Riccardo Bonomi

Prevention of Postoperative Seroma-Related Morbidity by Quilting of Latissimus Dorsi Flap Donor Site: A Systematic Review

OBJECTIVE To systematically analyze the effectiveness of quilting of latissimus dorsi (LD) flap donor site in the prevention of seroma and related morbidities. METHODS All published studies comparing the effectiveness of quilting versus no-quilting of LD flap donor site in the prevention of seroma and related morbidities in patients undergoing breast reconstruction were analysed systemically. RESULTS Five comparative studies on quilting versus no-quilting encompassing 440 patients were suitable for statistical analysis. There was no heterogeneity among trials. Therefore, in the fixed-effects model, quilting was effective in terms of reducing the incidence of donor-site seroma formation, reducing the average volume of the seroma, and reducing the total volume of drained seroma. In addition, quilting did not increase the risk of postoperative complications. Combined quilting and fibrin glue was also effective in reducing the average volume of the seroma and total drained volume of the seroma. Combination of quilting and glue did not influence the incidence of seroma formation at LD flap donor site and overall operative complications. CONCLUSION Quilting of the LD flap donor site is helpful in reducing the incidence of seroma formation, reducing seroma volume, and reducing total drained seroma volume. Combined quilting and fibrin glue further enhances its effectiveness. Quilting with or without fibrin glue may be considered an option in patients undergoing LD flap breast reconstruction to control seroma-related morbidity. However, a major multicenter randomized controlled trial is required to achieve stronger and reliable evidence before recommending it as a routine procedure.

Role of lipomodelling in improving aesthetic outcomes in patients undergoing immediate and delayed reconstructive breast surgery

AIMS The objective of this article is to report our findings regarding large-volume fat transfer in patients who have undergone autologous breast reconstruction with the latissimus dorsi (LD) flap and/or implant-based reconstruction with subsequent lipomodelling for symmetrisation. METHODS We retrospectively collected data on all patients who have undergone lipomodelling from October 2008 to October 2011. Fat was harvested using a low-negative pressure syringe method and centrifuged at 3000 r.p.m. for 3 min. The purified fat was injected in 1 mL increments into multilayered microtunnels, starting from deeper layers and moving to superficial layers in the subcutaneous tissue. Patient satisfaction was assessed using validated Picker questions in a face-to-face consultation during follow-up visits, and the results were documented in the case notes. RESULTS Thirty-one patients underwent lipomodelling following autologous breast reconstruction using the LD flap and implant-based reconstruction. Three patients in the study group had bilateral lipomodelling, and one patient required 3 lipomodelling sessions. Seven patients required 2 sessions, and 21 patients required a single session to achieve bilateral symmetry. The mean volume of fat that was harvested was 396 mL, and the mean injected volume of fat was 247 mL. Four patients (1 breast cancer recurrence, 2 patients with fat necrosis and 1 patient with oil cysts) developed postoperative complications. Twenty-nine patients (93%) were satisfied with the postoperative cosmetic outcome. CONCLUSION Lipomodelling offers an additional tool to refine breast reconstructive surgery. This study demonstrates that large volumes of fat can be injected for sculpture optimisation and for reshaping reconstructed breasts with improved softness and a natural feel.

The role of fibrin glue instillation under skin flaps in the prevention of seroma formation and related morbidities following breast and axillary surgery for breast cancer: A meta‐analysis

A systematic review of randomised, controlled trials investigating the effectiveness of fibrin glue (FG) in reducing the postoperative seroma and seroma related morbidities following breast and axillary surgery was conducted. FG failed to influence the incidence of postoperative seroma, average volume of seroma, wound infection, complications and length of hospital stay in patients undergoing breast cancer surgery. However, a major multicentre and high quality randomised, controlled trial is required to validate these findings. J. Surg. Oncol. 2012; 106:783–795.

Hyperpigmented Paget's disease of the nipple – a diagnostic dilemma

This case demonstrates how hyperpigmentation of the nipple due to Pagets disease can imitate malignant melanoma presenting a diagnostic dilemma.

Fat Transfer in Oncoplastic and Reconstructive Breast Surgery

Fat grafting has become an important part of the modern armamentarium for treating women with breast cancer. It has numerous applications in the oncoplastic and reconstructive arena to help optimize cosmesis, enhance symmetry and improve tissue quality which has been adversely affected by scaring or radiotherapy. Fat transfer in breast surgery is not a new concept, but technical refinements, improved understanding of its potential roles and reassurance about its oncological safety have seen the technique move into the mainstream of breast practice in recent years. Nano- and micro-fat grafting, fat transfer, fat injection and lipofilling, lipomodelling and even liposculpture are all terms used to describe the use of fat to surgically reconstruct defects and rejuvenate the breast by improving or changing the contour and shape, improve the consistency and enhance the volume of the breast. This chapter will review the indications and uses, contraindications, adverse effects, oncological safety and techniques of lipomodelling in the field of breast surgery.