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Abstract Background Surgery remains a priority for breast cancer treatment. This study aimed to compare the cosmetic outcomes of oncoplastic patients who had undergone breast-conserving surgery, mini-LDF (latissimus dorsi flap), and immediate implant reconstruction using both the Japanese scale and the BCCT.core (The Breast Cancer Conservative Treatment cosmetic results software) program and to validate this program. Patients and methods Patients who underwent surgery for breast cancer between 1997 and 2021 were retrospectively studied. Patients were divided into three groups: 1-those who had undergone breast-conserving surgery (245 patients, 71.3%), 2-those who had undergone mini-LDF after lumpectomy (38 patients, 11.02%), and 3- those who underwent reconstruction with implants after nipple-sparing mastectomy (61 patients, 17.68%). The patients were called for a follow-up examination, and their photos were taken. The photographs were shown to an independent breast surgeon and a plastic surgeon who was not included in the surgeries, and they were asked to evaluate and rate them according to the Japanese cosmetic evaluation scale. The same images were transferred to the computer and scored using BCCT.core. Results The plastic and breast surgeon evaluation results showed no significant difference between the three cosmetic techniques (p = 0.99, 0.98). The results of BCCT.core software measurements were similar to the results of plastic and breast surgeons (p: 0.43). Conclusion Patients are more knowledgeable about cosmetic outcomes and expect more objective data. In this study, we used 3 different cosmetic evaluation scales. We found that these techniques give results that are compatible with each other in terms of evaluating the work done in a more concrete way. For this reason, we recommend the use of such software, which offers objective results in a subjective field such as aesthetics and is very easy to apply.

Background: Surgery remains a priority for breast cancer treatment. This study aimed to compare the cosmetic outcomes of oncoplastic patients who had undergone breast-conserving surgery, mini-LDF (latissimus dorsi flap), and immediate implant reconstruction using both the Japanese scale and the BCCT.core (The Breast Cancer Conservative Treatment cosmetic results software) program and to validate this program. Patients and methods: Patients who underwent surgery for breast cancer between 1997 and 2021 were retrospectively studied. Patients were divided into three groups: 1-those who had undergone breast-conserving surgery (245 patients, 71.3%), 2-those who had undergone mini-LDF after lumpectomy (38 patients, 11.02%), and 3- those who underwent reconstruction with implants after nipple-sparing mastectomy (61 patients, 17.68%). The patients were called for a follow-up examination, and their photos were taken. The photographs were shown to an independent breast surgeon and a plastic surgeon who was not included in the surgeries, and they were asked to evaluate and rate them according to the Japanese cosmetic evaluation scale. The same images were transferred to the computer and scored using BCCT.core. Results: The plastic and breast surgeon evaluation results showed no significant difference between the three cosmetic techniques (p = 0.99, 0.98). The results of BCCT.core software measurements were similar to the results of plastic and breast surgeons (p: 0.43). Conclusion: Patients are more knowledgeable about cosmetic outcomes and expect more objective data. In this study, we used 3 different cosmetic evaluation scales. We found that these techniques give results that are compatible with each other in terms of evaluating the work done in a more concrete way. For this reason, we recommend the use of such software, which offers objective results in a subjective field such as aesthetics and is very easy to apply. [ABSTRACT FROM AUTHOR]

Introduction: The landscape of breast reconstruction has changed significantly with a shift in focus to include the restoration of a patient's quality of life after cancer. Reconstructive options can be divided into alloplastic (implant based) and autologous (tissue based). This paper aims to provide a current educational summary regarding implant-based reconstruction after breast cancer surgery and review the current literature. Method: A review of the literature was conducted utilising standard PRISMA flowchart. Databases searched included Pubmed, EMBASE, and MEDLINE. Results: Current practice is explored within the text, including types of implants, indications, and surgical approaches. Heterogenous cohorts, surgical technique variation, and selection bias can make comparison of the literature challenging. The major evidence reviews of implant-based reconstruction topics are discussed including, ADM use, radiotherapy, and complications. Despite the benefits of autologous reconstruction, implant-based techniques still represent a significant proportion of reconstructive breast procedures. However, implant-reconstruction is not without its risks and limitations and, with such variety in practice, there remains a lack of high-quality evidence guiding practice. Most importantly, patients need to be counselled about the pros and cons of each choice, particularly with the increasing utilisation of radiotherapy post-reconstruction. Ultimately, the patient and surgeon should reach a decision in full knowledge of the risks and potential outcomes. Conclusions: Further research is required into implant-based reconstructive therapy, which will allow a greater consensus for management and a pathway for both surgeons and patients.

In low- and middle-income countries, breast reconstruction is not widely practiced due to a lack of specialized equipment, skilled personnel, and high costs. The scarless latissimus dorsi flap is a useful technique which can harvest a major portion of the latissimus dorsi muscle using the same mastectomy incision without requiring repositioning of the patient, to cover the lower pole of prosthesis for reconstruction. The aim of this study was to assess and evaluate the cosmetic results and complications of scarless LD flap used as a lower pole cover in post-mastectomy breast reconstruction with implants. This is a pilot study of 18 breast cancer patients who underwent implant-based scarless LD flap breast reconstructions during a period of 4 years from 2017 to 2021. A questionnaire based on relevant subscales of BREAST-Q scores was completed by all the patients and used for evaluation. A total of 18 patients who underwent 20 surgeries were evaluated for the study. The median age was 44.5 years. The mean operative time was observed to be 164.50 min. The mean length of hospital stay was 3.1 days. From the Breast Q subscales, the mean cosmetic score was 31 out of 36 (range 27–36) (higher score reflecting better cosmetic outcome), and the mean physical well-being score was 17.25 out of 54 (range 12–29) (lower score reflecting better outcome). Overall complications were observed to be 20% which included minimal flap necrosis in 2 patients which was managed conservatively, and seromas in 2 patients which needed ultrasound-guided aspirations twice. There were no major complications. The scarless LD flap provides an adequate lower pole muscle coverage for implants in breast reconstruction. It has less morbidity and good cosmetic outcomes. It is time and cost-effective, requires no patient repositioning, and uses standard breast instruments. [ABSTRACT FROM AUTHOR]

Implant breast reconstruction is the most common form of breast reconstruction worldwide. Nipple sparing mastectomy (NSM) has been shown to be oncologically safe in appropriately selected patients and provide superior aesthetic outcomes. Patients with larger ptotic breasts traditionally have not been candidates for nipple sparing mastectomies due to higher rates of nipple and skin flap necrosis, leading to reconstructive failure, and difficulty positioning the nipple areolar complex (NAC) on the breast mound. Patient factors, breast factors and adjuvant oncological therapies should all be taken into account to determine the safest treatment for the patient. Surgical options can be grouped into single staged procedures with skin reducing incisions and direct to implant reconstruction versus staged procedures. This review article aims to highlight risk factors associated with surgical complications and examine the surgical options available to manage this complex problem with their associated outcomes.

The reconstruction of craniomaxillofacial deformities, especially zygomatic bone repair, can be exigent due to the complex anatomical structure and the sensitivity of the crucial organs involved. The need to reconstruct the zygomatic bone in the most precise way is of crucial importance for enhancing the patient outcomes and health care-related quality of life (HRQL). Autogenous bone grafts, despite being the gold standard, do not match bone forms, have limited donor sites and bone volume, and can induce substantial surgical site morbidity, which may lead to adverse outcomes. The goal of this study is to provide an integrated approach that includes various processes, from patient scanning to implant manufacture, for the restoration of zygomatic bone abnormalities utilizing Polyetheretherketone (PEEK) material, while retaining adequate aesthetic and facial symmetry. This study takes an integrated approach, including computer-aided implant design using the mirror reconstruction technique, investigating the biomechanical behavior of the implant under loading conditions, and carrying out a fitting accuracy analysis of the PEEK implant fabricated using state-of-the-art additive manufacturing technology. The findings of the biomechanical analysis results reveal the largest stress of approximately 0.89 MPa, which is relatively low in contrast to the material's yield strength and tensile strength. A high degree of sturdiness in the implant design is provided by the maximum value of strain and deformation, which is also relatively low at roughly 2.2 × 10−4 and 14 µm. This emphasizes the implant's capability for load resistance and safety under heavy loading. The 3D-printed PEEK implant observed a maximum deviation of 0.4810 mm in the outside direction, suggesting that the aesthetic result or the fitting precision is adequate. The 3D-printed PEEK implant has the potential to supplant the zygoma bone in cases of severe zygomatic reconstructive deformities, while improving the fit, stability, and strength of the implant. [ABSTRACT FROM AUTHOR]

Sinus augmentation has become an integrated surgical phase in posterior maxillary implant prosthesis reconstruction. Since the residual alveolar bony height usually requires additional volume particularly at this anatomical region, sinus floor augmentation is advocated routinely. Over the years, Implant success rate is proved to be comparable to the one in the pristine bone, which is well documented in the literature. Anatomical aspects as well as surgeon skills are at most importance to achieve predictable outcome. In this narrative review, the different osteotomy techniques, the indications toward 1 or 2‐stage approaches, the control of the Schneiderian membrane integrity as well as the management of intra‐ and post‐operative complications are thoroughly discussed according the current data. In light of the excellent long‐term implant success rate concurrent with the application of contemporary advanced techniques of the sinus augmentation via the lateral wall osteotomy approach, reduce invasiveness and less complication occurrences are well documented. A well‐codified patient selection involving the rhinologist as an integral medical team would be significantly beneficial toward early diagnosis. In‐depth knowledge of the anatomy, execution of a well standardized surgical technique, and understanding the complication etiology and their management are prerequisites for reducing patient morbidity to minimal discomfort and predictable successful outcome. [ABSTRACT FROM AUTHOR]

• Implant movement during EMT measurements is minimal in TRUS-guided treatment. • EMT measurements are reliable for QA and error detection in TRUS-guided treatment. • Implant movement during EMT measurements is high in CT-guided treatment. • EMT measurements could detect large implant deformations caused by patient repositioning. • Improved movement correction should be investigated for EMT in CT-guided treatment. Electromagnetic Tracking (EMT) technology has been integrated in a prototype high-dose-rate brachytherapy (HDR-BT) afterloading device. Its potential for dwell position (DP) monitoring has earlier been demonstrated in prostate phantoms. However, its performance for prostate BT in the clinical setting remains to be assessed. Assess the reliability and value of EMT measurements in transrectal ultrasound-based (TRUS-based) and computed tomography-based (CT-based) prostate HDR-BT. EMT measurements were conducted on 20 patients undergoing dual-fraction prostate HDR-BT monotherapy. In each treatment fraction an individual TRUS-based or CT-based treatment plan was generated. The measurements were compared to DPs of manually reconstructed needles in those TRUS-based or CT-based treatment plans. An internal reference sensor was also placed in one needle to assess internal movement levels and its potential for movement correction. For TRUS-based treatments, median Euclidean distances (ED) of 1.00 mm were observed between EMT measurements and manual DP determination. Reference sensor movement was minimal at a median of 0.18 mm. For DPs measured in the CT-room and treatment room, median EDs of 1.60 mm and 2.24 mm compared to CT-based DP determination respectively were observed, indicating the system's ability to detect changes in implant geometry over time and after patient repositioning. Median reference sensor movement of 0.97 mm was observed. Implementing reference sensor-based movement correction led to a significant but small decrease in ED for CT-based treatments. EMT is suitable for TRUS-based prostate HDR-BT quality assurance and error detection. While EMT can identify changes in implant geometry in CT-based prostate HDR-BT treatments, it showed lower accuracy in this setting. [ABSTRACT FROM AUTHOR]

• Assessing catheter implants using an afterloader prototype with EMT functionality. • Refining EMT implant reconstruction with image processing operations. • 64 patients comprising more than 1100 catheters included in the study. • Excellent accuracy compared to clinical reconstruction (median deviation 0.25 mm). • Streamlining implant reconstruction in interstitial brachytherapy of the breast. To develop a method for automatic reconstruction of catheter implants in interstitial brachytherapy (iBT) of the breast by means of electromagnetic tracking (EMT) with the goal of making treatment planning as time-effective and accurate as possible. The implant geometry of 64 patients was recorded using an afterloader prototype with EMT functionality immediately after the planning CT. EMT data were transferred to the CT image space by rigidly registering the catheter fixation buttons as landmarks. To further improve reconstruction accuracy, the EMT reconstruction points were used as starting points to define small regions of interest (ROI) in the CT image. Within these ROIs, the catheter track was segmented in the CT using image processing operations such as thresholding and blob detection, thus refining the reconstruction. The perpendicular distance between the refined EMT implant reconstruction points and the manually reconstructed catheters by an experienced treatment planner was calculated as a measure of their geometric agreement. Geometrically, the refined EMT based implant reconstruction shows excellent agreement with the manual reconstruction. The median distance across all patients is 0.25 mm and the 95th percentile is 1 mm. Refinement takes approximately 0.5 s per reconstruction point and typically does not exceed 3 min per implant at no user interaction. The refined EMT based implant reconstruction proved to be extremely accurate and fast compared to manual reconstruction. The presented procedure can in principle be easily transferred to clinical routine and therefore has enormous potential to provide significant time savings in iBT treatment planning whilst improving reconstruction accuracy. [ABSTRACT FROM AUTHOR]

There are multiple indications for mastectomy for breast cancer, including extent of tumor, inability to achieve negative margins after re-excision, patient preference, or prevention in women with a high lifetime risk of breast cancer. Multiple types of autologous or implant reconstruction options are available for cosmesis. Although rare, breast cancers after mastectomy can occur, and it is important for both surgeons and radiologists to be aware of the associated risk factors, common locations, and classic imaging features of these malignancies. This article reviews the types of mastectomies, reconstruction options, and information about the location, presentation, and prognosis of cancers in the reconstructed breast. [ABSTRACT FROM AUTHOR]

Background: The BREAST-Q is the most commonly used patient-reported outcome measure (PROM) for breast reconstruction research. However, clinical implementation of this PROM has been impeded by a lack of context for score interpretation. The aim of this study was to define reference values for the BREAST-Q at discrete timepoints following surgery, generating a tool for real-time score interpretation. Methods: BREAST-Q scores were prospectively obtained in women who underwent implant or autologous post-mastectomy breast reconstruction preoperatively and for 2 years following surgery at Memorial Sloan Kettering Cancer Center (MSK). Descriptive statistics were used to create reference values for BREAST-Q satisfaction and quality-of-life subscales. Reference values were externally validated by comparing patient characteristics and BREAST-Q scores between the MSK and the Mastectomy Reconstruction Outcomes Consortium (MROC) study cohorts. Results: Overall, 3268 MSK patients and 2814 MROC patients were included for analysis. When MSK and MROC cohorts were compared for validation, there were some statistical differences in BREAST-Q scores; however, most of these differences did not meet the minimal clinically important difference of 4 points. Reference values were used to create the BREAST-Q Real-time Engagement and Communication Tool (REACT). Conclusions: Using a large cohort of patients, we have defined BREAST-Q reference values for post-mastectomy breast reconstruction patients for use in clinical practice. The BREAST-Q REACT will help breast reconstruction providers gauge patient wellbeing and satisfaction relative to the "average" breast reconstruction patient and determine which patients may benefit from additional intervention. [ABSTRACT FROM AUTHOR]

Abstract Purpose The latissimus dorsi muscle has long been used in breast cancer (BC) patients for reconstruction. This study aimed to compare early stage BC patients who had partial mastectomy (PM) with mini latissimus dorsi flap (MLDF) and subcutaneous mastectomy with implant (MI) with respect to quality of life (QoL), cosmetic outcome (CO), and survival rates. Patients and methods The data of patients who underwent PM + MLDF (Group 1) and M + I (Group 2) between January 2010 and January 2018 were evaluated. Both groups were compared in terms of demographics, clinical and pathological characteristics, surgical morbidity, survival, quality of life, and cosmetic results. The EORTC-QLQ C30 and EORTC-QLO BR23 questionnaires and the Japanese Breast Cancer Society (JBCS) Cosmetic Evaluation Scale were used to assess the quality of life and the cosmetic outcome, respectively. Results A total of 317 patients were included in the study, 242 (76.3%) of them in group 1 and 75 (23.6%) of them in group 2. Median follow-up time was 56 (14–116) months. There were no differences identified between the groups in terms of tumor histology, hormonal receptors and HER-2 positivity, surgical morbidity, and 5-year overall and disease-free survival. Group 2 patients were significantly younger than group 1 (p = 0.003). The multifocality/multicentricity rate was higher in group 2 (p ≤ 0.001), whereas tumor size (p = 0.009), body mass index (BMI, p = 0.006), histological grade (p ≤ 0.001), lymph node positivity (p = 0.002), axillary lymph node dissection (ALND) rate (p = 0.005), and presence of lympho-vascular invasion (LVI, p = 0.013) were significantly higher in group 1. When the quality of life was assessed by using the EORTC QLQ C30 and BR23 questionnaires, it was seen that the body image perception (p < 0.001) and nausea/vomiting score (p = 0.024) were significantly better in PM + MLDF group whereas physical function score was significantly better in M + I group (p = 0.012). When both groups were examined in terms of cosmesis with JBCS Cosmetic Evaluation Scale, good cosmetic evaluation score was significantly higher in patients in MLDF group (p = 0.01). Discussion The results of this study indicate that in comparison to M + I procedure, the PM + MLDF procedure provides significantly superior results in terms of body image and cosmetic result with similar morbidity and oncologic outcomes. In selected patients with small breasts and a high tumor/breast ratio, PM + MLDF may be an alternative to subcutaneous mastectomy and implant.

Improvements in the recently observed breast reconstruction surgery techniques have changed the clinical practice in patients with breast cancer. Nowadays, every patient diagnosed with breast cancer clinical stage I, II and III, except for inflammatory breast cancer, should have the opportunity to undergo breast reconstruction. Radiation therapy increases the risk of complications following reconstruction. The aim of this paper is to review the current literature in an attempt to select the safest and most convenient reconstruction technique in patients requiring radiation therapy. Immediate autologous breast reconstruction seems to be the best option, but everyday clinical practice seems to contradict the conclusions from these data. The choice of the reconstruction type depends not only on the rate of complications but on the surgeon's skills, the patient's preference and the hospital's equipment. [ABSTRACT FROM AUTHOR]

Introduction: Recent years have seen a large increase in the proportion and number of sling-assisted, implant-based breast reconstructions. These are associated with significant rates of loss of the reconstruction. Various methods have been suggested to reduce this loss rate. One such method is the use of operating theatres with laminar flow. The majority of cases of sling-assisted, implant-based breast reconstruction in south-east Scotland are performed in two adjacent theatres, one with laminar flow and one without. This provided the opportunity to assess whether there was any difference in outcome potentially attributable to laminar flow.Methods: Patients undergoing sling-assisted, implant-based breast reconstruction between August 2013 and December 2018 were studied with follow up for at least 6 months.Results: 307 patients underwent a total of 470 procedures. 247 procedures were performed with laminar flow and 223 without. There was no difference in the indications for mastectomy, incision used or rates of smoking or radiotherapy between the two groups. Implant loss occurred in 15.8% of procedures with laminar flow and 14.3% of those without (p = 0.66). Wound problems occurred in 27.5% of procedures with laminar flow and 27.8% of those without (p = 0.97). There was no significant difference in loss rates between surgeons, mastectomy indication, sling materials or with chemotherapy use. Increased loss rates were observed in smokers, with radiotherapy, with incisions other than transverse, with larger breasts and with increasing patient weight.Conclusion: This study finds no evidence of benefit for laminar flow in theatre for sling-assisted, implant-based breast reconstruction. [ABSTRACT FROM AUTHOR]

Background Closed-suction drains are widely used in expander-based breast reconstruction. These drains are typically removed using a volume-based criterion. The drainage volume affects the hospital stay length and the recovery time. However, few studies have analyzed the factors that influence drainage volume after expander-based breast reconstruction. Methods We retrospectively analyzed data regarding daily drainage from patients who underwent expander-based breast reconstruction between April 2014 and January 2018 (159 patients, 176 expanders). Patient and operative factors were analyzed regarding their influence on total drainage volume and drain placement duration using univariate and multivariate analyses and analysis of variance. Results The mean total drainage volume was 1,210.77±611.44 mL. Univariate analysis showed correlations between total drainage volume and age (B=19.825, P

Background: Operating room (OR) time varies significantly in patients undergoing mastectomy. We sought to determine factors influencing OR time such that more accurate predictions could be made.Methods: Records of patients undergoing mastectomy at our institution between January 2010 and June 2018 were reviewed. Operating Room time was defined as time from incision to dressing. Nonparametric analyses were performed to determine factors associated with OR time. A predictive model using linear regression was created on a training set and evaluated in a separate testing set.Results: Our cohort included 1008 female patients who underwent either unilateral or bilateral mastectomy (BM), with or without reconstruction, and with or without concomitant axillary lymph node staging at our institution. The median OR time was 4.67 hours (range; .70-16.35 hours). To create a predictive model, we divided our cohort into a training set of 504 patients and a testing set of 504 patients. Across the training set, body mass index (BMI), BM, nonconventional mastectomies, intraoperative frozen sections, receipt of neoadjuvant chemotherapy, and reconstruction were associated with longer OR times on linear regression. A model generated from these findings on the training set was run on the testing set (Pearson correlation = .743 for predicted vs. actual OR times, P < .001).Conclusion: A number of preoperative factors such as BMI, unilateral vs. BM, type of mastectomy and reconstruction, use of intraoperative frozen sections, and receipt of neoadjuvant chemotherapy can influence OR times. Accurate predictions can be made using a simple model incorporating these factors. [ABSTRACT FROM AUTHOR]

La reconstruction mammaire par implant présente des inconvénients à long terme et conduit un nombre croissant de patientes à demander une chirurgie secondaire de correction. Deux stratégies chirurgicales sont possibles : le changement d'implant (associé à des gestes de capsulectomie/capsulotomie et/ou lipofilling) et le retrait d'implant associé à l'apport d'un tissu autologue (lambeau et/ou lipofilling). Entre 2010 et 2018, 54 patientes ont bénéficié d'une chirurgie secondaire de correction d'une première reconstruction mammaire par implant. Les motifs d'insatisfaction de la reconstruction initiale, les interventions réalisées et les complications postopératoires ont été analysés. Le bien-être et la satisfaction des patientes ont été évalués au moyen du questionnaire BREAST-Q. Trente-quatre patientes ont bénéficié d'un changement de prothèse et 20 patientes d'un retrait définitif de leur prothèse associé à l'apport d'un tissu autologue. La présence d'une coque périprothétique, la douleur, l'aspect figé du sein et l'asymétrie mammaire étaient les motifs d'insatisfaction les plus fréquents. Avec un recul moyen de 2,6 ans, les patientes ayant bénéficié d'une conversion autologue étaient globalement plus satisfaites de l'aspect de leurs seins que les patientes ayant conservé un implant mammaire (p < 0,0001). En cas de mauvais résultat esthétique ou fonctionnel d'une reconstruction mammaire par implant, le retrait de la prothèse associé à une reconstruction autologue donne de meilleurs résultats en termes de bien-être et de satisfaction que le changement d'implant. Breast reconstruction with implants has long-term disadvantages and is leading an increasing number of patients to request secondary corrective surgery. Two surgical strategies are possible: implant replacement (associated with capsulectomy/capsulotomy and/or lipofilling procedures) and implant removal associated with the provision of autologous tissue (flap and/or lipofilling). Between 2010 and 2018, 54 patients underwent secondary surgery for correction of a first implant breast reconstruction. The reasons for dissatisfaction with the initial reconstruction, the procedures performed, and postoperative complications were analysed. Patient well-being and satisfaction were evaluated using the BREAST-Q questionnaire. Thirty-four patients benefited from a prosthesis change and 20 patients benefited from a permanent removal of their prosthesis combined with the addition of autologous tissue. The presence of a periprosthetic shell, pain, fixed appearance of the breast and breast asymmetry were the most frequent reasons for dissatisfaction. With a mean follow-up of 2.6 years, autologous conversion patients were generally more satisfied with the appearance of their breasts than patients who retained a breast implant (P < 0.0001). In cases of poor esthetic or functional outcomes of implant-based breast reconstruction, removal of the prosthesis in combination with autologous reconstruction provides better results in terms of well-being and satisfaction than implant replacement. [ABSTRACT FROM AUTHOR]

Although an anatomical implant is no longer recommended in practice, frequent use of the implants in the past decade left apprehension to surgeons, and malrotation is one of the concerns. However, a limited amount of literature has focused on malrotation to date, especially in breast reconstruction, and there also exists a lack of consensus regarding the correction of malrotation. Given that implant-based reconstruction has increased in frequency and there remain many potential patients who have used earlier models of anatomical implants, this study sought to analyze predisposing risk factors and approaches to correct implant malrotation. A total of 132 implants in 118 patients who underwent expander/implant reconstruction were identified and retrospectively reviewed. Seventeen (12.9%) implants showed malrotation. The results of multivariate logistic regression revealed that tissue expander malrotation in the first stage and capsular contracture were significant risk factors associated with malrotation in two-stage implant-based breast reconstruction (both p < 0.001). When a patient presents with malrotation, it is recommended that the implant be changed to a round type if a patient has multiple risk factors because malrotation tends to recur after correction. Also, even when using a round implant during two-stage breast reconstruction, additional care should be adopted for those who experienced rotation after expander insertion. [ABSTRACT FROM AUTHOR]

Background: Robotic nipple-sparing mastectomy (R-NSM), which uses the da Vinci surgical platform (Intuitive Surgical, Sunnyvale, CA, USA), could perform NSM and immediate breast reconstruction through small and inconspicuous extramammary axillary incision. Its application in the management of early breast cancer or risk-reducing mastectomy had been reported in some series and a growing number of R-NSM were performed worldwide. The authors would like to present a single-center experience of R-NSM as well as review of the current literature.Materials and Methods: The medical records of patients who underwent R-NSM for breast cancer during the period from March 2017 to July 2018 were retrieved from a prospectively collected database. A review of case series of R-NSM in the current literature were also performed through the PubMed database to determine the effectiveness and oncologic safety of R-NSM.Results: A total of 37 breast cancer patients who received 46 R-NSM procedures were included in the study. Thirty-nine cases (84.8%) were performed for therapeutic purpose. No R-NSM procedure was converted to conventional or endoscopic mastectomy. One (2.6%, 1/39) R-NSM procedure was found to have positive margin involvement. The rate of total nipple-areolar complex (NAC) necrosis was 0%, and no implant loss or local recurrence was observed during a mean follow-up of 10.9 ± 8.2 months. In the joint collective analysis and review of the current literature, a total of 138 R-NSM procedures were available for analysis, and 59 of them were for therapeutic indications. The overall conversion rate was 2.2% (3/138), total NAC necrosis rate was 0%, implant loss rate was 0.8% (1/128), and margin involved rate was 1.7% (1/59). No local recurrence case was reported.Conclusion: From our preliminary experience and review of the current literature, R-NSM is a feasible and safe alternative for NSM in the management of breast cancer. The long-term oncological outcomes, however, will only be determined with longer follow-up.

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Purpose of Review: Women electing to undergo breast reconstruction following mastectomy have increased in frequency. Classically studied healthcare disparities have an influence on whether women undergo reconstruction. This review evaluates these domains, globally, while exploring why they exist. Recent Findings: In the USA, women who are young, white, with higher income and education level, private insurance, and those treated at private or academic hospitals are most likely to undergo reconstruction. Women of a minority race or ethnicity, lower socioeconomic group, early education status, and with public or no insurance remain less likely to undergo reconstruction. Breast reconstruction is not commonly available to women in low- and middle-income countries. Summary: Disparities in breast reconstruction persist though significant strides have been made in many high-income nations. Internationally, concerted efforts are needed that focus on health literacy education, access to surgical consultations, and an inclusion of breast reconstruction in the breast cancer treatment process. [ABSTRACT FROM AUTHOR]

Purpose: Women with different BMI, age and comorbidities seek for breast reconstruction. It is critical to understand the risk associated with each technique to ensure the most appropriate method and timing is used. Outcome after reconstructions have been studied, but consensus is lacking regarding predictive risk factors of complications. The authors present their experience of different autologous and alloplastic reconstructions with an emphasis on predictors of complications. Methods: Prospectively maintained reconstruction database from 2008 to 2019 was reviewed. Factors associated with complications were identified using logistic regression, multinomial logistic regression and risk factor score to determine predictors of complications. Results: A total of 850 breast reconstructions were performed in 793 women, including 447 DIEP, 283 LD, 12 TMG and 51 implant reconstructions. Complications included minor (n = 231, 29%), re-surgery requiring (n = 142, 18%) and medical complications (n = 7, 1%). Multivariable analysis showed that complications were associated independently with BMI > 30 (OR 1.59; 95% CI 1.05–2.39, p = 0.027), LD technique (OR 4.05; 95% CI 2.10–7.81, p < 0.001), asthma or chronic obstructive pulmonary disease (OR 2.77; 95% CI 1.50–5.12, p = 0.001) and immediate operation (OR 0.69; 95% CI 0.44–1.07, p = 0.099). Each factor contributed 1 point in the creation of a risk-scoring system. The overall complication rate was increased as the risk score increased (35%, 61%, 76% and 100% for 1, 2, 3 and 4 risk scores, respectively, p < 0.001). Conclusions: The rate of complication can be predicted by a risk-scoring system. In increasing trend of patients with medical problems undergoing breast reconstruction, tailoring of preventive measures to patients' risk factors and careful consideration of the best timing of reconstruction is mandatory to prevent complications and costs. [ABSTRACT FROM AUTHOR]

Nipple‐sparing mastectomies (NSMs) are accepted as safe oncologic procedures for select patient populations, but objective evaluation of aesthetic outcomes has not been clearly established. The purpose of this study was to utilize BCCT.core computer software to objectively evaluate NAC malposition following bilateral NSM with implant reconstruction and compare the analysis to an expert panel. Postoperative photographs of 43 patients who underwent bilateral NSM were analyzed with the BCCT.core and by an expert panel of plastic surgery residents and attendings. The panel was asked to only evaluate nipple asymmetry and position. The intraclass correlation coefficient (ICC) was used to determine interrater reliability (n = 12) and between expert panel ratings and BCCT.core ratings. Statistics were performed using SPSS statistical package version 24.0. The ICC for the expert panel interrater reliability was excellent (ICC = 0.941, 95% CI: 0.912‐0.964). The analysis between BCCT.core individual parameters, specifically the breast retraction assessment (ie, BRA score = the difference in nipple position between the two breasts assessing breast symmetry) and expert panel, showed statistically significant positive correlation. The parameters provided by the BCCT.core software were correlated with both the mean expert panel rating and BCCT.core ratings. Therefore, it is plausible that BCCT.core parameters could be used to objectively quantify NAC malposition/asymmetry and guide treatment in patients undergoing bilateral NSM with implant reconstruction. [ABSTRACT FROM AUTHOR]

Use of latissimus flap in prosthetic breast reconstruction after mastectomy is an established approach, particularly in patients who have failed breast-conserving therapy. This study presents a comparison of the prepectoral and the subpectoral approach for two-stage prosthetic breast reconstruction with a latissimus flap. A retrospective review of outcomes and complications was completed between the prepectoral group (n = 33 patients, 50 reconstructed breasts) and the subpectoral group (n = 22 patients, 36 reconstructed breasts). The demographics were similar between the prepectoral and subpectoral groups in terms of mean age (52.4 vs. 52.5 years, p = 0.97), smoking history (15.1% vs. 13.6%; p = 1.00), radiation history (75.8% vs. 91.0%; p = 0.28), and mean length of follow-up (479 vs. 680 days; p = 0.07). The body mass index was significantly higher in the prepectoral group (27.6 vs. 25.2 kg/m2; p = 0.03). Complications were similar between the groups in terms of hematoma (9.1% vs. 0.0%, p = 0.26), infection resulting in implant failure (9.1% vs. 4.5%, p = 0.64), thromboembolic events (3.0% vs. 4.5%, p = 1.0), donor site seroma (66.7% vs. 40.9%, p = 0.09), breast seroma (18.2% vs. 27.3%, p = 0.51), capsular contracture (9.1% vs. 4.5%, p = 0.64), animation deformity (39.4% vs. 50.0%, p = 0.58), and reoperation (24.2% vs. 22.8%, p = 1.00). Patient satisfaction scores were also similar between the groups (4.33 ± 1.08 vs. 4.14 ± 1.13, p = 0.52). The prepectoral approach for two-stage immediate prosthetic reconstruction with a latissimus flap has similar outcomes and complications to those of the subpectoral approach, yet obviating the need for any pectoralis major muscle dissection. [ABSTRACT FROM AUTHOR]

Purpose: This article describes a series of patients who underwent calvarial bone grafting (CBG) for reconstruction of extremely edentulous jaws for the purpose of implant placement. Materials and Methods: A retrospective review was conducted of all patients treated with split CBGs to the atrophic maxilla or mandible between 1999 and 2006. All patients were monitored for signs of infection, dehiscence, or other complications. The amount of augmentation was measured on panoramic radiographs. Results: A total of 15 reconstructed sites (eight maxillary, seven mandibular) in 13 consecutive patients with a mean preoperative height of 6 mm (range, 3 to 9 mm) were included in the study and followed for a mean of 32 months. Ten women and three men aged 40 to 88 years (mean, 63 years) underwent surgery. There were no complications associated with the bone harvesting technique, and all implants had primary stability at the time of placement. Two patients had graft exposure in the maxilla. Two implants were removed in one patient. On average, the gain in ridge height was 15 mm (range, 10 to 19 mm). A total of 53 implants were placed, with an average of four implants per patient. Conclusion: Split CBGs to the atrophic maxilla and mandible can restore optimal height to support and facilitate implantbased restorations. A prospective study with a longer follow-up period is required to evaluate the rate of resorption associated with split CBG. Immediate placement of implants at the time of grafting in the mandible shortens the treatment time. [ABSTRACT FROM AUTHOR]

Background: This study aims to compare the rate of nipple necrosis between the submuscular (SM) versus the prepectoral (PP) implant placement after immediate breast reconstruction (IBR)., Methods: An institutional review board-approved database was reviewed of patients who underwent nipple sparing mastectomy (NSM) with IBR at our institution between 2016 and 2019. Patients who had SM versus PP IBR were compared. Incidence of nipple necrosis was evaluated between the two groups., Results: A total of 525 NSM with IBR were performed in 320 patients with SM reconstruction in 61% (n ​= ​322) and PP in 39% (n ​= ​203) of the mastectomies. Overall, 43 nipples experienced some form of necrosis with 1% of mastectomies experiencing nipple loss. There was no difference between SM group and PP group at the rate of nipple necrosis (9 ​% vs 7 %, P ​= ​0.71)., Conclusion: In patients undergoing NSM with IBR, the rate of nipple necrosis, nipple loss or complications did not differ between groups whether the implant was placed SM or PP, supporting the safety of this newer procedure., Competing Interests: Declaration of competing interest ElSherif, MD, Bernard, MD, Djohan, MD, Atallah, MD, Tu, MS, Valente, DO have no conflicts of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Robotic nipple-sparing mastectomy (R-NSM), which uses the da Vinci surgical platform (Intuitive Surgical, Sunnyvale, CA, USA), could perform NSM and immediate breast reconstruction through small and inconspicuous extramammary axillary incision. Its application in the management of early breast cancer or risk-reducing mastectomy had been reported in some series and a growing number of R-NSM were performed worldwide. The authors would like to present a single-center experience of R-NSM as well as review of the current literature.Materials and Methods: The medical records of patients who underwent R-NSM for breast cancer during the period from March 2017 to July 2018 were retrieved from a prospectively collected database. A review of case series of R-NSM in the current literature were also performed through the PubMed database to determine the effectiveness and oncologic safety of R-NSM.Results: A total of 37 breast cancer patients who received 46 R-NSM procedures were included in the study. Thirty-nine cases (84.8%) were performed for therapeutic purpose. No R-NSM procedure was converted to conventional or endoscopic mastectomy. One (2.6%, 1/39) R-NSM procedure was found to have positive margin involvement. The rate of total nipple-areolar complex (NAC) necrosis was 0%, and no implant loss or local recurrence was observed during a mean follow-up of 10.9 ± 8.2 months. In the joint collective analysis and review of the current literature, a total of 138 R-NSM procedures were available for analysis, and 59 of them were for therapeutic indications. The overall conversion rate was 2.2% (3/138), total NAC necrosis rate was 0%, implant loss rate was 0.8% (1/128), and margin involved rate was 1.7% (1/59). No local recurrence case was reported.Conclusion: From our preliminary experience and review of the current literature, R-NSM is a feasible and safe alternative for NSM in the management of breast cancer. The long-term oncological outcomes, however, will only be determined with longer follow-up. [ABSTRACT FROM AUTHOR]

The article offers experience with implant-based delayed reconstruction in the setting of postmastectomy radiation, focusing on a composite of significantly undesirable outcomes. Topic include different approaches to implant-based reconstruction when radiation is involved with generally acceptable rates of complications and dissatisfaction.

Background and Objective: The treatment of breast cancer encompasses both the elimination of malignancy as well as reconstruction after tumor extirpation. Although the patient may have had successful treatment of her breast cancer, the resulting disfigurement and deformity can have a substantial impact on her physical and mental well-being. Breast reconstruction affords these patients the opportunity to correct these deformities and potentially to improve their quality of life. The current literature review evaluates patient-reported outcomes for the various options of breast reconstruction that are most commonly performed., Methods: A literature review on PubMed with the key words "patient-reported outcomes", "breast reconstruction", and "breast cancer" yielded 738 results, which were screened. Articles that specifically focused on patient-reported outcomes after various types of breast reconstruction were evaluated and included in this literature review., Key Content and Findings: The main options of alloplastic reconstruction, autologous tissue reconstruction, and oncoplastic reconstruction were reviewed and found to demonstrate high levels of patient satisfaction. Although there is no clear superior option, patient-reported outcomes demonstrate improved well-being compared to no reconstruction., Conclusions: Breast reconstruction provides the opportunity to correct the deformities after breast cancer treatment making it a crucial component of comprehensive cancer care. A variety of reconstructive options are available which can be tailored to each individual patient to achieve the optimal results for that particular patient. Therefore patient-reported outcomes are paramount to gauge the true success of not only breast cancer treatment but also reconstructive aspects after treatment., Competing Interests: Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm-23-1528/coif). The series “Breast Reconstruction” was commissioned by the editorial office without any funding or sponsorship. The author has no other conflicts of interest to declare., (2023 Annals of Translational Medicine. All rights reserved.)

Background and Objectives: Given advances that streamline breast reconstruction (e.g., prepectoral placement, acellular dermal matrix [ADM], oncoplastic surgery), there is concern that nonplastic surgeons are performing a growing proportion of breast reconstructive procedures. The purpose of this study was to evaluate US trends in the market share of breast reconstruction performed by plastic compared to general surgeons., Methods: IBM® MarketScan® Commercial Claims 2006-2017 and NSQIP 2005-2020 were queried to identify women who underwent mastectomy with alloplastic (tissue expander or implant-based) or free flap reconstruction, or lumpectomy with oncoplastic reconstruction (breast reduction, mastopexy, or local/regional flap). MarketScan included immediate and delayed reconstructions, while all NSQIP reconstructions were immediate. Poisson regression with incident rate ratios (IRRs) modeled trends in surgeon type over time., Results: The cohort included 65 168 encounters from MarketScan and 73 351 from NSQIP. Plastic surgeons performed 95.8% of free flap, 93.8% of alloplastic, and 64.9% of oncoplastic reconstructions. Plastic surgeons performed an increasing proportion of immediate oncoplastic reduction and mastopexy (MarketScan IRR: 1.077, 95% confidence interval [CI]: 1.060-1.094, p < 0.001; NSQIP IRR: 1.041, 95% CI: 1.030-1.052, p < 0.001). There were no clinically significant trends for delayed oncoplastic, alloplastic, or free flap reconstructions. Plastic surgeons were more likely to use ADM compared to general surgeons in NSQIP (p < 0.001)., Conclusions: Plastic surgeons gained market share in immediate oncoplastic breast reduction and mastopexy over the past two decades without any loss in alloplastic or free flap breast reconstruction. Plastic surgeons should continue collaboration with breast surgical oncologists to reinforce the shared surgeon model for management of breast cancer., (© 2023 Wiley Periodicals LLC.)

Background/aim: The purpose was to analyze the impact of post-mastectomy radiation therapy (PMRT) on implant-based breast reconstruction (IBR) in self-identified Hispanic patients compared to non-Hispanic counterparts., Patients and Methods: We retrospectively reviewed patients who underwent IBR between January 1, 2017 and December 31, 2019 at a single hospital system. Patients were cisgender women, assigned female at birth, 18 years or older, and underwent mastectomy with immediate IBR +/- PMRT. We compared characteristics between Hispanic and non-Hispanic patients, assessing capsular contracture and implant loss rates. Multivariable analysis was performed to identify factors associated with complications., Results: A total of 317 patients underwent mastectomy and reconstruction. Of these patients, 302 underwent a total of 467 mastectomies with IBR, and these 467 procedures were included in the analysis of complications. Complications occurred in 175 breasts (37.5%), regardless of PMRT. Seventy-two of the 302 patients (24%) received PMRT to one breast. The overall rates of capsular contracture, implant loss, and overall complications did not vary significantly between Hispanic and non-Hispanic patients (p=0.866, 0.974, and 0.761, respectively). When comparing only irradiated patients, there was a trend towards increased implant loss and overall complication rates in Hispanic versus non-Hispanic patients (p=0.107 and 0.113, respectively). Following PMRT the rate of any complication was 71% in Hispanic women and 53% in non-Hispanic women., Conclusion: Our study illuminates a trend towards higher complication rates after PMRT in Hispanic versus non-Hispanic patients. Further studies are needed to understand why Hispanic patients may have more side effects from radiation therapy., (Copyright © 2023 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Purpose: The functional implications of reconstructing the breast mound with a latissimus dorsi (LD) flap or placing an implant under the pectoralis major (PM) muscle is complicated by potential comorbidities from disinserting these muscles and adjuvant radiotherapy. We utilized novel robot-assisted measures of shoulder stiffness and strength to dissociate how breast reconstruction choice and inclusion of radiation therapy impact shoulder morbidity in post-mastectomy reconstruction patients.Methods: Shoulder strength and stiffness were collected from 10 irradiated LD flap breast reconstruction patients, 14 two-stage subpectoral implant reconstruction patients (subpectoral), and 10 irradiated deep inferior epigastric perforator (DIEP) flap patients an average of 659 days post-reconstruction. Univariate ANOVAs examined surgical group differences in strength and stiffness.Results: There were main effects of surgical group on vertical adduction, vertical abduction, and internal rotation strength. The LD flap group was significantly weaker than the subpectoral group in all measures and significantly weaker than the DIEP group during vertical adduction. There was also a main effect of surgical group on vertical adduction stiffness, where the LD group exhibited significantly reduced stiffness while producing vertical adduction torque. No significant differences between the subpectoral and DIEP groups existed for any measure of shoulder strength or stiffness.Conclusions: Disinsertion of the LD, not the disinsertion of the PM or radiotherapy, contributes to strength deficits following LD flap breast reconstructions. The combined disinsertion of the PM and LD compromises shoulder stability in the vertical plane. Shoulder function should be a focal point of the surgical decision-making process and postsurgical care. [ABSTRACT FROM AUTHOR]

Background: Evidence of racial disparities in the receipt of postmastectomy breast reconstruction is well documented. The objective of this study was to describe trends in racial disparities overall and by reconstructive technique.Methods: The American College of Surgeons National Surgical Quality Improvement Program database was used to identify women who underwent mastectomy and/or breast reconstruction from 2005 to 2014. Patient demographics were recorded, and cases were grouped by reconstructive status and technique. Trends were assessed with the Cochran-Armitage test and the index of disparity.Results: Over the study period, 92,960 postmastectomy patients were identified (77,049 white women, 10,396 black women, 4939 Asian women, and 576 Native American women), of whom 46,931 underwent reconstruction. Of these, 7692 women underwent autologous reconstructions (3913 free flaps and 3696 pedicled flaps). From 2005 to 2014, receipt of breast reconstruction by postmastectomy patients rose from 33.2% to 60.0%, receipt of autologous reconstruction by patients who underwent breast reconstruction fell from 30.4% to 15.9%, and receipt of free-flap reconstruction by patients who underwent autologous reconstruction rose from 15.0% to 70.8%. These trends were significant in all racial subgroups (P < .001), except for Native Americans (P = .269). The index of disparity decreased from 51.4% to 22.6% for overall receipt of breast reconstruction, decreased from 10.7% to 7.0% for tissue expander and implant-based reconstruction, increased from 18.0% to 27.3% for autologous reconstruction, and decreased from 66.7% to 4.3% for free-flap reconstruction.Conclusions: The use of postmastectomy breast reconstruction is steadily rising in the United States. Racial disparities persist, but progress has been made. Further efforts are needed to reduce racial disparities. Cancer 2018;124:2774-2784. © 2018 American Cancer Society. [ABSTRACT FROM AUTHOR]

Summary Background Post-mastectomy radiation therapy (PMRT) is known to increase the complication rate and implant loss in implant-based breast reconstruction. The purpose of this study was to systematically review the literature regarding the outcome of PMRT delivered to the permanent/definitive implant. Methods Systematic review and meta-analysis of studies involving immediate implant-based reconstruction and PMRT when delivered to the permanent implant. Results Seven studies included 2921 patients (520 PMRT, 2401 control). PMRT was associated with significant increase in capsular contracture (7 studies, 2529 patients, 494 PMRT, 2035 control, OR 10.21, 95% CI 3.74 to 27.89, p < 0.00001). In addition, PMRT was associated with a significant increase in revisional surgery (7 studies, 2921 patients, 520 PMRT, 2401 control, OR 2.18, 95% CI 1.33 to 3.57, p = 0.002) and reconstructive failure (6 studies, 2814 patients, 496 PMRT, 2318 control, OR 2.52, 95% CI 1.48 to 4.29, p+0.0007). Moreover, it was associated with a significant reduction in patient satisfaction (4 studies, 468 patients, 138 PMRT, 294 control, OR 0.29, 95% CI 0.15 to 0.57, p = 0.0003) and cosmetic outcome (4 studies, 1317 patients, 238 PMRT, 1009 control, OR 28, 95% CI. 0.11 to 0.67, p = 0.005). Conclusions This meta-analysis demonstrates that within the first 5 years, post implant-based reconstruction for those patients who receive PMRT, the rates of adverse events are increased, and there is a significant reduction in patient satisfaction and cosmetic outcome. [ABSTRACT FROM AUTHOR]

Improvements in breast surgery techniques such as skin and nipple preserving mastectomy and innovative prosthetics (implants, acellular dermal matrices and meshes) is renewing interest in subcutaneous (pre-pectoral) implant reconstruction. The aim of this paper is to review the current literature in an attempt to provide a rationale that may support a return to subcutaneous implant placement, so minimising the pain and functional problems resulting from submuscular breast reconstruction. [ABSTRACT FROM AUTHOR]

Background Correlation among age, clinical, and aesthetic outcomes in implantbased and autologous breast reconstructions was investigated. Methods Between 2004 and 2014, a retrospective study was performed on patients who underwent reconstruction following mastectomy. Patients were divided in group A (< 50 years), group B (≥ 50-59 years), group C (≥ 60-69 years), and group D (≥ 70 years). Demographics, comorbidities, American Society of Anesthesiologists (ASA) class, and length of stay were assessed using chi-square and Kruskal-Wallis H analysis considering p≤0.05 as significant. Pre- and postoperative photographs were taken to grade aesthetic results by patients and blinded plastic surgery team. Results A total of 993 patients underwent 1,251 breast reconstructions, of which 356 (28.5%) were implant-based, 402 (32.1%) pedicled-flap, 445 (35.6%) free-flap, and 48 (3.8%) fat-graft reconstructions. There were 316 (25.2%) complications, of which 124 (34.8%) in implant-based, 74 (18.4%) in pedicled-flap, 111 (24.9%) in free-flap, and 2 (4.2%) in fat-graft reconstructions. Mean length of stay was 5.4 days without significant difference between age groups (p =0.357). The incidence of overall complications was not significantly related to age, ASA class, smoking history, and previous radiotherapy. Body mass index was a significant predictor (p =0.001), but odds ratio (OR: 1.2) demonstrated only a minimal increase in risk. Implant-based reconstruction was associated with a higher risk for complications compared with the other ones (OR: 2.5, p= 0.001). Patient and surgeon aesthetic surveys demonstrated an overall positive opinion in all age groups for each reconstructive option. Conclusion Advanced age should not be considered a risk factor for breast reconstruction, while implant-based technique was associated with a higher risk for complications compared with autologous thatmay provide older women with greater benefits. [ABSTRACT FROM AUTHOR]

There are numerous options for breast reconstruction after mastectomy, and the final reconstructive option is often influenced by patient preference. This study surveyed plastic surgeons regarding their personal preferences for breast reconstruction after mastectomy to identify the impact of gender and age on reconstructive preference. An anonymous online survey was distributed to plastic surgeons in the American Society of Plastic Surgeons member directory and current plastic surgery residents. Female surgeons were asked to select reconstructive options for themselves as patients, while male surgeons were asked to answer the same questions as if advising a loved one. After unilateral mastectomy, 60.2 % of respondents preferred implant-based reconstruction, increasing to 67.8 % after bilateral mastectomy. Top reasons for selecting implant-based reconstruction were recovery time (78.0 %) and hospital length of stay (54.5 %). In contrast, respondents who preferred abdominal flap-based autologous reconstruction cited the longevity (83.3 %) and the aesthetic appearance of the final result (82.7 %) as top reasons. Female surgeons were significantly more likely to choose implant-based reconstruction than male surgeons (68.7 vs. 56.6 %, p = 0.001). Younger male surgeons preferred autologous reconstruction (58.8 %). Plastic surgeons' reconstructive choices parallel current patient-based surveys favoring breast reconstruction with implants. Respondents' reasons for selecting one reconstructive method over another are consistent with prior patient-based surveys. Female plastic surgeons prefer implant-based reconstruction to a greater extent than male plastic surgeons. This survey identifies the need for further prospective study of physician perspectives of patient experiences. Level of Evidence: Not ratable. [ABSTRACT FROM AUTHOR]

Amyloidosis is characterized by extracellular deposition of insoluble misfolded beta-pleated proteins. Amyloid disease involving the breast is rare and there is a paucity of literature guiding surgical management in caring for these patients. In this article we review medical and surgical management with an emphasis on post mastectomy breast reconstruction. We propose an algorithm for breast reconstructive options based on unique considerations in this patient population. An institutional database at the Medical College of Wisconsin was used to identify patients diagnosed with breast amyloidosis from 2011 to 2021. We utilized the electronic medical record to present patient demographics, diagnostic and treatment data regarding the medical and surgical management of these patients. Five women were identified with a median age of 70 years and a median follow up of 19 months (range, 9-80 months). All patients were diagnosed with light chain (AL) type of amyloidosis. Systemic amyloidosis was identified in 3 patients and localized disease was identified in 2 patients. Concurrent breast malignancy was identified in 2 patients who underwent skin-sparing mastectomies followed by breast reconstruction with both prosthetic and autologous techniques. Both prosthetic and autologous reconstructive techniques are safe in patients with amyloidosis, however careful consideration and preoperative work-up are warranted to avoid complications in this vulnerable population. Further studies are warranted to improve surgical outcomes in patients with amyloidosis involving the breast., Competing Interests: Declaration of Competing Interest Anita D’Souza reports institutional research funding from Abbvie, Caelum, Janssen, Novartis, Prothena, Sanofi, Takeda, and TeneoBio, Ad Board fees from BMS, Consulting fees from Prothena and Janssen. The remaining author(s) declared no potential conflict of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2023 Elsevier Inc. All rights reserved.)