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Optimizing Aesthetic Outcomes in Delayed Breast Reconstruction

BACKGROUND: The need to restore both the missing breast volume and breast surface area makes achieving excellent aesthetic outcomes in delayed breast reconstruction especially challenging. Autologous breast reconstruction can be used to achieve both goals. The aim of this study was to identify surgi...

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Autor principal: Dec, Wojciech
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5585439/
https://www.ncbi.nlm.nih.gov/pubmed/28894666
http://dx.doi.org/10.1097/GOX.0000000000001447
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author Dec, Wojciech
author_facet Dec, Wojciech
author_sort Dec, Wojciech
collection PubMed
description BACKGROUND: The need to restore both the missing breast volume and breast surface area makes achieving excellent aesthetic outcomes in delayed breast reconstruction especially challenging. Autologous breast reconstruction can be used to achieve both goals. The aim of this study was to identify surgical maneuvers that can optimize aesthetic outcomes in delayed breast reconstruction. METHODS: This is a retrospective review of operative and clinical records of all patients who underwent unilateral or bilateral delayed breast reconstruction with autologous tissue between April 2014 and January 2017. Three groups of delayed breast reconstruction patients were identified based on patient characteristics. RESULTS: A total of 26 flaps were successfully performed in 17 patients. Key surgical maneuvers for achieving aesthetically optimal results were identified. A statistically significant difference for volume requirements was identified in cases where a delayed breast reconstruction and a contralateral immediate breast reconstruction were performed simultaneously. CONCLUSIONS: Optimal aesthetic results can be achieved with: (1) restoration of breast skin envelope with tissue expansion when possible, (2) optimal positioning of a small skin paddle to be later incorporated entirely into a nipple areola reconstruction when adequate breast skin surface area is present, (3) limiting the reconstructed breast mound to 2 skin tones when large area skin resurfacing is required, (4) increasing breast volume by deepithelializing, not discarding, the inferior mastectomy flap skin, (5) eccentric division of abdominal flaps when an immediate and delayed bilateral breast reconstructions are performed simultaneously; and (6) performing second-stage breast reconstruction revisions and fat grafting.
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spelling pubmed-55854392017-09-11 Optimizing Aesthetic Outcomes in Delayed Breast Reconstruction Dec, Wojciech Plast Reconstr Surg Glob Open Original Article BACKGROUND: The need to restore both the missing breast volume and breast surface area makes achieving excellent aesthetic outcomes in delayed breast reconstruction especially challenging. Autologous breast reconstruction can be used to achieve both goals. The aim of this study was to identify surgical maneuvers that can optimize aesthetic outcomes in delayed breast reconstruction. METHODS: This is a retrospective review of operative and clinical records of all patients who underwent unilateral or bilateral delayed breast reconstruction with autologous tissue between April 2014 and January 2017. Three groups of delayed breast reconstruction patients were identified based on patient characteristics. RESULTS: A total of 26 flaps were successfully performed in 17 patients. Key surgical maneuvers for achieving aesthetically optimal results were identified. A statistically significant difference for volume requirements was identified in cases where a delayed breast reconstruction and a contralateral immediate breast reconstruction were performed simultaneously. CONCLUSIONS: Optimal aesthetic results can be achieved with: (1) restoration of breast skin envelope with tissue expansion when possible, (2) optimal positioning of a small skin paddle to be later incorporated entirely into a nipple areola reconstruction when adequate breast skin surface area is present, (3) limiting the reconstructed breast mound to 2 skin tones when large area skin resurfacing is required, (4) increasing breast volume by deepithelializing, not discarding, the inferior mastectomy flap skin, (5) eccentric division of abdominal flaps when an immediate and delayed bilateral breast reconstructions are performed simultaneously; and (6) performing second-stage breast reconstruction revisions and fat grafting. Wolters Kluwer Health 2017-08-09 /pmc/articles/PMC5585439/ /pubmed/28894666 http://dx.doi.org/10.1097/GOX.0000000000001447 Text en Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Original Article
Dec, Wojciech
Optimizing Aesthetic Outcomes in Delayed Breast Reconstruction
title Optimizing Aesthetic Outcomes in Delayed Breast Reconstruction
title_full Optimizing Aesthetic Outcomes in Delayed Breast Reconstruction
title_fullStr Optimizing Aesthetic Outcomes in Delayed Breast Reconstruction
title_full_unstemmed Optimizing Aesthetic Outcomes in Delayed Breast Reconstruction
title_short Optimizing Aesthetic Outcomes in Delayed Breast Reconstruction
title_sort optimizing aesthetic outcomes in delayed breast reconstruction
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5585439/
https://www.ncbi.nlm.nih.gov/pubmed/28894666
http://dx.doi.org/10.1097/GOX.0000000000001447
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