi.org/10.1177/1090820X13491279 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 441 TITLE The impact of acellular dermal matrix on tissue expander/implant loss in breast reconstruction: an analysis of the tracking outcomes and operations in plastic surgery database. AUTHOR NAMES Pannucci C.J. Antony A.K. Wilkins E.G. AUTHOR ADDRESSES (Pannucci C.J.) Section of Plastic Surgery, University of Michigan, Ann Arbor, MI 48109, USA. (Antony A.K.; Wilkins E.G.) CORRESPONDENCE ADDRESS C.J. Pannucci, Section of Plastic Surgery, University of Michigan, Ann Arbor, MI 48109, USA. Email: cpannucc@umich.edu SOURCE Plastic and reconstructive surgery (2013) 132:1 (1-10). Date of Publication: Jul 2013 ISSN 1529-4242 (electronic) ABSTRACT Use of acellular dermal matrix in breast reconstruction has been associated with increased complications. However, existing studies are generally small, from single centers, and underpowered to control for confounding using regression techniques. Here, the Tracking Outcomes and Operations in Plastic Surgery database was used to examine the effect of acellular dermal matrix on expander/implant loss when controlling for other confounders. Analysis was limited to patients having tissue expander or implant-based breast reconstruction. Surgeon-reported data, International Classification of Diseases, Ninth Edition codes, and Current Procedural Terminology codes were used to identify independent variables. The dependent variable of interest was 30-day rates of tissue expander or implant loss. Bivariate statistics were performed. Multivariable logistic regression identified independent predictors of expander/implant loss when controlling for other confounders. Data were available for 14,249 patients. The overall rate of expander/implant loss was 2.05 percent. Bivariate analysis demonstrated acellular dermal matrix was associated with an absolute increase in expander/implant loss of 0.7 percent (1.88 percent versus 2.58 percent, p = 0.012). The regression model demonstrated that rising body mass index, current smoking, and presence of diabetes were each independent predictors of expander/implant loss. When controlling for all other identified confounders, use of acellular dermal matrix was associated with a significant increase in expander/implant loss (odds ratio, 1.42; 95 percent confidence interval, 1.04 to 1.94; p = 0.026). Thirty-day risk for expander/implant loss after tissue expander or implant-based breast reconstruction was 2.05 percent. Use of acellular dermal matrix was associated with a 0.7 percent absolute risk increase for expander/implant loss. Risk, III. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix (adverse drug reaction) breast reconstruction medical record plastic surgery postoperative complication (epidemiology, etiology) risk assessment tissue expander EMTREE MEDICAL INDEX TERMS adult article comparative study female follow up human incidence methodology middle aged retrospective study statistics time United States (epidemiology) LANGUAGE OF ARTICLE English MEDLINE PMID 23508050 (http://www.ncbi.nlm.nih.gov/pubmed/23508050) PUI L369816870 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 442 TITLE Implant-based breast reconstruction using a titanium-coated polypropylene mesh (TiLOOP Bra): a multicenter study of 231 cases. AUTHOR NAMES Dieterich M. Paepke S. Zwiefel K. Dieterich H. Blohmer J. Faridi A. Klein E. Gerber B. Nestle-Kraemling C. AUTHOR ADDRESSES (Dieterich M.) Department of Obstetrics and Gynecology, Interdisciplinary Breast Center, University of Rostock, Rostock, Germany. (Paepke S.; Zwiefel K.; Dieterich H.; Blohmer J.; Faridi A.; Klein E.; Gerber B.; Nestle-Kraemling C.) CORRESPONDENCE ADDRESS M. Dieterich, Department of Obstetrics and Gynecology, Interdisciplinary Breast Center, University of Rostock, Rostock, Germany. Email: max.dieterich@uni-rostock.de SOURCE Plastic and reconstructive surgery (2013) 132:1 (8e-19e). Date of Publication: Jul 2013 ISSN 1529-4242 (electronic) ABSTRACT An alternative to implant-based breast reconstruction using acellular dermal matrix is the use of a titanium-coated polypropylene mesh. The mesh was approved for implant-based breast reconstruction in Europe in 2008, but only limited clinical data are available. Two hundred seven patients (231 breasts) with skin-sparing/nipple-sparing or modified radical mastectomy and immediate or delayed implant-based breast reconstruction using titanium-coated polypropylene mesh were evaluated retrospectively. The primary endpoints were identification of patient-related and surgical factors that were predictive for an adverse outcome and the development of recommendations for patients eligible for implant-based breast reconstruction using the mesh. Complications were divided into major (need for additional surgery), minor (conservative treatment), and implant loss. Univariate and multivariate logistic regression analyses were performed to determine the influence of the patient- and procedure-related characteristics on postoperative complications and implant loss. No risk factors were observed for patient-associated complications. Major complications occurred in 13.4 percent, minor complications in 15.6 percent, and implant loss in 8.7 percent of patients. Univariate analysis revealed procedure-related risk factors for postoperative complications with a bilateral procedure (p = 0.013) or skin expansion before implant surgery (p = 0.043). Multivariate analysis confirmed these risk factors and revealed an increased risk for implant loss in patients with skin necrosis (p < 0.001) and capsule fibrosis (p < 0.001). This titanium-coated polypropylene mesh shows acceptable complication rates and can be a helpful device in implant-based breast reconstruction. The mesh should only be used in primary cases and, when adhering to the proposed indications, is a safe and convenient option in implant-based breast reconstruction. Risk, III. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) biomaterial polypropylene titanium EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast implant breast reconstruction patient satisfaction surgical mesh EMTREE MEDICAL INDEX TERMS adult aged article breast tumor (surgery) comparative study controlled clinical trial controlled study female follow up Germany (epidemiology) human incidence mastectomy methodology middle aged multicenter study postoperative complication (epidemiology) prognosis randomized controlled trial retrospective study risk factor time CAS REGISTRY NUMBERS polypropylene (25085-53-4, 9003-07-0) titanium (7440-32-6) CLINICAL TRIAL NUMBERS ClinicalTrials.gov (NCT01544023) LANGUAGE OF ARTICLE English MEDLINE PMID 23806958 (http://www.ncbi.nlm.nih.gov/pubmed/23806958) PUI L369816929 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 443 TITLE Discussion: impact and outcome of human acellular dermal matrix size for immediate and two-stage breast reconstruction. AUTHOR NAMES Gurunluoglu R. AUTHOR ADDRESSES (Gurunluoglu R.) Plastic and Reconstructive Surgery, Denver Health Medical Center, Denver, CO 80204, USA. CORRESPONDENCE ADDRESS R. Gurunluoglu, Plastic and Reconstructive Surgery, Denver Health Medical Center, Denver, CO 80204, USA. Email: raffi.gurunluoglu@dhha.org SOURCE Plastic and reconstructive surgery (2013) 132:1 (19-21). Date of Publication: Jul 2013 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant breast reconstruction postoperative complication (prevention) EMTREE MEDICAL INDEX TERMS female human methodology note standard LANGUAGE OF ARTICLE English MEDLINE PMID 23806905 (http://www.ncbi.nlm.nih.gov/pubmed/23806905) PUI L369816876 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 444 TITLE Acellular dermal matrices in breast surgery: a comprehensive review. AUTHOR NAMES Ibrahim A.M. Ayeni O.A. Hughes K.B. Lee B.T. Slavin S.A. Lin S.J. AUTHOR ADDRESSES (Ibrahim A.M.) Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA. (Ayeni O.A.; Hughes K.B.; Lee B.T.; Slavin S.A.; Lin S.J.) CORRESPONDENCE ADDRESS A.M. Ibrahim, Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA. SOURCE Annals of plastic surgery (2013) 70:6 (732-738). Date of Publication: Jun 2013 ISSN 1536-3708 (electronic) ABSTRACT Acellular dermal matrices (ADMs) have become increasingly popular for use in plastic surgery. There has been an increase in the number of products that have paralleled their usage in various clinical settings and specifically breast surgery. A direct comparison of the most common ADMs used in breast surgery was performed including physical characteristics, level of sterility, maximum load sustained (N), stiffness (N/mm), and tensile strength (N/cm). A comprehensive review of the literature was also performed, detailing known results and complications. The direct comparison of most common ADMs is detailed along with a review of 26 series of breast reconstruction manuscripts involving the usage of ADMs. Specifically, Strattice and Permacol had the highest values of maximum loads sustained, stiffness, and tensile strength. ADMs have a role in breast surgery that continues to be defined. Future long-term follow-up remains crucial to the identification of the optimal biologic mesh. EMTREE DRUG INDEX TERMS collagen surgical mesh surgical mesh surgical mesh surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction EMTREE MEDICAL INDEX TERMS biomechanics comparative study female human mastectomy methodology reoperation review tensile strength weight bearing CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 23407245 (http://www.ncbi.nlm.nih.gov/pubmed/23407245) PUI L563022884 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 445 TITLE Acellular dermal matrices in breast surgery: a comprehensive review AUTHOR NAMES Ibrahim A.M. Ayeni O.A. Hughes K.B. Lee B.T. Slavin S.A. Lin S.J. AUTHOR ADDRESSES (Ibrahim A.M.; Ayeni O.A.; Hughes K.B.; Lee B.T.; Slavin S.A.; Lin S.J.) Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA SOURCE Annals of plastic surgery (2013) 70:6 (732-738). Date of Publication: 1 Jun 2013 ISSN 1536-3708 (electronic) ABSTRACT INTRODUCTION: Acellular dermal matrices (ADMs) have become increasingly popular for use in plastic surgery. There has been an increase in the number of products that have paralleled their usage in various clinical settings and specifically breast surgery.METHODS: A direct comparison of the most common ADMs used in breast surgery was performed including physical characteristics, level of sterility, maximum load sustained (N), stiffness (N/mm), and tensile strength (N/cm). A comprehensive review of the literature was also performed, detailing known results and complications.RESULTS: The direct comparison of most common ADMs is detailed along with a review of 26 series of breast reconstruction manuscripts involving the usage of ADMs. Specifically, Strattice and Permacol had the highest values of maximum loads sustained, stiffness, and tensile strength.CONCLUSIONS: ADMs have a role in breast surgery that continues to be defined. Future long-term follow-up remains crucial to the identification of the optimal biologic mesh. EMTREE DRUG INDEX TERMS collagen surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix procedures EMTREE MEDICAL INDEX TERMS biomechanics breast reconstruction comparative study female human mastectomy reoperation tensile strength weight bearing CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 23407245 (http://www.ncbi.nlm.nih.gov/pubmed/23407245) PUI L603056800 DOI 10.1097/SAP.0b013e31824b3d30 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0b013e31824b3d30 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 446 TITLE Combining muscle-sparing serratus flap with acellular dermal matrix in immediate breast reconstruction AUTHOR NAMES Ramanadham S. Lakhiani C. Malafa M. Lee M. Cheng A. Saint-Cyr M. AUTHOR ADDRESSES (Ramanadham S.; Lakhiani C.; Malafa M.; Lee M.; Cheng A.; Saint-Cyr M., saintcyr.michel@mayo.edu) Department of Plastic Surgery, University of Texas, Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390-9132, United States. CORRESPONDENCE ADDRESS M. Saint-Cyr, Department of Plastic Surgery, University of Texas, Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390-9132, United States. Email: saintcyr.michel@mayo.edu SOURCE European Journal of Plastic Surgery (2013) 36:6 (353-358). Date of Publication: June 2013 ISSN 0930-343X 1435-0130 (electronic) BOOK PUBLISHER Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany. ABSTRACT Background: Submuscular placement of tissue expanders is a common method of reconstruction in the postmastectomy patient. Though the pectoralis muscle provides ample coverage of the expander superomedially, it is insufficient for complete coverage. Inferior coverage has been described using both local muscle and fascial flaps as well as the more recently introduced acellular dermal matrix (ADM). Each method possesses advantages and disadvantages, while the use of both in conjunction may serve to provide a superior, cost-effective result. Methods: A retrospective review was undertaken of all patients undergoing immediate breast reconstruction from January 2008 to December 2011. Patients who underwent reconstruction with the use of combined ADM and muscle-sparing serratus flap were selected for further review. A total of 16 patients (27 reconstructed breasts) were identified. Data were collected regarding patient demographics, operative details, and complications. Results: Of the 16 patients, 6 received postoperative radiation and 9 received perioperative chemotherapy. Mean follow-up was 20.8 months. A single 8 × 16-cm sheet of ADM was sufficient for bilateral reconstruction. Complications included infection (three patients), mastectomy flap necrosis (two patients), expander exposure (one patient), wound dehiscence (one patient), hematoma (one patient), and seroma (one patient). There were no cases of capsular contracture. All patients were noted to have sufficient lateral fullness and optimal contour. Conclusions: Combined use of a muscle-sparing serratus anterior flap with ADM is a safe and viable method of complete inferior expander coverage in immediate breast reconstruction, which has not yet been described in the literature. Potential advantages include decreased donor site morbidity, improved lateral fullness, and greater efficiency in ADM use. Level of Evidence: Level IV, therapeutic study. © 2013 Springer-Verlag Berlin Heidelberg. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction muscle flap muscle sparing serratus flap EMTREE MEDICAL INDEX TERMS adult aged article clinical article graft necrosis (complication) hematoma (complication) human mastectomy priority journal retrospective study seroma (complication) surgical infection (complication) wound dehiscence (complication) EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013338520 PUI L52486800 DOI 10.1007/s00238-013-0815-6 FULL TEXT LINK http://dx.doi.org/10.1007/s00238-013-0815-6 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 447 TITLE Infection following implant-based reconstruction in 1952 consecutive breast reconstructions: salvage rates and predictors of success. AUTHOR NAMES Reish R.G. Damjanovic B. Austen Jr. W.G. Winograd J. Liao E.C. Cetrulo C.L. Balkin D.M. Colwell A.S. AUTHOR ADDRESSES (Reish R.G.) Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. (Damjanovic B.; Austen Jr. W.G.; Winograd J.; Liao E.C.; Cetrulo C.L.; Balkin D.M.; Colwell A.S.) CORRESPONDENCE ADDRESS R.G. Reish, Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. SOURCE Plastic and reconstructive surgery (2013) 131:6 (1223-1230). Date of Publication: Jun 2013 ISSN 1529-4242 (electronic) ABSTRACT Few studies address salvage rates for infection in implant-based breast reconstruction. An understanding of success rates and clinical predictors of failure may help guide management. A retrospective analysis of multisurgeon consecutive implant reconstructions from 2004 to 2010 was performed. Immediate implant-based reconstructions (n=1952) were performed in 1241 patients. Ninety-nine reconstruction patients (5.1 percent) were admitted for breast erythema and had a higher incidence of smoking (p=0.007), chemotherapy (p=0.007), radiation therapy (p=0.001), and mastectomy skin necrosis (p<0.0001). There was no difference in age, body mass index, or acellular dermal matrix usage. With intravenous antibiotics, 25 (25.3 percent) reconstruction patients cleared the infection, whereas 74 (74.7 percent) underwent attempted operative salvage (n=18) or explantation (n=56). Patients who failed to clear infection had a higher mean white blood cell count at admission (p<0.0001). Of the attempted operative salvage group, 12 cleared the infection with immediate implant exchange and six eventually lost the implant. Patients who failed implant salvage were more likely to have methicillin-resistant Staphylococcus aureus (p=0.004). The total explantation rate was 3.2 percent. Following explantation, 32 patients underwent attempted secondary tissue expander insertion. Twenty-six were successful and six had recurrent infection and implant loss. There were no differences in time interval to tissue expander insertion between successful and unsuccessful secondary operations. Salvage with intravenous antibiotics and implant exchange was successful in 37.3 percent of patients. Smoking, irradiation, chemotherapy, and mastectomy skin necrosis were predictors for developing infection. Patients with a higher white blood cell count at admission and methicillin-resistant S. aureus were more likely to fail implant salvage. There was no association with time interval to tissue expander insertion and secondary explantation. Therapeutic, IV. EMTREE DRUG INDEX TERMS antiinfective agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast implant breast reconstruction infection (etiology, surgery) postoperative complication (etiology, surgery) salvage therapy surgical infection (etiology, surgery) EMTREE MEDICAL INDEX TERMS acellular dermal matrix adjuvant chemoradiotherapy adult article body mass breast tumor (therapy) female human intravenous drug administration mastectomy methicillin resistant Staphylococcus aureus middle aged necrosis pathology recurrent disease reoperation retrospective study risk factor skin smoking (adverse drug reaction) Staphylococcus infection (etiology, surgery) treatment outcome LANGUAGE OF ARTICLE English MEDLINE PMID 23714788 (http://www.ncbi.nlm.nih.gov/pubmed/23714788) PUI L369459132 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 448 TITLE A comparative analysis of cryopreserved versus prehydrated human acellular dermal matrices in tissue expander breast reconstruction AUTHOR NAMES Seth A.K. Persing S. Connor C.M. Davila A. Hirsch E. Fine N.A. Kim J.Y. AUTHOR ADDRESSES (Seth A.K.; Persing S.; Connor C.M.; Davila A.; Hirsch E.; Fine N.A.; Kim J.Y.) Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA SOURCE Annals of plastic surgery (2013) 70:6 (632-635). Date of Publication: 1 Jun 2013 ISSN 1536-3708 (electronic) ABSTRACT BACKGROUND: The use of human acellular dermal matrices (HADMs) in breast reconstruction has become routine practice for many reconstructive surgeons. Comparative studies between 2 more common iterations of human acellular dermis are scarce. Our study evaluated reconstructive outcomes of cryopreserved and prehydrated HADMs in comparative fashion.METHODS: This study is a retrospective review of 369 consecutive tissue expander breast reconstructions performed by 2 board-certified plastic surgeons whose practice focuses on breast reconstruction. Data were collected independently by 2 reviewers, and a comparative analysis for statistical significance of outcomes was performed using the Fisher exact test, 2-tailed independent t tests, and regression analysis where appropriate.RESULTS: Over a 5-year period, 255 patients (369 breasts) underwent breast reconstruction utilizing either cryopreserved or prehydrated HADM. Of the total, 136 breasts received cryopreserved and 233 breasts received prehydrated HADMs. The total complication rates for cryopreserved and prehydrated HADMs were 19.1% and 19.3% (P = 1.0), respectively. Additional complication rates were calculated for flap necrosis (8.1% vs 9.0%, P = 0.849), infection requiring intravenous antibiotics (10.3% vs 5.2%, P = 0.09), hematoma (2.9% vs 1.3%, P = 0.431), seroma (2.2% vs 1.0%, P = 1.0), expander exposure/dehiscence (5.9% vs 6.4%, P = 1.0), and number of breasts requiring autologous reconstruction after a complication (4.4% vs 6.4%, P = 0.491). On regression analysis, HADM type was not an independent risk factor for any complication subtype.CONCLUSIONS: The results of this study suggest that there are no significant differences in complication rates between cryopreserved and prehydrated HADMs. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix cryopreservation procedures tissue expansion EMTREE MEDICAL INDEX TERMS adult breast reconstruction comparative study devices evaluation study female human laboratory diagnosis mastectomy middle aged outcome assessment postoperative complication (epidemiology, etiology) regression analysis retrospective study risk factor CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 23429218 (http://www.ncbi.nlm.nih.gov/pubmed/23429218) PUI L603056808 DOI 10.1097/SAP.0b013e318250f0b4 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0b013e318250f0b4 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 449 TITLE A comparative analysis of cryopreserved versus prehydrated human acellular dermal matrices in tissue expander breast reconstruction. AUTHOR NAMES Seth A.K. Persing S. Connor C.M. Davila A. Hirsch E. Fine N.A. Kim J.Y. AUTHOR ADDRESSES (Seth A.K.) Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA. (Persing S.; Connor C.M.; Davila A.; Hirsch E.; Fine N.A.; Kim J.Y.) CORRESPONDENCE ADDRESS A.K. Seth, Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA. SOURCE Annals of plastic surgery (2013) 70:6 (632-635). Date of Publication: Jun 2013 ISSN 1536-3708 (electronic) ABSTRACT The use of human acellular dermal matrices (HADMs) in breast reconstruction has become routine practice for many reconstructive surgeons. Comparative studies between 2 more common iterations of human acellular dermis are scarce. Our study evaluated reconstructive outcomes of cryopreserved and prehydrated HADMs in comparative fashion. This study is a retrospective review of 369 consecutive tissue expander breast reconstructions performed by 2 board-certified plastic surgeons whose practice focuses on breast reconstruction. Data were collected independently by 2 reviewers, and a comparative analysis for statistical significance of outcomes was performed using the Fisher exact test, 2-tailed independent t tests, and regression analysis where appropriate. Over a 5-year period, 255 patients (369 breasts) underwent breast reconstruction utilizing either cryopreserved or prehydrated HADM. Of the total, 136 breasts received cryopreserved and 233 breasts received prehydrated HADMs. The total complication rates for cryopreserved and prehydrated HADMs were 19.1% and 19.3% (P = 1.0), respectively. Additional complication rates were calculated for flap necrosis (8.1% vs 9.0%, P = 0.849), infection requiring intravenous antibiotics (10.3% vs 5.2%, P = 0.09), hematoma (2.9% vs 1.3%, P = 0.431), seroma (2.2% vs 1.0%, P = 1.0), expander exposure/dehiscence (5.9% vs 6.4%, P = 1.0), and number of breasts requiring autologous reconstruction after a complication (4.4% vs 6.4%, P = 0.491). On regression analysis, HADM type was not an independent risk factor for any complication subtype. The results of this study suggest that there are no significant differences in complication rates between cryopreserved and prehydrated HADMs. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen EMTREE DRUG INDEX TERMS surgical mesh surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction cryopreservation laboratory diagnosis tissue expansion EMTREE MEDICAL INDEX TERMS adult article comparative study devices evaluation study female human mastectomy methodology middle aged outcome assessment postoperative complication (epidemiology, etiology) regression analysis retrospective study risk factor CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 23429218 (http://www.ncbi.nlm.nih.gov/pubmed/23429218) PUI L563022885 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 450 TITLE Application of acellular dermal matrix in breast reconstruction AUTHOR NAMES Qi Y. You W.-T. Li D. Li J.-N. AUTHOR ADDRESSES (Qi Y.) Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Beijing 100041, China. (You W.-T.; Li D.; Li J.-N., lijianningprs@yahoo.com.cn) Department of Plastic Surgery, Peking University Third Hospital, Beijing 100191, China. CORRESPONDENCE ADDRESS J.-N. Li, Department of Plastic Surgery, Peking University Third Hospital, Peking University, Beijing 100191, China. Email: lijianningprs@yahoo.com.cn SOURCE Chinese Medical Journal (2013) 126:13 (2548-2552). Date of Publication: June 2013 ISSN 0366-6999 BOOK PUBLISHER Chinese Medical Association, 42 Dongsi Xidajie, Beijing, China. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction EMTREE MEDICAL INDEX TERMS acellular dermal matrix sling article breast areola human implant implant capsular contracture (complication) mastectomy nipple skin flap EMBASE CLASSIFICATIONS Surgery (9) Dermatology and Venereology (13) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2013419118 MEDLINE PMID 23823832 (http://www.ncbi.nlm.nih.gov/pubmed/23823832) PUI L369243969 DOI 10.3760/cma.j.issn.0366-6999.20121070 FULL TEXT LINK http://dx.doi.org/10.3760/cma.j.issn.0366-6999.20121070 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 451 TITLE Chest wall reconstruction with acellular dermal matrix (Strattice (™)) and a TRAM flap AUTHOR NAMES Brunbjerg M.E. Juhl A.A. Damsgaard T.E. AUTHOR ADDRESSES (Brunbjerg M.E., metteeline@hotmail.com; Juhl A.A.; Damsgaard T.E.) Aarhus University Hospital, Department of Plastic Surgery, Norrebrogade 44, Aarhus C., 8000, Denmark. CORRESPONDENCE ADDRESS M.E. Brunbjerg, Aarhus University Hospital, Department of Plastic Surgery, Norrebrogade 44, Aarhus C., 8000, Denmark. Email: metteeline@hotmail.com SOURCE Acta Oncologica (2013) 52:5 (1054-1056). Date of Publication: June 2013 ISSN 0284-186X 1651-226X (electronic) BOOK PUBLISHER Informa Healthcare, 69-77 Paul Street, London, United Kingdom. EMTREE DRUG INDEX TERMS polypropylene EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix thorax wall reconstruction tissue flap transverse rectus abdominus myocutaneous flap EMTREE MEDICAL INDEX TERMS aged breast cancer (surgery) cancer surgery case report female human letter mastectomy priority journal surgical mesh DEVICE TRADE NAMES Strattice CAS REGISTRY NUMBERS polypropylene (25085-53-4, 9003-07-0) EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2013296584 MEDLINE PMID 23095144 (http://www.ncbi.nlm.nih.gov/pubmed/23095144) PUI L368879754 DOI 10.3109/0284186X.2012.734925 FULL TEXT LINK http://dx.doi.org/10.3109/0284186X.2012.734925 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 452 TITLE 440 Consecutive immediate, implant-based, single-surgeon breast reconstructions in 281 patients: a comparison of early outcomes and costs between SurgiMend fetal bovine and AlloDerm human cadaveric acellular dermal matrices. AUTHOR NAMES Butterfield J.L. AUTHOR ADDRESSES (Butterfield J.L.) Women's Plastic Surgery & Rejuvenation Centre 4750 East Galbraith Road, Suite 215, Cincinnati, Ohio 45236, USA. CORRESPONDENCE ADDRESS J.L. Butterfield, Women's Plastic Surgery & Rejuvenation Centre 4750 East Galbraith Road, Suite 215, Cincinnati, Ohio 45236, USA. Email: butterjl@yahoo.com SOURCE Plastic and reconstructive surgery (2013) 131:5 (940-951). Date of Publication: May 2013 ISSN 1529-4242 (electronic) ABSTRACT A 2010 nationwide survey of plastic and reconstructive surgeons indicated that approximately 83 percent performed predominantly implant-based breast reconstruction, with acellular dermal matrix used by approximately half of those practitioners. Although the medical literature documents well over 2000 cases of breast reconstruction with matrices, relatively few cases using other than human cadaveric acellular dermal matrices have been reported. The author compared complications and costs using SurgiMend fetal bovine and AlloDerm human cadaveric acellular dermal matrices. A retrospective review of a single surgeon's 5-year experience was performed for consecutive, nonrandomized immediate breast reconstructions with acellular dermal matrix from 2005 to 2010. Two hundred eighty-one patients had 440 implant-based reconstructions using SurgiMend [222 patients (79.0 percent)] or AlloDerm [59 patients (21.0 percent)]. No significant differences in complication rates were observed between SurgiMend and AlloDerm for hematoma, infection, major skin necrosis, or breast implant removal. Seroma was the most prevalent complication; the seroma rate for AlloDerm (15.7 percent) was significantly greater than that for SurgiMend (8.3 percent). Using recent product costs for equivalently sized AlloDerm and SurgiMend units, the cost of SurgiMend was $1024 less per breast than AlloDerm. SurgiMend fetal bovine and AlloDerm human cadaveric acellular dermal matrices demonstrate similar rates of major early complications in breast reconstruction in this study. This similarity in complication rates between SurgiMend and AlloDerm and the cost savings seen with the use of SurgiMend are factors for the surgeon to consider in choosing a matrix for breast reconstruction. : Therapeutic, III. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen (drug therapy) EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant breast reconstruction breast tumor (surgery) EMTREE MEDICAL INDEX TERMS adult animal article bovine cadaver comparative study economics female hospital cost human methodology middle aged postoperative complication (prevention) retrospective study statistics tissue expander treatment outcome CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 23629076 (http://www.ncbi.nlm.nih.gov/pubmed/23629076) PUI L369317337 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 453 TITLE Patient reported outcomes following acellular dermal matrix plus implant based immediate breast reconstruction after mastectomy-experience from two centres AUTHOR NAMES Knight A. Hamidi-Latifi L. . Murali K. Seetharam S. Desai A. AUTHOR ADDRESSES (Knight A.; . Murali K.; Seetharam S.) Darent Valley Hospital, Dartford, United Kingdom. (Hamidi-Latifi L.; Desai A.) Princess Royal University Hospital, Orpington, United Kingdom. CORRESPONDENCE ADDRESS A. Knight, Darent Valley Hospital, Dartford, United Kingdom. SOURCE European Journal of Surgical Oncology (2013) 39:5 (470). Date of Publication: May 2013 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2013 CONFERENCE LOCATION Petersfield, Manchester, United Kingdom CONFERENCE DATE 2013-05-21 to 2013-05-22 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Immediate implant-only breast reconstruction results in psychosexual well being levels comparable to mastectomy alone and overall poorer aesthetic outcomes than autologous techniques. Acellular dermal matrix (ADM) slings offer improvements over traditional subpectoral implant- only reconstruction. Aim: Assess the impact of mastectomy and immediate breast reconstruction using an ADM plus implant based technique on quality of life. Methods: Modified BREAST-Q questionnaire sent to all women (n=54) undergoing this form of breast reconstruction in two centres since the techniques' introduction. Results: Response rate 85.2%. Mean age of respondents 51.1 years. Mean time from surgery 18 months. Over 90%, when clothed, are satisfied with the post-operative appearance of the breast area. 97.8% are satisfied with breast shape when wearing a bra. Over three-quarters are satisfied with the natural feel and position of the reconstructed breast. About two-thirds are satisfied with breast softness and unclothed symmetry. 80% reported satisfaction with the appearance of the reconstructed breast compared to pre-operatively. 86.7% reported feeling emotionally able, healthy, socially confident and feminine some or all of the time. 51.6% who responded to the section regarding sexuality feel satisfied with their sex-life most or all of the time. 97.8% report an excellent, very good or good overall outcome. This compares to 86% in the recent National Mastectomy and Breast Reconstruction (NMBR) Audit. Overall aesthetic outcomes are superior, with comparative psychosexual outcomes. Conclusions: ADM plus implant reconstruction offers aesthetic and psychosexual results that compare favourably to the NMBR Audit findings for immediate reconstruction, which take into account traditionally more favoured autologous techniques. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction breast surgery human implant mastectomy patient EMTREE MEDICAL INDEX TERMS breast clinical audit female hardness quality of life questionnaire satisfaction sexual behavior sexuality surgery wellbeing LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71050511 DOI 10.1016/j.ejso.2013.01.067 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2013.01.067 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 454 TITLE 232 Sheets of acellular dermal matrix, or, how we spent £500,000 on pigskin AUTHOR NAMES Barber M. AUTHOR ADDRESSES (Barber M.) Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom. CORRESPONDENCE ADDRESS M. Barber, Edinburgh Breast Unit, Western General Hospital, Edinburgh, United Kingdom. SOURCE European Journal of Surgical Oncology (2013) 39:5 (517-518). Date of Publication: May 2013 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2013 CONFERENCE LOCATION Petersfield, Manchester, United Kingdom CONFERENCE DATE 2013-05-21 to 2013-05-22 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: The use of acellular dermal matrix (ADM) to augment implant-based breast reconstruction has revolutionised this technique. It offers the option of a one-stage procedure and is felt to have benefits in cosmetic outcome. However, medium and long-term outcome is unknown. Methods: All cases where ADM was used in a breast reconstructive procedure in the Edinburgh Breast Unit from its initial use on 7/7/ 2008-31/7/2012 were reviewed retrospectively. Follow up was completed to 30/11/2012. Results: 147 patients received 232 sheets of ADM (156 Strattice, 73 Permacol and 3 Alloderm). 40 reconstructions were lost (17.2% or 27.2% of patients). 7 of 27 (25.9%) patients requiring adjuvant therapy had this delayed due to problems with the reconstruction. 30 of 80 patients (37.5%) undergoing unilateral surgery have undergone contralateral symmetrisation. Implant loss varied significantly with smoking (34.6% loss rate in smokers, p = 0.0009), with radiotherapy (28.1% loss rate, p = 0.0006) and with incision type. There was no statistically significant variation by operating surgeon, type of ADM used, chemotherapy use, patient weight, breast weight, nipple preservation or type of axillary surgery. Patients underwent a mean of 1.54 further operations (range 0-7). Conclusions: While offering potential cosmetic and financial benefits the use of ADM with implant-based reconstructions has a significant rate of implant loss, further surgery and potential delay in adjuvant therapy. These must be considered when planning treatment and consenting patients. EMTREE DRUG INDEX TERMS cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast surgery EMTREE MEDICAL INDEX TERMS adjuvant therapy breast breast reconstruction chemotherapy follow up human implant incision nipple patient planning preservation procedures radiotherapy smoking surgeon surgery weight LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71050676 DOI 10.1016/j.ejso.2013.01.016 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2013.01.016 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 455 TITLE Comparison of sterile versus nonsterile acellular dermal matrices for breast reconstruction. AUTHOR NAMES Buseman J. Wong L. Kemper P. Hill J.L. Nimtz J. Rinker B. Vasconez H.C. AUTHOR ADDRESSES (Buseman J.) Division of Plastic Surgery, Department of Surgery, University of Kentucky, Lexington, KY 40536-0284, USA. (Wong L.; Kemper P.; Hill J.L.; Nimtz J.; Rinker B.; Vasconez H.C.) CORRESPONDENCE ADDRESS J. Buseman, Division of Plastic Surgery, Department of Surgery, University of Kentucky, Lexington, KY 40536-0284, USA. SOURCE Annals of plastic surgery (2013) 70:5 (497-499). Date of Publication: May 2013 ISSN 1536-3708 (electronic) ABSTRACT Acellular dermal matrix (ADM) has been associated with an increased incidence of complications after implant-based breast reconstruction. Recently, sterile ADM has been introduced in an attempt to minimize these complications. To analyze the impact of this product on patient outcomes, we created a database of patients undergoing implant-based breast reconstruction. Patients undergoing implant-based breast reconstruction at the University of Kentucky Medical Center from January 1, 2011, to December 31, 2011 were identified. A database of patient characteristics and outcomes was created. Outcomes investigated included mastectomy flap necrosis, dehiscence, infection, red breast, capsular contracture, hematoma, and seroma. Statistical analysis was performed. Fifty-eight patients underwent breast reconstruction with implants or tissue expanders. Of the 58 patients, 9 had the sterile form of ADM placed, 25 had the original aseptic but not sterile ADM, and 24 were not reconstructed with ADM. The most frequent complication noted was seroma, occurring in 6/9 patients with sterile ADM as compared to 2/25 with the aseptic ADM. This was statistically significant (P = 0.003). The use of sterile ADM is associated with a statistically significant increase in seroma formation. The etiology of this increased incidence remains unknown, but it correlates with the introduction of the sterile form of ADM at our institution. A different preparation or sterilization process, or some other variable as yet unknown, may be responsible. Further studies comparing the different forms of ADM in an animal model may serve to clarify this issue. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation instrument sterilization mastectomy postoperative complication (epidemiology, etiology, prevention) seroma (epidemiology, etiology, prevention) EMTREE MEDICAL INDEX TERMS adult article asepsis breast implant breast tumor (surgery) comparative study devices evaluation study female follow up human methodology middle aged outcome assessment retrospective study tissue expander CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 23542856 (http://www.ncbi.nlm.nih.gov/pubmed/23542856) PUI L370092877 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 456 TITLE Factors affecting complications in radiated breast reconstruction. AUTHOR NAMES Pestana I.A. Campbell D.C. Bharti G. Thompson J.T. AUTHOR ADDRESSES (Pestana I.A.) From the Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, 27157-1075, USA. (Campbell D.C.; Bharti G.; Thompson J.T.) CORRESPONDENCE ADDRESS I.A. Pestana, From the Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, 27157-1075, USA. SOURCE Annals of plastic surgery (2013) 70:5 (542-545). Date of Publication: May 2013 ISSN 1536-3708 (electronic) ABSTRACT Breast irradiation in combination with breast reconstruction is associated with increased complications. Because of the diminishing threshold for radiotherapy, breast reconstruction irradiation is rising. Our aim was to evaluate factors affecting outcomes in irradiated breast reconstructions. A review of consecutive patients who underwent mastectomy, radiation, and breast reconstruction was conducted. Patient demographics, operative procedure, breast irradiation timing, and postoperative complications were collected. One hundred fifty-four patients (157 breast reconstructions) were included with a mean follow-up of 6 years. Average age at reconstruction was 50 years. One hundred nine cases were immediate and 48 cases were delayed. Sixty-eight cases were autologous reconstructions and 89 cases were implant-based. Thirty-seven cases used acellular dermal matrices (ADMs); 60% of cases were radiated before reconstruction and 40% were radiated afterward. Major complications occurred in 43% of patients and minor complications occurred in 17%. The presence of ADM led to an increase in complication rate with a 2.3-fold greater chance of requiring reoperation (P = 0.03). No significant difference in complication rates was associated with presence of hypertension, diabetes, smoking, elevated body mass index, autologous versus implant-based reconstructions, delayed versus immediate reconstructions, and time between radiation and reconstruction. Radiation after prosthetic reconstruction may produce an increase in failure rates. The use of ADMs in the face of breast irradiation increases the likelihood of a complication requiring reoperation. EMTREE DRUG INDEX TERMS collagen (adverse drug reaction) surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction breast tumor (radiotherapy, surgery) mastectomy postoperative complication (epidemiology, etiology) EMTREE MEDICAL INDEX TERMS acellular dermal matrix (adverse drug reaction) adjuvant therapy article breast implant (adverse drug reaction) devices evaluation study female follow up human methodology middle aged reoperation retrospective study risk factor treatment outcome CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 23542851 (http://www.ncbi.nlm.nih.gov/pubmed/23542851) PUI L370092872 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 457 TITLE Analysis of acellular dermal matrix integration and revascularization following tissue expander breast reconstruction in a clinically relevant large-animal model. AUTHOR NAMES Garcia Jr. O. Scott J.R. AUTHOR ADDRESSES (Garcia Jr. O.) Division of Plastic Surgery, University of Miami, Miami, Fl, USA. (Scott J.R.) CORRESPONDENCE ADDRESS O. Garcia, Division of Plastic Surgery, University of Miami, Miami, Fl, USA. SOURCE Plastic and reconstructive surgery (2013) 131:5 (741e-51e). Date of Publication: May 2013 ISSN 1529-4242 (electronic) ABSTRACT Postmastectomy breast reconstruction remains one of the most frequently performed plastic surgery procedures in the United States. Acellular dermal matrix has been used extensively in expander-implant breast reconstruction and therefore is an appropriate material to be used to develop a clinically relevant animal model of breast reconstruction. The study population consisted of 18 female Yorkshire pigs, which were assigned randomly to bilateral expander breast reconstruction with either AlloMax Surgical Graft or AlloDerm Regenerative Tissue Matrix (n = 9 per group). Each group was further randomized to 4-, 8-, or 12-week time points (n = 3), to evaluate integration and neovascularization by means of microcirculatory and histologic techniques. Microcirculatory analysis revealed early acellular dermal matrix angiogenesis at 4 weeks on the skin flap surfaces only, and well-formed vasculature on both acellular dermal matrix surfaces at 8 weeks. Both surfaces were vascularized and exhibited detectable flow at 12 weeks after implantation. Progressive acellular dermal matrix angiogenesis was also histologically observed over time by means of hematoxylin and eosin-stained slides, as indicated by direct vascular identification/scoring at 4, 8, and 12 weeks. The authors have developed a clinically relevant large-animal model of breast reconstruction using acellular dermal matrix. The acellular dermal matrix inflammatory, neovascularization, and tissue integration response should be evaluated in an in vivo setting that accurately simulates the anatomy, biomaterials, surgical techniques, and timeframes encountered in human postmastectomy breast reconstruction to appropriately predict clinical performance. Neovascularization of the acellular dermal matrix with detectable blood flow took place after postimplantation week 8, a much slower process than previously reported in models not clinically relevant to acellular dermal matrix-assisted tissue expander breast reconstruction. EMTREE DRUG INDEX TERMS tissue scaffold EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix angiogenesis animal model breast reconstruction pig tissue expander EMTREE MEDICAL INDEX TERMS animal article breast augmentation female human mastectomy methodology microcirculation physiology postoperative complication udder (surgery) LANGUAGE OF ARTICLE English MEDLINE PMID 23629113 (http://www.ncbi.nlm.nih.gov/pubmed/23629113) PUI L369317371 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 458 TITLE Patient reported outcomes in immediate breast reconstruction: Acellular dermal matrix is more comparable to autologous rather than implant based reconstruction AUTHOR NAMES Elgammal S. Brindle R. Johnson R. AUTHOR ADDRESSES (Elgammal S.; Brindle R.; Johnson R.) University Hospital of South Manchester, Manchester, United Kingdom. CORRESPONDENCE ADDRESS S. Elgammal, University Hospital of South Manchester, Manchester, United Kingdom. SOURCE European Journal of Surgical Oncology (2013) 39:5 (518). Date of Publication: May 2013 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2013 CONFERENCE LOCATION Petersfield, Manchester, United Kingdom CONFERENCE DATE 2013-05-21 to 2013-05-22 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Aims: To audit immediate breast reconstruction at UHSM, comparing patient reported outcome measures (PROMs) in our unit against National Mastectomy and Breast Reconstruction Audit (NMBRA) data. To compare, for the first time, PROMs of acellular dermal matrix (ADM) with implant or flap based reconstruction. Methods: All patients undergoing immediate breast reconstruction between May 2009 and May 2012 (n = 158) were sent a postal survey of the validated patient questionnaire used in NMBRA. Non-responders (n = 75) were sent a second survey after 4 months. Questions covered cosmetic, emotional and functional outcomes. Results: Of 158 patients identified, overall response rate was 67% (n = 107). Reconstruction consisted of flap based (Lat dorsi {LD, n = 29}, Deep Inferior Epigastric Perforator {DIEP, n = 17}, and implant based (Tissue Expander {TE, n = 28} ADM n = 33). High ('excellent'/'very good') overall satisfaction with surgery was reported by 69%, paralleling NMBRA (67%). Of 19 patients reporting overall satisfaction with surgery as fair or poor, 30% (fair) and 50% (poor) had undergone radiotherapy, compared to 15% in the high satisfaction group. High satisfaction with the sensitive marker of 'how natural the breast looked unclothed' were reported for flap based reconstructions (LD n = 24, 83%, DIEP n = 14, 82%). Reconstruction using TE rated poorly, at 39% (n = 11) but surprisingly, 82% (n = 27) of women undergoing ADM reported high satisfaction. Conclusions: Overall satisfaction with immediate reconstruction is good and compares favourably with NMBRA data. In this cohort of patients, ADM compares more closely with flap based reconstruction in terms of patient perceptions of cosmesis, and scores considerably better than TE. EMTREE DRUG INDEX TERMS cosmetic marker EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction breast surgery human implant patient EMTREE MEDICAL INDEX TERMS breast clinical audit deep inferior epigastric perforator flap female mastectomy questionnaire radiotherapy satisfaction surgery tissue expander LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71050677 DOI 10.1016/j.ejso.2013.01.017 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2013.01.017 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 459 TITLE The effect of acellular dermal matrix use on the outcomes of prosthetic breast reconstruction: A systematic review AUTHOR NAMES Potter S. Browning D. Savovic J. Warr R. Cawthorn S. Blazeby J. AUTHOR ADDRESSES (Potter S.; Savovic J.; Blazeby J.) University of Bristol, Bristol, United Kingdom. (Browning D.) Royal United Hospital, Bath, United Kingdom. (Warr R.; Cawthorn S.) North Bristol NHS Trust, Bristol, United Kingdom. CORRESPONDENCE ADDRESS S. Potter, University of Bristol, Bristol, United Kingdom. SOURCE European Journal of Surgical Oncology (2013) 39:5 (472). Date of Publication: May 2013 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2013 CONFERENCE LOCATION Petersfield, Manchester, United Kingdom CONFERENCE DATE 2013-05-21 to 2013-05-22 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Acellular dermal matrix (ADM) may improve outcomes in prosthetic breast reconstruction (PBR) but there is conflicting evidence to support these benefits. Existing systematic reviews have major methodological limitations. The aim of this study was to critically appraise and evaluate the current evidence for ADM-assisted PBR. Methods: Comprehensive electronic searches identified complete papers published in English between January 2000 and October 2012, reporting any outcome of ADM-assisted PBR. All randomised trials (RCTs) and non-randomised studies (NRSs) with more than 50 ADM-recipients were included and critically appraised using the modified Cochrane Risk of Bias tool, adapted for NRSs. Characteristics and results of identified studies were summarised. Results: 23 papers; 1 RCT, 17 cohort studies and 5 case-series were identified, all of which were considered at high-risk of bias. The median ADM sample size was 124 (interquartile range 67-189). Most studies were single- centre (n=21, 91.3%) and only half (n=13) reported duration of follow- up. ADM was most commonly used for immediate (n=16, 69.6%) two-stage PBR (n=15, 65.2%) with few studies evaluating ADM-assisted single-stage procedures (n=3, 13.0%). Most studies used AlloDerm (n=22, 95.7%) with less than 10%(n=2) assessing non-humanADMs(e.g.Strattice). All studies reported clinical outcomes and over half (n=13,56.5%) assessed process outcomes but fewevaluated cosmetic (n=3, 13%) or patient-reported outcomes (n=2, 8.7%). Heterogeneity between studies precluded meaningful cross-study comparison or data synthesis. Conclusions: There is currently a lack of high-quality evidence to support the use of ADM in PBR. Well-designed multi-centre RCTs are needed to evaluate whether ADM use may improve outcomes for patients choosing PBR. EMTREE DRUG INDEX TERMS cosmetic nitrogen 13 nitrogen 15 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction breast surgery systematic review EMTREE MEDICAL INDEX TERMS case study cohort analysis data synthesis follow up human patient procedures recipient risk sample size systematic review (topic) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71050518 DOI 10.1016/j.ejso.2013.01.074 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2013.01.074 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 460 TITLE Classification and management of seromas in immediate breast reconstruction using the tissue expander and acellular dermal matrix technique. AUTHOR NAMES Brzezienski M.A. Jarrell 4th. J.A. Mooty R.C. AUTHOR ADDRESSES (Brzezienski M.A.) From the Department of Plastic Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN 37403, USA. (Jarrell 4th. J.A.; Mooty R.C.) CORRESPONDENCE ADDRESS M.A. Brzezienski, From the Department of Plastic Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN 37403, USA. SOURCE Annals of plastic surgery (2013) 70:5 (488-492). Date of Publication: May 2013 ISSN 1536-3708 (electronic) ABSTRACT Tissue expander (TE)/acellular dermal matrix (ADM)-based breast reconstruction used in immediate postmastectomy breast reconstruction, although a popular technique, is not without complications.Although seroma formation is recognized and reported in the literature as a complication, little information addresses seroma(s) management. We conducted a retrospective review of 100 consecutive TE/ADM immediate reconstructions during a 2-year period, performed by a single surgeon. Data collection included patient demographics, adjuvant therapy, initial TE fill volume, time to completion of expansion, seroma formation, management of seroma, and wound complications, up to the time of definitive implant exchange. From December 2009 to December 2011, 67 patients (100 reconstructions) underwent TE/ADM immediate breast reconstruction. Thirty-one reconstructions were identified having clinically significant seroma(s). Eighteen of the reconstructions required multiple drainage procedures. With these data, a 3-group classification system was created based on the number of aspirations. In review of the 3 groups, 71% of group III required either Seroma-Cath or operative drainage beyond simple aspiration(s). Of the 100 reconstructions, 3 (3%) ended in TE explantation. Only 1 (3%) TE explantation, interestingly from group I, was attributable to seroma formation. Using the data, we devised a management strategy emphasizing attentiveness to seroma formation, recognition, and treatment. Seroma formation is a known entity linked to complications in TE/ADM reconstructive course. A seroma classification system and treatment algorithm is offered to minimize abandonment of the reconstruction and optimize outcomes. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction mastectomy postoperative complication (diagnosis, therapy) seroma (diagnosis, etiology, therapy) tissue expander EMTREE MEDICAL INDEX TERMS adult aged article breast augmentation breast tumor (surgery) classification devices evaluation study female follow up human methodology middle aged retrospective study statistics treatment outcome wound drainage CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 23542848 (http://www.ncbi.nlm.nih.gov/pubmed/23542848) PUI L370092870 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 461 TITLE Acellular dermal matrix (ADM) assisted breast reconstruction procedures: Joint guidelines from the Association of Breast Surgery and the British Association of Plastic, Reconstructive and Aesthetic Surgeons AUTHOR NAMES Martin L. O'Donoghue J.M. Horgan K. Thrush S. Johnson R. Gandhi A. AUTHOR ADDRESSES (Martin L., lee.martin@aintree.nhs.uk) Aintree University Hospital, Longmoor Lane, Aintree, Liverpool L9 7AL, United Kingdom. (O'Donoghue J.M., Joe.O'Donoghue@nuth.nhs.uk) Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne NE1 4LP, United Kingdom. (Horgan K., kieran.horgan@leedsth.nhs.uk) General Infirmary at Leeds, Leeds LS13EX, United Kingdom. (Thrush S., steven_thrush@hotmail.com) Breast Worcestershire Royal Hospital, Charles Hastings Way, Worcester WR5 1DD, United Kingdom. (Johnson R., richard.johnson@uhsm.nhs.uk; Gandhi A., ashu.gandhi@uhsm.nhs.uk) University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, United Kingdom. (Gandhi A., ashu.gandhi@uhsm.nhs.uk) Manchester Academic Health Science Centre, University of Manchester, United Kingdom. CORRESPONDENCE ADDRESS L. Martin, Aintree University Hospital, Longmoor Lane, Aintree, Liverpool L9 7AL, United Kingdom. Email: lee.martin@aintree.nhs.uk SOURCE European Journal of Surgical Oncology (2013) 39:5 (425-429). Date of Publication: May 2013 ISSN 0748-7983 1532-2157 (electronic) BOOK PUBLISHER W.B. Saunders Ltd, 32 Jamestown Road, London, United Kingdom. ABSTRACT Tissue expansion with delayed insertion of a definitive prosthesis is the most common form of immediate breast reconstruction performed in the United Kingdom. However, achieving total muscle coverage of the implant and natural ptosis is a key technical challenge. The use of acellular dermal matrices (ADM) to supplement the pectoralis major muscle at the lower and lateral aspects of the breast has been widely adopted in the UK, potentially allowing for a single stage procedure. There is however little published data on the clinical and quality criteria for its use, and no long term follow-up. The guidelines have been jointly produced by the Association of Breast Surgery and the British Association of Plastic, Reconstructive and Aesthetic Surgeons and their aims are: to inform those wishing to undertake ADM assisted breast reconstruction and, to identify clinical standards and quality indicators for audit purposes. The guidelines are based on expert opinion of a multi-disciplinary working group, who are experienced in the technique, and a review of the published data. © 2012 Elsevier Ltd. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction EMTREE MEDICAL INDEX TERMS article breast surgery human medical society plastic surgeon practice guideline priority journal EMBASE CLASSIFICATIONS Surgery (9) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013251638 MEDLINE PMID 23321393 (http://www.ncbi.nlm.nih.gov/pubmed/23321393) PUI L52390966 DOI 10.1016/j.ejso.2012.12.012 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2012.12.012 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 462 TITLE Risk-reducing mastectomy for BRCA1, BRCA2 carriers and high-risk women in a university hospital AUTHOR NAMES Lambert K. Barwell J. Valassiadou K. AUTHOR ADDRESSES (Lambert K.; Barwell J.; Valassiadou K.) University Hospitals Leicester, Leicestershire, United Kingdom. CORRESPONDENCE ADDRESS K. Lambert, University Hospitals Leicester, Leicestershire, United Kingdom. SOURCE European Journal of Surgical Oncology (2013) 39:5 (487). Date of Publication: May 2013 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2013 CONFERENCE LOCATION Petersfield, Manchester, United Kingdom CONFERENCE DATE 2013-05-21 to 2013-05-22 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Risk-reducing breast surgery is well established in tertiary centres in the UK and breast reconstruction is as essential for the wellbeing of high-risk women as the risk-reduction surgery is to their life span. Methods: A total of 35 women had 64 risk-reducing mastectomies in a University Hospital between 2003 and 2012. The type of surgery and the complications are analysed. Results: 34/35 women had reconstruction, 13/35 previous (CA) and 22/35 no previous breast cancer (PRO), 16 were BRCA1 and 7 BRCA2 carriers. In a median follow up of 35 months (2-102) none of the PRO developed breast cancer. Total 64 mastectomies 60/64 implant-based, 2/64 flap-based and 2/64 without reconstruction, 26/60 with nipple preservation, 51/60 1-stage (29/60 1-stage implant, 22/60 1-stage expandable implant) and 9/60 2-stage implant, 18/60 with biomesh (Strattice or Surgimend), 4/60 implants were removed due to infection and 1/60 due to rupture. All cause revision surgery was performed in 18/35 patients, 8, 5, 4 and 1/18 had 1, 2, 3 and 4 revision operations respectively. The use of biomesh was related to reduced revision rate 16% (3/18 mastectomies biomesh) vs 36% (15/42 no biomesh) but not to the infection/necrosis rate (16% in both groups, 3/18 vs 7/42). 208 Conclusions: None of the 64 prophylactic mastectomies developed breast cancer in a median follow up of 35 months. The revision rates of prophylactic surgery are high and the increasing use of biomesh reduces the revision rate. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast surgery female human mastectomy risk university hospital EMTREE MEDICAL INDEX TERMS breast cancer breast reconstruction follow up implant infection lifespan nipple patient preservation risk reduction rupture surgery United Kingdom wellbeing LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71050571 DOI 10.1016/j.ejso.2013.01.127 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2013.01.127 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 463 TITLE Resistance of acellular dermal matrix materials to microbial penetration AUTHOR NAMES Fahrenbach E.N. Qi C. Ibrahim O. Kim J.Y. Alam M. AUTHOR ADDRESSES (Fahrenbach E.N.) Department of Medicine, Loyola-Stritch School of Medicine, Maywood, IL, United States. (Qi C.) Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States. (Ibrahim O.; Alam M., m-alam@northwestern.edu) Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N St Clair St, Ste 1600, Chicago, IL 60611, United States. (Kim J.Y.) Department of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States. (Alam M., m-alam@northwestern.edu) Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States. (Alam M., m-alam@northwestern.edu) Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States. CORRESPONDENCE ADDRESS M. Alam, Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N St Clair St, Ste 1600, Chicago, IL 60611, United States. Email: m-alam@northwestern.edu SOURCE JAMA Dermatology (2013) 149:5 (571-575). Date of Publication: May 2013 ISSN 2168-6068 BOOK PUBLISHER American Medical Association, 515 North State Street, Chicago, United States. ABSTRACT Importance: Acellular dermal matrices have many current and potential applications, but their long-term safety has not been extensively studied. In particular, limited information exists regarding such materials' resistance to infection. Objective: To assess the resistance to microbial penetration of common acellular dermal matrix materials used in reconstruction after skin cancer excision, treatment of chronic ulcers and burns, breast reconstruction, hernia repairs, and other applications. Design: Comparative in vitro study of 4 commercially available dermal substitutes for their ability to act as barriers to penetration by common skin pathogens. Setting: University-based dermatology and plastic surgery departments and a hospital microbiology laboratory. Materials: Four commercially available dermal substitutes, including AlloDerm (LifeCell), FlexHD (Musculoskeletal Transplant Foundation), Strattice (LifeCell), and NeoForm (Mentor Corporation). Intervention: We tested the 4 dermal matrix materials with the following 4 organisms commonly implicated in wound infections: Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus pyogenes, and Candida albicans. Each material was inoculated with the same concentration of each pathogen. Main Outcome Measure: The number of bacterial colonies grown on blood agar plates. Results: AlloDerm and rehydrated FlexHD were found to be the best barriers to penetration by P aeruginosa. AlloDerm, FlexHD, and Strattice also prevented penetration by S aureus and S pyogenes; NeoForm was less effective in withstanding these organisms. The results of this study were inconclusive with regard to C albicans penetration. Conclusions and Relevance: Three of the 4 commonly used acellular dermal matrix materials are resistant to in vitro penetration by S aureus and S pyogenes and partially resistant to P aeruginosa. Resistance to fungal pathogens is uncertain. Antimicrobial differences across matrix materials may influence their selection for particular uses, such as treatment of refractory leg ulcers or reconstruction after skin cancer excision. ©2013 American Medical Association. All rights reserved. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) acellular dermal matrix material biomaterial EMTREE DRUG INDEX TERMS unclassified drug EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) permeability barrier EMTREE MEDICAL INDEX TERMS article bacterium colony bacterium identification Candida albicans comparative study controlled study fungus identification human human tissue in vitro study material state materials testing nonhuman priority journal Pseudomonas aeruginosa skin conductance skin permeability Staphylococcus aureus Streptococcus pyogenes DEVICE TRADE NAMES AlloDerm Lifecell FlexHD Musculoskeletal Transplant Foundation NeoForm Mentor Strattice Lifecell DEVICE MANUFACTURERS Lifecell Mentor Musculoskeletal Transplant Foundation EMBASE CLASSIFICATIONS Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Dermatology and Venereology (13) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013315330 MEDLINE PMID 23426233 (http://www.ncbi.nlm.nih.gov/pubmed/23426233) PUI L368935155 DOI 10.1001/jamadermatol.2013.1741 FULL TEXT LINK http://dx.doi.org/10.1001/jamadermatol.2013.1741 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 464 TITLE Short-term complications of prosthetic breast reconstruction with and without acellular dermal matrix: A comparative study AUTHOR NAMES Chambers A. Potter S. Govindajulu S. Sahu A. Warr R. Cawthorn S. AUTHOR ADDRESSES (Chambers A.; Govindajulu S.; Sahu A.; Warr R.; Cawthorn S.) North Bristol NHS Trust, Bristol, United Kingdom. (Potter S.) University of Bristol, Bristol, United Kingdom. CORRESPONDENCE ADDRESS A. Chambers, North Bristol NHS Trust, Bristol, United Kingdom. SOURCE European Journal of Surgical Oncology (2013) 39:5 (467-468). Date of Publication: May 2013 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2013 CONFERENCE LOCATION Petersfield, Manchester, United Kingdom CONFERENCE DATE 2013-05-21 to 2013-05-22 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Acellular dermal matrix (ADM) may improve outcomes in prosthetic breast reconstruction (PBR), but recent evidence suggests that complication rates may be higher when ADM is used. We retrospectively compared short-term complications in ADM-assisted and standard expander- implant breast reconstruction (EIBR) to determine the safety of the procedure in our centre. Methods: A retrospective case-note review of consecutive women undergoing PBR from May-2011 to November-2012 was performed. Data were extracted using a standardised study pro-forma. The rates of totalcomplications, major-complications requiring re-operation and implant loss were compared between groups. Results: 49 PBR; 34 (69.4%) ADM-assisted and 15 (30.6%) standard- EIBRwere performed in 34 women formalignancy (n=33,67.3%) or prophylaxis (n=16, 32.7%) over the 18-month study period. ADMfacilitated singlestage direct-to-implant reconstruction in 28 (82.4%) cases and expander-based reconstruction in 6 (17.6%). Protexa was used in 31 (91.2%) reconstructions and Strattice in 3 (8.8%) There were no differences between patient age, comorbidities, smoking or chemotherapy between groups, but ADM-patients were more likely to have received radiotherapy (30.4%- ADM group-vs- 0%-standard) than those undergoing standard-EIBR.Therewere no significant differences in the rates of overall (ADM-assisted- 12/34,35.3%;standard-PBR- 5/15,33.3%, p=1.00) or major (ADM-assisted-4/34,11.8%;standard-PBR-3/ 15,20.0%) complications between the ADM-assisted and standard-EIBR groups. The rate of implant loss was 11.8% (n=4) in the ADM group and 6.7% (n=1) in the standard group (p=1.00). All implant losses in the ADMgroup were associated with the receipt of radiotherapy. Conclusions: ADM-assisted PBR is safe and may improve outcomes for women by facilitating single-stage reconstruction. Robust prospective evaluation with randomised clinical trials including patient-reported and cosmetic outcomes are now needed to definitively evaluate the role of ADM in PBR. EMTREE DRUG INDEX TERMS cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction breast surgery comparative study EMTREE MEDICAL INDEX TERMS chemotherapy clinical trial (topic) female human implant patient procedures prophylaxis radiotherapy safety smoking LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71050504 DOI 10.1016/j.ejso.2013.01.060 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2013.01.060 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 465 TITLE Unilateral preoperative chest wall irradiation in bilateral tissue expander breast reconstruction with acellular dermal matrix: a prospective outcomes analysis. AUTHOR NAMES Weichman K.E. Cemal Y. Albornoz C.R. McCarthy C.M. Pusic A.L. Mehrara B.J. Disa J.J. AUTHOR ADDRESSES (Weichman K.E.) Department of Plastic Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA. (Cemal Y.; Albornoz C.R.; McCarthy C.M.; Pusic A.L.; Mehrara B.J.; Disa J.J.) CORRESPONDENCE ADDRESS K.E. Weichman, Department of Plastic Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA. SOURCE Plastic and reconstructive surgery (2013) 131:5 (921-927). Date of Publication: May 2013 ISSN 1529-4242 (electronic) ABSTRACT Prior breast irradiation increases the rate of postoperative complications, including capsular contracture, in tissue expander/implant reconstruction. Acellular dermal matrix is heralded to decrease capsular contracture, but recent evidence suggests a possible increase in postoperative complications. The authors evaluated outcomes in patients undergoing bilateral tissue expander/implant reconstruction with acellular dermal matrix in the setting of prior unilateral irradiation. A case-control study was conducted on all patients undergoing bilateral, acellular dermal matrix-assisted, tissue expander/implant reconstruction with a history of previous unilateral irradiation at Memorial Sloan-Kettering Cancer Center. Complication rates were compared. Twenty-three patients met inclusion criteria and had an average follow-up of 19 months (range, 4 to 60 months). The perioperative infection rate was 21.7 percent (n = 5) in irradiated breasts and 4.3 percent (n = 1) in control breasts (p = 0.079). Mastectomy skin flap necrosis, explantation, hematoma, and seroma rates were not significantly different between the groups. Sixty percent of patients had irradiated breast contracture that was one Baker grade greater than that in the nonirradiated breast. Body mass index greater than 25 and smoking history were significant independent risk factors for early postoperative complications in univariate analysis (p = 0.01). Previous irradiation does not appear to increase the risk of early postoperative complications associated with acellular dermal matrix use in tissue expander/implant breast reconstruction. However, body mass index greater than 25 and smoking history are cause for caution. In addition, acellular dermal matrix does not appear to affect the degree of capsular contracture formation in the setting of prior irradiation. : Therapeutic, III. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast tumor (epidemiology, radiotherapy, surgery) partial mastectomy tissue expander EMTREE MEDICAL INDEX TERMS adult aged article body mass case control study female follow up human middle aged pathology postoperative complication (epidemiology, prevention) prospective study radiation injury (epidemiology) retrospective study risk factor smoking (epidemiology) surgical flaps treatment outcome LANGUAGE OF ARTICLE English MEDLINE PMID 23385983 (http://www.ncbi.nlm.nih.gov/pubmed/23385983) PUI L369317328 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 466 TITLE A comparison of acellular dermal matrix to autologous dermal flaps in single-stage, implant-based immediate breast reconstruction: a cost-effectiveness analysis. AUTHOR NAMES Krishnan N.M. Chatterjee A. Van Vliet M.M. Powell S.G. Rosen J.M. Nigriny J.F. AUTHOR ADDRESSES (Krishnan N.M.) Geisel School of Medicine at Dartmouth 1 Rope Ferry Road, Hanover, N.H. 03755, USA. (Chatterjee A.; Van Vliet M.M.; Powell S.G.; Rosen J.M.; Nigriny J.F.) CORRESPONDENCE ADDRESS N.M. Krishnan, Geisel School of Medicine at Dartmouth 1 Rope Ferry Road, Hanover, N.H. 03755, USA. Email: naveen.m.krishnan@dartmouth.edu SOURCE Plastic and reconstructive surgery (2013) 131:5 (953-961). Date of Publication: May 2013 ISSN 1529-4242 (electronic) ABSTRACT The use of acellular dermal matrix has allowed for single-stage immediate breast reconstruction after mastectomy at a significantly decreased cost compared with two-stage expander/implant reconstruction. The use of a pedicled autologous dermal flap in the same fashion as acellular dermal matrix in women with larger, ptotic breasts has also allowed for single-stage immediate breast reconstruction with similarly low complication rates and without the added procedural cost of using acellular dermal matrix. There have been no prior studies evaluating whether the added procedural cost for acellular dermal matrix is cost-effective relative to using an autologous dermal flap in single-stage immediate breast reconstruction following mastectomy. A comprehensive literature review was conducted to identify published complication rates for single-stage, implant-based immediate breast reconstruction using either acellular dermal matrix or an autologous dermal flap. The probabilities of the most common complications were combined with Medicare Current Procedural Terminology reimbursement codes and expert utility estimates to fit into a decision model to evaluate the cost-effectiveness of acellular dermal matrix. : The decision model revealed a baseline cost difference of $261.72 and a 0.001 increase in the quality-adjusted life years when using acellular dermal matrix, yielding an incremental cost-utility ratio of $261,720 per quality-adjusted life year. Sensitivity analysis showed that acellular dermal matrix was not cost-effective when the complication rate for autologous dermal flaps was below 20 percent. The authors' study demonstrates that acellular dermal matrix is not a cost-effective technology in patients who can have an autologous dermal flap in single-stage immediate breast reconstruction. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant breast reconstruction surgical flaps EMTREE MEDICAL INDEX TERMS comparative study cost benefit analysis economics female human meta analysis methodology postoperative complication (prevention) quality adjusted life year review LANGUAGE OF ARTICLE English MEDLINE PMID 23629077 (http://www.ncbi.nlm.nih.gov/pubmed/23629077) PUI L369317338 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 467 TITLE Current trend in breast reconstruction using acellular demal matrix and pedicle flap: Outcomes of district general hospital and national survey AUTHOR NAMES Debnath D. Cook L. Burger A. Karat I. Laidlaw I. Raouf D. AUTHOR ADDRESSES (Debnath D.; Cook L.; Burger A.; Karat I.; Laidlaw I.; Raouf D.) Frimley Park Hospital, Frimley, United Kingdom. CORRESPONDENCE ADDRESS D. Debnath, Frimley Park Hospital, Frimley, United Kingdom. SOURCE European Journal of Surgical Oncology (2013) 39:5 (468-469). Date of Publication: May 2013 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2013 CONFERENCE LOCATION Petersfield, Manchester, United Kingdom CONFERENCE DATE 2013-05-21 to 2013-05-22 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Breast reconstruction using acellular dermal matrix (ADM) is an emerging technique. We aimed to assess whether such a practice is affecting the occurrence of traditional pedicle-flap based reconstruction in UK. Methods: All breast reconstructions that took place between October 2009 and May 2012 in a district general hospital (DGH) were analysed. Data were obtained from Picis± theatre database. An email-based survey of members of Association of Breast Surgery was also undertaken. Results: A total of 58 cases took place in the DGH (flap=24, ADM=34). ADM-based reconstruction, compared to flap-based reconstruction, entailed younger patients (45.7±10.1 vs. 50.7±8.3 years, p=0.05), shorter stay (4.2±2.2 vs. 6.1±2.2 days, p=0.002) and shorter operative time (215.2±58.3 vs. 282.3±45.1 minutes, p=0.0001). This period noticed a significant rise of ADM-based reconstruction (R2=0.94), compared to flap-based reconstruction (R2=0.25): 36 (out of 406) members of ABS responded to the survey. The national survey confirmed the trend of increased occurrence of ADM-based reconstruction by 177.8% [from 95 (2010) to 169 (2011)] and a decrease of incidence of flap-based reconstruction by 84.3% [from 249 (2010) to 210 (2011)] over last two years. Conclusions: DGH experience showed that shorter procedural time and stay were associated with ADM-based breast reconstructions. The latter had been rising steeply over recent times, with reciprocal fall of flapbased reconstruction, as shown by both local and national experience. These have implications on use of resources, future training, and patientexpectations. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction breast surgery general hospital pedicled skin flap EMTREE MEDICAL INDEX TERMS acellular dermal matrix data base e-mail human operation duration patient United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71050507 DOI 10.1016/j.ejso.2013.01.063 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2013.01.063 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 468 TITLE Learning curve in immediate breast reconstruction with Strattice acellular dermal matrix AUTHOR NAMES Shetty G. Salisbury R. Gandhi A. Zeiton A. Johnson R. Barr L. AUTHOR ADDRESSES (Salisbury R.; Gandhi A.; Zeiton A.; Johnson R.; Barr L.) University Hospital South Manchester, Manchester, United Kingdom. (Shetty G.) Russells Hall Hospital, Dudley, United Kingdom. CORRESPONDENCE ADDRESS G. Shetty, Russells Hall Hospital, Dudley, United Kingdom. SOURCE European Journal of Surgical Oncology (2013) 39:5 (464). Date of Publication: May 2013 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2013 CONFERENCE LOCATION Petersfield, Manchester, United Kingdom CONFERENCE DATE 2013-05-21 to 2013-05-22 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: In the last few years, the use of acellular dermal matrices (ADM) in breast reconstruction has increased enormously. Strattice is an ADM derived from porcine skin. It allows implant-based immediate breast reconstruction to be performed as a one-stage technique. The initial results are encouraging. With the introduction of any new technique, there is an associated learning curve involved. Our aim was to assess the surgeon's learning curve using Strattice for immediate breast reconstruction. Methods: A consecutive series of 67 patients who had bilateral and unilateral immediate breast reconstruction with Strattice between February 2009 and November 2011, were included in the study. Data on demographics, comorbidities, smoking history, and complications were collected. Operation times were collected from the operating room management system. The patients undergoing bilateral and unilateral reconstruction were analysed separately. The trends over time were assessed. Results: Forty patients had unilateral and 27 had bilateral reconstruction. The average age was 46.8 years. The average time for unilateral reconstruction 2.043hrs (ranging from 1.24hr-3.34hrs) and for bilateral operations was 3.186hrs (ranging from 2.08hrs-4.30hrs). Learning curve: The 67 patients were labelled chronologically regardless of the type of operation. Therewas a correlation between the surgical order (i.e. performed later in the series) and shorter operation times in both groups (Correlation Coefficient for unilateral e0.468 and bilateral -0.347). For unilateral patients, this correlation was statistically significant (P-value=0.002). No significant correlation was noted in either major or minor complication rates with the surgical order. Five (5.3%) implants were lost out of 94 procedures. Two of whom had received radiotherapy. Conclusion: Strattice ADM has been added to the list of options available for immediate breast reconstruction in recent years. There is always a learning curve with the introduction of any new technique. Our study has demonstrated a significantly shorter operative time following a learning curve but no difference in the complication rate. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction breast surgery learning curve EMTREE MEDICAL INDEX TERMS correlation coefficient human implant operating room operation duration patient procedures radiotherapy skin smoking statistical significance surgeon LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71050492 DOI 10.1016/j.ejso.2013.01.048 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2013.01.048 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 469 TITLE Use of acellular dermal based matrix (Strattice™) in breast reconstruction: Our experiences and lessons learnt AUTHOR NAMES Robinson A. Critchley A. Fasih T. Pervaz M. AUTHOR ADDRESSES (Robinson A.; Critchley A.; Fasih T.; Pervaz M.) Queen Elizabeth Hospital Gateshead, Tyne and Wear, United Kingdom. CORRESPONDENCE ADDRESS A. Robinson, Queen Elizabeth Hospital Gateshead, Tyne and Wear, United Kingdom. SOURCE European Journal of Surgical Oncology (2013) 39:5 (486). Date of Publication: May 2013 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2013 CONFERENCE LOCATION Petersfield, Manchester, United Kingdom CONFERENCE DATE 2013-05-21 to 2013-05-22 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: The use of Strattice™ (LifeCell Corp., Branchburg, NJ) assisted implant-based breast reconstruction is now an established technique in immediate and delayed breast reconstruction. The porcine derived acellular dermal matrix is used to reinforce the lower pole, provide implant coverage and provide reliable control of implant position. In our centre we have been using this technique since 2010. This retrospective study provides an insight into our experiences and lessons learnt. Methods: Retrospective data collection including all patients who underwent strattice based reconstruction from July 2010 to December 2012 in a district general hospital. This included patient demographics, operative technique and parameters, and any complications. All procedures were undertaken or directly supervised by two consultant breast surgeons. Results: A total of 33 reconstructions were undertaken in 29 patients. Median patient age was 52 (range 37-78). Average operating time was 2 hours. Either a 16x8cm or 16x10cm strattice was used depending on the cup size. 8X16 for A/B cup and 10X16 for bigger cup. 3 were prophylactic procedures. 16 were immediate reconstructions. One patient developed wound dehiscence with degeneration of the strattice and exposure of implant. This patient subsequently underwent a further strattice based reconstruction and has had no further complications. 8 patients had red breasts treated with a course of antibiotics. Conclusions: In our experience, Strattice™ (LifeCell Corp., Branchburg, NJ) based reconstruction of the breast is a safe and effective option in either the immediate or delayed setting. Caution is needed in smokers and any patient undergoing adjuvant radiotherapy. EMTREE DRUG INDEX TERMS antibiotic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction breast surgery EMTREE MEDICAL INDEX TERMS acellular dermal matrix adjuvant therapy breast consultation degeneration exposure general hospital human implant information processing operation duration parameters patient procedures retrospective study smoking surgeon surgical technique wound dehiscence LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71050568 DOI 10.1016/j.ejso.2013.01.124 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2013.01.124 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 470 TITLE Initial experience of the use of a titanium-coated polypropylene mesh (TiLOOP Bra) for immediate implant-based breast reconstruction AUTHOR NAMES Waheed S. Barry P. AUTHOR ADDRESSES (Waheed S.; Barry P.) Royal Marsden Hospital NHS Trust, London, United Kingdom. CORRESPONDENCE ADDRESS S. Waheed, Royal Marsden Hospital NHS Trust, London, United Kingdom. SOURCE European Journal of Surgical Oncology (2013) 39:5 (505). Date of Publication: May 2013 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2013 CONFERENCE LOCATION Petersfield, Manchester, United Kingdom CONFERENCE DATE 2013-05-21 to 2013-05-22 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: We report initial experience using an ultra-light (16g/m(2)), bio-compatible Titanium-coated polypropylene mesh (TiLOOP Bra) in immediate single-stage fixed-volume implant-only breast reconstruction. These meshes are used in a similar way to Acellular Dermal Matrices (ADM). Methods: This was a prospective audit of women with primary breast cancer who underwent immediate single-stage fixed-volume implant- based breast reconstruction using TiLOOP Bra. Patients were selected on good skin envelope quality. The mesh was sutured from the lower border of the pectoralis major muscle to the infra-mammary fold similar to an ADM. Data on demographics (age, ASA grade, BMI, Diabetes, smoking status, previous radiotherapy) and early post-operative outcomes (infection, seroma, hospital stay and early aesthetic appearance) were collected. Results: Four patients have undergone this procedure (age range 48-65 years). ASA Grade was 2 in all cases. None of the patients had had previous radiotherapy or were diabetic. There was 1 ex and 1 current smoker. Mean BMI was 24.3kg/m(2). All patients had one stage fixed volume implants inserted. Drains were used in all cases and removed on day 5 (median). Two patients developed post-operative seroma, one required ultrasound-guided aspiration. One patient was readmitted for intravenous antibiotics for cellulitis. There are no cases of malposition or implant loss to date. Median follow up is 3 months. One patient requires adjuvant radiotherapy. Conclusions: TiLOOP Bra in selected cases is safe and achieves good early cosmetic results. This is the largest UK series to date. Longer term follow up is required. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) polypropylene titanium EMTREE DRUG INDEX TERMS antibiotic agent cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction breast surgery implant EMTREE MEDICAL INDEX TERMS acellular dermal matrix adjuvant therapy aspiration breast cancer cellulitis clinical audit diabetes mellitus female follow up hospitalization human infection patient pectoralis major muscle procedures radiotherapy seroma skin smoking ultrasound United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71050638 DOI 10.1016/j.ejso.2013.01.195 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2013.01.195 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 471 TITLE Cost minimisation analysis of using acellular dermal matrix (Strattice™) for breast reconstruction compared with standard techniques AUTHOR NAMES Johnson R. Wright C. Barr L. Gandhi A. AUTHOR ADDRESSES (Johnson R.; Wright C.; Barr L.; Gandhi A.) University Hospital South Manchester, Manchester, United Kingdom. CORRESPONDENCE ADDRESS R. Johnson, University Hospital South Manchester, Manchester, United Kingdom. SOURCE European Journal of Surgical Oncology (2013) 39:5 (490). Date of Publication: May 2013 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2013 CONFERENCE LOCATION Petersfield, Manchester, United Kingdom CONFERENCE DATE 2013-05-21 to 2013-05-22 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Background: We performed a cost analysis (using UK 2011/12 NHS tariffs as a proxy for cost) comparing immediate breast reconstruction using the new one-stage technique of acellular dermal matrix (Strattice™) with implant versus the standard alternative techniques of tissue expander (TE)/implant as a two-stage procedure and latissimus dorsi (LD) flap reconstruction. Methods: Clinical report data were collected for operative time, length of stay, outpatient procedures, and number of elective and emergency admissions in our first consecutive 24 patients undergoing one-stage Strattice reconstruction. Total cost to the NHS based on tariff, assuming top-up payments to cover Strattice acquisition costs, was assessed and compared to the two historical control groups matched on key variables. Results: Eleven patients having unilateral Strattice reconstruction were compared to 10 having TE/implant reconstruction and 10 having LD flap and implant reconstruction. Thirteen patients having bilateral Strattice reconstruction were compared to 12 having bilateral TE/implant reconstruction. Total costs were: unilateral Strattice, £3685; unilateral TE, £4985; unilateral LD and implant, £6321; bilateral TE, £5478; and bilateral Strattice, £6771. Conclusions: The cost analysis shows a financial advantage of using acellular dermal matrix (Strattice) in unilateral breast reconstruction versus alternative procedures. The reimbursement system in England (Payment by Results, PbR) is based on disease-related groups (DRG) similar to that of many countries across Europe and tariffs are based on reported hospital costs, making this analysis of relevance in other countries. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction breast surgery EMTREE MEDICAL INDEX TERMS control group cost benefit analysis custodial care emergency Europe hospital cost human implant latissimus dorsi flap length of stay operation duration outpatient patient procedures reimbursement tissue expander United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71050582 DOI 10.1016/j.ejso.2013.01.138 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2013.01.138 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 472 TITLE Porcine acellular dermal matrix (strattice) in primary and revision cosmetic breast surgery. AUTHOR NAMES Spear S.L. Sinkin J.C. Al-Attar A. AUTHOR ADDRESSES (Spear S.L.) Department of Plastic Surgery, Georgetown University Hospital, Washington, DC20007 , USA. (Sinkin J.C.; Al-Attar A.) CORRESPONDENCE ADDRESS S.L. Spear, Department of Plastic Surgery, Georgetown University Hospital, Washington, DC20007 , USA. Email: spears@gunet.georgetown.edu SOURCE Plastic and reconstructive surgery (2013) 131:5 (1140-1148). Date of Publication: May 2013 ISSN 1529-4242 (electronic) ABSTRACT Although acellular dermal matrix materials have been in use for over a decade in primary and secondary breast reconstruction and in some cosmetic breast surgery, little has been published on the outcomes of these materials for cosmetic applications. A retrospective institutional review board-approved review was conducted of all patients who had a specific acellular dermal matrix, Strattice, used for cosmetic breast surgery performed by the senior author (S.L.S.). Patient demographics, indications, surgical findings, and postoperative course were collected and data analyzed using descriptive statistical tools. Between 2008 and 2012, Strattice was used in 43 cosmetic breast operations (75 breasts) performed by the senior author (S.L.S.). Sixty-nine of the 75 breasts (92 percent) were revision operations. Indications included inferior pole support [39 breasts (52 percent)], fold malpositions [28 breasts (37 percent)], capsular contracture [25 breasts (33 percent)], and rippling/palpability [six breasts (8 percent)]. Three patients (six breasts) had Strattice placed during primary augmentation/mastopexy. Seventy-four of the 75 breasts (98.7 percent) had successfully achieved the indication for which the Strattice was placed; one breast (1.2 percent) had some degree of relapse. The global complication rate for all patients in this study is 5.3 percent-two breasts (2.7 percent) had postoperative malposition, one breast (1.2 percent) had bottoming out, and one breast (1.2 percent) developed an infection that resulted in temporary device explantation. The use of Strattice is safe and may be helpful in the management of certain situations in cosmetic breast surgery, including needed lower pole support, capsular contracture, rippling, and implant malposition. Therapeutic, IV. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast implant breast reconstruction plastic surgery reoperation EMTREE MEDICAL INDEX TERMS adult aged animal article breast (surgery) contracture (surgery) female human methodology pig postoperative complication (prevention, surgery) retrospective study CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 23629094 (http://www.ncbi.nlm.nih.gov/pubmed/23629094) PUI L369317355 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 473 TITLE Complications in immediate breast reconstruction using Strattice™ AUTHOR NAMES Evgeniou E. Cain H. Amonkar S. Hennessy C. Bhaskar P. AUTHOR ADDRESSES (Evgeniou E., evgenios@doctors.org.uk) Department of Plastic Surgery, Heatherwood and Wexham Park NHS Foundation Trust, Wexham Road, SL24HL Berks, United Kingdom. (Cain H.; Amonkar S.; Hennessy C.; Bhaskar P.) Department of Breast Surgery, North Tees and Hartlepool University NHS Trust, Holdforth Road, Hartlepool, Cleveland, TS24 9AH, United Kingdom. CORRESPONDENCE ADDRESS E. Evgeniou, Department of Plastic Surgery, Heatherwood and Wexham Park NHS Foundation Trust, Wexham Road, SL24HL Berks, United Kingdom. Email: evgenios@doctors.org.uk SOURCE European Journal of Plastic Surgery (2013) 36:5 (301-306). Date of Publication: May 2013 ISSN 0930-343X 1435-0130 (electronic) BOOK PUBLISHER Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany. ABSTRACT Introduction: Immediate breast reconstruction (IBR) is becoming increasingly popular. Implant-based IBR has a lot of benefits over autologous IBR but also carries the disadvantages associated with implant use. Acellular dermal matrix, such as Strattice™, has been used as an alternative approach to provide implant coverage. Methods: All cases of implant-based IBR using Strattice™ performed between 2009 and 2011 at the North Tees and Hartlepool Breast Unit were reviewed to assess the outcomes, complications and impact on adjuvant therapy with the use of Strattice™ in IBR. Results: Twenty-one implant-based IBR utilising Strattice™ in 17 patients were reviewed, four were bilateral procedures. Ten patients had complications, nine of whom required a clinical intervention for these complications. Four patients had a foreign body reaction associated with a seroma. Five patients had a wound breakdown with eventual loss of the implant and one patient had an early contracture following radiotherapy. Four patients requiring adjuvant radiotherapy had a delay in starting treatment. Three out of six patients requiring adjuvant chemotherapy had a delay in commencing treatment, and three patients experienced delays between cycles resulting from complications. Conclusions: Strattice™ may offer an alternative solution to problems in implant-based reconstruction but there are concerns regarding the development of complications associated with this. Complications may delay adjuvant therapy. Further studies should investigate the impact on adjuvant therapy, when using Strattice™ in IBR. Level of evidence: Level IV, therapeutic study. © 2012 Springer-Verlag Berlin Heidelberg. EMTREE DRUG INDEX TERMS antineoplastic agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction EMTREE MEDICAL INDEX TERMS adjuvant chemotherapy adult aged article breast cancer (drug therapy, radiotherapy) breast implant cancer radiotherapy clinical article female foreign body reaction human priority journal seroma DEVICE TRADE NAMES Strattice , United StatesLifecell DEVICE MANUFACTURERS (United States)Lifecell EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013314887 PUI L52295063 DOI 10.1007/s00238-012-0779-y FULL TEXT LINK http://dx.doi.org/10.1007/s00238-012-0779-y COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 474 TITLE The use of Strattice™ in immediate implant based breast reconstruction in higher risk patients AUTHOR NAMES Appleton D. Richardson C. Rowlands D. Matey P. AUTHOR ADDRESSES (Appleton D.; Richardson C.; Rowlands D.; Matey P.) Royal Wolverhampton Hospital, Wolverhampton, United Kingdom. CORRESPONDENCE ADDRESS D. Appleton, Royal Wolverhampton Hospital, Wolverhampton, United Kingdom. SOURCE European Journal of Surgical Oncology (2013) 39:5 (501). Date of Publication: May 2013 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2013 CONFERENCE LOCATION Petersfield, Manchester, United Kingdom CONFERENCE DATE 2013-05-21 to 2013-05-22 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: There has been an increasing use of acellular dermal matrices in immediate implant based breast reconstruction (IBR) due to advantages which include natural ptosis, total implant coverage, and increased initial fill volume offering the possibility of a single stage procedure. Complications such as infection leading to unplanned revisions or implant loss, has led some units to exclude smokers and diabetics. We present our experience using Strattice™ in 22 patients. Methods: Data on 22 women undergoing Strattice™ assisted IBR between March 2010 and July 2012 was collected from a prospectively maintained database, which included demographics, co-morbidities, operative details, complications, histology and adjuvant treatments. Results: Four patients were smokers, 5 were obese, 3 had had recent breast surgery, and one was diabetic. One patient had neoadjuvant chemotherapy, 7 women had adjuvant chemotherapy and 5 had adjuvant radiotherapy. Four patients (18.2%) experienced significant complications including two patients with implant loss (9.1%), one due to infection and another due to skin flap necrosis. One of these patients had had recent breast surgery and was obese; the second patient had no risk factors. There have been no recurrences identified to date. Histopathology of Strattice™ biopsy taken at second operations showed full integration of the host tissues, including patients with diabetes and smokers, and in the two patients with implant loss. Conclusion: This data suggests that Strattice™ may be used in IBR in higher risk patients with acceptable surgical and cosmetic results. We would, however, not utilise it post radiotherapy. EMTREE DRUG INDEX TERMS cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction breast surgery high risk patient human implant EMTREE MEDICAL INDEX TERMS acellular dermal matrix adjuvant chemotherapy adjuvant therapy biopsy data base diabetes mellitus female graft necrosis histology histopathology infection morbidity patient procedures ptosis radiotherapy risk factor smoking tissues LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71050621 DOI 10.1016/j.ejso.2013.01.177 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2013.01.177 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 475 TITLE Acelluar dermal matrices in immediate implant based breast reconstruction: Our experience of complication rates using strattice and biodesign AUTHOR NAMES Caine P. Thomas H. Bright-Thomas R. Mullan M. Thrush S. AUTHOR ADDRESSES (Caine P.) University of Birmingham Medical School, Birmingham, United Kingdom. (Thomas H.; Bright-Thomas R.; Mullan M.; Thrush S.) Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom. CORRESPONDENCE ADDRESS P. Caine, University of Birmingham Medical School, Birmingham, United Kingdom. SOURCE European Journal of Surgical Oncology (2013) 39:5 (462). Date of Publication: May 2013 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2013 CONFERENCE LOCATION Petersfield, Manchester, United Kingdom CONFERENCE DATE 2013-05-21 to 2013-05-22 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: The introduction of biologic materials in implant based breast reconstruction has been postulated to have numerous health and economic benefits. There are concerns about the technique including potentially higher rates of implant explantation, seromas and skin loss. There is some evidence that the risks may be decreased with greater experience and with specific biologic materials. In our institution we have used two products - Strattice and Biodesign. Our aim was to look at our experience as an indicator to see if there is any difference between products. Methods: A retrospective case analysis of patients who underwent ADM assisted immediate implant based reconstruction between August 2009 and October 2012 was undertaken. Information regarding patient demographics, including risk factors, and complications were obtained. The operations were performed by surgeons with proven low explantation rates (<5%) using other implant based reconstruction techniques. Results: 15 implant based reconstructions were carried out using Strattice. Of these, 5 patients developed complications with 4 requiring implant removals. 15 implant based reconstruction procedures using Biodesign. Of these, 5 patients developed complications with 3 requiring removal of implants. Conclusions: Even with such small numbers our results suggest comparable complication and explantation rates for the two biologic materials, and the same complications are seen by all surgeons. The high explantation rate is of concern. The study highlights the need for good prospective data of this new technique. EMTREE DRUG INDEX TERMS biomaterial EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction breast surgery implant EMTREE MEDICAL INDEX TERMS explant health human patient procedures risk risk factor skin defect surgeon LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71050484 DOI 10.1016/j.ejso.2013.01.040 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2013.01.040 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 476 TITLE Histologic analysis of fetal bovine derived acellular dermal matrix in tissue expander breast reconstruction AUTHOR NAMES Gaster R.S. Berger A.J. Monica S.D. Sweeney R.T. Endress R. Lee G.K. AUTHOR ADDRESSES (Gaster R.S.; Berger A.J.; Monica S.D.; Sweeney R.T.; Endress R.; Lee G.K.) From the *Division of Plastic and Reconstructive Surgery, Department of General Surgery, and †Department of Pathology, Stanford University Medical Center, Stanford, CA SOURCE Annals of plastic surgery (2013) 70:4 (447-453). Date of Publication: 1 Apr 2013 ISSN 1536-3708 (electronic) ABSTRACT BACKGROUND: This study seeks to determine human host response to fetal bovine acellular dermal matrix (ADM) in staged implant-based breast reconstruction.METHODS: A prospective study was performed for patients undergoing immediate breast reconstruction with tissue expander placement and SurgiMend acellular fetal bovine dermis. At the time of exchange for permanent implant, we obtained tissue specimens of SurgiMend and native capsule. Histological and immunohistochemical assays were performed to characterize the extent of ADM incorporation/degradation, host cell infiltration, neovascularization, inflammation, and host replacement of acellular fetal bovine collagen.RESULTS: Seventeen capsules from 12 patients were included in our study. The average "implantation" time of SurgiMend was 7.8 months (range, 2-23 months). Histological analysis of the biopsy of tissue revealed rare infiltration of host inflammatory cells, even at 23 months. One patient had an infection requiring removal of the tissue expander at 2 months. Contracture, inflammatory changes, edema, and polymorphonuclear leukocyte infiltration were rare in the ADM. An acellular capsule was seen in many cases, at the interface of SurgiMend with the tissue expander.CONCLUSIONS: SurgiMend demonstrated a very infrequent inflammatory response. An antibody specific to bovine collagen allowed for direct identification of bovine collagen separate from human collagen. Cellular infiltration and neovascularization of SurgiMend correlated with the quality of the mastectomy skin flap rather than the duration of implantation. Future studies are needed to further characterize the molecular mechanisms underlying tissue incorporation of this product. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation breast implant tissue expander EMTREE MEDICAL INDEX TERMS adult animal bovine female fetus human middle aged procedures prospective study LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 23486129 (http://www.ncbi.nlm.nih.gov/pubmed/23486129) PUI L613024907 DOI 10.1097/SAP.0b013e31827e55af FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0b013e31827e55af COPYRIGHT Copyright 2016 Medline is the source for the citation and abstract of this record. RECORD 477 TITLE Implications of tissue expander salvage during implant-based breast reconstruction AUTHOR NAMES Adkinson J. Miller N. Eid S. Miles M. Murphy Jr. R. AUTHOR ADDRESSES (Adkinson J.; Miller N.; Eid S.; Miles M.; Murphy Jr. R.) Lehigh Valley Health Network, Allentown, United States. (Miller N.) Drexel University, College of Medicine, Philadelphia, United States. CORRESPONDENCE ADDRESS J. Adkinson, Lehigh Valley Health Network, Allentown, United States. SOURCE Annals of Surgical Oncology (2013) 20:2 SUPPL. 1 (12-13). Date of Publication: April 2013 CONFERENCE NAME 14th Annual Meeting of the American Society of Breast Surgeons CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2013-05-01 to 2013-05-05 ISSN 1068-9265 BOOK PUBLISHER Springer New York ABSTRACT Objectives : Tissue expander-based breast reconstruction continues to be the most commonly used reconstructive modality for women after mastectomy. No existing data correlate expander-related complications with permanent prosthesis outcomes. We sought to determine if patients with a previously salvaged tissue expander are at increased risk for permanent implant complications. Drexel University College of Medicine, Philadelphia, PA, USA Method: A review was performed from 2007-2011 assessing for age, cancer, tobacco use, body mass index, comorbidities, acellular dermal matrix, chemotherapy, radiation, timing of reconstruction, tissue expander fill, expander/permanent implant exposure/rupture, infection, seroma/hematoma, type of permanent implant, capsular contracture, and requirement for debridement, explantation, or flap salvage of expander/implant were assessed. A logistic regression was performed using SPSS 15.0 (SPSS Inc, Chicago, IL). Results : The database identified 196 patients undergoing mastectomy with 304 tissue expander-based breast reconstructions. One hundred seventy-five patients underwent immediate reconstruction, while 21 patients were delayed. One hundred sixty-six patients underwent second-stage exchange to a permanent implant (17 awaiting implant exchange, and 13 explanted prior to implant exchange). Twenty-six percent of patients (51/196) had an expander complication. Of those undergoing exchange to permanent implant, 21.7% (36/166) had a complication and 9.0% (15/166) had both expander and permanent implant complications. Excluding those awaiting secondstage reconstruction, 89.8% (158/176) successfully completed tissue-expander reconstruction. Only HTN, tobacco use, and radiation therapy were statistically significant variables associated with an increased likelihood of complications (Table 1). Patients with a salvaged tissue expander complication are 3 (OR = 3.183, 95%CI [1.408,7.198]) (p = 0.004) times more likely to have a complication after placement of a permanent implant (Table 2) and 9 times more likely to fail permanent implant reconstruction (explantation +/- flap salvage) (OR = 9.034, 95%CI [1.579,51.699]) (p = 0.003) (Table 3). (Table presented) Conclusions : Despite complications, almost 90% of women successfully complete tissue expander-based breast reconstruction. Women with complications during the expansion phase of breast reconstruction are at a statistically significantly increased risk after placement of a permanent implant. This patient subset should be closely followed after placement of implant to monitor for complications as they have a much higher likelihood of failing implantbased breast reconstruction. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast breast reconstruction human implant society surgeon tissue expander EMTREE MEDICAL INDEX TERMS acellular dermal matrix body mass chemotherapy college data base debridement explant female graft salvage implant capsular contracture infection logistic regression analysis mastectomy neoplasm patient prosthesis radiation radiotherapy risk tobacco use United States university LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71336378 DOI 10.1245/s10434-013-2964-z FULL TEXT LINK http://dx.doi.org/10.1245/s10434-013-2964-z COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 478 TITLE Breast Reconstruction AUTHOR NAMES DellaCroce F.J. Wolfe E.T. AUTHOR ADDRESSES (DellaCroce F.J., drd@breastcenter.com) Department of Plastic Surgery, Center for Restorative Breast Surgery, 1717 Saint Charles Avenue, New Orleans, LA 70130, United States. (Wolfe E.T.) Department of Surgery, Ochsner Health Care System, 1514 Jefferson Highway, Jefferson, LA 70121, United States. CORRESPONDENCE ADDRESS F.J. DellaCroce, Department of Plastic Surgery, Center for Restorative Breast Surgery, 1717 Saint Charles Avenue, New Orleans, LA 70130, United States. Email: drd@breastcenter.com SOURCE Surgical Clinics of North America (2013) 93:2 (445-454). Date of Publication: April 2013 ISSN 0039-6109 1558-3171 (electronic) BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT As diagnostic technology has progressed and the understanding of the disease process has evolved, the number of mastectomies performed in the United States has increased. Breast reconstructive techniques have commensurately become more sophisticated along the same timeline. The result is that those facing mastectomy have the potential to simultaneously retain physical beauty and wholeness. Only 33% of women who are otherwise candidates for immediate reconstruction at the time of mastectomy choose reconstruction. Patients generally have a high level of satisfaction with the option they choose, contributing to a feeling of overall recovery and physical and emotional wholeness. © 2013 Elsevier Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) breast reconstruction EMTREE MEDICAL INDEX TERMS abdominal hysterectomy abdominal injury acellular dermal matrix adjuvant therapy appendectomy aspiration bone graft breast areola breast augmentation breast tissue expander cesarean section cholecystectomy deep inferior epigastric perforator flap graft failure (complication) graft necrosis human mastectomy morbidity myocutaneous flap nipple obesity pectoralis major muscle priority journal radiotherapy rectus abdominis muscle review silicone breast implant skin flap superficial inferior epigastric artery flap tattooing vein anastomosis wound complication (complication) wound healing (complication) EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013191144 MEDLINE PMID 23464695 (http://www.ncbi.nlm.nih.gov/pubmed/23464695) PUI L368581700 DOI 10.1016/j.suc.2012.12.004 FULL TEXT LINK http://dx.doi.org/10.1016/j.suc.2012.12.004 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 479 TITLE Capsular flap: new applications. AUTHOR NAMES Bogdanov-Berezovsky A. Silberstein E. Shoham Y. Krieger Y. AUTHOR ADDRESSES (Bogdanov-Berezovsky A.) Department of Plastic and Reconstructive Surgery and Burn Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, 84101, Beer-Sheva, Israel. (Silberstein E.; Shoham Y.; Krieger Y.) CORRESPONDENCE ADDRESS A. Bogdanov-Berezovsky, Department of Plastic and Reconstructive Surgery and Burn Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, 84101, Beer-Sheva, Israel. Email: alexb@bgu.ac.il SOURCE Aesthetic plastic surgery (2013) 37:2 (395-397). Date of Publication: Apr 2013 ISSN 1432-5241 (electronic) ABSTRACT Breast augmentation with silicone implants is one of the most commonly performed procedures for women seeking improvement in their body image. Because the number of breast augmentation operations is growing, the number of subsequent reoperations is increasing. Causes for repeated operative procedures include infection, capsular contracture, silicone implant replacement, and breast reaugmentation. As the average volume of silicone implants used is steadily growing according to patients' wishes and fashion requirements, the plastic surgeon often is asked to replace the silicone implants with larger implants. Replacing breast implants with a similar sized implant is a relatively simple operation, but insertion of larger implants may present a challenge due to insufficient soft tissue coverage of the lower pole of the larger breast implant, especially in thin subjects. Total coverage of the breast implant can be achieved by use of tissue substitutes (TS), such as acellular dermal matrices. Usage of TS, however, is prone to complications and very costly, and these factors influence the implementation of TS in a private practice setup. This report describes a capsular flap used to cover the lower pole of breast implants. The flap guarantees multilayered stable wound closure and prevents displacement of the inframammary fold. The capsular flap also was used to correct an inferiorly displaced inframammary fold as a consequence of the breast augmentation. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . EMTREE DRUG INDEX TERMS silicone gel (adverse drug reaction) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation (adverse drug reaction) breast implant (adverse drug reaction) surgical flaps EMTREE MEDICAL INDEX TERMS article case report esthetics female follow up graft survival human methodology prosthesis prosthesis complication reoperation risk assessment treatment outcome LANGUAGE OF ARTICLE English MEDLINE PMID 23435509 (http://www.ncbi.nlm.nih.gov/pubmed/23435509) PUI L369837404 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 480 TITLE Efficacy of acellular dermal matrices in revisionary aesthetic breast surgery: A 6-year experience AUTHOR NAMES Maxwell G.P. Gabriel A. AUTHOR ADDRESSES (Maxwell G.P.; Gabriel A., gabrielallen@yahoo.com) Department of Plastic Surgery, Loma Linda University Medical Center, 11175 Campus St, #21126, Loma Linda, CA 92354, United States. CORRESPONDENCE ADDRESS A. Gabriel, Department of Plastic Surgery, Loma Linda University Medical Center, 11175 Campus St, #21126, Loma Linda, CA 92354, United States. Email: gabrielallen@yahoo.com SOURCE Aesthetic Surgery Journal (2013) 33:3 (389-399). Date of Publication: March 2013 ISSN 1090-820X 1527-330X (electronic) BOOK PUBLISHER SAGE Publications Inc., 2455 Teller Road, Thousand Oaks, United States. ABSTRACT Background: Augmentation mammaplasty and augmentation mastopexy are associated with a substantial primary and secondary revision rate. Capsular contracture (CC), implant malposition, ptosis, asymmetry, and rippling are the main reasons for revisionary surgery in these patients. Traditional corrective techniques have not been completely reliable in preventing or treating these complications. Recently, acellular dermal matrices (ADM) have been used to assist with revisionary surgery with promising results. Objective: The authors review their 6-year experience using ADM for revisionary surgery in aesthetic patients and evaluate long-term outcomes with this approach. Methods: Patients who underwent revisionary breast augmentation or augmentation mastopexy with ADM in conjunction with standard techniques over a 6-year period between October 2005 and December 2011 were retrospectively reviewed. Only patients with at least 1 year of follow-up were included in the analysis. Results: A total of 197 revisions were performed (197 patients). Reasons for revision included CC (61.8%), implant malposition (31.2%), rippling (4.8%), ptosis (4.8%), implant exposure (1.6%), and breast wound (0.5%). The mean ± SD follow-up period was 3.1 ± 1.1 years (range, 0.1-6.1 years). The complication rate was 4.8%, including Baker grade III/IV CC (1.6%), infection (1.6%), implant malposition (0.5%), hematoma (0.5%), and seroma (0.5%). Most (98%) revisions were successful, with no recurrence of the presenting complaint. Conclusions: The use of ADM in conjunction with standard techniques for the reinforcement of weak tissue in revision augmentation and augmentation mastopexy patients appears to be effective. © 2013 The American Society for Aesthetic Plastic Surgery, Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction EMTREE MEDICAL INDEX TERMS adult aged article breast augmentation follow up hematoma (complication) human implant capsular contracture (complication, surgery) major clinical study mastitis (complication) medical record review outcome assessment priority journal prosthesis complication (surgery) reoperation seroma (complication) DEVICE TRADE NAMES AlloDerm , United StatesLifecell DermaMatrix , United Statessynthes cmf FlexHD , United StatesEthicon NeoForm , United StatesMentor Strattice Lifecell SurgiMend , United StatesTEI DEVICE MANUFACTURERS (United States)Ethicon (United States)Lifecell (United States)Mentor (United States)synthes cmf (United States)TEI EMBASE CLASSIFICATIONS Surgery (9) Dermatology and Venereology (13) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013201549 MEDLINE PMID 23439064 (http://www.ncbi.nlm.nih.gov/pubmed/23439064) PUI L368607862 DOI 10.1177/1090820X13478967 FULL TEXT LINK http://dx.doi.org/10.1177/1090820X13478967 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 481 TITLE Porcine Acellular Dermal Matrix (STRATTICE®) based immediate breast reconstruction: The south eastern breast cancer experience AUTHOR NAMES Ferede A. Balakrishnan P. Fiuza-Castineira C. O'Donoghue G.T. AUTHOR ADDRESSES (Ferede A.; Balakrishnan P.; Fiuza-Castineira C.; O'Donoghue G.T.) Department of Surgery, South Eastern Breast Cancer Centre, Waterford Regional Hospital, Waterford, Ireland. CORRESPONDENCE ADDRESS A. Ferede, Department of Surgery, South Eastern Breast Cancer Centre, Waterford Regional Hospital, Waterford, Ireland. SOURCE Irish Journal of Medical Science (2013) 182 SUPPL. 2 (S45-S46). Date of Publication: March 2013 CONFERENCE NAME 21st Sylvester O'Halloran Meeting CONFERENCE LOCATION Co. Limerick, Ireland CONFERENCE DATE 2013-03-01 to 2013-03-02 ISSN 0021-1265 BOOK PUBLISHER Springer London ABSTRACT Introduction: The majority of post mastectomy implant based immediate breast reconstructions are two-stage Tissue Expander/ Implant based surgery. This approach requires multiple clinic visits for tissue expansion and second surgery for permanent implant placement. The advent of porcine acellular dermal matrix STRATTICE, serving as an internal sling between the detached Pectoralis Major inferior edge and the infra-mammary fold, allows for the use of a single stage mastectomy equivalent implant. This study represents the results of our pilot introduction of this technique. Methods: We performed a retrospective analysis of a prospectively maintained database of 200 histologically proven, surgically treated breast cancer patients from 2010 to 2012. For the subset undergoing STRATTICE reconstruction, patient demographics, average operating time, length of stay, complications, co-morbidities and smoking habits were analysed. Results: There were total of 35 STRATTICE based reconstructions following mastectomies. The overall infection complication rate was 17 % [6/35] and 5 out of these had reconstruction failure requiring implant removal. Mean age, operating time and Length of stay are demonstrated in the table: (Table Presented) In the complication group there was no statistical difference between microbiological organism cultures, patient co-morbidities and smoking habits. Conclusion: While implant based breast reconstruction techniques have recognized complication rates, our results, in the largest Irish series to date, compare favorably to international published studies.1 In our opinion STRATTICE based immediate breast reconstruction, performed in the South Eastern Breast Cancer, is a safe compromise between complication risk and cosmetic outcome without excessively prolonging hospital stay and operating time. EMTREE DRUG INDEX TERMS cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast cancer breast reconstruction EMTREE MEDICAL INDEX TERMS cancer patient data base hospital hospitalization human implant infection complication length of stay mastectomy morbidity operation duration organisms patient risk smoking habit surgery tissue expansion tissues LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71326287 DOI 10.1007/s11845-013-0908-z FULL TEXT LINK http://dx.doi.org/10.1007/s11845-013-0908-z COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 482 TITLE Postoperative antibiotic prophylaxis for implant-based breast reconstruction with acellular dermal matrix. AUTHOR NAMES Avashia Y.J. Mohan R. Berhane C. Oeltjen J.C. AUTHOR ADDRESSES (Avashia Y.J.) Division of Plastic and Reconstructive Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Health System, Miami, FL 33136, USA. (Mohan R.; Berhane C.; Oeltjen J.C.) CORRESPONDENCE ADDRESS Y.J. Avashia, Division of Plastic and Reconstructive Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Health System, Miami, FL 33136, USA. SOURCE Plastic and reconstructive surgery (2013) 131:3 (453-461). Date of Publication: Mar 2013 ISSN 1529-4242 (electronic) ABSTRACT The use of acellular dermal matrix in implant-based breast reconstruction has been described for improving inferolateral prosthesis coverage and support and inframammary fold reconstruction. Recommended guidelines for infection prophylaxis are the same as for any clean procedure-antibiotic administration only before surgery. Previous studies have demonstrated increased postoperative rates of infection and seroma associated with the use of acellular dermal matrix. The authors evaluated the impact of postoperative antibiotic prophylaxis on infection rates in postmastectomy expander-based breast reconstruction with acellular dermal matrix. : A retrospective study reviewed data of 96 patients who underwent either immediate or delayed expander-based breast reconstruction using AlloDerm allogenic acellular dermal matrix. Infection rates were analyzed after patients received postoperative antibiotic prophylaxis for at least 48 hours compared with those who received only perioperative antibiotics. Infection rates for breast reconstructions with a postoperative antibiotic course were 7.9 and 3.2 percent. Patients with only perioperative antibiotics had an infection rate of 31.6 percent. Infections were defined by the endpoint of implant removal. Patient demographics, comorbidities, and intraoperative variables were recorded. Uncontrolled variables were time course between mastectomy and reconstruction, nodal dissection, operative history, and whether reconstruction was unilateral or bilateral. This study demonstrates significant differences in the rate of infection between the groups of patients undergoing the first stage of two-stage implant-based breast reconstruction who received postoperative antibiotic prophylaxis and the group that received only perioperative antibiotics. This study suggests that the optimal duration of postoperative antibiotic prophylaxis is at least 48 hours. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix antibiotic prophylaxis breast implant breast reconstruction infection (prevention) postoperative care EMTREE MEDICAL INDEX TERMS article female human methodology middle aged retrospective study LANGUAGE OF ARTICLE English MEDLINE PMID 23446560 (http://www.ncbi.nlm.nih.gov/pubmed/23446560) PUI L368762679 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 483 TITLE Immediate breast reconstruction using porcine acellular dermal matrix (Strattice™): Long-term outcomes and complications AUTHOR NAMES Salzberg C.A. Dunavant C. Nocera N. AUTHOR ADDRESSES (Salzberg C.A., asalzbergmd@yahoo.com; Dunavant C.; Nocera N.) Division of Plastic Surgery, New York Medical College, NY, United States. CORRESPONDENCE ADDRESS C.A. Salzberg, Division of Plastic Surgery, New York Medical College, NY, United States. Email: asalzbergmd@yahoo.com SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2013) 66:3 (323-328). Date of Publication: March 2013 ISSN 1748-6815 1878-0539 (electronic) BOOK PUBLISHER Churchill Livingstone, 1-3 Baxter's Place, Leith Walk, Edinburgh, United Kingdom. ABSTRACT Background: There has been limited reported experience with the use of Strattice™ (LifeCell Corp., Branchburg, NJ), a porcine-derived acellular dermal matrix, in implant-based breast reconstruction. The purpose of this study is to evaluate our experience with this matrix. Methods: Patients who underwent immediate single-stage or two-stage implant-based breast reconstruction with the assistance of Strattice were included in this study. Patient charts were reviewed for indications for mastectomy, adjunctive radiotherapy use, implant or expander volume, length of follow-up period, and type and incidence of complications during the follow-up period. Biopsies of Strattice were taken for histological analyses. Results: A total of 105 reconstructions were performed in 54 patients: 77% were prophylactic and 23% were oncologic. All, but 4, reconstructions were single stage. Mean implant volume of single-stage reconstructions were 444.1 (range: 150-700 cc) and mean expander volume after completion of expansion was 400 (range: 350-450). Mean follow-up period was 41.3 months (range: 35.5-48.4 months). Total complication rate was 8.6%. Complications occurred in 9 breasts: implant loss or explantation (3.8%), infection (3.8%), skin breakdown or necrosis (2.9%), seroma (1.9%), implant exposure (1.0%), and delayed skin healing (1.0%). Histological analyses of implanted Strattice revealed a viable matrix with fibroblast infiltration and revascularization. Conclusions: Over a mean 3.5-year follow-up period, low complication rates and good outcomes were observed with the use of Strattice that are comparable to those reported with human acellular dermal matrices. © 2012 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. All rights reserved. EMTREE DRUG INDEX TERMS antineoplastic agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction EMTREE MEDICAL INDEX TERMS article breast biopsy breast cancer (drug therapy, prevention, radiotherapy, surgery) breast implant breast tissue expander cancer chemotherapy cancer radiotherapy cell infiltration explant fibroblast follow up graft failure (complication) histology human human tissue major clinical study mastectomy medical record review outcome assessment postoperative complication (complication) postoperative infection (complication) priority journal prophylaxis revascularization seroma (complication) skin defect (complication) skin necrosis (complication) surgical technique treatment indication wound healing impairment (complication) DEVICE TRADE NAMES Strattice , United StatesLifecell DEVICE MANUFACTURERS (United States)Lifecell EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013099399 MEDLINE PMID 23153519 (http://www.ncbi.nlm.nih.gov/pubmed/23153519) PUI L52299887 DOI 10.1016/j.bjps.2012.10.015 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2012.10.015 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 484 TITLE Cost minimisation analysis of using acellular dermal matrix (Strattice™) for breast reconstruction compared with standard techniques AUTHOR NAMES Johnson R.K. Wright C.K. Gandhi A. Charny M.C. Barr L. AUTHOR ADDRESSES (Johnson R.K., richard.johnson@uhsm.nhs.uk; Wright C.K., chloe.wright@uhsm.nhs.uk; Gandhi A., ashu.gandhi@uhsm.nhs.uk; Barr L., lester.barr@uhsm.nhs.uk) Nightingale Centre, Genesis Breast Cancer Prevention Centre, University Hospital South Manchester, Wythenshawe, M23 9LT Manchester, United Kingdom. (Charny M.C., mark.charny@translucency.co.uk) Translucency Limited, WR1 1HX Worcester, United Kingdom. CORRESPONDENCE ADDRESS L. Barr, Nightingale Centre, Genesis Breast Cancer Prevention Centre, University Hospital South Manchester, Wythenshawe, M23 9LT Manchester, United Kingdom. Email: lester.barr@uhsm.nhs.uk SOURCE European Journal of Surgical Oncology (2013) 39:3 (242-247). Date of Publication: March 2013 ISSN 0748-7983 1532-2157 (electronic) BOOK PUBLISHER W.B. Saunders Ltd, 32 Jamestown Road, London, United Kingdom. ABSTRACT Background: We performed a cost analysis (using UK 2011/12 NHS tariffs as a proxy for cost) comparing immediate breast reconstruction using the new one-stage technique of acellular dermal matrix (Strattice™) with implant versus the standard alternative techniques of tissue expander (TE)/implant as a two-stage procedure and latissimus dorsi (LD) flap reconstruction. Methods: Clinical report data were collected for operative time, length of stay, outpatient procedures, and number of elective and emergency admissions in our first consecutive 24 patients undergoing one-stage Strattice reconstruction. Total cost to the NHS based on tariff, assuming top-up payments to cover Strattice acquisition costs, was assessed and compared to the two historical control groups matched on key variables. Results: Eleven patients having unilateral Strattice reconstruction were compared to 10 having TE/implant reconstruction and 10 having LD flap and implant reconstruction. Thirteen patients having bilateral Strattice reconstruction were compared to 12 having bilateral TE/implant reconstruction. Total costs were: unilateral Strattice, £3685; unilateral TE, £4985; unilateral LD and implant, £6321; bilateral TE, £5478; and bilateral Strattice, £6771. Conclusions: The cost analysis shows a financial advantage of using acellular dermal matrix (Strattice) in unilateral breast reconstruction versus alternative procedures. The reimbursement system in England (Payment by Results) is based on disease-related groups similar to that of many countries across Europe and tariffs are based on reported hospital costs, making this analysis of relevance in other countries. © 2012 Published by Elsevier Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction breast tissue expander cost minimization analysis latissimus dorsi flap EMTREE MEDICAL INDEX TERMS adult aged article breast implant clinical article controlled study female hospital admission hospital cost hospitalization human intermethod comparison operation duration priority journal reimbursement DEVICE TRADE NAMES AlloDerm Regenerative Tissue Matrix , United StatesLifecell Strattice , United StatesLifecell DEVICE MANUFACTURERS (United States)Lifecell EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013117154 MEDLINE PMID 23266307 (http://www.ncbi.nlm.nih.gov/pubmed/23266307) PUI L52365352 DOI 10.1016/j.ejso.2012.12.002 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2012.12.002 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 485 TITLE The effects of acellular dermal matrix in expander-implant breast reconstruction after total skin-sparing mastectomy. AUTHOR NAMES Pérez-García A. del Mar Luis-Hidalgo M. Perales-Puchalt A. AUTHOR ADDRESSES (Pérez-García A.; del Mar Luis-Hidalgo M.; Perales-Puchalt A.) CORRESPONDENCE ADDRESS A. Pérez-García, SOURCE Plastic and reconstructive surgery (2013) 131:2 (278e-279e). Date of Publication: Feb 2013 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction dermis extracellular matrix mastectomy postoperative care skin transplantation tissue expansion EMTREE MEDICAL INDEX TERMS female human methodology note transplantation LANGUAGE OF ARTICLE English MEDLINE PMID 23358027 (http://www.ncbi.nlm.nih.gov/pubmed/23358027) PUI L368616048 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 486 TITLE Reply: The effects of acellular dermal matrix in expander-implant breast reconstruction after total skin-sparing mastectomy. AUTHOR NAMES Peled A.W. Esserman L.J. AUTHOR ADDRESSES (Peled A.W.; Esserman L.J.) CORRESPONDENCE ADDRESS A.W. Peled, SOURCE Plastic and reconstructive surgery (2013) 131:2 (279e). Date of Publication: Feb 2013 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction dermis extracellular matrix mastectomy postoperative care skin transplantation tissue expansion EMTREE MEDICAL INDEX TERMS female human methodology note transplantation LANGUAGE OF ARTICLE English MEDLINE PMID 23358028 (http://www.ncbi.nlm.nih.gov/pubmed/23358028) PUI L368616049 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 487 TITLE Evaluating sterile human acellular dermal matrix in immediate expander-based breast reconstruction: a multicenter, prospective, cohort study. AUTHOR NAMES Venturi M.L. Mesbahi A.N. Boehmler 4th. J.H. Marrogi A.J. AUTHOR ADDRESSES (Venturi M.L.) Department of Plastic Surgery, Georgetown University Hospital, Washington, DC, USA. (Mesbahi A.N.; Boehmler 4th. J.H.; Marrogi A.J.) CORRESPONDENCE ADDRESS M.L. Venturi, Department of Plastic Surgery, Georgetown University Hospital, Washington, DC, USA. SOURCE Plastic and reconstructive surgery (2013) 131:1 (9e-18e). Date of Publication: Jan 2013 ISSN 1529-4242 (electronic) ABSTRACT Human acellular dermal matrices have gained increasing use in immediate expander-based breast reconstruction. However, some studies suggest that these grafts may be associated with a higher incidence of infection and seroma. To evaluate complication rates after matrix-based breast reconstruction, the authors conducted a prospective, multicenter, cohort study to evaluate a sterile human acellular dermal matrix in immediate expander-based breast reconstruction, specifically, to determine whether it offered a more favorable risk profile with respect to infection and seroma. A secondary purpose was to determine whether the sterilization process affects graft incorporation. The authors performed 65 consecutive tissue expander-based breast reconstructions in a cohort of patients over a 1-year period using a single protocol. Sterile human matrix was used in all cases. The patients were evaluated for early complications (infection, seroma) and graft incorporation at the time of exchange or definitive reconstruction. Biopsies were performed in the first 20 reconstructions to provide histologic correlation of graft incorporation. Complications occurred in three breasts (4.6 percent), including one case of cellulitis (1.5 percent) and two cases of partial mastectomy flap necrosis (3.0 percent) that required débridement. There were no seromas or explantations. The grafts were incorporated in all cases and verified histologically in the first 20 biopsies. Sterile human acellular dermal matrix can offer reliable matrix incorporation and a low complication rate. Sterilization does not negatively impact incorporation of the graft. The infection and seroma rates in this prospective study compare favorably to those in previous studies with nonsterilized (aseptic) acellular dermal matrix. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction breast tumor (surgery) instrument sterilization tissue expansion EMTREE MEDICAL INDEX TERMS adult aged article breast cellulitis (epidemiology, etiology) clinical trial cohort analysis female human mastectomy methodology middle aged multicenter study necrosis (epidemiology, etiology) pathology postoperative complication (epidemiology) prospective study seroma (epidemiology, etiology) surgical infection (epidemiology) treatment outcome CLINICAL TRIAL NUMBERS ClinicalTrials.gov (NCT01372917) LANGUAGE OF ARTICLE English MEDLINE PMID 22990174 (http://www.ncbi.nlm.nih.gov/pubmed/22990174) PUI L366386212 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 488 TITLE The lateral inframammary fold incision for nipple-sparing mastectomy: Outcomes from over 50 immediate implant-based breast reconstructions AUTHOR NAMES Blechman K.M. Karp N.S. Levovitz C. Guth A.A. Axelrod D.M. Shapiro R.L. Choi M. AUTHOR ADDRESSES (Blechman K.M.; Karp N.S.; Levovitz C.; Guth A.A.; Axelrod D.M.; Shapiro R.L.; Choi M., mihye.choi@nyumc.org) New York University, School of Medicine, NY, United States. CORRESPONDENCE ADDRESS M. Choi, 305 East 47th Street, New York, NY 10017, United States. Email: mihye.choi@nyumc.org SOURCE Breast Journal (2013) 19:1 (31-40). Date of Publication: January-February 2013 ISSN 1075-122X 1524-4741 (electronic) BOOK PUBLISHER Blackwell Publishing Inc., 350 Main Street, Malden, United States. ABSTRACT Nipple-sparing mastectomy (NSM) as a therapeutic or prophylactic procedure for breast cancer is rapidly gaining popularity as the literature continues to support it safety. The lateral inframammary fold (IMF) approach provides adequate exposure and eliminates visible scars on the anterior surface of the breast, making this incision cosmetically superior to radial or periareolar approaches. We reviewed 55 consecutive NSMs performed through a lateral IMF incision with immediate implant-based reconstruction, with or without tissue expansion, between June 2008 and June 2011. Prior to incision, breasts were lightly infiltrated with dilute anesthetic solution with epinephrine. Sharp dissection, rather than electrocautery, was used as much as possible to minimize thermal injury to the mastectomy flap. When indicated, acellular dermal matrix was placed as an inferolateral sling. Subsequent fat grafting to correct contour deformities was performed in select patients. Three-dimensional (3D) photographs assessed changes in volume, antero-posterior projection, and ptosis. Mean patient age was 46 years, and mean follow-up time was 12 months. Twelve mastectomies (22%) were therapeutic, and the remaining 43 (78%) were prophylactic. Seven of the nine sentinel lymph node biopsies (including one axillary dissection) (78%) were performed through the lateral IMF incision without the need for a counter-incision. Acellular dermal matrix was used in 34 (62%) breasts. Average permanent implant volume was 416 cc (range 176-750 cc), and average fat grafting volume was 86 cc (range 10-177 cc). In one patient a positive intraoperative subareolar biopsy necessitated resection of the nipple-areola complex (NAC), and in two other patients NAC resection was performed at a subsequent procedure based on the final pathology report. Mastectomy flap necrosis, requiring operative debridement, occurred in two breasts (4%), both in the same patient. One of these breasts required a salvage latissimus dorsi myocutaneous flap to complete the reconstruction. Three nipples (6%) required office debridement for partial necrosis and operative reconstruction later. No patient had complete nipple necrosis. No statistically significant differences existed between therapeutic and prophylactic mastectomies for developing partial skin and/or nipple necrosis (p = 0.35). Three episodes (5%) of cellulitis occurred, which responded to antibiotics without the need for explantation. Morphological outcomes using 3D scan measurements showed reconstructed breasts were larger, more projected, and less ptotic than the preoperative breasts (196 versus 248 cc, 80 versus 90 mm, 146 versus 134 mm, p < 0.01 for each parameter). Excellent results can be achieved with immediate implant-based reconstruction of NSM through a lateral IMF incision. NAC survival is reliable, and complication rates are low. © 2012 Wiley Periodicals, Inc. EMTREE DRUG INDEX TERMS antibiotic agent (intravenous drug administration) epinephrine EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (surgery) breast implant breast reconstruction incision lateral inframammary fold incision nipple sparing mastectomy surgical technique EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult article axillary lymph node breast areola breast augmentation breast biopsy cauterization cellulitis (complication) clinical article debridement fat graft female follow up graft necrosis (surgery) hospital admission human inferolateral sling lymph node dissection mesh sling necrosis (complication) nipple necrosis (complication) prophylaxis sentinel lymph node biopsy surgical approach thermal injury three dimensional imaging tissue expansion tissue graft CAS REGISTRY NUMBERS adrenalin (51-43-4, 55-31-2, 6912-68-1) EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013032553 MEDLINE PMID 23252505 (http://www.ncbi.nlm.nih.gov/pubmed/23252505) PUI L52364309 DOI 10.1111/tbj.12043 FULL TEXT LINK http://dx.doi.org/10.1111/tbj.12043 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 489 TITLE The effect of acellular dermal matrix on drain secretions after immediate prosthetic breast reconstruction AUTHOR NAMES Israeli Ben-Noon H. Farber N. Weissman O. Tessone A. Stavrou D. Shabtai M. Maor Y. Haik J. Winkler E. AUTHOR ADDRESSES (Israeli Ben-Noon H., israelihmd@gmail.com; Farber N.; Weissman O.; Tessone A.; Stavrou D.; Haik J.; Winkler E.) Department of Plastic and Reconstructive Surgery, Burn Unit, Chaim Sheba Medical Center, Tel-Hashomer, IL-52621 Ramat Gan, Israel. (Tessone A.; Haik J.) Talpiot Medical Leadership Program, Sheba Medical Center, Tel-Hashomer, Israel. (Shabtai M.) Department of General Surgery B, Sheba Medical Center, Tel-Hashomer, Israel. (Maor Y.) Infectious Disease Unit, Sheba Medical Center, Tel-Hashomer, Israel. CORRESPONDENCE ADDRESS H. Israeli Ben-Noon, Email: israelihmd@gmail.com SOURCE Journal of Plastic Surgery and Hand Surgery (2013) 47:4 (308-312). Date of Publication: September 2013 ISSN 2000-656X ABSTRACT In recent years the acellular dermal matrix (ADM) has gained popularity in prosthetic breast reconstruction. These procedures involve placement of a closed suction drain in the reconstructed breast. Although it is now widely accepted that ADM has an overall positive effect on the outcome of breast reconstruction, data regarding its effect on postoperative drain secretions is lacking. This study was designed to quantitatively evaluate the influence of ADM on postoperative drain secretions in the setting of immediate prosthetic breast reconstruction (IPBR). This is a prospective, comparative controlled study. Two groups of 16 patients each underwent skin sparing mastectomies (SSM) and IPBR with or without ADM. Closed suction drains were left in all the reconstructed breasts and daily secretion volumes were recorded and compared. Postoperative complications were also noted. Patients in the ADM group showed higher daily and overall secretion volumes compared with patients in the control group (p = 0.014) and the time for removal of the drains was higher by an average of 5 days (13 compared with 8 days, respectively; p = 0.004). There was no correlation between ADM and infection. This study provides the first objective evidence that ADM contributes to elevated and prolonged drain secretions when used for IPBR. This might affect possible prosthesis-related complications (e.g., rotation and malposition, capsular contraction, seroma formation, and infection). This study also noted erythema of the post-mastectomy skin flaps in selected patients, which may be attributable to a local inflammatory reaction to the ADM rather than infection. © 2013 Informa Healthcare. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) artificial skin breast augmentation breast implant suction EMTREE MEDICAL INDEX TERMS adult analysis of variance antibiotic prophylaxis article breast tumor (surgery) case control study chi square distribution comparative study evaluation study female follow up human methodology middle aged nonparametric test pathology physiology preoperative care prospective study prosthesis complication risk assessment skin transplantation subcutaneous mastectomy time treatment outcome wound healing LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 23710783 (http://www.ncbi.nlm.nih.gov/pubmed/23710783) PUI L1369628941 DOI 10.3109/2000656X.2013.766202 FULL TEXT LINK http://dx.doi.org/10.3109/2000656X.2013.766202 COPYRIGHT Copyright 2014 Medline is the source for the citation and abstract of this record. RECORD 490 TITLE Comparison study of two types of expander-based breast reconstruction: acellular dermal matrix-assisted versus total submuscular placement. AUTHOR NAMES Hanna K.R. DeGeorge Jr. B.R. Mericli A.F. Lin K.Y. Drake D.B. AUTHOR ADDRESSES (Hanna K.R.) Department of Plastic and Reconstructive Surgery, University of Virginia, Charlottesville, VA 22908, USA. (DeGeorge Jr. B.R.; Mericli A.F.; Lin K.Y.; Drake D.B.) CORRESPONDENCE ADDRESS K.R. Hanna, Department of Plastic and Reconstructive Surgery, University of Virginia, Charlottesville, VA 22908, USA. SOURCE Annals of plastic surgery (2013) 70:1 (10-15). Date of Publication: Jan 2013 ISSN 1536-3708 (electronic) ABSTRACT Recent reported complications have called some authors to express concern regarding the increased popularity of acellular dermal matrix (ADM)-based breast reconstruction, and its role as an alternative to traditional total submuscular approaches. To address this issue, we compared tissue expansion properties, complication rates, and patient satisfaction for both operative techniques at the same institution. A retrospective review was completed on 75 patients and 100 tissue expander/implant-based breast reconstructions at a single academic institution from 2007 to 2010. Of these cases, 31 patients were reconstructed with ADM and 44 with a submuscular coverage technique. Total complications including seroma, hematoma, infection, skin necrosis, and explantation did not significantly differ between groups (n = 13 for ADM vs. 17 for submuscular, P = 0.814). Consistent with prior reports, ADM-based reconstructions were associated with significantly increased intraoperative fill volumes and lower total number of sessions to achieve final volume. Submuscular reconstructions required a significantly higher tissue expander fill volume. Eight patients in the submuscular group required surgical revision of the breast and inframammary fold, compared with 4 in the ADM group; however, this difference was not significant. Patient satisfaction was equivalent between the 2 groups; however, it was higher in patients with bilateral reconstruction and lower among those who had received adjuvant radiation therapy. Satisfaction with nipple reconstruction was inversely proportional to time elapsed from the procedure to survey conduction. This is the first study to perform a head-to-head comparison on the basis of patient satisfaction, the results of which may be useful in preoperative planning and counseling. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation breast tumor (surgery) mastectomy tissue expander tissue expansion EMTREE MEDICAL INDEX TERMS adult article breast implant comparative study devices evaluation study female follow up human methodology middle aged patient satisfaction postoperative complication (epidemiology) questionnaire reoperation retrospective study statistics LANGUAGE OF ARTICLE English MEDLINE PMID 21862915 (http://www.ncbi.nlm.nih.gov/pubmed/21862915) PUI L366407483 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 491 TITLE Minimizing complications with the use of acellular dermal matrix for immediate implant-based breast reconstruction. AUTHOR NAMES Ganske I. Verma K. Rosen H. Eriksson E. Chun Y.S. AUTHOR ADDRESSES (Ganske I.) From the *Brigham and Women's Hospital, Boston, MA; †Georgetown University Hospital, Washington, DC; ‡Vanderbilt University Medical Center, Nashville, TN; and §Brigham and Women's Faulkner Hospital, Boston, MA. (Verma K.; Rosen H.; Eriksson E.; Chun Y.S.) CORRESPONDENCE ADDRESS I. Ganske, SOURCE Annals of plastic surgery (2013) 71:5 (464-470). Date of Publication: Nov 2013 ISSN 1536-3708 (electronic) ABSTRACT Acellular dermal matrix (ADM) use in implant-based breast reconstruction has been associated with higher rates of postoperative seroma and infection. This follow-up study was performed to determine whether specific modifications in technique are associated with a reduction in the rate of complications. The authors performed a retrospective analysis of immediate ADM-assisted implant-based breast reconstructions performed by the lead author (Y.C.) during an 18-month period after instituting specific modifications to prevent seroma. These included draining both the submastectomy and sub-ADM planes, lowering the threshold for drain removal, and addition of postoperative soft compression dressings and surgical bras. A total of 179 implant-based reconstructions were evaluated for rates of complications, including infection, hematoma, seroma, and skin flap necrosis. These were compared to results of a series of 150 similar procedures performed by the lead author before institution of the procedural modifications described. Seroma rate decreased from 18.6% to 4.7% (P = 0.0022), and major infection rate decreased from 7% to 1.9% (0.0250). Although implant-based breast reconstruction using ADM has been associated with increased seroma and possible infection rates, the use of specific clinical practices designed to prevent seroma has minimized our rate of these postoperative complications. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation (adverse drug reaction) breast reconstruction (adverse drug reaction) seroma (etiology, prevention) surgical infection (etiology, prevention) tissue expansion EMTREE MEDICAL INDEX TERMS adult article breast implant (adverse drug reaction) comparative study female follow up human methodology middle aged postoperative care retrospective study surgical flaps treatment outcome LANGUAGE OF ARTICLE English MEDLINE PMID 24126333 (http://www.ncbi.nlm.nih.gov/pubmed/24126333) PUI L563066212 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 492 TITLE Human acellular dermis versus submuscular tissue expander breast reconstruction: A multivariate analysis of short-term complications AUTHOR NAMES Davila A.A. Seth A.K. Wang E. Hanwright P. Bilimoria K. Fine N. Kim J.Y.S. AUTHOR ADDRESSES (Davila A.A.; Seth A.K.; Hanwright P.; Fine N.; Kim J.Y.S., jokim@nmh.org) Division of Plastic and Reconstructive Surgery, United States. (Wang E.; Bilimoria K.) Department of Surgery, United States. (Wang E.) Biostatistics Core, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States. CORRESPONDENCE ADDRESS J. Y. S. Kim, Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, 675 North St. Clair Street, Galter Suite 19-250, Chicago, IL 60611, United States. Email: jokim@nmh.org SOURCE Archives of Plastic Surgery (2013) 40:1 (19-27). Date of Publication: January 2013 ISSN 2234-6163 2234-6171 (electronic) BOOK PUBLISHER Korean Society of Plastic and Reconstructive Surgeons, 1355-3 Seocho-Dong, Seocho-Gu, Seoul, South Korea. ABSTRACT Background Acellular dermal matrix (ADM) allografts and their putative benefits have been increasingly described in prosthesis based breast reconstruction. There have been a myriad of analyses outlining ADM complication profiles, but few large-scale, multi-institutional studies exploring these outcomes. In this study, complication rates of acellular dermis-assisted tissue expander breast reconstruction were compared with traditional submuscular methods by evaluation of the American College of Surgeon's National Surgical Quality Improvement Program (NSQIP) registry. Methods Patients who underwent immediate tissue expander breast reconstruction from 2006-2010 were identified using surgical procedure codes. Two hundred forty tracked variables from over 250 participating sites were extracted for patients undergoing acellular dermis-assisted versus submuscular tissue expander reconstruction. Thirty-day postoperative outcomes and captured risk factors for complications were compared between the two groups. Results A total of 9,159 patients underwent tissue expander breast reconstruction; 1,717 using acellular dermis and 7,442 with submuscular expander placement. Total complications and reconstruction related complications were similar in both cohorts (5.5% vs. 5.3%, P=0.68 and 4.7% vs. 4.3%, P=0.39, respectively). Multivariate logistic regression revealed body mass index and smoking as independent risk factors for reconstructive complications in both cohorts (P<0.01). Conclusions The NSQIP database provides large-scale, multi-institutional, independent outcomes for acellular dermis and submuscular breast reconstruction. Both thirty-day complication profiles and risk factors for post operative morbidity are similar between these two reconstructive approaches. © 2013 The Korean Society of Plastic and Reconstructive Surgeons. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction breast tissue expander EMTREE MEDICAL INDEX TERMS adult aged article body mass female human major clinical study mastectomy postoperative complication prediction prosthesis complication (complication) retrospective study risk factor smoking surgical infection (complication) surgical technique wound dehiscence (complication) EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2013163980 PUI L368209658 DOI 10.5999/aps.2013.40.1.19 FULL TEXT LINK http://dx.doi.org/10.5999/aps.2013.40.1.19 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 493 TITLE [The impact of acellular dermal matrix on complications of breast reconstruction using tissue expander/implant: a meta-analysis]. AUTHOR NAMES Dong J. Wu X.W. Tian F.X. AUTHOR ADDRESSES (Dong J.; Wu X.W.; Tian F.X.) Department of Plastic Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, China. CORRESPONDENCE ADDRESS J. Dong, SOURCE Zhonghua zheng xing wai ke za zhi = Zhonghua zhengxing waike zazhi = Chinese journal of plastic surgery (2013) 29:5 (356-361). Date of Publication: Sep 2013 ISSN 1009-4598 ABSTRACT To analyze the effect of acellular dermal matrix (ADM) on complications of breast reconstruction using tissue expander/implant, and to offer preliminary evidences for ADM clinical application. Articles published from Jan. 2010 to Oct. 2012 were searched in Pubmed, EMbase, Science Direct and CNKI database. Literatures were filtrated according to inclusive criteria. Values were extracted from included literatures; factors regarding complications were collected. Meta-analysis was performed with Stata 12. 0. 10 researches were included. Comparing to control group, the pooled odds ratio (OR) of overall complications, infections, hematomas/seromas, explantations are 1.51(P=0.038), 1.91(P=0.032), 1.80(P=0.005) and 2.37 (P=0.138) in ADM group In breast reconstruction using tissue expander/implant, ADM increases the respectively. occurrence of hematomas/sarcomas as well as risks of infections and overall complications. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction (adverse drug reaction) postoperative complication (etiology) tissue expander (adverse drug reaction) EMTREE MEDICAL INDEX TERMS article breast implant (adverse drug reaction) female human meta analysis methodology LANGUAGE OF ARTICLE Chinese MEDLINE PMID 24409778 (http://www.ncbi.nlm.nih.gov/pubmed/24409778) PUI L373949719 COPYRIGHT Copyright 2014 Medline is the source for the citation and abstract of this record. RECORD 494 TITLE Current trends in breast reconstruction: survey of American Society of Plastic Surgeons 2010. AUTHOR NAMES Gurunluoglu R. Gurunluoglu A. Williams S.A. Tebockhorst S. AUTHOR ADDRESSES (Gurunluoglu R.) Plastic and Reconstructive Surgery, Denver Health Medical Center, University of Colorado Health Sciences, Denver, Colorado 80204, USA. (Gurunluoglu A.; Williams S.A.; Tebockhorst S.) CORRESPONDENCE ADDRESS R. Gurunluoglu, Plastic and Reconstructive Surgery, Denver Health Medical Center, University of Colorado Health Sciences, Denver, Colorado 80204, USA. Email: raffi.gurunluoglu@dhha.org SOURCE Annals of plastic surgery (2013) 70:1 (103-110). Date of Publication: Jan 2013 ISSN 1536-3708 (electronic) ABSTRACT We conducted a retrospective survey of American Society of Plastic Surgeons to ascertain the current trends in breast reconstruction (BR). Surveys were sent to 2250 active American Society of Plastic Surgeons members by e-mail with a cover letter including the link using Survey Monkey for the year 2010. In all, 489 surveys (a response rate of 21.7%) were returned. Three hundred fifty-eight surveys from respondents performing BR in their practices were included in the study. The survey included questions on surgeon demographics, practice characteristics, BR after mastectomy, number of BR per year, type and timing of BR, use of acellular dermal matrix, reconstructive choices in the setting of previous irradiation and in patients requiring postmastectomy radiation therapy, timing of contralateral breast surgery, fat grafting, techniques used for nipple-areola reconstruction, the complications, and physician satisfaction and physician reported patient satisfaction. Returned responses were tabulated and assessed. After prophylactic mastectomy, 16% of BRs were performed. In all, 81.2% of plastic surgeons predominantly performed immediate BR. In patients requiring postmastectomy radiation therapy, 81% did not perform immediate BR. Regardless of practice setting and laterality of reconstruction, 82.7% of respondents predominantly performed implant-based BR. Half of the plastic surgeons performing prosthetic BR used acellular dermal matrix. Only 14% of plastic surgeons predominantly performed autologous BR. Surgeons in solo, plastic surgery group practices, and multispecialty group practices preferred implant-based BR for both unilateral and bilateral cases more frequently than those in academic practices (P < 0.05). Overall, plastic surgeons in academic settings preferred autologous BR more frequently than those in other practice locations (P < 0.05). Of total respondents, 64.8% did not perform microsurgical BR at all; 28% reported performing deep inferior epigastric perforator flap BR. Pedicled transverse rectus abdominis myocutaneous flap was the most often used option for unilateral autologous reconstruction, whereas deep inferior epigastric perforator flap was the most commonly used technique for bilateral BR. The overall complication rate reported by respondents was 11%. The survey provides an insight to the current trends in BR practice with respect to surgeon and practice setting characteristics. Although not necessarily the correct best practices, the survey does demonstrate a likely portrayal of what is being practiced in the United States in the area of BR. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction clinical practice EMTREE MEDICAL INDEX TERMS adult article female health care survey health personnel attitude human male mastectomy methodology middle aged patient satisfaction postoperative complication (epidemiology) questionnaire retrospective study statistics surgical flaps United States utilization review LANGUAGE OF ARTICLE English MEDLINE PMID 21862916 (http://www.ncbi.nlm.nih.gov/pubmed/21862916) PUI L366407484 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 495 TITLE The use of synthetic mesh in reconstructive, revision, and cosmetic breast surgery. AUTHOR NAMES Becker H. Lind 2nd. J.G. AUTHOR ADDRESSES (Becker H., hbecker100@aol.com) Hilton Becker Clinic of Plastic Surgery, 670 Glades Road #220, Boca Raton, FL, 33431, USA, (Lind 2nd. J.G.) CORRESPONDENCE ADDRESS H. Becker, Email: hbecker100@aol.com SOURCE Aesthetic plastic surgery (2013) 37:5 (914-921). Date of Publication: Oct 2013 ISSN 1432-5241 (electronic) ABSTRACT Recent evidence suggests that the use of acellular dermal matrices in prosthetic breast reconstruction, revision, or augmentation may be associated with an increased risk of complications. In this article we report our results of a potential alternative, using a new long-term resorbable synthetic matrix in these cases. A retrospective study was performed evaluating 11 primary breast reconstructions (19 breasts), 43 secondary reconstructions (77 breasts), 3 augmentation/augmentation mastopexys (6 breasts), and 5 mastopexys (10 breasts) in 62 patients using TIGR(®) Matrix Surgical Mesh. Follow-up ranged from 9.4 to 26.1 months with an average follow-up of 16.5 months. Average age was 54 years. The number of patients who had prior radiation was 9 (14.5 %). Four patients (6.5 %) were smokers. Postoperative breast complications included necrosis of two flaps (1.8 %), two seromas requiring drainage (1.8 %), four infection/extrusions (3.6 %), two relapses of inframammary fold/malposition (1.8 %), and two with rippling (1.8 %). Other complications included six cases of asymmetry that required a corrective procedure. In a variety of breast surgery cases very good aesthetic results were achieved. The long-term absorbable synthetic matrix, TIGR(®) Matrix Surgical Mesh, shows potential when used as temporary reinforcement in patients undergoing breast reconstruction or breast surgery revisions and in primary aesthetic procedures, and it appears to be a viable alternative to the use of acellular dermal matrices. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) biodegradable implant breast augmentation (adverse drug reaction) breast implant breast reconstruction surgical mesh EMTREE MEDICAL INDEX TERMS acellular dermal matrix article female human male methodology middle aged postoperative complication (epidemiology) prosthesis reoperation retrospective study tissue expansion LANGUAGE OF ARTICLE English MEDLINE PMID 23860816 (http://www.ncbi.nlm.nih.gov/pubmed/23860816) PUI L563063664 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 496 TITLE Bioprosthetics: Changing the landscape for breast reconstruction? AUTHOR NAMES Gandhi A. Barr L. Johnson R. AUTHOR ADDRESSES (Gandhi A., ashu.gandhi@uhsm.nhs.uk; Barr L., lester.barr@uhsm.nhs.uk; Johnson R., richard.johnson@uhsm.nhs.uk) Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, United Kingdom. CORRESPONDENCE ADDRESS A. Gandhi, Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, United Kingdom. Email: ashu.gandhi@uhsm.nhs.uk SOURCE European Journal of Surgical Oncology (2013) 39:1 (24-25). Date of Publication: January 2013 ISSN 0748-7983 1532-2157 (electronic) BOOK PUBLISHER W.B. Saunders Ltd, 32 Jamestown Road, London, United Kingdom. EMTREE DRUG INDEX TERMS collagen fiber elastin epitope galactose major histocompatibility antigen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast cancer (surgery) breast endoprosthesis breast reconstruction mastectomy EMTREE MEDICAL INDEX TERMS adult allograft bioprosthesis breast implant breast surgery cadaver cancer surgery dermis editorial female human immune response major clinical study morbidity myocutaneous flap nonhuman pig postoperative complication (complication) postoperative infection (complication) priority journal seroma (complication) skin species comparison surgical technique tissue expander treatment failure United Kingdom DEVICE TRADE NAMES Permacol , United StatesCovidien Strattice Lifecell DEVICE MANUFACTURERS (United States)Covidien Lifecell CAS REGISTRY NUMBERS elastin (9007-58-3) galactose (26566-61-0, 50855-33-9, 59-23-4) EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2012726439 MEDLINE PMID 22883962 (http://www.ncbi.nlm.nih.gov/pubmed/22883962) PUI L52152673 DOI 10.1016/j.ejso.2012.07.109 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2012.07.109 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 497 TITLE Chest wall reconstruction with acellular dermal matrix (Strattice(™)) and a TRAM flap AUTHOR NAMES Brunbjerg M.E. Juhl A.A. Damsgaard T.E. AUTHOR ADDRESSES (Brunbjerg M.E., metteeline@hotmail.com; Juhl A.A.; Damsgaard T.E.) Aarhus University Hospital, Department of Plastic Surgery, Nørrebrogade 44, Aarhus C, Denmark. CORRESPONDENCE ADDRESS M.E. Brunbjerg, Aarhus University Hospital, Department of Plastic Surgery, Nørrebrogade 44, Aarhus C, Denmark. Email: metteeline@hotmail.com SOURCE Acta Oncologica (2013) 52:5 (1054-1056). Date of Publication: 2013 ISSN 1651-226X (electronic) 0284-186X BOOK PUBLISHER Taylor and Francis Ltd, healthcare.enquiries@informa.com EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix thorax wall reconstruction transverse rectus abdominis musculocutaneous flap EMTREE MEDICAL INDEX TERMS aged breast cancer (radiotherapy, surgery) cancer hormone therapy cancer radiotherapy case report computer assisted tomography female human letter mastectomy priority journal DEVICE TRADE NAMES Strattice EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 20151058350 PUI L607386748 DOI 10.3109/0284186X.2012.734925 FULL TEXT LINK http://dx.doi.org/10.3109/0284186X.2012.734925 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 498 TITLE Propeller TAP flap: Is it usable for breast reconstruction? AUTHOR NAMES Thomsen J.B. Bille C. Wamberg P. Jakobsen E.H. Arffmann S. AUTHOR ADDRESSES (Thomsen J.B., jbth@dadlnet.dk; Bille C.; Arffmann S.) Department of Plastic Surgery, Vejle Hospital, Odense University Hospital, Kabbeltoft 25, DK-7100 Vejle, Denmark. (Wamberg P.) Department of Surgery, Section for Breast Surgery, Vejle Hospital, Vejle, Denmark. (Jakobsen E.H.) Department of Oncology, Vejle Hospital, Vejle, Denmark. CORRESPONDENCE ADDRESS J.B. Thomsen, Email: jbth@dadlnet.dk SOURCE Journal of Plastic Surgery and Hand Surgery (2013) 47:5 (379-382). Date of Publication: October 2013 ISSN 2000-656X ABSTRACT The aim of this study was to examine if a propeller thoracodorsal artery perforator (TAP) flap can be used for breast reconstruction. Fifteen women were reconstructed using a propeller TAP flap, an implant, and an ADM. Preoperative colour Doppler ultrasonography was used for patient selection to identify the dominant perforator in all cases. A total of 16 TAP flaps were performed; 12 flaps were based on one perforator and four were based on two. A permanent silicone implant was used in 14 cases and an expander implant in two. Minor complications were registered in three patients. Two cases had major complications needing additional surgery. One flap was lost due to a vascular problem. Breast reconstruction can be performed by a propeller TAP flap without cutting the descending branch of the thoracodorsal vessels. However, the authors would recommend that a small cuff of muscle is left around the perforator to ensure a sufficient venous return. © 2013 Informa Healthcare. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction (adverse drug reaction) mammary artery (surgery) perforator flap EMTREE MEDICAL INDEX TERMS adult aged article artificial skin breast implant breast tumor (surgery) color Doppler flowmetry comparative study Denmark epidemiology female follow up graft rejection graft survival human mastectomy methodology middle aged pathology patient satisfaction physiology postoperative complication (diagnosis, surgery) preoperative care reoperation risk assessment statistics time transplantation treatment outcome vascularization wound healing LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 23710792 (http://www.ncbi.nlm.nih.gov/pubmed/23710792) PUI L1369829566 DOI 10.3109/2000656X.2013.770401 FULL TEXT LINK http://dx.doi.org/10.3109/2000656X.2013.770401 COPYRIGHT Copyright 2014 Medline is the source for the citation and abstract of this record. RECORD 499 TITLE Barbed sutures in breast reconstruction. AUTHOR NAMES Salzberg C.A. AUTHOR ADDRESSES (Salzberg C.A.) Dr Salzberg is Associate Professor of Plastic Surgery, New York Medical College, Valhalla, New York, USA. CORRESPONDENCE ADDRESS C.A. Salzberg, SOURCE Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery (2013) 33:3 Suppl (40S-3S). Date of Publication: Sep 2013 ISSN 1527-330X (electronic) ABSTRACT Postoperative closure techniques in breast reconstruction have remained largely unchanged over the past 75 years, despite recent use of adhesives and subcuticular staples and the advent of self-anchoring barbed sutures. In this article, the author discusses the applications for barbed sutures in breast reconstruction and describes specific techniques. Innovations in barbed suture material are also described, and the author's personal experiences are presented in comparison with traditional suturing techniques. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction suture suture technique EMTREE MEDICAL INDEX TERMS acellular dermal matrix delayed devices equipment design female flaps history human immediate implant latissimus flap review streetcar supplement tissue expander treatment outcome LANGUAGE OF ARTICLE English MEDLINE PMID 24084878 (http://www.ncbi.nlm.nih.gov/pubmed/24084878) PUI L563063929 COPYRIGHT Copyright 2015 Medline is the source for the citation and abstract of this record. RECORD 500 TITLE Morphological characteristics of and factors related to moisture-associated dermatitis surrounding malignant wounds in breast cancer patients AUTHOR NAMES Tamai N. Horii M. Takehara K. Kato S. Yamamoto Y. Naito A. Tayama M. Tamahashi Y. Nakamura S. Kadono T. Oe M. Nagase T. Sanada H. AUTHOR ADDRESSES (Tamai N., ntamai-tky@umin.ac.jp; Takehara K.; Yamamoto Y.; Oe M.; Nagase T.; Sanada H., hsanada-tky@umin.ac.jp) Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. (Horii M.) Faculty of Nursing, Josai International University, 1 Gumyo, Togane-shi, Chiba, Japan. (Kato S.) Department of Nursing, Shukutoku University, 673 Nitonacho, Chuo-ku, Chiba-shi, Chiba, Japan. (Naito A.) Fujisawa City Hospital, 2-6-1 Fujisawa, Fujisawa-shi, Kanagawa, Japan. (Tayama M.; Tamahashi Y.) St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, Japan. (Nakamura S.) Department of Breast Surgical Oncology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan. (Kadono T.) Department of Dermatology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan. CORRESPONDENCE ADDRESS H. Sanada, Email: hsanada-tky@umin.ac.jp SOURCE European Journal of Oncology Nursing (2013) 17:5 (673-680). Date of Publication: October 2013 ISSN 1532-2122 (electronic) 1462-3889 ABSTRACT Purpose: Patients with malignant breast wounds (MBWs) have multiple symptoms. In particular, care for exudates or peri-wound moisture-associated dermatitis (MAD) is difficult. However, MAD has not been distinguished from peri-wound dermatitis. Therefore, care for patients with MAD has not been well established. The aim of this study was to describe morphological characteristics of MAD in MBWs and link morphological characteristics of MAD to related factors. Methods: We conducted a qualitative descriptive study and a cross-sectional study. Data were collected by qualitative participant observation and structured interviews. The qualitative descriptive study was conducted using the 'morphoqualitative analysis' method. Data analyses were performed using qualitative research methods. In the cross-sectional study, the participants were classified into 2 groups for comparison: with MAD (MAD group) and without MAD (non-MAD group). Results: Characteristics of 24 MBWs were examined. Morphoqualitative analyses of data generated 17 subcategories and 3 categories. We could morphologically define MAD by findings of 'radial shape matching the dressing' and 'half-fusiform shape over the dressing'. Regarding factors related to MAD, necrotic tissue type was significantly more severe in the MAD group than in the non-MAD group (p=0.048). Wound exudate leakage was significantly more frequent in the MAD group than in the non-MAD group (p=0.013). Conclusion: Our study provides several points for nursing MBWs. Morphoqualitative analyses of MAD are quite important for evaluating possible causes of MAD as well as selecting effective interventions. © 2013. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (surgery) dermatitis mastectomy (adverse drug reaction) surgical infection (etiology) EMTREE MEDICAL INDEX TERMS adult aged article breast cancer comparative study cross-sectional study evaluation study exudate female human Japan Malignant fungating wound methodology middle aged nursing Palliative pathology physiology postoperative complication (etiology) prognosis qualitative research risk factor severity of illness index skin care treatment outcome very elderly wound care wound healing LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English MEDLINE PMID 23850413 (http://www.ncbi.nlm.nih.gov/pubmed/23850413) PUI L1052675866 DOI 10.1016/j.ejon.2013.05.005 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejon.2013.05.005 COPYRIGHT Copyright 2014 Medline is the source for the citation and abstract of this record. RECORD 501 TITLE Long-term outcomes in breast cancer patients undergoing immediate 2-stage expander/implant reconstruction and postmastectomy radiation: Ho A, Cordeiro P, Disa J, et al (Memorial Sloan-Kettering Cancer Ctr, NY; Et al) Cancer 118:2552-2559, 2012 AUTHOR NAMES Blechman K.M. Kronowitz S.J. AUTHOR ADDRESSES (Blechman K.M.; Kronowitz S.J.) CORRESPONDENCE ADDRESS K.M. Blechman, SOURCE Breast Diseases (2012) 23:4 (368-369). Date of Publication: 2012 ISSN 1043-321X 1878-1918 (electronic) BOOK PUBLISHER Academic Press Inc., 1250 Sixth Avenue, San Diego, California, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (radiotherapy, surgery) breast implant breast reconstruction breast tissue expander cancer radiotherapy postmastectomy radiation EMTREE MEDICAL INDEX TERMS acellular dermal matrix autotransplantation cancer chemotherapy cancer recurrence cancer staging cancer survival distant metastasis follow up human long term care major clinical study mastectomy multimodal chemotherapy note outcome assessment overall survival risk benefit analysis survival rate EMBASE CLASSIFICATIONS Surgery (9) Radiology (14) Cancer (16) Public Health, Social Medicine and Epidemiology (17) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2012716693 PUI L366204433 DOI 10.1016/j.breastdis.2012.09.008 FULL TEXT LINK http://dx.doi.org/10.1016/j.breastdis.2012.09.008 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 502 TITLE Evolving trends in implant breast reconstruction AUTHOR NAMES Pusic A. AUTHOR ADDRESSES (Pusic A.) Memorial Sloan-Kettering Cancer Center, New York, United States. CORRESPONDENCE ADDRESS A. Pusic, Memorial Sloan-Kettering Cancer Center, New York, United States. SOURCE Cancer Research (2012) 72:24 SUPPL. 3. Date of Publication: 15 Dec 2012 CONFERENCE NAME 35th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2012-12-04 to 2012-12-08 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT For women undergoing mastectomy, implant breast reconstruction is increasingly common. Over the past 5 years, new trends in implant reconstruction have been evolving. The use of 'next-generation' silicone implants, acellular dermal matrices and fat grafting have expanded the range of options available to patients. In addition, for women undergoing both skin-sparing and nipple-sparing mastectomies, there is growing experience with single-stage implant reconstruction (i.e. implant placement directly at the time of mastectomy without use of a tissue expander). Finally, indications for post-mastectomy radiation continue to increase and this has important implications for long-term patient satisfaction with implant reconstruction. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer breast reconstruction implant EMTREE MEDICAL INDEX TERMS acellular dermal matrix chronic patient female human mastectomy nipple patient patient satisfaction radiation silicone prosthesis skin tissue expander LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71096686 DOI 10.1158/0008-5472.SABCS12-ES6-2 FULL TEXT LINK http://dx.doi.org/10.1158/0008-5472.SABCS12-ES6-2 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 503 TITLE A short-term follow-up of implant based breast reconstruction using a titanium-coated polypropylene mesh (TiLoop(®) Bra) AUTHOR NAMES Dieterich M. Reimer T. Dieterich H. Stubert J. Gerber B. AUTHOR ADDRESSES (Dieterich M., max.dieterich@uni-rostock.de; Reimer T.; Stubert J.; Gerber B.) Department of Obstetrics and Gynecology, University of Rostock, Interdisciplinary Breast Center, Suedring 81, 18059 Rostock, Germany. (Dieterich H.) Women Clinic and Breast Centre Rheinfelden, Therese-Herzog-Weg 2, 79618 Rheinfelden, Germany. CORRESPONDENCE ADDRESS M. Dieterich, Department of Obstetrics and Gynecology, University of Rostock, Interdisciplinary Breast Center, Suedring 81, 18059 Rostock, Germany. Email: max.dieterich@uni-rostock.de SOURCE European Journal of Surgical Oncology (2012) 38:12 (1225-1230). Date of Publication: December 2012 ISSN 0748-7983 1532-2157 (electronic) BOOK PUBLISHER W.B. Saunders Ltd, 32 Jamestown Road, London, United Kingdom. ABSTRACT Introduction: A new approach for implant based breast reconstruction (IBBR) is the use of a titanium-coated polypropylene mesh (TCPM) as an alternative to acellular dermal matrix (ADM). This TCPM has a good biocompatibility and can be used similarly to ADM. The aim of this study is to discuss indications, limitations and complications of TCPM in IBBR. Methods: A retrospective analysis of 42 patients undergoing immediate or delayed IBBR using a TCPM was performed. Primary endpoints were incidence of infection and expander/implant with mesh removal due to infected fluid collection or extrusion. Results: In two patients, mild hematoma, seroma or infection occurred. Skin necrosis or capsular contraction was observed in one patient. Mesh explantation was needed in 3 cases. These events were higher among the first cases and in patients with postoperative skin infection (p = 0.003). Conclusion: In selected patients with adequate soft tissue cover TCPM seems to be a helpful tool for implant stabilization in terms of lateral stabilization and fixation of the musculus pectoralis major. In comparison to ADM, TCPM is cheaper and initial results are promising, but further follow-up data are necessary. In patients with poor soft tissue cover ADM should be used. © 2012 Elsevier Ltd. All rights reserved. EMTREE DRUG INDEX TERMS titanium EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast implant breast reconstruction implant based breast reconstruction surgical mesh titanium coated polypropylene mesh EMTREE MEDICAL INDEX TERMS adult article breast cancer (surgery) clinical article disease severity female follow up hematoma (complication) human postoperative complication (complication) postoperative infection (complication) priority journal retrospective study seroma (complication) skin infection (complication) skin necrosis (complication) treatment outcome DEVICE TRADE NAMES TiLoop Bra CAS REGISTRY NUMBERS titanium (7440-32-6) EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012647328 MEDLINE PMID 22981749 (http://www.ncbi.nlm.nih.gov/pubmed/22981749) PUI L52208577 DOI 10.1016/j.ejso.2012.08.026 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2012.08.026 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 504 TITLE The use of dermal autograft as an adjunct to breast reconstruction with tissue expanders. AUTHOR NAMES Rinker B. AUTHOR ADDRESSES (Rinker B.) Department of Surgery, Division of Plastic Surgery, University of Kentucky, Lexington, Ky 40536-0284, USA. CORRESPONDENCE ADDRESS B. Rinker, Department of Surgery, Division of Plastic Surgery, University of Kentucky, Lexington, Ky 40536-0284, USA. Email: brink2@email.uky.edu SOURCE Plastic and reconstructive surgery (2012) 130:6 (1179-1185). Date of Publication: Dec 2012 ISSN 1529-4242 (electronic) ABSTRACT Acellular dermal matrices are commonly used in breast reconstruction but add cost to the procedure and have been associated with complications. Dermal autograft may represent a useful alternative to matrices. Sixteen patients (26 breasts) underwent breast reconstruction using tissue expanders and dermal autograft. Their ages ranged from 41 to 66 years (median, 51 years). Autografts were harvested by wide excision of preexisting abdominal scars. Demographic data, clinical history, and harvest and preparation time were recorded. The initial fill volume, number of expansions, and complications were recorded and compared with published data for acellular dermal matrix-assisted reconstruction. Patients rated their satisfaction with scar appearance on a seven-point scale. Follow-up ranged from 6 to 16 months (mean, 10 months). Three patients were smokers. Mean body mass index was 30.5 (range, 19.1 to 48.8). Three patients received chemotherapy between reconstructive stages, and none required irradiation. The mean time of autograft harvest was 38 minutes, the mean initial fill was 190 cc, and the average number of expansions was 3.5. There were no implant losses. There were three minor complications (19 percent). Initial expander fill, number of expansions, and complication rate were equivalent to historical values for matrix-assisted breast reconstruction. Fourteen of 16 patients (88 percent) were "very satisfied" with their scars. The use of dermal autograft in tissue expander breast reconstruction offers the advantages of acellular dermal matrix, without the associated expense. The technique adds minimally to the operative time and morbidity and is associated with a low complication rate. Therapeutic, IV. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction skin transplantation tissue expansion EMTREE MEDICAL INDEX TERMS adult aged article autotransplantation breast tumor (surgery) devices evaluation study female follow up human intraductal carcinoma (surgery) lung carcinoma (surgery) mastectomy methodology middle aged outcome assessment Paget nipple disease (surgery) patient satisfaction tissue expander LANGUAGE OF ARTICLE English MEDLINE PMID 23190802 (http://www.ncbi.nlm.nih.gov/pubmed/23190802) PUI L366373388 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 505 TITLE A meta-analysis of human acellular dermis and submuscular tissue expander breast reconstruction. AUTHOR NAMES Hajifathalian K. Zacharias D.G. Gonzalez-Gonzalez L.A. Goodman J. AUTHOR ADDRESSES (Hajifathalian K.; Zacharias D.G.; Gonzalez-Gonzalez L.A.; Goodman J.) CORRESPONDENCE ADDRESS K. Hajifathalian, SOURCE Plastic and reconstructive surgery (2012) 130:6 (896e; author reply 896e-898e). Date of Publication: Dec 2012 ISSN 1529-4242 (electronic) EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) artificial skin breast augmentation tissue expander EMTREE MEDICAL INDEX TERMS female human methodology note CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 23190846 (http://www.ncbi.nlm.nih.gov/pubmed/23190846) PUI L366373424 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 506 TITLE Complications of acellular dermal matrices in breast surgery. AUTHOR NAMES Israeli R. AUTHOR ADDRESSES (Israeli R.) Department of Surgery, Division of Plastic Surgery, Hofstra University School of Medicine in Partnership with the North Shore-LIJ Health System, Great Neck, NY 11021, USA. CORRESPONDENCE ADDRESS R. Israeli, Department of Surgery, Division of Plastic Surgery, Hofstra University School of Medicine in Partnership with the North Shore-LIJ Health System, Great Neck, NY 11021, USA. Email: risraeli@nybra.com SOURCE Plastic and reconstructive surgery (2012) 130:5 Suppl 2 (159S-72S). Date of Publication: Nov 2012 ISSN 1529-4242 (electronic) ABSTRACT Acellular dermal matrices have been used in breast surgery for a decade. They are widely used in implant-based breast reconstruction to provide coverage of the inferolateral aspects of the prosthesis. Numerous benefits have been reported with this approach including improved fold control, better support and control of the implant pocket with concomitant reduced risk of malposition, and improved lower pole expansion. Seroma, infection, mastectomy skin necrosis, and expander/implant loss are the most commonly reported complications with this approach, and the incidences vary widely among studies. Patient selection and adherence to established intraoperative technique principles related to acellular dermal matrix use are both critical to minimizing the risk of complications. Acellular dermal matrices are also being used in aesthetic breast surgery, revision breast surgery, and nipple reconstruction, but clinical experience is limited. This article reviews the complications associated with the use of matrices in breast surgery from the published literature. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix (adverse drug reaction) breast augmentation breast reconstruction postoperative complication (etiology, prevention) EMTREE MEDICAL INDEX TERMS adjuvant therapy (adverse drug reaction) breast breast tumor (radiotherapy, surgery) esthetics female human implant capsular contracture (etiology, prevention, surgery) mastectomy meta analysis (topic) methodology multimodality cancer therapy necrosis nipple (surgery) pathology patient selection pectoralis major muscle (surgery) retrospective study review risk factor seroma (etiology) suction surgical flaps surgical infection (etiology) suture technique tissue expander LANGUAGE OF ARTICLE English MEDLINE PMID 23096966 (http://www.ncbi.nlm.nih.gov/pubmed/23096966) PUI L366371844 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 507 TITLE The use of acellular dermal matrices in two-stage expander/implant reconstruction: a multicenter, blinded, randomized controlled trial. AUTHOR NAMES McCarthy C.M. Lee C.N. Halvorson E.G. Riedel E. Pusic A.L. Mehrara B.J. Disa J.J. AUTHOR ADDRESSES (McCarthy C.M.) Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA. (Lee C.N.; Halvorson E.G.; Riedel E.; Pusic A.L.; Mehrara B.J.; Disa J.J.) CORRESPONDENCE ADDRESS C.M. McCarthy, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA. Email: mccarthc@mskcc.org SOURCE Plastic and reconstructive surgery (2012) 130:5 Suppl 2 (57S-66S). Date of Publication: Nov 2012 ISSN 1529-4242 (electronic) ABSTRACT Current efficacy data supporting the routine use of acellular dermal matrices in postmastectomy tissue expander/implant reconstruction are limited. A multicenter, blinded, randomized controlled study was designed to evaluate the effectiveness of acellular dermal matrix in the setting of tissue expander/implant reconstruction. The primary objective of the study was to determine whether the use of matrix would decrease patient-reported postoperative pain. The secondary objective was to determine whether its use would accelerate the rate of postoperative expansion. The randomized controlled trial was conducted at two U.S. centers from 2008 to 2011. Immediately following mastectomy, all patients were randomized to one of two treatment arms: (1) acellular dermal matrix-assisted, tissue expander/implant reconstruction; and (2) submuscular tissue expander/implant placement. All patients were blinded to their treatment arm. One hundred eight consented to participate; 38 were excluded prior to randomization. In total, 70 patients were randomized. There were no differences seen in immediate postoperative pain (p = 0.19) or pain during the expansion phase (p = 0.65) between treatment arms. There was similarly no difference in postoperative narcotic use (p = 0.38). The rate of postoperative expansion did not differ between groups (p = 0.83). The results suggest that the use of acellular dermal matrix in the setting of tissue expander/implant reconstruction neither reduces postoperative pain nor accelerates the rate of postoperative expansion. An examination of its efficacy in improving long-term outcomes following tissue expander/implant reconstruction is warranted. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen (drug therapy) EMTREE DRUG INDEX TERMS antineoplastic agent (drug administration, drug therapy) narcotic agent (drug administration, drug therapy) surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation breast reconstruction postoperative pain (drug therapy, epidemiology, prevention) tissue expander EMTREE MEDICAL INDEX TERMS adjuvant chemotherapy adult aged article breast tumor (drug therapy, surgery) comparative study controlled clinical trial controlled study esthetics female human implant capsular contracture (epidemiology) mastectomy methodology middle aged multicenter study multimodality cancer therapy pain assessment patient controlled analgesia patient satisfaction psychological aspect quality of life randomized controlled trial single blind procedure time treatment outcome CAS REGISTRY NUMBERS collagen (9007-34-5) CLINICAL TRIAL NUMBERS ClinicalTrials.gov (NCT00639106) LANGUAGE OF ARTICLE English MEDLINE PMID 23096987 (http://www.ncbi.nlm.nih.gov/pubmed/23096987) PUI L366371864 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 508 TITLE Cost analysis of implant-based breast reconstruction with acellular dermal matrix. AUTHOR NAMES de Blacam C. Momoh A.O. Colakoglu S. Slavin S.A. Tobias A.M. Lee B.T. AUTHOR ADDRESSES (de Blacam C.) Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA. (Momoh A.O.; Colakoglu S.; Slavin S.A.; Tobias A.M.; Lee B.T.) CORRESPONDENCE ADDRESS C. de Blacam, Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA. SOURCE Annals of plastic surgery (2012) 69:5 (516-520). Date of Publication: Nov 2012 ISSN 1536-3708 (electronic) ABSTRACT A comparative cost analysis of breast reconstruction using acellular dermal matrix (ADM) and traditional tissue expander-/implant-based techniques was carried out. Medicare reimbursement costs were calculated for tissue expander/implant alone (TE/I), TE/I with ADM (TE/I + ADM), and single-stage implant (SSI) with ADM (SSI + ADM). The most expensive procedure at baseline was TE/I + ADM ($11,255.78), followed by TE/I alone ($10,934.18), and SSI + ADM ($5,423.02). Incorporating the probability of complications as derived from the published literature into the cost analysis resulted in an increase in the excess cost of ADM-based procedures (TE/I + ADM, $11,829.02; TE/I, $11,238.60; SSI + ADM, $5,909.83). Although SSI + ADM have the lowest cost, not all patients are suitable candidates for this type of procedure. With increasing focus on healthcare expenditure, it is important that plastic surgeons are aware of the cost implications of using ADM products. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation breast implant EMTREE MEDICAL INDEX TERMS article cost economics female human methodology prospective study LANGUAGE OF ARTICLE English MEDLINE PMID 21587037 (http://www.ncbi.nlm.nih.gov/pubmed/21587037) PUI L366398249 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 509 TITLE Focus on technique: one-stage implant-based breast reconstruction. AUTHOR NAMES Salzberg C.A. AUTHOR ADDRESSES (Salzberg C.A.) Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, 675 N. Saint Clair Street, Galter Suite 19-250, Chicago, Ill. 60611, USA. CORRESPONDENCE ADDRESS C.A. Salzberg, Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, 675 N. Saint Clair Street, Galter Suite 19-250, Chicago, Ill. 60611, USA. Email: jokim@nmh.org SOURCE Plastic and reconstructive surgery (2012) 130:5 Suppl 2 (95S-103S). Date of Publication: Nov 2012 ISSN 1529-4242 (electronic) ABSTRACT Direct-to-implant reconstruction with acellular dermal matrix has expanded the surgeon's repertoire and given the patient an opportunity to have a one-stage option after skin- or nipple-sparing mastectomy. The technique produces total implant coverage without the need for expansion, repeated operations, and delayed return of normal body image. In patients with adequate, good-quality mastectomy skin, a subpectoral pocket is created after mastectomy. The inferomedial pectoralis major muscle is elevated for implant placement. The acellular dermal matrix is sutured to the released inferior pole of the pectoralis muscle along its entire lower course and to the lateral mammary fold. The implant is introduced beneath the muscle-matrix layer, and the matrix is sutured to the inframammary fold at its desired position. Two suction drains are placed, one subpectorally and the other subcutaneously, through separate stab incisions, followed by skin closure. Over a 10-year period, the author has performed this technique in 439 patients (790 breasts). Consistently low complication rates and good aesthetic outcomes have been obtained. Major complications, including implant loss (1.6 percent), skin necrosis requiring reoperation (1.3 percent), infection (1.1 percent), hematoma (0.6 percent), seroma (0.5 percent), and capsular contracture (0.5 percent), have remained at an incidence of less than 2 percent. The author's 10-year results using acellular dermal matrix in direct-to-implant breast reconstructions demonstrate the effectiveness of the procedure, as well as its long-term safety and aesthetic benefits. Its success, however, relies on appropriate patient selection and specific intraoperative technique principles. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation breast reconstruction tissue expander EMTREE MEDICAL INDEX TERMS breast tumor (surgery) esthetics female human implant capsular contracture (etiology, prevention) mastectomy methodology patient selection pectoralis major muscle (surgery) postoperative complication (etiology, prevention) retrospective study review suction surgical flaps suture technique LANGUAGE OF ARTICLE English MEDLINE PMID 23096993 (http://www.ncbi.nlm.nih.gov/pubmed/23096993) PUI L366371870 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 510 TITLE The use of acellular dermal matrices in revisional breast reconstruction. AUTHOR NAMES Slavin S.A. Lin S.J. AUTHOR ADDRESSES (Slavin S.A.) Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. (Lin S.J.) CORRESPONDENCE ADDRESS S.A. Slavin, Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. SOURCE Plastic and reconstructive surgery (2012) 130:5 Suppl 2 (70S-85S). Date of Publication: Nov 2012 ISSN 1529-4242 (electronic) ABSTRACT The use of acellular dermal matrices in breast surgery has become popular in the last two decades, with a corresponding increase in experience and literature. The authors reviewed the literature and summarize key technical points regarding use of acellular dermal matrices in reconstructive breast surgery. Current applications have emphasized both primary and secondary breast reconstruction. Newer approaches focus on breast revisional surgery, especially when matrix material is used to correct deformities commonly arising after breast implant placement. In these situations, matrices have widened the indications and improved results by providing additional support to the lower pole, extending the pectoralis major muscle, and smoothing surface irregularities. Increased use of these products has also spurred our understanding of their biological properties of cell infiltration, tolerance, and inflammation. Acquired deformities, such as symmastia, rippling, malposition, and lower pole bottoming out, that were previously difficult to treat are significantly improved by placement of acellular dermal matrix in the affected area. Although most of the available studies demonstrate short-term results (1 to 2 years of follow-up), our technical ability to treat complications after breast augmentation and mastopexy has expanded. Use of onlay grafts of matrix in areas of capsulectomy and capsulorrhaphy, placement of grafts of varying thickness for thinned tissues, and the wide variety of shapes and sizes of product available are reducing unfavorable aesthetic results. Increased complications, including seroma formation, infection, wound dehiscence, and implant exposure, remain challenging problems. Long-term studies will be needed to prove the durability of acellular dermal matrices in breast revisional surgery. EMTREE DRUG INDEX TERMS collagen (drug therapy) surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast breast augmentation (adverse drug reaction) breast reconstruction reoperation EMTREE MEDICAL INDEX TERMS animal breast tumor (surgery) cost economics esthetics female follow up foreign body reaction (etiology) human implant implant capsular contracture (etiology, surgery) mastectomy (adverse drug reaction) meta analysis (topic) methodology pathology postoperative complication (epidemiology, prevention) radiation exposure review tissue expander CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 23096989 (http://www.ncbi.nlm.nih.gov/pubmed/23096989) PUI L366371866 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 511 TITLE The bovine pericardial patch in breast reconstruction: a case report. AUTHOR NAMES Semprini G. Cattin F. De Biasio F. Cedolini C. Parodi P.C. AUTHOR ADDRESSES (Semprini G.) Plastic and Reconstructive Surgery Department, University of Udine, Udine, Italy. (Cattin F.; De Biasio F.; Cedolini C.; Parodi P.C.) CORRESPONDENCE ADDRESS G. Semprini, Plastic and Reconstructive Surgery Department, University of Udine, Udine, Italy. SOURCE Il Giornale di chirurgia (2012) 33:11-12 (392-394). Date of Publication: 2012 Nov-Dec ISSN 0391-9005 ABSTRACT In the last years there has been a growing demand of plastic surgery for soft tissue reconstruction. In response to this, many biological and synthetic devices have been produced, aiming to allow wide and complex body reshapings. Acellular dermal matrices are one of these devices, and are made of human or animal tissues made acellular after their sampling. They are used for cervical, breast and abdominal wall reconstruction. Tutopatch®, generally used for face reconstruction or neurosurgery, is made of acellular bovine pericardium, and its high amount of collagen allows a fast tissue healing and a scaffold for the surrounding tissue regeneration. In our case report Tutopatch® has been used in immediate breast reconstruction after mastectomy. This device has been used to close laterally the subpectoral pocket, allowing a bigger volume prosthesis to be placed We have not experienced particular postoperatory complications, and after 12 months of follow up we have found a valid functional and aesthetic result. We consider Tutopatch® as a valid alternative to other acellular dermal matrices specifically designed for breast reconstruction. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction pericardium EMTREE MEDICAL INDEX TERMS acellular dermal matrix animal article bovine breast augmentation breast implant breast tumor (surgery) case report esthetics female follow up human mastectomy methodology middle aged plastic surgery transplantation treatment outcome wound healing xenograft CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 23140923 (http://www.ncbi.nlm.nih.gov/pubmed/23140923) PUI L366396531 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 512 TITLE Acellular dermal matrix in irradiated tissue expander/implant-based breast reconstruction: evidence-based review. AUTHOR NAMES Clemens M.W. Kronowitz S.J. AUTHOR ADDRESSES (Clemens M.W.) Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, USA. (Kronowitz S.J.) CORRESPONDENCE ADDRESS M.W. Clemens, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, USA. SOURCE Plastic and reconstructive surgery (2012) 130:5 Suppl 2 (27S-34S). Date of Publication: Nov 2012 ISSN 1529-4242 (electronic) ABSTRACT The benefits of acellular dermal matrix for breast reconstruction have been well described. However, its clinical impact for breast reconstruction in the setting of radiation therapy has not been well reported. The MEDLINE and EMBASE databases were reviewed for articles published between January of 2005 and February of 2012 on breast reconstruction using acellular dermal matrix in the setting of radiation therapy. The authors also reviewed their institutional experience of consecutive patients who met these criteria between January of 2008 and October of 2011. Thirteen articles were identified for review: three animal studies on acellular dermal matrix and 10 with level III evidence of its use in humans. The 10 clinical studies included 246 irradiated patients. The M. D. Anderson experience included 30 irradiated acellular dermal matrix patients for a total of 276 irradiated patients evaluated in this review. Use of acellular dermal matrix in implant-based breast reconstruction in the setting of radiation therapy did not predispose to higher infection or overall complication rates or prevent bioprosthetic mesh incorporation. However, the rate of mesh incorporation may be slowed. Its use allowed for increased intraoperative saline fill volumes, which improved aesthetic outcomes and allowed patients to awake from surgery with a formed breast. Use of acellular dermal matrix for implant-based breast reconstruction does not appear to increase or decrease the risk of complications, but it might provide psychological and aesthetic benefits. Multicenter or single-center randomized controlled trials that provide high-quality, level I evidence are warranted. EMTREE DRUG INDEX TERMS sodium chloride (drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix adjuvant therapy (adverse drug reaction) breast breast augmentation breast reconstruction implant capsular contracture (etiology, prevention) tissue expander EMTREE MEDICAL INDEX TERMS animal breast tumor (radiotherapy, surgery) clinical trial (topic) esthetics evaluation study evidence based medicine female human implant methodology multimodality cancer therapy partial mastectomy pathology postoperative complication (etiology, prevention) radiation exposure review suction surgical infection (etiology, prevention) CAS REGISTRY NUMBERS sodium chloride (7647-14-5) LANGUAGE OF ARTICLE English MEDLINE PMID 23096982 (http://www.ncbi.nlm.nih.gov/pubmed/23096982) PUI L366371860 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 513 TITLE Acellular dermal matrices in primary breast reconstruction: principles, concepts, and indications. AUTHOR NAMES Nahabedian M.Y. AUTHOR ADDRESSES (Nahabedian M.Y.) Department of Plastic Surgery, Georgetown University, 3800 Reservoir Road, N.W., Washington, DC 20007, USA. CORRESPONDENCE ADDRESS M.Y. Nahabedian, Department of Plastic Surgery, Georgetown University, 3800 Reservoir Road, N.W., Washington, DC 20007, USA. Email: drnahabedian@aol.com SOURCE Plastic and reconstructive surgery (2012) 130:5 Suppl 2 (44S-53S). Date of Publication: Nov 2012 ISSN 1529-4242 (electronic) ABSTRACT Prosthetic breast reconstruction using acellular dermal matrix is currently used by many plastic surgeons. As our understanding of these matrices expands, our results and outcomes are becoming more reproducible and predictable. As with most new technologies, there is a learning curve associated with using acellular dermal matrix. There are principles and concepts that should be heeded when considering their use. The purpose of this article is to review some of the important principles and concepts to improve our understanding of how these matrices perform and what can be expected of them. EMTREE DRUG INDEX TERMS sodium chloride (drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation breast reconstruction EMTREE MEDICAL INDEX TERMS adjuvant therapy angiogenesis breast tumor (radiotherapy, surgery) esthetics female fibrosis (prevention) foreign body reaction (etiology) human implant capsular contracture (etiology, prevention) mastectomy methodology morbid obesity (complication) multimodality cancer therapy pectoralis major muscle (surgery) postoperative complication (etiology, prevention) review smoking (adverse drug reaction) tissue expander CAS REGISTRY NUMBERS sodium chloride (7647-14-5) LANGUAGE OF ARTICLE English MEDLINE PMID 23096984 (http://www.ncbi.nlm.nih.gov/pubmed/23096984) PUI L366371862 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 514 TITLE The role of acellular dermal matrices in capsular contracture: a review of the evidence. AUTHOR NAMES Basu C.B. Jeffers L. AUTHOR ADDRESSES (Basu C.B.) Private Practice, Houston, Texas, USA. (Jeffers L.) CORRESPONDENCE ADDRESS C.B. Basu, Private Practice, Houston, Texas, USA. Email: drbasu@basuplasticsurgery.com SOURCE Plastic and reconstructive surgery (2012) 130:5 Suppl 2 (118S-24S). Date of Publication: Nov 2012 ISSN 1529-4242 (electronic) ABSTRACT Despite advances in breast implant surgery, capsular contracture remains a challenging sequela of reconstructive and cosmetic breast implant surgery. Although there are established modalities for treatment, most recently, acellular dermal matrix products have been suggested to have a role in preventing or diminishing the pathologic process of capsular contracture. In this article, the author presents a review of the literature to highlight the level of evidence on the role of acellular dermal matrices in the treatment of capsular contracture. EMTREE DRUG INDEX TERMS collagen (drug therapy) surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation breast reconstruction implant capsular contracture (etiology, prevention, surgery) tissue expander EMTREE MEDICAL INDEX TERMS adjuvant therapy (adverse drug reaction) breast tumor (radiotherapy, surgery) clinical trial (topic) esthetics female fibrosis follow up human mastectomy methodology pathology pectoralis major muscle (surgery) postoperative complication (etiology, prevention) retrospective study review surgical flaps CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 23096960 (http://www.ncbi.nlm.nih.gov/pubmed/23096960) PUI L366371838 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 515 TITLE Focus on technique: two-stage implant-based breast reconstruction. AUTHOR NAMES Kim J.Y. Connor C.M. AUTHOR ADDRESSES (Kim J.Y.) Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, 675 N. Saint Clair Street, Galter Suite 19-250, Chicago, IL 60611, USA. (Connor C.M.) CORRESPONDENCE ADDRESS J.Y. Kim, Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, 675 N. Saint Clair Street, Galter Suite 19-250, Chicago, IL 60611, USA. Email: jokim@nmh.org SOURCE Plastic and reconstructive surgery (2012) 130:5 Suppl 2 (104S-15S). Date of Publication: Nov 2012 ISSN 1529-4242 (electronic) ABSTRACT Acellular dermal matrix has become a frequent adjunct to traditional expander-based breast reconstruction. Its putative advantages include improved positioning of the prosthesis, better definition of the inframammary fold, amelioration of potential contracture, and overall enhancement of cosmesis. Concomitantly, there may be an increased risk of seroma, infection, and reconstructive failure. A thorough review of the techniques and outcomes of two-stage acellular dermis-assisted breast reconstruction was performed. Key technical aspects of two-stage acellular dermal matrix-based reconstruction are presented. Indications, techniques of handling and inset, and select strategies to avoid and manage common complications are discussed. Evidence-based outcomes are reviewed. Acellular dermal matrix-based two-stage reconstruction continues to evolve as a viable option in breast reconstruction. Future studies will better delineate the risks and benefits of the technique. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation breast reconstruction tissue expander EMTREE MEDICAL INDEX TERMS breast tumor (surgery) equipment design esthetics evidence based medicine female forecasting human implant capsular contracture (etiology, prevention) mastectomy methodology nipple (surgery) patient selection pectoralis major muscle (surgery) postoperative complication (etiology, prevention) preoperative care retrospective study review risk surgical flaps suture technique treatment outcome LANGUAGE OF ARTICLE English MEDLINE PMID 23096958 (http://www.ncbi.nlm.nih.gov/pubmed/23096958) PUI L366371836 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 516 TITLE Focus on technique: supporting the soft-tissue envelope in breast reconstruction. AUTHOR NAMES Spear S.L. Sher S.R. Al-Attar A. AUTHOR ADDRESSES (Spear S.L.) Department of Plastic Surgery, Georgetown University Hospital, 3800 Reservoir Road, N.W., Washington, DC 20007, USA. (Sher S.R.; Al-Attar A.) CORRESPONDENCE ADDRESS S.L. Spear, Department of Plastic Surgery, Georgetown University Hospital, 3800 Reservoir Road, N.W., Washington, DC 20007, USA. Email: spears@gunet.georgetown.edu SOURCE Plastic and reconstructive surgery (2012) 130:5 Suppl 2 (89S-94S). Date of Publication: Nov 2012 ISSN 1529-4242 (electronic) ABSTRACT Prosthetic-based breast reconstruction commonly involves device placement in either a total submuscular pocket or a partial subpectoral position for just superior pole coverage, with various possible strategies for inferior pole coverage. Historically, the pectoralis major muscle is managed either by suturing the muscle to the inferior flap or with marionette sutures; alternatively, the device is placed under total muscle/fascia coverage (under the pectoralis major, plus the serratus anterior and rectus abdominis muscles or fascia). For many plastic surgeons, acellular dermal matrix is now used instead to function as a sling or "hammock" supporting the periprosthetic pocket and thus covering the inferior pole of the device, attached to the pectoralis major muscle above and to the inframammary fold below. In addition to its added soft-tissue support in the inferior pole, acellular dermal matrix may help to stabilize the pectoralis major muscle along its inferolateral margin, create a well-defined inframammary fold, provide the opportunity to significantly increase intraoperative fill volume of the tissue expander, and reduce the incidence or severity of significant or symptomatic capsular contracture, particularly in a patient whose breast has been treated with radiation. In addition to its indications in primary breast reconstruction, acellular dermal matrix has been increasingly used in secondary revision reconstruction cases. It can be used to buttress capsulorrhapy and capsulotomy sites and it can be used to replace periprosthetic capsule following capsulectomy. While clinical experience is accruing for these indications, acellular dermal matrix continues to be used in primary and secondary breast reconstruction. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation breast reconstruction implant capsular contracture (etiology, prevention) EMTREE MEDICAL INDEX TERMS breast tumor (surgery) esthetics evidence based medicine female human mastectomy methodology review skeletal muscle (surgery) surgical flaps suture technique tissue expander treatment outcome LANGUAGE OF ARTICLE English MEDLINE PMID 23096992 (http://www.ncbi.nlm.nih.gov/pubmed/23096992) PUI L366371869 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 517 TITLE Acellular dermal matrices in secondary aesthetic breast surgery: indications, techniques, and outcomes. AUTHOR NAMES Bengtson B. AUTHOR ADDRESSES (Bengtson B.) Bengtson Center for Aesthetics and Plastic Surgery and Michigan State University School of Medicine, MI, USA. CORRESPONDENCE ADDRESS B. Bengtson, Bengtson Center for Aesthetics and Plastic Surgery and Michigan State University School of Medicine, MI, USA. Email: drb@bengtsoncenter.com SOURCE Plastic and reconstructive surgery (2012) 130:5 Suppl 2 (142S-56S). Date of Publication: Nov 2012 ISSN 1529-4242 (electronic) ABSTRACT Acellular dermal matrices are integrally involved in the majority of expander-implant reconstructions and complex hernia repairs today, and they are now making their way into secondary aesthetic breast surgery. The number of revisional breast surgery cases has continued to increase as the materials and repair techniques have improved. The aesthetic outcome bar is constantly being raised, and the complexity of patient deformities often requires additional tissues to achieve a successful repair. The most common complications in breast augmentation are reviewed, along with indications and some current repair techniques, general principles, and specific caveats to help plastic surgeons deal with these complex and challenging patient problems utilizing acellular dermal matrices. EMTREE DRUG INDEX TERMS collagen (drug administration, drug therapy) surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation breast reconstruction EMTREE MEDICAL INDEX TERMS animal article biomechanics cost cutaneous parameters economics esthetics female human implant implant capsular contracture (etiology, prevention, surgery) methodology pathology pectoralis major muscle (surgery) postoperative care postoperative complication (etiology, prevention) reoperation suture technique tissue expander CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 23096964 (http://www.ncbi.nlm.nih.gov/pubmed/23096964) PUI L366371842 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 518 TITLE 16th Annual Meeting of the European Society of Surgery, ESS 2012 AUTHOR ADDRESSES SOURCE European Surgery - Acta Chirurgica Austriaca (2012) 44 SUPPL. 247. Date of Publication: November 2012 CONFERENCE NAME 16th Annual Meeting of the European Society of Surgery, ESS 2012 CONFERENCE LOCATION Istanbul, Turkey CONFERENCE DATE 2012-11-22 to 2012-11-24 ISSN 1682-8631 BOOK PUBLISHER Springer-Verlag Wien ABSTRACT The proceedings contain 200 papers. The topics discussed include: feasibility of nipple sparing mastectomy for early breast cancer and risk reducing surgery; comparison of histopathological findings and survival of bilateral synchronous, multifocal and multicentric breast carcinoma; value of magnetic resonance in breast cancer diagnosis and its influence on surgical treatment; the effect of neoadjuvant chemotherapy on hormone receptors and HER-2 status; peritoneal carcinomatosis: intraoperative and postoperative assessment of patients undergoing cytoreduction and HIPEC; use of an autogenous dermal graft and an acellular dermal matrix in the treatment of high transsphincteric perianal fistula in an animal model; standardized laparoscopic sphincter preserving total mesorectal excision for rectal cancer: long-term oncologic outcome in 217 unselected patients; medical treatment of acute appendicitis and the role of CRP on treatment; and colorectal resections during cytoreductive surgery and hipecin ovarian carcinomatosis. EMTREE DRUG INDEX TERMS hormone receptor EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) society surgery EMTREE MEDICAL INDEX TERMS acellular dermal matrix acute appendicitis adjuvant chemotherapy animal model anus fistula breast cancer breast carcinoma cancer diagnosis carcinomatosis cytoreductive surgery excision human mastectomy nipple nuclear magnetic resonance patient rectum cancer risk skin graft sphincter survival therapy LANGUAGE OF ARTICLE English PUI L71644785 COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 519 TITLE Discussion: Acellular dermal matrices in primary breast reconstruction: principles, concepts, and indications. AUTHOR NAMES Gabriel A. Maxwell G.P. AUTHOR ADDRESSES (Gabriel A.) Department of Plastic Surgery, Loma Linda University Medical Center, 11175 Campus Street, Suite 21126, Loma Linda, CA 92350, USA. (Maxwell G.P.) CORRESPONDENCE ADDRESS A. Gabriel, Department of Plastic Surgery, Loma Linda University Medical Center, 11175 Campus Street, Suite 21126, Loma Linda, CA 92350, USA. Email: gabrielallen@yahoo.com SOURCE Plastic and reconstructive surgery (2012) 130:5 Suppl 2 (54S-6S). Date of Publication: Nov 2012 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation breast reconstruction EMTREE MEDICAL INDEX TERMS female human methodology note LANGUAGE OF ARTICLE English MEDLINE PMID 23096986 (http://www.ncbi.nlm.nih.gov/pubmed/23096986) PUI L366371863 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 520 TITLE Discussion: The use of acellular dermal matrices in revisional breast reconstruction. AUTHOR NAMES Namnoum J.D. AUTHOR ADDRESSES (Namnoum J.D.) Atlanta Plastic Surgery, 975 Johnson Ferry Road, Atlanta, GA 30342, USA. CORRESPONDENCE ADDRESS J.D. Namnoum, Atlanta Plastic Surgery, 975 Johnson Ferry Road, Atlanta, GA 30342, USA. SOURCE Plastic and reconstructive surgery (2012) 130:5 Suppl 2 (86S-8S). Date of Publication: Nov 2012 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast breast augmentation (adverse drug reaction) breast reconstruction reoperation EMTREE MEDICAL INDEX TERMS animal female human methodology note radiation exposure LANGUAGE OF ARTICLE English MEDLINE PMID 23096991 (http://www.ncbi.nlm.nih.gov/pubmed/23096991) PUI L366371868 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 521 TITLE Discussion: The role of acellular dermal matrices in capsular contracture: a review of the evidence. AUTHOR NAMES Zienowicz R.J. AUTHOR ADDRESSES (Zienowicz R.J.) Department of Plastic Surgery, Brown University School of Medicine, Corliss Landing, 10 Bridge Street, Providence, RI 02905, USA. CORRESPONDENCE ADDRESS R.J. Zienowicz, Department of Plastic Surgery, Brown University School of Medicine, Corliss Landing, 10 Bridge Street, Providence, RI 02905, USA. Email: rzienowicz@lifespan.org SOURCE Plastic and reconstructive surgery (2012) 130:5 Suppl 2 (125S). Date of Publication: Nov 2012 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation breast reconstruction implant capsular contracture (prevention) tissue expander EMTREE MEDICAL INDEX TERMS female human methodology note LANGUAGE OF ARTICLE English MEDLINE PMID 23096961 (http://www.ncbi.nlm.nih.gov/pubmed/23096961) PUI L366371839 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 522 TITLE Discussion: Acellular dermal matrices in secondary aesthetic breast surgery: indications, techniques, and outcomes. AUTHOR NAMES Hammond D.C. AUTHOR ADDRESSES (Hammond D.C.) Partners in Plastic Surgery, Grand Rapids, MI, USA. CORRESPONDENCE ADDRESS D.C. Hammond, Partners in Plastic Surgery, Grand Rapids, MI, USA. Email: hammonddc@aol.com SOURCE Plastic and reconstructive surgery (2012) 130:5 Suppl 2 (157S-8S). Date of Publication: Nov 2012 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation breast reconstruction EMTREE MEDICAL INDEX TERMS animal female human methodology note LANGUAGE OF ARTICLE English MEDLINE PMID 23096965 (http://www.ncbi.nlm.nih.gov/pubmed/23096965) PUI L366371843 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 523 TITLE Discussion: Complications of acellular dermal matrices in breast surgery. AUTHOR NAMES Fosnot J. Serletti J.M. AUTHOR ADDRESSES (Fosnot J.) Division of Plastic Surgery, University of Pennsylvania Health System, 10 Penn Tower, 3400 Spruce Street, Philadelphia, PA 19104, USA. (Serletti J.M.) CORRESPONDENCE ADDRESS J. Fosnot, Division of Plastic Surgery, University of Pennsylvania Health System, 10 Penn Tower, 3400 Spruce Street, Philadelphia, PA 19104, USA. SOURCE Plastic and reconstructive surgery (2012) 130:5 Suppl 2 (173S-4S). Date of Publication: Nov 2012 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix (adverse drug reaction) breast augmentation breast reconstruction postoperative complication (etiology) EMTREE MEDICAL INDEX TERMS female human methodology note LANGUAGE OF ARTICLE English MEDLINE PMID 23096967 (http://www.ncbi.nlm.nih.gov/pubmed/23096967) PUI L366371845 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 524 TITLE Discussion: The use of acellular dermal matrices in two-stage expander/implant reconstruction: a multicenter, blinded, randomized controlled trial. AUTHOR NAMES Nahabedian M.Y. AUTHOR ADDRESSES (Nahabedian M.Y.) Georgetown University Hospital, 3800 Reservoir Road, N.W., Washington, DC 20007, USA. CORRESPONDENCE ADDRESS M.Y. Nahabedian, Georgetown University Hospital, 3800 Reservoir Road, N.W., Washington, DC 20007, USA. Email: drnahabedian@aol.com SOURCE Plastic and reconstructive surgery (2012) 130:5 Suppl 2 (67S-9S). Date of Publication: Nov 2012 ISSN 1529-4242 (electronic) EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen (drug therapy) EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation breast reconstruction postoperative pain (prevention) tissue expander EMTREE MEDICAL INDEX TERMS female human methodology note CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 23096988 (http://www.ncbi.nlm.nih.gov/pubmed/23096988) PUI L366371865 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 525 TITLE Use of dermal matrix to prevent capsular contracture in aesthetic breast surgery. AUTHOR NAMES Hester Jr. T.R. Ghazi B.H. Moyer H.R. Nahai F.R. Wilton M. Stokes L. AUTHOR ADDRESSES (Hester Jr. T.R.) Paces Plastic Surgery, 3200 Downwood Circle, Suite 640, Atlanta, GA 30327, USA. (Ghazi B.H.; Moyer H.R.; Nahai F.R.; Wilton M.; Stokes L.) CORRESPONDENCE ADDRESS T.R. Hester, Paces Plastic Surgery, 3200 Downwood Circle, Suite 640, Atlanta, GA 30327, USA. Email: viper09.rh@gmail.com SOURCE Plastic and reconstructive surgery (2012) 130:5 Suppl 2 (126S-36S). Date of Publication: Nov 2012 ISSN 1529-4242 (electronic) ABSTRACT Capsular contracture remains a challenging complication of implant-based aesthetic breast surgery despite improvements in implant design. The lowering of capsular contracture rates noted with the past use of polyurethane foam-covered implants has increased awareness of the importance of the biologic response at the interface between the implant surface and breast tissue. Emerging evidence indicates that much like the polyurethane foam, acellular dermal matrices alter the biologic response at the surface interface, resulting in a more vascular and less constrictive pattern of collagen deposition. This study reports on the authors' clinical experience using Strattice Reconstructive Tissue Matrix (LifeCell Corporation, Branchburg, N.J.) for the treatment of capsular contracture in patients with established capsules and for prevention in patients undergoing primary augmentation or augmentation/mastopexy. Of 80 patients (154 breasts) in whom Strattice was used, clinically significant contracture (Baker grade III/IV) occurred in three breasts (3.75 percent), all of which were in the treatment of previous contracture group. In addition, the authors noted two seromas requiring implant removal (both patients developed capsules, as mentioned above) and two hematomas requiring revision, for an overall failure rate of 6.25 percent for Strattice-assisted surgery. The data confirm that the use of Strattice significantly lowers the incidence of capsular contracture in the first 3.5 years after implant placement. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen (drug administration, drug therapy) EMTREE DRUG INDEX TERMS biomaterial polyurethan surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation breast reconstruction implant capsular contracture (epidemiology, prevention, surgery) EMTREE MEDICAL INDEX TERMS article breast implant device removal equipment design esthetics evaluation study female foreign body reaction (etiology, prevention) hematoma (etiology, surgery) human methodology pathology pectoralis major muscle (surgery) postoperative complication (etiology, prevention, surgery) retrospective study seroma (etiology, surgery) suture technique tissue expander treatment failure CAS REGISTRY NUMBERS collagen (9007-34-5) polyurethan (61789-63-7) LANGUAGE OF ARTICLE English MEDLINE PMID 23096962 (http://www.ncbi.nlm.nih.gov/pubmed/23096962) PUI L366371840 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 526 TITLE Discussion: Focus on technique: two-stage implant-based breast reconstruction. AUTHOR NAMES Cordeiro P.G. AUTHOR ADDRESSES (Cordeiro P.G.) Plastic and Reconstructive Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. CORRESPONDENCE ADDRESS P.G. Cordeiro, Plastic and Reconstructive Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. SOURCE Plastic and reconstructive surgery (2012) 130:5 Suppl 2 (116S-7S). Date of Publication: Nov 2012 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation breast reconstruction tissue expander EMTREE MEDICAL INDEX TERMS female human methodology note LANGUAGE OF ARTICLE English MEDLINE PMID 23096959 (http://www.ncbi.nlm.nih.gov/pubmed/23096959) PUI L366371837 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 527 TITLE Discussion: Use of dermal matrix to prevent capsular contracture in aesthetic breast surgery. AUTHOR NAMES Bengtson B. AUTHOR ADDRESSES (Bengtson B.) Bengtson Center for Aesthetics and Plastic Surgery and Michigan State University School of Medicine, Grand Rapids, MI, USA. CORRESPONDENCE ADDRESS B. Bengtson, Bengtson Center for Aesthetics and Plastic Surgery and Michigan State University School of Medicine, Grand Rapids, MI, USA. Email: drb@bengtsoncenter.com SOURCE Plastic and reconstructive surgery (2012) 130:5 Suppl 2 (137S-41S). Date of Publication: Nov 2012 ISSN 1529-4242 (electronic) EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen (drug therapy) EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation breast reconstruction implant capsular contracture (prevention) EMTREE MEDICAL INDEX TERMS female human methodology note CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 23096963 (http://www.ncbi.nlm.nih.gov/pubmed/23096963) PUI L366371841 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 528 TITLE Complications in tissue expander breast reconstruction: a comparison of AlloDerm, DermaMatrix, and FlexHD acellular inferior pole dermal slings. AUTHOR NAMES Brooke S. Mesa J. Uluer M. Michelotti B. Moyer K. Neves R.I. Mackay D. Potochny J. AUTHOR ADDRESSES (Brooke S.) Division of Plastic Surgery, The Pennsylvania State University, College of Medicine, Penn State Milton S. Hershey Medicine Center, Hershey, PA 17033-0850, USA. (Mesa J.; Uluer M.; Michelotti B.; Moyer K.; Neves R.I.; Mackay D.; Potochny J.) CORRESPONDENCE ADDRESS S. Brooke, Division of Plastic Surgery, The Pennsylvania State University, College of Medicine, Penn State Milton S. Hershey Medicine Center, Hershey, PA 17033-0850, USA. Email: sbrooke@hmc.psu.edu SOURCE Annals of plastic surgery (2012) 69:4 (347-349). Date of Publication: Oct 2012 ISSN 1536-3708 (electronic) ABSTRACT Acellular dermal matrix (ADM) is frequently used in tissue expander breast reconstruction (TEBR) for coverage of the inferior pole. Several published studies have suggested increased rates of complications with the use of ADM. It is unknown, however, if the type of ADM used for TEBR impacts complication rates. The aim of this study is to compare 3 different types of ADM for TEBR in regard to clinically significant complications, specifically infection. We performed a retrospective analysis of primary breast cancer-related TEBR with or without ADM. Exclusion criteria consisted of prior major breast surgery, inadequate data, or loss to follow-up. Reconstructions were grouped by dermal sling type, AlloDerm, DermaMatrix (DM), FlexHD (FHD), or no ADM. Complications included cellulitis, abscess, seroma, expander leak or puncture, skin necrosis, wound dehiscence, or hematoma. Those requiring admission to hospital or reoperation were considered significant. Of 284 breasts reconstructed, 49 used AlloDerm, 110 used DM, 62 used FHD, and 64 used no ADM. The total complication rate with AlloDerm was 22% [95% confidence interval (CI), 11-34], with DM was 15% (95% CI, 8-21), and with FHD was 18% (95% CI, 8-28) (P=0.47). Infectious complication rates for AlloDerm, DM, and FHD were equal at 10% (P=0.97). The total complication rate of all ADM reconstructions as a grouped cohort was 17% compared to 11% without ADM (P=0.48). The overall incidence of infectious complications with ADM was 10% compared to 2% without ADM (P=0.09). There is no difference in the clinically significant overall complication rate or incidence of infection between AlloDerm, DM, and FHD. Isolating infectious complications, there is a trend toward increased incidence with ADM compared to reconstructions without. EMTREE DRUG INDEX TERMS collagen surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation postoperative complication (epidemiology, etiology, surgery) skin transplantation tissue expansion EMTREE MEDICAL INDEX TERMS adult aged article breast tumor (surgery) comparative study evaluation study female hospital readmission human incidence mastectomy methodology middle aged reoperation retrospective study CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 22868313 (http://www.ncbi.nlm.nih.gov/pubmed/22868313) PUI L366382658 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 529 TITLE Utility of acellular dermis-assisted breast reconstruction in the setting of radiation: a comparative analysis. AUTHOR NAMES Seth A.K. Hirsch E.M. Fine N.A. Kim J.Y. AUTHOR ADDRESSES (Seth A.K.) Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill. 60611, USA. (Hirsch E.M.; Fine N.A.; Kim J.Y.) CORRESPONDENCE ADDRESS A.K. Seth, Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill. 60611, USA. SOURCE Plastic and reconstructive surgery (2012) 130:4 (750-758). Date of Publication: Oct 2012 ISSN 1529-4242 (electronic) ABSTRACT The role of acellular dermis in immediate prosthetic breast reconstruction remains unclear, particularly within a radiated field. The authors evaluated and compare outcomes following reconstruction with and without acellular dermis, and analyzed patients exposed to radiation therapy. Retrospective review of 417 consecutive patients (592 breasts) treated from January of 2006 to October of 2008 at one institution was performed. Relevant patient characteristics and follow-up were recorded. Complications were categorized by type and end outcome, including nonoperative, operative, or explantation. Both groups had comparable follow-up (acellular dermis, 23.2 ± 8.9 months; no acellular dermis, 24.4 ± 12.7 months; p = 0.23). Appropriate statistical analyses, including multiple regression, were performed. Acellular dermis patients (n = 199 breasts) had larger body mass indexes (p = 0.0001) and more nipple-sparing mastectomies (p = 0.04) than non-acellular dermis patients (n = 393 breasts). Breasts with acellular dermis had larger intraoperative fill volumes (p < 0.0001) and decreased postoperative expansions (p = 0.02), but no decrease in time to implant exchange. There were no significant differences in complication profiles between acellular dermis and non-acellular dermis breasts, after adjusting for other relevant patient variables on regression analysis. After stratifying patients by exposure to radiation, acellular dermis breasts had a decreased risk of all complications related to radiation as compared with non-acellular dermis breasts. This study suggests that acellular dermis does not adversely affect complication rates following prosthetic breast reconstruction. It may be advantageous, however, in select patients, particularly those undergoing postoperative radiation therapy. Therefore, the choice to use acellular dermis does not compromise outcomes but should be individualized to each patient. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction (adverse drug reaction) breast tumor (radiotherapy, surgery) skin transplantation (adverse drug reaction) tissue expansion EMTREE MEDICAL INDEX TERMS adjuvant therapy adult article cohort analysis comparative study female follow up graft rejection graft survival human mastectomy methodology middle aged multivariate analysis pathophysiology physiology postoperative complication (surgery) postoperative period regression analysis retrospective study risk risk assessment subcutaneous mastectomy time tissue expander treatment outcome utilization review wound healing LANGUAGE OF ARTICLE English MEDLINE PMID 23018687 (http://www.ncbi.nlm.nih.gov/pubmed/23018687) PUI L366356804 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 530 TITLE Human acellular dermis versus no acellular dermis in tissue expansion breast reconstruction. AUTHOR NAMES Parks J.W. Hammond S.E. Walsh W.A. Adams R.L. Chandler R.G. Luce E.A. AUTHOR ADDRESSES (Parks J.W.) Plastic Surgery Group of Memphis, Tenn., USA. (Hammond S.E.; Walsh W.A.; Adams R.L.; Chandler R.G.; Luce E.A.) CORRESPONDENCE ADDRESS J.W. Parks, Plastic Surgery Group of Memphis, Tenn., USA. SOURCE Plastic and reconstructive surgery (2012) 130:4 (739-746). Date of Publication: Oct 2012 ISSN 1529-4242 (electronic) ABSTRACT Human acellular dermis has been adopted for routine use in tissue expander reconstruction. The purported benefits include higher intraoperative fill volume, facilitation of lower pole expansion, and enhanced definition of the lower pole of the breast. Recently, concerns have arisen about an increase in postoperative complications with its use. A retrospective review was conducted of patients who had immediate postmastectomy breast reconstruction with a tissue expander from July of 2001 to July of 2011. All tissue expander reconstructions before 2005 were performed submuscularly only and all subsequent to 2005 with the use of AlloDerm (LifeCell, Branchburg, N.J.) acellular dermis. Patient demographics were collected, and complications were recorded. The study cohort included 346 patients and 511 immediate breast reconstructions; 232 patients and 346 breasts were reconstructed with and 114 patients and 165 breasts without acellular dermis. Age, body mass index, diabetes, and tobacco use were equivalent in the two groups. Seroma occurrence in the acellular dermis group was nearly twice (30.0 versus 15.1 percent) that of the no acellular dermis breasts, but the tissue expander loss was only slightly higher (11.6 versus 8.5 percent) and not statistically significant. Body mass index in patients who lost their tissue expander was 31 kg/m, statistically significantly higher than in those who did not. The presence of acellular dermis did not increase the incidence of tissue expander loss, despite a doubling of frequency of seroma. Prior radiation and use of acellular dermis did culminate in a prohibitively high loss rate of the tissue expander. EMTREE DRUG INDEX TERMS collagen surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction (adverse drug reaction) skin transplantation tissue expander tissue expansion EMTREE MEDICAL INDEX TERMS adult age aged article autotransplantation body mass breast tumor (surgery) cohort analysis comparative study female follow up graft rejection graft survival human mastectomy methodology middle aged pathophysiology physiology postoperative complication (surgery) postoperative period retrospective study risk assessment seroma (etiology) statistical model time wound healing CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 23018685 (http://www.ncbi.nlm.nih.gov/pubmed/23018685) PUI L366356802 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 531 TITLE Tissue expander with acellular dermal matrix for breast reconstruction infected by an unusual pathogen: Candida parapsilosis AUTHOR NAMES Fox P.M. Lee G.K. AUTHOR ADDRESSES (Fox P.M.; Lee G.K., glee@stanford.edu) Department of Surgery, Medical Center, Stanford University, 770 Welch Road, Palo Alto, CA 94304-5715, United States. CORRESPONDENCE ADDRESS G.K. Lee, Department of Surgery, Medical Center, Stanford University, 770 Welch Road, Palo Alto, CA 94304-5715, United States. Email: glee@stanford.edu SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2012) 65:10 (e286-e289). Date of Publication: October 2012 ISSN 1748-6815 1878-0539 (electronic) BOOK PUBLISHER Churchill Livingstone, 1-3 Baxter's Place, Leith Walk, Edinburgh, United Kingdom. ABSTRACT Infections occur in approximately 2-5% percent of women undergoing breast reconstruction by tissue expansion depending on patient characteristics and timing of reconstruction. Bacteria, specifically Staphylococci, are the most common pathogens. Treatment varies depending on the surgeon and the aggressiveness of the infection. We report a case of unilateral tissue expander infection with Candida parapsilosis in an otherwise healthy female undergoing immediate tissue expander placement after bilateral nipple-sparing mastectomies. The patient was treated with a one-stage irrigation, debridement, and tissue expander exchange as well as a 21-day course of oral antifungal therapy. Her infection resolved and she was able to complete her implant-based reconstruction. C. parapsilosis is usually responsible for infections in critically ill patients found in association with central lines, peritoneal dialysis catheters and prosthetic heart valves. The affinity of C. parapsilosis for foreign material makes it a causative agent worth considering in difficult to treat tissue expander infections. © 2012 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. All rights reserved. EMTREE DRUG INDEX TERMS bacitracin cefazolin (intravenous drug administration) cotrimoxazole (oral drug administration) fluconazole (drug therapy, oral drug administration) silicone gel EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction Candida parapsilosis candidiasis (drug therapy, drug therapy, etiology) implant EMTREE MEDICAL INDEX TERMS adult article breast cancer (surgery) case report coagulase negative Staphylococcus debridement drug megadose erythema female hospital admission hospital discharge hospitalization human lavage length of stay mastectomy needle biopsy operating room postoperative pain postoperative period priority journal CAS REGISTRY NUMBERS bacitracin (1405-87-4) cefazolin (25953-19-9, 27164-46-1) cotrimoxazole (8064-90-2) fluconazole (86386-73-4) EMBASE CLASSIFICATIONS Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Surgery (9) Cancer (16) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012551131 MEDLINE PMID 22633394 (http://www.ncbi.nlm.nih.gov/pubmed/22633394) PUI L52027547 DOI 10.1016/j.bjps.2012.04.049 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2012.04.049 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 532 TITLE Veritas® bovine pericardium for immediate breast reconstruction: A xenograft alternative to acellular dermal matrix products AUTHOR NAMES Mofid M.M. Meininger M.S. Lacey M.S. AUTHOR ADDRESSES (Mofid M.M., drmofid@mofidplasticsurgery.com) Division of Plastic Surgery, University of California San Diego, 4150 Regents Park Row, San Diego, CA 92037, United States. (Meininger M.S.) Division of Plastic Surgery, Wayne State University, 1080 Kirts Blvd, Troy, MI 48084, United States. (Lacey M.S.) Department of Plastic and Hand Surgery, University of Minnesota, Minneapolis, Mail Stop 11503B, 640 Jackson Street, St. Paul, MN 55101, United States. CORRESPONDENCE ADDRESS M.M. Mofid, Division of Plastic Surgery, University of California San Diego, 4150 Regents Park Row, San Diego, CA 92037, United States. Email: drmofid@mofidplasticsurgery.com SOURCE European Journal of Plastic Surgery (2012) 35:10 (717-722). Date of Publication: October 2012 ISSN 0930-343X 1435-0130 (electronic) BOOK PUBLISHER Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany. ABSTRACT Background The technical advantages in utilizing human acellular dermalmatrix (ADM) products as pectoral extenders in immediate breast reconstruction with tissue expanders or implants are well documented in the medical literature. In this study, the authors examine a commonly used biologic xenograft product that has not yet been described in the medical literature for use in immediate breast reconstruction to determine whether a lower overall complication rate is identified compared to published data on ADM products. Methods A retrospective multicenter medical record review of data on 54 subjects in 93 tissue expander/implant-based, consecutive, immediate breast reconstructions from three surgeons at different institutions was performed in which Veritas® bovine pericardium was used as the biologic graft material for the pectoral extender. Results Over a 24-month period with an average of 11-month follow-up, complication rates using Veritas® in breast reconstruction for seroma formation (7.5 %), marginal skin flap necrosis (5.4 %) infection (6.5 %), and capsular contracture (0 %) were found to compare equally or favorably with statistically significant lower overall complications relative to one comparison study and lower rates of marginal skin flap necrosis relative to two comparison studies based upon previously published data from multisurgeon studies using ADM products. Conclusions Overall complications were found to be lower with Veritas® than ADM products in comparable multisurgeon studies, though this was found to be statistically significant in only one comparison study. Level of Evidence: Level II, theraputic study. © The Author(s) 2012. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction cow pericardium EMTREE MEDICAL INDEX TERMS adult article cancer chemotherapy cancer radiotherapy device removal female follow up graft necrosis (complication) hematoma (complication) human implant implant capsular contracture (complication) major clinical study medical record review multicenter study postoperative infection (complication) postoperative period priority journal Pseudomonas infection (complication) retrospective study seroma (complication) silicone prosthesis Staphylococcus infection (complication) xenograft DEVICE TRADE NAMES Veritas EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) CLINICAL TRIAL NUMBERS ClinicalTrials.gov (NCT01454713) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012569819 PUI L52065166 DOI 10.1007/s00238-012-0736-9 FULL TEXT LINK http://dx.doi.org/10.1007/s00238-012-0736-9 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 533 TITLE Titanized mesh for immediate prosthetic reconstruction of large/extra-large breasts AUTHOR NAMES Garganese G. Fragomeni S. Cervelli D. Magno S. Marazzi F. Arena V. Masetti R. Scambia G. AUTHOR ADDRESSES (Garganese G.; Fragomeni S.; Scambia G.) Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy. (Cervelli D.) Division of Plastic Surgery, Catholic University of the Sacred Heart, Rome, Italy. (Magno S.; Masetti R.) Institute of Surgery, Breast Division, Catholic University of the Sacred Heart, Rome, Italy. (Marazzi F.) Institute of Radiotherapy, Catholic University of the Sacred Heart, Rome, Italy. (Arena V.) Institute of Pathology, Catholic University of the Sacred Heart, Rome, Italy. CORRESPONDENCE ADDRESS G. Garganese, Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy. SOURCE International Journal of Gynecology and Obstetrics (2012) 119 SUPPL. 3 (S686-S687). Date of Publication: October 2012 CONFERENCE NAME 20th FIGO World Congress of Gynecology and Obstetrics CONFERENCE LOCATION Rome, Italy CONFERENCE DATE 2012-10-07 to 2012-10-12 ISSN 0020-7292 BOOK PUBLISHER Elsevier Ireland Ltd ABSTRACT Objectives: Skin-sparing and nipple-sparing mastectomies (SSM/ NSM) offer oncologically safe and cosmetically superior results compared with non-sparing procedures. Immediate one-step prosthetic reconstruction is feasible in small breasts (<300 cc); conversely in medium/large breasts (300-400/400-500 cc) implant size may significantly exceed the retro-pectoral pocket, requiring either one-step autologous tissue procedures (microsurgical skilled team, longer operation and hospital stay) or two-stage expander/implant reconstruction (higher cost and complication rates). Tissue supplements, joining to the pectoralis major muscle, enlarge the retro-pectoral pocket and allow a one-step prosthetic reconstruction also in medium/large breasts. Devices like AlloDerm entail possible allergic/immune responses, graft sloughing/failure, disease transmission and high cost, while polypropylene meshes may lead to inflammation and capsular contraction. “Titanized” polypropylene meshes (TiloopBra) have overcome these limitations. Materials: The study was conducted from november 2010 to June 2011. Firstly a Tiloop was implanted in a porcine hemithorax to assess its compatibility with radiotherapy (RT) and the main diagnostic imaging techniques (MRI, CT and US). Methods: One-step prosthetic reconstruction was then successfully performed implanting 5 Tiloops in 5 large breast patients (pts) after 2 NSM and 3 SSM (implant size range 410-520 cc); 7 more Tiloops were implanted in 5 extra-large breast pts (>500 cc) after 3 SSM (1 bilateral) and 2 skin-reducing mastectomies (1 bilateral) (implant size range 550-775 cc). In all 10 pts (Tab 1) reconstruction was performed prolonging muscle coverage by a large size mesh. Contralateral breast mastopexy or reductive mammoplasty was performed to improve symmetry. Results: Twelve Tiloop were implanted without early complications. Good symmetry was achieved in all cases (median patient satisfaction score 8/10). Postoperative pain on the Verbal Pain Scale was low to mild. Wound healing was achieved in 2 weeks. Four pts required post-mastectomy RT, performed without complications. Median follow up was 38 weeks. Conclusions: Tiloop allows one-step prosthetic reconstruction in large and extra-large breasts. Our preliminary data show low rates of early complications and high patient satisfaction. Larger series and longer FU are needed to assess possible complications after RT, capsular contracture and recurrence rates. (Table Presented) . EMTREE DRUG INDEX TERMS polypropylene EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast gynecology obstetrics EMTREE MEDICAL INDEX TERMS breast reconstruction contracture devices diagnostic imaging disease transmission follow up hospitalization human implant inflammation mastectomy microsurgery muscle nipple pain assessment patient patient satisfaction pectoralis major muscle postoperative pain procedures radiotherapy recurrence risk skin tissues wound healing LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70906577 DOI 10.1016/S0020-7292(12)61674-9 FULL TEXT LINK http://dx.doi.org/10.1016/S0020-7292(12)61674-9 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 534 TITLE Discussion: Human acellular dermis versus no acellular dermis in tissue expansion breast reconstruction. AUTHOR NAMES Slavin S.A. AUTHOR ADDRESSES (Slavin S.A.) Harvard Medical School, Brookline, Mass. 02446, USA. CORRESPONDENCE ADDRESS S.A. Slavin, Harvard Medical School, Brookline, Mass. 02446, USA. Email: ssbsj@aol.com SOURCE Plastic and reconstructive surgery (2012) 130:4 (747-748). Date of Publication: Oct 2012 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction skin transplantation tissue expander tissue expansion EMTREE MEDICAL INDEX TERMS female human methodology note LANGUAGE OF ARTICLE English MEDLINE PMID 23018686 (http://www.ncbi.nlm.nih.gov/pubmed/23018686) PUI L366356803 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 535 TITLE A simple technique to enhance breast aesthetics using porcine acellular dermal matrix (Strattice) in breast reconstruction. AUTHOR NAMES Abood A. Rhodes N. AUTHOR ADDRESSES (Abood A.) Royal Adelaide Hospital, Adelaide, South Australia, Australia. (Rhodes N.) CORRESPONDENCE ADDRESS A. Abood, Royal Adelaide Hospital, Adelaide, South Australia, Australia. Email: ahidabood@hotmail.com SOURCE Plastic and reconstructive surgery (2012) 130:4 (633e-634e). Date of Publication: Oct 2012 ISSN 1529-4242 (electronic) EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction skin transplantation EMTREE MEDICAL INDEX TERMS article esthetics female human methodology physiology wound healing CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 23018740 (http://www.ncbi.nlm.nih.gov/pubmed/23018740) PUI L366356849 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 536 TITLE Applications of Biomaterials in Plastic Surgery AUTHOR NAMES Kim J.J. Evans G.R.D. AUTHOR ADDRESSES (Kim J.J.; Evans G.R.D., gevans@uci.edu) Aesthetic and Plastic Surgery Institute, University of California, School of medicine, Irvine, 200 South Manchester, Suite 650, Orange, CA 92868, United States. CORRESPONDENCE ADDRESS G.R.D. Evans, Aesthetic and Plastic Surgery Institute, The University of California, Irvine, 200 South Manchester, Suite 650, Orange, CA 92868, United States. Email: gevans@uci.edu SOURCE Clinics in Plastic Surgery (2012) 39:4 (359-376). Date of Publication: October 2012 ISSN 0094-1298 1558-0504 (electronic) BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT The expansion of the application of biomaterials in plastic surgery has led to the increased availability of commercial products in recent years. This overview discusses soft tissue fillers, bioengineered skins, acellular dermal matrices, biomaterials for craniofacial surgery, and peripheral nerve repair. We summarize indications, properties, uses, types, advantages and disadvantages of some of the currently available products from each category. Finally, the current state of development in drug delivery system is also briefly summarized. © 2012. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) biomaterial EMTREE DRUG INDEX TERMS alginic acid calcium phosphate carboxymethylcellulose chondroitin 6 sulfate collagen elastomer fibrin glue gelatin heparin (drug therapy, pharmaceutics) hyaluronic acid hydroxyapatite marlex methacrylic acid methyl ester microsphere nylon pectin politef poly(methyl methacrylate) polycaprolactone polyethylene polyglactin polyglycolic acid polylactic acid recombinant growth factor silicone silver wound dressing EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) plastic surgery EMTREE MEDICAL INDEX TERMS acellular dermal matrix bioengineering bioprosthesis breast reconstruction central nervous system disease (drug therapy) controlled drug release craniofacial surgery drug delivery system epidermis foam dressing freeze drying human hydrocolloid dressing hydrogel keratinocyte nerve regeneration peripheral neuropathy (drug therapy) review skin fibroblast tissue engineering treatment indication wound dressing wound healing DRUG TRADE NAMES dexon vicryl DEVICE TRADE NAMES Acticoat , United KingdomSmith and Nephew Algicell Ag , United StatesDerma Sciences Algicell Calcium Alginate , United StatesDerma Sciences AlgiDERM , United StatesBard Allevyn , United KingdomSmith and Nephew AlloDerm , United StatesLifecell AlloMax , United StatesDavol Apligraft , United StatesOrganogenesis Aquacel Ag , United StatesConvatec Aquasite , United Statesdermasciences ArteCol , United StatesArtes ArteFill , United StatesArtes Biobrane , United KingdomSmith and Nephew Bioseed-S , GermanyBio Tissue BoneSource , GermanyStryker Leibinger CarraDres , United StatesCarrington CellerateRX , United StatesWound Care Innovations CellSpray , United StatesAvita Colactive , United KingdomSmith and Nephew Comfeel Triad , United StatesColoplast Cosmoderm , United StatesInamed Aesthetics Cosmoplast , United StatesInamed Aesthetics Cymetra , United StatesLifecell DermACELL , United Stateslifenet health Dermagraft , United StatesAdvanced BioHealing DermaMatrix , United StatesSynthes DuoDERM , United StatesConvatec Epicel , United StatesGenzyme EZ Derm , United StatesGenzyme FlexHD , United StatesEthicon GraftJacket , United StatesWright Hyalomatrix 3D , ItalyFidia Advanced Biopolymers Hyalomatrix PA , FranceAddmedica Hydrocol , United StatesBertek Hylaform Plus , United StatesInamed Aesthetics Hylaform , United StatesInamed Aesthetics Integra , United StatesIntegra Invacare Hydrocolloid , United StatesInvacare Iodoflex Pad , United StatesHealthpoint Iodosorb Gel , United StatesHealthpoint Juvederm , United StatesAllergan KALTOSTAT , United StatesConvatec Medifill , United StatesHuman Biosciences Mimix , United StatesWalter Lorenz MySkin , United KingdomAltrika NeuraGen , United StatesIntegra Neurolac , NetherlandsPolyganics NeuroMatrix , United StatesCollagen Matrix Neurotube , United StatesSynovis Norian , United StatesSynthes Oasis Wound Matrix , United StatesCook Biotech OrCel , United StatesOrtec Permacol , United StatesCovidien Promogran wound matrix , United KingdomSystagenix Radiesse , United StatesBioform Medical Restore Hydrogel , United StatesHollister Stier Restylane , United StatesMedicis Scultra , United StatesDermik Laboratories Silvercel , United StatesJohnson and Johnson Silverlon , United StatesSilverlon Consumer Products Strattice , United StatesLifecell SurgiMend , United StatesTEI Surgisis , United StatesCook Biotech Tegagen , United States3M Tegasorb , United States3M TransCyte , United StatesAdvanced BioHealing VivoDerm , United StatesER Squibb and Co DEVICE MANUFACTURERS (United States)3M (France)Addmedica (United States)Advanced BioHealing (United States)Allergan (United Kingdom)Altrika (United States)Artes (United States)Avita (United States)Bard (United States)Bertek (Germany)Bio Tissue (United States)Bioform Medical (United States)Carrington (United States)Collagen Matrix (United States)Coloplast (United States)Convatec (United States)Cook Biotech (United States)Covidien (United States)Davol (United States)Derma Sciences (United States)dermasciences (United States)Dermik Laboratories (United States)ER Squibb and Co (United States)Ethicon (Italy)Fidia Advanced Biopolymers (United States)Genzyme (United States)Healthpoint (United States)Hollister Stier (United States)Human Biosciences (United States)Inamed Aesthetics (United States)Integra (United States)Invacare (United States)Johnson and Johnson (United States)Lifecell (United States)lifenet health (United States)Medicis (United States)Organogenesis (United States)Ortec (Netherlands)Polyganics (United States)Silverlon Consumer Products (United Kingdom)Smith and Nephew (Germany)Stryker Leibinger (United States)Synovis (United States)Synthes (United Kingdom)Systagenix (United States)TEI (United States)Walter Lorenz (United States)Wound Care Innovations (United States)Wright CAS REGISTRY NUMBERS alginic acid (28961-37-7, 29894-36-8, 9005-32-7, 9005-38-3) calcium phosphate (10103-46-5, 13767-12-9, 14358-97-5, 7758-87-4) carboxymethylcellulose (8050-38-2, 9000-11-7, 9004-32-4, 9050-04-8) chondroitin 6 sulfate (25322-46-7) collagen (9007-34-5) gelatin (9000-70-8) heparin (37187-54-5, 8057-48-5, 8065-01-8, 9005-48-5) hyaluronic acid (31799-91-4, 9004-61-9, 9067-32-7) hydroxyapatite (1306-06-5, 51198-94-8) methacrylic acid methyl ester (80-62-6) pectin (9000-69-5) politef (9002-84-0, 9039-02-5) poly(methyl methacrylate) (39320-98-4, 9008-29-1) polycaprolactone (24980-41-4, 25248-42-4) polyethylene (9002-88-4) polyglactin (26780-50-7, 34346-01-5) polyglycolic acid (26009-03-0, 26124-68-5, 26202-08-4) polylactic acid (26100-51-6) silicone (63148-53-8, 8043-93-4, 8055-24-1) silver (7440-22-4) EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) Pharmacy (39) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012587757 MEDLINE PMID 23036287 (http://www.ncbi.nlm.nih.gov/pubmed/23036287) PUI L365785809 DOI 10.1016/j.cps.2012.07.007 FULL TEXT LINK http://dx.doi.org/10.1016/j.cps.2012.07.007 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 537 TITLE Discussion: Utility of acellular dermis-assisted breast reconstruction in the setting of radiation: a comparative analysis. AUTHOR NAMES McCarthy C.M. Cordeiro P.G. AUTHOR ADDRESSES (McCarthy C.M.) Memorial Sloan-Kettering Cancer Center, New York, NY 10021-6007, USA. (Cordeiro P.G.) CORRESPONDENCE ADDRESS C.M. McCarthy, Memorial Sloan-Kettering Cancer Center, New York, NY 10021-6007, USA. SOURCE Plastic and reconstructive surgery (2012) 130:4 (759-760). Date of Publication: Oct 2012 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction breast tumor (radiotherapy) skin transplantation tissue expansion EMTREE MEDICAL INDEX TERMS female human methodology note utilization review LANGUAGE OF ARTICLE English MEDLINE PMID 23018688 (http://www.ncbi.nlm.nih.gov/pubmed/23018688) PUI L366356805 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 538 TITLE New technologies in breast cancer surgery AUTHOR NAMES Thill M. Baumann K. AUTHOR ADDRESSES (Thill M., marc.thill@fdk.info; Baumann K.) Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Lbeck Campus, Germany. (Thill M., marc.thill@fdk.info) Department of Gynecology and Obstetrics, Agaplesion Markus Hospital, Breast Cancer Center, Wilhelm-Epstein-Straße 4, 60431 Frankfurt, Germany. CORRESPONDENCE ADDRESS M. Thill, Department of Gynecology and Obstetrics, Agaplesion Markus Hospital, Breast Cancer Center, Wilhelm-Epstein-Straße 4, 60431 Frankfurt, Germany. Email: marc.thill@fdk.info SOURCE Breast Care (2012) 7:5 (370-376). Date of Publication: October 2012 ISSN 1661-3791 1661-3805 (electronic) BOOK PUBLISHER S. Karger AG, Allschwilerstrasse 10, P.O. Box, Basel, Switzerland. ABSTRACT Since breast-conserving surgery has become the gold standard for early breast cancer, the development of less radical or less burdensome technologies has been pressed for in order to preserve the patient from unnecessary harm through the operative procedure. Different technical approaches are under evaluation, and some of them are already being used in the clinical setting. The aim of this article is to present a perspective on future breast cancer surgery by shedding light on the current innovative and new techniques. © 2012 S. Karger GmbH, Freiburg. EMTREE DRUG INDEX TERMS blue dye dye indocyanine green serum albumin tc 99m sienna (subcutaneous drug administration) tracer unclassified drug EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (radiotherapy, surgery) surgical technique EMTREE MEDICAL INDEX TERMS accuracy acellular dermal matrix automation breast reconstruction cancer cytodiagnosis cancer localization diffuse reflectance spectroscopy early cancer (surgery) fluorescence imaging frozen section histopathology human intraductal carcinoma (surgery) intraoperative radiotherapy intrinsic fluorescence spectroscopy nonhuman nucleic acid amplification partial mastectomy patient safety portable equipment priority journal radiofrequency spectroscopy review sensitivity and specificity sentinel lymph node single photon emission computed tomography spectroscopy surgical equipment surgical margin three dimensional imaging tumor invasion (diagnosis) DRUG TRADE NAMES sienna DEVICE TRADE NAMES Alloderm , United StatesLifecell declipseSPECT , GermanySurgicEye GmbH Epiflex , GermanyDIZG Harmonic Focus Curved Shears , GermanyEthicon Endo Surgery MarginProbe , United StatesDune Medical Devices SentiMag probe , United KingdomEndomagnetics SentiMag probe , GermanySysmex GmbH SpectroPen Strattice , United StatesLifecell SurgiMend , GermanyPolytech Health and Aesthetics DEVICE MANUFACTURERS (Germany)DIZG (United States)Dune Medical Devices (United Kingdom)Endomagnetics (Germany)Ethicon Endo Surgery (United States)Lifecell (Germany)Polytech Health and Aesthetics (Germany)SurgicEye GmbH (Germany)Sysmex GmbH (Japan)Sysmex CAS REGISTRY NUMBERS indocyanine green (3599-32-4) EMBASE CLASSIFICATIONS General Pathology and Pathological Anatomy (5) Surgery (9) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English, German EMBASE ACCESSION NUMBER 2012652782 PUI L365995042 DOI 10.1159/000343660 FULL TEXT LINK http://dx.doi.org/10.1159/000343660 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 539 TITLE The use of biomaterials for chest wall reconstruction 30 years after radical surgery and radiation AUTHOR NAMES Rocco G. Mori S. Fazioli F. La Rocca A. Martucci N. Setola S. AUTHOR ADDRESSES (Rocco G., gaetano.rocco@btopenworld.com; La Rocca A.; Martucci N.) Department of Thoracic Surgery and Oncology, National Cancer Institute, Pascale Foundation, Via Semmola 81, 80131, Naples, Italy. (Mori S.) Service of Reconstructive Surgery, National Cancer Institute, Pascale Foundation, Naples, Italy. (Fazioli F.) Service of Orthopedic Surgery, National Cancer Institute, Pascale Foundation, Naples, Italy. (Setola S.) Department of Radiodiagnostics, National Cancer Institute, Pascale Foundation, Naples, Italy. CORRESPONDENCE ADDRESS G. Rocco, Department of Thoracic Surgery and Oncology, National Cancer Institute, Pascale Foundation, Via Semmola 81, 80131, Naples, Italy. Email: gaetano.rocco@btopenworld.com SOURCE Annals of Thoracic Surgery (2012) 94:4 (e109-e110). Date of Publication: October 2012 ISSN 0003-4975 1552-6259 (electronic) BOOK PUBLISHER Elsevier USA, 6277 Sea Harbor Drive, Orlando, United States. ABSTRACT The combination of titanium plates and acellular collagen matrix was used to restore anterior chest wall integrity in a 68-year-old woman more than 30 years after a Halsted mastectomy and radiation treatment. A vertical rectus abdominis muscle flap was used for myocutaneous coverage of the reconstructed chest wall. Partial necrosis of the flap caused prolonged exposure of the collagen matrix and the titanium plates, which were then covered with a free skin graft. Long-term results were satisfactory despite continued infection treated with vacuum-assisted closure and surgical debridement. Recently introduced materials for chest wall reconstruction may offer resilience to infection, tolerability, and stability, and their use may be contemplated when the potential for local morbidity is high. © 2012 The Society of Thoracic Surgeons. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen titanium EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) thorax wall reconstruction vertical rectus abdominis musculocutaneous flap EMTREE MEDICAL INDEX TERMS aged article breast carcinoma (radiotherapy, surgery) case report chemoradiotherapy debridement female free skin graft graft necrosis (complication) human infection control mastectomy postoperative infection (surgery) priority journal vacuum assisted closure CAS REGISTRY NUMBERS collagen (9007-34-5) titanium (7440-32-6) EMBASE CLASSIFICATIONS Chest Diseases, Thoracic Surgery and Tuberculosis (15) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012569452 MEDLINE PMID 23006719 (http://www.ncbi.nlm.nih.gov/pubmed/23006719) PUI L365716570 DOI 10.1016/j.athoracsur.2012.08.029 FULL TEXT LINK http://dx.doi.org/10.1016/j.athoracsur.2012.08.029 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 540 TITLE Local carboxytherapy: New technology for gynecologists and obstetricians to accelerate and improve the closure of dehiscent surgical wounds AUTHOR NAMES Elias J. Carbone A. Gaspar A. Blugerman G. Schavelzon D. Pelosi M. Pelosi M. Galich M. AUTHOR ADDRESSES (Elias J.; Carbone A.; Galich M.) Sociedad de Obstetricia y Ginecologia de Buenos Aires (SOGIBA), Buenos Aires, Argentina. (Elias J.; Carbone A.; Gaspar A.; Pelosi M.; Pelosi M.) Pelosi Medical Center, Bayonne-New Jersey, United States. (Gaspar A.) Universidad de Mendoza, Mendoza, Argentina. (Elias J.; Carbone A.; Blugerman G.; Schavelzon D.) Centros ByS, Ciudad de Buenos Aires, Argentina. CORRESPONDENCE ADDRESS J. Elias, Sociedad de Obstetricia y Ginecologia de Buenos Aires (SOGIBA), Buenos Aires, Argentina. SOURCE International Journal of Gynecology and Obstetrics (2012) 119 SUPPL. 3 (S697). Date of Publication: October 2012 CONFERENCE NAME 20th FIGO World Congress of Gynecology and Obstetrics CONFERENCE LOCATION Rome, Italy CONFERENCE DATE 2012-10-07 to 2012-10-12 ISSN 0020-7292 BOOK PUBLISHER Elsevier Ireland Ltd ABSTRACT Objectives: The problem originating in open surgical wounds in the postoperative period is serious and not uncommon. Some forms of accelerating healing and the improvement of this process show a good resolution in terms of healing, but not in appearance. We present a methodology to achieve a faster resolution that is nearly complete for aesthetics and function, with little or no formation of scarring. Materials: CO2 was used in 10 patients with dehiscent wounds: 6 abdominal surgeries, 2 vulvovaginal, 1 breast lumpectomy and 1 foot surgery wound. All involved Dermo Thera® equipment; designed and intended for gynecologists, with hand pieces for the vagina and/or cervix, neck treatments and cutaneous superficial treatments. Sessions every 48 to 72 hours. We took a sample of the closed wound before its final apposition for an anatomical-pathological study of the growth tissue, and compared it with samples of tissue corresponding to wounds not closed with CO2. Methods: Study prospective, observational and descriptive. Results: We obtained a faster closure (according to the size of the dehiscence) and aesthetically very acceptable in the ten patients (100%), both factors were far superior to those achieved with the current treatments. Histopathological studies clearly showed the best neo-vascularization, minimal or absent inflammatory infiltrate, less significant fibrous reaction and an effective, ordered and faster collagenogenesis when comparing them to the standard/current treatments. Conclusions: Carboxytherapy has demonstrated the pathophysiological effect for the success of this treatment compared to treatment to the present. The Bohr effect caused by an increased pressure of the injected gas (CO2) causes rapid increase in arteriolar blood velocity, and the resulting higher flow rate causes an immediate transfer of O2 at high pressure and immediate 'interstitial fluid cleaning' of extracellular fluid by full reabsorption of toxic free radicals and cellular debris. This phenomenon forms the basis of the acceleration and improved circulation, improving skin healing and neovascularization, evidenced by more effective and sooner neocollagenogenesis and wound closure. In summary, we believe this study demonstrates the enormous benefits of Carboxytherapy for the quick physiological and aesthetic healing of surgical wounds. EMTREE DRUG INDEX TERMS clobetasol propionate free radical EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) gynecologist gynecology human obstetrics surgical wound technology EMTREE MEDICAL INDEX TERMS abdominal surgery acceleration blood flow velocity Bohr effect breast collagen synthesis extracellular fluid flow rate foot surgery gas healing histopathology hyperbarism inflammatory infiltrate interstitial fluid methodology neck neovascularization (pathology) partial mastectomy patient postoperative period scar formation skin tissues vagina vascularization wound wound closure LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70906605 DOI 10.1016/S0020-7292(12)61702-0 FULL TEXT LINK http://dx.doi.org/10.1016/S0020-7292(12)61702-0 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 541 TITLE Primary and secondary prophylactic nipple-sparing subcutaneous mastectomy (NSSM): A retrospective single-center analysis AUTHOR NAMES Paepke S. Allhorn S. Kiechle M. AUTHOR ADDRESSES (Paepke S.; Allhorn S.; Kiechle M.) Klinikum r.d. Isar Frauenklinik, Technische Universitaet Muenchen, Munich, Germany; Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Department of Obstetrics and Gynecology, Klinikum r.d. Isar Frauenklinik, Technische Universitaet Muenchen, Munich, Germany CORRESPONDENCE ADDRESS S. Paepke, SOURCE Journal of Clinical Oncology (2012) 30:27 SUPPL. 1. Date of Publication: 20 Sep 2012 CONFERENCE NAME 2012 Breast Cancer Symposium CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2012-09-13 to 2012-09-15 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology ABSTRACT Background: Given a strict indication the NSSM is a oncologically safe surgical procedure and allows breast reconstructive interventions with a good cosmetic result. With regard to prophylactic mastectomy (PM) the (radical) ablatio mammae is so far regarded as the therapy of choice, since a maximal removement of the breast glandular tissue seems ensured. So far, it is unclear if NSSM is a oncologically safe treatment option also in the context of prophylactic surgery. The introduction of new materials for tissue extension in plastic-reconstructive interventions such as porcine acellular dermis (Strattice) or titanized polypropylene meshes (TiLoopBra ) permits the reconstruction of the natural breast shape and size and thus the preservation of the body integrity also in prophylactic operations. Methods: This is a retrospective analysis of the PM performed at the Department of OB/GYN of the TU München (Munich, Germany) between 01/2005 and 12/2011 (76 cases). Primary PM were done in 13 cases due to positive family history (n=3), BRCA mutations (n=9) or at the request of the patient (n=1). 63 breast cancer patients were operated (secondary contralateral mastectomies) because of a positive familiy history (n=21), BRCA mutations (n=17) or high need for security (n=25). 19 mastectomies and 57 NSSMs were performed. With all NSSMs an instant reconstruction was done (17x expander, 25x implants, 1x TRAM, 14x DIEP), in 42 patients using a tissue extension (titanized poylpropylene meshes or acellular dermis). 9 patients with ablatio mammae received a breast reconstruction. Results: There was a continuous increase in prophylactic operations and NSSMs over the past five years. In four patients there was a coincidental pathological finding diagnosed in the healthy breast (2x DCIS, 1x Ca, 1x CLIS). In the group of primary prophylactic operated patients there were no (pre-)cancerous lesions found. In the secondary PM patients there were no recurrences, secondary cancers or metastases. Conclusions: In conclusion there was no difference between both surgical techniques with regard to oncologic safety. As far as breast reconstructive possibilities are concerned there are clear advantages in NSSM. EMTREE DRUG INDEX TERMS cosmetic plastic polypropylene EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer nipple subcutaneous mastectomy EMTREE MEDICAL INDEX TERMS acellular dermal matrix breast breast reconstruction cancer patient family history Germany human implant intraductal carcinoma mastectomy metastasis mutation patient preservation safety surgery surgical technique therapy tissues udder LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71086114 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 542 TITLE Subpectoral implants in oncoplastic-reconstructive breast surgery: Habit or necessity? AUTHOR NAMES Paepke S. Dittmer S. Rezai A. Klein E. Kiechle M. AUTHOR ADDRESSES (Paepke S.; Dittmer S.; Rezai A.; Klein E.; Kiechle M.) Klinikum r.d. Isar Frauenklinik, Technische Universitaet Muenchen, Munich, Germany; Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Frauenklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Department of Obstetrics and Gynecology, Klinikum r.d. Isar Frauenklinik, Technische Universitaet Muenchen, Munich, Germany CORRESPONDENCE ADDRESS S. Paepke, SOURCE Journal of Clinical Oncology (2012) 30:27 SUPPL. 1. Date of Publication: 20 Sep 2012 CONFERENCE NAME 2012 Breast Cancer Symposium CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2012-09-13 to 2012-09-15 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology ABSTRACT Background: We perform nipple-sparing subcutaneous mastectomies since 2002. Herein we report on 352 cases, in 156 of which acellular dermis (ADM) or meshs (tetanized polypropylene-mesh) as tissue interponates were used. The standard procedure of subpectoral implant positioning with or without caudo-lateral tissue interponates (acellular dermis or mesh) can lead to postoperative problems due to detachment of muscle. Against this background we did not form a submuscular pocket in individual cases, but instead placed the implant in a cranially and caudally covering ADM or mesh pocket. Methods: Between 06/11 and 03/12 17 patients were operated according to the above protocol, and the short-term follow up analyzed. Patients that had to get radiation therapy were not admitted to the study. Furthermore, we only included patients that were planned to get a second, contralateral operation so that corrections of the first operation were possible. Patients were between 34 and 58 years old. One patient had to receive radiotherapy due to a nodal involvement not diagnosed before. Results: Four patients had received prior surgery. Indications for subcutaneous mastectomies comprised invasive carcinomas with large DCIS, R1 resections or secondary prophylaxis. Mastectomy weights ranged between 225 and 1100 g; implant volumes ranged between 225 and 800 cm3. The cosmetic outcome was excellent, the margins of the implants were not visible. In three cases there was a partial necrosis of the nipple and in two cases a partial skin necrosis with the necessity of a wound revision. Conclusions: Using a ADM- or mesh-pocket instead of subpectoral positioning of the implant makes the operation in individual cases easier. Post-operative mobility is immediate and unrestricted. Since the implant size has to be chosen according to the tissue weight removed, a bilaterally identical cosmetic result can be archieved. Complications inculde a mild seroma formation without the necessity to puncture. However, the small number of cases and the short term follow up do not allow to make any statements about consecutive capsular fibrosis. EMTREE DRUG INDEX TERMS cosmetic polypropylene EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer breast surgery habit implant EMTREE MEDICAL INDEX TERMS acellular dermal matrix fibrosis follow up human intraductal carcinoma invasive carcinoma mastectomy muscle necrosis nipple patient procedures prophylaxis puncture radiotherapy seroma skin necrosis subcutaneous mastectomy surgery tissues weight wound LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71086113 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 543 TITLE Acellular dermis-assisted prosthetic breast reconstruction: mission accomplished? AUTHOR NAMES Larcher L. Riml S. Campisi C. Lazzeri D. Huemer G.M. AUTHOR ADDRESSES (Larcher L.) Section of Plastic, Aesthetic, and Reconstructive Surgery General Hospital Linz Linz, Austria. (Riml S.; Campisi C.; Lazzeri D.; Huemer G.M.) CORRESPONDENCE ADDRESS L. Larcher, Section of Plastic, Aesthetic, and Reconstructive Surgery General Hospital Linz Linz, Austria. SOURCE Plastic and reconstructive surgery (2012) 130:3 (499e-500e). Date of Publication: Sep 2012 ISSN 1529-4242 (electronic) EMTREE DRUG INDEX TERMS (MAJOR FOCUS) biomaterial collagen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast implant breast reconstruction postoperative complication (etiology) EMTREE MEDICAL INDEX TERMS female human methodology note CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 22929292 (http://www.ncbi.nlm.nih.gov/pubmed/22929292) PUI L366358697 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 544 TITLE One-stage immediate breast reconstruction with implants: a new option for immediate reconstruction. AUTHOR NAMES Cassileth L. Kohanzadeh S. Amersi F. AUTHOR ADDRESSES (Cassileth L.) Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA. (Kohanzadeh S.; Amersi F.) CORRESPONDENCE ADDRESS L. Cassileth, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Email: info@drcassileth.com SOURCE Annals of plastic surgery (2012) 69:2 (134-138). Date of Publication: Aug 2012 ISSN 1536-3708 (electronic) ABSTRACT The current standard of care for breast implant reconstruction after mastectomy is 2-stage reconstruction with placement of tissue expanders followed by implants. The immediate use of implants at the time of mastectomy, which eliminates the need for a second operative procedure, has been sparsely reported and is not yet accepted as the standard of care. This study describes a 1-stage immediate implant reconstruction technique and evaluates its risks. Between 2005 and 2010, immediate implant reconstruction was performed in 43 sequential patients on a total of 78 breasts. Permanent silicone implants were placed at the time of mastectomy with the assistance of acellular dermal matrix (ADM). Follow-up was for an average of 575 days. Implant sizes varied widely from 175 to 800 mL. In order to create the correct breast shape and implant placement, specific techniques of acellular dermal matrix placement in the reconstruction were critically important. Aesthetic evaluation of the patients was performed, evaluating pre- and postoperative photos by 20 evaluators. Pictures were rated according to a 4-point Harris breast scale. A 2-sided paired t test was then used to compare the rating scores. Complication rates were as follows: seroma occurred in 6.4% of breasts; infection resolving with antibiotics occurred in 2.6%; infection requiring implant removal occurred in 3.8%; and hematoma occurred in 1.3%. Neither preoperative breast size nor implant size correlated to an increased risk of complications (P>0.05). Complication rate increased with age (P=0.02). The average score for the preoperative images was 2.1, whereas the postoperative average was 2.4. This represented a statistically significant improvement above the baseline (preoperative) breasts with a P<0.001, according to a 2-sided paired t test. With complication rates similar to previously reported tissue expander reconstructions, immediate implant reconstruction is a viable alternative to 2-stage expander reconstruction, presenting many advantages over expander reconstruction while offering the same risk profile and eliminating the additional risks, costs, and discomfort of a second procedure. Additionally, aesthetic results were highly satisfactory according to patients themselves and based on evaluation by independent observers. EMTREE DRUG INDEX TERMS collagen silicone gel surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation breast tumor (surgery) mastectomy EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult aged article breast implant devices esthetics evaluation study female follow up human methodology middle aged outcome assessment postoperative complication (epidemiology, etiology) risk factor time CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 21734545 (http://www.ncbi.nlm.nih.gov/pubmed/21734545) PUI L366347754 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 545 TITLE The partial AlloDerm™ sling: Reducing allograft costs associated with breast reconstruction AUTHOR NAMES Chepla K.J. Dagget J.R. Soltanian H.T. AUTHOR ADDRESSES (Chepla K.J.; Soltanian H.T., hooman.soltanian@uhhospitals.org) University Hospitals-Case Medical Center, Department of Plastic Surgery, Mailstop LKS 5044, 11100 Euclid Ave., Cleveland, OH 44106, United States. (Dagget J.R.) University of South Florida, Division of Plastic Surgery, Tampa, FL, United States. CORRESPONDENCE ADDRESS H.T. Soltanian, University Hospitals-Case Medical Center, Department of Plastic Surgery, Mailstop LKS 5044, 11100 Euclid Ave., Cleveland, OH 44106, United States. Email: hooman.soltanian@uhhospitals.org SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2012) 65:7 (924-930). Date of Publication: July 2012 ISSN 1748-6815 1878-0539 (electronic) BOOK PUBLISHER Churchill Livingstone, 1-3 Baxter's Place, Leith Walk, Edinburgh, United Kingdom. ABSTRACT Background: Many surgeons now incorporate Acellular Dermal Matrix (ADM) into expander-based breast reconstruction. ADM is safe, provides full expander coverage, eliminates the need for additional muscular dissection and has improved aesthetic outcomes. However, its use increases surgical costs. Whether this cost is offset by decreased operative times or a reduced number of revision procedures is unknown. Methods: We have developed a new technique that minimises the amount of ADM required in many patients. The "partial sling" approach has been used for 145 consecutive patients (197 breasts) by a single surgeon from 2007 to 2010. After mastectomy, any portion of the pectoralis major insertion at, or <1 cm from, the planned inframmary fold is left intact and becomes the inferior margin of the expander pocket. The minimal size of ADM required is then determined by measuring from the pectoralis to the lateral breast margin. In this study, we exclusively used AlloDerm™. Preoperative breast measurements, intra-operative fill volume, time to exchange procedure, number of expansion procedures and complications were recorded for all patients. Results: Patients were grouped according to the surface area (cm(2)) of ADM required. Good aesthetic outcomes were obtained in all groups. Two groups had a significant difference in intra-operative fill volumes but this did not correlate to an increase in the number of expansion procedures required. Of 197 reconstructed breasts less than 64 cm(2) of ADM was used for 40 breasts (20%). Conclusions: The partial AlloDerm™ sling can minimise the costs associated with ADM use in breast reconstruction for many patients without increasing complications or altering aesthetic outcomes. © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix allograft breast reconstruction EMTREE MEDICAL INDEX TERMS adult aged article cost esthetics female graft infection (complication) graft necrosis (complication) hematoma (complication) human intraoperative period major clinical study mastectomy outcome assessment pectoralis major muscle postoperative complication (complication) preoperative evaluation priority journal rupture (complication) seroma (complication) surface property surgical approach surgical technique DEVICE TRADE NAMES AlloDerm , United StatesLifecell DEVICE MANUFACTURERS (United States)Lifecell EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012349309 MEDLINE PMID 22406261 (http://www.ncbi.nlm.nih.gov/pubmed/22406261) PUI L51901160 DOI 10.1016/j.bjps.2012.02.016 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2012.02.016 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 546 TITLE Two-stage prosthetic breast reconstruction using AlloDerm including outcomes of different timings of radiotherapy. AUTHOR NAMES Spear S.L. Seruya M. Rao S.S. Rottman S. Stolle E. Cohen M. Rose K.M. Parikh P.M. Nahabedian M.Y. AUTHOR ADDRESSES (Spear S.L.) Department of Plastic Surgery, Georgetown University Hospital, Washington, DC 20007, USA. (Seruya M.; Rao S.S.; Rottman S.; Stolle E.; Cohen M.; Rose K.M.; Parikh P.M.; Nahabedian M.Y.) CORRESPONDENCE ADDRESS S.L. Spear, Department of Plastic Surgery, Georgetown University Hospital, Washington, DC 20007, USA. Email: spears@gunet.georgetown.edu SOURCE Plastic and reconstructive surgery (2012) 130:1 (1-9). Date of Publication: Jul 2012 ISSN 1529-4242 (electronic) ABSTRACT The authors compared the outcomes of two-stage, acellular dermal matrix (AlloDerm)-assisted prosthetic breast reconstruction including different timings of radiotherapy. A review of two-stage, AlloDerm-assisted, prosthetic breast reconstructions from 2004 to 2010 was performed. All data were recorded prospectively and the study population was stratified by the timing of radiotherapy. Complications were analyzed following first- and second-stage reconstruction. The Spear-Baker classification of capsular contracture was modified for irradiated devices. Reconstructive failure was defined as nonelective removal of a breast prosthesis. : AlloDerm-assisted prosthetic reconstruction was performed in 289 women (428 breasts). After first-stage reconstruction, clinically significant capsular contracture rates (grade III/IV) were higher in the radiation therapy during expansion group and in the radiation therapy before mastectomy group compared with the no-radiation therapy group. Three hundred fifty-three breasts (85.9 percent) successfully underwent second-stage reconstruction, with a median follow-up of 15.2 months. Of those 353 breasts, clinically significant capsular contracture (grade III/IV) was highest in the radiation therapy during expansion group. More often than in the other groups, the radiation therapy during expansion group failed two-stage reconstruction and required flaps in addition or as replacement. In AlloDerm-assisted prosthetic breast reconstruction, irradiated devices demonstrated higher rates of clinically significant capsular contracture following the first stage. These rates declined considerably on completion of reconstruction, with prostheses irradiated during expansion still having the highest frequency of clinically significant capsular contracture. With the follow-up reported, irradiated devices failed breast reconstruction less frequently and required autologous tissue less often than has been historically reported without acellular dermal matrix. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast endoprosthesis breast reconstruction breast tumor (radiotherapy, surgery) EMTREE MEDICAL INDEX TERMS adult aged article artificial skin comparative study female follow up human mastectomy methodology middle aged prosthesis prosthesis complication radiation dose radiation exposure retrospective study time tissue expansion CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 22743866 (http://www.ncbi.nlm.nih.gov/pubmed/22743866) PUI L365544826 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 547 TITLE Evaluating allogenic acellular dermal matrix in implant-based breast reconstruction of post mastectomy cancer patients AUTHOR NAMES Nicolau I. Xie X. Dendukuri N. AUTHOR ADDRESSES (Nicolau I.; Xie X.; Dendukuri N.) Technology Assessment Unit, McGill University Health Centre, Montreal, Canada. CORRESPONDENCE ADDRESS I. Nicolau, Technology Assessment Unit, McGill University Health Centre, Montreal, Canada. SOURCE American Journal of Epidemiology (2012) 176:1 (81). Date of Publication: 1 Jul 2012 CONFERENCE NAME 2012 National Student Conference of the Canadian Society for Epidemiology and Biostatics, CSEB 2012 CONFERENCE LOCATION Saskatoon, SK, Canada CONFERENCE DATE 2012-05-13 to 2012-05-14 ISSN 0002-9262 BOOK PUBLISHER Oxford University Press ABSTRACT Acellular dermal matrix (ADM) is used in breast reconstruction surgery to increase implant expansion and improve capsular reinforcement. The objective was to conduct a systematic review and meta-analysis to assess the risk of postoperative complications in patients using ADM in implantbased reconstruction. Electronic databases and health technology assessment reports were searched. Meta-analysis was performed of the risk ratios of complications reported in studies that compared ADM to conventional reconstruction. There were 27 cohort studies and one systematic review eligible for inclusion published since 2005. The pooled risk of any complication with ADM was 20.8% (95% confidence interval [CI] 15.3, 27.7). The meta-analysis of nine comparative studies showed that ADM use was associated with a higher risk of implant loss (risk ratio [RR] 3.98; 95% CI 1.96, 8.11) infection without implant removal (RR 2.49; 95% CI 1.4, 14.37) and seroma (RR 2.72; 95% CI 1.75, 4.23), and lower risk of capsular contracture (RR 0.3; 95% CI 0.09, 0.998), compared to conventional reconstruction. The evidence suggests that there is a higher risk of certain types of complications with ADM use compared to non-ADM use. Further research is needed to assess the aesthetic outcomes of breast reconstruction surgeries using ADM. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction cancer patient epidemiology human implant mastectomy society student EMTREE MEDICAL INDEX TERMS cohort analysis comparative study confidence interval contracture data base health infection meta analysis patient plastic surgery postoperative complication reinforcement risk seroma systematic review technology LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70861863 DOI 10.1093/aje/kws292 FULL TEXT LINK http://dx.doi.org/10.1093/aje/kws292 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 548 TITLE Contributing variables to post mastectomy tissue expander infection AUTHOR NAMES Leyngold M.M. Stutman R.L. Khiabani K.T. Shah H. Fong E. Ho C.-H. Zamboni W.A. AUTHOR ADDRESSES (Leyngold M.M.; Stutman R.L.; Khiabani K.T.; Shah H.; Zamboni W.A., wzamboni@medicine.nevada.edu) Department of Surgery, School of Medicine, University of Nevada, 2040 W. Charleston Blvd., Ste 301, Las Vegas, NV, United States. (Fong E.; Ho C.-H.) Department of Mathematics, University of Nevada, Las Vegas, NV, United States. CORRESPONDENCE ADDRESS W.A. Zamboni, Department of Surgery, School of Medicine, University of Nevada, 2040 W. Charleston Blvd., Ste 301, Las Vegas, NV, United States. Email: wzamboni@medicine.nevada.edu SOURCE Breast Journal (2012) 18:4 (351-356). Date of Publication: July-August 2012 ISSN 1075-122X 1524-4741 (electronic) BOOK PUBLISHER Blackwell Publishing Inc., 350 Main Street, Malden, United States. ABSTRACT Tissue expander breast reconstruction is a common post mastectomy breast procedure performed by plastic surgeons. The purpose of this study was to define the incidence of breast reconstruction prosthetic infection, relate patient characteristics with increased rate of infection, and analyze the influence of postoperative complications to expander/implant infection. A retrospective, single-institution chart review of 195 women with post mastectomy tissue expander/implant reconstructions performed from 2006 through 2008 was conducted. Total periprosthetic infection rate was calculated. Patient factors, operative technique, and noninfectious complications were analyzed and related to increased periprosthetic infection rate. A binary logistic regression model was fitted using periprosthetic infection as the dependent variable and 12 patient characteristics as independent variables, followed by a step-wise model for best fit with a limited number of independent variables. The overall periprosthetic infection rate per patient over the 2 year period was 5.1%. The incidence of periprosthetic infection per reconstructed breast was 3.2%. Odds ratio estimates indicated that the presence of cellulitis increased the odds of periprosthetic infection more than 200 times (p = <0.0001), and inpatient procedures increased the odds 16 times (p = 0.02). Other variables (i.e., age > 65, DM, flap necrosis, smoking, dehiscence, AlloDerm, etc) failed to reach statistical significance (p > 0.05). Postoperative breast cellulitis and inpatient status appear to be significant risk factors for increased periprosthetic infection. No significant increase in periprosthetic infection rate was noted with other variables in this model. © 2012 Wiley Periodicals, Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction prosthesis infection (complication) EMTREE MEDICAL INDEX TERMS adult article breast cellulitis cellulitis female graft necrosis human implant major clinical study mastectomy postoperative complication risk factor smoking DEVICE TRADE NAMES Allergan , United StatesAllergan Mentor , United StatesMentor DEVICE MANUFACTURERS (United States)Allergan (United States)Mentor EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012399500 MEDLINE PMID 22616636 (http://www.ncbi.nlm.nih.gov/pubmed/22616636) PUI L52028974 DOI 10.1111/j.1524-4741.2012.01253.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1524-4741.2012.01253.x COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 549 TITLE Canadian Society for Epidemiology and Biostatics 2012 National Student Conference AUTHOR ADDRESSES SOURCE American Journal of Epidemiology (2012) 176:1. Date of Publication: 1 Jul 2012 CONFERENCE NAME 2012 National Student Conference of the Canadian Society for Epidemiology and Biostatics, CSEB 2012 CONFERENCE LOCATION Saskatoon, SK, Canada CONFERENCE DATE 2012-05-13 to 2012-05-14 ISSN 0002-9262 BOOK PUBLISHER Oxford University Press ABSTRACT The proceedings contain 12 papers. The topics discussed include: risk of incarceration for individuals with prenatal alcohol exposure; effect of high-dose vitamin d supplementation on blood pressure during the third trimester of pregnancy: a randomized controlled trial in Bangladesh; risk factors and correlates for stress and depression in university students in Canada and the united states; effects of polybrominated diphenyl ethers on thyroid hormones in pregnant women and their newborn children; evaluation of the maternal mental health program; Saskatchewan massage therapists' attitudes toward research and the provider characteristics that influence their use of research; evaluating allogenic acellular dermal matrix in implant-based breast reconstruction of post mastectomy cancer patients; and the association between condom use and the quality of relationships in the social networks of vulnerable people. EMTREE DRUG INDEX TERMS alcohol polybrominated diphenyl ether thyroid hormone vitamin D EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) epidemiology human society student EMTREE MEDICAL INDEX TERMS acellular dermal matrix Bangladesh blood pressure breast reconstruction Canada cancer patient condom drug megadose exposure female health program implant massage mastectomy mental health newborn pregnancy pregnant woman randomized controlled trial randomized controlled trial (topic) risk risk factor social network supplementation third trimester pregnancy United States university student vulnerable population LANGUAGE OF ARTICLE English PUI L70861869 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 550 TITLE The use of porcine acellular dermal matrix in silicone implant-based breast reconstruction AUTHOR NAMES Himsl I. Drinovac V. Lenhard M. Stöckl D. Weissenbacher T. Dian D. AUTHOR ADDRESSES (Himsl I., Isabelle.himsl@med.uni-muenchen.de; Drinovac V.; Lenhard M.; Stöckl D.; Weissenbacher T.; Dian D.) Department of Obstetrics and Gynaecology, Ludwig-Maximillians-University Hospital, Munich, Germany. (Himsl I., Isabelle.himsl@med.uni-muenchen.de; Drinovac V.; Lenhard M.; Stöckl D.; Weissenbacher T.; Dian D.) Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany. (Himsl I., Isabelle.himsl@med.uni-muenchen.de; Drinovac V.; Lenhard M.; Stöckl D.; Weissenbacher T.; Dian D.) Campus Innenstadt, Maistrasse 11, 80337 Munich, Germany. CORRESPONDENCE ADDRESS I. Himsl, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany. Email: Isabelle.himsl@med.uni-muenchen.de SOURCE Archives of Gynecology and Obstetrics (2012) 286:1 (187-192). Date of Publication: July 2012 ISSN 0932-0067 1432-0711 (electronic) BOOK PUBLISHER Springer Verlag, Tiergartenstrasse 17, Heidelberg, Germany. ABSTRACT Introduction The most frequently occurring long-term complication in implant-based breast reconstruction is Wbrotic capsule formation at the recipient site, with concurrent dysesthesia and poor aesthetic results. Using porcine acellular dermal matrix (PADM) as a connective tissue graft material is supposed to improve the quality and quantity of soft tissue in implant-based breast reconstruction. This study investigates the indications for and the results and the costs of using PADM for the correction or prevention of implant-associated breast deformities. Materials and methods This study reviewed a single surgeon's experience in the correction or prevention of implant-associated breast deformities with PADM in breast cancer-related breast reconstruction from 2009 to 2011. A total of 23 patients (27 breasts) were included in the study. The aesthetic outcome, the incidence and the type of complication were analysed. Twenty-three women underwent breast cancer-related breast reconstruction: 19 women underwent single-breast reconstruction and four women underwent bilateral reconstruction. Results Of the 23 patients who underwent breast reconstruction, 18 (78%) were "satisWed" with the aesthetic and haptic outcome after implant-based reconstruction with PADM. One patient (one breast) required another breast operation because of ipsilateral breast cancer recurrence during the follow-up period. PADM-assisted implant-based breast reconstruction has a satisfactory safety proWle. Conclusion The use of PADM as an interface matrix for implant-based breast reconstruction yielded predictable and acceptable aesthetic and haptic results by preventing capsu-lar contracture, rippling, implant malposition, soft-tissue thinning and failure of the silicone implant-based breast augmentation. © 2012 Springer-Verlag. EMTREE DRUG INDEX TERMS antineoplastic agent (drug therapy) tamoxifen (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction porcine acellular dermal matrix silicone implant based breast reconstruction EMTREE MEDICAL INDEX TERMS adult aged article breast cancer (drug therapy, radiotherapy, surgery) breast malformation (prevention, surgery) cancer adjuvant therapy cancer radiotherapy cancer recurrence (surgery) cancer surgery clinical article disease free survival esthetics female fibrosis (complication) follow up health care cost human intraductal carcinoma (drug therapy, surgery) morbidity seroma (complication) silicone prosthesis treatment indication DEVICE MANUFACTURERS Inamed Mentor CAS REGISTRY NUMBERS tamoxifen (10540-29-1) EMBASE CLASSIFICATIONS Surgery (9) Radiology (14) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) Health Policy, Economics and Management (36) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012452388 MEDLINE PMID 22382372 (http://www.ncbi.nlm.nih.gov/pubmed/22382372) PUI L51890503 DOI 10.1007/s00404-012-2266-x FULL TEXT LINK http://dx.doi.org/10.1007/s00404-012-2266-x COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 551 TITLE Implant-based breast reconstruction with acellular dermal matrix. AUTHOR NAMES Bonomi S. Settembrini F. Salval A. Gilardi R. Musumarra G. AUTHOR ADDRESSES (Bonomi S.; Settembrini F.; Salval A.; Gilardi R.; Musumarra G.) CORRESPONDENCE ADDRESS S. Bonomi, SOURCE Plastic and reconstructive surgery (2012) 130:1 (190e-191e; author reply 191e-192e). Date of Publication: Jul 2012 ISSN 1529-4242 (electronic) EMTREE DRUG INDEX TERMS (MAJOR FOCUS) biomaterial collagen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast endoprosthesis breast reconstruction postoperative complication (etiology) EMTREE MEDICAL INDEX TERMS female human methodology note CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 22743916 (http://www.ncbi.nlm.nih.gov/pubmed/22743916) PUI L365544864 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 552 TITLE AlloDerm and Strattice in breast reconstruction: a comparison and techniques for optimizing outcomes. AUTHOR NAMES Glasberg S.B. Light D. AUTHOR ADDRESSES (Glasberg S.B.) Lenox Hill Hospital, New York, NY, USA. (Light D.) CORRESPONDENCE ADDRESS S.B. Glasberg, Lenox Hill Hospital, New York, NY, USA. Email: scotbg@juno.com SOURCE Plastic and reconstructive surgery (2012) 129:6 (1223-1233). Date of Publication: Jun 2012 ISSN 1529-4242 (electronic) ABSTRACT Acellular dermal matrices are increasingly used to reinforce the lower pole of the breast during tissue expander/implant breast reconstruction. Although a low complication rate and good aesthetic outcome have been reported, meticulous technique is important for success. This retrospective study compared the clinical course and postoperative outcome of women who underwent breast reconstruction using AlloDerm or Strattice in the authors' practice and highlights key technical considerations that are important for optimizing outcomes. Patient records were reviewed for demographic data, operative parameters (length and volume of drainage), and type and frequency of postoperative complications, which were compared between the AlloDerm and Strattice groups. Biopsy specimens of acellular dermal matrices were taken for histologic analyses. Ninety-six patients (126 reconstructions) received AlloDerm, and 90 (144 reconstructions) received Strattice. Total complications were significantly higher with AlloDerm (21.4 percent versus 6.3 percent; p = 0.0003) and were driven by a significantly higher seroma rate (12.7 percent versus 1.4 percent; p = 0.0003). All other complications were similar between the groups. The capsular contracture rate (grade 1 or 2) was 2.4 percent with AlloDerm and 2.8 percent with Strattice, indicating that both may play a role in capsule formation. This was supported by histologic analyses indicating an absence of synovia-like metaplasia at the acellular dermal matrix/tissue expander interface. : Complications in this series were of low severity, which, together with consistent clinical outcomes seen in the authors' practice, justifies the cost associated with the use of acellular dermal matrices in breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic: III. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen (drug administration) EMTREE DRUG INDEX TERMS surgical mesh surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) bandage breast reconstruction EMTREE MEDICAL INDEX TERMS adult aged article artificial skin breast tumor (surgery) clinical trial comparative study female human mastectomy methodology middle aged multicenter study postoperative period retrospective study tissue expansion treatment outcome wound healing CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 22327891 (http://www.ncbi.nlm.nih.gov/pubmed/22327891) PUI L365369059 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 553 TITLE The effects of acellular dermal matrix in expander-implant breast reconstruction after total skin-sparing mastectomy: results of a prospective practice improvement study. AUTHOR NAMES Peled A.W. Foster R.D. Garwood E.R. Moore D.H. Ewing C.A. Alvarado M. Hwang E.S. Esserman L.J. AUTHOR ADDRESSES (Peled A.W.) Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California, San Francisco, USA. (Foster R.D.; Garwood E.R.; Moore D.H.; Ewing C.A.; Alvarado M.; Hwang E.S.; Esserman L.J.) CORRESPONDENCE ADDRESS A.W. Peled, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California, San Francisco, USA. SOURCE Plastic and reconstructive surgery (2012) 129:6 (901e-908e). Date of Publication: Jun 2012 ISSN 1529-4242 (electronic) ABSTRACT Neither outcome after total skin-sparing mastectomy and expander-implant reconstruction using acellular dermal matrix nor a strategy for optimal acellular dermal matrix selection criteria has been well described. Prospective review of three patient cohorts undergoing total skin-sparing mastectomy with preservation of the nipple-areola complex and immediate expander-implant reconstruction from 2006 to 2010 was performed. Cohort 1 (no acellular dermal matrix) comprised 90 cases in which acellular dermal matrix was not used. Cohort 2 (consecutive acellular dermal matrix) included the next 100 consecutive cases, which all received acellular dermal matrix. Cohort 3 (selective acellular dermal matrix) consisted of the next 260 cases, in which acellular dermal matrix was selectively used based on mastectomy skin flap thickness. Complication rates were compared using chi-square analysis. The study included 450 cases in 288 patients. Mean follow-up was 25.5 months. Infection occurred in 27.8 percent of the no-acellular dermal matrix cases, 20 percent of the consecutive cases, and 15.8 percent of the selective cases (p = 0.04). Unplanned return to the operating room was required in 23.3, 11, and 10 percent of cases, respectively (p = 0.004). Expander-implant loss occurred in 17.8, 7, and 5 percent of cases, respectively (p = 0.001). Additional analysis of the odds ratios of developing complications after postmastectomy radiation therapy demonstrated a specific protective benefit of acellular dermal matrix in irradiated patients. Acellular dermal matrix use in expander-implant reconstruction after total skin-sparing mastectomy reduced major postoperative complications in this study. Maximal benefit is achieved with selected use in patients with thin mastectomy skin flaps and those receiving radiation therapy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction dermis extracellular matrix mastectomy postoperative care skin transplantation tissue expansion EMTREE MEDICAL INDEX TERMS adult article breast tumor (surgery) comparative study female follow up human methodology middle aged nipple (surgery) plastic surgery prospective study total quality management transplantation LANGUAGE OF ARTICLE English MEDLINE PMID 22634688 (http://www.ncbi.nlm.nih.gov/pubmed/22634688) PUI L365369017 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 554 TITLE State of the art in breast reconstruction AUTHOR NAMES Kronowitz S.J. AUTHOR ADDRESSES (Kronowitz S.J., skronowi@mdanderson.org) Department of Plastic and Reconstructive Surgery, Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd., Houston, TX 77030, United States. CORRESPONDENCE ADDRESS S.J. Kronowitz, Department of Plastic and Reconstructive Surgery, Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd., Houston, TX 77030, United States. Email: skronowi@mdanderson.org SOURCE Current Breast Cancer Reports (2012) 4:2 (119-131). Date of Publication: June 2012 ISSN 1943-4588 1943-4596 (electronic) BOOK PUBLISHER Current Medicine Group LLC, 400 Market St,, Ste 700 Philadelphia, United States. ABSTRACT In patients undergoing breast reconstruction after partial and total mastectomy, selecting the appropriate timing as well as the best method of reconstruction are essential to optimize the outcome. At M.D. Anderson Cancer Center, the timing of oncoplastic repair after partial mastectomy defects and breast reconstruction after mastectomy tends to dictate the technique for reconstruction. In patients undergoing repair of a partial mastectomy defect, immediate or delayed repair before radiation therapy allows for the use of the remaining breast tissue to perform the repair. Delayed repair after radiation therapy is usually performed with autologous fat grafting or a flap. Immediate breast reconstruction after mastectomy is preferable for patients with a low risk of requiring postmastectomy radiation therapy (XRT) (stage I breast cancer, some stage II). In patients who are deemed preoperatively to be at an increased risk of requiring XRT (stage II breast cancer), delayedimmediate breast reconstruction may provide an additional option. Delayed-delayed reconstruction may be a consideration in patients known preoperatively to require XRT (stage III breast cancer), to allow for a skin-preserving delayed reconstruction after XRT. Newer techniques for breast reconstruction after mastectomy include one-stage implant, implant-based reconstruction plus acellular dermal matrix, autologous fat grafting after negative suction applied to chest wall, and perforator-based autologous tissue flaps. Often, the decision to perform a partial or total mastectomy depends upon reconstructive issues, not oncology-related considerations. Whether to repair a partial mastectomy defect or perform a total breast reconstruction after mastectomy is one of the most critical decisions in breast reconstruction. © Springer Science+Business Media, LLC 2012. EMTREE DRUG INDEX TERMS antineoplastic agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction EMTREE MEDICAL INDEX TERMS acellular dermal matrix adipose tissue adjuvant therapy advanced cancer (radiotherapy, surgery) article autograft brachytherapy breast cancer (drug therapy, radiotherapy, surgery) breast endoprosthesis cancer patient cancer radiotherapy cancer staging deep inferior epigastric perforator flap high risk patient human mastectomy partial mastectomy postoperative complication (complication) preoperative evaluation recurrent selection surgical approach surgical technique therapy delay tissue flap transverse rectus abdominis musculocutaneous flap EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012402308 PUI L51961180 DOI 10.1007/s12609-012-0078-4 FULL TEXT LINK http://dx.doi.org/10.1007/s12609-012-0078-4 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 555 TITLE Discussion: AlloDerm and Strattice in breast reconstruction: a comparison and techniques for optimizing outcomes. AUTHOR NAMES Hirsch E.M. Dumanian G.A. AUTHOR ADDRESSES (Hirsch E.M.) Division of Plastic Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, USA. (Dumanian G.A.) CORRESPONDENCE ADDRESS E.M. Hirsch, Division of Plastic Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, USA. SOURCE Plastic and reconstructive surgery (2012) 129:6 (1234-1235). Date of Publication: Jun 2012 ISSN 1529-4242 (electronic) EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen (drug administration) EMTREE DRUG INDEX TERMS surgical mesh surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) bandage breast reconstruction EMTREE MEDICAL INDEX TERMS female human methodology note CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 22634641 (http://www.ncbi.nlm.nih.gov/pubmed/22634641) PUI L365368976 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 556 TITLE Prospective outcomes trial of immediate, implant breast reconstruction using acellular dermal matrix (POBRAD Trial): Pilot series results AUTHOR NAMES Westbroek D. Douek M. AUTHOR ADDRESSES (Westbroek D.; Douek M.) Kings HealthPartners, London, United Kingdom. CORRESPONDENCE ADDRESS D. Westbroek, Kings HealthPartners, London, United Kingdom. SOURCE Journal of Clinical Oncology (2012) 30:15 SUPPL. 1. Date of Publication: 20 May 2012 CONFERENCE NAME 2012 Annual Meeting of the American Society of Clinical Oncology, ASCO CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2012-06-01 to 2012-06-05 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology ABSTRACT Background: Acellular dermal matrices (ADM) are biological meshes of dermal origin (allo- or xenografts) stripped of all cellular components leaving a structurally intact and immunologically inert extracellular matrix. They are currently in use as adjunctive subdermal scaffolding during implant breast reconstruction to optimise aesthetic outcome. Despite current use in clinical practice there is no prospective data on their clinical efficacy, associated complication rates and cost-benefit analysis. These are the endpoints of our pilot cohort series, intended to provide baseline event rates to help power a multi-centre prospective, phase II, outcomes cohort study. Methods: From July 2011 to January 2012 and with our institution review board's approval - 20 consecutive patients undergoing immediate, implant breast reconstruction were prospectively accrued to the study. Primary endpoints: 30-day complication rates; Secondary endpoints: cosmetic outcome and cost-benefit analysis. Indications for mastectomy included therapeutic intent and/or risk reduction. The ADM used in all cases was SurgiMend PRS (TEI Bioscience Inc. Boston, MA USA). Results: Preliminary 30 day complication rates are in keeping with peer reviewed estimates for implant based breast reconstruction. Sub-set analysis of cosmetic outcome and cost-benefit ratio's are currently pending. In overview, ADM's appear to deliver the aesthetic benefit of autologous- implant cover (eg. latissimus dorsi myocutaneous flap) without the downside of donorsite morbidity and prolonged in-patient admission. Conclusions: This is to our knowledge the only prospectively accrued dataset seeking to critically evaluate the clinical efficacy, cost-benefit value and enhanced aesthetic utillity of ADMs (SurgiMend PRS) in the immediate breast reconstruction setting. The early results provide new evidence in support of the use ADMs in breast reconstruction and validate our intention to extend the study to a multicentre trial. EMTREE DRUG INDEX TERMS cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction implant oncology society EMTREE MEDICAL INDEX TERMS clinical practice cohort analysis cost benefit analysis extracellular matrix hospital admission hospital patient human latissimus dorsi flap mastectomy morbidity multicenter study patient risk reduction United States xenograft LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71003224 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 557 TITLE A retrospective audit of outcomes for immediate breast reconstruction AUTHOR NAMES Roy J. Webster P. Kurfi R. Achuthan R. Turton P. AUTHOR ADDRESSES (Roy J.; Webster P.; Kurfi R.; Achuthan R.; Turton P.) Leeds General Infirmary, Leeds, United Kingdom. CORRESPONDENCE ADDRESS J. Roy, Leeds General Infirmary, Leeds, United Kingdom. SOURCE European Journal of Surgical Oncology (2012) 38:5 (464). Date of Publication: May 2012 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2012 CONFERENCE LOCATION Bournemouth, United Kingdom CONFERENCE DATE 2012-05-21 to 2012-05-22 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: The National Mastectomy Audit has been landmark as it is for the first time we have data regarding reconstructions in the UK. The proportion of mastectomy and immediate reconstruction patients, who had at least one complication, ranged from 15-18% in the National Mastectomy Audit 2011. There is limited data on newer techniques such as reconstructions using acellular dermal matrix. Literature reports complication rates varying from 3.2 - 48.7%. These figures are not insignificant and lead us to audit our results Method: A retrospective analysis of immediate breast reconstruction performed between October 2009 - May 2011 in our unit by four breast surgeons was done and all complications were assessed. Results: 76 patients underwent immediate breast reconstruction in the period. 67 were unilateral and 9 were bilateral. Reconstruction procedures involved autologous flaps, implant based surgery using Strattice ™ or Permacol™ and expanders. The mean period of follow up is 12 months (4-20 months). The complications noted are given in Table 1. Conclusion: Immediate breast reconstruction is a safe procedure but is associated with significant complications. Our figures are in conformity with the national data and literature. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction breast surgery clinical audit EMTREE MEDICAL INDEX TERMS acellular dermal matrix breast follow up human implant mastectomy patient procedures surgeon surgery United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70737222 DOI 10.1016/j.ejso.2012.02.028 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2012.02.028 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 558 TITLE Revisiting the free nipple graft as an option for women undergoing mastectomy with immediate reconstruction AUTHOR NAMES Lewis J. Smith P. Khakpour N. Laronga C. AUTHOR ADDRESSES (Lewis J.; Khakpour N.; Laronga C.) H. Lee Moffitt Cancer Cencer, Research Institute, Tampa, United States. (Lewis J.; Smith P.; Khakpour N.; Laronga C.) University of South Florida, Tampa, United States. CORRESPONDENCE ADDRESS J. Lewis, H. Lee Moffitt Cancer Cencer, Research Institute, Tampa, United States. SOURCE Annals of Surgical Oncology (2012) 19:2 SUPPL. 1 (77). Date of Publication: May 2012 CONFERENCE NAME 13th Annual Meeting of the American Society of Breast Surgeons CONFERENCE LOCATION Phoenix, AZ, United States CONFERENCE DATE 2012-05-02 to 2012-05-06 ISSN 1068-9265 BOOK PUBLISHER Springer New York ABSTRACT Objectives: Breast reconstruction options for treatment or prophylaxis of breast cancer continue to evolve and now include nipple-sparing mastectomy (NSM) techniques. Eligibility for NSM is comprised of oncologic and technical/cosmetic criteria. In women meeting oncologic criteria for NSM, we explored whether free nipple grafting can overcome some of the technical/cosmetic limitations. Method: An IRB-approved retrospective review of prospectively gathered women having NSM with/without immediate reconstruction was conducted to identify women having free nipple grafting synchronous with mastectomy and immediate reconstruction. Indications for NSM were either prophylaxis (risk reduction) or breast cancer treatment. Data reviewed included clinico-pathologic features, operative procedures, immediate postoperative and delayed complications, and outcomes. Technical eligibility for our standard NSM included no prior surgical procedures involving the nipple areolar complex, no history of breast/mantle irradiation, no smoking, location of the nipple above the inframammary fold, and breast size less than 700 grams. Patients desiring nipple preservation who did not meet these criteria were considered for free nipple grafting. Results: We identified 9 women who underwent NSM as a skin-sparing mastectomy through a circumareolar skin-sparing incision with immediate reconstruction, including free nipple grafting. Mean age was 45 years (range, 31-60), BMI 25.1 (range, 21.5-30.9), breast weight 559.1 g (range, 134.5- 1378), and follow-up 13.9 months (range, <1-48.8). Five of the women had a current diagnosis of cancer (2 unilateral, 3 bilateral) and 4 underwent their procedures purely for high-risk prophylaxis (all bilateral). Two patients underwent unilateral mastectomy with free nipple grafting; the remaining 7 had bilateral procedures. Reconstruction with free nipple grafting rather than NSM was chosen due to choice of transverse rectus abdominus musculocutaneous (TRAM) reconstruction (1 patient), breast ptosis (1 patient), prior circumareolar incision (2 patients), large breast size (2 patients), and history of breast irradiation (3 patients). Intraoperative evaluation of the nipple base was performed prior to re-implantation in 7 of the patients (1 touch prep, 6 frozen section) and was negative for cancer or atypia in all. Permanent pathologic evaluation of the nipple base in all patients was negative for cancer. Two women had TRAM flap reconstruction, 1 had tissue expanders with alloderm slings, and 6 had latissimus dorsi flaps with tissue expanders. One (11.1%) woman lost both of her nipple grafts due to tissue expander infections and later underwent nipple reconstruction. Nipple graft take averaged 91% (range, 60-100%). Four (44.4%) women developed some degree of nipple hypopigmentation; 1 (11.1%) required nipple tattooing twice. Two (22.2 %) women had complete loss and 4 (44.4%) had partial loss of nipple projection. None have experienced a new diagnosis of breast cancer or a recurrence. Conclusions: Free nipple grafting at the time of mastectomy with reconstruction is a viable option for women who meet the oncologic criteria to undergo NSM but have technical/cosmetic variations, including previous radiation therapy, unfavorable for a standard NSM approach. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast female human mastectomy nipple society surgeon EMTREE MEDICAL INDEX TERMS breast cancer breast reconstruction cancer therapy diagnosis follow up frozen section hypopigmentation incision infection irradiation latissimus dorsi flap neoplasm patient preservation procedures prophylaxis ptosis radiotherapy reimplantation risk risk reduction skin smoking surgical technique tattooing tissue expander transverse rectus abdominis musculocutaneous flap weight LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71387685 DOI 10.1245/s10434-012-2344-06p FULL TEXT LINK http://dx.doi.org/10.1245/s10434-012-2344-06p COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 559 TITLE Feasibility of nipple-sparing mastectomy: One community hospital's experience AUTHOR NAMES Washburn B. Dekhne N. Meininger M. AUTHOR ADDRESSES (Washburn B.; Dekhne N.; Meininger M.) Oakland University, William Beaumont School of Medicine, Royal Oak, United States. (Washburn B.; Dekhne N.; Meininger M.) William Beaumont Hospital, Royal Oak, United States. CORRESPONDENCE ADDRESS B. Washburn, Oakland University, William Beaumont School of Medicine, Royal Oak, United States. SOURCE Annals of Surgical Oncology (2012) 19:2 SUPPL. 1 (114-115). Date of Publication: May 2012 CONFERENCE NAME 13th Annual Meeting of the American Society of Breast Surgeons CONFERENCE LOCATION Phoenix, AZ, United States CONFERENCE DATE 2012-05-02 to 2012-05-06 ISSN 1068-9265 BOOK PUBLISHER Springer New York ABSTRACT Objectives: Recent studies and reviews of surgical outcomes have supported nipple-sparing mastectomy as a safe and cosmetically beneficial option for patients seeking risk reduction, as well as selective patients with early-stage breast cancer. This study reports 1 surgeon's short- and mid-term postoperative outcomes of nipple-sparing mastectomies at a community hospital. Method: The study enrolled 43 participants who chose to undergo NSM based on oncologic safety, anatomic eligibility, as well as patient preference. Fifty patients underwent 72 NSMs at our institution from October 2008 to October 2011. Indications for the surgery were 59 (82%) for prophylaxis, 5 (7%) for DCIS, and 8 (11%) for invasive ductal carcinoma. One patient was found to have DCIS in a prophylactic mastectomy specimen with a clean margin. The average patient age was 43.9 years (range, 28 to 61 years). For those patients with mastectomy for invasive ductal carcinoma, the average tumor size was 2.4 cm and all tumors were peripherally located. The stage of the breast cancers ranged from IA to IIB [IA (3), IIA (3), IIB (2)]. Results: Thirty-four mastectomies were performed through an inframammary incision, while 38 mastectomies were carried out through a radial incision. Fifty-one immediate reconstructions with implants were performed at the time of oncologic resection, while 21 tissue expanders were placed with final reconstruction at a later date. Acellular dermal matrix was utilized in 55 (76.3%) of the reconstructions. The nipple areolar complex was preserved in 68 (94.4%) mastectomies. A review of the major and minor complications notes 4 major complications of nipple loss. One patient had bilateral ischemic nipple loss 3 weeks postop, requiring surgical excision. Two patients had unilateral mastectomy specimens with a close nipple margin on final pathology requiring excision of the nipple areola complex at a second surgery. Two patients required postoperative chest wall radiation. One of these patients had implant loss after the completion of radiation therapy secondary to wound breakdown. Implant revision was performed due to cosmesis or wound issues in 8 (18.6%) patients. At the time of reporting, there was a median follow-up of 18.4 months (range, 4-41 months), and no local or systemic recurrences were noted for patients being treated for cancer. Cosmesis was noted as good or excellent in 40 (93%) patients, while 3 (7%) patients noted fair cosmesis due to implant wrinkling. Conclusions: The short-term data review shows that NSM can be performed safely and with good cosmetic outcomes for prophylaxis even in a community hospital setting. Long-term data will be needed to show the safety of performing NSM for patients with DCIS and invasive breast cancer. Long-term follow-up will also assist in better characterizing the selection criteria for patients who are the best candidates for NSM. EMTREE DRUG INDEX TERMS cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast community hospital human mastectomy nipple society surgeon EMTREE MEDICAL INDEX TERMS acellular dermal matrix breast areola breast cancer breast carcinoma excision follow up implant incision intraductal carcinoma neoplasm pathology patient patient preference prophylaxis radiation radiotherapy risk reduction safety surgery thorax wall tissue expander tumor volume wound wrinkle LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71387737 DOI 10.1245/s10434-012-2344-06p FULL TEXT LINK http://dx.doi.org/10.1245/s10434-012-2344-06p COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 560 TITLE Acellular dermal matrix as a volume replacement for immediate reconstruction of lumpectomy cavities: A pilot study AUTHOR NAMES Ojeda H. Tokin C. Hee Woo O. Sinha T. Chao J. Chen S. AUTHOR ADDRESSES (Ojeda H.; Tokin C.; Hee Woo O.; Sinha T.; Chao J.) University of California San Diego, San Diego, United States. (Chen S.) City of Hope National Medical Center, Duarte, United States. (Hee Woo O.) Korean University, Guro Hospital, Seoul Korea, South Korea. CORRESPONDENCE ADDRESS H. Ojeda, University of California San Diego, San Diego, United States. SOURCE Annals of Surgical Oncology (2012) 19:2 SUPPL. 1 (92-93). Date of Publication: May 2012 CONFERENCE NAME 13th Annual Meeting of the American Society of Breast Surgeons CONFERENCE LOCATION Phoenix, AZ, United States CONFERENCE DATE 2012-05-02 to 2012-05-06 ISSN 1068-9265 BOOK PUBLISHER Springer New York ABSTRACT Objectives: Breast conservation operations are the most common surgical treatment for breast cancer; however, approximately one third of women have a poor cosmetic outcome. Oncoplastics is a solution for some, but not all patients are good candidates. The use of an acellular dermal matrix (ADM) may provide a volume substitute in these cases. The objective of this study is to examine if breast volume can be maintained by the addition of ADM and its effect after lumpectomy plus radiation. Method: We retrospectively reviewed our institution's experience in ADM placement during lumpectomy operations for breast cancer. A 6- x12-cm piece of alloderm was accordion-folded and secured with 2-0 vicryl to the pectoralis major muscle immediately following the completion of the lumpectomy. We reviewed patient records and 1-year follow-up mammograms to calculate breast volume. Controls were drawn from the same time period matched on type of surgery and use of radiation. Wilcoxon rank sum tests were used to compare baseline values and percent change in breast volumes. Results: We identified 28 cases that had ADM placed during lumpectomy operations and had wholebreast radiation between 2008 and 2010. Median age was 56, median tumor size was 2.4 cm, and median specimen volume 96 cm(3). Mammograms were available on 18 cases and were matched with 23 control patients. Mean percent change in breast volume was 12% for ADM group and 15% for control (p = 0.5). Nine of 18 (50%) patients in the ADM group and 15 of 23 (65.2%) patients in the control group had a reduction of 15% or more in breast volume (p = 0.36). Conclusions: This pilot study demonstrates a trend toward maintenance of breast volume in patients having lumpectomy plus radiation. Breast volume as measured by compressed mammogram is estimation of overall breast size but not necessarily cosmetic appearance. This preliminary data warrants further prospective study of cosmetic outcome utilizing this technique, as well as continued follow-up, to assess longer term outcomes. EMTREE DRUG INDEX TERMS cosmetic polyglactin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast human partial mastectomy pilot study society surgeon EMTREE MEDICAL INDEX TERMS breast cancer control group female follow up medical record patient pectoralis major muscle prospective study radiation rank sum test surgery tumor volume LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71387706 DOI 10.1245/s10434-012-2344-06p FULL TEXT LINK http://dx.doi.org/10.1245/s10434-012-2344-06p COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 561 TITLE Immediate implant breast reconstruction is a safe option for high-risk patients who undergo nipple-areola or skin-sparing mastectomy for breast cancer AUTHOR NAMES Durkan B. Cassileth L. Amersi F. AUTHOR ADDRESSES (Durkan B.; Cassileth L.; Amersi F.) Cedars-Sinai Medical Center, Los Angeles, United States. CORRESPONDENCE ADDRESS B. Durkan, Cedars-Sinai Medical Center, Los Angeles, United States. SOURCE Annals of Surgical Oncology (2012) 19:2 SUPPL. 1 (43-44). Date of Publication: May 2012 CONFERENCE NAME 13th Annual Meeting of the American Society of Breast Surgeons CONFERENCE LOCATION Phoenix, AZ, United States CONFERENCE DATE 2012-05-02 to 2012-05-06 ISSN 1068-9265 BOOK PUBLISHER Springer New York ABSTRACT Objectives: Nipple areola-sparing mastectomy (NASM) and skin-sparing mastectomy (SSM) with immediate implant reconstruction has recently become an increasingly acceptable option for patients (pts) with breast cancer or BRCA+ pts; however, there is little data regarding the oncologic safety of this newer technique. Our objective was to identify patient characteristics and evaluate outcomes following immediate implant based reconstruction with allograft. Method: We performed a retrospective chart review and identified 63 women with breast cancer or who were BRCA+, who underwent NAS or SS mastectomy with immediate implant reconstruction Results: Of the 63 patients, 71 (64%) breasts had SS mastectomy and 40 (36%) breasts had NAS mastectomy. All breasts were reconstructed at the time of mastectomy with implants and Alloderm. Mean age of pts was 47.9 (range, 25-72) years. Mean time to follow-up was 14.4 (range, 3-58) months. Thirtysix patients (57.1%) underwent BRCA testing, of whom 13 pts (36.1%) were found to be BRCA positive. Fifty-nine (50.4%) of the breast specimens contained tumor, of which 39 (66%) were infiltrating ductal carcinoma, 3 (5.1%) were infiltrating lobular carcinoma, 3 (5.1) had mixed features, and 14 (24%) were DCIS. Mean tumor size was 2 cm (range, 0.2-9 cm). Fifty-nine sentinel lymph node (SLN) biopsies were performed, and 20 of the SLN (34%) had metastatic disease. Five patients (8.3%) had re-excision for close or positive margins. Postoperatively, 5 patients (7.9%) had implant loss, 1 patient (1.7%) had a wound dehiscence that required reoperation, 5 patients (7.9%) underwent implant exchanges for alternate-sized implant (8.3%), and 3 patients (5%) required latissimus-dorsi flaps for additional coverage. Nine patients (14.2%) required postoperative radiation (15%). Conclusions: This data suggests that SSM or NSM with immediate implant reconstruction is a safe option for patients with breast cancer. Patient selection may play a role in good outcomes for this technique. Reoperation for close tumor margins may still be safely performed following reconstruction using this technique. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast breast areola breast cancer breast reconstruction high risk patient human implant mastectomy skin society surgeon EMTREE MEDICAL INDEX TERMS allograft breast carcinoma excision female follow up intraductal carcinoma latissimus dorsi flap lung carcinoma medical record review metastasis neoplasm Paget nipple disease patient patient selection radiation reoperation safety sentinel lymph node biopsy tumor volume wound dehiscence LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71387637 DOI 10.1245/s10434-012-2344-06p FULL TEXT LINK http://dx.doi.org/10.1245/s10434-012-2344-06p COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 562 TITLE Acellular dermal matrix slings in tissue expander breast reconstruction: are there substantial benefits? AUTHOR NAMES Collis G.N. TerKonda S.P. Waldorf J.C. Perdikis G. AUTHOR ADDRESSES (Collis G.N.) Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA. (TerKonda S.P.; Waldorf J.C.; Perdikis G.) CORRESPONDENCE ADDRESS G.N. Collis, Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA. SOURCE Annals of plastic surgery (2012) 68:5 (425-428). Date of Publication: May 2012 ISSN 1536-3708 (electronic) ABSTRACT Acellular dermal matrix (ADM) slings in breast reconstruction are increasingly used but are not yet validated. This study compares immediate, expander-based breast reconstruction with and without the use of inferolateral ADM slings. There were 63 patients (106 breasts) in the ADM group and 42 patients (68 breasts) in the control group. Initial intraoperative fill volumes were significantly greater in the ADM group, median 69% full (250 mL) versus 50% full (180 mL; P < 0.001). However, the number of days to complete expansion between the 2 groups was similar. One less office visit was required to complete the fills in the ADM group (P < 0.01). Drains were removed 3 days later in the ADM group (P < 0.01). Overall complication rate was greater in the ADM group (18.9% vs. 7.4%, P < 0.05), with a slightly higher percentage of expanders requiring removal due to infection in the ADM group (5.7% vs. 4.4%, P = NS). This study suggests inferolateral ADM slings in expander-based breast reconstruction allow for significantly increased initial fill volumes and may offer an aesthetic advantage; however, its use is costly and increases complications. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) biomaterial (drug administration) collagen (drug administration) EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction implant EMTREE MEDICAL INDEX TERMS article breast augmentation breast tumor (surgery) comparative study devices evaluation study female human mastectomy methodology middle aged postoperative complication (epidemiology) retrospective study treatment outcome CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 21825969 (http://www.ncbi.nlm.nih.gov/pubmed/21825969) PUI L365456129 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 563 TITLE The reverse acellular dermal matrix sling-a reconstructive solution for patients with obesity and macromastia AUTHOR NAMES Young A.O. AUTHOR ADDRESSES (Young A.O.) New England Center for Oncoplastic Surgery, New Canaan, United States. CORRESPONDENCE ADDRESS A.O. Young, New England Center for Oncoplastic Surgery, New Canaan, United States. SOURCE Annals of Surgical Oncology (2012) 19:2 SUPPL. 1 (93). Date of Publication: May 2012 CONFERENCE NAME 13th Annual Meeting of the American Society of Breast Surgeons CONFERENCE LOCATION Phoenix, AZ, United States CONFERENCE DATE 2012-05-02 to 2012-05-06 ISSN 1068-9265 BOOK PUBLISHER Springer New York ABSTRACT Objectives: With the increasing incidence of obesity the number of patients who present for mastectomy reconstruction with severe macromastia is rising steadily. Patients with a very high BMI are often poor candidates for autologous reconstruction. Traditional implant-based reconstructions frequently result in a flat poorly projected breast mount. Wise pattern mastectomy incisions improve the cosmetic results; however, breast projection is compromised by the relatively small size of the pectoralis major muscle covering the superior implant pole, in comparison to the large implant size required to achieve an adequate breast mount. We describe a new technique using the large skin surplus of the lower breast pole as a de-epithelialised flap in conjunction with a superior acellular dermal matrix sling to line the implant pocket without the use of the pectoralis muscle. Method: To investigate the safety and efficiency of this method, we reviewed the medical records of 28 patients with a BMI more then 35, who underwent 48 implant-based immediate mastectomy reconstructions. All procedures were performed by the senior author and follow-up ranged from 6 weeks to 51 months. The implant size ranged from 550 to 800 cc; high-profile gel implants and shaped saline implants were used. The charts were analyzed for the occurrence of complications, such as infection, seroma, mastectomy flap necrosis, capsular contracture, and implant loss. All patients were asked to rate their result as poor, good, or excellent. Results: In 48 reconstructed breasts, we encountered 4 cases of limited mastectomy flap epidermolysis and 1 case of flap necrosis all treated with dressing changes, 1 case of cellulitis treated with oral antibiotics, 2 cases of Baker II capsular contracture, and 1 case of delayed implant removal after radiation treatment for an internal mammary lymph node recurrence. In terms of patient satisfaction, 20 patients rated their results as excellent; 8, good; none, poor. Satisfaction rates were highest in the bilateral mastectomy group. Conclusions: Our results compare favourable with data published in the literature, patient satisfaction is high and complication rates are reasonable in this high-risk population that historically has been a challenge for the reconstructive surgeon. EMTREE DRUG INDEX TERMS antibiotic agent cosmetic sodium chloride EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast breast hypertrophy human obesity patient society surgeon EMTREE MEDICAL INDEX TERMS cellulitis contracture epidermolysis follow up graft necrosis high risk population implant incision infection lymph node mastectomy medical record patient satisfaction pectoralis major muscle procedures radiotherapy safety satisfaction seroma skin LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71387707 DOI 10.1245/s10434-012-2344-06p FULL TEXT LINK http://dx.doi.org/10.1245/s10434-012-2344-06p COPYRIGHT Copyright 2014 Elsevier B.V., All rights reserved. RECORD 564 TITLE Infectious complications associated with the use of acellular dermal matrix in implant-based bilateral breast reconstruction. AUTHOR NAMES Hill J.L. Wong L. Kemper P. Buseman J. Davenport D.L. Vasconez H.C. AUTHOR ADDRESSES (Hill J.L.) Division of Plastic Surgery, University of Kentucky College of Medicine, Lexington, KY, USA. (Wong L.; Kemper P.; Buseman J.; Davenport D.L.; Vasconez H.C.) CORRESPONDENCE ADDRESS J.L. Hill, Division of Plastic Surgery, University of Kentucky College of Medicine, Lexington, KY, USA. SOURCE Annals of plastic surgery (2012) 68:5 (432-434). Date of Publication: May 2012 ISSN 1536-3708 (electronic) ABSTRACT The use of acellular dermal matrix (ADM) has become a routine practice in implant-based breast reconstruction. Bilateral mastectomy is becoming more popular in cases of unilateral breast cancer. ADM has been associated with an increased incidence of complications. We identified cases of bilateral implant-based breast reconstruction over a 5-year period. Data collection included medical comorbities, details of operative management, and details of postoperative cancer treatment. On univariate analysis, the use of ADM (31% vs. 7%, P = 0.018), smoking (37% vs. 13%, P = 0.045), and open wound (55% vs. 13%, P = 0.006) were significantly associated with increased risk of infection. Multivariate analysis revealed open wound as the strongest predictor of infection. The use of ADM is associated with an increased risk of infection in bilateral implant-based breast reconstruction. However, it does not appear to be an independent risk factor by itself. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) biomaterial (adverse drug reaction, drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation surgical infection (epidemiology, etiology) EMTREE MEDICAL INDEX TERMS adult aged article dermis devices evaluation study female human middle aged multivariate analysis retrospective study risk factor statistical model LANGUAGE OF ARTICLE English MEDLINE PMID 22531395 (http://www.ncbi.nlm.nih.gov/pubmed/22531395) PUI L365456082 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 565 TITLE Use of acellular dermal matrix in breast reconstruction facilitates a more rapid achievement of final breast volume than standard tissue expansion AUTHOR NAMES Wright C. Zeiton A. Johnson R. Barr L. AUTHOR ADDRESSES (Wright C.; Zeiton A.; Johnson R.; Barr L.) University Hospital South Manchester, Manchester, United Kingdom. CORRESPONDENCE ADDRESS C. Wright, University Hospital South Manchester, Manchester, United Kingdom. SOURCE European Journal of Surgical Oncology (2012) 38:5 (446). Date of Publication: May 2012 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2012 CONFERENCE LOCATION Bournemouth, United Kingdom CONFERENCE DATE 2012-05-21 to 2012-05-22 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: In the absence of acellular dermal matrix (StratticeTM), implant-based reconstructions are commonly performed as two-stage procedures: tissue expansion (TE) followed by exchange for permanent implant. The aim of this study was to determine whether Strattice facilitates more rapid achievement of final breast volume after immediate reconstruction. Methods: The notes of our first 24 single-stage Strattice breast reconstruction patients (13 bilateral) were reviewed and data retrieved on implant-type, on-table implant volume and number of out-patient expansions. A control group of 12 bilateral and 10 unilateral TE patients under the same surgeons in the period immediately preceding the advent of Strattice was selected. Results: In the Strattice group 6 patients had fixed-size implants and 18 had dual-function expander-implants. 9 patients in the TE group had standard expanders, 13 had dual-function implants. The volumes of implant at the end of surgery was statistically significantly greater in the Strattice group than the TE group (p=0.0007). The mean volume of implant at the end of operation was 307mls in the Strattice group (S.D: 121) and 191mls for the controls (S.D: 86). The mean number of out-patient expansions was 0.83 for the Strattice group and 2.7 for the TE group. Conclusions: Our study shows that use of Strattice facilitates a larger 'on-table' volume of implant, more rapid achievement of final volume, and fewer out-patient expansions.We believe that this maximises the use of the skin envelope and hence produces an improved cosmetic result over standard tissue-expander techniques. EMTREE DRUG INDEX TERMS cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix achievement breast breast reconstruction breast surgery tissue expansion EMTREE MEDICAL INDEX TERMS control group human implant outpatient patient procedures skin surgeon surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70737329 DOI 10.1016/j.ejso.2012.02.135 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2012.02.135 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 566 TITLE The use of acellular dermal matrix in immediate two-stage tissue expander breast reconstruction. AUTHOR NAMES Weichman K.E. Wilson S.C. Weinstein A.L. Hazen A. Levine J.P. Choi M. Karp N.S. AUTHOR ADDRESSES (Weichman K.E.) New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, NY, USA. (Wilson S.C.; Weinstein A.L.; Hazen A.; Levine J.P.; Choi M.; Karp N.S.) CORRESPONDENCE ADDRESS K.E. Weichman, New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, NY, USA. SOURCE Plastic and reconstructive surgery (2012) 129:5 (1049-1058). Date of Publication: May 2012 ISSN 1529-4242 (electronic) ABSTRACT Acellular dermal matrix is commonly used in implant-based breast reconstruction to allow for quicker tissue expansion with better coverage and definition of the lower pole of the breast. This study was performed to analyze complications associated with its use in immediate two-stage, implant-based breast reconstruction and to subsequently develop guidelines for its use. A retrospective analysis of 628 consecutive immediate two-stage tissue expander breast reconstructions at a single institution over a 3-year period was conducted. The reconstructions were divided into two groups: reconstruction with acellular dermal matrix and reconstruction without it. Demographic information, patient characteristics, surface area of acellular dermal matrix, and complications were analyzed and compared. A total of 407 patients underwent 628 immediate two-stage, implant-based breast reconstructions; 442 reconstructions (70.3 percent) used acellular dermal matrix and 186 (29.6 percent) did not. The groups had similar patient characteristics; however, major complications were significantly increased in the acellular dermal matrix group (15.3 versus 5.4 percent; p = 0.001). These complications included infection requiring intravenous antibiotics (8.6 versus 2.7 percent; p = 0.001), flap necrosis requiring excision (6.7 versus 2.7 percent; p = 0.015), and explantation of the tissue expander (7.7 versus 2.7 percent; p = 0.004). Use of acellular dermal matrix in immediate two-stage, implant-based breast cancer reconstruction is associated with a significant increase in major complications. Therefore, it should only be used in specific patients and in minimal amounts. Indications for its use include single-stage permanent implant reconstruction and inadequate local muscle coverage of the tissue expander. Therapeutic, III. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen (adverse drug reaction, drug therapy) EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation (adverse drug reaction) breast reconstruction (adverse drug reaction) breast tumor (prevention, surgery) mastectomy tissue expansion (adverse drug reaction) EMTREE MEDICAL INDEX TERMS adult article breast implant (adverse drug reaction) female human methodology middle aged retrospective study tissue expander (adverse drug reaction) CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 22544088 (http://www.ncbi.nlm.nih.gov/pubmed/22544088) PUI L366375306 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 567 TITLE Discussion: the use of acellular dermal matrix in immediate two-stage tissue expander breast reconstruction. AUTHOR NAMES Butler C.E. Selber J.C. AUTHOR ADDRESSES (Butler C.E.) Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, USA. (Selber J.C.) CORRESPONDENCE ADDRESS C.E. Butler, Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, USA. Email: cbutler@mdanderson.org SOURCE Plastic and reconstructive surgery (2012) 129:5 (1059-1060). Date of Publication: May 2012 ISSN 1529-4242 (electronic) EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen (adverse drug reaction) EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation (adverse drug reaction) breast reconstruction (adverse drug reaction) breast tumor (surgery) mastectomy tissue expansion (adverse drug reaction) EMTREE MEDICAL INDEX TERMS female human note CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 22544089 (http://www.ncbi.nlm.nih.gov/pubmed/22544089) PUI L366375307 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 568 TITLE Comparison of Different ADM Materials in Breast Surgery AUTHOR NAMES Cheng A. Saint-Cyr M. AUTHOR ADDRESSES (Cheng A.; Saint-Cyr M., MSaintCyr@me.com) Department of Plastic Surgery, UT Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390-9132, United States. CORRESPONDENCE ADDRESS M. Saint-Cyr, Department of Plastic Surgery, UT Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390-9132, United States. Email: MSaintCyr@me.com SOURCE Clinics in Plastic Surgery (2012) 39:2 (167-175). Date of Publication: April 2012 ISSN 0094-1298 1558-0504 (electronic) BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT This is a brief review of the history of the role of acellular dermal matrices in breast reconstruction surgery, with a summary of several currently available products, including a table of comparisons. Key features, including biologic tissue source, surgical preparation, sterility, polarity, contraindications, shelf life, and cost, are examined. A paucity of data exists to directly compare AlloDerm(®), DermaMatrix(®), Strattice™, Permacol™, DermACELL, FlexHD(®), SurgiMend(®), and ALLOMAX™ for breast reconstruction; most studies relate to hernia repair. An ideal acellular dermal matrix product is still unavailable but the information provided in this review should facilitate a breast surgeons decision-making process. © 2012. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast surgery EMTREE MEDICAL INDEX TERMS breast augmentation breast endoprosthesis breast reconstruction graft preservation human inflammation mastectomy plastic surgery prosthesis infection (complication) review shelf life skin flap split thickness skin graft surgical risk tensile strength treatment contraindication DEVICE TRADE NAMES AlloDerm , United StatesLifecell AlloMax Bard DermACELL LifeNet DermaMatrix , United StatesSynthes FlexHD Permacol , United StatesCovidien Strattice , United StatesLifecell SurgiMend TEI DEVICE MANUFACTURERS Bard (United States)Covidien (United States)Lifecell LifeNet (United States)Synthes TEI EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012197885 MEDLINE PMID 22482358 (http://www.ncbi.nlm.nih.gov/pubmed/22482358) PUI L364570943 DOI 10.1016/j.cps.2012.02.004 FULL TEXT LINK http://dx.doi.org/10.1016/j.cps.2012.02.004 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 569 TITLE Acellular Dermal Matrices in Breast Surgery: Tips and Pearls AUTHOR NAMES Ayeni O.A. Ibrahim A.M.S. Lin S.J. Slavin S.A. AUTHOR ADDRESSES (Ayeni O.A.; Ibrahim A.M.S.; Lin S.J.; Slavin S.A., sslavin@bidmc.harvard.edu) Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Lowry Suite 5A, Boston, MA 02215, United States. CORRESPONDENCE ADDRESS S.A. Slavin, Division of Plastic Surgery, 1101 Beacon Street, Brookline, MA 02446, United States. Email: sslavin@bidmc.harvard.edu SOURCE Clinics in Plastic Surgery (2012) 39:2 (177-186). Date of Publication: April 2012 ISSN 0094-1298 1558-0504 (electronic) BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT Acellular dermal matrices (ADMs) have been used for postmastectomy breast reconstruction, primary and secondary breast augmentation, and reduction mammaplasty. In postmastectomy breast reconstruction, ADMs can be used to either create an implant pocket in single-stage reconstruction or to create the inferolateral portion of the tissue expander pocket in two-stage reconstruction. Specific deformities after cosmetic breast augmentation such as contour irregularities and implant malposition can be addressed with ADMs. The use of ADMs is a safe alternative for the correction of breast deformities after reconstructive and aesthetic breast surgery. © 2012. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast surgery EMTREE MEDICAL INDEX TERMS biomechanics breast malformation (surgery) breast reconstruction breast reduction composite skin graft esthetic surgery human implant capsular contracture (complication) mastectomy microbial contamination outcome assessment postoperative period preoperative period prosthesis infection (complication) prosthesis material radiation dose review risk factor surgical approach surgical technique DEVICE TRADE NAMES AlloDerm , United StatesLifecell DermaMatrix , United StatesSynthes FlexHD , United StatesEthicon Strattice , United StatesLifecell DEVICE MANUFACTURERS (United States)Ethicon (United States)Lifecell (United States)Synthes EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012197886 MEDLINE PMID 22482359 (http://www.ncbi.nlm.nih.gov/pubmed/22482359) PUI L364570944 DOI 10.1016/j.cps.2012.02.003 FULL TEXT LINK http://dx.doi.org/10.1016/j.cps.2012.02.003 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 570 TITLE Acellular Dermal Matrices: Economic Considerations in Reconstructive and Aesthetic Breast Surgery AUTHOR NAMES Macadam S.A. Lennox P.A. AUTHOR ADDRESSES (Macadam S.A., drsamacadam@gmail.com; Lennox P.A.) Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver General Hospital, 2nd Floor, JPP 2. 855 West, 12th Avenue, Vancouver, BC V5Z 1M9, Canada. CORRESPONDENCE ADDRESS S.A. Macadam, 1000-777 West Broadway, Vancouver, BC V5Z4J7, Canada. Email: drsamacadam@gmail.com SOURCE Clinics in Plastic Surgery (2012) 39:2 (187-216). Date of Publication: April 2012 ISSN 0094-1298 1558-0504 (electronic) BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT This article is a review of cost considerations and outcomes pertaining to the use of acellular dermal matrices (ADMs) in reconstructive and aesthetic breast surgery. The history of the use of ADMs in breast surgery and all case series describing outcomes and use of ADM in breast reconstructive and aesthetic surgery are reviewed. Weighted averages for clinically relevant outcomes for reconstructive and aesthetic breast surgery are provided. Cost considerations of ADM use in breast surgery are described and as an example, a single institution's experience with implementation of ADM into a preexisting breast surgery program, is used. © 2012 Elsevier Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction breast surgery economic aspect esthetic surgery EMTREE MEDICAL INDEX TERMS biocompatibility clinical effectiveness cost benefit analysis cost control cost effectiveness analysis cost minimization analysis cost utility analysis encapsulation external beam radiotherapy graft necrosis (complication) human implant implant capsular contracture (complication) mastectomy mesh sling outcome assessment postoperative period prosthesis infection (complication) revascularization review seroma (complication) shelf life skin allograft surgical approach surgical technique DEVICE TRADE NAMES AlloDerm , United StatesLifecell AlloMax , United StatesDavol DermaMatrix , United StatesSynthes FlexHD , United StatesEthicon FlexHD , United StatesJohnson and Johnson Strattice , United StatesLifecell SurgiMend , United StatesTEI DEVICE MANUFACTURERS (United States)Davol (United States)Ethicon (United States)Johnson and Johnson (United States)Lifecell (United States)Synthes (United States)TEI EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) Health Policy, Economics and Management (36) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012197887 MEDLINE PMID 22482360 (http://www.ncbi.nlm.nih.gov/pubmed/22482360) PUI L364570945 DOI 10.1016/j.cps.2012.02.007 FULL TEXT LINK http://dx.doi.org/10.1016/j.cps.2012.02.007 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 571 TITLE Acellular Dermal Matrices in Breast Implant Surgery: Defining the Problem and Proof of Concept AUTHOR NAMES Baxter R.A. AUTHOR ADDRESSES (Baxter R.A., drbaxter@drbaxter.com) Private Practice, Seattle, WA, United States. CORRESPONDENCE ADDRESS R.A. Baxter, 6100 219th Street SW, Suite 290, Mountlake Terrace, WA 98043, United States. Email: drbaxter@drbaxter.com SOURCE Clinics in Plastic Surgery (2012) 39:2 (103-112). Date of Publication: April 2012 ISSN 0094-1298 1558-0504 (electronic) BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT The use of acellular dermal matrices (ADMs) has become a useful adjunct to implant-based breast reconstruction and revision of the augmented breast. In both instances, the goal is replacement or reinforcement of thinned or missing tissues for implant support and control of the implant pocket. This article reviews the factors that contribute to periprosthetic tissue thinning, and the advantages and limitations of the use of ADMs for revision breast surgery and breast reconstruction. Proof of concept for the use of ADMs in the periprosthetic space is detailed from early clinical experience and histologic analysis documenting vascular ingrowth and cellular repopulation. © 2012 Elsevier Inc.. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast endoprosthesis breast surgery EMTREE MEDICAL INDEX TERMS allograft atrophy (complication) breast cancer (surgery) breast reconstruction endoprosthesis loosening (complication) equipment design histology human implant capsular contracture (complication) mastectomy plastic surgery review tissue regeneration DEVICE TRADE NAMES AlloDerm EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012197878 MEDLINE PMID 22482351 (http://www.ncbi.nlm.nih.gov/pubmed/22482351) PUI L364570936 DOI 10.1016/j.cps.2011.12.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.cps.2011.12.001 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 572 TITLE Pocket Reinforcement Using Acellular Dermal Matrices in Revisionary Breast Augmentation AUTHOR NAMES Kaufman D. AUTHOR ADDRESSES (Kaufman D., David@thenaturalresult.com) Kaufman and Clark Plastic Surgery, 2220 East Bidwell Street, Folsom, CA 95630, United States. CORRESPONDENCE ADDRESS D. Kaufman, Kaufman and Clark Plastic Surgery, 2220 East Bidwell Street, Folsom, CA 95630, United States. Email: David@thenaturalresult.com SOURCE Clinics in Plastic Surgery (2012) 39:2 (137-148). Date of Publication: April 2012 ISSN 0094-1298 1558-0504 (electronic) BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT Revision breast augmentation to treat implant malposition is fraught with challenges. This article focuses on treatment of implant malposition by using acellular dermal matrices (ADMs) with the intent of creating more reliable and accurate results. The article discusses the use of ADMs in patients with breast implant complications such as bottoming out, lateral implant displacement, or synmastia. ADM is a foreign material, thereby adding potential complications to consider. © 2012 Elsevier Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation pocket reinforcement surgical technique EMTREE MEDICAL INDEX TERMS anatomical concepts breast malformation (prevention) capsulorrhapy capsulotomy composite skin graft esthetic surgery human implant capsular contracture (complication) implant malposition (complication) mastopexy patient satisfaction postoperative care postoperative complication (complication) prosthesis material reoperation review seroma (complication) surgical anatomy synmastia (complication) telemastia (complication) EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012197882 MEDLINE PMID 22482355 (http://www.ncbi.nlm.nih.gov/pubmed/22482355) PUI L364570940 DOI 10.1016/j.cps.2012.02.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.cps.2012.02.001 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 573 TITLE Do Acellularized Dermal Matrices Change the Rationale for Immediate Versus Delayed Breast Reconstruction? AUTHOR NAMES Draper L.B. Disa J.J. AUTHOR ADDRESSES (Draper L.B.) Institute for Reconstructive Plastic Surgery, New York University School of Medicine, New York, NY, United States. (Disa J.J., disaj@mskcc.org) Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States. CORRESPONDENCE ADDRESS J.J. Disa, Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States. Email: disaj@mskcc.org SOURCE Clinics in Plastic Surgery (2012) 39:2 (113-118). Date of Publication: April 2012 ISSN 0094-1298 1558-0504 (electronic) BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT This article focuses on the contribution of acellular dermal matrices (ADMs) to immediate breast reconstruction. The current literature on ADMs is reviewed and the potential advantages and disadvantages of their use are highlighted. Technical considerations on how to effectively use these materials is presented. © 2012 Elsevier Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction early intervention therapy delay EMTREE MEDICAL INDEX TERMS allograft breast endoprosthesis health care cost human mastectomy plastic surgery postoperative complication (complication, etiology) postoperative infection (complication) radiotherapy review risk factor seroma (complication) surgical technique tissue expansion treatment indication DEVICE TRADE NAMES AlloDerm , United StatesLifecell Permachol , United StatesCovidien Strattice , United StatesLifecell DEVICE MANUFACTURERS (United States)Covidien (United States)Lifecell EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012197879 MEDLINE PMID 22482352 (http://www.ncbi.nlm.nih.gov/pubmed/22482352) PUI L364570937 DOI 10.1016/j.cps.2011.12.002 FULL TEXT LINK http://dx.doi.org/10.1016/j.cps.2011.12.002 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 574 TITLE Emerging Applications for Acellular Dermal Matrices in Mastopexy AUTHOR NAMES Bengtson B.P. Baxter R.A. AUTHOR ADDRESSES (Bengtson B.P., drb@bengtsoncenter.com) Bengtson Center for Aesthetics and Plastic Surgery, 555 MidTowne Street NE, Suite 110, Grand Rapids, MI 49503, United States. (Baxter R.A.) Private Practice, Seattle, WA, United States. (Baxter R.A.) Plastic Surgery Clinic, 6100 219th Street SW, Suite 290, Mountlake Terrace, WA 98043, United States. CORRESPONDENCE ADDRESS B.P. Bengtson, Bengtson Center for Aesthetics and Plastic Surgery, 555 MidTowne Street NE, Suite 110, Grand Rapids, MI 49503, United States. Email: drb@bengtsoncenter.com SOURCE Clinics in Plastic Surgery (2012) 39:2 (159-166). Date of Publication: April 2012 ISSN 0094-1298 1558-0504 (electronic) BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT This article explores whether some new acellular dermal matrices (ADMs) can be applied to breast augmentation or reconstruction revision, and particularly whether they can withstand the centripetal pull and prevent recurrent stretch deformities following periareolar mastopexy. Acellular dermis use in breast reconstruction and aesthetic breast revision is a fortuitous development, because their original purpose was for burn reconstruction. Although level 1 evidence remains lacking, ADMs have become integral adjuncts in breast reconstruction, complex hernia, and aesthetic breast revision. New applications continue to be explored, although these are in early stages of development and their long-term value remains to be confirmed. © 2012 Elsevier Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast surgery mastopexy EMTREE MEDICAL INDEX TERMS breast augmentation breast reconstruction human in vitro study mesh sling periareolar mastopexy plastic surgery postoperative period review surgical approach surgical technique DEVICE TRADE NAMES AlloDerm FortaPerm , United StatesOrganogenesis Monoderm Quill , United StatesAngiotech Strattice , United StatesLifecell DEVICE MANUFACTURERS (United States)Angiotech (United States)Gore (United States)Lifecell (United States)Organogenesis EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012197884 MEDLINE PMID 22482357 (http://www.ncbi.nlm.nih.gov/pubmed/22482357) PUI L364570942 DOI 10.1016/j.cps.2012.02.006 FULL TEXT LINK http://dx.doi.org/10.1016/j.cps.2012.02.006 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 575 TITLE Direct-to-Implant Breast Reconstruction AUTHOR NAMES Salzberg C.A. AUTHOR ADDRESSES (Salzberg C.A., asalzbergmd@yahoo.com) New York Medical College, Grasslands Road, Valhalla, NY 10591, United States. CORRESPONDENCE ADDRESS C.A. Salzberg, 155 White Plains Road, Suite 109, Tarrytown, NY 10591, United States. Email: asalzbergmd@yahoo.com SOURCE Clinics in Plastic Surgery (2012) 39:2 (119-126). Date of Publication: April 2012 ISSN 0094-1298 1558-0504 (electronic) BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT The expectations for improved results in postmastectomy reconstruction for women have increased in the past decade. The modified radical mastectomy has given way to breast conservation techniques using principles of skin preservation. Skin-sparing and nipple-sparing mastectomies have allowed plastic surgeons to perform breast reconstruction with the advantage of an intact skin envelope. Acellular dermal matrix is a biotechnological tissue prepared from either human or porcine skin. During processing, the cellular components that cause rejection and inflammation are removed, producing a structurally intact tissue matrix that serves as the biologic scaffold necessary for tissue ingrowth, angiogenesis, and tissue regeneration. © 2012 Elsevier Inc.. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction direct to implant surgery EMTREE MEDICAL INDEX TERMS acellular dermal matrix allograft breast cancer (surgery) breast endoprosthesis human partial mastectomy postoperative care postoperative complication (complication) preoperative care review skin flap surgical technique tissue expansion treatment contraindication treatment indication xenograft DEVICE TRADE NAMES AlloDerm Lifecell DermaMatrix Synthes Flex HD Ethicon NeoForm Mentor Strattice Lifecell SurgiMend TEI Veritas Synovis DEVICE MANUFACTURERS Ethicon Lifecell Mentor Synovis Synthes TEI EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012197880 MEDLINE PMID 22482353 (http://www.ncbi.nlm.nih.gov/pubmed/22482353) PUI L364570938 DOI 10.1016/j.cps.2012.01.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.cps.2012.01.001 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 576 TITLE The Role of Acellular Dermal Matrix in the Treatment of Capsular Contracture AUTHOR NAMES Namnoum J.D. Moyer H.R. AUTHOR ADDRESSES (Namnoum J.D., jdnamnoum@atlplastic.com) Private Practice, Atlanta Plastic Surgery, Emory University, 975 Johnson Ferry Road, Suite 100, Atlanta, GA 30319, United States. (Moyer H.R.) Division of Plastic Surgery, Emory University, 975 Johnson Ferry Road, Suite 100, Atlanta, GA 30342, United States. CORRESPONDENCE ADDRESS J.D. Namnoum, Private Practice, Atlanta Plastic Surgery, Emory University, 975 Johnson Ferry Road, Suite 100, Atlanta, GA 30319, United States. Email: jdnamnoum@atlplastic.com SOURCE Clinics in Plastic Surgery (2012) 39:2 (127-136). Date of Publication: April 2012 ISSN 0094-1298 1558-0504 (electronic) BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT Capsular contracture is one of the most common complications following breast surgery with implants and is a common cause for reoperation. Many techniques have been described to treat or prevent recurrent capsular contracture with varying success. Acellular dermal matrix (ADM), in combination with periprosthetic capsulectomy, is a powerful tool to delay or prevent recurrent contracture. Excellent results have been obtained when this approach has been used in patients with capsular contracture, but at increased cost. © 2012 Elsevier Inc. EMTREE DRUG INDEX TERMS Smad protein (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix implant capsular contracture (complication, etiology, prevention, surgery) EMTREE MEDICAL INDEX TERMS breast endoprosthesis breast surgery capsulectomy cell stress foreign body reaction human myofibroblast partial mastectomy pathogenesis reoperation review risk factor surgical technique CAS REGISTRY NUMBERS Smad protein (62395-38-4) EMBASE CLASSIFICATIONS General Pathology and Pathological Anatomy (5) Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012197881 MEDLINE PMID 22482354 (http://www.ncbi.nlm.nih.gov/pubmed/22482354) PUI L364570939 DOI 10.1016/j.cps.2012.02.005 FULL TEXT LINK http://dx.doi.org/10.1016/j.cps.2012.02.005 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 577 TITLE A systematic review and meta-analysis of complications associated with acellular dermal matrix-assisted breast reconstruction. AUTHOR NAMES Ho G. Nguyen T.J. Shahabi A. Hwang B.H. Chan L.S. Wong A.K. AUTHOR ADDRESSES (Ho G.) Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, USA. (Nguyen T.J.; Shahabi A.; Hwang B.H.; Chan L.S.; Wong A.K.) CORRESPONDENCE ADDRESS G. Ho, Division of Plastic and Reconstructive Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, USA. SOURCE Annals of plastic surgery (2012) 68:4 (346-356). Date of Publication: Apr 2012 ISSN 1536-3708 (electronic) ABSTRACT Multiple outcome studies have been published on the use of acellular dermal matrix (ADM) in breast reconstruction with disparate results. The purpose of this study was to conduct a systematic review and meta-analysis to determine an aggregate estimate of risks associated with ADM-assisted breast reconstruction. The MEDLINE, Web of Science, and Cochrane Library databases were queried, and relevant articles published up to September 2010 were analyzed based on specific inclusion criteria. Seven complications were studied including seroma, cellulitis, infection, hematoma, skin flap necrosis, capsular contracture, and reconstructive failure. A pooled random effects estimate for each complication and 95% confidence intervals (CI) were derived. For comparisons of ADM and non-ADM, the pooled random effects odds ratio (OR) and 95% CI were derived. Heterogeneity was measured using the I2 statistic. Sixteen studies met the inclusion criteria. The pooled complication rates were seroma (6.9%; 95% CI, 5.3%-8.8%), cellulitis (2.0%; 95% CI, 1.2%-3.1%), infection (5.7%; 95% CI, 4.3%-7.3%), skin flap necrosis (10.9%; 95% CI, 8.7%-13.5%), hematoma (1.3%; 95% CI, 0.6%-2.4%), capsular contracture (0.6%; 95% CI, 0.1%-1.7%), and reconstructive failure (5.1%; 95% CI, 3.8%-6.7%). Five studies reported findings for both the ADM and non-ADM patients and were used in the meta-analysis to calculate pooled OR. ADM-assisted breast reconstructions had a higher likelihood of seroma (pooled OR, 3.9; 95% CI, 2.4-6.2), infection (pooled OR, 2.7; 95% CI, 1.1-6.4), and reconstructive failure (pooled OR, 3.0; 95% CI, 1.3-6.8) than breast reconstructions without the use of ADM. The relation of ADM use to hematoma (pooled OR, 2.0; 95% CI, 0.8-5.2), cellulitis (pooled OR, 2.0; 95% CI, 0.9-4.3), and skin flap necrosis (pooled OR, 1.9; 95% CI, 0.6-5.4) was inconclusive. In the studies evaluated, ADM-assisted breast reconstructions exhibited a higher likelihood of seroma, infection, and reconstructive failure than prosthetic-based breast reconstructions using traditional musculofascial flaps. ADM is associated with a lower rate of capsular contracture. A careful risk/benefit analysis should be performed when choosing to use ADM in implant-based breast reconstruction. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) artificial skin (adverse drug reaction) breast reconstruction (adverse drug reaction) postoperative complication (epidemiology) skin transplantation (adverse drug reaction) EMTREE MEDICAL INDEX TERMS adult aged breast implant (adverse drug reaction) cellulitis (epidemiology, etiology) contracture (epidemiology, etiology) female graft rejection hematoma (epidemiology, etiology) human incidence meta analysis methodology middle aged pathology prognosis review risk assessment seroma (epidemiology, etiology) surgical infection (epidemiology) tissue expansion United States LANGUAGE OF ARTICLE English MEDLINE PMID 22421476 (http://www.ncbi.nlm.nih.gov/pubmed/22421476) PUI L366375001 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 578 TITLE The Use of Human Acellular Dermal Matrices in Irradiated Breast Reconstruction AUTHOR NAMES Topol B.M. AUTHOR ADDRESSES (Topol B.M., drtopol@drtopol.com) Division of Plastic Surgery, The Elliot Hospital, Catholic Medical Center, 36 Bay Street, Manchester, NH 03104, United States. CORRESPONDENCE ADDRESS B.M. Topol, Division of Plastic Surgery, The Elliot Hospital, Catholic Medical Center, 36 Bay Street, Manchester, NH 03104, United States. Email: drtopol@drtopol.com SOURCE Clinics in Plastic Surgery (2012) 39:2 (149-158). Date of Publication: April 2012 ISSN 0094-1298 1558-0504 (electronic) BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT This article examines the effects of radiation on prosthetic breast reconstruction when human dermal allograft is used in the reconstruction. A brief review of radiation terminology and techniques as applied to the breast is given, followed by a review of the effects of radiation on wound healing in human tissue. The effects of radiation on prosthetic breast reconstruction before the advent of dermal allografting are reviewed. The addition of dermal allograft in reconstruction has led to a reduced number of complications. An algorithm for surgical treatment of irradiated prosthetic breast reconstructions is presented, with a discussion of the authors technique. © 2012 Elsevier Inc. EMTREE DRUG INDEX TERMS antibiotic agent (oral drug administration) silicone sodium chloride EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction external beam radiotherapy prosthesis material EMTREE MEDICAL INDEX TERMS capsulotomy cell cycle G2 phase cell cycle M phase cell cycle S phase composite skin graft drug dose regimen erythema human implant ionizing radiation mastectomy nonhuman postoperative care postoperative period protective equipment radiation dose radiation response rectus abdominis muscle review soft tissue disease surgical approach surgical drainage surgical technique wound healing DEVICE TRADE NAMES AlloDerm , United StatesLifecell DEVICE MANUFACTURERS (United States)Lifecell CAS REGISTRY NUMBERS silicone (63148-53-8, 8043-93-4, 8055-24-1) sodium chloride (7647-14-5) EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012197883 MEDLINE PMID 22482356 (http://www.ncbi.nlm.nih.gov/pubmed/22482356) PUI L364570941 DOI 10.1016/j.cps.2012.02.002 FULL TEXT LINK http://dx.doi.org/10.1016/j.cps.2012.02.002 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 579 TITLE Current State of the Art for Acellular Dermal Matrices in Breast Surgery AUTHOR NAMES Baxter R.A. AUTHOR ADDRESSES (Baxter R.A., drbaxter@drbaxter.com) Plastic Surgery Clinic, 6100 219th Street SW, Suite 290, Mountlake Terrace, WA 98043, United States. CORRESPONDENCE ADDRESS R.A. Baxter, Plastic Surgery Clinic, 6100 219th Street SW, Suite 290, Mountlake Terrace, WA 98043, United States. Email: drbaxter@drbaxter.com SOURCE Clinics in Plastic Surgery (2012) 39:2 (ix). Date of Publication: April 2012 ISSN 0094-1298 1558-0504 (electronic) BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast surgery EMTREE MEDICAL INDEX TERMS breast reconstruction editorial genetic screening human irradiation mastectomy oncogene partial mastectomy plastic surgery EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2012197876 MEDLINE PMID 22482361 (http://www.ncbi.nlm.nih.gov/pubmed/22482361) PUI L364570934 DOI 10.1016/j.cps.2012.02.008 FULL TEXT LINK http://dx.doi.org/10.1016/j.cps.2012.02.008 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 580 TITLE Use of fetal bovine acellular dermal xenograft with tissue expansion for staged breast reconstruction. AUTHOR NAMES Endress R. Choi M.S. Lee G.K. AUTHOR ADDRESSES (Endress R.) Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA, USA. (Choi M.S.; Lee G.K.) CORRESPONDENCE ADDRESS R. Endress, Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA, USA. SOURCE Annals of plastic surgery (2012) 68:4 (338-341). Date of Publication: Apr 2012 ISSN 1536-3708 (electronic) ABSTRACT Staged breast reconstruction with implants and human acellular cadaveric dermis offers advantages of precise expander positioning, higher initial expander fill volumes, and improved outcomes. This study reports breast reconstruction using fetal bovine acellular dermal matrix (FBADM). The high type III collagen content of FBADM may allow for more rapid tissue incorporation and healing. A total of 49 breast reconstructions in 28 patients (group A) with FBADM were retrospectively compared with 123 reconstructions in 91 patients operated without FBADM (group B). FBADM sizes ranged from 48 to 100 cm2 (mean size: 70.6 cm2). The mean immediate fill volume in group A was 181.2 ± 148.3 mL and 117.7 ± 66.3 mL in group B (P < 0.001). The duration of drainage was significantly shorter in group A (8.51 ± 3.4 days) as compared with controls (11.07 ± 5.1 days), t-test (P = 0.015). There was no significant difference in the overall complication rate (20.8% in group A, 13.0% in group B). Further subgroup analysis of group A patients with complications and without complications, showed that group with complications had significantly longer drain removal time (9.48 vs. 7.97 days), larger initial fill volumes (238.1 vs. 145.3 mL), and a higher BMI (25.8 vs. 22.6 kg/m2) when compared with the complication-free subgroup. The use of FBADM in breast reconstruction offers results comparable with that of human acellular dermal matrix as reported in the literature. However, FBADM significantly reduced wound drainage time in our study when compared with patients without FBADM. EMTREE DRUG INDEX TERMS biomaterial EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction (adverse drug reaction) skin transplantation tissue expansion xenograft (adverse drug reaction) EMTREE MEDICAL INDEX TERMS adult aged animal article bovine breast implant breast tumor (surgery) cohort analysis comparative study esthetics female follow up graft rejection graft survival human mastectomy methodology middle aged pathophysiology physiology postoperative care postoperative complication retrospective study treatment outcome wound healing LANGUAGE OF ARTICLE English MEDLINE PMID 22421474 (http://www.ncbi.nlm.nih.gov/pubmed/22421474) PUI L366374999 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 581 TITLE Pectoralis fascia grafts in breast reconstruction AUTHOR NAMES Gran M.V. Nicholson S. Mahajan A.L. AUTHOR ADDRESSES (Gran M.V.; Nicholson S.; Mahajan A.L., almahajan@yahoo.com) Department of Plastics and Reconstructive Surgery, Bradford Teaching Hospitals, NHS Foundation Trust, Bradford, United Kingdom. (Gran M.V.) Jagiellonian University, School of Medicine, Poland. CORRESPONDENCE ADDRESS M.V. Gran, Department of Plastics and Reconstructive Surgery, Bradford Teaching Hospitals, NHS Foundation Trust, Bradford, United Kingdom. SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2012) 65:4 (e104-e105). Date of Publication: April 2012 ISSN 1748-6815 1878-0539 (electronic) BOOK PUBLISHER Churchill Livingstone, 1-3 Baxter's Place, Leith Walk, Edinburgh, United Kingdom. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction implant pectoralis major muscle EMTREE MEDICAL INDEX TERMS acellular dermal matrix adult article case report female hernia human mastectomy priority journal EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2012127149 MEDLINE PMID 22122890 (http://www.ncbi.nlm.nih.gov/pubmed/22122890) PUI L51737364 DOI 10.1016/j.bjps.2011.11.008 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2011.11.008 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 582 TITLE Initial experience with the use of porcine acellular dermal matrix for breast reconstruction AUTHOR NAMES Kaushik M. Michalakis I. Krupa J. AUTHOR ADDRESSES (Kaushik M.; Michalakis I.; Krupa J.) Glenfield Hospital, Breast and Oncoplastic Surgery, Leicester, United Kingdom. CORRESPONDENCE ADDRESS M. Kaushik, Glenfield Hospital, Breast and Oncoplastic Surgery, Leicester, United Kingdom. SOURCE European Journal of Cancer (2012) 48 SUPPL. 1 (S204). Date of Publication: March 2012 CONFERENCE NAME European Breast Cancer Conference 2012, EBCC8 CONFERENCE LOCATION Vienna, Austria CONFERENCE DATE 2012-03-21 to 2012-03-24 ISSN 0959-8049 BOOK PUBLISHER Elsevier Ltd ABSTRACT Background: This study identifies criteria and assesses outcomes for pts undergoing immediate implant reconstruction with Strattice® (Acellular Dermal Matrix) after mastectomy. Methods: We identified 3 groups of pts (n = 10). 1. Patients with small/moderate size breasts undergoing skin/nipple sparing mastectomy and one stage subpectoral implant reconstruction. Porcine acellular dermal matrix was used as inferior sling. (n = 5). 2. Patients with large/ptotic breasts who had skin reducing mastectomy with expander/expander-implant placement. Acellular dermal matrix was used alongside dermoglandular flap during first stage (n = 4). 3. Patients with poor soft tissue implant coverage requiring revisional surgery due to capsular contracture/suboptimal expansion (n = 1). Patients were assessed during clinical review, pre and post operative photographs. Results: Mean follow up was 4 months. There were no cases of implant loss or skin flap necrosis. One patient had implant rippling due to thin skin cover. One patient had seroma which was drained percutaneously. One other patient had transient skin flap redness which subsided spontaneously. Patient satisfaction was very high (90%). All patients rated highly in objective assessment at pre and postoperative photographs. Conclusion: 50% of our patients successfully underwent single stage breast reconstruction which is cost effective. This is a small series with a short follow up, however early results seem to be encouraging. Long term follow up is needed to establish application of acellular dermal matrix in breast reconstructive surgery.. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast cancer breast reconstruction EMTREE MEDICAL INDEX TERMS breast follow up graft necrosis human implant mastectomy patient patient satisfaction photography plastic surgery seroma skin skin flap soft tissue surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70729629 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 583 TITLE Use of acellular dermis (Strattice TM) in problematic cases of breast reconstructive surgery AUTHOR NAMES Kiechle M. Klein E. Paepke D. Bronger H. Ettl J. Paepke S. AUTHOR ADDRESSES (Kiechle M.; Klein E.; Paepke D.; Bronger H.; Ettl J.; Paepke S.) Klinikum rechts der Isar, Technische Universität München, Department of Obstetrics and Gynaecology, München, Germany. CORRESPONDENCE ADDRESS M. Kiechle, Klinikum rechts der Isar, Technische Universität München, Department of Obstetrics and Gynaecology, München, Germany. SOURCE European Journal of Cancer (2012) 48 SUPPL. 1 (S177). Date of Publication: March 2012 CONFERENCE NAME European Breast Cancer Conference 2012, EBCC8 CONFERENCE LOCATION Vienna, Austria CONFERENCE DATE 2012-03-21 to 2012-03-24 ISSN 0959-8049 BOOK PUBLISHER Elsevier Ltd ABSTRACT Background: Since 2002 we have analyzed 302 cases of skin and nipple sparing mastectomies. In 107 cases tissue-supporting extraneous materials such as meshes or acellular dermis have been used. Because of its excellent texture the acellular dermis can in contrast to other tissue-supporting meshes be used as a direct tissue replacement. Therefore it is insertable in situations of difficult skin envelope, after radiotherapy or after prior surgical intervention, or even when radiotherapy is planned after the immediate reconstructive surgery. With these indications acellular dermis can give an alternative to flap surgery. Material and Methods: Since 03/11 we have performed 9 operations with sub muscular implant placement and coverage with acellular dermis. 8 patients had received a prior operation in the context of their breast cancer disease, thereof 4 had skin sparing mastectomy and radiotherapy and 5 had received chemotherapy. Results: The acellular dermis was placed interpectoral. In 5 cases form and size was not changed and inserted horizontally, in 3 cases the acellular dermis was specifically cut and sewed vertical as a inner bra. Two cases of wound complications with suture dehiscence could be solved operatively without removing the reconstruction and wound closure above the acellular dermis. None of the cases showed signs of postoperative infection. The average duration of drainage was 9 days (7-13). Conclusions: The application of acellular dermis demands a detailed surgical planning. The maintenance of important individual surgical steps is quite different from other tissue-supporting materials. The presented patient collective had a high risk for complications (former operation, former radiotherapy), but the cosmetic result was good and a second operation was could be spared. EMTREE DRUG INDEX TERMS cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast breast cancer plastic surgery EMTREE MEDICAL INDEX TERMS chemotherapy human implant mastectomy nipple patient planning postoperative infection radiotherapy risk skin surgery tissues wound closure wound complication wound dehiscence LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70729534 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 584 TITLE Subpectoral implants in oncoplastic-reconstructive breast surgery - Habit or necessity? AUTHOR NAMES Paepke S. Dittmer S. Rezai A. Klein E. Kiechle M. AUTHOR ADDRESSES (Paepke S.; Dittmer S.; Rezai A.; Klein E.; Kiechle M.) Klinikum Rechts der Isar, Technische Universit at München, Gynecology and Obstetrics, München, Germany. CORRESPONDENCE ADDRESS S. Paepke, Klinikum Rechts der Isar, Technische Universit at München, Gynecology and Obstetrics, München, Germany. SOURCE European Journal of Cancer (2012) 48 SUPPL. 1 (S212-S213). Date of Publication: March 2012 CONFERENCE NAME European Breast Cancer Conference 2012, EBCC8 CONFERENCE LOCATION Vienna, Austria CONFERENCE DATE 2012-03-21 to 2012-03-24 ISSN 0959-8049 BOOK PUBLISHER Elsevier Ltd ABSTRACT Introduction: We perform nipple-sparing subcutaneous mastectomies since 2002. Herein we report on 302 cases, in 107 of which acellular dermis or meshs as tissue interponates were used. The standard procedure of subpectoral implant positioning with or without caudo-lateral tissue interponates (acellular dermis or mesh) can lead to postoperative problems due to detachment of muscle. Against this background we did not form a submuscular pocket in individual cases, but instead placed the implant in a cranially and caudally covering mesh pocket. Material and Methods: Between 06 and 12/2011 seven patients were operated according to the above protocol, and the short-term follow up analyzed. Patients that had to get radiation therapy were not admitted to the study. Furthermore, we only included patients that were planned to get a second, contralateral operation so that corrections of the first operation were possible. Patients were between 34 and 58 years old. One patient had to receive radiotherapy due to a nodal involvement not diagnosed before. Results: Four patients had received prior surgery. Indications for subcutaneous mastectomies comprised invasive carcinomas with large DCIS, R1 resections or secondary prophylaxis. Mastectomy weights ranged between 225 and 480 g; implant volumes ranged between 225 and 430 cm(3). Titanized meshs (TiLoopBra) were used in four cases and partially absorbable polypropylen meshs (SeragynBR) in three cases as interponate materials. The cosmetic outcome was excellent, we the margins of the implants were not visible. In three cases there was a partial necrosis of the nipple and in one case a partial skin necrosis with the necessity of a wound revision. Discussion: Using a mesh-pocket instead of subpectoral positioning of the implant makes the operation in individual cases easier. Post-operative mobility is immediate and unrestricted. Since the implant size has to be chosen according to the tissue weight removed, a bilaterally identical cosmetic result can be archieved. Complications inculde a mild seroma formation without the necessity to puncture. However, the small number of cases and the short term follow up do not allow to make any statements about consectuive capsular fibrosis.. EMTREE DRUG INDEX TERMS cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer breast surgery habit implant EMTREE MEDICAL INDEX TERMS acellular dermal matrix fibrosis follow up human intraductal carcinoma invasive carcinoma mastectomy muscle necrosis nipple patient procedures prophylaxis puncture radiotherapy seroma skin necrosis subcutaneous mastectomy surgery tissues weight wound LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70729661 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 585 TITLE First experiences with the implementation of a two component polypropylen-vicryl mesh (SERAGYN® BR) as tissue-supporting extraneous material in plastic reconstructive surgery AUTHOR NAMES Dittmer S. Paepke S. Klein E. Ohlinger R. Kiechle M. AUTHOR ADDRESSES (Dittmer S.; Paepke S.; Klein E.; Ohlinger R.; Kiechle M.) Klinikum rechts der Isar, Technische Universit at München, Department of Obstetrics and Gynaecology, München, Germany. CORRESPONDENCE ADDRESS S. Dittmer, Klinikum rechts der Isar, Technische Universit at München, Department of Obstetrics and Gynaecology, München, Germany. SOURCE European Journal of Cancer (2012) 48 SUPPL. 1 (S224). Date of Publication: March 2012 CONFERENCE NAME European Breast Cancer Conference 2012, EBCC8 CONFERENCE LOCATION Vienna, Austria CONFERENCE DATE 2012-03-21 to 2012-03-24 ISSN 0959-8049 BOOK PUBLISHER Elsevier Ltd ABSTRACT Background: Because of excellent experiences, the application of acellular dermis and other tissue-supporting meshes in plastic reconstructive breast surgery is approved by guidelines of the gynecologic oncologic committee (AGO) in Germany. Since March 2011 a partially absorbable two component mesh is available. The basic fiber consists of an absorbable PGA-CL and after resorption 6 singular, parallel layed polypropylene filaments remain permanently. The material components are suitable for plastic reconstructive breast surgery. Material and Methods: From March 2011 to September 2011 we performed 12 subcutaneous mastectomies with immediate reconstruction via implant placement and application of the SERAGYN two component mesh (n = 14) in breast cancer patients (median age = 49 years). Results: Mastectomy weight averaged 329g (120-580g); implant volumes ranged between 125 and 515 cm(3) (median 335 cm(3)). Implant location was mainly sub pectoral, in 3 cases the implant was covered by mesh only. We recorded no mesh arrosion, no wound infection and no unscheduled second operations. The mean time of drainage summed up to 8 days, in one patient a maximum of 11 days and still a puncture of seroma after drainage removal was necessary. Conclusions: Because of the combination of the different materials and special texture of the large-pored, partially absorbing meshes a stability of shape and softness of the reconstruction can be achieved. Convincing also are low rates of complications and good cosmetic results. However the still small number of cases and the short follow up limits the validity of this conclusion. Currently a prospective, multicentre analysis will merge the experiences of the different study centers.. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) polyglactin EMTREE DRUG INDEX TERMS cosmetic plastic polypropylene EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer plastic surgery tissues EMTREE MEDICAL INDEX TERMS acellular dermal matrix breast surgery cancer patient fiber follow up Germany hardness human implant mastectomy patient puncture seroma subcutaneous mastectomy validity weight wound infection LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70729700 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 586 TITLE Initial experience with the use of porcine acellular dermal matrix (Strattice) for abdominal wall reinforcement after transverse rectus abdominis myocutaneous flap breast reconstruction. AUTHOR NAMES Cicilioni Jr. O. Araujo G. Mimbs N. Cox M.D. AUTHOR ADDRESSES (Cicilioni Jr. O.) Department of Plastic Surgery for Florida Hospital, 2501 North Orange Avenue, Orlando, FL 32804, USA. (Araujo G.; Mimbs N.; Cox M.D.) CORRESPONDENCE ADDRESS O. Cicilioni, Department of Plastic Surgery for Florida Hospital, 2501 North Orange Avenue, Orlando, FL 32804, USA. Email: ocicilioni@aol.com SOURCE Annals of plastic surgery (2012) 68:3 (265-270). Date of Publication: Mar 2012 ISSN 1536-3708 (electronic) ABSTRACT Reestablishing anterior rectus fascial integrity remains a clinical challenge after transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction. The main concerns include herniation and bulging due to abdominal weakness. Mesh-assisted closure of the fascial defect has improved bulging and herniation rates but infection, extrusion, and encapsulation are serious concerns with mesh use. Biologic tissue matrices may overcome some of these mesh-related complications. The initial experience of using Strattice for fascial closure after TRAM flap procedure is described in this article. Strattice was in-lain and sutured between the anterior and posterior layers of the rectus fascia, at the rectus muscle donor site. The abdominal wall was closed with progressive tension sutures. Postoperative complications at the donor site were assessed. A total of 16 unilateral and 9 bilateral reconstructions were performed in 25 patients. Length of hospital stay was 2 to 3 days which is shorter than with mesh repair (typically 4-5 days). During a mean follow-up period of 14.0 months, complications occurred in 7 patients (28%): seroma formation (2), minor skin separation (2), superficial skin infection (2), and superficial wound dehiscence (1). Complications were not directly related to Strattice and all, except one (superficial skin infection), were resolved without surgical intervention. In all patients, routine abdominal functions were restored 4 months postoperatively. Strattice is a safe, alternative option to synthetic mesh for fascial repair following TRAM flap breast reconstruction. When used in conjunction with progressive tension suture closure of the abdominal wall, dynamic reconstruction of the abdominal wall with resumption of abdominal function is possible with Strattice. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen (drug therapy) EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) abdominal wall (surgery) breast reconstruction (adverse drug reaction) muscle weakness (etiology, surgery) plastic surgery (adverse drug reaction) EMTREE MEDICAL INDEX TERMS abdominal wall musculature (surgery) animal article classification follow up human methodology middle aged pig postoperative complication retrospective study suture technique CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 21862920 (http://www.ncbi.nlm.nih.gov/pubmed/21862920) PUI L365005176 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 587 TITLE Breast Implant Infections AUTHOR NAMES Washer L.L. Gutowski K. AUTHOR ADDRESSES (Washer L.L., laraine@med.umich.edu) Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, 3119 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5378, United States. (Washer L.L., laraine@med.umich.edu) Department of Infection Control and Epidemiology, University of Michigan Health System, NI8B06 North Ingalls Building, Ann Arbor, MI 48109, United States. (Gutowski K.) Division of Plastic Surgery, University of Chicago Pritzker School of Medicine, Chicago, MC 6035, United States. (Gutowski K.) CORRESPONDENCE ADDRESS L.L. Washer, Division of Infectious Diseases, University of Michigan Health System, 3119 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5378, United States. Email: laraine@med.umich.edu SOURCE Infectious Disease Clinics of North America (2012) 26:1 (112-125). Date of Publication: March 2012 ISSN 0891-5520 1557-9824 (electronic) BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT Infection after breast implant surgery occurs in 1.1% to 2.5% of procedures performed for augmentation and up to 35% of procedures performed for reconstruction after mastectomy. Most infections result from skin organisms and occur in the immediate postoperative period, although infections can occasionally present after many years. Diagnosis of breast implant infection relies on the clinical presentation of breast pain, swelling, erythema, and drainage in conjunction with ultrasound-guided cultures of periprosthetic fluid. Management commonly involves implant removal, with device salvage attempted in select situations. © 2012 Elsevier Inc. EMTREE DRUG INDEX TERMS antibiotic agent (drug therapy) cefazolin (drug therapy) cefuroxime cephalosporin (drug therapy) gentamicin penicillin G (drug therapy) povidone iodine vancomycin (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast endoprosthesis prosthesis infection (drug therapy, complication, diagnosis, drug therapy, epidemiology, etiology, prevention, therapy) EMTREE MEDICAL INDEX TERMS acellular dermal matrix antibiotic prophylaxis asepsis bacterial colonization bacterium contamination cost of illness device removal drug effect epidemiological data erythema (complication) Gram negative infection (drug therapy) human infection control infection prevention infection risk mastalgia (complication) microbiology mycobacteriosis (drug therapy) nonhuman pathogenesis postoperative infection (complication, diagnosis, drug therapy, epidemiology, etiology, prevention, therapy) review risk assessment risk factor salvage therapy treatment duration treatment planning CAS REGISTRY NUMBERS cefazolin (25953-19-9, 27164-46-1) cefuroxime (55268-75-2, 56238-63-2) cephalosporin (11111-12-9) gentamicin (1392-48-9, 1403-66-3, 1405-41-0) penicillin G (1406-05-9, 61-33-6) povidone iodine (25655-41-8) vancomycin (1404-90-6, 1404-93-9) EMBASE CLASSIFICATIONS Microbiology: Bacteriology, Mycology, Parasitology and Virology (4) Public Health, Social Medicine and Epidemiology (17) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2012056044 MEDLINE PMID 22284379 (http://www.ncbi.nlm.nih.gov/pubmed/22284379) PUI L364146750 DOI 10.1016/j.idc.2011.09.003 FULL TEXT LINK http://dx.doi.org/10.1016/j.idc.2011.09.003 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 588 TITLE A novel technique for nipple-areola complex reconstruction: the acellular dermal matrix onlay graft. AUTHOR NAMES Seaman B.J. Akbari S.R. Davison S.P. AUTHOR ADDRESSES (Seaman B.J.; Akbari S.R.; Davison S.P.) CORRESPONDENCE ADDRESS B.J. Seaman, SOURCE Plastic and reconstructive surgery (2012) 129:3 (580e-581e). Date of Publication: Mar 2012 ISSN 1529-4242 (electronic) EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) artificial skin breast reconstruction nipple (surgery) EMTREE MEDICAL INDEX TERMS adult editorial female human methodology CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 22374028 (http://www.ncbi.nlm.nih.gov/pubmed/22374028) PUI L364649986 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 589 TITLE Risk factors for adverse outcome following skin-sparing mastectomy and immediate prosthetic reconstruction. AUTHOR NAMES Kobraei E.M. Nimtz J. Wong L. Buseman J. Kemper P. Wright H. Rinker B.D. AUTHOR ADDRESSES (Kobraei E.M.) University of Kentucky College of Medicine, Lexington, KY, USA. (Nimtz J.; Wong L.; Buseman J.; Kemper P.; Wright H.; Rinker B.D.) CORRESPONDENCE ADDRESS E.M. Kobraei, University of Kentucky College of Medicine, Lexington, KY, USA. SOURCE Plastic and reconstructive surgery (2012) 129:2 (234e-241e). Date of Publication: Feb 2012 ISSN 1529-4242 (electronic) ABSTRACT Attempts to identify risk factors for adverse outcome following skin-sparing mastectomy and immediate prosthetic reconstruction have yielded inconsistent results, and no clear patient selection criteria have emerged. The authors identified patient- and procedure-related characteristics that predict unfavorable postoperative outcomes. Knowledge of these risk factors will facilitate preoperative patient screening to reduce the rate of implant loss and other postoperative complications. The authors retrospectively evaluated the postoperative outcomes of implant loss and major and minor complications in 102 patients (155 breasts) undergoing the combined operation from January of 2005 to December of 2010. Univariate logistic regression analysis was performed to determine the influence of six patient-related and three procedure-related characteristics on implant loss and postoperative complications. The use of acellular dermis was associated with a greater than three-fold increased risk of postoperative complications. Radiotherapy exposure was found to have a significant association with implant loss. None of the patient-related characteristics studied behaved as risk factors for postoperative complications, and none of the procedure-related characteristics acted as risk factors for implant loss. A cautious and conservative approach to using acelluar dermal matrix in this setting is warranted until its effect on postoperative outcomes is more clearly defined. The authors' data support findings from other studies of the deleterious effect of breast radiotherapy on postoperative outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, IV. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation (adverse drug reaction) breast reconstruction (adverse drug reaction) mastectomy (adverse drug reaction) EMTREE MEDICAL INDEX TERMS adult aged article human methodology middle aged retrospective study risk factor skin time LANGUAGE OF ARTICLE English MEDLINE PMID 22286439 (http://www.ncbi.nlm.nih.gov/pubmed/22286439) PUI L364441470 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 590 TITLE Acellular dermal matrix masking detection of recurrent breast carcinoma: a novel complication. AUTHOR NAMES Parikh R.P. Pappas-Politis E. Smith P.D. AUTHOR ADDRESSES (Parikh R.P.) Division of Plastic Surgery, Department of Surgery, University of South Florida, 12901 Bruce B. Downs Boulevard, MDC 2, Tampa, FL 33612, USA. (Pappas-Politis E.; Smith P.D.) CORRESPONDENCE ADDRESS R.P. Parikh, Division of Plastic Surgery, Department of Surgery, University of South Florida, 12901 Bruce B. Downs Boulevard, MDC 2, Tampa, FL 33612, USA. Email: rajpparikh@gmail.com SOURCE Aesthetic plastic surgery (2012) 36:1 (149-152). Date of Publication: Feb 2012 ISSN 1432-5241 (electronic) ABSTRACT Acellular dermal matrix (ADM) use in prosthetic breast reconstruction has become increasingly popular. Several benefits have been reported with this technique including diminished donor-site morbidity and improved aesthetic outcomes. Recently, in an effort to ascertain the overall safety and efficacy of this approach, an emphasis has been placed on identifying potential postoperative complications. This report describes a unique complication experienced with ADM use in which ADM conceals the detection of recurrent breast carcinoma. EMTREE DRUG INDEX TERMS biomaterial EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) artificial skin (adverse drug reaction) breast augmentation (adverse drug reaction) breast tumor (diagnosis, surgery) diagnostic error Paget nipple disease (diagnosis, surgery) tumor recurrence (diagnosis) EMTREE MEDICAL INDEX TERMS adult article breast (surgery) case report female human LANGUAGE OF ARTICLE English MEDLINE PMID 21607537 (http://www.ncbi.nlm.nih.gov/pubmed/21607537) PUI L365005340 DOI 10.1007/s00266-011-9744-6 FULL TEXT LINK http://dx.doi.org/10.1007/s00266-011-9744-6 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 591 TITLE A meta-analysis of human acellular dermis and submuscular tissue expander breast reconstruction. AUTHOR NAMES Kim J.Y. Davila A.A. Persing S. Connor C.M. Jovanovic B. Khan S.A. Fine N. Rawlani V. AUTHOR ADDRESSES (Kim J.Y.) Division of Plastic and Reconstructive Surgery, Department of Preventative Medicine, and the Lynn Sage Breast Center, Northwestern University, Feinberg School of Medicine, Chicago, Ill 60611, USA. (Davila A.A.; Persing S.; Connor C.M.; Jovanovic B.; Khan S.A.; Fine N.; Rawlani V.) CORRESPONDENCE ADDRESS J.Y. Kim, Division of Plastic and Reconstructive Surgery, Department of Preventative Medicine, and the Lynn Sage Breast Center, Northwestern University, Feinberg School of Medicine, Chicago, Ill 60611, USA. Email: jokim@nmh.org SOURCE Plastic and reconstructive surgery (2012) 129:1 (28-41). Date of Publication: Jan 2012 ISSN 1529-4242 (electronic) ABSTRACT Human acellular dermal matrix has become an increasingly used adjunct to traditional submuscular tissue expander/implant breast reconstruction, but there is no strong consensus regarding complication outcomes. This study stratified outcomes based on a meta-analysis of complications. A query of the MEDLINE database for articles on human acellular dermal matrix and submuscular tissue expander breast reconstruction yielded 901 citations. Two levels of screening identified 48 relevant studies. The DerSimonian and Laird random-effects model was used to perform the meta-analysis. Risk ratios and pooled complication rates were calculated for each outcome of interest. Nineteen studies reporting human acellular dermal matrix (n = 2037) and 35 reporting submuscular outcomes (n = 12,847) were used to estimate complication rates. Rates were generally higher in acellular dermis patients: total complications, 15.4 versus 14.0 percent; seroma, 4.8 versus 3.5 percent; infection, 5.3 versus 4.7 percent; and flap necrosis, 6.9 versus 4.9 percent. Six studies reporting both acellular dermis and submuscular outcomes were used to estimate relative risks. There was an increased risk of total complications (relative risk, 2.05; 95 percent CI, 1.55 to 2.70), seroma (relative risk, 2.73; 95 percent CI, 1.67 to 4.46), infection (relative risk, 2.47; 95 percent CI, 1.71 to 3.57), and reconstructive failure (relative risk, 2.80; 95 percent CI, 1.76 to 4.45) in acellular dermis patients. The meta-analysis suggests that the use of human acellular dermal matrix increases complication rates vis-à-vis submuscular expander/implant reconstruction. This must be weighed against its reported advantages in enhancing cosmesis and ameliorating contracture. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, III. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen (drug therapy) EMTREE DRUG INDEX TERMS biomaterial surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) artificial skin breast augmentation implant EMTREE MEDICAL INDEX TERMS article breast tumor (surgery) female human meta analysis methodology CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 22186498 (http://www.ncbi.nlm.nih.gov/pubmed/22186498) PUI L560051115 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 592 TITLE An easy method of acellular dermal matrix fixation to the submammary fold in prosthetic breast reconstruction. AUTHOR NAMES Larcher L. Helml G.H. Huemer G.M. AUTHOR ADDRESSES (Larcher L.; Helml G.H.; Huemer G.M.) CORRESPONDENCE ADDRESS L. Larcher, SOURCE Plastic and reconstructive surgery (2012) 129:1 (170e-171e; author reply 171e-172e). Date of Publication: Jan 2012 ISSN 1529-4242 (electronic) EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen (adverse drug reaction) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction (adverse drug reaction) postoperative complication (epidemiology) EMTREE MEDICAL INDEX TERMS female human note CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 22186542 (http://www.ncbi.nlm.nih.gov/pubmed/22186542) PUI L560051151 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 593 TITLE Nipple-areolar sparing mastectomy: Utility of the lateral inframammary incision in immediate implant-based reconstructions AUTHOR NAMES Guth A.A. Blechman K. Levovitz C. Small K. Axelrod D. Karp N. Choi M. AUTHOR ADDRESSES (Guth A.A.; Blechman K.; Levovitz C.; Small K.; Axelrod D.; Karp N.; Choi M.) NYU-Langone Medical Center, New York, United States. CORRESPONDENCE ADDRESS A.A. Guth, NYU-Langone Medical Center, New York, United States. SOURCE Cancer Research (2011) 71:24 SUPPL. 3. Date of Publication: 15 Dec 2011 CONFERENCE NAME 34th Annual CTRC-AACR San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2011-12-06 to 2011-12-10 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Purpose: Nipple and/or areola-sparing mastectomy as a therapeutic or prophylactic procedure for breast cancer is rapidly gaining popularity as the literature continues to support it safety. The lateral inframammary fold (IMF) approach provides adequate exposure and eliminates visible scars on the anterior surface of the breast, making this incision cosmetically superior to radial or periareolar approaches. Methods: We reviewed 58 consecutive nipple and/or areola-sparing mastectomies performed through a lateral IMF incision with immediate implant-based reconstruction, with or without tissue expansion, between June 2008 and February 2011. Prior to incision, breasts were lightly tumesced with dilute anesthetic solution with epinephrine. Sharp dissection, rather than electrocautery, was used as much as possible to minimize thermal injury to the mastectomy flap. When indicated, acellular dermal matrix was placed as an inferolateral sling. Subsequent fat grafting to correct contour deformities was performed in select patients. Three-dimensional (3D) photographs assessed changes in volume, antero-posterior projection, and ptosis. Retroareolar/nipple tissue underwent routine intraoperative frozen section analysis in cancer cases. Results: Mean patient age was 44 years, and mean follow-up time was 14 months. Depending upon the judgment of the oncologic surgeon, 44 (76%) mastectomies were nipple/areola-sparing, and 14 (24%) were areola-sparing. Thirteen mastectomies (22%) were therapeutic, the remaining 45 mastectomies (78%) were prophylactic. Five of the nine sentinel lymph node biopsies (56%) were performed through the lateral IMF incision without the need for a counter-incision. Acellular dermal matrix was used in 44 (76%) breasts. Average permanent implant volume was 313 cc (range 170 to 750 cc), and average fat grafting volume was 90 cc (range 36 to 177 cc). Mastectomy flap necrosis, requiring operative debridement, occurred in three breasts (5%). One of these breasts required a salvage latissimus dorsi myocutaneous flap to complete the reconstruction. Of the 44 nipple/areola sparing mastectomies, three (7%) required operative debridement and reconstruction for partial nipple necrosis. No statistically significant differences existed between therapeutic and prophylactic mastectomies for developing partial skin or nipple necrosis (p = 0.65). Morphologic outcomes using 3D scan measurements showed reconstructed breasts were larger, more projected, and less ptotic (196 vs. 248 cc, 80 vs. 90 mm, 146 vs. 134 mm, p < 0.01 for each parameter). Conclusion: Excellent results can be achieved with immediate implant-based reconstruction of nipple and/or areola-sparing mastectomy through a lateral IMF incision. NAC survival is reliable, and complication rates are low. EMTREE DRUG INDEX TERMS anesthetic agent epinephrine suprofen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer implant incision mastectomy nipple EMTREE MEDICAL INDEX TERMS acellular dermal matrix breast cauterization debridement decision making deformity dissection exposure follow up frozen section graft necrosis human latissimus dorsi flap necrosis neoplasm patient photography procedures ptosis safety scar sentinel lymph node biopsy skin surgeon survival thermal injury tissue expansion tissues LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71078026 DOI 10.1158/0008-5472.SABCS11-P2-16-09 FULL TEXT LINK http://dx.doi.org/10.1158/0008-5472.SABCS11-P2-16-09 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 594 TITLE Use of human acellular dermal matrix in implant- based breast reconstruction: Evaluating the evidence AUTHOR NAMES Joanna Nguyen T. Carey J.N. Wong A.K. AUTHOR ADDRESSES (Joanna Nguyen T.; Carey J.N.; Wong A.K., alex.wong@med.usc.edu) Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St., Los Angeles, CA 90033, United States. CORRESPONDENCE ADDRESS A.K. Wong, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo St., Los Angeles, CA 90033, United States. Email: alex.wong@med.usc.edu SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2011) 64:12 (1553-1561). Date of Publication: December 2011 ISSN 1748-6815 1878-0539 (electronic) BOOK PUBLISHER Churchill Livingstone, 1-3 Baxter's Place, Leith Walk, Edinburgh, United Kingdom. ABSTRACT The use of acellular dermal matrix (ADM) in implant based breast reconstruction has become increasingly popular to the point that a subset of surgeons use ADM for virtually every tissue expander/implant based reconstruction. While there may be a number of perceived and anecdotal advantages such as decreased post-operative pain, increased initial expander fill volume, and improved aesthetic outcome, it remains unclear as to whether there is sufficient evidence to support these as well as other claims or its routine use. In this review, we identified all papers in the PubMed and Medline databases that addressed outcomes of the use of ADM in single and multiple staged implant based breast reconstruction. Papers were evaluated for any claim of benefit in using ADM in breast reconstruction. The following perceived advantages were supported solely by anecdotal reports and opinions: reduction in post-op pain, decreased operative time, precise control of the lateral and IMF, maximal use of mastectomy skin flaps, and improved lower pole expansion. There was inconsistent data for commonly perceived advantages, such as: eliminating the need for expanders, increased initial fill volumes, fewer expansions, faster time to reconstruction completion, decreased rate of revision, and improved aesthetic outcome. We found consistent support for a decreased incidence of capsular contracture; however the existing reports have limited long term follow-up. Despite the many heralded benefits of ADM in breast reconstruction, the data supporting these claims is mostly anecdotal. Both long term outcomes and randomized controlled prospective studies are needed in order to definitively evaluate the perceived advantages of ADM in breast reconstruction. © 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction EMTREE MEDICAL INDEX TERMS data base evidence based medicine follow up human implant capsular contracture (complication) mastectomy Medline operation duration outcome assessment postoperative pain (complication, prevention) priority journal review skin flap systematic review EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011628990 MEDLINE PMID 21388901 (http://www.ncbi.nlm.nih.gov/pubmed/21388901) PUI L51309184 DOI 10.1016/j.bjps.2011.02.001 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2011.02.001 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 595 TITLE Retrospective review of 331 consecutive immediate single-stage implant reconstructions with acellular dermal matrix: indications, complications, trends, and costs. AUTHOR NAMES Colwell A.S. Damjanovic B. Zahedi B. Medford-Davis L. Hertl C. Austen Jr. W.G. AUTHOR ADDRESSES (Colwell A.S.) Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. (Damjanovic B.; Zahedi B.; Medford-Davis L.; Hertl C.; Austen Jr. W.G.) CORRESPONDENCE ADDRESS A.S. Colwell, Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Email: acolwell@partners.org SOURCE Plastic and reconstructive surgery (2011) 128:6 (1170-1178). Date of Publication: Dec 2011 ISSN 1529-4242 (electronic) ABSTRACT Immediate single-stage direct-to-implant breast reconstruction with acellular dermal matrix optimizes aesthetics by preserving the mastectomy skin envelope. The authors report trends, early complications, and costs. A retrospective review of three surgeons' experience was performed for immediate single-stage implant reconstruction with acellular dermal matrix and tissue expander reconstruction without it at Massachusetts General Hospital. Two hundred eleven patients had 331 direct-to-implant reconstructions using AlloDerm following nipple-sparing (n = 66) or skin-sparing (n = 265) mastectomy for cancer (n = 216) or prophylaxis (n = 115). The number of single-stage implant reconstructions increased from seven in 2006 to 116 in 2009. The percentage performed for prophylaxis increased from 29 percent to 41 percent. Fifty-one patients underwent preoperative (n = 33) or postoperative (n = 18) irradiation. Total complications included 10 infections (3.0 percent), five seromas (1.5 percent), four hematomas (1.2 percent), and 30 reconstructions (9.1 percent), with skin necrosis leading to five implant losses (1.5 percent). Tissue expander reconstruction without AlloDerm had a similar total complication rate (158 reconstructions) (p = 0.18), including nine infections (5.7 percent), three seromas (1.9 percent), three hematomas (1.9 percent), and 16 reconstructions (10.1 percent), with skin necrosis leading to 11 implant losses (7.0 percent). A higher complication rate occurred in the surgeons' combined first year performing single-stage implant reconstruction (21.4 percent) compared with subsequent years (10.9 percent) (p < 0.02) and in one- or two-stage reconstruction patients undergoing irradiation (p = 0.005). There was no significant difference in total overall costs (p = 0.8). Immediate single-stage implant reconstruction using acellular dermal matrix offers a cost-effective reconstruction with a low complication rate. This may be the procedure of choice in select patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) biomaterial collagen EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast endoprosthesis breast reconstruction postoperative complication (etiology, surgery) EMTREE MEDICAL INDEX TERMS adult aged article comparative study cost economics female human mastectomy methodology middle aged reoperation retrospective study risk factor CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 22094736 (http://www.ncbi.nlm.nih.gov/pubmed/22094736) PUI L560008473 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 596 TITLE Acellular dermis-assisted prosthetic breast reconstruction: a systematic and critical review of efficacy and associated morbidity. AUTHOR NAMES Sbitany H. Serletti J.M. AUTHOR ADDRESSES (Sbitany H.) University of Pennsylvania, Philadelphia, PA, USA. (Serletti J.M.) CORRESPONDENCE ADDRESS H. Sbitany, University of Pennsylvania, Philadelphia, PA, USA. Email: hani.sbitany@uphs.upenn.edu SOURCE Plastic and reconstructive surgery (2011) 128:6 (1162-1169). Date of Publication: Dec 2011 ISSN 1529-4242 (electronic) ABSTRACT The use of acellular dermal matrix to assist in two-stage expander/implant breast reconstruction has increased over recent years. However, there are questions regarding the potential for increased morbidity when using these techniques relative to standard submuscular coverage techniques. This systematic review combines published data comparing the techniques, to compare morbidity and advantages of acellular dermal matrix relative to standard submuscular coverage techniques. An English language literature search was performed to find articles reporting outcomes of two-stage expander/implant reconstruction using acellular dermal matrix. The outcome categories analyzed were patient/treatment demographics, tissue expander characteristics, and complications. Nine articles met inclusion criteria for this analysis. Six of these were matched cohort studies comparing outcomes of acellular dermal matrix techniques to standard submuscular techniques. The remaining three were case series of acellular dermal matrix techniques. The only difference found in complications was a higher rate of seroma for the acellular dermal matrix group (4.3 percent versus 8.4 percent, p = 0.03). Despite this, both groups illustrated similar rates of infection leading to explantation (3.2 percent for submuscular and 3.4 percent for acellular dermal matrix, p = 0.18). In addition, acellular dermal matrix techniques illustrated greater intraoperative fill volumes and consistently fewer fills required to reach expander capacity. The use of acellular dermal matrix in two-stage expander/implant reconstruction offers a safety profile similar to that of standard submuscular techniques. Both techniques have shown similar rates of infection ultimately requiring explantation. In addition, acellular dermal matrix offers the advantage of a more rapid reconstruction with less need for manipulation of the prosthetic through filling. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) biomaterial collagen EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast endoprosthesis breast reconstruction postoperative complication (etiology, surgery) EMTREE MEDICAL INDEX TERMS cohort analysis comparative study female human implant infection (etiology, surgery) methodology reoperation review seroma (etiology) surgical infection (etiology, surgery) CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 22094735 (http://www.ncbi.nlm.nih.gov/pubmed/22094735) PUI L560008472 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 597 TITLE Tunneling of a leech into a free flap breast reconstruction AUTHOR NAMES Flurry M. Natoli N.B. Mesa J.M. Moyer K.E. AUTHOR ADDRESSES (Flurry M.; Natoli N.B.; Mesa J.M.; Moyer K.E., kmoyer2@hmc.psu.edu) Division of Plastic Surgery, Penn State Milton S Hershey Medical Center, MC H071, 500 University Dr, Hershey, PA 17033, United States. CORRESPONDENCE ADDRESS K.E. Moyer, Division of Plastic Surgery, Penn State Milton S Hershey Medical Center, MC H071, 500 University Dr, Hershey, PA 17033, United States. Email: kmoyer2@hmc.psu.edu SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2011) 64:12 (1687-1688). Date of Publication: December 2011 ISSN 1748-6815 1878-0539 (electronic) BOOK PUBLISHER Churchill Livingstone, 1-3 Baxter's Place, Leith Walk, Edinburgh, United Kingdom. ABSTRACT Leeches are well known to migrate over the surface of the treated tissues. At times, they can be located in remote locations once they become engorged and detach. We report the first case of a leech tunneling through a dermal bite wound on a breast free flap. © 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction free tissue graft leeching EMTREE MEDICAL INDEX TERMS adult article bite case report female human intraductal carcinoma (surgery) mastectomy medical examination priority journal treatment failure vascular patency vein anastomosis EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011629008 MEDLINE PMID 21664204 (http://www.ncbi.nlm.nih.gov/pubmed/21664204) PUI L51465857 DOI 10.1016/j.bjps.2011.05.014 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2011.05.014 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 598 TITLE Evaluation of the use of Permacol paste and sheet for breast reconstruction in a sheep model AUTHOR NAMES Soobrah R. Reichert R. Sibbons P. AUTHOR ADDRESSES (Soobrah R.; Sibbons P.) Northwick Park Institute for Medical Research, Northwick Park and St Mark's Hospitals, Watford Road, Harrow, Middlesex, HA1 3UJ, United Kingdom. (Reichert R.) Northwick Park Hospital, United Kingdom. CORRESPONDENCE ADDRESS R. Soobrah, Northwick Park Institute for Medical Research, Northwick Park and St Mark's Hospitals, Watford Road, Harrow, Middlesex, HA1 3UJ, United Kingdom. SOURCE European Journal of Surgical Oncology (2011) 37:11 (1013). Date of Publication: November 2011 CONFERENCE NAME BASO - The Association for Cancer Surgery Scientific Conference 2011 CONFERENCE LOCATION London, United Kingdom CONFERENCE DATE 2011-11-07 to 2011-11-07 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Permacol is an acellular non-immunogenic biocompatible implant made from porcine dermal collagen and its structural architecture is very close to human dermis. It has been widely used in a variety ofsurgical procedures; however, its use in animal or human breast tissue hasnot been investigated. The aim of this pilot study was to examine the ability of Permacol paste and Permacol sheet to integrate with ovine mammarytissue. Methods: Four adult female sheep underwent unilateral lumpectomyand injection of Permacol paste; two of them also had a Permacol meshinserted within the breast cavity. All animals were carefully monitoredfor 28 days postoperatively and subsequently euthanized. After adequatefixation, representative blocks of tissue were stained with Haematoxylin & Eosin and Picrosirius red combined with Miller's elastin and underwentmicroscopic examination.Results: Post-mortem macroscopic examination showed adequatewound healing, well-conserved mammary profiles and no evidence of capsule formation in all subjects. Microscopic examination revealed good neovascularisation throughout the paste, no excessive inflammatory responseand neo-collagenesis emanating from the host tissue. The mesh integratedwell with the paste and mammary tissue and showed no signs of degradation. Features of neo-collagenesis and neo-vascularisation were also seenwithin the mesh.Conclusion: This study shows that, in the short-term, Permacol im-plant integrates well with sheep mammary tissue. Long-term studies areneeded to assess its ability to integrate with surrounding breast tissue with-out creating superficial deformities or palpable lumps. EMTREE DRUG INDEX TERMS collagen elastin eosin hematoxylin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction cancer surgery model paste sheep EMTREE MEDICAL INDEX TERMS adult architecture breast deformity dermis examination female healing human implant injection microscopy pilot study plant tissues vascularization LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70557605 DOI 10.1016/j.ejso.2011.08.022 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2011.08.022 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 599 TITLE Comparison of implant-based immediate breast reconstruction with and without acellular dermal matrix. AUTHOR NAMES Vardanian A.J. Clayton J.L. Roostaeian J. Shirvanian V. Da Lio A. Lipa J.E. Crisera C. Festekjian J.H. AUTHOR ADDRESSES (Vardanian A.J.) Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA. (Clayton J.L.; Roostaeian J.; Shirvanian V.; Da Lio A.; Lipa J.E.; Crisera C.; Festekjian J.H.) CORRESPONDENCE ADDRESS A.J. Vardanian, Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA. SOURCE Plastic and reconstructive surgery (2011) 128:5 (403e-410e). Date of Publication: Nov 2011 ISSN 1529-4242 (electronic) ABSTRACT Acellular dermal matrix is frequently used in implant-based breast reconstruction to cover the inferior aspect of the breast pocket. Its performance profile remains equivocal. The authors studied whether adding it in implant-based immediate breast reconstruction improved outcomes when compared with non-acellular dermal matrix reconstruction. Patients undergoing implant-based immediate breast reconstruction at a single academic medical center were evaluated. Aesthetic outcomes and postoperative complications were assessed and direct comparisons were made between acellular dermal matrix and non-acellular dermal matrix cohorts. A total of 203 patients underwent 337 immediate expander-based breast reconstructions [with acellular dermal matrix, n=208 (61.7 percent); without, n=129 (38.3 percent)]. Patient characteristics, including age at time of reconstruction (mean, 49±11 versus 47±10 years) and body mass index (mean, 23±5 versus 23±3 kg/m) were similar between groups (p>0.05). Complications occurred in one-third of patients (33.5 percent). In univariate analyses, acellular dermal matrix use had fewer overall complications (odds ratio, 0.61; 95 percent CI, 0.38 to 0.97). The incidences of seroma/hematoma (p=0.59), infection (p=0.31), and wound complications (p=0.26) did not differ. Aesthetic outcomes were higher in the acellular dermal matrix group. In multivariate logistic regression, acellular dermal matrix use was associated with less capsular contracture (odds ratio, 0.18; 95 percent CI, 0.08 to 0.43) and mechanical shift (odds ratio, 0.23; 95 percent CI, 0.06 to 0.78). Optimizing the inframammary fold with acellular dermal matrix creates a superior aesthetic result. Its use appears safe and is associated with less capsular contracture and mechanical shift and improvement in the inframammary fold appearance, without increasing postoperative complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast endoprosthesis breast reconstruction (adverse drug reaction) mastectomy plastic surgery EMTREE MEDICAL INDEX TERMS adult article breast augmentation (adverse drug reaction) breast tumor (surgery) cohort analysis comparative study esthetics female follow up human methodology middle aged multivariate analysis pathology pathophysiology physiology postoperative care postoperative complication retrospective study risk risk assessment statistical model time tissue expansion treatment outcome wound healing CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 22030500 (http://www.ncbi.nlm.nih.gov/pubmed/22030500) PUI L560001714 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 600 TITLE High-throughput assay for bacterial adhesion on acellular dermal matrices and synthetic surgical materials. AUTHOR NAMES Nyame T.T. Lemon K.P. Kolter R. Liao E.C. AUTHOR ADDRESSES (Nyame T.T.) Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. (Lemon K.P.; Kolter R.; Liao E.C.) CORRESPONDENCE ADDRESS T.T. Nyame, Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. SOURCE Plastic and reconstructive surgery (2011) 128:5 (1061-1068). Date of Publication: Nov 2011 ISSN 1529-4242 (electronic) ABSTRACT There has been increasing use of synthetic and acellular dermal matrix materials in surgery, ranging from breast reconstruction to hernia repairs. There is a paucity of data on how acellular dermal matrix compares with other surgical materials as a substrate for bacterial adhesion, the first step in formation biofilm, which occurs in prosthetic wound infections. The authors have designed a high-throughput assay to evaluate Staphylococcus aureus adherence on various synthetic and biologically derived materials. Clinical isolates of S. aureus (strains SC-1 and UAMS-1) were cultured with different materials, and bacterial adherence was measured using a resazurin cell vitality assay. Four materials that are commonly used in surgery were evaluated: Prolene mesh, Vicryl mesh, and two different acellular dermal matrix preparations (AlloDerm and FlexHD). The authors were able to develop a high-throughput and reliable assay for quantifying bacterial adhesion on synthetic and biologically derived materials. The resazurin vitality assay can be reliably used to quantify bacterial adherence to acellular dermal matrix material and synthetic material. S. aureus strains SC-1 and UAMS-1 both adhered better to acellular dermal matrix materials (AlloDerm versus FlexHD) than to the synthetic material Prolene. S. aureus also adhered better to Vicryl than to Prolene. Strain UAMS-1 adhered better to Vicryl and acellular dermal matrix materials than did strain SC-1. The results show that S. aureus adheres more readily to acellular dermal matrix material than to synthetic material. The resazurin assay provides a standard method for evaluating surgical materials with regard to bacterial adherence and potential propensity for biofilm development. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen EMTREE DRUG INDEX TERMS biomaterial surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) bacterium adherence materials testing Staphylococcus aureus surgical equipment EMTREE MEDICAL INDEX TERMS article artificial skin culture medium growth, development and aging human methodology physiology prostheses and orthoses tissue engineering CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 22030489 (http://www.ncbi.nlm.nih.gov/pubmed/22030489) PUI L560001708 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 601 TITLE Evolving role of alloderm in breast surgery. AUTHOR NAMES Gabriel A. Maxwell G.P. AUTHOR ADDRESSES (Gabriel A.) Department of Surgery, Southwest Washington Medical Center, Vancouver, WA, USA. (Maxwell G.P.) CORRESPONDENCE ADDRESS A. Gabriel, Department of Surgery, Southwest Washington Medical Center, Vancouver, WA, USA. Email: gabrielallen@yahoo.com SOURCE Plastic surgical nursing : official journal of the American Society of Plastic and Reconstructive Surgical Nurses (2011) 31:4 (141-150). Date of Publication: 2011 Oct-Dec ISSN 1550-1841 (electronic) ABSTRACT The adjunctive use of acellular dermal matrices in breast surgery is expanding. The purpose of this article is to provide an overview of the various applications of acellular dermal matrices in breast surgery, the benefits and complications associated with their use, and best practices to optimize outcomes using a human acellular dermal matrix (AlloDerm [LifeCell Corp., Branchburg, NJ]) as an example. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen (drug therapy) EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction EMTREE MEDICAL INDEX TERMS female human mastectomy review CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 22157603 (http://www.ncbi.nlm.nih.gov/pubmed/22157603) PUI L560069759 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 602 TITLE Tissue expander breast reconstruction using different techniques for implant coverage: A comparative analysis AUTHOR NAMES Seth A.K. Hirsch E.M. Fine N.A. Dumanian G.A. Mustoe T.A. Kim J.Y. AUTHOR ADDRESSES (Seth A.K.; Hirsch E.M.; Fine N.A.; Dumanian G.A.; Mustoe T.A.; Kim J.Y.) Northwestern University, Chicago, United States. CORRESPONDENCE ADDRESS A.K. Seth, Northwestern University, Chicago, United States. SOURCE Journal of the American College of Surgeons (2011) 213:3 SUPPL. 1 (S93). Date of Publication: September 2011 CONFERENCE NAME 97th Annual Clinical Congress of the American College of Surgeons CONFERENCE LOCATION San Francisco, CA, United States CONFERENCE DATE 2011-10-23 to 2011-10-27 ISSN 1072-7515 BOOK PUBLISHER Elsevier Inc. ABSTRACT INTRODUCTION: Historically, multiple techniques have been used to obtain implant coverage during immediate tissue expander breast reconstruction (TE).We evaluate outcomes following reconstruction with complete submuscular (including serratus) coverage, elevation of serratus fascia, or incorporation of acellular dermis (ADM). METHODS: Retrospective review of 944 consecutive patients from 4/1998-8/2008 at one institution yielded 689 (942 breasts) that underwent mastectomy with TE using one-of-four procedures: elevation of serratus muscle (SM) or serratus fascia (SF), or human ADM implantation (cryopreserved [CHADM] or prehydrated [PHADM]).Demographic, operative, and postoperative factors, and follow-up were recorded. Statistics were calculated using one-way analysis of variance. RESULTS: Demographics were comparable among SM (n=370), SF (n=171), CHADM (n=85), and PHADM (n=63) patients. Mean follow-up was 29.5 months. There were no differences in total complications per breast (14.8-17.7%), particularly seromas requiring aspiration (1.1-5.5%), infection (4.5-5.6%), mastectomy flap necrosis (5.5-7.8%), unscheduled reoperation (5.4-7.8%), or explantation (8.5-9.4%) among any groups, including CHADM versus PHADM. SM patients had smaller intraoperative fill-volumes (p<0.001) and more postoperative expansions (p<0.01), but no increased time to expander-to-implant exchange, compared to all other groups. CONCLUSIONS: Our comparative analysis, the largest study-todate to stratify by type of submuscular (fascia vs. muscle) and ADM (CHADM vs. PHADM) coverage, demonstrates no increased complication rates secondary to ADM-assisted reconstruction, regardless of ADM-type used. However, ADM did not significantly decrease time to second-stage reconstruction despite reducing postoperative expansion requirements. Current autologous and non-autologous tissue coverage techniques are safe, comparable, and effective, allowing for versatility and adaptability when tailoring the optimal reconstruction for an individual patient. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction college human implant surgeon tissue expander EMTREE MEDICAL INDEX TERMS acellular dermal matrix analysis of variance aspiration breast explant fascia follow up graft necrosis implantation infection mastectomy muscle patient procedures reoperation statistics tissues LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71254616 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 603 TITLE Acellular dermal matrix in breast reconstruction in the setting of radiotherapy. AUTHOR NAMES Israeli R. Feingold R.S. AUTHOR ADDRESSES (Israeli R.) Division of Plastic Surgery, Department of Surgery, Hofstra University School of Medicine, in partnership with North Shore-LIJ Health System, Hempstead, New York, USA. (Feingold R.S.) CORRESPONDENCE ADDRESS R. Israeli, Division of Plastic Surgery, Department of Surgery, Hofstra University School of Medicine, in partnership with North Shore-LIJ Health System, Hempstead, New York, USA. Email: risraeli@bodyplasticsurgery.com SOURCE Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery (2011) 31:7 Suppl (51S-64S). Date of Publication: Sep 2011 ISSN 1527-330X (electronic) ABSTRACT Acellular dermal matrices (ADM) are becoming an integral component of immediate implant-based breast reconstruction, providing inferolateral coverage and support of the implant. Currently, five ADM products are available on the market for this purpose. Although their application has resulted in improved aesthetic results with low complication rates, the clinical performance of ADM when radiotherapy is a component of breast cancer treatment has yet to be defined. In this article, we present a thorough review of the current literature on the performance of ADM in the setting of radiotherapy from both animal and human studies, including our own experience with two proprietary ADM products. The other three products have little literature documenting their application for this type of reconstruction, and further studies specifically evaluating the performance of all ADM formulations in the setting of radiotherapy are still needed. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen (drug therapy) EMTREE DRUG INDEX TERMS biomaterial (drug therapy) surgical mesh surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation breast tumor (radiotherapy, surgery) EMTREE MEDICAL INDEX TERMS adjuvant therapy animal breast endoprosthesis breast reconstruction female human methodology review CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 21908824 (http://www.ncbi.nlm.nih.gov/pubmed/21908824) PUI L560022135 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 604 TITLE Acellular dermal matrix in primary breast reconstruction. AUTHOR NAMES Sbitany H. Langstein H.N. AUTHOR ADDRESSES (Sbitany H.) Division of Plastic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. (Langstein H.N.) CORRESPONDENCE ADDRESS H. Sbitany, Division of Plastic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. Email: Hani.Sbitany@gmail.com SOURCE Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery (2011) 31:7 Suppl (30S-7S). Date of Publication: Sep 2011 ISSN 1527-330X (electronic) ABSTRACT The use of acellular dermal matrix (ADM) in many plastic surgery procedures, including breast reconstruction, has increased dramatically in recent years. While expander/implant reconstruction can be performed successfully with standard techniques, the introduction of ADM has added a new tool with which to achieve lasting, predictable results. This article is a summary of existing literature on ADM for primary implant reconstruction, to provide a more thorough understanding of the benefits of ADM in single- and to two-stage breast reconstruction and to identify the areas where further investigation is needed. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) biomaterial (drug therapy) EMTREE DRUG INDEX TERMS collagen (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation breast reconstruction EMTREE MEDICAL INDEX TERMS animal breast endoprosthesis female human methodology review CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 21908822 (http://www.ncbi.nlm.nih.gov/pubmed/21908822) PUI L560022133 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 605 TITLE Acellular dermal matrix for secondary procedures following prosthetic breast reconstruction. AUTHOR NAMES Nahabedian M.Y. Spear S.L. AUTHOR ADDRESSES (Nahabedian M.Y.) Department of Plastic Surgery, Georgetown University Hospital, Washington, DC 20007, USA. (Spear S.L.) CORRESPONDENCE ADDRESS M.Y. Nahabedian, Department of Plastic Surgery, Georgetown University Hospital, Washington, DC 20007, USA. Email: DrNahabedian@aol.com SOURCE Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery (2011) 31:7 Suppl (38S-50S). Date of Publication: Sep 2011 ISSN 1527-330X (electronic) ABSTRACT Acellular dermal matrices (ADM) have generated interest for their possible applications in secondary revisions following prosthetic breast reconstruction. These materials can be effective in a variety of situations, including implant displacement, synmastia, capsular contracture, incisional support, and pocket conversion. ADM can also be placed in the setting of delayed breast reconstruction and to augment nipple projection. These biomaterials have demonstrated feasibility and success for many complex deformities. However, there is an associated learning curve that includes an understanding of proper technique and patient selection. The authors review their cumulative experience between 2004 and 2010 with ADM for the correction of secondary deformities following prosthetic breast reconstruction, focusing on the indications for repair, traditional management, and management with ADM. EMTREE DRUG INDEX TERMS biomaterial (drug therapy) collagen (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation breast reconstruction nipple (surgery) EMTREE MEDICAL INDEX TERMS breast endoprosthesis (adverse drug reaction) female human methodology patient selection review CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 21908823 (http://www.ncbi.nlm.nih.gov/pubmed/21908823) PUI L560022134 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 606 TITLE Acellular dermal matrix in aesthetic revisionary breast surgery. AUTHOR NAMES Maxwell G.P. Gabriel A. AUTHOR ADDRESSES (Maxwell G.P.) Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, California, USA. (Gabriel A.) CORRESPONDENCE ADDRESS G.P. Maxwell, Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, California, USA. SOURCE Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery (2011) 31:7 Suppl (65S-76S). Date of Publication: Sep 2011 ISSN 1527-330X (electronic) ABSTRACT Breast augmentation is one of the most commonly-performed cosmetic procedures worldwide. Unfortunately, many women require revisionary surgery related to unsatisfactory results or complications such as capsular contracture, implant malposition, and ptosis. While, historically, surgeons have relied on often-imperfect native tissue to correct these deformities, acellular dermal matrix (ADM) offers a new option for solving these difficult aesthetic problems. In this article, the authors provide background information about the role of ADM in providing excellent and lasting results to cosmetic breast augmentation patients, and they describe their method of subpectoral revisionary augmentation with ADM. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen (drug therapy) EMTREE DRUG INDEX TERMS biomaterial (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation (adverse drug reaction) breast endoprosthesis (adverse drug reaction) EMTREE MEDICAL INDEX TERMS article female human implant capsular contracture (surgery) methodology postoperative complication reoperation CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 21908825 (http://www.ncbi.nlm.nih.gov/pubmed/21908825) PUI L560022136 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 607 TITLE Acellular dermal matrix in cosmetic breast procedures and capsular contracture. AUTHOR NAMES Mofid M.M. AUTHOR ADDRESSES (Mofid M.M.) Division of Plastic Surgery, University of California, San Diego, California, USA. CORRESPONDENCE ADDRESS M.M. Mofid, Division of Plastic Surgery, University of California, San Diego, California, USA. Email: drmofid@mofidplasticsurgery.com SOURCE Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery (2011) 31:7 Suppl (77S-84S). Date of Publication: Sep 2011 ISSN 1527-330X (electronic) ABSTRACT Prevention and treatment of capsular contracture after breast augmentation is a controversial and oftentimes vexing problem. While there are traditional methods of addressing this condition, acellular dermal matrix materials offer a new and promising modality that is gaining momentum in the field of plastic surgery. In this article, the author examines the etiology and pathophysiology of capsular contracture and review the existing literature on acellular dermal matrix in breast surgery related to capsular contracture. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen (drug therapy) EMTREE DRUG INDEX TERMS biomaterial (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation (adverse drug reaction) implant capsular contracture (surgery) EMTREE MEDICAL INDEX TERMS animal breast endoprosthesis (adverse drug reaction) female human methodology pathology review CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 21908826 (http://www.ncbi.nlm.nih.gov/pubmed/21908826) PUI L560022137 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 608 TITLE Acellular dermal matrix inlays to correct significant implant malposition in patients with compromised local tissues. AUTHOR NAMES Shestak K.C. AUTHOR ADDRESSES (Shestak K.C.) Plastic Surgery Service at Magee-Womens Hospital, Division of Plastic Surgery, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 5213, USA. CORRESPONDENCE ADDRESS K.C. Shestak, Plastic Surgery Service at Magee-Womens Hospital, Division of Plastic Surgery, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 5213, USA. Email: shestakkc@upmc.edu SOURCE Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery (2011) 31:7 Suppl (85S-94S). Date of Publication: Sep 2011 ISSN 1527-330X (electronic) ABSTRACT Breast implant malposition is an increasingly recognized complication of breast augmentation and implant-based breast reconstruction. Etiologic factors include technical imprecision during surgery with overdissection or inadequate dissection of the pocket, inappropriately large implant selection, and the compromise of the local breast tissues, which produces an inability of a patient's natural tissues to support an implant in the placed position. In this article, the author describes a series of 19 patients with significant breast implant malposition following staged implant breast reconstruction in the setting of locally compromised tissues. Given the results, the author believes that an effective technique in the correction of severe implant malposition is reconfiguration and reconstruction of the periprosthetic capsular space, with a combination of focal "mirror image" capsule excision and permanent suture repair to restore breast folds, along with an acellular dermal matrix inlay technique designed to confer structural support to this repair. This strategy merits consideration in patients who have significant implant malposition in the face of severely compromised local breast tissues. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen (drug therapy) EMTREE DRUG INDEX TERMS surgical mesh surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation (adverse drug reaction) breast endoprosthesis (adverse drug reaction) EMTREE MEDICAL INDEX TERMS adult article case report female human methodology middle aged reoperation retrospective study CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 21908827 (http://www.ncbi.nlm.nih.gov/pubmed/21908827) PUI L560022138 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 609 TITLE Implant exposure through a breast augmentation incision repaired with porcine acellular dermal matrix (Strattice™): a technique to ensure graft take. AUTHOR NAMES Eisenberg T. AUTHOR ADDRESSES (Eisenberg T.) CORRESPONDENCE ADDRESS T. Eisenberg, SOURCE Aesthetic plastic surgery (2011) 35:4 (681-683). Date of Publication: Aug 2011 ISSN 1432-5241 (electronic) EMTREE DRUG INDEX TERMS (MAJOR FOCUS) biomaterial collagen EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast endoprosthesis (adverse drug reaction) breast reconstruction (adverse drug reaction) EMTREE MEDICAL INDEX TERMS breast augmentation (adverse drug reaction) human letter CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 21359980 (http://www.ncbi.nlm.nih.gov/pubmed/21359980) PUI L560007751 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 610 TITLE [Acellular cadaveric dermis-assisted immediate breast reconstruction: the preliminary experience]. AUTHOR NAMES Zeng A. Liu Z.F. Qiao Q. Wang Z. Zhang H.L. Long X. Si L.B. Bai M. AUTHOR ADDRESSES (Zeng A.) Plastic Surgery Department, Peking Union Medical College, Peking Union Medical College Hospital, Beijing 100032, China. (Liu Z.F.; Qiao Q.; Wang Z.; Zhang H.L.; Long X.; Si L.B.; Bai M.) CORRESPONDENCE ADDRESS A. Zeng, Plastic Surgery Department, Peking Union Medical College, Peking Union Medical College Hospital, Beijing 100032, China. SOURCE Zhonghua zheng xing wai ke za zhi = Zhonghua zhengxing waike zazhi = Chinese journal of plastic surgery (2011) 27:4 (250-253). Date of Publication: Jul 2011 ISSN 1009-4598 ABSTRACT To investigate the feasibility and therapeutic effect of acellular cadaveric dermis (ACD)-assisted immediate breast reconstruction. From Sep. 2009 to May 2010, 10 cases received ACD-assisted immediate breast reconstruction. During the operation, the ACD was used to cover inferior and lateral portion of the implants in 2 cases and expanders in 8 cases. The patients were followed up for an average period of 4 months with satisfactory breast appearance. The complications included infection in 2 cases and dehiscence in 2 cases. But no implant or expander was taken out. The ACD-assisted immediate breast reconstruction is a technically simple procedure with minimal morbidity. Satisfactory clinical outcome can be achieved with appropriate candidates. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction dermis skin transplantation EMTREE MEDICAL INDEX TERMS adult article breast implant female human methodology middle aged surgical flaps tissue expander transplantation treatment outcome LANGUAGE OF ARTICLE Chinese MEDLINE PMID 22097307 (http://www.ncbi.nlm.nih.gov/pubmed/22097307) PUI L560077856 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 611 TITLE The scarless latissimus dorsi flap for full muscle coverage in device-based immediate breast reconstruction: an autologous alternative to acellular dermal matrix. AUTHOR NAMES Elliott L.F. Ghazi B.H. Otterburn D.M. AUTHOR ADDRESSES (Elliott L.F.) Department of Plastic and Reconstructive Surgery, Emory University, Atlanta, Ga, USA. (Ghazi B.H.; Otterburn D.M.) CORRESPONDENCE ADDRESS L.F. Elliott, Department of Plastic and Reconstructive Surgery, Emory University, Atlanta, Ga, USA. Email: felliott@atlplastic.com SOURCE Plastic and reconstructive surgery (2011) 128:1 (71-79). Date of Publication: Jul 2011 ISSN 1529-4242 (electronic) ABSTRACT Thin patients have fewer autologous options in postmastectomy reconstruction and are frequently limited to device-based techniques. The latissimus dorsi flap remains a viable option with which to provide autologous coverage, although for certain patients the donor scar can be a point of contention. The scarless latissimus dorsi flap is a way of mitigating these concerns. The authors present their 6-year single-surgeon experience with scarless latissimus dorsi flap reconstruction. A retrospective review of scarless latissimus dorsi flap reconstruction was performed. Charts from 2003 to 2009 were queried for demographic characteristics, nonoperative therapies, and short- and long-term complications. Results were compared with historical data. Thirty-one patients with 52 flaps were identified. Fifty-one flaps were immediate reconstructions, with an average age of 47 years and body mass index of 22.8 kg/m. Thirteen patients were treated with chemotherapy and four were irradiated, two preoperatively. The single drain was removed on average at 21 days. Complications included three hematomas (5.8 percent), two capsular contractures (3.8 percent), and two infections (3.8 percent). Average time to secondary reconstruction was 143 days. There were five unplanned revisions (9.6 percent). There were no flap failures or tissue expander losses. The scarless latissimus dorsi flap is an effective method for providing durable homogenous device coverage in the thinner patient (body mass index <24). With the advent of acellular dermal matrices, device coverage has been made simpler, but this comes at a cost. Coverage is thin, the matrix is not initially vascularized, and products are expensive. For these reasons, use of the scarless latissimus dorsi flap is an excellent alternative, particularly in the patient with a low body mass index. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.(Figure is included in full-text article.). EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast endoprosthesis breast reconstruction plastic surgery EMTREE MEDICAL INDEX TERMS article body mass female human methodology middle aged retrospective study skeletal muscle skin transplantation time transplantation LANGUAGE OF ARTICLE English MEDLINE PMID 21701323 (http://www.ncbi.nlm.nih.gov/pubmed/21701323) PUI L362431975 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 612 TITLE Discussion: The scarless latissimus dorsi flap for full muscle coverage in device-based immediate breast reconstruction: an autologous alternative to acellular dermal matrix. AUTHOR NAMES Chang D.W. AUTHOR ADDRESSES (Chang D.W.) Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA. CORRESPONDENCE ADDRESS D.W. Chang, Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA. Email: dchang@mdanderson.org SOURCE Plastic and reconstructive surgery (2011) 128:1 (80-83). Date of Publication: Jul 2011 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast endoprosthesis breast reconstruction plastic surgery EMTREE MEDICAL INDEX TERMS body mass female human methodology note skeletal muscle skin transplantation time transplantation LANGUAGE OF ARTICLE English MEDLINE PMID 21701324 (http://www.ncbi.nlm.nih.gov/pubmed/21701324) PUI L362431976 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 613 TITLE Blood vessel characterization in human dermal wound repair and scarring AUTHOR NAMES Valluru M. Brown N.J. Cross S.S. Reed M.W.R. Staton C.A. AUTHOR ADDRESSES (Valluru M.; Brown N.J.; Reed M.W.R.; Staton C.A., c.a.staton@shef.ac.uk) Microcirculation Research Group, Academic Unit of Surgical Oncology, United Kingdom. (Cross S.S.) Academic Unit of Pathology, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield S10 2RX, United Kingdom. CORRESPONDENCE ADDRESS C. A. Staton, Microcirculation Research Group, Academic Unit of Surgical Oncology, United Kingdom. Email: c.a.staton@shef.ac.uk SOURCE British Journal of Dermatology (2011) 165:1 (221-224). Date of Publication: July 2011 ISSN 0007-0963 1365-2133 (electronic) BOOK PUBLISHER Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) alpha smooth muscle actin (endogenous compound) CD133 antigen (endogenous compound) CD34 antigen (endogenous compound) endoglin (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) scar formation wound healing EMTREE MEDICAL INDEX TERMS adult angiogenesis cell proliferation clinical article controlled study dermis endothelium cell female human human tissue immunohistochemistry letter mastectomy myofibroblast neovascularization (pathology) postoperative period priority journal punch biopsy skin biopsy skin blood vessel surgical patient EMBASE CLASSIFICATIONS General Pathology and Pathological Anatomy (5) Surgery (9) Dermatology and Venereology (13) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2011355168 MEDLINE PMID 21428973 (http://www.ncbi.nlm.nih.gov/pubmed/21428973) PUI L362036717 DOI 10.1111/j.1365-2133.2011.10327.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1365-2133.2011.10327.x COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 614 TITLE Novel use of acellularized dermis for breast reconstruction. AUTHOR NAMES Tom L. Broer N. Hoang D. Narayan D. AUTHOR ADDRESSES (Tom L.; Broer N.; Hoang D.; Narayan D.) CORRESPONDENCE ADDRESS L. Tom, SOURCE Plastic and reconstructive surgery (2011) 128:1 (31e-3e). Date of Publication: Jul 2011 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction skin transplantation EMTREE MEDICAL INDEX TERMS case report editorial female human methodology middle aged LANGUAGE OF ARTICLE English MEDLINE PMID 21701307 (http://www.ncbi.nlm.nih.gov/pubmed/21701307) PUI L362431959 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 615 TITLE The use of AlloDerm in postmastectomy alloplastic breast reconstruction: part II. A cost analysis. AUTHOR NAMES Jansen L.A. Macadam S.A. AUTHOR ADDRESSES (Jansen L.A.) Department of Surgery, Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, British Columbia, Canada. (Macadam S.A.) CORRESPONDENCE ADDRESS L.A. Jansen, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, British Columbia, Canada. Email: jansen.leigh@gmail.com SOURCE Plastic and reconstructive surgery (2011) 127:6 (2245-2254). Date of Publication: Jun 2011 ISSN 1529-4242 (electronic) ABSTRACT Increasingly, AlloDerm is being used in alloplastic breast reconstruction, and has been the subject of a recent systematic review. The authors' objective was to perform a cost analysis comparing direct-to-implant with AlloDerm reconstruction to two-stage non-AlloDerm reconstruction. Seven clinically important health outcomes and their probabilities for both types of reconstruction were derived from the recent review. A decision analytic model from the Canadian provincial payer's perspective was constructed based on these health states. Direct medical costs were estimated from a university-based hospital, yielding expected costs for direct-to-implant reconstruction with AlloDerm and two-stage non-AlloDerm reconstruction. Sensitivity analyses were conducted. Baseline and expected costs were calculated for direct-to-implant AlloDerm and two-stage non-AlloDerm reconstruction. Direct-to-implant reconstruction with AlloDerm was found to be less expensive in the baseline ($10,240 versus $10,584) and expected cost ($10,734 versus $11,251) using a 6 × 16-cm AlloDerm sheet. With a 6 × 12-cm sheet, expected cost falls to $9673. By increasing direct-to-implant operative time from 2 hours to 2.5 hours, expected cost rises to $11,784. If capsular contracture rate requiring revision is set at 15 percent for both procedures, expected costs are $10,926 and $11,251 for direct-to-implant and two-stage procedures, respectively. If the capsular contracture rate is lowered for either procedure, this has minimal impact on expected cost. Although AlloDerm is expensive, it appears to be cost-effective if used for direct-to-implant breast reconstruction. The methods used here may be extrapolated to different centers incorporating local costs and complication rates. A formal randomized controlled trial, including costs, is recommended. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen (adverse drug reaction) EMTREE DRUG INDEX TERMS biomaterial (adverse drug reaction) surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast endoprosthesis (adverse drug reaction) breast reconstruction (adverse drug reaction) mastectomy EMTREE MEDICAL INDEX TERMS breast tumor (surgery) Canada cost cost benefit analysis economics female human methodology review CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 21617459 (http://www.ncbi.nlm.nih.gov/pubmed/21617459) PUI L362295941 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 616 TITLE The use of AlloDerm in postmastectomy alloplastic breast reconstruction: part I. A systematic review. AUTHOR NAMES Jansen L.A. Macadam S.A. AUTHOR ADDRESSES (Jansen L.A.) Department of Surgery, Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, British Columbia, Canada. (Macadam S.A.) CORRESPONDENCE ADDRESS L.A. Jansen, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, British Columbia, Canada. Email: jansen.leigh@gmail.com SOURCE Plastic and reconstructive surgery (2011) 127:6 (2232-2244). Date of Publication: Jun 2011 ISSN 1529-4242 (electronic) ABSTRACT Postmastectomy alloplastic breast reconstruction is a common procedure that continues to evolve. Increasingly, AlloDerm is being used in both direct-to-implant and two-stage breast reconstruction. The objective of this systematic review was to summarize the outcomes from studies describing this use of AlloDerm, and to compare outcomes to those from studies reviewing non-AlloDerm alloplastic reconstruction. A computerized search was performed across multiple databases. Studies involving patients undergoing alloplastic breast reconstruction with AlloDerm were included. A systematic review was performed to include randomized controlled trials, comparative observational studies, noncomparative observational studies, and case series. A systematic review of the literature revealed 14 studies that satisfied inclusion criteria. Both acute and long-term complication rates were obtained. No objective validated outcomes were reported. Ninety-three percent of included studies were level IV evidence. Complication rates were as follows: infection, 0 to 11 percent; hematoma, 0 to 6.7 percent; seroma, 0 to 9 percent; partial flap necrosis, 0 to 25 percent; implant exposure with removal, 0 to 14 percent; implant exposure with salvage, 0 to 4 percent; capsular contracture, 0 to 8 percent; and rippling, 0 to 6 percent. No study included a cost analysis. Complications using AlloDerm are comparable to those of non-AlloDerm alloplastic reconstructions. AlloDerm appears to confer a low rate of capsular contracture. A formal analysis is required to determine AlloDerm's cost effectiveness in use for direct-to-implant reconstructions. In addition, a randomized controlled trial comparing AlloDerm use to conventional two-stage reconstruction is currently absent from the literature. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen (adverse drug reaction) EMTREE DRUG INDEX TERMS biomaterial surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast endoprosthesis (adverse drug reaction) breast reconstruction (adverse drug reaction) mastectomy EMTREE MEDICAL INDEX TERMS breast tumor (surgery) female human methodology review tissue expansion CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 21617458 (http://www.ncbi.nlm.nih.gov/pubmed/21617458) PUI L362295940 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 617 TITLE Tissue expander breast reconstruction using prehydrated human acellular dermis. AUTHOR NAMES Rawlani V. Buck 2nd. D.W. Johnson S.A. Heyer K.S. Kim J.Y. AUTHOR ADDRESSES (Rawlani V.) Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA. (Buck 2nd. D.W.; Johnson S.A.; Heyer K.S.; Kim J.Y.) CORRESPONDENCE ADDRESS V. Rawlani, Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA. SOURCE Annals of plastic surgery (2011) 66:6 (593-597). Date of Publication: Jun 2011 ISSN 1536-3708 (electronic) ABSTRACT Human acellular dermal matrices help facilitate immediate tissue expander-implant breast reconstruction by providing support to the inferolateral pole, improving control of implant position, and enhancing early volume expansion. Although several freeze-dried human acellular dermal products have demonstrated reasonable safety and efficacy in immediate tissue expander-implant breast reconstruction, no dedicated studies have evaluated clinical outcomes of prehydrated human acellular dermal matrix (PHADM) in breast reconstruction. The outcomes of 121 consecutive tissue expander reconstructions performed by the senior author using PHADM were evaluated. Mean intraoperative tissue expander fill volume was 256.6 ± 133 mL, 60% of final expander volume. Patients required an average of 3.2 additional expansions prior to tissue expander-to-implant exchange. Mean follow-up period after reconstruction was 44 ± 26.5 weeks. Complications occurred in 20 (16.5%) breasts, including 9 (7.4%) soft-tissue infections, 8 (6.6%) partial mastectomy flap necroses, and 2 (1.7%) seromas. Eleven (9.1%) breasts ultimately required explantation. Patients receiving radiation demonstrated a strong trend toward greater complications (30.8% vs. 13.7%, P = 0.0749). The outcomes and complication rates of PHADM tissue expander breast reconstruction are comparable to those reported with freeze-dried human acellular dermis. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) biomaterial (drug administration) collagen (drug administration) EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction (adverse drug reaction) implant EMTREE MEDICAL INDEX TERMS adult aged article female human mastectomy methodology middle aged CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 21233698 (http://www.ncbi.nlm.nih.gov/pubmed/21233698) PUI L362416727 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 618 TITLE Breast reconstruction with fat grafting alone. AUTHOR NAMES Serra-Renom J.M. Muñoz-Olmo J. Serra-Mestre J.M. AUTHOR ADDRESSES (Serra-Renom J.M.) From the Aesthetic Plastic Surgery Department, Hospital Quiron Barcelona, Universidad Internacional de Cataluña, Barcelona, Spain. (Muñoz-Olmo J.; Serra-Mestre J.M.) CORRESPONDENCE ADDRESS J.M. Serra-Renom, From the Aesthetic Plastic Surgery Department, Hospital Quiron Barcelona, Universidad Internacional de Cataluña, Barcelona, Spain. Email: serrarenom@gmail.com SOURCE Annals of plastic surgery (2011) 66:6 (598-601). Date of Publication: Jun 2011 ISSN 1536-3708 (electronic) ABSTRACT We describe our technique for breast reconstruction using fat grafting alone in patients with flaccid, elastic skin, via multiple injections of fat tissue. The technique involves following 3 stages: puckering stitches, to remodel the mass each time fat grafting is performed; cone formation-pexia, the creation and lifting of a cone with the tissue from the area; and neoformation of the inframammary fold, in which the cone is anchored in the pectoralis major and the fold at the level of the sixth rib. Using fat grafting and these 3 maneuvers, we obtain satisfactory breast reconstruction. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adipose tissue breast reconstruction EMTREE MEDICAL INDEX TERMS aged article case report human injection mastectomy methodology middle aged transplantation LANGUAGE OF ARTICLE English MEDLINE PMID 21508823 (http://www.ncbi.nlm.nih.gov/pubmed/21508823) PUI L362416741 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 619 TITLE Staged nipple reconstruction with vascularized SurgiMend acellular dermal matrix. AUTHOR NAMES Craft R.O. May Jr. J.W. AUTHOR ADDRESSES (Craft R.O.; May Jr. J.W.) CORRESPONDENCE ADDRESS R.O. Craft, SOURCE Plastic and reconstructive surgery (2011) 127:6 (148e-9e). Date of Publication: Jun 2011 ISSN 1529-4242 (electronic) EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) artificial skin breast reconstruction nipple (surgery) EMTREE MEDICAL INDEX TERMS article female human CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 21617431 (http://www.ncbi.nlm.nih.gov/pubmed/21617431) PUI L362295913 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 620 TITLE Chest wall reconstruction with porcine acellular dermal matrix (strattice) and a latissimus myocutaneous flap AUTHOR NAMES Huston T.L. Taback B. Rohde C.H. AUTHOR ADDRESSES (Huston T.L., tarahustonmd@gmail.com; Taback B.; Rohde C.H.) Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY, United States. CORRESPONDENCE ADDRESS T. L. Huston, New York Presbyterian Hospital, Weill Cornell Medical Center, 161 Fort Washington Avenue, New York, NY 10032, United States. Email: tarahustonmd@gmail.com SOURCE American Surgeon (2011) 77:6 (E115-E116). Date of Publication: June 2011 ISSN 0003-1348 BOOK PUBLISHER Southeastern Surgical Congress, 141 West Wieuca Road, Suite B100, Atlanta, United States. EMTREE DRUG INDEX TERMS cyclophosphamide (drug combination, drug therapy) doxorubicin (drug combination, drug therapy) paclitaxel (drug combination, drug therapy) sulfadiazine silver EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix latissimus dorsi flap thorax wall reconstruction EMTREE MEDICAL INDEX TERMS adult advanced cancer anamnesis animal tissue article breast cancer (drug therapy, surgery) cancer chemotherapy case report female human mastectomy nonhuman postoperative complication (complication) rib resection smoking suture technique wound healing CAS REGISTRY NUMBERS cyclophosphamide (50-18-0) doxorubicin (23214-92-8, 25316-40-9) paclitaxel (33069-62-4) sulfadiazine silver (22199-08-2) EMBASE CLASSIFICATIONS Dermatology and Venereology (13) Chest Diseases, Thoracic Surgery and Tuberculosis (15) Cancer (16) Drug Literature Index (37) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2011314581 MEDLINE PMID 21679622 (http://www.ncbi.nlm.nih.gov/pubmed/21679622) PUI L361904682 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 621 TITLE The effects of acellular dermal matrix in expander-implant breast reconstruction after total skin-sparing mastectomy: Results of a prospective practice improvement study AUTHOR NAMES Peled A.W. Foster R.D. Garwood E. Ewing C.A. Alvarado M. Hwang E.S. Esserman L. AUTHOR ADDRESSES (Peled A.W.; Foster R.D.; Garwood E.; Ewing C.A.; Alvarado M.; Hwang E.S.; Esserman L.) University of California, San Francisco, San Francisco, United States. (Peled A.W.; Foster R.D.; Garwood E.; Ewing C.A.; Alvarado M.; Hwang E.S.; Esserman L.) University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, United States. CORRESPONDENCE ADDRESS A.W. Peled, University of California, San Francisco, San Francisco, United States. SOURCE Journal of Clinical Oncology (2011) 29:15 SUPPL. 1. Date of Publication: 20 May 2011 CONFERENCE NAME ASCO Annual Meeting 2011 CONFERENCE LOCATION Chicago, IL, United States CONFERENCE DATE 2011-06-03 to 2011-06-07 ISSN 0732-183X BOOK PUBLISHER American Society of Clinical Oncology ABSTRACT Background: Outcomes after total skin-sparing mastectomy and expander-implant breast reconstruction using acellular dermal matrix (Alloderm) have not been well-documented, nor has a strategy for optimal case selection for Alloderm use been described. Methods: Single-institution review of three patient cohorts from 2006-2010 undergoing total skin-sparing mastectomy and immediate expander-implant breast reconstruction was performed. Cohort 1 (“No Alloderm”) was composed of 59 consecutive patients who did not have Alloderm placed. Cohort 2 (“Consecutive Alloderm”) consisted of the next 65 consecutive patients, who all received Alloderm. Cohort 3 (“Selective Alloderm”) consisted of the next 159 patients, who had selective use of Alloderm based on intra-operative assessment of mastectomy skin flap thickness. Cohorts were compared by chi-square analysis using STATA 10. Results: A total of 283 patients (444 breasts) underwent expander-implant reconstruction. Mean follow-up was 23.7 months. Patient and treatment characteristics including age, BMI, co-morbidities, post-mastectomy radiation therapy, and systemic therapy were not significantly different between cohorts. Overall, 23% of patients had post-mastectomy radiation therapy, 34% had neoadjuvant chemotherapy, and 20% had adjuvant chemotherapy. The incidence of post-operative infection requiring intravenous antibiotics was 15.3% for the No Alloderm cohort, 9.9% for the Consecutive Alloderm cohort, and 11.2% for the Selective Alloderm cohort (p = 0.048). Unplanned return to the operating room was required in 22.3%, 11.9%, and 9.7% of patients, respectively (p = 0.009). Expander/implant loss occurred in 8.2%, 4%, and 5.8% of patients, respectively (p = 0.007). Conclusions: The use of Alloderm in expander-implant reconstruction after total skin-sparing mastectomy reduced major post-operative complications in this study. Selective use of Alloderm conferred the same benefit as use in all patients with resultant optimization of patient outcomes and cost-effective care. EMTREE DRUG INDEX TERMS antibiotic agent EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction implant mastectomy skin EMTREE MEDICAL INDEX TERMS adjuvant chemotherapy breast chi square test follow up human morbidity operating room patient postoperative complication postoperative infection radiotherapy skin flap systemic therapy thickness LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70708798 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 622 TITLE First european experience of skin sparing mastectomy and immediate reconstruction using acellular dermal matrix strattice and implant AUTHOR NAMES Murphy C. Waterworth A. Rhodes N. Linforth R. AUTHOR ADDRESSES (Murphy C.; Waterworth A.; Linforth R.) Bradford Teaching Hospitals Foundation Trust, Department of Breast Surgery, Pre-assessment, St Lukes Hospital, Horton Wing, Little Horton Lane, Bradford, BD5 0NA, United Kingdom. (Rhodes N.) Department of Plastic Surgery, Bradford Teaching Hospitals Foundation Trust, United Kingdom. CORRESPONDENCE ADDRESS C. Murphy, Bradford Teaching Hospitals Foundation Trust, Department of Breast Surgery, Pre-assessment, St Lukes Hospital, Horton Wing, Little Horton Lane, Bradford, BD5 0NA, United Kingdom. SOURCE European Journal of Surgical Oncology (2011) 37:5 (S1-S2). Date of Publication: May 2011 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2011 CONFERENCE LOCATION Manchester, United Kingdom CONFERENCE DATE 2011-05-16 to 2011-05-17 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: We report the first European cases of immediate single stage implant based reconstruction performed in the UK using Alloderm™ and Strattice™ in patients undergoing skin sparing mastectomies. A limitation of tissue expander/implant based reconstruction is the lack of muscle cover in the lower pole of the breast relative to the breast skin envelope. Method: The creation of acellular dermal matrix grafts from human cadaver (Alloderm™) and porcine harvest (Strattice TM) has enabled single stage immediate breast reconstruction using a permanent silicone implant to be performed. Between June 2008 and Nov 2008, 4 patients underwent unilateral mastectomy and 4 patients had bilateral mastectomies using immediate implant/expander-Alloderm™ reconstruction (12 mastectomies) median follow up 30 months. Between Feb 2009 and Dec 2010 26 patients underwent unilateral mastectomy and 6 patients had bilateral mastectomies with reconstruction using immediate implant-Strattice™ (38 mastectomies). Median follow up 16.5 months (range 2-23 months). Seromas required only simple aspiration without complication. Two patients had haematomas evacuated.No capsular contractures have been encountered. Conclusion: Skin sparing mastectomy and immediate single stage implant based reconstruction using Strattice™ is a safe and highly effective method of immediate breast reconstruction with comparable complications to other reconstructive methods. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast surgery implant mastectomy skin EMTREE MEDICAL INDEX TERMS aspiration breast breast reconstruction cadaver contracture follow up harvest human muscle patient silicone prosthesis tissues United Kingdom LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70394293 DOI 10.1016/j.ejso.2011.03.008 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2011.03.008 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 623 TITLE The hybrid breast reconstruction - Use of autologous fat transfer to augment the autologous tissue to implant ratio in oncoplastic breast reconstruction AUTHOR NAMES Ott Young A. Zellner E. AUTHOR ADDRESSES (Ott Young A.) Plastic and Reconstructive Surgery, Yale New Haven Health System, Fairfield, United States. (Zellner E.) Plastic Surgery, Yale New Haven Health System, New Haven, United States. CORRESPONDENCE ADDRESS A. Ott Young, Plastic and Reconstructive Surgery, Yale New Haven Health System, Fairfield, United States. SOURCE Annals of Oncology (2011) 22 SUPPL. 2 (ii49). Date of Publication: May 2011 CONFERENCE NAME IMPAKT 2011 Breast Cancer Conference CONFERENCE LOCATION Brussels, Belgium CONFERENCE DATE 2011-05-05 to 2011-05-07 ISSN 0923-7534 BOOK PUBLISHER Oxford University Press ABSTRACT Objective: Implant-based breast reconstruction remains a popular choice. Outcomes are very dependent on soft tissue quality - thin mastectomy flaps, attenuated pectoral muscle and chest wall radiation frequently negatively affect results. In our experience oncoplastic mastectomy techniques utilizing deepithelialised dermal flaps, acellular dermal matrix and tissue expansion free implant techniques already significantly improve soft tissue quality. As an integral part of our treatment plan we routinely add autologous fat transfer to improve and modify the soft tissue envelope of our implant reconstructions. This combination of techniques achieves excellent soft tissue coverage and breast contour without the significant anatomical limitations and donor site morbidity of traditional autologous tissue transfer. Methods: To investigate the safety and efficiency of this method we reviewed the medical records of 100 patients who underwent 130 hybrid reconstructions over the last 3 years. All reconstructions were performed by the senior author and follow up ranged between 36 months and 2 months with a median of 8 months. The charts were analyzed for the occurrence of complications such as infection, seroma, hematoma, fat necrosis, as well as implant perforation, implant exposure, implant removal and locoregional recurrence. All patients were asked to rate their reconstruction on a scale of three: poor - good or excellent. Results: In our series of 130 reconstructions we encountered 1 case (1%) of infection resulting in implant removal (1%), one case (1%) of seroma at the mastectomy site and one case of (1%) self-resolving hematoma at the liposuction donor site and one case of fat necrosis (1%). No implant perforations or loco regional recurrences were encountered. Of the 100 patients 90 (90%) rated their result as excellent, nine (9%) as good and one (1%) as poor. Conclusion: Our results compare favorably with data published in the literature. Overall complication rates are low with high patient satisfaction rates. The addition of lipofilling as an integral part of oncoplastic implant reconstruction safely combines some of the benefits of autologous reconstruction with the minimal invasiveness of implant reconstruction. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer breast reconstruction implant tissues EMTREE MEDICAL INDEX TERMS acellular dermal matrix breast donor site exposure fat necrosis follow up hematoma infection liposuction mastectomy medical record morbidity patient patient satisfaction pectoral muscle perforation radiation safety seroma skin flap soft tissue thorax wall tissue expansion LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70426702 DOI 10.1093/annonc/mdr087 FULL TEXT LINK http://dx.doi.org/10.1093/annonc/mdr087 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 624 TITLE Acellular dermal matrix in immediate implant based breast reconstruction - A single surgeon's experience AUTHOR NAMES Alamouti R. Lancaster K. HoAsjoe M. AUTHOR ADDRESSES (Alamouti R.; Lancaster K.; HoAsjoe M.) St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom. CORRESPONDENCE ADDRESS R. Alamouti, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom. SOURCE European Journal of Surgical Oncology (2011) 37:5 (S1). Date of Publication: May 2011 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2011 CONFERENCE LOCATION Manchester, United Kingdom CONFERENCE DATE 2011-05-16 to 2011-05-17 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: Implant based procedures remain a popular choice in immediate breast reconstruction however the cosmetic outcome can be poor. The addition of acellular dermal matrix (ADM), sutured to create an inferolateral sling, improves aesthetics and ensures complete coverage of the device without the potential complications of a donor site. The purpose of this study was to evaluate a single surgeon's experience of ADM in immediate implant based breast reconstruction. Methods and materials: Data was collected prospectively for all patients undergoing an immediate implant/expander and ADM reconstruction and analysed over 2 periods, December 2008 to January 2010 and February to November 2010. In all cases a reconstructive tissue matrix derived from porcine dermis (Strattice™, Life Cell) was used. Results: ADM was used in 40 patients (46 breasts), 17 patients in the first period (22 breasts) and 23 (24 breasts) in the second. In period 1 major complications requiring return to theatre occurred in 45% of cases, with an overall explantation rate of 23%. Following these observations a number of technical refinements were made reducing the return to theatre rate to 8% and explantation to 0% in the second period. Conclusions: In this 2 year period it appears that ADM is safe and an effective means of covering and controlling the position of the implant/expander in immediate breast reconstruction. As is clear from our results there is a learning curve with this technique however we would suggest that ADM is a useful addition to the options available for immediate breast reconstruction. EMTREE DRUG INDEX TERMS cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction breast surgery implant surgeon EMTREE MEDICAL INDEX TERMS breast dermis devices donor site explant learning curve patient tissues LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70394291 DOI 10.1016/j.ejso.2011.03.006 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2011.03.006 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 625 TITLE A new technique for partial muscular cover in immediate implant-based reconstruction AUTHOR NAMES Barry P. Collins A. AUTHOR ADDRESSES (Barry P.) Canberra Hospital, Yamba Drive, Garran, Australia. (Collins A.) Bega District Hospital, United Kingdom. CORRESPONDENCE ADDRESS P. Barry, Canberra Hospital, Yamba Drive, Garran, Australia. SOURCE European Journal of Surgical Oncology (2011) 37:5 (S12). Date of Publication: May 2011 CONFERENCE NAME Association of Breast Surgery Conference and AGM, ABS 2011 CONFERENCE LOCATION Manchester, United Kingdom CONFERENCE DATE 2011-05-16 to 2011-05-17 ISSN 0748-7983 BOOK PUBLISHER W.B. Saunders Ltd ABSTRACT Introduction: To determine efficacy, safety, aesthetic and functional outcomes after immediate breast reconstruction using a segmented lateral thoracic artery-based pectoralis major muscle flap for partial dual-plane cover of implants. This technique was designed to minimize lateral implant displacement, provide complete separation of the wound / incision from the implant and a vascularised base for the NAC if needed. Methods: A new technique using a partial pectoralis muscle flap (based on the lateral thoracic artery) for partial cover of implants in patients undergoing immediate reconstruction after skin (or nipple)-sparing mastectomy for breast cancer is described. A prospectively designed pilot study in consecutive patients suitable for implant-only immediate reconstruction was undertaken. Patient demographics, tumour pathology and treatments factors were documented. All outcomes including implant infection, flap necrosis and any other complications were included as well as patient satisfaction and functional outcomes. Results: From April 2008 to November 2010 a total of 45 procedures were performed in 39 patients (6 bilateral). Mean age was 43 years (29-71) and no early implant loss or infection was encountered. Three patients experienced prolonged seroma formation ( > 3 months) and had their implants exchanged resulting in seroma resolution. Seven patients underwent post-mastectomy radiotherapy. Post-operative functional assessments on pectoral girdle function is described. Patient satisfaction ranged from moderately to very high in all patients. Conclusions: This technique is safe and well-tolerated by patients and may serve as an adjunct or alternative to the use of Alloderm or other methods of immediate implant reconstruction using partial muscular cover. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast surgery implant EMTREE MEDICAL INDEX TERMS breast cancer breast reconstruction functional assessment graft necrosis incision infection mammary artery mastectomy muscle flap neoplasm nipple pathology patient patient satisfaction pectoralis major muscle pilot study radiotherapy safety seroma skin wound LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70394330 DOI 10.1016/j.ejso.2011.03.045 FULL TEXT LINK http://dx.doi.org/10.1016/j.ejso.2011.03.045 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 626 TITLE Postoperative complications in prosthesis-based breast reconstruction using acellular dermal matrix. AUTHOR NAMES Liu A.S. Kao H.K. Reish R.G. Hergrueter C.A. May Jr. J.W. Guo L. AUTHOR ADDRESSES (Liu A.S.) Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Mass. 02115, USA. (Kao H.K.; Reish R.G.; Hergrueter C.A.; May Jr. J.W.; Guo L.) CORRESPONDENCE ADDRESS A.S. Liu, Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Mass. 02115, USA. SOURCE Plastic and reconstructive surgery (2011) 127:5 (1755-1762). Date of Publication: May 2011 ISSN 1529-4242 (electronic) ABSTRACT Acellular dermal matrix has become a common adjunct in prosthesis-based breast reconstruction. The authors' aim was to determine whether acellular dermal matrix use in immediate prosthesis-based breast reconstruction is associated with higher rate of complications. Over a 51/2-year period at the Brigham and Women's Hospital, 470 postmastectomy defects were reconstructed immediately using tissue expanders or implants. These were divided into two groups: reconstructions with or without acellular dermal matrix. Data were collected on patient comorbidities, radiation, intraoperative tumescent solution use, prosthesis size, initial fill volume, and complications. The risk for major infections that required prosthesis removal was elevated in the acellular dermal matrix group (4.9 versus 2.5 percent), but this increase did not reach statistical significance (p = 0.172). There was a statistically significant increase in overall wound infection rate in the acellular dermal matrix group (6.8 versus 2.5 percent, p = 0.031), but in a multivariate analysis, the use of acellular dermal matrix did not materialize as a significant risk factor for overall wound infection. Overall surgical complication rate was significantly higher in the acellular dermal matrix group at 19.5 percent, compared with the non-acellular dermal matrix group at 12.3 percent (p < 0.001). Other significant risk factors for overall surgical complication included smoking, higher body mass index, higher initial volume, and larger implant size. Patient selection for prosthesis reconstruction involving acellular dermal matrix should be judicious, especially among smokers and patients with elevated body mass index. Even though the use of acellular dermal matrix allows higher initial volumes and reduced number of expansions, one should be careful about putting in too high of an initial volume. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen (adverse drug reaction) EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction (adverse drug reaction) postoperative complication (epidemiology, prevention) EMTREE MEDICAL INDEX TERMS article artificial skin (adverse drug reaction) body mass comparative study female follow up human incidence methodology patient selection retrospective study risk factor time United States (epidemiology) CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 21228744 (http://www.ncbi.nlm.nih.gov/pubmed/21228744) PUI L362087540 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 627 TITLE Current practice among plastic surgeons of antibiotic prophylaxis and closed-suction drains in breast reconstruction: experience, evidence, and implications for postoperative care. AUTHOR NAMES Phillips B.T. Wang E.D. Mirrer J. Lanier S.T. Khan S.U. Dagum A.B. Bui D.T. AUTHOR ADDRESSES (Phillips B.T.) Division of Plastic and Reconstructive Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA. (Wang E.D.; Mirrer J.; Lanier S.T.; Khan S.U.; Dagum A.B.; Bui D.T.) CORRESPONDENCE ADDRESS B.T. Phillips, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA. Email: brett.phillips@stonybrook.edu SOURCE Annals of plastic surgery (2011) 66:5 (460-465). Date of Publication: May 2011 ISSN 1536-3708 (electronic) ABSTRACT Despite their widespread use, there are no evidence-based guidelines on the management of closed-suction drains or antibiotics in postmastectomy breast reconstruction. The purpose of this study was to assess consensus and variation in postoperative care among plastic surgeons. The authors designed and administered a self-reported, anonymous survey to 4669 American Society of Plastic Surgeons and Canadian Society of Plastic Surgeons members in October 2009. A total of 650 completed surveys were available for analysis. A majority (>81%) of respondents reported using closed-suction drains in breast reconstruction. Most surgeons (>93%) used a volume criteria for drain removal, most commonly when drain output was ≤30 mL over 24 hours (>86%). Preoperative antibiotic use was nearly universal (98%), usually consisting of intravenous cefazolin (97%). Postoperative care demonstrated less uniformity with outpatient antibiotics administered by 72% of respondents. Surgeons were divided on when to discontinue outpatient antibiotics: 46% preferred concomitant discontinuation with drains, whereas 52% preferred a specific postoperative day. No clear consensus was observed for the number (1 or 2) or type (Jackson-Pratt or Blake) of drains used. Respondents were further divided on the restriction of postoperative showering with drains and the use of acellular dermal matrix. These results demonstrate a consensus for drain use, drain removal, and preoperative antibiotic administration. There was no consensus for number or type of drain used, postoperative antibiotic use, shower restrictions, and use of acellular dermal matrix. Our results further emphasize the need for evidence-based postoperative-care guidelines specific to breast reconstruction. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) antibiotic prophylaxis breast reconstruction (adverse drug reaction) plastic surgery postoperative care suction EMTREE MEDICAL INDEX TERMS article Canada chi square distribution clinical practice comparative study devices esthetics evidence based medicine female follow up health care survey health personnel attitude human male medical society methodology questionnaire risk assessment standard surgical infection (prevention) treatment outcome United States LANGUAGE OF ARTICLE English MEDLINE PMID 21407050 (http://www.ncbi.nlm.nih.gov/pubmed/21407050) PUI L362345966 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 628 TITLE Long-term histologic and mechanical results of a Permacol™ abdominal wall explant AUTHOR NAMES O'Brien J.A. Ignotz R. Montilla R. Broderick G.B. Christakis A. Dunn R.M. AUTHOR ADDRESSES (O'Brien J.A., Julie.O'Brien@umassmemorial.org; Ignotz R.; Montilla R.; Broderick G.B.; Dunn R.M.) Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States. (Christakis A.) Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA 01609, United States. CORRESPONDENCE ADDRESS J. A. O'Brien, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, United States. Email: Julie.O'Brien@umassmemorial.org SOURCE Hernia (2011) 15:2 (211-215). Date of Publication: April 2011 ISSN 1265-4906 BOOK PUBLISHER Springer Paris, 1 rue Paul Cezanne, Paris, France. ABSTRACT Purpose: We hypothesize that Permacol™ may allow controlled integration over time while providing long-term mechanical stability and native tissue remodeling. The purpose of this report is to investigate these properties in an explanted piece of Permacol™ after 2 years in vivo. Methods: A 62-year-old female presented with a complex abdominal wall history having undergone a transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction 10 years ago, followed by an abdominal wall repair with Marlex™ mesh for weakness 3 years later. Two years ago, she developed an abdominal bulge repaired with a Permacol™ overlay. Twenty-three months postoperatively, she presented with abdominal distension. Computed tomography (CT) scanning demonstrated a fluid collection behind the Permacol™. She underwent incision and drainage of the hematoma/bursa and quilting repair of the abdominal wall. A 1 × 6-cm Permacol™ section was resected as part of closure. Histology, immunohistochemistry, and mechanical testing of the Permacol™ explant were performed. Results: Histology showed fibroblast and blood vessel ingrowth with no cellular infiltrates reflective of inflammation. Immunohistochemistry for human-specific collagen types I and III and elastin detected staining throughout. Sections stained with non-specific control antibody exhibited no discernable staining. Elastin highlighted blood vessels. Native Permacol™ had a breaking strength of ∼20 N, while for explanted Permacol™, it was ∼33 N. Conclusions: Permacol™ maintained durability while allowing vascular ingrowth without residual inflammation. Explant demonstrated integration with human collagen and elastin remodeling throughout. Increase in mechanical strength may reflect newly synthesized collagen and elastin. These histologic findings and clinical result support the use of Permacol™ in complex abdominal wall reconstruction. © 2010 Springer-Verlag. EMTREE DRUG INDEX TERMS collagen type 1 (endogenous compound) collagen type 3 (endogenous compound) elastin (endogenous compound) eosin hematoxylin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) abdominal wall hernia (surgery) EMTREE MEDICAL INDEX TERMS abdominal bulge (complication, surgery) abdominal distension (complication) abdominal wall adult article blood vessel breast reconstruction case report computer assisted tomography female fibroblast hematoma histology human immunohistochemistry implant in vivo study mechanics postoperative complication priority journal tensile strength transverse rectus abdominis musculocutaneous flap DEVICE TRADE NAMES Marlex Permacol , United StatesCovidien DEVICE MANUFACTURERS (United States)Covidien CAS REGISTRY NUMBERS elastin (9007-58-3) eosin (17372-87-1, 51395-88-1, 548-26-5) hematoxylin (517-28-2) EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) Clinical and Experimental Biochemistry (29) Gastroenterology (48) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011180251 MEDLINE PMID 20091328 (http://www.ncbi.nlm.nih.gov/pubmed/20091328) PUI L50772325 DOI 10.1007/s10029-010-0628-5 FULL TEXT LINK http://dx.doi.org/10.1007/s10029-010-0628-5 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 629 TITLE Immediate breast reconstruction with a saline implant and AlloDerm, following removal of a Phyllodes tumor AUTHOR NAMES Crenshaw S.A. Roller M.D. Chapman J.K. AUTHOR ADDRESSES (Crenshaw S.A., screnshs@rams.colostate.edu) Department of Chemistry, Colorado State University, Fort Collins, CO 80523, United States. (Roller M.D., macroll91@msn.com) Northern Colorado Surgical Associates, Fort Collins, CO 80528, United States. (Chapman J.K., drchapman@ncpsurgery.com) Northern Colorado Plastic Surgery, Fort Collins, CO 80524, United States. CORRESPONDENCE ADDRESS S.A. Crenshaw, Department of Chemistry, Colorado State University, Fort Collins, CO 80523, United States. Email: screnshs@rams.colostate.edu SOURCE World Journal of Surgical Oncology (2011) 9 Article Number: 34. Date of Publication: 21 Mar 2011 ISSN 1477-7819 (electronic) BOOK PUBLISHER BioMed Central Ltd., Floor 6, 236 Gray's Inn Road, London, United Kingdom. ABSTRACT Background: Phyllodes tumors are uncommon tumors of the breast that exhibit aggressive growth. While surgical management of the tumor has been reported, a single surgical approach with immediate breast reconstruction using AlloDerm has not been reported.Case presentation: A 22-year-old woman presented with a 4 cm mass in the left breast upon initial examination. Although the initial needle biopsy report indicated a fibroadenoma, the final pathologic report revealed a 6.5 cm × 6.4 cm × 6.4 cm benign phyllodes tumor ex vivo. Treatment was a simple nipple-sparing mastectomy coupled with immediate breast reconstruction. After the mastectomy, a subpectoral pocket was created for a saline implant and AlloDerm was stitched to the pectoralis and serratus muscle in the lower-pole of the breast.Conclusions: Saline implant with AlloDerm can be used for immediate breast reconstruction post-mastectomy for treatment of a phyllodes tumor. © 2011 Crenshaw et al; licensee BioMed Central Ltd. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) sodium chloride EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) implant phyllodes tumor (surgery) surgical mesh tissue graft EMTREE MEDICAL INDEX TERMS adipose tissue adult article breast reconstruction cancer surgery case report emotional stress female human mastectomy myocutaneous flap patient satisfaction surgical technique treatment outcome tumor volume CAS REGISTRY NUMBERS sodium chloride (7647-14-5) EMBASE CLASSIFICATIONS General Pathology and Pathological Anatomy (5) Surgery (9) Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011184598 MEDLINE PMID 21418652 (http://www.ncbi.nlm.nih.gov/pubmed/21418652) PUI L51342972 DOI 10.1186/1477-7819-9-34 FULL TEXT LINK http://dx.doi.org/10.1186/1477-7819-9-34 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 630 TITLE Successful use of matristem in difficult plastic & reconstructive surgery cases AUTHOR NAMES Stokes T.H. AUTHOR ADDRESSES (Stokes T.H.) Himmarshee Surgical Partners, Ft Lauderdale, United States. CORRESPONDENCE ADDRESS T.H. Stokes, Himmarshee Surgical Partners, Ft Lauderdale, United States. SOURCE Wound Repair and Regeneration (2011) 19:2 (A54). Date of Publication: March-April 2011 CONFERENCE NAME 21st Annual Meeting of the Wound Healing Society SAWC-Spring/WHS Joint Meeting CONFERENCE LOCATION Dallas, TX, United States CONFERENCE DATE 2011-04-14 to 2011-04-17 ISSN 1067-1927 BOOK PUBLISHER Blackwell Publishing Inc. ABSTRACT Large defects and recalcitrant wounds pose unique challenges for the plastic and reconstructive surgeon. A biomaterial that provides a bioactive scaffold for tissue repair and/or in situ tissue engineering would be a useful tool in the clinician's armamentarium. MatriStem® (ACell, Columbia, MD) is a sterile, extracellular- matrix biomaterial derived from porcine urinary bladder (UBM). UBM is composed of collagen (I, II, III, & IV), glycosaminoglycans, fibronectin, laminin, & elastin, and contains the following growth factors: VEGF, BMP-4, PDGF-BB, KGF, FGF-2, TGF-alpha, TGF-beta1, and EGF. Matri- Stem is FDA cleared for soft tissue repair, including chronic wounds. This case series illustrates one clinician's experience using MatriStem biomaterial in several difficult plastic and reconstructive surgery cases, including: 1) a failed traverse rectus abdominus myocutaneous (TRAM) flap procedure, complicated by pyoderma gangrenosum, totaling >900 square cm in size; 2) a full-thickness facial injury with exposed bone; and 3) use as a biological mesh in staged breast reconstruction, where the MatriStem was implanted immediately postmastectomy along with a tissue expander The TRAM injuries and severe facial injury were completely healed at 8 and 6.5 months, respectively. During exchange of the tissue expander in the staged breast reconstruction 2 months post implant, the MatriStem was macroscopically and histologically observed to have constructively remodeled with the host tissue, resulting in well vascularized tissue that was thicker than the original graft with an epithelialized surface adjacent to the expander. Seven months following implantation, the remodeled MatriStem graft site was histologically indistinguishable from the native tissue. These cases provide anecdotal support for the continued use of MatriStem in plastic and reconstructive surgery. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) plastic EMTREE DRUG INDEX TERMS biomaterial bone morphogenetic protein 4 collagen elastin fibronectin glycosaminoglycan growth factor laminin platelet derived growth factor transforming growth factor alpha transforming growth factor beta1 vasculotropin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) plastic surgery society wound healing EMTREE MEDICAL INDEX TERMS bladder bone breast reconstruction case study chronic wound Colombia extracellular matrix face injury food and drug administration implant implantation injury myocutaneous flap pyoderma gangrenosum soft tissue surgeon thickness tissue engineering tissue repair tissues wound LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70368162 DOI 10.1111/j.1524-475X.2010.00670.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1524-475X.2010.00670.x COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 631 TITLE The hybrid breast reconstruction-use of autologous fat transfer to increase autologous tissue to implant ratio in oncoplastic breast reconstruction AUTHOR NAMES Ott Young A. Davenport T. AUTHOR ADDRESSES (Ott Young A.) Plastic and Reconstructive Surgery, New England Center for Oncoplastic Surgery, New Canaan, United States. (Davenport T.) Plastic and Reconstructive Surgery, Withrop Hospital, Garden City, United States. CORRESPONDENCE ADDRESS A. Ott Young, Plastic and Reconstructive Surgery, New England Center for Oncoplastic Surgery, New Canaan, United States. SOURCE Breast (2011) 20 SUPPL. 1 (S52). Date of Publication: March 2011 CONFERENCE NAME 11th International Conference of the Primary Therapy of Early Breast Cancer CONFERENCE LOCATION St.Gallen, Switzerland CONFERENCE DATE 2011-03-16 to 2011-03-19 ISSN 0960-9776 BOOK PUBLISHER Churchill Livingstone ABSTRACT Goals: Implant based breast reconstruction remains a popular choice. Outcomes are very dependent on soft tissue quality - thin mastectomy flaps, attenuated pectoral muscle and chest wall radiation frequently negatively affect results. In our experience oncoplastic mastectomy techniques utilizing deepithelialised dermal flaps, acellular dermal matrix and tissue expansion free implant techniques already significantly improve soft tissue quality. As an integral part of our treatment plan we routinely add autologous fat transfer to improve and modify the soft tissue envelope of our implant reconstructions. This combination of techniques achieves excellent soft tissue coverage and breast contour without the significant anatomical limitations and donor site morbidity of traditional autologous tissue transfer. Methods: To investigate the safety and efficiency of this method we reviewed the medical records of 100 patients who underwent 130 hybrid reconstructions over the last 3 years. All reconstructions were performed by the senior author and follow up ranged between 36 months and 2 months with a median of 8 months. The charts were analyzed for the occurrence of complications such as infection, seroma, hematoma, fat necrosis, as well as implant perforation, implant exposure, implant removal and locoregional recurrence. All patients were asked to rate their reconstruction on a scale of three: poor, good or excellent. Results: In our series of 130 reconstructions we encountered 1 case (1%) of infection resulting in implant removal (1%), one case (1%) of seroma at the mastectomy site and one case of (1%) self resolving hematoma at the liposuction donor site and one case of fat necrosis (1%). No implant perforations or loco regional recurrences were encountered. Of the 100 patients 90 (90%) rated their result as excellent, nine (9%) as good and one (1%) as poor. Conclusion: Our results compare favorably with data published in the literature. Overall complication rates are low and patient satisfaction rates are high. Our preliminary data shows that lipofilling as an integral part of oncoplastic implant reconstruction safely combines some of the benefits of autologous reconstruction with the minimal invasiveness of implant reconstruction however further studies are needed to evaluate the long term outcomes of this procedure. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer breast reconstruction implant therapy tissues EMTREE MEDICAL INDEX TERMS acellular dermal matrix breast donor site exposure fat necrosis follow up hematoma human infection liposuction mastectomy medical record morbidity patient patient satisfaction pectoral muscle perforation procedures radiation safety seroma skin flap soft tissue thorax wall tissue expansion LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L71927631 COPYRIGHT Copyright 2015 Elsevier B.V., All rights reserved. RECORD 632 TITLE Acellular dermal matrix for the treatment and prevention of implant-associated breast deformities. AUTHOR NAMES Spear S.L. Seruya M. Clemens M.W. Teitelbaum S. Nahabedian M.Y. AUTHOR ADDRESSES (Spear S.L.) Department of Plastic Surgery, Georgetown University Hospital, Washington, DC 20007, USA. (Seruya M.; Clemens M.W.; Teitelbaum S.; Nahabedian M.Y.) CORRESPONDENCE ADDRESS S.L. Spear, Department of Plastic Surgery, Georgetown University Hospital, Washington, DC 20007, USA. Email: spears@gunet.georgetown.edu SOURCE Plastic and reconstructive surgery (2011) 127:3 (1047-1058). Date of Publication: Mar 2011 ISSN 1529-4242 (electronic) ABSTRACT Acellular dermal matrix has been increasingly accepted in prosthetic breast reconstruction. Observed benefits include improved control and support of implant position, better implant coverage, and the suggestion of a decreased capsular contracture rate. Based on this positive experience, it is not surprising that acellular dermal matrix would be applied to other challenging implant-related problems. This study investigates the use of acellular dermal matrix for correction or prevention of implant-associated breast deformities. Patients who underwent primary aesthetic breast surgery or secondary aesthetic or reconstructive breast surgery using acellular dermal matrix and implants between November of 2003 and October of 2009 were reviewed retrospectively. Patient demographics, indications for acellular dermal matrix, and acellular dermal matrix type and inset pattern were identified. Preoperative and postoperative photographs, success or failure of the procedure, complications, and need for related or unrelated revision surgery were recorded. Fifty-two patients had acellular dermal matrix placed alongside 77 breast prostheses, with a mean follow-up of 8.6 months (range, 0.4 to 30.4 months). Indications included prevention of implant bottoming-out (n = 6), treatment of malposition (n = 32), rippling (n = 20), capsular contracture (n = 16), and skin flap deficiency (n = 16). Seventy-four breasts (96.1 percent) were managed successfully with acellular dermal matrix. Three failures consisted of one breast with bottoming-out following treatment of capsular contracture, one breast with major infection requiring device explantation, and one breast with recurrent rippling. There was a 9.1 percent total complication rate, consisting of three mild infections, one major infection necessitating explantation, one hematoma, and one seroma. Based on this experience in 77 breasts, acellular dermal matrix has shown promise in treating and preventing capsular contracture, rippling, implant malposition, and soft-tissue thinning. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast endoprosthesis (adverse drug reaction) breast reconstruction dermis implant EMTREE MEDICAL INDEX TERMS adult aged article female follow up human methodology middle aged reoperation retrospective study time transplantation treatment outcome CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 21088648 (http://www.ncbi.nlm.nih.gov/pubmed/21088648) PUI L361643806 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 633 TITLE Current options in breast reconstruction with or without radiotherapy AUTHOR NAMES Roostaeian J. Crisera C. AUTHOR ADDRESSES (Roostaeian J.; Crisera C.) Division of Plastic and Reconstructive Surgery, University of California Los Angeles, 200 Medical Plaza, Los Angeles, CA 90095, United States. CORRESPONDENCE ADDRESS J. Roostaeian, Division of Plastic and Reconstructive Surgery, University of California Los Angeles, 200 Medical Plaza, Los Angeles, CA 90095, United States. SOURCE Current Opinion in Obstetrics and Gynecology (2011) 23:1 (44-50). Date of Publication: February 2011 ISSN 1040-872X BOOK PUBLISHER Lippincott Williams and Wilkins, 250 Waterloo Road, London, United Kingdom. ABSTRACT Purpose of Review: A brief overview of the current options in breast reconstruction with special consideration given to the effect of radiotherapy is presented. Recent Findings: Breast reconstruction is an important part of the overall care of mastectomy patients. Studies have demonstrated improved psychological well being, better quality of life, and most recently increased survival in women who have undergone breast reconstruction. Advancements such as nipple and skin sparing mastectomies, acellular dermal matrix, and improved implant technology have improved the results of implant-based breast reconstruction. The development of perforator flaps has further minimized donor-site morbidity with autologous tissue breast reconstruction. Despite much progress, difficulties remain in the management of patients with locally advanced breast cancer who will require radiation. Summary: Informed physician counseling of current breast reconstruction options is an integral part of the overall care of patients undergoing mastectomy. Special consideration needs to be made for patients with locally advanced breast cancer who require radiotherapy. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. EMTREE DRUG INDEX TERMS silicone gel sodium chloride EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction cancer radiotherapy EMTREE MEDICAL INDEX TERMS abdominoplasty acellular dermal matrix advanced cancer (radiotherapy, surgery) article breast cancer (radiotherapy, surgery) breast endoprosthesis deep inferior epigastric perforator flap donor site graft necrosis (complication) hematoma (complication) human incidence latissimus dorsi flap mastectomy nipple overall survival patient care patient counseling perforator flap physician postoperative care postoperative complication (complication, epidemiology) postoperative infection (complication) priority journal psychological well-being quality of life seroma (complication) subcutaneous mastectomy therapy effect transverse rectus abdominis musculocutaneous flap CAS REGISTRY NUMBERS sodium chloride (7647-14-5) EMBASE CLASSIFICATIONS Radiology (14) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011034024 MEDLINE PMID 20978439 (http://www.ncbi.nlm.nih.gov/pubmed/20978439) PUI L51125237 DOI 10.1097/GCO.0b013e328340e18a FULL TEXT LINK http://dx.doi.org/10.1097/GCO.0b013e328340e18a COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 634 TITLE An 8-year experience of direct-to-implant immediate breast reconstruction using human acellular dermal matrix (AlloDerm). AUTHOR NAMES Salzberg C.A. Ashikari A.Y. Koch R.M. Chabner-Thompson E. AUTHOR ADDRESSES (Salzberg C.A.) Division of Plastic Surgery, New York Medical College, New York, NY, USA. (Ashikari A.Y.; Koch R.M.; Chabner-Thompson E.) CORRESPONDENCE ADDRESS C.A. Salzberg, Division of Plastic Surgery, New York Medical College, New York, NY, USA. Email: asalzbergmd@yahoo.com SOURCE Plastic and reconstructive surgery (2011) 127:2 (514-524). Date of Publication: Feb 2011 ISSN 1529-4242 (electronic) ABSTRACT The advent of skin- and nipple-sparing mastectomy in conjunction with the use of human acellular dermal matrix to provide lower pole coverage has made direct-to-implant immediate breast reconstruction following mastectomy feasible. The purpose of this study was to evaluate long-term complications associated with this technique. All human acellular dermal matrix-assisted direct-to-implant immediate reconstructions performed over an 8-year period were included in this analysis. Patient charts were reviewed for type of mastectomy (oncologic or prophylactic), incision type, complications during follow-up, length of follow-up, rate and type of revision surgery in breasts without postoperative complications, contralateral procedures, and adjuvant radiotherapy. A total of 466 breasts (260 patients) were reconstructed; 68 percent were prophylactic and 32 percent were oncologic cases. Twenty-one breasts (4.5 percent) received radiotherapy. Mean implant size placed was 412.8 ± 24.7 cc (range, 150 to 600 cc). Mean follow-up was 28.9 ± 21.3 months (range, 0.3 to 97.7 months). The overall complication rate was 3.9 percent (implant loss, 1.3 percent; skin breakdown/necrosis, 1.1 percent; hematoma, 1.1 percent; human acellular dermal matrix exposure, 0.6 percent; capsular contracture, 0.4 percent; and infection, 0.2 percent). Type, incidence, and overall rate of complications did not differ significantly between prophylactic and oncologic breasts. Irradiated breasts had a fourfold higher rate of complications. In 354 breasts with more than 1 year of follow-up (mean, 36.7 ± 18.6 months; range, 12.1 to 97.7 months), there were no long-term complications. Human acellular dermal matrix-assisted direct-to-implant breast reconstruction following mastectomy is safe and reliable, with a low overall long-term complication rate. The low incidence of capsular contracture supports the growing body of evidence that human acellular dermal matrix mitigates capsular contracture. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) biomaterial (drug therapy) collagen (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) artificial skin breast augmentation EMTREE MEDICAL INDEX TERMS article breast tumor (prevention, surgery) female human male methodology retrospective study surgical mesh CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 21285756 (http://www.ncbi.nlm.nih.gov/pubmed/21285756) PUI L361594522 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 635 TITLE The true incidence of near-term postoperative complications in prosthetic breast reconstruction utilizing human acellular dermal matrices: a meta-analysis. AUTHOR NAMES Newman M.I. Swartz K.A. Samson M.C. Mahoney C.B. Diab K. AUTHOR ADDRESSES (Newman M.I.) Department of Plastic Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331, USA. (Swartz K.A.; Samson M.C.; Mahoney C.B.; Diab K.) CORRESPONDENCE ADDRESS M.I. Newman, Department of Plastic Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331, USA. Email: newmanm@ccf.org SOURCE Aesthetic plastic surgery (2011) 35:1 (100-106). Date of Publication: Feb 2011 ISSN 1432-5241 (electronic) ABSTRACT The use of human acellular dermal matrix (HADM) materials in prosthetic-based breast reconstruction has gained popularity in recent years. Questions remain, however, regarding the nature and incidence of postoperative complications associated with this technique. The results reported in the available literature vary widely. This meta-analysis examines this question further with a broad review of the available literature in an effort to better define the true nature and incidence of near-term complications associated with the use of HADM in prosthetic-based breast reconstruction. It does not aim to compare this method of reconstruction to others. A review of the available literature was performed in July 2009. The goal was to identify all previous works describing the placement of HADM at prosthetic-based breast reconstruction. Included were studies that documented the use of HADM for coverage of tissue expanders or permanent implants following therapeutic or prophylactic mastectomy. Excluded were studies that reported on the use of HADM in cosmetic breast surgery or studies that included the use of xenografts. Data collected included demographics as well as the nature and incidence of complications, with separate categories assigned for seroma, infection, flap necrosis, and "other." Data were analyzed using Comprehensive Meta-Analysis(®) software (Biostat, Englewood, NJ). Raw proportions, fixed-effect models, and random-effect models were used to assess the complication rates across studies. Eleven published articles and one abstract that was later published as an article were identified. Within these 12 studies, a total of 789 breasts were identified that had undergone reconstruction with HADM. The mean follow-up was 13.7 months. Under the random-effects model, the total complication rate was 12.0%. The most common complications were flap necrosis (3.3%), seroma (3.3%), and infection (5.6%). All complications not included in these categories were set apart in a separate category, "Other," and totaled 3.0% The true incidence of postoperative complications in the near term utilizing HADM in prosthetic-based breast reconstruction appears to be approximately 12%. The incidence of long-term complications such as capsular contracture remains unknown. However, as surgical experience with HADM grows, operative techniques designed at reducing risks will mature, strategies for managing complications will advance, and more advanced products designed to reduce the incidence of complications are likely to become available. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) biomaterial (adverse drug reaction, drug therapy) collagen (adverse drug reaction, drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast endoprosthesis (adverse drug reaction) breast reconstruction implant (adverse drug reaction) postoperative complication (epidemiology, prevention) EMTREE MEDICAL INDEX TERMS breast tumor (surgery) female human meta analysis methodology plastic surgery review risk factor statistics surgical infection (epidemiology) wound healing CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 21184070 (http://www.ncbi.nlm.nih.gov/pubmed/21184070) PUI L560012123 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 636 TITLE Adipose derived-stem cell adherence, proliferation, and migration on AlloDerm® matrix AUTHOR NAMES Slack G.C. Hagvall S. Zuk P. Rahgozar P. Yaghoubian A. Kruger E. Ehsani N. Tabit C. Bradley J. AUTHOR ADDRESSES (Slack G.C.; Hagvall S.; Zuk P.; Bradley J.) David Geffen School of Medicine, CA, UCLA, United States. (Slack G.C.; Hagvall S.; Zuk P.; Rahgozar P.; Yaghoubian A.; Kruger E.; Ehsani N.; Tabit C.; Bradley J.) UCLA, Los Angeles, United States. CORRESPONDENCE ADDRESS G.C. Slack, David Geffen School of Medicine, CA, UCLA, United States. SOURCE Journal of Investigative Medicine (2011) 59:1 (134-135). Date of Publication: January 2011 CONFERENCE NAME American Federation for Medical Research Western Regional Meeting, AFMR 2011 CONFERENCE LOCATION Carmel, CA, United States CONFERENCE DATE 2011-06-26 to 2011-06-29 ISSN 1081-5589 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Purpose of Study: The use of acellular dermal matrices, like AlloDerm® Regenerative Tissue Matrix, is currently used in breast reconstruction after ablative mastectomy surgery. Adipose derived stem cells (ASCs) are multipotent cells that may differentiate into fat, bone, muscle or nerve cells. The aim of our study was to determine if AlloDerm® may act as a suitable scaffold for ASCs to assist faster integration of local tissue and graft and promote revascularization, of importance prior to radiation treatment for breast cancer. Methods Used: ASCs, obtained from liposuction patients, were seeded onto the dermal face of the AlloDerm® scaffold by two methods: 1) pipet placement, 2) centrifugation (1000 rpm for 5 minutes). Constructs were harvested after 2, 5, 7, 14, 21, 28, and 42 days in tissue culture. H&E, DAPI, and SEM imaging studies for cell attachment, proliferation and migration at various matrix depths and real time reverse transcriptase polymerase chain reaction (RT-PCR) for adipogenic and osteogenic differentiation were performed at each time point. Summary of Results: ASC adherence and viability was confirmed by SEM imaging with cellular microvilli and interdigitation within the AlloDerm® scaffold for both seeding methods. Proliferation increased from 16 to 55 mean per high-powered field in the first week then stabilized. Migration increased from 13-18% to 3540% penetration into the matrix depth in the first week; by week 6, some ASC groups were limited to the surface though others had 100% penetration. Early studies show cultured ASCs retain adipogenic potential within AlloDerm® as seen by expression of adipogenic markers by RT-PCR. Conclusions: Our findings show that ASCs seeded, by drop or centrifuge method, onto AlloDerm® successfully attach and proliferate over a 6-week period. In vivo studies are being undertaken. EMTREE DRUG INDEX TERMS 4',6 diamidino 2 phenylindole marker EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adipose derived stem cell cell adhesion medical research EMTREE MEDICAL INDEX TERMS acellular dermal matrix bone breast cancer breast reconstruction centrifugation centrifuge human imaging in vivo study liposuction mastectomy microvillus multipotent stem cell muscle nerve cell patient pipette radiotherapy revascularization reverse transcription polymerase chain reaction surgery tissue culture tissues LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70524462 DOI 10.231/JIM.0b013e31820501bd FULL TEXT LINK http://dx.doi.org/10.231/JIM.0b013e31820501bd COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 637 TITLE Acellular human dermis implantation in 153 immediate two-stage tissue expander breast reconstructions: determining the incidence and significant predictors of complications. AUTHOR NAMES Nahabedian M.Y. AUTHOR ADDRESSES (Nahabedian M.Y.) CORRESPONDENCE ADDRESS M.Y. Nahabedian, SOURCE Plastic and reconstructive surgery (2011) 127:1 (481-482; author reply 482-483). Date of Publication: Jan 2011 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation breast reconstruction dermis implant EMTREE MEDICAL INDEX TERMS comparative study female human methodology note transplantation treatment failure LANGUAGE OF ARTICLE English MEDLINE PMID 21200253 (http://www.ncbi.nlm.nih.gov/pubmed/21200253) PUI L361357358 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 638 TITLE Preventing the "bottoming out" and "star-gazing" phenomena in inferior pedicle breast reduction with an acellular dermal matrix internal brassiere. AUTHOR NAMES Brown R.H. Izaddoost S. Bullocks J.M. AUTHOR ADDRESSES (Brown R.H.) Baylor College of Medicine, Clinical Care Center, Houston, TX 77030, USA. (Izaddoost S.; Bullocks J.M.) CORRESPONDENCE ADDRESS R.H. Brown, Baylor College of Medicine, Clinical Care Center, Houston, TX 77030, USA. Email: Rb140110@bcm.edu SOURCE Aesthetic plastic surgery (2010) 34:6 (760-767). Date of Publication: Dec 2010 ISSN 1432-5241 (electronic) ABSTRACT The phenomena of "bottoming out" (pseudoptosis) and "star-gazing" (the upward rotation of the nipple-areola complex) is a common postoperative problem when using the inferior pedicle breast reduction technique. Multiple techniques have been described to help prevent this problem, including internal suspension techniques and the use of mesh to support the pedicle. We describe our technique and present a case series in which acellular dermal matrix (AlloDerm(®)) is used as an internal brassiere or sling to support the inferior pedicle and prevent postoperative "bottoming out" and "star-gazing." Twenty-seven patients underwent inferior pedicle reduction mammaplasty through a Wise pattern performed by a single surgeon. In each case, acellular dermal matrix (0.79-2.03 mm thick) was sutured to the chest wall as a sling or internal brassiere to support the inferior pedicle. The pedicle was also plicated in a horizontal fashion to increase the projection of the breast and to improve the position of the nipple-areola complex. The mean weight of reduction per breast was 850 g. The mean distance from the nipple to the inframammary fold was 16.4 cm. The mean distance from the sternal notch to the nipple was 32.2 cm. Only one patient developed cellulitis and one patient had partial skin flap necrosis. There was no nipple loss. At routine follow-up it was found that the aesthetic breast shape has been retained and pseudoptosis or "bottoming out" was not significant in any patient. The longest follow-up is 29 months. The use of an acellular dermal matrix internal brassiere is a safe and effective technique for preventing the "bottoming out" and "star-gazing" phenomena that occurs after inferior pedicle breast reduction. Longer-term follow-up will be required to assess the longevity of these results. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast disease (surgery) breast reconstruction nipple (surgery) EMTREE MEDICAL INDEX TERMS adult article esthetics female follow up human methodology middle aged patient satisfaction surgical mesh treatment outcome CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 20602099 (http://www.ncbi.nlm.nih.gov/pubmed/20602099) PUI L360280832 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 639 TITLE Acellular cadaveric dermis decreases the inflammatory response in capsule formation in reconstructive breast surgery. AUTHOR NAMES Basu C.B. Leong M. Hicks M.J. AUTHOR ADDRESSES (Basu C.B.) Institute of Advanced Breast Reconstruction, the Section of Plastic Surgery, Michael E. DeBakey Veterans Affairs Medical Center, and the Department of Pathology, Baylor College of Medicine, Houston, TX 77030, USA. (Leong M.; Hicks M.J.) CORRESPONDENCE ADDRESS C.B. Basu, Institute of Advanced Breast Reconstruction, the Section of Plastic Surgery, Michael E. DeBakey Veterans Affairs Medical Center, and the Department of Pathology, Baylor College of Medicine, Houston, TX 77030, USA. Email: drbasu@basuplasticsurgery.com SOURCE Plastic and reconstructive surgery (2010) 126:6 (1842-1847). Date of Publication: Dec 2010 ISSN 1529-4242 (electronic) ABSTRACT Acellular cadaveric dermis in implant-based breast reconstruction provides an alternative to total submuscular placement. To date, there has been no detailed in vivo human analysis of the histopathologic sequelae of acellular cadaveric dermis in implant-based breast reconstruction. Based on clinical observations, we hypothesize that acellular cadaveric dermis decreases the inflammatory response and foreign body reaction normally seen around breast implants. Twenty patients underwent tissue expander reconstruction using the "dual-plane" acellular cadaveric dermis technique (AlloDerm). During implant exchange, intraoperative biopsy specimens were obtained of (1) biointegrated acellular cadaveric dermis and (2) native subpectoral capsule (internal control). Histopathologic analysis was performed. Masked biopsy specimens were scored semiquantitatively by an experienced histopathologist to reflect observed granulation tissue formation, vessel proliferation, chronic inflammatory changes, capsule fibrosis, fibroblast cellularity, and foreign body giant cell inflammatory reaction. Scores were analyzed statistically using the Wilcoxon signed rank test. Acellular cadaveric dermis (AlloDerm) had statistically diminished levels for all parameters compared with corresponding native breast capsules (p<0.001). This represents the first detailed histopathologic comparative analysis between biointegrated acellular cadaveric dermis and native capsules in implant-based breast reconstruction. These histopathologic findings suggest that certain properties intrinsic to acellular cadaveric dermis may limit capsule formation by diminishing inflammatory changes that initiate capsule formation. Further investigation is needed to determine whether acellular cadaveric dermis reduces the incidence of breast capsular contracture. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation breast tumor (surgery) fibrosis (prevention) foreign body reaction (prevention) postoperative complication (prevention) EMTREE MEDICAL INDEX TERMS adult article biopsy breast case control study clinical trial controlled clinical trial controlled study female human methodology middle aged pathology reoperation surgical mesh tissue expansion CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 21124125 (http://www.ncbi.nlm.nih.gov/pubmed/21124125) PUI L360250626 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 640 TITLE Patient-subjective cosmetic outcomes following the varying stages of tissue expander breast reconstruction: The importance of completion AUTHOR NAMES Buck D.W. Shenaq D. Heyer K. Kato C. Kim J.Y.S. AUTHOR ADDRESSES (Buck D.W.; Shenaq D.; Heyer K.; Kato C.; Kim J.Y.S., jokim@nmh.org) Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, 675 North St. Clair Street, Galter Suite 19-250, Chicago, IL 60611, United States. CORRESPONDENCE ADDRESS J.Y.S. Kim, Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, 675 North St. Clair Street, Galter Suite 19-250, Chicago, IL 60611, United States. Email: jokim@nmh.org SOURCE Breast (2010) 19:6 (521-526). Date of Publication: December 2010 ISSN 0960-9776 BOOK PUBLISHER Churchill Livingstone, 1-3 Baxter's Place, Leith Walk, Edinburgh, United Kingdom. ABSTRACT Introduction: Tissue expander breast reconstruction consists of three major surgical steps: placement of the expander after mastectomy, exchange of the expander for an implant, and nipple-areola complex reconstruction. The evolution of patient satisfaction throughout this process has not been evaluated. Here we performed a stratified analysis of patient-subjective cosmetic outcomes during the stages of breast reconstruction. Methods: Twenty-eight consecutive tissue expander-implant reconstructions were performed by the senior author using human acellular dermis. Cosmetic outcomes were assessed after each reconstructive stage using a validated Breast Evaluation Questionnaire consisting of questions related to breast size, shape and firmness in three separate contexts: intimate or sexual activities, leisure or social activities, and professional or job-related activities. Results: Eighteen patients underwent unilateral reconstruction, while 10 underwent bilateral reconstruction. Satisfaction scores were statistically higher following Stage I and II procedures for bilateral reconstructions. For unilateral reconstructions, there was a statistically significant elevation in scores following Stage II. The addition of nipple-areola reconstruction resulted in the highest scores for both unilateral and bilateral reconstructions. These score elevations were significant (p < 0.05) in nearly every measured context for unilateral reconstructions and as such, the significant differences in scores between unilateral and bilateral cohorts after stages I and II were nearly eliminated after completion of the entire reconstructive process. Conclusion: Satisfaction with tissue expander reconstruction is significantly affected by the patients' stage during the reconstructive process. Completion of all three stages, including nipple-areolar complex reconstruction, achieves maximal patient satisfaction. For unilateral reconstructions, completion of the entire reconstructive process, including contralateral symmetry procedures and nipple-areolar complex reconstruction, results in cosmesis scores that are similar to those in bilateral cases. © 2010 Elsevier Ltd. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction esthetic surgery patient satisfaction tissue expansion EMTREE MEDICAL INDEX TERMS adult article breast areola breast augmentation clinical article controlled study female human human relation intimacy job performance leisure male nipple outcome assessment priority journal questionnaire scoring system sexual behavior social behavior surgical technique treatment response EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010629850 MEDLINE PMID 21078486 (http://www.ncbi.nlm.nih.gov/pubmed/21078486) PUI L50957347 DOI 10.1016/j.breast.2010.05.017 FULL TEXT LINK http://dx.doi.org/10.1016/j.breast.2010.05.017 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 641 TITLE Preventing the "bottoming out and star-gazing" phenomenon in inferior pedicle breast reduction with an acellular dermal matrix internal brassiere. AUTHOR NAMES Góes J.C. AUTHOR ADDRESSES (Góes J.C.) CORRESPONDENCE ADDRESS J.C. Góes, Email: clinica@sampaiogoes.com SOURCE Aesthetic plastic surgery (2010) 34:6 (768). Date of Publication: Dec 2010 ISSN 1432-5241 (electronic) EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast disease (surgery) breast reconstruction nipple (surgery) EMTREE MEDICAL INDEX TERMS esthetics female human methodology note surgical mesh treatment outcome CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 20585947 (http://www.ncbi.nlm.nih.gov/pubmed/20585947) PUI L360280829 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 642 TITLE The use of human acellular dermal matrix for the correction of secondary deformities after breast augmentation: results and costs. AUTHOR NAMES Hartzell T.L. Taghinia A.H. Chang J. Lin S.J. Slavin S.A. AUTHOR ADDRESSES (Hartzell T.L.) Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02446, USA. (Taghinia A.H.; Chang J.; Lin S.J.; Slavin S.A.) CORRESPONDENCE ADDRESS T.L. Hartzell, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02446, USA. SOURCE Plastic and reconstructive surgery (2010) 126:5 (1711-1720). Date of Publication: Nov 2010 ISSN 1529-4242 (electronic) ABSTRACT Secondary breast deformities following breast augmentation constitute some of the most challenging and difficult problems to correct. Although the application and efficacy of human acellular dermal matrix in breast reconstruction has been previously reported, there is little information in the literature relating to its indications, results, or cost in aesthetic breast surgery. This study retrospectively reviewed a single surgeon's experience in correcting secondary deformities with human acellular dermal matrix after breast augmentation from 2005 to 2009. A total of 23 patients (38 breasts) were included in the study. There were 28 breasts with surface irregularities and 22 breasts with implant malposition (12 had both). On average, 1.13 sheets of human acellular dermal matrix were used per breast per operation. At the authors' institution, this material equates to a cost to the patient of $3536 to $4856 per breast (depending on sheet size and thickness). Twenty of 23 patients (87 percent) [32 of 38 breasts (84 percent)] had improvement in their breast deformity after breast revision surgery. Three patients (six breasts) needed another cosmetic breast operation before the end of the follow-up period: two because of persistent surface irregularities and one with a request for larger implants. One patient (3 percent) had an infection in one breast, requiring removal of the human acellular dermal matrix. Human acellular dermal matrix is a useful and safe adjunct for correction of contour deformities after breast augmentation. Its high cost, however, may be a deterrent to widespread use in self-pay patients. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) biomaterial (drug administration) collagen (drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation breast reconstruction (adverse drug reaction) EMTREE MEDICAL INDEX TERMS adult aged article female human middle aged reoperation surgical mesh CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 21042128 (http://www.ncbi.nlm.nih.gov/pubmed/21042128) PUI L360237069 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 643 TITLE Angiopoietin-1, angiopoietin-2 and Tie-2 receptor expression in human dermal wound repair and scarring AUTHOR NAMES Staton C.A. Valluru M. Hoh L. Reed M.W.R. Brown N.J. AUTHOR ADDRESSES (Staton C.A., c.a.staton@shef.ac.uk; Valluru M.; Hoh L.; Reed M.W.R.; Brown N.J.) Microcirculation Research Group, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield S10 2RX, United Kingdom. CORRESPONDENCE ADDRESS C. A. Staton, Microcirculation Research Group, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield S10 2RX, United Kingdom. Email: c.a.staton@shef.ac.uk SOURCE British Journal of Dermatology (2010) 163:5 (920-927). Date of Publication: November 2010 ISSN 0007-0963 1365-2133 (electronic) BOOK PUBLISHER Blackwell Publishing Ltd, 9600 Garsington Road, Oxford, United Kingdom. ABSTRACT Background The angiopoietin (Ang)/Tie-2 ligand/receptor system is known to interact with the vascular endothelial growth factor (VEGF) pathway to determine the fate of blood vessels during angiogenesis. However, the precise contribution of this system to angiogenesis and the mechanisms of vascular maturation and remodelling in human tissue repair have yet to be elucidated. Objectives To examine the spatial and temporal expression of Ang-1, Ang-2, Tie-2 and VEGF in relation to angiogenesis in human surgical wounds. Methods Punch biopsies were taken either from normal unwounded skin (controls) during surgery or from mastectomy scars between 3 days and 2 years postsurgery. Ang-1, Ang-2, Tie-2 and VEGF fibroblast/myofibroblast and endothelial expression were characterized by immunohistochemistry, analysed semiquantitatively and correlated with microvessel density (MVD) and scar age. Results The expression of VEGF, Ang-1, Ang-2 and Tie-2 in fibroblasts/myofibroblasts was increased significantly in early scars, decreased in older scars and was related to scar age (P<0·001) and MVD (P<0·0004), with strong correlations between all factors. In contrast, vascular expression of Ang-1 was decreased slightly in early scars, vascular Ang-2 remained constant and Tie-2 vascular expression increased, although there were no correlations with scar age or MVD. Conclusions These data demonstrate that angiopoietins and their receptor, Tie-2, are expressed in both fibroblasts/myofibroblasts and endothelial cells in healing human wounds. Fibroblast/myofibroblast expression correlates with angiogenesis and VEGF expression, suggesting a role for the angiopoietin/Tie-2 system in normal wound repair and scarring. © 2010 British Association of Dermatologists. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) angiopoietin 1 (endogenous compound) angiopoietin 2 (endogenous compound) angiopoietin receptor (endogenous compound) EMTREE DRUG INDEX TERMS vasculotropin (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) scar formation surgical wound wound healing EMTREE MEDICAL INDEX TERMS angiogenesis article controlled study endothelium cell fibroblast human human tissue immunohistochemistry major clinical study mastectomy microvasculature myofibroblast postoperative period priority journal protein expression punch biopsy CAS REGISTRY NUMBERS angiopoietin 1 (186270-49-5) angiopoietin 2 (194368-66-6) vasculotropin (127464-60-2) EMBASE CLASSIFICATIONS Dermatology and Venereology (13) Clinical and Experimental Biochemistry (29) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010621861 MEDLINE PMID 20633009 (http://www.ncbi.nlm.nih.gov/pubmed/20633009) PUI L359952301 DOI 10.1111/j.1365-2133.2010.09940.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1365-2133.2010.09940.x COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 644 TITLE Discussion. The use of human acellular dermal matrix for the correction of secondary deformities after breast augmentation: results and costs. AUTHOR NAMES Nahabedian M.Y. AUTHOR ADDRESSES (Nahabedian M.Y.) Department of Plastic Surgery, Georgetown University, Washington, DC 20007, USA. CORRESPONDENCE ADDRESS M.Y. Nahabedian, Department of Plastic Surgery, Georgetown University, Washington, DC 20007, USA. Email: drnahabedian@aol.com SOURCE Plastic and reconstructive surgery (2010) 126:5 (1721-1722). Date of Publication: Nov 2010 ISSN 1529-4242 (electronic) EMTREE DRUG INDEX TERMS (MAJOR FOCUS) biomaterial (drug administration) collagen (drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation breast reconstruction (adverse drug reaction) EMTREE MEDICAL INDEX TERMS article female human reoperation surgical mesh CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 21042129 (http://www.ncbi.nlm.nih.gov/pubmed/21042129) PUI L360237070 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 645 TITLE Acellular dermal matrix used for breast reconstruction after mastectomy AUTHOR NAMES Krockenberger M. Köhler G. Engel J. Zipp K. Dietl J. Hönig A. AUTHOR ADDRESSES (Krockenberger M.; Engel J.; Zipp K.; Dietl J.; Hönig A.) Universitätsfrauenklinik Würzburg, Würzburg, Germany. (Köhler G.) Abteilung für plastische Chirurgie, Chirurgische Universitätsklinik, Würzburg, Germany. CORRESPONDENCE ADDRESS M. Krockenberger, Universitätsfrauenklinik Würzburg, Würzburg, Germany. SOURCE Archives of Gynecology and Obstetrics (2010) 282 SUPPL. 1 (S232). Date of Publication: October 2010 CONFERENCE NAME 58th Congress of the German Society for Gynecology and Obstetrics (Deutsche Gesellschaft fur Gynakologie und Geburtshilfe, DGGG) CONFERENCE LOCATION Munich, Germany CONFERENCE DATE 2010-10-05 to 2010-10-08 ISSN 0932-0067 BOOK PUBLISHER Springer Verlag ABSTRACT Objective: Mastectomy can be a harming procedure for mental wellbeing of affected women, which underlines the importance of reconstructive surgery. There are several strategies. At first the use of autologous material like tram flap, latissimus dorsi flap or deep inferior epigastric perforator flap (diep), associated with the disadvantage of long operation durations, the risk of flap necrosis as well as scars in areas outside the breast or thorax. At second the expander/implant approach, that sometimes leads to a cranial position of implants, less natural form of the breast, dislocation of the implant and the need for a two stage procedure. A single stage reconstruction with good cosmetical outcome and no risk of flap necrosis would certainly mean progress. Acellular dermal matrix (ADM) has been popularized in other countries as an adjunct to tissue expander or implant breast reconstruction given its utility in providing additional coverage and support for the inferior pole. In Germany there is no government approval for alloderm® (acellular cadaveric dermis) therefore other materials like acellular dermal matrix based on pig skin (Strattice®) have to be used. Materials and methods: We have used ADM for reconstructive surgery after radical, skin sparing or subcutaneous mastectomy. The subpectoral pocket is opened laterally at the insertion of the pectoralis muscle. The submuscular and ADM pocket is subsequently formed. The acellular dermal matrix is used to create a nice submammarian fold which helps to give the permanent prosthesis a more caudal and therefore more natural position. The tissue expander (when necessary) or permanent prosthesis is then placed in the pocket and the pectoralis muscle is connected through interrupted stitches to the ADM. Without the use of ADM lower pole expansion is rather restricted. Conclusions: Encouraged by the good cosmetic results we will further use this technique, although longer follow up is needed. EMTREE DRUG INDEX TERMS cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction gynecology mastectomy obstetrics society EMTREE MEDICAL INDEX TERMS breast deep inferior epigastric perforator flap dermis female follow up Germany government graft necrosis implant latissimus dorsi flap operation duration pectoralis major muscle pig plastic surgery prosthesis risk scar skin subcutaneous mastectomy thorax transverse rectus abdominis musculocutaneous flap wellbeing LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70290103 DOI 10.1007/s00404-010-1634-7 FULL TEXT LINK http://dx.doi.org/10.1007/s00404-010-1634-7 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 646 TITLE A preliminary report on the clinical experience with AlloDerm in breast reconstruction and its radiologic appearance AUTHOR NAMES Tran Cao H.S. Tokin C. Konop J. Ojeda-Fournier H. Chao J. Blair S.L. AUTHOR ADDRESSES (Tran Cao H.S.; Tokin C.; Konop J.; Ojeda-Fournier H.; Chao J.; Blair S.L., slblair@ucsd.edu) University of California, San Diego Medical Center, San Diego, CA, United States. CORRESPONDENCE ADDRESS S. L. Blair, University of California, San Diego, Moores Cancer Center, 3855 Health Sciences Drive # 0987, San Diego, CA 92093-0987, United States. Email: slblair@ucsd.edu SOURCE American Surgeon (2010) 76:10 (1123-1126). Date of Publication: October 2010 ISSN 0003-1348 BOOK PUBLISHER Southeastern Surgical Congress, 141 West Wieuca Road, Suite B100, Atlanta, United States. ABSTRACT Human acellular tissue matrix (AlloDerm) use in breast reconstruction has become popular. Traditionally used for prosthesis coverage, it is also used in our practice as a filler for lumpectomy defects and a contouring device. However, no report presently exists that describes its appearance on oncologic surveillance studies. We performed a retrospective review of all charts of patients having undergone cancer-related breast reconstruction using AlloDerm as a filler at a single institution between 2005 and 2009. Postoperative mammograms and dynamic contrast enhanced breast magnetic resonance imaging were reviewed with a dedicated breast imager. Sixteen women underwent surgery involving placement of an AlloDerm roll in the breast. Postoperative films were unavailable for two of them. Of the remaining 14 patients, nine had postoperative mammograms only, three had postoperative dynamic contrast enhanced breast magnetic resonance imaging only, and two patients had both. In all cases, evaluation of the postoperative images was not affected by the presence of AlloDerm. In our short-term, retrospective experience, we find that a thorough radiographic evaluation of the breast tissue remains possible when AlloDerm rolls are used in reconstruction. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast cancer (surgery) breast reconstruction EMTREE MEDICAL INDEX TERMS aged article breast biopsy breast calcification cancer recurrence clinical article clinical evaluation contrast enhancement female human image analysis intraductal carcinoma (surgery) mammography medical record review nuclear magnetic resonance imaging partial mastectomy postoperative period retrospective study DEVICE TRADE NAMES AlloDerm , United StatesLifecell DEVICE MANUFACTURERS (United States)Lifecell EMBASE CLASSIFICATIONS Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2011028904 MEDLINE PMID 21105625 (http://www.ncbi.nlm.nih.gov/pubmed/21105625) PUI L361095179 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 647 TITLE Breast Implant Salvage with the Use of Acellular Dermal Matrix following Partial Mastectomy. AUTHOR NAMES Ellsworth W.A. Rizvi M. Lypka M. Bass B.L. Friedman J.D. AUTHOR ADDRESSES (Ellsworth W.A.) Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas, USA. (Rizvi M.; Lypka M.; Bass B.L.; Friedman J.D.) CORRESPONDENCE ADDRESS W.A. Ellsworth, Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas, USA. Email: we042844@bcm.edu SOURCE Plastic and reconstructive surgery (2010) 126:4 (189e-190e). Date of Publication: Oct 2010 ISSN 1529-4242 (electronic) EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast endoprosthesis breast reconstruction partial mastectomy salvage therapy EMTREE MEDICAL INDEX TERMS article breast augmentation breast tumor (surgery) case report female follow up human methodology middle aged Paget nipple disease (surgery) pathology surgical mesh treatment outcome CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 20885216 (http://www.ncbi.nlm.nih.gov/pubmed/20885216) PUI L360238443 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 648 TITLE Use of AlloDerm for correction of symmastia. AUTHOR NAMES Curtis M.S. Mahmood F. Nguyen M.D. Lee B.T. AUTHOR ADDRESSES (Curtis M.S.) Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. (Mahmood F.; Nguyen M.D.; Lee B.T.) CORRESPONDENCE ADDRESS M.S. Curtis, Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. SOURCE Plastic and reconstructive surgery (2010) 126:4 (192e-193e). Date of Publication: Oct 2010 ISSN 1529-4242 (electronic) EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast endoprosthesis (adverse drug reaction) breast reconstruction (adverse drug reaction) EMTREE MEDICAL INDEX TERMS adjuvant chemotherapy article artificial skin breast disease (etiology, therapy) breast tumor (drug therapy, surgery) case report female follow up human mastectomy methodology middle aged postoperative care postoperative complication (surgery) reoperation surgical mesh treatment outcome CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 20885218 (http://www.ncbi.nlm.nih.gov/pubmed/20885218) PUI L360250181 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 649 TITLE AlloDerm performance in the setting of prosthetic breast surgery, infection, and irradiation. AUTHOR NAMES Newman M.I. Hanabergh E. Samson M.C. AUTHOR ADDRESSES (Newman M.I.; Hanabergh E.; Samson M.C.) CORRESPONDENCE ADDRESS M.I. Newman, SOURCE Plastic and reconstructive surgery (2010) 126:3 (1120; author reply 1120-1121). Date of Publication: Sep 2010 ISSN 1529-4242 (electronic) EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen (adverse drug reaction) EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation (adverse drug reaction) breast disease (etiology) breast endoprosthesis (adverse drug reaction) breast tumor (radiotherapy, surgery) surgical infection (etiology) EMTREE MEDICAL INDEX TERMS female human note CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 20811254 (http://www.ncbi.nlm.nih.gov/pubmed/20811254) PUI L359690828 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 650 TITLE Techniques to reduce seroma and infection in acellular dermis-assisted prosthetic breast reconstruction. AUTHOR NAMES Sbitany H. AUTHOR ADDRESSES (Sbitany H.) CORRESPONDENCE ADDRESS H. Sbitany, SOURCE Plastic and reconstructive surgery (2010) 126:3 (1121-1122; author reply 1122). Date of Publication: Sep 2010 ISSN 1529-4242 (electronic) EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen (adverse drug reaction) EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation (adverse drug reaction) breast endoprosthesis (adverse drug reaction) seroma (etiology, prevention) surgical infection (etiology, prevention) EMTREE MEDICAL INDEX TERMS human methodology note CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 20811255 (http://www.ncbi.nlm.nih.gov/pubmed/20811255) PUI L359690829 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 651 TITLE The use of acellular dermal matrix in the correction of visible parasternal deformities after breast reconstruction. AUTHOR NAMES Uflacker A.B. Janis J.E. AUTHOR ADDRESSES (Uflacker A.B.; Janis J.E.) CORRESPONDENCE ADDRESS A.B. Uflacker, SOURCE Plastic and reconstructive surgery (2010) 126:1 (34e-36e). Date of Publication: Jul 2010 ISSN 1529-4242 (electronic) EMTREE DRUG INDEX TERMS (MAJOR FOCUS) biomaterial collagen EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (surgery) carcinoma (surgery) mastectomy (adverse drug reaction) postoperative complication (surgery) thorax wall (surgery) EMTREE MEDICAL INDEX TERMS adult case report female follow up human letter methodology pectoralis major muscle (surgery) plastic surgery sternum CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 20595842 (http://www.ncbi.nlm.nih.gov/pubmed/20595842) PUI L359454709 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 652 TITLE Acellular human dermis implantation in 153 immediate two-stage tissue expander breast reconstructions: determining the incidence and significant predictors of complications. AUTHOR NAMES Antony A.K. McCarthy C.M. Cordeiro P.G. Mehrara B.J. Pusic A.L. Teo E.H. Arriaga A.F. Disa J.J. AUTHOR ADDRESSES (Antony A.K.) Plastic and Reconstructive Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA. (McCarthy C.M.; Cordeiro P.G.; Mehrara B.J.; Pusic A.L.; Teo E.H.; Arriaga A.F.; Disa J.J.) CORRESPONDENCE ADDRESS A.K. Antony, Plastic and Reconstructive Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA. SOURCE Plastic and reconstructive surgery (2010) 125:6 (1606-1614). Date of Publication: Jun 2010 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Little information exists on the incidence of complications after acellular human dermis implantation in two-stage tissue expander breast reconstruction. The purpose of this study was to evaluate the incidence of postoperative adverse events and identify significant predictors of complications in acellular human dermis tissue expander breast reconstruction. METHODS: This study accrued all patients from January of 2004 through April of 2008 undergoing two-stage immediate tissue expander breast reconstruction using acellular human dermis. A total of 153 expanders were placed. Complications were assessed. Univariate and multivariate logistic regression modeling was performed. Comparison of complication rates using the traditional (non-acellular human dermis) technique from concurrent (2004 to 2008) and consecutive time periods (2001 to 2003) for 2910 and 1170 expanders, respectively, is provided. RESULTS: A total of 153 expanders were implanted in 96 women: 39 unilateral and 57 bilateral. Eleven (7.2 percent) were removed due to infection (n = 5, 3.3 percent), exposure (n = 4, 2.6 percent), or patient preference (n = 2, 1.3 percent). Other complications included cellulitis (3.9 percent), seroma (7.2 percent), hematoma (2.0 percent), mastectomy flap necrosis (4.6 percent), and leak/failed expansion (0.0 percent); 92.8 percent were successfully expanded and exchanged for a permanent implant. Eleven seromas (7.2 percent) were identified; nine underwent aspiration. None of these resulted in infection or reconstructive failure. Univariate analysis revealed age, body mass index, axillary dissection, and postoperative chemotherapy to be associated with reconstructive failure (p < 0.05). Multivariate analysis revealed that age, body mass index, and axillary dissection are independent risk factors for developing complications (p < 0.05). CONCLUSION: Acellular human dermis is a useful adjunct for intraoperative pocket development in immediate tissue expander reconstruction but can result in an increased risk of complications, in particular, seroma and reconstructive failure. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) biomaterial (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction dermis (surgery) postoperative complication (epidemiology) EMTREE MEDICAL INDEX TERMS adolescent adult aged article cellulitis (epidemiology) female human incidence mastectomy methodology middle aged necrosis pathology prediction and forecasting retrospective study risk factor seroma (epidemiology) statistical model statistics surgical infection (epidemiology) LANGUAGE OF ARTICLE English MEDLINE PMID 20517083 (http://www.ncbi.nlm.nih.gov/pubmed/20517083) PUI L359015915 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 653 TITLE The effect of acellular dermal matrix use on complication rates in tissue expander/implant breast reconstruction. AUTHOR NAMES Lanier S.T. Wang E.D. Chen J.J. Arora B.P. Katz S.M. Gelfand M.A. Khan S.U. Dagum A.B. Bui D.T. AUTHOR ADDRESSES (Lanier S.T.) Stony Brook University School of Medicine, Stony Brook, NY, USA. (Wang E.D.; Chen J.J.; Arora B.P.; Katz S.M.; Gelfand M.A.; Khan S.U.; Dagum A.B.; Bui D.T.) CORRESPONDENCE ADDRESS S.T. Lanier, Stony Brook University School of Medicine, Stony Brook, NY, USA. SOURCE Annals of plastic surgery (2010) 64:5 (674-678). Date of Publication: May 2010 ISSN 1536-3708 (electronic) ABSTRACT Tissue expander/implant breast reconstructions by 5 surgeons at a single institution from 2005 to 2008 were retrospectively identified and divided into 2 cohorts: use of acellular dermal matrix (ADM, n = 75) versus standard submuscular placement (n = 52). The ADM group had a statistically significant higher rate of infection (28.9% vs. 12.0%, P = 0.022), reoperation (25.0% vs. 8.0%, P = 0.011), expander explantation (19.2% vs. 5.3%, P = 0.020), and overall complications (46.2% vs. 22.7%, P = 0.007). When stratifying by breast size, a higher complication rate was not observed with the use of ADM in breasts less than 600 g, whereas ADM use in breasts larger than 600 g was associated with a statistically significant higher rate of infection when controlling for the occurrence of skin necrosis. The ADM cohort had a significantly higher mean initial tissue expander fill volume (256 mL vs. 74 mL, P < 0.001) and a significantly higher mean initial tissue expander fill ratio (49% vs. 17%, P < 0.001). Further work is needed to define the ideal patient population for ADM use in tissue expander/implant breast reconstruction. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen (drug therapy) EMTREE DRUG INDEX TERMS biomaterial surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation breast endoprosthesis breast reconstruction implant postoperative complication (epidemiology) EMTREE MEDICAL INDEX TERMS article breast tumor (surgery) female human methodology middle aged necrosis retrospective study treatment outcome CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 20395795 (http://www.ncbi.nlm.nih.gov/pubmed/20395795) PUI L359453167 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 654 TITLE Nipple-sparing mastectomy: Indications, preoperative planning, and intraoperative techniques AUTHOR NAMES Tran E.-J. Grube B. Adrejeva-Wright L. Christy C. Narayan D. Fusi S. Restifo R. Price G. Chicarelli Z. Philpotts L. Lannin D. AUTHOR ADDRESSES (Tran E.-J.; Grube B.; Christy C.; Narayan D.; Fusi S.; Restifo R.; Price G.; Chicarelli Z.; Lannin D.) Yale University, School of Medicine, Department of Surgery, New Haven, United States. (Adrejeva-Wright L.; Philpotts L.) Yale University, School of Medicine, Department of Radiology, New Haven, United States. CORRESPONDENCE ADDRESS E.-J. Tran, Yale University, School of Medicine, Department of Surgery, New Haven, United States. SOURCE Annals of Surgical Oncology (2010) 17 SUPPL. 2 (S190). Date of Publication: April 2010 CONFERENCE NAME 11th Annual Meeting of the American Society of Breast Surgeons CONFERENCE LOCATION Las Vegas, NV, United States CONFERENCE DATE 2010-04-28 to 2010-05-02 ISSN 1068-9265 BOOK PUBLISHER Springer New York ABSTRACT Objectives: Breast conservation has been the recommended treatment for earlystage breast cancer, but may not be feasible for some women. Mastectomy may be necessary for large ratio of tumor volume to breast size, multicentric disease, diffuse calcifications, and contraindication to radiotherapy or personal choice. Mastectomy may also be considered for individuals with inherited BRCA 1 or 2 mutations and for prophylaxis in the individual with a biopsy-proven contralateral breast cancer. Recent reports suggest that there has been a shift in patient choice from breast conservation to mastectomy. There has also been a significant shift in favor of sparing the skin envelope and nipple areolar complex (NAC) when mastectomy is performed for better cosmesis. The aim of this study is to examine the indications, preoperative planning, intraoperative techniques, and oncologic safety of nipple-sparing mastectomy (NSM). Methods: Retrospective analysis of 36 patients who underwent NSM over the last 3 years at an academic multidisciplinary breast center. NSM were done for treatment of breast cancer, risk reduction in BRCA 1 or 2 gene mutations, and/or for contralateral prophylaxis. Exclusion criteria included clinical suspicion of NAC involvement, inflammatory carcinoma, and preoperative chemotherapy. This study examines the demographics, indications, preoperative evaluation, surgical technique, reconstructive options, cancer involvement of NAC, and recurrence. Results: Data were available for 60 NSM performed on 36 patients (17 had BRCA 1 or 2 mutations), with median age of 49 (25-69), and median follow-up of 9.25 months (0.5-34.75). Indications for mastectomy were: 26 for risk reduction in BRCA 1 or 2 mutation carriers, 14 for treatment of invasive cancers, 8 for treatment of DCIS, and 12 for contralateral prophylaxis. Preoperative evaluation of cancer patients included mammography and MRI, showing an overall mean size (20.8 and 17.5 mm, respectively) and distance to NAC (66.3 and 53.1 mm, respectively). NSM was performed through a variety of incisions: 11 inframammary, 12 radial, 5 tennis-racket, 6 modified Wise reduction mammaplasty pattern, and 2 periareolar. Patients also had an assortment of reconstructive techniques: 23 expander placement, 7 immediate reconstruction with implants, 2 DIEP, 2 TRAM, 1 combined flap and expander, and 1 Alloderm with fat injection. No NAC involvement was detected at intraoperative frozen section. One nipple showed pagetoid spread of LIN on permanent and it was resected at a second operation. Axillary staging was performed on 25 patients with invasive cancer and/or DCIS, 2 had positive sentinel lymph node biopsy and underwent axillary lymph node dissection. There has been no evidence of locoregional recurrence thus far. Conclusions: The coupling of clinical assessment with modern imaging techniques allows for selection of patients who can be considered for NSM with a low incidence to pathologic involvement of the NAC. Preoperative planning that involves both the plastic surgeon and the breast surgeon led to combining a wide variety of incisions with many reconstructive options for optimal aesthetic outcomes. Short-term follow-up also suggests concurrence with larger published series that NSM is an oncologically safe approach. EMTREE DRUG INDEX TERMS plastic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast mastectomy nipple planning society surgeon EMTREE MEDICAL INDEX TERMS axillary lymph node biopsy breast cancer breast reduction calcification cancer patient cancer risk carcinoma chemotherapy clinical assessment female follow up frozen section gene mutation hospital patient imaging implant incision injection intraductal carcinoma lymph node dissection mammography mutation neoplasm nuclear magnetic resonance imaging patient preoperative evaluation prophylaxis radiotherapy risk reduction safety sentinel lymph node biopsy skin staging surgical technique tennis tumor invasion tumor volume LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70291741 DOI 10.1245/s10434-010-1048-6 FULL TEXT LINK http://dx.doi.org/10.1245/s10434-010-1048-6 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 655 TITLE Allo-Bra: A new 1-stage breast reconstruction option following skin/nipple-sparing mastectomy AUTHOR NAMES Apsey H. Bash D. Kreymerman P. Gray R. Wasif N. Casey W. Rebecca A. Pockaj B. AUTHOR ADDRESSES (Apsey H.; Bash D.; Kreymerman P.; Gray R.; Wasif N.; Casey W.; Rebecca A.; Pockaj B.) Mayo Clinic, Phoenix, United States. CORRESPONDENCE ADDRESS H. Apsey, Mayo Clinic, Phoenix, United States. SOURCE Annals of Surgical Oncology (2010) 17 SUPPL. 2 (S161). Date of Publication: April 2010 CONFERENCE NAME 11th Annual Meeting of the American Society of Breast Surgeons CONFERENCE LOCATION Las Vegas, NV, United States CONFERENCE DATE 2010-04-28 to 2010-05-02 ISSN 1068-9265 BOOK PUBLISHER Springer New York ABSTRACT Objective: There are multiple reconstructive options following mastectomy. The novel Allo-Bra procedure involves use of an allograft (acellular dermal matrix) to form an implant pouch superficial to the pectoralis major muscle for a single-stage reconstruction. This is a new technique with limited data; therefore a review of all patients undergoing Allo-Bra reconstruction was performed. Methods: A retrospective analysis of prospectively collected data on 14 patients undergoing immediate, 1-stage, implant-based Allo-Bra breast reconstruction. The technique uses a piece of hydrated acellular dermis draped over a steel cage, dermal side up, to fixate the shape. The Allo-Bra is secured by anchoring the acellular dermis to the anterior chest muscle fascia. A silicone implant is placed within the pouch to complete the reconstruction. Data review included demographics, pathology, and surgical outcomes. Results: Fourteen patients (27 breasts) underwent skin-sparing (n = 5, 36%) or nipple-sparing mastectomy (n = 9, 64%), followed by immediate single-stage implant reconstruction using the Allo-bra. Surgery was performed for prophylaxis in 2 patients, 6 had ductal carcinoma in situ, and 6 had invasive breast cancer. Mean age was 47 years. Mean BMI was 24. No patients used tobacco at the time of their operation, however 2 patients had a significant past smoking history. Mean tumor size was 1.2 cm for DCIS and 2.1 cm for invasive breast cancer (5 infiltrating ductal and 1 mixed ductal/lobular carcinoma). Ten patients underwent sentinel lymph node biopsy; 2 (20%) had metastases and went on to have complete axillary dissection. Mean total operative time for bilateral mastectomies with reconstruction was 4.5 hours. Unilateral mastectomy with reconstruction operative time was 2.75 hours. Jackson-Pratt drains remained in place for a mean of 8 days. Hospital stay was 1 night for 11 patients (80%) and 2 nights for 3 patients (20%). There was no nipple loss among the patients who underwent Allo-Bra reconstruction. Postoperative complications included 1 patient with a hematoma requireing surgical evacuation and 1 patient who developed bilateral implant infection requiring explantation after antibiotic failure. Median follow-up was 4 months. Cosmesis, as assessed by the plastic surgeon, was good to excellent in 11 patients, including 2 who had undergone whole-breast radiation with follow-up at 5 and 12 months postoperatively. One patient had bilateral inframammary fold flattening at 2 months. One had grade 2-3 bilateral capsular contracture. Two patients developed seromas-1 in the patient with bilateral implant infection and 1 requiring simple aspiration. Ten patients (70%) no longer required narcotic pain medication by the time of first follow-up (within 7 days). Conclusions: The Allo-Bra breast reconstruction is an option that can be performed in 1 stage at the time of mastectomy without disrupting the pectoralis muscle. In our early experience, the Allo-Bra provides good cosmesis with low rates of capsular contracture, minimal discomfort, and short postoperative hospital stay. It also appears that this type of reconstruction may remain durable following whole-breast radiation, however longer follow-up is needed. EMTREE DRUG INDEX TERMS antibiotic agent narcotic agent plastic steel EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast breast reconstruction mastectomy society surgeon EMTREE MEDICAL INDEX TERMS allograft aspiration breast cancer carcinoma contracture dermis dissection drug therapy experience explant fascia follow up hematoma hospitalization implant infection intraductal carcinoma metastasis muscle night nipple pain pathology patient pectoralis major muscle postoperative complication prophylaxis radiation sentinel lymph node biopsy silicone prosthesis skin smoking surgery thorax tobacco tumor volume LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70291627 DOI 10.1245/s10434-010-1048-6 FULL TEXT LINK http://dx.doi.org/10.1245/s10434-010-1048-6 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 656 TITLE Acellular dermis-assisted breast reconstruction with the use of crescentric tissue expansion: A functional cosmetic analysis of 40 consecutive patients AUTHOR NAMES Buck II D.W. Heyer K. Dibardino D. Bethke K. Kim J.Y.S. AUTHOR ADDRESSES (Buck II D.W.; Heyer K.; Dibardino D.; Bethke K.; Kim J.Y.S., jokim@nmh.org) Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, 675 North St.Clair Street, Galter 19-250, Chicago, IL 60611, United States. CORRESPONDENCE ADDRESS J. Y. S. Kim, Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, 675 North St.Clair Street, Galter 19-250, Chicago, IL 60611, United States. Email: jokim@nmh.org SOURCE Aesthetic Surgery Journal (2010) 30:2 (194-200). Date of Publication: April 2010 ISSN 1090-820X 1527-330X (electronic) BOOK PUBLISHER SAGE Publications Inc., 2455 Teller Road, Thousand Oaks, United States. ABSTRACT Background: Crescentric tissue expanders have the potential to improve postoperative aesthetic results via selective lower pole expansion; however, limited data are available on their efficacy. Objectives: The authors assess postoperative functional and cosmetic outcomes of acellular dermis-assisted breast reconstruction with crescentric tissue expansion. Methods: This study is a single-institution, retrospective review of 40 consecutive patients who underwent acellular dermis-assisted breast reconstruction with crescentric tissue expansion. Demographic data, operative details, and procedural outcomes were recorded and assessed. Cosmetic outcomes were assessed using the Breast Evaluation Questionnaire. Results: Fifty-eight breasts representing 36 bilateral and 22 unilateral reconstructions were analyzed. Of these, 45 (78%) underwent tissue expander (TE) to implant exchange. The mean interval between stage 1 and stage 2 was 92 ± 20 days, with a total follow-up time of 141 ± 16 days. The average intraoperative expander fill volume was 213.5 mL, with an average final fill of 285 mL (range, 180-740 mL). The average number of expansions was 1.6. Overall, there were five complications (8.6%). Eighty-three percent of patients participated in the breast evaluation questionnaire. Answers to each question were reported using a qualitative five-point scale that ranged from 1 (very dissatisfied ) to 5 (very satisfied). For the bilateral reconstructions, the average score in all contexts was 4.5 ± 0.3, 4.33 ± 0.5, and 4.36 ± 0.33 for size, shape, and firmness, respectively. For unilateral reconstructions, the average scores were 4.0 ± 0.58, 3.93 ± 0.38, and 4.13 ± 0.21, respectively. Conclusions: Crescentric expander-based reconstruction with acellular dermis assistance is well tolerated, especially in smaller breasted women. Functional and cosmetic outcomes were acceptable and comparable to previous reports of traditional expander-based reconstructions. © 2010 The American Society for Aesthetic Plastic Surgery, Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction esthetic surgery tissue expansion EMTREE MEDICAL INDEX TERMS adult aged article clinical article demography dermis female follow up graft necrosis (complication) hematoma (complication) human human tissue intraoperative period medical record review outcome assessment patient assessment patient satisfaction postoperative infection (complication) priority journal questionnaire seroma (complication) EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010393693 MEDLINE PMID 20442096 (http://www.ncbi.nlm.nih.gov/pubmed/20442096) PUI L359196318 DOI 10.1177/1090820X10366547 FULL TEXT LINK http://dx.doi.org/10.1177/1090820X10366547 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 657 TITLE The effect of incision choice on outcomes of nipple-sparing mastectomy reconstruction AUTHOR NAMES Kim J.Y. Rawlani V. Khan S. Hansen N. Fiuk J. Johnson S.A. Hirsch E. Fine N.A. AUTHOR ADDRESSES (Kim J.Y.; Rawlani V.; Khan S.; Hansen N.; Fiuk J.; Johnson S.A.; Hirsch E.; Fine N.A.) Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, United States. CORRESPONDENCE ADDRESS J.Y. Kim, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, United States. SOURCE Annals of Surgical Oncology (2010) 17 SUPPL. 1 (S51-S52). Date of Publication: February 2010 CONFERENCE NAME 63rd Annual Cancer Symposium of the Society of Surgical Oncology CONFERENCE LOCATION St. Louis, MO, United States CONFERENCE DATE 2010-03-03 to 2010-03-07 ISSN 1068-9265 BOOK PUBLISHER Springer New York ABSTRACT INTRODUCTION: The indications for nipple-sparing mastectomy (NSM) are broadening as more breast surgeons accept the utility of preserving the nipple- areolar comple× (NAC) in select cases of prophylactic and therapeutic mastectomies. A number of incision types are available to the mastectomy surgeon including the inframammary, lateral, and periareolar approaches. We endeavored to analyze the reconstructive outcomes associated with differing incisions. METHODS: Utilizing a single surgical technique, all NSM followed by tissue e×pander implant reconstruction using acellular dermis performed between 2007 and 2008 were retrospectively reviewed. RESULTS: Thirty-seven breast procedures performed on 20 patients were analyzed. Periareolar incision caused significantly more nipple necroses than the lateral or inframammary incisions (38.1% vs. 6.3%, p=0.028). Breasts receiving radiation demonstrated a trend toward increased nipple necrosis (45.5% vs. 15.4%, p=0.066) and soft-tissue infection (36.4% vs. 7.7%, p=0.051). Breasts receiving chemotherapy demonstrated a modest trend towards more soft-tissue infections (23.1% vs. 12.5%, p=0.156). There was a trend towards increased breast size (weight of breast tissue e×cised) in cases demonstrating nipple necrosis (540.4 grams vs. 425.7, p=0.130). There was no difference in initial intraoperative fill volume (p=0.812), percent intraoperative fill volume (initial fill volume/final fill volume, p=0.694), or final fill volume (p=0.797) in breasts demonstrating nipple necrosis. CONCLUSION: The periareolar incision results in a higher rate of nipple necrosis following tissue e×pander-based reconstruction. There is a trend towards greater complications associated with radiation treatment. With the lateral and inframammary incision, NSM with a tissue e×pander-acellular dermis reconstruction results in acceptable cosmetic and reconstructive outcomes. (table Presented). EMTREE DRUG INDEX TERMS cosmetic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) incision mastectomy neoplasm nipple oncology society EMTREE MEDICAL INDEX TERMS acellular dermal matrix breast chemotherapy implant necrosis patient radiation radiotherapy soft tissue infection surgeon surgical technique tissues weight LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70457520 DOI 10.1245/s10434-009-0903-9 FULL TEXT LINK http://dx.doi.org/10.1245/s10434-009-0903-9 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 658 TITLE Implant-based breast reconstruction using acellular dermal matrix and the risk of postoperative complications. AUTHOR NAMES Chun Y.S. Verma K. Rosen H. Lipsitz S. Morris D. Kenney P. Eriksson E. AUTHOR ADDRESSES (Chun Y.S.; Verma K.; Rosen H.; Lipsitz S.; Morris D.; Kenney P.; Eriksson E.) Division of Plastic Surgery, Department of Surgery, Harvard Medical School, Brigham and Women's Hospital/Faulkner Hospital, Boston, Mass, USA. CORRESPONDENCE ADDRESS Y.S. Chun, Division of Plastic Surgery, Department of Surgery, Harvard Medical School, Brigham and Women's Hospital/Faulkner Hospital, Boston, Mass, USA. Email: ychun@partners.org SOURCE Plastic and reconstructive surgery (2010) 125:2 (429-436). Date of Publication: Feb 2010 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Acellular dermal matrix has been popularized as an adjunct to tissue expander or implant breast reconstruction given its utility in providing additional coverage and support for the inferior pole. This study was performed to assess the risk of postoperative complications associated with the use of acellular dermal matrix-assisted implant-based reconstruction. METHODS: The authors performed a retrospective analysis of consecutive immediate breast reconstructions performed over a 6-year period. A total of 415 implant-based reconstructions were divided into two groups: tissue expander or implant-based reconstruction with or without acellular dermal matrix. Demographic information, comorbidities, oncologic data, adjuvant therapy, and complications were collected for comparison. RESULTS: A total of 283 patients underwent 415 immediate breast reconstructions (151 unilateral and 132 bilateral); 269 reconstructions were performed using tissue expander or implants with acellular dermal matrix, and 146 reconstructions were performed without acellular dermal matrix. The seroma and infection rates were higher in the acellular dermal matrix group (14.1 versus 2.7 percent, p = 0.0003, for seroma; 8.9 versus 2.1 percent, p = 0.0328, for infection). Multiple logistic regression analysis showed that acellular dermal matrix and body mass index were statistically significant risk factors for developing seroma and infection. The use of acellular dermal matrix increased the odds of seroma by 4.24 times (p = 0.018) and infection by 5.37 times (p = 0.006). CONCLUSIONS: Acellular dermal matrix has enhanced implant-based reconstruction and remains useful in immediate prosthetic breast reconstruction. It is associated, however, with higher rates of postoperative seroma and infection. Careful patient selection, choice of tissue expander/implant volume, and postoperative management are warranted to optimize overall reconstructive outcome. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) biomaterial (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction breast tumor (surgery) postoperative complication (epidemiology, prevention) EMTREE MEDICAL INDEX TERMS adult article breast endoprosthesis comorbidity female human implant mastectomy methodology middle aged plastic surgery retrospective study risk factor statistical model statistics surgical infection (epidemiology, prevention) LANGUAGE OF ARTICLE English MEDLINE PMID 20124828 (http://www.ncbi.nlm.nih.gov/pubmed/20124828) PUI L358360999 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 659 TITLE A novel cost-saving approach to the use of acellular dermal matrix (AlloDerm) in postmastectomy breast and nipple reconstructions. AUTHOR NAMES Chen W.F. Barounis D. Kalimuthu R. AUTHOR ADDRESSES (Chen W.F.; Barounis D.; Kalimuthu R.) Division of Plastic and Reconstructive Surgery, Department of Surgery, and the School of Medicine, University of Illinois at Chicago, Chicago, Ill, USA. CORRESPONDENCE ADDRESS W.F. Chen, Division of Plastic and Reconstructive Surgery, Department of Surgery, and the School of Medicine, University of Illinois at Chicago, Chicago, Ill, USA. Email: weifchen@hotmail.com SOURCE Plastic and reconstructive surgery (2010) 125:2 (479-481). Date of Publication: Feb 2010 ISSN 1529-4242 (electronic) EMTREE DRUG INDEX TERMS (MAJOR FOCUS) biomaterial (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction nipple (surgery) EMTREE MEDICAL INDEX TERMS adult aged article breast (surgery) breast endoprosthesis cost control economics female health insurance human implant mastectomy methodology middle aged patient satisfaction retrospective study LANGUAGE OF ARTICLE English MEDLINE PMID 20124833 (http://www.ncbi.nlm.nih.gov/pubmed/20124833) PUI L358361004 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 660 TITLE Reversed acellular dermis: failure of graft incorporation in primary tissue expander breast reconstruction resulting in recurrent breast cellulitis. AUTHOR NAMES Heyer K. Buck 2nd. D.W. Kato C. Khan S.A. Alam M. Kim J.Y. AUTHOR ADDRESSES (Heyer K.; Buck 2nd. D.W.; Kato C.; Khan S.A.; Alam M.; Kim J.Y.) Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill 60611, USA. CORRESPONDENCE ADDRESS K. Heyer, Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Ill 60611, USA. SOURCE Plastic and reconstructive surgery (2010) 125:2 (66e-68e). Date of Publication: Feb 2010 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction breast tumor (surgery) cellulitis (etiology) graft rejection implant skin transplantation EMTREE MEDICAL INDEX TERMS article artificial skin breast disease (etiology) breast endoprosthesis case report female human mastectomy methodology middle aged postoperative complication (etiology) recurrent disease LANGUAGE OF ARTICLE English MEDLINE PMID 20124811 (http://www.ncbi.nlm.nih.gov/pubmed/20124811) PUI L358360982 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 661 TITLE Breast reconstruction with implants, Tissue expanders and alloderm: Predicting volume and maximizing the skin envelope in skin sparing mastectomies AUTHOR NAMES Haddock N. Levine J. AUTHOR ADDRESSES (Haddock N.; Levine J., levinj04@med.nyu.edu) Institute of Reconstructive Plastic Surgery, 550 First Ave, TH169, New York, NY 10016, United States. CORRESPONDENCE ADDRESS J. Levine, Division of Plastic Surgery, NYU Medical Center, 550 First Ave TH 169, New York, NY 10016, United States. Email: levinj04@med.nyu.edu SOURCE Breast Journal (2010) 16:1 (14-19). Date of Publication: January-February 2010 ISSN 1075-122X 1524-4741 (electronic) BOOK PUBLISHER Blackwell Publishing Inc., 350 Main Street, Malden, United States. ABSTRACT AlloDerm has been used as a tissue supplement in conjunction with the pectoralis major muscle to provide full coverage over an implant in breast reconstruction. While this method of reconstruction has shown promising results there is little known on the relationship of AlloDerm size and potential immediate expansion volume. A retrospective chart review was completed evaluating all tissue expander or primary implant reconstructions using AlloDerm. Data recorded included: The type/size of implant/expander, dimensions of the AlloDerm used, initial fill volume, number of expansions and time period of expansion. Statistical analysis was completed with a linear regression model. AlloDerm was used on 49 patients (72 reconstructions). Thirty-four patients (50 reconstructions) underwent reconstruction with a tissue expander and 15 patients (22 reconstructions) underwent a single stage reconstruction with a permanent implant. The tissue expander volume filled (cc) could be predicted by 5 x surface area of AlloDerm (cm(2)) - 12 (R(2) = 0.62) and 80 x height of AlloDerm (cm) - 15 (R(2) = 0.59). The tissue expanders could be filled to an average of 75% of total size and required three to four injections in the postoperative period to reach full expansion. Obviously, a requirement for maximal implant expansion is an appropriate skin sparing mastectomy. There is a mathematical relationship between fill volume and surface area as well as height of AlloDerm used in breast reconstruction. This analysis provides a guideline for immediate implant expansion to surgeons using AlloDerm in reconstructive breast surgery. © 2009 Wiley Periodicals, Inc., 1075-122X/09. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast endoprosthesis breast reconstruction EMTREE MEDICAL INDEX TERMS adult article clinical article controlled study human implant implantation male mastectomy medical record review postoperative period skin sparing mastectomy surface property DEVICE TRADE NAMES AlloDerm EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2010127795 MEDLINE PMID 19929887 (http://www.ncbi.nlm.nih.gov/pubmed/19929887) PUI L358341886 DOI 10.1111/j.1524-4741.2009.00866.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1524-4741.2009.00866.x COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 662 TITLE Evaluation of acellular dermal matrix in breast reconstruction AUTHOR NAMES Tieman J.T. Agarwal J.P. Anderson L.A. AUTHOR ADDRESSES (Tieman J.T.) University of Arizona, College of Medicine, Tucson, United States. (Agarwal J.P.; Anderson L.A.) University of Utah, Salt Lake City, United States. CORRESPONDENCE ADDRESS J.T. Tieman, University of Arizona, College of Medicine, Tucson, United States. SOURCE Journal of Investigative Medicine (2010) 58:1 (236). Date of Publication: January 2010 CONFERENCE NAME American Federation for Medical Research Western Regional Meeting, AFMR 2010 CONFERENCE LOCATION Carmel, CA, United States CONFERENCE DATE 2010-01-27 to 2010-01-30 ISSN 1081-5589 BOOK PUBLISHER Lippincott Williams and Wilkins ABSTRACT Purpose of Study: Breast cancer patients have multiple options following mastectomy; with implant based reconstruction being one of the more common. Two different acellular dermal matrices are available, and are used to create a pocket for placement of the implant. While their use has been shown to be safe in breast reconstruction, no studies have compared them to each other with regards to complication rates, or effects of radiation on incorporation rates. Methods Used: Female patients ages 18-80, opting for breast reconstruction at the Huntsman Cancer Center in Utah, are study eligible. Patient data is collected and recorded in stages. Stage 1 is from time of expander placement to final reconstruction. Stage 2 is from final reconstruction to two months post-op, while stage 3 follows patients for two years. The first surgery is expander and dermal matrix placement. Patients follow a standard routine of care, with complications and progress recorded at routine visits. To allow for integration and revascularization of the matrix, the removal of expanders and final reconstruction does not occur before 3 months after initial surgery. Outcome data is patient satisfaction, histological data from punch biopsies taken at surgeries, as well as clinical evaluation of matrix to characterize its incorporation. The clinical findings are correlated with the pathologic features and evaluated and will be compared statistically. Summary of Results: At this point in the study, we are able to report on the stage 1 data and some stage 2 data. The data thus far does not indicate that there are any differences in the rate of complications between the two matrices, which would support our hypothesis. Additionally, there is no difference in the rates of incorporation between those patients receiving radiation and those who do not; however, there is a tighter capsule in those patients who received radiation. This may prove to translate into a higher rate of capsular contracture. There is also some preliminary data to indicate increased complication rates in patients with a history of smoking. Conclusions: This study will offer an extremely important insight into the proper timing of clinical treatment, and whether or not matrices should be used on patients undergoing radiation. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction medical research EMTREE MEDICAL INDEX TERMS breast cancer cancer center cancer patient clinical evaluation contracture female human hypothesis implant mastectomy patient patient coding patient satisfaction punch biopsy radiation revascularization smoking surgery United States LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70981878 DOI 10.231/JIM.0b013e3181c87db3 FULL TEXT LINK http://dx.doi.org/10.231/JIM.0b013e3181c87db3 COPYRIGHT Copyright 2013 Elsevier B.V., All rights reserved. RECORD 663 TITLE AlloDerm performance in the setting of prosthetic breast surgery, infection, and irradiation. AUTHOR NAMES Nahabedian M.Y. AUTHOR ADDRESSES (Nahabedian M.Y.) Department of Plastic Surgery, Georgetown University Hospital, Washington, DC 20007, USA. CORRESPONDENCE ADDRESS M.Y. Nahabedian, Department of Plastic Surgery, Georgetown University Hospital, Washington, DC 20007, USA. Email: drnahabedian@aol.com SOURCE Plastic and reconstructive surgery (2009) 124:6 (1743-1753). Date of Publication: Dec 2009 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: The performance of AlloDerm (LifeCell Corp., Branchburg, N.J.) in the setting of prosthetic breast reconstruction, infection, and radiation therapy has not been well documented. The purpose of this study was to review the author's experience with AlloDerm-assisted prosthetic breast surgery and determine the tolerance in the setting of infection and irradiation. METHODS: A total of 361 women and 476 breasts underwent reconstruction or revision with prosthetic devices. Of these, 76 women and 100 breasts underwent reconstruction using AlloDerm assistance. RESULTS: The incidence of postoperative infection was 5.85 percent (22 of 376) when prosthetic devices were used without AlloDerm and 5 percent (five of 100) when prosthetic devices were used with AlloDerm. Radiation therapy was a factor in 23 of 100 breasts reconstructed with AlloDerm. Adherence of AlloDerm was noted in 100 percent (23 of 23) and infection was noted in 8.7 percent (two of 23). The timing of irradiation (before or after AlloDerm insertion) did not affect the adherence or the infection rate. The overall incidence of seroma was 5 percent, the incidence of skin necrosis was 3 percent, and the incidence of incisional dehiscence was 4 percent. CONCLUSIONS: This study demonstrates that prosthetic breast surgery using AlloDerm is safe and well-tolerated. AlloDerm viability has been demonstrated in the setting of infection and radiation therapy. The risk of prosthetic breast infection in the setting with AlloDerm is no different from in the setting without AlloDerm. Local complications such as dehiscence, skin necrosis, and seroma formation can occur in accordance with radiotherapy. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen (drug therapy) EMTREE DRUG INDEX TERMS surgical mesh EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast breast augmentation (adverse drug reaction) breast endoprosthesis (adverse drug reaction) breast tumor (radiotherapy, surgery) surgical infection (diagnosis, epidemiology) EMTREE MEDICAL INDEX TERMS adolescent adult aged article cohort analysis comparative study esthetics female follow up graft rejection graft survival human implant (adverse drug reaction) incidence mastectomy methodology middle aged pathology physiology radiation exposure reoperation retrospective study risk assessment treatment outcome wound healing CAS REGISTRY NUMBERS collagen (9007-34-5) LANGUAGE OF ARTICLE English MEDLINE PMID 19952629 (http://www.ncbi.nlm.nih.gov/pubmed/19952629) PUI L355862734 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 664 TITLE Acellular dermis-assisted prosthetic breast reconstruction versus complete submuscular coverage: a head-to-head comparison of outcomes. AUTHOR NAMES Sbitany H. Sandeen S.N. Amalfi A.N. Davenport M.S. Langstein H.N. AUTHOR ADDRESSES (Sbitany H.; Sandeen S.N.; Amalfi A.N.; Davenport M.S.; Langstein H.N.) Division of Plastic and Reconstructive Surgery, University of Rochester, NY, USA. CORRESPONDENCE ADDRESS H. Sbitany, Division of Plastic and Reconstructive Surgery, University of Rochester, NY, USA. SOURCE Plastic and reconstructive surgery (2009) 124:6 (1735-1740). Date of Publication: Dec 2009 ISSN 1529-4242 (electronic) ABSTRACT BACKGROUND: Complete submuscular tissue expander coverage affords the best protection against implant exposure but restricts lower pole expansion. Techniques using acellular dermis as a pectoralis muscle extension can allow for more rapid fill of the expander and better control of the inframammary fold. This study compares both techniques with regard to relevant outcomes. METHODS: Results of 100 consecutive breast expander reconstructions performed by two surgeons between 2004 and 2007 were retrospectively reviewed. Patient demographics, expander coverage type, adjuvant treatment, length and characteristics of the expansion, and incidence and types of complications were analyzed. RESULTS: One hundred women underwent breast reconstruction with 172 expanders, in 50 using complete submuscular placement and in 50 using partial subpectoral placement with acellular dermis. The patient groups were similar in terms of demographic data. Mean number of fills to complete reconstruction was 4.31 in the submuscular group and 1.72 in the acellular dermis group (p = 0.0001). Mean intraoperative fill volume was 130 cc in the submuscular group, compared with 412 cc per expander in the acellular dermis group (p = 0.0001). Fisher's exact test demonstrated no significant difference in total complication rate between the two groups (14 percent versus 18 percent; p = 0.79). CONCLUSIONS: Acellular dermis allowed for a greater initial fill of saline. This potentially improves cosmetic outcome, as it better capitalizes on preserved mastectomy skin for reconstruction. The authors conclude that acellular dermis-assisted implant breast reconstruction has a safety profile no worse than that of complete submuscular coverage but offers the benefit of fewer expansions and the potential for more predictable secondary revisions. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) artificial skin breast reconstruction plastic surgery EMTREE MEDICAL INDEX TERMS adult aged article breast endoprosthesis breast tumor (surgery) cohort analysis comparative study esthetics female graft rejection graft survival human mastectomy methodology middle aged pathology pectoralis major muscle physiology probability retrospective study risk assessment skin transplantation transplantation treatment outcome wound healing LANGUAGE OF ARTICLE English MEDLINE PMID 19952627 (http://www.ncbi.nlm.nih.gov/pubmed/19952627) PUI L355862732 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 665 TITLE Discussion. Acellular dermis-assisted prosthetic breast reconstruction versus complete submuscular coverage: a head-to-head comparison of outcomes. AUTHOR NAMES Spear S.L. AUTHOR ADDRESSES (Spear S.L.) Department of Plastic Surgery, Georgetown University Hospital, Washington, DC 20007, USA. CORRESPONDENCE ADDRESS S.L. Spear, Department of Plastic Surgery, Georgetown University Hospital, Washington, DC 20007, USA. Email: spears@gunet.georgetown.edu SOURCE Plastic and reconstructive surgery (2009) 124:6 (1741-1742). Date of Publication: Dec 2009 ISSN 1529-4242 (electronic) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) artificial skin breast reconstruction plastic surgery EMTREE MEDICAL INDEX TERMS breast endoprosthesis comparative study esthetics female graft rejection graft survival human methodology note pectoralis major muscle physiology prognosis skin transplantation transplantation wound healing LANGUAGE OF ARTICLE English MEDLINE PMID 19952628 (http://www.ncbi.nlm.nih.gov/pubmed/19952628) PUI L355862733 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 666 TITLE Use of the Acellular Dermal Matrix in Revisionary Aesthetic Breast Surgery AUTHOR NAMES Maxwell G.P. Gabriel A. AUTHOR ADDRESSES (Maxwell G.P.; Gabriel A., gabrielallen@yahoo.com) SOURCE Aesthetic Surgery Journal (2009) 29:6 (485-493). Date of Publication: November-December 2009 ISSN 1090-820X 1527-330X (electronic) BOOK PUBLISHER SAGE Publications Inc., 2455 Teller Road, Thousand Oaks, United States. ABSTRACT Background: Revisionary augmentation and revision of augmentation mastopexy are of considerable interest to plastic surgeons who perform breast surgery because of the procedures' complexity. In these cases, surgeons are faced with either thinned breast tissues resulting from large breast implants with tissue stretch or encapsulation caused by excessive scarring. To our knowledge, there are currently no large-series studies describing the use of acellular dermal matrices (ADM) in cosmetic breast surgery. Objective: The authors describe the use of the ADM in revisionary breast surgery to establish the aesthetic breast form. Methods: A retrospective chart review was conducted of 78 consecutive patients who underwent revisionary breast augmentation and augmentation mastopexies with ADM during a period of just over two years (October 2005 to January 2008). Data collected included patient characteristics, complications, outcomes, and reoperation rates. Results: Seventy-eight procedures were performed with ADM during the two-year period, with a minimum of 12 months of follow-up. There were two complications requiring reoperations for a hematoma and implant malposition, respectively. There were no Baker III or IV capsular contractures at one year postprocedure. Conclusions: Revisionary augmentation and revision of augmentation mastopexy are commonly performed procedures and they have a significantly higher complication rate than primary procedures. This series shows that the ADM can be used both safely and effectively in revisionary cases, resulting in decreased rates of capsular contracture and implant cushioning/stabilization. © 2009 The American Society for Aesthetic Plastic Surgery, Inc. EMTREE DRUG INDEX TERMS antibiotic agent (drug therapy) cephalosporin (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast augmentation breast endoprosthesis esthetic surgery EMTREE MEDICAL INDEX TERMS article endoprosthesis loosening (complication) female follow up hematoma (complication) human major clinical study medical record review outcome assessment postoperative period priority journal reoperation seroma (complication) surgical infection (drug therapy, prevention) surgical patient DEVICE TRADE NAMES Alloderm Lifecell DermaMatrix Synthes FlexHD Ethicon Neoform Mentor Strattice Lifecell SurgiMend TEI DEVICE MANUFACTURERS Ethicon Lifecell Mentor Synthes TEI CAS REGISTRY NUMBERS cephalosporin (11111-12-9) EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009629862 MEDLINE PMID 19944993 (http://www.ncbi.nlm.nih.gov/pubmed/19944993) PUI L355760977 DOI 10.1016/j.asj.2009.09.007 FULL TEXT LINK http://dx.doi.org/10.1016/j.asj.2009.09.007 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 667 TITLE Abdominal fascial flaps for providing total implant coverage in one-stage breast reconstruction: An autologous solution AUTHOR NAMES Isken T. Onyedi M. Izmirli H. Alagoz S. AUTHOR ADDRESSES (Isken T., tongucisken@yahoo.com; Onyedi M.; Izmirli H.; Alagoz S.) Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey. CORRESPONDENCE ADDRESS T. Isken, Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey. Email: tongucisken@yahoo.com SOURCE Aesthetic Plastic Surgery (2009) 33:6 (853-858). Date of Publication: November 2009 ISSN 0364-216X BOOK PUBLISHER Springer New York, 233 Springer Street, New York, United States. ABSTRACT Background: Silicone implants are often used in immediate breast reconstruction. Complications associated with silicone-based implant reconstruction, such as capsular contracture, implant palpability, and visibility, are best avoided by placing the implant under a reliable soft-tissue cover such as the pectoralis major muscle. This muscle, however, is not always sufficient for complete coverage of the silicone implant. This is especially true for large implants. By including the fascia of the upper abdominal muscles in the reconstruction, this problem can be overcome. We describe our experience with one-stage breast reconstruction utilizing the fascia of the upper abdominal muscles to provide adequate soft-tissue coverage of the implant. Methods: This technique was used in the reconstructions of ten patients over 4 years (2005-2009). This method was selected by the operating surgeon at the time of surgery if the pectoralis major muscle was felt to be of inadequate size to provide adequate implant coverage. The pectoralis major muscle was released from its sternal and caudal attachments to the chest wall. The rectus abdominis fascia and external oblique fascia were elevated as a combined cephalic-based flap. This fascial flap was advanced cranially and sutured to the released pectoralis major muscle after insertion of the implant. Results: The mean size of the silicone implant was 448.2 cc and mean follow-up was 19.7 months. All implants were adequately covered with soft tissue at the end of each case. Complications included one patient with a hematoma, one patient with skin necrosis at the suture line, and one patient with an implant infection necessitating removal. Conclusion: There are many ways to provide soft-tissue coverage of silicone breast implants in breast reconstruction. These include acellular dermis slings, polyglycolic mesh, deepithelialized skin, and muscle. The ideal soft-tissue cover would be supple, easily harvested, of minimal morbidity, of minimal cost, and preferably autologous. We feel that the technique described here has these qualities and allows for complete coverage of silicone implants. An additional benefit of this technique is that it helps to increase the definition of the inframammary sulcus. This method is a good alternative in providing implant coverage during breast reconstruction, especially when there is a large implant or small pectoralis major muscle. © 2009 Springer Science+Business Media, LLC and International Society of Aesthetic Plastic Surgery. EMTREE DRUG INDEX TERMS silicone EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction fascial flap implant pedicled skin flap EMTREE MEDICAL INDEX TERMS abdominal wall musculature adult aged article clinical article female follow up hematoma (complication) human infection (complication) pectoralis major muscle priority journal rectus abdominis muscle silicone prosthesis skin necrosis (complication) soft tissue surgical technique suture CAS REGISTRY NUMBERS silicone (63148-53-8, 8043-93-4, 8055-24-1) EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009626416 MEDLINE PMID 19597865 (http://www.ncbi.nlm.nih.gov/pubmed/19597865) PUI L50579199 DOI 10.1007/s00266-009-9384-2 FULL TEXT LINK http://dx.doi.org/10.1007/s00266-009-9384-2 COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 668 TITLE Reply AUTHOR NAMES Komorowska-Timek E.D. AUTHOR ADDRESSES (Komorowska-Timek E.D., etimek@sbcglobal.net) Division of Plastic and Reconstructive Surgery, 770 Welch Road, Palo Alto, CA, United States. CORRESPONDENCE ADDRESS E. D. Komorowska-Timek, Division of Plastic and Reconstructive Surgery, 770 Welch Road, Palo Alto, CA, United States. Email: etimek@sbcglobal.net SOURCE Plastic and Reconstructive Surgery (2009) 124:4 (1369-1370). Date of Publication: October 2009 ISSN 0032-1052 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast reconstruction tissue flap EMTREE MEDICAL INDEX TERMS breast fibrosis (prevention) contracture (prevention) letter myofibroblast nonhuman priority journal EMBASE CLASSIFICATIONS Surgery (9) Immunology, Serology and Transplantation (26) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2009533208 PUI L355399797 DOI 10.1097/PRS.0b013e3181b4628a FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0b013e3181b4628a COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 669 TITLE Expander/implant reconstruction with AlloDerm: Recent experience AUTHOR NAMES Namnoum J.D. AUTHOR ADDRESSES (Namnoum J.D., jdnamnoum@atlplastic.com) Atlanta Plastic Surgery, 975 Johnson Ferry Road, Atlanta, GA 30342, United States. CORRESPONDENCE ADDRESS J. D. Namnoum, Atlanta Plastic Surgery, 975 Johnson Ferry Road, Atlanta, GA 30342, United States. Email: jdnamnoum@atlplastic.com SOURCE Plastic and Reconstructive Surgery (2009) 124:2 (387-394). Date of Publication: August 2009 ISSN 0032-1052 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. ABSTRACT BACKGROUND: Expander/implant reconstruction with acellular dermal matrix (AlloDerm) has become an increasingly popular technique. Potential advantages include lengthening of the pectoralis major muscle, preventing "window-shading" after muscle release; precise control of the inframammary fold and lateral breast border; and complete coverage of the device without resorting to additional muscle or fascial elevation. METHODS: Patients undergoing immediate breast reconstruction with tissue expanders underwent acellular dermal matrix augmentation of the pectoralis major muscle. After inferior pectoralis muscle release and creation of a subpectoral pocket, the acellular dermal matrix was draped out to length and sutured to the inframammary fold. An integral port, low-height tissue expander was placed into the pocket and the acellular dermal matrix was sewn to the cut edge of the muscle inferiorly. Subsequent placement of either a smooth-walled silicone gel implant or anatomically shaped cohesive gel device was performed secondarily. RESULTS: Twenty consecutive patients (29 breasts) undergoing immediate breast reconstruction with tissue expanders had acellular dermal matrix augmentation of the pectoralis major muscle. Follow-up averaged 21 months (range, 3 to 32 months). Infection occurred in one of 29 breasts (3.4 percent). One patient had a small area of suture line necrosis requiring revision. CONCLUSIONS: Acellular dermal matrix augmentation of the pectoralis major muscle in the setting of prosthetic breast reconstruction improves the soft-tissue drapery around devices without resorting to additional muscle or fascial flaps. Total device coverage and precise control of the pocket dimensions permit more predictably superior results in these patients. ©2009American Society of Plastic Surgeons. EMTREE DRUG INDEX TERMS silicone gel EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast endoprosthesis breast reconstruction EMTREE MEDICAL INDEX TERMS anatomy article clinical article devices female follow up human infection (complication, etiology) inflammation necrosis (complication, etiology) pectoralis major muscle plastic surgery priority journal seroma (complication, etiology) soft tissue surgical patient surgical technique treatment outcome DEVICE TRADE NAMES AlloDerm , United StatesLifecell DEVICE MANUFACTURERS (United States)Lifecell EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009451628 MEDLINE PMID 19644253 (http://www.ncbi.nlm.nih.gov/pubmed/19644253) PUI L355150418 DOI 10.1097/PRS.0b013e3181aee95b FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0b013e3181aee95b COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 670 TITLE Use of 2-octyl-cyanoacrylate skin adhesive (dermabond) for wound closure following reduction mammaplasty: A prospective, randomized intervention study. "Tips and tricks" to improve statistical analysis and significance of results AUTHOR NAMES Mangano A. Albertin A. LaColla L. AUTHOR ADDRESSES (Mangano A., alberto.surgery@libero.it) Vita-Salute San Raffaele University School of Medicine, IRCCS H San Raffaele, Via Mulini 12, Gravedona, Como, Italy. (Albertin A.) Department of Anesthesiology, IRCCS Multimedica, Sesto San Giovanni, Italy. (LaColla L.) Department of Anesthesiology, Vita-Salute San Raffaele University School of Medicine, IRCCS San Raffaele, Milan, Italy. CORRESPONDENCE ADDRESS A. Mangano, Vita-Salute San Raffaele University School of Medicine, IRCCS H San Raffaele, Via Mulini 12, Gravedona, Como, Italy. Email: alberto.surgery@libero.it SOURCE Plastic and Reconstructive Surgery (2009) 124:2 (669). Date of Publication: August 2009 ISSN 0032-1052 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) 2 octyl cyanoacrylate skin adhesive adhesive agent EMTREE DRUG INDEX TERMS unclassified drug EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reduction wound closure EMTREE MEDICAL INDEX TERMS clinical evaluation human letter post hoc analysis postoperative period power analysis priority journal prospective study sample size scoring system statistical significance DEVICE TRADE NAMES Dermabond EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2009451677 MEDLINE PMID 19644305 (http://www.ncbi.nlm.nih.gov/pubmed/19644305) PUI L355150467 DOI 10.1097/PRS.0b013e3181adde55 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0b013e3181adde55 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 671 TITLE The use of acellular dermal matrix to prevent capsule formation around implants in a primate model AUTHOR NAMES Stump A. Holton L.H. Connor J. Harper J.R. Slezak S. Silverman R.P. AUTHOR ADDRESSES (Stump A., amyshinminato@yahoo.com) Department of Surgery, University of Maryland Medical Center, 22 S. Greene Street, Baltimore, MD 21201, United States. (Holton L.H.; Connor J.; Harper J.R.; Slezak S.; Silverman R.P.) CORRESPONDENCE ADDRESS A. Stump, Department of Surgery, University of Maryland Medical Center, 22 S. Greene Street, Baltimore, MD 21201, United States. Email: amyshinminato@yahoo.com SOURCE Plastic and Reconstructive Surgery (2009) 124:1 (82-91). Date of Publication: July 2009 ISSN 0032-1052 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. ABSTRACT BACKGROUND: Implant-based breast reconstruction is a popular option after mastectomy, but capsular contracture may detract from long-term outcomes. The authors have observed that breast implants covered with acellular dermal matrix (AlloDerm) are less likely to develop a capsule in the area where the implant is in direct contact with the acellular matrix. The authors tested this observation experimentally by comparing capsular formation around implants in the presence and absence of AlloDerm in primates. METHODS: Eight smooth-surfaced tissue expanders were implanted into eight African green monkeys. In four experimental animals, a sheet of AlloDerm was draped over the tissue expander so as to cover the implant. Four control animals underwent placement of a tissue expander only. Animals were killed after 10 weeks and specimens underwent histologic and immunohistochemical analysis. RESULTS: Hematoxylin and eosin staining of control specimens revealed the presence of a distinct layer of wavy, parallel arrays of collagen fibers consistent with capsule formation. Immunostaining identified abundant myofibroblasts, a profibrotic cell found in breast capsules. In the AlloDerm-covered specimens, no capsule layer was visible, and specimens stained weakly for myofibroblasts. The difference in myofibroblast staining intensity was statistically significant. CONCLUSIONS: The use of AlloDerm to partially enclose implants effectively prevented formation of a capsule in areas where AlloDerm contacted the implant at 10 weeks. Long-term studies will be required to determine whether this is a durable result that can be reproduced in humans. © 2009 American Society of Plastic Surgeons. EMTREE DRUG INDEX TERMS alpha smooth muscle actin (endogenous compound) collagen fiber (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix artificial skin breast capsule contracture (prevention) breast endoprosthesis prosthesis complication (prevention) EMTREE MEDICAL INDEX TERMS animal experiment animal tissue article breast biopsy collagen synthesis controlled study experimental monkey histology immunohistochemistry myofibroblast nonhuman priority journal wound healing DEVICE TRADE NAMES AlloDerm , United StatesLifecell DEVICE MANUFACTURERS (United States)Lifecell EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009411165 MEDLINE PMID 19568048 (http://www.ncbi.nlm.nih.gov/pubmed/19568048) PUI L355051906 DOI 10.1097/PRS.0b013e3181ab112d FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0b013e3181ab112d COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 672 TITLE Toxic shock syndrome after prosthetic breast reconstruction with AlloDerm AUTHOR NAMES Vendemia N. Rohde C. AUTHOR ADDRESSES (Vendemia N.; Rohde C., chj_hsu@yahoo.com) Division of Plastic and Reconstructive Surgery, New York-Presbyterian Medical Center, New York, NY, United States. (Rohde C., chj_hsu@yahoo.com) 161 Fort Washington Avenue, New York, NY 10032, United States. CORRESPONDENCE ADDRESS C. Rohde, 161 Fort Washington Avenue, New York, NY 10032, United States. Email: chj_hsu@yahoo.com SOURCE Plastic and Reconstructive Surgery (2009) 124:1 (173e-174e). Date of Publication: July 2009 ISSN 0032-1052 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. EMTREE DRUG INDEX TERMS bicarbonate (endogenous compound) creatinine (endogenous compound) glucose (endogenous compound) liver enzyme (endogenous compound) potassium (endogenous compound) sodium (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast prosthesis breast reconstruction prosthesis material toxic shock syndrome (complication, diagnosis, etiology) EMTREE MEDICAL INDEX TERMS abdominal pain acute kidney failure adult bicarbonate blood level brain edema breast cancer (surgery) case report computer assisted tomography confusion creatinine blood level fever glucose blood level hospital discharge human hyperglycemia hyperkalemia hyponatremia hypotension implantation lethargy letter leukocyte count male mastectomy metabolic acidosis nausea physical examination platelet count potassium blood level priority journal sodium blood level soft tissue inflammation Staphylococcus aureus tachycardia thrombocytopenia DEVICE TRADE NAMES Alloderm , United StatesLifecell DEVICE MANUFACTURERS (United States)Lifecell CAS REGISTRY NUMBERS bicarbonate (144-55-8, 71-52-3) creatinine (19230-81-0, 60-27-5) glucose (50-99-7, 84778-64-3) potassium (7440-09-7) sodium (7440-23-5) EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2009411183 MEDLINE PMID 19568065 (http://www.ncbi.nlm.nih.gov/pubmed/19568065) PUI L355051924 DOI 10.1097/PRS.0b013e3181a83a19 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0b013e3181a83a19 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 673 TITLE Diagnostic dilemma: Acellular dermis mimicking a breast mass after immediate tissue expander breast reconstruction AUTHOR NAMES Buck II D.W. Heyer K. Wayne J.D. Yeldandi A. Kim J.Y.S. AUTHOR ADDRESSES (Buck II D.W.; Heyer K.; Kim J.Y.S., jokim@nmh.org) Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, 675 North St. Clair Street, Galter 19-250, Chicago, IL 60611, United States. (Wayne J.D.) Division of Surgical Oncology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States. (Yeldandi A.) Department of Surgical Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States. CORRESPONDENCE ADDRESS J. Y. S. Kim, Division of Plastic and Reconstructive Surgery, Northwestern University, Feinberg School of Medicine, 675 North St. Clair Street, Galter 19-250, Chicago, IL 60611, United States. Email: jokim@nmh.org SOURCE Plastic and Reconstructive Surgery (2009) 124:1 (174e-176e). Date of Publication: July 2009 ISSN 0032-1052 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix (complication, diagnosis, surgery) breast reconstruction breast tumor (complication, diagnosis, surgery) implant intraductal carcinoma (diagnosis, surgery) EMTREE MEDICAL INDEX TERMS adult case report chronic inflammation diagnostic imaging excision female histology human human tissue letter mastectomy peroperative care plastic surgery priority journal sentinel lymph node biopsy surgical technique EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2009411184 MEDLINE PMID 19568066 (http://www.ncbi.nlm.nih.gov/pubmed/19568066) PUI L355051925 DOI 10.1097/PRS.0b013e3181a83c69 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0b013e3181a83c69 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 674 TITLE Early results using sterilized acellular human dermis (neoform) in postmastectomy tissue expander breast reconstruction AUTHOR NAMES Losken A. AUTHOR ADDRESSES (Losken A., alosken@emory.edu) (Losken A., alosken@emory.edu) Division of Plastic and Reconstructive Surgery, Emory University, School of Medicine, . (Losken A., alosken@emory.edu) Emory Division of Plastic and Reconstructive Surgery, 550 Peachtree Street, Atlanta, GA 30308. CORRESPONDENCE ADDRESS A. Losken, Emory Division of Plastic and Reconstructive Surgery, 550 Peachtree Street, Atlanta, GA 30308. Email: alosken@emory.edu SOURCE Plastic and Reconstructive Surgery (2009) 123:6 (1654-1658). Date of Publication: June 2009 ISSN 0032-1052 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction dermis implant EMTREE MEDICAL INDEX TERMS adult aged article breast cancer (radiotherapy, surgery) breast endoprosthesis clinical article female human intraductal carcinoma (radiotherapy, surgery) mastectomy outcome assessment patient satisfaction pectoralis major muscle postoperative complication (complication) postoperative period priority journal risk factor surgical approach surgical technique DEVICE TRADE NAMES AlloDerm , United StatesLifecell NeoForm , United StatesMentor DEVICE MANUFACTURERS (United States)Lifecell (United States)Mentor EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2009389628 PUI L355003016 DOI 10.1097/PRS.0b013e31819c4337 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0b013e31819c4337 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 675 TITLE Anterior rectus sheath repair with porcine collagen (Permacol™) in patients undergoing breast reconstruction with free abdominal flaps AUTHOR NAMES Ramsden A.J. Allen V. O'Donoghue J.M. AUTHOR ADDRESSES (Ramsden A.J., alex.ramsden@nuth.nhs.uk; Allen V.; O'Donoghue J.M.) Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Trust, NE1 4LP, United Kingdom. CORRESPONDENCE ADDRESS A.J. Ramsden, Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Trust, NE1 4LP, United Kingdom. Email: alex.ramsden@nuth.nhs.uk SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2009) 62:6 (e170-e171). Date of Publication: June 2009 ISSN 1748-6815 BOOK PUBLISHER Churchill Livingstone, 1-3 Baxter's Place, Leith Walk, Edinburgh, United Kingdom. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagen EMTREE DRUG INDEX TERMS polypropylene EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction deep inferior epigastric perforator flap rectus abdominis muscle transverse rectus abdominis musculocutaneous flap EMTREE MEDICAL INDEX TERMS abdominal wall hernia (complication, surgery) controlled study hernioplasty human implantation intermethod comparison letter major clinical study priority journal surgical technique surgical wound wound healing wound infection DEVICE TRADE NAMES permacol Tissue Science prolene Ethicon DEVICE MANUFACTURERS Ethicon Tissue Science CAS REGISTRY NUMBERS collagen (9007-34-5) polypropylene (25085-53-4, 9003-07-0) EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2009235723 MEDLINE PMID 19010755 (http://www.ncbi.nlm.nih.gov/pubmed/19010755) PUI L50333336 DOI 10.1016/j.bjps.2008.08.072 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2008.08.072 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 676 TITLE AlloDerm in breast reconstruction:2 years later AUTHOR NAMES Newman M.I. Samson M.C. Berho M. AUTHOR ADDRESSES (Newman M.I., newmanm@ccf.org; Samson M.C.) Department of Plastic and Reconstructive Surgery, . (Berho M.) Department of Pathology, Cleveland Clinic Florida, Weston, FL. (Newman M.I., newmanm@ccf.org) Department of Plastic and Reconstructive Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331. CORRESPONDENCE ADDRESS M. I. Newman, Department of Plastic and Reconstructive Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331. Email: newmanm@ccf.org SOURCE Plastic and Reconstructive Surgery (2009) 123:6 (205e-206e). Date of Publication: June 2009 ISSN 0032-1052 BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327, Philadelphia, United States. EMTREE DRUG INDEX TERMS biomaterial collagen fibril polypropylene EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction skin graft EMTREE MEDICAL INDEX TERMS autotransplantation cauterization human letter priority journal silicone prosthesis staining surgical approach surgical technique suture CAS REGISTRY NUMBERS polypropylene (25085-53-4, 9003-07-0) EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2009389688 MEDLINE PMID 19483545 (http://www.ncbi.nlm.nih.gov/pubmed/19483545) PUI L355003076 DOI 10.1097/PRS.0b013e3181a3f595 FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0b013e3181a3f595 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 677 TITLE Wise-pattern breast reconstruction: Modification using alloderm and a vascularized dermal-subcutaneous pedicle AUTHOR NAMES Derderian C.A. Karp N.S. Choi M. AUTHOR ADDRESSES (Derderian C.A.; Karp N.S.; Choi M., mihye.choi@nyumc.org) Institute of Reconstructive Plastic Surgery, New York University School of Medicine, New York, NY, United States. (Choi M., mihye.choi@nyumc.org) 305 East 47th, New York, NY 10017, United States. CORRESPONDENCE ADDRESS M. Choi, 305 East 47th, New York, NY 10017, United States. Email: mihye.choi@nyumc.org SOURCE Annals of Plastic Surgery (2009) 62:5 (528-532). Date of Publication: May 2009 ISSN 0148-7043 BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327, Philadelphia, United States. ABSTRACT Immediate implant-based breast mound reconstruction offers many advantages over staged implant reconstruction techniques. For large volume breast reconstruction, a Wise-pattern skin resection may provide very good aesthetic results; however, the submuscular implant pocket is inadequate to cover the inferior pole of the breast. In this patient population, the risk of implant exposure from T-point breakdown is significant. We present our technique of Wise-pattern breast reconstruction using AlloDerm (LifeCell, Branchburg, NJ) and a vascularized dermal-subcutaneous pedicle (DSP) to augment the volume and quality of immediate breast implant coverage, particularly in the area of the T-point suture lines.We reviewed a series of 20 consecutive patients with large breasts who were treated with an immediate implant reconstruction of greater than 400 mL volume using the Wise-pattern with DSP. Preoperative and postoperative 3-dimensional surface scan studies were performed to evaluate breast symmetry.The average volume of breast reconstruction in this study group was 458 mL. T-point breakdown occurred in 5 patients (25%). These patients were treated with local wound care and healed with an excellent aesthetic result. None of these patients required implant removal, implant exchange, or operative debridement. Pre- and postoperative 3-dimensional surface scan analysis of these patients demonstrated comparable differences between the affected and unaffected sides in women undergoing immediate breast implant reconstruction when compared with a matched group of patients undergoing 2-stage breast reconstruction with tissue expanders.Wise-pattern skin-reducing mastectomy is an excellent strategy to provide an aesthetically pleasing, immediate implant breast reconstruction. This technique provides breast symmetry that is at least comparable to that of tissue expander-based, staged implant reconstructions. The reliability of the Wise-pattern technique is significantly improved with the addition of AlloDerm to the muscular pocket and a vascularized DSP to preserve the integrity of the reconstruction in the presence of T-point breakdown. © 2009 Lippincott Williams & Wilkins, Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction EMTREE MEDICAL INDEX TERMS article breast endoprosthesis clinical article control group controlled study female human human tissue implant mastectomy plastic surgery postoperative care preoperative care priority journal wound care EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009380348 MEDLINE PMID 19387155 (http://www.ncbi.nlm.nih.gov/pubmed/19387155) PUI L354983980 DOI 10.1097/SAP.0b013e3181a0cfee FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0b013e3181a0cfee COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 678 TITLE Outcomes of various techniques of abdominal fascia closure after TRAM flap breast reconstruction AUTHOR NAMES Boehmler J.H. Butler C.E. Ensor J. Kronowitz S.J. AUTHOR ADDRESSES (Boehmler J.H.; Butler C.E.; Ensor J.; Kronowitz S.J., skronowi@mdanderson.org) Department of Plastic Surgery, Division of Quantitative Sciences, University of Texas M. D. Anderson Cancer Center, . (Boehmler J.H.; Kronowitz S.J., skronowi@mdanderson.org) Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center, Unit 443, 1515 Holcombe Boulevard, Houston, TX 77030. CORRESPONDENCE ADDRESS J. H. Boehmler, Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center, Unit 443, 1515 Holcombe Boulevard, Houston, TX 77030. SOURCE Plastic and Reconstructive Surgery (2009) 123:3 (773-781). Date of Publication: March 2009 ISSN 0032-1052 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. ABSTRACT BACKGROUND:: There is no consensus regarding the optimal technique for closure of the abdominal fascia after transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction. The authors reviewed outcomes with various techniques to identify the optimal one. METHODS:: The authors reviewed the charts of 81 consecutive patients who underwent TRAM flap breast reconstruction at their institution from 2002 to 2005. Various amounts of anterior rectus sheath fascia were harvested with the TRAM flap. Patients were divided into five groups based on fascia closure technique: (1) human acellular dermal matrix bridging inlay graft, (2) human acellular dermal matrix bridging inlay graft with primary closure of overlying anterior rectus sheath, (3) polypropylene mesh inlay graft, (4) polypropylene mesh inlay graft with primary closure, and (5) primary closure. For comparative analysis, three additional groups were created: all human acellular dermal matrix bridging inlay graft (groups 1 and 2), all mesh (groups 3 and 4), and all inlay (groups 1 and 3). Rates of donor-site complications were compared between groups. RESULTS:: Rates of abdominal bulge formation were as follows: overall, 14.8 percent; human acellular dermal matrix bridging inlay graft alone, 31 percent; human acellular dermal matrix bridging inlay graft plus primary closure, 20 percent; mesh alone, 10 percent; mesh plus primary closure, 5 percent; and primary closure alone, 5 percent. Rates of any complication (including bulge) were as follows: overall, 23.5 percent; human acellular dermal matrix bridging inlay graft alone, 42 percent; human acellular dermal matrix plus primary closure, 20 percent; mesh alone, 30 percent; mesh plus primary closure, 10 percent; and primary closure alone, 5 percent. Time to bulge formation was longer for all human acellular dermal matrix versus all mesh (p = 0.021. Time to any complication was longer for all inlay versus primary closure alone (p = 0.048), human acellular dermal matrix alone versus primary closure alone (p = 0.041). CONCLUSIONS:: For abdominal fascia repair after TRAM flap breast reconstruction, primary closure, when feasible, is preferable to an inlay graft; polypropylene mesh is preferable to human acellular dermal matrix if an inlay graft is required; adding primary closure to a mesh or human acellular dermal matrix inlay graft reduces bulge formation and other complications; and bulge occurs later with human acellular dermal matrix than with synthetic mesh. Copyright © 2009 by the American Society of Plastic Surgeons. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) abdominal bulge (complication) breast reconstruction transverse rectus abdominis musculocutaneous flap EMTREE MEDICAL INDEX TERMS article controlled study donor site fascia follow up human human acellular dermal matrix bridging inlay graft human acellular dermal matrix bridging inlay graft with primary closure of overlying anterior rectus sheath major clinical study medical record review outcome assessment polypropylene mesh inlay graft polypropylene mesh inlay graft with primary closure postoperative complication primary closure priority journal surgical technique EMBASE CLASSIFICATIONS Surgery (9) Gastroenterology (48) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009385120 MEDLINE PMID 19319039 (http://www.ncbi.nlm.nih.gov/pubmed/19319039) PUI L354993926 DOI 10.1097/PRS.0b013e318199ef4f FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0b013e318199ef4f COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 679 TITLE Wise-pattern breast reconstruction: Pocket augmentation using alloderm and a vascularized dermal-subcutaneous pedicle AUTHOR NAMES Derderian C.A. Choi M. Karp N.S. AUTHOR ADDRESSES (Derderian C.A.; Choi M.; Karp N.S.) Surgery, Division Plastic Surgery, New York University, New York, United States. CORRESPONDENCE ADDRESS C.A. Derderian, Surgery, Division Plastic Surgery, New York University, New York, United States. SOURCE Cancer Research (2009) 69:2 Suppl. S. Date of Publication: 15 Jan 2009 CONFERENCE NAME 31st Annual San Antonio Breast Cancer Symposium CONFERENCE LOCATION San Antonio, TX, United States CONFERENCE DATE 2008-12-10 to 2008-12-14 ISSN 0008-5472 BOOK PUBLISHER American Association for Cancer Research Inc. ABSTRACT Introduction: Immediate breast reconstruction offers many advantages over staged techniques, including the psychological benefit of recovering from mastectomy with a reconstructed breast. In women with large breasts desiring immediate implant reconstruction, the challenge to the surgeon is to restore breast volume and provide adequate implant coverage. In the large-breasted woman desiring a large volume reconstruction a Wise-pattern skin resection provides good aesthetic results, however the submuscular implant pocket is inadequate to cover the inferior pole of the breast. In this patient population, the risk of implant exposure from T-point breakdown is significant. We present our technique of Wise-pattern breast reconstruction after skin-sparing mastectomy using alloderm and a vascularized dermal-subcutaneous pedicle to augment the volume and quality of implant coverage. Methods: A series of twenty patients have been reconstructed using the following technique. The selection criteria were women with large breasts who required an immediate implant reconstruction of ≥400cc volume. We employed a Wise-pattern design for resection of skin identical to that of a reduction mammaplasty. An inferiorly-based dermal-subcutaneous flap was developed. The T-point of the Wise pattern skin pattern was closed over this flap and provided vascularized coverage of the implant and alloderm at this vulnerable point. All patients underwent the standard skin-sparing mastectomy. The pectoralis major and seratus anterior muscles were released from their inferior and costal origins respectively, and as much alloderm as needed was sutured to these muscles to provide an adequate pocket for the desired implant volume. The dermal-subcutaneous pedicle was laid over the alloderm and sutured in place. The breast was then closed with the T-point overlying the dermal-subcutaneous pedicle. In unilateral reconstructions, a symmetrizing procedure using a Wise-pattern reduction mammaplasty was performed on the contralateral side. Results: The average volume of reconstruction in this study group was 458cc. Significant T-point breakdown occurred in 5 patients, and 3 of these would have had implant/alloderm exposure if the dermal pedicle were not present. These patients were treated with local wound care and healed with an excellent aesthetic result. None of these patients required implant removal, implant exchange or operative debridement. Conclusion: Wise-pattern skin-reducing mastectomy is an excellent strategy to provide an aesthetically pleasing, large immediate implant breast reconstruction. The reliability of this technique is significantly improved with the addition of alloderm to the muscular pocket and a vascularized dermal-subcutaneous pedicle to preserve the integrity of the reconstruction in the presence of T-point breakdown. This technique can be added to the armamentarium of the plastic surgeon to safely restore breast size in one stage, remove the morbidity of multiple operations, and provide patients with the psychological benefits of an immediate reconstruction. EMTREE DRUG INDEX TERMS plastic EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer breast reconstruction EMTREE MEDICAL INDEX TERMS breast breast reduction debridement exposure female implant mastectomy morbidity muscle patient population reliability risk skin surgeon surgery wound care LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70108431 DOI 10.1158/0008-5472.SABCS-4148 FULL TEXT LINK http://dx.doi.org/10.1158/0008-5472.SABCS-4148 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 680 TITLE AlloDerm versus dermamatrix in immediate expander-based breast reconstruction: A preliminary comparison of complication profiles and material compliance AUTHOR NAMES Becker S. Saint-Cyr M. Wong C. Dauwe P. Nagarkar P. Thornton J.F. Peng Y. AUTHOR ADDRESSES (Becker S.; Saint-Cyr M., michel.saint-cyr@utsouthwestern.edu; Wong C.; Dauwe P.; Nagarkar P.; Thornton J.F.; Peng Y.) Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390-9132, United States. CORRESPONDENCE ADDRESS S. Becker, Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390-9132, United States. SOURCE Plastic and Reconstructive Surgery (2009) 123:1 (1-6). Date of Publication: January 2009 ISSN 0032-1052 BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327, Philadelphia, United States. ABSTRACT BACKGROUND: Allogenic acellular dermal matrix can be used in single-stage, expander-based immediate and delayed breast reconstructions to provide inferolateral prosthesis coverage and reconstruction of the inframammary fold. Two allogenic dermal matrix products currently available, AlloDerm and DermaMatrix, differ in method of storage, cost, and intraoperative preparation. The purpose of this study was to determine, first, whether there are any significant differences in the rates of postoperative complications, material compliance, or capsule characteristics; and second, if differences are present, whether they had any impact on final outcome. METHODS: After institutional review board approval, a retrospective analysis of prospectively collected data of 30 patients (50 breasts) who underwent immediate expander-based breast reconstructions using either AlloDerm (n = 25) or DermaMatrix (n = 25) dermal substitutes was performed. Primary endpoints were (1) incidence of seroma, (2) wound infection, (3) number of days requiring drains, (4) rate of tissue expansion, (5) final expanded volume, (6) final implant volume, and (7) neovascularization. RESULTS: The mean follow-up was 6.7 months. During this time, no significant differences in the complication profile were found between the two groups. Both dermal substitutes were found to be well incorporated, with evidence of neovascularization, on histologic examination. CONCLUSIONS: This study demonstrated no significant differences in the rate of complications or material compliance. The total complication rate was 4 percent, with seroma and wound infection being the most common complications. The authors' preliminary findings indicate no significant difference between implant/expander-based reconstructions using AlloDerm and those using DermaMatrix. Copyright © 2008 by the American Society of Plastic Surgeons. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast endoprosthesis breast reconstruction EMTREE MEDICAL INDEX TERMS adult angiogenesis article biocompatibility breast cancer (surgery) cancer patient clinical article controlled study female follow up histopathology human intermethod comparison outcome assessment priority journal retrospective study seroma (complication) surgical drainage surgical infection (complication) tissue expansion treatment outcome DEVICE TRADE NAMES AlloDerm , United StatesLifecell DermaMatrix , United StatesSynthes DEVICE MANUFACTURERS (United States)Lifecell (United States)Synthes EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009413994 MEDLINE PMID 19116505 (http://www.ncbi.nlm.nih.gov/pubmed/19116505) PUI L355059259 DOI 10.1097/PRS.0b013e3181904bff FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0b013e3181904bff COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 681 TITLE Pocket Conversion Made Easy: A Simple Technique Using Alloderm to Convert Subglandular Breast Implants to the Dual-Plane Position AUTHOR NAMES Mofid M.M. Singh N.K. AUTHOR ADDRESSES (Mofid M.M., drmofid@mofidplasticsurgery.com; Singh N.K.) SOURCE Aesthetic Surgery Journal (2009) 29:1 (12-18). Date of Publication: January 2009/February 2009 ISSN 1090-820X 1527-330X (electronic) BOOK PUBLISHER SAGE Publications Inc., 2455 Teller Road, Thousand Oaks, United States. ABSTRACT Background: The advantages of dual-plane, partially submuscular breast implants are well documented. Standard conversion techniques to dual-plane positioning use marionette sutures and internal capsulorrhaphy sutures from the lower edge of the pectoralis major muscle to the anterior capsule or breast fascia within the subglandular plane. These techniques are limited by high rates of postoperative implant malposition and technical limitations that make combined mastopexy procedures difficult to perform. Objective: We describe a simple technique familiar to most plastic surgeons accustomed to placing tissue expanders for use in breast reconstruction using Alloderm (LifeCell Corp., Branchburg, NJ) as a sling beneath the pectoralis major muscle to the chest wall. Methods: We studied 25 women who underwent breast augmentation revision from the subglandular to the dual-plane position by performing a 9-year retrospective review from 1999 to 2007 of 2 surgeons' experience. We identified 10 women for whom Alloderm, sutured from the lower edge of the pectoralis major muscle to the chest wall, was used to create a composite pectoralis-Alloderm pocket for partial submuscular transfer of implants and 15 case controls who underwent pocket conversion using standard capsulorrhaphy and marionette suture techniques. Results: The principal outcome variable of at least 1 complication was 73.3% without Alloderm, resulting in a 40% need for revision surgery, versus 0% with Alloderm (Fisher exact test; P < .05). Conclusions: The standard techniques available for conversion of subglandular breast implants to the dual-plane position using capsulorrhaphy and marionette sutures are limited by a high complication rate for the reliable positioning into a stable dual-plane pocket during implant exchange. A commonly used technique in reconstructive breast surgery using Alloderm is shown to reliably convert subglandular implants to the dual-plane position. © 2009 American Society for Aesthetic Plastic Surgery, Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation breast endoprosthesis EMTREE MEDICAL INDEX TERMS adult article breast reconstruction chronic pain (complication) controlled study female human outcome assessment pectoralis major muscle priority journal surgical approach surgical technique suture technique thorax wall DEVICE TRADE NAMES Alloderm , United StatesLifecell DEVICE MANUFACTURERS (United States)Lifecell EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009077033 MEDLINE PMID 19233000 (http://www.ncbi.nlm.nih.gov/pubmed/19233000) PUI L354178351 DOI 10.1016/j.asj.2008.12.005 FULL TEXT LINK http://dx.doi.org/10.1016/j.asj.2008.12.005 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 682 TITLE Alloderm versus dermamatrix in immediate expander-based breast reconstruction: A preliminary comparison of complication profiles and material compliance AUTHOR NAMES Nahabedian M.Y. AUTHOR ADDRESSES (Nahabedian M.Y., drnahabedian@aol.com) Georgetown University, 3800 Reservoir Road, NW, Washington, DC 20007, United States. CORRESPONDENCE ADDRESS M. Y. Nahabedian, Georgetown University, 3800 Reservoir Road, NW, Washington, DC 20007, United States. Email: drnahabedian@aol.com SOURCE Plastic and Reconstructive Surgery (2009) 123:1 (7-8). Date of Publication: January 2009 ISSN 0032-1052 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast endoprosthesis breast reconstruction EMTREE MEDICAL INDEX TERMS angiogenesis biocompatibility cell regeneration extracellular matrix fibroblast human intermethod comparison molecular mechanics note outcome assessment priority journal seroma (complication) surgical infection (complication) treatment outcome DEVICE TRADE NAMES AlloDerm , United StatesLifecell DermaMatrix , United StatesSynthes DEVICE MANUFACTURERS (United States)Lifecell (United States)Synthes EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2009413995 PUI L355059260 DOI 10.1097/PRS.0b013e3181904c4b FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0b013e3181904c4b COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 683 TITLE Intra-arterial infusion chemotherapy for advanced breast cancer - 5 cases of marked response AUTHOR NAMES Miura T. Takeuchi I. Kikuoka S. Miura T. AUTHOR ADDRESSES (Miura T.; Takeuchi I.) Dept. of Surgery, Miura Hospital, Japan. (Kikuoka S.; Miura T.) Dept. of Clinical Oncology, Miura Hospital, Japan. CORRESPONDENCE ADDRESS T. Miura, Dept. of Surgery, Miura Hospital, Japan. SOURCE Japanese Journal of Cancer and Chemotherapy (2009) 36:12 (2108-2110). Date of Publication: November 2009 ISSN 0385-0684 BOOK PUBLISHER Japanese Journal of Cancer and Chemotherapy Publishers Inc., ccp@blue.ocn.ne.jp ABSTRACT In order to obtain less severe toxic reactions, while attaining maximal therapeutic effects, CPA, 5-FU and ADM or EPI have been administered through the catheter inserted into the internal thoracic artery with the IVR technique and the implantable infusion port system. Of the 181 patients with the unresectable or recurrent breast cancers attempted with intraarterial infusion chemotherapy for the past 19 years, more than half of the patients showed a good response to this modality of the chemotherapy. In 4 out of the 5 patients with unresectable breast cancer, radical mastectomy became feasible following the marked response with the intra-arterial infusion chemotherapy. However, a distant metastasis proved to be a limiting factor for improvement of survival. EMTREE DRUG INDEX TERMS fluorouracil EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer chemotherapy internal mammary artery intraarterial drug administration EMTREE MEDICAL INDEX TERMS catheter distant metastasis human infusion mastectomy patient survival therapy effect CAS REGISTRY NUMBERS fluorouracil (51-21-8) LANGUAGE OF ARTICLE Japanese LANGUAGE OF SUMMARY English, Japanese EMBASE ACCESSION NUMBER 2012461235 MEDLINE PMID 20037339 (http://www.ncbi.nlm.nih.gov/pubmed/20037339) PUI L365377773 COPYRIGHT Copyright 2016 Elsevier B.V., All rights reserved. RECORD 684 TITLE Single-staged breast cancer reconstruction using the combined spectrum expander/implant AUTHOR NAMES Lessard L. Al-Salmi L. Izadpanah A. AUTHOR ADDRESSES (Lessard L.; Al-Salmi L.; Izadpanah A.) McGill University Health Centre, Montreal, Canada. CORRESPONDENCE ADDRESS L. Lessard, McGill University Health Centre, Montreal, Canada. SOURCE Current Oncology (2009) 16:5 (100). Date of Publication: 2009 CONFERENCE NAME 3rd International Symposium on Hereditary Breast and Ovarian Cancer CONFERENCE LOCATION Montreal, QC, Canada CONFERENCE DATE 2009-10-14 to 2009-10-16 ISSN 1198-0052 BOOK PUBLISHER Multimed Inc. ABSTRACT Introduction: Breast reconstruction is an important procedure that requires attention to detail for optimal outcome. Spectrum implants (Mentor Corporation, Santa Barbara, CA, U.S.A.) have provided us with the tools to optimally adjust for achieving symmetry and patient satisfaction. Single-staged breast reconstruction with saline implants was first introduced by Becker in 1982. Despite advances in our surgical techniques and prosthesis, the reported complication rate remains high at 28%. Purpose: We present the senior author's experience over a period of 7 years for immediate and delayed breast reconstruction as it relates to implant reconstruction. This is the first reported study of breast reconstruction using Spectrum Expander/Implant with the use of the same retropectoral technique and no alloderm. All implants were saline-filled. Methods: A retrospective review analysis of patients undergoing Spectrum implants by the senior author from 2001 to 2008 is presented. Specific attention is paid to factors associated with major complications. Results: A total of 44 patients underwent 67 Spectrum breast implant reconstructions. The mean age of the study patients was 42.7 years (standard deviation: ±11.6 years; range: 17-67 years). There was no skin necrosis (0%). Complications requiring reoperation and general anesthesia were capsular contracture (n = 10; 14.9%), periprosthetic infection (n = 3; 4.5%), and delayed sudden deflation (n = 2; 3.0%). Only 1 patient was subsequently judged not suitable for reoperation/reconstruction because of severe neutropenia. The subcutaneous valves were removed under local anesthesia during nipple reconstruction without any complication. Photographic technical tips and final results are presented. Conclusions: Use of a versatile integrated all-in-one expander/implant (Spectrum) can achieve great results with minimal complication and reoperation rates. EMTREE DRUG INDEX TERMS sodium chloride EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast breast cancer ovary cancer EMTREE MEDICAL INDEX TERMS breast endoprosthesis breast reconstruction contracture general anesthesia implant infection local anesthesia neutropenia nipple patient patient satisfaction prosthesis reoperation skin necrosis surgical technique teacher United States LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English PUI L70048127 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 685 TITLE Possible Future Development of Implants and Breast Augmentation AUTHOR NAMES Maxwell G.P. Gabriel A. AUTHOR ADDRESSES (Maxwell G.P.; Gabriel A., gabrielallen@yahoo.com) Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, CA, United States. CORRESPONDENCE ADDRESS A. Gabriel, Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, CA, United States. Email: gabrielallen@yahoo.com SOURCE Clinics in Plastic Surgery (2009) 36:1 (167-172). Date of Publication: January 2009 ISSN 0094-1298 BOOK PUBLISHER W.B. Saunders, Independence Square West, Philadelphia, United States. ABSTRACT Since the introduction of the silicone gel prosthesis in 1962, breast augmentation has become one of the most frequently performed operations in plastic surgery. As we strive for perfect results, it is important to continue to gather and review data evaluating innovative techniques and devices. Now we even have more options available for breast augmentation, whether we use them in combination or alone. By combining all of the available options (acellular dermal matrix products, silicone implant, fat grafting), we have been able to create "bioengineered breasts" with high patient and surgeon satisfaction. As always in plastic surgery, our concern is with safety; as newer technology and products are introduced to us, patient education, consent, and follow-up remain important. © 2008. EMTREE DRUG INDEX TERMS silicone gel EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation breast endoprosthesis EMTREE MEDICAL INDEX TERMS bioengineering follow up informed consent patient education review silicone prosthesis EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2008563430 MEDLINE PMID 19055971 (http://www.ncbi.nlm.nih.gov/pubmed/19055971) PUI L352746811 DOI 10.1016/j.cps.2008.08.005 FULL TEXT LINK http://dx.doi.org/10.1016/j.cps.2008.08.005 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 686 TITLE Subcutaneous mastectomy and immediate reconstruction for prevention of breast cancer for high-risk patients. AUTHOR NAMES Ashikari R.H. Ashikari A.Y. Kelemen P.R. Salzberg C.A. AUTHOR ADDRESSES (Ashikari R.H.; Ashikari A.Y.; Kelemen P.R.; Salzberg C.A.) Ashikari Breast Center, 128 Ashford Avenue, Dobbs Ferry, NY 10522, USA. CORRESPONDENCE ADDRESS R.H. Ashikari, Ashikari Breast Center, 128 Ashford Avenue, Dobbs Ferry, NY 10522, USA. SOURCE Breast cancer (Tokyo, Japan) (2008) 15:3 (185-191). Date of Publication: 2008 ISSN 1880-4233 (electronic) ABSTRACT Breast cancer is the most common malignant tumor among females in the USA, with one out of eight American females developing breast cancer in their lifetimes. The latest studies show that 212,920 new cases of invasive cancer developed in 2006, which is 2.5 times more common than the incidence of lung cancer, and that 40,970 females will die from this disease each year. Therefore, awareness of this cancer is an important health issue, with more women beginning to assess their risk of breast cancer, either informally or with instruments such as the GAIL model. The availability of genetic testing for BRCA-1 and BRCA-2 has revealed many women who are at significantly increased risk. Many aggressive surveillance programs have been developed using advanced MRI and ultrasound, and reductions in breast cancer risk of 50% or more have been proven using chemoprevention strategies with tamoxifen and raloxifene. However, many women are starting to seriously consider prophylactic mastectomy for near-total reduction of breast cancer risk. At our institution, we have developed a procedure for prophylactic subcutaneous mastectomy via an inframammary incision that spares the nipple and is combined with immediate silicone implant reconstruction with the assistance of Alloderm. In this article we will describe the procedure and some of the important issues surrounding its implementation from our experience. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction breast tumor (diagnosis, prevention, surgery) subcutaneous mastectomy EMTREE MEDICAL INDEX TERMS adult aged article female follow up human methodology middle aged patient satisfaction quality of life retrospective study risk factor treatment outcome LANGUAGE OF ARTICLE English MEDLINE PMID 18575951 (http://www.ncbi.nlm.nih.gov/pubmed/18575951) PUI L550116516 DOI 10.1007/s12282-008-0059-7 FULL TEXT LINK http://dx.doi.org/10.1007/s12282-008-0059-7 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 687 TITLE Immediate single-stage breast reconstruction using implants and human acellular dermal tissue matrix with adjustment of the lower pole of the breast to reduce unwanted lift AUTHOR NAMES Topol B.M. Dalton E.F. Ponn T. Campbell C.J. AUTHOR ADDRESSES (Topol B.M., drtopol@drtopol.com) Department of Surgery, Section of Plastic Surgery, Elliot Hospital, Manchester, NH. (Dalton E.F.; Ponn T.) Elliot Breast Health Center, Elliot Hospital, Manchester, NH. (Campbell C.J.) Catholic Medical Center, Manchester, NH. (Topol B.M., drtopol@drtopol.com) 36 Bay St., Manchester, NH 03104. CORRESPONDENCE ADDRESS B. M. Topol, 36 Bay St., Manchester, NH 03104. Email: drtopol@drtopol.com SOURCE Annals of Plastic Surgery (2008) 61:5 (494-499). Date of Publication: November 2008 ISSN 0148-7043 BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327, Philadelphia, United States. ABSTRACT Breast reconstruction using implants remains an aesthetic challenge toward achieving symmetry and natural appearance. Closing the areolar defect results in a vertically elevated breast mound. The use of human acellular dermal tissue matrix has been reported to provide coverage and durability over breast implants while allowing for improved shape of the reconstructed breast.This study reports the operative technique used in a series of breast reconstructions using saline implants and human acellular dermal tissue matrix in an immediate one-stage procedure. Complications and appearance were evaluated for all reconstructions. Indications for inframammary fold reconstruction and lower pole breast enhancement using chest skin advancement were discussed.Twenty-three patients were included in the study; 11 had unilateral reconstruction and 12 had bilateral reconstruction for 35 total reconstructions. All patients had immediate reconstruction following skin-sparing mastectomy. Nine patients had inframammary fold reconstruction and 11 patients had a lower chest advancement flap with fold reconstruction. The mean follow-up was 9.5 months with a range of 1 to 24 months. Complications occurred in 3 patients.Human acellular dermal tissue matrix can successfully be used in conjunction with breast implants to achieve an aesthetically pleasing breast reconstruction in one stage at the time of skin-sparing mastectomy. The use of a tissue expander and its associated risks and costs are eliminated. The complication rate is low. In addition, either inframammary fold reconstruction or lower chest advancement and fold reconstruction to augment lower pole skin coverage can improve symmetry with the opposite breast. Copyright © 2008 by Lippincott Williams & Wilkins. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast endoprosthesis breast reconstruction human acellular dermal tissue matrix EMTREE MEDICAL INDEX TERMS article clinical article clinical evaluation female follow up hospital cost human human tissue partial mastectomy postoperative complication priority journal risk factor skin flap skinfold surgical technique DEVICE TRADE NAMES AlloDerm , United StatesLifecell Flex HD , United StatesMusculoskeletal Transplant Foundation DEVICE MANUFACTURERS (United States)Lifecell (United States)Musculoskeletal Transplant Foundation EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009240515 MEDLINE PMID 18948774 (http://www.ncbi.nlm.nih.gov/pubmed/18948774) PUI L354617711 DOI 10.1097/SAP.0b013e31816d82d9 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0b013e31816d82d9 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 688 TITLE Ultrasonic evaluation of breast prosthesis during the peri-implantation period AUTHOR NAMES Guan Q.-W. AUTHOR ADDRESSES (Guan Q.-W., Guanqiwen410@126.com) Wuhan Third Hospital, Wuhan 430060 Hubei Province, China. CORRESPONDENCE ADDRESS Q.-W. Guan, Wuhan Third Hospital, Wuhan 430060 Hubei Province, China. Email: Guanqiwen410@126.com SOURCE Journal of Clinical Rehabilitative Tissue Engineering Research (2008) 12:44 (8717-8719). Date of Publication: 28 Oct 2008 ISSN 1673-8225 BOOK PUBLISHER Journal of Clinical Rehabilitative, P.O. Box 1200, Shenyang, China. ABSTRACT Aim: To summarize application of ultrasonography in breast prosthesis implantation made of medical materials. Methods: Cases undergoing breast prosthesis implantation in Wuhan Third Hospital and Hubei People's Hospital from 1998 to 2008 were selected. Mammary gland tissue thickness, posterior space of mammary gland, and posterior space of pectoral muscle were observed preoperatively using color ultrasound, and abnormal pathology of prosthesis and periprosthesis mammary gland tissues following implantation were also observed. Thirty-four abnormal breasts with obvious complications were observed. Results: Thirty-four abnormal breasts were divided into five groups according to prosthesis materials: polyacrylamide hydrogel (n=18), hydroxyapatite (n=1), silicone gel (n=9), autologous fat prosthesis (n=1), and acellular dermal matrix patch prosthesis (n=4). Ultrasonic test showed that there were different complications in severe breast prosthesis, such as hematoma, infection, fibrosis adherence, sclerosis, fiber capsule contraction, displacement, and incision and pectoral muscle adherence. Complication incidence was the highest in polyacrylamide hydrogel breast, and lower in atellular dermal matrix breast. Conclusion: Complication incidence is the highest in polyacrylamide hydrogel breast, and lower in alellular dermal matrix breast. Color ultrasonography can guide breast prosthesis implantation and detect prosthesis abnormity and complications. EMTREE DRUG INDEX TERMS hydroxyapatite polyacrylamide silicone EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast prosthesis breast reconstruction echomammography EMTREE MEDICAL INDEX TERMS adult article breast fibrosis (complication) China color Doppler flowmetry controlled study hematoma (complication) human hydrogel incidence mammary gland pectoral muscle postoperative complication (complication) postoperative infection (complication) preoperative evaluation prosthesis material thickness CAS REGISTRY NUMBERS hydroxyapatite (1306-06-5, 51198-94-8) polyacrylamide (9003-05-8) silicone (63148-53-8, 8043-93-4, 8055-24-1) EMBASE CLASSIFICATIONS Surgery (9) Radiology (14) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE Chinese LANGUAGE OF SUMMARY English, Chinese EMBASE ACCESSION NUMBER 2008605085 PUI L352851408 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 689 TITLE Improving shape and symmetry in mastopexy with autologous or cadaveric dermal slings AUTHOR NAMES Colwell A.S. Breuing K.H. AUTHOR ADDRESSES (Colwell A.S., kbreuing@partners.org) Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. (Breuing K.H.) Brigham and Women's Hospital, Harvard Medical School, Boston, MA. CORRESPONDENCE ADDRESS A. S. Colwell, Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. Email: kbreuing@partners.org SOURCE Annals of Plastic Surgery (2008) 61:2 (138-142). Date of Publication: August 2008 ISSN 0148-7043 BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327, Philadelphia, United States. ABSTRACT Mastopexy and reduction mammaplasty reshape breast parenchyma and restore youthful contour in women with ptotic breasts. However, recurrent ptosis and breast base widening are common. We have been using internal autologous or cadaveric (AlloDerm) dermal slings to circumferentially support and shape the breasts for symmetry or rejuvenation. Ten patients underwent unilateral mastopexy (3), unilateral reduction-mastopexy (1), bilateral mastopexy (5), or bilateral reduction-mastopexy (1) with an internal dermal sling to correct breast reconstruction asymmetry (2), congenital asymmetry (2), or acquired ptosis (6). Three of 6 patients acquired breast ptosis after massive weight loss. Autologous dermis was used in 5 patients, and 5 patients were reconstructed with AlloDerm. Patients have maintained projection and breast base width after 6 months to 3 years. In conclusion, internal dermal slings improve shape, breast projection, and base width in select patients undergoing mastopexy. An algorithm based on quantity and quality of native skin is provided. © 2008 by Lippincott Williams & Wilkins. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast breast ptosis (surgery) breast surgery mastopexy ptosis (surgery) EMTREE MEDICAL INDEX TERMS adult article body mass breast reduction cadaveric dermal sling cancer surgery clinical article female human orthopedic fixation device outcome assessment patient information plastic surgery priority journal retrospective study second look surgery skin skin flap surgical technique treatment outcome DEVICE TRADE NAMES AlloDerm , United StatesLifecell DEVICE MANUFACTURERS (United States)Lifecell EMBASE CLASSIFICATIONS Surgery (9) Obstetrics and Gynecology (10) Cancer (16) Public Health, Social Medicine and Epidemiology (17) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009362254 MEDLINE PMID 18650604 (http://www.ncbi.nlm.nih.gov/pubmed/18650604) PUI L354941337 DOI 10.1097/SAP.0b013e31815bfe7c FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0b013e31815bfe7c COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 690 TITLE Use of 2-octyl-cyanoacrylate skin adhesive (dermabond) for wound closure following reduction mammaplasty: A prospective, randomized intervention study AUTHOR NAMES Nipshagen M.D. Hage J.J. Beekman W.H. AUTHOR ADDRESSES (Nipshagen M.D., md.nipshagen@tiscali.nl; Hage J.J.; Beekman W.H.) Department of Plastic Surgery, Tergooi Hospital, Van Riebeeckweg 212, 1213 XZ Hilversum, Netherlands. CORRESPONDENCE ADDRESS M. D. Nipshagen, Department of Plastic Surgery, Tergooi Hospital, Van Riebeeckweg 212, 1213 XZ Hilversum, Netherlands. Email: md.nipshagen@tiscali.nl SOURCE Plastic and Reconstructive Surgery (2008) 122:1 (10-18). Date of Publication: July 2008 ISSN 0032-1052 BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street,P O Box 327, Philadelphia, United States. ABSTRACT BACKGROUND: 2-Octyl-cyanoacrylate skin adhesive may be used for surgical wound closure. However, its use in plastic surgery has not been properly assessed. METHODS: The authors conducted a prospective, randomized, controlled clinical intervention study in which the scar characteristics after use of skin adhesive were compared with those after suture closure. Bilateral reduction mammaplasty was performed in 50 patients. The method of closure (sutures versus skin adhesive) applied to each breast was determined randomly, using each patient as her own control. Scars were assessed by the patient and by a blinded panel, at 1 week, 6 weeks, and 6 months after surgery, using a visual analogue scale, the modified Hollander Wound Evaluation Scale, and the Patient and Observer Scar Assessment Scale. RESULTS: Both patients and panelists expressed an overall preference for the adhesive side as of 1 week after surgery. Patients' visual analogue scale scores for scar comfort and scar appearance and panelists' visual analogue scale scores for aesthetic outcome were significantly better for the adhesive side after 6 weeks and 6 months (p < 0.05), as was the total Hollander Wound Evaluation Scale score of the panelists after 6 weeks (p < 0.02). The total Patient and Observer Scar Assessment Scale score after 6 months was significantly better for the adhesive side according to the patients (p < 0.01), but not according to the panelists (p = 0.11). CONCLUSION: The authors conclude that 2-octyl-cyanoacrylate is a sound alternative for wound closure. Copyright © 2008 by the American Society of Plastic Surgeons. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) cyanoacrylic acid octyl ester tissue adhesive EMTREE DRUG INDEX TERMS unclassified drug EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reduction wound closure EMTREE MEDICAL INDEX TERMS adult aged article clinical article clinical trial controlled clinical trial controlled study female follow up human intermethod comparison outcome assessment patient satisfaction priority journal randomized controlled trial rating scale scar formation single blind procedure surgical patient surgical wound suture technique therapy effect visual analog scale wound assessment DEVICE TRADE NAMES Dermabond , United Statesclosure medical DEVICE MANUFACTURERS (United States)closure medical EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2009388249 MEDLINE PMID 18594354 (http://www.ncbi.nlm.nih.gov/pubmed/18594354) PUI L355000523 DOI 10.1097/PRS.0b013e318171524b FULL TEXT LINK http://dx.doi.org/10.1097/PRS.0b013e318171524b COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 691 TITLE The influence of AlloDerm on expander dynamics and complications in the setting of immediate tissue expander/implant reconstruction: A matched-cohort study AUTHOR NAMES Preminger B.A. McCarthy C.M. Hu Q.Y. Mehrara B.J. Disa J.J. AUTHOR ADDRESSES (Preminger B.A., bap2104@columbia.edu) Division of Plastic and Reconstructive Surgery, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, United States. (McCarthy C.M.; Hu Q.Y.; Mehrara B.J.; Disa J.J.) Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, United States. (Preminger B.A., bap2104@columbia.edu) 1275 York Avenue, New York, NY 10065, United States. CORRESPONDENCE ADDRESS B. A. Preminger, 1275 York Avenue, New York, NY 10065, United States. Email: bap2104@columbia.edu SOURCE Annals of Plastic Surgery (2008) 60:5 (510-513). Date of Publication: May 2008 ISSN 0148-7043 BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United States. ABSTRACT AlloDerm (LifeCell, Branchburg, NJ) is gaining acceptance in tissue expander/implant (TE/I) breast reconstruction. Anecdotal evidence suggests its use limits postoperative musculoskeletal morbidity and allows injection of greater initial fill-volumes and rapid postoperative expansion. The objective of this study was to evaluate AlloDerm's impact on expansion rates in immediate TE/I reconstruction. A matched, retrospective cohort study was performed. Medical records of patients who underwent immediate TE/I reconstruction from 2004 to 2005 were reviewed. Two cohorts were identified: (1) underwent TE/I reconstruction with AlloDerm, and (2) underwent standard TE/I reconstruction. Individuals were matched 1:1 on the basis of: expander size (±100 mL), history of irradiation, and indication for mastectomy. Cohorts were compared for intraoperative volume injected (mL), rate of postoperative expansion (mL/ injection), number of expansions, and time to completion of expansion (days). Incidence of complications was evaluated. Pairwise comparisons were performed using the Wilcoxon sign rank test and McNemar test. Ninety immediate TE/I reconstructions were evaluated. Forty-five TE/I-AlloDerm reconstructions were matched to standard TE/I reconstructions. Intraoperatively, expanders in the AlloDerm and non-AlloDerm cohorts were filled to a mean volume of 223.8 and 201.1 mL (P = 0.180). Median number of expansions performed was 5 and 6 in the AlloDerm and non-AlloDerm cohorts (P = 0.117). There was no difference in the mean rate of postoperative tissue expansion (AlloDerm: 97 mL/injection versus non-AlloDerm: 95 mL/injection [P = 0.907]), nor in the incidence of complications (P = 0.289). Minor complications occurred in 13.1% of AlloDerm cases (cellulitis [n = 3], seroma [n = 3], hematoma [n = 1]. Although this study does not address AlloDerm's efficacy in decreasing morbidity or improving esthetic outcomes in TE/I reconstruction, it indicates that AlloDerm does not increase the rate of tissue expansion after immediate TE placement. It does not, however, appear to increase the risk of postoperative complications. © 2008 Lippincott Williams & Wilkins, Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) implant EMTREE MEDICAL INDEX TERMS conference paper controlled study human major clinical study mastectomy medical record review morbidity postoperative care priority journal retrospective study Wilcoxon signed ranks test DEVICE TRADE NAMES AlloDerm , United StatesLifecell DEVICE MANUFACTURERS (United States)Lifecell EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2008202084 MEDLINE PMID 18434824 (http://www.ncbi.nlm.nih.gov/pubmed/18434824) PUI L351591458 DOI 10.1097/SAP.0b013e31816f2836 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0b013e31816f2836 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 692 TITLE Acellular dermis-assisted breast reconstruction AUTHOR NAMES Spear S.L. Parikh P.M. Reisin E. Menon N.G. AUTHOR ADDRESSES (Spear S.L.; Parikh P.M., Parikh.Pranay@gmail.com; Reisin E.; Menon N.G.) Department of Plastic Surgery, Georgetown University, PHC Building, 3800 Reservoir Road NW, Washington, DC 20007, United States. CORRESPONDENCE ADDRESS P. M. Parikh, Department of Plastic Surgery, Georgetown University, PHC Building, 3800 Reservoir Road NW, Washington, DC 20007, United States. Email: Parikh.Pranay@gmail.com SOURCE Aesthetic Plastic Surgery (2008) 32:3 (418-425). Date of Publication: May 2008 ISSN 0364-216X BOOK PUBLISHER Springer New York, 233 Springer Street, New York, United States. ABSTRACT Background: In 2004, the authors reported their findings with placement of tissue expanders for breast reconstruction in the partial submuscular position, the equivalent of the "dual-plane" technique for breast augmentation. Limitations with subpectoral expander placement include difficulty controlling the lower pole of the pocket during expansion, unprotected device coverage by a thin inferior mastectomy flap, possible effacement of the inframammary fold, and limited control over the superior migration of the pectoralis major muscle. This study aimed to examine the safety and efficacy of an acellular dermal sling in providing inferolateral support to the device during immediate breast reconstruction and expansion. Methods: This study prospectively investigated 58 breasts of 43 consecutive women who underwent immediate breast reconstruction with tissue expanders and acellular dermis. After completion of adjuvant therapy and expansion, the devices were exchanged for implants. The patients were tracked through January, 2007. The study parameters included demographic information, oncologic data, complications, and aesthetic outcomes. Results: The mean time required to complete reconstruction was 8.6 months. The overall complication rate after expander/acellular dermis placement was 12%, whereas the complication rate after exchange to implants was 2.2%. The aesthetic outcome for reconstructed breasts did not differ significantly from that for the control subjects who had no surgery. Conclusions: Acellular dermis appears to be a useful adjunct in immediate prosthetic breast reconstruction. Acellular dermis-assisted breast reconstruction has a low complication rate, helps to reconstruct an aesthetically pleasing breast, and facilitates expeditious completion of the reconstruction. © 2008 Springer Science+Business Media, LLC. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast endoprosthesis breast reconstruction dermis EMTREE MEDICAL INDEX TERMS adult aged article clinical article controlled study demography esthetics female follow up hematoma (complication) human mastectomy outcome assessment postoperative complication (complication) postoperative infection (complication) priority journal prospective study safety seroma (complication) skin necrosis (complication) treatment failure treatment outcome EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2008262716 MEDLINE PMID 18338102 (http://www.ncbi.nlm.nih.gov/pubmed/18338102) PUI L50090924 DOI 10.1007/s00266-008-9128-8 FULL TEXT LINK http://dx.doi.org/10.1007/s00266-008-9128-8 COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 693 TITLE Correction of chest wall deformity after implant-based breast reconstruction using poly-l-lactic acid (Sculptra) AUTHOR NAMES Schulman M.R. Lipper J. Skolnik R.A. AUTHOR ADDRESSES (Schulman M.R., matthewschulman.md@gmail.com; Lipper J.; Skolnik R.A.) Division of Plastic and Reconstructive Surgery, Mount Sinai School of Medicine, Mount Sinai Hospital, New York, NY, United States. (Schulman M.R., matthewschulman.md@gmail.com) 21 E. 87th St., New York, NY 10128, United States. CORRESPONDENCE ADDRESS M.R. Schulman, 21 E. 87th St., New York, NY 10128, United States. Email: matthewschulman.md@gmail.com SOURCE Breast Journal (2008) 14:1 (92-96). Date of Publication: January/February 2008 ISSN 1075-122X 1524-4741 (electronic) BOOK PUBLISHER Blackwell Publishing Inc., 350 Main Street, Malden, United States. ABSTRACT Implant-based breast reconstruction after mastectomy offers excellent cosmetic results in select individuals. However, this technique may result in a step-off between the implant and the soft tissue of the chest wall, which can be problematic in the extremely thin patient. Also, the removal of soft tissue can result in prominent ribs and visible intercostal spaces. A number of surgical options exist to correct these defects and include dermal grafts, flap reconstruction, and implant exchange. We present the case of a thin woman with a persistent "step-off" deformity and visible intercostal spaces after mastectomy and two-stage implant reconstruction. Placement of acellular cadaveric dermis (Alloderm) failed to improve the appearance of her chest wall. The authors utilized poly-l-lactic acid (Sculptra) for soft tissue augmentation of her chest wall with significant esthetic improvement. This novel use of poly-l-lactic acid offers a useful alternative to invasive surgical procedures to correct a soft tissue deformity of the chest wall. While poly-l-lactic acid has recently gained popularity for soft tissue augmentation of the face, to date, no reports in the literature exist describing its use in the correction of difficult chest wall defects after mastectomy and implant reconstruction. We maintain that poly-l-lactic acid may also be useful to improve a variety of soft tissue deformities of the breast. © 2007 Blackwell Publishing, Inc. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) polylactic acid EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction implant thorax wall defect (complication, surgery) EMTREE MEDICAL INDEX TERMS adult article case report esthetics female human mastectomy skin graft soft tissue defect (complication, surgery) surgical technique treatment outcome DEVICE TRADE NAMES Alloderm , United StatesLifecell Sculptra , United StatesDermik DEVICE MANUFACTURERS (United States)Dermik (United States)Lifecell CAS REGISTRY NUMBERS polylactic acid (26100-51-6) EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2008015856 MEDLINE PMID 18186871 (http://www.ncbi.nlm.nih.gov/pubmed/18186871) PUI L351044509 DOI 10.1111/j.1524-4741.2007.00529.x FULL TEXT LINK http://dx.doi.org/10.1111/j.1524-4741.2007.00529.x COPYRIGHT Copyright 2010 Elsevier B.V., All rights reserved. RECORD 694 TITLE Fine-needle aspiration biopsy cytology of cutaneous calcinosis in a 74-year-old woman with dermatomyositis on methotrexate therapy: A case report AUTHOR NAMES Patel N.P. Bergman S. Geisinger K.R. AUTHOR ADDRESSES (Patel N.P.; Bergman S.; Geisinger K.R., kgeis@wfubmc.edu) Department of Padiology, Wake Forest University, School of Medicine, Winston-Salem, NC, United States. (Geisinger K.R., kgeis@wfubmc.edu) Surgical Padiology and Cytopadiology Laboratory Services, . (Geisinger K.R., kgeis@wfubmc.edu) Department of Pathology, Wake Forest University, School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1070, United States. CORRESPONDENCE ADDRESS K. R. Geisinger, Department of Pathology, Wake Forest University, School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1070, United States. Email: kgeis@wfubmc.edu SOURCE Acta Cytologica (2008) 52:4 (454-458). Date of Publication: July/August 2008 ISSN 1938-2650 (electronic) 0001-5547 BOOK PUBLISHER S. Karger AG ABSTRACT Background: Cutaneous calcinosis (CC) occurs in a variety of rheumatic diseases. Fine needle aspiration biopsy (FNAB) may be used in the office setting to evaluate such soft tissue lesions. For patients on methotrexate (MTX) therapy, methotrexate nodulosis (MN) should be considered in the differential diagnosis. Case: A 14-year-old Caucasian woman with adult-onset dermatomyositis (ADM) on MTX therapy presented for evaluation of a right breast mass and multiple soft tissue nodules. FNABs of the right breast mass and a left upper extremity nodule both demonstrated benign calcified material. Six months later, the patient returned for evaluation of the persistent right breast mass and repeat FNAB revealed adenocarcinoma. Concurrently, a right hip soft tissue nodule was aspirated, demonstrating benign crystalline debris. MTX therapy was discontinued, and the patient subsequently underwent a lumpectomy of the right breast 1 month after FNAB diagnosis, displaying infiltrative ductal carcinoma. Of note, 2 months after her lumpectomy, MTX therapy was restarted and the patient continues to have adequate control of ADM symptoms with persistent, clinically benign soft tissue calcifications. Conclusion: Performing FNAB on soft tissue lesions can obviate needless tissue biopsies of CC in appropriate rheumatology patients, thus avoiding the risks and complications associated with more invasive procedures. © The International Academy of Cytology. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) methotrexate (adverse drug reaction, drug therapy, oral drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) dermatomyositis (drug therapy) drug induced disease (complication) methotrexate nodule (complication) skin calcification (side effect, complication, side effect) EMTREE MEDICAL INDEX TERMS adenocarcinoma (diagnosis, surgery) aged article breast tumor (diagnosis, surgery) cancer adjuvant therapy cancer radiotherapy case report clinical evaluation drug withdrawal female fine needle aspiration biopsy human human tissue infiltrating ductal carcinoma (diagnosis, surgery) mammography partial mastectomy priority journal soft tissue calcification (complication) CAS REGISTRY NUMBERS methotrexate (15475-56-6, 59-05-2, 7413-34-5) EMBASE CLASSIFICATIONS Dermatology and Venereology (13) Cancer (16) Drug Literature Index (37) Adverse Reactions Titles (38) General Pathology and Pathological Anatomy (5) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2008359569 MEDLINE PMID 18702364 (http://www.ncbi.nlm.nih.gov/pubmed/18702364) PUI L352063026 COPYRIGHT Copyright 2017 Elsevier B.V., All rights reserved. RECORD 695 TITLE Use of acellular cadaveric dermis and tissue expansion in postmastectomy breast reconstruction AUTHOR NAMES Bindingnavele V. Gaon M. Ota K.S. Kulber D.A. Lee D.-J. AUTHOR ADDRESSES (Bindingnavele V.) Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, United States. (Gaon M.; Ota K.S., otak@westernu.edu; Kulber D.A.) The Division of Plastic and Reconstructive Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States. (Lee D.-J.) Department of Plastic Surgery, Kaiser Permanente West Los Angeles, Los Angeles, CA, United States. CORRESPONDENCE ADDRESS K.S. Ota, The Division of Plastic and Reconstructive Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States. Email: otak@westernu.edu SOURCE Journal of Plastic, Reconstructive and Aesthetic Surgery (2007) 60:11 (1214-1218). Date of Publication: November 2007 ISSN 1748-6815 BOOK PUBLISHER Churchill Livingstone, 1-3 Baxter's Place, Leith Walk, Edinburgh, United Kingdom. ABSTRACT Tissue expander or permanent implant coverage in postmastectomy breast reconstruction is often challenging. Multiple authors have demonstrated the use of acellular cadaveric dermis (ACD) in nonexpansive, single-stage breast reconstruction. The literature also suggests that tissue expansion may be accomplished with ACD as well for stage reconstructions. In many cases tissue expansion is necessary to create a submuscular and subACD pocket to accommodate a subsequent permanent prosthesis. In this study we report the outcomes and complication rates of using ACD in staged breast reconstruction. We reviewed the charts of 41 patients (65 breasts) in whom ACD was used in staged reconstructions. We analysed the patients' charts and operative records to determine postoperative complication rates and results. Complication rates for wound infection, expander removal, haematoma, and seroma were: 3.1% (two of 65), 1.5% (one of 65), 1.5% (one of 65), and 4.6% (three of 65), respectively. The use of ACD in expansive postmastectomy breast reconstruction has an extremely low complication rate, results in good cosmetic outcome, and should be in the repertoire of plastic surgeons. Further follow up is needed to evaluate the long term outcomes of ACD use in postmastectomy breast reconstruction. © 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. EMTREE DRUG INDEX TERMS antibiotic agent (drug therapy, intravenous drug administration, oral drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction EMTREE MEDICAL INDEX TERMS adult aged article cadaver cellulitis (complication, drug therapy) clinical article dermis female hematoma (complication, surgery) human human tissue implant infection rate mastectomy medical record review postoperative care postoperative infection (complication, drug therapy, prevention) postoperative period priority journal radiotherapy seroma (complication, surgery) surgical drainage EMBASE CLASSIFICATIONS Surgery (9) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007499494 MEDLINE PMID 17459797 (http://www.ncbi.nlm.nih.gov/pubmed/17459797) PUI L47570838 DOI 10.1016/j.bjps.2007.03.015 FULL TEXT LINK http://dx.doi.org/10.1016/j.bjps.2007.03.015 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 696 TITLE Does AlloDerm stretch? AUTHOR NAMES Nahabedian M.Y. AUTHOR ADDRESSES (Nahabedian M.Y., drnahabedian@aol.com) Department of Plastic Surgery, Georgetown University, Johns Hopkins University, Washington, DC, United States. (Nahabedian M.Y., drnahabedian@aol.com) Department of Plastic Surgery, Georgetown University Hospital, 3800 Reservoir Road, N.W., Washington, DC 20007, United States. CORRESPONDENCE ADDRESS M.Y. Nahabedian, Department of Plastic Surgery, Georgetown University Hospital, 3800 Reservoir Road, N.W., Washington, DC 20007, United States. Email: drnahabedian@aol.com SOURCE Plastic and Reconstructive Surgery (2007) 120:5 (1276-1280). Date of Publication: October 2007 ISSN 0032-1052 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) abdominal wall defect (complication, surgery) EMTREE MEDICAL INDEX TERMS article breast reconstruction clinical feature compressive strength deep inferior epigastric perforator flap human materials testing partial mastectomy priority journal reoperation surgical technique DEVICE TRADE NAMES AlloDerm , United StatesLifecell DEVICE MANUFACTURERS (United States)Lifecell EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2007477036 MEDLINE PMID 17898600 (http://www.ncbi.nlm.nih.gov/pubmed/17898600) PUI L47493951 DOI 10.1097/01.prs.0000279342.48795.9a FULL TEXT LINK http://dx.doi.org/10.1097/01.prs.0000279342.48795.9a COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 697 TITLE Inferolateral AlloDerm hammock for implant coverage in breast reconstruction AUTHOR NAMES Breuing K.H. Colwell A.S. AUTHOR ADDRESSES (Breuing K.H., kbreuing@partners.org; Colwell A.S.) Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States. (Breuing K.H., kbreuing@partners.org) Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States. CORRESPONDENCE ADDRESS K.H. Breuing, Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States. Email: kbreuing@partners.org SOURCE Annals of Plastic Surgery (2007) 59:3 (250-255). Date of Publication: September 2007 ISSN 0148-7043 BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United States. ABSTRACT PURPOSE: Implant reconstruction is commonly performed to reconstruct mastectomy defects or to correct breast hypoplasia. We have been using an inferolateral AlloDerm hammock as an inferior extension of the pectoralis major muscle to provide a mechanical barrier between the implant and skin and to control implant position. METHODS: The inferior border of the AlloDerm hammock is attached inferiorly to the rectus abdominis fascia and laterally to the serratus anterior fascia to create the borders of the implant pocket. The AlloDerm is then sewn to the pectoralis major muscle to enclose the implant. RESULTS: The AlloDerm hammock was used in 43 patients and 67 breasts for immediate expander-implant reconstruction (10), immediate silicone implant reconstruction (30), delayed expander-implant reconstruction (4), and revisional implant reconstruction for capsular contracture following capsulectomy (23). The AlloDerm hammock allowed complete coverage of the implant and symmetric positioning of the inframammary fold. In delayed reconstructions with existing skin redundancy at the mastectomy site, inferior epigastric tissue was recruited and tissue expanders filled over 75% of the desired volume, thus decreasing the need for subsequent filling. Patients were overall satisfied with their results and had few complications. No capsular contracture, hematoma, or seroma was observed in 6 months to 3 years of follow-up. CONCLUSION: Implant reconstruction with an inferolateral AlloDerm hammock facilitates positioning of the implant in immediate or revisional breast reconstruction and simplifies expander-implant reconstruction. This safe technique is easy to learn and should be considered a viable option for breast reconstruction. © 2007 Lippincott Williams & Wilkins, Inc. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction EMTREE MEDICAL INDEX TERMS adult article breast endoprosthesis clinical article contracture female hematoma human mastectomy patient satisfaction pectoralis major muscle priority journal rectus abdominis muscle seroma skin graft DEVICE TRADE NAMES AlloDerm EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007423921 MEDLINE PMID 17721209 (http://www.ncbi.nlm.nih.gov/pubmed/17721209) PUI L47329703 DOI 10.1097/SAP.0b013e31802f8426 FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0b013e31802f8426 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 698 TITLE Implant-based breast reconstruction with allograft AUTHOR NAMES Zienowicz R.J. Karacaoglu E. AUTHOR ADDRESSES (Karacaoglu E., ercan@brown.edu) 2 Dudley Street, Providence, RI 02905, United States. (Zienowicz R.J.) CORRESPONDENCE ADDRESS E. Karacaoglu, 2 Dudley Street, Providence, RI 02905, United States. Email: ercan@brown.edu SOURCE Plastic and Reconstructive Surgery (2007) 120:2 (373-381). Date of Publication: August 2007 ISSN 0032-1052 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. ABSTRACT BACKGROUND: Reconstructive breast surgeons often prefer autologous tissue for those patients who can tolerate it. However, reconstruction with implants is technically easier, quicker, less traumatic, and less costly. Nevertheless, inherent problems associated with implants present some limitations to their use in reconstruction. In this study, a multipurpose application of allogenic dermal grafts to solve the problems seen in immediate breast reconstruction with implants was examined. METHODS: After skin-sparing mastectomy, a subpectoral pocket is created for the implant. After the origins of the pectoralis major muscle are released, AlloDerm is sewn to the lower pole of the released muscle. Grafts are tailored according to the dimensions of the defect. AlloDerm, an allogenic dermal graft, is fixed to the pectoralis major superiorly, to the chest wall inferiorly and inferomedially, and to the serratus anterior flap laterally. A postoperative adjustable implant is placed into the pocket that has bene created. RESULT: Allografts were used to reconstruct 30 breasts in 24 patients immediately after skin- or nipple-sparing mastectomy. There was no complication related to simultaneous allograft application. No rippling, symmastia, or bottoming-out deformity was seen. CONCLUSIONS: Breast reconstruction with implant and AlloDerm enables the surgeon to create a submuscular pocket large enough to place a fully inflated breast implant. Interposition of a lower-pole internal sling, to increase the capacity of the pectoralis major pocket while providing immediate ability to achieve full or subtotal prosthetic fill and optimal aesthetic breast contouring and to maintain thicker muscle coverage in the upper and medial pole areas and stronger lower pole support, would obviate many of the current disadvantages to implant reconstruction. ©2007American Society of Plastic Surgeons. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast endoprosthesis breast reconstruction EMTREE MEDICAL INDEX TERMS adult allograft article clinical article female human mastectomy pectoralis major muscle postoperative period priority journal skin graft DEVICE TRADE NAMES AlloDerm , United StatesLifecell DEVICE MANUFACTURERS (United States)Lifecell (United States)Mentor (United States)Spectrum EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007345042 MEDLINE PMID 17632337 (http://www.ncbi.nlm.nih.gov/pubmed/17632337) PUI L47067486 DOI 10.1097/01.prs.0000267340.31742.1 FULL TEXT LINK http://dx.doi.org/10.1097/01.prs.0000267340.31742.1 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 699 TITLE Breast mound salvage using vacuum-assisted closure device as bridge to reconstruction with inferolateral AlloDerm hammock AUTHOR NAMES Liao E.C. Breuing K.H. AUTHOR ADDRESSES (Liao E.C.; Breuing K.H., kbreuing@partners.org) Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States. (Breuing K.H., kbreuing@partners.org) Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States. CORRESPONDENCE ADDRESS K.H. Breuing, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States. Email: kbreuing@partners.org SOURCE Annals of Plastic Surgery (2007) 59:2 (218-224). Date of Publication: August 2007 ISSN 0148-7043 BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United States. EMTREE DRUG INDEX TERMS bacitracin levofloxacin lisinopril (drug therapy) silicone gel sodium chloride vancomycin (drug therapy, intravenous drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction vacuum assisted closure EMTREE MEDICAL INDEX TERMS adult aged article body image borderline hypertension (drug therapy) breast carcinoma (surgery) breast endoprosthesis breast injury case report cellulitis (drug therapy) device removal female gardening human implant lung carcinoma (surgery) mastectomy nuclear magnetic resonance imaging operating room postoperative period priority journal silicone prosthesis surgical technique wound infection CAS REGISTRY NUMBERS bacitracin (1405-87-4) levofloxacin (100986-85-4, 138199-71-0) lisinopril (76547-98-3, 83915-83-7) sodium chloride (7647-14-5) vancomycin (1404-90-6, 1404-93-9) EMBASE CLASSIFICATIONS Surgery (9) Chest Diseases, Thoracic Surgery and Tuberculosis (15) Cancer (16) Drug Literature Index (37) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2007387529 MEDLINE PMID 17667419 (http://www.ncbi.nlm.nih.gov/pubmed/17667419) PUI L47220429 DOI 10.1097/SAP.0b013e31802c148c FULL TEXT LINK http://dx.doi.org/10.1097/SAP.0b013e31802c148c COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 700 TITLE Use of AlloDerm in primary nipple reconstruction to improve long-term nipple projection AUTHOR NAMES Garramone C.E. Lam B. AUTHOR ADDRESSES (Garramone C.E., cgarramone@yahoo.com; Lam B.) Department of Plastic and Reconstructive Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, United States. (Garramone C.E., cgarramone@yahoo.com) Aesthetic Plastic Surgery Institute, P.A., 220 S.W. 84th Avenue, Plantation, FL 33324, United States. CORRESPONDENCE ADDRESS C.E. Garramone, Aesthetic Plastic Surgery Institute, P.A., 220 S.W. 84th Avenue, Plantation, FL 33324, United States. Email: cgarramone@yahoo.com SOURCE Plastic and Reconstructive Surgery (2007) 119:6 (1663-1668). Date of Publication: May 2007 ISSN 0032-1052 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. ABSTRACT BACKGROUND: The objective of this study was to demonstrate the use of the authors' technique to improve long-term maintenance of nipple projection by using AlloDerm (LifeCell Corp., Branchburg, N.J.) as a central core in nipple reconstruction. METHODS: The nipple reconstruction technique involved the use of a modified star dermal flap pattern measuring 5 cm in length and 1.0 to 1.5 cm in width, depending on the amount of desired projection to match the opposite nipple. Then, a 1.5 × 4.5-cm piece of AlloDerm was placed into the core of the newly reconstructed nipple and sutured closed. After the incisions were closed, an ocular eye bubble protector was used to prevent compressive forces on the newly reconstructed nipple, and strict postoperative use of this protector was maintained for 6 weeks. RESULTS: A total of 30 nipple reconstructions were performed [14 transverse rectus abdominis musculocutaneous (TRAM) flaps and 16 tissue-expanded breast mounds]. Caliper measurements of nipple projection were recorded at the time of surgery and at 3, 6, and 12 months postoperatively. Twelve-month average maintenance of nipple projection was 56 percent for the TRAM flap group and 47 percent for the tissue-expanded group. There were no infections or associated complications. CONCLUSIONS: The authors' results demonstrate that the use of a modified star dermal flap pattern with the placement of an AlloDerm graft core is a safe, easily performed, and reproducible technique for improving the long-term maintenance of projection in reconstructed nipples. ©2007American Society of Plastic Surgeons. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction nipple EMTREE MEDICAL INDEX TERMS article clinical article compression dermis human infection postoperative care postoperative complication priority journal safety skin flap surgical technique suture technique tissue expansion transverse rectus abdominis musculocutaneous flap DEVICE MANUFACTURERS (United States)Lifecell EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007199025 MEDLINE PMID 17440338 (http://www.ncbi.nlm.nih.gov/pubmed/17440338) PUI L46632044 DOI 10.1097/01.prs.0000258831.38615.80 FULL TEXT LINK http://dx.doi.org/10.1097/01.prs.0000258831.38615.80 COPYRIGHT Copyright 2008 Elsevier B.V., All rights reserved. RECORD 701 TITLE A randomized controlled study comparing uracil-tegafur (UFT)+tamoxifen (UFT+TAM therapy) with cyclophosphamide+adriamycin+5-fluorouracil (CAF therapy) for women with stage I , II, or IIIa breast cancer with four or more involved nodes in the adjuvant setting AUTHOR NAMES Inaji H. Sakai K. Oka T. Ozawa K. Saito Y. Senoo T. Taguchi T. Terasawa T. Nakao K. Mori T. Koyama H. Oshima A. AUTHOR ADDRESSES (Inaji H.; Sakai K.; Oka T.; Ozawa K.; Saito Y.; Senoo T.; Taguchi T.; Terasawa T.; Nakao K.; Mori T.; Koyama H.; Oshima A.) Osaka Medical Center for Cancer and Cardiovascular Diseases. CORRESPONDENCE ADDRESS H. Inaji, Osaka Medical Center for Cancer and Cardiovascular Diseases. SOURCE Gan to kagaku ryoho. Cancer & chemotherapy (2006) 33:10 (1423-1429). Date of Publication: Oct 2006 ISSN 0385-0684 ABSTRACT We performed a controlled study to compare the response to cyclophosphamide (CPA), adriamycin (ADM), and fluorouracil (5-FU) (CAF therapy) with that to uracil-tegafur (UFT) plus tamoxifen (TAM) (UFT+TAM therapy), when given as postoperative adjuvant therapy to women with breast cancer. The patients were registered from September 1991 through February 1995 at 51 institutions in the Kinki district of Japan. All patients had stage I, II, or IIIa breast cancer with four or more lymph-node metastases and underwent mastectomy. CAF therapy and UFT+TAM therapy were started within 4 weeks after surgery. CAF therapy consisted of CPA (100 mg/day) on days 1 to 14, followed by 2 weeks of rest, plus ADM (20 mg/m(2)/day) on days 1 and 8 and 5-FU (300 mg/m(2)/day) on days 1 and 8. A total of 6 courses were delivered. UFT+TAM therapy consisted of 3 years of UFT (400 mg/day) plus TAM (20 mg/day), given daily. CAF therapy and UFT+TAM therapy were each assigned to 82 patients. The 5-year survival rate was significantly higher in the UFT+TAM group (82.1%) than in the CAF group (66.2%; p=0.04, logrank test). The 5-year relapse-free survival rate was higher in the UFT+TAM group (61.8%) than in the CAF group (46.3%; p=0.07, logrank test). As for adverse events, the rates of leukopenia, anorexia, nausea and vomiting, general malaise, and hair loss were lower in the UFT+TAM group than in the CAF group. These results suggest that long-term treatment with UFT+TAM may be a useful alternative adjuvant therapy for the management of breast cancer, especially in elderly patients. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) antineoplastic agent (adverse drug reaction, drug administration, drug therapy) EMTREE DRUG INDEX TERMS 1 UFT protocol 1-UFT protocol antineoplastic hormone agonists and antagonists (drug administration) CAF protocol cyclophosphamide (drug administration) doxorubicin (drug administration) fluorouracil (drug administration) tamoxifen (drug administration) tegafur (drug administration) uracil (drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (drug therapy, surgery) lymph node EMTREE MEDICAL INDEX TERMS adjuvant chemotherapy anorexia article cancer staging chemically induced disorder clinical trial comparative study controlled clinical trial controlled study drug administration female human leukopenia lymph node metastasis mastectomy middle aged mortality multicenter study multimodality cancer therapy pathology randomized controlled trial survival rate vomiting (etiology) CAS REGISTRY NUMBERS cyclophosphamide (50-18-0) doxorubicin (23214-92-8, 25316-40-9) fluorouracil (51-21-8) tamoxifen (10540-29-1) tegafur (17902-23-7) uracil (66-22-8) LANGUAGE OF ARTICLE Japanese MEDLINE PMID 17033231 (http://www.ncbi.nlm.nih.gov/pubmed/17033231) PUI L44695203 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 702 TITLE Nonexpansive immediate breast reconstruction using human acellular tissue matrix graft (AlloDerm) AUTHOR NAMES Salzberg C.A. AUTHOR ADDRESSES (Salzberg C.A., asalzbergmd@yahoo.com) Department of Surgery-Section of Plastic Surgery, New York Medical College, Valhalla, NY, United States. (Salzberg C.A., asalzbergmd@yahoo.com) New York Group for Plastic Surgery, 155 White Plains Road, Tarrytown, NY 10591, United States. CORRESPONDENCE ADDRESS C.A. Salzberg, New York Group for Plastic Surgery, 155 White Plains Road, Tarrytown, NY 10591, United States. Email: asalzbergmd@yahoo.com SOURCE Annals of Plastic Surgery (2006) 57:1 (1-5). Date of Publication: July 2006 ISSN 0148-7043 BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United States. ABSTRACT Immediate breast reconstruction has become a standard of care following mastectomy for cancer, largely due to improved esthetic and psychologic outcomes achieved with this technique. However, the current historical standards-transverse rectus abdominis myocutaneous flap reconstruction and expander-implant surgery-still have limitations as regards patient morbidity, short-term body-image improvements, and even cost. To address these shortcomings, we employ a novel concept of human tissue replacement to enhance breast shape and provide total coverage, enabling immediate mound reconstruction without the need for breast expansion prior to permanent implant placement. AlloDerm (human acellular tissue matrix) is a human-derived graft tissue with extensive experience in various settings of skin and soft tissue replacement surgery. This report describes the success using acellular tissue matrix to provide total coverage over the prosthesis in immediate reconstruction, with limited muscle dissection. In this population, 49 patients (76 breasts) successfully underwent the acellular tissue matrix-based immediate reconstruction, resulting in durable breast reconstruction with good symmetry. These findings may predict that acellular tissue matrix-supplemented immediate breast reconstruction will become a new technique for the immediate reconstruction of the postmastectomy breast. Copyright © 2006 by Lippincott Williams & Wilkins. EMTREE DRUG INDEX TERMS elastin (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular tissue matrix breast reconstruction implant mastectomy EMTREE MEDICAL INDEX TERMS article body image breast biopsy breast cancer (surgery) clinical article cost epidermolysis (complication) female follow up histopathology human length of stay mammography morbidity myocutaneous flap nuclear magnetic resonance imaging patient satisfaction patient selection postoperative care postoperative pain (complication) preoperative evaluation priority journal reoperation silicone prosthesis skin necrosis (complication) surgical technique tissue expansion DEVICE TRADE NAMES AlloDerm , United StatesLifecell DEVICE MANUFACTURERS (United States)Lifecell CAS REGISTRY NUMBERS elastin (9007-58-3) EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2006313774 MEDLINE PMID 16799299 (http://www.ncbi.nlm.nih.gov/pubmed/16799299) PUI L43982243 DOI 10.1097/01.sap.0000214873.13102.9f FULL TEXT LINK http://dx.doi.org/10.1097/01.sap.0000214873.13102.9f COPYRIGHT Copyright 2011 Elsevier B.V., All rights reserved. RECORD 703 TITLE Use of regenerative human acellular tissue (AlloDerm) to reconstruct the abdominal wall following pedicle TRAM flap breast reconstruction surgery AUTHOR NAMES Glasberg S.B. D'Amico R.A. AUTHOR ADDRESSES (Glasberg S.B., scotbg@juno.com) Cosmetic and Reconstructive Plastic Surgery, 42A East 74th Street, New York, NY 10021, United States. (D'Amico R.A.) CORRESPONDENCE ADDRESS S.B. Glasberg, Cosmetic and Reconstructive Plastic Surgery, 42A East 74th Street, New York, NY 10021, United States. Email: scotbg@juno.com SOURCE Plastic and Reconstructive Surgery (2006) 118:1 (8-15). Date of Publication: July 2006 ISSN 0032-1052 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. ABSTRACT BACKGROUND: Harvest of transverse rectus abdominis musculocutaneous (TRAM) flaps for breast reconstruction leaves a variable defect in the anterior rectus fascia. Inadequate closure of the defect could lead to the development of hernia or abdominal wall bulging. Various techniques have been developed to reduce the incidence of hernia and abdominal wall bulging. The authors describe a novel technique of using a regenerative human acellular matrix (AlloDerm) as a fascial substitute in closing the defect. METHODS: Fifty-four consecutive patients who opted for pedicle TRAM flap procedures for breast reconstruction postmastectomy were scheduled for donor-site repair with the use of AlloDerm. AlloDerm was placed interpositionally as an inlay graft to mimic the anterior rectus fascia. RESULTS: Hernia or infection did not develop in any of the patients. There was a greater incidence of seroma and bulging among the first 18 patients, with eight seromas (44.4 percent) and six bulges (33.3 percent). When the technique was ameliorated in the next 36 patients, there was a reduction in the incidence of seromas (16.7 percent, p = 0.03) and bulges (16.7 percent, p = 0.17). Of the three patients who experienced wound dehiscence, partial AlloDerm exposure occurred in two, but was resolved without further consequences. Biopsy specimens of AlloDerm, obtained 12 and 14 months after TRAM donor-site repair, showed full tissue integration. The cell density, vasculature, and collagen orientation in the biopsies were consistent with abdominal fascia tissue. CONCLUSION: Based on these results, the authors recommend the use of AlloDerm as an alternative option for abdominal fascia closure after TRAM flap harvest for breast reconstruction. Copyright ©2006 by the American Society of Plastic Surgeons. EMTREE DRUG INDEX TERMS collagen (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) abdominal surgery breast reconstruction myocutaneous flap plastic surgery tissue flap EMTREE MEDICAL INDEX TERMS abdominal wall abdominal wall hernia adult article biopsy cell density fascia female human human tissue incidence infection complication major clinical study pedicled skin flap postoperative complication (complication) postoperative period priority journal rectus abdominis muscle seroma (complication) surgical patient surgical technique vascularization wound dehiscence (complication) DEVICE TRADE NAMES AlloDerm , United StatesLifecell DEVICE MANUFACTURERS (United States)Lifecell CAS REGISTRY NUMBERS collagen (9007-34-5) EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2006427395 MEDLINE PMID 16816665 (http://www.ncbi.nlm.nih.gov/pubmed/16816665) PUI L44324158 DOI 10.1097/01.prs.0000220470.97776.f5 FULL TEXT LINK http://dx.doi.org/10.1097/01.prs.0000220470.97776.f5 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 704 TITLE Implant breast reconstruction using acellular dermal matrix AUTHOR NAMES Gamboa-Bobadilla G.M. AUTHOR ADDRESSES (Gamboa-Bobadilla G.M., MGamboa@mcg.edu) Section of Plastic Surgery, Department of Surgery, Medical College of Georgia, Augusta, GA, United States. (Gamboa-Bobadilla G.M., MGamboa@mcg.edu) Medical College of Georgia, HB-5040, 1467 Harper Street, Augusta, GA 30901-4080, United States. CORRESPONDENCE ADDRESS G.M. Gamboa-Bobadilla, Medical College of Georgia, HB-5040, 1467 Harper Street, Augusta, GA 30901-4080, United States. Email: MGamboa@mcg.edu SOURCE Annals of Plastic Surgery (2006) 56:1 (22-25). Date of Publication: January 2006 ISSN 0148-7043 BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United States. ABSTRACT Thirteen breast reconstructions in 11 patients, averaging 58 years of age, underwent mastectomies. The technique uses a saline implant either totally or partially covered with a human acellular dermal matrix. The mean postoperative follow-up time was 14 months. Ninety percent of the patients were considered high risk; the thickness of the human acellular dermal matrix was an average of 1.3 mm, with an average area per breast of 121 cm(2). There were 12 successful breast reconstructions (92%) that provided stability, increased soft tissue padding, which allowed a greater resemblance to normal breast shape and decreased rippling and implant visibility. The graft was used in an onlay fashion or as an extension of the pectoralis major muscle that covers the implant. A representative histologic cross-section of well-integrated human acellular dermal matrix is presented. The use of a human acellular dermal matrix in breast reconstruction is an alternative protocol in high-risk patients, resulting in a minimal increase in operative time and a decrease in morbidity compared with more extensive procedures. Copyright © 2005 by Lippincott Williams & Wilkins. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) sodium chloride EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) acellular dermal matrix breast endoprosthesis breast reconstruction EMTREE MEDICAL INDEX TERMS adult aged article clinical article follow up high risk patient histology human implant mastectomy pectoralis major muscle postoperative period priority journal surgical technique treatment outcome DEVICE TRADE NAMES AlloDerm , United StatesLifecell DEVICE MANUFACTURERS (United States)Lifecell CAS REGISTRY NUMBERS sodium chloride (7647-14-5) EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2006013836 MEDLINE PMID 16374090 (http://www.ncbi.nlm.nih.gov/pubmed/16374090) PUI L43042268 DOI 10.1097/01.sap.0000185460.31188.c1 FULL TEXT LINK http://dx.doi.org/10.1097/01.sap.0000185460.31188.c1 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 705 TITLE Total skin-sparing mastectomy without preservation of the nipple-areola complex AUTHOR NAMES Margulies A.G. Hochberg J. Kepple J. Henry-Tillman R.S. Westbrook K. Klimberg V.S. AUTHOR ADDRESSES (Margulies A.G.; Kepple J.; Henry-Tillman R.S.; Westbrook K.; Klimberg V.S., klimbergsuzanne@uams.edu) Division of Breast Surgical Oncology, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States. (Hochberg J.) Division of Plastic Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States. (Klimberg V.S., klimbergsuzanne@uams.edu) Central Arkansas Veterans Hospital Service, Little Rock, AR, United States. (Klimberg V.S., klimbergsuzanne@uams.edu) 4301 W. Markham, Little Rock, AR 72205-7199, United States. CORRESPONDENCE ADDRESS V.S. Klimberg, 4301 W. Markham, Little Rock, AR 72205-7199, United States. Email: klimbergsuzanne@uams.edu SOURCE American Journal of Surgery (2005) 190:6 (907-912). Date of Publication: December 2005 ISSN 0002-9610 BOOK PUBLISHER Elsevier Inc., 360 Park Avenue South, New York, United States. ABSTRACT Background: We hypothesized that total skin-sparing mastectomy (TSM) including where the skin overlying the nipple and areola is preserved would be oncologically safe and facilitate improved cosmetic reconstruction. Methods: A review (May 2003 through January 2005) was completed on all procedures that were performed through an inframammary incision or a previous scar with reconstruction using Botox, AlloDerm, and a subpectoral tissue implant. Results: Thirty-one patients had 50 TSMs. Twelve percent (6/50) of TSMs had the skin of the nipple and areola resected: 4 (14% of tumors) because of tumor involvement and 2 (4%) because of skin necrosis. Fourteen percent of patients had other complications: 4% (2/50) had infection and/or flap necrosis and 10% (5/50) had superficial epidermolysis requiring no intervention, for a total complication rate of 18%. Average cosmetic score was 8.5 (range 4 to 10). No recurrences are evident after mean follow-up of 7.9 ± 5.4 months. Conlusion: Our short-term experience suggests that TSM has an acceptable complication rate, is theoretically oncologically safe, and facilitates an improved cosmetic result. © 2005 Excerpta Medica Inc. All rights reserved. EMTREE DRUG INDEX TERMS botulinum toxin A EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast carcinoma (surgery) breast reconstruction partial mastectomy EMTREE MEDICAL INDEX TERMS adult aged article breast areola breast prosthesis clinical article controlled study epidermolysis (complication) esthetic surgery female follow up human muscle flap nipple patient monitoring pectoralis major muscle postoperative complication (complication) priority journal prosthesis infection (complication) recurrent disease scoring system skin incision skin necrosis (surgery) surgical patient surgical technique CAS REGISTRY NUMBERS botulinum toxin A (93384-43-1) EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2005531327 MEDLINE PMID 16307944 (http://www.ncbi.nlm.nih.gov/pubmed/16307944) PUI L41674622 DOI 10.1016/j.amjsurg.2005.08.019 FULL TEXT LINK http://dx.doi.org/10.1016/j.amjsurg.2005.08.019 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 706 TITLE Immediate bilateral breast reconstruction with implants and inferolateral AlloDerm slings AUTHOR NAMES Breuing K.H. Warren S.M. AUTHOR ADDRESSES (Breuing K.H., kbreuing@partners.org; Warren S.M.) Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States. (Breuing K.H., kbreuing@partners.org) Division of Plastic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States. CORRESPONDENCE ADDRESS K.H. Breuing, Division of Plastic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States. Email: kbreuing@partners.org SOURCE Annals of Plastic Surgery (2005) 55:3 (232-239). Date of Publication: September 2005 ISSN 0148-7043 BOOK PUBLISHER Lippincott Williams and Wilkins, 530 Walnut Street, Philadelphia, United States. ABSTRACT To shorten the reconstructive process, improve results, and provide additional options for women seeking mastectomy, we used an acellular cryopreserved dermal matrix (AlloDerm) sling to reestablish the lower pole of the pectoralis major muscle. This technique creates a subpectoral-sub-AlloDerm pocket that completely encloses the breast implant. By tailoring the width of the AlloDerm, we can precisely control the degree of lower-pole fullness. This technique shortens or eliminates the need for tissue expansion and provides an additional option for single-stage breast reconstruction with implants. We have selectively used this technique as a reconstructive option for 10 women undergoing bilateral mastectomy (20 breasts). Copyright © 2005 by Lippincott Williams & Wilkins. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast endoprosthesis breast reconstruction EMTREE MEDICAL INDEX TERMS adult article breast cancer (surgery) case report female human implant mastectomy pectoralis major muscle priority journal surgical technique tissue expansion DEVICE TRADE NAMES AlloDerm , United StatesLifecell DEVICE MANUFACTURERS (United States)Lifecell EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2005391868 MEDLINE PMID 16106158 (http://www.ncbi.nlm.nih.gov/pubmed/16106158) PUI L41216076 DOI 10.1097/01.sap.0000168527.52472.3c FULL TEXT LINK http://dx.doi.org/10.1097/01.sap.0000168527.52472.3c COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 707 TITLE Secondary nipple reconstruction using local flaps and AlloDerm AUTHOR NAMES Nahabedian M.Y. AUTHOR ADDRESSES (Nahabedian M.Y., moandanissa@aol.com) (Nahabedian M.Y., moandanissa@aol.com) Division of Plastic and Reconstructive Surgery, Johns Hopkins University, . (Nahabedian M.Y., moandanissa@aol.com) Georgetown University Hospital, 3800 Reservoir Road, N. W., Washington, DC 20007, United States. CORRESPONDENCE ADDRESS M.Y. Nahabedian, Georgetown University Hospital, 3800 Reservoir Road, N. W., Washington, DC 20007, United States. Email: moandanissa@aol.com SOURCE Plastic and Reconstructive Surgery (2005) 115:7 (2056-2061). Date of Publication: June 2005 ISSN 0032-1052 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. ABSTRACT Secondary nipple reconstruction using AlloDerm results in improved nipple projection. This was demonstrated in seven of eight nipple reconstructions (88 percent). In the only nipple that flattened, a tertiary reconstruction again using AlloDerm resulted in good projection. This limited experience has demonstrated that AlloDerm is simple to use, well tolerated, and has the potential for improved long-term nipple projection. Further studies are warranted. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast reconstruction nipple reconstruction skin flap EMTREE MEDICAL INDEX TERMS adult article breast endoprosthesis clinical article controlled study female follow up human nipple patient satisfaction plastic surgery priority journal skin blood flow skin graft surgical technique treatment indication treatment outcome DEVICE TRADE NAMES AlloDerm , United StatesLifecell DEVICE MANUFACTURERS (United States)Lifecell EMBASE CLASSIFICATIONS Surgery (9) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2005248777 MEDLINE PMID 15923855 (http://www.ncbi.nlm.nih.gov/pubmed/15923855) PUI L40770520 DOI 10.1097/01.PRS.0000164490.99581.F9 FULL TEXT LINK http://dx.doi.org/10.1097/01.PRS.0000164490.99581.F9 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 708 TITLE Chest wall reconstruction with acellular dermal matrix (AlloDerm) and a latissimus muscle flap [14] AUTHOR NAMES Cothren C.C. Gallego K. Anderson E.D. Schmidt D. AUTHOR ADDRESSES (Cothren C.C.) Department of Surgery, Denver Health Medical Center, Univ. of Colorado Hlth. Sci. Center, Denver, CO, United States. (Gallego K.; Anderson E.D.; Schmidt D., douglas.schmidt@dhha.org) Division of Plastic Surgery, Denver Health Medical Center, Univ. of Colorado Hlth. Sci. Center, Denver, CO, United States. (Schmidt D., douglas.schmidt@dhha.org) Department of Surgery, Denver Health Medical Center, MC 0206, 777 Bannock Street, Denver, CO 80204, United States. CORRESPONDENCE ADDRESS D. Schmidt, Department of Surgery, Denver Health Medical Center, MC 0206, 777 Bannock Street, Denver, CO 80204, United States. Email: douglas.schmidt@dhha.org SOURCE Plastic and Reconstructive Surgery (2004) 114:4 (1015-1017). Date of Publication: 15 Sep 2004 ISSN 0032-1052 BOOK PUBLISHER Lippincott Williams and Wilkins, 351 West Camden Street, Baltimore, United States. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) dermis latissimus dorsi flap thorax wall defect (surgery) thorax wall reconstruction EMTREE MEDICAL INDEX TERMS adult axillary lymph node breast carcinoma (surgery) case report clinical feature convalescence devices female follow up human letter lymph node dissection partial mastectomy priority journal skin ulcer (complication) spindle cell sarcoma (surgery) symptom thorax wall cancer (radiotherapy, surgery) tumor invasion (complication, surgery) wound closure DEVICE TRADE NAMES AlloDerm , United StatesLifecell DEVICE MANUFACTURERS (United States)Kinetic Concepts (United States)Lifecell EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Biophysics, Bioengineering and Medical Instrumentation (27) LANGUAGE OF ARTICLE English EMBASE ACCESSION NUMBER 2005122558 MEDLINE PMID 15468424 (http://www.ncbi.nlm.nih.gov/pubmed/15468424) PUI L40362134 DOI 10.1097/01.PRS.0000138709.06161.1B FULL TEXT LINK http://dx.doi.org/10.1097/01.PRS.0000138709.06161.1B COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 709 TITLE A case of breast cancer with multiple bone metastases demonstrating complete remission with high-dose toremifene therapy AUTHOR NAMES Saito Y. Amano S. Kashio M. Abe H. Kuboi Y. Sakurai K. Aoki N. Hata S. Negishi N. AUTHOR ADDRESSES (Saito Y.; Amano S.; Kashio M.; Abe H.; Kuboi Y.; Sakurai K.; Aoki N.; Hata S.; Negishi N.) Dept. of Breast and Endocrine Surgery, Nihon University School of Medicine. CORRESPONDENCE ADDRESS Y. Saito, Dept. of Breast and Endocrine Surgery, Nihon University School of Medicine. SOURCE Gan to kagaku ryoho. Cancer & chemotherapy (2004) 31:6 (911-914). Date of Publication: Jun 2004 ISSN 0385-0684 ABSTRACT We report a 64-year-old woman who underwent mastectomy for stage II (T2N1M0) advanced breast cancer, in whom multiple spine metastases developed 18 months postoperatively. She received 6 cycles of CA (cyclophosphamide 500 mg/m2, ADM 50 mg/m2 3 wq) therapy and oral tamoxifen (20 mg/body) administration for adjuvant therapy. The multiple bone metastases of the spine were revealed by technetium bone scan. The level of serum tumor marker CA15-3 increased two times over the normal range 18 months after surgery. She also developed osteoporosis a few years later, so we selected high-dose toremifene administration (120 mg/body) as a second-line therapy. No adverse effects have occurred and bone metastases disappeared. Moreover, the tumor marker was also normalized 6 months after toremifene therapy started. It was shown that high-dose treatment of toremifene was useful for recurrent breast cancer with bone metastasis. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) antineoplastic hormone agonists and antagonists (drug administration) toremifene (drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) bone tumor breast tumor (drug therapy) Paget nipple disease (drug therapy) EMTREE MEDICAL INDEX TERMS adjuvant chemotherapy article case report dose response drug administration female human mastectomy metastasis middle aged pathology remission CAS REGISTRY NUMBERS toremifene (89778-26-7) LANGUAGE OF ARTICLE Japanese MEDLINE PMID 15222111 (http://www.ncbi.nlm.nih.gov/pubmed/15222111) PUI L38837637 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 710 TITLE Surgical treatment of breast cancer after neoadjuvant therapy ORIGINAL (NON-ENGLISH) TITLE La chirurgia del cancro della mammella dopo terapia neoadiuvante. AUTHOR NAMES Gioffrè Florio M.A. Famà F. Giacobbe G. Pollicino A. Scarfò P. AUTHOR ADDRESSES (Gioffrè Florio M.A.; Famà F.; Giacobbe G.; Pollicino A.; Scarfò P.) Università degli Studi di Messina. CORRESPONDENCE ADDRESS M.A. Gioffrè Florio, Università degli Studi di Messina. SOURCE Chirurgia italiana (2003) 55:2 (173-178). Date of Publication: 2003 Mar-Apr ISSN 0009-4773 ABSTRACT Primary chemotherapy represents a new therapeutic strategy that allows the implementation of conservative surgical treatment in locally advanced breast cancer or in cancers measuring > 3 cm. Of 127 patients with breast cancers measuring > 2.5 cm, 86 were treated with primary chemotherapy. This consisted in the administration of the ADM + TAX protocol in 28 cases and CNF in 58 cases. Three complete responses, 8 cases of stable disease and 75 partial responses were observed. Eleven radical mastectomies and 74 conservative treatments were performed. The chemotherapy protocol enabled us to convert 87% of the patients treated to conservative treatment, thus affording a treatment that offers a better quality of life despite the existence of a voluminous cancer and is of considerable psychological help in patients suffering from cancer of the breast. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) antineoplastic agent (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adjuvant therapy breast tumor (drug therapy, surgery) partial mastectomy EMTREE MEDICAL INDEX TERMS adult aged article echography female human methodology middle aged psychological aspect quality of life retrospective study treatment outcome LANGUAGE OF ARTICLE Italian MEDLINE PMID 12744090 (http://www.ncbi.nlm.nih.gov/pubmed/12744090) PUI L36691446 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 711 TITLE Effective transarterial neoadjuvant chemotherapy with paclitaxel (TXL) in a case of locally advanced breast cancer AUTHOR NAMES Koga Y. Ohchi T. Kudo S. Ogata K. Nakamura T. Ishiodori H. Ochiai T. Muranaka T. Ishihara A. AUTHOR ADDRESSES (Koga Y.; Ohchi T.; Kudo S.; Ogata K.; Nakamura T.; Ishiodori H.; Ochiai T.; Muranaka T.; Ishihara A.) Dept. of Surgery, Miyazaki Prefectural Nobeoka Hospital. CORRESPONDENCE ADDRESS Y. Koga, Dept. of Surgery, Miyazaki Prefectural Nobeoka Hospital. SOURCE Gan to kagaku ryoho. Cancer & chemotherapy (2003) 30:2 (255-258). Date of Publication: Feb 2003 ISSN 0385-0684 ABSTRACT The patient was a 49-year-old woman who had locally advanced breast cancer with skin invasion. She was placed on neoadjuvant weekly systemic chemotherapy of TXL (65 mg/m2) and ADM (20 mg/m2). After systemic chemotherapy, she underwent 2 courses of transarterial neoadjuvant chemotherapy of TXL (day 1, 8, 15). We administered TXL (45 mg/m2) into the subclavian artery and TXL (20 mg/m2) into the internal thoracic artery. Although she experienced grade 3 leukopenia during systemic chemotherapy, she experienced only grade 2 alopecia and grade 1 nausea during transarterial chemotherapy. After chemotherapy, she underwent radical mastectomy. We report herein a case in which transarterial neoadjuvant chemotherapy with TXL was effective. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) antineoplastic agent (drug administration) paclitaxel (drug administration) EMTREE DRUG INDEX TERMS doxorubicin (drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (drug therapy, surgery) EMTREE MEDICAL INDEX TERMS adjuvant therapy article case report drug administration female human intraarterial drug administration mammary artery mastectomy middle aged subclavian artery CAS REGISTRY NUMBERS doxorubicin (23214-92-8, 25316-40-9) paclitaxel (33069-62-4) LANGUAGE OF ARTICLE Japanese MEDLINE PMID 12610875 (http://www.ncbi.nlm.nih.gov/pubmed/12610875) PUI L36489108 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 712 TITLE A case of advanced recurrent breast cancer responding to treatment with weekly docetaxel combined with doxorubicin AUTHOR NAMES Sawada M. Ono Y. Fukushima M. AUTHOR ADDRESSES (Sawada M.; Ono Y.; Fukushima M.) Dept. of Surgery, Hirosaki Central Hospital. CORRESPONDENCE ADDRESS M. Sawada, Dept. of Surgery, Hirosaki Central Hospital. SOURCE Gan to kagaku ryoho. Cancer & chemotherapy (2003) 30:2 (259-262). Date of Publication: Feb 2003 ISSN 0385-0684 ABSTRACT The patient was a 60-year-old women who had undergone left modified radical mastectomy on April 7, 1999, and was treated with chemo- and hormonal therapy of UFT and TAM. Two years and 6 months later, she showed multiple lung metastases. Because 5'-DFUR + MPA therapy was not effective, weekly docetaxel (TXT) + adriamycin (ADM) was carried out, and definite improvement in the lung and lymph nodes metastases was observed. It is suggested that this combination therapy may be useful for advanced recurrent breast cancer patients with multiple lung metastases. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) antineoplastic agent (drug therapy) paclitaxel (drug administration) taxoid EMTREE DRUG INDEX TERMS docetaxel doxifluridine doxorubicin (drug administration) drug derivative floxuridine (drug administration) medroxyprogesterone acetate (drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (drug therapy, surgery) Paget nipple disease (drug therapy, surgery) EMTREE MEDICAL INDEX TERMS article case report drug administration female human lung tumor lymph node metastasis mastectomy metastasis middle aged multimodality cancer therapy pathology skin tumor CAS REGISTRY NUMBERS docetaxel (114977-28-5) doxifluridine (3094-09-5) doxorubicin (23214-92-8, 25316-40-9) floxuridine (50-91-9) medroxyprogesterone acetate (71-58-9) paclitaxel (33069-62-4) LANGUAGE OF ARTICLE Japanese MEDLINE PMID 12610876 (http://www.ncbi.nlm.nih.gov/pubmed/12610876) PUI L36489109 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 713 TITLE Recurrence of right breast cancer at the thoracic wall successfully treated with intra-arterial infusion of doxorubicin hydrochloride--a case report AUTHOR NAMES Hasegawa S. Yamamoto Y. Ishiwa N. Yoshikawa T. Morinaga S. Noguchi Y. Matsumoto A. Nishimura J. Okoshi T. AUTHOR ADDRESSES (Hasegawa S.; Yamamoto Y.; Ishiwa N.; Yoshikawa T.; Morinaga S.; Noguchi Y.; Matsumoto A.; Nishimura J.; Okoshi T.) Dept. of Surgery, Kowan Hospital. CORRESPONDENCE ADDRESS S. Hasegawa, Dept. of Surgery, Kowan Hospital. SOURCE Gan to kagaku ryoho. Cancer & chemotherapy (2002) 29:12 (2399-2401). Date of Publication: Nov 2002 ISSN 0385-0684 ABSTRACT We report a recurrent case of breast cancer successfully treated with intra-arterial infusion of doxorubicin hydrochloride (ADM) combined with systemic CAF therapy. The patient, a 37-year-old woman, was diagnosed with a recurrence at the thoracic wall 55 months after curative resection for right breast cancer. She was treated with intra-arterial infusion chemotherapy of ADM, 30 mg, combined with systemic CAF therapy of cyclophosphamide, 100 mg from days 1 to 14, ADM, 30 mg on days 1 and 8, and 5-fluorouracil, 500 mg on days 1 and 8, as one course. Two courses of the treatment resulted in a complete response of the tumor. This result suggests that local and systemic chemotherapy could be effective for the treatment of local recurrence of breast cancer. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) antineoplastic agent (drug administration) doxorubicin (drug administration) EMTREE DRUG INDEX TERMS CAF protocol cyclophosphamide (drug administration) fluorouracil (drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (drug therapy, surgery) intraarterial drug administration EMTREE MEDICAL INDEX TERMS adult article case report female human mastectomy thorax tumor (drug therapy) tumor recurrence CAS REGISTRY NUMBERS cyclophosphamide (50-18-0) doxorubicin (23214-92-8, 25316-40-9) fluorouracil (51-21-8) LANGUAGE OF ARTICLE Japanese MEDLINE PMID 12484084 (http://www.ncbi.nlm.nih.gov/pubmed/12484084) PUI L35527623 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 714 TITLE Office education: sharing your knowledge. AUTHOR NAMES Akin J. AUTHOR ADDRESSES (Akin J.) CORRESPONDENCE ADDRESS J. Akin, SOURCE Plastic surgical nursing : official journal of the American Society of Plastic and Reconstructive Surgical Nurses (2002) 22:3 (157-160). Date of Publication: 2002 Fall ISSN 0741-5206 ABSTRACT The author's passion for plastic surgery nursing emerged from a life-changing experience involving skin grafting and skin reconstruction on her face from basal cell carcinoma. After many more skin cancer excisions, she decided to leave the hospital environment to pursue further study and work in the field of dermatology and wound care. This helped to expand her specialized knowledge of skin anatomy/physiology and prepare for a career in plastic/reconstructive surgery. During her masters degree program, the author developed educational guidelines and materials to facilitate her new role in plastic surgery as a nurse/patient/community educator. She finished her masters degree in nursing education and completed her clinical preceptor/internship with two board certified plastic and reconstructive surgeons in December of 2000. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast augmentation patient education EMTREE MEDICAL INDEX TERMS article human nursing postoperative care preoperative care United States LANGUAGE OF ARTICLE English MEDLINE PMID 12465425 (http://www.ncbi.nlm.nih.gov/pubmed/12465425) PUI L35516555 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 715 TITLE Iron oxide pigmentation of skin grafts without tattooing AUTHOR NAMES Spinelli H.M. Isenberg J.S. O'Brien M. Shapiro P.E. AUTHOR ADDRESSES (Spinelli H.M.; Isenberg J.S.; O'Brien M.; Shapiro P.E.) Dept. of Oral/Maxillofacial Surg., University of Oklahoma, Health Sciences Center, 216 N.W. 16th Street, Oklahoma City, OK 73103, United States. CORRESPONDENCE ADDRESS J.S. Isenberg, Dept. of Oral/Maxillofacial Surg., University of Oklahoma, Health Sciences Center, 216 N.W. 16th Street, Oklahoma City, OK 73103, United States. Email: ariella@flash.net SOURCE International Journal of Cosmetic Surgery and Aesthetic Dermatology (2002) 4:1 (43-46). Date of Publication: 2002 ISSN 1530-8200 ABSTRACT Traditional techniques available for nipple-areolar reconstruction following post-oncologic breast surgery have relied upon medical grade tattooing of the construct. This has required from one to several postoperative procedures to achieve the desired coloration of the nipple-areolar complex. In an effort to achieve a more streamlined reconstructive program investigation of the possibility of immediate pigmentation of areolar skin grafts at the time of nipple areolar reconstruction was performed. Full-thickness skin grafts from the dorsal surface of rats were harvested. To the wound bed a known amount of sterile iron oxide pigment was applied and grafts re-sutured into place. Post-operatively graft take was noted and full-thickness biopsies obtained for microscopic study. All skin grafts lived. Coloration of the grafts was assessed as good. Histologic evaluation showed retention of pigment in the dermal wound interface. Immediate pigmentation of skin grafts in the model of this experiment proved safe and effective suggesting application in the clinical setting is warranted. EMTREE DRUG INDEX TERMS iron oxide EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) skin graft skin pigmentation tattooing EMTREE MEDICAL INDEX TERMS animal experiment article breast areola breast reconstruction breast surgery controlled study epithelization experimental model female full thickness skin graft graft survival histology microscopy nipple nonhuman outcomes research postoperative period rat safety skin abrasion skin biopsy surgical wound suture CAS REGISTRY NUMBERS iron oxide (1332-37-2) EMBASE CLASSIFICATIONS Dermatology and Venereology (13) Surgery (9) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2002193896 PUI L34575526 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 716 TITLE Breast carcinoma in pregnancy: a clinical case ORIGINAL (NON-ENGLISH) TITLE Carcinoma della mammella in gravidanza: caso clinico. AUTHOR NAMES Cammisuli F. Catania V. Santuccio A. Mirone I. Pagano P. Cavallaro A. AUTHOR ADDRESSES (Cammisuli F.; Catania V.; Santuccio A.; Mirone I.; Pagano P.; Cavallaro A.) Cattedra di Chirurgia Oncologica, Università di Catania. CORRESPONDENCE ADDRESS F. Cammisuli, Cattedra di Chirurgia Oncologica, Università di Catania. SOURCE Annali italiani di chirurgia (2002) 73:3 (317-321). Date of Publication: 2002 May-Jun ISSN 0003-469X ABSTRACT Breast cancer is a rare, but frequently hidden pathology. A woman, 36 years old, during the early months of pregnancy found a little tumor in her right breast. A fine needle biopsy was negative for cancer. Despite this, the tumor rose and two months after delivery (the patient breast-fed her daughter for a month), she had pain in the right axillary region and the tumors involved all superior dials of the right breast. A Madden mastectomy was performed. The histopathological report was: ductal invasive breast cancer 3 of 19 lymph nodes involved, stage IIIA, TNM pT3N2M0, ER -, PgR +--. Chemotherapeutic regimens were: at first ADM 75 mg/m2 for 5 cycles, and after CMF 1-8 for 6 cycles. After six months the woman had a cutaneous recurrence in the scar of mastectomy, treated with surgery and RT. Thirteen months after, she had lung MTS and then brain MTS. The patient died thirty months after the mastectomy. The surgeons have to discover the women high-risk for the breast cancer before and during the pregnancy. Excisional biopsy is the diagnostic procedure of choice for breast lump during pregnancy. When a breast cancer develops during a pregnancy, the surgeon has to operate immediately the tumors. Chemotherapeutic regimens should be delayed until the second o third trimester or after delivery. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (therapy) Paget nipple disease (therapy) pregnancy complication (therapy) EMTREE MEDICAL INDEX TERMS adult article case report female human multimodality cancer therapy pregnancy LANGUAGE OF ARTICLE Italian MEDLINE PMID 12404900 (http://www.ncbi.nlm.nih.gov/pubmed/12404900) PUI L35517395 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 717 TITLE A case of long surviving advanced recurrent breast cancer with multiple bone metastases responding to treatment with 5'-DFUR combined with MPA AUTHOR NAMES Otsuka T. Terashima Y. Tashiro S. AUTHOR ADDRESSES (Otsuka T.; Terashima Y.; Tashiro S.) First Dept. of Surgery, Tokushima University School of Medicine. CORRESPONDENCE ADDRESS T. Otsuka, First Dept. of Surgery, Tokushima University School of Medicine. SOURCE Gan to kagaku ryoho. Cancer & chemotherapy (2002) 29:2 (313-316). Date of Publication: Feb 2002 ISSN 0385-0684 ABSTRACT The patient was a 69-year-old woman who had undergone right standard radical mastectomy on August 8, 1991, and was treated with chemo- and hormonal therapy of ADM, UFT and TMA. Three years later she showed multiple bone metastases with elevation of CEA, and 5'-DFUR 1,200 mg/day and MPA 800 mg/day were administered. Two years later her CEA levels were decreased, 5'-DFUR was discontinued and MPA 1,200 mg/day only was continued. Two months later a side effect of MPA, her body weight gain, was observed, and the dosage of MPA was reduced from 1,200 mg/day to 800 mg/day. Then the side effect was resolved. Bone scintigraphy and MRI showed that bone metastatic lesions were reduced 6 years after 5'-DFUR and MPA therapy. It is suggested that this combination therapy may be useful for advanced recurrent breast cancer patients with multiple bone metastases. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) antineoplastic agent (drug therapy) EMTREE DRUG INDEX TERMS doxifluridine floxuridine (drug administration) medroxyprogesterone (drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adenocarcinoma (drug therapy, surgery) bone tumor (drug therapy) breast tumor (surgery) EMTREE MEDICAL INDEX TERMS aged article case report drug administration female human mastectomy metastasis pathology survivor CAS REGISTRY NUMBERS doxifluridine (3094-09-5) floxuridine (50-91-9) medroxyprogesterone (520-85-4) LANGUAGE OF ARTICLE Japanese MEDLINE PMID 11865641 (http://www.ncbi.nlm.nih.gov/pubmed/11865641) PUI L35589055 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 718 TITLE Improved QOL with cancer chemotherapy in two patients with breast cancer suffering form carcinomatous pleurisy and carcinomatous peritonitis AUTHOR NAMES Fujitomi Y. Fujiyoshi K. Yasue K. AUTHOR ADDRESSES (Fujitomi Y.; Fujiyoshi K.; Yasue K.) Dept. of Surgery, Oita Ken Koseiren Tsurumi Hospital. CORRESPONDENCE ADDRESS Y. Fujitomi, Dept. of Surgery, Oita Ken Koseiren Tsurumi Hospital. SOURCE Gan to kagaku ryoho. Cancer & chemotherapy (2000) 27:2 (303-306). Date of Publication: Feb 2000 ISSN 0385-0684 ABSTRACT One of the breast cancer patients introduced here suffered from recurrent carcinomatous pleurisy and the other from recurrent carcinomatous peritonitis. The patient with recurrent carcinomatous pleurisy was a 47-year-old female with stage IIIa breast cancer. She underwent a standard mastectomy and, following surgery, radiotherapy (50 Gy) and CAF therapy (30 mg of ADM, 1,800 mg of futraful and 100 mg of CPA, administered p.o.). Dyspnea occurred 4 years after surgery. Pleural exudate cytodiagnosis proved positive and the patient was diagnosed with carcinomatous peritonitis. Continuous thoracic cavity drainage was carried out, and 30 mg of ADM was injected into the thoracic cavity. CAF therapy was performed. The dyspnea and thoracic effusion disappeared. At present, after one year and 7 months, the patient is receiving outpatient treatment and remains under observation. The patient with recurrent carcinomatous pleurisy was a 43-year-old female. The breast cancer was detected in a diagnosis of metastasis to the axillary lymph nodes. An increased CA15-3 level and ascitic retention were observed postoperatively at 5 months. Following administration of 600 mg of UFT and 1,200 mg of MPA, the ascites decreased and improvement of the thickened peritoneum was noted. The CA15-3 level was also lowered. It is anticipated that chemotherapy for carcinomatous pleurisy and carcinomatous peritonitis will contribute to an improvement in patients' QOL. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) antineoplastic agent (drug therapy) EMTREE DRUG INDEX TERMS 1 UFT protocol 1-UFT protocol CAF protocol cyclophosphamide (drug administration) doxorubicin (drug administration) fluorouracil (drug administration) medroxyprogesterone acetate (drug administration) tegafur (drug administration) uracil (drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor (drug therapy) peritonitis (drug therapy) pleurisy (drug therapy) quality of life EMTREE MEDICAL INDEX TERMS adult article case report drug administration female human middle aged psychological aspect CAS REGISTRY NUMBERS cyclophosphamide (50-18-0) doxorubicin (23214-92-8, 25316-40-9) fluorouracil (51-21-8) medroxyprogesterone acetate (71-58-9) tegafur (17902-23-7) uracil (66-22-8) LANGUAGE OF ARTICLE Japanese MEDLINE PMID 10700906 (http://www.ncbi.nlm.nih.gov/pubmed/10700906) PUI L31299389 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 719 TITLE A case of breast cancer patient of CAF (cyclophosphamide, adriamycin, 5-fluorouracil) resistant lung metastasis with remarkable response to reverse drug-resistance by toremifene AUTHOR NAMES Kusama M. Kaise H. Nakayama S. Ohta D. Aoki T. Koyanagi Y. AUTHOR ADDRESSES (Kusama M.; Kaise H.; Nakayama S.; Ohta D.; Aoki T.; Koyanagi Y.) Third Dept. of Surgery, Tokyo Medical University. CORRESPONDENCE ADDRESS M. Kusama, Third Dept. of Surgery, Tokyo Medical University. SOURCE Gan to kagaku ryoho. Cancer & chemotherapy (1999) 26:8 (1171-1175). Date of Publication: Jul 1999 ISSN 0385-0684 ABSTRACT A 43-year-old female underwent muscle preserving mastectomy with 6 cycles of adjuvant CMF chemotherapy for breast cancer. She developed multiple lung metastases 16 months later. The metastases were refractory to 3 cycles of CAF administration, and worsened (PD). We therefore added high-dose toremifene to her treatment. This combination therapy brought a marked decrease in the lung metastases. After 9 cycles of CAF with high-dose toremifene therapy, lung metastatic findings had almost disappeared from her chest X-ray. Following this treatment, UFT and toremifene were orally administered for maintenance therapy. Thirty-two months later at present, no increase in these lesions has been observed. High-dose antiestrogen drugs have the potential to inhibit P-glycoprotein. The combination of high-dose toremifene with CAF is potentially effective against ADM-resistant breast cancer. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) antiestrogen (drug administration) antineoplastic agent (drug administration) toremifene (drug administration) EMTREE DRUG INDEX TERMS CAF protocol cyclophosphamide (drug administration) doxorubicin (drug administration) fluorouracil (drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast tumor lung tumor (drug therapy) EMTREE MEDICAL INDEX TERMS adjuvant chemotherapy adult article case report drug resistance female human mastectomy metastasis pathology CAS REGISTRY NUMBERS cyclophosphamide (50-18-0) doxorubicin (23214-92-8, 25316-40-9) fluorouracil (51-21-8) toremifene (89778-26-7) LANGUAGE OF ARTICLE Japanese MEDLINE PMID 10431584 (http://www.ncbi.nlm.nih.gov/pubmed/10431584) PUI L129450206 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 720 TITLE High-dose chemotherapy with autologous peripheral blood stem cell transplantation support in a patient with breast cancer metastasis to bone marrow: immunocytochemical monitoring of cancer-cell contamination AUTHOR NAMES Uno H. Fujita M. Hino N. Nakagawa H. Miyagawa H. Aoki J. Taniyama K. Sasaki N. AUTHOR ADDRESSES (Uno H.; Fujita M.; Hino N.; Nakagawa H.; Miyagawa H.; Aoki J.; Taniyama K.; Sasaki N.) Department of Internal Medicine, Kure Kyosai Hospital, Japan. CORRESPONDENCE ADDRESS H. Uno, Department of Internal Medicine, Kure Kyosai Hospital, Japan. SOURCE [Rinshō ketsueki] The Japanese journal of clinical hematology (1999) 40:7 (556-562). Date of Publication: Jul 1999 ISSN 0485-1439 ABSTRACT A 32-year-old woman who 1 year earlier underwent a right mastectomy for stage II breast cancer with the histology of invasive ductal carcinoma (scirrhus type) was admitted due to recurrent, metastatic breast cancer in January 1997. She presented multiple metastatic lesions in the skin, lymph nodes, bone, lungs, liver, and spleen, and her bone marrow was replaced almost entirely by tumor cells. The patient was sequentially treated with 5 courses of cyclophosphamide (CPA) and adriamycin (ADM) (CA); 2 courses of CPA, ADM, and 5-fluorouracil; 5 caurses of docetaxel hydrate; and 1 course of CA. After recovery of the normal bone marrow by standard-dose chemotherapies, peripheral blood stem cells (PBSC) were then collected after mobilization with G-CSF. The number of breast cancer cells in bone marrow and PBSC samples was determined by immunocytochemical staining with an anti-cytokeratin monoclonal antibody. The number of tumor cells in PBSC sample was within the level for non-metastatic breast cancer. Complete remission was obtained with high-dose chemotherapy consisting of CPA and Thio-TEPA, and supported by autologous PBSC transplantation. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) antineoplastic agent (drug administration) EMTREE DRUG INDEX TERMS cisplatin (drug administration) doxorubicin (drug administration) M VAC protocol M-VAC protocol methotrexate (drug administration) vinblastine (drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) autotransplantation bone marrow cancer (therapy) breast tumor (therapy) hematopoietic stem cell transplantation Paget nipple disease (therapy) EMTREE MEDICAL INDEX TERMS adult article case report drug administration female human immunohistochemistry metastasis multimodality cancer therapy pathology CAS REGISTRY NUMBERS cisplatin (15663-27-1, 26035-31-4, 96081-74-2) doxorubicin (23214-92-8, 25316-40-9) methotrexate (15475-56-6, 59-05-2, 7413-34-5) vinblastine (865-21-4) LANGUAGE OF ARTICLE Japanese MEDLINE PMID 10483138 (http://www.ncbi.nlm.nih.gov/pubmed/10483138) PUI L129463094 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 721 TITLE A case of stage IV breast cancer showing long-term complete response to combination therapy with 5'-DFUR and MPA AUTHOR NAMES Kihara M. Matsusaka K. Miyauchi A. Maeda M. AUTHOR ADDRESSES (Kihara M.; Matsusaka K.; Miyauchi A.; Maeda M.) Second Dept. of Surgery, Kagawa Medical University. CORRESPONDENCE ADDRESS M. Kihara, Second Dept. of Surgery, Kagawa Medical University. SOURCE Gan to kagaku ryoho. Cancer & chemotherapy (1998) 25:13 (2123-2126). Date of Publication: Nov 1998 ISSN 0385-0684 ABSTRACT We report a 62-year-old woman with supraclavicular lymph node, pleural and bone metastases from breast cancer showing a long-term complete response to combination therapy with 5'-DFUR and MPA. A large amount of pleural effusion was drained followed by administration of ADM, which improved the amount of effusion. Treatment with CAF and TAM decreased tumor size, but CAF was abandoned due to severe leukopenia. Mastectomy was performed for local control. However, levels of tumor markers increased progressively. Administration of CMF was tried, but tumor markers continued to increase. Therefore, combined chemoendocrine therapy with 5'-DFUR and MPA was undertaken. Levels of tumor markers normalized and a complete response was obtained 13 months after starting this combination therapy. There are no further metastatic lesions evident, and this status has been consistently maintained for more than three years (six years and five months after diagnosis of breast cancer). There were no significant side effects of this combination therapy except for mild weight gain and moon face. This combination regimen with 5'-DFUR and MPA is considered useful as a second-line treatment for advanced breast cancer. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) antineoplastic agent (drug therapy) EMTREE DRUG INDEX TERMS doxifluridine floxuridine (drug administration) medroxyprogesterone acetate (drug administration) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adenocarcinoma (drug therapy, surgery) breast tumor (drug therapy, surgery) EMTREE MEDICAL INDEX TERMS article bone tumor case report female human lymph node metastasis mastectomy metastasis middle aged multimodality cancer therapy pathology remission CAS REGISTRY NUMBERS doxifluridine (3094-09-5) floxuridine (50-91-9) medroxyprogesterone acetate (71-58-9) LANGUAGE OF ARTICLE Japanese MEDLINE PMID 9838917 (http://www.ncbi.nlm.nih.gov/pubmed/9838917) PUI L128329770 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 722 TITLE Injection of Vitamin A acid, Vitamin E, and Vitamin C for treatment of tissue necrosis AUTHOR NAMES Personelle J. De Souza Pinto E.B. Ruiz R.O. AUTHOR ADDRESSES (Personelle J.; De Souza Pinto E.B.; Ruiz R.O.) (Personelle J.) Avenida Moema 170-111, São Paulo, Brazil. CORRESPONDENCE ADDRESS J. Personelle, Avenida Moema, 170-111 Sao Paulo, Brazil. SOURCE Aesthetic Plastic Surgery (1998) 22:1 (58-64). Date of Publication: 1998 ISSN 0364-216X BOOK PUBLISHER Springer New York LLC, 233 Springer Street, New York, United States. ABSTRACT Experimental studies concerning All-Trans Retinoic acid 0.1% with the antioxidant action of the Vitamin E (tocopherol acetate 0.20%) and Vitamin C (coated ascorbic acid 0.20%) efficacy in both the vascular neoformation induction and cellular membrane stabilization have been conducted by us to improve skin necrosis regression after routine plastic surgeries. Patients after rhytidectomy, breast reduction, and abdominoplasty with localized skin flap necrosis, were submitted to daily intradermic injections for a period of 15 days and had their skin healed by the effects of these vitamins. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) alpha tocopherol (drug therapy, pharmacology) ascorbic acid (drug therapy, pharmacology) retinol (drug therapy, pharmacology) EMTREE DRUG INDEX TERMS leukotriene B5 (endogenous compound) retinoic acid (drug dose, drug therapy, pharmacology) thromboxane A2 (endogenous compound) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) plastic surgery tissue necrosis (complication, drug therapy) EMTREE MEDICAL INDEX TERMS abdominoplasty animal experiment animal model animal tissue antioxidant activity article breast reduction controlled study drug efficacy female human intradermal drug administration male nonhuman postoperative complication priority journal rat rhytidoplasty skin flap tissue regeneration CAS REGISTRY NUMBERS alpha tocopherol (1406-18-4, 1406-70-8, 52225-20-4, 58-95-7, 59-02-9) ascorbic acid (134-03-2, 15421-15-5, 50-81-7) leukotriene B5 (80445-66-5) retinoic acid (302-79-4) retinol (68-26-8, 82445-97-4) thromboxane A2 (57576-52-0) EMBASE CLASSIFICATIONS Surgery (9) Drug Literature Index (37) LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1998061939 MEDLINE PMID 9456357 (http://www.ncbi.nlm.nih.gov/pubmed/9456357) PUI L28087102 DOI 10.1007/s002669900167 FULL TEXT LINK http://dx.doi.org/10.1007/s002669900167 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 723 TITLE Wound fluids and the pathogenesis of chronic wounds. AUTHOR NAMES Wysocki A.B. AUTHOR ADDRESSES (Wysocki A.B.) Department of Nursing, New York University Medical Center, NY 10016, USA. CORRESPONDENCE ADDRESS A.B. Wysocki, Department of Nursing, New York University Medical Center, NY 10016, USA. SOURCE Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society / WOCN (1996) 23:6 (283-290). Date of Publication: Nov 1996 ISSN 1071-5754 ABSTRACT PURPOSE: To describe two areas of ongoing investigation into analysis of wound fluids that may eventually lead to better understanding of pathophysiology of chronic wounds and to improved care and treatment. METHODS: Studies used Lowry protein assay, sodium dodecyl sulfate-polyacrylamide gel electrophoresis, Western blotting, and zymography to analyze fluids from acute and chronic wounds and serum samples collected from healthy and affected volunteers. SUBJECTS: Thirty-one subjects with ages ranging from 32 to 79 years participated in the research; fluid was collected from chronic wounds in 10 patients (two female, four male, and four unrecorded), fluid was collected from acute mastectomy wounds in 15 patients (all female); blister fluid and blood were collected from two volunteers (one male, one female); and blood for serum preparation was collected from four volunteers (two female, two male). PRIMARY OUTCOME VARIABLES: (1) Fibronectin degradation and (2) expression of matrix metalloproteinases. RESULTS: Fibronectin can be degraded in fluid from chronic wounds but remains intact in blood-derived serum, plasma-derived serum, blister fluid, and mastectomy wound fluid. Matrix metalloproteinases are overexpressed in fluid from chronic wounds compared with mastectomy wound fluid, blood-derived serum, and plasma-derived serum. Matrix metalloproteinases are also expressed of somewhat higher levels in mastectomy fluid than in blood-derived and plasma-derived serum. CONCLUSIONS: These studies identified two factors that may contribute to delayed healing of chronic wound: fibronectin degradation and overexpression of matrix metalioproteinases. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) collagenase fibronectin stromelysin EMTREE DRUG INDEX TERMS gelatinase B EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) exudate injury wound healing EMTREE MEDICAL INDEX TERMS acute disease adult aged article chemistry chronic disease comparative study enzymology female human male middle aged pathophysiology physiology CAS REGISTRY NUMBERS collagenase (37288-86-1, 39433-96-0) fibronectin (86088-83-7) gelatinase B (146480-36-6) stromelysin (79955-99-0) LANGUAGE OF ARTICLE English MEDLINE PMID 9043277 (http://www.ncbi.nlm.nih.gov/pubmed/9043277) PUI L127230648 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 724 TITLE A case of recurrent breast cancer responding to long-term treatment with 5'-DFUR combined with MPA AUTHOR NAMES Kimura M. Koida T. Sekihara M. AUTHOR ADDRESSES (Kimura M.; Koida T.; Sekihara M.) Dept. of Surgery, Gunma Cancer Center, Gunma, Japan. CORRESPONDENCE ADDRESS M. Kimura, Dept. of Surgery, Gunma Cancer Center, Gunma, Japan. SOURCE Japanese Journal of Cancer and Chemotherapy (1996) 23:9 (1183-1185). Date of Publication: 1996 ISSN 0385-0684 BOOK PUBLISHER Cancer and Chemotherapy Publ. Inc., 2-2-3 Nihonbashi, Chuo-ku, Tokyo, Japan. ABSTRACT A 55-year-old woman with recurrent breast cancer treated with sequential mastectomies, chemo-and hormonal therapy of UFT, CPM and TAM, achieved remission. Six months later she was admitted with a diagnosis of carcinomatous pleurisy. A large pleural effusion was drained followed by administration of ADM, which improved her effusion and accompanying dyspnea. The effusion recurred but the patient desired outpatient treatment. Thus, we prescribed oral 5'-DFUR and MPA. One month later, her cough had improved and her sputum cytology was negative, while on chest radiograph the pleural effusion had decreased and the patch-like shadows in her right lung field had disappeared. She was considered as a case of PR. At one year and 3 months after starting concomitant 5'-DFUR and MPA the pleural effusion disappeared. The patient has received this outpatient treatment for 2 years without adverse reactions. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) doxifluridine (drug administration, drug combination, drug development, drug therapy) medroxyprogesterone acetate (drug administration, drug combination, drug therapy) EMTREE DRUG INDEX TERMS doxorubicin (drug therapy) UFT (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, surgery) cancer recurrence (drug therapy) EMTREE MEDICAL INDEX TERMS adult article cancer chemotherapy cancer hormone therapy case report female human mastectomy oral drug administration pleura effusion (diagnosis, drug therapy) pleurisy (complication) thorax radiography CAS REGISTRY NUMBERS UFT (74578-38-4) doxifluridine (3094-09-5) doxorubicin (23214-92-8, 25316-40-9) medroxyprogesterone acetate (71-58-9) EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Cancer (16) Drug Literature Index (37) LANGUAGE OF ARTICLE Japanese LANGUAGE OF SUMMARY English, Japanese EMBASE ACCESSION NUMBER 1996279109 MEDLINE PMID 8751807 (http://www.ncbi.nlm.nih.gov/pubmed/8751807) PUI L26301305 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 725 TITLE Local effects and long term results of intraarterial infusion chemotherapy for locally advanced breast cancer with special reference to drugs administered AUTHOR NAMES Motomura K. Koyama H. Noguchi S. Inaji H. AUTHOR ADDRESSES (Motomura K.; Koyama H.; Noguchi S.; Inaji H.) Department of Surgery, Center for Adult Diseases, Osaka, Japan. CORRESPONDENCE ADDRESS K. Motomura, Department of Surgery, Center for Adult Diseases, Osaka, Japan. SOURCE Journal of Japan Society for Cancer Therapy (1995) 30:4 (621-627). Date of Publication: 1995 ISSN 0021-4671 ABSTRACT Seventy-nine patients with locally advanced breast cancer were treated with combination therapy including intraarterial infusion chemotherapy (IA chemotherapy). A combination of mitomycin C (MMC) and 5-fluorouracil (5-FU), adriamycin (ADR), or epirubicin (EPI) were infused depending on the protocols, and their local effects and long term results were analysed. Each patient then had an extended radical mastectomy including dissection of the parasternal lymphnodes. Subsequently, adjuvant chemo-endocrinetherapy was continued. According to the drugs infused, good local response defined as IIb or better in histological assessment was found in 69%, 81% and 43%, respectively. As for side effects, local toxicity such as dermatitis and retarded wound healing were less frequently encountered in the ADR group than in the combination of MMC and 5-FU or EPI groups. Patients in the ADR or EPI group showed better 3-year overall survival and disease free survival (67%, 61%; 71%, 57%) than did those in the combination of MMC and 5-FU group (62%, 48%). The above results suggest that the drug of first choice for IA chemotherapy in locally advanced breast cancer is ADR. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) doxorubicin (adverse drug reaction, drug combination, drug therapy) epirubicin (adverse drug reaction, drug combination, drug therapy) fluorouracil (adverse drug reaction, drug combination, drug therapy) mitomycin (adverse drug reaction, drug combination, drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, surgery) EMTREE MEDICAL INDEX TERMS article cancer chemotherapy combination chemotherapy dermatitis (side effect) human intraarterial drug administration lymph node major clinical study mastectomy skin toxicity (side effect) CAS REGISTRY NUMBERS doxorubicin (23214-92-8, 25316-40-9) epirubicin (56390-09-1, 56420-45-2) fluorouracil (51-21-8) mitomycin C (50-07-7, 74349-48-7) EMBASE CLASSIFICATIONS Obstetrics and Gynecology (10) Cancer (16) Drug Literature Index (37) Adverse Reactions Titles (38) LANGUAGE OF ARTICLE Japanese LANGUAGE OF SUMMARY Japanese, English EMBASE ACCESSION NUMBER 1995159105 PUI L25157356 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 726 TITLE A case of bilateral multiple lung metastases from breast cancer successfully treated with carboplatin AUTHOR NAMES Kinoshita S. Yoshida Y. Matsuda R. Takatsuki H. Shimahara Y. Kobayashi N. AUTHOR ADDRESSES (Kinoshita S.; Yoshida Y.; Matsuda R.; Takatsuki H.; Shimahara Y.; Kobayashi N.) Dept. of Surgery I, Ehime University, School of Medicine, Matsuyama 790, Japan. CORRESPONDENCE ADDRESS Y. Yoshida, Dept. of Surgery I, Ehime University, School of Medicine, Matsuyama 790, Japan. SOURCE Japanese Journal of Cancer and Chemotherapy (1995) 22:4 (557-560). Date of Publication: 1995 ISSN 0385-0684 BOOK PUBLISHER Cancer and Chemotherapy Publ. Inc., 2-2-3 Nihonbashi, Chuo-ku, Tokyo, Japan. ABSTRACT A 57-year-old female was admitted for right breast tumor. Modified radical mastectomy (Kodama method) was carried out. A prophylactic postoperative radiation was undertaken because of large tumor (T(4b)) and histologic metastasis to a Rotter's lymphnode. At the end of irradiation, bilateral lung metastases were found on chest CT gram. The combination endocrine chemotherapy using MPA 600 mg and UFT 3 capsules p.o. daily and ADM 10 or 20 mg i.v. every two weeks was performed on an outpatient basis. As the lung metastases were increased four months later, carboplatin 150 mg i.v. was replaced with ADM. Four months later, the metastases almost disappeared on CT gram. These results suggested the possibility of one of the therapeutic options for metastatic breast cancer. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) carboplatin (drug therapy) EMTREE DRUG INDEX TERMS medroxyprogesterone acetate (drug therapy) UFT (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (radiotherapy, surgery) lung metastasis (complication, diagnosis, drug therapy, radiotherapy) EMTREE MEDICAL INDEX TERMS adult article case report computer assisted tomography female human intravenous drug administration lymph node metastasis (radiotherapy) multiple cancer (complication, diagnosis, drug therapy, radiotherapy) oral drug administration CAS REGISTRY NUMBERS UFT (74578-38-4) carboplatin (41575-94-4) medroxyprogesterone acetate (71-58-9) EMBASE CLASSIFICATIONS Drug Literature Index (37) Clinical and Experimental Pharmacology (30) Cancer (16) Chest Diseases, Thoracic Surgery and Tuberculosis (15) Radiology (14) Obstetrics and Gynecology (10) Surgery (9) LANGUAGE OF ARTICLE Japanese LANGUAGE OF SUMMARY Japanese, English EMBASE ACCESSION NUMBER 1995110330 MEDLINE PMID 7887649 (http://www.ncbi.nlm.nih.gov/pubmed/7887649) PUI L25108921 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 727 TITLE Combination neoadjuvant therapy with continuous intra-arterial CDDP infusion and radiotherapy for locally advanced breast cancer AUTHOR NAMES Yokoyama S. Sugenoya A. Kasuga Y. Fujimori M. Oguchi M. Abe N. Tsuchiya S. Iida F. AUTHOR ADDRESSES (Yokoyama S.; Sugenoya A.; Kasuga Y.; Fujimori M.; Oguchi M.; Abe N.; Tsuchiya S.; Iida F.) Dept. of Surgery, Shinshu University School of Med., Matsumoto 390, Japan. CORRESPONDENCE ADDRESS S. Yokoyama, Dept. of Surgery, Shinshu University School of Med., Matsumoto 390, Japan. SOURCE Japanese Journal of Cancer and Chemotherapy (1994) 21:13 (2278-2281). Date of Publication: 1994 ISSN 0385-0684 BOOK PUBLISHER Cancer and Chemotherapy Publ. Inc., 2-2-3 Nihonbashi, Chuo-ku, Tokyo, Japan. ABSTRACT Neoadjuvant therapy combined with intra-arterial continuous infusion of CDDP and external radiation was evaluated in a patient with locally advanced breast cancer. Although only MR was observed on the primary tumor, PR was found in several metastatic lymphnodes and daughter nodules. All tumor markers elevated before treatment decreased to normal ranges only by this therapy, and histological damage was also recognized remarkably with a high concentration of free Pt (8. 89 μg/g) in cancer tissues. Since no severe side effects appeared during the present therapy, extended radical mastectomy with wide skin resection could be performed following additional intra-arterial chemotherapy using 5-FU, epi-ADM and MMC. From this experience, it was suggested that CDDP was a useful drug in the chemotherapy for breast cancer. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) cisplatin (drug concentration, drug therapy) epirubicin (drug therapy) fluorouracil (drug therapy) mitomycin (drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer (drug therapy, radiotherapy, surgery) EMTREE MEDICAL INDEX TERMS advanced cancer case report conference paper drug tissue level female human intraarterial drug administration CAS REGISTRY NUMBERS cisplatin (15663-27-1, 26035-31-4, 96081-74-2) epirubicin (56390-09-1, 56420-45-2) fluorouracil (51-21-8) mitomycin (1404-00-8) EMBASE CLASSIFICATIONS Cancer (16) Drug Literature Index (37) LANGUAGE OF ARTICLE Japanese LANGUAGE OF SUMMARY Japanese, English EMBASE ACCESSION NUMBER 1994328877 MEDLINE PMID 7944459 (http://www.ncbi.nlm.nih.gov/pubmed/7944459) PUI L24331775 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 728 TITLE Photocoagulation for choroidal cancer metastatic from the breast AUTHOR NAMES Sato A. Suzuki J. Sekine N. Nakagawa T. Ohba S. AUTHOR ADDRESSES (Sato A.; Suzuki J.; Sekine N.; Nakagawa T.; Ohba S.) Department of Ophthalmology, Sapporo Medical University, S-1 W-16, Chuo-ku, Sapporo 060, Japan. CORRESPONDENCE ADDRESS A. Sato, Department of Ophthalmology, Sapporo Medical University, S-1 W-16, Chuo-ku, Sapporo 060, Japan. SOURCE Japanese Journal of Clinical Ophthalmology (1994) 48:3 (423-427). Date of Publication: 1994 ISSN 0370-5579 ABSTRACT A 38-year-old woman presented with blurring in her right eye as chief complaint. She had undergone radical mastectomy for right breast cancer 3 years before. Funduscopy showed a bullous retinal detachment surrounded by choroidal elevation in the superonasal quadrant. Fluorescein angiography showed multiple pinpoint leakages from the retinal pigment epithelium. The subretinal fluid shifted inferiorly 2 days later. Metastasis of tumor was also detected in the lung and brain. She was treated by combination of systemic cyclophosphamide, ADM and fluorouracil (CAF). The choroidal tumor was treated by dye laser photocoagulation. Dye leakage disappeared 2 weeks later. The choroidal elevation and bullous detachment disappeared after 3 months of chemotherapy. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) cyclophosphamide (drug combination, drug therapy) doxorubicin (drug combination, drug therapy) fluorouracil (drug combination, drug therapy) EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer choroid cancer (complication, drug therapy, etiology, surgery) dye laser laser coagulation metastasis (drug therapy) EMTREE MEDICAL INDEX TERMS adult article case report clinical trial female human CAS REGISTRY NUMBERS cyclophosphamide (50-18-0) doxorubicin (23214-92-8, 25316-40-9) fluorouracil (51-21-8) EMBASE CLASSIFICATIONS Ophthalmology (12) Cancer (16) Drug Literature Index (37) Surgery (9) LANGUAGE OF ARTICLE Japanese LANGUAGE OF SUMMARY English, Japanese EMBASE ACCESSION NUMBER 1994145541 PUI L24149157 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 729 TITLE Anisomastia: Our experience in a case of giant fibroadenoma ORIGINAL (NON-ENGLISH) TITLE LE ANISOMASTIE: NOSTRA ESPERIENZA IN UN CASO DI FIBROADENOMA GIGANTE AUTHOR NAMES Gensini G. Luzi F. Esposito S. Nardi F. Barbetti E. Marinelli L.F. AUTHOR ADDRESSES (Gensini G.; Luzi F.; Esposito S.; Nardi F.; Barbetti E.; Marinelli L.F.) Divisione di Chirurgia Plastica, Ospedale S. Eugenio, Roma, Italy. CORRESPONDENCE ADDRESS G. Gensini, Divisione di Chirurgia Plastica, Ospedale S. Eugenio, Roma, Italy. SOURCE Rivista Italiana di Chirurgia Plastica (1993) 25:3 (275-277). Date of Publication: 1993 ISSN 0391-2221 ABSTRACT The asymmetry of the breast can be congenital, acquired or tumoral. Benign tumors usually cause only a slight difference and do not require major reconstructive surgery, because the asymmetry is often not very noticeable, with minor changes in the profile and shape of the breast and little disfigurement of the areola. Giant fibroadenoma is a separate case, though. The authors relate the case of a 19 yrs old patient who presented with such an extensive neoformation as to cause a considerable disfigurement and ptosis of the breast. After removal of the giant fibroadenoma, the problem was to recreate the symmetry with the other breast which was ideal in shape and size. In this case the authors chose the same technique that they use after subcutaneous mastectomy. The result was good and both reconstructive and cosmetic surgery principles have been followed. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast disease (surgery) fibroadenoma (surgery) ptosis (surgery) EMTREE MEDICAL INDEX TERMS adult article case report female human EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE Italian LANGUAGE OF SUMMARY English, Italian EMBASE ACCESSION NUMBER 1994057888 PUI L24069456 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 730 TITLE Diagnostic difficulty in rare benign breast lesions ORIGINAL (NON-ENGLISH) TITLE DIFFICOLTA DIAGNOSTICA IN RARE LESIONI BENIGNE DELLA MAMMELLA AUTHOR NAMES Vancini M. Andreini L. Dagustin A. Bondi A. Tagariello C. AUTHOR ADDRESSES (Vancini M.; Andreini L.; Dagustin A.; Bondi A.; Tagariello C.) Ospedale Civile, Divisione di Chirurgia Generale, 40024 Castel San Pietro Terme, Italy. CORRESPONDENCE ADDRESS M. Vancini, Ospedale Civile, Divisione di Chirurgia Generale, 40024 Castel San Pietro Terme, Italy. SOURCE Chirurgia (1993) 6:3 (144-147). Date of Publication: 1993 ISSN 0394-9508 ABSTRACT Four cases of unusual benign breast pathology are discussed: all the patients showed a clinically suspicious lump both on manual examination and instrumental investigation (echography, mammography). Two cases had previous cytologic reports that were not significant. For diagnosis histologic examination is necessary: a juvenile papillomatosis, a phylloid tumour, an amartoma and a tubular adenoma have been demonstrated. All cases underwent conservative surgical procedures and the benign nature of the diseases was confirmed by the pathologic examination. Three women underwent simple nodulectomy, for the phylloid tumour subcutaneous mastectomy was necessary, due to the fact that the neoformation almost completely filled the breast. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast disease (diagnosis) echography mammography EMTREE MEDICAL INDEX TERMS adenoma (diagnosis) adolescent adult article case report female human EMBASE CLASSIFICATIONS Surgery (9) LANGUAGE OF ARTICLE Italian LANGUAGE OF SUMMARY English, Italian EMBASE ACCESSION NUMBER 1993178308 PUI L23178294 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 731 TITLE Complete remission, obtained by multidisciplinary treatment of recurrent breast cancer with carcinomatous pleuritis, and cervical lymph node and diver metastasis AUTHOR NAMES Kusama M. Kimura K. Aoki T. Suzuki K. Kakuta T. Ishikawa M. Yoshimatsu A. AUTHOR ADDRESSES (Kusama M.; Kimura K.; Aoki T.; Suzuki K.; Kakuta T.; Ishikawa M.; Yoshimatsu A.) Dept. of Surgery, Tokyo Medical College. CORRESPONDENCE ADDRESS M. Kusama, Dept. of Surgery, Tokyo Medical College. SOURCE Gan no rinsho. Japan journal of cancer clinics (1989) 35:1 (93-99). Date of Publication: Jan 1989 ISSN 0021-4949 ABSTRACT A 46-year-old female, who had undergone a radical mastectomy for cancer of the breast 5 years previously at another institution presented a pleural effusion, in which malignant cells were detected, along with cervical lymph node metastasis. Although the patient initially responded to the H-CMcF regimen and intrathoracic injections of adriamycin (ADM), her condition subsequently was exacerbated, with metastasis occurring in the liver. A complete remission however, was achieved by local treatment, which included intrathoracic infusions of ADM and cis-platinum plus hepatic artery infusions of ADM and lipiodol, in addition to a systemic treatment consisting of a modification of the FEMP regimen employing UFT, CPA, MMC, and PDN, to which were added the immunopotentiators OK-432 and MPA. At present, 18 months after treatment, the patient is apparently disease free. The results obtained in this case suggest that even a distant metastasis can be controlled by aggressive local treatment for each metastatic lesion, in addition to a multidisciplinary treatment based mainly on intensive chemotherapy. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) antineoplastic agent (drug therapy) EMTREE DRUG INDEX TERMS cisplatin (drug administration) doxorubicin (drug administration) drug derivative medroxyprogesterone (drug administration) medroxyprogesterone acetate EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) adenocarcinoma (drug therapy) breast tumor (drug therapy) liver tumor (drug therapy) pleurisy (drug therapy) EMTREE MEDICAL INDEX TERMS adult article case report drug administration female human intraarterial drug administration lymph node metastasis metastasis multimodality cancer therapy pathology remission CAS REGISTRY NUMBERS cisplatin (15663-27-1, 26035-31-4, 96081-74-2) doxorubicin (23214-92-8, 25316-40-9) medroxyprogesterone (520-85-4) medroxyprogesterone acetate (71-58-9) LANGUAGE OF ARTICLE Japanese MEDLINE PMID 2522156 (http://www.ncbi.nlm.nih.gov/pubmed/2522156) PUI L19395323 COPYRIGHT MEDLINE® is the source for the citation and abstract of this record. RECORD 732 TITLE Preoperative infusion chemotherapy (adriamycin) in breast cancer AUTHOR NAMES Sawai K. Kato G. Takenaka A. AUTHOR ADDRESSES (Sawai K.; Kato G.; Takenaka A.) Dep. Surg., Kyoto II Red Cross Hosp., Kyoto CORRESPONDENCE ADDRESS Dep. Surg., Kyoto II Red Cross Hosp., Kyoto SOURCE Journal of Japan Society for Cancer Therapy (1982) 17:4 (1048-1055). Date of Publication: 1982 ISSN 0021-4671 ABSTRACT 51 patients with breast cancer treated with preoperative cancer chemotherapy and radical mastectomy from Jan. 1979, through Nov. 1981, are included in this study. Adriamycin (ADM) was given intra-arterially to 40 patients 3 to 7 days prior to the radical mastectomy and intra-venously to 11 patients 2 to 4 days prior to the surgery. For the intra-arterial infusion, the internal mammary artery was used on 7 patients, the lateral thoracic artery on 10, the thoracoacrominal artery on 5 and the subclavian artery on 18, respectively. The concentration of ADM in the tumor, normal mammary gland and metastatic lymph nodes was measured. Resected breast and lymph nodes were evaluated microscopically on the Takahashi's criterion. The results were as follows. The concentration of ADM was found significantly higher in the tumor and metastatic lymph nodes than in normal gland. No significant difference between arterial and venous administrations was found in the tissue concentration of ADM in the tumor and metastatic lymph nodes. The concentration of ADM was significantly higher in the medullary tubular carcinoma than in the papillotubular carcinoma and scirrhous carcinoma. Effective histological changes in the tumor were found in 32.5% of intra-arterial group and in 0% of intra-venous group. Intra-arterial infusion was significantly favoured. Effective histological changes in the metastatic lymph nodes were found in 36.8% of the arterial group and 0% of the intra-venous group. Effectiveness in the tumor was found in 50% for medullary tubular carcinoma, 33.3% for papillotubular carcinoma and 16.7% for scirrhous carcinoma. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) doxorubicin EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast cancer cancer chemotherapy EMTREE MEDICAL INDEX TERMS breast intravenous drug administration major clinical study premedication therapy CAS REGISTRY NUMBERS doxorubicin (23214-92-8, 25316-40-9) EMBASE CLASSIFICATIONS Surgery (9) Drug Literature Index (37) Immunology, Serology and Transplantation (26) Cancer (16) LANGUAGE OF ARTICLE Japanese LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1982227025 MEDLINE PMID 7130795 (http://www.ncbi.nlm.nih.gov/pubmed/7130795) PUI L12017141 COPYRIGHT Copyright 2009 Elsevier B.V., All rights reserved. RECORD 733 TITLE Possible prognostic criteria for the improvement of the treatment of primary carcinoma of the breast ORIGINAL (NON-ENGLISH) TITLE MOGLICHE PROGNOSTISCHE KRITERIEN ZUR THERAPIEVERBESSERUNG BEIM PRIMAREN MAMMAKARZINOM AUTHOR NAMES Kaufmann M. Klinga K. AUTHOR ADDRESSES (Kaufmann M.; Klinga K.) Univ. Frauenklin., 6900 Heidelberg 1 CORRESPONDENCE ADDRESS Univ. Frauenklin., 6900 Heidelberg 1 SOURCE Geburtshilfe und Frauenheilkunde (1982) 42:7 (501-509). Date of Publication: 1982 ISSN 0016-5751 ABSTRACT Primary carcinomas of the breast were examined by two biochemical methods and the results of the steroid hormone receptor determination ER and PR and the Adriamycin chemoresistance short test ADM were related to each other. The incidence and distribution of estrogen (ER) and progesterone (PR) receptors were determined in 197 patients with primary carcinoma of the breast both with positive and with negative lymph nodes. The results were compared to clinical criteria of risks such as age, menopause, size of the tumour, and lymphatic spread. In 95 cancers of the breast with positive lymph nodes a direct relationship between the lack of PR and reduction in the interval without recurrence following mastectomy was found (P = 0.02). An inverse relationship between the amount of PR and the frequency of recurrence was found. For ER no such relationship was proved. In 55 primary cancers with positive nodes the ADM chemoresistance test was done in addition to the receptor status. The division into chemosensitive and chemoresistant tumours (inhibition of 10(-2)mn. ADM/ml over >25% versus under <25%) showed a significant reduction in the interval free of recurrence for the chemosensitive tumours (p = 0.05). In addition to the determination of the PR alone (PR versus PR + : P + 0.004). A comparison of the combination of PR negative and chemosensitive tumours with PR positive and chemoresistant tumours provided the best prognostic information regarding the interval free of recurrence (p = 0.005). For the selection of patients at risk the steroid receptors analysis of ER and PR and the ADM chemo-resistance test were found to be reliable bio-chemical methods with relevant prognostic information. These tests can therefore help in the improvement of ancillary treatment in primary cancer of the breast. EMTREE DRUG INDEX TERMS (MAJOR FOCUS) doxorubicin estrogen receptor progesterone receptor EMTREE DRUG INDEX TERMS estradiol promegestone promegestone h 3 radioisotope thymidine h 3 unclassified drug uridine h 3 EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) breast carcinoma cancer chemotherapy EMTREE MEDICAL INDEX TERMS breast major clinical study methodology therapy DRUG TRADE NAMES r 5020 CAS REGISTRY NUMBERS doxorubicin (23214-92-8, 25316-40-9) estradiol (50-28-2) promegestone (34184-77-5) thymidine h 3 (50-88-4) EMBASE CLASSIFICATIONS Surgery (9) Cancer (16) Drug Literature Index (37) LANGUAGE OF ARTICLE German LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 1982167044 MEDLINE PMID 6922068 (http://www.ncbi.nlm.nih.gov/pubmed/6922068) PUI L12081157 COPYRIGHT Copyright 2012 Elsevier B.V., All rights reserved. RECORD 734 TITLE Lymphography in lymphoedema of the upper extremity after mastectomy ORIGINAL (NON-ENGLISH) TITLE La linfografia nel linfedema dell'arto superiore consequente alla mastectomia AUTHOR NAMES Toti A. Fabi M. De Bellis N. AUTHOR ADDRESSES (Toti A.; Fabi M.; De Bellis N.) SOURCE Nunt. Radiol. (1961) 27:3 (205-218). Date of Publication: 1961 ABSTRACT A description is given of the radiological anatomy of the lymphatic pathways of the arm, a good knowledge of which is indispensable for the correct interpretation of pathological lymphographic images, and a report is given of the results obtained with direct lymphography in a group of patients subjected to amputation of the breast for malignant neoplasia Up to one month after the operation, only a slight dilatation of the lymphatic ducts is observed, together with stasis and deceleration of the lymphatic circulation, but subsequently a retrograde obliteration of the main lymphatic vessels can be observed with simultaneous opening or neoformation of a thin, narrow subdermal lymphatic network. These anatomo-functional phenomena may explain the appearance of the oedema in these patients. It is probable that these alterations will have their repercussions on the finer lymphatic structures as well, and in the interstitium will modify the complex chemicophysic humoral mechanism which determines the appearance of the oedema. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) arm lymphedema lymphography mastectomy EMTREE MEDICAL INDEX TERMS amputation breast deceleration edema interstitium lymph flow lymph vessel malignant neoplasm patient LANGUAGE OF ARTICLE Italian LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2008073133 PUI L281274742 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved. RECORD 735 TITLE Lymphography in lymphoedema of the upper extremity after mastectomy (italian) AUTHOR NAMES Ton A. Fabi M. De Bellis N. AUTHOR ADDRESSES (Ton A.; Fabi M.; De Bellis N.) 1St. di Radiol., Univ. di Ferrara; Div. di Chir. Gen. e 1St. di Radiol., Arcisp. S. Anna di Ferrara, . CORRESPONDENCE ADDRESS A. Ton, 1St. di Radiol., Univ. di Ferrara; Div. di Chir. Gen. e 1St. di Radiol., Arcisp. S. Anna di Ferrara, . SOURCE Nunt. Radial. (Firenze) (1961) 27:3 (346-369). Date of Publication: 1961 ABSTRACT A description is given of the radiological anatomy of the lymphatic pathways of the arm, a good knowledge of which is indispensable for the correct interpretation of pathological lymphographic images, and a report is given of the results obtained with direct lymphography in a group of patients subjected to amputation of the breast for malignant tumours. Up to one month after the operation, only a slight dilatation of the lymphatic ducts is observed, together with stasis and deceleration of the lymphatic circulation, but subsequently a retrograde obliteration of the main lymphatic vessels can be observed, with simultaneous opening or neoformation of a thin, narrow subdermal lymphatic network. These anatomo-functional phenomena may explain the appearance of the oedema in these patients. It is probable that these alterations will have their repercussions on the finer lymphatic structures as well, and in the interstitium will modify the complex chemicophysical humoral mechanism which determines the appearance of the oedema. EMTREE MEDICAL INDEX TERMS (MAJOR FOCUS) arm lymphedema lymphography mastectomy EMTREE MEDICAL INDEX TERMS amputation breast deceleration edema interstitium lymph flow lymph vessel patient surgery LANGUAGE OF ARTICLE English LANGUAGE OF SUMMARY English EMBASE ACCESSION NUMBER 2007711225 PUI L281081268 COPYRIGHT Copyright 2007 Elsevier B.V., All rights reserved.