Author Archives: gliffen

BFACE: A Framework for Evaluating Breast Aesthetics

Summary: Although much has been written about breast aesthetics, the literature lacks a simple yet systematic and comprehensive approach for pre-operative breast assessment. With use of the mnemonic “BFACE,” the breast surgeon will analyze the bony skeleton and the breast footprint, areola, conus, and envelope. The authors present a thorough review of the important parameters that define the ideal breast, and several techniques for perceiving asymmetries more clearly. Strategic surgical planning is enabled by accurate perception.

(Plast. Reconstr. Surg. 140: 287e, 2017.)

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Safety of nipple sparing mastectomy

Some patients are worried about the safety of saving the nipple. The advantages are keeping the nipple , a hidden scar and a prettier shape. I also find that these patients tend to be less depressed after their surgery. Your mastectomy surgeon will decide if this is a safe option for you, but some patients continue to have some lingering doubts. Below is the latest evidence in favor of nipple sparing mastectomy safety.

‘Nipple-Sparing’ Mastectomies Don’t Raise Odds of Cancer’s Return: Study

Research suggests that the cosmetically superior procedure comes with no added risk

By Robert Preidt, HealthyDay Reporter

WEDNESDAY, July 19, 2017 (HealthDay News) — Surgeons performing mastectomies can offer a form of the procedure that allows women to retain the nipple for use in breast reconstruction.

Now, a reassuring study finds that this type of mastectomy doesn’t raise a woman’s risk for breast cancer recurrence.

“More women are requesting nipple-sparing mastectomy because of the superior cosmetic results. But doctors don’t want to take any chances with breast cancer patients’ safety for the sake of cosmetic improvement,” explained lead researcher Dr. Barbara Smith. She’s a surgical oncologist and director of the breast program at Massachusetts General Hospital in Boston.

“Our study, which has one of the longest reported follow-ups after therapeutic nipple-sparing mastectomy in the United States, provides additional support that it’s safe to leave the nipple intact during mastectomy with only a few exceptions,” she said in a news release from the Journal of the American College of Surgeons. It published the findings online July 17.

Most breast cancer patients are eligible for nipple-sparing mastectomy, which leaves the natural nipple in place. That’s different from a standard mastectomy, where the whole breast and breast skin, including the nipple, are removed.

Nipple-sparing mastectomy has several advantages over standard mastectomy, Smith said.

“Often, a woman feels more whole when she keeps her nipple,” she said. “Not only does the breast look more natural after [the surgery], a woman who still has fully intact breast skin can often choose to have a single-stage breast reconstruction with an implant, rather than needing a tissue expander (an inflatable breast implant) to stretch the skin over several months.”

In the new study, Smith’s team tracked outcomes for 297 women who underwent nipple-sparing mastectomy from June 2007 through 2012. Fourteen had cancer in both breasts and underwent nipple-sparing mastectomy on both sides, so the total number of surgeries was 311.

After a median follow-up of more than four years, there was a 5.5 percent breast cancer recurrence rate. None of the recurrences involved nipples retained during mastectomies, the findings showed.

The cancer recurrence rate among patients in this study was comparable to rates seen after standard mastectomy, Smith said.

Two breast cancer surgeons said the new findings should help women feel good about nipple-sparing mastectomy.

The study “encourages those of us who have been waiting for long-term results to now incorporate the procedure into our practices,” said Dr. Virginia Maurer, who directs breast surgery at NYU Winthrop Hospital in Mineola, N.Y. She said the hospital has already been offering women these surgeries “for five years with good results.”

Dr. Lauren Cassell is chief of breast surgery at Lenox Hill Hospital in New York City. She agreed that “nipple-sparing mastectomies offer our patients a cosmetic approach which allows them to look most like themselves, not to mention avoiding an additional procedure to recreate a nipple.”

However, “patients as well as physicians have been wary about the possible increased risk of local recurrence in the nipple areola complex,” Cassell said. But the Boston study appears to have laid those fears to rest, she noted.

More information

The American Cancer Society has more on breast cancer surgery.

SOURCES: Virginia Maurer, M.D., chief, division of breast surgery, NYU Winthrop Hospital, Mineola, N.Y.; Lauren Cassell, M.D., chief of breast surgery, Lenox Hill Hospital, New York City; Journal of the American College of Surgeons, news release, July 17, 2017


Reelevating the Mastectomy Flap: A Safe Technique for Improving Nipple-Areolar Complex Malposition after Nipple-Sparing Mastectomy

Summary: Nipple-areolar complex (NAC) malposition is one of the most common complications following nipple-sparing mastectomy with implant-based reconstruction. To maximize perfusion to the NAC, traditional methods of correcting NAC malposition limit undermining below the NAC. We demonstrate a series of cases in which improvement of NAC malposition was safely performed by reelevating the NAC and mastectomy flap to allow redraping of the soft tissue envelope over the implant and the overlying capsule. Thirty-four patients were identified in a span over 4 years where 44 NACs were repositioned using this method. There was zero incidence of postoperative ischemia or necrosis of the NAC or mastectomy flaps. There was noticeable improvement in the NAC position on the breast mound. Reelevation of the mastectomy skin flap to correct malposition of the NAC after nipple-sparing mastectomy is a safe and effective option, avoids additional scars, and can be performed more than once to further improve positioning of the NAC.

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Animation Deformity in Postmastectomy Implant-Based Reconstruction

Animation deformity (AD), including its prevalence and effect on patients, has been studied in the context of subpectoral augmentation mammaplasty.1 However, to our knowledge, only 1 other study has defined the prevalence and effect of AD in the subpectoral implant-based breast reconstruction patient population.2 Given the recent rise in prepectoral, implant-based reconstruction, an assessment of patient experience with AD in the partial subpectoral implant-based reconstruction population is timely and relevant.

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Bioengineered Breast: Concept, Technique, and Preliminary Results

We read with interest the article titled “Bioengineered Breast: Concept, Technique, and Preliminary Results” by Maxwell and Gabriel. The concept of “bioengineering” the breast using acellular dermal matrix and fat grafting has revolutionized prosthetic-based reconstruction; the authors’ contribution to the literature in this field is significant. The authors detail their method using acellular dermal matrix and fat grafting to augment the soft-tissue envelope in breast reconstruction during the second stage of breast reconstruction.

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Abdominoplasty Pain Study

I am pleased to announce that our practice has received Institutional Review Board approval to conduct a study to see if we can help improve abdominal pain after abdominoplasty. Participation in the study is completely optional.

Dysport is a medication similar to Botox in that it helps to weaken muscles temporarily. We are hoping that an injection of Dysport at the time of surgery will help the muscle spasm and tightness that patients usually feel after this surgery for several weeks to months. The dose given will not be enough to interfere with normal activities or exercise.

We have used Dysport on a few patients, and because we were so impressed with their decreased pain, decided to embark on this study. Patients will be randomized, which means they will either receive the Dysport or not. The Dysport injection is about a $500 value and will be given at no cost to the patient. All patients will be asked to keep a pain log for several months, and then we will see if we can detect a difference in the patients who received the Dysport with those who did not.

We are very excited about this research opportunity, but if it is not something you are interested in, you do not need to participate in the study.

Surgical Delay of the Nipple-Areolar Complex in High-risk Nipple-sparing Mastectomy Reconstruction

SUMMARY: As nipple-sparing mastectomy gains increasing popularity, minimizing the risk of nipple necrosis continues to be of critical importance to patients and surgeons. Patients with large or ptotic breasts, scars from previous cosmetic and/or oncologic breast surgery, or previous irradiation have often been denied nipple-sparing mastectomy (NSM) because of increased risk of nipple necrosis. A variety of interventions have been suggested to minimize the ischemic insult to the nipple–areolar complex (NAC). This article presents our experience in 26 high-risk patients with surgical delay of the NAC.

(Plast Reconstr Surg Glob Open 2016;4:e760; doi: 10.1097/GOX.0000000000000716; Published online 28 June 2016.)

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