Copy of October 2024 Edition

Welcome to the October edition of The Stitch! We appreciate your continued support and readership. Don't miss our Breast Cancer Education Quiz!!

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The Stitch Editorial Board

Breast Cancer Education Quiz

Breast cancer incidence in women in the US: 1/? Women will develop breast cancer in their lifetime
The average age of U.S. women diagnosed with breast cancer is ? Years old, but half of U.S. women who develop breast cancer are ? Years or younger when they are diagnosed
If a patient with breast cancer undergoes a sentinel lymph node biopsy and there are 3 or more positive nodes (T1 or T2), any positive T3 nodes, extra-nodal extension of tumor cells, or any positive nodes in a patient who will not undergo radiation, what should you do next?
What are the borders of the axilla?
What is removed in a modified radical mastectomy?
What are some options for reconstruction?

Rib Grafts and Tip Shaping in Rhinoplasty: A Retrospective Review

Article Review by Joyce Zhu, University of South Florida Morsani College of Medicine

Role of Rib Graft for Tip Shaping in Primary Rhinoplasty: A Retrospective Case Series of 30 Patients

Published in Plastic and Reconstructive Surgery, July 2024

As the role of rib grafts in primary rhinoplasty remains underexplored, this retrospective review aimed to identify indications and anatomical features correlated with their use. The study examined 638 primary rhinoplasties performed by a surgeon at the Dallas Plastic Surgery Institute, identifying 30 cases where fresh frozen allograft rib cartilage was necessary for tip shaping. Notably, the majority of these patients were of non-Caucasian ethnicities.

The robust rib graft, combined with a fixed-mobile septal extension graft (SEG) technique, allowed for precise shaping by tensioning the lower lateral cartilages to the apex of the graft while overcoming challenges like thick nasal skin. Acting as a “tent-pole”, the graft projects the nasal tip tripod into the skin envelope and produces a well-defined tip.

The study found that patients with thick nasal skin, weak cartilaginous tip support, and/or a history of nasal or septal trauma were more likely to require rib cartilage for tip shaping in primary rhinoplasty. Certain ethnic groups were suggested to be predisposed to this need. For medical students preparing to enter the field of surgery, understanding patient-specific anatomical variations and diverse surgical techniques will be essential for optimizing outcomes in procedures such as rhinoplasty.

Factors Impacting Satisfaction with Breast Reconstruction

Article Review by Raymond Richards, University at Buffalo

Satisfaction with Breasts Following Autologous Reconstruction: Assessing Associated Factors and the Impact of Revisions

Published in Plastic and Reconstructive Surgery, June 2024

Patient satisfaction in autologous breast reconstruction may be improved with additional elective procedures

Autologous breast reconstruction (ABR) often results in greater patient satisfaction rates when compared to implant reconstruction. Kim et al sought to determine which factors may be responsible for influencing satisfaction with surgery in patients undergoing ABR. In this retrospective cohort study, 959 patients were assessed using the BREAST-Q survey, focusing on the Satisfaction with Breasts score. There was a significant improvement (p<0.001) in the Satisfaction with Breasts score across the cohort at 1 year follow-up. Lower postoperative satisfaction scores were associated with a lower preoperative score, Asian race, flap necrosis, radiation therapy, and history of psychiatric diagnosis.

Importantly, breast revision procedures and nipple-areola-complex (NAC) reconstruction significantly improved satisfaction. Timing of reconstruction (delayed vs. immediate) did not result in a statistically significant difference.

The authors grouped elective revision procedures as breast revisions (fat grafting and breast skin revisions), NAC reconstruction, and procedures to improve symmetry (reduction, augmentation, mastopexy, fat grafting).

Revision surgery, like any other procedure, carries risks. In the context of aesthetic outcomes, revisions may not provide the result the patient envisions. This study is notable for the insight it provides into the impact on satisfaction of specific revision procedures. It also may help predict satisfaction as it relates to both specific patient and surgical factors.

Is the improvement in satisfaction seen with NAC reconstruction related to aesthetic outcomes or possibly sensation? Future studies might provide additional benefit by exploring these factors in more depth.

Breast Cancer Education Quiz Answers

ANSWERS:

8
62
Axillary Lymph Node Dissection
Apex: costoclavicular ligament, Base: skin and axillary fascia, Anterior: pec major, pec minor, subclavius muscles, in the clavipectoral fascia, Posterior: subscapularis, teres minor, latissimus dorsi muscles, Lateral: bicipital groove of humerus, Medial: ribs, intercostal muscles, serratus anterior muscle
Breast, underlying fascia of the pec major, and level I and II axillary lymph nodes
Implants, tissue expanders, latissimus dorsi flap, pedicled or free TRAM, DIEP