Imaging breast augmentation and reconstruction.
The British journal of radiology, Jul 2008 (epub: 14 Apr 2008), vol. 81, no. 967,
p. 587-95, 8 refs
Glynn-C, Litherland-J.
Abstract
Breast augmentation and breast reconstruction, either immediate or delayed, are increasingly common operations. All radiologists need to be able to recognize the normal appearances of the more commonly used implants on various imaging modalities, and breast radiologists in particular are facing new challenges when imaging the women involved. This article aims to review the normal and abnormal findings in women who have had breast augmentation and reconstruction, including implant insertion and reconstruction by autologous myocutaneous flaps.
Friday, 25 July 2008
Use of enoxaparin results in more haemorrhagic complications
Use of enoxaparin results in more haemorrhagic complications after breast surgery than unfractionated heparin.
The British journal of surgery, Jul 2008, vol. 95, no. 7
p. 834-6
Author(s)
Hardy-R-G, Williams-L, Dixon-J-M.
Abstract
BACKGROUND: Low molecular weight heparin (LMWH) is used in preference to unfractionated heparin (UFH) for the prevention of postoperative thromboembolism in many UK surgical units. There are, however, conflicting reports on the relative risk of significant bleeding in surgical patients, and no data exist in the literature for patients undergoing breast surgery. METHODS: Data for patients in the Edinburgh Breast Unit with postoperative breast haematoma that needed surgical intervention were analysed for two 12-month intervals in which either UFH (2001) or LMWH (2005-2006) was used for thromboprophylaxis. Haematoma rates in the 6 months after UFH was reintroduced in 2006-2007 were also determined. RESULTS: The rate of haematoma requiring surgical intervention was 0.4 per cent (six of 1452 wounds) in patients who had UFH, compared with 1.8 per cent (32 of 1780 wounds) for LMWH. The rate fell to 0.5 per cent (four of 773 wounds) on reinstituting UFH. The relative risk of haematoma was significantly higher with LMWH than with UFH (4.00 (95 per cent confidence interval 1.97 to 8.11); P < 0.001). No significant postoperative thromboembolic complications were recorded. CONCLUSION: LMWH thromboprophylaxis was associated with a significant increase in haemorrhagic complications after breast surgery compared with UFH.
The British journal of surgery, Jul 2008, vol. 95, no. 7
p. 834-6
Author(s)
Hardy-R-G, Williams-L, Dixon-J-M.
Abstract
BACKGROUND: Low molecular weight heparin (LMWH) is used in preference to unfractionated heparin (UFH) for the prevention of postoperative thromboembolism in many UK surgical units. There are, however, conflicting reports on the relative risk of significant bleeding in surgical patients, and no data exist in the literature for patients undergoing breast surgery. METHODS: Data for patients in the Edinburgh Breast Unit with postoperative breast haematoma that needed surgical intervention were analysed for two 12-month intervals in which either UFH (2001) or LMWH (2005-2006) was used for thromboprophylaxis. Haematoma rates in the 6 months after UFH was reintroduced in 2006-2007 were also determined. RESULTS: The rate of haematoma requiring surgical intervention was 0.4 per cent (six of 1452 wounds) in patients who had UFH, compared with 1.8 per cent (32 of 1780 wounds) for LMWH. The rate fell to 0.5 per cent (four of 773 wounds) on reinstituting UFH. The relative risk of haematoma was significantly higher with LMWH than with UFH (4.00 (95 per cent confidence interval 1.97 to 8.11); P < 0.001). No significant postoperative thromboembolic complications were recorded. CONCLUSION: LMWH thromboprophylaxis was associated with a significant increase in haemorrhagic complications after breast surgery compared with UFH.
Prospective matched-pair comparison of outcome after treatment for lobular and ductal breast carcinoma.
Prospective matched-pair comparison of outcome after treatment for lobular and ductal breast carcinoma.
The British journal of surgery, Jul 2008, vol. 95, no. 7
p. 827-33
Mhuircheartaigh-J-Ni, Curran-C, Hennessy-E, Kerin-M-J.
Abstract
BACKGROUND: Whether the prognosis of invasive lobular carcinoma is different from that of other invasive breast cancers is controversial. The aim of this study was to compare the outcome in age- and stage-matched patients with lobular carcinoma and those with invasive breast cancer, and in particular to compare predictors of outcome. METHODS: Data were obtained from a prospectively maintained database that included patients who had breast surgery for invasive cancer. Patients were matched for International Union Against Cancer stage and age at diagnosis within 5 years. Two patients with invasive ductal carcinoma were matched to each patient with invasive lobular carcinoma. RESULTS: There was no significant difference between invasive ductal and lobular carcinomas in terms of overall survival. Oestrogen receptor (ER)-positive invasive ductal carcinoma had a better prognosis than ER-positive invasive lobular carcinoma (P = 0.011). Similarly, ER-negative invasive ductal carcinoma was associated with worse survival than ER-negative invasive lobular carcinoma (P = 0.054). CONCLUSION: These results suggested that the differences in outcome between invasive ductal and lobular carcinomas may be determined by ER status.
The British journal of surgery, Jul 2008, vol. 95, no. 7
p. 827-33
Mhuircheartaigh-J-Ni, Curran-C, Hennessy-E, Kerin-M-J.
Abstract
BACKGROUND: Whether the prognosis of invasive lobular carcinoma is different from that of other invasive breast cancers is controversial. The aim of this study was to compare the outcome in age- and stage-matched patients with lobular carcinoma and those with invasive breast cancer, and in particular to compare predictors of outcome. METHODS: Data were obtained from a prospectively maintained database that included patients who had breast surgery for invasive cancer. Patients were matched for International Union Against Cancer stage and age at diagnosis within 5 years. Two patients with invasive ductal carcinoma were matched to each patient with invasive lobular carcinoma. RESULTS: There was no significant difference between invasive ductal and lobular carcinomas in terms of overall survival. Oestrogen receptor (ER)-positive invasive ductal carcinoma had a better prognosis than ER-positive invasive lobular carcinoma (P = 0.011). Similarly, ER-negative invasive ductal carcinoma was associated with worse survival than ER-negative invasive lobular carcinoma (P = 0.054). CONCLUSION: These results suggested that the differences in outcome between invasive ductal and lobular carcinomas may be determined by ER status.
Recovery after transverse rectus abdominis myocutaneous flap breast reconstruction surgery
Recovery after transverse rectus abdominis myocutaneous flap breast reconstruction surgery.
Oncology Nursing Forum, Mar 2008, vol. 35, no. 2, p. 189-96
Dell-D, Weaver-C, Kozempel-J.
Research in the USA on pain, activity limitations and recovery goals after transverse rectus abdominis myocutaneous flap breast reconstruction following mastectomy for breast cancer. Patient satisfaction with educational material provided by nurses and physiotherapists was assessed. 24 refs.
Oncology Nursing Forum, Mar 2008, vol. 35, no. 2, p. 189-96
Dell-D, Weaver-C, Kozempel-J.
Research in the USA on pain, activity limitations and recovery goals after transverse rectus abdominis myocutaneous flap breast reconstruction following mastectomy for breast cancer. Patient satisfaction with educational material provided by nurses and physiotherapists was assessed. 24 refs.
Role of primary tumor characteristics in predicting positive sentinel lymph nodes
Role of primary tumor characteristics in predicting positive sentinel lymph nodes in patients with ductal carcinoma in situ or microinvasive breast cancer.
American journal of surgery Jul 2008 (epub: 23 Apr 2008), vol. 196, no. 1, p. 81-7
Yi-Min, Krishnamurthy-Savitri, Kuerer-Henry-M et al
Abstract
BACKGROUND: We determined the incidence of positive sentinel lymph nodes (SLNs) in patients with ductal carcinoma in situ (DCIS) or microinvasive breast cancer (MIC) and the predictive factors of SLN metastasis in these patients. METHODS: Of 4,503 patients who underwent SLN dissection between March 1994 and March 2006 at our institution, we identified those with a preoperative diagnosis or final diagnosis of DCIS or MIC. Clinicopathologic factors were examined by logistic regression analysis. RESULTS: Of the 624 patients with a preoperative diagnosis of DCIS or MIC, 40 had positive SLNs (6.4%). Of the 475 patients with a final diagnosis of DCIS or MIC, 9 had positive SLNs (1.9%). Clinical DCIS size >5 cm was the only independent predictor of positive SLN for patients with a preoperative diagnosis and patients with a final diagnosis of DCIS or MIC. Core biopsy as the method of preoperative diagnosis and DCIS size >5 cm were independent predictors for a final diagnosis of invasive carcinoma in the 149 patients who had a preoperative diagnosis of DCIS or MIC. CONCLUSIONS: SLN dissection for patients with a diagnosis of DCIS should be limited to patients who are planned for mastectomy or who have DCIS size >5 cm. Patients who have a core-needle biopsy diagnosis of DCIS have a higher risk of invasive breast cancer on final pathologic assessment of the primary tumor. This information can be used in preoperative counseling of patients with DCIS regarding the timing of SLN biopsy.
American journal of surgery Jul 2008 (epub: 23 Apr 2008), vol. 196, no. 1, p. 81-7
Yi-Min, Krishnamurthy-Savitri, Kuerer-Henry-M et al
Abstract
BACKGROUND: We determined the incidence of positive sentinel lymph nodes (SLNs) in patients with ductal carcinoma in situ (DCIS) or microinvasive breast cancer (MIC) and the predictive factors of SLN metastasis in these patients. METHODS: Of 4,503 patients who underwent SLN dissection between March 1994 and March 2006 at our institution, we identified those with a preoperative diagnosis or final diagnosis of DCIS or MIC. Clinicopathologic factors were examined by logistic regression analysis. RESULTS: Of the 624 patients with a preoperative diagnosis of DCIS or MIC, 40 had positive SLNs (6.4%). Of the 475 patients with a final diagnosis of DCIS or MIC, 9 had positive SLNs (1.9%). Clinical DCIS size >5 cm was the only independent predictor of positive SLN for patients with a preoperative diagnosis and patients with a final diagnosis of DCIS or MIC. Core biopsy as the method of preoperative diagnosis and DCIS size >5 cm were independent predictors for a final diagnosis of invasive carcinoma in the 149 patients who had a preoperative diagnosis of DCIS or MIC. CONCLUSIONS: SLN dissection for patients with a diagnosis of DCIS should be limited to patients who are planned for mastectomy or who have DCIS size >5 cm. Patients who have a core-needle biopsy diagnosis of DCIS have a higher risk of invasive breast cancer on final pathologic assessment of the primary tumor. This information can be used in preoperative counseling of patients with DCIS regarding the timing of SLN biopsy.
The effects of race and age on axillary lymph node involvement
The effects of race and age on axillary lymph node involvement in breast cancer patients at a Midwestern safety-net hospital.
American journal of surgery, Jul 2008 (epub: 25 Apr 2008), vol. 196, no. 1
p. 64-9
Kenney-Robert-J, Marszalek-Jacob-M, McNally-Megan-E et al
Abstract
BACKGROUND: Black and premenopausal patients have been shown to have poorer stage for stage survival than the overall population. The purpose of this study was to define the effects of age and race on axillary lymph node involvement at a Midwestern safety-net hospital. The hypothesis was that black patients under the age of 50 would be found to have increased rates of axillary involvement in breast cancer. METHODS: A retrospective case review was performed of 184 breast cancer patients from 2000 to 2005. Statistical analysis was performed by race and age. Patients under 50 years of age were defined as premenopausal. RESULTS: The overall rate of axillary involvement was 47.8%. Black patients had an overall rate of axillary involvement of 52.9%. However, premenopausal black patients had a 70.8% rate of axillary involvement (P < .05). Premenopausal white patients had a 46.3% rate of axillary involvement. Logistic regression analysis was performed, and premenopausal age and tumor size were found to be independent predictors of positive lymph node status in black patients. CONCLUSION: In our study, premenopausal black patients had a much higher rate of axillary lymph node involvement than any other group. This finding was consistent even when tumor size was taken into account. More research needs to be done to better define this difference and to detect this disease at an earlier stage.
American journal of surgery, Jul 2008 (epub: 25 Apr 2008), vol. 196, no. 1
p. 64-9
Kenney-Robert-J, Marszalek-Jacob-M, McNally-Megan-E et al
Abstract
BACKGROUND: Black and premenopausal patients have been shown to have poorer stage for stage survival than the overall population. The purpose of this study was to define the effects of age and race on axillary lymph node involvement at a Midwestern safety-net hospital. The hypothesis was that black patients under the age of 50 would be found to have increased rates of axillary involvement in breast cancer. METHODS: A retrospective case review was performed of 184 breast cancer patients from 2000 to 2005. Statistical analysis was performed by race and age. Patients under 50 years of age were defined as premenopausal. RESULTS: The overall rate of axillary involvement was 47.8%. Black patients had an overall rate of axillary involvement of 52.9%. However, premenopausal black patients had a 70.8% rate of axillary involvement (P < .05). Premenopausal white patients had a 46.3% rate of axillary involvement. Logistic regression analysis was performed, and premenopausal age and tumor size were found to be independent predictors of positive lymph node status in black patients. CONCLUSION: In our study, premenopausal black patients had a much higher rate of axillary lymph node involvement than any other group. This finding was consistent even when tumor size was taken into account. More research needs to be done to better define this difference and to detect this disease at an earlier stage.
Safety and efficiency of the ultrasound-guided large needle core biopsy of axilla lymph nodes.
The safety and efficiency of the ultrasound-guided large needle core biopsy of axilla lymph nodes.
Yonsei medical journal, 30 Apr 2008, vol. 49, no. 2, p. 249-54
Kim-Ki-Hong, Son-Eun-Ju et al
Abstract
PURPOSE: To evaluate the safety and efficiency of the Ultrasound (US)-guided large needle core biopsy of axilla lymph nodes. MATERIALS AND METHODS: From March 2004 to September 2005, 31 patients underwent the US-guided core biopsy for axilla lymph nodes. Twenty five lesions out of 31 were detected during breast US, and 6 of 31 cases were palpable. Lymph nodes were classified based on their shape and cortical morphology. The core biopsy of axilla lymph nodes was performed on suspicious lymph nodes found during breast ultrasonography to find out whether the patients had a history of breast cancer or not. Among the 31 patients, 16 patients were associated with breast cancer. The lesion sizes varied from 0.6 cm to 3.3 cm (mean=1.59+/-0.76 cm). US-guided core biopsies were performed with 14 G needles with an automated biopsy gun. Total 3 or 5 specimens were obtained. RESULTS: Among the 31 cases of axilla lymph nodes core biopsies, 11 cases showed malignant pathology. Seven out of 11 cases were metastatic lymph nodes from breast cancer; 2 cases were from primary unknown and 2 cases from lymphomas. On the other hand, 20 histopathologic results of axilla lesions were benign: subacute necrotizing lymphadenitis (n=2), dermatopathic lymphadenitis (n=1), reactive hyperplasia (n=10) and free of carcinoma (n=7). CONCLUSION: The US-guided large needle core biopsy of axilla lesions is safe and effective for the pathological evaluation. The core biopsy is believed to be easy to perform if suspicious lymph nodes or mass lesions are found in the axilla.
Yonsei medical journal, 30 Apr 2008, vol. 49, no. 2, p. 249-54
Kim-Ki-Hong, Son-Eun-Ju et al
Abstract
PURPOSE: To evaluate the safety and efficiency of the Ultrasound (US)-guided large needle core biopsy of axilla lymph nodes. MATERIALS AND METHODS: From March 2004 to September 2005, 31 patients underwent the US-guided core biopsy for axilla lymph nodes. Twenty five lesions out of 31 were detected during breast US, and 6 of 31 cases were palpable. Lymph nodes were classified based on their shape and cortical morphology. The core biopsy of axilla lymph nodes was performed on suspicious lymph nodes found during breast ultrasonography to find out whether the patients had a history of breast cancer or not. Among the 31 patients, 16 patients were associated with breast cancer. The lesion sizes varied from 0.6 cm to 3.3 cm (mean=1.59+/-0.76 cm). US-guided core biopsies were performed with 14 G needles with an automated biopsy gun. Total 3 or 5 specimens were obtained. RESULTS: Among the 31 cases of axilla lymph nodes core biopsies, 11 cases showed malignant pathology. Seven out of 11 cases were metastatic lymph nodes from breast cancer; 2 cases were from primary unknown and 2 cases from lymphomas. On the other hand, 20 histopathologic results of axilla lesions were benign: subacute necrotizing lymphadenitis (n=2), dermatopathic lymphadenitis (n=1), reactive hyperplasia (n=10) and free of carcinoma (n=7). CONCLUSION: The US-guided large needle core biopsy of axilla lesions is safe and effective for the pathological evaluation. The core biopsy is believed to be easy to perform if suspicious lymph nodes or mass lesions are found in the axilla.
Exercise rehabilitation program for women following a modified radical mastectomy and axillary node dissection
Effectiveness of a self-administered, home-based exercise rehabilitation program for women following a modified radical mastectomy and axillary node dissection: a preliminary study.
Breast cancer research and treatment, May 2008 (epub: 11 Jul 2007), vol. 109, no. 2,
p. 285-95
Kilgour-Robert-D, Jones-David-H, Keyserlingk-John-R.
Abstract
OBJECTIVE: This pilot study examined the effects of a self- administered, home-based exercise (HBE) rehabilitation programme designed to help women regain shoulder mobility immediately following surgery for a modified radical mastectomy and axillary node dissection. METHODS: Twenty-seven women who were scheduled for surgery were randomly assigned to either a post-surgical experimental HBE rehabilitation group (n = 16) or a usual care group (UC; n = 11). Women assigned to the HBE group followed an 11 day (days 3-14 post- surgery), home-based rehabilitation programme consisting of shoulder flexibility and stretching exercises that were described on videotape. The videotape programme was modelled after the exercises and guidelines described in a brochure produced by the Canadian Cancer Society.
RESULTS: As a result of the exercise programme intervention, there was a time x group interaction indicating that the HBE group demonstrated a significantly greater increase in shoulder flexion range of motion (ROM) (p = 0.003) and abduction ROM (p = 0.036) when compared to the UC. There were no statistical differences in shoulder strength between groups over time. External rotation (p = 0.036) and grip strength (p = 0.001) significantly increased in both groups during the intervention period but there were no interaction effects. With respect to the forearm circumferences, there was a significant decrease over time (p < 0.001) but no interaction between groups.
CONCLUSION: This HBE rehabilitation programme is an effective way to improve shoulder mobility and ROM during the immediate 2-week recovery period following surgery.
Journal-Article, Randomized-Controlled-Trial
Breast cancer research and treatment, May 2008 (epub: 11 Jul 2007), vol. 109, no. 2,
p. 285-95
Kilgour-Robert-D, Jones-David-H, Keyserlingk-John-R.
Abstract
OBJECTIVE: This pilot study examined the effects of a self- administered, home-based exercise (HBE) rehabilitation programme designed to help women regain shoulder mobility immediately following surgery for a modified radical mastectomy and axillary node dissection. METHODS: Twenty-seven women who were scheduled for surgery were randomly assigned to either a post-surgical experimental HBE rehabilitation group (n = 16) or a usual care group (UC; n = 11). Women assigned to the HBE group followed an 11 day (days 3-14 post- surgery), home-based rehabilitation programme consisting of shoulder flexibility and stretching exercises that were described on videotape. The videotape programme was modelled after the exercises and guidelines described in a brochure produced by the Canadian Cancer Society.
RESULTS: As a result of the exercise programme intervention, there was a time x group interaction indicating that the HBE group demonstrated a significantly greater increase in shoulder flexion range of motion (ROM) (p = 0.003) and abduction ROM (p = 0.036) when compared to the UC. There were no statistical differences in shoulder strength between groups over time. External rotation (p = 0.036) and grip strength (p = 0.001) significantly increased in both groups during the intervention period but there were no interaction effects. With respect to the forearm circumferences, there was a significant decrease over time (p < 0.001) but no interaction between groups.
CONCLUSION: This HBE rehabilitation programme is an effective way to improve shoulder mobility and ROM during the immediate 2-week recovery period following surgery.
Journal-Article, Randomized-Controlled-Trial
Modified radical mastectomy with axillary dissection using the electrothermal bipolar vessel sealing system.
Modified radical mastectomy with axillary dissection using the electrothermal bipolar vessel sealing system.
Archives of surgery, Jun 2008, vol. 143, no. 6
p. 575-80; discussion 581
Manouras-Andreas, Markogiannakis-Haridimos, Genetzakis-Michael et al
Abstract
HYPOTHESIS: The use of the electrothermal bipolar vessel sealing system is feasible, safe, and effective in modified radical mastectomy with axillary dissection in terms of lymph vessel sealing, hemostasis, and perioperative complications. DESIGN: Prospective study. SETTING: University surgical department. PATIENTS: Between January 1, 2003, and December 31, 2003, 60 patients with locally advanced breast cancer (T2 or T3) admitted for modified radical mastectomy with axillary dissection were included in this study. The entire procedure was performed by the same surgical team using the electrothermal bipolar vessel sealing system. MAIN OUTCOME MEASURES: Final outcome, operative time, hospitalization stay duration, intraoperative blood loss, postoperative mastectomy and axillary drainage volume and duration, and postoperative complications (seroma, bleeding, skin burn, hematoma, lymphedema, pneumothorax, and wound infection or necrosis). RESULTS: The mean (SD) intraoperative blood loss was 45 (12) mL, and the mean (SD) operative time was 105 (7) minutes. No postoperative bleeding, seroma, hematoma, lymphedema, or other complications occurred. The mean (SD) mastectomy and axillary drainage volumes were 20 (8) and 155 (35) mL, respectively, and the mean (SD) drainage durations were 1.3 (0.2) and 2.7 (0.5) days, respectively. The mean (SD) hospital stay was 3.7 (0.6) days. CONCLUSIONS: In this first report (to our knowledge) of modified radical mastectomy with axillary dissection using the electrothermal bipolar vessel sealing system, the technique was feasible, safe, and effective. The device simplified the surgical procedure, while achieving efficient lymph vessel sealing and hemostasis. Compared with historical data regarding the conventional or harmonic scalpel, this technique seems to result in reduced operative time, perioperative blood loss, drainage volume and duration, and incidence of seroma or lymphedema. Prospective randomized controlled studies are necessary to evaluate the effect of this technique on perioperative complications.
Archives of surgery, Jun 2008, vol. 143, no. 6
p. 575-80; discussion 581
Manouras-Andreas, Markogiannakis-Haridimos, Genetzakis-Michael et al
Abstract
HYPOTHESIS: The use of the electrothermal bipolar vessel sealing system is feasible, safe, and effective in modified radical mastectomy with axillary dissection in terms of lymph vessel sealing, hemostasis, and perioperative complications. DESIGN: Prospective study. SETTING: University surgical department. PATIENTS: Between January 1, 2003, and December 31, 2003, 60 patients with locally advanced breast cancer (T2 or T3) admitted for modified radical mastectomy with axillary dissection were included in this study. The entire procedure was performed by the same surgical team using the electrothermal bipolar vessel sealing system. MAIN OUTCOME MEASURES: Final outcome, operative time, hospitalization stay duration, intraoperative blood loss, postoperative mastectomy and axillary drainage volume and duration, and postoperative complications (seroma, bleeding, skin burn, hematoma, lymphedema, pneumothorax, and wound infection or necrosis). RESULTS: The mean (SD) intraoperative blood loss was 45 (12) mL, and the mean (SD) operative time was 105 (7) minutes. No postoperative bleeding, seroma, hematoma, lymphedema, or other complications occurred. The mean (SD) mastectomy and axillary drainage volumes were 20 (8) and 155 (35) mL, respectively, and the mean (SD) drainage durations were 1.3 (0.2) and 2.7 (0.5) days, respectively. The mean (SD) hospital stay was 3.7 (0.6) days. CONCLUSIONS: In this first report (to our knowledge) of modified radical mastectomy with axillary dissection using the electrothermal bipolar vessel sealing system, the technique was feasible, safe, and effective. The device simplified the surgical procedure, while achieving efficient lymph vessel sealing and hemostasis. Compared with historical data regarding the conventional or harmonic scalpel, this technique seems to result in reduced operative time, perioperative blood loss, drainage volume and duration, and incidence of seroma or lymphedema. Prospective randomized controlled studies are necessary to evaluate the effect of this technique on perioperative complications.
Antibiotic prophylaxis in hernia repair and breast surgery: a prospective randomized study comparing piperacillin/tazobactam versus placebo.
Journal of chemotherapy, Jun 2006, vol. 18, no. 3
p. 278-84
Esposito-S, Leone-S, Noviello-S, Ianniello-F, Marvaso-A, Cuniato-V, Bellitti-F.
Abstract
Although antibiotic prophylaxis is not explicitly indicated for hernia repair and breast surgery, its use for these clean procedures is widely adopted, albeit to a different extent in different countries, often on the personal decision of the individual surgeon. The present study was carried out to compare the efficacy of a single pre-operative dose of piperacillin-tazobactam with placebo in preventing surgical wound infections and to determine the main risk factors associated with infections following two main elective surgical clean procedures such as hernia repair and breast surgery.A total of 501 patients undergoing elective inguinal/femoral hernia repair or breast surgery were enrolled in this prospective randomized clinical study. Patients were randomly assigned to receive preoperative antibiotic prophylaxis or placebo. One dose of piperacillin-tazobactam 2.250 g or placebo was administered i.v. 30 minutes prior to the surgical procedure.Using statistical univariate analysis, the following variables were correlated with a higher infection risk: age >40 years, concomitant disease, WBC <3500,>9cm, use of drainages, non-prophylaxis. Using multivariate analysis, no antibiotic pre-operative prophylaxis, concurrent chronic diseases, especially diabetes (risk 15 times higher), and length of intervention >45 min (risk 6 times higher) were independent predictors of infection. Finally, patients with postoperative infections had a significantly longer hospitalisation .One pre-operative dose of piperacillin-tazobactam 2.250 g is more effective than placebo in preventing postoperative infections in breast surgery and hernia repair.
Journal of chemotherapy, Jun 2006, vol. 18, no. 3
p. 278-84
Esposito-S, Leone-S, Noviello-S, Ianniello-F, Marvaso-A, Cuniato-V, Bellitti-F.
Abstract
Although antibiotic prophylaxis is not explicitly indicated for hernia repair and breast surgery, its use for these clean procedures is widely adopted, albeit to a different extent in different countries, often on the personal decision of the individual surgeon. The present study was carried out to compare the efficacy of a single pre-operative dose of piperacillin-tazobactam with placebo in preventing surgical wound infections and to determine the main risk factors associated with infections following two main elective surgical clean procedures such as hernia repair and breast surgery.A total of 501 patients undergoing elective inguinal/femoral hernia repair or breast surgery were enrolled in this prospective randomized clinical study. Patients were randomly assigned to receive preoperative antibiotic prophylaxis or placebo. One dose of piperacillin-tazobactam 2.250 g or placebo was administered i.v. 30 minutes prior to the surgical procedure.Using statistical univariate analysis, the following variables were correlated with a higher infection risk: age >40 years, concomitant disease, WBC <3500,>9cm, use of drainages, non-prophylaxis. Using multivariate analysis, no antibiotic pre-operative prophylaxis, concurrent chronic diseases, especially diabetes (risk 15 times higher), and length of intervention >45 min (risk 6 times higher) were independent predictors of infection. Finally, patients with postoperative infections had a significantly longer hospitalisation .One pre-operative dose of piperacillin-tazobactam 2.250 g is more effective than placebo in preventing postoperative infections in breast surgery and hernia repair.
Factors predicting additional disease in the axilla
Factors predicting additional disease in the axilla in patients with positive sentinel lymph nodes after neoadjuvant chemotherapy.
Cancer, 15 Jun 2008, vol. 112, no. 12
p. 2646-54
Jeruss-Jacqueline-S, Newman-Lisa-A, Ayers-Gregory-D et al
Abstract
BACKGROUND: The utility of sentinel lymph node (SNL) biopsy (SLNB) as a predictor of axillary lymph node status is similar in patients who receive neoadjuvant chemotherapy and patients who undergo surgery first. The authors of this study hypothesized that patients with positive SLNs after neoadjuvant therapy would have unique clinicopathologic factors that would be predictive of additional positive non-SLNs distinct from patients who underwent surgery first. METHODS: One hundred four patients were identified who received neoadjuvant chemotherapy, had a positive SLN, and underwent axillary dissection between 1997 and 2005. At the time of presentation, 66 patients had clinically negative lymph nodes by ultrasonography, and 38 patients had positive lymph nodes confirmed by fine-needle aspiration. Eighteen factors were assessed for their ability to predict positive non-SLNs using chi-square and logistic regression analysis with a bootstrapped, backwards elimination procedure. The resulting nomogram was tested by using a patient cohort from another institution. RESULTS: Patients with clinically negative lymph nodes at presentation were less likely than patients with positive lymph nodes to have positive non-SLNs (47% vs 71%; P=.017). On multivariate analysis, lymphovascular invasion, the method for detecting SLN metastasis, multicentricity, positive axillary lymph nodes at presentation, and pathologic tumor size retained grouped significance with a bootstrap-adjusted area under the curve (AUC) of 0.762. The resulting nomogram was validated in the external patient cohort (AUC, 0.78). CONCLUSIONS: A significant proportion of patients with positive SLNs after neoadjuvant chemotherapy had no positive non- SLNs. The use of a nomogram based on 5 predictive variables that were identified in this study may be useful for predicting the risk of positive non-SLNs in patients who have positive SLNs after chemotherapy. Copyright (c) 2008 American Cancer Society.
Cancer, 15 Jun 2008, vol. 112, no. 12
p. 2646-54
Jeruss-Jacqueline-S, Newman-Lisa-A, Ayers-Gregory-D et al
Abstract
BACKGROUND: The utility of sentinel lymph node (SNL) biopsy (SLNB) as a predictor of axillary lymph node status is similar in patients who receive neoadjuvant chemotherapy and patients who undergo surgery first. The authors of this study hypothesized that patients with positive SLNs after neoadjuvant therapy would have unique clinicopathologic factors that would be predictive of additional positive non-SLNs distinct from patients who underwent surgery first. METHODS: One hundred four patients were identified who received neoadjuvant chemotherapy, had a positive SLN, and underwent axillary dissection between 1997 and 2005. At the time of presentation, 66 patients had clinically negative lymph nodes by ultrasonography, and 38 patients had positive lymph nodes confirmed by fine-needle aspiration. Eighteen factors were assessed for their ability to predict positive non-SLNs using chi-square and logistic regression analysis with a bootstrapped, backwards elimination procedure. The resulting nomogram was tested by using a patient cohort from another institution. RESULTS: Patients with clinically negative lymph nodes at presentation were less likely than patients with positive lymph nodes to have positive non-SLNs (47% vs 71%; P=.017). On multivariate analysis, lymphovascular invasion, the method for detecting SLN metastasis, multicentricity, positive axillary lymph nodes at presentation, and pathologic tumor size retained grouped significance with a bootstrap-adjusted area under the curve (AUC) of 0.762. The resulting nomogram was validated in the external patient cohort (AUC, 0.78). CONCLUSIONS: A significant proportion of patients with positive SLNs after neoadjuvant chemotherapy had no positive non- SLNs. The use of a nomogram based on 5 predictive variables that were identified in this study may be useful for predicting the risk of positive non-SLNs in patients who have positive SLNs after chemotherapy. Copyright (c) 2008 American Cancer Society.
National Breast Cancer Audit - Aus & NZ
National Breast Cancer Audit: the use of multidisciplinary care teams by breast surgeons in Australia and New Zealand.
Full text available at ProQuest
The Medical journal of Australia 7 Apr 2008, vol. 188, no. 7
p. 385-8
Marsh-Claire-J, Boult-Margaret, Wang-Jim-X et al
Abstract
OBJECTIVE: To explore the involvement of members of the Royal Australasian College of Surgeons (RACS) Section of Breast Surgery in Australia and New Zealand in multidisciplinary care (MDC) teams. DESIGN AND SETTING: Questionnaire sent to all full members of the RACS Section of Breast Surgery in December 2006. PARTICIPANTS: 239 of 262 active full members of the RACS Section of Breast Surgery (response rate, 91.2%). MAIN OUTCOME MEASURES: Surgeons' use of, and the composition and functioning of, MDC teams in public and private practice, and in metropolitan, regional and rural settings. RESULTS: 85% of responding surgeons reported participating in at least one fully established MDC team. Public-sector teams were operationally more consistent and functional than private teams, and rural teams were less well developed than those in metropolitan and regional centres. The six core disciplines recommended by the National Breast Cancer Centre appear to be well represented in most teams. Patients and their general practitioners were not considered to be part of the treatment team by surgeons. CONCLUSIONS: MDC is supported by most breast surgeons, but there are deficits in rural areas, and in the private sector relative to the public sector.
Full text available at ProQuest
The Medical journal of Australia 7 Apr 2008, vol. 188, no. 7
p. 385-8
Marsh-Claire-J, Boult-Margaret, Wang-Jim-X et al
Abstract
OBJECTIVE: To explore the involvement of members of the Royal Australasian College of Surgeons (RACS) Section of Breast Surgery in Australia and New Zealand in multidisciplinary care (MDC) teams. DESIGN AND SETTING: Questionnaire sent to all full members of the RACS Section of Breast Surgery in December 2006. PARTICIPANTS: 239 of 262 active full members of the RACS Section of Breast Surgery (response rate, 91.2%). MAIN OUTCOME MEASURES: Surgeons' use of, and the composition and functioning of, MDC teams in public and private practice, and in metropolitan, regional and rural settings. RESULTS: 85% of responding surgeons reported participating in at least one fully established MDC team. Public-sector teams were operationally more consistent and functional than private teams, and rural teams were less well developed than those in metropolitan and regional centres. The six core disciplines recommended by the National Breast Cancer Centre appear to be well represented in most teams. Patients and their general practitioners were not considered to be part of the treatment team by surgeons. CONCLUSIONS: MDC is supported by most breast surgeons, but there are deficits in rural areas, and in the private sector relative to the public sector.
Nonvisualization of a sentinel lymph node on lymphoscintigraphy
Nonvisualization of a sentinel lymph node on lymphoscintigraphy requiring reinjection of sulfur colloid in a patient with breast cancer.
Clinical nuclear medicine, Jun 2008, vol. 33, no. 6
p. 389-90
Teal-Christine-B, Brem-Rachel-F, Rapelyea-Jocelyn-A, Akin-Esma-A.
Abstract
PURPOSE: The injection techniques and use of lymphoscintigraphy for sentinel lymph node (SLN) biopsy in breast cancer patients vary. Some do not advocate routine use of lymphoscintigraphy. The purpose of this case report is to illustrate when lymphoscintigraphy should be used. METHODS: At our institution, we use periareolar intradermal injections of 0.6 mCi Tc-99m sulfur colloid followed by lymphoscintigraphy with reported identification rates greater than 99%. The only patient in our series who did not have a SLN identified had presented after excisional biopsy of an upper outer quadrant cancer. We report the case of another patient who presented after excision of an upper outer quadrant invasive ductal carcinoma and had no evidence of lymphatic drainage on lymphoscintigraphy after the periareolar injections of radioisotope. RESULTS: Additional injections of 0.4 mCi Tc-99m sulfur colloid were performed lateral to the incision in the upper outer quadrant. On lymphoscintigraphy a SLN was visualized and was subsequently successfully identified intraoperatively. CONCLUSION: This case report supports the value of lymphoscintigraphy for successful identification of a SLN in a patient with prior surgery. We therefore recommend imaging patients who have had prior breast surgery, particularly excisions in the upper outer quadrant.
Clinical nuclear medicine, Jun 2008, vol. 33, no. 6
p. 389-90
Teal-Christine-B, Brem-Rachel-F, Rapelyea-Jocelyn-A, Akin-Esma-A.
Abstract
PURPOSE: The injection techniques and use of lymphoscintigraphy for sentinel lymph node (SLN) biopsy in breast cancer patients vary. Some do not advocate routine use of lymphoscintigraphy. The purpose of this case report is to illustrate when lymphoscintigraphy should be used. METHODS: At our institution, we use periareolar intradermal injections of 0.6 mCi Tc-99m sulfur colloid followed by lymphoscintigraphy with reported identification rates greater than 99%. The only patient in our series who did not have a SLN identified had presented after excisional biopsy of an upper outer quadrant cancer. We report the case of another patient who presented after excision of an upper outer quadrant invasive ductal carcinoma and had no evidence of lymphatic drainage on lymphoscintigraphy after the periareolar injections of radioisotope. RESULTS: Additional injections of 0.4 mCi Tc-99m sulfur colloid were performed lateral to the incision in the upper outer quadrant. On lymphoscintigraphy a SLN was visualized and was subsequently successfully identified intraoperatively. CONCLUSION: This case report supports the value of lymphoscintigraphy for successful identification of a SLN in a patient with prior surgery. We therefore recommend imaging patients who have had prior breast surgery, particularly excisions in the upper outer quadrant.
Prospective analysis of long-term psychosocial outcomes in breast reconstruction
Prospective analysis of long-term psychosocial outcomes in breast reconstruction: two-year postoperative results from the Michigan Breast Reconstruction Outcomes Study.
Full text available at OVID for NHS
Annals of surgery, Jun 2008, vol. 247, no. 6,
p. 1019-28
Atisha-Dunya, Alderman-Amy-K, Lowery-Julie-C et al
Abstract
OBJECTIVE: To prospectively evaluate the psychosocial outcomes and body image of patients 2 years postmastectomy reconstruction using a multicenter, multisurgeon approach. BACKGROUND: Although breast reconstruction has been shown to confer significant psychosocial benefits in breast cancer patients at year 1 postreconstruction, we considered the possibility that psychosocial outcomes may remain in a state of flux for years after surgery. METHODS: Patients were recruited as part of the Michigan Breast Reconstruction Outcome Study, a 12 center, 23 surgeon prospective cohort study of mastectomy reconstruction patients. Two-sided paired sample t tests were used to compare change scores for the various psychosocial subscales. Multiple regression analysis was used to determine whether the magnitude of the change score varied by procedure type. RESULTS: Preoperative and postoperative year 2 surveys were received from 173 patients; 116 with immediate and 57 with delayed reconstruction. For the immediate reconstruction cohort, significant improvements were observed in all psychosocial subscales except for body image. This occurred essentially independent of procedure type. In the cohort with delayed reconstruction, significant change scores were observed only in body image. Women with transverse rectus abdominis musculocutaneous flaps had significantly greater gains in body image scores (P = 0.003 and P = 0.034, respectively) when compared with expander/implants. CONCLUSIONS: General psychosocial benefits and body image gains continued to manifest at 2 years postmastectomy reconstruction. In addition, procedure type had a surprisingly limited effect on psychosocial well being. With outcomes evolving beyond year 1, these data support the need for additional longitudinal breast reconstruction outcome studies.
Full text available at OVID for NHS
Annals of surgery, Jun 2008, vol. 247, no. 6,
p. 1019-28
Atisha-Dunya, Alderman-Amy-K, Lowery-Julie-C et al
Abstract
OBJECTIVE: To prospectively evaluate the psychosocial outcomes and body image of patients 2 years postmastectomy reconstruction using a multicenter, multisurgeon approach. BACKGROUND: Although breast reconstruction has been shown to confer significant psychosocial benefits in breast cancer patients at year 1 postreconstruction, we considered the possibility that psychosocial outcomes may remain in a state of flux for years after surgery. METHODS: Patients were recruited as part of the Michigan Breast Reconstruction Outcome Study, a 12 center, 23 surgeon prospective cohort study of mastectomy reconstruction patients. Two-sided paired sample t tests were used to compare change scores for the various psychosocial subscales. Multiple regression analysis was used to determine whether the magnitude of the change score varied by procedure type. RESULTS: Preoperative and postoperative year 2 surveys were received from 173 patients; 116 with immediate and 57 with delayed reconstruction. For the immediate reconstruction cohort, significant improvements were observed in all psychosocial subscales except for body image. This occurred essentially independent of procedure type. In the cohort with delayed reconstruction, significant change scores were observed only in body image. Women with transverse rectus abdominis musculocutaneous flaps had significantly greater gains in body image scores (P = 0.003 and P = 0.034, respectively) when compared with expander/implants. CONCLUSIONS: General psychosocial benefits and body image gains continued to manifest at 2 years postmastectomy reconstruction. In addition, procedure type had a surprisingly limited effect on psychosocial well being. With outcomes evolving beyond year 1, these data support the need for additional longitudinal breast reconstruction outcome studies.
Do all patients want to go to high-volume hospitals?
Breast cancer surgery: do all patients want to go to high-volume hospitals?
Surgery, Jun 2008 (epub: 09 May 2008), vol. 143, no. 6,
p. 699-705
Bouche-Gauthier, Migeot-Virginie et al
Abstract
BACKGROUND: Inequalities in access to high-volume hospitals have been found for many surgical procedures. We aimed to assess the association between patients' choice and the volume of the hospital where they underwent breast cancer surgery. METHODS: Multivariate analysis of data from 932 women who underwent breast cancer surgery in low-, moderate- or high-volume hospitals in France. RESULTS: One hundred fifty-six (17%) patients underwent an operation in low- volume, 414 (44%) in moderate-volume, and 362 (39%) in high-volume hospitals. Patients in low-volume hospitals were more likely to be >70 years old (adjusted odds ratio (OR), 2.2; 95% confidence interval (CI), 1.2-3.4), and to have an elementary education level (adjusted OR, 7.1; 95% CI, 2.4-21.2). In areas where there was a low number of surgical beds per 1000 population, patients were more likely to go to low-volume hospitals, with no difference between patients involved (adjusted OR, 10.1; 95% CI, 3.3-31.0) and not involved (adjusted OR, 11.6; 95% CI, 2.9-46.0) in surgeon choice. In areas where there was a higher number of surgical beds per 1000 population, patients who were involved in surgeon choice were more likely to go to low-volume hospitals (adjusted OR, 4.4; 95% CI, 1.5-13.1). CONCLUSION: Some patients who were involved in surgeon choice opted to go to a low- volume hospital, nearer to their place of residence. Even though a minimum threshold of activity has been established in France for breast cancer surgery, volume-based referral policies should anticipate their potentially negative consequences of going against the will of older and more isolated patients.
Surgery, Jun 2008 (epub: 09 May 2008), vol. 143, no. 6,
p. 699-705
Bouche-Gauthier, Migeot-Virginie et al
Abstract
BACKGROUND: Inequalities in access to high-volume hospitals have been found for many surgical procedures. We aimed to assess the association between patients' choice and the volume of the hospital where they underwent breast cancer surgery. METHODS: Multivariate analysis of data from 932 women who underwent breast cancer surgery in low-, moderate- or high-volume hospitals in France. RESULTS: One hundred fifty-six (17%) patients underwent an operation in low- volume, 414 (44%) in moderate-volume, and 362 (39%) in high-volume hospitals. Patients in low-volume hospitals were more likely to be >70 years old (adjusted odds ratio (OR), 2.2; 95% confidence interval (CI), 1.2-3.4), and to have an elementary education level (adjusted OR, 7.1; 95% CI, 2.4-21.2). In areas where there was a low number of surgical beds per 1000 population, patients were more likely to go to low-volume hospitals, with no difference between patients involved (adjusted OR, 10.1; 95% CI, 3.3-31.0) and not involved (adjusted OR, 11.6; 95% CI, 2.9-46.0) in surgeon choice. In areas where there was a higher number of surgical beds per 1000 population, patients who were involved in surgeon choice were more likely to go to low-volume hospitals (adjusted OR, 4.4; 95% CI, 1.5-13.1). CONCLUSION: Some patients who were involved in surgeon choice opted to go to a low- volume hospital, nearer to their place of residence. Even though a minimum threshold of activity has been established in France for breast cancer surgery, volume-based referral policies should anticipate their potentially negative consequences of going against the will of older and more isolated patients.
Wednesday, 9 July 2008
Radiology Management 2008 Vol 30 Part 3
Breast and Prostate MRI : New Frontiers in Women and Men's Imaging
Curry , S . ; Belmont , V . ; Osiason , A . ; Boonstra , J .
Page: 20-33
Curry , S . ; Belmont , V . ; Osiason , A . ; Boonstra , J .
Page: 20-33
British Journal of Radiology 2008 Vol 81 Part 966
A novel method for CT - scan - based localization of the internal mammary chain by internal mammary catheterization : an aid in breast cancer radiation therapy planning
Munshi , A . ; Mallick , I . ; Budrukkar , A . et al
Page: 485-489
Munshi , A . ; Mallick , I . ; Budrukkar , A . et al
Page: 485-489
Beauty and the Beast: Management of Breast Cancer After Plastic Surgery
Bleicher, Richard J.; Topham, Neal S.; Morrow, Monica
Beauty and the Beast: Management of Breast Cancer After Plastic Surgery
Annals of Surgery. 247(4):680-686, April 2008.
Abstract
Objectives: Cosmetic surgery procedures increase in incidence annually, with 11 million performed in 2006. Because breast cancer is the most frequently occurring malignancy in women, a personal history of cosmetic surgery in those undergoing treatment for breast cancer is becoming more common.
Methods: This review identified key studies from the PubMed database, to consolidate existing data related to treatment of breast cancer after plastic surgery. Data were reviewed for factors affecting breast cancer treatment after breast augmentation, breast reduction, abdominoplasty, and suction lipectomy.
Results: There are little comprehensive data on the management of breast cancer after plastic surgical procedures. Plastic surgery may affect diagnostic imaging, surgical options, and radiotherapy management. Breast augmentation and reduction are two of the most common cosmetic procedures performed and knowledge of their influence on the incidence, diagnosis, and treatment of breast cancer is important for proper management.
Conclusions: Plastic surgery does not significantly affect breast cancer outcomes but does present management challenges that must be anticipated when deciding various treatment options. Knowledge of the existing literature may be helpful in discussing those options with patients and planning the multidisciplinary approach to this malignancy.(C) 2008 Lippincott Williams & Wilkins, Inc.
Beauty and the Beast: Management of Breast Cancer After Plastic Surgery
Annals of Surgery. 247(4):680-686, April 2008.
Abstract
Objectives: Cosmetic surgery procedures increase in incidence annually, with 11 million performed in 2006. Because breast cancer is the most frequently occurring malignancy in women, a personal history of cosmetic surgery in those undergoing treatment for breast cancer is becoming more common.
Methods: This review identified key studies from the PubMed database, to consolidate existing data related to treatment of breast cancer after plastic surgery. Data were reviewed for factors affecting breast cancer treatment after breast augmentation, breast reduction, abdominoplasty, and suction lipectomy.
Results: There are little comprehensive data on the management of breast cancer after plastic surgical procedures. Plastic surgery may affect diagnostic imaging, surgical options, and radiotherapy management. Breast augmentation and reduction are two of the most common cosmetic procedures performed and knowledge of their influence on the incidence, diagnosis, and treatment of breast cancer is important for proper management.
Conclusions: Plastic surgery does not significantly affect breast cancer outcomes but does present management challenges that must be anticipated when deciding various treatment options. Knowledge of the existing literature may be helpful in discussing those options with patients and planning the multidisciplinary approach to this malignancy.(C) 2008 Lippincott Williams & Wilkins, Inc.
Link to journal
Spear, Scott L.; Schwarz, Karl A.; Venturi, Mark L. ; Barbosa, Todd ; Al-Attar, Ali
Prophylactic Mastectomy and Reconstruction: Clinical Outcomes and Patient Satisfaction
Plastic & Reconstructive Surgery. 122(1):1-9, July 2008.
Abstract
Background: The purpose of this study was to evaluate both clinical outcomes and satisfaction in patients who have undergone prophylactic mastectomy and breast reconstruction.
Methods: A 5-year retrospective analysis of the senior author's (S.L.S.) experience with breast reconstruction following prophylactic mastectomy was performed. Timing, type of mastectomy and reconstruction, complications, and cancer occurrence/recurrence were examined. Patients reported their level of satisfaction and willingness to undergo the procedure again. Aesthetic outcomes were graded by an independent and blinded group of surgeons.
Results: There were 101 breast reconstructions performed in 74 patients following prophylactic mastectomy. With a mean follow-up of 31 months, there were three breast-site complications in this group (3 percent). Forty-seven patients in the study had a unilateral prophylactic mastectomy; on the contralateral side with cancer, there were five breast-site complications in reconstructions following therapeutic mastectomy (10 percent). Aesthetic outcome ratings by surgeons were higher in the bilateral prophylactic mastectomy and reconstruction patients compared with the cancer patients who had undergone a therapeutic mastectomy and reconstruction along with a contralateral prophylactic mastectomy; however, this difference did not reach statistical significance. Patient satisfaction was higher in the bilateral prophylactic group, with all of the patients completing the survey stating they would undergo the procedure again.
Conclusions: Breast reconstruction following prophylactic mastectomy was as safe as or more safe than that following therapeutic mastectomy, which has been shown in other studies to result in a high percentage of patient satisfaction. Although not statistically significant, the results from reconstruction after prophylactic mastectomy trended toward improved aesthetic outcome with a lower complication rate compared with reconstruction after therapeutic mastectomy.
Spear, Scott L.; Schwarz, Karl A.; Venturi, Mark L. ; Barbosa, Todd ; Al-Attar, Ali
Prophylactic Mastectomy and Reconstruction: Clinical Outcomes and Patient Satisfaction
Plastic & Reconstructive Surgery. 122(1):1-9, July 2008.
Abstract
Background: The purpose of this study was to evaluate both clinical outcomes and satisfaction in patients who have undergone prophylactic mastectomy and breast reconstruction.
Methods: A 5-year retrospective analysis of the senior author's (S.L.S.) experience with breast reconstruction following prophylactic mastectomy was performed. Timing, type of mastectomy and reconstruction, complications, and cancer occurrence/recurrence were examined. Patients reported their level of satisfaction and willingness to undergo the procedure again. Aesthetic outcomes were graded by an independent and blinded group of surgeons.
Results: There were 101 breast reconstructions performed in 74 patients following prophylactic mastectomy. With a mean follow-up of 31 months, there were three breast-site complications in this group (3 percent). Forty-seven patients in the study had a unilateral prophylactic mastectomy; on the contralateral side with cancer, there were five breast-site complications in reconstructions following therapeutic mastectomy (10 percent). Aesthetic outcome ratings by surgeons were higher in the bilateral prophylactic mastectomy and reconstruction patients compared with the cancer patients who had undergone a therapeutic mastectomy and reconstruction along with a contralateral prophylactic mastectomy; however, this difference did not reach statistical significance. Patient satisfaction was higher in the bilateral prophylactic group, with all of the patients completing the survey stating they would undergo the procedure again.
Conclusions: Breast reconstruction following prophylactic mastectomy was as safe as or more safe than that following therapeutic mastectomy, which has been shown in other studies to result in a high percentage of patient satisfaction. Although not statistically significant, the results from reconstruction after prophylactic mastectomy trended toward improved aesthetic outcome with a lower complication rate compared with reconstruction after therapeutic mastectomy.
Plastic & Reconstructive Surgery 122(1) July 2008
Link to journal
Wang, Hongyan M.D.; Jiang, Yuxin M.D.; Meng, Hua M.D.; Yu, Yuan M.D.; Qi, Keming M.D.;
Sonographic Assessment on Breast Augmentation after Autologous Fat Graft. [Editorial]
Plastic & Reconstructive Surgery. 122(1):36e-38e, July 2008.
Rozen, Warren M. , Phillips, Timoth J et al
A New Preoperative Imaging Modality for Free Flaps in Breast Reconstruction: Computed Tomographic Angiography.[Editorial]
Source
Plastic & Reconstructive Surgery. 122(1):38e-40e, July 2008.
Wang, Hongyan M.D.; Jiang, Yuxin M.D.; Meng, Hua M.D.; Yu, Yuan M.D.; Qi, Keming M.D.;
Sonographic Assessment on Breast Augmentation after Autologous Fat Graft. [Editorial]
Plastic & Reconstructive Surgery. 122(1):36e-38e, July 2008.
Rozen, Warren M. , Phillips, Timoth J et al
A New Preoperative Imaging Modality for Free Flaps in Breast Reconstruction: Computed Tomographic Angiography.[Editorial]
Source
Plastic & Reconstructive Surgery. 122(1):38e-40e, July 2008.
Fat Grafting to the Breast Revisited
Link to journal
Coleman, Sydney R. M.D.; Saboeiro, Alesia P. M.D.;
Fat Grafting to the Breast Revisited: Safety and Efficacy
Plastic & Reconstructive Surgery. 119(3):775-785, March 2007.
Abstract
Background: A 1987 American Society of Plastic and Reconstructive Surgeons position paper predicted that fat grafting would compromise breast cancer detection and should therefore be prohibited. However, there is no evidence that fat grafting to breasts is less safe than any other form of breast surgery. As discussions of fat grafting to the breast are surfacing all over the world, it is time to reexamine the opinions of the 1987 American Society of Plastic and Reconstructive Surgeons position paper.
Methods: This is a retrospective examination of 17 breast procedures performed using fat grafting from 1995 to 2000. Indications included micromastia, postaugmentation deformity, tuberous breast deformity, Poland's syndrome, and postmastectomy reconstruction deformities. The technique used was the Coleman method of fat grafting, which attempts to minimize trauma and place grafted fat in small aliquots at many levels.
Results: All women had a significant improvement in their breast size and/or shape postoperatively and all had breasts that were soft and natural in appearance and feel. Postoperative mammograms identified changes one would expect after any breast procedure.
Conclusions: Given these results and reports of other plastic surgeons, free fat grafting should be considered as an alternative or adjunct to breast augmentation and reconstruction procedures. It is time to end the discrimination created by the 1987 position paper and judge fat grafting to the breast with the same caution and enthusiasm as any other useful breast procedure.
Coleman, Sydney R. M.D.; Saboeiro, Alesia P. M.D.;
Fat Grafting to the Breast Revisited: Safety and Efficacy
Plastic & Reconstructive Surgery. 119(3):775-785, March 2007.
Abstract
Background: A 1987 American Society of Plastic and Reconstructive Surgeons position paper predicted that fat grafting would compromise breast cancer detection and should therefore be prohibited. However, there is no evidence that fat grafting to breasts is less safe than any other form of breast surgery. As discussions of fat grafting to the breast are surfacing all over the world, it is time to reexamine the opinions of the 1987 American Society of Plastic and Reconstructive Surgeons position paper.
Methods: This is a retrospective examination of 17 breast procedures performed using fat grafting from 1995 to 2000. Indications included micromastia, postaugmentation deformity, tuberous breast deformity, Poland's syndrome, and postmastectomy reconstruction deformities. The technique used was the Coleman method of fat grafting, which attempts to minimize trauma and place grafted fat in small aliquots at many levels.
Results: All women had a significant improvement in their breast size and/or shape postoperatively and all had breasts that were soft and natural in appearance and feel. Postoperative mammograms identified changes one would expect after any breast procedure.
Conclusions: Given these results and reports of other plastic surgeons, free fat grafting should be considered as an alternative or adjunct to breast augmentation and reconstruction procedures. It is time to end the discrimination created by the 1987 position paper and judge fat grafting to the breast with the same caution and enthusiasm as any other useful breast procedure.
Innovative 3D Approach to Defining the Anatomical Changes Occurring after Short Scar-Medial Pedicle Reduction Mammaplasty
Link to journal
Tepper, Oren M. ; Choi, Mihye et al
An Innovative Three-Dimensional Approach to Defining the Anatomical Changes Occurring after Short Scar-Medial Pedicle Reduction Mammaplasty
Plastic & Reconstructive Surgery. 121(6):1875-1885, June 2008.
Abstract
Background: Three-dimensional photography of the breast offers new opportunities to advance the fields of aesthetic and reconstructive breast surgery. The following study investigates the use of three-dimensional imaging to assess changes in breast surface anatomy, volume, tissue distribution, and projection following medial pedicle reduction mammaplasty.
Methods: Preoperative and postoperative three-dimensional scans were obtained from patients undergoing short-scar medial pedicle breast reduction. Three-dimensional models were analyzed by topographical color maps, changes in the lowest point of the breast, surface measurements, and the point of maximal projection. Total breast volume and percentage volumetric tissue distribution in the upper and lower poles were also determined.
Results: Thirty patients underwent reduction mammaplasty (mean postoperative scan, 80 +/- 5 days). Color maps highlighted the majority of spatial changes in the central, upper poles. Reduction mammaplasty resulted in a significant decrease in the anteroposterior projection of the breast (6.3 +/- 0.2 postoperatively compared with 8.1 +/- 0.2 cm preoperatively
Tepper, Oren M. ; Choi, Mihye et al
An Innovative Three-Dimensional Approach to Defining the Anatomical Changes Occurring after Short Scar-Medial Pedicle Reduction Mammaplasty
Plastic & Reconstructive Surgery. 121(6):1875-1885, June 2008.
Abstract
Background: Three-dimensional photography of the breast offers new opportunities to advance the fields of aesthetic and reconstructive breast surgery. The following study investigates the use of three-dimensional imaging to assess changes in breast surface anatomy, volume, tissue distribution, and projection following medial pedicle reduction mammaplasty.
Methods: Preoperative and postoperative three-dimensional scans were obtained from patients undergoing short-scar medial pedicle breast reduction. Three-dimensional models were analyzed by topographical color maps, changes in the lowest point of the breast, surface measurements, and the point of maximal projection. Total breast volume and percentage volumetric tissue distribution in the upper and lower poles were also determined.
Results: Thirty patients underwent reduction mammaplasty (mean postoperative scan, 80 +/- 5 days). Color maps highlighted the majority of spatial changes in the central, upper poles. Reduction mammaplasty resulted in a significant decrease in the anteroposterior projection of the breast (6.3 +/- 0.2 postoperatively compared with 8.1 +/- 0.2 cm preoperatively
Subscribe to:
Posts (Atom)