Breast Reconstruction

Question 1

best candidates for
immediate and single-stage reconstruction

Answer 1

Healthy
patients with smaller breasts, early stage breast cancer, and
healthy mastectomy skin flaps are the best candidates for
immediate and single-stage reconstruction

Question 2

Acellular dermal matrix useful adjunct to provide total implant coverage while
defining and maintaining implant position

Answer 2

T

Question 3

Risk factors
for complications in implant reconstruction

Answer 3

■ Smoking
■ Obesity (BMI >30)
■ Large breasts
■ Diabetes (Hgb AlC >6.5%)

Question 4

large mastectomy specimen weight was found to be an independent risk factor for implant loss in prosthetic reconstruction

Answer 4

T

Question 5

activesmokers have an odds ratio of four
for early tissue expander loss compared to nonsmokers

Answer 5

T

Question 6

those who stopped smoking I month or more
before surgery, is similar to the rate of complications in active smokers.

Answer 6

T

Question 7

even
well-controlled diabetes (average preoperative blood glucose 137 mg/
dL) increases the I-year rate of wound healing problems following
autologous reconstruction

Answer 7

F following prostheticbut not autologous reconstruction

Question 8

perioperative glucose management should
be undertaken with the goal of preoperative Hgb AlC <6.5%, and
perioperative glucose levels under 200 mg/dL.

Answer 8

T

Question 9

I-year rate of infectious and wound complications in
patients undergoingexpander/implant reconstruction was significantly
higher in patients with BMI >30

Answer 9

T

Question 10

patients with BMI >30 were almost seven times more likely
to experience reconstructive failure following prosthetic reconstruction than their nonobese counterparts

Answer 10

T

Question 11

device projection
may be severely limited in patients with overly thick mastectomy flaps

Answer 11

T

Question 12

Obese patients should be counseled that preoperative weight
loss will.

Answer 12

decrease their risk of postoperative complications
improve the appearance of the final result.

Question 13

macromastia is contraindication
to implant-based reconstruction

Answer 13

F macromastia is not a contraindication
to implant-based reconstruction, but does require attention to tailoring
of the skin envelope

Question 14

delayed prosthetic reconstruction
have argued that this approach results in a lower rate of complications including mastectomy skin flap necrosis, capsular contracture,
and need for device removal

Answer 14

T

Question 15

The decision to perform a prosthetic
reconstruction based on&raquo_space;»

Answer 15

based on patient factors, oncologic factors, and technical aspects of the
mastectomy itself

Question 16

immediate reconstruction will achieve optimal results inpatients with a lower preoperative risk profile (nonsmoker, nonobese) and early stage cancers

Answer 16

T

Question 17

intraoperative decision to delay reconstruction may be
appropriate

Answer 17

T

Question 18

A
direct-to-implant approach has the obvious advantage

Answer 18

(1) multiple office visits for device expansion, (2) risk of infection related to expander filling access and manipulation, and (3)
second-stage surgery for expander-to-implant exchange.

Question 19

quality mastectomy is a major determinant ofthe success of
direct-to-implant reconstruction

Answer 19

T

Question 20

Adjuncts such as indocyanine green angiography can provide an
objective assessment of skin flap perfusion

Answer 20

T

Question 21

skin flap necrosis, need for reoperation,
and reconstructive failure in patients undergoing direct-to-implant
reconstruction

Answer 21

T

Question 22

The overall
absolute rate ofimplant loss was 14.4% for single- and 8.7% for two-stage reconstruction

Answer 22

T

Question 23

ADM benefit

Answer 23

can help maintain the device in the optimal position on the chest wall, add
definition to the inframammary fold and lateral breast border, and
improve lower pole projection
a higher intraoperative fill volume and shorter time to optimal expansion
ADM is useful in both the primary prevention and secondary treatment of capsular contracture
ADM may ameliorate some ofthe negative sequelae associated with radiation treatment

Question 24

Percentage of breast contracture with ADM

Answer 24

Decrease from 10% and 30% to 0-4 %

Question 25

Acute postoperative complications of ADM

Answer 25

infection, seroma, skin flap necrosis, and reconstructive failure in prosthetic reconstructions employing ADM

Question 26

the benefits of ADM use likely outweigh the potential drawbacks

Answer 26

T

Question 27

Implant projection the most important parameter for intraoperative device selection

Answer 27

F , base width is the most important parameter for intraoperative device selection

Question 28

matching the device base Width to the width of the breast footprint on the chest wall eliminates dead space and skin redundancy while optimizing the final expansion pocket

Answer 28

T

Question 29

Expander capacity is less important, as many expander devices may be filled well beyond their stated maximum volumes.

Answer 29

T

Question 30

saline implant have higher rates of implant visibility and rippling.

Answer 30

T

Question 31

silicone leak or implant rupture may be harder to detect and can lead to capsular contracture; in contrast, saline is physiologically inert and is simply absorbed ifthere is a leak.

Answer 31

T

Question 32

Salin implant has hight rate of rapture than silicon implant

Answer 32

F rupture and capsular contracture maybe slightly higher in silicone implants than in saline at 10 years the following implantation

Question 33

patients with silicone implants are more likely to develop rare neurologic or connective tissue diseases

Answer 33

F There is no evidence to support the idea that patients with silicone implants are more likely to develop rare neurologic or connective tissue diseases

Question 34

rates of capsular contracture do appear to be lower with textured devices, though this difference appears less significant when implants are placed in the submuscular position

Answer 34

T

Question 35

benefit of textured implants includes a more stable position within the pocket, which theoretically decreases lower pole stretch over time.

Answer 35

T

Question 36

breast-implant-associated anaplastic large-cell lymphoma(BIA-ALCL) increases with smooth implant

Answer 36

There appears to be a small increase in the risk of breast-implant-associated anaplastic large-cell lymphoma(BIA-ALCL) with the use of textured devices. This effect may be greatest with macrotexturedimplants

Question 37

Anatomic-shaped implants better match the device to the original breast footprint

Answer 37

T

Question 38

Shaped implants may result in improved upper pole shape and volume, especially in reconstruction of breasts that are taller than they are wide

Answer 38

T

Question 39

Draw back of anatomical implant

Answer 39

- without precise pocket control, implant rotation may result. - firmer feel compared to a softer, round silicone implant

Question 40

All currently available anatomic-shaped implants are also textured to limit unwanted implant movement/ rotation;

Answer 40

T

Question 41

If viability or skin quality is a concern, by Indocyanine green angiography placement of an expander is relatively contraindicated and may be deferred to a later time.

Answer 41

T

Question 42

Additional muscle origin along the most inferior portions of the sternum may be divided further if increased lower pole projection is needed or desired

Answer 42

T

Question 43

Radiation of a prosthetic device can lead to increased rates of early complications such as infection, seroma, and mastectomy flap necrosis, as well as delayed complications such as capsular contracture, poor aesthetic outcome, and reconstructive failure

Answer 43

T

Question 44

Patient with prosthetic reconstruction develop reconstructive failure is generally accepted to be around 20% compared to 3% in those not receiving adjuvant radiotherapy

Answer 44

T

Question 45

radiation of the permanent implant was associated with a higher rate of capsular contracture and subsequently worse aesthetic outcomes

Answer 45

T

Question 46

In the setting of radiation of the tissue expander, increasing the interval of time between completion of radiation and exchange to permanent implant appears to improve outcomes, with intervals ranging from 3 to 8 months.

Answer 46

T

Question 47

However, with modern techniques and modeling, more recent data seem to suggest that radiation of even a fully inflated expander or permanent implant is safe, does not result in decreased radiation dose administration, and may result in a lower rate of complications compared to radiation of a deflated device

Answer 47

T

Question 48

he use of ADM in previously irradiated patients is not protective against reconstructive failure and may increase the rate of skin flap and infectious complications

Answer 48

T

Question 49

Although increasing tl1e time interval between previous irradiation and salvage mastectomy beyond 1 year does not appear to improve the rate of complications, performing the reconstruction in a delayed rather than immediate fashion may result in a lower rate of reconstructive failure

Answer 49

T

Question 50

there is no clear evidence that either neoadjuvant or adjuvant chemotherapy increases complication rates in patients undergoing prosthetic reconstruction,

Answer 50

T

Question 51

Cmplication of implant base breast reconstruction

Answer 51

Hematoma Infection Capsular Contracture Implant Malposition or Asymmetry

Question 52

most hematomas require return to the operating room for evacuation,

Answer 52

T

Question 53

even small hematomas can increase the risk of mastectomy skin flap necrosis, capsular contracture, and poor aesthetic outcome.

Answer 53

T

Question 54

elevated white blood cell count at admission and methicillin-resistant S. aureus (MRSA) infection as predictors of salvage failure of the implant

Answer 54

T

Question 55

Rates of capsular contracture following implant-based reconstruction at 3 years are estimated at between 10% and 13%

Answer 55

T

Question 56

. Hematoma, radiation, silicone rupture, and biofilm formation are all considered to increase the incidence of capsular contracture

Answer 56

T

Question 57

evidence-based approach to treatment of capsular contracture is lacking

Answer 57

T

Question 58

drains are left in the subcutaneous space until output is less than 30 cc over a 24-hour period. Typical drain duration is I to 2 weeks.

Answer 58

T

Question 59

there was insufficient evidence to recommend continuing antibiotics on an outpatient basis

Answer 59

T

Question 60

Disadvantages of implant base reconstraction

Answer 60

■ Implant-related complications (implant infection, capsular contracture, implant malposition, rippling, rupture) ■ Less natural feel compared to autologous tissue ■ Difficult to achieve symmetry in unilateral reconstruction

Question 61

active smokers have an odds ratio of four for early tissue expander loss compared to nonsmokers

Answer 61

t

Question 62

. The size of the tumor and lymph node status are crucial pieces of information for the reconstructive surgeon

Answer 62

T

Question 63

Immediate breast reconstruction optimize aesthetic outcomes and patient satisfaction

Answer 63

T

Question 64

intraoperative decision to delay reconstruction may be appropriate

Answer 64

T

Question 65

undergoing direct-to-implant reconstruction found a significantly increased risk of skin flap necrosis, need for reoperation, and reconstructive failure

Answer 65

T

Question 66

found a significantly increased risk of skin flap necrosis, need for reoperation, and reconstructive failure in patients

Answer 66

T

Question 67

late complications such as capsular contracture and reconstructive failure appear to be two to three times more likely in previously irradiated patients

Answer 67

T

Question 68

the rate of successful completion of prosthetic reconstruction in previously irradiated breasts was 83%

Answer 68

T

Question 69

no evidence that hormonal therapies such as tamoxifen or aromatase inhibitors increase complication rates in prosthetic recon

Answer 69

T

Question 70

Gram-positive bacteria such as Staphylococcus, Streptococcus, and Propionibacteria are the most common pathogenic organisms in implant-associated infection

Answer 70

T