The Experts below are selected from a list of 60780 Experts worldwide ranked by ideXlab platform

Koenraad Van Landuyt - One of the best experts on this subject based on the ideXlab platform.

  • shaping the Breast in aesthetic and reconstructive Breast Surgery an easy three step principle part iv aesthetic Breast Surgery
    Plastic and Reconstructive Surgery, 2009
    Co-Authors: Phillip Blondeel, John B Hijjawi, Herman Depypere, Nathalie Roche, Koenraad Van Landuyt
    Abstract:

    SUMMARY: This is part IV of four articles describing the three-step principle for easy shaping of the Breast in reconstructive and aesthetic Breast Surgery. This article may seem overdue because aesthetic corrections are routinely performed, frequently written about, and easier to execute, as no prior ablative Surgery or radiotherapy has damaged the gland. Nevertheless, a number of difficult aesthetic Breast Surgery cases can present themselves that might be more challenging to correct (e.g., tubular Breast deformities or corrections after failed aesthetic Breast Surgery). By understanding the three main anatomical features of a Breast--the footprint, the conus, and the skin envelope--and how they interact, as explained in part I, one is able not only to analyze the deformities of each individual problematic Breast but also to teach others and to execute a specific surgical strategy on how to obtain reproducible aesthetically pleasing results. The three-step principle will be applied and explained for Breast augmentation, reduction, mastopexy, and tubular Breast deformity.

  • shaping the Breast in aesthetic and reconstructive Breast Surgery an easy three step principle
    Plastic and Reconstructive Surgery, 2009
    Co-Authors: Phillip Blondeel, John B Hijjawi, Herman Depypere, Nathalie Roche, Koenraad Van Landuyt
    Abstract:

    Creating or recreating an aesthetically pleasing Breast shape in reconstructive and aesthetic Breast Surgery is an act that most experienced "Breast" surgeons will find self-evident. We propose a simple three-step philosophical and hands-on approach that will make it easier for young and unexperienced plastic surgeons to not only analyze the problematic Breast but also come up with an easy surgical strategy to create reproducible results.This is Part I of four parts describing the three-step principle being applied in reconstructive and aesthetic Breast Surgery. Part I explains how to analyze a problematic Breast by understanding the three main anatomical features of a Breast and how they interact: the footprint, the conus of the Breast, and the skin envelope. Part II deals with reconstructions after complete mastectomy and Part III covers reconstruction after Breast conservation Surgery. Finally, Part IV applies the same principles in the field of aesthetic Breast Surgery. Throughout these four parts, the three-step principle will be the red line to fall back on to define the problem and to propose a solution.

Francis Bonnet - One of the best experts on this subject based on the ideXlab platform.

  • prospect guideline for oncological Breast Surgery a systematic review and procedure specific postoperative pain management recommendations
    Anaesthesia, 2020
    Co-Authors: A Jacobs, A Lemoine, Girish P Joshi, M Van De Velde, Francis Bonnet
    Abstract:

    Analgesic protocols used to treat pain after Breast Surgery vary significantly. The aim of this systematic review was to evaluate the available literature on this topic and develop recommendations for optimal pain management after oncological Breast Surgery. A systematic review using preferred reporting items for systematic reviews and meta-analysis guidance with procedure-specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials assessing postoperative pain using analgesic, anaesthetic or surgical interventions were identified. Seven hundred and forty-nine studies were found, of which 53 randomised controlled trials and nine meta-analyses met the inclusion criteria and were included in this review. Quantitative analysis suggests that dexamethasone and gabapentin reduced postoperative pain. The use of paravertebral blocks also reduced postoperative pain scores, analgesia consumption and the incidence of postoperative nausea and vomiting. Intra-operative opioid requirements were documented to be lower when a pectoral nerves block was performed, which also reduced postoperative pain scores and opioid consumption. We recommend basic analgesics (i.e. paracetamol and non-steroidal anti-inflammatory drugs) administered pre-operatively or intra-operatively and continued postoperatively. In addition, pre-operative gabapentin and dexamethasone are also recommended. In major Breast Surgery, a regional anaesthetic technique such as paravertebral block or pectoral nerves block and/or local anaesthetic wound infiltration may be considered for additional pain relief. Paravertebral block may be continued postoperatively using catheter techniques. Opioids should be reserved as rescue analgesics in the postoperative period. Research is needed to evaluate the role of novel regional analgesic techniques such as erector spinae plane or retrolaminar plane blocks combined with basic analgesics in an enhanced recovery setting.

Kariem Elboghdadly - One of the best experts on this subject based on the ideXlab platform.

  • analgesic efficacy of pecs and serratus plane blocks after Breast Surgery a systematic review meta analysis and trial sequential analysis
    Journal of Clinical Anesthesia, 2020
    Co-Authors: S Grape, Eric Jaunin, Kariem Elboghdadly, Vincent W S Chan, Eric Albrecht
    Abstract:

    Abstract Study objective To determine whether pectoral nerves (PECS) blocks provide effective postoperative analgesia when compared with no regional technique in patients undergoing Breast Surgery. Design Systematic review, meta-analysis and trial sequential analysis. Setting Operating room, postoperative recovery area and ward, up to 24 postoperative hours. Patients Patients undergoing Breast Surgery under general anaesthesia with either PECS block or no regional technique. Interventions We searched five electronic databases for randomized controlled trials comparing PECS block with no block or sham injection. Measurements The primary outcome was rest pain scores (analogue scale, 0–10) at 2 h, analysed according to Surgery (mastectomy vs other Breast Surgery) and regional technique (PECS 2 vs other blocks), among others. Secondary outcomes included morphine equivalent consumption, and rate of postoperative nausea and vomiting at 24 h. Main results Sixteen trials including 1026 patients were identified. Rest pain scores at 2 h were decreased in the PECS blocks group, with a mean (95%CI) difference of −1.5 (−2.0, −1.0); I2 = 93%; p  Conclusions There is moderate-to-high level evidence that PECS blocks provide postoperative analgesia after Breast Surgery when compared with no regional technique and reduce rate of PONV. This might provide the most benefit to those at high-risk of postoperative pain.

  • combined thoracic paravertebral and pectoral nerve blocks for Breast Surgery under sedation a prospective observational case series
    Anaesthesia, 2018
    Co-Authors: A Pawa, J M Wight, D N Onwochei, R Vargulescu, I Reed, L Chrisman, E Pushpanathan, Ashutosh Kothari, Kariem Elboghdadly
    Abstract:

    Avoidance of general anaesthesia for Breast Surgery may be because of clinical reasons or patient choice. There is emerging evidence that the use of regional anaesthesia and the avoidance of volatile anaesthetics and opioid analgesia may have beneficial effects on oncological outcomes. We conducted a prospective observational case series of 16 Breast cancer surgeries performed under thoracic paravertebral plus pectoral nerve block with propofol sedation to demonstrate feasibility of technique, patient acceptability and surgeon satisfaction. Fifteen out of 16 cases were successfully completed under sedation and regional anaesthesia, with one conversion to general anaesthesia. Eleven out of 16 cases required low-dose intra-operative opioid analgesia. Out of the 15 surgical procedures completed under regional anaesthesia with sedation, all patients experienced either no or minimal intra-operative pain, and all would choose this anaesthetic technique again. Surgeon-reported operating conditions were 'indistinguishable from general anaesthesia' in most cases, and surgeons were 'extremely satisfied' or 'satisfied' with the technique after every procedure. Combined thoracic paravertebral plus pectoral nerve block with intra-operative sedation is a feasible technique for Breast Surgery.

Ali Alattar - One of the best experts on this subject based on the ideXlab platform.

Peter K Zahn - One of the best experts on this subject based on the ideXlab platform.

  • efficacy and safety of paravertebral blocks in Breast Surgery a meta analysis of randomized controlled trials
    BJA: British Journal of Anaesthesia, 2010
    Co-Authors: Alexander Schnabel, Sylvia U Reichl, Peter Kranke, Esther M Pogatzkizahn, Peter K Zahn
    Abstract:

    Abstract Background Thoracic paravertebral blocks (PVBs) are successfully performed for pain management after Breast Surgery. The aim of the present quantitative systematic review was to assess the efficacy and adverse events of PVB in women undergoing Breast Surgery. Methods The systematic search, data extraction, critical appraisal, and pooled analysis were performed according to the PRISMA statement. The relative risk (RR), mean difference (MD), and their corresponding 95% confidence intervals (CIs) were calculated using the RevMan® statistical software for dichotomous and continuous outcomes, respectively. Pain scores were converted to a scale ranging from 0 (no pain) to 10 (worst pain). Results Fifteen randomized controlled trials (published between 1999 and 2009) including 877 patients met the inclusion criteria. There was a significant difference in worst postoperative pain scores between PVB and general anaesthesia (GA) at Conclusions There is considerable evidence that PVB in addition to GA or alone provide a better postoperative pain control with little adverse effects compared with other analgesic treatment strategies.