BACKGROUNDImplant-based reconstruction is currently the most common postmastectomy breast reconstruction modality with over 86,000 procedures performed in 2017. Although various methods for ...reconstruction techniques have been described, partial subpectoral implant placement with or without acellular dermal matrix coverage remains the most popular approach. Recently, prepectoral implant placement has gained increased recognition as a method that avoids some of the potential morbidities of submuscular implant placement. Currently, few studies have examined the outcomes of performing this approach. The purpose of this study was to evaluate and compare the outcomes of prepectoral and subpectoral direct to implant (DTI) immediate breast reconstruction.
METHODSData from a prospective cohort of consecutive patients undergoing prepectoral DTI immediate breast reconstructions at our institution from February 2016 to November 2017 were collected. The incidence of complications such as mastectomy skin flap necrosis, seroma, hematoma, infection, implant loss, and unexpected reoperation were recorded and compared with a cohort of consecutive patients who underwent subpectoral DTI immediate breast reconstruction from May 2014 to July 2015.
RESULTSOne hundred twelve prepectoral DTI immediate breast reconstructions were performed on 62 patients. Four breasts (4.4%) were diagnosed with infection. There were 8 breasts (7.1%) that suffered from mastectomy skin flap necrosis (5 partial thickness necrosis, 3 full thickness necrosis). There was 1 implant loss related to full thickness necrosis that required salvage with autologous tissue reconstruction. Prepectoral breast reconstruction had less esthetic revisions and comparable complications when compared with the historical subpectoral cohort.
CONCLUSIONSWhen compared with the subpectoral DTI approach, prepectoral DTI breast reconstruction grants favorable complication rates and improved esthetic outcomes. Prepectoral DTI breast reconstruction is a safe modality that should be considered in any patient who is a candidate for immediate breast reconstruction.
PURPOSEPostoperative infection is the most common complications after implant-based immediate breast reconstruction (IBR), with reported rates ranging from less than 1% to 43%. This heterogeneity ...among the literature may be explained by a lack of consensus on the definition of postoperative infection. The purpose of this study was to review the prevalence of infection and how it is defined in studies involving prosthetic-based IBR. It is necessary to establish a clear definition of infection to standardize the reporting of complications.
METHODSA comprehensive literature review was performed to identify infection rates among implant/tissue expander–based IBR performed between 1996 and 2017. A PubMed search using the keywords “immediate breast reconstruction” matched with “infection” and “tissue expanders” or “implant” was performed. Reconstructive modality, infection rates, and definitions were recorded and reviewed.
RESULTSAn initial search provided 196 articles; 138 articles met inclusion criteria and were reviewed. Eighty-five (61%) articles failed to define infection and reported an infection rate ranging from 0% to 22%. The studies that characterized infection had highly variable definitions. Whereas some authors chose to define infection based on Centers for Disease Control guidelines, others used more subjective findings such as clinical signs of infection.
CONCLUSIONSCurrently, there is no consensus on the definition of infection after implant-based IBR. We propose that the definition should include the administration of antibiotics beyond the surgeonʼs standard perioperative period with or without the presence of localized clinical signs of infection (erythema, pain, increased temperature, etc). A universal definition of postoperative infection after implant-based IBR that accurately captures the incidence of infection will allow better comparisons between future studies.
BACKGROUNDCurrent literature comparing outcomes of immediate breast reconstruction using direct-to-implant (DTI) single-stage and 2-stage tissue expanders (TEs) is conflicting. This study compared ...overall outcomes and determined predictive patient factors associated with higher complication rates.
METHODSAfter institutional review board approval, a retrospective cohort study of consecutive patients who underwent immediate breast reconstruction from 2010 to 2014 at a single hospital was performed. Demographic data and complications were recorded and compared using univariate analysis. Infection was defined as any patient receiving antibiotics beyond the expected postoperative course or restarting antibiotics for a suspected infection.
RESULTSSeventy-nine breasts (50 patients) underwent immediate breast reconstruction using tissue expansion, and 117 breasts (69 patients) underwent immediate breast reconstruction using the DTI technique. Overall complications, infection rate, and rate of aesthetic revisions were higher in the TE group compared with the DTI group. There was no difference in rates of seroma, hematoma, and mastectomy skin flap necrosis between the 2 groups. Infectious complications were significantly higher in patients with body mass index of greater than 30 who underwent TE-based reconstruction than those who underwent DTI-based reconstruction.
CONCLUSIONSSingle-stage DTI immediate breast reconstruction has less overall complications than 2-stage TE-based immediate reconstruction. Direct-to-implant immediate breast reconstruction may provide favorable outcomes in patients with body mass index of greater than 30.
Abstract
Background
Capsular contracture is a common complication of breast augmentation surgery and many techniques to prevent and treat it have been suggested with inconsistent or variably ...effective results.
Objectives
The aim of this paper was to describe a protocol for treating established capsular contracture after breast augmentation with a low recurrence rate.
Methods
From January 2009 to December 2012, 79 previous bilateral breast augmentation patients presented for treatment of established capsular contracture. There were 135 breasts with capsular contracture: 56 were bilateral and 23 were unilateral. Ten patients opted for no treatment; 2 patients opted for implant removal. Twenty-four were treated with the ICES (implant exchange, capsulectomy, and possible exchange of site) protocol and 43 were treated with the SPICES (Strattice placement in the reconstructive position, implant exchange, capsulectomy, and possible exchange of site) protocol.
Results
The 24 patients treated with the ICES protocol had a recurrent capsular contracture rate of 15%. The 43 patients treated with the SPICES protocol had a 2.7% recurrent capsular contracture incidence and an 2.7% complication rate.
Conclusions
Capsular contracture after breast augmentation, whether primary or recurrent, can be successfully treated with the SPICES protocol.
Level of Evidence: 4
Selecting suitable sites for new distributed generation installations is a critical step for long‐term efficient power generation planning. Locating distributed generations involves studying many ...factors such as economic, social, environmental, geographic, availability of electrical infrastructure etc. In this paper, a novel system based on the analytical hierarchy process (AHP) and fuzzy AHP (FAHP) are developed to select proper sites for small modular reactor (SMR) power generation units. Renewable energy generation, electrical and non‐electrical loads, existing and retiring generation, transmission lines, and switching stations in location‐dependent scenarios are considered to determine preferable sites. Realistic simulation scenarios are developed to validate the top two locations from the AHP and FAHP SMR siting results using a power system model to show renewable generation and non‐electrical applications support. It is assumed that the surplus power from SMR units is utilised for non‐electrical applications in the selected locations. Moreover, the quality of support for non‐electrical applications are compared with the integration of SMR units to both wind and solar energy.
► Here we present a revision on biological activity of ruthenium nitrosyl complexes. ► These complexes were reviewed regarding to their efficiencies
in vitro and in vivo. NO-carriers can be activated ...chemically or photochemically. ► Therefore, the biological actions were explained based on the complex proprieties. ► Among these proprieties were considered
E
NO
+
/
NO
0
,
k
-NO, and ϕ
NO.
Nitric oxide plays an important role in various biological processes, such as neurotransmission, blood pressure control, immunological responses, and antioxidant action. The control of its local concentration, which is crucial for obtaining the desired effect, can be achieved with exogenous NO-carriers. Coordination compounds, in particular ruthenium(III) and (II) amines, are good NO-captors and -deliverers. The chemical and photochemical properties of several ruthenium amine complexes as NO-carriers
in vitro and
in vivo have been reviewed. These nitrosyl complexes can stimulate mice hippocampus slices, promote the lowering of blood pressure in several
in vitro and
in vivo models, and control
Trypanosoma cruzi and
Leishmania major infections, and they are also effective against tumor cells in different models of cancer. These complexes can be activated chemically or photochemically, and the observed biological effects can be attributed to the presence of NO in the compound. Their efficiencies are explained on the basis of the Ru
IINO
+
3+/Ru
IINO
0
2+ reduction potential, the specific rate constant for NO liberation from the RuNO
2+ moiety, and the quantum yield of NO release.
We expand upon work from many hands on the decomposition of nuclear maps. Such maps can be characterised by their ability to be approximately written as the composition of maps to and from matrices. ...Under certain conditions (such as quasidiagonality), we can find a decomposition whose maps behave nicely, by preserving multiplication up to an arbitrary degree of accuracy and being constructed from order-zero maps (as in the definition of nuclear dimension). We investigate these conditions and relate them to a W*-analogue.
BACKGROUND:Laser-assisted indocyanine green angiography (LAIGA) has been proven to accurately detect mastectomy skin flap necrosis (MSFN) intraoperatively and prevent postoperative complications in ...breast reconstruction. The purpose of this study was to examine the cost-effectiveness of the routine use of LAIGA in immediate breast reconstruction and to perform a break-even point analysis.
METHODS:This is a retrospective review of prospectively gathered data from all patients who underwent immediate breast reconstruction from January 2014 to January 2015. LAIGA was routinely used in all cases. Patients were followed for at least 90 days to capture postoperative complications. Costs were calculated by reviewing itemized bills and Medicare Reimbursement Current Procedural Terminology codes to assess surgeon fees. Outcomes and costs were compared with a historical cohort of patients who underwent breast reconstruction before the implementation of LAIGA.
RESULTS:Two-hundred-and-six immediate breast reconstructions (126 patients) were performed using LAIGA for a total cost of $210,700. The average cost of MSFN in our LAIGA cohort was $30,496. The routine use of LAIGA decreased the MSFN rate from 12.4% to 6.3% and prevented MSFN on 13 breasts resulting in a gross cost savings of $396,453, and net savings of $185,753. Break-even point analysis demonstrated that number of cases needed to break even decreases as the average MSFN cost and MSFN reduction rate increase.
CONCLUSION:The routine use of LAIGA in immediate breast reconstruction is cost-effective in reducing the incidence of MSFN, implant loss, and overall unexpected reoperation rate.
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