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Item An Alternative Technique for Immediate Direct-to-Implant Breast Reconstruction-A Case Series(Wolters Kluwer, 2016-07-22) Downs, Ronald K.; Hedges, Kellee; Department of Surgery, IU School of MedicineBACKGROUND: The practice of breast reconstruction continues to evolve with the introduction of new technologies. The authors describe a unique approach allowing immediate direct-to-implant reconstruction that can be performed on an outpatient basis. METHODS: After a nipple-sparing mastectomy, acellular dermal matrix (ADM)-covered implants are placed in a prepectoral position in an immediate reconstruction. Assessment of results was performed via a retrospective review of demographic and procedural data. RESULTS: Forty-five patients (79 breasts), mean age 46.8 years, were treated with direct-to-implant reconstruction using ADM-wrapped implants placed above the muscle with mean follow-up of 23.1 months (median 22 mo). Mean body mass index was 24.3, and 15 patients (33.3%) were current or former smokers. Twenty-seven patients (60%) had prior breast surgery with 22 (49%) exposed to chemotherapy and 34 (76%) radiation. Procedure time averaged 155 minutes and hospital length of stay averaged 0.6 days. Complications included flap necrosis in 22 cases (28%), seroma in 12 (15%), infection in 8 (10%), rippling in 28 (35%), and contracture in 8 (10%). In 14 breasts (18%), postoperative wound complications (flap necrosis or infection) led to implant loss. CONCLUSIONS: The availability of ADM and cohesive gel implants has allowed us to perform above-the-muscle implant breast reconstruction in reduced time and often on an outpatient basis. Complication rates were comparable to expected results of standard expander-to-implant, staged breast reconstruction. This technique is a viable option delivering clinically and aesthetically acceptable results in select patients.Item Evaluation of an Extended-duration Chemoprophylaxis Regimen for Venous Thromboembolism after Microsurgical Breast Reconstruction(Wolters Kluwer, 2021-08) Pittelkow, Eric M.; DeBrock, Will C.; Mailey, Brian; Ballinger, Tarah J.; Socas, Juan; Lester, Mary E.; Hassanein, Aladdin H.; Medicine, School of MedicinePatients undergoing free flap breast reconstruction are at a high risk for venous thromboembolism based upon Caprini scores. Guidelines for venous thromboembolism prophylaxis recommend high-risk groups receive extended chemoprophylaxis for several weeks after gynecological, orthopedic, and surgical oncology cases. Extended prophylaxis has not been studied in free flap breast reconstruction. The purpose of this study was to compare outcomes of free flap breast reconstruction patients who received extended venous thromboembolism (VTE) prophylaxis with those who received standard inpatient-only prophylaxis. Methods: Patients undergoing microsurgical breast reconstruction were divided into two groups: standard VTE prophylaxis (Group I) and extended prophylaxis (Group II). Both groups received prophylactic subcutaneous heparin or enoxaparin preoperatively and enoxaparin 40 mg daily postoperatively while inpatient. Group II was discharged with a home regimen of enoxaparin 40 mg daily for an additional 14 days. Results: In total, 103 patients met inclusion criteria (36 patients in Group I, 67 patients in Group II). The incidence of VTE was 1.5% in Group II compared with 2.8% in Group I (P = 0.6). There was no difference in reoperative hematoma between Group I (n = 0) and Group II (n = 1) (P = 0.7). Total flap loss was 2.2%. Conclusions: Although this retrospective pilot study did not show statistical significance in VTE between those receiving extended home chemoprophylaxis (1.5% incidence) compared with inpatient-only chemoprophylaxis (2.8%), the risk of bleeding complications was similar. These results indicate that a larger, higher powered study is justified to assess if an extended home chemoprophylaxis protocol should be standard of care post free flap breast reconstruction.