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      Patient Satisfaction with Implant Based Breast Reconstruction Associated with Implant Volume and Mastectomy Specimen Weight Ratio

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          Abstract

          Purpose

          Breast volume assessment is one of the most important steps during implant-based breast reconstruction because it is critical in selecting implant size. According to previous studies, there is a close relationship between the mastectomy specimen weight and resected breast volume. The aim of this study was to evaluate long-term patient satisfaction with implant-based breast reconstruction guided by the ratio of implant volume to mastectomy specimen weight. In doing so, we describe the ideal ratio for patient satisfaction.

          Methods

          A total of 84 patients who underwent implant-based breast reconstruction for breast cancer were included in this study. The patients were grouped by the ratio of implant size to mastectomy specimen weight (group 1, <65%; group 2, 65%–75%; and group 3, >75%). Outcome analysis was performed using a questionnaire of patient satisfaction and the desired implant size.

          Results

          Patient satisfaction scores concerning the postoperative body image, size, and position of the reconstructed breast were significantly higher in group 2. The average ratio of the ideal implant volume to mastectomy specimen weight for each group was 71.9% (range, 54.5%–96.7%), with the differences across the three groups being not significant ( p=0.244).

          Conclusion

          Since there is an increase in breast reconstruction, selecting the appropriate breast implant is undoubtedly important. Our novel technique using the ratio of implant volume to mastectomy specimen weight provides physicians a firm guide to intraoperative selection of the proper implant in reconstructive breast surgery.

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          Most cited references25

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          Breast reconstruction after mastectomy using the temporary expander.

          C Radovan (1982)
          Breast reconstruction after a radical mastectomy using the temporary subcutaneous tissue expander is described. The main principle of this method is recovery of the amount of lost tissue through expansion of the remaining chest skin to large proportions and filling of the breast envelope with a smaller permanent mammary implant. Sixty-eight patients were reconstructed with an average follow-up of 18 months. Average expansion time for breast development was 6 weeks, with an average reconstructed breast size of 300 to 400 cc. Contralateral round dermal mastopexy with simultaneous nipple enlargement, contralateral subcutaneous mastectomy through a similar round dermal mastopexy, and reconstruction of the nipple are discussed.
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            An 8-year experience of direct-to-implant immediate breast reconstruction using human acellular dermal matrix (AlloDerm).

            The advent of skin- and nipple-sparing mastectomy in conjunction with the use of human acellular dermal matrix to provide lower pole coverage has made direct-to-implant immediate breast reconstruction following mastectomy feasible. The purpose of this study was to evaluate long-term complications associated with this technique. All human acellular dermal matrix-assisted direct-to-implant immediate reconstructions performed over an 8-year period were included in this analysis. Patient charts were reviewed for type of mastectomy (oncologic or prophylactic), incision type, complications during follow-up, length of follow-up, rate and type of revision surgery in breasts without postoperative complications, contralateral procedures, and adjuvant radiotherapy. A total of 466 breasts (260 patients) were reconstructed; 68 percent were prophylactic and 32 percent were oncologic cases. Twenty-one breasts (4.5 percent) received radiotherapy. Mean implant size placed was 412.8 ± 24.7 cc (range, 150 to 600 cc). Mean follow-up was 28.9 ± 21.3 months (range, 0.3 to 97.7 months). The overall complication rate was 3.9 percent (implant loss, 1.3 percent; skin breakdown/necrosis, 1.1 percent; hematoma, 1.1 percent; human acellular dermal matrix exposure, 0.6 percent; capsular contracture, 0.4 percent; and infection, 0.2 percent). Type, incidence, and overall rate of complications did not differ significantly between prophylactic and oncologic breasts. Irradiated breasts had a fourfold higher rate of complications. In 354 breasts with more than 1 year of follow-up (mean, 36.7 ± 18.6 months; range, 12.1 to 97.7 months), there were no long-term complications. Human acellular dermal matrix-assisted direct-to-implant breast reconstruction following mastectomy is safe and reliable, with a low overall long-term complication rate. The low incidence of capsular contracture supports the growing body of evidence that human acellular dermal matrix mitigates capsular contracture.
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              Five Methods of Breast Volume Measurement: A Comparative Study of Measurements of Specimen Volume in 30 Mastectomy Cases

              Background: To compare breast volume measurement techniques in terms of accuracy, convenience, and cost. Methods: Breast volumes of 30 patients who were scheduled to undergo total mastectomy surgery were measured preoperatively by using five different methods (mammography, anatomic [anthropometric], thermoplastic casting, the Archimedes procedure, and the Grossman-Roudner device). Specimen volume after total mastectomy was measured in each patient with the water displacement method (Archimedes). The results were compared statistically with the values obtained by the five different methods. Results: The mean mastectomy specimen volume was 623.5 (range 150–1490) mL. The breast volume values were established to be 615.7 mL (r = 0.997) with the mammographic method, 645.4 mL (r = 0.975) with the anthropometric method, 565.8 mL (r = 0.934) with the Grossman-Roudner device, 583.2 mL (r = 0.989) with the Archimedes procedure, and 544.7 mL (r = 0.94) with the casting technique. Examination of r values revealed that the most accurate method was mammography for all volume ranges, followed by the Archimedes method. Conclusion: The present study demonstrated that the most accurate method of breast volume measurement is mammography, followed by the Archimedes method. However, when patient comfort, ease of application, and cost were taken into consideration, the Grossman-Roudner device and anatomic measurement were relatively less expensive, and easier methods with an acceptable degree of accuracy.
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                Author and article information

                Journal
                J Breast Cancer
                J Breast Cancer
                JBC
                Journal of Breast Cancer
                Korean Breast Cancer Society
                1738-6756
                2092-9900
                March 2017
                24 March 2017
                : 20
                : 1
                : 98-103
                Affiliations
                Institute of Human Tissue Restoration, Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea.
                [1 ]Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
                Author notes
                Correspondence to: Tai Suk Roh. Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Tel: +82-2-2019-3421, Fax: +82-2-577-4914, ROHTS@ 123456yuhs.ac
                Article
                10.4048/jbc.2017.20.1.98
                5378585
                28382100
                d3e564a8-5c90-42d7-a4d4-424114298e9a
                © 2017 Korean Breast Cancer Society

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 06 September 2016
                : 07 December 2016
                Categories
                Original Article

                Oncology & Radiotherapy
                breast implants,mammaplasty,patient satisfaction
                Oncology & Radiotherapy
                breast implants, mammaplasty, patient satisfaction

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