The Experts below are selected from a list of 8439 Experts worldwide ranked by ideXlab platform
Neil A Fine - One of the best experts on this subject based on the ideXlab platform.
-
risk factors for mastectomy flap necrosis following immediate Tissue Expander breast reconstruction
Journal of Plastic Surgery and Hand Surgery, 2014Co-Authors: Alexei S Mlodinow, Neil A Fine, Nima Khavanin, John Y S KimAbstract:Tissue Expander placement is a mainstay of reconstructive surgery in the post-mastectomy patient. Necrosis of the native breast Tissue is one of the most significant concerns in their post-operative care. The goal of this study is to elucidate factors that confer risk of this outcome. Chart review was conducted for a consecutive series of immediate Tissue Expander reconstructions by the two senior authors. Data was collected for several preoperative and intraoperative variables, as well as the outcome of mastectomy flap necrosis. Of the 1566 breasts that were examined, 135 (8.6%) experienced flap necrosis. The cohorts with and without flap necrosis were well matched. Those with the outcome of interest had significantly higher rates of switching to an autologous method of reconstruction (31.9% vs 6.2%, p 66.67%) intraoperative Tissue Expander fill to confer increased risk of mastectomy flap necrosis. While smoking and older age are well-supported by the literature, tumescent technique and Tissue Expander fill are more novel points of discussion, which may serve as proxies for other issues. Awareness of these risk factors and their interplay will aid in clinical judgement and postoperative care of these patients.
-
outcomes of immediate Tissue Expander breast reconstruction followed by reconstruction of choice in the setting of postmastectomy radiation therapy reply
Annals of Plastic Surgery, 2014Co-Authors: Elliot M Hirsch, Akhil K Seth, Neil A FineAbstract:A common sequence for performing staged Tissue Expander breast reconstruction is to immediately insert a Tissue Expander, complete expansion before radiotherapy, and then perform the definitive reconstruction after radiotherapy is complete. This study evaluates the outcomes of this treatment regimen in 237 patients over a 10-year period at Northwestern Memorial Hospital. Overall, 62% of the patients successfully completed Tissue Expander/implant reconstruction, 22.3% experienced major complications leading to explantations or conversions to flap, and 13.5% completed Tissue Expander/elective autologous reconstruction. Of the patients who underwent second-stage Tissue Expander to implant exchange, 87.5% successfully completed reconstruction without experiencing complications leading to explantation or conversion to autologous reconstruction. Thus, this study indicates that immediate Tissue Expander followed by reconstruction of choice breast reconstruction in the setting of postmastectomy radiation therapy can be successfully performed in most of the patients.
-
a predictive model of risk and outcomes in Tissue Expander reconstruction a multivariate analysis of 9786 patients
Journal of Plastic Surgery and Hand Surgery, 2013Co-Authors: Philip J Hanwright, Neil A Fine, Armando A Davila, Lauren M Mioton, Karl Y Bilimoria, John Y S KimAbstract:AbstractOutcomes of Tissue Expander breast reconstruction show variability based on presurgical risk factors. Few comprehensive, multi-institutional risk analyses exist. Patients who underwent Tissue Expander reconstruction were identified in a multi-institutional registry that spans over 240 institutions with over 200 variables per patient. Bivariate analysis of preoperative variables was performed across outcomes. Multivariate logistic regression was used to adjust for confounders and identify risk factors for complications. In 9786 total Tissue Expander patients, 526 (5.38%) patients experienced one or more complications. Wound infection and reoperations occurred in 3.45% and 6.76% of patients, respectively. Body mass index (BMI) was found to be a significant independent risk factor for overall morbidity, reoperation, prosthesis failure, and wound infection. Overweight, obese, and morbidly obese patients were at 1.7-, 2.6-, and 5.1-times greater risk of morbidity, respectively (p < 0.001 for all). Reco...
-
immediate two stage Tissue Expander breast reconstruction compared with one stage permanent implant breast reconstruction a multi institutional comparison of short term complications
Journal of Plastic Surgery and Hand Surgery, 2013Co-Authors: Armando A Davila, Neil A Fine, Lauren M Mioton, Karl Y Bilimoria, Geoffrey Chow, Edward Wang, Ryan P Merkow, John Y S KimAbstract:AbstractProsthesis-based techniques are the predominant form of breast reconstruction worldwide, with two-stage Tissue Expander procedures being the most popular. In the past decade, there has been increasing interest in performing single-stage implant reconstruction immediately following mastectomy as an attempt to simplify the reconstructive course and improve psychosocial morbidity. However, there is a paucity of large-scale, multi-institutional data comparing the outcomes of these two reconstructive strategies. Patients who underwent immediate Tissue Expander or implant reconstruction following mastectomy from 2006–2010 were identified using standardised operation codes. Demographic information for patients, 30-day outcomes, and adverse events for each type of reconstruction were analysed and compared between groups. A total of 10,561 patients underwent immediate breast reconstruction. There were 9033 patients who underwent Tissue Expander placement (2752 bilateral), and 1528 patients who underwent im...
-
human acellular dermis versus submuscular Tissue Expander breast reconstruction a multivariate analysis of short term complications
Archives of Plastic Surgery, 2013Co-Authors: Armando A Davila, Akhil K Seth, Philip J Hanwright, Karl Y Bilimoria, Edward Wang, Neil A FineAbstract: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.
Peter G. Cordeiro - One of the best experts on this subject based on the ideXlab platform.
-
immediate Tissue Expander implast breast reconstruction after salvage mastectomy for cancer recurrence following lumpectomy irradiation
Plastic and Reconstructive Surgery, 2012Co-Authors: Peter G. Cordeiro, Laura Snell, Alexandra S Heerdt, Colleen M MccarthyAbstract:Background:The objective of this study was to analyze early complications and long-term outcomes in patients undergoing salvage mastectomy and immediate Tissue Expander/implant reconstruction for cancer recurrence following breast conservation therapy (lumpectomy/irradiation).Methods:A review of all
-
Prevention of postpneumonectomy syndrome in children with prophylactic Tissue Expander insertion
Journal of pediatric surgery, 2012Co-Authors: Lydia Choi, Michael P. Laquaglia, Peter G. CordeiroAbstract:Abstract Introduction Postpneumonectomy syndrome (PPS) is an often life-threatening complication of pneumonectomy that occurs in up to 15% of children. This occurrence is higher than in adults, presumably because of more elastic Tissues in younger patients. Methods We present a case series of 4 pediatric patients at Memorial Sloan Kettering Cancer Center, in whom prophylactic Tissue Expanders were inserted immediately after pneumonectomy. Results Insertion of the Tissue Expander and prevention of PPS was successful in all patients. The presence of the Tissue Expander did not result in infection in any patient. Our only complication was rupture of the Tissue Expander in 1 patient, but by the time of removal, a capsule had already formed within the lung and replacement was unnecessary. Conclusion This case series, although limited in number and follow-up, presents evidence that prophylactic Tissue Expander insertion appears to be a safe option for children requiring pneumonectomy. Its insertion at the time of pneumonectomy may prevent the devastating complications of PPS. Because it may result in a higher total number of procedures, the benefits must be weighed against the risks of insertion and decisions made for individual patients on a case-by-case basis.
-
acellular human dermis implantation in 153 immediate two stage Tissue Expander breast reconstructions determining the incidence and significant predictors of complications
Plastic and Reconstructive Surgery, 2010Co-Authors: Anuja K Antony, Peter G. Cordeiro, Colleen M Mccarthy, Andrea L Pusic, Babak J Mehrara, Alexander F Arriaga, Joseph J DisaAbstract: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 complica
-
salvage of Tissue Expander in the setting of mastectomy flap necrosis a 13 year experience using timed excision with continued expansion
Plastic and Reconstructive Surgery, 2009Co-Authors: Anuja K Antony, Colleen M Mccarthy, Andrea L Pusic, Joseph J Disa, Babak Mehrara, Toni Zhong, Nina Kropf, Peter G. CordeiroAbstract:Background: Mastectomy flap necrosis after immediate Tissue Expander placement can have profound implications, resulting in prosthetic infection necessitating Tissue Expander removal. The purpose of this investigation was to evaluate the safety and efficacy of timed, surgical excision during continued serials expansion in the setting of mastectomy flap necrosis and to identify an algorithm for surgeons faced with the management of this difficult problem. Methods: Consecutive patients in whom documented mastectomy flap necrosis developed following immediate Tissue Expander placement from 1995 to 2008 were identified. Patient demographic, reconstructive, and complication data were obtained from a prospectively maintained clinical database. Medical records were then retrospectively reviewed to further characterize the extent of mastectomy flap necrosis and its management. Results: Over the 13-year study period, 178 patients with documented mastectomy flap necrosis following immediate Tissue Expander were identified. In 58 patients (33 percent), surgical excision of the mastectomy flap necrosis was performed. Surgical excision occurred a mean 36 days (range, 8 to 153 days) after Tissue Expander placement. Mean surface area of eschar excised was 42.5 cm 2 (range, 2.5 to 240 cm 2 ). In nine (15.5 percent) of the 58 patients, resection of such an extensive area of mastectomy flap necrosis necessitated explantation of the Tissue Expander and subsequent flap closure (local advancement flaps, n = 8; latissimus flap, n = 1). Of the remaining patients, only three (6 percent) developed a subsequent infection necessitating the premature removal of a Tissue Expander. Conclusions: Timed excision with continued expansion is a straightforward procedure associated with a low incidence of failure. This approach allows for salvage of a significant percentage of threatened Tissue Expanders and may be coordinated with adjuvant oncologic therapy without excessive delays.
-
a single surgeon s 12 year experience with Tissue Expander implant breast reconstruction part i a prospective analysis of early complications
Plastic and Reconstructive Surgery, 2006Co-Authors: Peter G. Cordeiro, Colleen M MccarthyAbstract:Background:Multiple prior reports are conflicted regarding the true incidence of complications following implant-based breast reconstruction. A review of a single surgeon's extensive experience with Tissue Expander/implant reconstruction provides the opportunity to critically evaluate outcomes in a
Colleen M Mccarthy - One of the best experts on this subject based on the ideXlab platform.
-
unilateral preoperative chest wall irradiation in bilateral Tissue Expander breast reconstruction with acellular dermal matrix a prospective outcomes analysis
Plastic and Reconstructive Surgery, 2013Co-Authors: Katie E Weichman, Colleen M Mccarthy, Andrea L Pusic, Babak J Mehrara, Yeliz Cemal, Claudia R Albornoz, Joseph J DisaAbstract:BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSIONS 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. CLINICAL QUESTION/LEVEL OF EVIDENCE : Therapeutic, III.
-
immediate Tissue Expander implast breast reconstruction after salvage mastectomy for cancer recurrence following lumpectomy irradiation
Plastic and Reconstructive Surgery, 2012Co-Authors: Peter G. Cordeiro, Laura Snell, Alexandra S Heerdt, Colleen M MccarthyAbstract:Background:The objective of this study was to analyze early complications and long-term outcomes in patients undergoing salvage mastectomy and immediate Tissue Expander/implant reconstruction for cancer recurrence following breast conservation therapy (lumpectomy/irradiation).Methods:A review of all
-
acellular human dermis implantation in 153 immediate two stage Tissue Expander breast reconstructions determining the incidence and significant predictors of complications
Plastic and Reconstructive Surgery, 2010Co-Authors: Anuja K Antony, Peter G. Cordeiro, Colleen M Mccarthy, Andrea L Pusic, Babak J Mehrara, Alexander F Arriaga, Joseph J DisaAbstract: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 complica
-
salvage of Tissue Expander in the setting of mastectomy flap necrosis a 13 year experience using timed excision with continued expansion
Plastic and Reconstructive Surgery, 2009Co-Authors: Anuja K Antony, Colleen M Mccarthy, Andrea L Pusic, Joseph J Disa, Babak Mehrara, Toni Zhong, Nina Kropf, Peter G. CordeiroAbstract:Background: Mastectomy flap necrosis after immediate Tissue Expander placement can have profound implications, resulting in prosthetic infection necessitating Tissue Expander removal. The purpose of this investigation was to evaluate the safety and efficacy of timed, surgical excision during continued serials expansion in the setting of mastectomy flap necrosis and to identify an algorithm for surgeons faced with the management of this difficult problem. Methods: Consecutive patients in whom documented mastectomy flap necrosis developed following immediate Tissue Expander placement from 1995 to 2008 were identified. Patient demographic, reconstructive, and complication data were obtained from a prospectively maintained clinical database. Medical records were then retrospectively reviewed to further characterize the extent of mastectomy flap necrosis and its management. Results: Over the 13-year study period, 178 patients with documented mastectomy flap necrosis following immediate Tissue Expander were identified. In 58 patients (33 percent), surgical excision of the mastectomy flap necrosis was performed. Surgical excision occurred a mean 36 days (range, 8 to 153 days) after Tissue Expander placement. Mean surface area of eschar excised was 42.5 cm 2 (range, 2.5 to 240 cm 2 ). In nine (15.5 percent) of the 58 patients, resection of such an extensive area of mastectomy flap necrosis necessitated explantation of the Tissue Expander and subsequent flap closure (local advancement flaps, n = 8; latissimus flap, n = 1). Of the remaining patients, only three (6 percent) developed a subsequent infection necessitating the premature removal of a Tissue Expander. Conclusions: Timed excision with continued expansion is a straightforward procedure associated with a low incidence of failure. This approach allows for salvage of a significant percentage of threatened Tissue Expanders and may be coordinated with adjuvant oncologic therapy without excessive delays.
-
a single surgeon s 12 year experience with Tissue Expander implant breast reconstruction part i a prospective analysis of early complications
Plastic and Reconstructive Surgery, 2006Co-Authors: Peter G. Cordeiro, Colleen M MccarthyAbstract:Background:Multiple prior reports are conflicted regarding the true incidence of complications following implant-based breast reconstruction. A review of a single surgeon's extensive experience with Tissue Expander/implant reconstruction provides the opportunity to critically evaluate outcomes in a
Joseph J Disa - One of the best experts on this subject based on the ideXlab platform.
-
unilateral preoperative chest wall irradiation in bilateral Tissue Expander breast reconstruction with acellular dermal matrix a prospective outcomes analysis
Plastic and Reconstructive Surgery, 2013Co-Authors: Katie E Weichman, Colleen M Mccarthy, Andrea L Pusic, Babak J Mehrara, Yeliz Cemal, Claudia R Albornoz, Joseph J DisaAbstract:BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSIONS 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. CLINICAL QUESTION/LEVEL OF EVIDENCE : Therapeutic, III.
-
acellular human dermis implantation in 153 immediate two stage Tissue Expander breast reconstructions determining the incidence and significant predictors of complications
Plastic and Reconstructive Surgery, 2010Co-Authors: Anuja K Antony, Peter G. Cordeiro, Colleen M Mccarthy, Andrea L Pusic, Babak J Mehrara, Alexander F Arriaga, Joseph J DisaAbstract: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 complica
-
salvage of Tissue Expander in the setting of mastectomy flap necrosis a 13 year experience using timed excision with continued expansion
Plastic and Reconstructive Surgery, 2009Co-Authors: Anuja K Antony, Colleen M Mccarthy, Andrea L Pusic, Joseph J Disa, Babak Mehrara, Toni Zhong, Nina Kropf, Peter G. CordeiroAbstract:Background: Mastectomy flap necrosis after immediate Tissue Expander placement can have profound implications, resulting in prosthetic infection necessitating Tissue Expander removal. The purpose of this investigation was to evaluate the safety and efficacy of timed, surgical excision during continued serials expansion in the setting of mastectomy flap necrosis and to identify an algorithm for surgeons faced with the management of this difficult problem. Methods: Consecutive patients in whom documented mastectomy flap necrosis developed following immediate Tissue Expander placement from 1995 to 2008 were identified. Patient demographic, reconstructive, and complication data were obtained from a prospectively maintained clinical database. Medical records were then retrospectively reviewed to further characterize the extent of mastectomy flap necrosis and its management. Results: Over the 13-year study period, 178 patients with documented mastectomy flap necrosis following immediate Tissue Expander were identified. In 58 patients (33 percent), surgical excision of the mastectomy flap necrosis was performed. Surgical excision occurred a mean 36 days (range, 8 to 153 days) after Tissue Expander placement. Mean surface area of eschar excised was 42.5 cm 2 (range, 2.5 to 240 cm 2 ). In nine (15.5 percent) of the 58 patients, resection of such an extensive area of mastectomy flap necrosis necessitated explantation of the Tissue Expander and subsequent flap closure (local advancement flaps, n = 8; latissimus flap, n = 1). Of the remaining patients, only three (6 percent) developed a subsequent infection necessitating the premature removal of a Tissue Expander. Conclusions: Timed excision with continued expansion is a straightforward procedure associated with a low incidence of failure. This approach allows for salvage of a significant percentage of threatened Tissue Expanders and may be coordinated with adjuvant oncologic therapy without excessive delays.
-
complications in smokers after postmastectomy Tissue Expander implant breast reconstruction
Annals of Plastic Surgery, 2005Co-Authors: Susie J Goodwin, Peter G. Cordeiro, Colleen M Mccarthy, Andrea L Pusic, Duc T Bui, Michael A Howard, Joseph J Disa, Babak J MehraraAbstract:Smoking is universally considered to be a risk factor for surgical complications. The incidence of complications following Tissue Expander/implant breast reconstruction in patients who smoke has not been previously evaluated.A review of complications following Tissue Expander/implant reconstruction in 515 patients was performed. Patients who had 2-stage, Tissue Expander/implant reconstruction at Memorial Sloan-Kettering Cancer Center between May 2002 and December 2003 were included. Complications in smokers (n=132) and nonsmokers (n=383) were compared. The rate of overall complications, reconstructive failure, mastectomy flap necrosis, and infectious complications was significantly higher in smokers compared with nonsmokers. The rate of complications in ex-smokers was also higher than in nonsmokers. Using multivariate statistical analysis to adjust for confounding variables, smoking was identified as independent predictor of postoperative complications.A significant association between smoking status and postoperative complications exists. Thus, smokers who undergo postmastectomy Expander/implant reconstruction should be informed of the increased risk of surgical complications and should be counseled on smoking cessation.
-
irradiation after immediate Tissue Expander implant breast reconstruction outcomes complications aesthetic results and satisfaction among 156 patients
Plastic and Reconstructive Surgery, 2004Co-Authors: Peter G. Cordeiro, Andrea L Pusic, Joseph J Disa, Beryl Mccormick, Kimberly VanzeeAbstract:Chest wall irradiation is becoming increasingly common for mastectomy patients who have opted for immediate breast reconstruction with Tissue Expanders and implants. The optimal approach for such patients has not yet been defined. This study assesses the outcomes of a reconstruction protocol for patients who require irradiation after Tissue Expander/implant reconstruction. The charts of all patients who underwent immediate Tissue Expander/implant reconstruction at Memorial Sloan-Kettering Cancer Center between January of 1995 and June of 2001 and who had not previously undergone irradiation were retrospectively reviewed. A subgroup of patients who required chest wall irradiation after mastectomy and reconstruction was identified. Those patients were treated according to the following treatment algorithm: (1) reconstruction with Tissue Expander placement at the time of mastectomy , (2) Tissue expansion during postoperative chemotherapy, (3) exchange of the Tissue Expander for a permanent implant approximately 4 weeks after the completion of chemotherapy, and (4) chest wall irradiation beginning 4 weeks after the exchange. All irradiated patients with at least 1 year of follow-up monitoring after the completion of radiotherapy were evaluated with respect to aesthetic outcomes, capsular contracture, and patient satisfaction. A control group of nonirradiated patients was randomly selected from the cohort of patients treated during the study period. During the 5-year study period, a total of 687 patients underwent immediate reconstruction with Tissue Expanders. Eighty-one patients underwent postoperative irradiation after placement of the final implant. A total of 68 patients who received postoperative chest wall irradiation underwent at least 1 year of follow-up monitoring after the completion of radiotherapy, with a mean follow-up period of 34 months. Seventy-five nonirradiated patients were evaluated as a control group. Overall, 68 percent of the irradiated patients developed capsular contracture, compared with 40 percent in the nonirradiated group (p = 0.025). Eighty percent of the irradiated patients demonstrated acceptable (good to excellent) aesthetic results, compared with 88 percent in the nonirradiated group (p = not significant). Sixty-seven percent of the irradiated patients were satisfied with their reconstructions, compared with 88 percent of the nonirradiated patients (p = 0.004). Seventy-two percent of the irradiated patients stated that they would choose the same form of reconstruction again, compared with 85 percent of the nonirradiated patients. The results of this study suggest that Tissue Expander/implant reconstruction is an acceptable surgical option even when followed by postoperative radiotherapy and should be considered in the reconstruction algorithm for all patients, particularly those who may not be candidates for autogenous reconstruction.
John Y S Kim - One of the best experts on this subject based on the ideXlab platform.
-
a prospective analysis of dynamic loss of breast projection in Tissue Expander implant reconstruction
Archives of Plastic Surgery, 2015Co-Authors: Lauren M Mioton, Sumanas W Jordan, John Y S KimAbstract:BACKGROUND Breast projection is a critical element of breast reconstruction aesthetics, but little has been published regarding breast projection as the firm Expander is changed to a softer implant. Quantitative data representing this loss in projection may enhance patient education and improve our management of patient expectations. METHODS Female patients who were undergoing immediate Tissue-Expander breast reconstruction with the senior author were enrolled in this prospective study. Three-dimensional camera software was used for all patient photographs and data analysis. Projection was calculated as the distance between the chest wall and the point of maximal projection of the breast form. Values were calculated for final Tissue Expander expansion and at varying intervals 3, 6, and 12 months after implant placement. RESULTS Fourteen breasts from 12 patients were included in the final analysis. Twelve of the 14 breasts had a loss of projection at three months following the implant placement or beyond. The percentage of projection lost in these 12 breasts ranged from 6.30% to 43.4%, with an average loss of projection of 21.05%. CONCLUSIONS This study is the first prospective quantitative analysis of temporal changes in breast projection after Expander-implant reconstruction. By prospectively capturing projection data with three-dimensional photographic software, we reveal a loss of projection in this population by three months post-implant exchange. These findings will not only aid in managing patient expectations, but our methodology provides a foundation for future objective studies of the breast form.
-
assessing outcomes and safety of inpatient versus outpatient Tissue Expander immediate breast reconstruction
Annals of Surgical Oncology, 2015Co-Authors: Charles Qin, Anuja K Antony, Apas Aggarwal, Sumanas W Jordan, Karol A Gutowski, John Y S KimAbstract:Background With the rising cost of healthcare delivery and bundled payments for episodes of care, there has been impetus to minimize hospitalization and increase utilization of outpatient surgery mechanisms. Given the increase in outpatient mastectomy and immediate Tissue Expander (TE)-based reconstruction and the paucity of data on its comparative safety to inpatient procedures, we sought to understand the risk for early postoperative complications in an outpatient model compared with more traditional inpatient status using the National Surgical Quality Improvement Program database.
-
risk factors for mastectomy flap necrosis following immediate Tissue Expander breast reconstruction
Journal of Plastic Surgery and Hand Surgery, 2014Co-Authors: Alexei S Mlodinow, Neil A Fine, Nima Khavanin, John Y S KimAbstract:Tissue Expander placement is a mainstay of reconstructive surgery in the post-mastectomy patient. Necrosis of the native breast Tissue is one of the most significant concerns in their post-operative care. The goal of this study is to elucidate factors that confer risk of this outcome. Chart review was conducted for a consecutive series of immediate Tissue Expander reconstructions by the two senior authors. Data was collected for several preoperative and intraoperative variables, as well as the outcome of mastectomy flap necrosis. Of the 1566 breasts that were examined, 135 (8.6%) experienced flap necrosis. The cohorts with and without flap necrosis were well matched. Those with the outcome of interest had significantly higher rates of switching to an autologous method of reconstruction (31.9% vs 6.2%, p 66.67%) intraoperative Tissue Expander fill to confer increased risk of mastectomy flap necrosis. While smoking and older age are well-supported by the literature, tumescent technique and Tissue Expander fill are more novel points of discussion, which may serve as proxies for other issues. Awareness of these risk factors and their interplay will aid in clinical judgement and postoperative care of these patients.
-
a predictive model of risk and outcomes in Tissue Expander reconstruction a multivariate analysis of 9786 patients
Journal of Plastic Surgery and Hand Surgery, 2013Co-Authors: Philip J Hanwright, Neil A Fine, Armando A Davila, Lauren M Mioton, Karl Y Bilimoria, John Y S KimAbstract:AbstractOutcomes of Tissue Expander breast reconstruction show variability based on presurgical risk factors. Few comprehensive, multi-institutional risk analyses exist. Patients who underwent Tissue Expander reconstruction were identified in a multi-institutional registry that spans over 240 institutions with over 200 variables per patient. Bivariate analysis of preoperative variables was performed across outcomes. Multivariate logistic regression was used to adjust for confounders and identify risk factors for complications. In 9786 total Tissue Expander patients, 526 (5.38%) patients experienced one or more complications. Wound infection and reoperations occurred in 3.45% and 6.76% of patients, respectively. Body mass index (BMI) was found to be a significant independent risk factor for overall morbidity, reoperation, prosthesis failure, and wound infection. Overweight, obese, and morbidly obese patients were at 1.7-, 2.6-, and 5.1-times greater risk of morbidity, respectively (p < 0.001 for all). Reco...
-
immediate two stage Tissue Expander breast reconstruction compared with one stage permanent implant breast reconstruction a multi institutional comparison of short term complications
Journal of Plastic Surgery and Hand Surgery, 2013Co-Authors: Armando A Davila, Neil A Fine, Lauren M Mioton, Karl Y Bilimoria, Geoffrey Chow, Edward Wang, Ryan P Merkow, John Y S KimAbstract:AbstractProsthesis-based techniques are the predominant form of breast reconstruction worldwide, with two-stage Tissue Expander procedures being the most popular. In the past decade, there has been increasing interest in performing single-stage implant reconstruction immediately following mastectomy as an attempt to simplify the reconstructive course and improve psychosocial morbidity. However, there is a paucity of large-scale, multi-institutional data comparing the outcomes of these two reconstructive strategies. Patients who underwent immediate Tissue Expander or implant reconstruction following mastectomy from 2006–2010 were identified using standardised operation codes. Demographic information for patients, 30-day outcomes, and adverse events for each type of reconstruction were analysed and compared between groups. A total of 10,561 patients underwent immediate breast reconstruction. There were 9033 patients who underwent Tissue Expander placement (2752 bilateral), and 1528 patients who underwent im...
