Susanna MC Kauhanen

• MD, PhD. Associate Professor
• Chief Physician at Helsinki University Hospital Division of Muskuloskeletal and Plastic Surgery

Background and aims The present study aimed to compare patients who underwent deep inferior epigastric perforator (DIEP) flap reconstruction with and without the implementation of the new optimized surgical recovery pathway. The new protocol aims to standardize and optimize perioperative management, shorten hospital stays, and lower complication ra...

Lymphedema occurs when the lymphatic system is malformed, leaking or is damaged by infection or cancer treatment. Enlarged extremities due to extensive fluid retention and adipose tissue deposition, recurrent cellulitis, and the requirement for hard-to-wear compression garments lead to impaired limb function and decreased quality of life. This narr...

Introduction The BREAST-Q can be used to evaluate the health-related quality of life (HRQL) of breast cancer patients. Data interpretation is limited by the lack of previous reference values based solely on patients with a recent breast cancer diagnosis. Methods A total of 627 patients, all with newly diagnosed breast cancer, were asked to partici...

Background and objective Breast cancer and its treatments can have a marked impact on the patient health-related quality of life. The aim of this study was to produce and validate Finnish versions of the breast-conserving treatment, mastectomy and breast reconstruction modules of the BREAST-Q, a patient-reported outcome tool designed specifically f...

BACKGROUND Breast cancer-related lymphedema (BCRL) is a common complication lacking medical treatment. Lymfactin® is an adenovirus type 5-based gene therapy and prolymphangiogenic growth factor vector that induces vascular endothelial growth factor C (VEGF-C) expression. Our aim was to evaluate the therapeutic effect of Lymfactin ® with vascularize...

Background and aims Tuberous breast is a rare anomaly affecting the development of mainly the female breast. It presents with varying degrees of hypoplasia in the breast base and skin. In some cases, herniation and widening of the areola is observed. The condition constitutes a great challenge for the reconstructive surgeon. In this study, the surg...

Background: Postoperative bleeding requiring reoperation is an untoward event in breast surgery. Topical tranexamic acid (TXA) has been routinely used to reduce the risk of postoperative bleeding in some surgical fields. In breast surgery, it is not routinely used owing to scarce information. We investigated whether the intraoperatively applied to...

Antibiotic prophylaxis is frequently used in plastic surgery procedures, despite the generally low rates of infection and few guidelines on the practice. The increasing prevalence of bacterial resistance to antibiotics calls for a reduction in unnecessary antibiotic use. The aim of this review was to create an updated summary of the available data...

Background: Lipofilling can be used to reconstruct a breast without additional implants or autologous composite grafts. However, methods to maximize retention of the transferred fat remain under debate. Here we present our experience of breast reconstruction with lipofilling without concomitant use of tissue expanders. Methods: Patients who had...

Background Reconstruction of the breast following mastectomy can improve patients’ health-related quality of life (HRQL). We aimed to assess HRQL in women after mastectomy and breast reconstruction and to identify differences in HRQL related to the reconstruction method used. Methods A cross-sectional study was performed on patients who had underg...

Aim . Demand for nipple and skin sparing mastectomy (NSM/SSM) with immediate breast reconstruction (BR) has increased at the same time as indications for post-mastectomy radiation therapy (PMRT) have broadened. The aim of the Oncoplastic Breast Consortium initiative was to address relevant questions arising with this clinically challenging scenari...

Tutkimuksen tarkoitus. Kirurgisen hoidon vaikutusta elämänlaatuun painotetaan lisääntyvästi kliinisissä hoitopäätöksissä ja tutkimuksessa. BREAST-Q-mittari on rintarauhaskirurgisten potilaiden terveyteen liittyvää elämänlaatua arvioimaan kehitetty, moduuli-rakenteinen mittari. Tavoitteenamme oli tuottaa ja validoida suomenkielinen versio BREAST-Q-m...

Background:. The 21-cm notch-to-nipple distance has been accepted without academic scrutiny as a key measure in breast aesthetics. The Fibonacci sequence and phi ratio occur frequently in nature. They have previously been used to assess aesthetics of the face, but not the breast. This study aims to assess if the static 21-cm measure or the proporti...

Rintojen pienennysleikkaus-hartiat kevenevät ja syöpäkin voi löytyä Rintojen pienennysleikkaus on yleinen plastiikkakirurginen toimenpide. Tyypillisimpiä leikkausaiheita ovat suurten rintojen aiheuttamat oireet, rintojen merkittävä kokoero tai rintojen koon tasapainotta minen rintasyöpäleikkauksen aikana tai sen jälkeen. Ennen leikkausta rinnat tav...

The aims of the Oncoplastic Breast Consortium initiative were to identify important knowledge gaps in the field of oncoplastic breast-conserving surgery and nipple-sparing or skin-sparing mastectomy with immediate breast reconstruction, and to recommend appropriate research strategies to address these gaps. A total of 212 surgeons and 26 patient ad...

Mastectomy without immediate reconstruction leaves us with a population of women who may need a new breast in a delayed fashion. These women are often elderly, not fit for major flap surgery or reluctant to have long scars or implants. Free fat grafting has mainly been used as an adjunct to other reconstructive methods. We present an option for del...

Background:. Fat grafting is commonly used when treating soft-tissue defects. However, much of the basic biology behind fat transfer is still uncovered. Adipocytes can be divided into energy storing white and energy burning brown adipose cells. It is now well known, that also adult humans have metabolically active brown adipose tissue (BAT) within...

Introduction: Contralateral reduction mammaplasty is regularly included in the treatment of breast cancer patients. We analyzed the incidence of occult breast cancer and high-risk lesions in reduction mammaplasty specimens of women with previous breast cancer. We also analyzed if timing of reduction mammaplasty in relation to oncological treatment...

Background The role of preoperative imaging and the usability of different imaging modalities is highly variable and controversial in reduction mammaplasty patients. Our study describes the imaging process in a single center in regard to modality selection, age and timing, and of the association between imaging and histopathological findings in red...

Background: Reduction mammaplasty is one of the most common plastic surgery procedures. Preoperative imaging and histopathology protocols vary among countries and institutions. We aimed to analyze the incidence of occult breast cancer and high-risk lesions in reduction mammaplasty specimens. We also analyzed whether patients with abnormal histopat...

Background and aims: Reduction mammaplasties are increasingly performed as outpatient procedures. Cost savings are assumed, but published data on the subject are scarce. The aim of this study was to retrospectively determine the possible cost savings achieved by performing reduction mammaplasties as outpatient procedures. Material and methods: R...

It has been shown, that the myocutaneous latissimus dorsi flap volume and consistency remain mainly the same regardless the nerve is cut or not in breast reconstruction. It is controversial how big impact the flap innervation has on the muscle activity of the flap. The aim of the study was to prospectively evaluate the influence of latissimus dorsi...

Reduction mammaplasty is an increasingly common plastic surgical procedure. In the United States, majority of breast reductions are performed as outpatient surgery. In European public health care, outpatient breast reductions have still been rare. Our aim was to retrospectively determine clinical outcome and the success rate of outpatient reduction...

Reduction mammaplasty is a popular procedure in plastic surgery. Occasionally, occult invasive breast carcinoma or findings demonstrating increased risk of breast cancer occur in reduction mammaplasty specimens. The incidences have been studied elsewhere, but in Finland, the data on this subject are lacking. Our aim was to analyze the incidence of...

Background: Autologous fat grafting has become a frequent, simple, reproducible and low-risk technique for revisional or partial breast reconstruction. The presented European multicenter study describes an optimized treatment and follow-up protocol for the de novo breast reconstruction after total mastectomy by lipotransfer alone. Methods: A retros...

Free fat transfer or lipofilling is a procedure quickly increasing in popularity. Free fat transfer offers treatment for soft tissue defects caused by trauma or cancer, congenital anomalies, painful scars, irradiation injuries and aesthetic indications. The advantages compared to, e.g., traditional flap reconstructions includes surgical easiness, m...

Skeletal muscle is prone to injury upon trauma or nerve damage. In reconstructive surgery, it is an interesting spare part. Fortunately, skeletal muscle is capable of extensive regeneration. Satellite cells, quiescent myogenic precursor cells, become activated following muscle injury: they divide and form myoblasts, fuse into myotubes, and finally...

It is controversial whether surgical denervation of the thoracodorsal nerve should be performed in breast reconstruction with a myocutaneous latissimus dorsi flap. Denervation may prevent discomforting symptoms caused by muscle contraction, but the flap may also lose significant volume. The authors prospectively evaluated the influence of latissimu...

Vascularization and angiogenicity of human nonvascularized nerve grafts in the second stage of facial reanimation were studied. Immunohistochemistry for endothelial markers (CD-31) and vascular endothelial growth factor (VEGF) and its receptors Flt-1 and Flk-1 was performed on distal end biopsies from 35 cross-facial nerve grafts. In grafted nonvas...

: We report microvascular free tissue transfers in pediatric patients in a retrospective series. : Forty-six children were treated in collaboration between the departments of Pediatric Surgery and Plastic Surgery, Helsinki University Hospital between 1986 and 2004 for microvascular free flap surgery. Trauma, tumor resection, congenital malformation...

The histopathology of the deep portion of the vastus intermedius (VIP) muscle from 13 rabbit hind-limbs immobilized in shortened position for 2–2.5 (n=4), 3 (n = 3), 14 (n = 3) and 28 (n = 3) days and VIP muscles from 13 rabbit hindlimbs immobilized for the same time periods and subsequently remobilized for 4 weeks were compared. After 3 days of im...

The purpose of this study was to elucidate the expression of p75 nerve growth factor receptor (p75NGFR) in human cross-facial nerve grafts and to compare the immunohistological findings with patient data and the functional outcome in facial reanimation. The study comprised 37 sural nerve graft specimens. All of the patients had long-lasting complet...

The purpose of this study was to characterize microneurovascular (MNV) muscle transplants immunohistochemically up to 10 years after transfer. Histological data was related to long-term functional outcome. The study comprised 17 patients with a mean age of 41 years suffering from complete unilateral long-lasting facial paralysis. A two-stage proced...

The purpose of this study was to describe the survival and volume of microneurovascular muscle flaps at different times after two-stage facial reanimation procedure by using magnetic resonance imaging (MRI) and to compare the functional outcome with MRI findings. Fifteen patients with a mean age of 36 years (range 7-63 years) operated on between 19...

The two-stage operation for reanimation of long-standing facial paralysis by cross-facial nerve grafting and later free microneurovascular muscle transfer has been the treatment of choice for nearly 25 years. However, the functional outcome may be unpredictable. We therefore need to know more about the factors that influence the final result. We ha...

Reinnervation, muscle regeneration, density of microvessels, and muscle-type specific atrophy were studied 3–4 years after surgery in surgically nonreinnervated free microvascular muscle flaps to 13 patients transplanted to the upper or lower extremities. Routine histology and immunohistochemistry for PGP 9.5 and S-100 (neuronal markers), Ki-67 (ce...

Satellite cell proliferation, reinnervation, and revascularization were studied in human nonreinnervated free microvascular muscle flaps to characterize mechanisms of muscle regeneration after flap surgery. Patient biopsies (n = 19) were taken at operation and five timepoints up to 9 months after operation, and corresponding clinical data were obta...

Immobilization of the rabbit knee in extended position results in damage to the vastus intermedius profundus (VIP) muscle. To examine the mechanisms involved in initiation of the injury, we studied the light and electron microscopic morphology of the VIP muscle, as well as the activity and distribution of NADH tetrazolium reductase (NADH-TR) in the...

The time course and pattern of mitotic activity in the deep part of the vastus intermedius muscle (VIP) immobilized in a shortened position in 16 adult NZW rabbit hindlimbs for time periods ranging from 12 h to 56 days and in VIP muscles from 10 rabbit hindlimbs immobilized from 3 to 28 days and subsequently remobilized for 4 weeks were compared. P...

The histology of free microvascular muscle flaps in 19 patients was studied prospectively. Biopsies were taken during operation, and after 2 and 6 weeks, as well as 3, 6, and 9 months, postoperatively, fixed and stained using the van Gieson method. Fiber diameters were analyzed morphometrically and fiber types defined immunohistochemically using my...

The histopathology of the deep portion of the vastus intermedius (VIP) muscle from 13 rabbit hindlimbs immobilized in shortened position for 2-2.5 (n = 4), 3 (n = 3), 14 (n = 3) and 28 (n = 3) days and VIP muscles from 13 rabbit hindlimbs immobilized for the same time periods and subsequently remobilized for 4 weeks were compared. After 3 days of i...

In this article we report the development and findings of our longlasting study investicating the effect of immobilisation on limb tissues using a rabbit model. Immobilisation of the rabbit knee in extension led in all limb tissues to changes similar to those seen in an aseptic arthritis and osteoarthritis in man. Repeated manipulation of immobilis...

Immobilization of the rabbit knee in extension has previously been shown to damage the vastus intermedius profundus (VIP) muscle. To examine the mechanism of the early stages of the muscle damage, the authors studied creatine kinase activity in serum, and both light and electron microscopic changes in the affected muscle. The right knee was immobil...