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Purpose: Autologous fat transfer (AFT) is increasingly used in breast reconstructive surgery. Due to post-surgical changes, in breast imaging after AFT, it can be challenging to differentiate between benign and suspicious findings. This systematic review aimed to present an overview of the literature on breast imaging after AFT-based breast reconstruction. The descriptive radiologic findings focus on different breast imaging modalities (i.e., mammography (MG), ultrasound (US), and breast magnetic resonance imaging (MRI)) to provide an overview of the most commonly reported benign and suspicious findings., Results: The literature search yielded 20 studies from 2006-2022 that reported AFT-based breast reconstructions and included the radiologic evaluation of the included breast imaging modalities. Only six of the 20 included studies provided qualitative descriptions of radiologic findings. Fat necrosis was most frequently reported. On MG, fat necrosis was described in a variety of stages such as oil cyst or cytosteatonecrosis with or without calcifications. On US, it was described as a nonvascular hypo- or anechoic mass, and on breast MRI, it was most frequently reported as hypointense homogenous architectural distortion. Additional biopsies to differentiate between benign and malignant findings after AFT-based breast reconstruction were reported in 13 of the 20 studies. Among all included studies in the current review, a total of 34 of 137 biopsies were considered malignant (24.8%)., Conclusion: Qualitative descriptions of the reported radiologic findings after AFT for breast reconstruction were limited. Additional biopsies can be considered to differentiate between benign and suspicious findings. More experience and research are necessary to improve the interpretation of breast imaging after AFT-based breast reconstructions., (© 2024 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.)

Background: Quality strategies, interventions, and frameworks have been developed to facilitate a better understanding of healthcare systems. Reporting adverse events is one of these strategies. Gynaecology and obstetrics are one of the specialties with many adverse events. To understand the main causes of medical errors in gynaecology and obstetrics and how they could be prevented, we conducted this systematic review. Methods: This systematic review was performed in compliance with the Prisma 2020 guidelines. We searched several databases for relevant studies (Jan 2010-May 2023). Studies were included if they indicated the presence of any potential risk factor at the hospital level for medical errors or adverse events in gynaecology or obstetrics. Results: We included 26 articles in the quantitative analysis of this review. Most of these ( n = 12) are cross-sectional studies; eight are case-control studies, and six are cohort studies. One of the most frequently reported contributing factors is delay in healthcare. In addition, the availability of products and trained staff, team training, and communication are often reported to contribute to near-misses/maternal deaths. Conclusions: All risk factors that were found in our review imply several categories of contributing factors regarding: (1) delay of care, (2) coordination and management of care, and (3) scarcity of supply, personnel, and knowledge.

Introduction and Importance: Total breast reconstruction with autologous fat transfer (AFT) has a low complication rate. Fat necrosis, infection, skin necrosis and hematoma are the most common complications. Infections are usually mild and manifested by a unilateral red painful breast and treated with oral antibiotics with or without superficial irrigation of the wound., Case Presentation: One of our patients reported an ill-fitting pre-expansion device several days after surgery. This was due to a severe bilateral breast infection following a session of total breast reconstruction with AFT despite perioperative and postoperative antibiotic prophylaxis. Surgical evacuation was performed in combination with both systemic and oral antibiotic treatment., Clinical Discussion: Most infections can be prevented in the early post-operative period with antibiotic prophylaxis. If an infection does occur, it is treated with antibiotics or superficial irrigation of the wound. A delay in identification of an alarming course could be reduced by monitoring the fit to the EVEBRA device, implementing video consultations on indication, limiting the means of communication and better informing the patient on what complications to monitor. The recognition of an alarming course following a subsequent session of AFT is not guaranteed after a session without complication., Conclusion: Besides temperature and redness of the breast, a pre-expansion device that doesn't fit can be an alarming sign. Patient communication should be adapted as severe infections can be insufficiently recognized by phone. Evacuation should be considered when an infection does occur., Competing Interests: Conflicts of interest Not applicable., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)