Scientific Abstract Presentations: Breast Session 9 Saturday, October 17 Sat, Oct 17 2:00-3:30 p.m. CDT

Introduction: Acellular dermal matrices (ADM) and long-term resorbable synthetic meshes (such as TIGR mesh) are the principal scaffolds used to support implant-based breast reconstruction, yet head-to-head clinical comparisons remain limited. We evaluated perioperative efficiency and early complications and infection rates between TIGR mesh and ADM-type mesh in immediate implant-based reconstruction.

Methods: This is a single-surgeon, single-center retrospective cohort of consecutive immediate implant reconstructions performed December 27, 2019 - April 2, 2025. All tissue-expander based reconstructions were excluded, due to likely selection bias. Demographics, comorbidities, operative details, and postoperative outcomes (seroma, hematoma, infection, skin necrosis, "any complication") were abstracted from the record. Primary endpoint was overall complication rate per breast; secondary endpoints included individual complications, drain duration (days), and operative time (minutes). Group comparisons used Welch t-tests and proportion tests (α=0.05).

Results: We analyzed 517 reconstructions (TIGR n=78; ADM n=439), with complications assessed per breast (TIGR 118; ADM 706). TIGR patients were older with higher BMI and more baseline risk (smoking 15.4% vs 5.9%; prior radiation 30.8% vs 10.3%). Operative time was shorter with TIGR (median 138 [IQR 94–183] vs 180 [148.5–224] minutes; p<0.001). Overall total complications were lower with TIGR (13.6% [16/118] vs 21.5% [152/706]; p=0.023), driven by markedly fewer infections (3.4% vs 12.3%; p<0.001). Unadjusted odds ratios favored TIGR for "any complication" (OR 0.43, 95% CI 0.25–0.71; p=0.0006) and infection (OR 0.35, 95% CI 0.15–0.82; p=0.008); seroma, hematoma, and skin-necrosis odds did not differ significantly. Drain removal time was longer with TIGR (median 16.0 days [IQR 12.0–22.3] vs 13.0 [9.0–16.0]; p=2.34×10⁻⁷).

Conclusion: In immediate implant-based breast reconstruction, TIGR mesh was associated with shorter operative time, fewer infections, and a lower overall complication rate than ADM, despite greater baseline risk in the TIGR cohort, while exhibiting longer drain duration. These data support TIGR as a clinically safe, operationally efficient alternative to ADM.

Introduction: Polycystic ovarian syndrome (PCOS) is a common endocrinological disorder characterized by dysfunction of the hypothalamus-pituitary-ovarian axis associated with insulin resistance and visceral adiposity. Preclinical evidence suggests that PCOS may delay wound healing in the context of inflammatory aberration and slowed keratinocytic migration. However, no study exists to bear out this finding clinically. Thus, we investigated PCOS as a potential risk factor for postoperative complications of breast reduction (BR).

Methods: The US Research Network of TriNetX was queried to identify patients who have undergone BR. Those with a prior history of PCOS were eligible for the exposure cohort; those without were for the control cohort. Cohorts were propensity score-matched 1:1 for demographic variables, comorbidities, and body mass index classifications. The primary outcome measure was postoperative wound dehiscence. Secondary outcome measures were postoperative infection, bleeding, seroma, venous thromboembolism, pain, emergency department visits, and hospitalizations. All outcomes were assessed at postoperative days 30, 60, and 90.

Results: After matching, each cohort included 2,084 patients. At postoperative day 90, patients with PCOS were at significantly higher risks of wound dehiscence (risk ratio [RR] 1.459, P-value [P] 0.0199), pain (RR 1.544, P 0.0088), emergency department visits (RR 1.257, P 0.0187), and hospitalizations (RR 1.447, P 0.0002). These risks were elevated at all measured timepoints.

Conclusions: Despite preclinical evidence, clinical implications of PCOS as a significant risk factor for postoperative complications have not been established. Considering the broad swaths of patients who are affected by PCOS, this study of BR may prompt future research of these risks in other procedural contexts and therapeutic targets to improve outcomes.

Introduction Nipple-sparing mastectomy (NSM) is largely considered superior to skin-sparing mastectomy (SSM) due to its oncologic safety and improved aesthetic appearance. However, preserving the nipple-areolar complex (NAC) can increase risk for necrosis, infection, and reconstructive failure (1, 2). Therefore we sought to develop a clinically useful risk prediction scoring system to better inform mastectomy type recommendation based on assessment of NSM and SSM complication profiles.

Methods We retrospectively reviewed patients who underwent NSM or SSM with immediate implant-based reconstruction from January 2019 through June 2025. Demographics, surgical details, and postoperative complications including infection, hematoma, seroma, delayed wound healing, mastectomy skin flap necrosis (MSFN), NAC necrosis, unplanned re-operation, and implant loss (IL) were recorded. IL was defined as device removal necessitated by infection or exposure. Independent t-tests and chi-square tests were used to identify differences between groups, and multivariable logistic regression models were generated to identify predictors of complications. A point-based risk scoring system was created to estimate IL probability. Regression coefficients were scaled by the smallest absolute beta coefficient. Medians of continuous variables served as baseline values. The calculated risk score for each patient represents the sum of weighted contributions of all variables included in regression modeling. We defined clinically relevant risk tiers (Low<5%, Moderate=5-10%, High>10%). Score thresholds corresponding to each risk tier was determined empirically. Receiver operating characteristic (ROC) analysis was performed to assess discriminative ability of these tiers.

Results 727 patients (1268 breasts) were identified, of which 633 patients (1108 breasts) underwent NSM and 94 patients (160 breasts) underwent SSM. NSM patients were significantly younger (p=0.0003), had lower BMI (p<0.0001) and lower incidences of diabetes (p=0.002), hypertension (p<0.001), hyperlipidemia (p=0.002), and breast cancer diagnoses (p=0.018). Mastectomy weight (p<0.0001) and rates of concurrent axillary surgery (p<0.001) were lower in NSM breasts. NSM breasts more frequently underwent direct-to-implant (p=0.021) and subpectoral reconstruction (p=0.057). When comparing complications, NSM was associated with lower rates of infection (p<0.001), delayed wound healing (p=0.022), MSFN (p=0.033), re-operation (p=0.001) and IL (p<0.001). Multivariable logistic regression identified age as an independent predictor of IL (OR: 1.02; p=0.026), while hyperlipidemia was inversely associated with IL (OR: 0.53; p=0.028). NSM was not found to be independently associated with IL . Our scoring system was calculated as follows: low risk was defined as a score of less than -1.18, moderate risk as a score between -1.18 and 2.48, and high risk as >2.48. On ROC analysis, area under the curve was 0.6541.

Conclusion NSM has become the gold standard for mastectomy choice. Complication rates following NSM were significantly lower than that of SSM, likely reflecting appropriate shared decision making. Using a points-based system may allow patients and providers to better assess their personal risk for complications, and in doing so, implement preoperative strategies to lower their score or pivot surgical plan.

References: 1. Olsen-MA, Nickel-KB, Margenthaler-JA, Myckatyn-TM, Warren-DK. Nipple-sparing mastectomy and infection risk after immediate breast reconstruction. Journal-of-the-American-College-of-Surgeons. 2025;241(2):254-260. doi:10.1097/xcs.0000000000001424 2. Agha-RA, Al-Omran-Y, Wellstead-G, et al. Systematic review of therapeutic nipple‐sparingversusskin‐sparing mastectomy. BJS-Open. 2018;3(2):135-145. doi:10.1002/bjs5.50119

Background: The optimal implant plane for implant-based breast reconstruction has not been definitively established, as available studies report mixed results across complications and patient-reported outcomes and are limited by heterogeneity in patient selection and operative techniques. Thus, we performed a meta-analysis comparing clinical complications, patient-reported outcomes, pain, and resource use between subpectoral and prepectoral implant placement.

Methods: A systematic review and meta-analysis of comparative cohorts evaluating subpectoral versus prepectoral reconstruction was conducted. Random-effects meta-analyses were performed using Mantel–Haenszel risk ratios (RRs) for dichotomous outcomes and inverse-variance standardized mean differences (SMDs) for continuous outcomes. Prespecified subgroup analyses were performed by reconstruction type (direct-to-implant [DTI], two-stage tissue expander [TE], and mixed/not reported), with sensitivity analyses where appropriate. Funnel plots were visually inspected for small-study effects.

Results: Across 107 cohorts including 27,314 reconstructions, there was no significant difference between planes for seroma (RR 0.88, 95% CI 0.73–1.07), hematoma (RR 0.95, 0.79–1.14), implant exchange (RR 1.16, 0.47–2.86), malposition/rotation/flipping (RR 1.58, 0.75–3.34), or breast reoperation (RR 0.92, 0.79–1.06). Subpectoral placement was associated with slightly lower risks of infection (RR 0.82, 0.71–0.96), wound dehiscence (RR 0.78, 0.64–0.93), and implant removal/explantation/loss (RR 0.81, 0.70–0.94). Conversely, subpectoral placement demonstrated higher risks of capsular contracture (RR 1.40, 1.12–1.75), animation deformity (RR 10.33, 4.21–25.37), and chronic pain (RR 2.68, 1.12–6.42), as well as higher POD1 pain scores (SMD 0.46, 0.20–0.71) and longer length of stay (SMD 0.46, 0.26–0.67). Patient-reported outcomes favored prepectoral placement, including higher BREAST-Q satisfaction with breasts (SMD −0.53, −0.85 to −0.21), satisfaction with outcome (SMD −0.22, −0.42 to −0.02), physical well-being (SMD −0.18, −0.32 to −0.03), and sexual well-being (SMD −0.16, −0.29 to −0.03). Subpectoral placement was associated with less rippling (RR 0.33, 0.20–0.53). Funnel plots generally showed no marked asymmetry.

Conclusion: Although subpectoral reconstruction was associated with slightly lower risks of infectious/wound complications, implant loss, and rippling, it resulted in substantially higher risks of animation deformity, capsular contracture, and pain, with worse patient-reported outcomes and longer hospitalization.

Background DIEP flap breast reconstruction uses abdominal tissue to recreate the breast after mastectomy and is a widely used technique. Non-tobacco nicotine products (e.g., vapes, gum, pouches) are increasingly common, but nicotine's vasoconstrictive effects may impair wound healing. The impact of these products on outcomes following DIEP flap surgery is not well understood. This study investigates the association between preoperative non-tobacco nicotine use and postoperative complications in DIEP flap reconstruction. Methods Female patients aged 18 years and older who underwent DIEP flap breast reconstruction between 2016 and 2024 were identified using CPT codes within the TriNetX Research Network. Patients with documented nicotine dependence (excluding patients with cigarettes use, chewing tobacco, tobacco products) within one year prior to surgery were compared to those without nicotine exposure. Primary outcomes included postoperative infection, wound disruption, skin flap necrosis, fat necrosis of the breast, seroma, hematoma, sepsis, cellulitis, and postprocedural pain. Propensity score matching controlled for demographics, BMI, substance use, major comorbidities, and treatment of chemotherapy or radiotherapy. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated at 30 and 60 days postoperatively. Statistical significance was defined as p < 0.05. Results Among 1,136 matched patients per group, non-tobacco nicotine users had significantly higher 30-day rates of infection (RR: 1.474, CI: 1.016–2.137, p = 0.0395), seroma (RR: 2.094, CI: 1.086–4.037, p = 0.0238), skin flap necrosis (RR: 1.770, CI: 1.067–2.935, p = 0.0249), and cellulitis (RR: 1.752, CI: 1.096–2.800, p = 0.0176), with no significant differences in wound disruption, sepsis, fat necrosis, hematoma, or postprocedural pain. At 60 days, infection (RR: 1.530, CI: 1.124–2.082, p = 0.0064), wound disruption (RR: 1.553, CI: 1.162–2.074, p = 0.0026), and skin flap necrosis (RR: 1.665, CI: 1.089–2.547, p = 0.0173) remained elevated, with a significantly increased risk of cellulitis (RR: 1.868, CI: 1.254–2.785, p = 0.0018). There were no significant differences in fat necrosis, seroma, sepsis, postprocedural pain, and hematoma at 60 days. Conclusion Preoperative non-tobacco nicotine use is associated with increased risk of postoperative complications following DIEP flap breast reconstruction. These findings suggest the importance of identifying patients using nicotine products and optimizing cessation strategies prior to elective breast reconstruction.

Background: To mitigate recurrent ptosis, mesh has been proposed in breast reduction and mastopexy as a means of providing additional internal structural support. However, as an implanted foreign body, mesh might increase the risk of infection, and its impact on short-term postoperative complications remains poorly defined. This study aimed to evaluate whether mesh placement during breast reduction or mastopexy is associated with increased postoperative surgical site infection.

Methods: The TriNetX Global Collaborative Network was queried for adult patients undergoing breast reduction or mastopexy with and without concurrent mesh placement. Patients undergoing concomitant breast augmentation were excluded. One-to-one propensity score matching was performed to balance demographics, race/ethnicity, BMI, comorbidities, and medication use. The primary outcome within 90 days was surgical site infection (SSI), and secondary outcomes were wound dehiscence, emergency department (ED) visits, antibiotic use, and debridement procedures.

Results: After 1:1 propensity score matching, 1,191 patients were included in each cohort. At 90 days after surgery, mesh use was associated with significantly higher rates of SSI (5.0% vs 1.3%; RR 3.75, 95% CI 2.17–6.47; p<0.001), wound dehiscence (3.4% vs 2.0%; RR 1.67; p=0.043), ED visits (10.2% vs 5.8%; RR 1.75; p<0.001), antibiotic use (18.2% vs 7.7%; RR 2.36; p<0.001), and debridement procedures (4.2% vs 1.0%; RR 4.17; p<0.001).

Conclusion: This study's findings suggest that mesh placement during breast reduction or mastopexy is associated with significantly increased 90-day postoperative complications, including nearly fourfold higher infection and debridement rates. These findings raise concerns about mesh use, underscore the need for careful patient selection, and highlight the need for further prospective studies to better define its risk–benefit profile.

BACKGROUND: Implant-based breast reconstruction is commonly performed following mastectomy; however, outcomes in patients with autoimmune disease remain controversial. Although several studies have analyzed outcomes in this challenging patient population, there exists limited high-quality evidence, therefore, further large-scale analysis is warranted.

METHODS: A retrospective cohort study was performed using the TriNetX Research Network (107 healthcare organizations). Patients undergoing implant-based breast reconstruction were identified using CPT and ICD-10PCS codes. Cohort A included patients with a prior diagnosis of autoimmune disease (including rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, dermatomyositis, Sjögren syndrome, and related overlap syndromes) prior to reconstruction. Cohort B included patients without prior autoimmune diagnoses. Propensity score matching (1:1) was performed for demographic and clinical covariates, resulting in 2,380 patients per cohort (4,760 total). Outcomes assessed within 30 and 90 days postoperatively included infection, surgical site infection, wound dehiscence, hematoma, reoperation, implant infection, and implant loss/capsular contracture/mechanical complication. Risk differences, risk ratios, and odds ratios were calculated.

RESULTS: A total of 4,760 patients were identified and included in the matched full cohort analysis (2,380 autoimmune vs 2,380 controls). Autoimmune disease was associated with significant increases in postoperative surgical site infection (1 month 2.1% vs 1.3%, p=0.045; 3 months 4.2% vs 3.0%, p=0.029). No statistically significant differences were observed at 1 month in hematoma, reoperation, implant infection, or implant loss/capsular contracture/mechanical complication. At 3 months, autoimmune disease was associated with significant increases in overall infection (4.8% vs 3.3%, p=0.029), surgical site infection (4.2% vs 3.0%, p=0.029), and implant loss/capsular contracture/mechanical complication (5.4% vs 3.7%, p=0.007). No statistically significant differences were observed at 3 months in hematoma, reoperation, or implant infection rates. In patients with BMI >30 kg/m² (n=2,648), autoimmune disease remained associated with increased wound-related complications, though no additional statistically significant differences beyond those observed in the full matched cohort were identified.

CONCLUSIONS: The results of this study suggest autoimmune disease is associated with an increased rate of postoperative surgical site infection and implant-related complications following implant-based breast reconstruction. These findings were most pronounced 3-months postoperatively. These findings suggest that autoimmune disease functions as an independent risk factor for early wound and implant-related complications and highlight the importance of preoperative risk stratification, multidisciplinary management, and close postoperative monitoring in this high-risk population.

Introduction: Breast revision surgeries are frequently performed after free flap breast reconstruction and often include procedures such as mastopexy. Patients with moderate to severe breast ptosis may require nipple-areolar complex (NAC) repositioning. This paper presents a single surgeon's experience with nipple-preserving secondary mastopexy and examines the factors that may impact complication rates. Methods: This retrospective institutional review examines patients with grade 2 or 3 ptosis who received nipple-sparing mastectomy (NSM) followed by either immediate or delayed free flap reconstruction and subsequently underwent nipple-preserving mastopexy. All patients had peri-areolar incisions with preservation of an inferior dermal pedicle connected to the NAC. Complications were recorded, and potential variables influencing complication rates were analyzed. Results: Eleven patients with 21 breasts were studied. A vertical incision was made on 11 breasts (52.4%) during mastectomy, and five breasts received radiation. Complications occurred in eight breasts (38.1%), primarily minor wound dehiscence (19.0%) and nipple epidermolysis (9.5%). In one case (4.8%), the NAC was converted to grafts due to extensive debulking. Patients needing therapeutic NSM had significantly higher complication odds than those with prophylactic NSM (P=0.02). Prior radiation showed a trend toward increased complications (P=0.06) but was not statistically significant. Conclusion: Wound healing issues are a common complication associated with secondary mastopexy. A therapeutic indication for mastectomy and history of radiation were associated with an increased likelihood of complications. The use of indocyanine green angiography assists the surgeon in making informed decisions, such as switching to nipple grafts when concerns arise.

Introduction

Autologous breast reconstruction using free tissue transfer, primarily the Deep Inferior Epigastric Perforator (DIEP) flap, is the gold standard for post-mastectomy restoration. Despite high success rates, post-operative haematoma remains a common complication (2-15%) that can jeopardize flap viability via pedicle compression or vasospasm. While Tranexamic Acid (TXA) is a proven anti-fibrinolytic in other specialties, concerns persist regarding its safety in microsurgery due to the theoretical risk of microvascular thrombosis and systemic venous thromboembolism (VTE). This study evaluates the safety and efficacy of TXA in a large microsurgical breast reconstruction cohort.

Methods

A retrospective cohort study was conducted on patients undergoing free flap breast reconstruction between January 2022 and December 2024. TXA was typically administered as a 1g single dose at induction. Outcomes measured included flap failure, haematoma incidence, return to theatre (RTT), and transfusion requirements. Statistical analysis utilized logistic regression and Student's t-tests, with multivariate models adjusted for age, BMI, smoking status, concurrent axillary surgery and recent neoadjuvant chemotherapy or prior radiotherapy.

Results

A total of 370 flaps were performed in 318 patients, with TXA administered in 256 patients (69.2%). Complete flap failure occurred in only 1% of cases (n=4). Logistic regression showed no association between TXA administration and flap failure (OR 0.21, p=0.1). Post-operative haematoma occurred in 6.6% of patients (n=21). Crucially, TXA administration was significantly associated with a reduction in RTT for haematoma (OR 0.21, p=0.01). While TXA patients had a statistically smaller drop in haemoglobin (3g/L, p=0.008), there was no significant reduction in transfusion requirements (OR 0.95, p=0.9). No VTE events were recorded in the cohort.

Conclusion

TXA appears safe for use in microsurgical breast reconstruction, and is associated with a reduced return to theatre rate for intervention in the context of haematoma. This is without increasing the risk of flap failure or thromboembolic events. These findings support the routine inclusion of TXA in multimodal protocols to minimize perioperative morbidity in free tissue transfer.

Introduction: Drains are the most common tool employed for the prevention of seroma in breast surgery patients (1). Closed suction with bulb reservoirs is the present standard for evacuation of fluid from a surgical space (2). A recent advancement in internalized NPWT has allowed for the application of continuous negative pressure via drain tubing as an alternative to standard closed suction with bulbs (3). Negative pressure wound therapy (NPWT) utilizes sub-atmospheric pressure to facilitate healing in both acute and chronic wounds (3,4). This study aimed to discern patients' subjective experiences with an internal NPWT device as well as the seroma rate in comparison to standard bulb drains.

Methods: A retrospective chart review was performed of 107 patients who underwent breast surgery at a single center between 2012-2025 and received either a bulb drain or internal NPWT device. Patient demographics, operative details, drain type, postoperative complications, and patient satisfaction and pain on a 10-point Likert scale at final follow-up were collected. All statistical analyses were performed in SPSS.

Results: Patients who received an internal NPWT device were both significantly more satisfied with their experience compared to those who received bulb drains (9.19/10 vs 7.84/10, P=0.002) and experienced a significantly lower rate of seroma (0.0% vs 12.0%, P = 0.009). There was an increased number of all complications in the bulb drain group (28.0% vs 15.8%, P = 0.125) and more than double the return to OR rate in the bulb drain group (12.0% v 5.3%, P=0.299), though these differences were not found to be statistically significant.

Conclusion: Internal NPWT devices appear to have a positive impact on overall patient experience and may help prevent seroma formation and related complications in postoperative breast patients compared to closed suction bulb drains.

Reference: 1. Fairhurst, K., Roberts, K., Fairbrother, P., Potter, S., Abbott, N., Achuthan, R., Ahmed, G., Ainsworth, R., Arthur, L., Bains, S., Barber, Z., Batt, J., Bell, A., Carter, J., Chambers Current use of drains and management of seroma following mastectomy and axillary surgery: results of a United Kingdom national practice survey. Breast Cancer Research and Treatment. 2023; 203. https://doi.org/10.1007/s10549-023-07042-7. 2. Khansa, I., Khansa, L., Meyerson, J., & Janis, J. Optimal Use of Surgical Drains: Evidence-Based Strategies. Plastic and Reconstructive Surgery. 2018; 141. https://doi.org/10.1097/prs.0000000000004413. 3. Apelqvist, J., Willy, C., Fagerdahl, A., Fraccalvieri, M., Malmsjö, M., Piaggesi, A., Probst, A., & Vowden, P. EWMA Document: Negative Pressure Wound Therapy.. Journal of wound care. 2017; 26 Sup3. https://doi.org/10.12968/jowc.2017.26.sup3.s1. 4. Cui, H., Joo, S., Cho, Y., Park, J., Kim, J., & Seo, C. Effect of Combining Low Temperature Plasma, Negative Pressure Wound Therapy, and Bone Marrow Mesenchymal Stem Cells on an Acute Skin Wound Healing Mouse Model. International Journal of Molecular Sciences. 2020; 21. https://doi.org/10.3390/ijms21103675.

Background: The L-scar (short lateral scar) technique has gained renewed interest in aesthetic breast surgery as a strategy to minimize visible scarring while maintaining breast shape, projection, and nipple–areolar complex (NAC) viability [1-3]. Although widely described, pooled evidence regarding its safety profile and patient-reported outcomes remains limited. This study systematically evaluates complication rates and satisfaction associated with the L-scar approach in reduction mammaplasty and mastopexy.

Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA and Cochrane guidelines and prospectively registered in PROSPERO (CRD420251047389). PubMed, Embase, Scopus, Web of Science, and Cochrane databases were searched through December 2024. Studies evaluating the L-scar technique and reporting postoperative complications or patient satisfaction were included. A single-arm meta-analysis using a random-effects model calculated pooled prevalences with 95% confidence intervals (CIs). Heterogeneity was assessed using the I² statistic, and risk of bias was evaluated using ROBINS-I.

Results: Twelve studies comprising 3,130 patients met inclusion criteria. Overall complication rates were low. Breast asymmetry occurred in 1.94%, scar hypertrophy in 1.74%, wound dehiscence in 1.81%, seroma in 0.61%, hematoma in 1.18%, and infection in 0.6%. Dog-ear deformity was observed in 5.07% of cases. Fat necrosis occurred in 5.8%. Partial NAC necrosis was rare (0.36%), and no cases of complete NAC necrosis were reported. Sensory outcomes demonstrated nipple sensation loss in 2.2% and sensation reduction in 20.1% of patients. Pooled patient satisfaction was high at 91.9%. Although moderate-to-high heterogeneity was observed in selected outcomes, sensitivity analyses confirmed the stability of pooled estimates.

Conclusions: The L-scar technique demonstrates a favorable safety profile, extremely low rates of NAC compromise, minimal scar-related morbidity, and excellent patient satisfaction. By reducing horizontal scar burden without increasing major complications, the L-scar represents a reliable and effective alternative to traditional inverted-T approaches in appropriately selected patients. Further prospective comparative studies are warranted to assess long-term outcomes and refine patient selection criteria.

Reference: 1. Pallua N, Kim B-S, O'Dey DM. The short scar three-block L-wing technique. J Plast Reconstr Aesthet Surg. 2020;73(6):1075-80. 2. Triana L, Palacios Huatuco RM, Campilgio G, Liscano E. Correction: Trends in surgical and nonsurgical aesthetic procedures: A 14-year analysis of the international society of aesthetic plastic surgery-ISAPS. Aesthetic Plast Surg. 2024;48(21):4601. 3. Akyurek M, Chappell AG. Short-scar mammaplasty in severe macromastia. Ann Plast Surg. 2016;77(6):609-14.

Background: Lymphedema occurs in 20-40% of mastectomies following axillary lymph node dissection. We aimed to evaluate the associated rates of lymphedema with GLP-1 therapy following mastectomy with axillary lymph node dissection (ALND).

Methods: Data from the TriNetX Research Network was analyzed, including 107,169 patients who underwent mastectomy with ALND. Propensity score matching was performed for each comparison, ensuring that matched characteristics including age, body mass index, ethnicity, race, comorbidities, oncological history, and procedural history were consistent. Outcomes were assessed using ICD-10 codes and were reported as risk differences, risk ratios, and odds ratios with 95% confidence intervals.

Results: After matching, GLP-1 therapy was associated with reduction in lymphedema (3.0% vs. 8.8 %; p <0.0001) following mastectomy with ALND. Moreover, GLP-1 therapy was associated with lower rates of postoperative seroma and infection.

Conclusion: Postmastectomy lymphedema syndrome and lymphedema, not otherwise classified, were diagnosed less in patients with GLP-1 therapy, supporting a potential benefit of GLP-1 agonists following ALND. GLP-1 agents were associated with lower rates of postoperative complications. Active GLP-1 therapy may have more therapeutic benefits than simply prevention of obesity. GLP-1 receptor agonists may be considered as a medical option in combination with lymphatic surgery for prevention of postmastectomy lymphedema.

Background: Despite enhanced recovery after surgery (ERAS) protocols, postoperative pain management after deep inferior epigastric perforator (DIEP) flap breast reconstruction usually requires opioid analgesia, exposing patients to opioid-related risks. Suzetrigine, a selective peripheral NaV1.8 sodium channel inhibitor, has demonstrated efficacy for acute postoperative pain in randomized- controlled trials, but its role in autologous breast reconstruction remains unknown. Methods: A retrospective cohort study was performed in patients undergoing DIEP flap breast reconstruction. Patients receiving suzetrigine were compared with controls managed under a standardized ERAS protocol. Repeated postoperative pain scores were analyzed using a joint longitudinal-time-to-discharge model to account for informative censoring at hospital discharge. Average pain burden was summarized using the area under the pain-time curve. To confirm findings, a propensity score-matched sensitivity analysis was performed. Opioid use during hospitalization was analyzed using logistic regression analysis. Results: A total of 136 patients with 1,945 pain observations were included (27 treated with suzetrigine, 109 controls). Suzetrigine significantly reduced early postoperative pain trajectories in the full dataset (P=0.049) and reduced average pain burden over 24 and 48 hours (posterior probability of benefit 0.96 resp. 0.97). Opioid administration occurred in 52% of suzetrigine patients vs. 100% of controls (odds ratio 0.005; P<0.001). Findings were confirmed by matched sensitivity analyses. Conclusion: Adjunctive suzetrigine within an ERAS pathway was associated with reduced early postoperative pain burden and substantial opioid sparing after DIEP flap breast reconstruction. These findings support NaV1.8 inhibition as a promising non-opioid component of multimodal analgesia in autologous breast reconstruction.

Introduction: The incidence of capsular contracture ranges from 5-19% following aesthetic breast augmentation and 19-25% following implant-based breast reconstruction. (1) Symptoms most commonly present within the first two years following surgery. The pathogenesis of capsular contracture is multifactorial and is suspected to involve both endogenous and exogenous factors. (2) Intraoperative bleeding has been implicated. Tranexamic acid is an antifibrinolytic agent commonly used in several fields to prevent excessive blood loss through inhibition of fibrin clot breakdown. Data on the use of tranexamic acid in plastic surgery is limited, with most studies focusing on craniofacial procedures. (3) This study aims to assess the use of intraoperative tranexamic acid on rates of capsular contracture in patients who are undergoing breast implant placement.

Methods: This retrospective review of the TriNetX Analytics Network queried the Global Collaborative Network with over 170 million patients to identify patients undergoing breast implant placement. We compared patients that had received tranexamic acid within the peri-operative period of surgery to patients who had not received tranexamic acid and looked at their rates of capsulectomy. We excluded patients with a history of long term or current use of anticoagulation therapy as well as patients who received any form of blood products during or after surgery within the perioperative period. Patients were propensity score matched for demographics, history of smoking, obesity, and diabetes mellitus. Patients were identified using diagnosis and procedure codes. Rates of revision breast capsulectomy were compared between 1:1 propensity score matched cohorts. Risk ratios and T-tests were used to compare outcomes.

Results: A total of 53,326 patients who underwent breast implant placement and did not receive tranexamic acid were propensity matched to 3,214 patients who received tranexamic acid, with 3,211 patients in each cohort after propensity matching. Patients who received tranexamic acid peri-operatively were less likely to undergo revision capsulectomy as compared to the non-tranexamic acid cohort (p=0.0135) at 5-years.

Conclusion: Patients receiving tranexamic acid perioperatively for breast implant procedures have lower rates of capsulectomy at 5-years. While these findings do not implicate bleeding as a definitive cause of capsular contracture, it suggests that strategies that reduce hematoma may affect rates of capsular contracture formation.

1. Clark A, Shauly O, Sherrer J, Losken A. Understanding Capsular Contracture: Mechanisms, Management, and Patient Outcomes in Implant-based Breast Augmentation and Reconstruction. Plast Reconstr Surg Glob Open. 2026;14(1):e7407. doi:10.1097/GOX.0000000000007407
2. Vinsensia M, Schaub R, Meixner E, et al. Incidence and Risk Assessment of Capsular Contracture in Breast Cancer Patients following Post-Mastectomy Radiotherapy and Implant-Based Reconstruction. Cancers (Basel). 2024;16(2):265. doi:10.3390/cancers16020265
3. Wachtel C, Rothenberger J, Nichlos E, et al. Optimising breast implant replacement surgery: Benefits of systemic tranexamic acid on post-operative blood loss and drain time. J Plast Reconstr Aesthet Surg. 2025;104:479-486. doi:10.1016/j.bjps.2025.02.055