The National Dutch Breast Implant Registry: user-reported experiences and importance

Background: Robust (inter-)national breast implant registries are important. For some, registries are an administrative burden, for others they represent a solution for the discussions involving breast implants. The DBIR is one of the first national, opt-out, clinical registries of breast implants, providing information for clinical auditing and product recall. Four years after its introduction, it is time to address users’ comments in order to keep improving quality of registration, and patient safety. This study assesses users’ feedback focusing on importance of registration, logistics and user experience, and areas of improvement. Methods: In May 2018, a standardized online study–specific questionnaire was sent out to all members of the Netherlands Society of Plastic Surgery. Descriptive statistics were reported in absolute frequencies and/or percentages. Results: A total of 102 members responded to the questionnaire (response rate, 24.2%). Of all respondents, 97.1% were actively registering in DBIR. Respondents rated the importance of registration in DBIR as 8.1 out of 10 points. Ninety-one respondents suggested improvements for the DBIR. All comments were related to registration convenience and provision of automatically generated data. Conclusions: Respondents believe that registration is highly important and worth the administrative burden. However, we should collectively keep improving accuracy, usability and sustainability of breast

Aesthetic Evaluation of Breast Reconstruction with Autologous Fat Transfer vs. Implants

BACKGROUND: Autologous fat transfer (AFT) seems to be a new minimal invasive method for total breast reconstruction, yet how patients, surgeons, and laymen evaluate cosmesis is lacking. The aim of this study was to evaluate the aesthetic outcome of AFT (intervention group) for total breast reconstruction post-mastectomy, as compared to implant-based reconstruction (IBR) (control group). METHODS: A random and blinded 3D photographic aesthetic outcome study was performed on a selection of 50 patients, scored by three panels: plastic surgeons, breast cancer patients, and laymen. Secondary outcomes included agreement within groups and possible patient characteristics influencing scoring. RESULTS: Breast cancer patients and plastic surgeons did not differ in the aesthetic scores between the treatment groups. In contrast, the laymen group scored AFT patients lower than IBR patients (- 1.04, p < 0.001). Remarkably, mean given scores were low for all groups and overall agreement within groups was poor (ICC < 0.50). Higher scores were given when subjects underwent a bilateral reconstruction and if a mamilla was present. CONCLUSION: Evaluation of aesthetic outcomes varies greatly. Hence, aesthetic outcome remains a very personal measure and this emphasizes the importance of thorough patient counseling including information on achievable aesthetic results before starting a reconstructive procedure. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

Is single-stage implant-based breast reconstruction (SSBR) with an acellular matrix safe?

Background: Acellular matrices (AM) might enable a direct single-stage breast reconstruction procedure resulting in an improved efficacy of the reconstruction phase for patients. Safety concerns are an important issue due to a recent study which shows that single-stage breast reconstruction with Strattice™ resulted in more complications versus a two-stage reconstruction. Therefore, the goal of this study is to compare the short- and long-term complications of a single-stage breast reconstruction with the use of two types of AM (Strattice™ and Meso Biomatrix®) versus two-stage breast reconstruction without the use of an AM. Methods: Cohort study with single-stage breast reconstruction with Strattice™ (n = 28) or Meso BioMatrix® (n = 20) or two-stage breast reconstruction without an AM (n = 36) at the Maastricht Academic Hospital, the Netherlands. All complications, in particular major complications with the need for re-admission to the hospital, re-exploration, and implant explantation, were the primary outcome measures. A 1-year follow-up was achieved for all patients. Results: Baseline characteristics of all 52 patients were similar between groups. There was a significantly higher complication rate in the single-stage AM groups with loss of the implant in 40.0% of the breasts from the Meso BioMatrix® group and in 10.7% of the Strattice™ group compared to no implant loss in the control group. Conclusions: This cohort study clearly suggests that the use of a single-stage breast reconstruction is not safe with the use of these AMs. Well-designed prospective studies that guarantee the safety of those matrices should be published before these AMs are used in implant-based surgery. Level of Evidence: Level III, risk / prognostic study

Medical Students Perceive Better Group Learning Processes when Large Classes Are Made to Seem Small

<div><p>Objective</p><p>Medical schools struggle with large classes, which might interfere with the effectiveness of learning within small groups due to students being unfamiliar to fellow students. The aim of this study was to assess the effects of making a large class <i>seem</i> small on the students' collaborative learning processes.</p><p>Design</p><p>A randomised controlled intervention study was undertaken to make a large class seem small, without the need to reduce the number of students enrolling in the medical programme. The class was divided into subsets: two small subsets (n = 50) as the intervention groups; a control group (n = 102) was mixed with the remaining students (the non-randomised group n∼100) to create one large subset.</p><p>Setting</p><p>The undergraduate curriculum of the Maastricht Medical School, applying the Problem-Based Learning principles. In this learning context, students learn mainly in tutorial groups, composed randomly from a large class every 6–10 weeks.</p><p>Intervention</p><p>The formal group learning activities were organised within the subsets. Students from the intervention groups met frequently within the formal groups, in contrast to the students from the large subset who hardly enrolled with the same students in formal activities.</p><p>Main Outcome Measures</p><p>Three outcome measures assessed students' group learning processes over time: learning within formally organised small groups, learning with other students in the informal context and perceptions of the intervention.</p><p>Results</p><p>Formal group learning processes were perceived more positive in the intervention groups from the second study year on, with a mean increase of β = 0.48. Informal group learning activities occurred almost exclusively within the subsets as defined by the intervention from the first week involved in the medical curriculum (E-I indexes>−0.69). Interviews tapped mainly positive effects and negligible negative side effects of the intervention.</p><p>Conclusion</p><p>Better group learning processes can be achieved in large medical schools by making large classes seem small.</p></div

Donor Site Satisfaction Following Autologous Fat Transfer for Total Breast Reconstruction

BACKGROUND: With evolving breast cancer survival and patient preferences, it is essential that reconstructive surgeons worldwide keep searching for the best reconstruction technique for patients. Autologous fat transfer (AFT) is a relatively new technique for total breast reconstruction that has already proven to be effective and safe with all advantages of autologous tissue. However, little is known about aesthetic results and satisfaction concerning donor sites. OBJECTIVES: The aim of this study was to measure donor site satisfaction following AFT for total breast reconstruction in breast cancer patients. METHODS: Between May and August of 2021, participants of the BREAST- trial who were at least 24 months after their final reconstruction surgery were invited to fill out an additional survey concerning donor sites. The BODY-Q was utilized for data collection. Results of AFT patients were compared to a control group: implant-based reconstruction patients who do not have a donor site. RESULTS: A total of 51 patients (20 control, 31 intervention) completed the questionnaire. No statistical differences in satisfaction with body were found between these groups. The most frequent complaint was contour irregularities (31 reports, 60.8%) with the least favorable donor site being thighs (23 reports, 53.5%) in the AFT group. CONCLUSIONS: There is no difference in satisfaction with body between breast cancer patients receiving AFT or IBR, meaning that large volume liposuction does not aesthetically affect the utilized donor sites. Nevertheless, reconstructive surgeons should be aware of possible donor site complications, especially contour irregularities at the thighs, and discuss this with their patients

Overview of the instrument assessment over time.

<p><i>Students progressed through six modules every study year. Formal interaction was assessed in the first tutorial group (M1 and M2; since the composition of first two modules did not change), the second tutorial group (M3) and in year two the second and penultimate tutorial groups (M2 and M5 in curriculum year two). The assessment consisted of two observations within the module, indicated as * in the orange boxes. The first observation took place in the second week of the tutorial group and the second in the penultimate week. Informal learning in social networks was assessed during the first three modules in the first year and during two modules in the second study year (T1–T5). Finally, semi-structured interviews assessed the perceptions of the intervention during M2 and M6 of the second curriculum year.</i></p