Rachel Lentz

Radiation therapy and expander-implant breast reconstruction: an analysis of timing and comparison of complications.

BackgroundThe optimal timing of expander-implant exchange in the setting of postmastectomy radiation therapy (PMRT) remains unclear with prior reports yielding inconsistent and variable results. The purpose of this study was to characterize complications associated with the sequencing of expander-implant breast reconstruction before or after PMRT and to compare the outcomes between early (<4 months) and late (>4 months) expander-implant exchange in the subset of patients who received PMRT before exchange. Materials and MethodsThe medical records of all patients PMRT in the setting of tissue expander-implant breast reconstruction between June 2004 and June 2011 at our institution were reviewed retrospectively. Patients were first classified as having undergone expander-implant exchange before the initiation of PMRT or after the completion of PMRT. Patients who underwent expander-implant exchange after PMRT were then classified as having undergone exchange early (<4 months after PMRT) or late (>4 months after PMRT). All complications requiring additional surgery or hospitalization were recorded. ResultsFifty-five eligible patients were identified as having undergone 56 two-stage tissue expander-implant breast reconstructions. Twenty-two reconstructions underwent exchange before PMRT and 34 reconstructions underwent exchange after PMRT. There was no significant difference in overall complication rate (54.55% vs 47.06%, P = 0.785) or reconstruction failure rate (13.64% vs 20.59%, P = 0.724) between the 2 cohorts. Twenty reconstructions underwent exchange less than 4 months after PMRT and 14 underwent exchange more than 4 months after PMRT. There was no significant difference in overall complication rate (40% vs 57.14%, P = 0.487) or failure rate (25% vs 14.29%, P = 0.672) between the 2 groups. Trends suggest a higher rate of infection in patients who underwent exchange earlier (30% vs 14.29%, P = 0.422) and a higher rate of capsular contracture in patients who underwent exchange later (5% vs 21.43%, P = 0.283); however, statistical significance was not reached. ConclusionsOur findings suggest that neither the sequencing nor timing of expander-implant exchange in the setting of PMRT affects overall complication or reconstruction failure rate. However, the timing of exchange may impact the type of complication encountered. Further investigation is necessary to determine an optimal time for expander-implant exchange.

A Comparison of Superomedial versus Inferior Pedicle Reduction Mammaplasty Using Three-Dimensional Analysis.

A COMPARISON OF SUPEROMEDIAL VERSUS INFERIOR PEDICLE REDUCTION MAMMOPLASTY USING THREE-DIMENSIONAL ANALYSIS. Victor Z. Zhu, Ajul Shah, Rachel Lentz, Tracy Sturrock, Alexander F. Au, Stephanie L. Kwei. Section of Plastic and Reconstructive Surgery, Department of Surgery, Yale University, School of Medicine, New Haven, CT. Reduction mammoplasty using the inferior pedicle (IP) technique continues to be more commonly performed than the superomedial pedicle (SMP). This study uses three-dimensional (3D) imaging to compare postoperative linear and volumetric changes in SMP and IP breast reductions. Reduction mammoplasty was performed using either a SMP or IP, with a Wise-pattern skin incision. Patients in each cohort were matched based on total postoperative breast size, BMI, and age. Postoperative 3D photographs were taken at 1-3 months and 6-12 months. Measurements included: sternal notch to nipple distance, areola surface area, total breast volume, breast projection, proportion superior pole volume, proportion medial pole volume, and tissue shifting over time. There were 13 SMP patients (26 breasts) and 14 IP patients (28 breasts). There were significant differences at 1-3 months between the cohorts in sternal notch to nipple distance (21.6+0.4cm SMP vs. 24.1+0.3cm IP, p<0.01), and proportion superior pole volume (53.9+1.2% SMP vs. 57.3+1.1% IP, p=0.04). The sternal notch to nipple distance (21.6+0.4cm SMP vs. 24.6+0.4cm IP, p<0.01) remained different between the two cohorts at 6-12 months; however, there was no difference in superior pole fullness at this time point. There was a significant difference in proportion medial pole volume (38.1+2.0% SMP vs. 45.8+1.4% IP, p<0.01). There were changes in volumetric distribution over time in both cohorts, with decreased proportion medial pole volume in the SMP cohort, and increased proportion medial pole volume in the IP cohort (p<0.01) over time. Areola surface area increased significantly more over time in the IP cohort than the SMP cohort (2.87+0.77cm IP vs. 0.01+0.57cm SMP, p<0.01). There is no difference between the SMP and IP technique in proportion superior pole volume or breast projection within the 12-month postoperative period; however, the IP technique demonstrated greater proportion medial pole volume and increased areolar surface area over time.

A mammometric comparison of modified Robertson versus Wise pattern inferior pedicle reduction mammoplasty

Aim: The advent of 3D photoimaging and mammometrics has allowed for quantitative, volumetric breast analyses. This study uses 3D photoimaging and mammometrics to compare the postoperative morphometric outcomes of the modified Robertson technique to the more traditional Wise pattern inferior pedicle technique. Methods: Inferior pedicle reduction mammoplasty was performed using either a Wise pattern or modified Robertson skin incision. 3D photography and analysis were done at 1-3 months and 6-12 months postoperatively. Results: There were 14 breasts in the modified Robertson group (ROB) and 24 breasts in the Wise pattern group (WISE). There were no significant differences in demographic data or amount of tissue resected. At 6-12 months, the modified Robertson cohort demonstrated increased superior pole fullness (62.9% ROB vs. 58.3% WISE, P = 0.05). The Wise cohort, however, maintained greater maximum breast projection (5.52 cm ROB vs. 6.54 cm WISE, P = 0.01) and increased medial pole fullness (29.6% ROB vs. 46.9% WISE, P < 0.01). There was no difference in tissue shifting from the superior pole to the inferior pole over time (+3.36 superior pole % ROB vs. +1.42 superior pole % WISE, P = 0.28). Areola surface area increased equally in both cohorts (+3.08 cm2 ROB vs. +2.59 cm2 WISE, P = 0.77); however, the final size of the areola was greater in the modified Robertson cohort (26.9 cm2 ROB vs. 21.6 cm2 WISE, P < 0.01). Conclusion: Using 3D mammometrics, we found increased superior pole fullness in the modified Robertson group while the Wise pattern group demonstrated greater medial pole fullness and maximum breast projection. ABSTRACT

Three Dimensional Analysis of Early Post-Operative Volumetric and Morphologic Changes Following Vertical Reduction Mammoplasty Using a Superomedial Pedicle

IntroductIon: Reduction mammoplasty is one of the most frequently performed breast operations in the United States. The vertical reduction using a superomedial pedicle is increasingly popular, with proponents claiming superior aesthetics and projection over time. Prior studies have described the use of 3-dimensional (3D) photography for analysis of the long term changes in volume following medial pedicle breast reductions. The purpose of this study was to use similar 3D technology to analyze early post-operative morphologic and volumetric changes that occur with superomedial pedicle breast reductions.