Acellular dermal matrices and synthetic meshes are commonly used to improve inframammary-fold definition, minimize muscle excision, and allow for greater control over the surgical technique in ...implant-based breast reconstruction. The aims of this study are to compare various combinations of placement planes and biosynthetic scaffolds and to further examine the respective incidences of postoperative complications and the timeline of capsular contracture development.
A data set consisting of 220 patients (393 samples) who underwent 2-stage reconstruction between 2012 and 2021 was used in the study. χ 2 , Fisher exact test, and 1-way analysis of variance were used to identify significant differences between the 4 subgroups. Cox proportional-hazards model and Kaplan-Meier estimator were used for survival analysis.
On univariate logistic regression (odds ratio, 0.21; P = 0.005), survival analysis ( P = 0.0082), and Cox-proportional hazard model (hazard ratio, 1.6; P = 0.01), poly-4-hydroxybutyrate mesh usage was linked to an increased risk of capsular contracture development. Prepectoral placement with no mesh and dual-plane placement with acellular dermal matrix showed similar timelines of capsular contracture development. The lowest incidences of capsular contracture occurred in the prepectoral placement and no mesh (49/161, 30.4%) and total submuscular subgroups (3/14, 21.4%). Infection, necrosis, and revision surgery rates did not differ significantly between the 4 groups.
The use of poly-4-hydroxybutyrate mesh in 2-stage breast reconstruction is correlated with a statistically significant increase in capsular contracture. Prepectoral placement with no biosynthetic scaffold had one of the lowest rates of contracture and may provide the most optimal balance between economic and clinical considerations in implant-based reconstruction.
Capsular contracture is a common complication after 2-stage breast reconstruction. The relationships between native breast size, the rate of tissue expander expansion, and capsule formation have not ...been elucidated. This study aims to evaluate how these factors contribute to capsular contracture and establish cutoff values for increased risk.
A data set consisting of 229 patients who underwent 2-stage breast reconstruction between 2012 and 2021 was included in the study. The rate of expansion is estimated as the final expanded volume subtracted by the initial filling volume of the tissue expander over time elapsed. The native breast size was estimated using various preoperative breast measurements and the weight of mastectomy specimen (grams). Further stratified analysis evaluated patients separately based on postoperative radiation status.
Greater nipple-inframammary fold distance and faster tissue expander enlargement rate conferred decreased odds of developing capsular contracture ( P < 0.05). On stratified analysis, faster tissue expansion rate was not significant in the nonradiated cohort but remained a significant negative predictor in the radiation group (odds ratio, 0.996; P < 0.05). Cut-point analysis showed an expansion rate of <240 mL/mo and a nipple-inframammary fold value of <10.5 cm as conferring a greater risk of capsular contracture.
Smaller inframammary fold distance may be associated with a higher risk of capsular contracture. Slower expansion rates correlate with increased odds of contracture in patients undergoing adjuvant radiation. Breast geometry should be considered when risk stratifying various reconstruction approaches (implant vs autologous). In addition, longer delays between implant exchange and initial tissue expansion should be avoided if clinically feasible.
BackgroundTwo-stage breast reconstruction is a common technique used to restore preoperative appearance in patients undergoing mastectomy. However, capsular contracture may develop and lead to ...implant failure and significant morbidity. The objective of this study is to build a machine-learning model that can determine the risk of developing contracture formation after two-stage breast reconstruction. MethodsA total of 209 women (406 samples) were included in the study cohort. Patient characteristics that were readily accessible at the preoperative visit and details pertaining to the surgical approach were used as input data for the machine-learning model. Supervised learning models were assessed using 5-fold cross validation. A neural network model is also evaluated using a 0.8/0.1/0.1 train/validate/test split. ResultsAmong the subjects, 144 (35.47%) developed capsular contracture. Older age, smaller nipple-inframammary fold distance, retropectoral implant placement, synthetic mesh usage, and postoperative radiation increased the odds of capsular contracture (p < 0.05). The neural network achieved the best performance metrics among the models tested, with a test accuracy of 0.82 and area under receiver operative curve of 0.79. ConclusionTo our knowledge, this is the first study that uses a neural network to predict the development of capsular contraction after two-stage implant-based reconstruction. At the preoperative visit, surgeons may counsel high-risk patients on the potential need for further revisions or guide them toward autologous reconstruction.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Canine adenovirus type 1 (CAdV‐1) is responsible for infectious canine hepatitis. The disease has been described in captive American black bear (Ursus americanus) and European brown bear (Ursus ...arctos arctos), with just one recently reported case in a cub of a free‐ranging brown bear (Ursus arctos horribilis) from Alaska. The aim of this work is to summarize findings related to presence and associated mortality of CAdV‐1 in 21 free‐ranging Cantabrian brown bears (Ursus arctos arctos) submitted to necropsy in Asturias and Castilla y León (northwestern Spain) from 1998 to 2018. On the basis of the anatomopathological findings and laboratory results three free‐ranging brown bears died due to infectious canine hepatitis, which is to our knowledge the first description of death due to this disease in free‐ranging bears in Europe. Gross lesions consisted of petechial haemorrhages and congestion in different internal organs, haemorrhagic fluid in internal cavities, friable and yellowish liver and thickening of gall bladder. Microscopic lesions were observed mainly in liver, kidney and brain and consisted of multifocal necrosis of cells with presence of basophilic intranuclear inclusions. Immunohistochemical (IHC) and real‐time polymerase chain reaction (qPCR) techniques were used to assess the presence of CAdV‐1 in paraffin‐embedded liver samples. Viral antigens were detected by IHC labelling within hepatocytes and Küppfer cells in the three animals. The presence of viral DNA was confirmed by qPCR in one of them. In order to evaluate the circulation of CAdV‐1 in brown bears, a retrospective study was performed using both IHC and qPCR techniques in 11 and 12 additional brown bears, respectively. An extra brown bear was found positive by IHC. This study shows that CAdV‐1 surveillance of brown bears and sympatric carnivores should be considered as major concern for the monitoring the population evolution throughout time in this endangered species.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
