Jul 2026· Annals of Surgical Oncology· 0 citations· 20 references
Medicine
TL;DR
Thresholds of average QP ≥ 49 and minimum QP < 33, integrated with Yale Grade ≤ 3, provide a practical, tiered framework for intraoperative decision-making for intraoperative risk stratification.
. Abstract Background: Oncoplastic breast surgery seeks to preserve aesthetic outcomes without compromising oncological safety. Various flap techniques based on tumour location exist, yet limited evidence exists evaluating perforator-based oncoplastic breast reconstruction. This study evaluates surgical and patient-reported outcomes of partial breast reconstruction using chest wall perforator flaps (CWPFs) without Doppler assistance. Methods: The study included 137 patients who underwent CWPFs post-January 2020 and completed 1 year of follow-up before April 2025. Data were analysed from a prospectively maintained database, recording demographics, perioperative events and surgical outcomes. Patient satisfaction was assessed with the BREAST-Q TM questionnaire six months after radiotherapy completion. Results: The mean age of the study population was 48.1 years. Lateral intercostal artery perforator, medial intercostal artery perforator and anterior intercostal artery perforator were performed in 59.1%, 28.5%, and 12.4%, respectively. Mean operative time for flap
Ashutosh Mishra, Amit Kumar, Ajay Gogia et al.· ecancermedicalscience· 0 citations
INTRODUCTION
There is a paucity of data on surgical outcomes after ambulatory mastectomy and immediate reconstruction. Our objective was to evaluate the feasibility and safety of ambulatory mastectomy with immediate alloplastic reconstruction.
METHODS
We conducted a single institution retrospective cohort study of patients who underwent ambulatory mastectomy with immediate alloplastic reconstruction between 2015 and 2021. Demographic and clinical data were collected from medical chart review and summarized with descriptive statistics. A multivariable logistic regression model was used to determine the predictors of a surgical complication. P values < 0.05 were considered significant.
RESULTS
Three hundred forty women underwent ambulatory mastectomy with immediate reconstruction for breast cancer (169, 50%) or risk reduction (171, 50%). One hundred seventy five (51.5%) women underwent skin-sparing mastectomy and 165 (48.5%) underwent nipple-sparing mastectomy. Two hundred fifty seven (76%) had a subpectoral implant and 83 (24%) had a prepectoral implant. Forty eight (14%) of the patients developed a post-operative complication, 36 (11%) required a return to the operating room, and 15 (4%) had loss of their reconstruction. Only 21 patients (6%) required a hospital admission. In a multivariate logistic regression analysis, obesity was associated with significantly increased odds of developing a complication (OR 24.92, 95% CI 1.34-464.5, P = 0.03). However, other factors such as mastectomy type and device location did not affect complication rates.
CONCLUSIONS
Eighty six percent of the women undergoing pre-planned ambulatory mastectomy with immediate alloplastic reconstruction for risk reduction or breast cancer did not experience a post-operative complication. In our specific context, our experience suggests that mastectomy with immediate alloplastic reconstruction can be considered for same day discharge.
Simran S Sandhu, Matin Arabkhari, J. Semple et al.· Journal of Surgical Research· 0 citations
BACKGROUND
Breast cancer is the most prevalent malignancy among women globally, and mastectomy often forms a critical part of its treatment. Breast reconstruction is an important aspect of post-mastectomy care, contributing to improved psychological well-being and quality of life. This study compares the outcomes of two distinct Latissimus Dorsi (LD) flap reconstruction techniques: one utilizing implant augmentation (LD-I) and the other employing autologous fat graft (lipofilling) for volume restoration (LD-L).
METHODS
A retrospective cohort study was conducted, analyzing 116 patients who underwent breast reconstruction with either the LD-I or LD-L technique between 2013 and May 2024. Data was collected from two centers in Brazil. The primary outcome was the rate of major complications, defined as those requiring surgical re-intervention or hospital readmission. Secondary outcomes included the incidence of early (≤ 6 months) and late (> 6 months) complications and the correlation of clinical characteristics in regards to the complications, such as comorbidities and vices.
RESULTS
The study population comprised 50 patients in the LD-I group and 66 patients in the LD-L group. The mean age of patients was approximately 50 years in both groups. There were no significant differences between the groups regarding oncologic characteristics, including tumor stage, histological subtype, and receipt of neoadjuvant or adjuvant therapies. While the overall rate of major complications was not statistically different between the two groups (18% LD-I vs. 7.6% LD-L, p = 0.079), specific complications varied. The LD-I group exhibited a significantly higher rate of early infections (20% vs. 6.1%, p = 0.023) and a greater incidence of late reconstruction loss due to implant-related issues (10% vs. 0%, p = 0.013).
CONCLUSION
Both LD-I and LD-L techniques provide viable options for breast reconstruction. However, the LD-L technique demonstrated a lower risk of infection and reconstruction loss in this cohort. These findings suggest that LD-L may offer a favorable alternative for minimizing specific complications and improving long-term outcomes in post-mastectomy breast reconstruction. However, these findings should be analyzed with caution and further prospective, randomized studies with larger sample sizes are warranted to confirm these observations and to identify specific patient subgroups that may benefit most from each technique.
Aline Prado de Almeida, V. M. de Oliveira, R. Paulinelli et al.· World Journal of Surgery· 0 citations
BACKGROUND
Oncoplastic breast reconstruction (OP), combining tumor resection with volume reduction and soft tissue rearrangement, benefits women undergoing breast conservation surgery by both alleviating macromastia symptoms and enhancing symmetry, shape, and cosmesis. This study compared oncoplastic breast reconstruction with standard bilateral breast reduction (BBR) across three domains: (1) clinical safety profile, (2) patient-reported outcomes, and (3) aesthetic results.
METHODS
A single-surgeon, single-institution retrospective review was conducted on patients who underwent OP or BBR from April 2022 to May 2025. Demographics, clinical data, BREAST-Q surveys, and aesthetic outcomes were collected via electronic medical record. Statistical analyses included univariate testing and minimal ANCOVA.
RESULTS
Among 180 patients, 116 (64.4%) received BBR and 64 (35.6%) OP. BBR patients were younger and had greater resection weights (p<0.05). OP patients had higher BMI and ASA class (p<0.05). Wise pattern incision was utilized in all BBR and 97% of OP cases. While minor wound breakdown was statistically more frequent in the oncoplastic cohort, major complication rates were comparable between the two cohorts. Both cohorts showed significantly higher post-op BREAST-Q scores in psychosocial, sexual, and physical well-being, in addition to satisfaction with breasts, controlling for age and BMI. Comparing aesthetic scores between 10 patients of each group, BBR was slightly favored, though by less than 0.5 Likert scale in all six domains.
CONCLUSIONS
OP provides significant QoL improvement with comparable major safety profile and aesthetic outcomes to BBR, further supporting its role as a favorable reconstructive option when lumpectomy is indicated.
S. J. Oh, Jennifer Rodriguez, Kevin Hu et al.· Plastic and Reconstructive S...· 0 citations
BACKGROUND
Ischemia time is a key determinant of microsurgical free-flap survival and potentially modifiable risk factor in autologous breast reconstruction. However, factors influencing ischemia time within complex workflows are insufficiently understood. Existing evidence is largely limited to single-center, retrospective studies that focused predominantly on deep inferior epigastric perforator flaps.
METHODS
Prospectively collected data from the German national registry, including 22 centers, for autologous breast reconstruction were analyzed. A subcohort of 4209 unilateral microsurgical breast reconstructions performed in 4113 patients between 2011 and 2018 was evaluated. Generalized linear models were used to assess the effects of flap type, intraoperative repositioning, anastomosis technique, surgeon-related factors, and recipient vessel choice on ischemia time. Associations with operative duration and clinical outcomes were examined using multivariable regression.
RESULTS
Procedures that required intraoperative repositioning showed significantly longer ischemia times than non-repositioning procedures (mean difference 43 min, p <0.001). Hand-sewn venous anastomoses resulted in significantly longer ischemia times than did coupler-assisted anastomoses, with this difference increasing over time (mean difference 15 min, p =0.003). Prolonged ischemia time was associated with arterial revision and flap loss, whereas operative duration showed the strongest association with venous revision.
CONCLUSION
Ischemia time in microsurgical breast reconstruction is strongly influenced by technical and organizational factors. Coupler-assisted anastomoses shortened the ischemia time and appeared to be less influenced by surgeon-related variability and procedural complexity. Prolonged ischemia time continued to be associated after adjustment with arterial complications and flap loss, whereas operative duration showed its strongest and most robust association with venous anastomotic revision, thereby supporting ischemia time as a clinically relevant workflow-dependent quality metric.
U. von Fritschen, M. Keck, S. Fertsch et al.· Journal of Plastic, Reconstr...· 0 citations
BACKGROUND
Immediate breast reconstruction helps breast cancer patients regain physical and emotional confidence, but the risk of skin flap necrosis can lead to reconstruction failure. Laser speckle contrast imaging (LSCI) has emerged as an innovative technique for predicting necrosis. This study prospectively compared the effectiveness of indocyanine green (ICG) fluorescence imaging with LSCI in predicting the risk of necrosis after direct-to-implant reconstruction.
METHODS
This study included 87 patients undergoing mastectomy and immediate reconstruction from December of 2022 to January of 2024. Perfusion of the 195 measurement units, including nipple-areola complex and peri-incision skin flaps, was assessed by both LSCI and ICG imaging intraoperatively and postoperatively.
RESULTS
A total of 195 measurement units were analyzed, showing significant differences in perfusion values between surviving and necrotic flaps. LSCI demonstrated superior sensitivity (87.10% versus 81.82%), with a perfusion threshold of 37.93% intraoperatively and 22.84% postoperatively. ICG imaging showed higher specificity (80.42% versus 71.60%) but was limited to a single intraoperative use.
CONCLUSIONS
Both LSCI and ICG were superior predictors of postoperative flap necrosis. LSCI offers the advantage of repeated measurements, making it a versatile tool for ongoing assessment. While the 2 methods showed consistent differences in measured values, LSCI may serve as a viable alternative to ICG in evaluating tissue viability.
Runzhu Liu, Yining Lan, Hailin Zhang et al.· Plastic and Reconstructive S...· 0 citations
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