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Purpose: We aimed to establish a relationship between the amount of Montgomery tubercles (MTs) per nipple-areolar complex (NAC) given patient characteristics such as age, BMI, menopausal status, race/ethnicity, and NAC size to better inform current 3D NAC tattooing practices., Methods: Preoperative photographs of patients pursuing breast reconstruction after mastectomy in 2010 through 2018 were reviewed. The number of MTs on each native NAC was quantified. The impact of patient factors on the quantity of MTs was evaluated via Pearson correlation and bivariate analyses., Results: Two hundred and eleven patients (399 breasts) were reviewed. On average, patients had 5.0 ± 5.2 MTs (range, 0-25 MTs). Number of MTs did not correlate with patient age, BMI, or NAC size. Premenopausal females were more likely than postmenopausal females to have a greater number of MTs per breast (p-value = 0.0183)., Conclusions: Postmastectomy patients desiring a more "youthful" NAC may consider additional MTs when pursuing 3D NAC tattooing., Competing Interests: Declaration of competing interest There are no financial conflicts of interest to disclose., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Limited data exist outlining reoperations after direct-to-implant (DTI), tissue expander (TE) and autologous free-flap breast reconstruction., Methods: Patients undergoing mastectomy with reconstruction from 2008 to 18 were reviewed. Patient factors, surgical techniques, planned, unplanned, and total reoperations were analyzed., Results: Among 544 total patients, the majority underwent DTI (294, 54%) or TE (176, 32%); 74 (14%) received autologous free-flaps. Majority of DTI patients (55%) underwent subsequent reoperations. Compared to autologous tissue, DTI had less patients undergo additional surgery (76% vs. 55%, P = 0.001). Incidence of total unplanned reoperations did not significantly differ between reconstructive groups. The rate of unplanned reoperations due to complications was lowest for DTI (39%) when compared to TE (48%) and autologous (55%, P = 0.015). Compared to TE, DTI carried a lower risk for ≥2 total reoperations (OR = 0.21, 95% CI 0.13-0.33, P < 0.001)., Conclusions: Seldom "one and done," additional surgery after DTI remains significant., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Capsular contracture causes pain, poor cosmesis, and reoperations. This study analyzes its incidence and risk factors in a more modern treatment era., Methods: Patients undergoing mastectomy with implant reconstruction from 2010 to 18 were reviewed. Univariate and multivariate analysis evaluated rates and risk factors for capsular contracture., Results: Among 451 patients, the majority underwent nipple-sparing mastectomy (262, 58.1%) with one-stage reconstruction (283, 62.7%) utilizing subpectoral implants (353, 77.4%) and acellular dermal matrix (354, 78.5%). Overall capsular contracture incidence was 9.8%; the rate after post-mastectomy radiation therapy (PMRT) was 18.7%, and 7.5% for patients without PMRT. Significant factors included neoadjuvant chemotherapy (P = 0.006), hematoma (P = 0.047), and PMRT (P = 0.001). Multivariate analysis showed that PMRT increased risk of capsular contracture (OR = 3.12, 95% CI 1.55-6.26, P = 0.001), and adjuvant chemotherapy was protective (OR = 0.289, 95% CI 0.114-0.731, P = 0.01)., Conclusions: Incidence of capsular contracture is lower than previously reported. Advancing therapeutic techniques may reduce the risk of this complication., Competing Interests: Declaration of competing interest The authors have no financial or commercial conflicts of interest to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Ramifications of postoperative complications on long-term survival after mastectomy are uncertain., Methods: Overall complications (Clavien-Dindo Grades I-IIIB) and wound complications were analyzed using the Kaplan-Meier method for impact on 5-year overall (OS) and disease-free survival (DFS)., Results: A total of 378 patients underwent mastectomy alone (157, 41%) or mastectomy with reconstruction (221, 59%) for Stage I-III disease with a median follow-up of 5 years. Postoperative complications occurred in 186 patients (49%), requiring non-surgical (I/II = 83, 22%) or surgical (IIIa/IIIb = 103, 27%) management. Wound complications occurred in 140 patients (37%). Reconstruction was associated with a higher rate of complication (P < 0.001). Postoperative complications after mastectomy (with or without reconstruction) did not significantly affect OS or DFS. Wound complications also showed no significant effect on OS or DFS following mastectomy alone, or mastectomy with reconstruction., Conclusions: Postoperative complications after mastectomy, with or without reconstruction, bear no significant impact on 5-year survival., Competing Interests: Declaration of competing interest The authors have no financial or commercial conflicts of interest to disclose., (Copyright © 2020. Published by Elsevier Inc.)

Introduction: The aim of this study was to investigate long-term breast reconstruction outcomes at a single institution in order to offer data-driven counseling for patients., Methods: A retrospective review was performed of 399 patients who underwent mastectomy with 1-stage implant-based breast reconstruction (IBBR), 2-stage IBBR, or autologous tissue reconstruction (ATR) for invasive breast cancer or ductal carcinoma in situ at our institution from 2010 to 2017. Complications were classified as major for any unplanned return to the operating room (OR)., Results: Overall complication rates were similar among 1-stage IBBR (59%), 2-stage IBBR (60%), and ATR (52%, p = 0.54). Factors independently associated with major complications were diabetes (OR = 25.4 95% CI: 3.2-202.4; p = 0.002), and 1-stage IBBR vs. ATR (1-stage: OR = 2.0 95% CI: 1.0-4.0; p = 0.04). Bilateral procedures were also at increased risk of major complications on univariate analysis (OR = 1.59 95% CI: 1.0-2.5; p = 0.04)., Conclusions: Long-term breast reconstruction complication rates are higher than previously anticipated. Patients should be counseled that IBBR is associated with higher rates of complications, including unplanned return to the OR, compared to ATR., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Among hospital staff, little is known concerning barriers to recycling and perception of waste in the operating room (OR), despite continued improvement in recycling programs. This study sought to identify barriers to OR recycling and implement a recycling improvement educational program., Methods: A survey was administered within Mayo Clinic at four campuses. Based on survey results, a recycling improvement program was devised and implemented at a surgery center in Paradise Valley, Arizona. A cost-savings analysis was performed thereafter., Results: Of 524 participants, 56.7% reported being unclear which OR items are recyclable, and 47.7% thought the greatest barrier to recycling was lack of knowledge. After implementation of the recycling educational program, cost savings of 10.3% (p = 0.004) were achieved in sharps waste disposal when compared to the previous year at the surgery center., Conclusions: Addressing barriers to recycling in the OR can significantly reduce waste and save valuable healthcare dollars., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Many surgical options exist for breast cancer, including breast conserving therapy (BCT), mastectomy with reconstruction (MAST+RECON) or without reconstruction (MAST). Long-term results regarding oncologic outcomes are few and primarily retrospective studies., Methods: A retrospective review of a prospectively collected database of patients undergoing breast surgery for breast cancer from 2002 to 2014 was performed. Patients were separated into 3 time periods for analysis: 2002 to 2005, 2006 to 2009, and 2010 to 2014. Recurrence outcomes were compared at 4 years between MAST+RECON patients., Results: Two thousand seventy-six patients were identified: 61.2% underwent BCT, 19.7% had MAST, and 19.1% had MAST+RECON. BCT patients were older and had smaller tumors. MAST+RECON increased in prevalence, whereas BCT decreased. Implant-based reconstruction and conservative mastectomy rates increased over the study period. Four-year local recurrence-free rates were similar in nipple-sparing and skin-sparing mastectomy groups., Conclusions: BCT usage has decreased, trending toward immediate, nipple-sparing mastectomy, implant-based reconstruction. Surgeons should be aware of trends to optimally offer patients their surgical options., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Neoadjuvant therapy is important in the treatment of advanced breast cancer., Methods: Postoperative complications in neoadjuvant patients were analyzed., Results: One hundred forty patients underwent 148 breast cancer surgeries after neoadjuvant therapy: 28% breast-conserving therapy procedures, 36% mastectomies, 28% mastectomies with immediate reconstruction, and 8% mastectomies with delayed reconstruction. Forty-seven patients (34%) suffered 59 complications: 18% of those undergoing breast-conserving therapy, 30% of those undergoing mastectomy, 44% of those undergoing mastectomy with immediate reconstruction, and 67% of those undergoing mastectomy with delayed reconstruction. Major complications occurred in 18% of patients. Skin loss occurred in 6% of patients. One patient had partial nipple necrosis. Three patients suffered implant loss. One patient had deep inferior epigastric artery perforator flap loss. Eleven hematomas and 5 infectious complications required reoperation., Conclusions: Surgery after neoadjuvant therapy is safe, but careful counseling is warranted given that 18% of patients experienced major complications. Complications rates are higher with reconstruction, but feared complications of skin, nipple, implant, or flap loss were infrequent., (Copyright © 2013 Elsevier Inc. All rights reserved.)