Complications Following Abdominal-Based Microsurgical Breast Reconstruction.

Surgical Outcomes of Ambulatory Mastectomy and Immediate Alloplastic Reconstruction for Breast Cancer or Risk Reduction.

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.

Immediate breast reconstruction versus delayed immediate breast reconstruction: A Strasbourg experience retrospective study.

BACKGROUND Delayed-immediate breast reconstruction (DIBR) using a temporary tissue expander is commonly recommended when post-mastectomy radiotherapy (PMRT) is anticipated, with the aim of optimizing aesthetic outcomes. However, the actual benefit of tissue expanders compared with immediate breast reconstruction (IBR) remains debated. METHODS We conducted a retrospective monocentric observational study including patients who underwent curative or prophylactic mastectomy followed by IBR or DIBR between January 2019 and December 2023. Reconstruction techniques included definitive implants, tissue expanders, and autologous flaps. The primary endpoint was aesthetic outcome assessed on standardized postoperative photographs using the Vrieling scale by six blinded plastic surgeons. Secondary endpoints included patient-reported outcomes using the BREAST-Q questionnaire, number of surgical procedures, capsular contracture (Baker classification), and postoperative complications (Clavien-Dindo). Multivariate analyses were performed to account for confounders, including radiotherapy. RESULTS A total of 149 patients (192 reconstructions) were included (160 IBR, 32 DIBR). No significant difference in aesthetic outcomes was observed between IBR and DIBR overall, nor within implant-based or flap-based subgroups. BREAST-Q scores were comparable between groups across psychosocial, sexual well-being, and breast satisfaction domains, although chest physical well-being was significantly lower in the DIBR group (P=0.03). Patients undergoing flap reconstruction reported higher breast satisfaction than those with implant-based reconstruction (P<0.001). DIBR required significantly more surgical procedures than IBR (2.3 vs. 1.6; P<0.001). Radiotherapy negatively impacted patient-reported satisfaction but did not significantly influence aesthetic scores or complication rates between groups. CONCLUSION Among patients who completed reconstruction, DIBR did not confer a measurable aesthetic advantage over IBR, while requiring more surgical procedures and being associated with lower chest physical well-being. Immediate reconstruction may be sufficient in selected patients, even when radiotherapy is required.

Complications, Functional Recovery, and Quality of Life in Breast Cancer Patients Undergoing Axillary Surgery

Background Survivorship considerations have gained increasing importance in patients with early breast cancer. Every surgical procedure poses a risk of complications and a potential negative impact on patient‐reported outcomes (PROs), thereby driving growing interest in de‐escalation strategies in breast cancer surgery. In this context, we aimed to assess complication rates, the potential role of physiatric rehabilitation in managing these complications, and the impact of axillary surgery on PROs. Methods This retrospective single‐center cohort study included breast cancer patients who underwent surgery between January 2022 and March 2023 at the Breast Unit of Policlinico Umberto I, Rome. Among 164 patients operated on during the study period, 71 who underwent axillary surgery and received postoperative physiatric evaluation according to the institutional care pathway (PDTA) were included. The Disability of the Arm, Shoulder and Hand (DASH) questionnaire was administered to evaluate PROs. Results Among the included patients (n = 71), SLNB was performed in 71.83% and ALND in 21.13%. A total of 34/71 patients (47.89%) developed complications requiring rehabilitative treatment and were classified as cases, while the remaining patients constituted the control group. Overall, shoulder painful mobility limitation (56.34%) (SPML), motor deficit (54.93%) (MD), and sensory deficit (46.48%) (SD) were the most frequent complications, whereas lymphedema (LE) and scapular winging (SW) occurred in 4.23% each. More extensive axillary procedures were associated with a higher number of lymph nodes removed (p < 0.0001). Cases had significantly more lymph nodes removed than controls (p = 0.0003). Patients requiring rehabilitation were younger on average than controls. Recovery time differed significantly between cases and controls (p < 0.0001), with most patients recovering within 3 months from the first physiatric visit. DASH scores were significantly worse in patients requiring rehabilitative treatment than in controls (p < 0.0001). The mean DASH score was 14%. Higher DASH values were associated with postoperative complications requiring rehabilitation and delayed or absent recovery, particularly SPML, DM, DS, and SW. Conclusions Functional impairment of the upper limb remained frequent and may affect patients’ daily activities. These findings support the importance of integrating surgical management with early physiatric evaluation and rehabilitation to optimize functional recovery. Systematic assessment using patient‐reported outcome measures (PROMs), such as the DASH questionnaire, may help identify disability early and support patient follow‐up.

Comparison of DermACELL™ and Braxon® in prepectoral implant-based breast reconstruction: Complication rates and clinical implications.

BACKGROUND Breast cancer remains the most common malignancy among women worldwide, with many patients undergoing mastectomy followed by implant-based reconstruction (IBR). Prepectoral IBR has gained popularity due to reduced postoperative pain and improved esthetic outcomes. This approach frequently utilizes acellular dermal matrices (ADMs), including DermACELL™ (human-derived, partial coverage) and Braxon® (porcine-derived, full-wrap), which differ in composition and surgical application. Evidence comparing their complication profiles remains inconclusive. This study aimed to compare postoperative outcomes between these two ADMs in prepectoral IBR. METHODS A retrospective review was conducted of patients who underwent prepectoral IBR with Braxon® or DermACELL™ between June 2022 and January 2026 at a single institution. Data collected included demographics, surgical characteristics, ADM type, adjuvant therapy, and postoperative complications. Groups were compared using univariable analyzes, and multivariable logistic regression was performed to adjust for confounders. RESULTS A total of 125 cases were included (58 Braxon®, 67 DermACELL™). Baseline demographics and operative characteristics were comparable. Differences were noted in antibiotic regimens and surgeon distribution. The overall complication rate was 37.6% (n=47), including 18.4% minor and 19.2% major complications. The most common complications were seroma (14.4%) and wound dehiscence (13.6%). Capsular contracture ≥ grade III occurred in 7.2%, and reoperation was required in 18.4% of cases. No significant differences were observed between groups in complication rates or timing. Reoperation was numerically higher in the Braxon® group than in the DermACELL™ group, although this did not reach statistical significance (p = 0.063). CONCLUSION No statistically significant differences in overall complications, major complications, or specific complications were observed between Braxon® and DermACELL™ in prepectoral IBR. Observed differences may reflect institutional practices, surgeon preference, or perioperative protocols rather than ADM-specific effects alone. Larger prospective studies are needed to evaluate long-term outcomes.

Partial Breast Reconstruction and Oncoplasty: Our Experience

Objective: To evaluate outcomes of partial breast reconstruction and oncoplastic procedure in a tertiary care setup. Study Design: Prospective observational study. Place and Duration of Study: Combined Military Hospital Rawalpindi, Pakistan from Jan 2023 to Jun 2024. Methodology: In this study, 46 patients were included who had benign or malignant breast tumor with high tumor to breast ratio, requiring surgical excision when adequate downsizing was not achieved or was not possible with primary systemic therapy, were offered breast oncoplastic surgery. Each case underwent Triple Assessment and discussed in Multi-Disciplinary Meeting. All cases were staged using American Joint Committee on Cancer (AJCC) staging system. Clinically T4 and metastatic disease patients were excluded. Patients were followed for post operative complications including bleeding, infection, flap necrosis, seroma formation, fat necrosis, length of hospital stay and recurrence, and evaluated for aesthetic outcomes. Results: This study included total of 46 patients with a mean age of 47 years. Majority of patients had clinical T2 tumor and stage 2 disease. Most patients were luminal A type or DCIS, and upfront surgery was performed. Early post operative complications include bleeding and hematoma formation in 4.3% of patients, wound infection in 9.3 %, 4.3% had wound dehiscence. Mean hospital stay was 3 days, and none required re-admission for any complication encountered. Conclusion: Oncoplastic breast surgery, despite its associated early postoperative complications, achieves good aesthetic outcomes and is oncologically safe across all age group and surgical setting.

Flying Following Breast Augmentation. How Safe is it? An Evidence-Based Report of 20 Years of Experience.