Faculty Bibliography

PURPOSE: Reduction mammoplasty (RM) during breast-conserving surgery is popular among women with large-volume breasts because it reduces redundant breast folds and may decrease skin-related morbidity from radiation therapy. However, RM may obscure the lumpectomy cavity (LC) and pose challenges to administering an LC boost, potentially affecting local control. We investigated the impact of RM on acute side effects and use of LC boosts. METHODS AND MATERIALS: The records of 645 consecutive women treated with whole-breast irradiation at an urban university and 2 community practices between January 2012 and December 2014 were reviewed on an institutional review board-approved study. The primary endpoint was grade >/=3 radiation dermatitis; the secondary endpoint was use of LC boost. Student 2-sample t tests, Pearson chi2 tests, Fisher exact tests, and univariate and multivariable logistic regression analyses were performed. RESULTS: Forty-three (7%) RMs were performed in 650 treated breasts. No significant differences in grade 3 toxicities were identified among RM and non-RM patients. LC boost was delivered to 474 breasts. Fewer (16/43) RM patients received LC boosts compared with non-RM patients (458/607), P = .0001. RM patients were more likely to have neoadjuvant chemotherapy, stage III or multifocal disease, higher body mass index, larger planning treatment volumes, and conventional fractionation (P < .05). CONCLUSIONS: RM was associated with decreased use of LC boost without significant differences in acute toxicities. Further investigation to delineate LCs in patients undergoing RM or identify alternative strategies for delivering LC dose is needed.

BACKGROUND: Nipple-areola complex (NAC) malposition after nipple-sparing mastectomy (NSM) can be a challenging issue to correct. The current literature is largely limited to smaller series and implant-based reconstructions. METHODS: A retrospective review of all NSMs from 2006 to 2016 at a single institution was performed. Incidence, risk factors and corrective techniques of NAC malposition were analyzed. RESULTS: 1037 cases of NSM were identified, of which 77 (7.4%) underwent NAC repositioning. All were performed in a delayed fashion. The most common techniques included crescentic periareolar excision (25; 32.5%) and directional skin excision (10; 13.0%).Cases requiring NAC repositioning were significantly more likely to have preoperative radiation (p=0.0008), a vertical or Wise pattern incision (p=0.0157), autologous reconstruction (p=0.0219), and minor mastectomy flap necrosis (p=0.0462) (Table 1). Previous radiation (OR=3.6827, p=0.0028), vertical radial mastectomy incisions (OR=1.8218, p=0.0202), and autologous reconstruction (OR=1.77, p=0.0053) were positive independent predictors of NAC repositioning, whereas implant-based reconstruction (OR=0.5552, p<0.0001) was a negative independent predictor of repositioning. BMI (p=0.7104) and adjuvant radiation (p=0.9536), among other variables, were not predictors of NAC repositioning. CONCLUSIONS: NAC malposition after NSM can be successfully corrected with various techniques. Previous radiation, vertical mastectomy incisions, and autologous reconstruction are independently predictive of NAC malposition.

BACKGROUND: Ischemic complications after nipple-sparing mastectomy (NSM) have been associated with numerous variables. However, the impact of NSM flap thickness has been incompletely evaluated. METHODS: NSM flap thickness was determined for all NSMs from 2006 to 2016 with available pre- or postoperative breast magnetic resonance imaging (MRIs). Demographics and outcomes were stratified by those with and without ischemic complications. RESULTS: Of 1,037 NSM reconstructions, 420 NSMs had MRI data available, which included 379 preoperative MRIs and 60 postoperative MRIs. Average total preoperative skin/subcutaneous tissue NSM flap thickness was 11.4 mm. Average total postoperative NSM flap thickness was 8.7 mm. NSMs with ischemic complications were found to have significantly thinner overall postoperative NSM flap thickness compared with those without ischemic complications (P = 0.0280). Average overall postoperative NSM flap thickness less than 8.0 mm was found to be an independent predictor of ischemic complications (odds ratio, 6.5263; P = 0.026). In NSMs with both pre- and postoperative MRIs, the overall average postoperative NSM flap thickness was 68.2% of preoperative measurements. Average overall postoperative NSM flap thickness was significantly less than average overall preoperative NSM flap thickness (P < 0.0001). NSMs with ischemic complications were found to have a significantly lower ratio of overall postoperative to preoperative flap thickness (52.0% versus 74.0%; P < 0.0001). CONCLUSIONS: Ischemic complications after NSM are significantly associated with thinner postoperative NSM flap thickness. Particularly, NSM flap thickness less than 8.0 mm is a positive independent predictor of ischemic complications. The ratio of postoperative to preoperative NSM flap thickness was significantly lower in reconstructions with ischemic complications.

This study evaluated the reliability of implant-supported crowns repaired with resin composites. Fifty-four titanium abutments were divided in three groups (n = 18 each) to support resin nanoceramic molar crowns, as follows: (LU) (Lava Ultimate, 3M ESPE); LU repaired with either a direct or an indirect resin composite. Samples were subjected to mouth-motion accelerated-life testing in water (n = 18). Cumulative damage with a use stress of 300 N was used to plot Weibull curves for group comparison. Reliability was calculated for a mission of 100,000 cycles at 400 N load. Beta values were 0.83 for LU, 0.31 and 0.27 for LU repaired with Filtek and Ceramage, respectively. Weibull modulus for LU was 9.5 and eta = 1047 N, m = 6.85, and eta = 1002 N for LU repaired with Ceramage, and m = 4.65 and eta = 766 N for LU repaired with Filtek (p < 0.10 between LU and LU repaired with Filtek). Reliability at 400 N was 100% for both LU and LU repaired with Ceramage which were significantly higher than LU Filtek repair (32%). LU restored crowns failed cohesively. Fractures were confined within the restored material, and detailed fractography is presented. The performance of resin nanoceramic material repaired with an indirect composite was maintained after accelerated-life testing compared to unrepaired controls. (c) 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2016.

OBJECTIVE: This work aims to present a pilot study of a non-destructive dental histo-anatomical analysis technique as well as to push the boundaries of the presently available restorative workflows for the fabrication of highly customized ceramic restorations. MATERIALS AND METHODS: An extracted human maxillary central incisor was subject to a micro computed tomography scan and the acquired data was transferred into a workstation, reconstructed, segmented, evaluated and later imported into a Computer-Aided Design/Computer-Aided Manufacturing software for the fabrication of a ceramic resin-bonded prosthesis. RESULTS: The obtained prosthesis presented an encouraging optical behavior and was used clinically as final restoration. CONCLUSION: The digitally layered restorative replication of natural tooth morphology presents today as a clear possibility. New clinical and laboratory-fabricated, biologically inspired digital restorative protocols are to be expected in the near future. CLINICAL SIGNIFICANCE: The digitally layered restorative replication of natural tooth morphology presents today as a clear possibility. This pilot study may represent a stimulus for future research and applications of digital imaging as well as digital restorative workflows in service of esthetic dentistry.