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Lymphoedema is a frequent condition after surgical treatment for breast cancer. Lymphoedema causes great discomfort for the patients and is primarily treated conservatively with compression garments and physical therapy. Recently, surgical interventions have gained popularity in the form of lympho-lymphatic anastomoses, lympho-venous anastomoses and autologous lymph node transplantation, either as stand-alone treatment or in combination with secondary breast reconstruction. In Denmark, lympho-venous anastomoses is currently the primary surgical treatment for lymphoedema.

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OBJECTIVE: Necrosis in implant-based immediate breast reconstruction is a feared complication. Accurate evaluation of mastectomy skin flaps per-operatively is necessary to decrease this risk. The present study is the first in Scandinavia to review the effects of perioperative evaluation with laser-assisted indocyanine green fluorescence angiography (LA-ICGA). METHOD: A retrospective review was performed using data from the electronic patient record at the Department of Plastic and Breast Surgery at Aarhus University Hospital in Denmark on all patients who underwent implant-based skin-sparing immediate breast reconstruction with ADM in the time period March 2012 to October 2015. A total of 92 patients undergoing 128 breasts reconstructions were included in the study. An evaluation of complications before and after the implementation of LA-ICGA was performed. RESULTS: No significant difference in necrosis rates requiring surgical revision (p = .411) or conservative treatment (p = .149) in patients undergoing implant-based immediate breast reconstruction were found. CONCLUSION: Our results differ from previously published studies in that no beneficial effect on necrosis rates of was found after implementing LA-ICGA, possibly due to our limited sample size.

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BACKGROUND: It has been suggested that personality traits may influence patient-reported outcomes of breast reconstruction, but the research is limited. We investigated, in a prospective study, whether personality traits predict the achieved body image and quality of life (QoL) after breast reconstruction. METHODS: Patients planning to undergo breast reconstruction at a University Hospital were consecutively recruited from January 2014 to January 2016. Participants completed validated measures of personality, body image, and QoL, before and 6 months after breast reconstruction. The influence of personality traits on achieved body image and QoL was explored with multivariate linear regression modelling, adjusting for baseline scores, demographics, and clinical variables. RESULTS: Of 247 eligible patients, 208 (84%) participated. Twelve patients (6%) were excluded due to failed reconstruction. Of the remaining 196 patients, 180 (92%) completed the follow-up questionnaire. When adjusted for baseline QoL scores, higher trait Neuroticism, higher trait Openness, and higher body mass index measured at baseline showed to be independent and statistically significant predictors of deteriorating QoL scores from baseline to 6-month follow-up (P < 0.001; R2 = 0.45). When adjusted for body image scores at baseline, higher trait Neuroticism and immediate reconstruction were found to be independent predictors of poorer body image from baseline to 6-months follow-up (P < 0.001; R2 = 0.36). CONCLUSIONS: The present study suggests personality traits, in particular Neuroticism, as independent predictors of the achieved body image and QoL after breast reconstruction. Weighing in the personality traits of the patients may be an important adjunct in improving patient-reported outcomes after breast reconstructions.

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PURPOSE: The present study aimed to compare the clinical outcome for patients with or without muscle flap reconstruction after deep sternal wound infection due to open-heart surgery. METHODS: The study was a retrospective cohort study, including patients who developed deep sternal wound infection after open-heart surgery in the Western Denmark Region from 1999 to 2011. Journals of included patients were reviewed for clinical data regarding the treatment of their sternal defect. Patients were divided into two groups depending on whether they received a muscle-flap-based sternal reconstruction or traditional rewiring of the sternum. RESULTS: A total of 130 patients developed deep sternal wound infection in the study period. In all, 12 patients died before being discharged, leaving a total of 118 patients for analysis. Of these, 50 (42%) patients received muscle flap reconstruction. Muscle flap recipients had significantly longer total hospital stays (p <0.001). However, after receiving muscle flap reconstruction, patients were discharged after a median of 14 days, with 74% not needing additional surgery. CONCLUSION: It is difficult to predict which patients eventually require muscle flap reconstruction after deep sternal wound infection. Although patients receiving muscle flap reconstructions have longer hospital stays, they are quickly discharged after the reconstruction.

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PURPOSE: Persistent pain is a common side effect of breast cancer treatment. The present study aimed to assess the prevalence, associated treatment-related factors, and the type of pain (neuropathic or nociceptive) in patients who had undergone a unilateral mastectomy. METHODS: All women who underwent a unilateral mastectomy at a University Hospital between 2009 and 2013 were eligible for inclusion. Women with breast reconstruction or active cancer were excluded. Participants were mailed a questionnaire evaluating the prevalence, location, intensity, and frequency of surgical site pain. Additionally, the painDETECT®, a validated instrument to evaluate neuropathic pain, was mailed to all participants. RESULTS: A total of 305 women were included, and of them, 261 (85.6%) completed the study questionnaire. After a median follow-up period of 3.0 years, 100 women (38.3%) reported experiencing pain at the surgical site. Body mass index ≥30 kg/m2, radiation therapy, and axillary lymph node dissection were significantly associated with persistent pain in univariate models. However, only body mass index ≥30 kg/m2 was independently associated with persistent pain (odds ratio, 2.13; 95% confidence interval, 1.06-4.27; p=0.034) in a multivariate analysis. Of the patients reporting pain, 71.0% were unlikely to have a neuropathic pain component. A moderate, but highly significant, positive correlation was observed between the pain intensity and the painDETECT® score (rs=0.47, p<0.001). CONCLUSION: Persistent pain after breast cancer treatment continues to have a high prevalence. Our results indicate that the largest proportion of patients experiencing persistent pain after breast cancer treatment do not have a clear neuropathic pain component.

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OBJECTIVES: The management of sternal defects arisen after deep sternal wound infection is challenging and often requires extensive interdisciplinary teamwork between plastic and thoracic surgeons. In this study, the published literature on methods used to reconstruct sternal defects arisen as a result of deep sternal wound infection after open-heart surgery will be reviewed. DESIGN: The Cochrane, Embase, PubMed, and SveMed + databases were searched in December 2011. Only papers regarding treatment of deep sternal wound infection after open-heart surgery in adults were included. RESULTS: The literature search identified 224 original papers that met the inclusion criteria. The majority dealt with surgical techniques. None of the studies regarding reconstructive options were designed as randomized controlled trials, and the levels of evidence are generally low. CONCLUSION: The treatment of deep sternal wound infection has evolved considerably, but there is still little consensus regarding optimal surgical management and a general lack of a standard treatment protocol. The use of muscle flap transposition is well documented. Recent studies recommend the use of topical negative pressure therapy as an adjunct to surgical reconstruction.

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