Michelle Coriddi

Analysis of Satisfaction and Well-Being Following Breast Reduction Using a Validated Survey Instrument: The Breast-Q

Background: Breast reduction surgery has been proven in the literature to have a high rate of patient satisfaction, with improvement in quality of life. However, few studies have used validated survey instruments. The BREAST-Q is the only questionnaire to evaluate breast reduction that meets international and federal standards for questionnaire development. Therefore, the aim of this study was to implement this survey to analyze patient-reported satisfaction and quality of life following breast reduction. Methods: All patients seen in consultation for breast reduction between January of 2008 and May of 2009 were asked to fill out BREAST-Q surveys anonymously, both preoperatively and 6 weeks postoperatively. Statistical analysis was performed and a value of p < 0.05 was considered significant. Results: Forty-nine patients underwent breast reduction performed by a single surgeon (A.T.) during the study period. Of these patients, 38 (78 percent) completed the prereduction survey and 38 (78 percent) completed the postreduction survey. Statistically significant improvements were observed in satisfaction with breast appearance, psychosocial well-being, sexual well-being, and physical well-being. Satisfaction with overall outcomes most strongly correlated to satisfaction with breast appearance. Conclusions: As the implementation of evidence-based medicine continues to grow in everyday practice, there is increasing pressure to use validated survey instruments to demonstrate patient-reported outcomes. In this study, we have shown that breast reduction significantly improves satisfaction with breast appearance and psychosocial, sexual, and physical well-being, and that overall patient satisfaction is most strongly correlated with satisfaction in appearance of their breasts CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Analysis of Satisfaction and Well-Being in the Short Follow-up From Breast Augmentation Using the BREAST-Q, a Validated Survey Instrument

BACKGROUND Improvements in satisfaction and quality of life following breast augmentation have been shown in the literature. However, few studies have used validated survey instruments. The BREAST-Q is a strong and validated questionnaire for breast augmentation. OBJECTIVE The authors implement the BREAST-Q to analyze patient-reported satisfaction and quality of life following breast augmentation. METHODS In this prospective study, all patients who underwent breast augmentation with a single surgeon (AT) between January 2008 and May 2009 were asked to fill out BREAST-Q surveys anonymously during the preoperative and 6-week postoperative periods. Statistical analysis was performed and a P value of <.05 was considered significant. RESULTS Of the 155 patients who underwent breast augmentation during the study time period, 59 (38%) completed the preoperative survey and 70 (45%) completed the postoperative survey. Significant improvements were seen for satisfaction with breast appearance (P < .001), psychosocial well-being (P < .001), and sexual well-being (P < .01) between pre- and postoperative surveys. Conversely, a significant decrease was seen in the physical well-being category (P < .001). Satisfaction with overall outcomes most strongly correlated to satisfaction with appearance of breasts (r = 0.8) and less strongly with psychosocial well-being and sexual well-being (r = 0.6). No correlation was found between satisfaction with overall outcomes and physical well-being (r = 0.0). CONCLUSIONS As the implementation of evidence-based medicine continues to grow in everyday practice, there is increasing pressure to use validated survey instruments to demonstrate patient-reported outcomes. In this study, the authors have shown that breast augmentation significantly improves satisfaction with breast appearance, psychosocial well-being, and sexual well-being and that overall satisfaction is most strongly correlated with breast appearance satisfaction.

Vascularized jejunal mesenteric lymph node transfer for treatment of extremity lymphedema.

Vascularized lymph node transfer (VLNT) has emerged as a possible surgical treatment for lymphedema. Described donor sites include the groin, axillary, submental, and supraclavicular areas. However, each of these sites has significant disadvantages. Harvest from either the groin, axilla, or supraclavicular region can result in lymphedema of the donor site extremity, harvest from the supraclavicular area can have variable anatomy, and harvest from the submentum leaves a visible scar and there is a risk for injury to the marginal mandibular nerve. We propose a novel donor site for VLNT: the jejunal mesentery. This donor site is ideal as there is no risk of subsequent lymphedema, the scar is small and easily concealed, and the vascular anatomy is reliable. To our knowledge, this is the first description of the vascularized jejunal mesenteric lymph node transfer for the surgical treatment of lymphedema. The flap is harvested through a midline minilaparotomy incision, that is, 3–5 cm. The desired section of jejunum is identified and delivered from the abdomen. Lymph nodes with adjacent vascular structures are identified by inspection, palpation, and trans-illumination. Once a favorable cluster of nodes and associated vessels are identified, the peritoneum is incised around the distal periphery of the flap and distal branches are ligated. The flap is then elevated from the periphery toward the root of the mesentery, preserving the deep peritoneal layer to avoid an internal hernia. Dissection continues until vessel caliber is adequate for microvascular anastomosis (artery 1–1.5 mm and vein 2–3 mm), while preserving all major branches to the jejunum. The flap is raised with the cluster of lymph nodes and mesenteric vascular pedicle en bloc (Fig. 1). Bowel continuity is preserved. We have found that flaps harvested from the periphery of the mesentery are preferable, as they appear to have better balance of arterial inflow and venous outflow when compared with flaps raised closer to the root of the mesentery. The recipient site on the anterior distal leg, groin, distal forearm or axilla is prepared. Mesenteric lymph nodes are transferred and vascular anastomoses are performed. The recipient site is chosen according to the location of lymphedema and prior treatment history. Flap inset includes removal of scar tissue when applicable. Closure with placement of a skin graft over the flap is

Analysis of Factors Contributing to Severity of Breast Cancer Related Lymphedema

BackgroundUpper extremity lymphedema is a well-described complication of breast cancer treatment. Risk factors for lymphedema development include axillary lymph node dissection (ALND), obesity, increasing age, radiation, and postoperative complications. In this study, we seek to evaluate a cohort of patients who have either self-referred or been referred to the Department of Physical Therapy for lymphedema treatment. Our goal is to evaluate specific risk factors associated with the severity of lymphedema in this patient population. MethodsAll patients who presented to the Wexner Medical Center at the Ohio State University between January 1, 2009, and December 31, 2010, with a chief complaint of upper extremity lymphedema after breast cancer treatment were reviewed retrospectively. Upper extremity lymphedema index (UELI) was used as a severity indicator and patient factors including demographics and breast cancer treatments were evaluated. Univariate and multivariate statistical analyses were performed. ResultsFifty (4.5%) patients presented for upper extremity lymphedema treatment after breast cancer treatment (total of 1106 patients treated surgically for breast cancer). Greater UELIs were found in patients 50 years and older, those with ALND, radiation, chemotherapy, pathologic stage greater than 3, and an International Society of Lymphology lymphedema stage II (P < 0.05). The multivariate model showed age older than 50 years and pathologic stage greater than 3 were significant predictors of higher UELI (P < 0.05). ConclusionsIn this study, we report that in patients who present for lymphedema treatment, increased UELI is significantly related to ALND, radiation therapy, chemotherapy, age, and pathologic stage. An improved understanding of the patient population referred for lymphedema treatment will allow for the identification of patients who may be candidates for therapeutic intervention.

Reduction mammaplasty, obesity, and massive weight loss: temporal relationships of satisfaction with breast contour.

Background: Reduction mammaplasty is often performed on obese women. With the rise in bariatric procedures, secondary changes to breast contour are increasing. This study aims to investigate the temporal relationships of breast contour satisfaction with weight status. Methods: One hundred ninety patients were examined. Patient demographics, comorbidities, body mass index, surgical history, and weight loss method used were evaluated. Patients who underwent reduction mammaplasty before massive weight loss were selected and administered a telephone survey (group I). Patients who did not undergo breast surgery before massive weight loss were selected as a control group (group II). Results: Of the 15 patients (7.9 percent) in group I, 14 completed the survey (93 percent). For group I, all patients felt the appearance of their breasts improved after reduction (p < 0.001) but felt appearance worsened or stayed the same after weight loss (p = 0.003). Seventy-one percent of patients were able to exercise more and 64 percent were able to lose weight on their own because of their reduction. For group II, 79 percent of patients felt the appearance of their breasts worsened or stayed the same after massive weight loss (p = 0.03). Conclusions: Most reduction patients before massive weight loss are glad they had the reduction and become more active but ultimately needed bariatric surgery to accomplish weight loss goals and are dissatisfied with breast contour following massive weight loss. Thus, patients who are considering bariatric procedures should be encouraged to pursue that operation before proceeding with reduction mammaplasty. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Lymphedema strategies for investigation and treatment: a review.

The goal of this article was to define lymphedema as a disease entity, to introduce the American Lymphedema Framework Project, and to summarize current surgical strategies on the horizon in the surgical treatment of lymphedema.

The Impact of Intraoperative Microvascular Compromise on Outcomes in Microsurgical Breast Reconstruction

BACKGROUND In microsurgical breast reconstruction, the nature and fate of postoperative vascular compromise has been well studied, but limited data exist on intraoperative vascular compromise. METHODS A review of all breast free flaps between 2007 and 2012 was performed. Details of intraoperative vascular compromise were recorded. Patients who experienced intraoperative microvascular compromise (Group I) were compared with patients who experienced only postoperative microvascular compromise (Group P) and all other patients (Group N). RESULTS A total of 612 microsurgical breast reconstructions were reviewed. There were 73 (11.9%) flaps in Group I, 27 (4.4%) in Group P, and 512 (83.7%) in Group N. Compared with Group P, Group I more often involved arterial problems (p = 0.01), required supercharging for venous problems (p = 0.02), and was more likely to be salvaged (89.0 vs. 70.4%, p = 0.03). Group I had a similar overall complication rate compared with all other flaps (Group N + P) (31.5 vs. 27.1%, p = 0.49), but a higher flap loss rate (11.0 vs. 1.7%, p = 0.0003). The need to perform > 1 arterial revision was a risk factor for flap loss in Group I (p = 0.028). Total ischemia times > 175 minutes (p = 0.047) and reperfusion times > 80 minutes (p = 0.041) significantly increased the risk of flap loss to approximately 50%. CONCLUSION Intraoperative vascular problems occur more frequently than postoperative vascular problems but are more frequently salvaged. They do not increase the likelihood of reoperation or total complications compared with all other flaps but do increase the risk of flap loss.

Timing of prophylactic hysterectomy‐oophorectomy, mastectomy, and microsurgical breast reconstruction in BRCA1 and BRCA2 carriers

BRCA (breast cancer susceptibility gene) carriers are at high risk for breast and ovarian malignancies, and often undergo prophylactic total abdominal hysterectomy‐bilateral salpingo‐oophorectomy (TAH‐BSO), bilateral mastectomy, and microsurgical breast reconstruction. Our goal was to determine whether abdominal wall complications and flap choice are affected by the order of those procedures.

Face Transplantation: Medical Considerations

Face transplantation has been performed in 37 patients worldwide. To provide excellent outcomes, it is important to understand the medical considerations that are present in every aspect of this procedure. Pre-operative medical considerations are largely related to patient selection, intra-operative considerations are related to anesthesia, and post-operative considerations include complications and treatment of adverse effects of immunosuppression. This paper will discuss each area in more detail.